SFG2274 MINISTRY OF HEALTH Resettlement Policy Framework For Uganda Reproductive, Maternal, Neonatal, and Child Health Improvement Project May 2016 AWE is member of International Federation of Consulting Engineers (FIDIC-GAMA) Uganda  Kenya  Rwanda  USA Page |i Acronyms BDR Births and Deaths Registration MGLSD Ministry of Gender, Labour & Social Development CR Civil Registration MoLHUD Ministry of Lands, Housing and Urban Development CRVS Civil Registration and Vital Statistics MoH Ministry of Health CSOs Civil Society Organizations MoU Memorandum of Understanding DHIS2 District Health Information System 2 MoWE Ministry of Water and Environment DHMT District Health Management Team MTEF Medium Term Expenditure Framework DHTs District health teams NEMA National Environment Management Authority DLB District Land Board NGOs Non-Governmental Organizations DLIs Disbursement-Linked Indicators NIRA National Identification and Registration Authority DLT District League Table OHS Occupational Health and Safety DRC Democratic Republic of Congo OP Operational Policy EDHMT Expanded District Health Management PAPs Project Affected Persons Team EEPs Eligible Expenditure Programs PHC Primary healthcare ESIAs Environmental and Social Impact PDOs Project Development Objectives Assessments EIA Environmental Impact Assessment PWDs Persons With Disabilities ESMF Environmental and Social Management RAPs Resettlement Action Plans Framework FQCAP Facility Quality of Care Assessment RBF Result Based Financing Program GFF Global Financing Facility RMNCAH Reproductive, Maternal, New born, Child and Adolescent Health GoU Government of Uganda RMNCH Reproductive, Maternal, Neonatal, and Child Health HC III Health Centre III ROPA Registration of Persons Act HC IVs Health Centre IVs RPF Resettlement Policy Framework HMIS Health management information systems UBOS Uganda Bureau of Statistics HRHMIS Human Resources for Health Management UHMG Uganda Health Marketing Group Information Systems HSSP Health Systems Strengthening Project URSB Uganda Registration Services Bureau ICD International Classification of Diseases USE Universal Secondary Education IDA International Development Association VHT Village Health Teams IWRM Integrated Water Resources Management WB World Bank M&E Monitoring and Evaluation WID Wetlands Management Department MDAs Government Ministries Departments and WRMD Water Resources Management Directorate Agencies MDG Millennium Development Goal MFPED Ministry of Finance, Planning and Economic Development P a g e | ii CONTENTS ACRONYMS ....................................................................................................................................................................I LIST OF TABLES ......................................................................................................................................................... IV LIST OF FIGURES ........................................................................................................................................................ IV GLOSSARY OF TERMS ................................................................................................................................................ V EXECUTIVE SUMMARY .............................................................................................................................................. VII 1 INTRODUCTION ...................................................................................................................................................1 1.1 PROJECT DEVELOPMENT OBJECTIVE ................................................................................................................1 1.2 PROJECT BENEFICIARIES ..................................................................................................................................1 2 PROJECT DESCRIPTION .....................................................................................................................................1 2.1 PROJECT COMPONENTS ....................................................................................................................................1 2.1.1 Component 1: Results-Based Financing for Primary Health Care Services...........................................2 2.1.2 Component 2: Strengthen Health Systems to Deliver RMNCAH Services.............................................2 2.1.3 Component 3: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services ..3 2.1.4 Component 4: Enhance Institutional Capacity to Manage Project Supported Activities .........................4 2.2 PROJECT FINANCING .........................................................................................................................................5 3 OVERVIEW OF UGANDA’S SOCIO-ECONOMIC ENVIRONMENTAL CONDITIONS ..............................................6 3.1 NATURAL RESOURCES .......................................................................................................................................6 3.2 SOCIO-ECONOMIC AND CULTURAL ENVIRONMENT ..............................................................................................6 4 PREPARATION AND OBJECTIVES OF THE RPF .................................................................................................9 4.1 OBJECTIVES OF THE RPF ..................................................................................................................................9 4.2 METHODOLOGY FOR RPF AND STAKEHOLDER ENGAGEMENT/CONSULTATION......................................................9 5 POLICY, LEGAL AND INSTITUTIONAL FRAMEWORK.......................................................................................10 5.1 LEGAL FRAMEWORK FOR EXPROPRIATION AND COMPENSATION ........................................................................10 5.1.1 Political Economy and Governance in Uganda ....................................................................................10 5.1.2 Property and Land Rights in Uganda ...................................................................................................16 5.1.3 Acquisition and Valuation of Land and other Assets ............................................................................16 5.1.4 Human Rights and Compensation .......................................................................................................18 5.1.5 Dispute Resolution and Grievance Mechanisms ..................................................................................19 5.2 INSTITUTIONAL FRAMEWORK ............................................................................................................................19 5.2.1 Ministry of Gender, Labour & Social Development (MGLSD) ..............................................................19 5.2.2 Ministry of Lands, Housing & Urban Development ...............................................................................20 5.2.3 Ministry of Health (MoH).......................................................................................................................20 5.2.4 National Identification Registration Authority (NIRA) ............................................................................20 5.2.5 National Environment Management Authority (NEMA) ........................................................................21 5.2.6 Wetlands Management Department (WID) in MoWE ...........................................................................21 6 OVER VIEW OF WORLD BANK’S SAFEGUARD POLICIES................................................................................22 7 LAND ACQUISITION AND RESETTLEMENT IMPACTS ......................................................................................30 P a g e | iii 8 RPF PREPARATION PROCESS .........................................................................................................................32 8.1 PRINCIPLES GOVERNING RESETTLEMENT PREPARATION AND IMPLEMENTATION .................................................32 8.1.1 Basic Principles of the Resettlement Program .....................................................................................32 8.1.2 Objectives of the Resettlement Policy ..................................................................................................32 8.1.3 Overall Process ....................................................................................................................................33 8.1.4 Project Affected Entities .......................................................................................................................34 8.1.5 Eligibility Criteria and Cut-Off Dates .....................................................................................................36 8.1.6 Method to Determine Cut-off dates ......................................................................................................36 8.1.7 Basis for Valuation ...............................................................................................................................37 8.1.8 Compensation Payments and Related considerations .........................................................................38 8.1.9 Entitlement Matrix ................................................................................................................................39 8.1.10 Timeframes ..........................................................................................................................................46 8.1.11 Linking Resettlement Implementation to Civil Works ...........................................................................46 9 GUIDING PRINCIPLES FOR LAND ACQUISITION AND COMPENSATION .........................................................47 9.1 LAND ACQUISITION MECHANISM .......................................................................................................................47 9.2 VOLUNTARY LAND CONTRIBUTIONS WITH COMPENSATION.................................................................................47 9.3 INVOLUNTARY ACQUISITION OF LAND ...............................................................................................................47 9.4 ELIGIBILITY CRITERIA FOR COMPENSATION .......................................................................................................48 9.5 PROCEDURES FOR PAYMENT OF COMPENSATION .............................................................................................48 9.6 UGANDAN LEGISLATION ON COMPENSATION .....................................................................................................49 9.7 DETERMINATION OF COMPENSATION PAYMENTS ...............................................................................................49 10 GRIEVANCE MANAGEMENT MECHANISM ........................................................................................................50 11 PUBLIC CONSULTATION AND DISCLOSURE PLAN .........................................................................................52 11.1 DATA COLLECTION PHASE ...........................................................................................................................53 11.2 IMPLEMENTATION PHASE .............................................................................................................................53 11.3 MONITORING AND EVALUATION PHASE .........................................................................................................53 11.4 DISCLOSURE ARRANGEMENTS FOR RPFS AND SUBSEQUENT RAPS .............................................................53 12 ORGANIZATIONAL ELEMENTS FOR DELIVERY OF COMPENSATION .............................................................54 13 IMPLEMENTATION COSTS FOR THE RPF .........................................................................................................55 14 MONITORING AND EVALUATION PLAN ............................................................................................................56 14.1 MONITORING INDICATORS ...........................................................................................................................56 14.1.1 Performance/evaluation indicators .......................................................................................................57 14.1.2 Indicators to Measure RAP Performance .............................................................................................57 14.1.3 Indicators to monitor and evaluate implementation of RAPs ................................................................58 14.1.4 RAP Implementation Completion Report .............................................................................................58 14.2 EXTERNAL MONITORING PROCESS ...............................................................................................................58 14.3 RESPONSIBILITY OF THE AUTHORITIES .........................................................................................................58 14.4 INDICATORS TO DETERMINE STATUS OF AFFECTED PEOPLE .........................................................................59 14.5 ANNUAL AUDIT ............................................................................................................................................60 14.6 SOCIO-ECONOMIC MONITORING ...................................................................................................................60 14.7 REPORTING AND DOCUMENTATION ..............................................................................................................60 ANNEX 1: ANNOTATED OUTLINE FOR PREPARING A RESETTLEMENT ACTION PLAN (RAP) .......................62 ANNEX 2: SAMPLE GRIEVANCE AND RESOLUTION FORM .................................................................................66 ANNEX 3: GRIEVANCE FORM .................................................................................................................................67 P a g e | iv ANNEX 4: RANGE OF SERVICES AND STAFFING BY TYPE OF HEALTH CENTRES IN UGANDA ....................68 ANNEX 5: RECORD OF STAKEHOLDER CONSULTATION ...................................................................................69 LIST OF TABLES Table 6-2: World Bank policies triggered operational policies and reason ...................................................................22 Table 6-1: Comparison of Uganda and World Bank Resettlement Requirements .......................................................25 Table 7-1: Likely adverse resettlement impacts and management measures .............................................................30 Table 8-1: Forms of compensation ..............................................................................................................................38 Table 8-2: Entitlement Matrix .......................................................................................................................................40 Table 12-1: Framework for estimate of costs for RAP implementation ........................................................................55 Table 14-1: Institutions to be involved in project monitoring ........................................................................................59 LIST OF FIGURES Figure 1: Illustration of the grievance process .............................................................................................................51 Page |v GLOSSARY OF TERMS Census A field survey carried out to identify and determine the number of Project Affected Persons (PAPs) or Displaced Persons (DPs) as a result of land acquisition and related impacts. The census provides the basic information necessary for determining eligibility for compensation, resettlement, and other measures emanating from consultations with affected communities and the local government institutions. Compensation The payment in kind, cash or other assets given in exchange for the acquisition of land including fixed assets, is called compensation. These include other impacts resulting from activities to rehabilitate or cushion the impacts from displacement. Cutoff Date The cut-off date is the date of commencement of the census of PAPs or DPs within the EASP program area boundaries. This is the date on and beyond which any person whose land is occupied for EASP program, will not be eligible for compensation. Grievance The RPF contains a grievance mechanism based on policies and procedures that are designed Mechanism to ensure that the complaints or disputes about any aspect of the land acquisition, compensation, resettlement, and rehabilitation process, etc. are being addressed. This mechanism includes a procedure for filing of complaints and a process for dispute resolution within an acceptable time period. Implementation The RPF contains an implementation schedule that outlines the time frame for planning, Schedule implementation, and monitoring and evaluation of the RAPs for sub-projects, if applicable. Land Land refers to all types of agricultural and/or non-agricultural land and any structures thereon whether temporary or permanent and which may be acquired by the project. Land Acquisition Land acquisition means the possession of or alienation of land, buildings, or other assets thereon for purposes of the project. Project Affected Project affected persons (PAPs) or Displaced Persons (DPs) are persons affected by land and Persons (PAPs) other assets loss as a result of EASP activities. These person(s) are affected because they or Displaced may lose, be denied, or be restricted access to economic assets; lose shelter, income sources, Persons (DPs) or means of livelihood. These persons are affected whether or not they will move to another location. Most often, the term DPs applies to those who are physically relocated. These people may have their: standard of living adversely affected, whether or not the Displaced Person will move to another location ; lose right, title, interest in any houses, land (including premises, agricultural and grazing land) or any other fixed or movable assets acquired or possessed, lose access to productive assets or any means of livelihood. Project Impacts Impacts on the people living and working in the affected areas of the project, including the surrounding and host communities are assessed as part of the overall evaluation of the project. Project Some projects make use of project implementing units (PIUs), which are generally separate Implementing Unit units within the project recipient’s agency. The PIU is often composed of full time staff (PIU) devoted to implementing the project, and have been encouraged to have separate teams with environment and social specialists who can carry out the activities, for example, as outlined in the RPF or RAP. Rehabilitation Rehabilitation assistance is the provision of development assistance in addition to Assistance compensation such as livelihood support, credit facilities, training, or job opportunities, needed P a g e | vi to assist PAPs or DPs restore their livelihoods. Replacement Replacement cost refers to the amount sufficient to cover full recovery of lost assets and related Cost transaction costs. Resettlement The RAP is a resettlement instrument (document) to be prepared when sub-project locations Action Plan (RAP) are identified. In such cases, land acquisition leads to physical displacement of persons, and/or loss of shelter, and /or loss of livelihoods and/or loss, denial or restriction of access to economic resources. RAPs are prepared by the implementing agency and contain specific and legal binding requirements to resettle and compensate the affected people before project implementation. Resettlement Resettlement assistance refers to activities that are usually provided during, and immediately Assistance after, relocation, such as moving allowances, residential housing, or rentals or other assistance to make the transition smoother for affected households. Resettlement The RPF is an instrument to be used throughout the project’s implementation. The RPF sets Policy Framework out the objectives and principles, organizational arrangements, and funding mechanisms for (RPF) any resettlement, that may be necessary during implementation. The RPF guides the preparation of Resettlement Action Plans (RAPs), as needed, for sub-projects. Rights and Rights and entitlements are defined for PAPs and DPs (with the cut-off date) and cover those Entitlements losing businesses, jobs, and income. These include options for land-for-land or cash compensation. Options regarding community and individual resettlement, and provisions and entitlements to be provided for each affected community or household will be determined and explained, usually in an entitlement matrix. Witness NGO or Some RPFs refer to a witness NGO or an independent monitor that can be contracted to Independent observe the compensation process and provide an independent assessment of the quality of Monitor the process. These are usually NGOs or other agencies that are not directly involved in the project and have a reputation for independence and integrity. P a g e | vii EXECUTIVE SUMMARY Government of Uganda (GoU) with financing support from of World Bank (The Bank) plans to improve reproductive, maternal, neonatal and child health from implementation of the Uganda Reproductive, Maternal, Neonatal and Child Health Improvement Project (RMNCAH Project). The Project Development Objectives (PDOs) are to: (a) improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts; and (b) scale up birth and death registration services. The primary project beneficiaries are women of childbearing age, adolescents, and children under-five (including newborns and infants) from selected districts in the country with a high disease burden. The beneficiaries will benefit from a package of high impact quality and cost-effective RMNCAH interventions. In addition, communities will benefit from enhanced BDR services. The project has four components listed below:  Component 1: Results-Based Financing for Primary Health Care Services  Component 2: Strengthen Health Systems to Deliver RMNCAH Services  Component 3: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services  Component 4: Enhance Institutional Capacity to Manage Project Supported Activities The project under Component 1 will support implementation of Results Based Financing (RBF) activities in a phased manner to ultimately cover sixty districts. The RBF activities are aimed at incentivizing the District Health Teams and Health Centres III and IV to expand provision of quality and cost-effective RMNCAH services. Only facilities (Health Centres III and IV) that provide that provide maternity services were selected. Health Centre II do not provide maternity services. The interventions under the project involve improvement in provision of health services to communities, including those that are vulnerable. The project will contribute to improved health services and the treatment of more people and consequently there will be increased generation of medical waste in the health facilities, and the need for appropriate controls to minimize the associated risk of spread of disease. Component 2 will involve small scale repairs, renovations, and construction of maternity wards and appropriate environmental and social controls will be needed in respect to any land acquisition and construction activity. The environmental and social impacts that could arise from the project have been predicted. In order to comply with the GoU and WB’s involuntary resettlement and land acquisition requirements and to aid various stakeholders to identify and effectively manage potential resettlement and social impacts of the proposed project, this Resettlement Policy (RPF) was prepared. The RPF is meant to ensure t h at the provision of infrastructure under the project complies with the World Bank Safeguard Policies. This report outlines the mechanisms to determine and assess involuntary resettlement and land acquisition impacts arising from project implementation, and sets out appropriate mitigation measures, and institutional arrangement for monitoring. This framework is needed since specific project locations under the proposed project are yet to be determined. However, the coverage of the project is countrywide benefiting numerous local governments. This framework will guide in program screening and in determining the extent of required RAP once program locations and specifications are known. The report has a detailed program background, reviews the RPF implementation legislative and institutional framework, identifies potential resettlement and land P a g e | viii acquisition impacts and their mitigation, and provides guiding principles for land acquisition and grievance management mechanism . Key potential resettlement impacts of the project components and their mitigation are outlined in Table ES1 below. Table ES1: Likely resettlement and land acquisition impacts and their mitigation measures Project activity Nature of impact Management measure 1 Construction of maternity Plot for infrastructure Replace land and/or pay wards compensation; Compensate for other assets 2 Disposal of unclaimed bodies Plot for space Replace land and/or pay compensation; Compensate for other assets Key stakeholders who will be involved with implementation or monitoring this project are listed below:  Ministry of Health  Ministry of Gender Labour & Social Development, MGLUD  Ministry of Lands, Housing and Urban Development, MLHUD  District land board  District Health Officers  Representative of PAPs from each division  Village Health Teams  NGOs working in health sector Page |1 1 INTRODUCTION Government of Uganda (GoU) with financing support from of World Bank (The Bank) plans to improve reproductive, maternal, neonatal and child health from implementation of the Uganda Reproductive, Maternal, Neonatal and Child Health Improvement Project (RMNCAH Project). The project will support the national efforts to scale up delivery of essential RMNCAH services. In doing so, the project will assist the MoH to address critical health systems bottlenecks constraining RMNCAH service delivery, including strengthening supervisory functions and improving the quality of care. In addition, the project will support efforts to strengthen institutional capacity for Civil Registration and Vital Statistics (CRVS) to scale up provision and utilization of Births and Deaths Registration (BDR) services 1.1 Project Development Objective The Project Development Objectives (PDOs) are to: (a) improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target districts; and (b) scale up birth and death registration services. 1.2 Project Beneficiaries The primary project beneficiaries are women of childbearing age, adolescents, and children under-five (including newborns and infants) from selected districts in the country with a high disease burden. The beneficiaries will benefit from a package of high impact quality and cost-effective RMNCAH interventions. In addition, communities will benefit from enhanced BDR services. This resettlement policy framework (RPF) has been prepared through a consultative process to manage possible resettlement impacts of the proposed project. 2 PROJECT DESCRIPTION This chapter outlines components of the proposed project and financing arrangements. 2.1 Project Components The project comprises four components, namely:  Component 1: Results-Based Financing for Primary Health Care Services (allocated budget  Component 2: Strengthen Health Systems to Deliver RMNCAH Services  Component 3: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services  Component 4: Enhance Institutional Capacity to Manage Project Supported Activities Page |2 Component 1 will support implementation of RBF activities in a phased manner to ultimately cover 60 districts in Uganda. Activities for Components 2 and 3 are mainly national-level activities, and will accord priority to low capacity and remote districts. 2.1.1 Component 1: Results-Based Financing for Primary Health Care Services The objective of this component is to institutionalize and scale-up RBF with a focus on RMNCAH services. The RBF design for the project draws on the National RBF Framework, and aims at incentivizing the District Health Teams (DHTs) and HC III and IV to expand provision of quality and cost-effective RMNCAH services. Under this, the health centres will support the VHTs in their catchment areas to promote community based RMNCAH services, including nutrition.1 The district selection was based on a predefined criteria, which included: district poverty levels, access/coverage of RMNCAH services, disease burden, and presence/absence of other RBF schemes.2 The selection of health facilities in the designated districts will be based on their readiness to provide RMNCAH services using a RBF readiness assessment tool adapted from the health facility quality of care program. To further strengthen the referral system, strategically located hospitals with capacity to provide ambulance and RMNCAH referral services will be selected based on criteria outlined in the Project Implementation Manual (PIM). As part of the RBF institutionalization, government will establish an RBF unit in the Health Planning Department to oversee RBF operations. The unit will also serve as the secretariat for the Interagency RBF Coordination Committee to promote coordination, alignment and harmonization of RBF programs. Implementing the various RBF programs together, within a common framework is expected to promote RBF sustainability. The RBF package of high-impact interventions were selected from the RMNCAH Sharpened Plan. The RMNCAH package comprises interventions at health facilities and the community level, and includes: (a) ANC, (b) safe delivery; (iii) comprehensive emergency obstetric care; (iv) essential newborn and postnatal care services; (v) post-abortal care; (vi) family planning; and (vii) community-based RMNCAH services including nutrition, prevention and treatment of common childhood diseases and provision adolescent health services. HCs on the RBF scheme will be rewarded for performance based on key quantity and quality indicators using a fee-for-service provider payment mechanism embedded with a quality enhancing score. DHTs will be rewarded to supervise RBF facilities on key health systems governance indicators on a quarterly basis. The RBF payment framework will embrace an equity dimension to cater for districts in remote or hard- to-reach areas. The project under this component will finance: (a) selection process and training of RBF health providers; (b) performance-based payments to health facilities, hospitals and the DHTs based on verified results; (c) RBF supervision and capacity building; and (d) external verification/counter-verification. 2.1.2 Component 2: Strengthen Health Systems to Deliver RMNCAH Services The objective of this component is to strengthen institutional capacity to deliver RMNCAH services. The project will support the MoH to implement priority health systems strengthening actions to enhance capacity to deliver RMNCAH services. The selected priority actions from the RMNCAH Sharpened Plan address the 1The government is considering adopting CHEWs. The project will support the CHEWs when the change takes effect. 2Reproductive health voucher schemes are currently under implementation in 50 districts (26 under the Bank financed project (P144102) and 24 under the USAID-funded project. In addition, the BTC is implementing a supply-side RBF in 10 districts and CORDAID in the Busoga Region. These excludes small schemes by partners in the districts. Page |3 most critical health systems bottlenecks to RMNCAH service delivery, and include improving: (a) availability of essential drugs and supplies; (b) availability and management of the health workforce; (c) availability and functionality of medical equipment in health facilities; (d) health infrastructure for Primary Healthcare (PHC) services; (e) quality of care and supervision. The actions will be included in the annual plans and budgets of the MoH. (a) Improved availability of essential drugs and supplies (US$10 million): The MoH will (i) procure and distribute essential RMNCAH commodities, including mama kits, manual vacuum aspiration kits, and contraceptives and (ii) upgrade the warehousing system in National Medical Stores (NMS). In order to strengthen district capacity to quantify drug needs, the MoH will support the districts to assign medicines management supervisors to the DHTs and complete the roll out the electronic logistics management system in the remaining districts. (b) Improved availability and management of the health workforce (US$5 million): The MoH will support districts to (i) recruit staff and fill vacancies within the available annual wage bill allocation in a timely manner; (ii) train RMNCAH cadres in short supply (midwives, anaesthetists and laboratory technicians); and (iii) support in-service training and mentorship programs targeting RMNCAH services.3 (c) Improved availability and functionality of medical equipment in health facilities (US$10 million): The project will support the MoH to: (i) procure and distribute critical RMNCAH equipment to selected facilities; (ii) redistribute basic medical equipment from districts/health facilities where they are not in use; and (iii) strengthen the inventory management system for equipment. (d) Improved health infrastructure for PHC health facilities (US$17 million): The project will support the MoH to: (i) construct maternity units in 40 HC IIIs (in non RBF districts) after establishing a clear justification and rationale and (ii) develop guidelines for RBF health facilities to perform simple renovation of health facilities to enhance their functionality. (e) Improved quality of care and supervision (US$10 million): The project will support the MoH to: (i) effectively supervise and support DHTs in a coordinated and systematic manner through the area supervision teams;4 (ii) roll out the HFQCAP; (iii) issue service standards/protocols including maternal and perinatal death audits, health care waste management (HCWM); and client charters; (iv) develop and issue guidelines to the districts to contract eligible hospitals to provide ambulance and referral services on a fee-for-service basis; (v) support DHTs to strengthen their community health outreach programs through properly trained, equipped, motivated and supervised VHTs; and (vi) strengthen citizen engagement through the Health Unit Management Committees (HUMCs), constituency task forces and client charters.5 2.1.3 Component 3: Strengthen Capacity to Scale-up Delivery of Births and Deaths Registration Services The objective of the component is to strengthen institutional capacity for CRVS and scale-up BDR services. The project will support government efforts to strengthen capacity of the principle CRVS institutions at central and subnational levels to carry out their mandate to provide BDR services and to scale-up BDR services 3 Using Association of Gynecologists, Pediatricians, Private Midwives and RMNCAH community service organizations 4 Area Teams comprise central level staff and are responsible for the quarterly supervision of the districts. The Resource Centre is responsible for managing the HMIS. 5 These citizen engagement tools are already in use. The project will support expansion of their implementation. Page |4 countrywide. Sub-component 3.1: Strengthen Institutional Capacity to Deliver BDR Services (US$2 million). The key objective of the sub-component is to strengthen the principle CRVS institutions to carry out their mandates of BDR. The project will support NIRA at the national level to enhance its oversight and coordination function and its affiliate offices at subnational level (district and sub-county) to provide BDR services, giving priority to:  development and dissemination of a national CRVS policy, strategy and communication strategy;  development and training of staff on the BDR protocols and manuals; and  establishment and operationalization of a CRVS monitoring and evaluation (M&E) system, and use of CRVS data for planning and accountability purposes. Sub-component 3.2: Scale-up Birth and Death Registration Services (US$8 million) The objective of the sub-component is to support NIRA to scale-up BDR services at the health facilities and the communities. The project will support NIRA to (a) establish BDR mobile outreach services for effective coverage within 63 districts; (b) scale-up the Mobile Vital Records System (MVRS) for birth registration to an additional 54 districts; (c) expand birth registration to 218 HC IVs, and 1,300 HC IIIs; (d) expand mobile/outreach birth registration services to remote and underserved communities; (e) train facility and community-based registration personnel on BDR; (f) design the death registration module within the existing MVRS; (g) train clinical staff and Maternal and Perinatal Death Audit Committees on cause-of-death reporting according to International Classification of Diseases (ICD) guidelines; (h) develop a customized DHIS26 module for reporting cause of death and ICD coding; and (viii) acquire the necessary materials, tools and equipment for BDR (office equipment, IT equipment - computers and mobile phones - and BDR registers). 2.1.4 Component 4: Enhance Institutional Capacity to Manage Project Supported Activities This objective of the component is to enhance institutional capacity for management of project supported activities. This component will support costs related to overall project management, training, and project operations (safeguards, M&E, citizen engagement) in order to ensure the intended objectives are achieved in a sustainable manner. The project will address the skills gaps in project management and build institutional capacity of the relevant units for efficient and effective project implementation. This will include the following: (a) Strengthen project management, including fiduciary capacity. This will entail enhancing capacity for project management, financial management, procurement, and both internal and external audit functions. This component of the project will additionally ensure that the required tools and equipment are available for project operations (such as office equipment and motor vehicles). (b) Strengthen capacity to implement RBF programs. Special attention will be paid towards training key staff in RBF design and implementation, as well as national coordination of the various RBF programs/schemes in the country. (c) Strengthen capacity for management of environmental and social safeguards related activities . This is to enable the MoH to plan, coordinate, monitor, and report on implementation of the relevant mitigation activities. 6 DHIS2 is a health management information system used 47 countries including Uganda, and used by 23 organizations Page |5 (d) Enhance monitoring and evaluation functions. The project will support the resource center to generate reliable data to facilitate routine project monitoring, verification of RBF outputs, and coordination and implementation of the mid-term and end-of-project evaluation. (e) Support information, education and communication and citizen engagement . This will involve engaging the media, revision and dissemination of appropriate tools, and materials on citizen engagement, and monitoring of citizen engagement related activities. 2.2 Project Financing The project is financed through an Investment Project Financing (IPF) instrument. Out of the total project cost of US$140 million, US$110 million is financed under the IDA Credit, and US$30 million from the Global Financing Facility (GFF) grant. Page |6 3 OVERVIEW OF UGANDA’s SOCIO-ECONOMIC ENVIRONMENTAL CONDITIONS 3.1 Natural Resources a) Water Water is life, and Uganda has significant quantities of the resource. From both hydrological and social water scarcity considerations at the moment, Uganda is not water stressed. However, by 2025, indications are that there will be reason to worry as a result of increasing demands for human, livestock, wildlife, irrigation and industrial water. Uganda is ranked in a group of countries that must plan to secure more than twice the amount of water they used in 1998 in order to meet reasonable future requirements. The quality of the water from available sources is another area of concern principally as a result of pollution – residential, industrial and agricultural land discharges into the open water bodies. To some extent the buffering capacity of wetlands is making a contribution towards reductions in pollution, but this will continue only if the integrity of the wetlands can be sustained. Relation to the project: The proposed RMNCH infrastructure such as new maternity wards and ground for disposal of unclaimed bodies may have foot print on natural resources such as forests, swamps and wildlife conservation areas. Construction of the infrastructure could therefore pose impacts on these resources in absence of control measures. Construction of project facilities is expected to take small quantities of water and for only the short duration of construction activities. 3.2 Socio-Economic and Cultural Environment a) Urbanization Although Uganda is one of the least urbanized countries in the world in absolute terms, the urban population is growing. Urban population in Uganda increased from less than one million persons in 1980 to about three million in 2002, representing a nearly fourfold increase. However, between 2002 and 2014, the urban population rapidly increased to 6.64 million. Relation to the project: Due to land scarcity in urban areas it’s increasingly becoming costly to compensate landowners to acquire land for project facilities. This will be reflected in resettlement cost of the project where proposed RMNCH infrastructure result into land take impacts users of land. b) Land Tenure and Land Use Rights Land tenure systems differ across Uganda and tenure practices are a mixture of traditional practice, colonial regulations and post-colonial legislation. There are four types of land tenure systems in Uganda, customary, mailo, freehold and leasehold (NEMA, 1996). i) Customary Tenure  Land is owned in perpetuity;  This tenure is governed by rules generally accepted as binding and authoritative by the class of persons to which it applies. In other words customary regime is not governed by written law; Page |7  Customary occupants are occupants of former public land and occupy land by virtue of their customary rights; they have proprietary interest in the land and are entitled to certificates of customary ownership which may be acquired through application to the Parish Land Committee and eventual issuance by the District Land Board. This tenure system is found all over the country, predominates in the northern, eastern and western regions. ii) Mailo Tenure The Mailo land tenure system is a feudal ownership introduced by the British in 1900 under the Buganda Agreement. "Mailo" is a Luganda word for “mile” as the original grants under the agreement were measured in square miles. Prior to the 1975 Land Reform Decree, Mailo land was owned in perpetuity by individuals and by the Kabaka (hereditary King of Buganda). All Mailo land parcels have title deeds. Persons who buy portions (kibanja7) on Mailo land are protected by Ugandan law to live on and use the land, but they are obliged to pay certain annual royalties to the Mailo owner according to land law. No title deed is associated with kibanja purchase: the Mailo owner would simply write a sale (purchase) agreement witnessed by village local leaders (LCs), giving the kibanja buyer full rights to own and use the purchased portion of Mailo land. Such a buyer can sell his/her kibanja to a new owner but notify Mailo owner and local leaders about the changed ownership. The Mailo tenure system:  Derives its legality from the Constitution and its incidents from the written law;  Involves holding of land in perpetuity.  Permits separation of ownership of land from the ownership of development on land made by a lawful or bona fide occupant.  Enables the holder to exercise all the powers of ownership, subject to the rights of those persons occupying the land at the time of the creation of the mailo title and their successors. This tenure system is found all over the country, predominates in the northern, eastern and western regions. iii) Freehold Tenure  This tenure derives its legality from the Constitution of Uganda and its incidents from the written law;  It enables the holder to exercise, subject to the law, full powers of ownership.  It involves the holding of land in perpetuity or for a period less than perpetuity fixed by a condition. This system is found mainly in parts of eastern and western Uganda. iv) Leasehold Tenure This tenure system is: is a Luganda word for a portion of land bought from Mailo land. Kibanja owner does not have a title deed but only a purchase 7“Kibanja” agreement from Mailo owner (who holds the title deed). “Bibanja” is plural for kibanja. Luganda is language of Baganda the largest tribe in Uganda. Page |8  Created either by contract or by operation of the law;  Where the tenant has security of tenure and a proprietary interest in the land;  A form under which the landlord of lessor grants the tenant or lessee exclusive possession of the land, usually for a period defined and in return for a rent; Relation to the project: Due to a high rate of population growth, land continues to be increasingly scarce all over the country. In many cases this has led to encroachment of land belonging to the healthcare facilities. c) Cultural heritage Cultural heritage is part of humanity’s link with the world and its past, its achievements and discoveries. The National Environmental Act provides for protection of the country’s cultural heritage. About 187 known physical, cultural, historical and para-archaeological sites have been identified and their specific locations recorded in Uganda. Relation to the project: This will only be relevant to the proposed project in the unlikely event that construction of RMNCH infrastructure affects known physical cultural resources or when chance finds encountered are damaged. A protocol to manage chance finds if encountered at any site during project implementation is provided in ESMF and known PCRs shall be assessed as part of the specific ESIA and managed in accordance with Management Plans that may be developed . d) Healthcare Waste (HCW) and Environmental pollution In spite of a National Policy on Injection Safety and Health Care waste management, HCW management system is still inadequate due to unsegregated waste and waste management commodities 8. In 2010, a health facility assessment was conducted jointly by the Ministry of Health and the AIDSTAR-One project in 99 health facilities, including 12 hospitals, 17 level IV health centers, 43 level III health centers, and 24 level II health centers throughout 18 districts. The findings of the assessment showed that on average, each hospital generates 92 kg of waste per day, 40 percent of which is hazardous. A level IV health center generates 42 kg of waste daily, while level III and II health centers generate 25 kg and 20 kg per day, respectively. Very few of these facilities have acceptable methods of final waste disposal; open burning is widely accepted. Although larger facilities have incinerators to reduce the volume of waste, the majority do not achieve recommended temperature and smoke emission requirements. Relation to the project: HCW burning and incineration are some of the acceptable and widely used waste treatment and disposal methods. The project activities under Component 1 and Component 2 will require more land for maternity wards and HCW management activities. USAID& PEPFAR, 2012: AIDSTAR-One FACT SHEET; Health Care Waste Management in Uganda. 8 Page |9 4 PREPARATION AND OBJECTIVES OF THE RPF 4.1 Objectives of the RPF The main objective of the assignment is to prepare a Resettlement Policy Framework (RFP) that is to be used for social screening and assessment of project components to be funded within the framework of the RMNCH. The Resettlement Policy Framework (RPF) will guide implementation of RMNCH civil works packages to ensure that displacement issues are resolved and that the livelihoods of the affected persons are not negatively impacted on and where it is unavoidable they are compensated and/or resettled. The other objectives of the Resettlement Policy Framework (RPF) are to:  Establish RMNCH land acquisition, resettlement and compensation principles and implementation arrangements;  Describe the legal and institutional framework underlying Ugandan approaches for land acquisition, resettlement and compensation;  Define the eligibility criteria for identification of project affected persons (PAPs) and entitlements;  Describe the consultation procedures and participatory approaches involving PAPs and other key stakeholders;  Provide procedures for filing grievances and resolving disputes; and  Enhance positive social and environmental impacts of the project and avoid/minimize or manages any potential adverse impacts. In line with involuntary resettlement /land acquisition requirements of Government of Uganda and the World Bank, the environment and social safeguard policies of the World Bank shall be applied to the project components. The RPF provides the procedures and methodologies for identifying potential land take/displacement during implementation and outlines management instruments required to effectively address them. Appropriate institutional arrangements towards implementing the RPF and RAPs have been provided in the framework. The RPF also provides guidance in cases where screening indicates that a separate Resettlement Action Plan (RAP) is required. The RPF includes principles, organizational arrangements, and implementation mechanisms and costs for resettlement/land acquisition that may arise during sub-component implementation. The RAP preparation process outlined in this RPF is consistent with the National Land Act Cap 227 and the Bank’s Operational; Policy OP. 4.12 Involuntary Resettlement. 4.2 Methodology for RPF and Stakeholder Engagement/Consultation The RPF was prepared based on the following methodology a) Review of project documents b) Regulatory review (Uganda) c) Review of World Bank Safeguard Policies d) Visit to selected project sites/districts e) Stakeholder consultations Stakeholders’ views are presented in Annex 5 P a g e | 10 5 POLICY, LEGAL AND INSTITUTIONAL FRAMEWORK 5.1 Legal Framework for Expropriation and Compensation This RPF will take into account the laws, legislation, regulations, and local rules governing the use of land and other assets in Uganda. This legal and institutional framework is presented in six sections. These are: a. Political economy and governance in Uganda; b. Property and land rights, as defined by Ugandan law and customary practice; c. Comparison with World Bank OP4.12, using equivalence and acceptability standards. d. Acquisition of land and other assets, including regulations over the buying and selling of these assets; e. Human rights and compensation, in particular, the accepted norms influencing peoples’ basic rights to livelihood and social services; and f. Dispute resolution and grievance mechanisms, specifically the legal and institutional arrangements for filing grievances or complaints and how those grievances are addressed through formal and informal systems of dispute resolution. 5.1.1 Political Economy and Governance in Uganda The political and legal context for the application of Resettlement Policy Frameworks (RPFs) is mainly governed by:  The Constitution of Uganda 1995;  The Land Act of 1998 (as amended in 2004);  The Acquisition Act 1965,  The Physical Planning Act, 2010;  Local government Act 1967;  Historical Monuments Act 1967;  The Occupational safety and Health Act, 2006 These are further explained below. 5.1.1.1 The Constitution of the Republic of Uganda 1995 The Constitution of the Republic of Uganda (1995) provides government and local authorities a statutory power of compulsory acquisition of land in public interest, an d makes provision, inter alia, for the “prompt payment of fair and adequate compensation” prior to the taking of possession of any privately -owned property. Such compensation is assessed in accordance with the valuation principles laid out in Section 78 of the Land Act (Cap 227), briefly outlined below:  The value for customary land is the open market value of unimproved land;  The value of buildings on the land is taken at open market value for urban areas, and depreciated replacement cost for rural areas; P a g e | 11  The value of standing crops on the land is determined in accordance with the district compensation rates established by the respective District Land Board. Annual crops which could be harvested during the period of notice to vacate given to the landowner/ occupier of the land are excluded in determining compensation values;  In addition to the total compensation assessed, there is a disturbance allowance paid of 15% or, if less than six months’ notice to vacate is given, 30% of the total sum assessed. All compensation and resettlement will follow Uganda’s constitution, out of which all regulations are developed. In addition, OP4.12 will be used to bridge any gap that might exist between national law and World Bank requirements in order to address potential negative impacts of resettlement activities. Article 237 of the Constitution, 1995, vests land ownership in citizens of Uganda and identifies four land tenure systems, namely: customary; freehold; mailo; and leasehold. These systems are detailed under Section 4 of the Land Act (Cap 227) and outlined below: a) Customary Tenure  Land is owned in perpetuity;  This tenure is governed by rules generally accepted as binding and authoritative by the class of persons to which it applies. In other words customary regime is not governed by written law;  Customary occupants are occupants of former public land and occupy land by virtue of their customary rights; they have proprietary interest in the land and are entitled to certificates of customary ownership which may be acquired through application to the Parish Land Committee and eventual issuance by the District Land Board. b) Freehold Tenure  This tenure derives its legality from the Constitution of Uganda and its incidents from the written law;  It enables the holder to exercise, subject to the law, full powers of ownership.  It involves the holding of land in perpetuity or for a period less than perpetuity fixed by a condition. c) Leasehold Tenure This tenure system is:  Created either by contract or by operation of the law;  Where the tenant has security of tenure and a proprietary interest in the land;  A form under which the landlord of lessor grants the tenant or lessee exclusive possession of the land, usually for a period defined and in return for a rent; d) Mailo Tenure P a g e | 12 The Mailo land tenure system is a feudal ownership introduced by the British in 1900 under the Buganda Agreement. "Mailo" is a Luganda word for “mile” as the original grants under the agreement were measured in square miles. Prior to the 1975 Land Reform Decree, Mailo land was owned in perpetuity by individuals and by the Kabaka (hereditary King of Buganda). All Mailo land parcels have title deeds. Persons who buy portions (kibanja9) on Mailo land are protected by Ugandan law to live on and use the land, but they are obliged to pay certain annual royalties to the Mailo owner (currently UgShs 1000 about US 60 cents per household per year according to land law). No title deed is associated with kibanja purchase: the Mailo owner would simply write a sale (purchase) agreement witnessed by village local leaders (LCs), giving the kibanja buyer full rights to own and use the purchased portion of Mailo land. Such a buyer can sell his/her kibanja to a new owner but notify Mailo owner and local leaders about the changed ownership. In cases of compensation, an apportionment of land value of 60% and 40% share of the market value is given to the landlord and kibanja owners respectively, depending on developments invested on the affected land. For example, a kibanja owner who has a permanent structures or perennial crops is entitled to a 60% share of the compensation value while one with only temporary structures or annual (seasonal) crops is entitled to only 40%. The Mailo tenure system:  Derives its legality from the Constitution and its incidents from the written law;  Involves holding of land in perpetuity.  Permits separation of ownership of land from the ownership of development on land made by a lawful or bona fide occupant10.  Enables the holder to exercise all the powers of ownership, subject to the rights of those persons occupying the land at the time of the creation of the mailo title and their successors. Although only these latter forms of tenure are legally defined under the Land Act, the context of common law also recognizes “Licensee” or “Sharecroppers”, these terms having similar meanings in practice. Licensees are persons granted authority to use land for agricultural production. Traditionally, such production would be limited to annual crops and not perennial types. Licensees have no legal security of tenure or any property right in the land and their tenure is purely contractual. It will be noted, however, that WB safeguard policies require compensation of PAPs irrespective of legality of their tenure on land. In this regard squatters, users and encroachers in encountered will receive resettlement assistance in compliance with World Bank’s policy. In compensation and resettlement, rights of spouses and children are protected under the Constitution of Uganda and the Land Act (Cap 227). The consent of spouse and children must be acquired prior to any transaction by head of households on land on which the family lives. 9“Kibanja” is a Luganda word for a portion of land bought from Mailo land. Kibanja owner does not have a title deed but only a purchase agreement from Mailo owner (who holds the title deed). “Bibanja” is plural for kibanja. Luganda is language of Baganda the largest tribe in Uganda. 10 Lawful and “bona fide” occupants are defined under the Land Act, Section 30. They are called “ kibanja” occupants. P a g e | 13 Section 40 of the Land Act, 1998 requires that no person shall: a. Sell, exchange, transfer, pledge, mortgage or lease any land; or enter into any contract for the sale, exchange, transfer, pledge, mortgage or lease of any land; b. Give away any land or enter into any transaction in respect of land:  In the case of land on which ordinarily reside orphans, whom are still minors, with interest in inheritance of the land, except with prior written consent of the Committee.  In the case of land on which the person ordinarily resides with his or her spouse, and from which they derive their sustenance, except with the prior written consent of the spouse;  In the case of land on which the person ordinarily resides with his or her dependent children (minors) except with the prior written consent of the Committee11;  In the case of land on which the person ordinarily resides with his or her dependent children (minors) of majority age, except with the prior written consent of the dependent children (minors). Inference: Relevance of the Constitution to the project is in the fact that it is the principal law onto which all social-environmental protection laws are derived. It requires equitable compensation for any land take recognises various land tenure systems and gives credence to the law (Land Act) governing land acquisition and rights of spouses in compensation. Note that in addition, OP4.12 will be used to bridge any gap that might exist between national law and World Bank requirements in order to address potential negative impacts of resettlement activities. 5.1.1.2 Land Act, Cap 227 The Land Act principally addresses four issues namely; holding, control, management and land disputes. As regards tenure, the Act repeats, in Section 3, provisions of Article 237 of the Constitution which vests all land in the citizens of Uganda, to be held under customary, freehold, mailo or leasehold tenure systems. However, the Land Act provides for acquisition of land or rights to use land for execution of public works. Regarding control of land use, the Act reaffirms the statutory power of compulsory acquisition conferred on the government and local authorities under articles 26 (2) and 237(2) (a) of the Constitution (Section 43). Since the Act does not repeal the Land Acquisition Act No. 14 of 1965, it is assumed that this legislation, meets requirements of Article 26(2) of the Constitution that requires a law to be in place for the payment of compensation and access to the courts. The Act also requires that landowners manage and utilize land in accordance with regulatory land use planning (Sections 44 and 46). Section 77(2) of the revised edition (2000) of the Land Act 1998 provides for a disturbance allowance on top of the computed compensation amount as follows: “Committees “are defined under Section 65 of the Land Act; they are ParishLand Committees. 11 P a g e | 14  30% of compensation amount if quit notice is given within 3 months.  15% of compensation amount if quit notice is given after 6 months. The Land Act will govern all aspects related to land taken by the project and its compensation either by replacement with physical land parcels or cash payments. Inference: The Land Act is the principal law to be followed during land acquisition and compensation for other affected property such as crops and buildings. Note that in addition, OP4.12 will be used to bridge any gap that might exist between national law and World Bank requirements in order to address potential negative impacts of resettlement activities. 5.1.1.3 The Physical Planning Act, 2011 This Act replaced the Town and Country Planning Act, Cap 246 which was enacted in 1951 and revised in 1964 but is now inconsistent with contemporary government system in Uganda. The 1951 Act was enacted to regulate and operate in a centralised system of governance where physical planning was carried out at national level through the Town and Country Planning Board. Implementation of the Act was supervised by local governments, especially the urban local governments. Uganda has since gone through many social, political and economic changes. For example, promulgation of the 1995 Constitution established a decentralised system of governance which divulged powers and functions including physical planning, finance and execution of projects from the central government to local governments. This therefore created a need to enact a physical planning legislation which is consistent with this Constitutional requirement. The Physical Planning Act, 2011 establishes district and urban physical planning committees, provides for making and approval of physical development plans and applications for development. Section 37 of The Physical Planning Act, 2011 requires an EIA permit for developments before they are implemented, stating: “Where a development application related to matters that require an environmental impact assessment, the approving authority may grant preliminary approval subject to the applicant obtaining an EIA certificate in accordance with the National Environment Act”. Inference: The Act is relevant to the RMNCH since infrastructure to be developed will have to be considered as part of future physical planning in certain areas and therefore conformity to local physical planning requirements is essential. 5.1.1.4 Local Government Act (1997) Local Government Act 1997 provides for the system of Local Governments, which is based on the District. P a g e | 15 Under the District there are lower Local Governments and administrative units. This system provides for elected councils that have both legislative and executive powers. Thus the district councils play an important role in land administration; land surveying, physical planning, and management of municipal resources that are not the responsibility of the central government. This act provides for a district- based system of local governments. They are therefore charged with the crucial role of acquisition of land for development/construction purposes and in the sensitization and mobilization of the local communities. This system also provides for elected Councils whereby chairmen nominate the executive committee of each council, functions of which include: i) Initiating and formulating policy for approval by council; ii) Overseeing the implementation of Government and Council policies, and monitor and coordinate activities of Non-Government Organizations in the district; and iii) Receiving and solving disputes forwarded to it from lower local governments. The Act empowers districts administrations to develop and implement district rates upon which compensation for crops and non-permanent structures is based. This together with the fact that local administrations (districts and local councils or LCs) will have an important role during resettlement and verification of affected persons Inference: The Act is relevant to the RMNCH project since the district-based system of local governments will have an important role during valuation, resettlement and verification of affected property and persons. 5.1.1.5 Historical Monuments Act 1967 Assented to on 21st October, 1967 and came into force on 15th May 1968, this Act provides for the preservation and protection of historical monuments and objects of archaeological, paleontological, ethnographical and traditional interest. According to this Act, the responsible Minister may, by statutory instrument, declare any object of archeological, paleontological, ethnographical, traditional or historical interest to be a protected object. Once thus declared, the Act adds, no person whether owner or not shall do any of the following:  cultivate or plough soil so as to affect to its detriment any object declared to be preserved or protected;  make alteration, addition to, or repair, destroy, deface or injure any object declared to be preserved or protected; Sub-section 12(1) requires that any portable object discovered in the course of an excavation shall be surrendered to the Minister who shall deposit it in the Museum. However, the Act adds that, notwithstanding provisions of the subsection, where any object is discovered in a protected site, place, or monument, the P a g e | 16 owner of the protected site, place, or monument shall be entitled to reasonable compensation. Inference: This Act also relates to “chance finds” that could be encountered during infrastructure development program. 5.1.2 Property and Land Rights in Uganda The Constitution of Uganda, 1995 vests all land directly in the Citizens of Uganda, and states that every person in Uganda has the right to own property. The Constitution also sets the standard for any form of compensation in Uganda and provides for prompt payment of fair and adequate compensation prior to the taking possession or acquisition of the land/property. Ugandan law recognizes four distinct land tenure systems, customary tenure, Freehold tenure, Leasehold tenure, and Mailo tenure.  Customary land is owned in perpetuity and is governed by the customary laws by the peoples who have customary tenure. It is governed by rules generally acceptable as binding and authoritative by the class of people to which it applies. These people have propriety interest in the land and can acquire a certificate of customary ownership or a freehold certificate of title by requesting one through the Parish Land Committee (which will then be granted by the District Land Board). Land is owned in perpetuity under customary tenure.  Freehold tenure involves the holding of land in perpetuity or of a period less than perpetuity fixed by a condition. It enables the holder to exercise full power of ownership. A freehold title can be subjected to conditions, restrictions or limitations which may be positive or negative in their application.  Mailo tenure involves the holding of land in perpetuity. It was established under the Uganda Agreement of 1900. It permits the separation of ownership of land from the ownership of developments on land made by a lawful occupant. Additionally, it enables the holder to exercise full power of ownership, subject to the customary and statutory rights of those persons lawful or bonafide in occupation of the land at the time that tenure was created and their successors in title.  Leasehold tenure is created either by contract or by operation of the law. The landlord or lessor grants the tenants or lessee exclusive possession of the land, usually for a period defined and in return for a rent. The tenant or lessee has security of tenure and a proprietary interest in the land. Additionally, under common law the statute of a “licensee” or “sharecropper” is also recognized . Licensees are granted authority to use land for agricultural production, usually limited to annual crops. They have no legal security of tenure or any propriety right in the land. 5.1.3 Acquisition and Valuation of Land and other Assets 5.1.1.6 Land Acquisition Both The Constitution, 1995 and The Land Act, Cap 227 gives the government and local governments’ power to compulsorily acquire land. The Constitution states that “no person shall be compulsorily deprived of P a g e | 17 property or any interests in or any right over property of any description except” if the taking of the land necessary “for public use or in the interest of defence, public safety, public order, pub lic morality or public health.” Section 87 of the National Land Policy (2013) states that: the government shall ensure that the acquisition of land for investment purposes is in accordance with the following:  National development objectives;  Established laws and procedures; and  Appropriate evaluation, due process and due diligence. The Land Acquisition Act, 1965 makes provision for the procedures and method of compulsory acquisition of land for public purposes. The Land Acquisition Act, 1965 states that the minister responsible for land may authorize any person to enter said land to survey the land, bore the subsoil, or any other examination necessary for determining whether the land is suitable for a public purpose. Additionally, once the assessment officer takes possession, the land immediately becomes vested in the land commission. Any dispute as to the compensation payable is to be referred to the Attorney General or court for decision. 5.1.1.7 Valuation Section 77 of the Land Act gives valuation principles for compensation; i.e. crops are compensated at rates set by the District Land Boards; the basis of compensation for land is open market value. The value of buildings is to be taken at open market value for urban areas and depreciated replacement cost in the rural areas. In addition, a 15% or 30% disturbance allowance must be paid if six months or less notice is given to the owner. The Land Act gives powers to District Land Tribunals to determine any dispute relating to the amount of compensation to be paid for land acquired compulsorily. 5.1.1.8 Principles and Polices for Land Acquisition Compensation shall aim to enable PAPs to restore their pre-project incomes and standard of living by the end of the project. The RPF shall apply the following principles of land acquisition: i. Principle of Equivalence Where land take is unavoidable compensation will follow OP4.12 principle that requires affected persons to be compensated at full replacement cost. ii. Principle of Severance Used when the government exercises its power to take private property for public use through the right of Eminent Domain. If only part of the property is taken and the value of the remaining property depreciates because of the government’s proposed use of the taken share, the owner is entitled to compensation called severance damage. P a g e | 18 iii. Principle of Injurious Affection Loss or damage to non-physical nature to land remaining with a dispossessed owner after a partial compulsory acquisition. Excludes any sentimental value; E.g. (i) Direct, physical interference or obstruction; (ii) loss of view or loss of privacy In addition, MoH will avoid or minimize land take by utilizing land that is least inhabited. Upon declaration (section 3 of Land Acquisition Act) of Government’s interest in the land the persons with interest in said land shall be served with notice (section 5 of Land Acquisition Act). In addition,  To ensure that PAPs/stakeholders have ways to access information and raise their issues –MoH to have a clear communication plan/strategy, whichever is visible.  Clear communication and information on all (negative and positive) project impacts and mitigations (a continuous process)  Accessible means of raising issues and grievances and to manage/responding to issues and grievances appropriately and timely 5.1.4 Human Rights and Compensation Ugandan law makes provision for compensation when development projects affect people’s land, property, or livelihoods. It also details the rights and privileges of citizens in dealing with the government and the compulsory acquisition of property. a) Economic Well-being and Social and Cultural Values The Constitution states that, where the government compulsorily acquires land, and where the government will resettle PAPs, it will fairly and promptly compensate displaced PAPs or resettle them on suitable alternative land with due regard for their economic well-being and social and cultural values. b) Prompt and Adequate Compensation The Constitution states that the government may only compulsory acquire property if a law exists that provides for the prompt payment of fair and adequate compensation (Constitution, Article 20). The Lands Act emphasizes the payment of compensation to the victims of acquisition made under the Act. The basis of the compensation should be either the market value or replacement value. Additionally, compensation amounts must take into account the cost of disturbance and incidental expenses or other damage suffered because of the resettlement. c) Damage or Loss P a g e | 19 The government Lands Act also makes provision for compensation for any person who suffers any loss or damage due to “the carrying out of any survey, as a result of installation, construction, inspection, maintenance, replacement, or removal of any specified work.” The DLB will base the amount of compensation on any loss or damage, and may take into account how much the person’s land has increased in value as a result of the installation or construction of the works. 5.1.5 Dispute Resolution and Grievance Mechanisms The Land Act, Cap 227 states that land tribunals must be established at district level. It empowers the District Land Tribunals to determine disputes relating to amount of compensation to be paid for land acquired compulsorily. The affected person may appeal to a higher ordinary court. The Land Acquisition Act allows for any person to appeal to the High Court within 60 days of the award being made. All land disputes must be processed by the tribunals, before the case can be taken to the ordinary courts. The act also states that traditional authority mediators must retain their jurisdiction to deal with, and settle, land disputes. 5.2 Institutional Framework The institutional arrangement for program implementation will be as par the Government of Uganda structure and consistent with existing legal provisions. Institutions that will be directly involved in the RMNCH project include, Ministry of Gender, Labour& Social Development (MGLSD-OHS Department), Ministry of Health (MoH), Ministry of Finance, Planning and Economic Development (MoFPED), Ministry of Lands, Housing & Urban Development, Department of Museums & Monuments (for conservation of cultural heritage), National Environment Management Authority (NEMA) and National Identification Registration Authority (NIRA). These shall ensure that program resources are budgeted for and disbursed within the national Medium Term Expenditure Framework (MTEF), and that program accounts are audited as per statutory requirements. In addition Health centers IIIs and IVs all country wide will be involved. The above entities and their roles are outlined below: 5.2.1 Ministry of Gender, Labour & Social Development (MGLSD) The Ministry guides all actors in the social development sector and creates an enabling environment for social transformation, leading to improved standards of living for all, increased equality and social cohesion. These roles make MGLSD a key secondary stakeholder in proposed RMNCH projects with roles of empowering project communities to harness their potential through cultural growth, skills development and labour productivity for sustainable and gender responsive development. MGLSD has a department of occupational health and safety which is mandated to inspect workplaces to ensure safety and gender equity. Matters relating to vulnerable groups like orphans, marginalized groups like the disabled and women are a responsibility of the Ministry of Gender, Labour and Social Development (MoGLSD). Further, the same ministry coordinates HIV/AIDS in work places and therefore it is imperative that MoH and MoGLSD talk to each other in resolving land acquisition related matters especially compensation, HIV/AIDS in construction related activities and provision of job opportunities and other rehabilitation measures to the project affected persons. And in relation to the RMNCH, the ministry should make sure that vulnerable persons for example P a g e | 20 PWDs are catered for regarding RMNCH services development. 5.2.2 Ministry of Lands, Housing & Urban Development The Ministry of Lands, Housing and Urban Development (MoLHUD) is a major stakeholder in this project. The Chief Government Valuer in the Valuation Division in the Ministry of Housing and Urban Development is responsible for approving the Valuation Roll. This demands fair and transparent compensation and as such all property valued are first inspected by the Chief Government Valuer. Chief Government Valuer’s office is also involved in resolving public complaints that arise from land acquisition valuations and compensation payments. Section 2 (1) of the Land Acquisition Act 1964 states: “In order to ascertain the suitability of any land for a public purpose, any person authorized by the Minister may enter upon the land and; a) Survey the land b) Dig or bore into the subsoil and remove sample, and c) Do any other thing necessary for ascertaining its suitability for that purpose. 5.2.3 Ministry of Health (MoH) The Ministry of Health (MoH) is a government body set up with the mandate of;  policy formulation and policy dialogue with Health Development Partners,  resource mobilization and budgeting,  strategic planning, regulation, advising other ministries on health matters, setting standards and quality assurance, capacity development and technical support, and  provision of nationally coordinated services such as epidemic control, coordination of health research and monitoring and evaluation of the overall sector performance. The Ministry is one of the key implementing entities, responsible for implementation of activities under component one; Scale up Results Based Financing for Frontline Health Services and component two; Systems Strengthening to Deliver RMNCAH Services of the project. The Permanent Secretary, MoH supported by a full-time Project Coordinator responsible for overseeing day-to-day coordination of project implementation will serve as the Project Director; the Commissioner Health Planning Department will head component one, Scale up Results Based Financing for Frontline Health Services; and the Director Community and Clinical Services deputized by the Commissioner Community and Clinical Services will head component two, Systems Strengthening to Deliver RMNCAH Services . 5.2.4 National Identification Registration Authority (NIRA) The National Identification and Registration Authority is mandated by the Registration of Persons Act 2015 to create, manage, maintain and operationalize the National Identification Register by;  Registering all citizens of Uganda; P a g e | 21  Registering non-citizens of Uganda who are lawfully residents in Uganda;  Registering births and deaths  Assigning a unique National Identification Number to every person registered  Issuing National Identification Cards and Aliens’ Identification Cards to all registered persons NIRA is a key implementing entity responsible for implementation of project activities under component three: Strengthen capacity for Civil Registration and Vital Statistics (CRVS). 5.2.5 National Environment Management Authority (NEMA) The National Environment Act (Cap 153) provides for the establishment of NEMA as the principal agency responsible for coordination, monitoring and supervision of environmental conservation activities. NEMA is under the Ministry of Water and Environment (MoWE) but has a cross-sectoral mandate to oversee the conduct of ESIAs through issuance of ESIA guidelines, regulations and registration of practitioners. NEMA would work with MoH Environment Officers and District environment officials at each district who also undertake inspection, monitoring and enforce compliance on its behalf. For this project, NEMA will review and approve environmental impact statement (EIS) of this project in consultation with any relevant lead agencies. 5.2.6 Wetlands Management Department (WID) in MoWE Through its technical arm (Water Resources Management Directorate - WRMD), MoWE has a responsibility to regulate quality and quantity of water resources in the country. The Directorate is responsible for the full range of integrated water resources management (IWRM) activities including monitoring, assessing, planning, allocating and regulating water resources. Specifically, the Water Resources Planning Department which is responsible for water regulation through issuance of permits for abstraction of water will also play a key role in providing permitting needs for proposed RMNCH facilities. P a g e | 22 6 OVERVIEW OF WORLD BANK’S SAFEGUARD POLICIES The World Bank is committed to a number of operational and safeguard policies which aim to prevent and mitigate undue harm to people and their environment in any development initiative involving the bank. The World Bank’s ten safeguard policies are designed to help ensure that programs proposed for Bank financing are environmentally and socially sustainable, and thus improve decision-making. The triggered operational policies are outlined below: Table 6-1: World Bank policies triggered operational policies and reason Safeguard Policies Triggered? Reason Yes No OP/BP 4.01 is triggered because the project will entail civil works (e.g. construction of maternity wards and HCW management activities) and because increase of health services will lead to increase of medical waste. In participating districts construction of maternity wards at selected HC III is planned. Construction of maternity wards will require materials such as sand, aggregates, cement and timber among others and use of water. Project construction and operation phases will generate waste. OP4.01 Environmental Management measures of materials source and X Assessment transportation, and waste generated will be guided in the ESMF and ESMPs. All the structures to be constructed shall follow national construction standards and World Bank policy and guidelines, including gender and disability requirements. The RMNCH project ESMF will be adopted, revised by the Borrower and applied to this project to guide implementation of environmental and social aspects of the project. X The project will have no adverse impact on natural OP4.04 Natural Habitats habitats. OP4.09 Pest Management X The project will not entail use of pesticides. This is triggered because project investments involve civil works and may encounter chance OP4.11 Physical Cultural X finds. Resources The project ESMF has included a chance finds P a g e | 23 Safeguard Policies Triggered? Reason Yes No management procedure, but any subsequent ESIAs to be undertaken for any component or facility of this project will include Physical Cultural Resources investigation, assessment and management measures. The project will involve construction of maternity wards which may require land for siting. There OP4.12 Involuntary Resettlement X may be displacement of land uses due to civil works. Therefore, a resettlement policy framework will be applied to this project. This policy has been triggered because some project districts may have indigenous peoples: such as Ik in Kaabong District, and Batwa in Districts of Kisoro, Bundibugyo, Kasese and Kanungu. Therefore two instruments were prepared as OP4.10 Indigenous People X follows:  Indigenous Peoples Planning Framework to cater for districts that have Batwa in which specifc project locations are not known,  IPP for Kaabong District where it is certain that a health center used by Ik indigenous people will be involved in this project. X The project is not expected to affect the OP4.36 Forests management of forests and neither will it support forest nor logging operations. OP4.37 Safety of Dams X The project will not support or depend on dams. OP7.50 Projects on International X This does not apply to the project. Waterways OP 7.60 Projects in Disputed X The project will not be implemented in disputed Areas. areas. OP4.12 Involuntary Resettlement is the safeguard policy that provides basis on which the World Bank screens proposed projects to determine the appropriate extent and type of RAP to be prepared and implemented. This project triggers this policy due to land take and land use change impacts. OP 4.12 is triggered because the construction of the maternity wards at selected HC IIIs, IVs and HC waste management activities with result in the acquisition of land and therefore the PAPs will lose both social and economic assets. The Policy describes the details and elements that a resettlement plan should include. These include objectives, potential impacts, socio economic studies, legal and institutional framework, eligibility, valuation and compensation for losses, resettlement measures, relocation planning, community participation, and grievance redress procedures, implementation schedule, costs and budgets, and monitoring and evaluation. P a g e | 24 There are significant gaps between Ugandan laws and regulations and requirements for resettlement as laid out in OP 4.12. The Ugandan systems on involuntary resettlement are reckoned not to be equivalent with the Bank’s. Error! Reference source not found. below highlights the differences between Ugandan laws and World Bank policies regarding resettlement and compensation. Below is a short discussion of the most important differences. Although the Ugandan Constitution requires that prompt, fair and adequate compensation be paid prior to displacement, this is not on par with OP 4.12, as there is no requirement that states that the government should provide alternative land or assist with resettlement. Additionally it is unclear how to interpret “prompt, fair and adequate” compensation. OP 4.12 states that displaced persons should be compensated at full replacement cost. OP 4.12 requires that PAPs be consulted regarding project implementation and resettlement. Affected communities should also receive the opportunity to participate, implement, and monitor resettlement. There are no explicit provisions for consultations and disclosure but there are guidelines issued by separate ministries. The Ugandan law also makes no specific accommodations for potentially vulnerable groups such as women, children, the elderly, ethnic minorities, indigenous people, the landless, and those living under the poverty line. These groups are at highest risk to experience negative effects due to resettlement and should receive special consideration during the preparation of a resettlement policy framework to ensure that they can maintain at least the same standard of living after displacement takes place. P a g e | 25 Table 6-2: Comparison of Uganda and World Bank Resettlement Requirements No. Impact World Bank Requirements Uganda Legislative Requirements Gaps and how these will be addressed 1. Project Compensation for loss of land, Compensation should be provided to Gap. Affected property, resources and access to land legal land owners. No compensation is People and resources, and resettlement provided to land users. Project will provide compensation to legal assistance is provided to all affected and non-legal owners, and to all affected users (including those with formal legal users (including those with formal legal rights, those with non-formal customary rights, those with non-formal customary rights, and those with no legal rights or rights, and those with no legal rights or claims). claims). 2. Loss of land For land owners (legal or customary): Cash compensation based upon market Gap. and assets Compensate for land and all assets at value of unimproved land + disturbance full replacement cost, allowance (15%) if household is moved Market value is based on recent OR within 6 months (this rises to 30% if transactions and thus if alternative property households are moved before 6 is purchased within a reasonable period of replacement of land at equal/ greater months). payment of compensation, it is likely that value and compensation for other market value will reflect replacement value. assets, However where this condition does not manifest, World Bank requirements for compensation will be followed, as per OP4.12 which states, “Where domestic law does not meet the standard of compensation at full replacement cost, compensation under domestic law is supplemented by additional measures necessary to meet the replacement cost standard.” P a g e | 26 No. Impact World Bank Requirements Uganda Legislative Requirements Gaps and how these will be addressed For tenants (land use holders): Entitled to compensation based on the Gap. Compensated for assets (crops, amount of right they hold to the land. improvements) other than land and Land owners and users must be other losses (time it takes to restore compensated whatever the legal livelihood: dead time), recognition of their occupancy. If tenants AND have no legal land title, they are compensated for crops or any Relocation assistance (incl. assistance improvements they have made to the land in acquiring replacement land, financial based on OP4.12 policy. Relocation payment for the cost of the relocation), assistance will be provided. Non- legal land users: No compensation is applicable under Gap. Compensated for assets (crops, Ugandan legislation. Non legal land users will be considered improvements) other than land and eligible under the RAP and will be other losses (time it takes to restore compensated following the principles of livelihood: dead time) OP4.12 policy. AND Relocation assistance (incl. assistance in acquiring replacement land, financial payment for the cost of the relocation) Provide additional targeted assistance No legislative requirement. To be paid Gap. and opportunities to restore/ improve for by disturbance allowance of 15-30%. livelihood. Livelihood restoration assistance to be provided. Provide transitional support based on No legislative requirement, To be paid Gap. reasonable estimate of time required to for by disturbance allowance of 15-30% restore income earning capacity. Transitional assistance to be provided. P a g e | 27 No. Impact World Bank Requirements Uganda Legislative Requirements Gaps and how these will be addressed 3 Loss of crops Compensation for crops, trees, and Sharecroppers: Not entitled to Gap. and trees other fixed assets at full replacement compensation for land, entitled to cost and should be sufficient to enable compensation for crops. For sharecroppers and annual (seasonal) affected people to restore their crops, the Project will provide time to enable standard of living after resettlement. Annual (seasonal) crops: No these to be harvested by households. Once compensation since the 6-month notice harvested, there will be no further planting, is supposed to allow people to harvest and households will be able to consume their annual crops. planting of crops on alternative land, and thus no loss will be experienced. A Perennial crops: Cash compensation disturbance allowance will be paid to based upon rates per square meter overcome any time delays. /bush/tree/plant established at District level plus disturbance allowance (15%). For perennial crops, compensation was Rates are calculated as the one-year based on estimated income lost for 3 years, net agricultural income. Disturbance which provided replacement value. A allowance is meant to take care of the disturbance allowance will be paid. establishment period for these crops with establishment more than one year. P a g e | 28 No. Impact World Bank Requirements Uganda Legislative Requirements Gaps and how these will be addressed 4 Loss of Compensation for structures should Owners of “Permanent” Buildings: Gap. structures cover full replacement cost exclusive of Valuation by valuer + disturbance and other depreciation and inclusive of all fees allowance (15%). Valuation is based on Project will provide compensation based on improvements (such as construction permits and title depreciated market value. replacement value. This will include the (fences, etc) charges) and labour costs. payment of government valuation rates, the including Walls: classed as permanent structures, payment of a disturbance allowance, and a communal but value calculated on investment top up allowance (based on the current structures method. inflation rate) to compensate for the rise in construction materials. Owners of “Non-permanent” Buildings: Cash compensation based upon rates per square meter established at District level plus disturbance allowance (15%). Note: Rates are based on depreciated market value. Tenants of structures: repayment of unused rent, and 6 months’ notice to vacate structure. Fences: barbed wire fences valued by government rate, based on the investment method. 5 Loss of Compensate affected business owners No compensation. The 6-month notice is Gap. business for the cost of re-establishing supposed to allow people to re-establish commercial activities elsewhere, for their business. The project will provide transitional lost net income during the period of allowance. transition, and for the costs of the transfer and reinstallation of the business. P a g e | 29 No. Impact World Bank Requirements Uganda Legislative Requirements Gaps and how these will be addressed 6 Loss of Provide adequate replacement housing Owners of “Permanent” Buildings: Gap. dwelling OR cash compensation at full Valuation by valuer + disturbance structures replacement value. allowance (15%). Valuation is based on Project will provide compensation based on depreciated market value. replacement value. This will include the payment of government valuation rates, the Walls: classed as permanent structures, payment of a disturbance allowance, and a but value calculated on investment top up allowance (based on the current method. inflation rate) to compensate for the rise in construction materials. Owners of “Non-permanent” Buildings: Cash compensation based upon rates per square meter established at District level plus disturbance allowance (15%). Note: Rates are based on depreciated market value. Tenants of structures: repayment of unused rent, and 6 months’ notice to vacate structure. Provide security of tenure at the new No legislative requirement. Gap. site. Legal land ownership will be replaced if lost. P a g e | 30 7 LAND ACQUISITION AND RESETTLEMENT IMPACTS The implementation of the envisaged RMNCH facilities will affect people and activities differently (both positively and negatively) depending on the location, the existing developments in the location, land tenure system pertaining in the area and the socio-economic activities in the area. Construction of healthcare facilities will likely require land and there are two key social implications associated with potential land acquisition as outlined below:  Necessary land may be already owned by the health centers but encroached upon, in which case, existing uses thereon (e.g. subsistence cultivation, operation of business activities) would be displaced upon project implementation. If a facility has adequate land available business activities such as kiosks would not be banished from the campus during construction; rather they would only be moved to an alternative location on same health center land.  Where land needed is owned by the health center and is free to be used without encroachment.  Where health center does not own the land required and needs to acquire it out rightly from a single seller or from the community. Plate 1: Example of wooden movable kiosks near health centers which vend retail goods to patients and medical staff. Potential resettlement impacts are given in table below. Table 7-1: Likely adverse resettlement impacts and management measures Project activity Nature of impact Impact management / mitigation 1 Construction of New land acquisition already  Prepare a RAP according to this RPF healthcare buildings owned by health center but and compensate accordingly to the displacing existing users and entitlement matrix prior to land squatters. acquisition. P a g e | 31 Project activity Nature of impact Impact management / mitigation New land acquisition without  Evidence of due diligence required. encroachment Prepare a RAP according to this RPF and compensate accordingly to the entitlement matrix prior to land acquisition. . New land acquisition via  Evidence of purchase and due straight purchase diligence. 2 Acquisition of land for Land requirement for a  straight purchase of unencumbered the disposal of cemetery where none exists land from a single owner unclaimed bodies at or near the health center  Compensation and resettlement via an abbreviated RAP for cases where land is encumbered. P a g e | 32 8 RPF PREPARATION PROCESS 8.1 Principles Governing Resettlement Preparation and Implementation 8.1.1 Basic Principles of the Resettlement Program The impacts due to involuntary resettlement from development projects, may give rise to economic, social and environmental risks resulting in production systems being dismantled, people facing impoverishment when their productive assets or income sources are affected. This Resettlement Policy Framework (RPF) has been prepared for the purpose of establishing the principles and procedures to be applied in the event that involuntary resettlement, loss of land or other fixed assets, disturbance affecting livelihood or natural resource limitations leading to nonphysical displacement would arise as a result of the proposed RMNCH implementation. The RPF is developed based on the World Bank Operational Policy 4.12 and the laws of Uganda and regulations will form the basis for resettlement planning. 8.1.2 Objectives of the Resettlement Policy Therefore, the objectives of this policy are the following;  Land acquisition and impact on assets, including livelihoods, will be avoided where feasible, or minimized, by exploring all viable alternatives;  Where impacts are unavoidable, resettlement and compensation activities will be conceived and executed as sustainable development programs, ensure replacement of losses, provide sufficient resources to give the persons impacted by the project the opportunity to share project benefits. Impacted persons will be meaningfully consulted and will have opportunities to participate in planning and implementing resettlement and compensation programs; and  Impacted persons will be assisted in their efforts to improve their livelihoods and standards of living or at least to restore them, in real terms, to pre-impact levels or levels prevailing prior to the beginning of the project implementation, whichever is higher. Affected people, according to the Bank policy, refer to people who are directly affected socially and economically by Bank-assisted investment projects caused by:  relocation or loss of shelter;  loss of assets or access to assets, whether or not the affected persons must move to another location;  loss of income sources or means of livelihood, whether or not the affected persons must move to another location; or  the involuntary restriction or access to legally designated parks and protected areas results in adverse impacts on the livelihood of the impacted persons. The resettlement policy applies to all components under the project, whether or not they are directly funded in whole or in part by the Bank. The RPF will also apply to sub-projects associated with RMNCH, whether or not funding is received from the World Bank. The policy applies to all affected persons regardless of the total P a g e | 33 number affected, the severity of the impact and whether or not they have legal title to the land. Particular attention will be paid to the needs of vulnerable groups among those impacted; especially those below the poverty line; the landless, the elderly, women and children, and ethnic minorities, orphans, or other affected persons who may not be protected through national land compensation legislation. In particular for RMNCH, the policy also requires that the implementation of individual resettlement and compensation plans are a prerequisite for the implementation of sub project activities causing land acquisition or impact on assets, to ensure that impacts or restriction to access does not occur before necessary measures for compensation are in place. It is particularly important to neutralize to the extent possible any socio-economic pressures in the communities that are likely to be exacerbated by project impacts, by facilitating the participation of those impacted in the project activities. Therefore, impacted communities must be consulted and are part of the planning process and implementation. Finally, the RPF seeks to ensure that affected communities are meaningfully consulted, have participated in the planning process and, are adequately compensated to the extent that their pre-impact standard of living have been restored and that the process is a fair and transparent one. 8.1.3 Overall Process Resettlement Action Plans (RAP) or Abbreviated Resettlement Action plans (ARAP) may be required in instances where PAPs have been identified. In such cases, a number of actions will be required by implementing agency. The steps to be undertaken in preparing a RAP or ARAP are discussed below. Step 1: Consultation and participatory approaches. The program investment activities to be undertaken and the locations of the investments will undergo preliminary evaluation on the basis of the objectives of the program. A participatory approach is adopted to initiate the compensation process. The consultations must start during the planning stages when the technical designs are being developed, and at the land selection/screening stage. The process therefore seeks the involvement of PAPs throughout the census for identifying eligible PAPs and throughout the RAP preparation process. Step 2: Census of affected entities. In this step every owner of an asset to be affected by the project is enumerated and their socio-economic condition documented. Step 3: Disclosure and notification. MoH will approach the communities impacted through the local government authorities with the view to arriving at a consensus on possible sites for the type of facility to be adopted. All eligible PAPs are informed about the project and the RAP process. A cut-off date is established as part of determining PAPs eligibility. In special cases where there are no clearly identifiable owners or users of the land or asset, the RAP team must notify the respective local authorities and leaders. Step 4: Documentation and verification of land and other assets. The government authorities at both national and local levels (village councils, parish/sub-county and district development committees); community elders and leaders; representatives from MoH will arrange meetings with PAPs to discuss the compensation and valuation process. For each individual or household affected by the sub-project, the RAP preparation team will complete a Compensation Report containing necessary personal information on the PAPs and their household members; their total land holdings; inventory of assets affected; and demographic and socio-economic information for monitoring of impacts. This information will be documented in a Report, P a g e | 34 and ideally should be “witnessed” by an independent or locally acceptable body (e.g. Resettlement Committee). The Reports will be regularly updated and monitored. Step 5: Compensation and valuation. All types of compensation will be clearly explained to the individual and households involved. These refer especially to the basis for valuing the land and other assets. Once such valuation is established, MoH will produce a Contract or Agreement that lists all property and assets being acquired by the sub-project and the types of compensation selected. Table 7-2 below provides a sample of entitlements that are eligible for compensation. These options include in-kind (e.g. replacement housing) and cash compensation. All compensation should occur in the presence of the affected persons and the community local leaders. Step 6: Community payments. This will apply where the proposed project affected and belong to a community. Examples of community compensation expansion of grazing grounds or school land Step 7: Grievance mechanism. The sub-project RAP team will establish an independent grievance mechanism. This may be set up through Local Authorities, including a Resettlement or Land Committee and through community leaders. All PAPs will be informed about how to register grievances or complaints, including specific concerns about compensation and relocation. The PAPs should also be informed about the dispute resolution process, specifically about how the disputes will be resolved in an impartial and timely manner. The RAP Team will produce a report containing a summary of all grievances. If needed, the dispute resolution process should include Ugandan Courts of Law, but traditional institutions can be an effective first step in both receiving and resolving grievances. Step 8: Defining Entitlements and Preparing an Entitlement Matrix. The basis of what is to be paid as compensation will be determined by identifying the most appropriate entitlement for each loss. Based on the entitlements, options for resettlement would be selected in accordance with Bank Policy OP 4.12 (6a (ii)) and the merits of the option. The RAP planner will prepare an entitlement matrix with respect to both temporary and permanent displacement. This matrix will set the measure for the payment for all losses or impacts. It will also list the type of loss, criteria for eligibility and define entitlements as presented in Table V. 8.1.4 Project Affected Entities These are entities whose assets may be lost, or access to natural and/or economic resources restricted as a result of activities related to sub-project(s). Project affected persons (PAPs) irrespective of their status (whether they have formal title, legal rights, non-legal right) are eligible for some kind of assistance if they occupied a given land parcel before the cut-off date. According to World Bank policies, owners of businesses or persons employed are also eligible for compensation. The likely displaced persons can be categorized into four groups, namely: i) Affected Individuals An individual who suffers loss of assets or investments, land and property and/or access to natural and/or economic resources as a result of the sub-project activities and to whom compensation is due; for example, P a g e | 35 an affected individual is a person who farms a land, or who has built a structure on land that is now required by a sub project for purposes other than farming or residence by the initial individuals. ii) Affected Household A household is affected if one or more of its members is affected by sub-project activities, either by loss of property, land, loss of access, or otherwise affected in any way by project activities. This provides for:  any members in the households, men, women, children, dependent relatives and friends, tenants.  vulnerable individuals who may be too old or ill to farm along with the others.  relatives who depend on one another for their daily existence.  relatives who may not eat together but provide housekeeping and other domestic choirs, and  other vulnerable people who cannot participate for physical or cultural reasons in production, consumption, or co-residence. iii) Community A community is affected if project activities affect their socio-economic and/or social-cultural relationships or cohesion. Siting of maternity wards to be constructed at some HC III will cause permanent impact on land use when done on community assets (play grounds or path). iv) Vulnerable Households Vulnerable people are people who by virtue of gender, ethnicity, age, physical or mental disability, economic disadvantage, or social status, may be more adversely affected by resettlement than others and who may be limited in their ability to claim or take advantage of resettlement assistance and related development benefits. For this project, this category will include orphans, the infirm or ill, children, elderly people, women and people with disabilities. v) Institutions This category comprises as schools and community resource centers. Compensation in this case is given to institution as a single entity rather than individual. vi) Utility companies whose infrastructures may be damaged when constructing maternity wards cables  Telecommunication companies  Water/sewerage companies  Power supply companies P a g e | 36 8.1.5 Eligibility Criteria and Cut-Off Dates According to OP 4.12 of the World Bank, the criteria for determining eligibility for compensation, resettlement and rehabilitation assistance measures for persons to be displaced, will be based on the following: a) Persons that have formal legal rights to land, including customary and traditional; and religious rights recognized under the laws of Uganda. This class of people includes those holding leasehold land, freehold land and land held within the family or passed on through generations. b) Persons who do not have formal legal rights to land or assets at the time the census begins. c) Persons who have no recognizable legal right or claim to the land they are occupying, using or getting their livelihood from. This class of people includes encroachers, illegal occupants/squatters Affected persons classified under paragraph (a) and (b) will be provided compensation, resettlement and rehabilitation assistance for the land, building or fixed assets on the land and buildings taken by the project. The compensation will be in accordance with the provisions of this framework and if affected persons occupied the project area prior to the date of commencement of the Census. Persons covered under sub- section (c) above are to be provided with resettlement assistance in lieu of compensation for land. In addition, they have to be given the necessary relocation assistance in conformity with the provisions of this policy framework provided the land was occupied prior to the established cut-off date. All persons in the three sub-sections above are to be provided with compensation for loss of assets other than land. Consequently, this policy advocates for some kind of assistance to all affected persons, including illegal occupants/squatters and encroachers, that is, irrespective of whether they have formal titles, legal rights or not. Therefore, it is clear that all affected persons irrespective of their status or whether they have formal titles, legal rights or not, are eligible for some kind of assistance if they occupied the land before the entitlement cut-off date. The entitlement cut-off date refers to the time when the census of persons and their property in the area is carried out, i.e. the time when the project area has been identified and when the socio-economic study is taking place. Thereafter, no new cases of affected people will be considered. Persons who encroach the area after the socio-economic study (census and valuation) are not eligible for compensation or any form of resettlement assistance. 8.1.6 Method to Determine Cut-off dates The cut-off date is considered by the surveying and valuation consultant as the last day of the census of affected people and properties. The cut-off date after which no settlers or developers are eligible for compensation is publicized among potentially affected people. This is explained during the census and valuation exercise to all stakeholders in the area, including: Project-affected people, identified and individually surveyed, Parish Land Committee (LC2 level), and, LC 1 officials in which consultations are undertaken. The importance of cut-off date necessitates clear communication to project affected persons and communities and this should be enshrined in the communication plan of the RAP preparation and P a g e | 37 implementation. Failure of setting and clearly communicating this date often leads to speculative development within project area in effort to target compensation. This affects project schedule and unduly increases resettlement cost. Communicating and enforcing the cut-off date will be the role for MoH. Continued information on the cut-off-date should be communicated as part of the community engagement on the eligibility to avoid speculative encroachment on project areas. 8.1.7 Basis for Valuation Project Affected Persons when displaced by the project will be provided full replacement cost of lost structures and will be able to rebuild or replace their structures without difficulties. The valuation will estimate building/structure compensation rates based on full replacemen t cost without depreciation. World Bank’s OP 4.12 stipulates that depreciation of an asset and value derived from salvaging materials from razed structures should not be discounted when deriving replacement cost. Additionally the policy (OP 4.12) requires replacement value to include cost of materials transport to site, labour costs and any transfer fees or taxes involved in replacing an asset. In addition, persons who will lose their crops and trees due to sub-project activities will be compensated based on the district rates provided by the District Land Boards of the respective districts, which should take into account the replacement cost. In this respect it is the duty and responsibility of District Land Boards to compile or review district compensation rates for their respective districts. Relevant data to be captured during valuation will include:  location details of the land, boundaries of the area/section of the land to be affected;  affected immovable properties: detailed measurement of buildings, shops and structures;  property details including noting accommodation, constructional details of affected property external works (fence walls, gates, pavements) affected details etc where relevant.  categorizing temporary structures based on constructional details (wall materials, affixed to concrete not), size of structure and use of structure (business/residential); and,  data on households affected (tenants, owners, relatives apprentices/trainees and livelihood Although the sub-project locations have not been identified, it can be concluded that the RMNCH investments may cover several types of land, including urban, peri-urban and rural segments. For all the three segments (urban, peri-urban and rural) land and assets will be valued at a replacement cost and compensated for according to the following guidelines and as appropriate for each segment:  The RMNCH will compensate for assets and investments (including labour, crops, trees, buildings, and other improvements) according to the provisions of the resettlement plan.  Eligibility for compensation will not be valid for new persons occupying/using the project sites after the cut-off date, in accordance with this policy.  Compensation cost values will be based on replacement costs, as of the date that the replacement is to be provided or at the date of project identification, whichever is higher. P a g e | 38  The market prices for cash crops will have to be determined based on the values (taking into account the replacement cost) as determined by each district. 8.1.8 Compensation Payments and Related considerations Two main resettlement packages, to be used will be designed to ensure satisfactory compensation for PAPs who lose assets or livelihoods when the project is implemented. These packages will be developed in consultation with PAPs. Each PAP will have the opportunity to choose the option that best suits their circumstance. In-kind and/or in cash resettlement packages will be used as means of compensation (Table 8-1). The type of compensation will be an individual choice although every effort will be made to instill the importance and preference of accepting in kind compensation if the loss amounts to more than 20% of the total loss of subsistence assets. PAPs will be advised about benefits of replacement of physical assets and risk inherent in cash payments. For example unless the affected person chooses cash compensation land-for-land compensation will be encouraged as it ensures PAPs immediately have land for settlement or farming and avoids risk of squandering compensation payments. Table 8-1: Forms of compensation Cash payments Compensation will be calculated and paid in local currency. Rates will be adjusted for inflation. In-kind compensation Compensation may include items such as land, houses other buildings, building materials, seedlings, agricultural inputs and financial credits for equipment. Assistance Assistance may include moving allowance, transportation and labour, title fees, or other related costs. Making compensation payments raises some issues regarding inflation, security, and timing. One purpose of providing in-kind compensation is to reduce inflationary pressures on the costs of goods and services. Local inflation may still occur, thus market prices shall be monitored within the time period that compensation is being made to allow for adjustments in compensation values. The question of security, especially for people who will be receiving cash compensation payment, needs to be addressed by the MoH. The time and place for in-kind compensation payments shall be decided upon by each recipient in consultation with the district officials. Monetary payments should be paid at a time in relation to the seasonal calendar. a) Compensation for loss of land Compensation for the loss of land will be based on prevailing market value, however if livelihoods are based on land, preference should be land-for-land (with comparable productive value). b) Determination of crop compensation rates P a g e | 39 Cash compensation will be provided for loss of crops (perennial or annual), calculated using the approved district rates (considered adequate for replacement value). In addition, a transitional allowance will be provided to cover loss of livelihood during the period between loss of these crops and the time owners would start earning income from the new crops. c) Compensation for Buildings and Structures The project will compensate, at replacement value, for any private assets affected during implementation. 8.1.9 Entitlement Matrix A summary of all the assets that the PAP is entitled to shall be prepared for easy reference. Table 8-2 below also provides a sample of entitlements that are eligible for compensation. These options include in-kind (e.g. replacement housing) and cash compensation. All compensation should occur in the presence of the affected persons and the community local leaders. The RMNCH Environmental and Social Specialist should be involved in preparing a country specific entitlement matrix under the RMNCH with the assistance of the project unit and the relevant regional and local resettlement committees. P a g e | 40 Table 8-2: Entitlement Matrix Land and Assets Types of Impact Affected Entities Compensation/Entitlement/Benefits Urban agricultural Cash compensation for Farmer/ title holder Cash (monetary) compensation – at replacement cost for affected land affected land equivalent to land equivalent to replacement value. In addition, either 15% or market value 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Tenant/ lease holder Cash compensation (at replacement cost) for the harvest or product from the affected land or asset, equivalent to average market value of last 3 years, or market value of the crop for the remaining period of tenancy/ lease agreement, whichever is greater. In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Commercial Land Land used for business Title holder/ business Cash compensation (at replacement cost ) for affected land partially affected owner Opportunity cost compensation equivalent to 5% of net annual Limited loss income based on tax records for previous year (or tax records from comparable business, or estimates where such records do not exist). In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Business owner is Opportunity cost compensation equivalent to 10% of net annual lease holder income based on tax records for previous year (or tax records from comparable business, or estimates where such records do not exist) Assets used for business Title holder/business Land for land replacement or compensation in cash (at severely affected owner replacement cost) according to PAP’s choice. Land for land replacement will be provided in terms of a new parcel of land of If partially affected, the equivalent size and market potential with a secured tenure status remaining assets become at an available location which is acceptable to the PAP. P a g e | 41 Land and Assets Types of Impact Affected Entities Compensation/Entitlement/Benefits insufficient for business purposes Transfer of the land to the PAP shall be free of taxes, registration, and other costs. Relocation assistance (costs of shifting + allowance) Opportunity cost compensation equivalent to 2 months net income based on tax records for previous year (or tax records from comparable business, or estimates) Business person is Opportunity cost compensation equivalent to 2 months net income lease holder based on tax records for previous year (or tax records from comparable business, or estimates), or the relocation allowance, whichever is higher. Relocation assistance (costs of shifting) Assistance in rental/ lease of alternative land/ property (for a maximum of 6 months) to reestablish the business. Residential Land Land used for residence Title holder Cash compensation at replacement cost for affected land. In partially affected, limited loss addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Rental/lease holder Cash compensation equivalent to 10% of lease/ rental fee for the remaining period of rental/ lease agreement (written or verbal). In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Title holder Land for land replacement or compensation in cash according to PAP’s choice. Land for land replacement shall be of minimum plot of acceptable size under the zoning law/ s or a plot of equivalent size, whichever P a g e | 42 Land and Assets Types of Impact Affected Entities Compensation/Entitlement/Benefits is larger, in either the community or a nearby resettlement area with adequate physical and social infrastructure systems as well as secured tenure status. When the affected holding is larger than the relocation plot, cash compensation to cover the difference in value. In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Transfer of the land to the PAP shall be free of taxes, registration, and other costs. Relocation assistance (costs of shifting + allowance) Land and assets used for Rental/lease holder Refund of any lease/ rental fees paid for time/ use after date of residence severely affected removal Remaining area insufficient for Cash compensation at replacement cost equivalent to 3 months of continued use or becomes lease/ rental fee In addition, either 15% or 30% disturbance smaller than minimally allowance on each entitlement as appropriate depending on accepted under zoning laws whether a 6 or 3 months’ notice to leave affected property is issues, respectively.. Assistance in rental/ lease of alternative land/ property Relocation assistance (costs of shifting + allowance) Buildings and Structures are partially affected Owner Cash compensation for affected building and other fixed assets structures Remaining structures viable for Cash assistance to cover costs of restoration of the remaining continued use structure. P a g e | 43 Land and Assets Types of Impact Affected Entities Compensation/Entitlement/Benefits In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Rental/lease holder Cash compensation at replacement cost for affected assets (verifiable improvements to the property by the tenant). In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Disturbance compensation equivalent to two months rental costs Entire structures are affected or Owner Cash compensation at replacement cost for entire structure and partially affected other fixed assets without depreciation, or alternative structure of equal or better size and quality in an available location which is Remaining structures not acceptable to the PAP. suitable for continued use In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Right to salvage materials without deduction from compensation Relocation assistance (costs of shifting + allowance) Rehabilitation assistance if required (assistance with job placement, skills training) Rental/lease holder Cash compensation at replacement cost for affected assets (verifiable improvements to the property by the tenant). In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Relocation assistance (costs of shifting + allowance equivalent to four months rental costs) P a g e | 44 Land and Assets Types of Impact Affected Entities Compensation/Entitlement/Benefits Rehabilitation assistance if required (assistance with job placement, skills training) Squatter/informal Cash compensation at replacement cost for affected structure dweller without depreciation. In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Right to salvage materials without deduction from compensation Relocation assistance (costs of shifting + assistance to find alternative secure accommodation preferably in the community of residence through involvement of the project Alternatively, assistance to find accommodation in rental housing or in a squatter settlement scheme, if available) Rehabilitation assistance if required assistance with job placement, skills training) Street vendor Opportunity cost compensation equivalent to 2 months net income (informal without title based on tax records for previous year (or tax records from or lease to the stall or comparable business, or estimates), or the relocation allowance, shop) whichever is higher. Relocation assistance (costs of shifting) Assistance to obtain alternative site to re- establish the business. Standing crops Crops affected by land PAP (whether owner, Cash compensation at replacement cost equivalent to average of acquisition or temporary tenant, or squatter) last 3 years market value for the mature and harvested crop. In acquisition or easement addition, either 15% or 30% disturbance allowance on each P a g e | 45 Land and Assets Types of Impact Affected Entities Compensation/Entitlement/Benefits entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Trees Trees lost Title holder Cash compensation at replacement cost based on type, age and productive value of affected trees plus 10% premium. In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Temporary Temporary acquisition PAP (whether owner, Cash compensation at replacement cost for any assets affected Acquisition tenant, or squatter) (e.g. boundary wall demolished, trees removed). In addition, either 15% or 30% disturbance allowance on each entitlement as appropriate depending on whether a 6 or 3 months’ notice to leave affected property is issues, respectively. Utility companies Damage to underground Utility companies Compensation for repair of damaged infrastructure and restoration facilities and interruption of of service. service P a g e | 46 8.1.10 Timeframes The following key timeframes shall apply in cases of any RAP implementation related to this project:  asset inventory shall be completed at most four months prior to the commencement of work;  Resettlement Plan shall be submitted to the Chief Government Valuer and the Bank for approval immediately after completion of asset inventory;  Civil works shall commence after compensation or resettlement activities have been effected. Adequate time and attention shall be allowed for consultation of affected parties. The actual duration will depend on the extent of the resettlement and compensation and will have to be agreed upon by all parties. 8.1.11 Linking Resettlement Implementation to Civil Works PAPs will need to be compensated, in accordance with this Resettlement Policy Framework and subsequent Resettlement and Compensation Plan, before civil works on that segment of the health facility can begin. For activities involving land acquisition or loss, denial or restriction to access of resources, it is required that provisions be made, for compensation and for other assistance required for relocation, prior to displacement. The assistance includes provision and preparation of resettlement sites with adequate facilities. For project activities requiring relocation or resulting in loss of shelter, the resettlement policy further requires that measures to assist the project affected persons are implemented in accordance with the individual RAPs. In the implementation schedule of each RAP, details on resettlement and compensation must be provided. The schedule for the implementation of activities, as agreed between the project planning teams and PAPs must include:  target dates for start and completion of civil works,  timetables for transfers of completed civil works to PAPs,  the link between RAP activities to the implementation of the project. P a g e | 47 9 GUIDING PRINCIPLES FOR LAND ACQUISITION AND COMPENSATION Plots for siting maternity wards construction may be leased or acquired from land owners, therefore cases of land acquisition may arise during project implementation. Where these cases arise, the following principles will guide land acquisition. 9.1 Land Acquisition Mechanism Ideally project implementation will seek to utilize available space on the HCs land parcel hence minimize land take but where acquisition of land is required, the project will either undertake a Resettlement Action Plan (RAP) or an Abbreviated Resettlement Action Plan (ARAP) to guide compensation for affected assets. In the case of customary land, Local Government Authorities, the community leaders such as chiefs and community, including youths and women should be party to any consensus to acquisition of land and the modalities envisaged. The RAP or ARAP will document: i) Size of land to be acquired; ii) names of owners and occupiers or users of that land as far as they can be ascertained; or in the case of customary land the name of the land owner who is the holder of the right over the land as ascertained by the community; iii) local community leaders/representatives to assist in the process of land acquisition; iv) magnitude of impacts relative to the need for resettlement and/or compensation and valuation of assets to be compensated for; v) financial records showing the costs of relocation and compensation, the beneficiaries and indicating how these costs were arrived at; vi) information on households or individuals eligible for relocation to their socioeconomic standing (incomes, production material assets, debts etc); vii) details of resettlement after-care and assistance, where appropriate and; viii) consultation process Note: Preparation and implementation of the RAP/ARAP and compensation will be undertaken prior to the start of any civil works on the subproject begins. 9.2 Voluntary Land Contributions with Compensation Voluntary Land Contribution with Compensation refers to cases where individuals or community land owners agree to provide land to the project for free or for a negotiated compensation sum. Voluntary land contribution without compensation is however not recommended, because it often affects poor or vulnerable households. Where land is voluntarily donated to the proposed project, it should be clearly documented as a donation with witnesses that include (but not limited to) the District Chief Administrative Officer (CAO), local council chairperson and a religious leader. 9.3 Involuntary Acquisition of Land Involuntary acquisition of land should be avoided or minimized to the greatest extent possible. The displaced P a g e | 48 persons will participate throughout the various stages of the planning and implementation of land acquisition, compensation and resettlement plans and processes. Prior to preparation of Resettlement Action Plans, persons to be displaced will be informed of provisions of this framework and their entitlements at public meetings. 9.4 Eligibility Criteria for Compensation The Bank’s OP 4.12 suggests the following three criterions for eligibility; a) Those who have formal rights to land (including customary and statutory rights of occupancy recognized under the Laws of each respective country) b) Those who do not have formal legal rights to land at the time the census begins but have a claim to such land or assets provided that such claims are recognized under the laws of Uganda. c) Those who have no claim to land they are occupying or using. Those covered under a) and b) above are to be provided compensation for land they lose, and other assistance in accordance with the policy. Persons covered under c) above are to be provided with resettlement assistance in lieu of compensation for the land they occupy or use, and other assistance, as necessary, to achieve the objectives set out in this policy, if they occupy or use the project area prior to a cut-off date plus compensation for assets other than land. Persons who encroach on project land after the cut-off date are not entitled to compensation or any other form of resettlement assistance. Therefore, it is clear that all affected persons irrespective of their status or whether they have formal titles, legal rights or not, are eligible for some kind of assistance if they occupied the land before the entitlement cut-off date. The entitlement cut-off date refers to the time when the census of persons and their property in the area is carried out, i.e. the time when the project area has been identified and when the socio-economic study is taking place. Thereafter, no new cases of affected people will be considered. Persons who encroach the area after the socio-economic study (census and valuation) are not eligible for compensation or any form of resettlement assistance. 9.5 Procedures for Payment of Compensation Compensation payment will be made in the following ways: (a) By agreement between the MoH and the PAPs or entities (individuals /households /communities):  MoH will offer such sums deemed adequate as compensation to the entity who may accept that amount as compensation payable to him or her and;  Such sums will be disbursed directly to the beneficiary entity with the relevant records of payments (land acquisition mechanism) consigned to the RAPs and the records of the appropriate local government authority (district land board). (b) In case of grievances, by court order on the amount of compensation where this has been the subject of litigation between MoH and the affected entity. P a g e | 49 9.6 Ugandan Legislation on Compensation In general, cash compensations are paid based upon market value of land, district rates in case of crops and replacement value for structures. It is recognized that Ugandan laws fall short of World Bank requirements and hence MoH will undertake compensation based on the Bank’s safeguard (RPF) requirements. 9.7 Determination of Compensation Payments In estimating the compensation to be given for any land or any estate therein or the potential profits thereof, the following will be taken into account:  The value of such lands, estates or interests or profits at the time of the emission of the notice to acquire, and will not take into account any improvements or works made or constructed thereafter on the lands,  That part only of the lands belonging to any entity /person acquired under this Act without consideration for the enhancement of the value of the residue of the lands by reason of the proximity of any improvements or works to be made or constructed by the project;  The value of the lands acquired for public purposes but also to the damage, if any, to be sustained by the owner by reason of the injurious effects of severance of such lands from other lands belonging to such owner or occupier. For cash payments, compensation will be calculated in Ugandan currency as outlined below: a) Compensation for Land Compensation for land is aimed at providing for loss of crops and the labour used to cultivate the crop. Compensation relating to land will cover the market price of the land, the cost of the labour invested, as well as the replacement cost of the crop lost. b) Compensation for Crops All affected seasonal crops will be compensated as per prevailing district rates. According to Uganda law, perennial crops are compensated based on district rates which do not provide for replacement value. Therefore to meet World Bank requirements, replacement value based on historical production records or estimates must be provided where crops such as fruit trees, cash crops are affected by the project especially during siting for construction of maternity wards. c) Compensation for Buildings and Structures Compensation for buildings and other structures will be paid by replacement costs for labor and construction materials of these structures including fences, water and sanitation facilities, etc, will be used to calculate the values. Where part of the compensation is to be paid in cash the applicable replacement costs for construction materials will be used to calculate the values. Alternatively, compensation will be paid in-kind for the replacement cost without depreciation of the structure. P a g e | 50 10 GRIEVANCE MANAGEMENT MECHANISM This section describes avenues for PAPs to lodge complaint or express grievance against the project, its staff or contractors during RAP implementation. It also describes procedures, roles and responsibilities in grievance management process. To be effective, the mechanism shall utilize existing MoH client charter at the different levels. All grievances concerning non-fulfillment of contracts, levels of compensation, or seizure of assets without compensation shall be addressed to the village health team (VHT) coordinator. MoH’s Social Scientist shall work with VHT coordinators in the project area to set up a Village Grievance Committee to be the first point grievances are addressed. All attempts shall be made to settle grievances amicably before resort to courts of law. Entities seeking redress and wishing to record grievances will do so by notifying their Local Leader (Village Grievance Committee Chairperson) who will chair the Village Grievance Committee at village level set up with guidance of MoH’s Social Scientist. The Local Leader will inform and consult with the District Administration to determine validity of claims. If valid, the Local Leader will convene meeting of the LC1 Grievance Committee to resolve the grievance and notify the complainant of the outcome. If the complainant’s claim is rejected, the matter shall be brought before the District government authority for settlement. All objections to land acquisition shall be recorded in writing, in the language that the PAPs understands and are familiar with, to the Local Leader. Copies of the complaint shall be sent to MoH, within 20 days if no agreeable solution is reached. Channeling complaints through the Village Grievance Committee is aimed at addressing the problem of distance and cost the PAP may have to face. The Local Leaders (trained by MoH’s Social Scientist) shall maintain records of grievances and complaints, including minutes of discussions, recommendations and resolutions made. The procedure for handling grievances should be as follows: a) The affected person should file his/her grievance in writing or orally to the Local Leader. The grievance note should be signed and dated by the aggrieved person. Where the affected person is unable to write, s/he should obtain assistance to write the note and emboss the letter with his/her thumbprint; b) The Local Leader should respond within 14 days during which any meetings and discussions to be held with the aggrieved person should be conducted. If the grievance relates to valuation of assets, a valuer may need to revalue the assets. In this case, the aggrieved person must be notified by the Local Leader that his/her complaint is being considered; c) If the aggrieved person does not receive a response or is not satisfied with the outcome within the agreed time s/he can lodge grievance to the District Administration (District); and d) The District Administration will then attempt to resolve the problem (through dialogue and negotiation) within 14 days of the complaint being lodged. If no agreement is reached at this stage, then the complaint is taken to MoH’s Grievance Committee comprising the following entities: i) A Grievance Officer (MoH Staff) P a g e | 51 ii) A Village grievance committee Chairperson iii)District Representatives (e.g. Community Development Officer (CDO); District Health Officer (DHO); Health Sub District (HSD); CAO; Member of District Land Board) iv) A community representative in project area (VHT member; religious leader; HC In-charge) Note that persons in ii)-iv) will be location specific. A flow process of grievance mechanism is illustrated in Figure 1. Written grievance Village Grievance Committee Is grievance solved Yes Close in 14 days? No District Administration (Including: Land Board, HDS, CDO, CAO) Is grievance solved Yes Close in 14 days? No MoH Grievance Is grievance solved Close Committee in 21 days? Yes No Courts of Law Figure 1: Illustration of the grievance process P a g e | 52 11 PUBLIC CONSULTATION AND DISCLOSURE PLAN The purpose of the Resettlement Policy Framework is to guide the Management of the Resettlement process for RMNCH activities. Led by the MoH, several actors will be involved as beneficiaries and financiers. These roles are complementary and should therefore be coordinated to achieve maximum and best results. MoH will coordinate and manage the following:- a) Project preparation: b) Identification of RMNCH activities with the involvement and contribution of the local authorities, utility and service deliverers and specialist establishments; c) Preparation of Resettlement Action Plans (RAPs). d) Management of technical inputs required for the preparation and appraisal of the project for funding by the Bank; e) Management of the resettlement process f) Prepare and keep an update road map for the delivery of RMNCH. g) Establish monitoring and evaluation modalities for RMNCH. Public consultation and participation are essential because they provide an opportunity for informing the stakeholders about the proposed project. Public consultation and participation create a sense of ownership for the project, providing an opportunity for people to present their views and values and allowing consideration and discussion of sensitive social mitigation measures and trade-offs. Public consultation and participation will afford the PAPs an opportunity to contribute to both the design and implementation of the program activities. In so doing, the likelihood for conflicts between and among the affected and with the management committees will be reduced. In recognition of this, particular attention shall be paid to public consultation with PAPs, households and homesteads (including host communities) when resettlement and compensation concerns are involved. Public consultations in relation to the RAP occur at all stages, starting with inception and planning when the potential lands and alternative sites are being considered. A participatory approach will be adopted as an on- going strategy throughout the entire project cycle. Public participation and consultations related to RMNCH will take place via meetings in project communities, television or radio programs. PAPs are consulted in the survey process; public notices where explanations of the sub-project are made; RAP implementation activities; and during the monitoring and evaluation process. Selection of ways to consult, and expand participation by PAPs and other stakeholders, will take into consideration literacy levels prevalent in affected communities; ethnicity and cultural aspects; and practical conditions (like distance). The role of traditional, political and cultural leaders, including the community elders, in the participation strategy will be important. The RAP team should ensure that these leaders and local representatives of PAPs are fully involved in designing the public consultation procedures. P a g e | 53 11.1 Data collection phase For projects components that require Resettlement Action Plans, this process should start with acquisition of socio-economic data from affected entities. This information will be used to derive equitable compensation and resettlement where applicable. 11.2 Implementation phase During implementation, PAPs will be informed about their rights and options. The grievance mechanism will continue to operate and all grievances will be recorded. The participation of local leaders and PAPs in disseminating information and resolving disputes will be important once RAP implementation starts. A dynamic participatory approach involves PAPs in decision making about livelihood and community development programs. 11.3 Monitoring and evaluation phase PAPs representatives will participate in the sub-project workshops at mid-term and at the end of RAP implementation. To the extent possible, the RAP should include social accountability tools like citizen report cards to assess the quality of RAP implementation, and in some cases, assist the RAP team in tracking expenditures. The latter would be significant in helping PAPs with money management and restoring their livelihoods. PAPs will be able to suggest corrective measures, as needed, to improve RAP implementation in the sub-project(s). Prior to closing the RAP, PAPs will participate in a feedback survey as part of the RAP’s independent impact evaluation exercise. 11.4 Disclosure Arrangements for RPFs and subsequent RAPs a) In country disclosure MoH shall disclose the RPF on its website, print media, public libraries and all districts where RMNCH activities will be implemented. All RAPs prepared guided by the RPF should also be similarly disclosed after having received the Bank’s No-Objection. b) World Bank Info shop RPF and any subsequent RAPs prepared for the project specific activities shall be cleared and be disclosed on World Bank’s Infoshop before its implementation. P a g e | 54 12 ORGANIZATIONAL ELEMENTS FOR DELIVERY OF COMPENSATION Compensation and resettlement will be effected by MoH in conformity with the RAPs prepared for the project. The following broad principles will be followed in delivery of the RAP. The compensation process will involve several steps and would be in accordance with the individual project resettlement and compensation plans, significantly; a) Public Participation with the local communities would initiate the compensation process as part of an ongoing process that would have started at the land selection/screening stage and at the time the socio- economic assessment is being carried. This would ensure that no affected individual/household is simply “notified” one day that they are affected in this way. Instead, this process seeks their involvement and wishes to inform communities in a participatory approach with the project, from the beginning. b) Notification of land resource holders – the respective local/district heads involved in identifying the land will notify the District, Village Council and village inhabitants who will help to identify and locate the property users. The users will be informed through both a formal notification in writing and, as many people are illiterate, by verbal notification delivered in the presence of the Local Council Officer or his representative. In addition, the Village Committees and individuals who control land will accompany the survey teams to verify owners. Those who hold title deed to the land will be informed about t the compensation process and requirements needed to evince ownership. Where there are clearly no identified owners or users, MoH, the respective local government administrations, lands offices and traditional leaders will be solicited to help identify owners or users and sensitize them on the program and its implications. It is hoped, however that the media publications would be sufficient to avoid such eventuality. Results of the census surveys including: c) Documentation of Holdings and Assets – Village, and District Officials to arrange meetings with affected individuals and/or households to discuss the compensation process. For each individual or household affected, the District Official completes a compensation dossier containing necessary personal information on the affected party and those that s/he claims as household members, dependents, total landholdings, inventory of assets affected, and information for monitoring their future situation. This information is confirmed and witnessed by Village Local Council Officials. Dossiers will be kept current and will include documentation of all assets surrendered and/or impacted. Each individual will be provided a copy of the dossier at the time of negotiations. This is necessary because it is one way in which individuals and households can be monitored over time. All claims and assets will be documented in writing. d) Agreement on Compensation and Preparation of Contracts– All types of compensation are clearly explained to the individual or household. The Technical Planning Team draws up a contract, listing all property and land being surrendered and/or assets impacted, and the types of compensation (cash and/or in-kind) selected. A person selecting in-kind compensation has an order form, which is signed and witnessed. The compensation contract is read aloud in the presence of the affected party and the respective Technical Planning Team, Village officials and other village leaders prior to signing. e) Compensation Payments –All handing over of property such as land and buildings and compensation payments will be made in the presence of the affected party and the village officials. P a g e | 55 13 IMPLEMENTATION COSTS FOR THE RPF At this stage, it is not possible to estimate the likely number of people who will be affected by the proposed project. However MoH commits to secure a provisional sum of USD 100,000 to cater for legal costs associated with any entity contesting ownership of HCl and parcel where MoH infrastructure is placed. By policy, RMNCH infrastructure will be constructed on land owned by the health centers, therefore no physical displacement of people is anticipated. MoH shall obtain this provisional sum from the annual budget of Ministry of Health (MoH) in the financial Year 2016/17. In cases where resettlement cost is to be determined, key entries in table below will be sentential. Table 13-1: Framework for estimate of costs for RAP implementation Asset acquisition Amount or Total estimated Agency responsible number cost Land Structure Crops and economic tress Community infrastructure Land Acquisition and Preparation Land Structures Crops areas and others Community infrastructure Economic Rehabilitation Training Capital Investments Technical Assistance Monitoring # Item Costs Assumptions 1 Compensation for loss of Land For land acquisition purposes, based Per hectare on Ugandan average market cost, or from similar projects 2 Compensation for loss of Crops Includes costs of labour invested Per hectare and average of highest price of of farm lost staple food crops and Ugandan market prices 3 Compensation for Buildings and Structures This compensation may be in-kind or When cash. Costs for basic housing needs applicable should include ventilated pit latrines, outside kitchen, and storage. 4 Compensation for Trees Includes costs of labour invested Per and average of highest price of trees year/tree (and tree products) and Ugandan market prices 5 Cost of Income Restoration For affected businesses, income getting asset owners. P a g e | 56 14 MONITORING AND EVALUATION PLAN In order to assess whether the goals of the resettlement and compensation plan are being met, a monitoring plan will be required. This monitoring plan will indicate parameters to be monitored, institute monitoring milestones and provide resources including responsible persons or institutions to carry out the monitoring activities. The arrangements for monitoring the resettlement and compensation activities will fit the overall monitoring programme of the entire RMNCH, which will fall under the overall responsibility of the different executing agencies. The executing agencies, with support from the Resettlement Specialist, will institute an administrative reporting system that: a) alerts project authorities on the necessity and procedures for land acquisition for the project activities and the need to incorporate land acquisition, resettlement, loss of assets and impact on livelihood provisions in the design technical specifications and budgets; b) provides timely information about the asset valuation and negotiation process, c) maintains records of any grievances that require resolution, d) documents timely completion of project resettlement obligations (i.e. payment of the agreed-upon sums, construction of new structures, etc.) for all permanent and temporary loses, as well as unanticipated, additional construction damage, and e) updates the database with respect to changes that occur on the ground as resettlement and compensation activities are being implemented. Periodic evaluations will be made in order to determine whether the PAPs have been paid in full and before implementation of the sub project activities; and whether the PAPs enjoy the same or higher standard of living than before. This framework is suggesting that where appropriate and where it is determined to be cost effective, the office of the District Administration shall be structured to host the monitoring and evaluation component of the project. This will take the form of giving the districts the mandate to carry out independent monitoring of the implementation of the resettlement and compensation plans at periodic intervals of quarterly or half yearly (as circumstances dictate) during the program life. The objective will be to make a final evaluation in order to determine: a) if affected people have been paid in full before implementation of the subproject , and b) if the people who were affected by the subproject have been affected in such a way that they are now living a higher standard than before, living at the same standard as before, or they are they are actually poorer than before. 14.1 Monitoring indicators A number of objectively verifiable indicators (OVI’s) shall be used to monitor the impacts of the compensation and resettlement activities. These indicators will be targeted at quantitatively measuring the physical and socio-economic status of the PAPs, to determine and guide improvement in their social wellbeing. Therefore, monitoring indicators to be used for the RAP will have to be developed to respond to specific site conditions. As a general guide, the following indicators should be utilized during monitoring. i) Number and place of public consultation meetings held with PAPs and local authorities in preparation of, or during RAP implementation; P a g e | 57 ii) Number of PAPs effectively compensated and aggregated amount disbursed compensation (actual versus planned); iii) Number of people resettled or provided with new business premises (whatever is applicable); iv) Number of complaints:  Total received; total justified; total non-justified. This should include the subject matter for all complaints; an explanation for non-justified complaints;  Total resolved at various levels including the type of agreement reached;  Total referred to the legal system/ Courts of Law, including a clarification on who initiated (local leaders, PAP or project implementing agency) the referral and the subject matter. 14.1.1 Performance/evaluation indicators Suggested performance/evaluation indicators include: i) Total nature and level of all complaints received, resolved; ii) Completion of payment within, or after 2 months of estimated completion date indicated in the RAP implementation plan; iii) Completion of demolition of structures (if any) or crops/trees in the project area within 3 months after the notice to demolish; v) Revival of affected businesses /farming activities within 4 months after the compensation payment; vi) Submission of monitoring reports at the frequency indicated in the M/E of the RAP implementation report or quarterly. 14.1.2 Indicators to Measure RAP Performance In terms of the resettlement process, the following indicators could be used to understand the success of the measures identified and the working of the relevant parties in implementation the RAP: i) Percentage of individuals selecting cash or a combination of cash and in-kind Compensation; ii) The number of contentious cases as a percentage of the total cases; iii) The number of grievances and time and quality of resolution; iv) The ability of individuals and families to re-establish their pre-displacement activities; v) Number of impacted locals employed by the civil works contractors; vi) General relations between the project and the local communities. These will be determined through the following activities: i) Questionnaire data will be entered into a database for comparative analysis; ii) Each individual will have a compensation dossier recording his or her initial situation, all subsequent project use of assets/improvements, and compensation agreed upon and received; iii) MoH will maintain a complete database on every individual impacted by the subproject land use requirements including iv) Relocation/resettlement and compensation, land impacts or damages; and MoH should prepare Resettlement Completion Reports for each RAP, in addition to other regular monitoring reports. P a g e | 58 14.1.3 Indicators to monitor and evaluate implementation of RAPs Financial records will be maintained by the Local Governments and the executing agencies to permit calculation of the final cost of resettlement and compensation per individual or household. Each individual receiving compensation will have a record containing;  Individual bio-data information,  Number of people s/he claims as household dependents  Amount of land available to the individual or household when the dossier is opened. Additional information will be acquired for individuals eligible for resettlement/compensation:  Level of income and of production  Inventory of material assets and improvements in land, and  Debts. 14.1.4 RAP Implementation Completion Report RAP Implementation Completion Report should be prepared and submitted to the Bank six (6) months after the end of compensation payment by project implementing agency or before the Implementation Completion Report by the Bank, whichever comes first. The RAP implementation report should include (but not be limited to) the following information: i) Background of the RAP preparation including a description of the project activities, scope of impacts, number of affected persons, and estimate budget. ii) Update of its implementation with actual numbers of displaced persons by segments, compensation paid, issues/complaints raised and solutions provided iii) Complains status iv) Early assessment of the impacts of resettlement and compensation on affected categories at the time of the report production. v) Total sum disbursed vi) Lessons learned from the RAP implementation vii) Suggested annex: 14.2 External monitoring process External monitoring will be conducted by external agency e.g. independent entity/consultant. The program management structure will be envisaged to enable effective communication and distribution of responsibilities amongst different participants of the RMNCH at all different levels. The external evaluation process will be informed by internal monitoring reports. 14.3 Responsibility of the authorities The role of the implementing authorities is critical in the operationalization of the Resettlement Policy Framework. The following are important points to observe:- i) Ensure that there is trust between the PAPs and the authorities throughout the process by being P a g e | 59 transparent in every action and sharing information. ii) Being realistic with time frames and sequencing of related activities:  when registration will be completed,  when assessment will be completed,  when computation of entitlements will be carried out,  when payments will be made by whom and where,  when the acquired land will be vacated and when the contractor will move on site. iii) Adhering to the agreed and publicized timetable of delivery of compensation is critical. This calls for a deliberate effort to ensure funds for compensation are ready set aside and accessible when payment commences. Table 14-1: Institutions to be involved in project monitoring Institution /entity Monitoring role MoH RAP implementation Ministry of Gender Labour & Social Occupational safety on worksites, gender impacts and impacts on Development, MGLUD persons with disabilities. National Environment Management Monitoring environmental compliance during project Authority, NEMA implementation. Ministry of Lands, Housing and Urban Approving property valuations and monitoring land acquisition. Development, MLHUD Representative of PAPs from each Monitoring how PAPs grievances are effectiveness addressed division District land board Providing valuation rates for property and crops Village Health Teams Monitoring how PAPs grievances are effectiveness addressed 14.4 Indicators to Determine Status of Affected People These indicators are most important with respect to the RPF policy on resettlement and compensation. They will be informed by the baseline survey and will provide the council and the development pattern data and trends for refocusing the project and for improving delivery as a whole. The following will be considered: i) Affected individuals, households, and communities are able to maintain their pre project ii) standard of living, and even improve on it; iii) The local communities remain supportive of the project, and iv) Specific indicators may include the following, which would indicate a change in:  quality of, and access to services, number of people employed;  number of people engaged in income-generating activities;  number of vulnerable people;  sources of income;  expenditure pattern. P a g e | 60 14.5 Annual audit The annual audit of RPF implementation, and as applicable RAP implementation in sub-project(s), includes: (i) a summary of RAP performance of each sub-project; (ii) a compliance review of RAP implementation process; and (iii) a progress report on the quality of RAP implementation in terms of application of guidelines provided in this RPF. The audit will verify results of monitoring of RAP implementation indicators, and assess whether the project achieved the resettlement objectives. A specific measure of whether livelihood and living standards have been restored or enhanced will be completed. The audit will also assess the efficiency, effectiveness, impact, and sustainability of RAP sub-project activities. The aim is to learn lessons for application to future sub- projects or other projects in the sector and in the country. Finally, the audit will ascertain whether the resettlement entitlements were appropriate, as defined in the RPF guidelines. 14.6 Socio-economic monitoring This will entail monitoring project impacts on trading and business activities in the project sites utilizing indicators such as complaints or reported weekly losses occasioned by project activities. 14.7 Reporting and documentation Reporting should entail documentation of mid-term and end term RAP evaluation of the implementation process including enforcement of cut-off dates and these reports should be shared with the development pattern. Where RAPs are undertaken for given project components, completion reports should be undertaken and shared with development pattern. P a g e | 61 REFERENCES 1. Findings & recommendations of Uganda Urbanization Review (2012) 2. HIV AIDS work place policy, September 2009 3. Land Acquisition and compensation Act 1991 4. Ministry of Finance, Planning and Economic Development; 2012 5. Population Secretariat (2010). Uganda: Population Factors & National Development. Kampala Uganda 6. The Land Act 1998 7. The Public Health Act, Cap 281 8. The Water Act Cap 152 9. UBOS (2007). Projections of demographic trends in Uganda 2007-2017. Volume I. Kampala Uganda 10. Uganda 1997: The Local Governments Act. 11. USAID& PEPFAR ( 2012): AIDSTAR-One FACT SHEET; Health Care Waste Management in Uganda 12. World Bank O.P.412 on Resettlement 13. World Bank Operational Manual 14. World Bank (2209): Africa Development Indicators: Youth and Employment in Africa, the Potential, the Problem, the Promise 15. MoH (1997): Package of Basic Health Services for Uganda P a g e | 62 ANNEX 1: Annotated Outline for Preparing a Resettlement Action Plan (RAP) This template is extracted from OP 4.12 Annex A. Its full description can be found in the World Bank external website. The scope and level of detail of the RAP will vary depending on the magnitude and complexity of resettlement or displacement. The RAP is prepared based on the most recent and accurate information on the: (i) proposed resettlement and its impacts on displaced persons and other adversely affected groups; and (ii) legal issues affecting resettlement. The RAP covers elements that are specific to the project context. A broad outline of the RAP, as applied to sub-projects covered under a RPF includes, but is not limited to, the following: Description of the sub-project: General description of the sub-project and identification of sub-project area or areas. Potential Impacts: Identification of the: (i) the sub-project components or activities that require resettlement or restriction of access; (ii) zone of impact of components or activities; (iii) alternatives considered to avoid or minimize resettlement or restricted access; and (iv) mechanisms established to minimize resettlement, displacement, and restricted access, to the extent possible, during project implementation. Objectives: The main objectives of the resettlement program as these apply to the sub-projects. Socio-economic studies: The findings of socio-economic studies to be conducted in the early stages of project preparation, and with the involvement of potentially affected people will be needed. These generally include the results of a census of the affected populations covering: i) Current occupants of the affected area as a basis for design of the RAP and to clearly set a cut-off date, the purpose of which is to exclude subsequent inflows of people from eligibility for compensation and resettlement assistance; ii) Standard characteristics of displaced households, including a description of production systems, labor, and household organization; and baseline information on livelihoods (including, as relevant, production levels and income derived from both formal and informal economic activities) and standards of living (including health status) of the displaced population; iii) Magnitude of the expected loss, total or partial, of assets, and the extent of displacement, physical or economic; iv) Information on vulnerable groups or persons, for whom special provisions may have to be made; and v) Provisions for regular updates on the displaced people’s livelihoods and standards of living so that the latest information is available at the time of their displacement, and to measure impacts (or changes) in their livelihood and living conditions. There may be other studies that the RAP can draw upon, such as those describing the following: i) Land tenure, property, and transfer systems, including an inventory of common property natural resources from which people derive their livelihoods and sustenance, non-title-based usufruct P a g e | 63 systems (including fishing, grazing, or use of forest areas) governed by local recognized land allocation mechanisms, and any issues raised by different tenure systems in the sub project area; ii) Patterns of social interaction in the affected communities, including social support systems, and how they will be affected by the sub-project; iii) Public infrastructure and social services that will be affected; and iv) Social and cultural characteristics of displaced communities, and their host communities, including a description of formal and informal institutions. These may cover, for example, community organizations; cultural, social or ritual groups; and non-governmental organizations (NGOs) that may be relevant to the consultation strategy and to designing and implementing the resettlement activities. LegalFramework: The analysis of the legal and institutional framework should cover the following: i) Scope of existing land and property laws governing resources, including state-owned lands under eminent domain and the nature of compensation associated with valuation methodologies; land market; mode and timing of payments, etc; ii) Applicable legal and administrative procedures, including a description of the grievance procedures and remedies available to PAPs in the judicial process and the execution of these procedures, including any available alternative dispute resolution mechanisms that may be relevant to implementation of the RAP for the sub-project; iii) Relevant laws ( including customary and traditional law) governing land tenure, valuation of assets and losses, compensation, and natural resource usage rights, customary personal law; communal laws, etc related to displacement and resettlement, and environmental laws and social welfare legislation; iv) Laws and regulations relating to the agencies responsible for implementing resettlement activities in the sub-projects; v) Gaps, if any, between local laws covering resettlement and the Bank’s resettlement policy, and the mechanisms for addressing such gaps; and vi) Legal steps necessary to ensure the effective implementation of RAP activities in the sub-projects, including, as appropriate, a process for recognizing claims to legal rights to land, including claims that derive from customary and traditional usage, etc and which are specific to the sub-projects. The institutional framework governing RAP implementation generally covers: i) Agencies and offices responsible for resettlement activities and civil society groups like NGOs that may have a role in RAP implementation Eligibility: Definition of displaced persons or PAPS and criteria for determining their eligibility for compensation and other resettlement assistance, including relevant cut-off dates. Valuation of and compensation for losses: The methodology to be used for valuing losses, or damages, for the purpose of determining their replacement costs; and a description of the proposed types and levels of compensation consistent with national and local laws and measures, as necessary, to ensure that these are based on acceptable values (e.g. market rates). Resettlement Measures: A description of the compensation and other resettlement measures that will assist each category of eligible PAPs to achieve the objectives of OP 4.12. Aside from compensation, these P a g e | 64 measures should include programs for livelihood restoration, grievance mechanisms, consultations, and disclosure of information. Site selection, site preparation, and relocation: Alternative relocation sites should be described and cover the following: i) Institutional and technical arrangements for identifying and preparing relocation sites, whether rural or urban, for which a combination of productive potential, location advantages, and other factors is at least comparable to the advantages of the old sites, with an estimate of the time needed to acquire and transfer land and ancillary resources; ii) Any measures necessary to prevent land speculation or influx of eligible persons at the selected sites; iii) Procedures for physical relocation under the project, including timetables for site preparation and transfer; and iv) Legal arrangements for recognizing (or regularizing) tenure and transferring titles to those being resettled Housing, infrastructure, and social services: Plans to provide (or to finance provision of) housing, infrastructure (e.g. water supply, feeder roads), and social services to host populations; and any other necessary site development, engineering, and architectural designs for these facilities should be described. Environmental protection and management; A description of the boundaries of the relocation area is needed. This description includes an assessment of the environmental impacts of the proposed resettlement and measures to mitigate and manage these impacts (coordinated as appropriate with the environmental assessment of the main investment requiring the resettlement). Community Participation: Consistent with the World Bank’s policy on consultation and disclosure, a strategy for consultation with, and participation of, PAPs and host communities, should include: i) Description of the strategy for consultation with and participation of PAPs and hosts in the design and implementation of resettlement activities; ii) Summary of the consultations and how PAPs’ views were taken into account in preparing the resettlement plan; and iii) Review of resettlement alternatives presented and the choices made by PAPs regarding options available to them, including choices related to forms of compensation and resettlement assistance, to relocating as individual families or as parts of pre-existing communities or kinship groups, to sustaining existing patterns of group organization, and to retaining access to cultural property (e.g. places of worship, pilgrimage centers, cemeteries); and iv) Arrangements on how PAPs can communicate their concerns to project authorities throughout planning and implementation, and measures to ensure that vulnerable groups (including indigenous peoples, ethnic minorities, landless, children and youth, and women) are adequately represented. The consultations should cover measures to mitigate the impact of resettlement on any host communities, including: i) Consultations with host communities and local governments; P a g e | 65 ii) Arrangements for prompt tendering of any payment due the hosts for land or other assets provided to PAPs; iii) Conflict resolution involving PAPs and host communities; and iv) Additional services (e.g. education, water, health, and production services) in host communities to make them at least comparable to services available to PAPs Grievance procedures: The RAP should provide mechanisms for ensuring that an affordable and accessible procedure is in place for third-party settlement of disputes arising from resettlement. These mechanisms should take into account the availability of judicial and legal services, as well as community and traditional dispute settlement mechanisms. RAP implementation responsibilities: The RAP should be clear about the implementation responsibilities of various agencies, offices, and local representatives. These responsibilities should cover (i) delivery of RAP compensation and rehabilitation measures and provision of services; (ii) appropriate coordination between agencies and jurisdictions involved in RAP implementation; and (iii) measures (including technical assistance) needed to strengthen the implementing agencies’ capacities of responsibility for managing facilities and services provided under the project and for transferring to PAPs some responsibilities related to RAP components (e.g. community-based livelihood restoration; participatory monitoring; etc). Implementation Schedule: An implementation schedule covering all RAP activities from preparation, implementation, and monitoring and evaluation should be included. These should identify the target dates for delivery of benefits to the resettled population and the hosts, as well as clearly defining a closing date. The schedule should indicate how the RAP activities are linked to the implementation of the overall project. Costs and budget: The RAP for the specific sub-projects should provide detailed (itemized) cost estimates for all RAP activities, including allowances for inflation, population growth, and other contingencies; timetable for expenditures; sources of funds; and arrangements for timely flow of funds. These should include other fiduciary arrangements consistent with the rest of the project governing financial management and procurement. Monitoring and evaluation: Arrangements for monitoring of RAP activities by the implementing agency, and the independent monitoring of these activities, should be included in the RAP section on monitoring and evaluation. The final evaluation should be done by an independent monitor or agency to measure RAP outcomes and impacts on PAPs’ livelihood and living conditions. The World Bank has examples of performance monitoring indicators to measure inputs, outputs, and outcomes for RAP activities; involvement of PAPS in the monitoring process; evaluation of the impact of RAP activities over a reasonable period after resettlement and compensation, and using the results of RAP impact monitoring to guide subsequent implementation. P a g e | 66 ANNEX 2: Sample Grievance and Resolution Form Name (Filer of Complaint): __________________________________ ID Number: __________________________________ (PAPs ID number) Contact Information: __________________________________ (Village; mobile phone) Nature of Grievance or Complaint: _____________________________________________________________________________________ ______________________________________________________________________ Date Individuals Contacted Summary of Discussion ____________ _____________________________________________ Signature_______________________ Date: ____________ Signed (Filer of Complaint): ______________________________________ Name of Person Filing Complaint :__________________________( if different from Filer) Position or Relationship to Filer: __________________________________ Review/Resolution Date of Conciliation Session: ______________________________________ Was Filer Present? : Yes No Was field verification of complaint conducted? Yes No Findings of field investigation: _____________________________________________________________________________________ _____________________________________________________________________________________ Summary of Conciliation Session Discussion: _________________________________________________________________________ _____________________________________________________________________________________ ____ Issues _____________________________________________________________________________ Was agreement reached on the issues? Yes No If agreement was reached, detail the agreement below: If agreement was not reached, specify the points of disagreement below: Signed (Conciliator): ___________________________ Signed (Filer): ________________ Signed: ___________________________ Independent Observer Date: ___________________________ P a g e | 67 ANNEX 3: Grievance Form PROJECT PUBLIC GRIEVANCE FORM REFERENCE NUMBER: NAME OF COMPLAINANT: CONTACT INFORMATION: By Post: Please provide mailing address (Please mark how you would like to be contacted: mail, By Telephone: telephone, email, in person) By Email: TYPE OF GRIEVANCE: Individual: Group: Cultural: DESCRIPTION OF What happened? Where did it happen? Who did it happen to? What INCIDENCE OR is the result of the problem? GRIEVANCE: HAS THIS GRIEVANCE No BEEN RAISED PREVIOUSLY Yes BY YOU OR ANYONE ELSE? Details: DATE OF INCIDENCE One time incidence/grievance (date …) GRIEVANCE: Happened more than once (how many times …) On-going (currently experiencing problem) WHAT WOULD YOU LIKE TO SEE HAPPEN TO RESOLVE THE PROBLEM? Signature: Date: Please return this form to: Grievance Manager [Add details of contact] ASSESSMENT CATEGORY GRIEVANCE ACCEPTED Yes / No RESPONSE/ FOLLOW UP (SUMMARY OF RESPONSE AND CORRECTIVE ACTIONS TAKEN) RESPONSE TO APPLICATION Date: Person: Observations: CORRECTIVE ACTION AND SIGN-OFF Applicant satisfied with corrective action: Yes / No (Details) Is further action required: No / Yes (Details) If Yes, date sign-off received from Application: P a g e | 68 ANNEX 4: Range of Services and staffing by type of Health Centres in Uganda Source MoH, Package of Basic Health Services for Uganda, 1997 P a g e | 69 ANNEX 5: Record of stakeholder consultation Air Water Earth (AWE) T +256 41 4268466 27 Binayomba Road Bugolobi, Kampala, Uganda E mail@awe-engineers.com PO Box 22428 W www.awe-engineers.com Kampala, Uganda Meeting Record Week Meeting 4 April 2016 date Recorded Richard by Meeting with Obongi HC IV Administrators on RPF, IPP and IPF For Uganda Reproductive, Total Meeting/subject 2 Maternal, Neonatal, and Child Health pages Improvement Project Item Update 1. Introduction The team leader started explained the proposed project and purpose of the consultation exercise and how findings would be utilised in preparation of the project’s RPF. 2. Issues discussed How is the land owned? Land on which Obongi HC IV is located by was donated by the local community which currently has increasing land scarcity. Although there is congestion within the health centre fence, the community does not welcome the idea of donating any more land to the healthcare facility. There was noted a need to acquire a larger land parcel which can accommodate all the health facility space needs, and a new site had already been identified and meeting held with the family of the landowner which agreed to offer 88.8 acres of land. There was reported a plan to have a hospital in the future and a nurse training school. How has the affected health centre managed this problem? “We, tried by all means to come to a common agreement with them but it failed therefore the issue is still in court waiting for the court ruling”. 2.1. How do you want the District Land Board to help? They should ensure that all government facilities have documented ownership in form of a title deed in order to avoid occurrence of similar problem in the future. P a g e | 70 Item Update How are sub-county authorities involved in managing land ownership issues between health center and communities? They have helped by requesting that all government entities have their land surveyed, registered and title deeds issued to avoid encroachment. Are there strong existing laws to protect land owned by the healthcare facilities? Yes there are land ordinances enacted by the district land office. What needs does this health centre have?  An x-ray machine.  There is need to have personnel to operate an ultrasound machine which currently lacks an operator.  We should have two doctors to make it easier to run both administrative work and health issues.  An ambulance.  Water system needs to be repaired: the current water has a lot of iron which stains equipment.  Solar lighting systems are always affected during rainy season.  The proximity of the isolation ward (TB), to the boardroom and out patients department is a challenge to healthcare providers. Therefore we request that it is shifted elsewhere.  There is lack of shade for OPD that is screening of patients is done under a mango tree so we are with the view of having a permanent shade. There should be a shaded connecting walkway to the ward to for protection from rain and very hot sunshine.  We also need to acquire a mortuary for the health centre to help bury dead ones decently.  For proper waste management, an incinerator to is required because at the moment an open rubbish pit is used for disposal of medical waste- this is a huge public health risk.  The drug store is too congested and not in good condition for storing drugs: on hot days temperature in there rises up to 40oC.  Finally internet service to be installed in order to ease communication within and outside the health centre P a g e | 71 Week Meeting 4 April 2016 date Recorded Richard by Meeting with Obongi Health Centre IV Medical Staff on RPF, IPP and IPF For Total Meeting/subject 1 Uganda Reproductive, Maternal, Neonatal, pages and Child Health Improvement Project Item Update 3. Introduction The team leader started explained the proposed project and purpose of the consultation exercise and how findings would be utilised in preparation of the project’s RPF. 4. Issues discussed What are the most common diseases you register in Obongi health centre? Malaria, pneumonia, trauma, gastro-intestinal disorder, intestinal worms and diarrhoea What is the most rare but dangerous disease encountered at the health center ? Sleeping sickness. Are there staff in the health facility who speak the language of Obongi people? Yes, there is completely no language barrier. Are you aware of any cultural practices preventing people from visiting health centres for treatment? Yes, the traditional healers, herbalists, and the witchdoctors. Are there any harmful cultural practices which affect health? Not any today but in the past there was a cultural practice of cutting marks on babies chests in a decorative pattern How do you manage medical waste? We use a rubbish pit for open air burning of solid medical waste. 4.1. Are there any needs concerning waste management? Yes, there is need to have an incinerator and placenta pit for proper disposal of medical waste. Is construction waste managed well? This waste is somehow managed well but not satisfactorily. Do you have a health centre cemetery? No we do not have a cemetery. Not even the health centre mortuary. Why don’t you have a mortuary? For so long we have complained for it but there is no fund for the construction Do you have land which can be allocated for cemetery? No, it has to be purchased What can be done to acquire land for a mortuary ? There are two options: either the health center buys land for this purpose or it requests the local community to donate land, however it is unlikely that this would be successful without it (community) asking for compensation or land purchase at market value P a g e | 72 Week Meeting 4 April 2016 date Recorded Richard by Meeting with Village Health Teams VHTs on RPF, IPP and IPF For Uganda Reproductive, Total Meeting/subject 2 Maternal, Neonatal, and Child Health pages Improvement Project Item Update 5. Introduction The team leader started explained the proposed project and purpose of the consultation exercise and how findings would be utilised in preparation of the project’s RPF. 6. Answer session Are village heath teams active and functioning effectively? Yes we are active. How do you solve health issues in your villages? 6.1.  We start by identification and counselling affected persons.  We administer first aid and pain killers to them.  Then we prepare them for referral to a healthcare facility.  We strive to involve local leaders in health matters such as proper sanitation.  We advise community on disadvantages of poor health practices P a g e | 73 Item Update When you come to the health centre do you get proper services supposed to be provided by a Health Centre IV facility?  There are always challenges: staff are not enough.  Blood transfusion services are lacking and cases of children with anaemia dying on a weekly basis are not rare.  Fuelling of the health centre ambulance at a fee of 80,000 per trip remains a big financial constraint. This is because the health centre provides the vehicle and the driver only but the fuel cost should be borne by patients. It is not easy for a poor peasant to quickly mobilise UgShs 80,000 at short notice moreover during an emergency.  There is a major problem in the operation theatre since there is only one doctor to handle both minor and major operations.  Moyo General Hospital is the closet referral hospital is located a very long distance away and that is why sometimes patients go to Adjumani District.  There is inadequate water supply at Obongi Health Centre IV. And the water has a high iron content which stains medical equipment and tools.  There is a problem of diagnosis in the health centre, there when you come with a complain of headache you will be given malaria treatment even before proper investigations done. Is it a challenge to bring patients from villages to the health centre? It is not challenging to nearby villages but serious for people in distant locations far because bicycle ambulances which were given are either all broken down or considered outdated, Motorcycles are easier to use nowadays. What are your suggestions? Bicycles ambulance to be given and put under the control of the VHTs to manage them but kept by the village local council chiefs (LCs). People fear using bicycles because they take long to reach the health centre in an emergency. People prefer to use motor-cycles instead and if possible, motorcycle ambulance should be provided. In your view, how do you want your health centre to be like?  At least we hope to have two doctors to manage the high number of patients.  The theatre should be improved and even an ultra sound department opened up.  More specialized staffs should be hired for instance Dental health, Eye Care, ENT clinic.  Power system that is the generator should be properly maintained in order to avoid power blackouts, and its fuel should always be available in adequate quantities.  Admission rooms should be enlarged and separated accordingly. This is because at the moment there is only one ward called the general ward handling all illnesses apart from maternity, regardless of age and sex.  Isolations wards to be erected to avoid transmission of air borne diseases P a g e | 74 Item Update As VHTs do you know of any cultural practices preventing people to seek services from health centers? There might be there but not very common due to rising literacy levels and sensitization done by VHTs. Do you have staff here in the hospital that speaks local languages? Yes. Are there any language barriers in your health centre? It is not a problem because here we have three languages namely Gimara, Madi and Lugbara which we are all comfortable with. What is the most rare disease but dangerous here? Cholera and Meningitis. What are the challenges faced by the VHTs?  There is low motivation in terms of salary and wages.  Health kits given to us are not stocked/supplied with medicines in time.  There is no followup after training us on health issues.  Mobilization gadgets like micro-phones, public address systems and loud speakers are not availed to us making mobilization a problem.  We lack training and refresher courses to keep abreast with on health issues.  Lack of gear like gumboots, torches, overalls, gloves to avoid riskof contracting diseases from patients. P a g e | 75 P a g e | 76 P a g e | 77 Week Meeting 31 March 2016 date Recorded Richard by Meeting with Kaabong District Health Officials and Kamion HC II Officials on RPF, Total Meeting/subject IPP and IPF For Uganda Reproductive, 2 pages Maternal, Neonatal, and Child Health Improvement Project Item Update 1. Introduction The team leader started by introducing himself, the project and purpose of the meeting which was primarily to inquire abotu health related issues concerning the Ik people in Kaabong district. Kamion Health Centre II is one of the health centre located in the Ik community. The DHO welcomed the team and he expressed gratitude to consult the Ik people who for long have been marginalized and seen as minority among the people of the district. 2. Issues discussed Do you have Village Health Team (VHT) in Kaabong District? We have them in all the sub- counties and villages. Are they active in their work? Yes they are active. What common diseases are there among the IK? There are many diseases but the most common ones are, Malaria, Respiratory Tract Infections (RTIs), Diarrhoea, Gastro-interties, eye infections and skin diseases. Which is the most prevalent but most dangerous? Malaria, Chicken pox, dysentery Are there staff who speak Ik language in health center(s) visited by Ik people? Unfortunately no and Ik people are compelled to use Karamojong language since they are the minority. Do the IK people practice any traditional health practice? Yes for example consulting 2.1. traditional healers, medicine men/women and foretellers. Do Ik people have culture practices that may be harmful to their health? They copy the practice of the Karamojong for example body tattooing. Are the services provided to the IK very specific or general even to the other communities? No special services are provided to the Ik people. However, services such as safe delivery education are often offered, and they (Ik) are also taken as priority at any time, for example they are always attended to 24 hours 7 days a week. Is there any cultural practice that prevents them from seeking medical help? Not many apart from the practice of mothers demanding to keep placentas after birth. What is the staffing of health centre II? It is supposed to be 9 staff; however for our case we have only 3. P a g e | 78 Item Update Do you offer services of Health Centre II or Health Centre III? This is Health CenterII which is meant to offer only out-patient department (OPD). However being the only health centre in the area we offer also other services for health centre III for example, antenatal care (ANC), family planning and deliveries and in-patient (Admission) but with only one bed. Does the community get epidemics and when? We get epidemics especially during wet season when there are many mosquitoes. How does Kamion HC II manage medical waste? Through segregation into different categories since there are different types of waste for example pharmaceutical waste, human excretes, and other waste. Do you have proper waste disposal facilities? No, due to the fact that there is no functional incinerator. How does the HC dispose of unclaimed dead bodies? They are always taken to the hospital cemetery Does the HC own a cemetery? No. What do you suggest about the above? I suggest that the local health centre administration should purchase a parcel of land for that purpose. Who owns the land where the health centre located? It was donated by the local community. Is there some encroachment on the health centre land? Yes. How do you manage the land encroachment problem? Through meetings with the health unit management committee and the encroaching people so that we reach a mutual agreement. Generally, what are the challenges faced here?  No communication network available which creates communication gap between the health centre and the main hospital.  There is lack of transport to facilitate health workers movement during outreach programs and implementation of health programs.  Health programmes on radio, posters and brochures are only in Karamojong language creating an information gap for Ik people. 3. Recommendations What do you think needs to be done to improve health sector facilities / services here?  Number of staff to be increased from 3 to 9.  Staff housing to be constructed so as to motivate them to offer quality services.  General structure of the health centre to be improved. 3.1. What are your recommendations on health?  Health equipment supply to be increased due to wide catchment area.  Power to be installed for instance solar or standby generator for the purpose of proper storage of medicine and lighting as well.  Ambulance and bicycles to be given to VHTs.  Hiring Ik staff in the health department to make them help each other well. P a g e | 79 P a g e | 80 Week Meeting 31 March 2016 date Recorded Richard by Meeting with Kamion HC II VHTs on RPF, IPP and IPF For Uganda Reproductive, Total Meeting/subject 1 Maternal, Neonatal, and Child Health pages Improvement Project Item Update 4. Introduction The team leader started by introducing himself, the project and purpose of consultations that would benefit stakeholders and the project. 5. Answer session When visit a local health center do you get all the services you expect? No, not all, there are some problems not handled by the health center. What are other problems faced?  security since the area is a route for the cattle raiders.  Network to communicate health related issues to the unit.  Inadequate number of qualified staffs to handle patients.  Problem of common but very important medicines such as panadol. If there is health problem how do you handle it as a VHT? We help the sick with first aid then later take them to the health unit for further investigation and treatment. 5.1. How do you think this health centre should be help to improve?  Clean/safe drinking water to be provided.  Need to construct more structures to accommodate the ever rising health related issue.  The VHT should be supported with means of transport.  The standard to be upgraded to HCIII.  Need to fence it to avoid encroachers and to accommodate patients in quiet environment. What other cultural practices prevent people to seek health assistance? Preventing children to go for immunization and the language use in the health centre which does not favour the Ik patients. P a g e | 81 Week Meeting 1 April 2016 date Recorded Richard by Meeting with the Ik Local Community on RPF, IPP and IPF For Uganda Reproductive, Total Meeting/subject 1 Maternal, Neonatal, and Child Health pages Improvement Project Item Update 1. Introduction The Ik communities were mobilized by the area LCI for a meeting with the team in one of the village and the following were their responses to the questions asked. 2. Answer session Do you people have communication challenges when you visit a local health centre? There was mixed answers: some people said yes because they did not speak know Karamojong language well yet those at the health facility speak only that language, while others said no problem because they spoke Karamojong. Do you think it would be good if one of you was trained to work in the local health centre? Yes it would be a very good idea Why? Because he/she would avoid the communication barrier and secondly it will help to reduced 2.1. marginalization of the Ik people. What are the common diseases you suffer from? Malaria, headache, skin diseases, scabies, eye infections. What challenges do you face from the health centre?  There is no adequate drug to cater for us and the neighboring communities.  There are few healthcare staff making the ratio of patient to staff high.  The distance from peoples homes to the hospital is too long. P a g e | 82 P a g e | 83 P a g e | 84 P a g e | 85 Photographs of stakeholder consultations Consultation meeting with In charge Obongi Health Centre IV Consultation meeting with Health Inspector, Chairperson Health Management Committee and Senior Nursing Officer Obongi Health Center IV. Consultation meeting with VHTs at Obongi Health center IV P a g e | 86 Small lamps used at in a maternity ward at night . An IK homestead Security fence around an Ik homestead for protection from hostile tribes like the Karamojong and Turkana. P a g e | 87 A consultation meeting with IK community Village Health Team at Kamion Health Centre II. A refrigerator at Kamion Health Centre II IK community A typical dwelling in an Ik household