E2389 vol 2 MINISTRY OF HEALTH ENVIRONMENTAL AUDIT FRAMEWORK AND COMPREHENSIVE MITIGATION PLAN FOR THE SWAZILAND HEALTH, HIV/AIDS, AND TB PROJECT _________________ Prepared by:- Maqhawe Magongo - Environmental Health Officer :-MoH Bongani Sigudla ­ Environmental Health Officer :-MoH Sibekile Mtetwa - Technical Assistant :- WB Ministry of Health P.O. Box 5 Mbabane Swaziland Page | i TABLE OF CONTENTS ACRONYMS AND DEFINITIONS.............................................................................................................................. III GLOSSARY ............................................................................................................................................................. IV EXECUTIVE SUMMARY ........................................................................................................................................... V CHAPTER ONE: INTRODUCTION .......................................................................................................................... 1 1.1 BACKGROUND .......................................................................................................................................... 1 1.2 OBJECTIVES OF THE ENVIRONMENTAL AUDIT FRAMEWORK AND COMPREHENSIVE MITIGATION PLAN (EAFCMP) ........................................................................................................................................................... 1 1.3 OBJECTIVES OF THE ENVIRONMENTAL AUDIT .......................................................................................... 2 1.4 APPROACH AND METHODOLOGY ............................................................................................................. 2 1.4.1 Methodology ..................................................................................................................................... 2 CHAPTER TWO DESCRIPTION OF THE PROJECT ................................................................................................... 4 2.1 BACKGROUND ­ HEALTH CHALLENGES IN SWAZILAND ............................................................................ 4 2.2 PROJECT DESIGN PRINCIPLES .................................................................................................................... 4 2.3 PROJECT STRUCTURE ................................................................................................................................ 4 2.4 PROJECT DEVELOPMENT OBJECTIVES....................................................................................................... 5 2.5 ENVIRONMENTAL AND SOCIAL ISSUES ..................................................................................................... 5 CHAPTER THREE POLICY, LEGAL AND INSTITUTIONAL FRAMEWORK .................................................................. 6 3.1 INTRODUCTION ........................................................................................................................................ 6 3.2 POLICIES .................................................................................................................................................... 6 3.2.2 National Health and Social Welfare Policy (2002) ............................................................................. 6 3.2.3 National Environmental Health Policy (2002) ................................................................................... 6 3.3 LEGAL FRAMEWORK ................................................................................................................................. 6 3.3.1 Public Health Regulations, (1935): .................................................................................................... 6 3.3.2 The Environmental Audit, Assessment and Review Regulations, 2000: ............................................ 6 3.3.3 The Waste Regulation, (2000): .......................................................................................................... 6 3.3.4 The Swaziland Environment Authority Act (1992) ............................................................................. 7 3.3.5 The Swaziland Environmental Management Act (2003): .................................................................. 7 3.3.6 Occupational Health and Safety Act (OHS) (2001): ........................................................................... 7 3.3.7 Conveyance and Burial of Dead Bodies Act, (1970): .......................................................................... 7 3.3.8 The Public Health Act, No.5 (1969): ................................................................................................... 7 3.3.9 The Water Act, (2003): ....................................................................................................................... 7 3.4 INSTITUTIONAL FRAMEWORK .................................................................................................................. 7 3.4.1 Swaziland Environmental Authority (SEA) ......................................................................................... 7 3.4.2 Ministry of Health (MoH) ................................................................................................................... 8 3.4.3 Regional Local Administration ........................................................................................................... 8 3.5 WORLD BANK POLICIES ............................................................................................................................. 8 3.5.1 The Policies ........................................................................................................................................ 8 3.5.2 WB Guidelines.................................................................................................................................... 9 CHAPTER 4.0 BASELINE ENVIRONMENTAL STATUS OF HEALTH CARE FACILITIES ............................................. 10 4.1 INTRODUCTION ...................................................................................................................................... 10 4.3.1 Horo Clinic........................................................................................................................................ 10 4.3.2 Emkhuzweni Health Centre.............................................................................................................. 10 4.3.3 Mbabane Government Hospital ...................................................................................................... 10 4.3.4 Services offered at health facilities .................................................................................................. 11 CHAPTER FIVE POTENTIAL ENVIRONMENTAL AND SOCIAL IMPACTS ............................................................... 12 5.1 POTENTIAL IMPACTS............................................................................................................................... 12 5.2 ENVIRONMENTAL IMPACTS ..................................................................................................................... 12 5.2.1 Planning Phase Impacts ................................................................................................................... 12 5.2.2 Construction Phase .......................................................................................................................... 12 Page | i 5.2.3 Operation Phase .............................................................................................................................. 14 5.3 SOCIAL AND HEALTH IMPACTS ................................................................................................................ 14 5.3.1 Planning Phase Impacts ................................................................................................................... 14 5.3.2 Construction Phase .......................................................................................................................... 14 5.3.3 Operation Phase .............................................................................................................................. 16 CHAPTER SIX THE SCREENING PROCESS ........................................................................................................... 18 6.1 INTRODUCTION TO THE SCREENING PROCESS ....................................................................................... 18 6.2. STEP 1: SCREENING OF PROJECT ACTIVITIES AND SITES.......................................................................... 19 6.3. STEP 2: ASSIGNING THE APPROPRIATE ENVIRONMENTAL CATEGORIES ................................................ 20 6.4 STEP 3: CARRYING OUT ENVIRONMENTAL WORK .................................................................................. 20 6.5 STEP 4: REVIEW AND APPROVAL OF THE PROJECT ACTIVITIES ................................................................ 20 6.6 STEP 5: PUBLIC CONSULTATION AND DISCLOSURE ................................................................................. 21 6.7 STEP 6: MONITORING ............................................................................................................................. 21 6.8 STEP 7: MONITORING INDICATORS......................................................................................................... 22 6.9 SUMMARY OF THE SCREENING PROCESS................................................................................................ 22 CHAPTER SEVEN:- ENVIRONMENTAL MANAGEMENT PLANS (EMP) ................................................................. 23 7.1 INTRODUCTION ...................................................................................................................................... 23 7.2 ENVIRONMENTAL MANAGEMENT PLAN FOR A CLINIC ........................................................................... 24 7.3 ENVIRONMENTAL MANAGEMENT PLAN FOR A HEALTH CENTRE ........................................................... 28 7.4 ENVIRONMENTAL MANAGEMENT PLAN FOR A HOSPITAL ..................................................................... 33 7.5 PUBLIC CONSULTATION PLAN ................................................................................................................. 39 7.5.1 OBJECTIVES ........................................................................................................................................... 39 7.5.2 IDENTIFYING STAKEHOLDERS ................................................................................................................ 39 7.6 MITIGATION FUNDING ........................................................................................................................... 40 7.6.1 Cost of Design Measures ................................................................................................................. 40 7.6.2 HIV/AIDS Awareness Program ......................................................................................................... 40 CHAPTER EIGHT CONCLUSION ......................................................................................................................... 41 BIBLIOGRAPHIES .................................................................................................................................................. 42 APPENDICES......................................................................................................................................................... 43 APPENDIX 1: ENVIRONMENTAL AND SOCIAL SCREENING FORM ..................................................................... 43 APPENDIX 2: CONSULTED STAKEHOLDERS ....................................................................................................... 47 APPENDIX 3: SUMMARY OF WORLD BANK ENVIRONMENTAL AND SOCIAL SAFEGUARD POLICIES. ............. 49 APPENDIX 4: CONTRACT PROVISIONS: ENVIRONMENTAL AND SOCIAL IMPACTS ........................................ 51 TABLES Table 4.1: Major challenges. ....................................................................................... 10 Table 4.2: The services offered at facilities. ....................................................................... 11 Table 5.1: Major environmental impacts resulting from the rehabilitation. .................................... 12 Table 7.1: Environmental Management Plan - Clinic. ............................................................ 24 Table 7.2: Environmental Management Plan - Health Centre. ................................................... 28 Table 7.3: Environmental Management Plan - Hospital. ......................................................... 33 Table 7.4: Stakeholder Identification Matrix ...................................................................... 39 Page | ii ACRONYMS AND DEFINITIONS CMP: comprehensive mitigation plan EAAR: Environmental Audit, Assessment and Review Regulations EAFCMP: Environmental Audit Framework and Comprehensive Mitigation Plan ECC: Environmental Compliance Certificate EHS Environmental Health and safety ESIA: Environmental & Social Impact Assessment ESMF Environmental and Social Impact Assessment Management Framework ESMP: Environmental and Social Management Plan GIIP: Good international industry practice GoS Government of Swaziland HCF: Healthcare facility/ facilities HCW: Healthcare Waste HCWM: Healthcare Waste Management HCWMP: Healthcare Waste Management Plan HIV/AIDS: Human immunodeficiency virus/ acquired immunodeficiency syndrome IDA: International Development Association 1 MoH: Ministry of Health NHSSP National Health Sector Strategic Plan OHS: Occupational Health Services SEA: Swaziland Environment Authority ToR: Terms of Reference WBG: World Bank Group WHO: World Health Organization EMPS: Environmental Management Plan RAP: Resettlement Action Plan EIA: Environmental Impact Assessment 1 IDA is the part of World Bank that helps the world's poorest countries. Established in 1960, IDA offers interest-free credit and grants to the world's 81 poorest countries- home to 2.5 billion where a majority of the people live on less than 2 US dollars per day. This highly concessionary financing is vital because such countries have little capacity to borrow on market terms. IDA resources and technical assistance supports country-led poverty reduction strategies in key areas, namely increased productivity, better governance and accountability, access to education and healthcare for poor people. Page | iii GLOSSARY Environmental audit: - Systematic, documented verification process of objectively obtaining and evaluating evidence to determine whether specified environmental activities, events, conditions, management systems, or information about these matters conform with audit criteria. Environmental performance: - Measurable results of the environmental management system, related to an organisation's control of its environmental aspects, based on environmental policy, objectives and targets. Point sources: - These are discrete, stationary, identifiable sources of emissions that release pollutants to the atmosphere (e.g. incinerators). Infectious Waste: - This is the portion of medical waste that can transmit disease. On average about 10-15% of medical waste is actually infectious waste. Infectious waste comprises five categories: cultures and stocks, human pathological waste, human blood and blood products and sharps. Hazardous waste: - Shares the properties of a hazardous material (e.g. ignitability, corrosivity, reactivity, or toxicity), or other physical, chemical, or biological characteristics that may pose a potential risk to human health or the environment if improperly managed. Hospital Waste: - All solid waste, both biological and non-biological, that is produced at a hospital and is discarded without further use. Medical Waste: - Materials generated as a result of patient diagnosis and/or treatment or the immunization of human beings. Solid (non-hazardous): - wastes: Generally include any garbage, refuse. Examples of such waste include domestic trash and garbage; inert construction / demolition materials; refuse, such as metal scrap and empty containers (except those previously used to contain hazardous materials which should, in principle, be manage d as a hazardous waste). Incineration: - is a waste treatment technology that involves combustion of organic materials and/or substances converting them into incinerator bottom ash, flue gases, and particulates. Flue gases may contain significant amounts of particulate matter, heavy metals, dioxins, furans, sulfur dioxide and hydrochloric acid. Flue gases are therefore cleaned before they are dispersed in the atmosphere. Page | iv EXECUTIVE SUMMARY The Swaziland Government developed a National Health Sector Strategic Plan 2008-2013 (NHSSP) for addressing the country's health sector challenges. The proposed Swaziland Health, HIV/AIDS and TB Project will contribute towards achieving the overall objectives of the NHSSP. The project-specific objectives are to improve (i) access to and quality of health services in Swaziland with a particular focus on primary health care, maternal health and TB, and (ii) to increase social safety net access for Orphans and Vulnerable Children (OVC) through a cash transfer pilot. The proposed project will be jointly funded by the World Bank, the European Union and the Government of Swaziland. This document serves as an Environmental Audit Framework and Comprehensive Mitigation Plan (EAFCMP) for the proposed project. The preparation of an EAFCMP is required by the Swaziland Environmental Authority (SEA) for all major rehabilitation of existing building/structures in Swaziland and is equivalent to the World Bank's Environmental and Social Management Framework (ESMF). An Environmental Audit Framework and Comprehensive Mitigation Plan (EAFCMP) is prepared whenever the location and design of the eventual sub-projects are not known at project appraisal, even though the types of potential subprojects may be fairly well defined This EAFCMP serves as a framework for screening environmental issues for all rehabilitation work to be undertaken under the Swaziland Health, HIV/AIDS and TB project. The EAFCMP establishes a unified process for addressing all environmental and social safeguards issues on sub-projects from preparation, through review and approval, to implementation. The EAFCMP covers a sample of all health care facilities in Swaziland for the proposed rehabilitation under health care project. An audit of a representative sample of the health care facilities was carried out in order to determine potential environmental and social impacts resulting from proposed rehabilitation in conformity with the Swaziland Environmental Audit Assessment and Review Regulations (2000). The objectives for undertaking the audits are to: provide an assessment of the facilities' status and operation levels; provide an overview of issues or impacts relating to the proposed rehabilitation and subsequent operation of the facilities; Establish a process for identifying and addressing the environmental and social safeguards issues on various health care facility sites to be rehabilitated under the proposed project. Propose mitigation measures/ or environmental management plan for rehabilitation works to be undertaken. Thus the EAFCMP/ESMF ensures that the substantive concerns of the relevant World Bank safeguard policies and Swaziland legislation will be addressed during the rehabilitation of selected health care facilities. This study focused on the identification of significant environmental impacts that may result from the proposed refurbishments of the health care facilities and then crafted mitigation measures that can be put in place. The study consisted of the following: Page | v a) Establishment of Baseline Socio-Environmental Conditions b) Review of policy, regulations, institutional framework c) Assessment of requirements for adequate and environmentally safe solid and liquid waste management at healthcare facilities d) Assessment of Social impacts In order to ensure compliance of the project with legal requirements the following policies, regulations and acts were reviewed: Health Care Waste Management Plan National Health and Social Welfare Policy National Environmental Health Policy Public Health Regulations, 1935: The Environmental Audit, Assessment and Review Regulations, 2000: The Waste Regulation, 2000: The Swaziland Environment Authority Act 1992 The Swaziland Environmental Management Act 2003: Occupational Health and Safety Act of 2001: Conveyance and Burial of Dead Bodies Act, 1970: The Public Health Act, No.5 of 1969: The Water Act, 2003 The legal review established that the health care delivery system is supported by a host of laws and regulations for the protection of humans and the environment at large, from any potential negative impacts that may arise from it. On the other hand the World Bank Environmental Safeguards Policies and other guidelines require some measures to be taken to protect the physical environment from all forms of degradation and to prevent any potential social impacts. The Swaziland Environmental Management Act, (2003) established the Swaziland Environmental Authority (SEA) as the lead agency in environmental protection. SEA in turn has delegated some of its functions to the Environmental Health Department of the Ministry of Health (MoH). The MoH is one of the two executing agencies for this project and undertakes policy formulation, quality assurance, coordination, monitoring and evaluation of health service delivery in Swaziland. For this exercise, a sample consisting of one hospital, one health centre and one clinic were selected to represent the situation in all the health facilities in the country. The facilities were found to be in a serious state of disrepair since most of them have very old buildings which are poorly maintained. Major challenges included lack of working space, cracked walls, dilapidated roofs, and shortages of materials such as beds, medicine and up-to-date equipment. Water, sewage, and electricity services are also erratic and unreliable. Judging by the current state of the sample of health care facilities, the refurbishment requirements will vary from painting walls, repairing cracks, replacing roofs, expanding rooms, to complete replacement of equipment. Page | vi Using a comprehensive stakeholder consultation process, the potential environmental and social impacts of the project were identified and assessed. Upon identification and assessment, an environmental management plan (EMP) was drawn for each level of Health Care Facility. The EMPs outline the mitigation measures that have to be put in place in order to reduce the effects of the potential impacts that were identified. Generally, the proposed project has the potential to significantly improve the quality and efficiency of healthcare service provision in Swaziland with socio-environmental benefits such as reduced occurrence of deaths and increased productivity of labor. This will raise the household incomes (especially for rural agrarian communities) and afford access to healthcare services, hitherto unavailable at health facilities due to lack of equipment or facilities (e.g. operating theaters). Besides, project development and operation will provide considerable economic opportunity for material or equipment suppliers, construction contractors and medical professionals. All potential adverse impacts can be mitigated when measures proposed in the Comprehensive Mitigation Plan are implemented, in which case benefits of this project to the nation would by far outweigh potential negative effects. Page | vii CHAPTER ONE: INTRODUCTION 1.1 BACKGROUND The Swaziland Government has requested financial assistance from the World Bank for the preparation of the Health, HIV/AIDS and TB Project that will contribute towards addressing the country's health sector challenges in line with the National Health Sector Strategic Plan 2008-2013 (NHSSP) developed by the Government. The proposed Health , HIV/AIDS and TB project will support the Swaziland Government in its efforts to redress the serious deterioration in the delivery of basic health care services and provide a more sustainable development of the health care system by (i) improving access to and quality of health services in Swaziland with a particular focus on primary health care, maternal health and TB, and (ii) increasing social safety net access for orphans and vulnerable children (OVC) through a cash transfer pilot. This document serves as an Environmental Audit Framework and Comprehensive Mitigation Plan (EAFCM) for the proposed Swaziland Health, HIV/AIDS, and TB Project. The preparation of an EAFCM is required by the Swaziland Environmental Authority (SEA) for all major rehabilitation work and is equivalent to the World Bank's Environmental and Social Management Framework (ESMF). The EAFCM has been prepared as a guide for the integration of environmental and social considerations in the planning and implementation of the proposed Project activities. The principal aims of an environmental audit are to identify and evaluate potential liabilities, risks and hazards associated with a particular activity or production process. The environmental audit focused on two elements: (i) the status of the existing facilities and operations in relation to expected service delivery; and (ii) the nature and extent of significant adverse environmental impacts that may result from any rehabilitative development at the facilities. 1.2 OBJECTIVES OF THE ENVIRONMENTAL AUDIT FRAMEWORK AND COMPREHENSIVE MITIGATION PLAN (EAFCMP) The primary objective of this EAFCMP is to improve decision making and to ensure that the design, refurbishment, upgrading of health care facilities and other activities being considered under the proposed project are environmentally sound and sustainable. The secondary objective is to ensure that in-country capacity, regulatory framework; principles and procedures are established to provide a basis for environmental assessments of all sub- projects to be carried out under this additional financing. More specifically, the purpose of the framework is to: i Assess the potential environmental and social impacts of the sub- projects(rehabilitation, extension), whether positive or negative and propose mitigation measures; ii Inform the project preparation team and the Swaziland Government of the potential impacts of different anticipated subprojects and relevant mitigation measures and strategies;` iii Establish clear directives and methodologies for the environmental and social Page | 1 screening of sub-projects to be financed by the project; and iv Identify potential environmental policies, legal and institutional framework pertaining to the project. The EAFCM establishes a process for addressing the environmental and social safeguards issues on various health care facility sites to be rehabilitated under the proposed project. The Environmental Audit describes a process that will ensure that the substantive concerns of the relevant World Bank Safeguard Policies and Swaziland legislation are addressed during the rehabilitation of the selected health care facilities. 1.3 OBJECTIVES OF THE ENVIRONMENTAL AUDIT The objectives for undertaking an EA of the Health Care Facilities were to: provide an assessment of the facilities' status and operation levels; provide an overview of issues or impacts relating to the proposed rehabilitation and subsequent operation of the facilities; Establish a process for identifying and addressing the environmental and social safeguards issues on various health care facility sites to be rehabilitated under the proposed project. An Environmental Audit Framework and Comprehensive Mitigation Plan (EAFCMP) is prepared whenever the location and design of the eventual sub-projects are not known at project appraisal though the types of potential subprojects may be fairly well defined. The audit Framework provides a guide for integration of environmental and social considerations into the planning and implementation process of Project activities. 1.4 APPROACH AND METHODOLOGY 1.4.1 Methodology The EAFCMP study was conducted on the premise that key project activities will entail: Renovation/refurbishment of health care facilities, Supply, installation and commissioning of medical equipment and medical furniture, Construction and/or supply and installation of incinerators at selected Health care facilities The EAFCMP study was prepared in accordance with applicable World Bank safeguard policies and Swazi environmental impact assessment guidelines. The distinct phases of the study include: · Data Gathering; · Literature review; · Reconnaissance Surveys and visits to potential sub-projects sites; · Characterization of the baseline conditions; · Identification of potential impacts; · Identification of impact mitigation measures; · Preparation of an Environmental and Social Management Plan; and · Preparation of sub-project guidelines a) Data Gathering Page | 2 The consultant assembled and evaluated relevant baseline data related to the physical, biological and socio-cultural environment of the country. b) Literature Review The approach was based on review of available literature and other strategic planning documents for Swaziland. Specifically, the following were reviewed: project concept notes (PCN), draft project appraisal document (PAD) and concept-stage Integrated Safeguards Data Sheet (ISDS) of the project. Also consulted were the general environmental management conditions for construction contracts; the environmental laws regulations acts, policies and guidelines; World Bank safeguard policies and other relevant documents. c) Baseline Socio-Environmental Conditions Environmental audit data was collected using a variety of standard methods including the following: Holding preliminary discussions with the beneficiary ministry ­ Ministry of Health, to fully understand their plans and views about the proposed project. Consultations with the Health facility personnel: i) management ii) professional staff, iii) support staff, and iv) the health committees. Consultation with the representatives of the Swaziland Environmental Authority (SEA), local churches, local health committees, local schools, local police stations, Mbabane City Council, Swaziland Traditional Healers Organisation (THO), Ministry of Tinkundla, Biomedical Engineers, Ministry of Agriculture ­ RDA, Public health units, and the Ministry of Public Works. Conducting comprehensive site inspection of the facilities noting the structural and operational deficiencies needing attention. d) The policy, regulations, institutional framework review This was done to ensure that the proposed project is in line with national policies, environmental laws and regulations. e) Assessment of requirements for adequate and environmentally safe solid and liquid waste management at healthcare facilities This aimed to ensure that project design was based on best-practice healthcare waste management. The waste handling practices at each facility were thoroughly examined. f) Social impact assessment Potential social impacts investigated included: Opportunities for or loss of local job opportunities Effects of changes in land use around project sites Physical or economic displacement from near or within healthcare facilities being redeveloped. Page | 3 CHAPTER TWO DESCRIPTION OF THE PROJECT 2.1 BACKGROUND ­ HEALTH CHALLENGES IN SWAZILAND Swaziland has the highest rates of HIV and TB in the world and is struggling to address one of the worst co-epidemics in Africa. HIV prevalence is 26% among the sexually active population (15-49 years), with infection rates higher among women (31.1%) than men (19%). HIV prevalence peaks at 49% for women age 25-29, almost five times the rate among women age 15-19 and more than double the rate among women age 45-49. HIV-related illnesses have become the major cause of morbidity and mortality among under-5 children. According to the MOH, HIV-related illnesses account for 47% deaths among under-fives. Pneumonia and diarrheal diseases account for 12% and 10% respectively. HIV infection could be a contributory factor to the mortality due to pneumonia and diarrheal diseases, whereas limited access to clean water and sanitation, especially in rural areas are indicated as the major direct risk factor. 2.2 PROJECT DESIGN PRINCIPLES The project focuses on building capacity in the health sector and social welfare sector, which will contribute to delivering adequate health care and social welfare services to the Swazi population. 2.3 PROJECT STRUCTURE The proposed project lending instrument is a Specific Investment Loan (SIL). An IBRD loan of US$20 million will be combined with financing from the European Union (Euros 14.5 million or US$ 19.0 million equivalent) and the Government of Swaziland (GoS) (approximately US$ 2.0 million). The project implementation period is five years. The project comprises three components as follows: Component 1: Strengthening the Capacity of the Health Sector (US$ 3.71 million) This component will support interventions to strengthen the capacity of the Ministry of Health (MOH) at different levels with respect to governance, management and planning. Component 2: Facility-level Support to Improve Access, Quality and Efficiency of Services (US$ 24.7 million) This component will support interventions to rehabilitate and improve targeted facilities at different levels of the health system, focusing on Primary Health Care (PHC), the HIV and TB Co-epidemic Response and Emergency Obstetric and Neonatal Care (EmONC). This component has two sub-components: Sub-component 2a: Support to Hospitals, Health Centres and Clinics Sub-component 2b- Support to the nursing training institutions Component 3: HIV/AIDS Impact Mitigation (US$ 6.17 million) This component aims to increase the social safety net access for OVC through a pilot cash transfer project. The component has two sub-components: Sub-component 3a: Capacity Building and System Strengthening: Sub-component 3b: OVC Cash Transfer Pilot Page | 4 2.4 PROJECT DEVELOPMENT OBJECTIVES The project development objectives are to (i)improve access to and quality of health services in Swaziland with a particular focus on primary health care, maternal health and TB, and (ii) to increase social safety net access for OVC through a cash transfer pilot. 2.5 ENVIRONMENTAL AND SOCIAL ISSUES The rehabilitation and improvement of targeted existing Health Care Facilities covered in component 2 of the proposed project, will by nature impact on the environment. An Environmental Audit Framework and Comprehensive Mitigation Plan (EAFCMP) is thus required to address environmental and safeguard issues related with activities under Component 2. Page | 5 CHAPTER THREE POLICY, LEGAL AND INSTITUTIONAL FRAMEWORK 3.1 INTRODUCTION Swaziland has developed a number of important initiatives in policies, laws and regulations applicable to the environment and health sectors. The major national policies and regulations that are considered relevant to the project are summarized in this section. 3.2 POLICIES 3.2.2 National Health and Social Welfare Policy (2002) The National Health and Social Welfare Policy embodies the vision and mission of the Ministry of Health essentially as to improve the health and social welfare status of the people of Swaziland ,by providing preventive, promotive, curative and rehabilitative services (MoH, 2002), which are relevant, socially acceptable and affordable and accessible to all. 3.2.3 National Environmental Health Policy (2002) The National Environmental Health Policy seeks to ensure a safe environment, health and sustainable development for the promotion and sustenance of good health and improved quality of life for all people in Swaziland ,whatever their financial resources or place of domicile. 3.3 LEGAL FRAMEWORK 3.3.1 Public Health Regulations, (1935): These regulations aim to prevent the spread of plague, cholera, yellow fever, small pox and venereal (sexually transmitted infections) diseases. Medical health facilities, by virtue of dealing with people affected by infections of all kinds, are obligated to ensure that infectious and venereal diseases are treated and controlled appropriately to prevent epidemics and thus promote compliance with these regulations. 3.3.2 The Environmental Audit, Assessment and Review Regulations, 2000: The regulations give guidance on the actual implementation of projects and the attendant environmental considerations. The Regulations outline how projects are to be categorized according to the extent and significance of the likely impacts, and define the processes and procedures to be followed in generating environmental assessment documents. The Regulations also provide guidelines on the time limits for each stage of the project. 3.3.3 The Waste Regulation, (2000): The Waste Regulations, regulate the management of solid waste and liquid wastes disposed of on land and are binding also on the state. The Waste Regulation provides definitions of the different classes of waste including the minimum requirements for the management of each type of these waste. The Regulations provide guidelines for the management of waste in urban areas, in waste control areas, the construction and operation of waste disposal facilities, recovery of waste, and many other aspects related to waste handling and disposal. Page | 6 3.3.4 The Swaziland Environment Authority Act (1992) This Act establishes the Swaziland Environment Authority (SEA) and gives it powers to create and enforce guidelines relating to air, water and land quality, as well as standards for environmental impact assessment, audit and evaluations. The Environmental Audit Assessment and Review Regulation of 2000, and waste regulations were developed under this Act to regulate practices in fulfillment of its requirements. 3.3.5 The Swaziland Environmental Management Act (2003): The Act establishes the SEA as a corporate body and promotes the enhancement, protection and conservation of the country's natural resources. It outlines the SEA's powers, functions, principles, regulations, strategies, and practices with regard to environmental assessment, compliance issues and promotes integrated environmental management. 3.3.6 Occupational Health and Safety Act (OHS) (2001): This Act provides for the safety and health of persons at work and at workplaces and the protection of persons other than workers against hazards to safety and health arising from activities in the work place. It also outlines duties of the employer in ensuring the safety of all persons in the workplace including work done outside the employer's premises as long as it is based on the employer's instruction. 3.3.7 Conveyance and Burial of Dead Bodies Act, (1970): This Act makes provision for the conveyance of dead bodies, their burial and incidental or connected matters; removal of bodies of persons who died of infectious diseases; and the keeping of dead bodies pending burial. 3.3.8 The Public Health Act, No.5 (1969): The Public Health Act makes provisions for public health and incidental or connected matters. It details what diseases are termed as communicable diseases, the management procedures of any related incident, and the responsibilities of public individuals and officers in public health matters. The Act also covers the definition and examples of nuisances, relevant procedures relating to nuisances, and general provisions relating to buildings used for storage of food and powers given to public officials. 3.3.9 The Water Act, (2003): Establishes a National Water Authority, whose function covers the preparation of a Master Plan that advocates for fair and equitable use of water, and regulates water pricing. All facilities that use water or draw water from natural sources are supposed to comply with the requirements of this law. 3.4 INSTITUTIONAL FRAMEWORK 3.4.1 Swaziland Environmental Authority (SEA) The Swaziland Environmental Management Act 2003 establishes the Swaziland Environmental Authority (SEA) as a corporate body whose principal responsibility is coordination, monitoring and supervision of environmental conservation activities. SEA is under the Ministry of Environment but has a cross-sectoral mandate to oversee the conduct of EIAs through issuance of guidelines, regulations and registration of practitioners. It Page | 7 reviews and approves environmental impact statements in consultation with any relevant lead agencies. 3.4.2 Ministry of Health (MoH) The Health, HIV/AIDS and TB project will be executed by the MoH which undertakes policy formulation, quality assurance, coordination, monitoring and evaluation of health service delivery in Swaziland. The Occupational Health and Safety (OHS) unit in the Ministry is responsible for inspection and monitoring of occupational safety in workplaces and this could be during project construction and operation of the healthcare facilities. MoH must ensure that all its operations and those of its contractors conform to all relevant and applicable environmental requirements as outlined in this EAFCMP document, throughout the project implementation. The Environmental Health Department in the MOH is responsible for health care waste management and environmental inspections. This unit will be responsible for ensuring that the recommendations of the EMPs is implemented throughout the project implementation . 3.4.3 Regional Local Administration The proposed project is within the jurisdictions of all the four regions. Various regional offices whose functions would be relevant to the project include offices of Natural Resources/Environment, Regional Health Inspector, Regional Planner, Community Development Officer, Regional Director of Health Services, Land Office, Regional Water Officer, Town Council and Regional Engineer. Equally important are community-level local leadership. Leaders at these levels of local administration are closer to residents and therefore important in effective community mobilization, sensitization and dispute resolution. The consultations should deliberately target the local leadership. 3.5 WORLD BANK POLICIES 3.5.1 The Policies The World Bank has ten (10) environmental and social safeguard policies (see Appendix 3) that it uses to examine potential environmental risks and benefits associated with Bank lending operations. The ten environmental and social safeguard policies cover the implications of the proposed project for the following areas: · OP/BP 4.01: Environmental Assessment · OP/BP 4.04: Natural Habitats · OP 4.09: Pest Management · OP/BP 4.12: Involuntary Resettlement · OD 4.20: Indigenous Peoples · OPN 11.03: Cultural Property · OP 4.36: Forests · OP/BP 4.37: Safety of Dams · OP/BP 7.50: Projects on International Waters · OP/BP 7.60: Projects in Disputed Areas Page | 8 3.5.2 WB Guidelines Under its "General Environmental Health and Safety (EHS) Guidelines (April 30, 2007)", The World Bank has several guidelines, many of which are applicable to components 2 of the proposed Project namely: i) air emissions from onsite waste combustion units ("incinerators") ii) hazardous waste management iii) noise iv) occupational health and safety (against biological and radiological hazards). v) community health and safety including traffic safety such as during project construction or disease prevention (where incinerators emission waft into and affect not only local communities but also patients visiting healthcare facilities). Page | 9 CHAPTER 4.0 BASELINE ENVIRONMENTAL STATUS OF HEALTH CARE FACILITIES 4.1 INTRODUCTION A representative sample of a Governmental Hospital (Mbabane Government Hospital) , a Health centre (Emkhuzweni in Hhohho region) and a clinic (Horo clinic in Hhohho region) were selected for all health facilities in the country. The following is an outline of the site profile at each of the three selected health care facilities: At all the sample facilities, the waste disposal services are poorly developed and the waste disposal methods in use are either burying in pits or open-air burning. Sharps and non sharp medical waste types are not properly separated. 4.3.1 Horo Clinic Horo Clinic has one main building housing all the programmes: Outpatient Department (OPD), maternity units, HIV/AIDS Counseling and testing, child welfare units, and administration offices, Wards (Maternity, Female, Male and Paediatric) and Theatre (which is incomplete and not functional). Another building is attached to the main building and it houses two families. Two other structures are used as staff houses but are dilapidated. The clinic is on grid electricity and piped water supply. 4.3.2 Emkhuzweni Health Centre The Health centre has several buildings that are used as: Outpatient Department (OPD), Wards (Maternity, Female, Male and Paediatric) and Theatre. There are thirty (30) staff buildings, ten (10) of which are dilapidated with serious cracks. The Health centre is on grid electricity and is on piped water pumped from a borehole. There is only one old pump which frequently breaks down leaving the health centre without water.. 4.3.3 Mbabane Government Hospital At Mbabane Government Hospital, virtually every department requires attention as the buildings are old, with various structural faults like cracks, weathered roofs, falling ceilings and dysfunctional services. The most affected departments are the OPD, Casualty, isolation ward, most wards, the kitchen and the laundry. Some of the major challenges being faced by the healthcare facilities that need serious attention include the following; Table 4.1: Major challenges. No. CHALLENGE HORO EMKHUZWENI MBABANE 1 Shortage of beds and mattresses. 2 Roofing for most buildings . 3 Unreliable grid power supply. 4 Unreliable water supply. 5 Lack of modern ­ theatre, surgical equipment, operating beds, Ultra­sound. 6 O.P.D is too small for the ever-increasing number of patients. 7 Dental clinic lacks complete dental unit equipment. 8 Poor laundry facility 9 Small room for X-rays. Page | 10 10 Poorly designed wards. 11 Poorly designed and wrongly sited kitchen. 12 Poorly functioning mortuary. 13 Poor health care waste management equipment. 14 Staff houses dilapidated and too few for the staff compliment. 15 Lack of reliable means of transport to carry out community outreach and home visiting 16 Rapid consumption of supplies / medicines due to many patients /clients. 17 Shortage of testing kits in laboratories and blood transfusion services. 18 Allocated stand for the clinic too small and on steep terrain. 19 Shortage of rooms to carry out all necessary programmes. 20 Lack of proper maternity facility. 4.3.4 Services offered at health facilities Table 4.2 below summarises the services offered by the Health Facilities: Table 4.2: The services offered at facilities. No. CHALLENGE HORO EMKHUZWENI MBABANE 1 Out patients 2 In-patients 3 Reproductive Health Services. 4 Miner operational 5 Major operational 6 Immunizations 7 Ophthalmology Services 8 Health Education 9 Laboratory Services 10 Health Inspection and sanitation 11 Dental services 12 Referrals Services Page | 11 CHAPTER FIVE POTENTIAL ENVIRONMENTAL AND SOCIAL IMPACTS 5.1 POTENTIAL IMPACTS The first stage of impact assessment was the identification of the project activities that have the potential to generate impacts at the Health facilities. This was followed by identification of receptors which allowed understanding of possible impact pathways and receptors sensitivity to change (impact). All this was done through a comprehensive stakeholder consultation exercise that was carried out at a representative sample of the Health Care Facilities in the country. (See Appendix 2 for stakeholders consulted and Annex for proof of public consultation) The implementation of the proposed Health, HIV/AIDS and TB project will enhance the health and socio-economic development of the country through the facilitation of improved health care services and access to all. Table 5.1; gives an overview of the major environmental impacts resulting from the rehabilitation/refurbishment and operation of health care facilities. Table 5.1: Major environmental impacts resulting from the rehabilitation. ENVIRONMENTAL PARAMETERS IMPACTS Soil erosion and modification of surface relief Sedimentation of roadside water bodies and drains Soil Contamination from waste materials e.g. cement, paints, lubricants, fuels and detergents Modification in flow of surface water /increased runoff Drainage clogging and creation of stagnant water pools Water Contamination from hazardous wastes e.g. paints, lubricants, fuels Sedimentation of surface water bodies Clearing of vegetation Ecosystem Transmission of diseases Air Air pollutants emission from construction machinery Change in natural drainage pattern Landscape Clearing of vegetation Transmission of diseases Contamination of local water supplies Human health and safety Air pollution Noise & vibration disturbance Obstructions owing to presence of road side barriers 5.2 ENVIRONMENTAL IMPACTS 5.2.1 Planning Phase Impacts 5.2.1.1 Physical Restrictions on building space. The size of the health care facilities premises are either too small, with little room to expand outwards or on steep slopes with high erosion potentials. 5.2.2 Construction Phase 5.2.2.1 Flora and Fauna The rehabilitation, refurbishment and upgrading of existing Health Care Facilities could result in clearing and depletion of vegetation that will result in: loss of plant cover, Page | 12 disturbance and loss of fauna habitats, weakening and degradation of soils, disturbance of the natural landscape and disfiguring of the natural morphology. 5.2.2.2 Soil and Land Degradation Earth-moving equipment such as excavators will be used in excavation work. This earth moving equipment will expose the soil to erosion and also compact it and break down the soil structure which will potentially decrease the drainage of the areas. Furthermore, the risk of accidental discharge of hazardous products, leakage of hydrocarbons, oils or grease from construction machinery also constitute potential sources of soils and water pollution. Moreover, the high pressure on water resources can cause potential conflicts, particularly during the dry seasons in certain localities of high water scarcity such as Horo. 5.2.2.3 Vehicular Traffic Construction works will result in a high volume of traffic around the Health Care Facilities and within the communities. The transportation of raw materials will introduce a number of heavy trucks on the access road and this could increase the risk of vehicular accidents. 5.2.2.4 Waste Management Activities at construction sites will produce construction wastes such as excavated soils and cement bags, paint drums, brick and concrete rubble, metal, broken glass, timber waste and debris. Excavated wastes could obstruct the general public, the movement of the workers and vehicles as well as affect the aesthetics of the environment. 5.2.2.5 Ambient air quality Air Quality will be impacted by emissions from vehicles, earthmoving equipment and released particulate matters. Demolition to modify the built environment will lead to considerable levels of cement dust which can affect workers and patients. Deteriorated indoor air quality will be of critical effect to especially asthmatic construction workers, patients and health workers, with either minor or severe health impact depending on level and duration of exposure. 5.2.2.6 Water Quality Water quality will be impacted by wastewater discharges from construction activities. These will include discharges from onsite sewage system and rainwater run-off from the developed areas such as workshops etc. The discharge of this wastewater into surface waters will impact water quality by causing changes to its physical, chemical and biological properties. Given the high anticipated volume of waste/spoil that will be generated, it is likely that the waste will be stockpiled on road sides. If it is not properly contained, rains could carry it along with runoff into other surface waters, leading to increased turbidity and siltation. This could affect aquatic resources such as fisheries and aquatic invertebrates. Page | 13 5.2.2.7 Temporary Visual Intrusion Construction activities will require material, equipment and cordons at healthcare facilities. Since facilities under renovation would not be closed from access by the public,these activities and materials thereof will cause temporary visual intrusion at all sites. This may be exacerbated by the contractor setting up camp on site. 5.2.3 Operation Phase 5.2.3.1 Visual Intrusion Health Care Facilities rehabilitation and upgrading will change the characters of the area (marred landscapes). The clearing of vegetation required for the refurbishment of existing buildings will impact the visual amenity of nearby houses and surrounding communities. 5.3 SOCIAL AND HEALTH IMPACTS 5.3.1 Planning Phase Impacts 5.3.1.1 Anxiety and Anticipation The planning stage is bringing a lot of anxiety and anticipation as both staff and management do not know exactly which facilities are involved, what civil works will take place, and when they will happen. As a result, management has temporarily stopped various programs whilst waiting for the promised rehabilitation. The hospitals/clinics cannot do patch work until there is a clear agreement on when and how the promised extension and refurbishments will be undertaken. 5.3.1.2 Poor Stakeholder Participation Despite various efforts (e.g. newspaper notices, bulletins at the potential sites, announcement at various local meetings) to reach out to people affected by the project, there has been relatively low participation of communities, staff members and other stakeholders during project planning and designing. There is a risk that, despite this low participation, people will start complaining about being left out, once the project is under way. 5.3.2 Construction Phase 5.3.2.1 Disruption of Utilities Service The excavation and cutting during construction may cause temporary disruptions of utility services such as electricity communication and water. Such disruptions may incur the anger of the communities in the project area. 5.3.2.2 Temporary disruption of healthcare services Since facilities under renovation will not be closed, they will experience shortages of working space. Thus modifications of buildings in which medical services are provided may entail moving patients or equipment from one area or room to another. This may cause temporary disruption in delivery of health services to patients at facilities under renovation. Page | 14 5.3.2.3 Occupational Safety and Health The safety of the local population may be at risk during construction activities. The movement of trucks to and from the site, the operation of various equipment and machinery and the actual construction activities will expose the workers to work-related accidents and injuries. Pollutants such as dust and noise could also have negative implications for the health of workers and near-by communities. 5.3.2.4 Impacts of construction activities on patients, healthcare staff and other stakeholders. Refurbishment work undertaken in the same buildings having patients has potential to cause injuries to patients or health workers. At all sites, renovation works will have the following potential hazards to staff and patients: Exposure to asbestos containing materials. (Old Buildings with asbestos roofs). Falling from tripping on building materials. Noise and vibrations during demolition Injury from falling or flying debris when demolishing walls Cracking of existing structures from vibrations Spillages and dust during transportation of materials 5.3.2.5 Noise Noise and vibration caused by machines, site vehicles, pneumatic drills etc will be commonplace during construction activities. These impacts can affect the quietness of the communities and provoke irritation and anger. 5.3.2.6 Traffic Communities around the rehabilitation sites will experience heavier human and vehicular traffic. Construction related activities will be a nuisance to road users e.g. storage of construction stones by the roadside. 5.3.2.7 Social misdemeanor by construction workers While most workers may originate from the local community where they have families, there might be others from distant places and working away from their families. Contractors might be lionized as being wealthy by local people especially for HCFs in rural settings or trading centers. With some disposable income to spend, this might induce illicit sexual relationships, with attendant risk for spread of HIV/AIDS. Also criminal activities may increase at the facilities due to the high population. 5.3.2.8 Income to material/ equipment suppliers and contractors The proposed renovation of health facilities will necessitate the procurement of equipment, construction materials and services, providing income to suppliers and contractors. This is a positive but short-term and reversible impact. Considering that construction labor would be local or national but medical equipment will be procured internationally. This impact has local, national and international spatial extent. Page | 15 5.3.3 Operation Phase 5.3.3.1 Employment opportunities Equipping healthcare facilities with modern equipment, enabling provision of new healthcare services and resultant increase in visiting patients may create additional long- term technical and non-technical job opportunities for medical professionals, janitors, security guards, etc. 5.3.3.2 Road Accidents The improvement of access and quality of Health Care Facilities will translate into a higher pedestrian traffic (patients and staff). This could increase the likelihood of road accidents. 5.3.3.3 Improved medical services at healthcare facilities The project will positively impact on the health of the Swazis through easing access to quality medical care currently nonexistent at these facilities. Renovation of facilities and installation of medical equipment will enable currently ineffective healthcare facilities to provide new or improved services to patients such as maternity. Renovation of HCF will save money for poor people when it is no longer necessary to travel to distant medical facilities for healthcare services. This is a long-term secondary benefit. 5.3.3.4 Improvement in livelihoods and local economies Improved healthcare will reduce morbidity; improve labor productivity and household incomes leading to the long-term benefit of improved local economies. 5.3.3.5 Reduced public risks due to improvement in healthcare waste management Proper management of medical waste involving segregation of hazardous from non- hazardous streams and proper disposal would mitigate existing public health risk associated with improper disposal of healthcare waste. Properly designed healthcare waste incineration units without stack plume downwash would avoid offsite health risk associated with incineration emissions. 5.3.3.6 Improved aesthetics and life of healthcare facilities Renovation will improve aesthetics of healthcare facilities which, in present state, look dilapidated. Some buildings currently under use, have been condemned as unfit for occupation. Renovation will also give healthcare buildings and equipment extended life. 5.3.3.7 Air pollution from onsite incinerators Incineration of the increased amounts of Health care waste if carried out in inappropriate facilities could result into localized pollution of air with pollutants such as respirable ash, furans and dioxins. Dioxins are known to promote cancers in humans. Downwash of incinerator emissions has potential to degrade indoor air quality of healthcare buildings or those of nearby offsite buildings. 5.3.3.8 Community health risk due to improper waste management Page | 16 Improper infectious waste disposal can cause public health risks due to environmental pollution: impaired air quality, wastewater/sewage handling, storm water contamination of water courses or when adults and children rummage through raw waste stockpiles. 5.3.3.9 Occupational health and safety risks Medical facilities are a potential source of infectious waste in gaseous, liquid or solid forms. These could pose unsafe conditions for healthcare staff. Of particular concern are janitors handling infectious waste (including sharps) without adequate protective gear, storage of sharps in containers that are not puncture-proof and management of radioactive waste at healthcare facilities where x-ray equipment will be installed. While some OHS risks will be borne by new equipment or services introduced after renovation or upgrade of facilities, most other effects are existing (hence cumulative) and would only be exacerbated by increased scale of healthcare services. 5.3.3.10 Fire Safety Fire Extinguishers are either not serviced or non-existent in most of the facilities. Without adequate provisions for fire safety, an outbreak at healthcare facilities could result in endangering life and/or financial loss. Fires can start from ignitable materials in laboratories, cigarette smoking in non-designated places or old electrical connections. 5.3.3.11 Misuse or inability to use installed equipment Healthcare staff must have the requisite training and skill to use installed equipment for improved service delivery. Lack of this training will have a significant, negative medium-term but reversible impact. Page | 17 CHAPTER SIX THE SCREENING PROCESS 6.1 INTRODUCTION TO THE SCREENING PROCESS Environmental assessment requirements are governed by the Environmental Audit, Assessment and Review Regulations of 2000. These regulations apply to all sectors of the biophysical and social environment. Part C of the Regulations makes it compulsory to carry out a screening process for all development projects, programmes or activities likely to affect the human and social environment on account of their size or type. The ultimate purpose of the screening process is to obtain an Environmental Compliance Certificate (ECC) from the SEA, which officially gives the project the green light to proceed notwithstanding any other permission from other authorities that may be required. The activities and works that are likely to be subjected to EA can be classified into three categories: Category 1: projects under this category are unlikely to cause any significant environmental impact and do not require any additional environmental assessment. Category 2: projects under this category are likely to cause environmental impacts, some of which may be significant unless mitigation actions are taken. Such projects cause impacts which are relatively well known and easy to predict. Also, the mitigation actions to prevent or reduce the impacts are well known. Category 3: projects under this category are likely to have significant adverse environmental impacts whose scale, extent and significance cannot be determined without in-depth study. Appropriate mitigation measures can only be identified after such study. The World Bank requires that all projects financed by the Bank are screened for their potential environmental and social impacts to determine the appropriate extent and type of environmental work. The Bank classifies the proposed projects into one of four categories as follows: Category A: A proposed project is classified as Category A, if it is likely to have significant adverse environmental impacts that are sensitive, diverse, or unprecedented. These impacts may affect an area broader than the sites or facilities subject to physical works. Category B: A proposed project is classified as Category B, if its potential adverse environmental impacts on human populations or environmentally important areas ­ including wetlands, forests , grasslands and other natural habitats ­ are less adverse than those of category A projects. These impacts are site ­ specific , few if any of them are irreversible; and in most cases mitigatory measures can be designed more readily than for category A projects. Category C: A proposed project is classified as Category C, if it is likely to have minimal or no adverse environmental impacts. Page | 18 Category FI: If it involves investment of Bank funds through a financial intermediary in sub- projects that result in adverse environmental impacts. Comparison Of Swaziland's And The Banks' Environmental Screening Process. The Bank requires that all projects be screened and the requisite environmental assessment work be carried out based on these screening results. To ensure that future small scale sub- projects are implemented in an environmentally and socially sustainable manner the bank has developed an environmental and social screening process for small scale sub-projects consistent with OP 4.01. While Swaziland's EA procedures are generally consistent with the Bank's policies, there exists a gap regarding the screening of small scale sub-projects where the sites and potential adverse localized impacts cannot be identified prior to the appraisal of the project. Therefore the Swaziland Health, HIV/AIDS and TB Project will use the environmental and social screening process as described herein. The sections below (steps 1-7) detail the stages of the environmental and social screening process (the screening process) leading towards the review and approval of any sub-project for rehabilitation, that will be undertaken in the Swaziland Health, HIV/AIDS, and TB Project The purpose of this screening process is (a) to determine which construction and rehabilitation activities are likely to have potential negative environmental and social impacts; (b) to determine appropriate mitigation measures for activities with adverse impacts; (c) to incorporate mitigation measures into the development plans; (d) to review and approve construction and rehabilitation proposals, and (e) to monitor environmental parameters during the construction and rehabilitation of the Health Care Facilities and their subsequent operation and maintenance. The extent of environmental work that might be required prior to the commencement of construction and rehabilitation of the Health Care Facilities will depend on the outcome of the screening process described below. 6.2. STEP 1: SCREENING OF PROJECT ACTIVITIES AND SITES. Prior to going to the sites, a desk appraisal of the upgrading and rehabilitation plans, including designs, will be carried out by a technical team comprising experts from i) Environmental Heath Department of Ministry of Health (EHD - MoH), ii) Environmental Heath Department of the Regional/Local Authority, iii) SEA, and iv) Works Department, to ensure that all pertinent environmental issues are identified. Subsequently, the initial screening in the field will be carried out through the use of the Environmental and Social Screening Form (Appendix 1). This form will be completed by Health Facility Manager, with assistance from the technical team. which will be led by the Environmental Heath Department of Ministry of Health (EHD - MoH) or a consultancy engaged by the Ministry of Health. Page | 19 Completion of this screening form will facilitate the identification of potential environmental and social impacts, determination of their significance, assignment of the appropriate environmental category, proposal of appropriate environmental mitigation measures, and conduct any further environmental work, if necessary. Suitably qualified officials will conduct the screening process and if none are available, training will be provided. 6.3. STEP 2: ASSIGNING THE APPROPRIATE ENVIRONMENTAL CATEGORIES The assignment of the appropriate environmental category to a particular upgrading or rehabilitation activity will be based on the information provided in the environmental and social screening form (Appendix 1). The technical team of experts, will be responsible for categorizing a construction or rehabilitation activity either as A, B, or C ­ The assignment of the appropriate environmental category will be based on provisions in Operational Policy (OP) 4.01 Environmental Assessment. Consistent with this operational policy, most upgrading and rehabilitation activities of the current project are likely to be categorized as B, meaning that their potential adverse environmental impacts on human populations or environmentally important areas ­ including wetlands, forests, grasslands, and other natural habitats ­ are site-specific, few if any of the impacts are irreversible, and they can be mitigated readily. Some rehabilitation activities such as the water proofing of leaky roofs or painting buildings might be categorized as "C" if the environmental and social screening results indicate that such activities will have no significant environmental and social impacts and therefore do not require additional environmental work. Thus, if the screening form has only "No" entries, the proposed activity will not require further environmental work, and the technical team of experts will recommend approval of this proposal and implementation can proceed immediately in line with category 1 of the Government of Swaziland EIA guidelines. The environmental category "A" (significant, irreversible impacts) most likely will not apply to the construction, upgrading and rehabilitation activities to be funded in the proposed project. 6.4 STEP 3: CARRYING OUT ENVIRONMENTAL WORK After reviewing the information provided in the environmental and social screening form (Appendix 1), and having determined the appropriate environmental category, the technical Team of experts will carry out the required environmental work, that is to determine, whether (a) the application of simple mitigation measures outlined in the Environmental and Social screening form (Appendix 1) will suffice; or whether further Environmental work needs to be done. 6.5 STEP 4: REVIEW AND APPROVAL OF THE PROJECT ACTIVITIES (a) Review Under the guidance of the technical team of experts, the central level Consisting of SEA, MoH and Works Department, will review :(i) the results and recommendations Page | 20 presented in the environmental and social screening forms; (ii) the proposed mitigation measures ; and (iii) as appropriate, progress of any further environmental work.. (b) Recommendation for Approval/Disapproval: Based on the results of the above review process, and discussions with the relevant stakeholders and potentially affected persons, the Central level will make recommendations to SEA for approval/disapproval and endorsement of the review results and proposed mitigation measures. (c) National level review and approval: After the first stage of screening, the Central Level will determine which of the sub-projects require further environmental work. 6.6 STEP 5: PUBLIC CONSULTATION AND DISCLOSURE Public consultations are critical in preparing an effective proposal for the upgrading and rehabilitation of the health care facilities. The first step is to hold public consultations with the local communities and all other interested/affected parties during the screening process and in the course of any further environmental work. These consultations should identify key issues and determine how the concerns of all parties will be addressed. The public consultation methods include press conferences, information notices, brochures/fliers, interviews, questionnaires and polls, open houses, community meetings, advisory committees, and public hearings. The guidelines for public consultation include, among others, a requirement that major elements of the consultation program should be timed to coincide with significant planning and decision-making activities in the project cycle. In terms of Swaziland's EA process, public consultation should be undertaken during (i) the preparation of the EA terms of reference; (ii) the carrying out of an EA; (iii) government review of an EA report; and (iv) the preparation of environmental terms and conditions of approval. To meet the consultation and disclosure requirements of the Bank, the Swaziland Government will issue a disclosure letter to inform the Bank of (i) the Government's approval of the EAFCMP; (ii) the actual disclosure of these documents to all relevant stakeholders and potentially affected persons in Swaziland, and (iii) the Government's authorization to the Bank to disclose these documents in its Info shop in Washington D.C. The steps towards disclosure of the safeguard documents have to be completed prior to appraisal of the Project as required by the Bank's Disclosure Policy OP 17.50. 6.7 STEP 6: MONITORING Environmental monitoring needs to be carried out during the upgrading and rehabilitation of the Health Care Facilities. The Contractor will have contractual obligations to mitigate any environmental or social impacts they cause as outlined in Appendix 4. During the rehabilitation/refurbishment, designated members of the technical team of experts will be responsible for the monitoring of :(i) refurbishment techniques and the inclusion of environmental design features as required in the architectural plans; (ii) provisions for traffic safety, reduction of noise and dust levels; (iii) construction of site waste management (proper storage of construction materials, sanitation, solid waste disposal, Page | 21 waste water disposal); and (v) the implementation of plans for the restoration of the construction sites once the rehabilitation work has been completed. 6.8 STEP 7: MONITORING INDICATORS In order to be able to assess the effectiveness of the proposed construction and rehabilitation and the subsequent operation and maintenance, the following will be used as indicators for monitoring the rehabilitation programmes: Hectarage of vegetation clearance. Length of infrastructure rehabilitated. Hectarage of leveled land Number of pit latrines for excreta disposal for workers Quality of construction materials for the camps and lodges Quality of water discharged from the establishments. Number of employment opportunities for locals 6.9 SUMMARY OF THE SCREENING PROCESS Each project funded by the World Bank will have to undergo the Environmental and Social screening process. If it is assigned category 1 and 2 (Swaziland Guidelines) or B and C (World Bank) then no further environmental work will be needed and the Environmental Audit Framework and Comprehensive management plan herein will be applied at the facility. If it is assigned category 3 (Swaziland Guidelines) or A or complex B (World Bank) then further environmental work will be required. Figure 5.1 below is an outline of the screening process: Category 1 & 2 (B & C) CENTRAL LEVEL SEA Technical Technical team: team Review the recommendations in the screening Approval/disapproval Endorsement Monitoring: form of review results and of the approval Construction Review the proposed mitigation measures from proposed mitigation techniques checklists measures Inclusion of Conduct public consultation environmental Make recommendations to Central level design features. Facility Management and Technical Team Technical team Screening of Project activities and sites. (To be based on checklist and screening Assignment of appropriate form) environmental category, based on Desk appraisal of the Environmental and Social screening construction and rehabilitation forms and World Bank OP 4.01. plans (Tech. Team) Identification of Environmental Proposal of mitigation measures and social impacts (Mang & Determination of the need for EIA Tech. Team) Determination of the need for RAPS Determination of Significance of impacts Category 3 (A) Refer to SEA, WorldBank or Lands Ministry EIA required Preparation of project brief RAP required based on RPF Preparation of EIA (Ref. Category 3 of Swaziland EIA Guidelines and Preparation of RAP World Bank OP 4.01) Determination of Consultant. Figure 6.1 .......An outline of the screening process Page | 22 CHAPTER SEVEN:- ENVIRONMENTAL MANAGEMENT PLANS (EMP) 7.1 INTRODUCTION The proposed impact monitoring and management plans (Table 7.1, 7.2 and 7.3) for the proposed renovation works of healthcare facilities in Swaziland, provide guidelines for the management of potential environmental and social aspects at the three levels of the Health Care Facilities, i.e. clinic, health centre and government hospital. In each case the EMP identifies parties responsible for monitoring actions, and any training or capacity building needs. Mitigation measures have been identified that will reduce both existing and potential impacts associated with existing facilities and rehabilitation/upgrading on the proposed project. In addition, mitigation measures are identified as either social or physical measures. Social mitigation includes the measures used to mitigate effects such as noise, land use, and other effects to the human environment. Physical mitigation includes measures that address impacts to the physical environment, such as biological communities, vegetation, air quality, and others. The Ministry of Health will be responsible for the implementation of the environmental management plans (EMPs) for all the health care centres to be rehabilitated and is committed to an ongoing public consultation during the rehabilitation phase. Page | 23 7.2 ENVIRONMENTAL MANAGEMENT PLAN FOR A CLINIC Table 7.1: Environmental Management Plan - Clinic. TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY BUILDING REFERENCE 5.2 ENVIRONMENTAL IMPACTS 5.2.1 Planning Phase 5.2.1.1 Physical Restrictions on Building Space The size of construction sites are generally small. Does not apply for refurbishing existing buildings but may entail the MoH and None erection of high rise buildings for any lateral expansion. Contractor The construction sites are on steep terrain, institute measures to reduce erosion potential like stabilising slopes MoH and None and planting vegetation Contractor 5.2.2 Construction Phase 5.2.2.1 Flora and Fauna Limited Vegetation clearing may be done Sensitive habitats will be avoided MoH and Environmental Clearing will be limited to working areas only Contractor awareness training 5.2.2.2 Soil and land degradation Point source contamination from diesel, lubricants etc around workshop Appropriate containment measures for all operational areas MoH and Environmental areas. and proper disposal of used lubricants. Contractor awareness training Increased soil erosion due to vegetation clearing , soil trampling and Soil erosion control measures (e.g. re-vegetation, reseeding of compaction grasses, land preparation, terracing etc) Increased rapid runoff due to vegetation clearing and soil compaction diminishing infiltration capacity Deterioration of soil characteristics due to increased erosion 5.2.2.4 waste management Activities at construction sites will produce construction wastes whose Seek guidance of local environmental officers to identify MoH; Likely hazardous disposal will pose a threat to the environment. acceptable disposal sites Contractor; and non-hazardous Contractors will undertake waste segregation at source to Local construction waste separate hazardous from non-hazardous waste Environmental Officer. 5.2.2.5 Ambient air quality deterioration due to dust Air Quality will be impacted by emissions from vehicles, earthmoving Contractors will use dust screens or nets in windows, doorways and MoH and None equipment and released particulate matters. ventilators of rooms where demolition or other dusty construction Contractor Demolition to modify the built environment will lead to considerable activities are occurring levels of cement dust which can affect workers and patients. 5.2.2.7 Temporary Visual Intrusions Page | 24 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY BUILDING REFERENCE Construction materials and contractor camps will cause temporary visual Contractor will ensure minimum footprint of construction activities Contractor and none blight at sites. and provide decent accommodation for workers. facility management. 5.2.3 Operation Phase 5.2.3.1 Visual Intrusions Health Care Facilities rehabilitation and upgrading will change the characters All altered landscapes (Sand pits etc) will be rehabilitated by the of the area (marred landscapes). contractor 5.3 SOCIAL AND HEALTH IMPACTS 5.3.1 Planning Phase 5.3.1.2 Poor Stakeholder Participation Poor participation of communities, staff members and other stakeholders in All relevant stakeholders will be continuously involved and attend MoH and None the planning and designing of the project. meetings from planning to construction Contractor 5.3.2 Construction Phase 5.3.2.2 Temporary disruption of healthcare services Since facilities under renovation will not be closed, they will experience Plan pre-construction activities early to identify suitable rooms or MoH; None shortages of working space. adjoining buildings into which to relocate patients or service areas Contractor; with minimal inconvenience, especially to patients under intensive HC care Administrator/ Refurbishment will be in phases so that the whole facility is not Superintendent disrupted at once. 5.3.2.3 Occupational Health Safety risks to construction workers The movement of trucks to and from the site, the operation of various All safety precautions must be enforced MoH and Application of equipment and machinery and the actual construction activities will Provide PPE to all workers Contractor various types of PPE expose the workers to work-related accidents and injuries. and their proper Pollutants such as dust and noise could also have negative implications use. for the health of workers. 5.3.2.4 Impacts of Construction Activities on Patients, healthcare workers or other stakeholders Page | 25 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY BUILDING REFERENCE Refurbishment work undertaken in the same buildings having patients has Contractors will cordon off areas under construction MoH and Good construction potential to cause inconvenience or even injuries to the patients. Ensure good housekeeping and clean operations always Contractor practices immediately removing rubble strewn outside construction areas. Construction workers will limit verbal noise or other forms of noise during renovation works inside medical buildings Contractors will use screens or nets to avoid flying debris and dust 5.3.2.5 Noise Noise and vibration caused by machines, site vehicles, pneumatic drills etc Contractor to avoid old equipment MoH and None Heavy duty equipment to be minimized Contractor Noisy operations to be limited to certain times Noise levels to be limited to within acceptable levels 5.3.2.7 Social misdemeanor by construction workers Impacts associated with the contractor's camp include: As a contractual obligation, contractors will be required to have MoH ; None disposal of liquid and solid wastes. an HIV/AIDS policy and a framework (responsible staff, action Contractor theft, alcoholism and sexually transmitted diseases (especially HIV/AIDS). plan, etc) to implement it during project execution. Contractor to curb thefts and misbehavior through a code of conduct Contractor to manage any of its waste properly 5.3.3 Operation Phase 5.3.3.1 Employment Opportunities Expanded Health care facilities will result in more patients coming and thus Offer appropriate training for staff to manage the improved MoH and facility Staff training in create long-term technical and non-technical job opportunities at the facilities. facilities. management operation of improved facilities 5.3.3.3 Improved medical services at healthcare facilities Improved health care facilities will ease the access to quality medical care Renovation of healthcare facilities will be matched with MoH and Staff training in currently nonexistent at these facilities. commensurate staffing with medical personnel adequately trained supplier operation of newly Renovation of facilities and installation of medical equipment will enable in the use of newly installed equipment installed medical currently ineffective healthcare facilities to provide new or improved services equipment to patients such as maternity 5.3.3.4 Improvement in livelihoods and local economies Page | 26 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY BUILDING REFERENCE Improved healthcare will reduce morbidity and hence improve productivity Leadership will promote viable economic activities. MoH and local Stake holder and lifestyles. leadership training in entrepreneurship. 5.3.3.5 Reduced public risks due to improvement in healthcare waste management (including incineration) Improvements in the healthcare waste management systems will reduce Further raise awareness of the need to manage waste properly. MoH Operation of public risks. incineration units 5.3.3.6 Improved aesthetics and life of healthcare facilities Renovation of healthcare facilities will improve their aesthetics and this will be Maintenance teams to be stationed at the Health Care facilities. MoH and facility Maintenance Staff maintained. Planned maintenance of machines and buildings to be management training in the instituted maintenance of newly installed medical equipment 5.3.3.7 Air pollution from onsite incinerators Incineration of the increased amounts of Health care waste if carried out in Incinerator stacks designed according to GIIP or WBG MoH; Operation of inappropriate facilities could result into localized pollution of air with guidelines Healthcare incineration unit/ pollutants such as respirable ash, furans and dioxins Incinerators will be properly operated facility facility administrator Page | 27 7.3 ENVIRONMENTAL MANAGEMENT PLAN FOR A HEALTH CENTRE Table 7.2: Environmental Management Plan - Health Centre. TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING AND TRAINING REQUIREMENTS 5.2 ENVIRONMENTAL IMPACTS 5.2.1 Planning Phase 5.2.1.1 Physical Restrictions on Building Space The size of construction sites are generally small. Does not apply for refurbishing existing buildings but may entail MoH and None the erection of high rise buildings for any lateral expansion. Contractor The construction sites are on steep terrain, institute measures to reduce erosion potential like stabilising MoH and None slopes and planting vegetation Contractor 5.2.2 Construction Phase 5.2.2.1 Flora and Fauna Limited Vegetation clearing may be done Sensitive habitats will be avoided MoH and Environmental Clearing will be limited to working areas only Contractor awareness training 5.2.2.2 Soil and land degradation Point source contamination from diesel, lubricants etc around Appropriate containment measures for all operational areas MoH and Environmental workshop areas. and proper disposal of used lubricants. Contractor awareness Increased soil erosion due to vegetation clearing , soil trampling and Soil erosion control measures (e.g. re-vegetation, reseeding training compaction of grasses, land preparation, terracing etc) Increased rapid runoff due to vegetation clearing and soil compaction diminishing infiltration capacity Deterioration of soil characteristics due to increased erosion 5.2.2.4 waste management Activities at construction sites will produce construction wastes whose Seek guidance of local environmental officers to identify MoH; Likely hazardous disposal will pose a threat to the environment. acceptable disposal sites Contractor; and non- Contractors will undertake waste segregation at source to Local hazardous separate hazardous from non-hazardous waste Environmental construction Officer. waste 5.2.2.5 Ambient air quality deterioration due to dust Page | 28 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING AND TRAINING REQUIREMENTS Air Quality will be impacted by emissions from vehicles, earthmoving Contractors will use dust screens or nets in windows, doorways MoH and None equipment and released particulate matters. and ventilators of rooms where demolition or other dusty Contractor Demolition to modify the built environment will lead to considerable construction activities are occurring levels of cement dust which can affect workers and patients. 5.2.2.7 Temporary Visual Intrusions Construction materials and contractor camps will cause temporary visual Contractor will ensure minimum footprint of construction Contractor and none blight at sites. activities and provide decent accommodation for workers. facility management. 5.2.3 Operation Phase 5.2.3.1 Visual Intrusions Health Care Facilities rehabilitation and upgrading will change the characters All altered landscapes (Sand pits etc) will be rehabilitated by the of the area (marred landscapes). contractor 5.3 SOCIAL AND HEALTH IMPACTS 5.3.1 Planning Phase 5.3.1.1 Anxiety and Anticipation Project planning lacks transparency and has taken rather long. The planning stage must be shortened and on commencement MoH and None the implementation must be within schedule. Contractor 5.3.1.2 Poor Stakeholder Participation Poor participation of communities, staff members and other stakeholders in All relevant stakeholders will be continuously involved and attend MoH and None the planning and designing of the project. meetings from planning to construction Contractor 5.3.2 Construction Phase 5.3.2.1 Disruption of Utilities Services The excavations during refurbishments may cause temporary disruptions of Any service disruption must be reconnected as soon as MoH ; None utility services such as electricity communication and water. possible Contractor; Alternative means of providing the service must also be HC Administrator/ used. Superintendent 5.3.2.2 Temporary disruption of healthcare services Since facilities under renovation will not be closed, they will experience Plan pre-construction activities early to identify suitable rooms or MoH; None shortages of working space. adjoining buildings into which to relocate patients or service Contractor; areas with minimal inconvenience, especially to patients under HC Administrator/ intensive care Superintendent Refurbishment will be in phases so that the whole facility is not disrupted at once. Page | 29 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING AND TRAINING REQUIREMENTS 5.3.2.3 Occupational Health Safety risks to construction workers The movement of trucks to and from the site, the operation of various All safety precautions must be enforced MoH and Application of equipment and machinery and the actual construction activities will Provide PPE to all workers Contractor various types of expose the workers to work-related accidents and injuries. PPE and their Pollutants such as dust and noise could also have negative implications proper use. for the health of workers. 5.3.2.4 Impacts of Construction Activities on Patients, healthcare workers or other stakeholders Refurbishment work undertaken in the same buildings having patients has Contractors will cordon off areas under construction MoH and Good potential to cause inconvenience or even injuries to the patients. Ensure good housekeeping and clean operations always Contractor construction immediately removing rubble strewn outside construction practices areas. Construction workers will limit verbal noise or other forms of noise during renovation works inside medical buildings Contractors will use screens or nets to avoid flying debris and dust 5.3.2.5 Noise Noise and vibration caused by machines, site vehicles, pneumatic drills etc Contractor to avoid old equipment MoH and None Heavy duty equipment to be minimized Contractor Noisy operations to be limited to certain times Noise levels to be limited to within acceptable levels 5.3.2.6 Traffic Communities around the rehabilitation sites will experience heavier human Traffic safety procedures to be observed by construction workers. MoH and None and vehicular traffic. Contractor 5.3.2.7 Social misdemeanor by construction workers Impacts associated with the contractor's camp include: As a contractual obligation, contractors will be required to MoH ; None disposal of liquid and solid wastes. have an HIV/AIDS policy and a framework (responsible staff, Contractor theft, alcoholism and sexually transmitted diseases (especially action plan, etc) to implement during project execution. HIV/AIDS). Contractor to curb thefts and misbehavior through a code of conduct Contractor to manage any of its waste properly Page | 30 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING AND TRAINING REQUIREMENTS 5.3.2.8 Income to equipment ad material suppliers Project will promote local procurement where technically or commercially For earth materials, procure from legitimate sources to avoid MoH and None reasonable and feasible. encouraging environmental degradation Contractor 5.3.3 Operation Phase 5.3.3.1 Employment Opportunities Expanded Health care facilities will result in more patients coming and thus Offer appropriate training for staff to manage the improved MoH and facility Staff training in create long-term technical and non-technical job opportunities at the facilities. management operation of facilities. improved facilities 5.3.3.3 Improved medical services at healthcare facilities Improved health care facilities will ease the access to quality medical care Renovation of healthcare facilities will be matched with MoH and supplier Staff training in currently nonexistent at these facilities. commensurate staffing with medical personnel adequately operation of Renovation of facilities and installation of medical equipment will enable trained in the use of newly installed equipment newly installed currently ineffective healthcare facilities to provide new or improved medical services to patients such as maternity equipment 5.3.3.4 Improvement in livelihoods and local economies Improved healthcare will reduce morbidity and hence improve productivity Leadership will promote viable economic activities. MoH and local Stake holder and lifestyles. leadership training in entrepreneurshi p. 5.3.3.5 Reduced public risks due to improvement in healthcare waste management (including incineration) Improvements in the healthcare waste management systems will reduce Further raise awareness of the need to manage waste properly. MoH Operation of public risks. incineration units 5.3.3.6 Improved aesthetics and life of healthcare facilities Renovation of healthcare facilities will improve their aesthetics and this will Maintenance teams to be stationed at the Health Care MoH and facility Maintenance be maintained. facilities. management Staff training in Planned maintenance of machines and buildings to be the maintenance instituted of newly installed medical equipment 5.3.3.7 Air pollution from onsite incinerators Page | 31 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING AND TRAINING REQUIREMENTS Incineration of the increased amounts of Health care waste if carried out in Incinerator stacks designed according to GIIP or WBG MoH; Operation of inappropriate facilities could result into localized pollution of air with guidelines Healthcare facility incineration pollutants such as respirable ash, furans and dioxins Incinerators will be properly operated administrator unit/ facility 5.3.8 Community health risk due to improper waste management Improper infectious waste disposal can cause public health risks due to Ensure proper waste management practices as recommended in Healthcare facility None environmental pollution. the healthcare waste management Plan for Swaziland. administrator/ Waste information system will put in place/implemented. Superintend 5.3.3.9 Occupational health and safety risks Medical facilities are a potential source of infectious waste in gaseous, liquid Provide PPE to all workers Healthcare facility None or solid forms. These could pose unsafe conditions for healthcare staff administrator/ Superintend 5.3.3.10 Fire Safety Fire Extinguishers are either not serviced or non-existent in most of the Provide fire extinguishers to healthcare facilities MoH Basic fire facilities posing a high a risk of fire outbreak at the healthcare facilities with Train staff on fire management fighting skills disastrous life and financial impact 5.3.3.11 Misuse or inability to use installed equipment Use of the improved facilities will be impaired if the staff are not fully Provide requisite training during equipment installation MoH Training on use trained. of all new gadgets. Page | 32 7.4 ENVIRONMENTAL MANAGEMENT PLAN FOR A HOSPITAL Table 7.3: Environmental Management Plan - Hospital. TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING 5.2 ENVIRONMENTAL IMPACTS 5.2.1 Planning Phase 5.2.1.1 Physical Restrictions on Building Space The size of construction sites are generally small. Does not apply for refurbishing existing buildings but may entail the MoH and None erection of high rise buildings for any lateral expansion. Contractor The construction sites are on steep terrain, institute measures to reduce erosion potential like stabilising slopes MoH and None and planting vegetation Contractor 5.2.2 Construction Phase 5.2.2.1 Flora and Fauna Limited Vegetation clearing may be done Sensitive habitats will be avoided MoH and Environmental Clearing will be limited to working areas only Contractor awareness training 5.2.2.2 Soil and land degradation Point source contamination from diesel, lubricants etc around Appropriate containment measures for all operational areas MoH and Environmental workshop areas. and proper disposal of used lubricants. Contractor awareness training Increased soil erosion due to vegetation clearing , soil trampling and Soil erosion control measures (e.g. re-vegetation, reseeding of compaction grasses, land preparation, terracing etc) Increased rapid runoff due to vegetation clearing and soil compaction diminishing infiltration capacity Deterioration of soil characteristics due to increased erosion 5.2.2.3 Traffic accidents high traffic volume around the Health Care Facilities and within the Ensure drivers respect speed limits through built areas and MoH and Contractor needs communities resulting in accidents urban centers. Contractor speed awareness Employ safe traffic control measures, including temporary through built areas road signs and flag persons to warn of dangerous conditions and urban areas and children crossings 5.2.2.4 waste management Page | 33 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING Activities at construction sites will produce construction wastes whose Seek guidance of local environmental officers to identify MoH; Likely hazardous disposal will pose a threat to the environment. acceptable disposal sites Contractor; and non- Contractors will undertake waste segregation at source to Local hazardous separate hazardous from non-hazardous waste Environmental construction waste Officer. 5.2.2.5 Ambient air quality deterioration due to dust Air Quality will be impacted by emissions from vehicles, Contractors will use dust screens or nets in windows, doorways and MoH and None earthmoving equipment and released particulate matters. ventilators of rooms where demolition or other dusty construction Contractor Demolition to modify the built environment will lead to activities are occurring considerable levels of cement dust which can affect workers and patients. 5.2.2.6 Water Quality Water quality will be impacted by wastewater discharges from Contractor to erect proper sanitary facilities MoH and None construction activities including . onsite sewage and rainwater run-off. Pollution from lubricants and other wastes to be avoided. Contractor 5.2.2.7 Temporary Visual Intrusions Construction materials and contractor camps will cause temporary Contractor will ensure minimum footprint of construction activities Contractor and none visual blight at sites. and provide decent accommodation for workers. facility management. 5.2.3 Operation Phase 5.2.3.1 Visual Intrusions Health Care Facilities rehabilitation and upgrading will change the All altered landscapes (Sand pits etc) will be rehabilitated by the characters of the area(marred landscapes). contractor 5.3 SOCIAL AND HEALTH IMPACTS 5.3.1 Planning Phase 5.3.1.1 Anxiety and Anticipation Project planning lacks transparency and has taken rather long. The planning stage must be shortened and on commencement the MoH and None implementation must be within schedule. Contractor 5.3.1.2 Poor Stakeholder Participation Poor participation of communities, staff members and other All relevant stakeholders will be continuously involved and attend MoH and None stakeholders in the planning and designing of the project. meetings from planning to construction Contractor 5.3.2 Construction Phase 5.3.2.1 Disruption of Utilities Services The excavations during refurbishments may cause temporary disruptions Any service disruption must be reconnected as soon as MoH ; None of utility services such as electricity communication and water. possible Contractor; Page | 34 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING Alternative means of providing the service must also be used. HC Administrator/ Superintendent 5.3.2.2 Temporary disruption of healthcare services Since facilities under renovation will not be closed, they will experience Plan pre-construction activities early to identify suitable rooms or MoH; None shortages of working space. adjoining buildings into which to relocate patients or service areas Contractor; with minimal inconvenience, especially to patients under intensive HC care Administrator/ Refurbishment will be in phases so that the whole facility is not Superintendent disrupted at once. 5.3.2.3 Occupational Health Safety risks to construction workers The movement of trucks to and from the site, the operation of All safety precautions must be enforced MoH and Application of various equipment and machinery and the actual construction Provide PPE to all workers Contractor various types of activities will expose the workers to work-related accidents and PPE and their injuries. proper use. Pollutants such as dust and noise could also have negative implications for the health of workers. 5.3.2.4 Impacts of Construction Activities on Patients, healthcare workers or other stakeholders Refurbishment work undertaken in the same buildings having patients has Contractors will cordon off areas under construction MoH and Good construction potential to cause inconvenience or even injuries to the patients. Ensure good housekeeping and clean operations always Contractor practices immediately removing rubble strewn outside construction areas. Construction workers will limit verbal noise or other forms of noise during renovation works inside medical buildings Contractors will use screens or nets to avoid flying debris and dust 5.3.2.5 Noise Noise and vibration caused by machines, site vehicles, pneumatic drills Contractor to avoid old equipment MoH and None etc Heavy duty equipment to be minimized Contractor Noisy operations to be limited to certain times Noise levels to be limited to within acceptable levels 5.3.2.6 Traffic Communities around the rehabilitation sites will experience heavier Traffic safety procedures to be observed by construction workers. MoH and None Page | 35 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING human and vehicular traffic. Contractor 5.3.2.7 Social misdemeanor by construction workers Impacts associated with the contractor's camp include: As a contractual obligation, contractors will be required to MoH ; None disposal of liquid and solid wastes. have an HIV/AIDS policy and a framework (responsible staff, Contractor theft, alcoholism and sexually transmitted diseases (especially action plan, etc) to implement it during project execution. HIV/AIDS). Contractor to curb thefts and misbehavior through a code of conduct Contractor to manage any of its waste properly 5.3.2.8 Income to equipment ad material suppliers Project will promote local procurement where technically or For earth materials, procure from legitimate sources to avoid MoH and None commercially reasonable and feasible. encouraging environmental degradation Contractor 5.3.3 Operation Phase 5.3.3.1 Employment Opportunities Expanded Health care facilities will result in more patients coming and Offer appropriate training for staff to manage the improved MoH and facility Staff training in thus create long-term technical and non-technical job opportunities at facilities. management operation of the facilities. improved facilities 5.3.3.2 Road Accidents The improved access and quality of Health Care Facilities will translate Clearly mark the roads and pedestrian walkways. MoH and facility into a higher pedestrian traffic (patients and staff), increasing the Enforce speed limits management likelihood of road accidents at the facilities. 5.3.3.3 Improved medical services at healthcare facilities Improved health care facilities will ease the access to quality medical Renovation of healthcare facilities will be matched with MoH and Staff training in care currently nonexistent at these facilities. commensurate staffing with medical personnel adequately trained supplier operation of newly Renovation of facilities and installation of medical equipment will enable in the use of newly installed equipment installed medical currently ineffective healthcare facilities to provide new or improved equipment services to patients such as maternity 5.3.3.4 Improvement in livelihoods and local economies Improved healthcare will reduce morbidity and hence improve Leadership will promote viable economic activities. MoH and local Stake holder productivity and lifestyles. leadership training in entrepreneurship. 5.3.3.5 Reduced public risks due to improvement in healthcare waste management (including incineration) Improvements in the healthcare waste management systems will reduce Further raise awareness of the need to manage waste properly. MoH Operation of public risks. incineration units 5.3.3.6 Improved aesthetics and life of healthcare facilities Page | 36 TEXT IMPACT MITIGATION/ENHANCEMENT RESPONSIBILITY CAPACITY REFERENCE BUILDING Renovation of healthcare facilities will improve their aesthetics and this Maintenance teams to be stationed at the Health Care MoH and facility Maintenance Staff will be maintained. facilities. management training in the Planned maintenance of machines and buildings to be maintenance of instituted newly installed medical equipment 5.3.3.7 Air pollution from onsite incinerators Incineration of the increased amounts of Health care waste if carried out Incinerator stacks designed according to GIIP or WBG MoH; Operation of in inappropriate facilities could result into localized pollution of air with guidelines Healthcare incineration unit/ pollutants such as respirable ash, furans and dioxins Incinerators will be properly operated facility facility administrator 5.3.8 Community health risk due to improper waste management Improper infectious waste disposal can cause public health risks due to Ensure proper waste management practices as recommended in Healthcare None environmental pollution. the healthcare waste management Plan for Swaziland facility administrator/ Superintend 5.3.3.9 Occupational health and safety risks Medical facilities are a potential source of infectious waste in gaseous, Provide PPE to all workers Healthcare None liquid or solid forms. These could pose unsafe conditions for healthcare facility staff administrator/ Superintend 5.3.3.10 Fire Safety Fire Extinguishers are either not serviced or non-existent in most of the Provide fire extinguishers to healthcare facilities MoH Basic fire fighting facilities posing a high a risk of fire outbreak at the healthcare facilities Train staff on fire management skills with disastrous life and financial impact 5.3.3.11 Misuse or inability to use installed equipment Use of the improved facilities will be impaired if the staff are not fully Provide requisite training during equipment installation MoH Training on use of trained. all new gadgets. Page | 37 Table 7.4 Indicative Funding Requirements For Mitigation Measures and HIV/AIDS awareness campaigns to be implemented by the MOH. Impact and Mitigation/Enhancement commitments Responsibility Incremental Costs (USD) for all 14 HCFs sites TOTAL CONSTRUCTION PHASE OHS risks to construction workers MoH and $ 2000 for a team of 50 workers at 1 HCF (hence $20,000 Provide PPE to all workers 20 000.00 Contractor for 10 HCFs). Injury to patients or healthcare workers by construction activities MoH and Contractors should use screens or nets to avoid flying debris and dust $ 250 at 1 HFC (hence $2,500 for 10 HC).Fs 2 500.00 Contractor Indoor air quality deterioration due to dust Contractors should use dust screens or nets in windows, doorways and ventilators of rooms MoH and $ 250 at 1 HFC (hence $2,500 for 10 HC).Fs 2 500.00 where demolition or other dusty construction activities are occurring Contractor Traffic accidents Employ safe traffic control measures, including temporary road signs and flag persons to MoH and $ 500 at 1 HCF site, (hence $5,000 for 10 HCF sites). 5 000.00 warn of dangerous conditions and children crossings Contractor Social misdemeanor by construction workers MoH ; As a contractual obligation, contractors should be required to have an HIV/AIDS policy and a $ 600 for 500 HIV/AIDS posters/fliers and free condoms Contractor 6 000.00 framework (responsible staff, action plan, etc) to implement it during project execution. (hence $6000 for 10 HCF sites) OPERATION PHASE Reduced public risks due to improvement in healthcare waste management (including incineration) Environmental audit cost: Reduced public risks due to improvement in healthcare waste management MoH USD5000 (for each of HCIV-IV). 50 000.00 (Hence $50000 for 10 HC F Sites.) Air pollution due to improperly designed incinerator stacks Incinerators are properly operated MoH USD 1000 per site (hence $10,000 for 10 HC F Sites) 10 000.00 Fire risk $100 per extinguisher Provide fire extinguishers to healthcare facilities MoH (Provide for at least 5 x 2 types/ units per HCF hence 1 000.00 $1000 for 10 HCF sites). TOTAL 97 000.00 Page | 38 7.5 PUBLIC CONSULTATION PLAN The implementing agency, Ministry of Health has the responsibility to effectively engage stakeholders in achieving the project objectives for the benefit of all. This public consultation plan (PCP) forms part of the EMPs and is the same for all the three categories of health care centres. It is for use during public consultation in the screening processes for every bank funded sub-project. 7.5.1 OBJECTIVES This plan provides a framework for achieving effective stakeholder involvement and promoting greater awareness and understanding of issues so that the project is carried out effectively within budget and on-time to the satisfaction of all concerned. To ensure effective implementation of this plan, the MoH shall be committed to the following principles: · promoting openness and communication; · ensuring effective stakeholder involvement in the development of the project; · increasing public knowledge and understanding of the project implementation process · using all strategies and techniques which provide appropriate, timely and adequate opportunities for all stakeholders to participate; and · evaluating the effectiveness of the engagement plan in accordance with the expected outcomes. 7.5.2 IDENTIFYING STAKEHOLDERS Stakeholders for the purpose of this project shall be defined as all those people and institutions that have an interest in the successful planning and execution of the project. This includes those likely to be positively and negatively affected by the project. Table 8.1 identifies the key stakeholders. Table 7.5: Stakeholder Identification Matrix AFFECTED PARTIES HOW TO IDENTIFY THEM People living in the vicinity of the proposed Identify the local government area(s) that falls within 500m radius works. (students, teachers, parents etc) of the proposed schools. Review available data to determine the profile of the whole stakeholder or relevant group. Use identified groups and individuals to tap into stakeholder networks to identify others. Special interest groups Identify key individuals or groups through organized groups, local clubs, community halls and religious places. Be aware of similar local groups or individuals. The consultation process shall ensure that all those identified as stakeholders are conferred with. Subject to MoH coordinator's approval, the Environmental/Social consultant will share information about the project with the public to enable meaningful contributions and thus enhance the success of the project Page | 39 Public consultation will take place through workshops, seminars, meetings, radio programs, request for written proposals/comments, questionnaire administration, public reading and explanation of project ideas and requirements 7.6 MITIGATION FUNDING 7.6.1 Cost of Design Measures Table 7.4 includes indicative financing for environmental and social mitigation measures related to the rehabilitation of the targeted facilities at different levels of the health system that are addressed by the project. Once the exact civil works are known, the quantities, specifications and estimated costs of design measures to avoid or mitigate negative impacts will be assessed by the civil design contractor and incorporated into the bidding documents, and the financing amounts will be finalized. The contractor will execute all required works and will be reimbursed through pay items in the bill of quantities, which will be financed by the project. 7.6.2 HIV/AIDS Awareness Program Table 7.4 includes indicative financing for HIV/AIDS awareness and condom distribution. The quantities, specifications and estimated costs of the HIV/AIDS Awareness Program and condom distribution will be assessed by the design consultant and incorporated into the works bidding documents. The contractor will execute the program through a subcontractor and will be reimbursed through pay items in the bill of quantities, which will be financed by the project. The Government of Swaziland is committed to finance approximately 20% of the total cost estimate of the implementation of the Mitigation Plan, as outlined in Table 7.4. The proposed project will finance the remaining 80% of the total cost estimate as outlined in Table 7.4. Page | 40 CHAPTER EIGHT CONCLUSION The proposed project has potential to significantly improve quality of healthcare services and efficiency of service provision in Swaziland with socio-environmental benefits such as reduced morbidity and increased productivity of labor hence higher household incomes (especially for rural agrarian communities); opportunity to have access to healthcare services hitherto unavailable at HCFs due to lack of equipment or facilities (e.g. operating theaters). Besides, project development and operation will provide considerable economic opportunity for material/equipment suppliers, construction contractors and medical professionals. One of the significant negative impact will arise from healthcare waste management, especially incineration. As the Health Care facilities provide their expanded services, more Health Care waste will be generated which if not taken care of will end up polluting the environment. Further, when incinerator stacks adopt a standard height irrespective of density of habitation and nature of nearby buildings, there is a risk of chronic exposure to incineration emissions due to plume downwash. This impact would be exacerbated by inadequately trained operators. Where raw medical waste continues to be improperly dumped at public dumps, the project would aggravate public health risk when children or people rummage through potentially infectious waste. However a Health Care Waste Management Plan (HCWMP) has been prepared for the project and will be used to mitigate this impact during the rehabilitation of the health care facilities. All potential adverse impacts can be mitigated through the implementation of the measures proposed (Chapter 5 ­ potential socio-environmental impacts), in which case benefits of this project to the nation would by far outweigh potential negative effects. Page | 41 BIBLIOGRAPHIES GoS, 1969, The Public Health Act, 1969, Government of Swaziland, Mbabane, Swaziland GoS, 2000, The Waste Regulations 2000, Legal Notice No. 31 of 2000, Government of Swaziland, Mbabane, Swaziland GoS, 2002, The Environment Management Act, Act No. 5 of 2002, Government of Swaziland, Mbabane, Swaziland MoH, 2002, National Environmental Health Policy, Environmental Health Department, Ministry of Health and Social Welfare, Government of Swaziland, Webster Printers Mbabane, Swaziland, April 2002. MoH, 2009, Health Care Waste Management plan for Swaziland, Environmental Health Department, Ministry of Health and Social Welfare, Government of Swaziland, Webster Printers Mbabane, Swaziland, August 2009. MoH, 2009, National Health Care Waste Management Guidelines, Zero Draft, Environmental Health Department, Ministry of Health and Social Welfare, Government of Swaziland, Mbabane, Swaziland, March 2009. NERCHA, 2009, Swaziland HIV Prevention Response and Modes of Transmission Analysis, National Emergency Response Council on HIV and AIDS, Mbabane, Swaziland, Supported by GHAP and UNAIDS, March 2009 Vilakati J. D. and Zuke S. (ed), 2009, Environment Matters, Swaziland Environmental Authority News Letter, Volume 1, issue 2, September 2009. World Bank, 2006, General Assessment of the Mbabane Government Hospital, Swaziland, Report No. 45867 ­ SZ World Bank, 2008 (a), Safeguard Policies Basics, quality Assurances and compliance Unit (GACU), Washington, D.C. World Bank, 2008 (b), Environmental and Social Management Framework for World Bank Projects with Multiple Small Scale Sub-projects. A Toolkit, Washington, D.C. Page | 42 APPENDICES APPENDIX 1: ENVIRONMENTAL AND SOCIAL SCREENING FORM THE KINGDOM OF SWAZILAND PROJECT SITE AND IMPACT EVALUATION FORM GUIDELINES FOR THE EVALUATION 1. The evaluator to undertake the assignment after adequate knowledge of baseline information of the area. 2. The evaluator to undertake the assignment after adequate knowledge of proposed project activities in the area. 3. The evaluator to undertake the assignment after prior briefing/training of the exercise. 4. The form to be completed by consensus of at least three people. Project Name Estimated Cost (USD) District & Traditional Authority Funding Agency Project Objectives Proposed Main Project Activities: Name of Evaluator Date of Field Appraisal Page | 43 SCOPE AND FOCUS OF SCREENING METHODOLOGY OF POTENTIAL SCREENING MITIGATION MEASURES Appraisal Initial Potential Mitigation of Evaluation of measures for Impacts Scope & marginal impacts Significance of The Impacts No Yes Margi Extensi nal ve Minor Large Low High 1.0 SCREENING CRITERIA FOR PROPOSED SITE SUGGESTED FOR THE PROJECT MITIGATION MEASURES FOR MINOR IMPACTS. Is the project site within and/ or will it affects following environmentally- sensitive areas? 1.1 National parks and game reserve 1.2 Wet-lands 1.3 Productive traditional agricultural /grazing lands 1.5 Areas with rare or endangered flora or fauna 1.6 Areas with outstanding scenery/tourist site 1.7 Within steep slopes/mountains 1.8 Dry tropical forest s such as Brachsystegia species 1.9 Along lakes , along beaches, riverines 1.10 Near industrial activities 1.12 Within prime ground water recharge area 1.13 Within prime surface run off of water 2.0 SCREENING CRITERIA FOR IMPACTS DURING IMPLEMENTATION AND OPERATION Will the implementation and operations of the project activities within the selected site generate the following externalities/costs/impacts? 2.1 Deforestation and loss of tree species 2.2 Excessive soil erosion and siltation 2.3 Damage of wildlife species and habitat Page | 44 2.5 Increased exposure to agro-chemical pollutants 2.6 Nuisance - smell or noise 2.7 Reduced water quality 2.8 Increase in costs of water treatment 2.9 Soil contamination 2.10 Health hazards to workers and communities 2.12 Siltation of watercourses, dams 2.13 Loss of soil fertility 2.14 Increasing incidence of communicable diseases 2.15 Reduced flow and availability of water for users 2.16 Long term depletion of water resource 2.17 Increased incidence of flooding 2.18 Salinization or alkalinisation of soils 2.19 Changes in migration patterns of animals 2.20 Introduce alien plants and diseases in the area 3.0 SCREENING CRITERIA FOR SOCIAL AND ECONOMIC IMPACTS Will the implementation and operation of the project activities within the selected site generate the following socio- economic costs/impacts? 3.1 Loss of land for human settlement, farming, grazing 3.2 Loss of property- houses ,agricultural produce etc 3.3 Loss of cultural sites, graveyards, monuments 3.4 Interference in marriages for local people by workers 3.5 Spread of HIV/AIDS,STD due to migrant workers 3.6 Changes in human settlement patterns of villages 3.7 Conflicts over use of local water resources 3.8 Conflicts on land use and ownership 3.9 Disruption of important pathways, roads Page | 45 OVERALL EVALUATION OF THE SCREENING PROCESS ON THE SITE AND PROJECT ACTIVITY The result of the screening process would be either the proposed project would be permitted to proceed on the site or the proposed project needs further compliance with EIA requirements. The basis of these options is listed in the table below: The Proposed Project Activity Can Be The Proposed Project Activity Needs Further Exempted From Further Compliance With EIA Compliance With EIA Requirements On The Requirements On The Following Observations. Following Observations. Field appraisals indicate that the site of the Field appraisals indicate that the project site project will not be within environmentally ­ is within environmentally ­sensitive areas, sensitive areas, protected areas protected areas. No families will be displaced from site Cause adverse socio-economic impacts Identified impacts are minor, marginal and Significant number of people, families will be of little significance displaced from site Mitigation measures for the identified Some of the predicted impacts will be long impacts are well understood and practiced term, complicated, extensive in the area The stakeholders have adequate practical Appropriate mitigation measures for some experiences in natural resource predicted impacts are not well known in the conservation and management. area Completion by Environmental District Officer Completion by Director of Environmental Affairs Is This Project Likely To YES/ NO Date Received from Need An EIA District Assembly: List A/B Paragraph Dated Reviewed: Numbers Date Exempted Date of Submission of Project Brief Date Forwarded To DEA Date of Submission Head Office of EIA Reports Name & Signature of Date of EDO Approval/Rejection NOTES: Once the Environmental and Social Screening Form is completed it is analysed by experts from the technical team who will classify it into the appropriate category based on a predetermined criteria and the information provided in the form. All projects' proponents exempted from further impact assessment must be informed to proceed with other necessary procedures. All projects recommended for further impact assessment will have to follow procedures outlined in the Environmental Management Act, and the Swaziland Government's Guidelines for Environmental Impact Assessment. Page | 46 APPENDIX 2: CONSULTED STAKEHOLDERS NAME DESIGNATION CONTACT NO Id Number 1.0 HORO CLINIC 1.1 HORO MANAGEMENT Dudu Dlamini Nursing Sister 76173219 5904301100036 1.2 HORO PROFESSIONAL STAFF Futhi Temalangeni Dlamini Staff Nurse 76345920 / 4371706 8404281100152 Albertina Sonto Magagula Nursing Assistant 76051472 / 4371706 5312131100012 1.3 HORO SUPPORT STAFF Nhlanhla Mhlanga Orderly 76282567 7207086100058 Wandile Dlamini E/C 76616522 8308056100075 Dudu Sigudla M2M 76272419 Nomtandazo Khumalo M2M 76575017 Winile Nyatsi Orderly 76319178 7005201100098 Bangekile Simelane E/C 76862722 1.4 HORO HEALTH COMMITTEE Bobo Ndwandwe Health Committee Chairman Petros Mtfupha Health Committee Member 76230101 3611276100014 Ellias Vilane Health Committee Member 76408824 Petros Masango Health Committee Member 76706409 Sonto Magagula Nurse 76051472 5312131100012 Dudu Dlamini Nursing Sister 76173219 5904301100036 Bongani Sigudla EHO 76155042 7006266100049 Maqhawe Magongo EHO 76182007 Sibekile Mtetwa W/B Technical Assistant 76422357 63 - 413245 P 22 1.5 HORO OTHER HORO CLINIC STAKEHOLDERS Boy Mkhabane Secretary;- Traditional healers Organisation 3434707 Jabulani Mncina Reverend;- Church of the Nazarene 4371984 4812196100014 Moses Dlamini Police;-Sergeant ­ Post Commander 76039790 6503076100020 Eric M. Mavuso Head teacher;-Emvembili Central Primary School 4373294 / 76183505 5202056100065 2.0 EMKHUZWENI HEALTH CENTRE 2.1 EMKHUZWENI MANAGEMENT AND TECHNICAL STAFF Zodwa Dlamini Senior Nurse 76155042 Dr. Mollyn Chikanga DO 76496805 Rosemarry Mahlalela Staff Nurse 76117025 Mirriam Mkhata Switchboard 76330482 Busisiwe Malidzisa Senior Nurse 76790291 Beished Shabangu Lab 76086011 Manzini Munamay Radiographer (X-ray) 76120783 0403026 Dube Sipho. A Senior Nurse 76089089/ 77120556 Dr. Edmore Mapfeka Acting SMO 76305382 Eleazor groening Catering Officer 76458365 Margaret Lubhedze Nursing Sister 76115814 Nomsa Swane Mdluli Rehabilitation Technician 76148401 6910221100054 Jabu Dlamini Statistics 76229133 2.2 EMKHUZWENI SUPPORT STAFF Agnes Shabangu Hospital orderly 76924361 Margaret Mamba Orderly 76087970 Princess Maponga Orderly 76337375 Spiwe Magagula Hospital orderly 76951227 Lucky Ngwenya Laundry 76675022 Lindiwe Shongwe Dish washer 76520100 Busisiwe Motsa Hospital orderly 76923945 Thoko Matsebula Hospital orderly 76490248 Michael Matsebule orderly 76330064 Thembi Dube Mento Mother 76283736 Fortunate Dlamini Mento Mother 76075010 Zanele Mhlanga Cook 76085960 Ncenekile Sukati Hospital orderly 76306033 / 76181059 2.3 EMKHUZWENI HEALTH COMMITTEE Page | 47 NAME DESIGNATION CONTACT NO Id Number Thelma Dlamini Health Committee Member 76555739 Richard Gama Health Committee Chairman 76530539 Bhekie Mahlalela Health Committee Member 76325060 Gladies Fakudze Health Committee Member 76224149 Phumzile A. Mkhohla Nursing Sister 76148853 Swane Mdluli Rehab. Technician 76148401 Margaret Lubhedze Nursing Sister 76115814 2.4 EMKHUZWENI OTHER STAKEHOLDERS Sandile B. Kunene Reverend: -Holiness Church 76087599 6812046100089 Reverend Florence Mkhonta Reverend:- Jutjwa Church of the Nazarene 76272763 6405041100107 Sabelo Gwebu Pastor: -Assemblies of God Church 76428223 6503016100015 Mthunzi Dlamini Induna Yenkhundla 76049409 Mpendulo Buhlebegwala Bucopho 76030427 7311236100222 Mabuza Magolide S. Ndwandwe Bucopho 76220647 7704276100112 David Mavuso Animal Health Inspector 4351012 Masiwane RDA ­ Veterinary Dept George Mkhonta Executive Officer: -Masiwane RDA ­ MoA 4351037 76075163 Samson M. Nxumalo Head Teacher:- Gisa High School ­ Emkhuzweni 76132994 6403156100182 Edward M. Mgavu Head Teacher: -Emkhuzweni Primary School 4351016 5412306100209 3.0 MBABANE GOVERNMENT HOSPITAL 3.1 MBABANE MANAGEMENT TEAM T.A. Maseko Hospital Manager 76051667 Cebile D. Dlamini Hospital Administrator 76308445 Nomsa Simelane Matron 76259046 3.2 MBABANE PROFESSIONAL STAFF Florah Vilakati Nursing Sister 76120762 Swiwe Sukati Nursing Sister 76232706 Nokuthula Zwane Nursing Sister 77121431 / 76119041 Khentile Kunene Pharmacist 76067274 Zanele Dlamini Radiographer 76034207 Babazile Dlamini Nursing Sister 76144675 Elizabeth Dlamini Nursing Sister 76150702 3.3 MBABANE SUPPORT STAFF Ellinah Matsenjwa Laundry Supervisor 76140025 Cythia Dlamini Senior Orderly 76173755 Themba Langa Medical Records Officer 76457850 Zandile Mavuso Accounts Officer 76219206 Sipho Mndzebele Senior Orderly 76447489 Patrick T. Nkambule Telephonist 76040115 3.4 MBABANE OTHER STAKEHOLDERS Bongiwe Catering Officer 4042111 ext 2174 7011021100201 Fedics Catering Company Thembie Catering Manager 6808131100034 Fedics Catering Company Leonard M. Zwane Biomedical Engineer 76636600 Celiwe Malinga Environmental Health Officer 4043506 Mbabane Public Health Unit 76039093 Theresa Mncina Public Health Nursing Sister 4050842 5807131100045 Mbabane Public Health Unit Thabiso Nsibande Environmental Officer 4097036 Mbabane City Council J. D. Vilakati Director 4046960 Swaziland Environmental Authority Andrew Bhembe Ministry of Public Works 4099238 Page | 48 APPENDIX 3: SUMMARY OF WORLD BANK ENVIRONMENTAL AND SOCIAL SAFEGUARD POLICIES. · Environmental Assessment (OP 4.01). Outlines Bank policy and procedure for the environmental assessment of Bank lending operations. The Bank undertakes environmental screening of each proposed project to determine the appropriate extent and type of EA process. This environmental process will apply to all sub-projects to be funded by the proposed project. · Natural Habitats (OP 4.04). The conservation of natural habitats, like other measures that protect and enhance the environment, is essential for long-term sustainable development. The Bank does not support projects involving the significant conversion of natural habitats unless there are no feasible alternatives for the project and its siting, and comprehensive analysis demonstrates that overall benefits from the project substantially outweigh the environmental costs. If the environmental assessment indicates that a project would significantly convert or degrade natural habitats, the project includes mitigation measures acceptable to the Bank. Such mitigation measures include, as appropriate, minimizing habitat loss (e.g. strategic habitat retention and post-development restoration) and establishing and maintaining an ecologically similar protected area. The Bank accepts other forms of mitigation measures only when they are technically justified. Should the sub- project-specific EMPs indicate that natural habitats might be affected negatively by the proposed sub-project activities with suitable mitigation measures, such sub-projects will not be funded under this project · Pest Management (OP 4.09) The policy supports safe, affective, and environmentally sound pest management. It promotes the use of biological and environmental control methods. An assessment is made of the capacity of the country's regulatory framework and institutions to promote and support safe, effective, and environmentally sound pest management. This policy was not triggered by the proposed project. · Involuntary Resettlement (OP 4.12) This policy covers direct economic and social impacts that both result from Bank-assisted investment projects, and are caused by (a) the involuntary taking of land resulting in (i) relocation or loss of shelter; (ii) loss of assets or access to assets, or (iii) loss of income sources or means of livelihood, whether or not the affected persons must move to another location; or (b) the involuntary restriction of access to legally designated parks and protected areas resulting in adverse impacts on the livelihoods of the displaced persons. The project did not trigger this policy. · Indigenous Peoples (OD 4.20) This directive provides guidance to ensure that indigenous peoples benefit from development projects, and to avoid or mitigate adverse effects of Bank-financed development projects on indigenous peoples. Measures to address issues pertaining to indigenous peoples must be based on the informed participation of the indigenous people themselves. Sub-projects that would have negative impacts on indigenous people will not be funded under the proposed project. · Forests (OP 4.36) This policy applies to the following types of Bank-financed investment projects: (a) projects that have or may have impacts on the health and quality of forests; (b) projects that affect the rights and welfare of people and their level of dependence upon or interaction with forests; and (c) projects that aim to bring about changes in the management, protection, or utilization of natural forests or plantations, whether they are publicly, privately, or communally owned. The Bank does not finance projects that, in its opinion, would involve significant conversion or degradation of critical Page | 49 forest areas or related critical habitats. If a project involves the significant conversion or degradation of natural forests or related natural habitats that the Bank determines are not critical, and the Bank determines that there are no feasible alternatives to the project and its siting, and comprehensive analysis demonstrates that overall benefits from the project substantially outweigh the environmental costs, the Bank may finance the project provided that it incorporates appropriate mitigation measures. Sub-projects with likelihood of having negative impacts on forests will not be funded under the project. · Cultural Property (OPN 11.03) The term "cultural property" includes sites having archaeological (prehistoric), paleontological, historical, religious, and unique natural values. The Bank's general policy regarding cultural property is to assist in their preservation, and to seek to avoid their elimination. Specifically, the Bank (i) normally declines to finance projects that will significantly damage non-replicable cultural property, and will assist only those projects that are sited or designed so as to prevent such damage; and (ii) will assist in the protection and enhancement of cultural properties encountered in Bank-financed projects, rather than leaving that protection to chance. The management of cultural property of a country is the responsibility of the government. The government's attention should be drawn specifically to what is known about the cultural property aspects of the proposed project site and appropriate agencies, NGOs, or university departments should be consulted; if there are any questions concerning cultural property in the area, a brief reconnaissance survey should be undertaken in the field by a specialist. The proposed project will not fund sub-projects that will have negative impacts on cultural property. · Safety of Dams (OP 4.37) For the life of any dam, the owner is responsible for ensuring that appropriate measures are taken and sufficient resources provided for the safety to the dam, irrespective of its funding sources or construction status. The Bank distinguishes between small and large dams. Small dams are normally less than 15 m in height; this category includes, for example, farm ponds, local silt retention dams, and low embankment tanks. For small dams, generic dam safety measures designed by qualified engineers are usually adequate. This policy does not apply to the proposed project. · Projects on International Waterways (OP 7.50) The Bank recognizes that the cooperation and good will of riparians is essential for the efficient utilization and protection of international waterways and attaches great importance to riparians making appropriate agreements or arrangement for the entire waterway or any part thereof. Projects that trigger this policy include hydroelectric, irrigation, flood control, navigation, drainage, water and sewerage, industrial, and similar projects that involve the use or potential pollution of international waterways. The proposed project did not triggered this policy · Disputed Areas (OP/BP/GP 7.60). Project in disputed areas may occur in the Bank and its member countries as well as between the borrower and one or more neighbouring countries. Any dispute over an area in which a proposed project is located requires formal procedures at the earliest possible stage. The Bank attempts to acquire assurance that it may proceed with a project in a disputed area if the governments concerned agree that, pending the settlement of the dispute, the project proposed can go forward without prejudice to the claims of the country having a dispute. This policy is not expected to be triggered by sub-projects. This policy is unlikely to be triggered by sub-projects to be funded by this project. Page | 50 APPENDIX 4: CONTRACT PROVISIONS: ENVIRONMENTAL AND SOCIAL IMPACTS 1. General Provisions and Precautions The contractor shall take all necessary measures and precautions and otherwise ensure that the execution of the works and all associated operations on the work sites or offsite are carried out in conformity with statutory and regulatory environmental requirement of Swaziland. The contractor shall take all measures and precautions to avoid any nuisance or disturbance arising from the execution of the work. This shall, wherever possible, be achieved by suppression of the nuisance at source rather than abatement of the nuisance once generated. In the event of any soil or debris or silt from the work sites being deposited on any adjacent land, the contractor shall immediately remove all such spoil debris or silt and restore the affected area to its original state to the satisfaction of the responsible authorities. 2. Water Quality The following conditions shall apply to avoid adverse impacts to water quality: · The contractor shall prevent any interference with supply to, or abstraction from, water resources and the pollution of water resources (including underground percolating water) as a result of the execution of the works. · The contractor shall not discharge or deposit any matter arising from the execution of the work into any waters except with the permission of the regulatory authorities concerned. · The contractor shall at all times ensure that all existing stream courses and drains within and adjacent to the site are kept safe and free from any debris and any material arising from the works. · The contractor shall protect all water courses, waterways, ditches, canals, drains, lakes and the like from pollution, silting, flooding or erosion as a result of the execution of the works. 3. Air Quality The following conditions shall apply to avoid adverse impacts to air quality: · Open burning will be prohibited. · Blasting (If any) will be carried out using small charges, and dust ­ generating items will be conveyed under cover. · In periods of high wind, dust- generating operations shall not be permitted within 200 meters of residential areas having regard to the prevailing direction of the wind. · Water sprays shall be used during the delivery and handling of materials when dust is likely to be created and to dampen stored materials during dry and windy weather. · Stockpiles of materials shall be sited in sheltered areas or within hoarding, away from sensitive areas. Stockpiles of friable material shall be covered with tarpaulins. With application of sprayed water during dry and windy weather. Stockpiles of material or debris shall be dampened prior to their movement whenever warranted. · Vehicle with an open load ­ carrying area used for transporting potentially dust- producing material shall have proper fitting side and tailboards. Materials having the potential to produce dust shall not be loaded to a level higher than the side and tail Page | 51 boards, and shall be covered with a clean tarpaulin in good condition. The tarpaulin shall be properly secured and extend over the edges of the side and tailboards. · In periods of adverse weather adverse impacts to adjacent residents or site employees during construction will be mitigated by either discontinuing until favourable conditions are restored, or, if warranted, sites may be watered to prevent dust generation, particularly at crushing plants. · Machinery and equipment will be fitted with pollution control devices, which will be checked at regular intervals to ensure that they are in working order. Best available pollution control technologies will be used 4. Protection of soils Borrow pits. The following conditions shall apply to borrow pits: · Borrow areas will be located outside the Health Facility premises. · Pit restoration will follow the completion of works in full compliance with all applicable standards and specification. · The excavation and restoration of the borrow areas and their surroundings, in an environmentally sound manner to the satisfaction of the contractor is required before final acceptance and payment under the terms of contracts. · Borrow pit areas will be graded to ensure drainage and visual uniformity, or to create permanent tanks\dams. · Topsoil from borrow pit areas will be saved and reused in re-vegetating the pits to the satisfaction of the contractor. Quarries. To ensure adequate mitigation of potential adverse impacts, only licensed quarrying operations are to be used for material sources. If licensed quarries are not available the contractors may be made responsible for setting up their dedicated crusher plants at approved quarry sites. Erosion. To avoid potential adverse impacts due to erosion, the contractor shall: · Line spillage ways with riprap to prevent undercutting. · Provide mitigation plantings and fencing where necessary to stabilize the soil and reduce erosion. · Upgrade and adequately size, line and contour storm drainage to minimize erosion potential. · To avoid erosion and gullying of road formations, the contractor should reduce his earthworks during the peak of rainy seasons, use gabions and miter drains and avoid angle termination at the intersections of cuts and fills. As noted in elsewhere in these specifications, ditches shall be designed for the toe of slopes in cut sections with gutters or drainage chutes being employed to carry water down slopes to prevent erosion. Interceptor ditches shall be designed and constructed near the top of the back of slopes or on benches in the cut slopes as well as when there is a slope on Page | 52 adjacent ground toward the fill. When the roadway has a steep longitudinal slope, a drain is to be designed and constructed at the down ­ slope end of the cut to intercept longitudinal flow and carry it safely away from the fill slopes. 5. Avoidance of Social Impacts To avoid adverse social impacts, the Contractor shall: · Coordinate all construction activities with neighboring land uses and respect the rights of local landowner. If located outside the Health care Facility Premises, written agreements with local landowners for temporary use of the property will be required and sites must be restored to a level acceptable to the owner within a predetermined time period. · Maintain and cleanup campsites. · Attend to health and safety of their worker by providing basic emergency health facilities for workers and incorporate programs aimed at the prevention of sexually transmitted diseases as a part of all construction employee orientation programs. · Obtain approval of all diversions and accommodation of traffic. A stipulated by section- which states that "the Contractor shall provide the contractor with a written traffic control plan which is to include when and where flagmen shall be employed and when and where traffic cones or other devices such as barricades and \or lights will be used. Where ....traffic diversions area planned for ....additional areas (will) be determined and the diversions clearly defined for travel." · Construct and maintain by ­ passes around bridges to be reconstructed until such time as the bridge is open for traffic. By- passes will be removed and the affected areas re- graded so as to blend in with the existing contour when the bridge is opened. 6. Noise To avoid adverse impacts due to noise, the contractor shall: · Consider noise as an environmental constraint in his planning and execution of the works. · Use equipment conforming to international standards and directives on noise and vibration emissions. · Take all necessary measures to ensure that the operation of all mechanical equipment and construction processes on and off the site shall not cause any unnecessary or excessive noise, taking into account applicable environmental requirements. · Maintain exhaust systems in good working order; properly design engine enclosures, use intake silencers where appropriate and regularly regular maintain noise ­ generating equipment. · Use all necessary measures and shall maintain plant and silencing equipment in good condition so as to minimize the noise emission during construction works. · Schedule operations to coincide with periods when people would least likely be affected and by the contractor having due regard for possible noise disturbance to the local residents or other activities. Construction activities will be strictly prohibited between 10PM and 6PM. · Incorporate noise considerations in public notification of construction operations and specify methods to handle complaints. Disposal sites and routes will be coordinated with local officials to avoid adverse traffic noise. Page | 53 7. Protection of Historic and Cultural resources To avoid potential adverse impacts to historic and cultural resources, the contractor shall; in the event of unanticipated discoveries of cultural or historic artifacts (movable or Immovable) in the course of the work, the subcontractor shall take all necessary measures to protect the findings and shall notify the contractor and provincial- level representatives of the Archaeological committee under the ministry of Information and culture. If continuation of the work would endanger the finding, project work shall be suspended until a solution for preservation of the artifacts is agreed upon. 8. Protection of Utilities To avoid potential adverse impacts to utilities, the Contractor shall: Ascertain and take into account in his method of working the presence of utility services on and in the vicinity of the site. Take into account in his programme the periods required to locate, access, protect, support and divert such services, including any periods of notice required to effect such work in consultation with authorities operating such services. Assume all responsibility to locate or to confirm the details and location of all utility services on or in the vicinity of the site. Exercise the greatest care at all times to avoid damage to or interference with services. Assume responsibility for any damage and \or interference caused by him or his agents, directly or indirectly, arising from actions taken or a failure to take action, and for full restoration of the damage. 9. Waste Disposal and Hazardous materials Water and waste products shall be collected, removed via suitable and properly designed temporary drainage systems and disposed of at a location and in a manner that will cause neither pollution nor nuisance. Insofar as possible, all temporary construction facilities will be located at least 50 metres away from a water course, stream or canal. The contractor shall not dispose of used pavement material on the road or highway side, nor in water courses or wetlands. Such material shall be utilized or disposed of in places approved by the SEA. 10. Environmental monitoring Monitoring or direct impact will be carried out by the SEA and will include, but not restricted to, the following concerns: · Erosion along highway segments and borrow sites during and after construction; · Silting and increased sediment loads to streams crossed by the highway. · Verification that proper waste disposal at construction sites and road camps is done; · Prevention of damage to undiscovered significant archaeological or historical findings; · Assurance that construction sites and road camps are cleaned after construction and Page | 54 · Inspection of vegetation covers (removal and re- growth) on the basis of field examinations. Page | 55