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INITIAL ENVIRONMENTAL EXAMINATIONPROJECT/ACTIVITY DATA

Project/Activity Name: USAID/Guinea Integrated Health Program (IHP), Health Services Delivery D.O. 1

Geographic Location(s) (Country/Region):

Guinea/West Africa

Amendment (Yes/No), if Yes indicate # (1, 2...):

Yes, #2

Implementation Start/End Date (FY or M/D/Y):

FY 2015 – FY 2020

If Amended, specify New End Date:

30 Dec 2021

Solicitation/Contract/Award Number:Implementing Partner(s): JHPIEGOBureau Tracking ID: Guinea IHP IEE Amendment #2

https://ecd.usaid.gov/document.php?doc_id=51888Tracking ID of Related RCE/IEE (if any):

Guinea IHP IEE; approved 12/16/2014 http://ecd.usaid.gov/document.php?doc_id=42351

Guinea IHP IEE Amendment #1; approved 05/11/2017https://ecd.usaid.gov/repository/pdf/50063.pdf

Tracking ID of Other, Related Analyses:

Guinea Stop Palu IEE signed 12/10/2013 https://ecd.usaid.gov/document.php?doc_id=39700

Guinea Stop Palu IEE Amendment #1; approved 9/15/2014 https://ecd.usaid.gov/repository/pdf/41941.pdf

Guinea Malaria Stop Palu IEE Amendment #2; approved 03/05/2019https://ecd.usaid.gov/document.php?doc_id=51862

ORGANIZATIONAL/ADMINISTRATIVE DATA

Implementing Operating Unit(s): USAID/AFR1

AFR BUREAU/ USAID/GUINEA INTEGRATED HEALTH PROJECT AMENDMENT 2

USAID 216 IEE TEMPLATE VERSION 2, APRIL 2018

(e.g. Mission or Bureau or Office) Other Affected Operating Unit(s): Lead BEO Bureau: AFRFunding Account(s) (if available):Original Funding Amount: $121.55 million If Amended, specify funding amount:

$4.8 million

If Amended, specify new funding total:

$ 126.35 million

Prepared by: Jennifer Mbabazi, Health TeamDate Prepared: 01 January 2019

ENVIRONMENTAL COMPLIANCE REVIEW DATAAnalysis Type: Environmental

Examination• Deferral

Environmental Determination(s): Categorical Exclusion(s)

Negative

• Positive• Deferred (per

22CFR216.3(a)(7)(iv)

IEE Expiration Date (if different from implementation end date): 03/28/2020Additional Analyses/Reporting Required:Climate Risks Identified (#): Low ____ Moderate _____ High ______Climate Risks Addressed (#): Low ____ Moderate ____ High ______

THRESHOLD DETERMINATION AND SUMMARY OF FINDINGS

PROJECT/ACTIVITY SUMMARY:The purpose of this Amendment #2 to the Integrated Health Project DO1 IEE file #: Guinea IHP of 12/16/2014 is to:

1. Increase the original funding amount from USD $121.55 million to $126 million to account for a new mobile clinic activity incorporated into the Health Services Delivery project.

2. Change the original end date of the Guinea IHP IEE which will be extended to 12/30/2021

SUMMARY OF FINDINGS:This Amendment #2 to the USAID/Guinea Integrated Health Project IEE_2011-2018 now USAID/Guinea’s Health Services Project referred incorporates and addresses

2AFR BUREAU/ USAID/GUINEA INTEGRATED HEALTH PROJECT AMENDMENT 2


the new planned activity “Mobile Clinics”. USAID/Guinea’s Health Services Project encompasses all three IRs.

Except as modified by this Amendment, the facts and conclusions set out in the original IEE remain valid and in effect. The scope of the nature of activities described in the original IEE remains the same.

This amendment #2 to the USAID/Guinea Health Services Delivery provides, in accordance with 22 CFR 216, the review of reasonably foreseeable environmental effects of the Health Services Delivery planned activity: the Mobile Clinic activity as specified in the background and assistance description section.



TABLE 1: ENVIRONMENTAL DETERMINATIONSProjects/Activities Categorical Exclusion

Citation (if applicable)Negative Determination

IR 1.1 Delivery of Quality Health Services Improved

(w/ conditions)

IR 1.2 Healthy Behaviors and Demand for Quality Health Services Increased

IR 1.3. Health System Strengthened (w/ Conditions)

IR 1.1. DELIVERY OF QUALITY HEALTH SERVICES IMPROVED:Activities under this IR contribute to increasing the availability and use of quality and integrated health services by improving access to quality, evidence-based and community and facility-based health interventions. USAID supports the Ministry of Health (MOH) using evidence-based and innovative approaches and strategies to:

● Restore existing basic health service delivery, Introduce, scale-up, and deliver culturally-appropriate, cost-effective, high-impact, and integrated package of priority health services. Services provided mainly focus on: maternal, newborn & child health, family planning, fistula prevention & care, gender-based violence prevention & mitigation, drug supply, facility-based management and leadership and referral systems. The project aims to address a number of barriers that reduce access of target population to priority health services. These include but are not limited to lack of essential commodities, insufficient/non-existent referral system, incompetent staff etc.

● To improve the quality of services, USAID supports the Government of Guinea (GOG) to improve competencies of health service providers, quality assurance/control systems (e.g. accelerated and strengthened training in infection prevention and control at both public and private facilities), and capacity of local partners to deliver quality health services thus restoring the community’s confidence in the public sector health facilities.

Specific interventions primarily include the following:

● Capacity Building: Ensure health care providers at health facilities have the necessary competencies and that national policies, strategies, guidelines, training packages and job aids exist to support the delivery of the integrated services.



● Referral System: Assist and support the implementation of a comprehensive referral system to ensure linkages are made along the continuum of health care.

● Quality Improvement: Support the implementation of a continuous quality improvement (QI) system, Standards-Based Management and Recognition (SBM-R®); strengthening clinical governance, supervision and mentoring; and monitoring the delivery of the package of services in order to guarantee that the availability of prevention, care and treatment services is increased and sustained.

● Community Health Workers: Support community members to have greater access to care by increasing the number of competent health community workers who provide care in the community.

● Health Facility Maintenance. This includes both small rural clinics that previously had not been renovated to large urban facilities that were renovated with USAID assistance. To address this concern, the Implementing Partner will promote innovative maintenance models that can be adapted for sustained health facility maintenance. Using an incentive system, those in need of maintenance will be required to develop a detailed “maintenance plan” which includes the maintenance work needed, equipment required for maintenance, the staff needed, and a timeline for each maintenance activity. When a satisfactory maintenance plan is developed, maintenance staff attached to the Mobile Clinics will establish a “maintenance partnership” with the facility maintenance staff and collaboratively begin the maintenance of health facilities by the cleaning, upkeep and rehabilitation of the facility buildings and grounds according to the maintenance plan. Mobile Clinic maintenance staff will have all the tools needed for the rehabilitation and maintenance of local clinics (e.g., brooms, mops, carpentry tools) as well as supplies necessary for maintenance (e.g., cleaning fluids, paint, garbage bags).

● Community Outreach: Health Services and Awareness of Health Service Providers. In order to restore routine health services and rebuild community confidence in the health system, the implementing partner is expected to conduct a series of outreach activities, in the form of Mobile Clinics in four prefectures and 31 sub-prefectures heavily impacted by Ebola. These Mobile Clinics will consist of health facility staff, community health workers (CHWs) and other health care professionals (doctors and nurses) from larger, more experienced health care facilities providing primary health care examinations and treatment (e.g., cardiac care and hypertension, family planning, HIV examination and treatment, counseling, vaccinations, dental). Mobile clinics will test and treat febrile diseases, offer other basic health services, and provide referrals to nearby health centers. When a condition



cannot be diagnosed or treated by the Mobile Clinic a referral will be made to a health facility that can diagnose and treat the disorder, thereby bringing the population back into the health care system. The implementing partner will support health facility staff to keep records of all consultations and referrals made, linking to the health management information system. The partner will work with local health facility staff and local leaders to organize these Mobile Clinics, ensuring that they are well located, and people are aware of the events and the services to be offered.

● Behavior Change Messaging: In addition to primary health care services, the Mobile Health Clinics and the CHWs attached to them will conduct behavior change messaging aimed at restoring community confidence in health facilities and CHWs and encouraging health care workers to resume or continue providing health service delivery. In order to strengthen the link between the CHW and the health facility, CHWs will present themselves as a “bridge” between the community and the local clinic and other health facilities. Messaging will make the community aware of the role of the CHW – what services they provide, where they are located, and how they can be contacted. Working side-by-side with local clinics, CHWs will provide information about monetary barriers to health services with the community and discuss financially viable ways to access services.

IR 1.2. HEALTHY BEHAVIORS AND DEMAND FOR QUALITY HEALTH SERVICES INCREASED: USAID will build on previous successful activities and approaches to strengthen the role and capacity of civil society and local NGOs in promoting good health and governance practices as well as in advocacy and creating demand for quality FP/MNCH/Malaria services and accountability and transparency from their leaders.

IR 1.3. HEALTH SYSTEM STRENGTHENED: Recommendations regarding gaps in crucial policies related to priority health issues (including: MCH, malaria, emerging and communicable diseases) emergency preparedness for health crisis, access and equity of health services, human resources, health financing, and governance issues which impact health will be made. Based on the assessment results, USAID will develop activities to address policy gaps and/or strengthen weak policies as determined by Government of Guinea and USAID.

MONITORING AND EVALUATION: General implementation measures and monitoring conditions remain unchanged from those identified in the Guinea IHP IEE Section 3 and 4, unless otherwise noted. These require:



● Implementing partner (IP) briefings on environmental compliance responsibilities;

● Integration of compliance responsibilities in prime and sub-contracts and grant agreements;

● Assurance of sub-grantee and sub-contractor capacity for compliance;

● Integrated Health Project team environmental compliance monitoring; and

● 22CFR216 documentation coverage for new or modified activities and compliance with host country requirements.

BEO SPECIFIED CONDITIONS OF APPROVALN/A

IMPLEMENTATIONIn accordance with 22CFR216 and Agency policy, the conditions and requirements of this document become mandatory upon approval. This includes the relevant limitations, conditions and requirements in this document as stated in Sections 3, 4, and 5 of the IEE and any BEO Specified Conditions of Approval.



USAID APPROVAL OF INITIAL ENVIRONMENTAL EXAMINATIONProject Name: USAID/GUINEA Integrated Health Project IEE Amendment #2

Bureau Tracking ID: https://ecd.usaid.gov/document.php?doc_id=51888

Approval: Cleared 2/25/2019Jeff Bryan, Mission Director Date

Clearance: Cleared 2/22/2019Jennifer Mbabazi, Activity Manager Date

Clearance: Cleared 2/22/2019Morgan M. Limo, Mission Environmental Officer

Cleared

Date

2/25/2019Clearance: Henry Aryeetey, Regional Environmental Advisor Date

Concurrence:

Cleared 3/25/2019

Brian Hirsh, Bureau Environmental Officer Date



https://ecd.usaid.gov/document.php?doc_id=51888

ACRONYMSBCC Behavior Change CommunicationCAM Club des Amis du MondeCDC US Centers for Disease Control and PreventionCENAFOD Centre Africain de Formation pour le DéveloppementCFR Code of Federal Regulation (22CFR216)CHW Community Health WorkerCRM Climate Risk Management CSH Comité de Santé et d’Hygiène (Health and Hygiene Committee)DPS Direction Préfectorale de la Santé (Prefectural Health Directorate)DRS Direction Régionale de la Santé (Regional Health Directorate)EA Environmental AssessmentEMMP Environmental Monitoring and Mitigation PlanGOG Government of GuineaINAASPO Initiatives et Actions pour l’Amélioration de la Santé des

PopulationsIEE Initial Environmental ExaminationLLIN long-lasting insecticide-treated netMERLA Monitoring, Evaluation, Research, Leaning, and AdaptationMIP Malaria in Pregnancy MOH Ministry of HealthPCG Pharmacie Centrale de Guinée (Central Pharmacy of Guinea)PMI US President’s Malaria InitiativePSM Procurement and Supply Management project SBCC social and behavior change communicationSGPD Solidarité Guinéenne pour le DéveloppementSMC seasonal malaria chemopreventionTWG Technical Working GroupUSAID US Agency for International DevelopmentWHO World Health Organization



1.0 PROJECT/ACTIVITY DESCRIPTIONProgram/Activity Number: Guinea Integrated Health Project

Country/Region: USAID/Guinea, West Africa

Program/Activity Title: Guinea Integrated Health Project

Foreign Assistance Objective 4: Investing in People

Program Area 3.1: Health

Program Element: 3.1.6. Maternal Health and Child Health

1.1 PURPOSE AND SCOPE OF IEE

This IEE addresses all activities under the Development Objective 1 of USAID Guinea’s Country Development Cooperation Strategy (CDCS), which is “Utilization of Quality Health Services Increased.” USAID/Guinea developed a Project Appraisal Document (PAD) that covers the entire DO1 – the name of which is Integrated Health Project. Thus, this IEE is intended to cover all activities under the DO1 and accompanying Integrated Health Project. In accordance with 22CFR216, this IEE provides the initial environmental review of all activities to be implemented under the Integrated Health Project and recommends environmental threshold determinations, including conditions in some cases for all activities to be implemented under the program.

1.2 BACKGROUNDDespite an abundance of natural resources, Guinea remains one of the poorest countries in Africa with a per capita Gross National Product (GNP) of $460 (2013). Guinea is ranked at 178 out of 187 countries on the 2013 Human Development Index. The population of Guinea is currently estimated at 12 million. With a 3.1 percent annual population growth rate, Guinea’s demographic profile reflects a large and growing “youth” bulge. According to GOG statistics, 42.5 percent of the population is under the age of fifteen. The life expectancy for women is 59.6 years and only 56.6 years for men, indicative of a heavy disease burden.

Infectious and communicable diseases dominate the disease burden. According to the preliminary findings of the 2018 Demographic and Health Survey (DHS), basic sanitation in Guinea is very poor allowing cholera and typhoid epidemics to occur regularly. The study showed that diarrheal disease, malaria, and malnutrition are the leading causes of death among children under five years of age. Thirty-one percent of children under five years suffer from chronic malnutrition (stunting) and



10 percent suffer from acute malnutrition (wasting). Eighteen percent are underweight, 77 percent of children 6-59 months and 49 percent of women 15 to 49 years of age are anemic. Only 21 percent of children under six months of age are exclusively breastfed. Vaccine shortages in the national pharmacy, an unreliable drug and vaccine distribution system, and a weak national outreach program for immunization services have collectively caused setbacks to the GOG immunization program. As well, infant mortality is 123 per 1,000 live births with more than 60 percent of deliveries not assisted by a skilled birth attendant. Maternal mortality, still high, has decreased from 980 per 100,000 live births as reported in the 2005 DHS to 724/100,000 in the 2012 DHS. Hindered by the poor nutritional status of women in their reproductive years, this figure reflects an overall stagnation in adult mortality since 2005 and is also attributable to the failure of the health system to provide adequate emergency obstetric and postnatal care.

Despite evidence of a 28.7% reduction in malaria prevalence from the 2012 DHS figure of 44%, malaria is still the leading communicable disease in Guinea, Malaria is the leading cause of outpatient visits and health facility admissions of children under five years of age, accounting for 30% of reported outpatient visits, nearly 25% of admissions, and 14% of hospital deaths in public facilities.

Guinea is one of the countries where neglected tropical diseases pose a high burden on people’s health and socio-economic development, particularly in rural settings. Neglected tropical diseases (NTD) are prioritized by the Ministry of Health in Guinea, as evidenced by their NTD Strategic Plan (2011-2015) and their inclusion in the country’s Strategic Framework for Poverty Reduction. The burden of Neglected Tropical Diseases (NTDs) is high and Lymphatic filariasis (LF), onchocerciasis, schistosomiasis (SCH), soil-transmitted helminths (STH), and trachoma are endemic in Guinea. Onchocerciasis is prevalent in 24 health districts in the country and in 7 out of the 8 regions. A 1999 prevalence study shows the rates of STH are high: hookworm (Ancylostoma duodenale ) prevalence is 43.8%, roundworm (Trichocephalus trichiurus) prevalence is 9.4%; and tapeworm (Ascaris lumbricoides) is 31.3%. Schistosomiasis was identified in over 90% of site mapped (29 out 31 health districts) with an at-risk population of 10,445,598 people. In Guinea, trachoma-endemic areas are located in the area of highest poverty rates (Upper Guinea region & northern part of Middle Guinea). An epidemiological survey carried out on trachoma in 10 districts of Upper Guinea in 2001 showed an average prevalence of 33% for active trachoma among children aged 1-9 years and 2.7% for trachomatis trichiasis (TT) among women over 15 years.

In early 2014, the world’s largest ebola outbreak started in Guinea and quickly escalated, in part, due to the weak health infrastructure. The ebola outbreak spread to Sierra Leone, Liberia and Nigeria. In Guinea the ebola outbreak had a devastating toll on an already weak health system and caused panic in Guinea, across the region and globally. The average case fatality rate in Guinea was estimate a 62%, in addition to deaths from ebola, health services were stretched thin and could not



adequately provide other necessary services, food prices rised combined with borders closing which posed real threats to food security, and security issues occurred. The Government of Guinea (GOG) had been responding to the outbreak since it first emerged but continued to struggle with a number of issues such as: accessing all affected communities; weak national health systems; endemic corruption; and the unavailability of the requisite medical personnel and goods on a scale adequate to prevent, trace, and treat the disease. The ebola outbreak has further shed light into the weakness of the health care sector and the work proposed in this project is an essential means to help rebuild and strengthen the health care system to increase service delivery and to remain resistant in the face of a public health emergency. A whole-of-government approach is necessary to prepare for and respond to emerging diseases and other public health emergencies in the future, as well as to remain vigilant about the long term risk of ebola. Strengthen health communication and the role of the community, health care infection control, procurement and logistics system; disease early warning and health information system, as well as the epidemiological response are critical to sustain ebola control and to prevent other public health emergencies.

1.1 DESCRIPTION OF ACTIVITIES

The accompanying PAD provides a detailed description of USAID/Guinea’s proposed 8 year (2015-2022), $160.3 million Integrated Health Project to deliver quality health service, promote healthy behaviors, and to strengthen currently fragile health systems. USAID/Guinea designed the project to carry out activities to achieve DO 1 of USAID’s CDCS: “Utilization of Quality Health Services Increased.” Implementation started in the first quarter of FY 2014, the project will build on USAID/Guinea’s past six years pioneering efforts to improve health in Guinea. The new project will focus USAID’s support on areas that will bring direct benefits to ordinary Guinean citizens. It will generate nationwide benefits and contribute to improved governance which will be measured by citizens’ perception of transparency and social accountability. Specifically, activities would consolidate and build on USAID’s experience in improving health outcomes at the local level, forge new coalitions with the private sector, including civil society organizations and public-private partnerships

USAID will implement the health activities under the Integrated Health Project as part of the whole-of-government approach which entails close coordination between USAID, State Department, Centers for Disease Control, and the Peace Corps -- the four USG Agencies supporting the USG global health mandate in Guinea.

1.3.1 USAID/GUINEA RESULTS FRAMEWORK FOR DEVELOPMENT OBJECTIVE #1







1.3.2 ACTIVITIES RESULTS FRAMEWORKIR 1.1 DELIVERY OF QUALITY HEALTH SERVICES IMPROVED: Activities under this IR will contribute to increasing the availability and use of quality and integrated health services by improving access to quality, evidence-based and community and facility-based health interventions. USAID will assist the Ministry of Health (MOH) using evidence-based and innovative approaches and strategies to restore existing basic health service delivery and introduce, scale-up, and deliver culturally-appropriate, cost-effective, high-impact, and integrated package of priority health activities with focus on maternal, newborn & child health, family planning, fistula prevention & care, gender based violence prevention & mitigation, drug supply at the health facilities and facility-based management and leadership and referral systems and services. The project will address a number of barriers that reduce access of target population to priority health services. These include but are not limited to lack of essential commodities, insufficient/non-existent referral system, incompetent staff etc. To improve the quality of services, USAID will assist the Government of Guinea (GOG) to improve competencies of health service providers, quality assurance/control systems (e.g accelerated and strengthened training in infection prevention and control at both public and private facilities), and capacity of local partners to deliver health services and restore community’s confidence on the public sector health facilities. Specific interventions will include the following:

● Family Planning and Reproductive Health: In Guinea, with its high fertility rate and child and maternal mortality ratios, family planning is a high-impact primary intervention to target. USAID will support the priorities outlined in the Ouagadougou Action Plan, the national roadmap to accelerate the reduction of maternal and child morbidity and mortality, the national health development plan currently under design, the national strategic plan for reproductive health commodities security; and other national strategies as well as regional harmonized guidelines and strategies, and build upon the approaches initiated by other USAID projects to contribute to the increase of modern contraceptive uptake and thus increase prevalence rate in Guinea. Family planning will be integrated into a larger package of maternal and child health services that will expand access use of modern contraceptives in the community. Finally, it is envisioned that family planning curricula will be integrated at all levels of medical school instruction.

● Maternal, Newborn and Child Health (MNCH): USAID build on the work begun by MCHIP, UNICEF and others to ensure that MNH services are implemented according to standard and monitored for quality. The primary emphasis of MNCH services will focus on antenatal care, safe pregnancy and safe birthing, postpartum hemorrhage management and prevention



(including active management of third stage of labor (AMTSL) with use of uterotonics-oxytocin), management of eclampsia, essential newborn care, and early postpartum/postnatal follow-up care. Synergy in implementation of activities, increased governance and effective management is expected to produce substantial increase in the number, proportion, and quality in pregnant women receiving four antenatal care visits, pregnant women receiving required doses of tetanus toxoid, iron folate, and malaria prophylaxis, pregnant women with a birth plan to deliver in a health facility, facility births in which AMTSL is implemented according to standard, newborns receiving essential newborn care, and the number of mothers and newborns followed up in the first days and weeks of the postpartum period according to standard.

● Fistula: USAID will build on the progress made, and tools and approaches used by the Fistula Care Project, and continue support to the hospitals and local government / community to provide fistula repair, prevention and accompanying reintegration services. Synergy in implementation of activities, increased governance and effective management is expected to produce substantial increases in the number, proportion, and quality of both fistula repair and fistula prevention. USAID will increase the number of women living with fistula who receive fistula repair surgery at the established fistula repair hospitals, as well as regional hospitals. To prevent fistula occurrence, USAID will improve quality birthing services at district and regional hospitals and health centers in target areas and ensure they are using appropriate standards for partograph to monitor labor and birth.

● Post-Abortion Care: USAID will build on the progress that has made Guinea a leader among West African countries in its offer of post-abortion care, having expanded services to over 23 facilities with support from USAID projects. Synergy in implementation of activities, increased governance and effective management is expected to produce substantial increases in the number, proportion, and quality of the number of women seeking post-abortion care services treated according to standard and women seeking post abortion care services that are counseled and offered/provided a voluntary informed choice of a contraceptive method of her choice before leaving the facility.

● Child Health: USAID will focus on appropriate identification, early treatment and referrals for malaria, diarrhea, pneumonia, TB, ebola, and other diseases. Delays in treatment result in a missed opportunity for survival. Synergy in implementation of activities, increased governance and effective management is expected to produce substantial increases in the number, proportion, and quality of sick children identified by/referred to a community health worker (CMW) within 24 hours; children under 5 with diarrhea correctly treated with ORS +Zinc within 24 hours by CHWs and/or facilities; children



under 5 with fever tested for malaria and treated/referred within 24 hours; children with fever and with risks factors for ebola be tested and referred to the appropriate Ebola Treatment Unit (ETU), children with pneumonia identified, referred, and treated within 24 hours; and, children with TB symptoms should be tested and treated within 24 hours.

● Malaria: Prevention, early detection and treatment of malaria are integral components of maternal, newborn, and child health services; expected results and performance standards for ANC prophylaxis and case management are included under MNH and CH sections. In addition, an essential component of the malaria prevention efforts focus on bed nets, which are essential components of the package of services as well as pregnant women prescribed appropriate doses of IPTp during ANC clinics visits.

● Gender-Based Violence (Gbv) Prevention: Poor governance is at the core of the perpetuation of domestic violence in Guinea. Laws are not enforced, and women who have the courage to report domestic abuse to the police face even more violence at home and are ostracized from their communities for speaking out. Communities are generally unaware of the impact of domestic violence on women and children and how to prevent its occurrence. Linkages between maternal and child health services and referral to USAID-supported legal clinics, combined with awareness campaigns, and increased community and civil society engagement, reinforced by the use of modern communication technologies- will significantly decrease domestic violence. This project will increase the number of health facilities that integrate GBV screening and counseling with maternal and child health activities and increase the number of GBV-prevention committees established by local leaders.

● Public-Private Partnerships: Increased application of advances in Information and Communications Technology (ICT) are a priority for the Guinean Ministry of Health, and USAID is an active proponent of using these technologies to improve quality service delivery in the health sector. USAID will explore the use of private sector partnerships in the use of mobile technology to increase access to family planning and maternal and child health services and improve performance of service delivery. USAID will seek, develop, and maintain private and public sector partnerships that augment project interventions and sustain them beyond the life of the project. USAID will involve the private sector in service delivery management costs and to consider how best to reinvest in communities surrounding mining areas in order to improve health outcomes.

● Pre-Service Training: USAID will build on success of past projects focused on pre-service education to build capacity of future service providers to better address issues related to maternal, newborn, and child health. The



expected results of the pre-service education are discussed under the health system strengthening IR.

● In-Service Training and Mentorship: USAID is expected to build the institutional capacity of specialized institutions and services, such as the neonatology and nutrition institute (INSE), the maternity services in the national hospitals and link them to district and regional hospitals to develop a mentorship programs. This will allow those that have high level skills to train, monitor and expand specific services in hospitals up-country to allow the workforce that accepted to work in remote areas to keep linked to the central level and get updated on new technologies and current sciences and implement standards operating procedures and national strategies.

● Outreach Health Service Provision: The new mobile clinic activity aims to restore and rebuild community confidence in the public health care system through increased outreach and improved maintenance of rural health facilities. This will in turn result in improved use of routine primary health care services and greater health outcomes

IR 1.2 HEALTHY BEHAVIORS AND DEMAND FOR QUALITY HEALTH SERVICES INCREASED: In order to improve delivery, access, and utilization of quality services, and strengthen public health, an improvement in healthy behaviors is critical. Activities under this IR will increase demand for priority health services by improving health seeking practices and behaviors and improving the process that safeguard those practices and behaviors. The effectiveness of a social and behavior change, and communication program will require that interventions be evidence-based and well-grounded in a thorough understanding of population’s beliefs, perceptions, and practices in order to address individual and interpersonal factors, gender and social and cultural norms, and structural issues that promotes or impedes healthy behaviors and lifestyles for men and women.

The main focus areas will target (1) maternal and child health and family planning, (2) communicable diseases, (3) nutrition practices and any other harmful practices; and (4) good governance practices and accountability with regards to health. Other areas of focus and public health threats that are identified may be considered as additional focus areas. The targeted behavior change strategy for each of the four focus areas will be developed in coordination with all key stakeholders including Government of Guinea; USAID and projects, and partners working on Ebola communications (UNICEF, Plan Guinea, CCF, Faisons Ensemble, Engender health; and donors (including Global Fund) to identify key target areas for behavior change efforts that also leverage their efforts and avoid duplications. The behavior change strategy will identify the risky behaviors that activities will then seek to change; the target populations; and, plans for collecting and measuring impact (including



collecting baseline data as needed). For each of these areas additional surveys or information may be needed to better understand the behaviors and/or impediments to changing these behaviors. Additional partners- NGO and Academic will be considered as needed. The activities under this IR can support awareness rising for general health and hygiene issues; but the majority of efforts will focus on measurable change in key risky behaviors under each of the four areas.

There is a boom in communication in Guinea in recent years with a large presence of public, private, urban and rural radio stations and well endeavors implemented mobile technology companies. USAID expects to develop high impact interventions around these opportunities to foster behavior change. USAID will support the development of communication content that are evidence based, targeted and focused, and tailored to the Guinea context and culture. Targeting key community and religious leaders, including Marabous and traditional communication channels such as “griots,” as well as key behavior influencers such as mother in-laws, traditional birth attendants, religious and community leaders and decision makers will be critical to the success of this project. Other targeted audiences will include service providers at the facility and community level, regional and prefectural decision makers, fathers, mothers, other influent family members and youth, as well as community elected leaders.

Approaches will go well beyond knowledge- and sensitization-focused “messaging” to strategies that are solidly informed by evidence and will result in a change of risky behavior for improved health outcomes. Appropriate individual-level/interpersonal communications, community-level interaction, small group interventions, local media, campaigns targeting specific health issues or behaviors and promoting appropriate community norms will help maximize behavioral impact.

Evidence have shown that local NGOs and civil society groups can be very effective implementers and partners in advocacy, communication and mobilization activities, as they bring local credibility, grassroots networks, and a clear social welfare agenda. USAID will build on previous successful activities and approaches to strengthen the role and capacity of civil society and local NGOs in promoting good health and governance practices as well as in advocacy and creating demand for quality FP/MNCH/Malaria services and accountability and transparency from their leaders. USAID will build the capacity of women’s group and community leaders to become champions and change agents. USAID will pursue approaches that are multi-sectoral and empowers and promotes active involvement civil society and local NGOs. USAID interventions will be harmonized and concerted with GOG communication strategies and messages.

USAID and its partners will focus on improving the participatory processes that empower communities to make the changes necessary to achieve and maintain health because individuals’ ability to affect positive behavior is dependent on a



supportive community environment, and an individual’s ability and the community’s ability to support social and behavior change are interrelated and interdependent. USAID will thus support activities to increase the openness of traditional and faith leaders, as the custodians of sociocultural norms and religious values to support social and behavior change dialogue; activities that mobilize community leaders to encourage positive behavior and uptake services; build the capacity of women’s groups to become champions and change agents.

IR 1.3 HEALTH SYSTEM STRENGTHENED: Activities under this IR will focus on the core functions of the health system that support service delivery mainly: human resources for health, drugs and commodities, health financing, health information system, and governance. As such, improving governance at the national and local levels and improving coordination of in country health partners and projects -- remains vital to achieving results that ensure sustainability. Thus USAID will coordinate closely with other health and governance projects in order to leverage the best possible outcomes. As a first step in providing assistance to the MOH to improve health systems, USAID carried out an institutional audit across the following four areas: (1) policies related to health; (2) human resources; (3) health information management system (HMIS), (4) health financing and governance including planning and financial management internal and external control, quality control and quality assurance, supervision, monitoring and evaluation and institutional capacity. Interventions for quality improvement in a health system take place against a backdrop of existing policies, priorities and procedures, and these factors need to be understood from the beginning of the effort. While the main focus of the analysis was on the health system, connections were made between health and other sectors and issues which have an impact on the performance of the health system. USAID took into account the many past and current efforts to map and assess the various domains of quality interventions in the Guinean health system as many of the reports and documents resulting from these efforts outline sound recommendations for actions to improve and monitor quality health systems. Specific interventions will include the following:

● Policies Related To Health: USAID will support design, implementation, monitoring, and evaluation of GOG key health policies and strategies, such as health financing for universal health coverage strategy, the Ouagadougou partnership action plan, the roadmap to accelerate reduction of maternal and child health mortality, the national health development plan the human resources development strategic plan and quality improvement and standard operating procedures as well. The lack of policies and regulations regarding the private sector result in a substandard service which impact a large number people who seek services in the private sector (approximately 50%). A strengthened private sector is needed to ensure access of services. An in-depth review of the numbers of types of GOG policies which impact health is needed to fully understand gaps. Once there is an understanding of the policies then key



policies, such as those reference above, need to be evaluated for quality then selected priority policies be investigated to determine leverage of implementation and enforcement. Recommendations regarding gaps in crucial policies related to priority health issues (including: MCH, malaria, emerging and communicable diseases) emergency preparedness for health crisis, access and equity of health services, human resources, health financing, and governance issues which impact health will be made. Based on the assessment results, USAID will develop activities to address policy gaps and/or strengthen weak policies as determined by Government of Guinea and USAID.

● Human Resources: The magnitude of the issues of human resources across health sectors including clinician, pharmacists, laboratory technician and managers, epidemiologists, logicians, etc. is not well understood or documented. The ebola crisis in Guinea demonstrates the need for a strong public health system which includes rapid ability for a national epidemiological investigation. Additionally, the distribution of human resources remains a major problem particularly for rural areas. USAID will examine the distributions issues with focus on understanding policies, approaches, and incentives which have been/are implemented in Guinea to understand what has worked and to recommend incentives and approaches, including novel approaches, to help address the inequity of services. The issues of salaries and payments for health care staff is a major issue linked to the health financing; healthcare is provided by a large number of volunteers which is not conducive to quality or retention. USAID will continue alongside other partners to support financial management and oversight from the facilities level to government. Efforts will focus on strengthening human resources on a number of selected areas and will build upon previous and ongoing USAID programs and efforts to strengthen training. This includes building upon the successes of prior USAID projects in pre-service education at the medical school of the University of Conakry and the midwifery training center of Kindia. Creativity, innovation, and women’s leadership in the area of health will be promoted. Promotion of continuing education in the areas of maternal, newborn and child health and public health will be enhanced through partnerships with the University of Conakry.

● Health Management Information System (HMIS): USAID supported an assessment of the MOH’s HMIS in March 2014 with plans to provide additional support to develop a plan to address the key recommendations to improve data quality and to increase the level of use of information. The development of this plan will involve the Ministry of Health and Prevention, private sector financial partners, multilateral and bilateral partners, and NGOs working in the field of strategic information. USAID will address technical and organizational areas with an emphasis on improving written standard operating procedures for data



collections; training and improved supervision to collect, enter, and analysis data; and, standardizing transmission of data. USAID will assist with collecting and increasing quality data through the introduction and scale up of the use of information and communications technologies including mHealth, or other appropriate technologies. Strengthening disease surveillance and response at the national, regional and community level will be an important element of USAID’s support. It is expected that that the USAID will coordinate and partner with the MOH, the private sector, other donors including UN agencies to support a public private partnership to promote innovative and creative initiatives around mHealth.

● Health Financing and Governance: USAID undertook an institutional audit that looked at challenges and opportunities around health financing & governance. Based on the findings of the situational analysis, USAID designed state-of-the-art, innovative, and evidence based-strategies to build institutional capacity and improve governance of the health system at the national, regional and district levels. Special focus was on targeted institutions for more in-depth support that would have the greatest impact on health indicators. USAID will implement governance principles at all levels of the health sector. In doing so, USAID seeks to improve transparency for increased equity in accessing quality health services and products. This will be done principally through strengthening controls around the procurement and distribution of essential drugs. USAID will build on its previous investments’ best practices such as publicly displaying the costs of medicines and fees to reduce opportunities for corruption within the health system. USAID will also strengthen the capacity of the national pharmaceutical supply system will be strengthened to minimize the number of critically needed drugs that are commonly out of stock. USAID will strengthen the capacity of managers and service providers to quantify and manage essential drugs. USAID will partner with the GOG to develop policies and plans to help eradicate the large illicit network of counterfeit, unsafe medicines and improve commodity security. USAID will continue to assist the Central Medical Store (CMS-PCG) improve its ability to store and distribute medicines in a timely manner. The ebola outbreak highlighted that the logistics and medical supply system was not equipped to deal with a public health emergency. USAID will partner with the GOG to ensure that supplies can be distributed without reliance on donor support. In addition to supply issues, USAID will seek to address pharmaceutical and medical commodities issues at the facilities level by strengthening the use of appropriate guidelines aligned with national policies and strategies in how pharmaceutical products are dispensed to patients.



2.0 COUNTRY AND ENVIRONMENTAL INFORMATION (BASELINE INFORMATION)

Guinea has suffered economically, socially and culturally in that there has been limited tolerance for critical thinking and debate in all sectors. Despite tangible nascent progress towards democratic and constitutional governance and the initiation by the current Administration of transformative reforms, high illiteracy, grinding poverty, weak public and private institutions, and widespread distrust of the government at all levels, and a winner-take-all, zero-sum entrenched political culture threaten further socio-economic advancement and stability.

Since independence, the monopoly of political power in Guinea’s executive and, by extension, its judiciary and legislative branches, combined with an oppressed civil society, informal market structures, and violence have stymied the country’s economic and political development. Decades of degenerative and authoritarian rule, resulted in a lack of citizen demand for government accountability and services at the local, prefecture and national level. Despite recent successes with local level government and communities working towards achieving shared interests, there is a critical absence of citizen participation in government decision-making on issues that affect their livelihoods, access to essential services, and even their personal security. Today, “many government activities are shrouded in secrecy.”

2.1 LOCATIONS AFFECTEDThe Republic of Guinea covers 245,857 square kilometers and lies about 10 degrees north of the equator. The country is divided into four natural regions with distinct human, geographic, and climatic characteristics: Maritime Guinea (La Guinée Maritime), Mid-Guinea (La Moyenne-Guinée), Upper-Guinea (La Haute-Guinée), and Forested Guinea (Guinée forestière). Guinea is further divided into eight administrative regions (Conakry, Nzérékoré, Kankan, Kindia, Boké, Labé, Farannah, and Mamou) and into thirty-three prefectures.

Only Conakry features a tropical monsoon climate. Unlike a good portion of West Africa, Conakry's wet season sees an extraordinary amount of precipitation. As a result, Conakry averages nearly 3,800 mm (149 in.) of precipitation per year, earning the city a tropical monsoon climate classification. The dry season is influenced by the harmattan winds between December and April, with relatively little precipitation during these months.

Guinea has important agrarian and mining potentials that constitute major advantages for its economic and social development. The climate and vegetation are favorable for agriculture, and animal husbandry. The country is rich in bauxite,



diamond, iron, nickel, uranium, manganese, and many other minerals. Guinea is considered to be the “catchment basin of Western Africa” because many rivers and waterways have their origin in the Fouta-Djalon and Guinean ridge.

The Integrated Health Project will be national in scope in that it will touch on all major regions of Guinea. The current physical environments of the zones of intervention are degraded in terms of soil, water, and floral and faunal diversity. Anarchic construction of homes, abusive deforestation, slash and burn agriculture on steep slopes, charcoal production, fire, and over hunting all hamper the natural resources. The human communities living and working in these zones are extremely poor, and face food shortages on an annual basis. With increasingly erratic rainfall patterns, heat waves, and insect pests all playing a role in degrading people's’ livelihood activities, the zones are in need of activities that promote resilience to climate changes in order to stabilize ecosystems and sustainable revenues.

There are major areas that were previously forested but are now exposed to wind, sun, and rain, thereby increasing erosion and degrading land productivity. In once rich forests, there now remains a paucity of species, which severely limits ecosystem productivity. In once robust mangrove systems, there are now rice fields and salt mines, which hamper marine life reproduction.

2.2 APPLICABLE ENVIRONMENTAL POLICIES AND PROCEDURES OF HOST COUNTRY The National Assembly of the Republic of Guinea adopted and the President promulgated the Basic Law on the environment. The current Governance Plus activities are covered by an umbrella National Act on Environment (Code sur la Protection et la mise en valeur de l’Environnement N°045/PRG/SGG/87 of 28 May 1987).

The law defines the principle of protection of the soil, continental and marine waters, air, fauna, flora, and human establishments. It also regulates the management of waste, chemical substances, noise, and smells and defines installations and establishments for the protection of the environment. It envisages that wastes must be appropriately treated to eliminate or to reduce their damaging effects on human health, natural resources, fauna and the flora, or the quality of the environment in general.

To effectively address some of the sector-specific issues, the government has formulated and allowed for other applicable regulations to be followed. For example, to adapt the national forest policy to regional characteristics, regional forest plans are established in natural areas under the legislation. The regional forest plans have the same content as the National Forest Plan.



For the purposes of conservation, management and sustainable development, the protection of the environment, the maintenance of wildlife and preservation of biodiversity habitats, it is established a national policy on wildlife. The national policy of wildlife is defined by the Government, at the proposal of ministerial authority responsible for hunting in accordance with the implementing regulations of this Code. The general guidelines of the national policy on wildlife are subject to a national plan.

Subject to the provisions of Article 34 and notwithstanding the provisions of international conventions on the prevention and repression of marine pollution ratified by the Republic of Guinea, are prohibited the discharge, dumping and incineration in waters under Guinean jurisdiction of substances of any kind that:

● Harm the health of humans and living resources;● Harm to marine activities, including boating and fishing; and/or● Degrade the amenity values and the tourism potential of the sea and

coastline.



3.0 EVALUATION OF “INTEGRATED HEALTH PROJECT” ISSUES WITH RESPECT TO ENVIRONMENTAL IMPACT POTENTIAL

IR 1.1: DELIVERY OF QUALITY HEALTH SERVICES IMPROVED Interventions Potential Adverse

Environmental ImpactRecommended Threshold Determination

1.1.1 Increasing availability of integrated quality maternal, neonatal, and child health services

1.1.2 Strengthening referral linkages

1.1.3 Increasing availability of prevention, care, and treatment services

Potential adverse environmental impact that could result from these interventions include generation of medical waste including sharps and syringes, contaminated testing equipment, which when disposed inappropriately could harm both human health and the natural environment.

Negative Determination per 22CFR216.3(c)(2)(iii) is recommended subject to the following conditions:

Training programs incorporate best practice standards in health care delivery as evident from the USAID’s sector guidelines on health available at http://www.usaidgems.org/Sectors/healthcareWaste.htm.

Any healthcare waste directly generated by USAID-funded training activities must be appropriately managed. *

Medical facilities receiving support from USAID in strengthening health system must have management protocols in place to handle, store and dispose medical waste in a manner consistent with USAID’s sector guidelines on health care waste available at http://www.usaidgems.org/Sectors/healthcareWaste.htm

Training, supervision, curricula development and other health care worker/work force capacity building must address appropriate management practices*



Interventions Potential Adverse Environmental Impact

Recommended Threshold Determination

concerning the proper handling, use, and disposal of medical waste, including blood, sputum, and sharps, when techniques or care situations being addressed would generate and require disposal of hazardous or highly hazardous waste (e.g. sharps, afterbirth from delivery, waste from screening for HIV or STDs, sputum samples for diagnosis of TB).

Note that this condition applies to activities targeting home care AND community health workers, not just those in clinics and health facilities. Wherever relevant, appropriate disposal mechanisms in home-based and community-based situations that are cost effective and safe must be identified and appropriately incorporated in training, protocols, and guidelines. This includes training home care and community health workers to deliver positive messages about personal and household hygiene, sanitation, and proper disposal of condoms and other potentially harmful materials.

1.1.4 Improving access to health services

Scaling up high impact and proven interventions in community health

Negative Determination per 22CFR216.3(c)(2)(iii) is recommended subject to the





delivery is meant to promote best practices in community health delivery. These activities intend to increase the access and the use of health services which could result in the generation of medical waste and increase risk of injury and infection.

condition that, in particular, adequate procedures and capacities must be in place to appropriately* handle, label, treat, store, transport and dispose of blood, sharps and other medical waste and that norms and training include environmental health considerations. These practices must be consistent with USAID health sector guidelines available at http://www.usaidgems.org/Sectors/healthcareWaste.htm .

*For all activities in this category, “Appropriate Management” of health care wastes is defined as being in substantial conformity with the USAID’s Sector Environmental Guidelines (SEG) “Health Care Waste” chapter (www.usaidgems.org/Sectors/healthcareWaste.htm), particularly the section titled, “Minimum elements of a complete waste management program.” Other important references to consult for sound waste management practices are “WHO’s Safe Management of Wastes from Healthcare Activities.”



http://www.usaidgems.org/Sectors/healthcareWaste.htm

http://www.usaidgems.org/Sectors/healthcareWaste.htm%20


IR 1.2: HEALTHY BEHAVIORS AND DEMAND FOR HEALTH SERVICES INCREASED



1.2.1 Improving national and sub-national coordination of behavior change activities

1.2.2 Improving quality, targeting, and scale of behavior change activities

1.2.3 Improving quality, targeting, and scale of health promotion activities

No significant adverse environmental impacts foreseen.

Categorical Exclusion is recommended for these activities pursuant to the following;

22CFR216.2(c)(1)(i) for actions that do not have an effect on the natural or physical environment.

22CFR216.2(c)(2)(i) education, technical assistance or training programs to the extent such programs do not include construction/rehabilitation of facilities.

22CFR216.2(c)(2)(v) document and information transfers

22CFR216.2(c)(2)(xiv) studies, project or programs intended to develop the capability of recipient countries to engage in development planning except to the extent designed to include construction and rehabilitation of facilities.



IR 1.3: HEALTH SYSTEMS STRENGTHENED



1.3.1 Strengtheningpolicy, planning, and transparent governance

Building capacity for formulation and implementation of policies in the health sector is intended to improve the quality of health sector delivery. These activities intend to increase the access and the use of health services which could result in the generation of medical waste and increase risk of injury and infection

Negative Determination per 22 CFR 216.3(c)(2)(iii) is recommended subject to the condition that, in particular, adequate procedures and capacities must be in place to appropriately* handle, label, treat, store, transport and dispose of blood, sharps and other medical waste and that norms and training include environmental health considerations. These practices must be consistent with USAID health sector guidelines available at http://www.usaidgems.org/Sectors/healthcareWaste.htm .

1.3.2 Strengthening

human resourcesfor health

Potential adverse environmental impact that could result from these interventions include generation of medical waste including sharps and syringes, contaminated testing equipment, which when disposed of inappropriately could harm both human health and the natural environment.

Negative Determination per 22CFR216.3(c)(2)(iii) is recommended subject to the following conditions:

Training programs incorporate best practice standards in health care delivery as evident from the USAID’s sector guidelines on health available at http://www.usaidgems.org/Sectors/healthcareWaste.htm.

Any healthcare waste directly generated by USAID-funded training activities must be appropriately managed.*

Medical facilities receiving support from USAID in strengthening health system must have management protocols in place to handle, store and dispose medical waste in a manner consistent with USAID’s sector guidelines on health care







waste available at http://www.usaidgems.org/Sectors/healthcareWaste.htm

Training, supervision, curricula development and other health care worker/work force capacity building must address appropriate management practices* concerning the proper handling, use, and disposal of medical waste, including blood, sputum, and sharps, when techniques or care situations being addressed would generate and require disposal of hazardous or highly hazardous waste (e.g. sharps, afterbirth from delivery, waste from screening for HIV or STDs, sputum samples for diagnosis of TB).

Note that this condition applies to activities targeting home care AND community health workers, not just those in clinics and health facilities. Wherever relevant, appropriate disposal mechanisms in home-based and community-based situations that are cost effective and safe must be identified and appropriately incorporated in training, protocols, and guidelines. This includes training home care and community health workers to deliver positive messages about personal and household hygiene, sanitation, and proper disposal of condoms and other potentially harmful materials.





1.3.3 Increasing availability of health commodities and essential drugs

Technical assistance to support national supply chain management for essential drugs is intended to strengthen the value chain for essential drugs supply. However, unintended environmental risk exists in the supply chain if the TA fails to address issues of proper storage of drugs at the appropriate temperatures and supply of expired drugs.

Negative Determination per 22CFR216.3(c)(2)(iii) is recommended subject to the condition that technical assistance addresses best management practices in proper storage of essential drugs appropriate systems to detect, store and dispose of expired drugs.

1.3.4 Improving availability of quality strategic information for evidence-based decision making

No significant adverse environmental impacts foreseen.

Categorical Exclusion is recommended for these activities pursuant to the following;

22CFR216.2(c)(1)(i) for actions that do not have an effect on the natural or physical environment.

22CFR216.2(c)(2)(i) education, technical assistance or training programs to the extent such programs do not include construction/rehabilitation of facilities.

22CFR216.2(c)(2)(v) document and information transfers

*For all activities in this category, “Appropriate Management” of health care wastes is defined as being in substantial conformity with the USAID’s Sector Environmental Guidelines (SEG) “Health Care Waste” chapter (www.usaidgems.org/Sectors/healthcareWaste.htm), particularly the section titled, “Minimum elements of a complete waste management program.” Other important references to consult for sound waste management practices are “WHO’s Safe Management of Wastes from Healthcare Activities.”



http://www.usaidgems.org/Sectors/healthcareWaste.htm



4.0 RECOMMENDED THRESHOLD DECISIONS & MITIGATION ACTIONS (INCLUDING MONITORING AND EVALUATION)In addition to conditions enumerated in section 3 of this IEE, full implementation of this IEE is contingent on the following general monitoring and implementation requirements:

1. Implementing Partner (IP) Briefings on Environmental Compliance Responsibilities: USAID/Guinea health team shall provide each IP, with a copy of this IEE; each IP shall be briefed on their environmental compliance responsibilities by their cognizant C/AOR. During this briefing, any IEE conditions applicable to the IP’s activities will be identified.

2. Integration of compliance responsibilities in prime contracts, grants, and agreements, as well as in all sub-awards:

a. USAID/Guinea team managing this activity shall assure that any future contracts or agreements for implementation of Governance Plus activities, and/or significant modification to current contracts/agreements shall reference and require compliance with any conditions of this IEE, as amended, as required by ADS 204.3.4.a.6 and ADS 303.3.6.3.e.

b. IPs shall assure that future sub-contract and sub-grant agreements, and/or significant modifications to existing agreements, reference and require compliance with all relevant conditions in this IEE.

3. Assurance of sub-awardee capacity and compliance: Prime IPs shall assure that sub-awardees have the capability to implement the relevant requirements of this IEE. The prime IP shall, as and if appropriate, provide training to sub-awardees in their environmental compliance responsibilities and in Environmentally Sound Design and Management (ESDM) of their activities.

4. IP monitoring responsibility: As required by ADS 204.5.4, the prime IPs will actively monitor and evaluate whether any conditions of this IEE, as amended, are being implemented effectively and whether there are new or unforeseen consequences arising during implementation that were not identified and reviewed in this IEE.

5. If new or unforeseen consequences arise during implementation, the team with support from the cognizant A/CO will suspend the activity and initiate appropriate, further review in accordance with 22 CFR 216. USAID monitoring shall include regular site visits.



6. New or modified activities: As part of their annual work plans, prime IPs, in collaboration with their A/COR, shall review all ongoing and planned activities to determine if they are within the scope of this IEE.

7. If interventions outside the scope of this IEE are planned, prime IPs – along with A/CORs -- shall ensure that an amendment to this IEE addressing these interventions is prepared and approved prior to implementation of any such interventions.

8. Any ongoing activities found to be outside the scope of the approved 22CFR216 environmental documentation shall be modified to comply or halted until an amendment to the documentation is submitted and approved.

9. Compliance with host country requirements: Nothing in this IEE substitutes for or supersedes prime IP or sub-awardee responsibility for compliance with all applicable host country laws and regulations. The prime IP and sub-awardees must comply with host country environmental regulations.



Documents

Project/Activity Data - United States Agency for ... · Web viewUSAID will seek, develop, and maintain private and public sector partnerships that augment project interventions