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US Agency for International Development (USAID) / India

Initial Environmental Examination (IEE)

Program/Project/Activity Data:

Activity/Project Title: Health Office Project Approval Document (PAD) Amendment / Solicitation #: N.A.
Contract /Award Number (if known): N.A
Geographic Location : India;386
Originating Bureau/Office: USAID/India, Health Office
Supplemental IEE: ☐ Yes ☒No
Amendment: ☒Yes ☐No
Programmatic IEE: ☐Yes ☒No / DCN and date of Original document: N.A
DCN and ECD link (s) of Amendment (s): N.A
Amendment No:
Original IEE-Asia 13-38 @ 3/13/2013
Amendment 1-Asia 15-009 @ 12/9/2014
Amendment 2- No activity was implemented, hence no IEE was approved by BEO.
Amendment 3-Asia 14-163@10/16/2014
Funding Amount: $251,332,489 / Life of Project Amount: $251,332,489
Implementation Start/End: FY 2018/ FY 2022
Prepared By: Rodger Garner / Date Prepared: May 18, 2017
Expiration Date (if any): / Reporting due dates (if any): N.A
Environmental Media and /or Human Health Potentially Impacted (check all that apply)
None ☒Air ☐ Water ☐ Land ☐ Biodiversity ☐Human Health ☐Other ☐
Recommended Threshold Determination:
☒Negative Determination ☒With Conditions
☒Categorical Exclusion
☐Positive Determination / ☐Deferral
☐Exemption
☐USG Domestic NEPA action
Climate Change
☐GCC/Adaptation ☐GCC/Mitigation ☒Climate Change Vulnerability Analysis (included)
Adaptation/Mitigation Measures: Not Applicable

SUMMARY OF FINDINGS

The purpose of this Amendment No. 4 is to:

  1. Extend the duration of the Initial Environmental Examination validity for the extended Health Office PAD and activities under the PAD from 2018 to 2022 to coincide with the PAD timeline.
  1. Increase the Life of Project (LOP) funding for the PAD from $178,706,000 to $251,332,489 million; and
  1. Modify selected previously authorized activities;
  1. authorizes new activities under DO1;

The health activities continue to focus on the Maternal and Child Health; Family Planning; TB and HIV/AIDS as outlined in the original PAD. In alignment with the CDCS Development Objective (DO) 1, in the amended PAD the Health Office proposes to modify 16 existing activities and design two new activities in the following sectors: Maternal and Child Health; Family Planning; Tuberculosis (TB) and HIV/AIDS.

Six of the activities are field support activities managed by USAID/Washington.As the field support activities are covered by Washington-issued IEEs, these activities are not addressed in this IEE, but are noted herein for clarity and described in the related PAD. This IEE covers the remaining Mission-managed components that are addressed in detail in Attachment 1.

Recommended Action:

  1. Recommended Action: Categorical Exclusion; : Pursuant to 22 CFR 216.2(c )(3), the “core” activities, representing over 65% ($163,366,118)of the total project’s LOP funding level, the originator of the activities, i.e., the Health Office (HO), has determined that “core” program activities under all program’s new components (Table 1) which include technical assistance, participant training, information dissemination and other similar types of environmentally neutral actions consist of types of interventions entirely within the categories listed in 216.2(c )(2) and are therefore recommended to be categorically excluded under the following classes of action:
  1. Education, technical assistance, or training program, except to the extent such programs include activities directly affecting the environment {22 CFR 216.2(c)(2)(i)};
  2. Analysis, studies, academic, or research workshops and meetings
  3. {22 CFR 216.2(c)(2)(iii)};
  4. Document and information transfer {22 CFR 216.2(c)(v)};
  5. Studies, projects, or programs intended to develop the capability of recipient countries and their institutions to engage in developmental planning, except to the extent designed to result in activities directly affecting the environment {22 CFR 216.2 (c)(2)(xiv)}.
  1. Recommended Action: Negative Determination with Conditions for activities representing over 35% ($87,966,371)of the total project’s LOP funding level,involving Reproductive, Maternal, Newborn, Child, and Adolescent Health activities having potential medical waste management risks, testing and implementation of innovation pilots, replication and scale-up activities that may have a potential impact on the natural or physical environment( Refer Table 1). The Implementing Partners (IPs) will assess each activity to screen for potential environmental risks against the Environmental Review and Assessment Checklist (ER Checklist) attached as Annexure 1. Activities with Negative Determination with Conditions can go forward after the IPsdevelop environmental compliance criteria and Environmental Mitigation and Monitoring Plans (EMMPs,) incorporating findings of climate risk screening at the project and activity levels, and after these are approved by Agreement/Contract Officers Representative (A/COR) and Mission Environmental Officer (MEO). If potential significant adverse environmental and social effects areas confirmed, a Scoping Statement (SS) and Environmental Assessment (EA) shall be done by the IPsprior to start of the activity, and both the SS and EA Report shall be reviewed and approved by the Bureau Environment Officer (BEO) /Asia. SSand EA shall be accompanied by meaningful public consultation with potentially affected people and key relevant stakeholders. Terms of Reference for SS and EA will be reviewed by the MEO in consultation with the Regional Environment Adviser (REA), and approved by the BEO/Asia. All proposed actions must conform with national standards or best practices to ensure no significant effect on the environment.

Climate Risk Screening:

As per World Bank report (Turn Down The Heat: Climate Extremes, Regional Impacts and the Case for Resilience –2013)Climate change is expected to have major health impacts in India- increasing malnutrition and related health disorders such as child stunting - with the poor likely to be affected most severely. Child stunting is projected to increase by 35% by 2050 compared to a scenario without climate change.

Malaria and other vector-borne diseases, along with and diarrheal infections which are a major cause of child mortality, are likely to spread into areas where colder temperatures had previously limited transmission.

Heat waves are likely to result in a very substantial rise in mortality and death, and injuries from extreme weather events are likely to increase.

Major health effects due to changing climate can be broadly classified as follows:

• Extreme weather-related health effects

• Air pollution-related health effects

• Water and food-borne diseases

• Vector-borne diseases

• Effects of food and water shortages

• Psycho-social impacts on displaced populations

• Health impacts from conflicts over access to vital resources

In order to address some of the predicted changes as well as those are taking place in India in an effective manner, more emphasis is required on the following policies:

• Strengthening health systems and service delivery mechanisms

• Provision of safe drinking water and sanitation facility to all

• Provision of funding for low income communities with poor sheltering and high exposure/risk to heat and cold waves

• Educating people about climate-related diseases

The initial screening of the project against climate change effects indicates that the activities do not pose social or environmental risks that need to be further analyzed through additional steps of the identification process. Based on the information available, none of the proposed project activities will affect climate change or eco-systems or cause Greenhouse Gas (GHG) emissions. The project area is not exposed to climate hazards like cyclones, droughts, floods and storm surges. There are no demographic and socio-economic aspects of the project that increase the vulnerability of the project to climate change. In case of project activities that are predicted to be affected by weather variability, change in precipitation patterns and water availability, the IPs responsible for activities shall conduct a climate risk screening and prepare detailed EMMPs with proper follow-up action to be reviewed and approved by Agreement/Contract Officers Representative (A/COR) and MEO. The project will benefit from the EMMP developed for each activity having any potential to impact the environment. The project will support policies and programs in the community and in the health system that authentically engage and partner with community residents in addressing climate and health problems. The activities will include advocacy for investments in disadvantaged and highly-impacted communities to reduce social and economic vulnerability risks associated with extreme weather-related health effects like air pollution-related health effects, water and food-borne diseases and vector-borne diseases.

The Project-Level Climate Risk Management Summary Table Template is attached in the Annex 2.

  1. BACKGROUND AND ACTIVITY DESCRIPTION:

1.1Purpose and Scope of the IEE

USAID/India’s Development Objective 1 (DO1), approved on March 1, 2013, is the Health Office’s multi-sectoral effort to address the country’s health challenges. DO1 aims to: “Increase the capacity of India’s health system to improve the health of vulnerable populations in India”. DO1 proposes to consolidate and sustain achievements gained under the previously approved CDCS by building on proven strategies and high-impact, evidence-based interventions in health. DO1 will also reflect strategic shifts to address changes in the country’s context as well as emerging challenges.

Since March 1, 2013 there have been a number of amendments to the DO1 PAD to authorize new programs and funding. PAD Amendment #1 (TB-Free India program) was approved on August 1, 2014. DO1 PAD Amendment #2 (Supply Chain Management) was approved on August 13, 2014. DO1 PAD Amendment #3 (Tibet Fund Program) was approved on October 24, 2014.

The purpose of this Amendment is to reflect on the new PAD timeline (FY2018 – FY 2022),; increased LOP funding ($182,000,000) to reflect current funding levels; and the addition of modified and new activities in the Partnership in Health Office Program. This amendment will allow Health Office to meet the requirement for accelerating program implementation as outlined in the PAD.

PAD Amendment #4 includes proposed activities for FY 2018-2022. The proposed activities continue to align with strategic priorities and policies of the Government of India (GOI). Many of the activities under the original PAD are continuing and included in this revised PAD with modifications interms of +increased funding and extened LOP of the activities. Out of the 18 atvities listed in th PAD, 16 activiites are ongoing with modifications and two activities are new. Out of the 16 activities, 6 activities are through field support mechanism arecovered by Washington-issued IEEs.

1.2Description of Activities

Activities modified

Maternal Child Health and Family Planning Activities:

1. Scaling Up Interventions in Reproductive, Maternal, Neonatal and Child Health (RMNCH+A)

Brief Description: Implemented in collaboration with the GOI’s Ministry of Health and Family Welfare (MOHFW), this technical assistance activity aims to increase the quality of services in the maternal and child health, nutrition, WASH and family planning sectors. To date, this activity has benefitted six million women and children by reducing post-partum hemorrhage (the largest cause of maternal death in India) through high-impact interventions such as care around birth, post-partum family planning and community-based misoprostol.

The modification will build on the lessons learned and best practices from phase one to reach at least ten million more mothers and children in new high-burden geographies. The next phase will also focus more on strengthening human resources, financing, quality initiatives and supply chain systems at the state level.

2. The Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Alliance

Brief Description: The ‘Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Alliance’ is a collaborative alliance formed in 2013 between USAID, Kiawah Trust, the Piramal Foundation, and Dasra that has successfully demonstrated high impact innovative approaches to empower adolescent girls.

The modification will build on lessons learned and best practices from phase one to reach more adolescents between the ages of 10-19 in new high-burden geographies. The project will build a platform to enable scale-up of adolescent, reproductive, and sexual health programs that aim to delay marriage, increase secondary education and increase voluntary use of family planning services. The expanded activity will integrate USAID-funded health activities with private sector funded education and livelihood interventions creating a more holistic approach to address the needs of adolescents and support the national adolescent health program.

3. Digital Integration to Scale Gender-Sensitive Nutrition Social and Behavior

Change Communication (SBCC)

Brief Description: Working closely with the MOHFW, the Ministry of Women and Child Development and the Ministry of Rural Development in select states, this project uses digital technology to implement gender-sensitive social and behavior communication change (SBCC) approaches to improve health, nutrition and WASH outcomes at the community level. The project works closely within existing public, private, and civil society channels for agricultural, public health, and nutritional extension directly engaging 200,000 women and reaching over a million people.

The modification will employ new digital technologies such as community radio, mobile solutions, interactive voice response, and broadcast media to increase the reach of SBCC related to family planning, nutrition, WASH, and maternal and child health interventions. While primarily focused in rural areas, the project will also pilot new SBCC mediums in urban poor areas to improve health outcomes.

4. Strengthening Health Outcomes through the Private Sector (SHOPS) Plus

Brief Description: The primary goal of SHOPS Plus is to improve health outcomes and contribute to the achievement of key Health Office priorities such as Ending Preventable Child and Maternal Deaths,Family Planning 2020, and the End-TB Strategy.

Going forward, SHOPS Plus will strategically engage private sector providers in India, who are integral to the health system and important providers of priority health care services. The project will focus on (1) strengthening the provision of private sector health, nutrition and WASH information, products, and services at the community and health facility levels so that the full extent of private sector resources are mobilized; (2) enhancing effective public-private engagement, leading to the optimized use of resources – including financial, human, supply chain and infrastructure; (3) improving the enabling environment for the private sector within the health system; and (4) enhancing private sector programming through the dissemination of innovative models and best practices.

5. Helping 100,000 Babies Survive and Thrive

Brief Description: The Helping 100,000 Babies Survive and Thrive initiative is a partnership between the American Academy of Pediatrics and the Indian Academy of Pediatrics which aims to save newborn lives by scaling up the Helping Babies Survive training and quality improvement initiatives. The purpose of this project is to create a replicable model in five pilot program districts, which support major care goals as outlined in the India Newborn Action Plan (INAP). Once the pilot is completed the MOHFW has committed to scaling this training package across the country.

6. Polio

Brief Description: The USAID-GOI partnership on polio eradication covers three broad areas: (1) surveillance, (2) community and social mobilization and (3) partner coordination. USAID works with local community organizations, women’s groups and self-help groups to disseminate social mobilization messages that have gone well beyond polio to address other immunizations, water and sanitation, breastfeeding, and handwashing. USAID’s support for facility-based and community-based disease surveillance collects data and verifies that the efficacy of immunization efforts. Although India was certified polio free in 2014, continued vigilance is critical to prevent the risk of polio importation from neighboring countries of Afghanistan and Pakistan, where the disease is still endemic.

7. The Maternal and Child Survival Program

Brief Description: In collaboration with the GOI, the Maternal and Child Survival Program introduces and supports high-impact health interventions that reduce preventable child and maternal deaths and introduce new family planning methods to meet USAID’s global FP2020 commitments. The Program ensures that women, newborns and children in high-burden urban and rural geographies have equitable access to quality health care, nutrition and WASH services. The Program will work within the public and private health sector to tackle these issues through approaches that also focus on health systems strengthening, household and community mobilization, gender integration and eHealth, among others.

Going forward, USAID will intensify efforts to unlock public and private resources in urban areas, and will implement new health solutions for the urban poor. The project will work with urban local governments to build their capacity to manage, implement and monitor local government’s response to health, nutrition and WASH issues. Additionally, the project will introduce and demonstrate adolescent reproductive and sexual health models at the community and facility levels to engage adolescents in the age group 15-19 years. This will help to change attitudes towards social norms regarding reproductive needs of adolescents. The project will also provide technical support to the GOI to strengthen human resource systems through pre-service education programs in nursing, midwifery and other areas.

8. Wajood

Brief Description: Wajood is a collaborative initiative between USAID and Indrani’s Light Foundation. The project aims to improve health outcomes and reduce gender-based violence (GBV) among women and girls.

The project will be modified to include components beyond GBV to build a platform that supports the scale-up of initiatives that address gender equality, unmet needs of health information, and family planning services among married and unmarried youth across several states in India. The project will also intensify engagement with adolescent girls and boys in urban areas to test models to increase access to family planning and other health services, and to support the national adolescent health program.

9. The Partnerships for Affordable Health Access and Longevity

Brief Description: The Partnerships for Affordable Health Access and Longevity (PAHAL) aims to develop equitable, sustainable and scalable private markets capable of improving access and delivering high-quality, affordable primary healthcare with a focus on reproductive, maternal, neonatal and child health for India’s urban poor and reduced out-of-pocket expenditure.