Rwanda
Great Lakes Emergency Sexual and Gender Based Violence and Women’s Health Project
Environmental and Social Management Approach, including Environmental Management Plan and Medical Waste Management Plan
Executive Summary and Conclusions
The Environmental and Social Management Approach (ESMA) provides general policies, guidelines, codes of practice and procedures to mainstream environmental and social (E&S) due diligence during the implementation of the World Bank supported Great Lakes Emergency Sexual and Gender Based Violence and Women’s Health Project. The objective of the abbreviated ESMA is to help ensure that activities will be in compliance with the national legislations of Rwanda and the World Bank’s E&S safeguards policies.
The document is the main due diligence instrument required by the World Bank as financer, and additionally covers and goes beyond the Rwandan national regulatory requirements for project-level environmental assessment and management. The Environmental and Social Management Plan (ESMP) will be the main resource for environmental management and monitoring for the Client and set the standards and practices that will guide environmental and social project performance. It will become part of the tender package and environmental management and compliance will constitute a subsection of line items in the bill of quantities (BoQ). The selected bidders will be required to accept E&S conditions and tasks upon contract signature, and the implementation of the ESMP will be an integral part of the construction contracts. The monitoring of E&S performance will, much as other quality criteria, be tied to contractual penalties and damage restoration requirements via appropriate contractual clauses.
The project has been designedto cause minimal environmental or social adverse impacts; those which are expected are temporary, minor, confined to locations within already existing structures, compounds and built up areas, and are mitigable with standard, readily available measures. Due to the need to manage the limited, site-specific environmental and social impacts caused by activities supported by the proposed operation, the World Bank’s Safeguards policy on environmental assessment (OP 4.01) was triggered.
The following two safeguards instruments are anticipated to fully manage and mitigate the potential adverse social and environmental impacts of activities: (i) an Environmental Management Plan, and (ii) a Medical Waste Management Plan.
Project Description
The Great Lakes Emergency Sexual and Gender Based Violence and Women’s Health Project includes Burundi, the Democratic Republic of Congo, Rwanda and the International Conference on the Great Lakes Region (ICGLR). The Project Development Objectives (PDO) of the regional project are to (i) expand the provision of services to mitigate the short and medium term impact of SGBV, and (ii) to expand utilization of a package of health and nutrition interventions targeted to poor and vulnerable females. The Rwanda project will contribute to the first objective of the regional project. Direct project beneficiaries include male, female and child survivors of SGBV. In addition, the project will provide selected support to families of survivors as well as support at the community level.
The project will support the following components: (i) Holistic support to survivors of SGBV and violence prevention, and (ii) Regional and National Knowledge Sharing, Research and Capacity Building.
Component 1: Holistic Support to Survivors of Sexual and Gender Based Violence and Violence Prevention
This component will support delivering an integrated package of short and medium term assistance to survivors of SGBV at both community and health facility levels through scaling-up the ISANGE OSCs while promoting gender equality, behavioral change and violence prevention in the intervention zones. The holistic approach aims to support survivors’ physical, mental, social and economic well-being, taking into account the multiple needs, causes and consequences of SGBV. A holistic response will contribute to preventing or decreasing different consequences related to SGBV and breaking the cycle of violence. Specifically, this component will support: (i) Integrated Support for Survivors of SGBV and Prevention of Violence at Community Levels; and (ii) Integrated Support for Survivors of SGBV at Health Facility level.
Sub-component 1A: Integrated Support for Survivors of SGBV and Prevention of Violence at Community Levels. This sub-component will include activities to support long-term behavioral and social norm changes to promote gender equality and reduce levels of violence, including SGBV through: (i) launching sensitization and advocacy activities to promote gender equality through public awareness campaigns (including radio, theater and television shows) at the national and community level including on existing laws, policies and services as well as the development of educational/informative modules designed to examine a range of issues directly or indirectly related to SGBV; and (ii) promoting behavioral change through the scaling-up of effective models for working with women, men, boys and girls at the community level to change behaviors and reduce violence in cooperation with other development partners. In addition, this sub-component will provide support to (iii) ensuring follow-up at the community level through social services and referrals to existing social protection programs for the economically vulnerable survivors of SGBV to promote their economic empowerment; and (iv) supporting safe houses to help survivors of SGBV to benefit from temporary safe housing before returning to their communities of origin.
Sub-component 1B: Integrated Support for Survivors of SGBV at Health Facility level. This sub-component would support needs of survivors through scaling-up the ISANGE OSCs at the district level, using the established Multidisciplinary Investigation and Intervention Team Model (MDIIT). The ISANGE OSCs will be established in 17 existing hospitals which would be rehabilitated and modernized to accommodate the OCSs in line with the National Strategy to ensure multidisciplinary services and protection of survivors, 4 of which will focus on providing services to refugee SGBV survivors.[1] In addition, during the fourth year of the project, 6 additional ISANGE OSCs close to refugee camps and boarder areas currently supported by the Government of the Netherlands will be supported. The services are available free of charge, 24 hours per day, 7 days a week. The support provided under this sub-component will complement the recently signed three-year project to support the scaling-up of the ISANGE OSC model with support from the Government of the Netherlands and One-UN. Specifically, this sub-component will include: (i) setting up the ISANGE OSCs in selected hospitals with the necessary facilities, equipment and medical supplies; (ii) supporting clinical care, case management, rapid initial support, and referral depending on the needs of SGBV survivors and based on an individualized and confidential service-delivery plan addressing these needs; (iii) providing PEP emergency kits, medical care services, surgery equipment and medical consumable; (iv) providing medico-legal support through the collection of forensic evidence and the completion of the standard medico-legal form from the national police with the necessary additional equipment and intervention services; (v) providing mental health and psychological support through specialized psychotherapeutic interventions, family mediation, family mental health support, and psychiatric referral, as needed in coordination with social services; and (vi) providing legal aid through police services, legal advice, free legal counseling and representation in court, transport and judicial follow-up, in coordination with social services.
Component 2: Regional and National Knowledge Sharing, Research and Capacity Building.
The second component will support: (i) Regional and National Learning and Capacity Building; (ii) Research and Surveys; and (iii) Project Management. Under (i) two pre-identified buildings will be upgraded to function as a Center of Excellence on Sexual and Gender Based Violence.
Environmental Baseline Data
The environmental baseline of all potential project locations is characterized by a pre-existing use as medical facilities, usually within larger villages or cities, within urbanized areas, compounds designated as hospitals for several years already, and entirely within existing structures. The medical facilities within which the ISANGE OSCs would be established are currently well managed, especially in terms of medical waste generation, which is treated in modern incinerators that are installed in about 90 percent of the 42 current district hospitals. Some incinerators are shared by several clinics, and all clinics and hospitals have access to incinerators to dispose their medical waste.
Regulatory oversight over waste management and general environmental impacts are shared by the Rwanda Environmental Management Authority (REMA) and MoH’s Department for Environmental Health (DEH), and is exercised in a diligent, professional and comprehensive manner.
Environmental and Social Impacts
The project is expected to increase social cohesion at the family and community level by specifically addressing issues of stigmatization and rejection of survivors of SGBV, as well as activities to promote gender equality and change negative attitudes and norms towards women and girls. In addition, the project support will provide targeted communities with better access to basic health service. Project investments may strengthen sound environmental and social practices around health facilities.
The project is not expected to have large scale, significant, or irreversible environmental or social impacts. Project activities are focused on delivery of an integrated package of short and medium term assistance to survivors of SGBV at both the community and health facility level, as well as providing high impact maternal and reproductive health and nutrition services or vulnerable and poor women. To ensure survivors of SGBV will be received in an adequate environment, the project will support setting up in existing health centers special rooms and upgrade existing ones.
Three types of activities have a potential to cause minor adverse impacts that will need to be minimized, mitigated and managed:
(i)The civil works related to the small construction or rehabilitation activities at the 17 identified ISANGE OSCs, which may cause noise, vibrations and emissions from vehicles and machinery, generate construction waste and involve potential risks regarding workplace and community health and safety.
(ii)The same type of impacts, but possibly on a slightly larger scale for the rehabilitation of two pre-identified buildings, dedicated to become the SGBV Center of Excellence.
(iii)The generation of additional quantities of medical waste during the operation of the health facilities.
The planned construction activities under (i) and (ii), and subsequent operation of the ISANGE OSCs and rehabilitation for the Center of Excellence represent a minor scale and are following well established approaches and plans with little scope for variation. The expected impacts will be on a very small scale and widely dispersed and so may induce marginal adverse environmental impacts, significant or cumulative effects are not expected. The anticipated adverse impacts are not expected to go beyond the scope, intensity, and duration that would be generated by similar projects using Best Available Techniques (BAT). In addition, the scaling-up of the ISANGE OSCs follows the National Strategy for Scaling-up ISANGE OSCs (2013) issued by the GoR outlines in detail the models for ISANGE OSCs and need to be followed for all ISANGE OSCs across the country. The generation of medical waste is an unavoidable feature of operating clinics.
Compliance with World Bank and national safeguards policies
The activities supported by the proposed operation are expected to have minor environmental and (to even lesser extent) social risks, that could manifest into negative impacts, if not properly managed.; therefore, the World Bank’s Safeguards policy on Environmental Assessment (OP4.01) is triggered.
Overall, the current project design will cause minimal environmental or social adverse impacts, all of which are temporary, minor, confined to locations within already existing structures, compounds and built up areas, and mitigable with standard, readily available measures. In activities (i) and (ii) (see section above) the expected impacts are those of any small scale construction site (noise, dust, exhaust gases, waste generation, workplace and community health and safety). The main anticipated adverse potential impact could occur during the operation of the health facilities, where the planned medical care services will produce medical waste, that – classifiable as hazardous – will need to be managed appropriately. The generation of medical waste is an unavoidable feature of operating clinics. In activities (i) and (ii) the expected impacts will be on a very small scale and widely dispersed and so may induce marginal adverse environmental impacts, significant or cumulative effects are not expected.
The type, magnitude, duration and scope of impacts are currently well understood. The sites for the upgrading of ISANGE OSCs have been identified and the works are planned and designed with a high degree of certainty. The site for the center of excellence has been identified, consisting of 3 existing buildings which will be upgraded. No detailed ESIAs are required to determine the environmental and social impacts, which will be of a standard nature to be expected from all minor construction activities.
The current system of medical waste management in Rwanda is well organized and is fully understood by the project team. A system of incinerators, transport arrangements and treatment and disposal procedures exists, which the project will largely utilize, albeit with potential scale-up and upgrading activities. In addition, the MoH will use and follow the Ministerial Guidelines on Sorting, Transportation, Treatment and Final Disposal of Medical Waste from Site of Generation to Site of Final Disposal.
An environmental impact assessment will not be required for any of the sites, as both the project activities and the resulting impacts are clearly delineated and do not require additional investigations or assessments to be sufficiently understood to produce ESMPs for project implementation.
Regulatory Framework
Rwanda is just revising and enacting new institutional, policy and legislative framework in all its sectors and sub sectors after operating with colonial framework until after 1994. Most of the government ministries have already developed the respective sector policies and strategic plans most of which are based on poverty reduction strategy.
The constitution of the Republic of Rwanda
Adopted by the Rwandans during the Referendum of 26th March, 2003, it stipulates through different wordings of law the following message:
‐ Article 49: Each citizen has the right to healthy and satisfying environment. Each person has the right to protect to conserve and promote the environment. The government will take care of the environment protection. An Act defines the procedures of protecting, conserving and promoting environment.
Organic Law on Environment Protection and Management
Article 67 of the organic law No 04/2005 of 08/04/2005 determining the modalities of protection, conservation and promotion of environment in Rwanda stipulates that every project shall be subjected to environmental impact assessment before obtaining authorization for its implementation. This applies to programmes and policies that may affect the environment.
Furthermore, the ministerial order No 003/2008 of 15/08/2008 gives the requirements and procedure for environment impact assessment and the ministerial order No 004/2008 of 15/08/2008 establishes the list of works, activities and projects that have to undertake an environment impact assessment highlights some projects including construction and repair of international and national roads, large bridges, industries, factories, hydro‐dams and electrical lines, public dams for water conservation, rain water harvesting for agricultural activities and artificial lakes, large hotels public building which accommodate more than one hundred daily, extraction of mines and public land fills among others.
No public institution shall take a decision ,to warrant a certificate, approve or authorize the commencement of the project mentioned in annex of this order without prior environment impact assessment .Notwithstanding what is provided in this paragraph, Rwanda Development Board(RDB) May grant permission for a project to commence without carrying out environmental impact assessment .In addition ,when it is necessary and evident that the project might have a negative impact on the environment, RDB shall have the power to request the project ‘s owner to conduct an environmental impact assessment even if it is no listed in the annex.
Mitigation Measures:
For the upgrading of health facilities: Environmental Management Plan (EMP) using the “checklist format” has been developed for this activity due to the small scale, routine manner of interventions, and the expected minor, temporary and localized nature of the potential impacts (see Annex 1.). The objective of the Environmental Management Plan (EMP) is to provide clearly structured guidance how to mitigate negative impacts and to enhance positive impacts resulting from the investment project. The EMP includes check-list format for constructions to be rehabilitated and Mitigation Plan and a Monitoring Plan. The checklist-format EMP will be customized to specific construction projects and become part of the tender and contract documents.The EMP will be produced, reviewed by the Bank, disclosed, consulted on and finalized before any disbursement on physical works of this type of activity may be undertaken.
For rehabilitation of buildings for the Center of Excellence:While the expected impacts are analogous to those of the clinic rehabilitation works, they are expected to be slightly larger in scale. Thus the Checklist EMP may be too rudimentary an instrument and will be expanded with a more detailed narrative on site conditions, and more detailed provisions for E&S management, especially dust and noise control as well as traffic and pedestrian safety (due to nearby residential areas), and construction waste management. Also a building survey will be conducted to check for hazardous materials, especially asbestos. While Rwandan environmental regulations do not require separate management instruments for construction of the envisioned small scale, the approach proposed for the Bank-financed activities was fully endorsed by REMA.