ENVIRONMENTAL AND SOCIAL IMPACT ASSESSMENT REPORT FOR THE PROPOSED BIOSAFETY LEVEL II LABORATORY (BSL2), ISOLATION UNIT, & AN INCINERATOR PROJECT AT MOI TEACHING AND REFERRAL HOSPITAL LOCATED ALONG NANDI ROAD, ELDORET TOWN IN UASIN GISHU COUNTY Proponent MINISTRY OF HEALTH, P.O. BOX 30016-00100, NAIROBI, KENYA. CERTIFICATION This ESIA Project Report was conducted and prepared by the following NEMA registered Environmental Assessment Experts; Neolife Consultants Ltd, P. O. BOX 36942 - 00200 Nairobi. Mobile: 0722-796 282, 0780- 796 282 justneolife@gmail.com ENG. GITAU MUIRURI LEAD EXPERT REG. NO. 0434 MR. ONGERI ABEL LEAD EXPERT REG. NO. 9019 For and on behalf of; HEALTH, MINISTRY OF HEALTH, 30016-00100, P.O. BOX 30016- KENYA. NAIROBI, KENYA. DISCLAIMER: This Environmental and Social Impact Assessment Project Report is strictly confidential to the Ministry of Health, Kenya and any use of the materials thereof should strictly be in accordance with the agreement between the Ministry of Health , Kenya (the client) and Neolife Consultants Ltd(Registered Firm of Experts in EIA & Audits). It is however, subject to conditions spelt out in the World Bank Group’s Environment, Health, and Safety (EHS) Guidelines and the World Bank Operational Policies and Bank Procedures on Environmental Assessment and the EMCA, CAP 387, Laws of Kenya. 2 Acronyms and Abbreviations PR Project Report ESIA Environmental and Social Impact Assessment ESMP Environmental and Social Management Plan EMCA Environmental Management and Coordination Act NEAP National Environmental Action Plan MTRH Moi Teaching and Referral Hospital NEMA National Environment Management Authority KPLC Kenya Power and Lighting Company KNH Kenyatta National Hospital MOH Ministry of Health ELDOWAS Eldoret Water and SanitationCompany Limited LR Land Registration TOR Terms of Reference PPE Personal Protective Equipment EHS Environment, Health and Safety BS British Standards WBG World Bank Group WHO World HealthOrganisation CIDP CountyIntegratedDevelopment Plan NGOs Non-GovernmentalOrganizations PVC Polyvinylchloride GoK Government of Kenya WB World Bank IFC International Finance Corporation WHO World HealthOrganization D.P.C Damp Proof Course GRM GrievanceRedressMechanism PCR Physical Cultural Resources 3 TABLE OF CONTENTS CERTIFICATION .................................................................................................................................................... 2 Acronyms and Abbreviations .................................................................................................................................. 3 TABLE OF CONTENTS.......................................................................................................................................... 4 EXECUTIVE SUMMARY ...................................................................................................................................... 10 Introduction: ...................................................................................................................................................... 10 Background: ..................................................................................................................................................... 10 SUMMARY OF SIGNIFICANT ENVIRONMENTAL AND SOCIAL IMPACTS AND MITIGATION MEASURES 14 1.0 INTRODUCTION. ........................................................................................................................................... 21 1.1 Background ................................................................................................................................................ 21 1.2 OBJECTIVES AND SCOPE OF THE ENVIRONMENTAL AND SOCIAL IMPACT ASSESSMENT (ESIA) 22 1.2.1 Screening to determine whether ESIA is required: .............................................................................. 22 1.2.2 Scoping. ............................................................................................................................................... 22 1.2.3 Category of the project: ....................................................................................................................... 22 1.2.4 Scope of the ESIA ............................................................................................................................... 23 1.2.5 ESIA Criteria. ....................................................................................................................................... 23 1.2.6 The Objectives of the Project. .............................................................................................................. 23 1.2.7 Project Justification. ............................................................................................................................. 23 1.2.8 Methodology Outline: ........................................................................................................................... 24 2.0 TERMS OF REFERENCE (TOR) ................................................................................................................... 24 2.1 Activities by the Consultant:........................................................................................................................ 24 2.2 Expected Outputs ....................................................................................................................................... 25 2.3 Responsibility of the Client ......................................................................................................................... 25 3.0 POLICY, LEGAL, AND INSTITUTIONAL FRAMEWORK ............................................................................... 26 3.1 General View .............................................................................................................................................. 26 3.2 Policy Framework ....................................................................................................................................... 26 3.2.1 The Constitution of Kenya, 2010.......................................................................................................... 26 3.2.2 Kenya Vision 2030 ............................................................................................................................... 27 3.2.3 Health Care Waste Management Strategic Plan 2015-2020 (2015) .................................................... 28 3.2.4 National Environmental Action Plan (NEAP), 2009-2013..................................................................... 28 3.2.5 National Guidelines on Safe Management and Disposal of Asbestos, Revised 2013.......................... 28 3.2.6 National Policy on Water Resources Management and Development, 1999 ....................................... 29 4 3.2.7 Policy Paper on Environment and Development (Sessional Paper No. 6 of 1999). ............................. 29 3.2.8 The National Poverty Eradication Plan (NPEP) and the Poverty Reduction Strategies Paper (PRSP) 30 3.3 Environmental Management Statutes. ........................................................................................................ 30 3.3.1 The Environment Management and Coordination Act, Cap 387 .......................................................... 30 3.3.2 Environmental (Impact Assessment and Audit) Regulations, 2003 (Legal Notice No.101) .................. 31 3.3.3 The Environmental Management and Coordination (Air Quality) Regulations, 2014 ........................... 31 3.3.4 The Environmental Management and Co-ordination (Water Quality) Regulations, 2006. .................... 32 3.3.5 The Environmental Management and Co-ordination (Waste Management) Regulations, 2006. ......... 33 3.3.6 The Environmental Management and Coordination (Noise and Excessive Vibration Pollution) Control Regulations, 2009 ......................................................................................................................................... 34 3.4 Institutional Framework............................................................................................................................... 36 3.4.1 The National Environment Management Authority (NEMA) ................................................................. 36 3.4.2 The National Environment Tribunal ..................................................................................................... 36 3.4.3 The Ministry of Health .......................................................................................................................... 36 3.4.4 The County Government...................................................................................................................... 36 3.4.5 The Directorate of Occupational Safety and Health Services (DOSHS) .............................................. 37 3.4.6 The National Construction Authority (NCA) ......................................................................................... 37 3.5 Other Local Laws that Apply to this Project ................................................................................................ 37 3.5.1 The Water Act, 2016 ............................................................................................................................ 37 3.5.2 The Public Health Act (Cap. 242), Revised 2012................................................................................. 38 3.5.3 The Physical Planning Act, Cap 286 (Revised 2012) .......................................................................... 38 3.5.4 The Building Code, 2000. .................................................................................................................... 39 3.5.5 The Work Injury Benefits Act, 2007. .................................................................................................... 39 3.5.6 The Occupational Safety and Health Act, 2007. .................................................................................. 40 3.5.7 The Standards Act, Cap 496 (Revised 2013) ...................................................................................... 42 3.5.8 Safety and Health Committees Rules, 2004. ....................................................................................... 42 3.5.9 First Aid Rules, 1977 ........................................................................................................................... 42 3.6 Relevant International Guidelines. .............................................................................................................. 43 3.6.1 World Bank Operational Policies and Procedures on Environmental Assessment (EA) (OP/BP 4.01).43 3.6.2 WHO National Guidelines on Safe Disposal of Pharmaceutical Waste, 2001. .................................... 43 3.6.3 World Bank Group (WBG) Guidelines: Environmental, Health and Safety Guidelines General EHS Guidelines..................................................................................................................................................... 43 3.6.4 WBG EHS Guidelines: Air Emissions and Ambient Air Quality ............................................................ 44 5 3.6.5 WBG EHS Guidelines: Waste Management ........................................................................................ 44 3.6.6 WBG EHS Guidelines: Noise ............................................................................................................... 44 3.6.7 WBG EHS Guidelines: Occupational Safety and Health ...................................................................... 44 3.6.8 WBG EHS Guidelines: Construction and Decommissioning. ............................................................... 45 3.6.9 WHO: Safety in Healthcare Laboratories, 1997. .................................................................................. 45 3.7 Alignment of WB and GoK Polices Relevant to this ESIA ........................................................................... 45 4.0 PROJECT DESCRIPTION ............................................................................................................................. 46 4.1 The Proposed Location of the Project......................................................................................................... 46 4.2 Project Design Considerations.................................................................................................................... 49 4.2.1 Environmental and Sustainable Development Considerations ............................................................ 49 4.3 Project components. ................................................................................................................................... 50 4.3.1 Bio-safety Level 2 Laboratory Requirements. ...................................................................................... 50 4.3.2 Isolation Unit Requirements ................................................................................................................. 51 4.3.3 LAYOUTS ............................................................................................................................................ 52 4.4 Construction specifications: ........................................................................................................................ 55 4.4.1 Bio safety level 2 Laboratory................................................................................................................ 55 4.4.2 Isolation unit......................................................................................................................................... 56 4.4.3 General construction specification ....................................................................................................... 56 4.5 Design of the incinerator ............................................................................................................................. 56 4.5.1 Design Parameters .............................................................................................................................. 56 4.5.2 Siting.................................................................................................................................................... 57 4.6 MODEL I8-200 DETAILS: ........................................................................................................................... 59 4.7 Site (Project) Activities during the Construction Phase: .............................................................................. 59 4.7.1 Material Storage and Handling ............................................................................................................ 59 4.7.2 Non-Hazardous Materials .................................................................................................................... 59 4.7.3 Hazardous Materials ............................................................................................................................ 59 4.7.4 Material Sources and Management ..................................................................................................... 60 4.8 Project Cost: ............................................................................................................................................... 60 5.0 ENVIRONMENTAL AND SOCIO-ECONOMIC SETTING OF THE PROJECT AREA .................................... 61 5.1 PHYSICAL ENVIRONMENT....................................................................................................................... 61 5.1.1 Topography:......................................................................................................................................... 61 5.1.2 Climate: ............................................................................................................................................... 61 5.1.3 Geology ............................................................................................................................................... 62 6 5.1.4 Soils ..................................................................................................................................................... 62 5.2 BIOLOGICAL ENVIRONMENT................................................................................................................... 62 5.2.1 Wildlife and Forests ............................................................................................................................. 63 5.2.2 Water Resources. ................................................................................................................................ 63 5.3 WASTE MANAGEMENT AND POLLUTION PREVENTION ...................................................................... 64 5.3.1 Sewage Management .......................................................................................................................... 64 5.3.2 Solid Waste Management .................................................................................................................... 64 5.4 SOCIO-ECONOMIC ENVIRONMENT ........................................................................................................ 65 5.4.1 Land Use: ............................................................................................................................................ 65 5.4.2 Population and Demography: .............................................................................................................. 65 5.4.3 Poverty, Gender and Vulnerable Groups ............................................................................................. 66 5.4.4 Housing ............................................................................................................................................... 66 5.4.5 Socio-economic Importance of the Proposed Project .......................................................................... 67 5.4.6 Social Impact Assessment ................................................................................................................... 67 6.0 PUBLIC CONSULTATION .............................................................................................................................. 71 6.1 Overview..................................................................................................................................................... 71 6.2 Public Meeting ............................................................................................................................................ 71 6.3 Results of Public Consultation .................................................................................................................... 71 6.4 Summary of Public Comments as Per the Questionnaires ......................................................................... 72 6.5 Conclusion .................................................................................................................................................. 75 7.0 POTENTIAL ENVIRONMENTAL AND SOCIAL IMPACTS AND MITIGATION MEASURES ......................... 76 7.1 INTRODUCTION ........................................................................................................................................ 76 7.2 POSITIVE IMPACTS .................................................................................................................................. 76 7.3 ANTICIPATED NEGATIVE IMPACTS AND MITIGATION MEASURES ..................................................... 77 7.3.1 Demolition Phase................................................................................................................................. 77 7.3.2 Construction phase .............................................................................................................................. 80 7.3.3 Construction Phase Mitigation Measures............................................................................................. 82 7.3.4 Operation Phase .................................................................................................................................. 85 7.3.5 Operational Phase Mitigation Measures .............................................................................................. 87 8.0 ANALYSIS OF PROJECT ALTERNATIVES ................................................................................................... 90 8.1 The No Action Alternative ........................................................................................................................... 90 8.2 Analysis of Alternatives to Incineration ....................................................................................................... 91 8.2.1 Open uncontrolled, non-engineered dump sites .................................................................................. 91 7 8.2.2 Sanitary landfill .................................................................................................................................... 91 8.2.3 Incineration .......................................................................................................................................... 91 8.2.4 Crude burning ...................................................................................................................................... 92 8.2.5 Microwaving ......................................................................................................................................... 92 8.2.6 Autoclaves ........................................................................................................................................... 92 8.2.7 Plasma Pyrolysis ................................................................................................................................. 93 8.3 Analyses of Alternative Construction Materials and Technology ................................................................ 94 8.4 Wastewater (Effluent) Management Alternatives ........................................................................................ 94 8.5 Solid Waste Management........................................................................................................................... 95 8.6 Comparison of alternatives ......................................................................................................................... 95 9.0 ENVIRONMENTAL AND SOCIAL MANAGEMENT PLANS ........................................................................... 95 9.1 Environmental and Social Management Plan for the Construction and Operation Phases......................... 95 9.2 Environmental and Social Management Plan for Decommissioning Phase .............................................. 102 10.0 INSTITUTIONAL ARRANGEMENTS FOR THE ESMP IMPLEMENTATION ............................................. 104 10.1 Internal Monitoring .................................................................................................................................. 104 10.2 External Monitoring ................................................................................................................................. 105 10.3 Grievance Redress Mechanism (GRM) .................................................................................................. 105 11.0 CONCLUSION AND RECOMMENDATION................................................................................................ 107 REFERENCES ................................................................................................................................................... 108 APPENDICES .................................................................................................................................................... 110 Annex 1: Minutes of the Consultative Public Participation .............................................................................. 111 Annex 2: Approved Architectural Drawings .................................................................................................... 113 Annex 3: Standards for Effluent Discharge into the Environment ................................................................... 122 Annex 4: Standards for Effluent Discharge into Public Sewers....................................................................... 123 Annex 5: Effluent Levels for Health Care Facilities ......................................................................................... 124 Annex 6: Air Emission Levels for Hospital Waste Incineration Facilities ......................................................... 125 Annex 7: Guidance to Preparation of Chance Find Procedures ..................................................................... 126 8 List of Tables Table 1: A summary of significant environmental and social impacts........................................................................................................ 14 Table 2: First Schedule - Maximum Permissible Noise Levels .................................................................................................................. 35 Table 3: Second Schedule-Maximum Permissible Noise Levels for Construction Sites (Measurement taken within the facility) ............. 35 Table 4: Clinical Waste Groups ................................................................................................................................................................. 56 Table 5: Types of solid waste (non-clinical solid waste) ............................................................................................................................ 57 Table 6: Population demographics in the project area............................................................................................................................... 66 Table 7: Shows a summary of respondents and data tabulation ............................................................................................................... 68 Table 8: Respondents' comments and mitigation measures as per the filled questionnaires ................................................................... 72 Table 9: Environmental and Social Management Plan for the Construction and Operation Phases ......................................................... 95 Table 10: Environmental and Social Management Plan for Decommissioning Phase ............................................................................ 102 List of Figures Figure 1: Shows the site for the proposed bio safety laboratory and isolation unit respectively ................................................................ 47 Figure 2: Shows a satellite image showing the location of MTRH in relation to Sosiani River which is approximately 1Km away ........... 49 Figure 3: Shows the side elevation of the Bio-safety Laboratory ............................................................................................................... 52 Figure 4: Shows approved layout of the Bio safety Laboratory ................................................................................................................. 53 Figure 5: Shows the layout of the new incinerator shed ............................................................................................................................ 54 Figure 6: Shows the layout of the Isolation Unit......................................................................................................................................... 55 Figure 7: Shows the proposed incinerator site........................................................................................................................................... 58 Figure 8: Shows one of the broken down incinerator that is not in use ..................................................................................................... 58 Figure 9: Shows the climatic pattern of Eldoret area ................................................................................................................................. 62 9 EXECUTIVE SUMMARY Introduction: Environmental and Social Impact Assessment, (ESIA) has been identified as a key process for predicting and assessing the potential environmental and social impacts of a proposed project, evaluating alternatives, designing appropriate mitigation, management, and monitoring measures. Early identification of possible development impacts to the environment and human populations enhances and promotes environmental sustainability as anthropogenic factors are balanced with natural environmental needs. The World Bank requires an environmental and social assessment (ESA) of projects proposedby borrowers for Bank financing to help ensure that they are environmentally and socially sound and sustainable, and thus to improve decision making. The Bank undertakes environmental and social screening of each proposed project to determine the appropriate extent and type of environmental and social assessment. It classifies a proposed project into one of four Environmental Assessment (EA) categories, depending on the type, location, sensitivity, and scale of the project and the nature and magnitude of its potential environmental and social risks and impacts. It is also a requirement by the National Environment Management Authority (NEMA) under the Environmental Management and Coordination Act (EMCA), CAP 387 and the Environmental (Impact Assessment and Audit) Regulations of 2003, Laws of Kenya for projects of such nature to undergo an environmental impact assessment (EIA) process. The proposed Biosafety Level II Laboratory project falls under Category B of the World Bank EA categorization. Under this general category, “a proposed project is classified as Category B if its potential adverse environmental impacts on human populations or environmentally important areas-including wetlands, forests, grasslands, and other natural habitats--are less adverse than those of Category A projects. These impacts are site-specific; few if any of them are irreversible; and in most cases, mitigating measures can be designed more readily than for Category A projects. The scope of assessment for a Category B project may vary from project to project, but it is narrower than that of Category A assessment. Like Category A assessment, it examines the project's potential negative and positive environmental and social impacts and recommends any measures needed to prevent, minimize, mitigate, or compensate for adverse impacts and improve environmental performance.” The proposed project triggers one World Bank safeguard policy that is key in avoiding, preventing and mitigating undue harm to people and their environment in the development process. This is World Bank’s safeguards operational policies and procedures on Environmental Assessment (OP/BP 4.01). Apart from the above- mentioned WB policy, EMCA CAP 387, and EIA/EA Regulations of 2003, this ESIA was also therefore developed in light of a number of national and international policies, procedures, regulations, laws and statutes, some of which are discussed in detail in Section 3 of this report. Project alternatives considered included not taking action or choosing a different construction site. However, after an in-depth evaluation of a number of factors the project was proposed to go ahead at the proposed site. With regard to stakeholder consultations for the proposed project, the ESIA team interviewed a number of stakeholders from different areas who may be affected by the proposed project. Most of them generally agreed that the project should go on as planned since it is within an operational national referral hospital. Background: The project proponent is the Ministry of Health who intends to put up a Biosafety Level II public laboratory, Isolation Unit and an incinerator facility at the Moi Teaching and Referral Hospital (MTRH). The MTRH is a public 10 hospital owned by the Government of Kenya and it stands on public land. The selected construction site for the proposed project is within the existing fenced MTRH. Therefore, the land where the proposed project will be undertaken is public land owned by the Government of Kenya. There are no illegal or other occupants likely to be affected by the proposed project. Consequently, there are no issues on land acquisition (physical nor economic) on this project. This is a development being undertaken under the East Africa Public Health Laboratory Networking Project. The Regional Public Health Laboratory Project is a combined initiative of the Government of Kenya, Rwanda, Uganda, Tanzania, Burundi and the World Bank in support of efficient laboratory networking. The member countries have jointly mobilized resources to revamp public health laboratory services delivery. The project will deliver rehabilitated public health laboratories provided with critical equipment, improved technical and managerial skills for laboratory workers and strengthened institutional governance. The overall project objective is to strengthen capacities for diagnosis and surveillance of Tuberculosis and other communicable and non-communicable diseases by establishing a network of efficient, high quality and accessible public health laboratories and by promoting innovation and knowledge sharing. In addition, the incinerator facility will ensure sound health waste environmental management. The overall responsibility for project implementation will be with the Ministry of Health (MoH)). At the national level, the Director of Medical Services will provide leadership and ensure effective inter-ministerial coordination, all of whom are responsible to their respective Principal Secretaries or duly appointed representatives. A dedicated Project Coordination Unit will support the Head, National Public Health Laboratory in the implementation of the Project. Moi Teaching and Referral Hospital (MTRH) is the second largest National Referral Hospital in Kenya after Kenyatta National Hospital (KNH) in Kenya. The hospital is located along Nandi Road in Eldoret town (310 kilometers Northwest of Nairobi, the capital city of Kenya), UasinGishu County, in the North Rift region of Western Kenya. The Hospital was started in 1917, as a cottage Hospital with a bed capacity of 60 to cater for the health needs of Africans. From this humble beginning it has grown tremendously to a National Referral Hospital with a current bed capacity of 800 beds. The project proponentappointed Neolife Consultants Ltd to carry out an Environmental and Social Impact Assessment of the project for the World Bank and prepare a related Project Report (PR)for the National Environment Management Authority NEMA. This is in line with the World Bank Operational Policies and Bank Procedures on Environmental Assessment and also refers to the World Bank Group’s Environment, Health and Safety, (EHS) Guidelines as well as the Environmental Management and Coordination Act, CAP 387 and the Environmental (Impact Assessment and Audit) Regulations, 2003 contained in the Kenya gazette supplement No. 56, legislative supplement No. 31 Legal Notice No. 101 of 13thJune, 2003 Laws of Kenya. The purpose of the ESIA is to identify potential positive and negative environmental and social impacts associated with the proposed project and make recommendations on how to take advantage of the positive impacts on one hand and how to mitigate the negative impacts on the other. The ESIA team carried out the project’s ESIA using a combination of methods, which included; ground surveys, a public consultative meeting, questionnaires and interviews with the broad spectrum of stakeholders. In addition, existing literature on statutory and other requirements were reviewed. The potential environmental and social impacts identified are classified into the following categories: impacts on: air resources, water resources, 11 ecological resources, biodiversity and socio-economic issues. The key aspects include; dust generation, including asbestos waste/dust, noise generation, health and safety issues, waste management issues, and fire and chemical hazards. Wastewater (effluent) from the hospital is managed through an existing public sewer line which serves the area. The proposed new facilities will also connect to the sewer line. What will just be required to ensure that wastewater from the proposed project is connected is for the MTRH to secure permission from the relevant authorities i.e. the Eldoret Water and Sewerage Company. Potential environmental liabilities at the MTRH include the broken down old incinerator which shall be demolished and dumped appropriately as per the Environmental Management and Coordination (Waste Management) Regulations, 2006 Laws of Kenya. The dug-out pit used in burning waste in the open is another environmental liability which shall be covered well using excavated soils from the foundations of the new proposed structures and landscaped. Presently, the MTRH has a well-functioning grievance redress mechanism (GRM). It involves lodging of complaints by aggrieved stakeholders or submission of comments from hospital staff, patients, neighbours or community members to a suggestion box located in the hospital’s premises. The proponent (MOH) shall establisha GRM specifically for the proposed project to ensure that all issues as they pertain to the proposed project are addressed as and when they arise. The contractor shall be required to adopt the GRM by the MOH for addressing all grievances during the construction phase of the project. On the other hand, once the contractor hands over the facilities to MOH, the project level GRM may cease to function and all grievances would then be handled from the hospital level GRM. A chance find procedure is a project-specific procedure that outlines the actions to be taken if previously unknown cultural heritage is encountered. According to the World Bank’s safeguards policy on Physical Cultural Resources - PCR (BP 4.11), the borrower (represented by MOH) shall inform the Bank of the relevant requirements of its legislation and of its procedures for identifying and mitigating potential impacts on physical cultural resources, including provisions for monitoring such impacts, and or for managing chance finds. be responsible for siting and designing the project to avoid significant adverse impacts to cultural heritage. In the case of the proposed project, the MOH has developed provisions for managing chance finds (see annex 7) that would be incorporated into the main contractor’s contract and monitored by the Site Engineer. Mitigation measures have been developed in respect of the significant negative environmental and social impacts which when adopted, will meet environmental and social sustainability considerations and make the proposed project viable. In addition, The ESIA team has developed an environmental and social management plan (ESMP), which should be adopted in order to ensure that the mitigation process is successful.Table 1: A summary of significant environmental and social impacts and corresponding costed and time-bound mitigation measures. It also provides names of institutions that will be responsible for implementing certain mitigation actions,It is important that the contractor shall develop the Contractor’s ESMP and get this approved by the supervising consultant (or MOH) before starting the construction activities. The contractor’s ESMP and its implementation shall form part of contractor’s contract obligations, and remedies applied for non-compliance. 12 Socio-economic Importance of the Proposed Project: The proposed project will have the following positive socio-economic impacts: i. The proposed development will positively impact the health of Kenyans through provision of high quality laboratory testing and specialized care for people with high risk communicable diseases. ii. Operation of the facilities will create additional long-term technical and non-technical job opportunities for medical professionals and other non-medical professionals. iii. The proposed project will contribute towards increase in revenue collection by the central and county governments. iv. The proposed project will be connected to the municipal sewer line mains and water supply network hence will generate revenue to the Eldoret Water and Sanitation Company Limited through payment of connection and service fees. v. Apart from the direct employment of construction and operation workers, the proposed project will also benefit the following categories of individuals: Transporters: Investors on lorry and trailer transport will benefit greatly from the project. This benefit will extend to vehicle dealers, manufacturers and lorry drivers. Sand Harvesters: Locals involved in sand harvesting in nearby areas are to be major beneficiaries of the project. The benefits will extend to the county government entitled to levy taxes on sand transporters. Ballast Quarries: There will be massive use of ballast. This will ensure that the quarry owners and workers benefit greatly. Cement Manufacturers: The local cement manufacturers, their employees and shareholders are direct beneficiaries of the development. The government will also get some impressive increase in V.A.T. and other taxes levied on cement. Manufacturers and dealers of other building materials: Most of the building materials to be used are locally manufactured. Relevant companies, their workers and shareholders will be direct beneficiaries of the development. 13 SUMMARY OF SIGNIFICANT ENVIRONMENTAL AND SOCIAL IMPACTS AND MITIGATION MEASURES Table 1: A summary of significant environmental and social impacts, costed mitigation measures and responsible institutions Activity Environmental Potential Proposed Mitigation Estimated Cost (Kshs) Timeframe/ and Social Environmental and Measures Responsibility Aspects Social Impacts Pre-construction & Construction phase • Internal road paving • Dust • Adverse human • Install signs to limit vehicle speed at the site • 300,000 • During construction and construction. generation, health e.g. • Provide workers with appropriate Personal phase by Main Contractor • Excavation of including intensified Protective Equipment (PPE). for civil works building foundation asbestos respiratory health • Ensure regular maintenance of roads. and related earth waste/dust problems and • Apply water spray to roads during construction in the works asbestos poisoning dry season. e.g. concrete mixing. • Impaired visibility. • Train site workers on dust minimization techniques, • Loading and • Legal non – and removal and handling of asbestos. unloading of compliance. • Wet asbestos sheets before removal and transport materials. • Nuisance to • Outsource asbestos removal, handling and disposal • Stockpile neighbours and/or to NEMA licensed firms accumulation and workers. • Avoid re-use or recycling of asbestos containing compaction. • Air pollution and materials • Movement of eventual water • Truck loads to be kept within designated load limits. vehicles. pollution through • Trucks carrying dusty material to be covered with • Handling of soils and settling of dust. canvas sheet. broken/crushed • Dirt settling on • Limit haul truck traffic only to authorized routes and concrete. peoples’ properties. designated entrance and exit points. • Removal and • Creation of unsafe • Promote the progressive re-vegetation of disturbed handling of asbestos working conditions areas as much as possible. waste/dust through impaired • Cease construction activities which generate visibility. excessive dust until effective control measures are • implemented. • Fence off/barricade the site with iron sheets prior to construction work to minimize spread of dust to the immediate neighbourhood. • Securely cover skips containing dusty wastes where possible. • Use dust nets at high levels. Activity Environmental Potential Proposed Mitigating Estimated Cost (Kshs) Timeframe/ and Social Environmental and Measures Responsibility Aspect social Impacts • Internal road/ paving • Noise • Adverse human • Avoid construction activities during the night. • 80,000 • During construction and construction. generation health such as • Regular servicing and maintenance of construction phase by Main • Excavation of hearing impairment. equipment. Install silencers to curb excessive noise Contractor for civil works building foundation • Nuisance to • Use of ear protectors by workers. and related earth neighbours & • Establish an inspection program for equipment. works. workers, hospital • Avoid leaving vehicles and other equipment idling for • Demolition of existing workers, students, in- prolonged periods. buildings on site. and out-patients. • Sensitize drivers to avoid unnecessary noise making • Actual construction • Legal non- and hooting. works e.g. drilling, compliance. crushing, batching • Conflict between and mixing of neighbours and civil concrete. works contractor, • Loading and construction workers unloading of and the hospital materials. management • Stockpiling and compacting • Handling of soils and broken/crushed concrete Activity Environmentalan Potential Proposed Mitigating Estimated Cost (Kshs) Timeframe/ d Social Aspect Environmental and Measures Responsibility Social Impacts • Road construction. Emissions from • Legal non - • Regular servicing and maintenance of equipment. • 20,000 • During construction • Transportation of transporting compliance • Establish a regular inspection program for phase by Main workers to and from trucks, bull dozers • Adverse human equipment. Contractor for civil works the construction site. & stationary health • Excavation of equipment • Greenhouse effect building foundation including: (global warming) and related earth • Particulates • Acid rain. works. • Carbon dioxide • Smog. • Construction works • Carbon e.g. concrete mixing. monoxide, • SOx and NOx • Storing fuel on site • Oil(including • Adverse human • Establish site spill and fire control and management • 50,000 • During construction 15 • Road construction. lubricant and health because of procedures. phase by Main Contractor • Transportation of fuel) spills consuming oil • Constitute and train a spill and fire management team for civil works workers to and from • Fire hazard contaminated water on site the construction site. and food. • Training of workers on spill and fire • Excavation of • Contamination of control/management procedures and emergency building foundation surface water. preparedness. and related earth • Contamination of • Spill control kits should be availed at the site. works. ground water. • Personnel carrying out refuelling and lubrication of • Actual construction • Contamination of soil construction equipment should undergo training in related works e.g. resources. spill response and management. drilling, crushing, • Burns to humans and • Implement fuel delivery and storage procedures and batching and mixing property spill prevention and control plans applicable to the of concrete. delivery and storage of fuel for the construction • On-site refuelling and equipment. lubrication • Transportation of • Over speeding • Increased number of • Enlighten the drivers on the importance of observing • 100,000 • During construction by construction workers, • Overloading accidents. traffic rules. roads/traffic department staff, materials and • Non- • Violation of traffic • Install signs for speed limits along the access road equipment. compliance rules and regulations. and within the institution. with road • Loss of time in case • Discourage driving while drunk. safety of accidents leading • Install signs to prohibit obstruction. regulations to injury or death. • Discourage overloading. • • Ensure use of insured and roadworthy vehicles. • Discourage use of mobile phones while driving. • Enforce use of safety belts even on short distances. • Train drivers on road safety. • Truck loads to be kept within designated load limits and load covers to be used always. • All roads being used by the project should be well maintained and left in a good state as they were found, if not better. • Involve the community during road upgrades. • Influx of labour to • Workers’ health • Accidents and death. • Provide employment for locals, which controls influx. • 700,000 • During construction by construction site and safety. • Transmission of • Enforce occupational health, safety and hazard the contractor • Health and safety sexually transmitted control on site of local residents, diseases and • Workers sign a code of conduct. hospital staff, HIV/AIDS. • Issues of occupation, health and safety addressed in 16 students, in- and • Gender-based the tool box meeting. out-patients. violence (GBV) and • Inform local communities of major activities in • Disruption to sexual exploitation advance social networks and abuse (SEA) • Screen the health of potential workers for and local • Conflicts between communicable diseases as part of the recruitment customs. immigrants and local process. • Traffic safety residents • Undertake background checks of potential workers about any past involvement in GBV/SEA related offenses • Provide the workforce with access to primary healthcare on site, including prescriptions, prophylactics, condoms and basic testing for TB etc. • Provide awareness training to the workforce, in particular regarding the transmission of STDs, and traffic safety awareness, • Develop and enforce a strict code of conduct for workers to regulate behavior in the local communities • Prepare local communities for any large influx of workers by developing community-policing systems. • Establish a functional grievance redress mechanism (GRM) on site Activity Environmental Potential Proposed Mitigating Estimated Cost (Kshs) Timeframe/ and Social Environmental and Measures Responsibility Aspect Social Impacts Operation phase Operations of the lab • Introduction • Abuse/risk of • Constitute a lab management committee to include • 250,000 • Head of Laboratory such as drawing and and spread of unauthorized entry an occupational health and safety officer during operation testing of blood disease • Adverse human • Display clear warning signage at vantage points; specimens, stool and creating health through • The doors to the lab should be under lock and key urine, etc pathogens. contact with disease unless one is allowed in. • Risk to lab spreading pathogens. • Enforce entry/exit rules workers, lab • Increased risk of • Laboratory doors should be self-closing. cleaners and disease spread to the • Laboratory supervisor must ensure that laboratory out-patients neighbours personnel receive appropriate training regarding their • Increased pricks and duties; and the necessary precautions to prevent cuts when using exposures, and exposure evaluation procedures. sharps • Use and wearing of appropriate PPEs 17 Operations of the lab • Fire hazard • Loss of life and/or • Constitute a lab management committee to include • 600,000 • Head of Laboratory such as storage and • Spillage of property. an occupational health and safety officer during operation handling of laboratory laboratory • Adverse human • Wash hands after working with potentially hazardous reagents. reagents (e.g. health such as materials. acids) bronchial and skin • Wash hands before leaving the laboratory. • Chemical disorders through • Provide adequate personal protective equipment to fumes inhaling, imbibing all the workers. • Leakage of contaminated foods • Provide emergency exits in storage areas. materials. and drinks or coming • Provide spill containment kits. into direct contact • Equip storage areas with fire protection features with chemical (passive fire-resistant materials). reagents. • Provide adequate natural and/or artificial lighting. • Nuisance to staff and • Stacking and shelving of medical products should be neighbours. in a secure and orderly way with clearly visible • Loss of work time in labels. case of injury or • Mechanical pipetting devices must be used instead death of mouth pipetting. • Maintain proper records of all products stored, used or temporally kept prior to disposal. • Maintain an adequate number of first aid kits at strategic points within the bio-safety laboratory. • Post at strategic places “No smoking” signs. • Install an adequate number of firefighting equipment and systems including portable fire extinguishers and hose reels. • Provide emergency eye and body showers. • Provide adequate ventilation. • A sign incorporating the universal biohazard symbol must be posted at the entrance to the laboratory when infectious agents are present. The sign may include the name of the agent(s) in use, and the name and phone number of the laboratory supervisor or other responsible personnel. • An effective integrated pest management program is required. Storage and handling of • Fire hazard • Loss of life and/or • Provide adequate personal protective equipment to • 300,000 • Head of Laboratory flammable substances. • Spillage of property. all the workers. during operation 18 laboratory • Adverse human • Provide emergency exits in storage areas. reagents (e.g. health. • Provide spill containment kits. methylated • Contamination of • Ensure the storage area is equipped with fire spirits, ethanol) surface water protection features (passive fire resistant materials • Chemical • Contamination of including doors). fumes ground water • Provide adequate natural and/or artificial lighting. • Leakage of • Contamination of soil • Stacking and shelving of medical products should be materials. resources in a secure and orderly way with clearly visible • Nuisance to staff and labels. neighbours. • Maintain a record of all products stored. • Loss of workforce in • Post “No smoking” signs. case of injury or • Install adequate protection against fire preferably a death. fire suppression system. • High cost for • Provide emergency eye and body showers at the treatment of sick or entrance to the storage areas. injured personnel. • Provide adequate ventilation. Incineration of • Atmospheric • Adverse human • The kilns/combustion chambers should be designed • 400,000 • Proponent during hazardous waste. emissions e.g. health including with provisions for flue gas trapping, smoke operation hydrocarbons, bronchial infections interception and stacks fitted with scrubbers (for nitrogen and and skin problems. gases) and filters for removal of particulate matter. sulphur oxides • Soil pollution • Seek NEMA’s permit for installation and operation of • Contact with resulting from incinerator hazardous waste deposition of • Conduct annual air quality surveys within the site of including sharps residuals from plant the incineration plant and maintain such records on and pathological operations. site. wastes. • Water pollution • Fly ash and other incineration residuals should be • Disposal of ash resulting from direct disposed of in landfills or other NEMA approved residuals deposition, surface dumping sites. • Consumption of runoff or infiltration • Holding yards for hazardous waste should be kept energy. into groundwater moist at all times to prevent dust emission into the sources. atmosphere and the windward side of the site. • Fire outbreaks • The waste holding and sorting area should be leading to loss of life compartmentalized to allow for segregation of and/or property. various waste categories as classified on source. • Complaints and • Observe good housekeeping at all times with concerns from the particular focus on waste management. public on health and • Training and induction of all employees and visitors safety. on site to enhance safety. 19 • Conflicts at off-site • Provide employees with appropriate PPE and landfills or dumping enforce their usage within the work area. areas. • Implement energy saving measures by accumulating hazardous waste first before incineration to reduce frequency of incineration. • Establish public relation strategies with the stakeholders for enhanced co-existence and tolerance. • Invest in corporate social responsibility initiatives. Activity Environmental Potential Proposed Mitigating Estimated Cost (Kshs) Timeframe/ and Social Environmental and Measures Responsibility Aspect Social Impacts Solid waste • Hazardous • Adverse human • Provide adequate personal protective equipment to • 300,000 • Proponent during management. waste including health. all the workers. operation expired drugs. • Soil contamination. • Provide an adequate number of waste receptors • Empty • Contamination of showing names of various waste streams at packaging surface and ground strategic points within the institution. materials. water bodies. • Ensure there is proper waste segregation. • Office waste • Nuisance to • Empty containers to be cleaned prior to disposal. paper. neighbours and staff. • Avoid undue accumulation of waste. • Biodegradable • Provide a central waste collection centres/points. waste. • Ensure that hazardous waste is incinerated using either in-house incinerator or through outsourcing. Ensure the collector and transporter is NEMA- licensed • Train workers on waste management. • Institute waste reduction/minimization strategies within the institution. 20 1.0 INTRODUCTION. 1.1 Background The project proponent is the Ministry of Health who intends to put up a Biosafety Level II public laboratory, an Isolation Unit, and an incineration plant at Moi Teaching and Referral Hospital (MTRH). This is a development being undertaken under the East Africa Public Health Laboratory Networking Project. The Regional Public Health Laboratory Project is a combined initiative of the Governments of Kenya, Rwanda, Uganda, Tanzania, Burundi and the World Bank in support of efficient laboratory networking. The member countries have jointly mobilized resources to revamp public health laboratory services delivery. The project will deliver rehabilitated public health laboratories provided with critical equipment, improved technical and managerial skills for laboratory workers and strengthened institutional governance. The overall project objective is to strengthen capacities for diagnosis and surveillance of Tuberculosis and other communicable and non-communicable diseases by establishing a network of efficient, high quality and accessible public health laboratories and by promoting innovation and knowledge sharing. The overall responsibility for project implementation will be with the Ministry of Health (MoH). At the national level, the Director of Medical Services will provide leadership and ensure effective inter-ministerial coordination, all of whom are responsible to their respective Principal Secretaries or duly appointed representatives. A dedicated Project Coordination Unit will support the Head, National Public Health Laboratory in the implementation of the Project. Moi Teaching and Referral Hospital (MTRH) is the second largest National Referral Hospital in Kenya after Kenyatta National Hospital (KNH). The hospital is located along Nandi Road in Eldoret town (310 kilometers Northwest of Nairobi, the capital city of Kenya), UasinGishu County, in the North Rift region of Western Kenya. The hospital was started in 1917, as a cottage hospital with a bed capacity of 60 to cater for the health needs of Africans. From this humble beginning, it has grown tremendously to a National Referral Hospital with a current bed capacity of 800 beds. Section 1 of the report provides details on the project background and a summary of the environmental and social impacts associated with the project. Section 2 describes the project objectives, methodology, screening and scoping processes used during the ESIA study whereas section 3 gives the Terms of Reference of the project while Section 4 gives details on the policy and legal framework on environmental management in Kenya and internationally with highlights on relevance to the proposed project. Section 5 of the report gives descriptive information on the proposed project location and the construction details. The current environmental and social setting (baseline information) has been described in Section 6 of the report while Section7 discusses the results of the public consultation conducted. Section 8 discusses the potential environmental and social impacts associated with the project with the respective mitigation measures. Section 9 discusses the project alternatives while the environmental and social management plan and the plan for compliance with relevant environmental legislations have been outlined in sections10 and 11 respectively. Sections 12 contains the conclusions and recommendations. 1.2 OBJECTIVES AND SCOPE OF THE ENVIRONMENTAL AND SOCIAL IMPACT ASSESSMENT (ESIA) 1.2.1 Screening to determine whether ESIA is required: The ESIA was done in reference to the requirements of the World Bank Operational Policies and Bank Procedures on Environmental Assessment and World Bank Group’s Environment, Health, and Safety (EHS) Guidelines as well as the principal environmental legislation and specifically the second schedule of EMCA, CAP 387, Laws of Kenya. Issues considered included the physical location and the nature of the anticipated impacts of the proposed project. The project proponent is the Ministry of Health, which intends to put up a Bio-Safety Level II public laboratory, an incinerator facility and an Isolation Unit at Moi Teaching and Referral Hospital (MTRH). 1.2.2 Scoping. The scoping process was carried out with a view to identifying key issues and to help focus available resources on the issues. The first step was to identify all interested parties relevant to the project. The second step was to develop information on the resource to be affected, potential concerns and project alternatives. The scoping process involved: • Discussions with the proponent and consultation with relevant officials in the regulatory Authorities, • Verbal interviews with key project beneficiaries and key stakeholders. • Physical investigation of the site and the surrounding areas using a checklist with a view to identify potential environmental, social and safety issues that pertain to the project. • Documentary review of the nature of the proposed activities, relevant legal and regulatory framework 1.2.3 Category of the project: The proposed project falls under Category B of the World Bank Environmental Assessment categorization. Under this general category, “a proposed project is classified as Category B if its potential adverse environmental and social impacts on human populations or environmentally important areas-including wetlands, forests, grasslands, and other natural habitats-are less adverse than those of Category A projects. These impacts are site-specific; few if any of them are irreversible; and in most cases, mitigating measures can be designed more readily than for Category A projects. The scope of assessment for a Category B project may vary from project to project, but it is narrower than that of Category A assessment. Like Category A assessment, it examines the project's potential negative and positive environmental impacts and recommends any measures needed to prevent, minimize, mitigate, or compensate for adverse impacts and improve environmental performance.” The proposed bio-safety laboratory, incinerator and Isolation Unit subprojects fall under the category B as their assessments shall examine the potential negative and positive environmental and social impacts and mitigating measures shall be proposed for the significant negative impacts. Their mitigating measures can also be designed more readily than for category A projects. According to EMCA, CAP 387 and the EIA/EA Regulations, 2003, Laws of Kenya, NEMA categorizes the proposed project as a low risk project. Low risk projects are expected to submit EIA project reports to NEMA. Low risk projects are those that:- Are likely to have minimal adverse environmental impacts, Projects impacts that are easily mitigated, Projects designed for positive environmental and social uplifting projects. 22 The proposed bio-safety laboratory, incinerator and Isolation Unit are classified as low risk because they are rehabilitation, maintenance, and modernization (small scale) projects within an existing hospital. They are also projects designed for positive environmental and social uplifting within the hospital. Subject to the above-mentioned provisions, the project proponent has contracted Neolife Consultants Ltdto conduct an ESIA for submission, review and clearance to the World Bank.NEMA has already issued an EIA license, based on a project report submitted to it earlier by MOH 1.2.4 Scope of the ESIA The Environmental and Social Impact Assessment (ESIA) was carried out to cover risks and impacts and these could be mitigated within the project boundaries. The ESIA team carried out the project’s environmental and social impact assessment using a combination of methods which includes; ground surveys, development and use of questionnaires and interviews with a broad spectrum of stakeholders including residents living close to the MTRH and from far, healthcare workers and government agencies and review of existing literature on statutory and other requirements. The ESIA process entailed a description of the project, the baseline information (environmental and socio- economic setting), identification of the potential positive and negative impacts, development of mitigation measures and an environmental and social management plan that includes budget for implementing mitigation actions and indicators for monitoring. 1.2.5 ESIA Criteria. The ESIA was conducted in accordance with the World Bank Operational Policies and Bank Procedures on Environmental Assessmentand theWorld Bank Group’s Environment, Health and Safety, (EHS) Guidelines. It is in line with the Environmental Management and Coordination Act, Cap 387, the Environmental (Impact Assessment and Audit) Regulations, 2003 contained in the Kenya gazette supplement No. 56, legislative supplement No. 31 Legal notice No. 101 of 13thJune, 2003 and the best practice guidelines on safety and health contained in the Occupational Safety and Health Act, 2007, Laws of Kenya. 1.2.6 The Objectives of the Project. The overall project objective is to strengthen capacities for diagnosis and surveillance of Tuberculosis and other communicable and non-communicable diseases by establishing a network of efficient, high quality and accessible public health laboratories and by promoting innovation and knowledge sharing. In addition, the incineration facilities will also ensure sound waste management at the hospital. 1.2.7 Project Justification. Chapter 8.0 ANALYSIS OF PROJECT ALTERNATIVES) of this report has discussed at length the alternatives considered including to the incinerator. Open uncontrolled non-engineered dumpsites, sanitary landfills, crude burning, microwaving, autoclaves, and plasma pyrolysis have been analysed as alternatives to incineration. Though autoclaves are considered more efficient and environmentally friendly, they are too expensive, they require technical persons in maintenance that are hard to find in Kenya. Incineratorsaccept the greatest variety of waste, volume of waste are significantly reduced through incineration, trained personnel are readily available and the device is cheaper to run and maintain. Based on several considerations, the project opted for incinerator use in managing hazardous hospital waste. The overall project objective is to strengthen capacities for diagnosis and surveillance of Tuberculosis and other communicable and non-communicable diseases. The facilities to be constructed under the proposed project will include an efficient, high quality and accessible public health laboratory that will promote innovation and knowledge sharing and an Isolation Unit for isolating and treating patients with highly infectious diseases. The incineration facility will ensure sound waste management of waste at the hospital. 23 1.2.8 Methodology Outline: The following general steps were followed during the assessment to ensure comprehensiveness and completeness of the report: - Environment and social screening in which the project was identified as among those requiring environmental and social impact assessment study under the World Bank Operational Policies and Bank Procedures on Environmental Assessment and the World Bank Group’s Environment, Health and Safety, (EHS) Guidelines. It is in line with the Environmental Management and Coordination Act, Cap 387, Laws of Kenya. Environmental and social scooping that provided the key environmental issues. Physical inspection of the site and its environs. Stakeholder engagement and discussions. Desktop studies, literature reviews, consultations, questionnaires and interviews with the proponent and his consultants among others. Reporting. 2.0 TERMS OF REFERENCE (TOR) 2.1 Activities by the Consultant: The Consultant shall carry out an environmental and social impact assessment of the proposed development and prepare a project report, which shall incorporate the following details: • The proposed location of the project. • A concise description of the national and international environmental legislative and regulatory framework, baseline information and any other relevant information related to the project. • The objective of the project. • The technology, procedures and processes to be used, in the implementation of the project. • The products, by- products and waste generated by the project. • A description of the potentially affected environment. • The environmental effects of the project including the social and cultural effects and the direct, indirect, cumulative, irreversible, short term and long term effects anticipated. • Alternative technologies and processes available and reasons for preferring the chosen technology and processes. • Stakeholder analysis and consultations. • Analysis of alternatives including project site, design and technologies and the reasons for preferring the proposed site design and technologies. • An environmental and social management plan proposing the measures for eliminating, minimizing or mitigating adverse impacts on the environment and human populations, including the cost, time frame and responsibility to implement the measures. • Public consultation and stakeholder engagement. • Provision of an action plan for the prevention and management of foreseeable accidents and hazardous activities in the course of carrying out activities or major industrial and other development projects. 24 • The measures to prevent health hazards and to ensure security in the working environment for the employees and for the management of emergencies. • An identification of gaps in knowledge and uncertainties which were encountered in compiling the information. • An economic and social analysis of the project. • An indication of whether the environment of any other state is likely to be affected and the available alternatives and mitigating measures, and • Such other matters as the authority may require. 2.2 Expected Outputs An environmental and social impact assessment project report acceptable by the World Bank. 2.3 Responsibility of the Client • Provide the necessary assistance required by the consultants. • Pay consultancy fees for preparing the project report. 25 3.0 POLICY, LEGAL, AND INSTITUTIONAL FRAMEWORK 3.1 General View Under the World Bank Group’s Environment, Health and Safety, (EHS) Guidelines and the World Bank Operational Policies and Bank Procedures on Environmental Assessment (OP/BP 4.01), it is a requirement that project proponents perform environmental assessments on projects before bank financing. In addition, Kenya has a policy, legal and administrative framework for environmental management. Under the framework, the National Environment Management Authority (NEMA) is responsible for ensuring that environmental and social impact assessments (ESIAs) are carried out for new projects and environmental audits on existing facilities as per the Environmental Management and Coordination Act, CAP 387, Laws of Kenya. ESIAs are carried out in order to identify potential positive and negative impacts associated with the proposed project with a view to taking advantage of the positive impacts and developing mitigation measures for the negative impacts. The proposed project triggers one safeguard policy developed by the World Bank that is key in prevention and mitigating undue harm to people and their environment in the development process. This is; operation policies and bank procedures on Environmental Assessment (OP/BP 4.01). According to World Bank Operational Policies and Bank Procedures on Environmental Assessment, proponents of projects requiring financing from the World Bank shall be responsible for carrying out environmental and social impact assessments on all activities that are likely to have a significant adverse effect on the bio-physical and socio-economic environment. Environmental auditing (EA) is a tool for environmental conservation and has been identified as a key requirement for existing facilities to ensure sustainable operations with respect to environmental resources and socio-economic activities in the neighbourhood of the facilities. The Government of Kenya has established regulations to facilitate the process on ESIAs and environmental audits. The regulations are contained in the Kenya Gazette Supplement No. 56, Legislative Supplement No. 31, and Legal Notice No. 101 of 13th June 2003. The Proponent will be required to observe the provisions of the various statutes that are aimed at maintaining a clean, healthy and sustainable environment. Some of the policy and legal provisions are briefly presented in the following sub-Sections; 3.2 Policy Framework 3.2.1 The Constitution of Kenya, 2010 Article 42 of the Bill of Rights of the Kenyan Constitution provides that ‘every Kenyan has the right to a clean and healthy environment, which includes the right to have the environment protected for the benefit of present and future generations through legislative and other measures’. Under Chapter 5 (Land and Environment), Part 1 is devoted to land. It requires that land be used and managed in ‘a manner that is equitable, efficient, productive and sustainable, and in accordance with the following principles: (i) Equitable access to land; (ii) Security of land rights; (iii) Sustainable and productive management of land resources; 26 (iv) Transparent and cost effective administration of land; and (v) Sound conservation and protection of ecologically sensitive areas. Part 2 of Chapter 5 of the Constitution is dedicated to Environment and Natural Resources. Article 69 in Part 2 provides that the state shall; (i) Ensure sustainable exploitation, utilization, management and conservation of the environment and natural resources, and ensure the equitable sharing of the accruing benefits; (ii) Work to achieve and maintain tree cover of at least ten per cent of the land area of Kenya; (iii) Encourage public participation in the management of, protection and conservation of the environment; (iv) Protect genetic resources and biological diversity; (v) Establish systems of environmental impact assessment, environmental audit and monitoring of the environment; (vi) Eliminate processes and activities that are likely to endanger the environment; and (vii) Utilize the environment and natural resources for the benefit of the people of Kenya. Further, Article 70 states that if a person alleges that a right to a clean and healthy environment recognized and protected under Article 42 has been, is being or is likely to be, denied, violated, infringed or threatened, the person may apply to a court for redress. The proposed project should ensure the sustainability of livelihoods and biological resources within the project areas are protected. Any development proposals should also be cognizant of the increased powers under the Constitution given to communities and individuals to enforce their rights through legal redress. 3.2.2 Kenya Vision 2030 Kenya Vision 2030 is the current national development blueprint for period 2008 to 2030 and was developed following on the successful implementation of the Economic Recovery Strategy for Wealth and Employment Creation which saw the country’s economy back on the path to rapid growth since 2002. GDP growth rose from 0.6% to 7% in 2007, but dropped to between 1.7% and 1.8% in 2008 and 2009 respectively. The objective of the Kenya Vision 2030 is to transform Kenya into a middle income country with a consistent annual growth of 10 % by the year 2030”. The 2030 goal for urban areas is to achieve “a well-housed population living in an environmentally-secure urban environment.” This will be achieved by bringing basic infrastructure and services namely roads, street lights, water and sanitation facilities, storm water drains, footpaths, and others. One of the aims of the vision is to make Kenya to be a nation that has a clean, secure and sustainable environment by 2030. This will be achieved through promoting environmental conservation to better support the economic pillar. Improving pollution and waste management through the application of the right economic incentives in development initiatives is critical. 27 3.2.3 Health Care Waste Management Strategic Plan 2015-2020 (2015) The Health Care Waste Management Strategic Plan2015-2010 developed in 2015 by the Ministry of Health in Kenyais a document intended for use by health managers and program officers across the health sector (including those in the private health sector).The purpose of developing this plan was to provide a tool that gives health managers guidance in planning, implementing and monitoring the activities of health care waste management in health facilities. This plan describes the situation of health care waste management on the basis of a survey which was conducted in order to document the situation of waste management in Kenya. A holistic approach has been recommended to include, clear delineation of responsibilities, occupational health and safety programs, waste minimization and segregation. This document is designed to provide viable options to address the challenges encountered in planning for health care waste management in Kenya. 3.2.4 National Environmental Action Plan (NEAP), 2009-2013 The NEAP provides a framework for the implementation of the Environment Policy and realization of the National Millennium Development Goals and Vision 2030. The plan outlines measures to combat climate change including mitigation and adaptation, improving inter-sectoral coordination, mainstreaming sustainable land management into national planning, policy and legal frameworks and undertake research on impact of climate change on environmental, social and economic sector. The plan also aims to increase the country's forest cover and adopt economic incentives for management of forest products. Under the NEAP process, Environmental and Social Impact Assessments were introduced targeting the industrialists, business community and local authorities. 3.2.5 National Guidelines on Safe Management and Disposal of Asbestos, Revised 2013 The guidelines developed in 2012 and revised in 2013 require the proponent to: a) Take appropriate measures to prevent or control release of asbestos dust into the air. b) Ensure that exposure limits or other exposure criteria are complied with. c) Reduce exposure to asbestos dust to as low a level as is reasonably practical. d) Provide, maintain and replace as necessary, at no cost to the workers, adequate respiratory protective equipment in the event measures prescribed in (a) to (c) do not bring exposure to asbestos within exposure limits or do not comply with other exposure criteria. e) Establish and implement practical measures for prevention and control of exposure of workers to asbestos and for their protection to hazards due to asbestos. f) Engage contractors recognized by NEMA as qualified in removal of asbestos according to provision of the guidelines. e) Ensure that the contractor before starting demolition works (removal of asbestos) draws up a work plan (in consultation with workers or their representatives) specifying the measures to be taken including: Providing necessary protection to workers. Limit the release of asbestos dust into the air and Provide for disposal of asbestos according to Article 19 of the Asbestos Convention of 1986. f) Provide appropriate working clothes (PPEs) which shall not be worn outside the workplace in situations where the workers’ personal clothing may be contaminated with asbestos dust. 28 g) Ensure handling and cleaning of used work clothing and special protective clothing is carried out under controlled conditions as required by NEMA to prevent release of asbestos dust. h) Clean, maintain and store work clothing, special protective clothing and PPEs. i) Provide facilities for workers exposed to asbestos to wash, take a bath or shower at workplace as appropriate. j) Dispose waste containing asbestos in a manner that does not pose health risks to workers concerned including those handling asbestos waste or population in the vicinity of the plant. k) Take appropriate measures to prevent pollution of the general environment by asbestos dust released from the workplace. l) Where it is necessary for protection of health of workers, Measure concentration of airborne asbestos dust in workplace and monitor the exposure to workers at intervals and using methods specified by NEMA. The contractor shall be required to follow these guidelines when handling, transporting and disposing the asbestos from the old mortuary house. 3.2.6 National Policy on Water Resources Management and Development, 1999 While the National Policy on Water Resources Management and Development (1999) enhances a systematic development of water facilities in all sectors for promotion of the country’s socio-economic progress, it also recognizes the by-products of this process as wastewater. It, therefore, calls for development of appropriate sanitation systems to protect people’s health and water resources from institutional pollution. Industrial and business development activities, therefore, should be accompanied by corresponding waste management systems to handle the wastewater and other waste emanating there from. The same policy requires that such projects should also undergo comprehensive ESIAs that will provide suitable measures to be taken to ensure environmental resources and people’s health in the immediate neighbourhood and further downstream is not negatively impacted by the emissions. As a follow-up to this, EMCA, CAP 387, Laws of Kenya requires annual environmental audits to be conducted in order to ensure that mitigation measures and other improvements identified during the ESIA process are implemented. In addition, the policy provides for charging levies on wastewater on the basis of quantity and quality. The “polluter-pays-principle” applies in which case parties contaminating water are required to meet the appropriate cost of remediation. The policy provides for establishment of standards to protect water bodies receiving wastewater, a process that is on-going. 3.2.7 Policy Paper on Environment and Development (Sessional Paper No. 6 of 1999). The key objectives of the policy include: • To ensure that from the onset, all development policies, programmes and projects take environmental considerations into account, • To ensure that an independent environmental and social impact assessment (ESIA) report is prepared for any industrial venture or other development before implementation, • To come up with effluent treatment standards that will conform to acceptable health guidelines. 29 Under this paper, broad categories of development issues have been covered that require a “sustainable development” approach. These issues relate to waste management and human settlement. The policy recommends the need for enhanced re-use/recycling of residues including wastewater, use of low or non-waste technologies, increased public awareness and appreciation of a clean environment. It also encourages participation of stakeholders in the management of wastes within their localities. Regarding human settlement, the paper encourages better planning in both rural and urban areas and provision of basic needs such as water, drainage and waste disposal facilities among others. 3.2.8 The National Poverty Eradication Plan (NPEP) and the Poverty Reduction Strategies Paper (PRSP) The objective of the NPEP is to reduce the incidence of poverty in both urban and rural areas by 50% by the year 2015 as well as strengthening the capabilities of the poor and the vulnerable groups to earn income. Also it aims to narrow gender and geographical disparities and create a healthy, better educated and more productive population. The plan has been prepared in line with the goals and commitment of The World Summit for Social Development (WSSD) of 1995 and focuses on the four WSSD themes of poverty eradication, reduction of unemployment, social integration of the disadvantaged people and creation of enabling economic, political, and cultural environment. This plan is to be implemented by the Poverty Eradication Commission (PEC) formed in collaboration with government ministries; community based organizations, the private sector, non-governmental organizations, and bilateral and multilateral donors. The NPEP emphasizes the empowerment of poor people and their communities to better manage their resources for collective advancement. The PRSP has the twin objectives of poverty reduction and economic growth. The paper articulates Kenya’s commitment and approach to fighting poverty, with the basic rationale that the war against poverty cannot be won without participation of the poor themselves. Any development project that incorporates these strategies in its plans is most welcome in Kenya. 3.3 Environmental Management Statutes. The key national laws that govern the management of environmental resources in the country have been briefly discussed in the following paragraphs. Note that wherever any of the laws contradict each other, the Environmental Management and Coordination Act, Cap 387 prevails. 3.3.1 The Environment Management and Coordination Act, Cap 387 Part II Section 3(I) of the Environment Management & Coordination Act, Cap 387 states that “every person in Kenya is entitled to a clean and healthy environment in accordance with the constitution and relevant laws and has the duty to safeguard and enhance the environment.” According to Section 58 of the Act, an Environmental Impact Assessment study needs to be carried out on projects specified in the second schedule of the Act that are likely to have a significant impact on the environment. This project is considered to fall under the second schedule of the Act. It is in line with this provision that the Proponent has appointed Neolife Consultants Ltd to carry out an ESIA and prepare a project report in respect of the proposed development. 30 Part VII, Section 68 of the same Act requires operators of projects or undertakings to carry out environmental audits in order to determine level of conformance with statements made during the ESIA. The environmental audit shall be carried out by the Authority or its designated agents. The Project Proponent will need to prepare and submit an environmental audit report in the first year of operation to confirm the efficacy and adequacy of the Environmental and Social Management Plan. Part VIII Section 72(1) of the Act prohibits discharging or applying poisonous, toxic, noxious or obstructing matter, radioactive waste or any other pollutants into the aquatic environment. Section 73 requires that operators of projects which discharges effluent or other pollutants to submit to NEMA accurate information about the quantity and quality of the effluent. Section 74 demands that all effluent generated from point sources are discharged only into the existing sewerage system upon issuance of prescribed permit from the relevant entity Section 87 sub-section 1 states that no person shall discharge or dispose of any wastes, whether generated within or outside Kenya, in such a manner as to cause pollution to the environment or ill health to any person, while Section 88 provides information on acquisition of a license for generation, transporting or operating a waste disposal facility. According to section 89, any person who, at the commencement of this Act, owns or operates a waste disposal site or plant or generate hazardous waste, shall apply to the Authority for a license. 3.3.2 Environmental (Impact Assessment and Audit) Regulations, 2003 (Legal Notice No.101) Part V Section 31 states that an Environmental audit is expected to be undertaken on the development activities likely to have adverse environmental impacts. The audit exercise is expected to be conducted by a qualified environmental inspector registered in accordance with regulation 14.Section 31(3) the environmental Audit study is prepared based on the baseline information provided in the Environmental impact assessment report study which will be used as baseline information upon which subsequent environmental control audit studies shall be undertaken. According to section 31(7) information required to be included in the audit report is mentioned; past and present impacts of the project, responsibility and proficiency of the operators of the project, existing internal control mechanisms to identify and mitigate activities with negative environmental impacts, existing internal control mechanisms to ensure workers health and safety, existence of environmental awareness and sensitization measures including environmental standards and regulations, law and policy for managerial and operational personnel. Compliance Aspects Provides a guide to the environmental inspectors and auditors on the requirements during the audit process. NEMA ESIA License is obtained before project commencement. 3.3.3 The Environmental Management and Coordination (Air Quality) Regulations, 2014 According to the Act, 5. (1) No person shall- (a) act in a way that directly or indirectly causes, or is likely to cause immediate or subsequent air pollution; or 31 (b) emit any liquid, solid or gaseous substance or deposit any such substance in levels exceeding those set out in the First Schedule. 6. No person shall cause or allow emission of the priority air pollutants prescribed in the Second Schedule to cause the ambient air quality limits prescribed in the First Schedule to be exceeded. 7. No person shall cause the ambient air quality levels specified in the First Schedule of these Regulations to be exceeded. 8. (1) No person shall cause or allow particulate emissions into the atmosphere from any facility listed under the Fourth Schedule in excess of those limits stipulated under the Third Schedule. Where “suspended Particulate matter” means all particulate material which persists in the atmosphere or in flue gas stream for lengthy periods because the Particles are too small in size to have appreciable falling velocity; 9. A person, being an owner of premises, who causes or allows the generation, from any source, of any odour which unreasonably interferes, or is likely to unreasonably interfere, with any other person’s lawful use or enjoyment of his property shall ensure that the odour emission limits comply with the ambient quality limits set out under the First Schedule of these regulations. This regulation was formulated to provide for prevention, control and abatement of air pollution to ensure clean and healthy ambient air. The proposed project has potential to impact on air quality. In the light of the above, these Regulations prohibit the Proponent from: Acting in a way that directly or indirectly cause or may cause air pollution to exceed levels set out in the second Schedule to the Regulations. Allowing particulates emissions into the atmosphere from any source not listed in the six schedule of the Regulations. Causing ambient air quality in controlled areas (listed in Schedule Thirteen) to exceed those stipulated under second Schedule. Allowing (during removal and transportation of asbestos sheets) emission of particulate matter above the limits stipulated in second Schedule. Compliance Aspect The proponent shall be required to apply for the following licenses: 1. Emission License and 2. License to own/operate an incinerator plant 3. Air quality monitoring shall be done regularly. 3.3.4 The Environmental Management and Co-ordination (Water Quality) Regulations, 2006. These Regulations were published in the Kenya Gazette Supplement No. 68, Legislative Supplement No. 36, Legal Notice No. 120 of 29th September 2006.The Regulations provides for sustainable management of water resources including prevention of water pollution and protection of water sources (lakes, rivers, streams, springs, wells and other water sources). It is an offence under Regulation No. 4 (2), for any person to throw or cause to flow into or near a water resource any liquid, solid or gaseous substance or deposit any such substance in or near it, as to cause pollution. Regulation No. 11 further makes it an offence for any person to discharge or apply any poison, toxic, noxious or obstructing matter, radioactive waste or other pollutants or permit the dumping or discharge of such matter into the aquatic environment unless such discharge, poison, toxic, noxious or obstructing matter, radioactive waste or pollutant complies with the standards for effluent discharge into the environment 32 Regulation No. 14 (1) requires every licensed person generating and discharging effluent into the environment to carry out daily effluent discharge quality and quantity monitoring and to submit quarterly records of such monitoring to the Authority or its designated representatives. Compliance Aspect The Proponent will have to ensure that appropriate measures to prevent pollution of underground and surface water sources are implemented throughout the project cycle. 3.3.5 The Environmental Management and Co-ordination (Waste Management) Regulations, 2006. These Regulations were published in the Kenya Gazette Supplement No. 69, Legislative Supplement No. 37, and Legal Notice No. 121 of 29th September 2006. The regulations provide details on management (handling, storage, transportation, treatment and disposal) of various waste streams including: • domestic waste • industrial waste, • hazardous and toxic waste • biomedical wastes and • radioactive waste Regulation No. 4 (1) makes it an offence for any person to dispose of any waste on a public highway, street, road, recreational area or in any public place except in a designated waste receptacle. Regulation 5 (1) provides categories of cleaner production methods that should be adopted by waste generators in order to minimize the amount of waste generated and they include: i. Improvement of production process through- • Conserving raw materials and energy • Eliminating the use of toxic raw materials and wastes • Reducing toxic emissions and wastes ii. Monitoring the product cycle from beginning to end by- • Identifying and eliminating potential negative impacts of the product • Enabling the recovery and re-use of the product where possible, and • Reclamation and recycling and iii. Incorporating environmental concerns in the design and disposal of a product Compliance Aspect The Proponent shall ensure that the main contractor adopts and implements all possible cleaner production methods during the construction phase of the project. Regulation 6 requires waste generators to segregate waste by separating hazardous waste from non-hazardous waste for appropriate disposal. Regulation 14 (1) requires every trade or industrial undertaking to install at its premises anti-pollution equipment for the treatment of waste emanating from such trade or industrial undertaking. Regulation 15 prohibits any 33 industry from discharging or disposing of any untreated waste in any state into the environment. Regulation 17 (1) makes it an offence for any person to engage in any activity likely to generate any hazardous waste without a valid Environmental Impact Assessment license issued by NEMA. Regulation 18 requires all generators of hazardous waste to ensure that every container or package for storing such waste is fixed with a label containing the following information: • The identity of the hazardous waste • The name and address of the generator of waste • The net contents • The normal storage stability and methods of storage • The name and percentage of weight of active ingredients and names and percentages of weights of other ingredients or half-life of radioactive material • Warning or caution statements which may include any of the following as appropriate- -the words “WARNING” or “CAUTION” -the word “POISON”, marked indelibly in red on a contrasting background; and -the words “DANGER! KEEP AWAY” or “NO ENTRY FOR UNAUTHORIZED PERSONS” and -a pictogram of a skull and crossbones Regulation 19 (1) requires every person who generates toxic or hazardous waste to treat or cause to be treated such hazardous waste. Compliance Aspect During the construction phase of the project, the proponent shall ensure that the main contractor implements the above-mentioned measures as necessary to enhance sound environmental management of waste. The County Government of UasinGishu is responsible in the management of waste within Eldoret town and therefore the ash from the proposed incinerator will be disposed at the County approved dumpsite. 3.3.6 The Environmental Management and Coordination (Noise and Excessive Vibration Pollution) Control Regulations, 2009 These regulations were published as Legal Notice No. 61 being a subsidiary legislation to the Environmental Management and Co-ordination Act, Cap 387. The regulations provide information on the following: (i) Prohibition of excessive noise and vibration. (ii) Provisions relating to noise from certain sources. (iii) Provisions relating to licensing procedures for certain activities with a potential of emitting excessive noise and/or vibrations and; (iv) Noise and excessive vibrations mapping. According to regulation 3 (1), no person shall make or cause to be made any loud, unreasonable, unnecessary or unusual noise which annoys, disturbs, injures or endangers the comfort, repose, health or safety of others and the environment. Regulation 4 prohibits any person to (a) make or cause to be made excessive vibrations which annoy, disturb, injure or endanger the comfort, repose, health or safety of others and the environment; or (b) cause to be made excessive vibrations which exceed 0.5 centimetres per second beyond any source property boundary or 30 metres from any moving source. Regulation 5 further makes it an offence for any person to make, continue or cause to be made or continued any noise in excess of the noise levels set in the First Schedule to these Regulations, unless such noise is reasonably necessary to the preservation of life, health, safety or property. 34 Table 2: First Schedule - Maximum Permissible Noise Levels Zone Sound Level Limits dB(A) Noise Rating Level (NR) (Leq, 14h)0 (Leq,14h) Day Night Day Night A Silent Zone 40 35 30 25 B. Places of worship 40 35 30 25 C. Residential: Indoor 45 35 35 25 Outdoor 50 35 40 25 D. Mixed residential (with some commercial and places of entertainment) 55 35 50 25 E. Commercial 60 35 55 25 Time Frame: Day: 6.01 a.m. - 8.00 p.m. (Leq, 14 h) Night: 8.01 p.m. – 6.00 a.m. (Leq, 10 h) Regulation 12 (1) makes it an offence for any person to operate a motor vehicle which- (a) produces any loud and unusual sound; and (b) exceeds 84 dB(A) when accelerating. According to sub regulation2 of this regulation, no person shall at any time sound the horn or other warning device of a vehicle except when necessary to prevent an accident or an incident. Regulation 13 (1) provides that except for the purposes specified in sub-Regulation (2) there under, no person shall operate construction equipment (including but not limited to any pile driver, steam shovel, pneumatic hammer, derrick or steam or electric hoist) or perform any outside construction or repair work so as to emit noise in excess of the permissible levels as set out in the Second Schedule to these Regulations. Table 3: Second Schedule-Maximum Permissible Noise Levels for Construction Sites (Measurement taken within the facility) Facility Maximum Noise Level Permitted (Leq) in dB(A) Day Night i. Health facilities, educational institutions, homes for disabled etc. 60 35 ii. Residential 60 35 iii. Areas other than those 75 65 prescribed in (i) and (ii) Time Frame: Day: 6.01 a.m. – 6.00 p.m. (Leq, 14 h) Night: 6.01 p.m. – 6.00 a.m. (Leq, 14 h) Regulation 16 (1) stipulates that where a sound source is planned, installed or intended to be installed or modified by any person in such a manner that such source shall create or is likely to emit noise or excessive vibrations, or otherwise fail to comply with the provisions of these Regulations, such person shall apply for a license to the Authority. According to regulation 18 (6) this license shall be valid for a period not exceeding seven (7) days. 35 Regulation 19 (1) prohibits any person to carry out activities relating to fireworks, demolitions, firing ranges or specific heavy industry without a valid permit issued by the Authority. According to sub regulation 4, such permit shall be valid for a period not exceeding three months. Compliance Aspect The main contractor will be required to comply with the above-mentioned regulations throughout the construction phase of the project in order to promote a healthy and safe working environment. 3.4 Institutional Framework Some of the institutions relevant to the proposed project include: 3.4.1 The National Environment Management Authority (NEMA) The responsibility of the National Environment Management Authority (NEMA) is to exercise general supervision and co-ordination over all matters relating to the environment and to be principle instrument of government in the implementation of policies relating to the environment. In addition to NEMA, EMCA, CAP 387, Laws of Kenya provides for the establishment and enforcement of environmental quality standards to be set by the technical committee of NEMA known as the Standards and Enforcement Review Committee (SERC). The Authority has registered environmental assessment experts who conduct environmental assessment of proposed projects on its behalf to assess potential negative and positive impacts and develop mitigation measures. Therefore, it shall be the responsibility of the Authority to ensure that an ESIA for the proposed project is conducted and that a license is issued before the project can commence. The Authority shall ensure that under the ESIA report, the ESIA experts give feedback on public consultation of affected stakeholders in the form of questionnaires to take into account their views in the decision-making. 3.4.2 The National Environment Tribunal This tribunal guides the handling of cases related to environmental offences in the Republic of Kenya. If disputes to this project arise, they are supposed to be presented here for hearing and legal direction. 3.4.3The Ministry of Health The proposed project is under the Ministry of Health and it shall be the primary role of the Ministry to monitor and measure the progress of implementation of the social and environmental safeguards. During project implementation, it shall undertake inspections to verify compliance by NEMA and the Ministry of Lands with the safeguards and measure progress toward the expected outcomes. The Ministry, through the hospital management shall then prepare periodic reports, which shall be submitted, to the World Bank for review. 3.4.4 The County Government The County Government of UasinGishu has powers to control or prohibit all businesses, factories and other activities including the proposed project which by reason of smoke, fumes, gases, dust, noise or other cause, 36 maybe or become a source of danger, discomfort or annoyance to the neighbourhood and to prescribe conditions subject to which such businesses, factories etc. shall be carried. The new constitution grants county governments the powers to grant or renew businesses licenses or refuse the same. The county government is empowered to make by laws in respect of all such matters as are necessary or desirable for the maintenance of health, safety and well-being of the inhabitants of the area. This includes construction and maintenance of water supply, sewage and solid waste management systems. 3.4.5The Directorate of Occupational Safety and Health Services (DOSHS) The construction site is a workplace and the health, safety and welfare of all persons must be taken into account. The occupier (MOH) shall acquire a certificate of registration of the workplace before occupation. However, the proposed project being within a hospital setting has a hospital occupation certificate. All workers within the construction site shall also be required to use appropriate PPEs. 3.4.6 The National Construction Authority (NCA) The NCA is responsible for issuing permits to construction sites and advising the government of Kenya on construction. The proposed project shall acquire a permit from NCA and ensure the contractor is registered by the NCA board. 3.5 Other Local Laws that Apply to this Project 3.5.1 The Water Act, 2016 Part III section 21 (1) of this Act provides for national monitoring and geo -referenced information systems on water resources to be effected by the Water Resources Management Authority. Following on this, sub-section 2 allows the Authority to demand from any person or institution, within a reasonable time or on a regular basis, specified information, documents, samples or materials on water resources. Under these rules, specific records may require to be kept by a site operator and the information thereof furnished to the authority. Part IV Section 63 states that “every person in Kenya has a right to clean and safe water in adequate quantities and to reasonable standards of sanitation as stipulated in Article 43 of the Constitution” Section 110 of the Act allows a person with license (licensee) to supply water to make regulations for purposes of protecting against degradation of water sources. Section 107 and sub-section 1 allows the licensee to construct and maintain drains, sewers and other works for intercepting, treating or disposing of any foul water arising or flowing upon such land for preventing pollution of water sources within his/her jurisdiction. Section 108 subsections 2 and 3 state that a person shall not discharge any trade effluent from any trade premises into the sewers of a licensee without the consent of the licensee upon application indicating the nature and composition of the trade effluent, maximum quantity of effluent to be discharged on any one day, highest rate of discharge and any other information deemed necessary. The consent shall be issued on conditions including payment of rates for the discharge as may be provided under section 109 of the same Act. Section 143 subsections 1 (b) of the Act makes it an offence to throw, convey, cause or permit to be thrown or conveyed, any rubbish, dirt, refuse, effluent, trade waste or other offensive matter or thing into or near to any water resource in such a manner as to cause, or be likely to cause, pollution of the water resource. Compliance Aspect 37 The project proponent will be required to ensure that all construction waste is collected and dumped at approved sites to prevent potential for contaminating surface and underground water sources. The Act applies anytime throughout the project cycle when there is discharge of effluent to the environment. 3.5.2 The Public Health Act (Cap. 242), Revised 2012 Part IX, Section 115 of the Act states that no person/institution shall cause nuisance or condition liable to be injurious or dangerous to human health. Section 116 requires Local Authorities to take all lawful, necessary and reasonably practicable measures to maintain areas under their jurisdiction clean and sanitary to prevent occurrence of nuisance or condition liable for injurious or dangerous to human health. Such nuisance or conditions are defined under Section 118 waste pipes, sewers, drains or refuse pits in such a state, situated or constructed as in the opinion of the medical officer of health to be offensive or injurious to health. Any noxious matter or waste water flowing or discharged from any premises into a public street or into the gutter or side channel or watercourse, irrigation channel or bed not approved for discharge is also deemed as a nuisance. Other nuisances are accumulation of materials or refuse which in the opinion of the medical officer of health is likely to harbour rats or other vermin. Compliance Aspect This applies for all projects with direct and indirect implication to the health of workers and neighbouring communities to the project area. The Proponent will be required to abide by these provisions throughout the project cycle. On the responsibility of local authorities, Part XI Section 129 of the Act states in part “It shall be the duty of every local authority to take all lawful, necessary and reasonably practicable measures for preventing any pollution dangerous to health of any supply of water which the public within its district has a right to use and does use for drinking or domestic purpose.” Section 130 provides for making and imposing regulations by the local authorities and others the duty of enforcing rules in respect of prohibiting use of water supply or erection of structures draining filth or noxious matter into water supply as mentioned in Section 129. This provision is supplemented by Section 126A that requires local authorities to develop by-laws for controlling and regulating among others private sewers, communication between drains and sewers and between sewers as well as regulating sanitary conveniences in connection to buildings, drainage, cesspools, etc. for reception or disposal of foul matter. Compliance Aspect The Proponent will be required to contract a licensed solid waste transporter to transport all solid waste from the site for dumping at approved sites by the UasinGishu County Government. Sewage from the site will be discharged through the Eldoret Water and Sanitation Company sewer line. 3.5.3The Physical Planning Act, Cap 286 (Revised 2012) The County Governments are empowered under Section 29 of the Act to reserve and maintain all land planned for open spaces, parks, urban forests and green belts. The same Section, therefore, allows for prohibition or controls the use and development of land and buildings in the interest of proper and orderly development of an area. 38 Section 30 states that any person who carries out development without permission will be required to restore the land to its original condition. It also states that NO other licensing authority shall grant license for commercial or industrial use or occupation of any building without a development permission granted by the respective local authority. Compliance Aspect The Proponent will be required to obtain development permission from the UasinGishu County Government by seeking approval of the architectural plans in respect of the proposed project. Finally, Section 36 states that if in connection with a development application, local authority is of the opinion that the proposed development activity will have injurious impact on the environment; the applicant shall be required to submit together with the application an environmental and social impact assessment (ESIA) report. EMCA, Cap 387 echoes the same by requiring that such an ESIA is approved by the National Environmental Management Authority (NEMA) and should be followed by annual environmental audits. Compliance Aspect The Proponent has complied with this provision by appointing Neolife Consultants Ltd to prepare and submit this Environmental and Social Impact Assessment Project Report to the Authority. 3.5.4 The Building Code, 2000. Section 194 requires that where a sewer exists, the occupants of the nearby premises shall apply to the local authority for a permit to connect to the sewer line and that all wastewater must be discharged into the sewers. The code also prohibits construction of structures or buildings on sewer lines. Compliance Aspect The project proponent will be required to make a written application to the Eldoret Water and Sanitation Company for authority to connect the proposed development to the existing sewer line mains and pay the required charges. 3.5.5 The Work Injury Benefits Act, 2007. This is an Act of Parliament to provide for compensation to employees for work related injuries and diseases contracted in the course of their employment and for connected purposes. The Act was published on 26thOctober 2007. The salient features addressed by the Act include the following: (i) Obligations of employers (ii) Right to compensation (iii) Reporting of accidents (iv) Compensation (v) Occupational diseases (vi) Medical aid and (vii) Appeals According to section 7 (1) of the Act, every employer is required to obtain and maintain an insurance policy, with an insurer approved by the Minister in respect of any liability that the employer may incur under the Act to any of his employees. In addition, every employer carrying on business in Kenya shall within the prescribed period and 39 in the prescribed manner register with the Director - section 8 (1). Pursuant to section 10 (2) of the Act, it is the duty of every employee to ensure his/her safety at the place of work and hence where an accident, not resulting in serious disablement or death, is caused by the deliberate and wilful misconduct of the employee, such an employee is not entitled to compensation. However, according to section 12 if an employee is injured in an occupational accident or contracts an occupational disease while the employee, with the consent of the employer, is engaged in any organized first aid, ambulance or rescue work, fire-fighting or other emergency service, the accident or disease is for the purposes of this Act, deemed to have arisen out of and in the course of the employee’s employment. In a circumstance where an accident occurs in the course of employment, section 21 makes it a requirement for a written or verbal notice of such an accident to be given by or on behalf of the employee concerned to the employer who shall send a copy of the notice to the Director within twenty four hours of its occurrence in the case of a fatal accident. In line with section 22 (1), an accident that has occurred should be reported to the Director by the employer in the prescribed manner within seven days from the date of receiving a notice of the accident or having learned that an employee has been injured in an accident. Similarly, it is the responsibility of the employee to report to his/her employer the occurrence of an accident not later than 12 months from the date of such an accident or else the right to benefits, in accordance with section 27 (1), shall lapse if the accident is not reported within such a period of time (12 months). According to section 46 (1), the employer shall be responsible for availing necessary means of transport where an employee is injured in an accident, which necessitates his conveyance to a hospital medical facility and from a hospital or medical facility to his residence. Compliance Aspect Under the above Act, the main contractor is required to: • Maintain an insurance policy cover for all staff. • Report any accident that has occurred to the Directorate of Occupational Health and Safety Service within 7 days from the date of occurrence or receiving notice. • Maintain a record of accidents on site. • Sensitize staff and create awareness on health and safety measures. 3.5.6 The Occupational Safety and Health Act, 2007. This is an Act of Parliament to provide for the safety, health and welfare of workers and all persons lawfully present at workplaces, to provide for the establishment of the National Council for Occupational Safety and Health and for connected purposes. The Act was published in the Kenya Gazette Supplement No. 111 (Acts No.15). It received presidential assent on 22nd October 2007 and became operational on 26th October 2007. The key areas addressed by the Act include: i) General duties including duties of occupiers, self-employed persons and employees ii) Enforcement of the act including powers of an occupational safety and health officer iii) Registration of workplaces iv) Health General Provisions including cleanliness, ventilation, lighting and sanitary conveniences v) Machinery safety including safe handling of transmission machinery, hand held and portable power tools, self-acting machines, hoists and lifts, chains, ropes & lifting tackle, cranes and other lifting machines, steam boilers, air receivers, refrigeration plants and compressed air receiver vi) Safety General Provisions including safe storage of dangerous liquids, fire safety, evacuation procedures, precautions with respect to explosives or inflammable dust or gas 40 vii) Chemical safety including the use of material safety data sheets, control of air pollution, noise and vibration, the handling, transportation and disposal of chemicals and other hazardous substances materials viii) Welfare general provisions including supply of drinking water, washing facilities, and first aid ix) Offences, penalties and legal proceedings Under section 6 of this Act, every occupier is obliged to ensure safety, health and welfare of all persons working in his workplace. The occupier shall achieve this objective by preparing and as often as may be appropriate, revising a written statement of his general policy with respect to the safety and health at work of his employees and the organization and arrangements for the time being in force for carrying out that policy (Section 7). He is also required to establish a safety and health committee at the workplace in a situation where the number of employees exceeds twenty (section 9) and to cause a thorough safety and health audit of his workplace to be carried out at least once in every period of twelve months by a registered safety and health advisor (Section 11). In addition, any accident, dangerous occurrence, or occupational poisoning which has occurred at the workplace needs to be reported to the occupational safety and health officer of the respective area by an employer or self- employed person (section 21). According to section 44, potential occupiers or users of any premises as work places are required to apply for registration to the Director for all premises intended for use as workplaces. Such places shall be maintained in a clean state during the operation phase (section 47). To ensure machinery safety, every hoist or lift – section 63 and/or all chains, ropes and lifting tackles – section 64 (1d), shall be thoroughly examined at least once in every period of six months by a person approved by the Director of Occupational Health and Safety Services. In relation to fire safety, section 78 (3) requires spillage or leaks of any flammable liquid to be contained or immediately drained off to a suitable container or to a safe place, or otherwise treated to make it safe. Furthermore, a clear and bold notice indicating that smoking is prohibited should be conspicuously displayed in any place in which explosive, highly flammable or highly combustible substances, are manufactured, used, handled or stored-section 78 (5). In addition, necessary precautions for dealing with fire incidents should be implemented including provision of means for extinguishing fire and means for escape, in case of fire, for the persons employed in any workplace or workroom – section 81. As far as disaster preparedness and emergency response program is concerned, section 82 (1) makes it a mandatory requirement for every occupier of a workplace to design evacuation procedures to be used during any emergency situation and to have them tested at regular intervals. To promote health and safety of employees who are at risk of being exposed to chemical substances, section 84 (3) and 85 (4) requires every employer to maintain at the workplace material safety data sheets and chemical safety data sheets respectively for all chemicals and other hazardous substances in use and ensure that they are easily available to the employees. The employers’ positive contribution towards the welfare of the employees include provision and maintenance of adequate supply of wholesome drinking water - section 91 and a first aid box or cupboard of the prescribed standard – section 95 at suitable point (s) conveniently accessible to all employees. Other precautionary measures include: issuance of a permit to work to any employee, likely to be exposed to hazardous work processes or hazardous working environment, including such work processes as the maintenance and repair of boilers, dock work, confined spaces, and the maintenance of machinery and 41 equipment, electrical energy installations, indicating the necessary precautions to be taken – section 96 (1); provision and maintenance for the use of employees, adequate, effective and suitable protective clothing including suitable gloves, footwear, goggle and head coverings in any workplace where employees are likely to be exposed to wet, injurious or offensive substance – section 101 (1). Compliance Aspect The Proponent will be required to ensure that the ESMP forms part of the contract document and the main contractor prepares a contractor specific Environment and social management plan and includes adequate measures to promote safety and health of workers and community during the construction phase of the proposed project. The contractor is expected to handle issues of occupational health and safety and community health and safety especially during construction phase of the project. 3.5.7 The Standards Act, Cap 496 (Revised 2013) This Act promotes the standardization of the specification of commodities and provides for the standardization of commodities and codes of practice to ensure public health and safety. It establishes the Kenya Bureau of Standards (KBS) and defines its functions as related to: • Promotion of standardization in industry and commerce; and • Making arrangements or provision of facilities for the testing and calibration of precision instruments, gauges and scientific apparatus, for the determination of their degree of accuracy by comparison with standards approved by the Minister on the recommendation of the Council and for the issue of certificates in regard thereto. Compliance Aspect The Proponent has to ensure all materials and equipment in use during construction as well as operation of the facilities adhere to the highest standards and do not pose any human health and/or safety risk. 3.5.8 Safety and Health Committees Rules, 2004. These rules state that any employer/proponent/occupier who employs more than twenty persons must establish a committee to address the health, safety and welfare of workers. The employer must also cause to be carried out a health and safety audit of all his operations on an annual basis by a registered health and safety advisor who should forward such a report to the Director of Occupational Health and Safety Services. Compliance Aspect The proponent shall ensure a workplace safety and health committee is formed and regularly trained during the construction and operation phase of the project. 3.5.9 First Aid Rules, 1977 These have details on first aid requirements in terms of facilities and capacity building among non- medical workers. Compliance Aspect The contractor should avail at the site an adequate number of well-stocked first aid kits during the construction phase of the project. 42 3.6 Relevant International Guidelines. 3.6.1 World Bank Operational Policies and Procedures on Environmental Assessment (EA) (OP/BP 4.01). The Bank requires environmental assessment (EA) of projects proposed for Bank financing to help ensure that they are environmentally sound and sustainable, and thus to improve decision-making. EA is a process whose breadth, depth, and type of analysis depend on the nature, scale, and potential environmental impact of the proposed project. EA evaluates a project's potential environmental risks and impacts in its area of influence; examines project alternatives; identifies ways of improving project selection, siting, planning, design, and implementation by preventing, minimizing, mitigating, or compensating for adverse environmental impacts and enhancing positive impacts; and includes the process of mitigating and managing adverse environmental impacts throughout project implementation. OP/BP 4.01 on Environment Assessment was triggered mainly due to planned construction and rehabilitation of laboratories, isolation units as well as the generation of the health care waste from the lab 3.6.2WHO National Guidelines on Safe Disposal of Pharmaceutical Waste, 2001. The provisions of these guidelines describe a series of steps that need to be followed in order to dispose waste and or expired pharmaceuticals. The steps required include identification of pharmaceutical waste, sorting of pharmaceutical waste by category, filling the relevant forms to seek authority from the authorities in charge of disposing such waste. Upon obtaining all the relevant approvals, the disposal of the pharmaceutical waste shall be effected under the supervision of the local pharmaceutical waste disposal team or the Waste Management Team. The recommended methods for disposing of unwanted pharmaceuticals include: • The use of either medium temperatures incineration at a minimum of 850 degrees Celsius or high temperature incineration exceeding 1200 degrees Celsius with two chamber incinerator for solids, semi- solids and powders for controlled substances e.g. anti-neoplastic. • Engineered sanitary landfill to be used for disposal of expired or unwanted pharmaceuticals. • Sewer disposal for diluted liquids, syrups, intravenous fluids, small quantities of diluted disinfectants and antiseptics. These guidelines are relevant in informing the generator of pharmaceutical wastes on safe disposal methods. The proponent shall however contract a licensed waste handler who disposes the pharmaceutical wastes in the manner provided by the Kenya legal framework and the best international practice and guidelines. 3.6.3World Bank Group (WBG) Guidelines: Environmental, Health and Safety Guidelines General EHS Guidelines. The Environment, Health and Safety (EHS) Guidelines contain performance levels and measures for development of industrial projects that are considered to be achievable in new facilities at reasonable costs by existing technology. Under these guidelines, the World Bank has several guidelines many of which are applicable to various components of the proposed project namely: • EHS Guidelines-Air Emissions and Ambient Air Quality • EHS Guidelines-Waste Management. • EHS Guidelines-Health Care Facilities. • EHS Guidelines-Hazardous Materials Management • EHS Guidelines-Construction and Decommissioning. 43 3.6.4WBG EHS Guidelines: Air Emissions and Ambient Air Quality These guidelines are meant for all types of projects with “significant” emissions, sources of air emissions, and potential for significant impacts to ambient air quality to prevent or minimize impacts by ensuring that emissions do not result in pollutant concentrations that reach or exceed relevant ambient quality guidelines and standards. They require the application of national legislated standard, or in their absence, the current WHO Air Quality Guidelines, or other internationally recognised sources. Kenya currently has Environmental Management and Coordination (Air Quality) Regulations, 2014 applicable to this project. In this project, there will be fugitive air emissions, which are expected during construction and operation phases of the project. These guidelines are useful as they give control and monitoring measures. 3.6.5WBG EHS Guidelines: Waste Management The guidelines apply to the management of non-hazardous and hazardous waste. This project will be a major generator of both hazardous and non-hazardous waste. These guidelines provide categories of various wastes and a summary of treatment and disposal options. These guidelines provide good guidance on waste on-site handling, collection, treatment and disposal for both the proponent and the contractors during construction and operation phases respectively. This report greatly adopts the guidance while formulating the environmental and social management plan. 3.6.6WBG EHS Guidelines: Noise This section addresses impacts of noise beyond the property boundary of the facilities. These guidelines are applicable during construction phase whereby construction equipment and activities are expected to emit noise. Our local regulation, EMCA (Noise and Excessive Vibration) Pollution Control Regulations, 2009 give permissible levels during construction works. The proponent therefore has adequate guidance to ensure noise levels are maintained as low as reasonably practicable. 3.6.7WBG EHS Guidelines: Occupational Safety and Health These guidelines guide employers and supervisors in fulfilling their obligation to implement all reasonable precautions to protect the health and safety of workers. The guidelines provide guidance and examples of reasonable precautions to implement in managing principal risks to occupational health and safety. Although the focus is placed on the operational phase of projects, much of the guidance also applies to construction and decommissioning activities. The guidelines also describe how facility operation workplace design should be undertaken to prevent occupational health and safety risks and hazards. The guidelines also give examples of internationally published exposure guidelines which may be used to measure occupational health and safety performance examples, to include the Threshold Limit Value, Occupational Exposure Guidelines and Biological Exposure Indices published by American Conference of Governmental Industrial Hygienists, the Pocket Guide to Chemical Hazards published by the United States National Institute for Occupational Health and Safety, Permissible Exposure Limits published by the Occupational Safety and Health Administration of the United States, Indicative Occupational Exposure Limit Values. The guidelines also provide guidelines on handling chemical hazards of asbestos containing materials. 44 3.6.8WBG EHS Guidelines: Construction and Decommissioning. These provide additional and specific guidance on prevention and control of community health and safety impacts that may occur during new project development, at the end of the project life-cycle, or due to expansion or modification of existing project facilities. 3.6.9WHO: Safety in Healthcare Laboratories, 1997. This is a manual intended for healthcare laboratories workers and those responsible for laboratory administration and planning. It provides key guidelines for health and safety in the laboratory activities. It offers a pragmatic approach to problems encountered in routine practice. These guidelines will be useful during operation phase of the project. 3.7 Alignment of WB and GoK Polices Relevant to this ESIA (i) Both the World Bank safeguards and GoK laws are generally aligned in principle and objective: Both require Environmental Assessment before project design and implementation (which also includes an assessment of social impacts), (ii) Both require public disclosure of EIA reports and stakeholder consultation during preparation, (iii) While OP 4.01 of World Bank stipulates different scales of EIA for different category of projects, EMCA requires EIA for all sizes of projects, which require to be scoped as applicable, (iv) EMCA recognizes other sectoral laws while WB has safeguards for specific thematic areas; (v) The Bank requires that stakeholder consultations be undertaken during planning, implementation and operation phases of the project which is equivalent to the EMCA requirements, (vi) Additionally, statutory annual environmental audits are required by EMCA. In Kenya, it is a mandatory requirement under EMCA, CAP 387for all development projects (Schedule Two) to be preceded by an EIA study. Thus, under the Laws of Kenya, environmental assessment is fully mainstreamed in all development process consistent with World Bank policies. However, since EMCA provides no minimum size threshold, all projects will be screened at identification stage so as to determine level of environmental assessment required under EMCA. Further, in order to fully insure against triggers to WB safeguard policies, individual investments will be screened against each policy as part of the EIA Study. 45 4.0 PROJECT DESCRIPTION 4.1 The Proposed Location of the Project The proposed project will be located along Nandi Road in Eldoret town, UasinGishu County. The piece of land is registered under the name of the proponent, Ministry of Health. The site, MTRH is a public hospital owned by the Government of Kenya. Consequently, there are no issues related to land acquisition on the proposed project. Currently, the site designated for the construction of the bio safety level II laboratory contains an old mortuary house, a waste collection area, an area for wood fuel storage and a flower and tree garden, located behind the mortuary house. All demolished waste,including from those containing asbestos will be transported by NEMA accredited waste handlers who will transport them to NEMA/UasinGishu County Government designated dumpsites or landfills. Prior to commencing construction, the hospital management will also establish an alternative waste collection area and a wood fuel storage area within the hospital. The old mortuary house has asbestos roofing, which shall require to be removed, transportedand disposed at appropriate sites by specialised personnel/firm (licensed by NEMA) before any demolition can begin. Solid waste including cardboards and office paper is also disposed on site whereas biomedical waste is temporarily accumulated in enclosed bins before transportation to the incinerator. The site also acts as a temporal storage area for wood fuel that is used within the hospital. Beforecivil works commence under the proposed project, the hospital management will be required to identify alternative sites for disposal of non-hazardous solid waste and storage of the wood fuel. Vegetation cover on site includes cypress and gravillea tree species; flower species such as hibiscus and roses; and grass that covers the ground. The existing mortuary house will be demolished while the trees behind it will have to be felled and transported out of the compound. The isolation unit area is currently a parking area covered with grass and surrounded by trees a few of which will be felled and transported as explained above. The GPS coordinates for the proposed new lab are Latitude: 0.51138451 and Longitude: 35.280897. 46 Figure 1: Shows the site for the proposed bio safety laboratory and isolation unit respectively The location of the hospital is in a densely populated area that is characterised by commercial and institutional buildings and establishments. Most of these commercial buildings are located in the nearby Eldoret town and they include; Naivas Supermarket, Riverside Hotel and the National Oil Corporation. Institutions neighbouring MTRH offer the same or related services and they include; Ziwa Memorial Hospital, and St. Luke Orthopaedic & Trauma Hospital. The institutions are in the neighbourhood within a radius of 200m.The common means of transportation in the neighbourhood is the road network. Major roads serving the area include Nandi Road, Waiganjo Street and Malaba Road. There are no residential houses within a radius of 0.5km from the hospital since institutions and commercial businesses have acquired most of the land. The immediate neighbourhood of the proposed development mainly features commercial developments and institutions. 47 Figure 2: Shows the Eldoret Hospital located to the west of MTRH 48 Sosiani River at GPS Coordinates (Latitude 0.511025, Longitude 35.277582) and appr. 1Km away : Shows a satellite image showing the location of MTRH in relation to Sosiani River which is approximately 1Km away Figure 2: 4.2 Project Design Considerations 4.2.1 Environmental and Sustainable Development Considerations The ESIA takes into account activities and impacts as well as recommended mitigation actions during the construction, operation and decommissioning phases of the project in a bid to ensure that environmental and sustainable development considerations are upheld. This is in accordance with the World Bank Operational Policies on Safeguards and the WBG’s EHS guidelines. Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs. economy In sustainable development, the objective is to strike a balance between equity, econom y and ecology. As per national laws and regulations, t h the following broad environmental, safety, health and sustainability development: considerations have been factored in the proposed development 1. The construction of the lab, isolation unit, and incinerator requires an Environmental and Social Impact Assessment (ESIA) Project Report, which must be approved by NEMA prior to the commencement of any civil work. UasinGishuCounty 2. The proposed development is subject to approval by the UasinGishu ounty Government and hence mitted as required. drawings to be submitted 49 3. Sewage and foul water from the facilities will be discharged into the Eldoret Water and Sanitation Company Limited (ELDOWAS) sewer line system. 4. Foul water from the laboratory will be discharged into the sewers through dilution traps. 5. The facility will be connected to water supply from ELDOWAS. 6. The development will include an incinerator for hazardous waste such as biomedical waste. The existing environmental liabilities to be supported by the proposed project include the broken down incinerator, site for keeping non-hazardous solid waste, wood fuel storage and the dug-out pit used in waste disposal. The broken down incinerator shall be demolished and disposed at the NEMA/County Government approved dumpsites while the dug-out pit should also be covered very wellusing the excavated soils from the laying of foundations of the proposed site and landscaped. The project design will take into account the Guidelines of the American Institute of Architects (AIA) and the Facility Guidelines Institute (FGI), the American Society for Healthcare Engineering (ASHE) of the American Hospital Association (AHA), and the Green Guide for Health Care (www.gghc.org). These guidelines should be used to verify the adequacy of planning for new facilities. 4.3 Project components. The project components include a Bio Safety Level II Laboratory and an Isolation Unit for treating communicable diseases. An incinerator will be constructed for the treatment/management of the health care waste from the laboratory and isolation unit. 4.3.1 Bio-safety Level 2 Laboratory Requirements. General design requirements for the Bio Safety Level II laboratory at Moi Teaching and Referral Hospital, MTRH i This shall be a freestanding building block, located behind anatomy lab (currently parking) and access to the premises must be controlled. ii Design of the building must provide universal access to persons with disability (PWD) and the aged as determined by the Constitution of Kenya. iii Staff entrance area should have changing rooms for both genders. These changing rooms should have washrooms with both toilets and shower rooms. iv The lab should have at least one staff room. v Signage should be provided to direct people unfamiliar with the facility to entrances and parking areas. Corridors, doors and stairs/ramps should have signage for direction or warning. vi Each unit size and layout shall be determined by projected workload for the next 15 years. vii The ceiling finish should be concrete on ground floor and on upper floor gypsum board finish. All ceilings should have a washable paint and the minimum room height of 3.0meters. viii The floor must be a one piece slip resistant, non-pervious and with skirting along the wall. Preferably heat welded vinyl flooring or epoxy coated concrete slab. The floor should also be wear resistant and easy to clean. ix Wall finishes should be washable, moisture-resistant and smooth; wall finish treatments should not create ledges or crevices that can harbor dust and dirt. General Scope of Work for the Bio-safety Level II Laboratory at Moi Teaching and Referral Hospital (MTRH) i. Construction of a new laboratory within the hospital compound next to the current laboratory ii. Electrical and mechanical works iii. Installation of water storage tanks (underground and overhead) 50 iv. Installation of firefighting equipment. v. Installation of desalination equipment and piping works for the hospital borehole (due to presence of scaled pipes). vi. Provision of water distillation unit. 4.3.2 Isolation Unit Requirements The Isolation Unit will have the following sections: • Reception area • Changing rooms • Nurse station • Suspected cases area • Confirmed cases area • Body holding area • Waste treatment area • A septic tank • Lab (Specimen holding and referral) area The following sections shall be provided: Reception area • Reception desk area • Two (2) consultation rooms Changing room • Shall be close to the entrance • Separate shower cubicles and WCs for both genders Nurse Station • Store • Clean store • Nurse station Suspected cases area. • Five (5) self-contained cubicles • Scrubbing room • Sluice room Confirmed cases area. • Five (5) self-contained cubicles • Scrubbing room and sluice room • Changing rooms The area of the unit should be between 700-800 square meters The surface areas of the proposed Bio-Safety Level 2 Laboratory and the Isolation Unit are given in the table below: GROUND FIRST TOTAL AREA FLOOR(M2) FLOOR(M2) (M2) LAB 651 636 1287 51 ISOLATION UNIT 590 0 590 4.3.3 LAYOUTS Figure 3: Shows the side elevation of the Bio-safety Laboratory 52 Figure 4: Shows approved layout of the Bio safety Laboratory 53 : Shows the layout of the new incinerator shed Figure 5: 54 Figure 6: Shows the layout of the Isolation Unit 4.4 Construction specifications: The construction specifications for the proposed development are as follows: 4.4.1 Bio safety level 2 Laboratory Floor slab: “Marmoran’ stone finish with glaze coat on render backing by an approved specialist to architects approval. Preferably heat welded vinyl flooring or epoxy coated concrete slab. Roof: glas in 10mm thick laminated glass skylight of 5mm thick stained toughened glass approved powder coated aluminium framing to detail. Windows: Circular windows on powder coated aluminium casement to schedule. Masonry wall Natural stone with key finish to external wall only parapet wall finish by an approved specialist. 55 4.4.2 Isolation unit Floor slab: “Marmoran’ stone finish with glaze coat on render backing by an approved specialist to architects approval. Roof: 10mm thick laminated glass skylight of 5mm thick stained toughened glass in approved powder coated aluminium framing to detail. Windows: Circular windows on powder coated aluminium casement to schedule Masonry wall Natural stone with key finish to external wall only parapet wall finish by an approved specialist. 4.4.3 General construction specification • All slabs at ground level to be poured over 1000-gauge polythene sheeting on 50mm thick murram binding on hard-core. • All soils under slabs and around external foundation to be poisoned for termite control. • All soils or cut embankments to be stabilized and the slope not to exceed natural angle of response. • All black cotton soil to be removed from below all buildings and paved surfaces. • All walls less than 150mm thick to be reinforced with hoop irons at every alternate course. • All adjacent reinforced concrete work and masonry wall to be tied with strip iron at every course 4.5 Design of the incinerator The incinerator is a modern waste disposal unit, designed to burn medical waste in a clean and environmentally efficient manner. The prescribed incinerator unit for the MTRH has a worldwide application and employs a temperature based logic control system to provide optimum control of the operating conditions. To ensure the unit’s effective destruction of the combustion products, the unit will incorporate a high capacity thermal oxidizing secondary chamber. 4.5.1 Design Parameters a) Waste The unit should be able to handle medical and general waste Groups A, B, C, D and E and general waste generally comprising of groups 0, 1, 2, and 3 (See table 4 and 5 below for explanation of these groups and types). Table 4: Clinical Waste Groups Waste Group Type of Clinical Waste Group A Identifiable human tissue, blood, tissue from hospitals or laboratories. Soiled surgical dressings, swabs and other similar soiled waste. Infectious disease cases, excluding any in Groups B-E. Group B Discarded syringe needles, cartridges, broken glass and any other contaminated disposable sharp instruments or items. Group C Microbiological cultures and potentially infected waste from pathology departments and other clinical or research laboratories. Group D Drugs or other pharmaceutical products Group E Items used to dispose of urine, faeces and other bodily secretions or excretions which i.e. bed pans or bed pan liners, incontinence pads, stoma bags and urine containers. 56 clinical solid waste) Table 5: Types of solid waste (non-clinical Throughput: 75kg/hour at a nominal calorific value of 4,000 kcal/kg and an average bulk density of 120kg/M³ Ash: The waste will be reduced by 90~95% to leave 5% ash. Environmental Standards • The World Bank Operational Policies and Bank Procedures on Environmental Assessment and World Bank Group’s Environment, Health, and Safety (EHS) Guidelines. • The Environmental Management and Coordination (Air Quality) Regulations, 2014 • EMCA, CAP 387, Laws of f Kenya Operating Period Anticipated daily operating period 8 hours Maximum operating period 12 hours 4.5.2 Siting The location of the incinerator can significantly affect dispersion of the plume from the chimney, which in turn tions, deposition and exposures to hospital staff, in – and – out – patient, workers and affects ambient concentrations, the community. In addition to addressing the physical factors affecting dispersion, siting must also address issues of permissions/ownership, access, convenience, etc . Best practices siting has the goal of finding a location for the etc. incinerator that minimizes potential risks to public health and the environment. This can be achieved by: • Minimizing ambient air concentrations and deposition of pollutants to soils, foods, and other surfaces, e.g., Open fields or hilltops without trees or tall vegetation are preferable. Siting within forested areas is not advisable as dispersion will be significantly impaired. 57 Valleys, areas near ridges, wooded areas should be avoided as these tend to channel winds and/or plumes tend to impinge on elevated surfaces or downwash under some conditions. • Minimizing the number of people potentially exposed, e.g., athlet fields, Areas near the incinerator should not be populated e.g., containing housing, athletic markets or other areas where people congregate. Areas near the incinerators should not be used for agriculture purposes, e.g., leafy crops, grasses or grains for animals plant The proposed site for the incinerator is near the existing incineration plant and the microwaving plant. Isolationunit. The site is within MTRH premises but away from the proposed bio safety laboratory and Isolationunit.The approximate distance between the proposed incinerator and the proposed lab is 400m and that from the proposed lab and the proposed isolation unit is approximately 200m. The adjacent area is also neither populated nor used for agricultural purposes hence it was best suited for the incineration plant. hospitall waste has to be burnt manually in a The existing hospital incinerator is not functioning anymore and the hospita dug out pit. It exposes the staff disposing the waste There is a proposed new incinerator being installed near the old incinerator Figure 7: Shows the proposed incinerator site : Shows one of the broken down incinerator that is not in use Figure 8: 58 4.6 MODEL I8-200 DETAILS: The I8-200 is a proven and unique design, which is currently operating in many different applications throughout the world. They have a high build quality that ensures durability and ease of installation, operation and servicing. They are suitable for many purposes including medical waste, animal waste, industrial waste, camp waste and general waste applications. Advantages: • Ease of use -Fully automatic control of burners with temperature monitoring display -90% factory pre-installed for easy and simple on-site installation. • Fuel efficiency -29litres per hour (dependent on application) -Thick monolith refractory lining rated to 16000C in main chamber retains heat, increasing efficiency. Thermostatic control of burners. • Quality built to last -Heat resistant 5mm steel. -Stainless steel stack. -12cm of refractory lining –steel reinforced. 4.7 Site (Project) Activities during the Construction Phase: The activities during the construction phase include: i) Establishment of a site office with site staff amenities, ii) Establishment of a store for materials storage and handling, iii) Site clearance and fencing, iv) Excavation of foundations, v) Construction of access roads, vi) Construction of spoil and stock pile areas. 4.7.1 Material Storage and Handling The contractors shall construct temporary site offices to run and manage all activities at different phases. This will also include connection of the utility services such as water, electricity which will be crucial for the construction activities. All materials to be used shall conform to the Kenya Bureau of Standards’ requirements for quality or equal and approved. 4.7.2 Non-Hazardous Materials The store for non-hazardous materials will be accommodated within the site office. Materials to be stored in this store shall include samples for review/testing by consultants and inspectors. 4.7.3 Hazardous Materials Hazardous materials likely to be stored at the site shall include paints, oil, grease and fuel. The store for these materials shall have iron sheet walling, roof, and a waterproof concrete floor to contain spills. Storage and handling of all hazardous chemicals shall be in accordance with manufacturer’s instructions as outlined on the material safety data sheets. 59 4.7.4 Material Sources and Management The bulk materials that will be purchased from licenced dealership are likely to be stored on site. They include: sand, ballast, stones, cement, quarry chips and timber. Sand will be sourced from nearby centres, ballast and quarry chips from adjacent areas and timber and cement from the hardware stores within the town centre. However, to avoid material accumulation with potential for impeding site activities, inducing safety hazards and creating a nuisance in the neighbourhood, the main contractor intends to have materials delivered to the site in small quantities. Timber will be used mainly for roofing, formwork, ceiling, joinery and other carpentry needs. Most joinery works will be fixed at a workshop located outside the site before being delivered ready for installation. Formwork timber will be fixed at the site. Consideration will be given to the working area and material storage requirements to ensure there is no conflict with the movement of the workers. i. Ballast and Quarry Chips The contractor must identify appropriate and suitable ballast and quarry chips materials from NEMA approved areas within UasinGishu County. The materials will be sourced from these areas after careful due diligence. ii. Water Since the proposed project is within an already existing hospital, water for construction will be sourced from the existing supply within the hospital with an approval from the water company supplying the hospital. iii. Sand Sand will be sourced from nearby approved/licensed centres within UasinGishu County. iv. Timber and cement These will be sourced from the licensed hardware stores within Eldoret Town. 4.8 Project Cost: The estimated cost of the proposed project is Kenya shillings one hundred and forty-nine million, two hundred and twenty-two thousand, five hundred and thirty seven only (Kshs 149,222,537.00). 60 5.0 ENVIRONMENTAL AND SOCIO-ECONOMIC SETTING OF THE PROJECT AREA This section describes the existing physical, biological, and socio-economic environment at the proposed site and its neighbourhood. The description provides the baseline information upon which potential impacts of the proposed project were determined. 5.1 PHYSICAL ENVIRONMENT 5.1.1 Topography: The project site is generally flat. The proposed project site slopes towards the western boundary. The gradient of the slope is slight, approximated at 1:100. The western boundary noticeably slopes from the last 20m towards the river running in a south-easterly direction. Within approximately 100m from the river, the gradient becomes more appreciable, at approximately 1:15.The slope to the northeast of the site ranges between 0% and 2%; while to the west of the site the slope ranges from 11% to 24%. Most parts of the site were found to have naturally growing grass giving potential for elaborate landscaping of the site. 5.1.2 Climate: Eldoret town located in UasinGishu County has a marine west coast climate that is mild with no dry season, warm summers. Heavy precipitation occurs during mild winters which are dominated by mid-latitude cyclones. According to the Holdridge life zones system of bioclimatic classification Eldoret is situated in or near the subtropical moist forest biome. The annual mean temperature is 16.6 degrees Celsius. Average monthly temperatures vary by 3 degrees Celsius. 61 : Shows the climatic pattern of Eldoret area Figure 9: 5.1.3 Geology The project area lies at an average altitude of 2100metres above mean sea level. The regional history described below covers the geological area south of Cherengani Hills. The rock occurrence in the area is dominated by the tertiary volcanic rock formations (Kenya Geological Maps).Recent sediment deposits and soils overlay the rock formation. 5.1.4 Soils The soils comprise of fairly drained, shallow to moderately deep loam soils and friable clayey soils. loamy silts, clay loamy silts and varying ranges of gravel silts overlay the stratum. This soil can be very good for agricultural use and will be opportune for landscaping at the site. 5.2 BIOLOGICAL ENVIRONMENT This report endeavours to describe key biological elements, including the identification and distribution of dominant, rare and unique plant and animal species within the regio n of concern (proposed project sites and region other potentially affected areas). Three categories are recognized as follows: wildlife and forests, community and habitat characterization and ecologically significant features. The proposed site for the constructionon of the bio safety level II laboratory consists of various tree species, flowers and grass. The site is a habitat for various invertebrates such as insects and small reptiles including chameleons Isolation and lizards. There is no wildlife on the site. The Isolation Unit site comprises of various grass species with Kikuyu grass being the predominant type. The site has no visible tree cover except for pine trees, which are planted on the adjacent plot along the boundary. 62 5.2.1 Wildlife and Forests 5.2.1.1 Aquatic Communities include: In this case, aquatic communities refer to those organisms that inhabit rivers and streams. The nearest aquatic ecosystem to the proposed site is the Sosiani River which lies approximately 1km to the South of the site. The aquatic communities in this river comprise of producers mainly; autotrophic phytoplanktons and higher plants (macrophytes), macro-consumers such as zooplankton, frogs and micro-consumers chiefly bacteria, fungi, which are responsible for the degradation of the particulate or dissolved organic substances by autotrophic processes or coming from allochthonous sources. 5.2.1.2 Wetland Communities. This refers to living organisms that inhabit areas normally frequently inundated by water (or marshy areas). They comprise of flora such as reeds, water lettuce (Pistastratiotes), Salvaniamolesta, Azollasp, hydrillavericillata and cordia grass and fauna such as insects and macro and micro invertebrates (e.g.Oligochaete like tubificidae and limnodrilus, insects like mosquitoes, horse flies, Caddies flies, butterflies and beetles), fish mainly mad fish, amphibians (frogs and toads), reptiles (e.g. water snakes) and birds of different species. In addition, protozoa are also abundant. The proposed sites for development are not swampy. 5.2.1.3 Terrestrial Communities. This refers to those organisms that inhabit dry land areas. Terrestrial communities in UasinGishu County include the Burnt forest, Kaptagat forest and the Kipkabus forest. These forests are a home to a wide range of wild animals. The natural vegetation of Eldoret is mainly highland grassland type. The proposed site for development is covered with various tree species, flowers and grass. Note: There is no documented information of rare, threatened or endangered species of flora or fauna in the project site and the immediate neighbourhood. 5.2.2 Water Resources. Water Sources (Quantity & Quality) a) Surface Water Resources: Surface water is fresh water on the Earth’s surface in streams, rivers, lakes, ponds, reservoirs and wetlands. Surface waters are replenished by the runoff of precipitation from land and are therefore considered a renewable resource although finite in nature. Rivers are the main sources of surface water in UasinGishu County. Rapid population growth, urbanisation and industrialization have put enormous pressure on the rivers of UasinGishu County. Untreated industrial effluents, raw sewage and other waste emanating from human settlements that lie along the rivers have severely impacted the rivers’ quality and quantity, resulting in eutrophication, proliferation of hazardous microbes and acute chemical stress on the aquatic ecosystem. Pollution of the rivers becomes more apparent as they flow through the urban areas/centres and finally reach alarmingly high levels in the industrial areas. The Government of Kenya (GoK) has already realised the magnitude of the problems facing the rivers through the uncontrolled settlements which continue to exist and expand along the rivers and has therefore embarked on various outreach campaigning strategies to create awareness on environmental degradation of the river basin. 63 The nearest source of surface water is the Sosiani River which lies approximately 1km to the South of the site. The existing site uses water from the Eldoret Water and Sanitation Company Limited water supply network. b) Groundwater Resources: Ground water occurrence is dependent upon geology, rainfall, weathering and recharge. The best aquifers are found when a conjunction occurs of optimum recharge (rainfall and soil permeability), storage (porous rocks) and transmissivity (the ease with which water can travel, both vertically and horizontally within an aquifer). Ground water in Eldoret town in general is used for domestic, commercial, institutional and industrial purposes. The quality of ground water in most of the areas in Eldoret is good with fluoride content that is within the acceptable limits as per the Environmental Management and Coordination (Water Quality) Regulations, 2006. 5.3 WASTE MANAGEMENT AND POLLUTION PREVENTION To ensure a clean and healthy environment, waste should be managed properly. Proper waste management enhances improved sanitary conditions that are associated with a reduction of disease incidences. The existing waste management practices in the neighbourhood of the proposed project site and within the UasinGishu County in general include: 5.3.1 Sewage Management The Eldoret Water and Sanitation Company Limited (ELDOWAS) which is the sewerage service provider in the area requires all sewage discharges to be connected to the existing sewerage network. Wastewater and trade effluent are a potential source of heavy metals and other inorganic and organic wastes. The presence of these wastes in an aquatic ecosystem adversely affects it’s biological, physical and chemical characteristics and thus the capacity to support aquatic life. For this reason, such wastes should be treated as required prior to release into the sewage system. In cases where it is not feasible to connect the discharges to the existing sewerage system, the same should be released into a septic tank and an emptying program established. Currently, MTRH discharges approximately a volume of 300 litres per day of effluent into the existing sewer line.MTRH has a 300mm diameter sewer line connecting to the County trunk sewer system. The proposed project will connect to the existing ELDOWAS sewer line mains. 5.3.2 Solid Waste Management Solid and liquid wastes should not be mixed together. In addition, solid wastes should be sorted out (depending on their nature e.g. biodegradable from non-biodegradable, reusable from recyclable, metallic from plastic, clinical from non-clinical and toxic from non-toxic) prior to disposal. NEMA, in line with the Environmental Management and Coordination (Waste Management) Regulations, 2006 requires all solid waste (unless the generator opts to recycle) to be dumped at approved landfill sites. The neighbourhood of the proposed site relies on private garbage collectors to dispose of non-hazardous solid waste. Currently, MTRH produces approximately 50 to 70 kg of waste per day that are collected and transported to NEMA licensed dumpsites/landfills for disposal. 64 The proposed incinerator will be used to treat hazardous waste at the hospital while the rest of the solid waste will be collected by a NEMA registered waste collector and dumped at NEMA approved dumpsites within UasinGishu County. 5.4 SOCIO-ECONOMIC ENVIRONMENT The attributes of socio-economic environment include land use; population and housing; economic activity (including employment and income), community; transportation and health and safety 5.4.1 Land Use: Land use is a primary indicator of the extent and degree of the impact man has made on the surface of the Earth. It reflects political, social, and economic aspects of the intensity of human lifestyles. The relationship between land, soil, and physical conditions on one hand and human activities on the other hand may be used to evaluate land use conditions. The proposed project site is along Nandi Road in Eldoret town, UasinGishu County. Currently the piece of land designated for the construction of the bio safety laboratory contains an old mortuary house, various trees species, flowers and grass. The Isolation Unit site consists of various grass species with the predominant type being the Kikuyu grass.). The neighbourhood of the proposed development mainly features commercial developments. To the immediate East of the site is AMPATH Kenya whereas residential developments can be sighted to the West of the hospital. Moi University College of Health Sciences is located to the North of the hospital while Shoe 4 Africa Children’s Hospital lies to the South. 5.4.2 Population and Demography: Eldoret is the administrative headquarters of Uasin-Gishu County. According to the 2009 Population and Housing Census, the total population of UasinGishu County stood at 894,179 while Eldoret town had a population of 289,380. At an inter-censual population growth rate of 3.8%, the total population of the county was projected to grow to 1,211,853 by 2017. The population growth rate is higher than the national growth rate at 2.9%. The population density is 267 persons per sq. Km. which was expected to increase to 362 persons per sq. km. by 2017. This will have implications on the average size of land holding. In 2012, the population age group between 0 to 14 years was 41.4% of the total; while the economically active age group of between 15 and 64 years accounted for 55.7% of the total. This implies that the County has a high dependency ratio and a high potential for labour force. The age group under one year is projected to grow from 29,175 in 2009 to 39,539 by 2017, while that aged between 2 and 5 years is expected to grow from 162,559 in 2009 to 220,311 by 2017. The age group between 15 and 29 years comprises the youth; and was expected to grow from 284,278 to 385,273 by 2017. The majority of the youth in the County are dependants due to limited employment and income generating opportunities.The youth also fall in the reproductive age groups of between 15 and 49 years which was projected to grow from 227,089 in 2009 to 307,766 by 2017. This will imply that the County invests more in reproductive health programmes aimed at reducing fertility in the light of the prevalent high dependency ratio coupled with high population growth rate. The age group between 16 and 64 years which constitutes the labour force, was expected to grow from 497,808 in 2009 to 674,663 by 2017. The following table shows the population of different towns within UasinGishu County including Eldoret town where the proposed project is located. The data was retrieved from KNBS, 2009 Population Census. 65 Table 6: Population demographics in the project area Town Population Eldoret 289,380 Moi’s Bridge 14,596 Matunda 10,031 Burnt Forest 4,925 Jua Kali 3,427 Turbo 2,831 Retrieved: KNBS 2009 Population Census 5.4.3 Poverty, Gender and Vulnerable Groups UasinGishu is a cosmopolitan county, with the Nandi people of the Kalenjin communities having the highest settlement. Apart from Kalenjin sub tribes, other communities with notable presence in the county especially in urban settlements include Luhya, Kikuyu, Luo, Kamba, Kisii among others. Other minority communities that inhabit the area include the Somali and Indians, who mostly ply their trade within Eldoret town. Some of these minority groups are often subjected to marginalization in decision-making and policy formulation by project developers and other authorities within the county. However, with the promulgation of the Kenyan 2010 constitution, which provides for public participation in policy-making and formulation, the concerns of these groups have and continue to be addressed through their involvement in public meetings and barazas. Poor people are also less likely to be involved in project development or policy formulation as they lack the financial resources or capacity that is necessary in this process. Poor people are also more vulnerable to the negative environmental or social impacts that may arise from certain projects. Generally, gender differences in productivity and earnings are systematic and persistent and women tend to exhibit lower average productivity and earn lower wages than men. More men than women are likely to be employed as workers in construction sites due to gender misconceptions that are persistent in our society. This leads to disparities in income generation since most households will have men earning more income than women. The project contractor should aim to recruit workers without bias on their gender. The proposed project should seek to involve all groups within the project area, including marginalized communities, poor people and women in different phases of the project including; hiring of labourers from marginalised communities during the construction phase, hiring women and the poor and consulting elders or representatives of these vulnerable groups in decision-making processes. The 2013 County Development Profile reports that causes of poverty in the county include lack of market for farm produce, high cost of farm inputs and poor storage. 5.4.4 Housing Considering the houses built in the county, 45.6% are made of mud or wood as the main walling material. This is followed by brick/block at 25.4%, stone at 12.3% and mud cement 5.8%. The main roofing materials are corrugated iron sheets, accounting for 84.4% followed by grass at 7.7%. The county needs to come up with strategies to encourage more investments in the housing sub-sector to deal with the shortage of housing units in the county especially in Eldoret Municipality and other towns within the county. According to the National Housing Policy of 2004, of the required 150,000 additional housing units per year for urban households in the county, only 30,000-50,000 (20-30%) are supplied leaving a deficit of 80-70% unmet. This contributes to the emergence of informal settlements. Investment in housing supply is therefore a desirable and priority investment for the country as whole and urban centres across the country, Eldoret Municipality being included. Project Staff: 66 Project development phase staff will stay in rentals or their own houses within Eldoret town. Neighbouring Community: The site lies in an upmarket cum business area comprising of shops, offices, schools and colleges and commercial building. The neighbouring community consists of people who stay in either rented or own premises. The area is densely populated just like most of the areas in the town such as Kapsoya, Langas, West Indies and Mwanzo estates. 5.4.5 Socio-economic Importance of the Proposed Project The proposed project will have the following positive socio-economic impacts: i. The proposed development will positively impact the health of Kenyans through provision of high quality laboratory testing and specialized care for people with high risk communicable diseases. ii. Operation of the facilities will create additional long-term technical and non-technical job opportunities for medical professionals and other non-medical professionals. iii. The proposed project will contribute towards increase in revenue collection by the central and county governments. iv. The proposed project will be connected to the municipal sewer line mains and water supply network hence will generate revenue to the Eldoret Water and Sanitation Company Limited through payment of connection and service fees. v. Apart from the direct employment of construction workers, the proposed project will also benefit the following categories of individuals: • Transporters. Investors on lorry and trailer transport will benefit greatly from the project. This benefit will extend to vehicle dealers, manufacturers and lorry drivers. • Sand Harvesters. Locals involved in sand harvesting in nearby areas are to be major beneficiaries of the project. The benefits will extend to the county government entitled to levy taxes on sand transporters. • Ballast Quarries. There will be massive use of ballast. This will ensure that the quarry owners and workers benefit greatly. • Cement Manufacturers. The local cement manufacturers, their employees and shareholders are direct beneficiaries of the development. The government will also get some impressive increase in V.A.T. and other taxes levied on cement. • Manufacturers and dealers of other building materials. Most of the building materials to be used are locally manufactured. Relevant companies, their workers and shareholders will be direct beneficiaries of the development. 5.4.6 Social Impact Assessment During the public participation, 74 people were consulted on the proposed project to get their input before the proposed project officially commences. Those interviewed were drawn from far and near. Eldoret, being a big town mostly has businessmen doing their businesses and retreating to their homes at night. All those interviewed there were giving the distance from the proposed site to their various homes. A few people gave short distances from the proposed site to their residences. The table below gives a summary of those interviewed between 5th and 8th June, 2018. 67 Table 7: Shows a summary of respondents and data tabulation NAME OF RESPONDENT AGE BRACKET DISTANCE OBJECTION FROM PROJECT S/no <35 35-50 >50 SITE Years Years Years 1. Duncan Kiplimo 600m No Objection 2. Hughes N. 500m No Objection 3. HidrisKhata 1km No Objection 4. B. Kigen 35m No Objection 5. HellenAgola On site No Objection 6. Erastus Lyate 500m No Objection 7. Moraa Sylvia On site No Objection 8. Winny Rob On site No Objection 9. Bruno Koiwa 300m No Objection 10. Chebii Lynne 1.5km No Objection 11. Kelvin Kirwa 100m No Objection 12. Maureen Kiewe 1km No Objection 13. Fridah Mweru On site No Objection 14. Nancy Wawira On site No Objection 15. Maitha Robert 1km No Objection 16. Kelvin Mchedzi 35km No Objection 17. Joshua Letting 27km No Objection 18. HellenToroitich 15km No Objection 19. Eric Kemboi 10km No Objection 20. James Mmbaitsi 13km No Objection 21. Salina Kibur 12km No Objection 22. Stella Jelagat 16km No Objection 23. Alex Kiptoo 26km No Objection 24. Claudia Chelagat 10km No Objection 25. Kelly Cherutich 22km No Objection 26. Cherop Sarah 15km No Objection 27. BabraChepkoech 18km No Objection 28. Kiprop Patrick 16km No Objection 29. Vincent Kiptanui 30km No Objection 30. Patrick Kemboi 17km No Objection 31. Cornelius Kemboi 25km No Objection 32. Sarah Jelimo 22km No Objection 33. George Orieko 13km No Objection 34. ScolasticaKoech 24km No Objection 35. Andrew Kipkoech 19km No Objection 36. JosphatKimutai 16km No Objection 37. Kibet Alvin 21km No Objection 38. EnockKemboi 25km No Objection 39. Emmanuel Opidi 13km No Objection 40. Sammy Melgut 24km No Objection 41. Albert Mutai 28km No Objection 68 42. Esther Jeptoo 28km No Objection 43. HellenCherop 16km No Objection 44. Salina Rono 13km No Objection 45. Ken Mutai 15km No Objection 46. Julius Kipsang 26km No Objection 47. KiprotichKerow 14km No Objection 48. Peter Juma 15km No Objection 49. Alex Sang 16km No Objection 50. Sammy Kipkorir 13km No Objection 51. Kea Kiprotich 14km No Objection 52. Joseph Owino 17km No Objection 53. Augustin Lelit 18km No Objection 54. Jones Muli 16km No Objection 55. Samuel Aiyabei 19km No Objection 56. Evans Buhasio 16km No Objection 57. Richard Kiplagat 19km No Objection 58. RonoGeraline 34km No Objection 59. PeninahWanja 26km No Objection 60. Caroline Rotich 18km No Objection 61. EdnahChesire 13km No Objection 62. Fiona Bartocho 18km No Objection 63. Christine Nekesa 18km No Objection 64. Caroline Rono 17km No Objection 65. Edwin Kibor 24km No Objection 66. Mark Tarus 21km No Objection 67. Moses Kiplagat 14km No Objection 68. Peter Maiyo 13km No Objection 69. Peter Kimitei 10km No Objection 70. Peter Limo 15km No Objection 71. Dennis Kemboi 15km No Objection 72. Joseph KosgeiMengich 17km No Objection 73. Emmanuel Kibor 27km No Objection 74. Jimmy Kibet 13km No Objection Data Tabulation Total no. of respondents 74 Disabled 4 Youth (<35 Years) 37 Middle aged (35-50 Years) 17 Aged (>50 Years) 16 Total Men 48 Total Women 26 Wards -Kimumu (Eldoret Township) -Kaptagat -Kapsoya -Kesses 69 Locations -Kimumu -Kapsoya Sub location -Chepkoilel -Kapsoya -Lotonyok -Sirgoit 70 6.0 PUBLIC CONSULTATION 6.1 Overview The World Bank Safeguards Operational Policy/Bank Procedures (OP/BP 4.01 Environmental Safeguard) requires that public consultations including disclosure of information on potential impacts and proposed measures be undertaken. Similarly, the Environment Management & Coordination Act (EMCA) CAP 387 and Environmental (Impact Assessment and Audit) Regulations, 2003, Laws of Kenya provide that the project proponent shall in consultation with NEMA, seek the views of persons who may be affected by the proposed project.Stakeholder engagement helps to provide feedback on the project design by the affected persons. Local communities and stakeholders give their views, inputs and opinions and any significant issue is addressed at the initiation stage. On the basis of the above requirements, beneficiaries and members of the public affected by the proposed project are consulted to seek their views and opinions regarding the projects before they are implemented. Consultative public participation is therefore an important process in ESIA studies. Through this process, stakeholders have an opportunity to internalize and contribute to the overall project design by making recommendations and raising concerns. In addition, the process creates a sense of responsibility, commitment and local ownership for smooth implementation of the project. The participants included area residents, business persons, patients, and government officials. Table 7in the foregoing chapter above summarizes levels of participation by different categories. Participants in the consultative meetings and interviews indicated that they could perform various roles and responsibilities in the proposed project implementation which would include among others: (i) Supporting the project positively by providing constructing ideas concerning it. (ii) Providing manpower required especially casual labour. (iii) Ensuring safe interwork with the contractor and cooperating with him. (iv) Providing food stuffs and beverages to workers. 6.2 Public Meeting One public consultative meeting was undertaken at the project site on 5th June 2018 between 3:18PM and 4:30PM(See Annex 1: Minutes of the Consultative Public Participation). There were 44 participants in the meeting. The forum was a major avenue for communities within EldoretTown and the larger UasinGishu County to propose and thereby contribute to improvement of the public hospital. During the meeting, the attendees were provided with information required before the commencement of the proposed project. The minutes were taken and any issues recorded so as to provide appropriate mitigation measures. 6.3 Results of Public Consultation The consultations were done by use of the consultative meeting, questionnaires, and by visiting various places. Those interviewed were drawn from far and near. Eldoret, being a big town mostly has businessmen doing their businesses and retreating to their homes at night. All those interviewed there were giving the distance from the proposed site to their various homes. Table 8 below provides a summary of comments received from the public as per the copies of questionnaires attached separately. The consultations captured the following groups:- 1. The business community 2. Local administration 3. The neighbouring community including various vulnerable groups (the physically challenged, women, the old, and the youth) 71 4. Potential users of the hospital from far and wide. 6.4 Summary of Public Comments as Per the Questionnaires Table 8: Respondents' comments and mitigation measures as per the filled questionnaires S/No NAME OF RESPONDENT COMMENT(S) GIVEN MITIGATION MEASURES/REMARKS 1. Duncan Kiplimo • More business opportunities. • Put up proper waste disposal measures. 2. Hughes N. • Environmental pollution. • Use authorized contractor. 3. HidrisKhata • Employment creation. • Use qualified engineers. 4. B. Kigen • Social interaction. • Avoid corruption. 5. HellenAgola • Tourist attraction. • Use authorized contractor. 6. Erastus Lyate • Economic growth. • Use qualified engineers. 7. Moraa Sylvia • Health facility improvement. • Avoid corruption. 8. Winny Rob • Employment creation. • Avoid corruption. 9. Bruno Koiwa • Social interaction. • Use qualified contractors. 10. Chebii Lynne • Tourist attraction. • Avoid corruption. 11. Kelvin Kirwa • Economic growth. • Use qualified contractors. 12. Maureen Kiewe • Health facility improvement. • Avoid corruption. 13. Fridah Mweru • Trade expansion. • Use durable construction materials. 14. Nancy Wawira • Employment creation. • Avoid corruption. 15. Maitha Robert • Employment creation. • Use durable construction materials. 16. Kelvin Mchedzi • Employment creation. • Good disposal of waste materials 17. Joshua Letting • Employment creation. • Develop proper framework. • Pollution • Dispose waste materials properly. 18. HellenToroitich • Employment creation. • Use modern technology. • Curing of diseases. • Water and air pollution. 19. Eric Kemboi • Employment for the locals. • Plant more trees. • Services efficiency. • Provision of PPEs. • Reduction in infection. • Personnel training. • No health hazards. • Deforestation. • Air pollution. 20. James Mmbaitsi • Employment creation. • No negative impact suggested. 21. Salina Kibur • Employment creation. • Use machines with low noise. Noise pollution. 22. Stella Jelagat • Reduced congestion. • No negative impact suggested. • Livelihood improvement. 23. Alex Kiptoo • Employment creation. • Follow regulations. 24. Claudia Chelagat • Job creation. • No negative impacts suggested. 25. Kelly Cherutich • Job creation. • Pollution prevention. 26. Cherop Sarah • Efficient service delivery to the • The respondent did not identify any negative 72 community impact/ no mitigation measures required 27. BabraChepkoech • Easy accessibility of laboratory • The respondent did not identify any negative services impact/ no mitigation measures required 28. Kiprop Patrick • Easy accessibility of laboratory • The respondent did not identify any negative services. impact/ no mitigation measures required 29. Vincent Kiptanui • Efficient service delivery to the • The respondent did not identify any negative community impact/ no mitigation measures required 30. Patrick Kemboi • More business opportunities. • Put up proper waste disposal measures. • Environmental pollution. 31. Cornelius Kemboi • Employment creation. • Use authorized contractor. • Social interaction. • Use qualified engineers. • Tourist attraction. • Avoid corruption. • Economic growth. • Health facility improvement. 32. Sarah Jelimo • Employment creation. • Use authorized contractor. • Social interaction. • Use qualified engineers. • Tourist attraction. • Avoid corruption. • Economic growth. • Health facility improvement. 33. George Orieko • Trade expansion. • Avoid corruption. • Employment creation. • Use qualified contractors. 34. ScolasticaKoech • Employment creation. • Avoid corruption. • Social interaction. • Use qualified contractors. • Tourist attraction. • Economic growth. • Health facility improvement. 35. Andrew Kipkoech • Job creation. • Avoid corruption. • Urban development. • Use durable construction materials. • Trade promotion. • Economic development. 36. JosphatKimutai • Job creation. • Avoid corruption. • Urban development. • Use durable construction materials. • Trade promotion. • Use qualified engineers and contractors. • Economic development. • Hospital growth. 37. Kibet Alvin • Town expansion. • Avoid corruption. • Job creation. • Use durable construction materials. • Trade promotion. • Tourist attraction. • Economic development. • Hospital growth. 38. EnockKemboi • Employment creation. • Avoid corruption. • Social interaction. • Use qualified contractors. • Tourist attraction. • Economic growth. • Health facility improvement. 39. Emmanuel Opidi • Employment creation. • Avoid corruption. • Social interaction. • Skilful people to run the project. • Tourist attraction. 73 • Economic growth. • Health facility improvement. 40. Sammy Melgut • More business opportunities. • Put up proper waste disposal measures. • Environmental pollution. 41. Albert Mutai • Employment creation. • Use authorized contractor. • Social interaction. • Use qualified engineers. • Tourist attraction. • Avoid corruption. • Economic growth. • Health facility improvement. 42. Esther Jeptoo • Employment creation. • Use authorized contractor. • Social interaction. • Use qualified engineers. • Tourist attraction. • Avoid corruption. • Economic growth. • Health facility improvement. 43. HellenCherop • Trade expansion. • Avoid corruption. • Employment creation. • Use qualified contractors. 44. Salina Rono • Employment creation. • Good disposal of waste materials Mobile No. 0727 150 598 45. Ken Mutai • Employment creation. • Develop proper framework. Mobile No. 0723 707 109 • Pollution • Dispose waste materials properly. 46. Julius Kipsang’ • Employment creation. • Use modern technology. Mobile No. 0723 527 059 • Curing of diseases. • Water and air pollution. 47. KiprotichKerow • Employment for the locals. • Plant more trees. Mobile No. 0725 293 895 • Services efficiency. • Provision of PPEs. • Reduction in infection. • Personnel training. • No health hazards. • Deforestation. • Air pollution. 48. Peter Juma • Employment creation. • No negative impact suggested. Mobile No. 0715 214 893 49. Alex Sang • Employment creation. • Use machines with low noise. Mobile No. 0727 332 006 • Noise pollution. 50. Sammy Kipkorir • Reduced congestion. • No negative impact suggested. Mobile No. 0708 262 723 • Livelihood improvement. 51. Kea Kiprotich • Employment creation. • Follow regulations. Mobile No. 0708 885 575 52. Joseph Owino • Job creation. • No negative impacts suggested. Mobile No. 0725 699 262 53. Augustin Lelit • Job creation. • Pollution prevention. Mbile No. 0723 275 914 54. Jones Muli • Job creation. • Follow rules. Mobile No. 0721 465 332 55. Samuel Aiyabei • Job creation • No negative impact suggested. Mobile No. 0724 764 023 56. Evans Buhasio • Job creation. • No negative impacts suggested. Mobile No. 0733 745 919 57. Richard Kiplagat • Job creation. • No negative impacts suggested. 74 Mobile No. 0723 599 632 • Disease control. 58. RonoGeraline • Employment creation. • No negative impacts suggested. Mobile No. 0728 159 258 • Reduced congestion. 59. PeninahWanja • Job creation. • Follow regulations. Mobile No. 0722 598 366 60. Caroline Rotich • Provision of lab services. • Use proper PPEs. Mobile No. 0721 299 383 • Avoid congestion. • Risk of infections. • Air pollution. 61. EdnahChesire • Employment creation. • No negative impacts suggested. 62. Fiona Bartocho • Employment creation. • Improve project standards. Mobile No. 0724 278 219 • Services accessibility. • Pollution problems. 63. Christine Nekesa • Reduce communicable • No negative impacts suggested. Mobile No. 0722 595 318 diseases 64. Caroline Rono • Employment creation. • No negative impacts suggested. Mobile No. 0725 048 973 65. Edwin Kibor (Area Chief) • Employment creation. • Use machines of less noise. Mobile No. 0723 891 442 • Reduced congestion. • Improved waste management. • Air and noise pollution. 66. Mark Tarus • Employment creation. • Reduce air and noise pollution. Mobile No. 0724 608 052 • Increased good health. • Fence off the site. • Air and noise pollution. 67. Moses Kiplagat • Job creation. • No negative impacts suggested. Mobile No. 0722 350 309 68. Peter Maiyo • Reduced environmental • No negative impact suggested. Mobile No. 0728 025 527 pollution. • Employment creation. • Reduced congestion. 69. Peter Kimitei • Employment creation. • Use modern technology. Mobile No. 0726 358 865 • Reduced congestion. • Use dust nets. • Noise and air pollution. 70. Peter Limo • Employment creation. • Follow regulations. 71. Dennis Kemboi • Job creation. • No negative impacts suggested. 72. Joseph KosgeiMengich • Job creation. • Pollution prevention. 73. Emmanuel Kibor • Job creation. • Follow rules. 74. Jimmy Kibet • Job creation • No negative impact suggested. 6.5 Conclusion In summary, some respondents mentioned problems about pollution from the proposed project. These included air, water, and noise pollution. However, the ESIA experts have suggested appropriate mitigation measures for the issues raised as detailed under section seven of this report. The respondents however mentioned many benefits that would come up from the project including creation of employment opportunities. These and many more issues foreseen have been adequately addressed in section seven. 75 7.0 POTENTIAL ENVIRONMENTAL AND SOCIAL IMPACTS AND MITIGATION MEASURES 7.1 INTRODUCTION The proposed project will be handling hazardous wastes through incineration. It is therefore expected that there are potential emission of various gases and particulate matter into the atmosphere, depositions of particulate matter onto land and vegetation in the surrounding and discharge of effluent and contaminated runoff into open drains around the premises. This scenario implies potential linkages with the surrounding environment and ecological setting that require to be addressed during the construction and upon commissioning. The following sections outline these linkages as well as proposed corrective measures. 7.2 POSITIVE IMPACTS The proposed project has an overall positive implication to the hospital and the country at large. The benefits include: i. The isolation unit will help prevent spread of infectious diseases. ii. The lab will help in detecting or diagnosing of diseases to ensure timely treatment and prevention. iii. The incinerator will be used in mopping up of hazardous and toxic materials that may be generated in the hospital and not exposing them to the external environment. iv. The incinerator will also ensure proper handling and disposal of all hazardous waste generated within the hospital, which could be dumped into public garbage disposal sites, or water bodies and end up having greater negative implications on human health. v. The facility will provide a multiple of direct and indirect employment opportunities within the area. vi. The facility is a blue print of Kenya’s vision 2030 aimed at having a clean and healthy environment for all. vii. There will be incremental facilities at the hospital. The proposed project will also have the following positive socio-economic impacts: i. The proposed development will positively impact the health of Kenyans through provision of high quality laboratory testing and specialized care for people with high risk communicable diseases. ii. Operation of the facilities will create additional long-term technical and non-technical job opportunities for medical professionals and other non-medical professionals. iii. The proposed project will contribute towards increase in revenue collection by the central and county governments. iv. The proposed project will be connected to the existing public utilities hence will generate revenue to the water and power companies through payment of connection and service fees. v. Apart from the direct employment of construction and operation workers, the proposed project will also benefit the following categories of individuals: Transporters: Investors on lorry and trailer transport will benefit greatly from the project. This benefit will extend to vehicle dealers, manufacturers and lorry drivers. Sand Harvesters: Locals involved in sand harvesting in nearby areas are to be major beneficiaries of the project. The benefits will extend to the county government entitled to levy taxes on sand transporters. 76 Ballast Quarries: There will be massive use of ballast. This will ensure that the quarry owners and workers benefit greatly. Cement Manufacturers: The local cement manufacturers, their employees and shareholders are direct beneficiaries of the development. The government will also get some impressive increase in V.A.T. and other taxes levied on cement. Manufacturers and dealers of other building materials: Most of the building materials to be used are locally manufactured. Relevant companies, their workers and shareholders will be direct beneficiaries of the development. 7.3 ANTICIPATED NEGATIVE IMPACTS AND MITIGATION MEASURES 7.3.1 Demolition Phase 7.3.1.1 Handling of Asbestos The following steps will be necessary for the main contractor to ensure, as far as is practicable, the prevention of contamination by asbestos from the site and also to ensure that asbestos containing materials are stored, labeled and disposed of appropriately. The following precautions shall be observed when removing asbestos materials from the building: • Secure the site to prevent unauthorized persons and to restrict movement • Wet the asbestos sheets before removal. If asbestos sheets should begin to crack or crumble, immediately wet the cracked or broken areas with the pintsize spray bottle or garden pump sprayer. • Remove pieces of asbestos sheets by pulling any fasteners (nails, screws, rivets) or cutting fastener heads so as to minimize breakage. If necessary, carefully lift asbestos sheets with pry tools to expose the fasteners’ heads. • Do not slide asbestos sheets over each other. • Carefully lower removed asbestos sheets to the ground. Do not throw or drop it. • Care should be taken not to stand or sit on the asbestos sheets to avoid breakage. • The workers removing the asbestos must have the appropriate Personal Protective Equipment, which must be removed as they enter the shower room immediately after removal of the asbestos. Temporary Storage If the asbestos must be stored in containers before disposal, it must be ensured that the containers are secured from accidental or deliberate damage, access by staff and the general public. • Temporary storage refers to the time between removal and final disposal of asbestos waste. The duration for temporary storage of asbestos waste should not exceed thirty (30) days from the time of removal. • The temporary site should be within the premises where the asbestos materials are being removed. • The removed bulky asbestos, such as roofing sheets, beams, joists, and studs, should be stacked and wrapped, into stacks which can be easily loaded into the transportation vessel, in a plastic sheet of a minimum of 500 gauge double wrapped and secured with tape and labeled • Any debris (broken pieces) should be collected in a sealed polythene woven bag or any other airtight container. The bags should then be wrapped, into stacks, which can be easily loaded into the transportation vessel, in a polythene sheet awaiting final disposal. 77 • The bags should be considered full when half full and should be tightly sealed or when filled up to a level where the open neck can be twisted tightly, folded over into a “gooseneck," and the ends sealed to the side of the bag with heavy plastic tape such as duct tape. • Care should be taken to ensure that sharp pieces do not puncher the bags/ wrappers • Removed asbestos sheets should not be allowed to lie about the site where they may be further broken or crashed by machinery or site traffic. • The storage area must have restricted entrance and locked or secured on a 24 hour basis. • Warning label (“Asbestos hazard area, keep off”) and danger signs should be affixed to each wrapped stack or storage area using English, Swahili and local language. NOTE: The Moi Teaching and Referral Hospital intends to temporarily store the asbestos removed from the mortuary house in the asbestos holding area within its premises before disposal. This area contains asbestos roof materials that has been removed from other structures within the hospital which have been stored for between 4-6 months. The asbestos will be covered in an impermeable plastic material temporarily awaiting an environmental impact assessment before final disposal approved by NEMA and the County Government of UasinGishu where the proposed project falls. The contractor shall therefore be required to strictly adhere to the above storage procedures. Preparation for Transportation Material containing asbestos or contaminated with asbestos must be viewed as hazardous and packaged to keep fibers from getting into the air. Containers used for packaging may be hard or flexible and must seal airtight. The following are some of the precautions that should be observed in the packaging. • The waste transporting vessel must be lined with a 500 gauge double wrapped plastic sheet with every seam sealed with a tape and covered. • The transportation vessel should be labeled "Danger - Contains Asbestos Fibers. Cancers and Lung Disease Hazard “and contain the following information: (i) the identity of the hazardous waste. (ii) the name, physical address and telephone contact of the generator of waste • The bags and stacks should be gently loaded into transportation vessel. • The goosenecks should not be used as handles for carrying the bags, because that might unseal the ends or tear the bags. Tossing the bags into a waste transporting vessel must be avoided because of the risk of rupture. • The asbestos waste should be transported by NEMA accredited transporter of such hazardous materials to a prepared disposal site that is authorized by NEMA. Transportation The vehicle transporting the asbestos waste should be licensed as per the EMCA (Waste Management) Regulations, 2006 and must be accompanied by a tracking document. The waste shall be transported to the disposal site in an enclosed vehicle or container, capable of being washed without lodgment of debris and fibers, and secure from escape of fibers to the atmosphere. The contractor should ensure that all persons involved in handling and disposal of asbestos are trained in emergency operating procedures. These procedures shall include how the waste is to be handled, services to be contacted during such an exposure, and additional personal protective equipment’s Disposal Site 78 Disposal of asbestos must be at a site; • Designated by the County Government and licensed by NEMA; • Privately owned disposal facility licensed by NEMA; • Designated by the waste generator (on-site disposal). Where a designated site by the local authorities or privately-owned facility does not exist the waste generator shall identify an appropriate site, undertake an EIA and be duly licensed. The disposal site should be as per specifications in the EIA report. However, the following minimum conditions must be observed: • The optimal distance of the disposal pit shall be as far as practicable from the nearest human settlement and as it shall be determined by the Ministry of Public Health and Sanitation. • A lined pit that does not reach the water table or according to other standards that maybe approved by NEMA. • Disposed material to be one meter below ground level. • Disposal site should be fenced off appropriately and the gate locked. Disposal Operation The waste generator shall ensure that the following precautions are observed when disposing asbestos wastes: i) The waste generator shall notify the Authority on commencement of disposal activities. ii) Asbestos materials must not be reused or offered for sale. iii) All asbestos sheets and the debris should be wrapped before it is hauled to the disposal site or transfer station in a covered vehicle. iv) Asbestos waste must be disposed of at approved disposal sites only v) The depth of the disposal pit shall be as deep as practically possible to accommodate more asbestos waste but at least one (1) meter above water table. vi) The asbestos should be lowered gently into the disposal site and should not be dropped from any height to avoid breakage. vii) When all available asbestos has been lowered into the pit, cover with polythene paper followed by 15cm layer of soil. Continue doing this until the pit is full or the waste is finished. viii) The pit shall be considered full when the asbestos waste is 100cmbelow the ground level or the asbestos waste is exhausted. ix) After the pit is full, cover with 500 gauges double wrapped polythene sheet and fill the pit with layer of soil up to the ground level. x) Disposal site should be completely fenced off with at least chain link and a lockable gate which shall be locked at all times. The fence should be at least one (1) meter from the edge of the pit. xi) Warning notices stating “Asbestos hazard area, keep out” shall be placed at the disposal site. These signs, with lettering of minimum 150mm in height, are to be placed so that they are clearly visible. Post-Disposal i) All transportation vessels, re-useable containers or any other similar article which have been in contact with asbestos waste shall be cleaned at the disposal site. ii) The disposal site should be maintained including the warning signs, the fence, the gate among others to prevent vandalism and interference. 79 iii) Human activities which might interfere with the buried asbestos waste such as construction and pitting should not be allowed at the disposal site. iv) The waste generator shall notify the Authority in writing on completion of disposal of asbestos waste. 7.3.1.2 Handling of other demolition waste Currently, the site designated for the construction of the bio safety level II laboratory contains an old mortuary house, a waste collection area non-hazardous material, an area for wood fuel storage and a flower and tree garden, located behind the mortuary house. Handling solid waste from demolitionwould require sound waste management system. All demolished waste including from those containing asbestos will be transported by NEMA accredited waste handlers who will transport them to NEMA/UasinGishu County Government designated dumpsites. The hospital management will also provide an alternative waste collection area and a wood fuel storage area within the hospital. 7.3.2 Construction phase 7.3.2.1 Air Quality There will be minimal production of particulate matter during the project execution. This is because; the proposed construction and installation will be within an already operational hospital. The construction of the hospital was commenced after appropriate approvals were obtained from the Government of the republic of Kenya. The main impacts of the dusty conditions are: i. Aesthetic and visual problems, though there are no notable settlements within the vicinity of the site, ii. Potential risks of health (mainly bronchial infections) though there are no notable inhabitants in the immediate neighborhood, iii. Deposition of dust on vegetation hampering development of the same, iv. Air pollution aspects including contribution towards climate change. 7.3.2.2 Noise Levels i. Potential disturbance to premises around the project site, ii. Noise and vibrations caused by heavy construction machinery could potentially cause noise to buildings around the site, iii. Non-compliance with the elevated noise and vibrations regulations is a likely health risk to the neighborhood. iv. Non-observance with the occupational health and safety to the construction workers e.g. use of noise prevention PPEs. 7.3.2.3 Land Degradation and Soil Loss i. Removal of top soils at material sites (normally rich in nutrients and organic matter) and vegetation cover to give way to appropriate project foundation. ii. Exposing of land to erosion agents (mainly runoff). iii. Land degradation at construction material sites (sand, quarry chips, stone quarries) and construction camps from pollutant deposition and top soil disruption. 80 7.3.2.4 Health and Safety The main concern in this regard is the occupational welfare of the construction workers from the effects of dust and emissions coming from the machineries. There are also potential physical risks from moving machinery, falling from high places especially during installations on heights like chimneys as well as personal injuries from objects around the construction site. There will also be potential impacts as a result of working at heights, working on electricity circuits, and traffic accidents. Other health and safety concerns include: Potential health risks from sanitation and hygiene at the construction site, Potential increase on cases of other communicable diseases (STIs, TB, etc.), Public health problems associated with dust emissions (eye problems, bronchitis, etc.). Generation of dust and gaseous emissions from machinery could have potential implications to public health. Possible health risks from elevated noise levels.Potential risks to safety from existing trucks transporting construction materials to the site. Leaving un-rehabilitated material sites (borrow pits, and quarry sites) hence creation of accident prone areas. 7.3.2.5 Topography and Physiology i. Aesthetic changes to areas in immediate neighborhood of materials sites (sand and stone quarry sites). 7.3.2.6 Social Impacts Anticipated social impacts would be related to gaseous emissions and generation of dust and noise from the construction site.Labor influx to the construction site will lead to increased demand and prices over social services and rental houses. This will also lead to increased demand on local resources especially water leading to social conflicts. It will also lead to social related infections associated with interactions including HIV/AIDS and other communicable diseases. It should be noted that the proposed projects will be located within MTRH which is a public health facility. The hospital is located on public land. Therefore, issues associated with land acquisition do not apply to this project. Others include: i. Potential risks to safety of intruders on project site. ii. Dust emissions with potential effects to public health during transportation of building materials to site. iii. Potential conflicts on employment opportunities may arise between the contractor and the local community. iv. Accidents and death. v. Transmission of sexually transmitted diseases and HIV/AIDS. vi. Gender-based violence (GBV) and sexual exploitation and abuse (SEA) vii. Conflicts between immigrants and local residents 7.3.2.7 Construction materials Various construction materials are required for execution of the various respective activities. There is a possibility of sourcing for construction materials of poor quality, but also from unlicensed sources. The source of building 81 materials including stones and quarry chips would create quarry sites and borrow pits. Sources of sand mainly outside the project area have potential risks to damage the sources. 7.3.2.8 Environmental Liabilities At the MTRH, there exists environmental liabilities which are likely to cause safety issues.These include the broken down old incinerator, dug-out pit used in burning waste in the open, non-hazardous waste collection site, and wood fuel storage site. 7.3.2.9 Chance Finds Procedure A chance find procedure is a project-specific procedure that outlines the actions to be taken if previously unknown cultural heritage is encountered. In situations where chance find procedure is not analyzed, the proponent is at risk of losing cultural heritage. A guidance note for the preparation of chance find procedures has been attached to this ESIA (annex 7). 7.3.2.10 Grievance Redress Mechanism (GRM) During the construction phase, different people may be aggrieved on issues pertaining to undertaking of the proposed project. If such issues are not addressed properly, they may hinder the development of the proposed project. 7.3.3 Construction Phase Mitigation Measures 7.3.3.1 Air Quality Ensure constant watering of construction sections and dry materials piles to keep dust low throughout the project areas, Similar measures will be necessary at the material sites as well as the access road for the delivery trucks, Maintain construction machinery and vehicles at reasonable state of service to minimize unnecessary exhaust emission into the atmosphere. 7.3.3.2 Noise Inform the neighboring communities including those within the hospital of any un-usual construction activities with extraordinary noise levels such as to include timing, expected duration and any safety precautions required, Utilize low noise machinery for the construction to the extent possible (Noise levels to be below 35dBA to the nearest receptors by day). Provide all construction workers with relevant safety gear including ear corks at all times while at work and enforce application. 7.3.3.3 Social Impacts i) The foreign labor to embrace local culture. ii) Minimum resource requirements for the local communities to be maintained. iii) Ensure at least 60% of the casual employment is drawn from the local communities, iv) Consult with neighborhoods on activities affecting them and collaborate mitigation; 82 v) Ensure effective signage and information to road users when transporting materials; vi) The contractor to establish and manage initiatives on social mitigation measures. vii) Incorporate HIV/AIDS and communicable diseases control program as part of the construction deliverables. viii) Enforce occupational health, safety and hazard control on site ix) Inform local communities of major activities in advance x) Screen the health of potential workers for communicable diseases as part of the recruitment process. xi) Undertake background checks of potential workers about any past involvement in any offenses. xii) Provide the workforce with access to primary healthcare on site, including prescriptions, prophylactics, condoms and basic testing for TB etc. xiii) Provide awareness training to the workforce, in particular regarding the transmission of STDs, and traffic safety awareness, xiv) Develop and enforce a strict code of conduct for workers to regulate behavior in the local communities, xv) Prepare local communities for any large influx of workers by developing community-policing systems. xvi) Establish a functional grievance redress mechanism (GRM) on site as below (see Chapter 2.3.3.4). 7.3.3.4 Grievance Redress Mechanism (GRM) Presently, the hospital has a grievance redress mechanism that is well structured. It involves lodging of complaints by aggrieved stakeholders or submission of comments from hospital staff, patients, neighbors or community members to a suggestion box located in the hospital’s premises. The MOH and the contractor shall jointly set up a grievance redress committee (GRC) comprising of project workers’ representatives and senior hospital management staff who shall address any disputes, conflicts or concerns arising from stakeholders that may be affected by the project. The Grievance Redress Committee (GRC) The GRC is an institution by which queries or clarifications about the project will be responded to, problems with implementation, resolved and, complaints and grievances addressed efficiently and effectively. The GRC will address various issues ranging from any or combination of the following forms: compensation if any, political, commercial, employment, health, social and space availability. The GRC is composed of representatives from the following: (i) National government (ii) County government (iii) Ministry of Health (vi) Contractor (vii) Supervising Engineer The roles of the GRC are as follows: (i) Enhance stakeholder participation during the project implementation; (ii) Solicit inquiries and suggestions that can be used to improve operational performance; (iii) To enhance the project’s legitimacy among stakeholders; 83 (iv) Mitigate project risks; (v) Promote transparency and accountability; (vi) Screen and refer the complaints where necessary; (vii) Maintain grievance-related documents, reports, and attendance registers; (viii) Undertake field inspections and; (ix) Provide feedback to affected persons and agencies involved in grievances. 7.3.3.5 Health and Safety i) Incorporate HIV/AIDS control program as part of the construction deliverables ii) Provide acceptable sanitation facilities in all work areas, iii) Ensure driving discipline among the drivers and other construction workers with respect to the public safety. iv) Ensure Occupational Health and Safety (OHS) requirements are observed at all times during the construction. v) Provision of fire extinguishers to fuel storage areas. 7.3.3.6 Construction Materials Construction materials should be of the appropriate quality, specifications and standards. This can be ensured through: i) Should be sourced from licensed dealers and suppliers who are compliant especially with environmental requirements. Quality should be thoroughly controlled through regular tests. No construction material will be sourced from unlicensed dealers. ii) Procurement of the materials should follow specifications by the structural engineers and architects. iii) All construction materials’ waste must be removed from the site and disposed of as per local regulations. iv) All construction materials/equipment should be removed from the site. v) Construction camps and materials sites be restored back to their original conditions upon project completion. Any borrow pits/quarries created as a result of the proposed project should be restored as per NEMA regulations. An ESIA for decommissioning of project site and quarries and borrow pits created should be done and submitted to NEMA for approval. vi) The contractor should review the site management plan such as to cover the operations and restoration (site decommissioning) upon project completion. vii) Landscaping of project site and introducing vegetation that match with the buildings. viii) Ensure compliance with established sand harvesting regulations. ix) If sand is obtained through independent suppliers, the contractor to ensure due diligence on abstraction and haulage. 7.3.3.7 Land Degradation and Soil Loss The project will utilize the existing materials sites to the extent possible and comply with the NEMA conditions issued thereof. This will also apply to the existing construction camp sites. Construction wastes (including spoil earth, oils/grease, vegetation and other materials) be disposed of in approved dumping areas by the UasinGishu County Government. 84 Construction camps and materials sites be restored back to their original conditions upon project completion. 7.3.3.8 Topography and Physiology Material sites should be rehabilitated and restored to near the original status as soon as they are exhausted to restore the micro-topographical outlook, The cut sections to be done such as not to lose compatibility with the adjoining land areas, The proposed project to blend with the surroundings to the extent possible (project to engage a landscape/aesthetic architect to minimize visual disruption). 7.3.3.9 Environmental Liabilities The broken down incinerator should be demolished and disposed at the NEMA/County Government approved dumpsites. The dug-out pit should also be covered very well using the dug soils from the laying of foundations of the new proposed site. Asbestos containing materials will be removed and transported by NEMA licensed specialized firm and deposited/disposed off in accordance with national regulations 7.3.3.10 Chance Finds Procedure According to the World Bank’s safeguards policy on Physical Cultural Resources - PCR (BP 4.11), the borrower (represented by MOH) shall inform the Bank of the relevant requirements of its legislation and of its procedures for identifying and mitigating potential impacts on physical cultural resources, including provisions for monitoring such impacts, and or for managing chance finds. be responsible for siting and designing the project to avoid significant adverse impacts to cultural heritage. In the case of the proposed project, the MOH has developed provisions for managing chance finds (see annex 7) that would be incorporated into the main contractor’s contract and monitored by the Site Engineer.. 7.3.4Operation Phase It should be noted that the proposed project will be done in an already existing hospital and therefore not much will change as pertains to the operation phase of the proposed project. However, as usual for any proposed project, the following impacts are inevitable: 7.3.4.1 Air Quality Major potential point sources of particulate matter (chemical residuals and smoke) and gaseous emissions in and around the proposed premises are expected to be as follows; i. The incineration will involve burning hazardous at very high temperatures (between 800oC – 1,500oC). Particulate matter will comprise of ashes and flue gases from the burning process and smoke as a combustion product. Other emissions from this point are hydrocarbon residuals, carbon dioxide, carbon oxide, nitrogen oxides and Sulphur oxides from fuels and related combustion processes, ii. Over all, it is estimated that the smoke of opacity within the premises could be slightly more than the 20% opacity level recommended by the European Union, though there are no matching standards in the country. Impacts associated with the above air pollution would include; 85 i. Health effects mainly bronchial infections, skin problems, visibility, etc. This is likely to affect those working in the hospital, the patients, and the general neighborhoods, ii. Soil quality degradation that may result from deposition of pollutants from the plant operations or carried to other areas through surface runoff, iii. Pollution of water sources through direct deposition, surface runoff and/or infiltration into groundwater aquifers, iv. Emissions of acetylene gas into the air have a potential to cause fire in the premises with far reaching implications on the neighboring land users. 7.3.4.2 Noise Levels The proposed project operations are likely to generate some little amounts of noise levels from pumping of waste oil and sludge from the sludge tank to the incinerator. This situation is likely to have occupational health and safety implications as well as effects to the workers. Those within the site and in the neighborhoods of the project site may be affected. 7.3.4.3 Environmental Pollution The key environmental pollution anticipated from the site activities includes the following; i. Deposition of emitted particulate matter and dust on land affects the soil quality and the effect could also compromise on the integrity of water sources (both the surface and ground aquifers). ii. Deposition of particulate matter as well as the fly ash from the incinerator kilns could be undesirable for disposal onto open land. One reason is because the flash is an atmospheric pollutant and deposition could be an aesthetic nuisance, iii. Aerial emissions are perhaps the worst feature of an incineration activity. Hydrocarbons, nitrogen oxides, sulphur oxides and flue gas are among contaminants anticipated into the air with significant implications to the residents and commercial activities on the windward direction, iv. Disposal of inert solid waste from the premises could become an extended environmental problem that would affect physical environmental quality, biodiversity and public health at points of disposal. Such waste including fly ash, drums, scrap metals and kiln tiles are notable potential waste requiring planned disposal strategy. 7.3.4.4 Health and Safety The health of the workers and clients varies from one section to another as outlined below; i. Health risks are found in the management of the hazardous waste holding areas, the transfer routes and preparation procedures. The risks including exposing the workers to a wide range of chemical poisoning, toxicity or long-term health complications. The neighborhood could also be affected through wind or surface runoff transferring contaminants from the waste holding areas to the external environment. Waste oil and sludge is pumped into the sludge tank, then will be moved to the incinerator through a pipework connection hence such risks will be minimal. ii. Combustion areas are the most critical sections in respect of health and safety. The kilns emits fumes and particulate matter originating from the wastes burning exposing the workers directly handling the 86 same as well as others working elsewhere within the same premises. The affected workers are exposed through inhalation, skin and to some extent ingestion. Emissions from the kilns is also likely to reach external recipients through stacks if not well designed and managed. iii. Heat is also a serious impact to the employees operating the kilns since they are likely to be open. The general ambient heat around the entire premises is also likely to be relatively high extending the risk to more workers. iv. Personal accidents and risks of getting injured by falling objects to the workers and visitors while moving around the premises cannot be ignored. Heavy, corrosive and hot objects including welding are among potential risks to safety anticipated in the proposed premises. v. There are risks of fire outbreaks from kilns, oil and fuel storage areas posing potential danger to not only the site, but also the neighboring land users including the main MTRH. 7.3.4.5 Pathogen Release Risk of healthcare-acquired infections (HCAI) is omnipresent in healthcare facilities worldwide, and understanding transmission routes is key to effective control. While the transmission routes for some diseases are well documented, the precise mode of transmission is uncertain for many infections, particularly for those pathogens that cause HCAI. Although it is probable that the majority of transmission occurs via a contact route (Sax et al., 2009), there is increasing recognition that the hospital environment plays an important role. Evidence suggests that at least 20% of HCAIs potentially could have arisen from an environmental reservoir (Harbarth et al., 2003) and several recent studies have highlighted the importance of surface contamination and indicated a causal link to subsequent patient infection (Bhalla et al., 2004a). 7.3.5 Operational Phase Mitigation Measures 7.3.5.1 Hazardous Wastewater Management The following are basic aspects for inclusion in the site design and the wastewater handled in accordance with the Environmental Management and Coordination (Waste Management) Regulations Legal Notice No. 120 of September 2006. The effluent from the proposed facilities will be discharged into the public sewer system. The existing public sewer line has enough capacity to handle the entire wastewater from the Moi Teaching and Referral Hospital (MTRH) including the proposed facilities. MTRH has a 300mm diameter sewer line connecting to the County trunk sewer system.Within the MTRH, hazardous wastewater is not discharged into the public sewer system. Any wastewater containing hazardous chemicals e.g. expired reagents is confined, recorded, and incinerated while the non-hazardous wastewater is left to freely move into the public sewer line. The existing regulations of discharging effluents into public sewer lines shall be adhered to. Reference shall be made to Annex 4: Standards for Effluent Discharge into Public Sewersand Annex 5: Effluent Levels for Health Care Facilities. Regular monitoring of the wastewater from the proposed facilities shall be done to ensure the quality standards of discharge of effluents into the public sewer line are met. I. Maintain appropriate records on wastewater quality for compliance evaluation and comparison with the gazetted standards on a continuous basis. Refer to Annex 3: Standards for Effluent Discharge into the Environment, Annex 4: Standards for Effluent Discharge into Public Sewers, Annex 5: Effluent Levels for Health 87 Care Facilities in the appendices for the quality of wastewater to be discharged either to the environment or to public sewers. II. Oil storage areas should be provided with slabs with surrounding bunds to contain any spilt oils. 7.3.5.2 Hazardous Solid Waste Management Handling of solid wastes at the site will require the following components and handled in compliance with the Environmental Management and Coordination (Waste Management) Regulations Legal Notice No. 121 of September 2006; i. The waste slab should be provided with compartments for segregation of various categories of waste classified on source and physical nature that should also be handled separately, ii. Provide solid waste holding bins at strategic locations around the premises and install transfer stations and modalities of waste removal to approved dumping grounds. Hazardous materials should be handled through incineration, iii. Fly ash and other incineration residuals shall be disposed of in landfills or other NEMA approved dumping grounds in conjunction with the County Government of UasinGishu, iv. Oils and grease from moving machine parts and other sources should be handled as hazardous wastes in accordance with the waste regulations, v. At the MTRH, there is an existing Health Care Waste Management Plan (HCWMP) currently being implemented with an internal Standard Operating Procedures. The HCWMP is geared towards realization of a proper health care waste within MTRH i.e. from waste generation to the final treatment point.The HCWMP is adequate forthe scale and type of activities and identified hazards. The Plan takes into account the following components during operation and maintenance: a) Waste Minimization, Reuse, and Recycling; b) Waste Segregation Strategies; c) On-site Handling, Collection, Transport and Storage; d) Transport to External Facilities; and e) Treatment and Disposal Options. The existing HCWMP shallcontinue to be implemented during the operation phase. 7.3.5.3Aerial Emissions Gaseous and particulate matter is perhaps the most critical environmental aspect associated with the proposed operations. The following measures should be considered to reduce the elated impacts: i. Hazardous wastes holding yards require to be kept moist at all times to prevent dust emission into the atmosphere and the windward side of the site during in-house movement or just in storage, ii. The kilns should be designed with provisions of flue gas trapping, smoke interception and stacks fitted with scrubbers (for gases) and filters for particulate matter removal, iii. The flue gases shall be cleaned of gaseous and particulate pollutants before they are dispersed into the atmosphere. iv. A permanent and regular air quality monitoring shall be done to determine levels of emissions to the atmosphere. Annex 6: Air Emission Levels for Hospital Waste Incineration Facilities shall be used to determine the levels. v. Seek NEMA’s permit for installation and operation of incinerator and an emission license according to the Environmental Management and Coordination (Waste Management) Regulations, 2006 and the 88 Environmental Management and Coordination (Air Quality) Regulations, 2014 Laws of Kenya respectively. This will ensure annual monitoring of the air quality. vi. The incinerator should be operated and maintained by trained employees to ensure proper combustion temperature, time, and turbulence specifications necessary for adequate combustion of waste vii. Pollution prevention and control measures including application of waste segregation and selection including removal of: a) halogenated plastics (PVC), pressurized gas containers, large amounts of active chemical waste, silver salts and photographic / radiographic waste, waste with high heavy metal content (e.g. broken thermometers, batteries), and sealed ampoules or ampoules containing heavy metals. 7.3.5.4 Health and Safety Attention should also be on the health and safety of the workers, visitors, customers and neighboring community such as to include; i. All moving machine parts and high temperature areas should be fitted with guardrails and restrict access, ii. Provide all employees with personal protective gear and enforce application at all times within the place of work, iii. Workers operating within the high temperature zones (melting, rolling mills and galvanizing plant should not exceed 2hrs continuous presence or/as may be directed by the Occupational Health and Safety Experts, iv. Segregate scrap materials on sources basis and devise safe modes of handling each category with particular focus on those likely to be hazardous/toxic. v. Training and induction of all employees and visitors on site to enhance safety. 7.3.5.5 Pathogen Release To prevent pathogen release, the following measures are necessary: • Exposures from pathogen release leading to laboratory-acquired infections and to release outside the community i.e. those leading to community-acquired infections will require the presence of a sophisticated occupational medicine program to assess and manage potential exposures as varied as needle sticks and fomite and aerosol exposures. This may include hospitalization, isolation, and critical care of infected people and quarantine of contacts. • Surface hygiene in the laboratory should be key. • Hand hygiene especially use of hand gloves reduces pathogen exposure. 89 8.0 ANALYSIS OF PROJECT ALTERNATIVES This section analyses the projects alternatives in terms of site, technology, scale and waste management options. The proposed project sites have been chosen after consideration of several factors including water supply, sewer line connection and proximity to other facilities that undertake similar or related functions within the hospital. Thus, the proposed sites were best suited for undertaking the development. 8.1 The No Action Alternative This alternative describes a situation where the proposed development fails to be implemented. In case this happens, positive impacts associated with the proposed development will not accrue to the stakeholders including patients, the development consultants, contractors and suppliers of materials. However, from an environmental management perspective, the “No action alternative” will be beneficial in the sense that any potential negative impacts associated with the project will be avoided. The “No Action Alternative” should not be adopted, as we need to encourage development on better health care services so long as it is undertaken on an environment sustainable basis. The no project alternative option in respect to the proposed project implies that the status quo is maintained. This option is the most suitable alternative from the extreme environmental perspective as it ensures non-interference with the existing conditions. Under no project alternative, the proponent’s proposal would not receive the necessary approval from NEMA, proposed project would not be constructed/installed and there would be no demand for the proposed project. This option will however, involve several losses both to the hospital and the community as a whole. The proponent will not utilize the land for the purpose it was intended for leaving the property remains idle. The no project option is the least preferred from the socio-economic and partly environmental perspective due to the following factors; Discouragement for hospital investments. There will be no incinerator installation yet there is acute need for such facility within Moi Teaching and Referral Hospital, Eldoret. Land will remain idle. No employment opportunities will be created for Kenyans bearing in mind that the proposed project will have employment opportunities both directly or indirectly during construction and operations phases and thus improve lifestyles and livelihoods. Local skills would remain under-utilized. Development of infrastructural facilities (energy facilities, roads, electrical etc. will not be undertaken). Vision 2030 will be far from being achieved/ attained bearing in mind that this is one of sector which need infrastructural improvement to gear the nation towards realization of vision 2030. From the analysis above, it becomes apparent that the No Project alternative is no alternative to the local people, the hospital, and the government of Kenya. 90 8.2 Analysis of Alternatives to Incineration 8.2.1 Open uncontrolled, non-engineered dump sites i. Open dumps are probably the most common land disposal method in developing countries, Kenya included. ii. Untreated waste discharged into an uncontrolled, non-engineered, open dump does not protect the local environment and should not be used. Discharging waste in open dumps either within the healthcare institutions or in the municipal facilities is insufficient solution and may lead to environmental pollution. iii. As a last resort where other methods of disposal are not available the healthcare waste if disposed of on open dump must be covered immediately with inert material such as soil. This method could not be considered because it does not protect the environment. 8.2.2 Sanitary landfill i. Properly constructed and operated land fill sites offer a relatively safe disposal route for municipal solid waste including healthcare wastes. ii. The priority is protection of the water aquifers and each day’s waste is compacted and covered with soil to maintain sanitary conditions. This method could not also be considered because it requires a larger space for compaction of each day’s waste. 8.2.3 Incineration i. Incineration is a high-temperature dry oxidation process that reduces organic and combustible waste to inorganic, incombustible matter and result in very significant reduction of waste volume and weight. ii. This process is usually selected to treat waste that cannot be recycled, reused or directly disposed off in sanitary landfill. Medium temperature incineration i. In many developing countries, Kenya included, there are no high temperature double chamber incinerators designed to handle hazardous waste. Such incinerators meet strict emission control standards such as those set by the European Union. ii. All types of incinerators if operated properly eliminate pathogens from the waste and reduce waste to ashes. iii. However certain types of healthcare waste e.g. pharmaceutical waste or chemical waste require higher temperatures for complete destruction. Higher operating temperatures and cleaning of exhaust gases limit the atmospheric pollution and odors produced by the incineration process. Advantages of incineration include: Accept the greatest variety of waste, Treated waste isunrecognizable as ash, Significant volumereduction, Energy recovery, Waste totally sterilized. Trained personnel readily available, Existing guidelines in place, Cheaper to install and maintain compared to other methods like autoclaves. Disadvantages include: Acid gases in airemissions, Heavy metals inash residues, 91 Convert biologicalproblem intopotential air qualityemission problems, Major source of dioxinand furan emissions. Because of the many advantages of incinerators including that they accept the greatest variety of waste, significant volume is reduced, trained personnel are readily available and that they are cheaper to install and maintain, this method is considered provided the mitigation measures provided in this ESIA report are considered. 8.2.4 Crude burning i. Burning healthcare waste at low temperatures in the open should be discouraged because this may release toxic pollutants into the air. This method is discouraged and could not even try to consider it. 8.2.5 Microwaving Microwave technology of clinical waste in the healthcare waste sector is considered an alternative technology of the incinerator and is a steam-based process, and electromagnetic waves with frequencies between radio and infrared waves that use wet inside the wastes or by additional steam to sterilize wastes and destroy infectious agents and pathogenic organisms in the waste. So it includes the use of high-intensity radiation to heat the moisture inside the waste. The types of waste generally treated in microwave systems are equal to those treated in autoclaves. Also, microwave methods cycle very rapidly between positive and negative and the very high frequency around 2.4 billion significant times per second that when receive the body of liquid or solid vibrate very quickly to result in friction to create significant amounts of heat. Advantages of Microwaving include: Technologyis easy, Reduce volumeby 80%, Environmentallysound, No liquideffluents, The emissionsare minimal Disadvantages include: Cost is very high, Not suitablefor all typesof wastes, The shredderused is noisy, Offensive odors This method could not be considered given that it is not suitable for all types of waste. 8.2.6 Autoclaves An autoclave consists of a metal chamber sealed by a charging door and surrounded by a steam jacket. Steam is introduced into both the outside jacket and the inside chamber which is designed to withstand elevated pressures.Heating the outside jacket reduces condensation in the inside chamber wall and allows the use of steam at lower temperatures. Because air is an effective insulator, the removal of air from the chamber is essential to ensure penetration of heat into the waste. This is done in two general ways: gravity displacement or pre-vacuuming. A gravity-displacement (or downward-displacement) autoclave takes advantage of the fact that 92 steam is lighter than air; steam is introduced under pressure into the chamber, forcing the air downward into an outlet port or drain line in the lower part of the chamber. Advantages of Autoclaves: Steam treatment is a proven technology with a longand successful track record, The technology is easily understood and readily acceptedby hospital staff and communities, It is approved or accepted as an alternative technologyin all states, The time-temperature parameters needed to achievehigh levels of disinfection are well-established, Autoclaves are available in a wide range of sizes, capableof treating from a few pounds to several tonsper hour, If proper precautions are taken to exclude hazardousmaterials, the emissions from autoclaves and retortsare minimal. Many autoclave manufacturers offer many featuresand options such as programmable computer control,tracks and lifts for carts, permanent recording oftreatment parameters, autoclavable carts and cartwashers, and shredders. The disadvantages include the following: They are too expensive to install and maintain. The technology does not render waste unrecognizableand does not reduce the volume of treated wasteunless a shredder or grinder is added, Any large, hard metal object in the waste can damageany shredder or grinder, Offensive odors can be generated but are minimizedby proper air handling equipment, If hazardous chemicals such as formaldehyde, phenol,cytotoxic agents, or mercury are in the waste,these toxic contaminants are released into the air,wastewater, or remain in the waste to contaminatethe landfill, If the technology does not include a way of drying thewaste, the resulting treated waste will be heavier thatwhen it was first put in because of condensed steam, Barriers to direct steam exposure or heat transfer(such as inefficient air evacuation; excessive wastemass; bulky waste materials with low thermal conductivities;or waste loads with multiple bags, airpockets, sealed heat-resistant containers, etc.) maycompromise the effectiveness of the system to decontaminatewaste. Examples of waste that may needto be collected separately and treated using anothertechnology include evacuated containers andpleurovac machines. They require trained personnel to implement. Though modern, this method was found to be too expensive to install and maintain, they are not common, and that they require trained personnel to implement who are hard to find. This, in addition to the above disadvantages rendered the technology not considerable. 8.2.7 Plasma Pyrolysis Plasma pyrolysis is a modern technology for safe disposal of healthcare waste. Also, it is an environmentally friendly technology that transforms organic waste into useful products, and it is another type of thermalparsing of carbonaceous materials in oxygen. Plasma pyrolysis technology needs two chambers installed so thatthe primary chamber takes place at a high temperature of 1,100ºC and secondary chamber ignition takes place at 950 to 1,000ºC. In addition, due to the severe heat generated by the plasma, it can dispose of all types of waste, including municipal solid waste, biomedical waste, and hazardous waste in a safe and reliable manner. Advantages include: 93 Suitable for all types of wastes, Consumes less space, Environmentally sound, Not require chimney, Toxic residuals is much below, Not require segregation, Energy recovery, Reduce volumemore than 99% Disadvantages include: Requires technical persons, Cost is very expensive. They are not common. Large initial investment costs relative to that of alternatives, including landfill and incineration. Operational costs are high relative to that of incineration. Little or even negative net energy production. Wet feed stock results in less syngas production and higher energy consumption. Frequent maintenance and limited plant availability. This technology could not be considered because of the high cost involved including other disadvantages highlighted above. 8.3 Analyses of Alternative Construction Materials and Technology The proposed project will be constructed using modern, locally and internationally accepted materials to achieve public health safety, security and environmental aesthetic requirements. Equipment that save energy and water will be given first priority without compromising on cost or availability factors. Heavy use of timber during construction is discouraged because of massive destruction of forests. The exotic species would be preferred to indigenous species in the construction where need may arise. However, this will require very little timber. The proponent should consider installing solar panels so that solar energy is also used as an alternative. 8.4 Wastewater (Effluent) Management Alternatives Five locally available technologies are discussed below: 1. Wastewater treatment plant: This involves the construction of a plant and use of chemicals to treat the effluents to locally accepted environmental standards before it is discharged into the environment. A lot of wastewater will be discharged from the hospital as a result of the proposed project during the operation phase. However, a wastewater treatment plant will not be appropriate in an area served by a public sewer line. 2. Use of stabilization ponds/lagoons: This refers to the use of a series of ponds/lagoons which allow several biological processes to take place, before the water is released back to the river. The lagoons can be used for aquaculture purposes and irrigation. However, they occupy a lot of space but are less costly. No chemicals are used/heavy metals sink and decomposition processes take place. They are usually a nuisance to the public because of smell from the lagoons/ponds. This option is not preferable in the area because the required space is not only available, and the surrounding community is not likely to accept the option. 94 3. Use of Constructed/Artificial wetland: This is one of the powerful tools/methods used in raising the quality of life and health standards of local communities in developing countries. Constructed wetland plants act as filters for toxins. The advantages of the system are the simple technology, low capital and maintenance costs required. However, they require space and a longer time to function. Long-term studies on plant species on the site will also be required to avoid weed biological behavioral problems. Hence it is not the best alternative for this kind of project. 4. Use of septic tanks: This involves the construction of underground concrete-made tanks to store the sludge with soak pits. It is expensive to construct and requires regular empting. Septic tanks if not well constructed and monitored can lead to blockages and leaks to the underground water. This alternative is not suitable in areas served by a public sewer line. 5. Connection to the existing sewer system: Connection to a sewer line will solve the effluent management issue at a very minimal cost and in environmentally efficient manner. This is the most suitable alternative for the proposed project since the area is served by a public sewer line. The wastewater from the hospital is handled through a public sewer system which has enough capacity to handle it. However, monitoring shall be done to ensure the discharge into the public sewer line meets the standards. Reference shall be made to Annex 4: Standards for Effluent Discharge into Public Sewers. 8.5 Solid Waste Management The proposed project will generate considerable amounts of solid wastes both during construction and operational phases. An integrated solid waste management system is recommended. The proponent will give priority to reduction of the materials at source. This option will demand a solid waste management awareness program in to be effected by the management and the entire workforce. In addition to that, recycling, reuse and composting of waste will be an alternative in priority. This issue calls for a source separation program to be put in place-the proponent/hospital management should introduce separate and adequately marked skips/ dustbins for sorting the recyclable wastes, organic matter and the other waste. The recyclable waste is sold to waste buyers within Eldoret town and surrounding areas, organic matter are sold for use as compost while the rest can be taken to an approved dump-site/ sanitary landfill i.e. ash that will be generated by the incinerator. The third priority in the hierarchy of options is combustion of the waste that is not recyclable in order to produce energy. Finally, sanitary land filling will be the last option for the proponent to consider. The County Government of UasinGishu has an overall responsibility of collection of waste and therefore will ensure the ash from the incinerator will be disposed appropriately. 8.6 Comparison of alternatives The proposed project is the best alternative since it will provide a laboratory, isolation ward, and a hazardous waste management facility within the hospital. In addition to this, the facility will lead to revenue for the proponent and the government, improvement in service (hazardous waste) delivery and will create employment opportunities for more people. According to Maryam, K. G andRosnahB. M. Y (2015) Advantages and Disadvantages of Healthcare Waste Treatment and Disposal Alternatives,studies on healthcare waste treatment show that among many methods for health care waste treatment, about 59-60% are treated via incineration, 37-20% by steam sterilization, and 4-5% by other treatment technologies. Incineration methods are most used among the technologies for healthcare waste treatment in most countries including Kenya. Therefore, the proponent opted for incineration against the other waste treatment options. 95 9.0 ENVIRONMENTAL AND SOCIAL MANAGEMENT PLANS This environmental and social management plans presents integrated scenarios with the environmental aspects, anticipated impacts during construction and occupation as well as preventive (mitigation) action plans. Other issues covered include the responsibilities, costs implications, timeframes and parameters for monitoring of the trends. The EMP matrix is designed such that it is self-implementing and can be implemented. 9.1 Environmental and Social Management Plan for the Construction and Operation Phases Table 9: Environmental and Social Management Plan for the Construction and Operation Phases Project Phase Aspect Action Estimated cost Timeframe Monitoring Parameters (Kshs) /Responsibility Demolition, • ESMP • Collaboration between 5,000,000 From demolition to operation The ESMP construction, and implementation different stakeholders in annually from by the MOH operation phases implementing the ESMP. demolition to operation. Demolition Phase • Disposal of asbestos • Dispose all asbestos containing 200,000 • Before construction by the • Number of holding days containing materials from materials according to WBG/IFC proponent (MOH). demolitions EHS guidelines and NEMA requirements. Construction Phase • Public health, occupational • Fence off the site to keep off 700,000 • During construction by the • Complaints on health, safety, health and safety, and intruders. contractor and security aspects security • Train staff/workers on occupational health and safety. • Special focus on material • Provide full protective gear & sites and the project site workmen’s compensation cover in addition to the right tools and operational instructions & manuals during construction. • Ensure use of standard construction materials and to the specifications. Avoid undesirable, substandard, hazardous or unauthorized materials during construction & maintenance. • Sensitized staff on social/health issues such as drugs. • Ensure machinery and equipment servicing and maintenance as per schedules & legal requirements. • Post strategically the Factories and Other Places of Work Act Abstract. • Post clear warning signs e.g. ‘No unauthorized use of machines’, ensure there are guards on moving parts etc. • Provide fully equipped First Aid kits & train staff on its use. • Ensure adherence with the legal requirements- OSHA, 2007. • Sensitize construction workers on environmental management. • Deploy a security personnel(s) at the entrance to the construction area to monitor how construction workers move in and out of site. Materials/equipment moving in and out should also be recorded. Construction Phase • Road safety issues • Enforce speed limits for 10,000 • During the construction • Speed limits construction vehicles especially phase by traffic and roads along roads leading to the site department/transporters even within the hospital. • Provide bill boards at the site/entrance to notify motorists about the development. • Provide safe entry and exit points. Construction phase • Fall Hazard from high level • Provide safety harnesses and 100,000 • Before and during • PPEs’ use scaffolding construction • Main contractor for civil works Construction phase • Falling objects from high • Provide helmets 130,000 • Before and during • PPEs’ use level construction • Main contractor for civil works Construction phase • Dust • Water the ground before and 100,000 • Before excavation • Construction related dust during excavation • Main contractor for civil level within the project; 96 works • Exhaust fumes from construction machineries. • Provide dust nets at high levels 100,000 • During construction at high level • Main contractor is responsible Construction phase • Noise • Use of ear protectors (ear 80,000 • Main contractor to provide • Noise Level plugs/muffs) by workers the protective gear to the • Recondition engine exhaust workers systems • Before excavation by main • Engine tune-up contractor for civil works • Establish inspection program for equipment Construction phase • Emissions • Use of respirators by workers 120,000 for • Main contractor to provide Air Quality • Recondition engine exhaust respirators the protective gear to the systems workers • Engine tune-up • Before excavation by main • Establish inspection program for contractor for civil works equipment/incinerator Construction phase • Sewage disposal • Provide water borne toilets for 80,000 • Main contractor to provide the • Particular attention on gents and ladies. sanitary facilities to the pollutants from construction workers site. • Before excavation by main contractor for civil works Project Phase Aspect Action Estimated cost Timeframe Monitoring Parameters (Kshs) /Responsibility Construction phase • Storage and handling of • Obtain material safety data sheets 140,000 per • Main contractor • Material Safety Data Sheet hazardous materials for all hazardous materials and annum • During construction products handled at the site • Obtain personal protective equipment for the workers responsible for handling hazardous materials • Train the workers on safe handling procedures 97 Construction phase • Accumulation of waste oil Provide labelled containers for waste • 3,000 per drum • Main contractor • Particular attention on waste oil. • During construction oil Construction phase • Disposal of waste oil. • Appoint a NEMA licensed • 4,000 per • Main contractor • Particular attention on waste contractor to collect waste oil. month • During construction oil Construction phase • Spill control • Obtain spill control kits • 70,000 for spill • During construction • Particular attention on spills • Train staff on spill control kit and training • By main contractor Construction Phase • Environmental liability • The broken down incinerator • 100,000 • During decommissioning • Environmental Liability including the broken down should be demolished and after construction phase. old incinerator and the dug- disposed at the NEMA/County out pit used in burning Government approved dumpsites. waste in the open. • The dug-out pit should also be • Site fo keeping non- covered very well using the dug hazardous solid waste and soils from the laying of foundations wood fuel of the proposed site. • Undertake immediate disposal of waste • Establish new safe sites within the hospital and relocate material Construction and • Emergency response • Keep a record of the public • 50,000 per • During construction and • Safety response operation phases emergency service telephone group of operation of the medical numbers including: trainees facilities. Police • Main contractor and Fire brigade proponent Ambulance services • Document an emergency response procedure • Train staff on emergency response Construction and • Compliance with legal and • Refer to relevant policy, legal and 20,000 • During construction and Legal requirement operation phases regulatory requirements administrative framework and operation of the medical comply facilities. • Main contractor and proponent 98 Construction phase • Decommissioning after • All waste must be removed from the 500,000 • Immediately after • Usability of the affected camps’ project construction site and disposed of as per local construction and clearing of and material sites. regulations. the medical facilities. • Sustainability • Allconstruction materials/equipment • Main contractor and project parameters in the rehabilitation should be removed from the site. proponent. plan. • Construction camps and materials sites be restored back to their original conditions upon project completion.Any borrow pits/quarries created as a result of the proposed project should be restored as per NEMA regulations. • Contractor to review the site management plan such as to cover the operations and restoration (site decommissioning) upon project completion • Landscaping of project site and introducing vegetation that match with the buildings. Construction phase • Socio-economic issues • Ensure at least 60% of the casual 100,000 • During construction phase • Trends in socio-economic Labor influx employment is drawn from the dynamics Social relationships local communities, • Trends in HIV/AIDS cases in the and contacts during area, • Consult with neighborhoods on construction; Safety issues; activities affecting them and Social related collaborate mitigation; infections associated • Ensure effective signage and with interactions information to road users when including HIV/AIDS transporting materials; and other communicable • The contractor to establish and diseases. manage initiatives on social mitigation measures. Sources: Construction • Incorporate HIV/AIDS and machineries; communicable diseases control Construction campsite; program as part of the construction deliverables. • Enforce occupational health, safety and hazard control on site. 99 • Inform local communities of major activities in advance. • Screen the health of potential workers for communicable diseases as part of the recruitment process. • Undertake background checks of potential workers about any past involvement in any offenses. • Provide the workforce with access to primary healthcare on site, including prescriptions, prophylactics, condoms and basic testing for TB etc. • Provide awareness training to the workforce, in particular regarding the transmission of STDs, and traffic safety awareness, • Develop and enforce a strict code of conduct for workers to regulate behavior in the local communities, • Prepare local communities for any large influx of workers by developing community-policing systems. • Establish a functional grievance redress mechanism (GRM) on site. Project Phase Aspect Action Estimated cost Timeframe Monitoring Parameters (Kshs) /Responsibility Operation phase • Environmental audits • To be carried out against the 120,000 per • Annually. Environmental quality trends environmental and social annum • Proponent management plan and the mitigation plan in this report. Operation phase • Emissions from the incinerator • Conduct annual air quality surveys 90,000 per • Annually Air quality measurement within the site of the incinerator. survey. • Proponent 100 Operation phase • Management of hazardous • Incinerate all hazardous waste on 2,000,000 for the • Continuous Attention on hazardous waste waste site. implementation • Proponent (MOH) and the Health Care Waste • Segregate hazardous waste and training Management Plan. emanating from various sources. activities of the • The existing Health Care Waste HCWMP for one Management Plan (HCWMP) shall year. be implemented during the operation phase. • Fly ash and other incineration residuals shall be disposed of in landfills or other NEMA approved dumping grounds in conjunction with the County Government of UasinGishu. • The flue gases shall be cleaned of gaseous and particulate pollutants before they are dispersed into the atmosphere. Operation phase • Fire protection • Install firefighting equipment 1,500 per fire • Proponent • Fire safety preparedness • Ensure firefighting equipment are equipment • During operation phase inspected semi-annually • Conduct fire drills • Appoint fire volunteer aiders Operation phase • Disposal of solid waste • Appoint a NEMA licensed waste 10,000 per month • Proponent • Particular attention on pollutants transporterand management entity. • Prior and during operation. from construction site. Operation phase • Occupational Health and • Develop and strategically display 15,000 per • Proponent Complaints on health and safety Safety an OHS policy. training • During operation • Ensure the OHS policy is 30,000 per implemented. training • Provide staff with appropriate PPEs and enforce their use. • Conduct regular first-aid training of first aiders. • Conduct regular training of staff on OHS. • Provide an adequate number of well-stocked first aid kits. 101 • To avoid electrocutions, ensure electric circuits are disconnected by KPLC Operation phase • Community health and safety • Take safe measures to prevent 50,000 per • Proponent • Pathogen release resulting from pathogen release of pathogens into the session release into the environment environment from the laboratory 9.2 Environmental and Social Management Plan for Decommissioning Phase The environmental and social management plan for potential negative impacts during decommissioning phase is provided below: Table 10: Environmental and Social Management Plan for Decommissioning Phase Activity Environmental/ Action Cost (Kshs) Responsibility and time frame Social aspect • Power • Electric safety • Disconnection to be done by KPLC. Nil • Proponent disconnection. • Prior to commencement of demolition • Traffic jams and accidents • Provide traffic signs at site warning of Nil • Proponent around site ‘heavy trucks turning’ • During demolition and transportation • Provide appropriate signage to direct flow process of traffic within the site. • Spillage of fuel from trucks • Maintain a spill response kit outside the 2,000 for spill response kit • Proponent and heavy demolition building. • During demolition and transportation machines • Adhere to spill response procedures process developed. • Noise • Limit idling time of stationery vehicles and • Demolition and other construction equipment transportation of • Driver of vehicles to be warned against debris to approved unnecessary hooting and playing of loud site. music while at the site using appropriate notices. • Use of properly serviced and maintained vehicles and other construction equipment. 102 • Gaseous Emissions • Regular servicing and maintenance of vehicles and other demolition equipment • Fall Protection • Establishment of criteria for use of 100 5,000 • Proponent and contractor per cent fall protection. The fall • During demolition and transportation protection system should be appropriate process for the storey building and necessary movements, including ascent, descent, and moving from point to point. • When operating power tools at height, workers should use a second (backup) safety strap. Demolition • Dust • Provide dust masks to workers 5,000 • Proponent • Enclose the site with iron sheets • Throughout Demolition of wall • Working at elevated • The area around which elevated work is 15,000 • Proponent heights taking place should be barricaded to • During demolition process prevent unauthorized access. • Provision of personal protective equipment • Maintain a standard first aid kit at the site Clean-up of the site • Indiscriminate disposal of • Segregate waste into various waste 2,000 • Proponent waste streams • Implement procedures for the management of various categories of waste including temporary storage, transport and final disposal or selling to licensed scrap dealers. • Transport waste from the site for 10,000 Proponent appropriate disposal in accordance with Environmental Management and Coordination (Waste Management) Regulations, 2006 103 10.0 INSTITUTIONAL ARRANGEMENTS FOR THE ESMP IMPLEMENTATION The environmental monitoring for the ESMP shall be implemented to address all activities that have been identified to have potentially significant impacts on the environment during normal operations and upset conditions. The implementation of the project environment and social component will be overseen by different institutional arrangements. The players include the following: 10.1 Internal Monitoring Ministry of Health (MoH) The proponent (MoH) will establish a specific project desk to be charged with the responsibility of coordinating all matters pertaining to the implementation of the project. The Project Engineer manning the desk will work with the Environment Manager among others, who will directly interact with the Environment and Social Experts from the Supervision and the Contractor. Supervision Consultant Monitoring activities will be the responsibility of the supervision with the Resident Engineer being the Leader. Among other staff, the Resident Engineer will have a qualified Environmental Expert and a Sociologist. Among the immediate and follow-up tasks of the Environmentalist and Social Experts at the Resident Engineers office will include; (i) Development of a monitoring tool/ checklist based on the ESMP and guided by the project physical layout; (ii) Develop a monitoring program for the works targeting specific project working sites, material sites, sensitive environment and social areas, etc. (iii) Prepare monthly site meetings to involve the Contractor, Client and Stakeholders. (iv) Monthly reports in addition to continuous communications to the Contractor, Client, the Authorities and the Stakeholders as situations require, (v) The Resident Engineer will convene monthly meetings for progress reporting by the Contractor and the Supervision Team. The Client will attend all the meetings. The Contractor The Contractor is expected to integrate environmental and social focus in the Project Manager. To ensure effective implementation of the projects impacts mitigation measures, therefore, the contractor will mobilize in-house Environment and Social Expert with the following responsibilities; (i) Evaluate and review the ESMP developed from the main ESIA process and internalize the provisions for implementation on the basis of the realities of the project; (ii) Customize the project ESMP and generate a Construction Environmentaland Social Management Plan (C.E.S.M.P) as a tool to guide the implementation and monitoring of indicators. File a copy with the Resident Engineer. 104 (iii) Procure necessary equipment for environment measurements or engage an appropriate expert personnel for the activity in specific environment quality aspects including air quality, noise, water and soil quality, (iv) Monthly reporting throughout the project period. 10.2 External Monitoring Stakeholders and environmental Authorities will have a significant role to play in monitoring and ensuring compliance in consultation with MoH at all times. Among the external monitoring parties will include; Regulatory (i) NEMA for surveillance on the impacts management and compliance of projects. The Authority will also be invited to attend monthly meetings. (ii) Health and safety department will be involved in the surveillance of public and occupational health aspects of the project such as transportation of construction workers, road safety for the public, fire safety preparedness in the camp sites, sanitation and hygiene in camp sites and work areas, (iii) Labor authorities to keep watch on the compliance of labor laws for the construction works, especially in regard to child labor and gender equity, (iv) UasinGishu County Government to be involved in handling public concerns and especially where there are social conflicts. Independent Audits External experts may be called upon to undertake limited monitoring activities for the Contractor and/or the Consultant on pre-agreed terms. The areas requiring this initiative will include environment quality sampling and measurements (water, air, soil and noise) etc. The External Experts will be engaged on need basis through the Contractor or Client but within the project implementation structures. 10.3 Grievance Redress Mechanism (GRM) Presently, the hospital has a grievance redress mechanism that is well structured. It involves lodging of complaints by aggrieved stakeholders or submission of comments from hospital staff, patients, neighbors or community members to a suggestion box located in the hospital’s premises. During the construction phase of the proposed project, the proponent and contractor should jointly set up a grievance redress team comprising of project workers’ representatives and senior hospital management staff who shall address any disputes, conflicts or concerns arising from stakeholders that may be affected by the project. The grievance redress team shall liaise with the contractor and proponent in developing the redress actions and communicate with the affected stakeholders any resolutions made. Thereafter, the affected stakeholders shall be involved in monitoring and evaluation of the redress actions to assess their effectiveness. 105 During the operation phase, the GRM established under the hospital management, which is appropriate for use by all relevant stakeholders, with an accountability mechanism for handling issues, disputes, and complaints will be used. It must be available so that individuals, workers, communities, and / or civil society organizations that are being affected by any activities of the hospital can use it. It should function in a way that communities and civil society are engaged in the monitoring of implementation of redress actions on the ground. It should be ensured that communities and potentially affected people are aware of the proposed redress mechanism. A quality management team should also be set up in the senior management level, which will monitor the feedback of the patients, workers, communities and other organizations in all the departments within the hospital. There should be a quality manager in each of the departments within the hospital to ensure that the system is properly followed. Patients visiting the outpatient departments or indoor departments or their caretakers have to fill up a form where they will give a detailed account of their experience in the hospital. They will have to furnish the details on how long the patients had to wait at the OPD or in indoor departments to consult a doctor. There will be another option where the patients can also mention whether they were satisfied with the overall performance of the doctors and the hospital staff members. The quality managers based on their observations will then file a report to the Health department officials. 106 11.0 CONCLUSION AND RECOMMENDATION From the ESIA report, it is clear that the proposed project is associated with both positive and negative environmental and social impacts during the proposed project cycle. The MOH shall follow the guidelines on environment, health and safety in order to reduce incidences of accidents, health problems and compromise to the environmental well-being. Continuous monitoring of the various indicators shall be followed throughout the project cycle. The following shall be undertaken: All solid waste materials and debris resulting from construction activities including the asbestos containing materials shall be disposed of at approved dumpsites and according to local and international regulations. The wastes should be properly segregated and separated to encourage recycling of some useful waste materials; i.e. some excavated stone materials can be used as backfills. The proponent (MOH) shall acquire all relevant approvals from relevant authorities before implementation of the proposed project. All construction materials and especially sand, gravel, hardcore and wood shall be sourced/procured from legalized dealers. The incinerator shall also be bought from legalized sources. Construction activities shall be undertaken only during the day i.e. between 0800 hours to 1700 hours. This will minimize disturbance to the general public within the proximity of the site/project. Once earthworks have been done, restoration of the worked areas shall be carried out immediately by backfilling, professional landscaping/leveling and planting of low grass in open areas. This will also include restoration of any quarries and borrow pits. Proper and regular maintenance of construction machinery and equipment will reduce emission of hazardous fumes and noise resulting from friction of rubbing metal bodies. The contractor shall develop an ESMP which shall be followed as recommended in the ESIA report. The contractor in conjunction with the MOH shall integrate the grievance redress mechanisms (GRM) in the project implementation Aerial emissions shall be controlled through appropriate extraction fans in the operation areas into bag houses, electrostatic precipitators and installed scrubbers in the stacks to ensure no hazardous residuals finds their way back in to the natural environment. Safety measures for the workers and the neighboring community shall be integrated in the entire project cycle. Compliance with the existing laws and regulations shall be upheld at all times. 107 The above environmental and social management plans shall be adopted and applied as the basis for addressing environmental and social aspects throughout the project cycle with necessary amendments as may be found appropriate. In this connection, it will be the guiding tool for future audits and monitoring exercises. REFERENCES Allen, L.J.S. (2008) An Introduction to Stochastic Processes with Applications to Biology, 2nd edn, Upper Saddle River, NJ, Chapman and Hall/CRC. Assessment of Small-Scale Incinerators for Health Care Waste, Completed for: Water, Sanitation and Health Protection of the Human Environment World Health Organization 20 Avenue Appia CH-1211, Geneva 27, Switzerland. By Stuart Batterman Environmental Health Sciences University of Michigan 109 Observatory Drive, Ann Arbor, MI 48109 USA, January 2004 Barnes, J.,O’Hanlon, B., Feeley, F., Mckeon, K and Gitonga, N.,and Decker C (2010) Private Health Sector Assessment in Kenya. World Bank: Washington D.C. Bhalla, A., Pultz, N.J., Gries, D.M., Ray, A.J., Eckstein, E.C., Aron, D.C., Donskey, C.J., Lepelletier, D., Perron, S., Huguenin, H., Picard, M. and Caillon, J. (2004b) Concise communications which strategies follow from the surveillance of multidrug-resistant bacteria to strengthen the control of their spread? A French experience, Infect. Control Hosp. Epidemiol., 25, 162–177. EHS Guidelines www.ifc.org/ehsguidelines GOK (Government of Kenya) Environmental Management and Coordination (Amendment) Act, CAP 387. Nairobi: Government printers. GOK (Government of Kenya) (2003) the environmental (Impact Assessment and Audit) Nairobi: Government printers. GOK (Government of Kenya) (1999) Environmental Management and Coordination (Amendment) Act. Nairobi: Government printers. GOK (Government of Kenya) (2009) Government of Kenya, 2009. Kenya Vision 2030:Nairobi: Government printers. GOK (Government of Kenya) (1994) National Environmental Action Plan: Nairobi: Government printers. 108 GOK (Government of Kenya) (1999) Sessional paper No 6 of 1999 on Environmental and Development: Nairobi: Government printers. Good land, R., Mercier, J.R., and Shimwayi M (Eds) 1995, Environmental Assesment in Africa. World Bank Commitment Harbarth, S., Sax, H. and Gastmeier, P. (2003) The preventable proportion of nosocomial infections: an overview of published reports, J. Hosp. Infect., 54, 258–266. Managing Health Care Waste Disposal: Construct, Use, and Maintain a Waste Disposal Unit, September 2005, Prepared with the assistance of the World Health Organization, Africa Region, Harare, Zimbabwe; and IT Power India, Pvt. Ltd., Pondicherry, India Funded by PATH, Seattle, Washington, USA Maryam, K. G and Rosnah B. M. Y (2015) Advantages and Disadvantages of Healthcare Waste Treatment and Disposal Alternatives, Malaysia NEMA (National Environmental Management Authority) (2009), Environmental Management and Coordination (Noise and excessive vibrations Pollution) (control) Regulations, Nairobi: Government printer. NEMA (National Environmental Management Authority) (2006), Environmental Management and Coordination (Waste Management) Regulations, Nairobi: Government printer. NEMA (National Environmental Management Authority) (2006), Environmental Management and Coordination (Water Quality) Regulations, Nairobi: Government printer. World Bank. 1999. World Bank Safeguards Policies – Environmental Assessment. Washington, DC: World Bank. 109 APPENDICES Annex 1:Minutes of the Consultative Public Participation Annex 2: Approved Architectural Drawings Annex 3: Standards for Effluent Discharge into the Environment Annex 4: Standards for Effluent Discharge into Public Sewers Annex 5: Effluent Levels for Health Care Facilities Annex 6: Air Emission Levels for Hospital Waste Incineration Facilities Annex 7: Guidance to Preparation of Chance Find Procedures 110 Annex 1: Minutes of the Consultative Public Participation MINUTES OF THE CONSULTATIVE PUBLIC PARTICIPATION MEETING WITH STAKEHOLDERS HELD AT THE PROPOSED SITE ON 5TH JUNE 2018 AT 3:18PM – 4:30 PM PRESENT (PARTICIPANTS) 1. Caroline Rotich 2. Ken Mutai 3. HellenToroitich 4. EdnahChesire 5. Julius Kipsang 6. Eric Kemboi 7. Fiona Bartocho 8. KiprotichKerow 9. James Mmbaitsi 10. Christine Nekesa 11. Peter Juma 12. Salina Kibur 13. Caroline Rono 14. Alex Sang 15. Stella Jelagat 16. Edwin Kibor 17. Sammy Kipkorir 18. Alex Kiptoo 19. Mark Tarus 20. Kea Kiprotich 21. Claudia Chelagat 22. Moses Kiplagat 23. Joseph Owino 24. Kelly Cherutich 25. Peter Maiyo 26. Augustin Lelit 27. Cherop Sarah 28. Peter Kimitei 29. Jones Muli 30. BabraChepkoech 31. Peter Limo 32. Samuel Aiyabei 33. Kiprop Patrick 34. Dennis Kemboi 35. Evans Buhasio 36. Vincent Kiptanui 37. Joseph KosgeiMengich 38. Richard Kiplagat 39. Patrick Kemboi 40. Emmanuel Kibor 41. RonoGeraline 42. Cornelius Kemboi 43. Jimmy Kibet 44. PeninahWanja Agenda 1: Preliminary The meeting was called to order by the area senior chief at 3.18pm. He welcomed all participants and explained to them that the proposed project would affect them hence it was very important to hear their views towards the proposed project. He invited a participant who led in prayers and invited the consultant to make his presentation. The meeting was attended by people withinEldoret Town, various business communities, local administration, and various stakeholders from far and wide who were interested or affected by the proposed project. Agenda 2: Presentation of the project concept The project ESIA expert explained the main objective of the exercise which was to inform stakeholders about the project and its likely effects, which in turn would incorporate the inputs, views and concerns and thus enable their views to be taken into account during the decision-making. The specific objectives of the consultations were geared towards:- • Obtaining local and traditional knowledge that may be useful to decision makingincluding Indigenous Knowledge Systems (IKS). • Facilitating consideration of alternatives, mitigation measures and trade-offs (if any). • Ensuring that important impacts are not overlooked and benefits are maximised. • Reducing chances of conflicts through early identification of contentious issues. • Providing an opportunity for stakeholders to influence the project design and operational plan in a positive manner. • Improving transparency and accountability of decision making. • Increase public confidence in the ESIA process. 111 The consultant, on behalf of the Ministry of Health expounded in details the project design and told the participants that they are greatly involved in the project as key stakeholders. Agenda 3: Open session It was agreed that the proposed project had no major issues since it was just an expansion of facilities to an already existing public hospital. Suggestions and recommendations The participants discussed and made the following suggestions and recommendations: (i) The locals should be given first priority for casual employment. (ii) Dust and noise emissions to be reduced to the minimum. (iii) Corruption to be avoided during the project cycle. Agenda 4: Questionnaires The consultants also explained more on the proposed project with the aid of structured questionnaires. The questionnaire involved clear explanation of the structure of the proposed development to the individual stakeholders within UasinGishu County and appropriate response to their questions. The questionnaires were issued to those in the meeting to fill and return to the consultants. All the 44 participants filled the questionnaires issued to them. The questionnaires issued contained a brief description of the proposed project, legal requirements and spaces for providing personal details (name, I.D/Passport number or phone numbers) and views regarding the proposed project. Agenda 5: Closing There being no other business, the meeting was adjourned at 12.30pm by the area chief. 112 Annex 2: Approved Architectural Drawings 113 114 115 116 117 118 119 120 121 : Standards for Effluent Discharge into the Environment Annex 3: 122 Discharge into Public Sewers Annex 4: Standards for Effluent D Annex 3 & 4 Source:The Environmental Management and Co Co-ordination (Water Quality) Regulations, 2006 - Kenya Gazette Supplement No. 68, Legislative Supplement No. 36, Legal Notice No. 120 of 29th September, 2006. 123 : Effluent Levels for Health Care Facilities Annex 5: Source: IFC/World Bank Group’s Environmental, Health, and Safety Guidelines for Health Care Facilities https://www.ifc.org/wps/wcm/connect/bc554d80488658b6b6e6f66a6515bb18/Final%2B- https://www.ifc.org/wps/wcm/connect/bc554d80488658b6b6e6f66a6515bb18/Final%2B %2BHealth%2BCare%2BFacilities.pdf?MOD=AJPERES&id=1323161961169 124 Annex 6: Air Emission Levels for Hospital Waste Incineration Facilities Source: IFC/World BankGroup’s Environmental, Health, and Safety Guidelines https://www.ifc.org/wps/wcm/connect/bc554d80488658b6b6e6f66a6515bb18/Final%2B- https://www.ifc.org/wps/wcm/connect/bc554d80488658b6b6e6 %2BHealth%2BCare%2BFacilities.pdf?MOD=AJPERES&id=1323161961169 125 Annex 7: Guidance to Preparation of Chance Find Procedures Contracts for civil works involving excavations should normally incorporate procedures for dealing with situations in which buried physical cultural resources (PCR) are unexpectedly encountered. The final form of these procedures will depend upon the local regulatory environment, including any chance find procedures already incorporated in legislation dealing with antiquities or archaeology. For MRTH, chance finds procedures contain the following elements: 1. PCR Definition In some cases, the chance finds procedure is confined to archaeological finds; more commonly it covers all types of PCR. In the absence of any other definition from the local cultural authorities, the Kenya National Museum, the following definition could be used: “movable or immovable objects, sites, structures or groups of structures having archaeological, paleontological, historical, architectural, religious, aesthetic, or other cultural significance”. 2. Ownership The identity of the owner of the artifacts found should be ascertained if at all possible. Depending on the circumstances, the owner could typically be, for example, the state, the government, a religious institution, the land owner, or could be left for later determination by the concerned authorities. 3. Recognition As noted above, in PCR-sensitive areas, recognition and confirmation of the specific PCR may require the contractor to be accompanied by a specialist. A clause on chance finds should be included in every contractor’s specifications. 4. Procedure upon Discovery Suspension of Work If a PCR comes to light during the execution of the works, the contractor shall stop the works. Depending on the magnitude of the PCR, the contractor should check with the Resident Engineer and MOH for advice on whether all works should be stopped, or only the works immediately involved in the discovery, or, in some cases where large buried structures may be expected, all works may be stopped within a specified distance of the discovery. MOH’s decision should be informed by a qualified archaeologist certified by the Kenya National Museum. After stopping work, the contractor must immediately report the discovery to the Resident Engineer who will in turn report to MOH and the Kenya National Museum. The contractor may not be entitled to claim compensation for work suspension during this period. The Resident Engineer may be entitled to suspend work and to request from the contractor some excavations at the contractor’s expense if he thinks that a discovery was made and not reported. Demarcation of the Discovery Site With the approval of the Resident Engineer, the contractor is then required to temporarily demarcate, and limit access to, the site. The contractor secures the site to prevent any damage or loss of removable objects. In cases of anticipated theft, a guard shall be present until the responsible authorities take over the site. Non-Suspension of Work The procedure may empower the Resident Engineer to decide whether the PCR can be removed and for the work to continue, for example in cases where the find is one coin. 126 Chance Find Report The contractor should then, at the request of the Resident Engineer, and within a specified time period, make a Chance Find Report, recording: · Date and time of discovery; · Location of the discovery; · Description of the PCR; · Estimated weight and dimensions of the PCR; · Temporary protection implemented. The Chance Find Report should be submitted to the Resident Engineer, and other concerned parties as agreed with the cultural authority, and in accordance with national legislation. The Resident Engineer, or MOH, other party as agreed, is required to inform the cultural authority accordingly. Arrival and Actions of Cultural Authority The cultural authority undertakes to ensure that a representative will arrive at the discovery site within an agreed time and determine the action to be taken. Such actions may include, but not be limited to: · Removal of PCR deemed to be of significance; · Execution of further excavation within a specified distance of the discovery point; · Extension or reduction of the area demarcated by the contractor. These actions should be taken within a specified period. The contractor may or may not be entitled to claim compensation for work suspension during this period. If the cultural authority fails to arrive within the stipulated period (for example, 24 hours), the Resident Engineer may have the authority to extend the period by a further stipulated time. If the cultural authority fails to arrive after the extension period, the Resident Engineer may have the authority to instruct the contractor to remove the PCR or undertake other mitigating measures and resume work. Such additional works can be charged to the contract. However, the contractor may not be entitled to claim compensation for work suspension during this period. Further Suspension of Work During this notification period, the cultural authority may be entitled to request the temporary suspension of the work at or in the vicinity of the discovery site for an additional period of time. The contractor may, or may not be, entitled to claim compensation for work suspension during this period. However, the contractor will be entitled to establish an agreement with the cultural authority for additional services or resources during this further period under a separate contract with the cultural authority. Resumption of Works Construction work will resume only after authorization is given by the responsible national authority, Kenya National Museum, concerning the safeguard of the property. Supervision and Monitoring These procedures must be reflected to as standard provisions in the constructor’s contract, and the Site Engineer shall monitor its implementation during project supervision. 127