Final ESMP EIA Avian Human Influenza Working Copy 11 Judy...

The Republic of Uganda

Office of the Prime Minister

Environmental and Social Management Plan for the Avian and Human Influenza Preparedness and Response Project

(OPM/SRVCS/10-‐11/00229)

Environmental Impact Statement

Prepared by:

Plot 843 Shelter Road, Naalya Estate P.O. Box 25250, Kampala, Uganda Tel: +256 712 654651 e-mail: [email protected] [email protected] Website: www.savimaxx.co.ug

Final Report

May 2012

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The Republic of Uganda

Office of the Prime Minister

Environmental and Social Management Plan for the Avian and Human Influenza Preparedness and Response Project

(OPM/SRVCS/10-‐11/00229)

Environmental Impact Statement Submitted by:

Plot 843 Shelter Road Naalya Estate P.O. Box 25250, Kampala, Uganda Tel: +256 712 654651 e-mail: [email protected] [email protected] Website: www.savimaxx.co.ug

Final Report Consulting Team 1. Mr. Samuel Vivian Matagi Team Leader/Environmental Practitioner 2. Dr. Eng. Moses Kiiza Musaazi Incinerator Specialist 3. Hanifah Nassaka Lubega Environmental Engineer/Environmental Practitioner 4. Gerald Pande Public Health Specialist 5. Esther Nanfuka Kalule Sociologist/Environmental Practitioner 6. David Mugisa Occupational Health and Safety Specialist 7. Judy Obitre-Gama Environmental Lawyer 8. Dr. Denis K. Byarugaba Veterinary Virologist

May 2012

Environmental and Social Management Plan/EIA for the Avian and Human Influenza Preparedness and Response Project

Office of the Prime Minister - Uganda Savimaxx Limited iii

TABLE OF CONTENTS

ACKNOWLEDGEMENT ........................................................................................................................... V ABBREVIATIONS AND ACRONYMS ..................................................................................................... VI EXECUTIVE SUMMARY ......................................................................................................................... IX 1 INTRODUCTION ................................................................................................................................ 1 1.1 Background ...................................................................................................................................... 1 1.2 Chronology of Influenza Outbreaks ................................................................................................. 1 1.3 Types of Influenza Viruses ............................................................................................................... 1 1.4 Epidemiology of Avian Influenza ...................................................................................................... 2 1.5 The 2009 H1N1 Pandemic ............................................................................................................... 2 1.6 The Poultry Industry in Uganda ....................................................................................................... 3 1.7 The Impact of Influenza on Public Health ........................................................................................ 4 1.8 Objective of the ESMP/EIA .............................................................................................................. 9 2 PROJECT DESCRIPTION ............................................................................................................... 10 2.1 The Avian Human Influenza Project .............................................................................................. 10 2.2 Project Development Objectives .................................................................................................... 10 2.3 Project Components ...................................................................................................................... 10 2.4 Project Site Specific Activities ........................................................................................................ 14 3 OVERVIEW OF POLICY AND LEGAL FRAMEWORK ................................................................... 15 3.1 Policy Framework .......................................................................................................................... 15 3.2 Legislative Framework ................................................................................................................... 23 3.3 The World Bank Safe Guard Policies ............................................................................................ 28 3.4 International Agreements ............................................................................................................... 28 4 UGANDA’S ENVIRONMENTAL BASELINE CONDITIONS ............................................................ 30 4.1 General location ............................................................................................................................. 30 4.2 Bio-Physical Environment .............................................................................................................. 30 4.3 Socio-Economic Environment ........................................................................................................ 32 4.4 Project Site Specific Baseline Conditions ...................................................................................... 34 5 INSTITUTIONAL ARRANGEMENTS ............................................................................................... 48 5.1 AHIP Implementation ..................................................................................................................... 48 5.2 Central Government Level ............................................................................................................. 48 5.3 Local Government .......................................................................................................................... 49 6 PUBLIC CONSULTATION AND DISCLOSURE .............................................................................. 50 6.1 Rationale ........................................................................................................................................ 50 6.2 Approach and methodology ........................................................................................................... 50 6.3 Stakeholders’ views of the project impacts .................................................................................... 50 6.4 Proposed measures to minimise the identified negative impacts .................................................. 52 6.5 Other concerns .............................................................................................................................. 52 6.6 Specific Concerns from National Drug Quality Control Laboratory ................................................ 52 6.7 Disclosure of the Draft ESMP/EIA Report ...................................................................................... 53 7 IMPACTS, MITIGATION AND ENVIRONMENTAL MANAGEMENT PLAN ................................... 54 7.1 Impact Identification, Quantification and Ranking .......................................................................... 54 7.2 Positive Impacts ............................................................................................................................. 54 7.3 Negative Environmental Impacts ................................................................................................... 55 7.4 Negative Environmental Impacts for Project Specific Activities ..................................................... 55 7.5 Mitigation Measures ....................................................................................................................... 57 7.6 Environmental Management Plan .................................................................................................. 62 8 CARCASS DISPOSAL OPTIONS .................................................................................................... 69


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8.1 Available Technologies for Carcass Disposal ................................................................................ 69 8.2 Technology and Site Selection Guidelines .................................................................................... 72 9 ENVIRONMENTAL MONITORING PLAN ....................................................................................... 73 9.1 Monitoring Objectives .................................................................................................................... 73 9.2 Monitoring Requirements ............................................................................................................... 73 9.3 Monitoring Procedure ..................................................................................................................... 73 9.4 Responsibility of Implementing the Monitoring Plan ...................................................................... 73 10 CONCLUSION AND RECOMMENDATIONS ................................................................................ 80 11 REFERENCES ............................................................................................................................... 82 APPENDIX A: SITE PLANS AND ARCHITECTURAL DRAWINGS OF SITE SPECIFIC PROJECTS .. 86 APPENDIX B: PUBLIC CONSULTATIONS AND ATTENDANCE LIST ................................................. 93 APPENDIX C: CONSTRUCTION OF AN ISOLATION WARD IN A DENSELY POPULATED AREA. 120 APPENDIX D: REPLY OF AN ISOLATION WARD IN A DENSELY POPULATED AREA .................. 123 APPENDIX E: GENERAL CONDITIONS FOR THE CONTRACTOR .................................................. 125 APPENDIX F: OCCUPATIONAL AND SAFETY MANAGEMENT PLAN .............................................. 133 APPENDIX G: DRAWING OF THE WASTEWATER PRE-TREATMENT PLANT ............................... 136 List of Tables Table 1.1 Pandemic H1N1 cases reported in Uganda from July-December 2009 ...................................... 5 Table 7.1: Impact Ranking according to the Rapid Impact Assessment Matrix ......................................... 54 Table 7.2: Maximum Permissible Noise Levels for Construction Site ........................................................ 58 Table 7.3: Some of the recommended design features for BSL3 Laboratory ............................................ 61 Table 7.4: Environmental Management Plan to mitigate potential impacts of AHIP .................................. 63 Table 9.1: Monitoring Plan ......................................................................................................................... 74 List of Figures Figure 4.1: Infrastructure at the National Animal Disease Diagnostic and Epidemiology Centre .............. 35 Figure 4.2: Overview of the NADDEC project site location ........................................................................ 35 Figure 4.3: The NADDEC laboratory site and surrounding infrastructure .................................................. 36 Figure 4.4: Vegetation at the NADDEC site dominated by Lantana camara ............................................. 36 Figure 4.5: Soil types at the NADDEC site ................................................................................................. 37 Figure 4.6: Waste management practices at NADDEC ............................................................................. 38 Figure 4.7: Overview of the NIC site for the Laboratory extension ............................................................ 39 Figure 4.8: Drainage channel along the existing NIC laboratory ................................................................ 39 Figure 4.9: Geo technical Investigations at NIC laboratory ........................................................................ 40 Figure 4.10: Waste management practices at NIC/UVRI ........................................................................... 41 Figure 4.11: Overview of the proposed Entebbe Isolation ward site and area land use ............................ 42 Figure 4.12: Pictorial view of the Entebbe Isolation ward site and immediate neighbourhood. ................. 42 Figure 4.13: Vegetation at the Entebbe Isolation ward site ........................................................................ 43 Figure 4.14: Geo-technical investigations the proposed Entebbe Hospital Isolation Ward ........................ 44 Figure 4.15: Overview of the location and neighbourhood at the Mulago Isolation Ward site ................... 45 Figure 4.16: Geo-technical investigations the proposed Entebbe Hospital Isolation Ward ........................ 46 Figure 4.17: Monthly Rainfall for Kampala in Millimetres ........................................................................... 46 Figure 4.18: Vegetation at the proposed Mulago Hospital isolation unit site ............................................. 47 Figure 4.19: Waste handling practices and incinerator at Mulago hospital ................................................ 47 Figure 5.1: The Institutional Arrangement for the AHIP ............................................................................. 49 Figure 7.1: The Class III Bio Safety Cabinet .............................................................................................. 59 Figure 7.2: A typical Bio-safety Level 3 laboratory ..................................................................................... 62 Figure 8.1: Local manufactured Mak Incinerators ...................................................................................... 72

Environmental Scoping Report for the Avian and Human Influenza Preparedness and Response Project

Office of the Prime Minister - Uganda Samuel Vivian Matagi, Team Leader v

ACKNOWLEDGEMENT


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ABBREVIATIONS AND ACRONYMS

ACODE Advocates Coalition for Development and Environment

AHI Avian and Human Influenza AHIP Avian and Human Influenza Preparedness and Response Project

AHITF Avian and Human Influenza Trust Fund

AHSPR Annual Health Sector Performance Review

AI Avian Influenza APL Adaptable Program Loan

AIV Avian Influenza Virus

BSL Bio-Safety Level

CAA Civil Aviation Authority CBSS Community-Based Surveillance System

CDC Centre of Disease Control and Prevention

CFP Communication Focal Points

DPs Development Partners DWRM Directorate of Water Resources Management

EIA Environmental Impact Assessment

EIS Environmental Impact Statement EMP Environmental Management Plan

ERC Emergency Recovery Credit

ESMP Environmental and Social Management Plan

FAO Food and Agriculture Organisation FGD Focus Group Discussion

GDP Gross Domestic Product

GOU Government of Uganda GPAI The global Program for Avian Influenza GPS The global Positioning System H Haemagglutinin H5 Haemagglutinin 5 H7 Haemagglutinin 7 H1N1 Haemagglutinin 1 Neuraminidase 1 H3N2 Haemagglutinin 3 Neuraminidase 2 H5N1 Haemagglutinin 5 Neuraminidase 1 H5N3 Haemagglutinin 5 Neuraminidase 3 HDP Health Development Partners HPAI Highly Pathogenic Avian Influenza

HSDs Health Sub-Districts

HSE Health, Safety and Environment

HSSIP The Health Sector Strategic & Investment Plan

HSSP Health Sector Strategic Plan


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HUMC Health Unit Management Committees ICS Incident Command System IDA International Development Association IEC Information, Education and Communication LG Local Government ILI Influenza Like Illnesses

ILRI International Livestock Research Institute INAP Integrated National Action Programme

LPAI Low Pathogenic Avian Influenza

MAAIF Ministry of Agriculture, Animal Industry and Fisheries

M & E Monitoring and Evaluation MOH Ministry of Health

MSDS Material Safety Data Sheet N Neuraminidase

NAADS National Agricultural Advisory Services NADDEC National Animal Disease Diagnostic and Epidemiology Centre

NARO National Agricultural Research Organisation

NDA National Drug Authority

NDQCL National Drug Quality Control Laboratory of the National Drug Authority

NDP National Development Plan

NEMA National Environment Management Authority

NEMP National Environment Management Policy

NGO Non-Governmental Organisation NIMES National Implementation, Monitoring and Evaluation System

NPSC National Project Steering Committee NHP National Health Policy NRH National Referral Hospital

NTF National Task Force

OIE International Office for Epizootics OPM Office of the Prime Minister

PAs Protected Areas

PCT Project Co-ordination Team

PHC Primary Health Care P&P Preparedness and Prevention

PPDA Public Procurement and Disposal Authority

PPP Public Private Partnership

PPE Personal Protective Equipment R&D Research and Development

(R&R) Response and Recovery

RRH Regional Referral Hospital

RRT Rapid Response Team RVR Royal Veterinary College

SARS Severe Acute Respiratory Syndrome


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SOP Standard Operating Procedure

TOR Terms of Reference

TADs Trans-boundary Animal Diseases

UBOS Uganda Bureau of Statistics UMA Uganda Medical Association

UPA Uganda Poultry Association

UNHRO Uganda National Health Research Organisations

UNBS Uganda National Bureau of Standards UNFF Uganda National Farmers’ Federation

UNMHCP Uganda National Minimum Health Care Package

UTM Universal Transverse Mercator

UVA Uganda Veterinary Association UWA Uganda Wildlife Authority

UVRI Uganda Virus Research

VHT Village Health Teams

WB World Bank WHO World Health Organization


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EXECUTIVE SUMMARY Avian influenza (AI) is highly infectious disease that affects birds and animals. The virus is excreted through infected birds' faeces and secretions from the nose, mouth, and eyes, and spreads primarily through direct contact between healthy birds and infected birds, and through indirect contact with contaminated equipment and materials. The virus can remain viable at moderate temperatures for long periods in the environment and can survive indefinitely in frozen material. In essence, the virus can survive for over 30 days at 0°C (over one month at freezing temperature), 6 days at 37°C (one week at human body temperature), decades in permanently frozen lakes, on hard non-porous surface such as plastic or stainless steel for 24–48 hours and on clothes, paper and tissues for 8–12 hours. In the past one decade, a lot of research indicates that humans are at a very high risk of zoonotic diseases. Zoonotic diseases, those that can transfer from animals and birds to humans, are becoming more prevalent due to animal and bird proximity. Both livestock and domesticated animals can carry such diseases like Avian Influenza A caused by the highly pathogenic H5N1 avian influenza (AI) and Severe Acute Respiratory Syndrome (SARS). These two zoonotic diseases have been the subject of widespread outbreaks that have caused a lot of public health concern in the past decade. Influenza viruses are the most feared pandemic threats because of the high and efficient transmission and potential spread across the world. Influenza pandemics are associated with a rapid surge experienced the globally, in the number of cases of respiratory illnesses and deaths in humans and economic losses in poultry production. The highly pathogenic H5N1 strain virus caused the largest and most severe outbreaks of highly pathogenic disease ever recorded in poultry. Over 300 million domestic birds died or were culled. The spread of AI (H5N1) from birds to humans is attributed to risk factors such as plucking and butchering of diseased poultry or wild birds, handling of fighting cocks, exposure to live poultry, consumption of uncooked duck's blood, and intimate contact with infected humans in household or hospital settings. Environmental exposure to poultry viruses through swimming or bathing in contaminated water, and exposure to poultry manure fertilizers, have also been identified as possible risk factors for human infection with the H5N1 Avian Influenza virus. Places that are categorised as highly susceptible to AI in Africa include; places where poultry is imported, traded (legally or illegally), produced, and consumed. These include main roads, major markets and major metropolitan areas—places of dense human populations where a lot of poultry is likely to be concentrated, traded and consumed and ports and airports. Major the global flyways for migratory birds and their resting places are also highly susceptible areas. In this regard, the places of concern include wetlands, lakes, rivers and other water bodies. At the height of the Avian Human Influenza outbreaks in Africa, A joint World Bank (WB), Food and Agriculture Organization (FAO), International Office for Epizootics (OIE) and World Health Organization (WHO) Mission visited Uganda in 2007. The mission assessed the risk of AI in the country, reviewed the prevention, preparedness and response capacity in the country and also reviewed the Government’s National Plan of Action for Preparedness and Response to Avian Influenza to ensure its consistency with the established international standards and guidelines of the WHO, FAO, and the OIE. The team determined that Uganda was at risk of HPAI because of continuing progression of HPAI in Africa during that period, reported infections close to its Northern Border, people’s attitude of poultry rearing and trading as well as the presence of wild birds and numerous water bodies among other factors. The assessment resulted in the development of an Integrated National Action Programme (INAP). At the request of the Government of Uganda (GOU), the World Bank agreed to support the INAP through Avian Human Influenza Project (AHIP) as an Emergency Recovery Credit (ERC) under the Bank’s policy for emergency operations (OP/BP 8.00). The AHIP is co-financed by: (i) an IDA credit under the GPAI Adaptable Program Loan (APL) approved by the Executive Directors on and (ii) grant funds from the Avian and Human Influenza Trust Fund (AHITF), which is being administered by the Bank. The AHIP in Uganda is coordinated by the Office of the Prime Minister (OPM) and implemented by the Ministry of Agriculture Animal Industry and Fisheries (MAAIF) and the Ministry of Health (MOH).


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The overall objective of the AHIP/INAP is to substantially reduce the threat posed to the poultry industry and humans in Uganda by High Pathogenic Avian Influenza infection and other zoonoses and to prepare for, control, and respond effectively to future AI pandemics and other infectious disease emergencies in livestock and humans. The project is implemented at two tier levels i.e. (i) Prevention and Preparedness and (ii) Response and Recovery and executed through four components: -

• Animal Health • Human Health • Communication • Co-ordination, Monitoring and Evaluation

Project specific infrastructure construction activities include: -

• The construction a Bio Safety Level three (BSL 3) influenza laboratory at the Uganda Virus Research Institute, Entebbe;

• The construction a Bio Safety Level three (BSL 3) influenza laboratory, installation of an ultra modern incinerator and the rehabilitation and refurbishment of the dilapidated physical infrastructure at the National Animal Disease Diagnostic and Epidemiology Centre in Entebbe;

• Construction of the state of the art modern influenza isolation ward at Mulago National Referral Hospital, Kampala and;

• Construction of the state of the art modern influenza isolation ward at Entebbe Hospital, Wakiso District.

As a requirement for the implementation of the AHIP, an environmental and social management plan is required to mitigate the impacts of the project activities consistent with World Bank funded programmes. In this regard an Environmental and Social Management Plan (ESMP)/Environmental Impact Assessment (EIA) of key project activities was conducted. The major objective of the ESMP/EIA was to enable the AHIP to meet both Government of Uganda (GOU) legal requirements and the funding conditions of the World Bank. The major positive impacts envisaged from the components of the AHIP include: the improvement in Uganda’s institutional capacity to prepare and respond to Avian and Human Influenza outbreaks; facilitation of the country to set up an elaborate and functional implementation mechanism and administrative structure that meets the standards of OIE, improvement in disease surveillance through upgrading laboratories at Uganda Virus Research Institute and the National Animal Disease Diagnostic and Epidemiology Centre to Bio Safety Level three (BSL 3) and construction and equip isolation wards for the containment of contagious diseases. The major negative environmental impacts expected from the project activities are mainly related to the construction of BSL 3 laboratories, quarantine spots and isolation wards; disposal of expired drugs; and the exposure of the public, animal and human healthcare providers to viral agents through contamination and cross contamination. Other negative impacts were identified at the culling, transportation and disposal of both poultry and wild birds during AI outbreaks, decontamination of facilities, laboratory bio-safety and bio-security threats and the release of green house gases, petroleum waste, solid waste, electronic waste and electromagnetic fields that are related to project vehicles and computers, respectively. Some of the recommended mitigation measures include:

∗ Implementation of good construction practices by the contractors to ensure minimal impairment on air quality, minimal noise and disruption of activities within the respective site neighbourhood especially since all the sites are in sensitive areas. Good construction practices should be based on: -

(i) FIDIC, the International Federation of Consulting Engineers (the acronym stands for the French version of the name) represents the global consulting engineering industry and promotes internationally accepted construction standards for works – details can be found at http://www.fidic.org/.

(ii) The Building Rules and Regulations of the Public Health Act Cap 281 (iii) Appendix E: General Conditions for the Contractor (iv) Appendix F: Occupational and Safety Management Plan


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(v) Kampala Capital City Authority and Entebbe Municipal Council building approval permits;

∗ To minimize erosion during construction in dug up areas should be promptly re-filled and the areas should be re-vegetated;

∗ Vegetation clearance should be limited to the required construction area to limit the extent of vegetation loss and soil exposure;

∗ Proper handling of generated debris and associated waste during construction/demolition. These wastes should be disposed to designate sites approved by Kampala Capital City Authority and Entebbe Municipal Council. Proper handling may include but not limited to the following: -

(i) Sort waste by type (ii) Proper storage to avoid scattering/littering on the project sites (iii) Recycle waste that is reusable (iv) Covering disposal trucks to prevent scattering of waste while en-route to the

dump site; ∗ Minimize dust generation during construction works by applying dust control measures including

sprinkling water on the bare ground of the project site after soil excavation is undertaken and ensure that trucks ferrying gravel/soil are properly covered with tarpaulin material, in order to limit dust nuisance and littering in the immediate neighbourhood.

∗ The facilities, especially isolation units, should be well sited in such a way as to minimise public exposure. The design of the isolation units should meet the following design criteria: -

§ Maintain similar air temperature and pressure between adjacent areas in the ward to prevent the transfer of air and infectious agents to prevent bi-directional air flow;

§ Frequently replace or remove exhaust filters to ensure negative pressure is maintained in patient rooms (i.e., air flows into but not out of patient isolation rooms);

§ Prevent uneven exhaust patterns in isolation rooms with more than one bed which may result in the transfer of infectious agents from one patient to another;

§ Transfer air diffusers placed away from exhaust grilles to ensure proper system performance;

§ Encourage regular maintenance checks to ensure that isolation ward airflow direction and air exchange rates are functioning properly.

∗ The diagnostics laboratories (both at NADDEC and NIC) should be designed to meet the requirements of Bio-safety Level-3 laboratory. The designs should be based on standards recommended by Centre for Disease Control and Protection (CDC) for the case of medical laboratories; World Health Organisation (WHO) and World Organisation of Animal Heath (WOAH) for the case of animal laboratories. The following should be incorporated in the project set-up: -

(i) Provision of double-door zone and sealed penetrations, (ii) Provision of ventilation system that ensures the air is not re-circulated to other

areas within the building and that filters are installed to trap particulates which allow for re-conditioning and re-circulation of air within the laboratory,

(iii) Install double filtration systems, that is, high efficiency particulate air (HEPA) filter to prevent the spread of airborne contaminants and to allow only clean un-contaminated air out of the bio-safety cabinets,

(iv) Provision of fire escape routes, fire detection and fire suppression equipment, (v) Provision of first aid kits and equipment with first aid instructions which should be

posted in a visible and easily accessible location for use in case of emergency treatment,

(vi) Provision of baths on strategic entrances to the laboratories; ∗ Thorough decontamination of trucks and equipment used in disposal operations. The

disinfectants used should be bio-gradable (soaps and detergents) and should be disposed of in a safe manner. Transport distances should be minimal and loads must be covered to minimize the risk of virus spread;

∗ Biosafety in a BSL 3 laboratory will need a Class III Bio Safety Cabinet that has the following specifications as recommended by the U.S. Department of Health and Human Services: - (i) A gas-tight (no leak greater than 1x10-7 cc/sec with 1% test gas at 3 inches pressure Water Gauge enclosure with a non-opening view window;


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(ii) Access for passage of materials into the cabinet should be through a dunk tank, that is accessible through the cabinet floor, or double-door pass-through box (e.g., an autoclave) that can be decontaminated between uses. Reversing that process allows materials to be removed from the Class III BSC safely; (iii) Both supply and exhaust air should be HEPA filtered on a Class III cabinet. (iv) Exhaust air must pass through two HEPA filters, or a HEPA filter and an air incinerator, before discharge directly to the outdoors. Class III cabinets should not be exhausted through the general laboratory exhaust system. Airflow is maintained by an exhaust system exterior to the cabinet, which keeps the cabinet under negative pressure (minimum of 0.5 inches of water gauge). Depending on the design of the cabinet, the supply HEPA filter provides particulate-free, albeit somewhat turbulent, airflow within the work environment. Laminar airflow is not a characteristic of a Class III cabinet; (iii) Long, heavy-duty rubber gloves are attached in a gas-tight manner to ports in the cabinet to allow direct manipulation of the materials isolated inside. Although these gloves restrict movement, they prevent the user’s direct contact with the hazardous materials. The trade-off is clearly on the side of maximizing personal safety.

∗ Disinfection of generated waste will minimise the possibility of infection and/or pollution at the disposal facility;

∗ Ensure that adequate and appropriate Personal Protection Equipment (PPE) is provided and its use should be enforced.

(i) Appropriate PPE for construction should include safety helmets, latches, hand gloves, overalls, gumboots, nose masks and earmuffs, eye goggles etc,

(ii) Appropriate PPE for handling viral agents should include but is not limited to gumboots, coveralls- disposable, clean non sterile gloves, fluid resistant gowns, fluid resistant apron/mackintosh, N95 respirator mask, eye protection/face mask /goggles, side shields;

∗ AI diagnostic laboratories should have biosecurity measures designed to prevent the loss, theft, misuse, diversion or intentional release of pathogens and toxins. The following are expected of a good laboratory biosecurity system: - (i) A qualitative risk assessment to define risks that a security system should protect against; (ii) A defined acceptable risks and incidence response planning parameters; (iii) A securely locked building when unoccupied; (iv) Doors and windows should be break-proof; (v) Rooms containing hazardous materials and expensive equipment should be locked when unoccupied; (vi) Access to rooms, equipment and materials with hazardous materials should be controlled and documented;

∗ In order to avoid contamination and cross contamination appropriate investigative methods should be used in the collection and laboratory analysis of samples. Participating laboratories should develop their own SOPs along those recommended by the World Health Organisation on Biosafety listed below: -

(i) Safe handling of specimens; (ii) Good methods of using pipettes and pipetting aids; (iii) Avoiding the dispersal of infectious materials; (iii) Use of biological safety cabinets; (iv) Avoiding ingestion of infectious materials and contact with skin and eyes; (vi) Avoiding injection of infectious materials; (vii) Good methods of separation of serum; (viii) Good methods of using centrifuges; (ix) Good methods of using homogenizers, shakers, blenders and sonicators; (xi) Good methods of using tissue grinders; (xii) Care and use of refrigerators and freezers; (xiii) Opening of ampoules containing lyophilized infectious materials; (xiv) Storage of ampoules containing infectious materials; (xv) Standard precautions with blood and other body fluids, tissues and excreta; (xvi) Precautions with materials that may contain prions.

∗ The incinerators must be adequate to handle the anticipated waste and operated by qualified personnel to minimize potential spillage of fuel, oil and fat during incineration;


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∗ Public awareness and education of the disease and its consequences to both human and animal health should continue throughout the project lifecycle. This would reduce the possible public outcry at the culling and disposal of infected poultry. Disposal sites should be secured and restricted;

∗ Gaseous discharge from vehicles that include green house gases, smoke, particulate matter can be mitigated by gas filters, catalytic converters and the use of non lead fuel;

∗ Computer impacts like electronic waste should be handled by NEMA licensed waste handlers and low electromagnetic emission computers with screens should be procured to protect users from electromagnetic exposure;

∗ Infectious waste and solid waste should be handled by NEMA licensed waste handlers; ∗ The designs of the BSL 3 laboratories should meet the required design standards as

recommended by Centre for Disease Control and Protection (CDC) for the case of medical laboratories; World Health Organisation (WHO) and World Organisation of Animal Heath (WOAH) for the case of animal laboratories. It should incorporate the required equipment including an autoclave, air filter and adequate PPE. The Labs should have negative pressure and air should exit through vents fitted with filters;

∗ Household-based quarantine and case isolation should be undertaken to limit morbidity of the virus and hence the mortality rate;

∗ Movement of affected patients, housekeeping and use of adequate protection should be emphasised;

The following conclusions and recommendations are proposed: -

• Uganda is at high risk of having an AI epidemic because it is situated along the corridor of migratory birds, which are suspected to be the main natural reservoir of the disease.

• AI is a highly pathogenic disease and very infectious. Therefore, the AHIP should continue to be implemented in order to prepare the country for an avian influenza outbreak.

• Sentinel surveillance show that the less pathogenic H1N1 hit Uganda at the beginning of July 2009, three months after it had been first reported in the North America. However, the most pathogenic H5N1 virus has not yet been detected up to date.

• Influenza surveillance in poultry and pigs show negative results for Influenza Type A up to date. • The specific project activities like building BSL 3 diagnostic laboratories and isolation wards have

slightly significant impacts because they will be constructed in an already built up environment. The proposed mitigations are adequate to address all environmental impacts identified at the construction phase.

• The project should improve on the public awareness campaigns in the Communication Component.

• The project should incorporate early warning systems to alert the public in case of an outbreak. This system should consider other countries in the African region because of the trans-boundary nature of the disease.

• The activities and operations of diagnostic laboratories and isolation wards are considered safe once bio-safety, bio-security, the environmental management plan, the occupational health and safety plan are put in place and adhered to as recommended by the Centre for Disease Control and Prevention (CDC), World Health Organisation (WHO) and World Organisation of Animal Heath (WOAH).

• MAAIF and MOH should strengthen already exiting relevant policies, guidelines, manuals, standard operating procedures for all strategic activities of the project. The project should carry out a gap analysis to find missing tools. Then it should fund consultancies so that the missing policies, guidelines, manuals and standard operating procedures are written and distributed to stakeholders.

• The implementing agencies i.e. OPM, MAAIF and MOH and their Consultants, Architects, Supervisors, Contractors and Sub-contractors should implement the environmental management plan, the environment monitoring plan, occupational health and safety plan.

• NEMA, District Local Governments and the Department of Occupational Health and Safety should enforce construction, environmental, occupational health and safety standards.

• The project should use the Material Safety Data Sheet for each chemical. Hazardous waste should be handled according to The National Environment (Waste Management) Regulations (SI 153-2).

• The structural engineering design of the buildings should follow the recommendations of the geo-technical investigations. All geo-technical results showed that all the project sites had firm


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ground, consistence in stiffness increased with depth and no water table was encountered at a depth of 3m. The average bearing capacity ranged from 168.15 to 338.2 kPa.

• Wastewater from BSL 3 laboratories and isolation wards should be pre-treated before it is discharged into public sewers. A three-treatment chamber process is recommended. The first chamber should have chlorine dosed into it. The second chamber should be a contact tank to allow enough time for chlorine to disinfect the wastewater. The third chamber should be a pH correction tank before the wastewater is discharged into a public sewer.

• Both the BSL 3 laboratories and isolation wards should have negative pressure. Air exit in both facilities should be in one direction. The exits should have vents fitted with filters to trap air droplets, which may contain viruses.

• The Disclosure Workshop participants recommended that the isolation wards should also accommodate other infectious diseases like ebola, marburg, cholera and typhoid.

• The Clauses in Conditions for Contractors (Appendix E) should form a benchmark for the environmental management plan during construction and Occupational Safety and Health Plan (Appendix F) should be included in the contract for Contractors.

• The Architect, the contractor and sub-contractors should follow physical plans and construction guidelines of local authorities.

• There are several methods of carcasses disposal. However, burial, open air burning and incineration are the most feasible options of choice recommended for Uganda.

• The MAAIF should develop Standard Operating Systems (SOP’s) for each of the recommended Carcass Disposal Method.

• New Fixed Incinerators should be installed at NADDEC, Mulago and Entebbe isolation wards. The brick incinerators at UVRI and NADDC should be decommissioned. The electricity incinerator at UVRI was satisfactory.

• Only incinerators that reach temperature above 800O C are recommended. This is because carcinogenic dioxins and furans are destroyed at this temperature.

• The construction and operation of incinerators should be in accordance with the National Environment (Waste Management) Regulations, 1999, Sections 13 and 14. Incinerators constructed outside project site-specific locations in Entebbe and Kampala will need a separate and independent EIA. Ash and other hazardous material that may be generated from incineration should be appropriately handled, preferably given to a NEMA licensed hazardous waste handlers for proper disposal.

• The use of brick incinerators should be discouraged because they ever go beyond 5500C. This leaves carcinogenic dioxins and furans in the smoke. Incinerators that attain a temperature above 8000C where all dioxins and furans are completely destroyed are recommended.

• The project benefits out weigh the negative environmental impacts. It is recommended that NEMA approves the ESMP/EIA and grants incinerator operation licences to the project site-specific locations in Entebbe and Kampala, so that Uganda can be prepared to respond effectively in the event of an AI outbreak.


The Office of the Prime Minister - Uganda Savimaxx Limited 1

1 INTRODUCTION

1.1 Background Savimaxx Limited (the “Consultant”) was selected by the Office of the Prime Minister (the “OPM”) to provide consultancy services for the Environmental and Social Management Plan (ESMP)/ Environmental Impact Assessment (EIA) for the Avian and Human Influenza Preparedness and Response Project (AHIP).

The World Bank, Multilateral Funding Agencies and National Environmental Management Authority (NEMA) have their own nomenclature for ESMP documentation including “Environmental Assessment”, “Environmental Impact Assessment”, “Environmental Impact Statement”, “Environmental and Social Impact Assessment” and “Social and Environmental Assessment”. For the purposes of this project the term Environmental and Social Management Plan is considered to be synonymous with the different terms used by various entities. According to the Environment Law (Cap 153) an Environmental Impact Statement is a report of the Environmental Impact Assessment Study. This Environmental Impact Statement (the “Report”) presents an overview of the project; site visits to the proposed project sites; policy, legal and institutional framework; baseline data; impacts, mitigation and environmental management plan; monitoring plan and public participation.

1.2 Chronology of Influenza Outbreaks Influenza viruses are the most feared pandemic threats because of the high and efficient transmission and potential spread across the world. Influenza pandemics are associated with a rapid surge experienced the globally, in the number of cases of respiratory illness and death in humans and economic losses in poultry production. Three human pandemics occurred during the previous century: Spanish flu in 1918, Asian flu in 1957 and Hong Kong flu in 1968. While the world was coming to terms with the H5N1 that broke out in mid-2003, the triple re-assortant H1N1 of swine origin suddenly broke out in 2009 causing significant mortalities and spreading quickly to many countries. In poultry, the highly pathogenic H5N1 strain virus caused the largest and most severe outbreaks of highly pathogenic disease ever recorded in poultry. Over 300 million domestic birds died or were culled. The nucleus of the disease was in south-east Asia spreading across Europe and Africa. Losses for the agricultural sector have been estimated at over US$ 10 billion. The H5N1 strain is a fast mutating and highly pathogenic avian influenza virus (HPAI) found in multiple bird species. It is both epizootic and panzootic. Since 1997 studies of H5N1 indicate that these viruses continue to evolve, with an expanded host range in avian species and the ability to infect other animal species with enhanced pathogenicity and increased environmental stability (Chen et al., 2006). With more and more emerging and re-emerging pandemic threats including the well-known influenza, it is critical to put mechanisms in place for rapid response and control.

1.3 Types of Influenza Viruses Influenza viruses are ubiquitous and wild water birds are known to be their natural reservoirs (Stalknecht and Shane, 1988; Perez et al., 2003). The influenza viruses that constitute this family are classified into types A, B or C. Influenza virus to which the highly pathogenic H5N1 and the recent 2009 pandemic H1N1 belong are type A. Influenza viruses are further categorised into subtypes according to the antigens of the haemagglutinin (H) and neuraminidase (N) projections on their surfaces. Although there are 16 haemagglutinin subtypes and 9 neuraminidase subtypes of influenza A viruses that can occur in any combination and AI viruses have representatives in all of these subtypes, to date all highly pathogenic AI viruses that cause generalised rather than respiratory disease in poultry belong to either the H5 or H7 subtypes. However, not all H5 and H7 viruses are virulent for poultry. In humans, circulating influenza has largely been limited to H1N1, H2N2, H3N2, and H1N2, but a limited number of human infections with influenza viruses containing H5, H7, and H9 hemagglutinins have been documented. Swine may be infected with all subtypes of influenza A, but the most common are H1N1, H3N2, and H1N2 subtypes (Alexander, 2000). The highly pathogenic avian influenza virus subtype H5N1 is already panzootic in poultry, with attendant economic consequences while the 2009 pandemic H1N1 caused significant deaths and spread to several countries warranting declaration of a pandemic in 2009. The H5N1 continues to cross species barriers to infect humans and other mammals, often with fatal outcomes (Liu et al., 2003). The current mortality events



due to H5N1 also represent the first significant AIV mortality in free-living wild bird species since HPAI H5N3- related mortality in common terns in South Africa. Research to date clearly demonstrates that species and population structure are important in AI maintenance, transmission, and possibly long-distance movement. Differences related to general behaviour, spatial and temporal distribution, habitat utilization, migration behaviour, population age structure, and individual species susceptibility all potentially influence a species’ role in AI epidemiology. The unprecedented mortality associated with HPAI and H5N1 infection in wild birds has provided for a possibility of exchange of AIVs between wild and domestic birds and further demonstrates and expands the varied roles that wild birds may play in AI epidemiology.

1.4 Epidemiology of Avian Influenza Little information is available about the epidemiology and ecology of AI in both domestic and wild birds in Africa, in particular in sub-Saharan Africa. FAO carried out surveillance in 12 African countries of northern, western, eastern and southern Africa excluding Uganda in 2006. The surveillance focused on wild birds, in large wetland areas where Palaearctic migratory, inter-African migratory and African resident water birds congregate. The results of the surveillance indicated an overall prevalence of AI of 3%, and no positivity for H5N1 and HPAI (Gaidet et al, 2007). However, AI were detected in both Palaearctic and African bird species, indicating that viruses have been circulating in Africa within the sub-Saharan region, in both migratory and resident water bird communities. These findings revealed the occurrence of LPAI virus in sub-tropical environments, and support the hypothesis that AI could be perpetuated in wild birds throughout the year, including in Palearctic water birds wintering in sub-Saharan Africa before their northwards spring migration. The risk of influenza epizootics and pandemics in Africa increased as a result of avian influenza epizootic due to H5N1 that was reported in Nigeria on February 7, 2006. Subsequently unprecedented spread occurred to more than 12 African countries. Previously documented outbreaks of Avian Influenza strain were the low pathogenic H5N2 reported among ostriches in South Africa and in Zimbabwe (Becker, 1966). Avian influenza was first identified over 100 years ago during an outbreak in Italy. The disease cropped up at irregular intervals thereafter in all world regions. In 2003, poultry exports from Thailand accounted for nearly 7 percent of the global poultry meat trade, with an export value of approximately US$1 billion and this was curtailed by the H5N1 outbreaks which was a significant economic loss to the country. The epidemiological data currently available confirms that wild birds play a significant role in the influenza cycle and could be the initial source for highly pathogenic influenza viruses. The the global spread of H5N1 in birds is considered a serious threat. Because of the fast mutating and high pathogenicity of H5N1 virus (HPAI) found in multiple bird species it is considered to be a potential for pandemic threat (Alexander, 2000). Studies of H5N1 indicate that these viruses continue to evolve, with multiple changes resulting in an expanded host range in avian species and they have the ability to infect other animal species including man in which they cause systemic infections and acquire an increased environmental stability (Claas et al., 1998).

1.5 The 2009 H1N1 Pandemic While the world was worried of the H5N1, the 2009 H1N1 strain that appeared from Mexico spread around the world like fire reaching all continents and in the communities very quickly. As was expected the search and development of a vaccine took a couple of months and the hopes of producing sufficient doses to reach out to all those affected were never met. Had this strain been very virulent it would have caused catastrophic mortalities. The strain also demonstrated how the public health systems were unprepared for a serious pandemic and was a wake-up call for more concerted efforts for search and development of more robust strategies as well as a call for heavy investment in research and development (R&D) for control technologies that can predict such pandemics. To-date, re-assortment of the 2009 pandemic virus with classical swine influenza viruses has been reported in pigs further demonstrating the potential for serious trouble ahead should this result in a more virulent virus crossing back into humans or causing greater losses in animals.



1.6 The Poultry Industry in Uganda The poultry sector in Uganda was recently reviewed and described (Byarugaba, 2007). The poultry population was estimated at about 37.4 million (MAAIF, UBOS, 2009). Many people depend on poultry as a source of animal protein as well as income and several other socio-economic benefits. Besides the direct financial benefits derived from poultry production, poultry play several important roles in the livelihoods of the communities in addressing issues of vulnerability, powerlessness, and assets as well as gender equity. Village poultry are known to be taken care of by women and in some cases its one of the assets that women own and are free to dispose of without men’s intervention. Poultry plays various roles among both the rich and poor to meet various needs. The contribution of the poultry sector to GDP in Uganda has not been precisely ascertained due to the limited measurable indicators and the fact that about 80% is free-range. The poultry industry in Uganda is conveniently categorized into two: viz, (i) commercial poultry which includes both intensive and semi-intensive poultry production for commercial purposes and (ii) free-range poultry production sometimes called village poultry kept for subsistence. Although it is possible to classify the production system according to the FAO sectors 1-4, it is still rather difficult because of lack of accessible records regarding biosecurity levels, numbers of birds kept, management routines, and other criteria used by FAO. Free-range production clearly still predominates (over 80%) the poultry sector in the country. There is an increasing number of commercial units, as well as an upcoming organized semi-intensive production system of commercial producers keeping indigenous breeds of chickens who have organized themselves into a national association that supports them in breeding, hatching and provision of extension services as well as inputs. The incentive for this upcoming system is to exploit the market for local breeds for both meat and eggs in urban centres and to obtain additional income. The entire poultry production is largely private sector driven for both supply of inputs, feeds, vaccines, drugs and the farming itself while the public sector is restricted to regulatory services, some training and research services. The free-range sector is a low-input and low-output system with minimal extension services and regulation from veterinary services. There is no regular vaccination, birds depend largely on scavenging for their own food with little supplementation with household remains. Several attempts by both private sector and government agencies to give out poultry as handouts to farmers have not been sustainable. The marketing structure is still largely informal and not well organized, so is the processing with only a few formal commercial poultry processing plants. The rest of the processing is undertaken by households, restaurants and consumers in their homes. Although there is no data about the poultry per capita contribution to the GDP, it is obvious that poultry plays a significant role in the household food security and incomes of various categories of people in varying degrees but needs to be quantified through economic indicators. Following the recent outbreaks of AI in Sudan and other countries, there was some negative impact although not quantified as was revealed by farmers who ceased production until the scare declined. The ban that was imposed on importation from some countries and consumer scare, all had a negative impact which was never evaluated although production quickly picked up following media campaigns and awareness about the disease (FAO, 2009 b). The current laws and policies generally provide the overall framework for disease control, production and marketing (FAO, 2009 c), in addition to the specific gazetting of avian influenza as a disease in 2008 with several guidelines for biosecurity and compensation in case of outbreaks (FAO/MAAIF, 2010). In an effort to prevent HPAI introduction in Uganda the MAAIF through the Support Programme to Integrated National Action Plans for Avian and Human Influenza (SPINAP-AHI) carried out active surveillance of AI with strong emphasis in northern Uganda and West Nile region due to their proximity to Sudan where the disease had been reported (MAAIF & MOH, 2011; MAAIF, 2008). In addition, these regions were of importance because of the large volume of trade in poultry and poultry products between Uganda and Sudan/Democratic Republic of Congo thereby increasing the chances of rapid spread in case of an outbreak (MAAIF & MOH, 2011). Other districts were covered because of their high risk because of being near to the Sudanese bounder, water bodies, swamps, rice fields, back yard open poultry production systems with poor bio-security increasing the chances of the introduction of the HPAI virus from wild birds to poultry, poultry marketing systems (open live bird markets, road side markets etc) and proximity to



National Parks and game reserves. A total of 1022 samples were collected from poultry and 80 samples from pigs from 28 districts presenting 38% of the country. Laboratory and field tests using Anigen AIV Antigen Rapid Screening Test showed all samples were negative of for Influenza virus Type A (MAAIF & MOH, 2011; MAAIF, 2008).

1.7 The Impact of Influenza on Public Health Public health concerns with strong links to animal and bird populations have been alluded to. In the past decade, a lot of research has been undertaken that indicates that humans are at a very high risk of zoonotic diseases (Factor et al., 2009). Zoonotic diseases (diseases that can transfer from animals and birds to humans) are becoming more prevalent due to animal and bird proximity to humans. More than 85% of the households in rural Africa raise poultry for food and income with many people living in close proximity with their poultry. Both livestock and domesticated animals can carry such diseases like Avian Influenza A caused by the highly pathogenic H5N1 avian influenza virus (AI) and Severe Acute Respiratory Syndrome (SARS) (Factor et al., 2009). These two zoonotic diseases have been the subject of widespread outbreaks causing a lot of public health concern. Other examples of known or suspected zoonoses include many pathogens of high concern in modern society, such as anthrax, ebola, tuberculosis, and some strains of influenza. But of the 1415 pathogens known to affect humans, 61% are zoonotic (Taylor et al, 2001). Avian influenza (AI) is highly infectious and spreads primarily through direct contact between healthy birds and infected birds, and through indirect contact with contaminated equipment and materials. The virus is excreted through infected birds' faeces and secretions from the nose, mouth, and eyes. The virus can remain viable at moderate temperatures for long periods in the environment: over 30 days at 0°C (over one month at freezing temperature); 6 days at 37°C (one week at human body temperature); decades in permanently frozen lakes; on hard non-porous surface such as plastic or stainless steel for 24–48 hours and on clothes, paper and tissues for 8–12 hours. One gram of contaminated manure can contain enough viruses to infect 1 million birds (Mitamura and Sugaya, 2006). The spread of AI from birds to humans is through plucking and butchering of diseased poultry or wild birds, handling of fighting cocks, exposure to live poultry, consumption of uncooked duck's blood, and close contact with infected humans in household or hospital settings (Bridges et al. 2000, 2002, Beigelet al. 2005, CDC 2006, Dinh et al. 2006, Gilsdorf et al. 2006). Environmental exposure to poultry viruses through swimming or bathing in contaminated water, and exposure to poultry manure fertilizer, have been identified as possible risk factors for human infection with the H5N1 avian influenza virus (Abdel-Ghafar et al 2008). Low pathogenic avian influenza symptoms are typically mild in poultry. The main symptoms of the disease in poultry are decreased food consumption, respiratory signs (coughing and sneezing), and a decrease in egg production. Complete secession of egg production has been reported in turkeys infected with low pathogenic influenza virus. Birds that are affected with highly pathogenic avian influenza have a greater level of sickness and could exhibit one or more of the following clinical signs: sudden death; lack of energy and appetite; decreased egg production; soft-shelled or misshapen eggs; swelling of the head; purple discoloration of the skin, nasal discharge; coughing, sneezing and lack of coordination and diarrhoea (Neumann et al, 2010). Vaccinated birds are less likely to become infected and are less likely to excrete the virus. Therefore, vaccination can be used either as a tool to support eradication or as a tool to control the disease and reduce the viral load in the environment. Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of avian influenza in human may depend on which specific virus subtype and strain has caused the infection. Two main risks for human health from avian influenza are the risk of direct infection when the virus passes from the infected bird to humans, sometimes resulting in severe disease; and the risk that the virus, if given enough opportunities, will change into a form that is highly infectious for humans and spreads easily from person to person (Neumann et al, 2010). In Uganda between 2009 and 2010 the MOH carried out field and laboratory surveillance for the pandemic influenza type A H1N1, the highly pathogenic avian influenza H5H1 as well as Influenza Like Illnesses (ILI) (MAAIF & MOH, 2010). This was after an outbreak of pandemic influenza type A H1N1 that was reported at the beginning of July 2009. Initial cases were confirmed starting July 2009 among international travellers. Later, there was increased evidence of local transmission especially in schools (MAAIF & MOH,



2010). Cases were confirmed in Kampala, Wakiso, Luwero, Kabalole, Jinja, Mbarara, Mukono and Bushenyi Districts. About 63% of the confirmed cases were from schools, while 20% were from the community (Table 1.1). Cases were mild to moderate. There was a very good response to treatment with oseltamivir phosphate (Tami flu). The results of the surveillance show that over 1020 suspected cases were investigated of which only 2 were confirmed pandemic strains, 25 being A H3N2 co-circulating with seasonal influenza type B (8 isolates only). However they were no detection of H5N1 positive cases through out the country after March 2010. The Pandemic A H1N1 was declared over by WHO in July 2010 (MAAIF & MOH, 2010). Table 1.1 Pandemic H1N1 cases reported in Uganda from July-December 2009 No. Category Lab confirmed cases Death 1 Foreign Nationals 9 0 2 Local Contacts to Foreign Nationals 4 0 3 Ugandan International Travellers 2 0 4 Contacts of Ugandan Internal Travellers 4 0 5 Community 23 0 6 Schools: Students/Pupils 72 0 7 Total 114 0 (Source. MAAIF & MOH (2010). End of Project Report 2008- 2010. Support Programme to Integrated National Action Plans for Avian and Human Influenza. Ministry of Agriculture, Animal Industry and Fisheries and Ministry of Health). In a clinic and hospital based sentinel surveillance for influenza in Uganda from 2007 to 2011, Lutwama et al (in preparation) showed that out of 2,758 screened patients 96% had influenza-Like-Illness (ILI) and 4% had Severe Acute Respiratory Illness (SARI). Influenza Type A contributed 74.4% and while Influenza Type B contributed 25.6% of influenza infection. However, in June 2009 the pandemic H1N1 was first detected and by September 2010 it contributed 5.8% of the total influenza infection. Median age of ILI and SARI case-patients was 4 years (range, 2 months–67 years); patients aged 5–14 years had the highest influenza-positive rate (19.6%) and patients aged 0–4 years the lowest (9.1%) rate. The study showed outpatients at sentinel surveillance sites with influenza A were identified more frequently compared with influenza B. Influenza-positive rates peaked during October–November, coinciding with the second rainy season Lutwama et al (in preparation). In a parallel study between September to December 2008 Balinandi et al (in preparation) investigated the presence of virus associated with influenza like illness in Entebbe and Kampala. The results showed that out of a total of 369 patients (52.3% females) were enrolled; median age was 6 years (range <1-70). One or more respiratory viruses were detected in 172 (46.6%) cases and their prevalence were influenza A virus (19.2%), adenovirus (8.7%), human rhinovirus A (7.9%), coronavirus OC43 (4.3%), parainfluenza virus 1 (2.7%), parainfluenza virus 3 (2.7%), influenza B virus (2.2%), respiratory syncytial virus B (2.2%), human metapneumovirus (1.4%), respiratory syncytial virus A (1.1%), parainfluenza virus 2 (0.5%) and coronavirus 229E (0.5%). There were 24 (14.0%) mixed infections. The study showed that some previously unknown viruses were in circulation causing influenza-like-illness in the Ugandan population Balinandi et al (in preparation). In Uganda there are several markets along the major road highways where poultry among other commodities is transacted. These markets are characterized by both live and processed (roasted) poultry. Often the consumers of these poultry are not critical about the safety in terms of risk for transmission of zoonotic diseases. Avian influenza viruses are now widely recognized as important threats to agricultural bio-security and public health, and as the potential source for pandemic human influenza viruses. These outbreaks are a cause of concern. The out breaks particularly in Southern Sudan and South Africa have led Uganda to prepare for an epidemic outbreak through the World Bank/IDA AHIP. The maps in Figs 1.1 and 1.2 show areas in Africa of high AI susceptibility. The most susceptible areas to the spread of AI once introduced appears to be: West Africa, the northern African coastline, along the Nile river-including the Nile Delta, Uganda, Rwanda, Burundi, southern Kenya and eastern South Africa. Figure 1.1 shows the degree of risk in parts of Africa for the spread of HPAI H5NI into domestic poultry population is via a combination of migratory birds, major transport routes, markets where poultry may be traded and wetlands with the possibility of contact between poultry and wild birds. The higher the concentration of birds, the more likely chances of epidemic outbreaks. Wetlands, lakes, rivers and other water bodies are highly susceptible because of migratory birds the natural reservoirs of AI. Figure 1.2 shows the likelihood of



overall occurrence of virulent avian influenza in Africa. Areas that appear likely for HPAI H5NI to occur follow a similar pattern to areas suitable for spread most likely West Africa, the northern African coastline, along the Nile river, including the Nile Delta, Uganda, Rwanda, Burundi, southern Kenya and eastern south Africa.



Fig. 1.1 Identification of areas in Africa at high risk of introduction of Avian Influenza

The scale ranges from least likely (green) to most likely (red) Source: RVR and ILRI, 2010: Risk mapping for HPAI H5N1 in Africa, improving surveillance for bird flu. User guide for bird flu risk maps



Fig. 1.2 Areas in Africa with the potential for spread of Avian Influenza, once the disease has been introduced

Source: RVR and ILRI, 2010: Risk mapping for HPAI H5N1 in Africa, improving surveillance for bird flu. User guide for bird flu risk maps



1.8 Objective of the ESMP/EIA Avian and Human Influenza Preparedness and Response Project (AHIP) is to prepare an Environmental and Social Management Plan (ESMP)/Environmental Impact Assessment (EIA) which includes guidelines for carcass disposal facilities and a summary of potential negative impacts of disposal, as well as, providing measures for mitigating and monitoring those impacts. The intent of the ESMP/EIA is to ensure that AHIP meets: -

• Government of Uganda legal requirements; • Funding requirements of the World Bank.



2 PROJECT DESCRIPTION

2.1 The Avian Human Influenza Project At the height of the Avian Human Influenza outbreaks in Africa, a joint World Bank (WB), Food and Agriculture Organization (FAO), International Office for Epizootics (OIE) and World Health Organization (WHO) Mission visited Uganda in 2007. Their mission was to assess the risk of AI in the country, review the prevention, preparedness and response capacity in country and also review the Government’s National Plan of Action for Preparedness and Response to Avian Influenza to ensure its consistency with the established international standards and guidelines of the WHO, FAO, and the OIE. The team determined that Uganda was at risk of HPAI because of continuing progression of HPAI in Africa during that period, reported infections close to its northern border, people’s attitude of poultry rearing and trading as well as the presence of wild birds and numerous water bodies among other factors. The assessment resulted in the development of an Integrated National Action Programme (INAP) The INAP has two main components (prevention and preparedness and response and recovery) that described the outputs and activities that need to be implemented during the 5 years period to strengthen the capacity of the country to detect and prevent AI and a contingency plan for the control of the disease in the event of outbreaks in animals and first animal to human cases. Both plans therefore cover planning and coordination, animal health, human health and communication sectors. It also proposed a multi-sectoral monitoring and evaluation system. The above processes undertaken by the GOU are consistent with key principles identified in the Bank’s The global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI) and at the request of GOU, the Bank agreed to process AHIP as an Emergency Recovery Credit (ERC) under the Bank’s policy for emergency operations (OP/BP 8.00). The AHIP is co-financed by: (i) an IDA credit under the GPAI Adaptable Program Loan (APL) approved by the Executive Directors and (ii) grant funds from the Avian and Human Influenza Trust Fund (AHITF), which is being administered by the Bank. The AHIP supports the government’s INAP over a four year period. As a requirement for implementation of the AHIP an environmental and social management plan is required to mitigate the impacts of the project activities consistent with WB funded programmes. 2.2 Project Development Objectives The overall development objective is to substantially reduce the threat posed to the poultry industry and humans in Uganda by HPAI infection and other zoonoses and to prepare for, control, and respond effectively to future AHI pandemics and other infectious disease emergencies in livestock and humans. To achieve this, support will be provided in three main areas: (i) preparedness and prevention, (ii) outbreak response and recovery, and (iii) coordination, monitoring and evaluation. 2.3 Project Components The project operation will take place throughout four components:

Ø Animal health; Ø Human health; Ø Communication; and Ø Coordination, monitoring and evaluation.

Detailed activities, steps and schedules for each component and sub-component are elaborated in respective sections below. 2.3.1 Component 1: Animal Health This component is the primary focus of the project as HPAI outbreaks must be addressed at source. The component aims at overall institutional strengthening for animal disease prevention and control, with emphasis on the emerging zoonoses including Transboundary Animal Diseases (TADs). It supports national prevention and control strategies proposed to cover the country’s needs over the short- and medium-term, based on detailed assessments of the avian influenza epidemiological status, the capacity of the National Veterinary Service (NVS) to cope with HPAI epidemic and the vulnerability of the poultry



industry to new emerging infectious diseases. The component will provide funds for increased monitoring and surveillance of migratory and resident birds. The following activities are conducted within the framework of each sub-component. Component 1: Animal Health Part 1 Preparedness and Prevention (P&P)

v Sub-component 1.1: Strengthening Capacity for Animal Health Surveillance, Monitoring and Emergency Disease Control: The project uses the existing institutional framework for surveillance, monitoring and emergency disease control. The project supports: (i) MAAIF to strengthen its epidemiological unit: (ii) MAAIF to put in place a system in all the districts to detect the appearance of HPAI in migratory birds and domestic animals; (iii) strengthening the surveillance capacity of MAAIF, HPAI Rapid Response Teams (RRTs), and Uganda Wildlife Authority (UWA) through training, provision of PPEs and procurement of necessary equipment and supplies for control of HPAI and other emerging diseases.

v Sub-component 1.2: Strengthening of National Veterinary Services (NVS): This

subcomponent supports activities to strengthen NVS to enhance animal disease surveillance, diagnosis and control. The support covers the following: (i) upgrading knowledge and skills through training, equipping laboratories, provision of transport; (ii) development and distribution of Standard Operating Procedures (SOPs) for reporting between MAAIF and other line ministries; (iii) dissemination of the OIE developed Performance Vision Strategy document; (iv) Sero-prevalence surveys to establish baseline data on the epidemiology of re-emerging diseases; (v) review of curricula of the School of Veterinary Medicine, Makerere University (SVM-MUK) and Para-Veterinary schools to cater for HPAI and other TADs; and (vi) strengthening of the regulatory framework.

v Sub-component 1.3: Improved Veterinary Technical Competence for emerging disease

prevention, early detection and rapid response: The project will build capacity in risk analysis, through training and research in various areas of specialisation (risk analysis, infectious disease epidemiology, wildlife surveillance). Simulation exercises for HPAI and other infectious diseases will also be undertaken.

v Sub-component 1.4: A Balanced Veterinary Epidemio-surveillance programme capable

of early detection of emerging infectious diseases and other TADs: The project supports: (i) passive, active and targeted surveillance, (ii) improving animal health information flow among relevant agencies; (iii) early detection and timely reporting and follow-up of suspected or positive cases; (iv) public and Community-Based Surveillance System (CBSS) by establishing a community-based early warning system; (v) routine serological surveys and epidemio-surveillance; and (vi) upgrading of the laboratories earmarked to carry out diagnostics for HPAI including upgrading of the MAAIF National Diagnostics and Epidemiology laboratory to Bio-Safety Level 3 (BSL-3). Animal disease surveillance has been strengthened through provision of the necessary infrastructure, equipment, supplies and transport capacity.

v Sub-component 1.5: Evidence-Based Veterinary Rapid Response Capacity for Emerging

Infectious Diseases Preparedness, Detection and Control: To enhance the capacity for effective rapid response, the project has: (i) established an Incident Command System (ICS) for animal HPAI outbreak response; (ii) develop national policies and SOPs for HPAI rapid response and control; (iii) procured rapid response supplies and equipment for all levels of NVS, including PPEs, disinfection units and culling equipment; (iv) improved commercial farm and backyard poultry production bio-security; (v) strengthened NVS quarantine capacity; and (vi) supported preparation of compensation policy and guidelines.



v Sub-component 1.6: Coordination, monitoring and evaluation: MAAIF is responsible for coordination, monitoring and evaluation of animal health activities planned under the project. The OPM is responsible for the overall M&E activities. The project provides funds to all the implementing ministries responsible for their own coordination, monitoring and evaluation.

Component 1: Animal Health Part 2 Response and Recovery (R&R) The purpose of this part will be to provide additional costs to cater for immediate response, over and above the expenses related to P&P activities. This subcomponent will provide support for immediate reaction to the outbreak; implementation of sanitary measures; quarantine and movement control; strengthening of surveillance; initiation of recovery activities (compensation), improvement of bio-security; strengthening of public awareness; and re-enforcement of active surveillance (e.g. border check posts). 2.3.2 Component 2: Human Health The AHIP has strengthened the human health strategy for the preparedness and response to Avian Influenza (AI) in Uganda by helping to build the health system capacity to detect early, respond and contain the infection at source. The project has provided funds for adapting guidelines and training materials (including infection control guidelines), conducting training, activating and strengthening of national and district RRTs, establishing isolation units, upgrading laboratories and pre-positioning PPEs, supplies and medicines. The following activities are to be conducted within the framework of each sub-component. Component 2: Human Health Part 1 Preparedness and Prevention (P&P)

v Sub-component 2.1: Strengthening of Surveillance of humans for influenza: Surveillance activities for human influenza will be strengthened in all aspects and the number of sentinel sites will remain at the present three sites. The project will provide funds to strengthen MOH’s existing field disease investigation system.

v Sub-component 2.2: Strengthening the Capacity of the Uganda National Health Research

Organization: This includes: (i) strengthening of the capacity of UNHRO for developing policies to ensure effective coordination and to harmonise research in new and emerging infectious diseases including avian influenza (ii) upgrading the National Influenza Centre (NIC) laboratory at the Uganda Virus Research Institute (UVRI) to BSL3, including provision of laboratory diagnostic equipment and reagents; and (iii) training of staff for quality control in AI diagnostics, field specimen collection, and testing for influenza viruses.

v Sub-component 2.3: Consolidation of preparedness for AHI Prevention, Containment and

Control: This sub-component supports: (i) development of infection control procedures and educational programs for the most vulnerable and at risk communities and health workers and (ii) establishment of isolation facilities and procurement of infection control materials and PPEs.

v Sub-component 2.4: Improving Food safety and Environmental Hygiene: The project supports

activities and assessments aimed at improvement of environmental, occupational and food safety of poultry and poultry products in poultry markets and along major highway food vending points.

v Sub-component 2.5: Health Services and Systems Prepared to handle suspected cases:

Based on the lessons learnt from the Ebola outbreak, the implementation of this subcomponent is aimed at increase the surge capacity and flexible deployment of both human and infrastructure resources. This will be achieved mainly by training of health workers in case management and rapid response, development and conducting of simulation exercises and the development of a contingency plan of human resource management in case of an outbreak.

v Sub-component 2.6: Preparation for Effective Case Management: The ultimate aim of any

outbreak management strategy is to ensure proper treatment of all cases detected. The project will: (i) provide limited stock of pharmaceuticals for emergencies (Tamiflu® and other antibiotics) while adequate budgetary provision should be made for additional supplies when the situation



warrants; (ii) support preparation of guidelines and SOPs; and (iii) procurement of necessary accessories and medical supplies (including vaccines).

v Sub-component 2.7: Coordination, monitoring and evaluation: MOH is responsible for

coordination, monitoring and evaluation of human health activities planned under the project. The OPM is responsible for the overall M&E activities. The project provides funds to all the implementing ministries responsible for their own coordination, monitoring and evaluation.

Component 2: Human Health Part 2 Response and Recovery (R&R) Project will help create and sustain a system that can rapidly contain the infection as this is one of the key elements which will drastically reduce human to human transmission, suffering and death. Support will be provided for activating RRTs to undertake active case investigations, intensify collaboration with the veterinary services in the areas of disease surveillance, provision of PPEs, prophylaxis to investigating teams and treatment of human cases to control the spread of the epidemic. In the pandemic phase support will be provided for exceptional measures like quarantine and restricting movement of people, closure of schools and markets. 2.3.3 Component 3: Communication The main challenges faced in fighting AI relate to lack of motivation due to low risk perception and a general lack of knowledge of AI among the general public and a wide range of stakeholders, especially the small-scale back-yard poultry farmers. To address these constraints, the Project will provide funds to: Component 3: Communication Part 1: Preparedness and Prevention (P&P) (i) brief policy makers on AI through development and presentation of policy papers; (ii) enhance the communication skills of key policy makers and spokespersons through training; (iii) establish a Communications Center within the coordination/operation centers at central and district levels, designate Communication Focal Points (CFPs) within them, and equip the CFPs with dedicated communication facilities, ready supply of posters, and standard protocols for reporting any outbreaks; (iv) mount media campaigns using Information, Education and Communication (IEC) materials specially developed, and establish a national AI web-site; (v) train farmers and households with back yard poultry, local government officials, and religious and cultural leaders on the risks of AI; (vi) build strategic partnerships with the media through briefings and simulation exercises; and (vii) develop an M&E system. Component 3: Communication Part 2: Response and Recovery (R&R) The R&R strategy should be launched within the first 24 hours of any report of an outbreak. To facilitate this, the project will support: (i) establishment of SOPs for the outbreak communication strategy; (ii) dissemination of IEC materials for outbreaks; (iii) activation of media plan for outbreaks; (iv) strengthening of communication to the public at the outbreak foci or ‘ground zero’; (v) plan for officially communicating the end of the emergency phase; and (vi) the evaluation of the impact of the communication effort. 2.3.4 Component 4: Coordination, Monitoring & Evaluation Coordination: This component will support implementation costs associated with project planning, coordination, management, as well as overall monitoring and evaluation (M&E) at the national and district levels. This will cover support for these functions for the OPM. This support covers the operational costs for the National Project Steering Committee (NPSC), Project Coordination Team (PCT), Public Private Partnership (PPP) and coordination with Development Partners (DPs). Monitoring and Evaluation: The OPM has in place a National Implementation, Monitoring and Evaluation System (NIMES). The project will support the development of, and integration of an M&E system for AHIP activities into the NIMES.



2.4 Project Site Specific Activities 2.4.1 Project Activities at the National Animal Disease and Epidemiology Centre The Animal Health Component of the AHIP provides for strengthening of the laboratories earmarked to carry out diagnostics for HPAI including animal disease surveillance. Through the project, the necessary infrastructure, equipment, supplies, transport capacity and upgrading of the MAAIF National Animal Disease Diagnostic and Epidemiology Centre laboratory to Bio-Safety Level 3 (BSL-3) will be implemented (Appendix A). The existing laboratories will be rehabilitated and remodelled. 2.4.2 Project Activities at the National Influenza Centre, Uganda Virus Research Institute The activities proposed under the Human Health Component include; upgrading the National Influenza Centre (NIC) laboratory at the Uganda Virus Research Institute (UVRI) to BSL3, the provision of laboratory diagnostic equipment and reagents and training of staff for quality control in AI diagnostics, field specimen collection and testing for influenza viruses. A new BSL3 will be built (Appendix A). 2.4.3 Project Activities at Mulago National Referral Hospital and Entebbe Hospital The Health Component of the AHIP also provides for the establishment of new isolation wards and procurement of infection control materials and PPEs. Isolation wards have been proposed as part of Entebbe Hospital and the Mulago National Referral Hospital (Appendix A).



3 OVERVIEW OF POLICY AND LEGAL FRAMEWORK In this section, an overview of the relevant policies and legislation under which the AHIP will operate in Uganda is presented.

3.1 Policy Framework

3.1.1 Environmental Policies The National Environment Management Policy 1994 The National Environment Management Policy (NEMP) is premised on sustainable development as its overall goal; the promotion of sustainable economic and social development that enhances environmental quality without compromising the ability of future generations to meet their own needs. It is within this context that the environment policy was formulated.

The NEMP makes provision for EIA for development activities that may have an impact on the environment in order to foresee, eliminate or mitigate any adverse impacts. Public and private sector development options are required to be environmentally sound and sustainable. Any environmental consequences should be recognised early and taken into account in project design.

Health is identified as a service that is a source of pollution in Uganda. The objective of the NEMP in this regard is to control pollution and promote sound management of wastes and hazardous materials. One of the guiding principles to attain this objective is establishing clear linkages to other sectoral policies including those on water resources, human settlements, health and disaster prevention and preparedness. Formulation of a national strategy on medical waste management and disposal and carrying out urgent rehabilitation of medical waste incinerators is a specified strategy under the NEMP. In establishing laboratory and other medical facilities, cognisance must be had to these pertinent provisions of the NEMP indicating that the EIA requirements could be triggered and would have to be complied with. Further, the NEMP identifies the maintenance of regular environmental audits as a strategy to ensure the adoption of environmentally sound practices.

With regards to the breeding of poultry, the NEMP has stipulations for livestock and rangeland management which are applicable to poultry farming. The policy objective is to manage the nation’s rangeland resources within the capacity of the land to support both livestock and wildlife. The strategies identified to attain this objective include the development of a comprehensive policy on livestock and range management to include, inter alia, stocking and disease control.

The National Environment Action Plan 1995 The Plan notes the importance of EIA and echoes the provisions of NEMP for the creation of an EIA process and development of EIA capacity within sectoral ministries and departments. The place of the EIA process in sustainable development is stressed. It reiterates the NEMP objectives, guiding principles and strategies on pollution control and on livestock and rangeland management. 3.1.2 Health Related Policies National Policy on Injection Safety and Health Care Waste Management 2004 The policy addresses the improper disposal and destruction of injections and other health care wastes. The situational analysis revealed that injections and other health care wastes were dumped, buried or burned indiscriminately in a number of health facilities across the country. Incinerators were limited and, where available, tended to be improperly utilized. The purpose of the policy is to minimize the risk due to unsafe injection and health care waste management practices to the patient, health workers, the community and the environment. The policy seeks to attain behavioural change among the health workers and the community to reduce the use of injections, prevent the reuse of injections by health workers and among family members, and cause the proper disposal of injections and other health care waste. As regards health care management, the policy issue was lack of an adequate health care management system for health facilities and the community. The policy intent is to have every health facility have a designated person in charge of health care waste management; and waste management guidelines (as elaborated in the National Infection Prevention and Control Guidelines) should be availed to health workers who are enjoined to follow them. Health care waste must be segregated at source into pre-color coded containers with sharps being collected into sharps containers or safety boxes immediately after use. Sharps containers should be



immediately disposed of when ¾ full by incineration or where an incinerator is unavailable, by open burning followed by burying the residual waste. The strategies adopted include the establishment and implementation of a system for ensuring that injection and other health care waste is properly managed by the facilities generating the waste; development and dissemination of guidelines for injection and other health care waste management; construction/installation of injection and other health care waste disposal destruction facilities; and exploration of alternative environmentally friendly technologies for destruction of these wastes. As regards health workers, the policy seeks to ensure that they are appropriately trained in waste disposal and management and adequately deployed across the country to serve in both public and private health facilities. Monitoring and evaluation were identified as important to ensure policy implementation and redress inadequacies. Implementation of the Policy would be within the ambit of the National Health Policy and through the institutional structures of the Ministry of Health. As regards regulation, the National Drug Authority was identified as the agency that would ensure compliance of health commodities and their waste management with national regulations and standards; while the National Environment Management Authority would have the responsibility for advisory and regulatory matters related to environmental control standards associated with management of injection and other health care waste. The management of injection waste shall be consistent with environmental control standards with efforts specifically made to minimize the contamination of underground water resources and the emission of organic pollutants such as Dioxin and Furan. Though the Policy mentions health care waste, it is premised primarily on injections and associated inputs as the focus of the waste management system. As a result, the policy does not address the other waste material generated by health facilities and ancillary services which waste may be more hazardous than injections and related waste. The National Medical Equipment Policy 2009 The policy provides for the acquisition, use maintenance and disposal of medical equipment with the aim of enhancing health care service delivery and minimizing risks associated with the equipment management. This fourth edition has been structured to provide guidance on the medical equipment management cycle; the standard list of equipment for each healthcare level; and detailed technical specifications for recommended medical equipment. Equipping of health facilities in Uganda should therefore be carried out based on the principles set out in this policy to ensure rationalized and coordinated equipping of health facilities. The National Drug Authority (NDA) and Uganda National Bureau of Standards (UNBS), as the responsible regulatory bodies in the country, are mandated to monitor equipment imported into the country for both Government and non government health facilities. NDA and UNBS should monitor all equipment importation into the country to ensure that the equipment being acquired is safe. The National Medical Equipment Policy was developed and is continuously being updated to complement the National Health Policy in guiding provision of health care services delivery. One of the guiding principles of the Policy is that all medical equipment should be installed in accordance with the manufacturers’ specifications as well as building/electrical and occupational health and safety specifications. Equipment and consumables used in medical care should not contaminate the local environment. Health workers have the responsibility to protect patients and themselves against safety hazards that are potentially caused by use of medical equipment. Prevention of cross infection mediated by medical equipment is a crucial issue in all health facilities.

The Policy provides for disposal of medical waste. The reasons for disposal include obsolescence, uneconomical use, and lack of spare parts. Maintenance workshop managers should report to the health facility in-charges or designated administration officers any equipment that is due for decommissioning and disposal. The workshop managers should advise on the risk that could arise from continuous use of the equipment. Accordingly, the health facility in-charges and designated administration officers should report the cases to the accounting officers to initiate the disposal process. Disposal procedures of medical equipment should be in line with the environment laws of Uganda, and Public Procurement and Disposal Authority (PPDA) Regulations. When the equipment is due for disposal, international standards and guidelines should be followed. Many types of medical equipment used in hospitals are designated as special or hazardous waste and should not be disposed of like any waste that is not hazardous. Such items contain hazardous components that are restricted from disposal in a usual manner of non hazardous waste.



The Annual Health Sector Performance Report 2009/10 The Annual Health Sector Performance Review (AHSPR) for the Financial Year 2009/10 marked the end of the Health Sector Strategic Plan (HSSP) II for the strategic period that run from 2005/06 to 2009/10. The main objective of health promotion and education during the period was to increase community awareness and health literacy on disease prevention; and promotion of a healthy lifestyle in order to have a healthy and productive population. Thus the implementation of health promotion and education was envisaged as cardinal to the attainment of the overall health sector mandate. Institution of Village Health Teams (VHT) was identified as the main sector strategy for engaging with communities in order to improve awareness and health literacy on disease prevention and promotion of a healthy lifestyle. Complementary strategies included the development and production of relevant information, education and communication (IEC) materials; increasing the participation of political, religious and cultural institutions in promoting health; and wider use of the media. The scale up of VHT functionality was constrained by lack of adequate funding. For instance, in 2008/09 only 13 of the planned 42 VHTs were established. In 2009/10, there were plans to establish an additional 42 VHTs but less than 50% of the budgeted resources were released. Experiences from functional VHTs demonstrate that they are viable structures with potential to contribute to improved community health. Community participation remains a strategy for better healthcare in the Second National Health Policy and in the HSSIP and VHTs remain a mechanism for the delivery of better health care. Reporting on epidemic management and control, the AHSPR indicated that Integrated Disease Surveillance and Response reports are used in tracking the trends of epidemic potential diseases in the country. Working with the District Rapid Response teams, the Ministry of Health was able to investigate all the suspected disease outbreaks that were notified. In addition, case based data was collected for all the confirmed epidemics, which is critical for identification of the risk factors in outbreak that guide the implementation of the appropriate control interventions. The percentage of outbreaks notified to the Ministry timely (within 24 hours) however still fell short of the target (80%). Improvement in outbreak notification was mainly hampered by lack of community based disease surveillance, poor communication means and lack of knowledge on part of peripheral health facility staff. Only 68% of epidemics were responded to by the Ministry within 48 hours of notification (target 80%). AHIP should participate in promoting community awareness and participation; and strengthening the capacity of health facility staff in avian influenza identification, notification and control. The Uganda Virus Research Institute (UVRI) is one of the constituent institutions under the Uganda National Health Research Organisations (UNHRO) an autonomous organization under the Ministry of Health. The Institute’s broad mission is to carry out scientific investigations concerning communicable diseases especially viral diseases of public health importance and to advise government on strategies for their control and prevention. The specific objectives of UVRI include contribution towards the strengthening of laboratory networks; and contributing to effective infectious diseases, surveillance and monitoring systems. In order to realize these objectives, UVRI requires adequate infrastructure including well-equipped laboratories and highly trained and well motivated human resources to ensure retention. The Institute has been identified as the facility to construct laboratory facilities for control of avian influenza. The Second National Health Policy 2010 The development of the Second National Health Policy (NHPII) has been informed by the National Development Plan (NDP) for the period 2010/11-2014/15, the Constitution of the Republic of Uganda 1995 (as amended) and the new the global dynamics. The NDP places emphasis on investing in the promotion of people’s health and nutrition which constitute a fundamental human right for all people. Constitutionally, the Government of Uganda (GoU) has an obligation to provide basic health services to its people and to promote proper nutrition and healthy lifestyles. This policy has, in addition, been formulated within the context of the provisions of the Local Government Act Cap 243 (as amended) which decentralised governance and service delivery. The MOH has devolved responsibilities to the districts for them to manage the delivery of health services by both the public and private sectors. The supervision of the National Referral Hospital (NRH) and the Regional Referral Hospitals (RRH) remains under the MOH headquarters. The NHP II also takes into account the significant increase in the number of districts. This puts additional strain on resources for the health sector and its organisation. At national level, the functions of the Ministry of Health (MOH) include resource mobilisation and budgeting; policy formulation and policy dialogue with health development partners (HDPs), strategic planning, regulation, advising other ministries on health matters, setting standards and quality assurance, capacity development and technical support, provision of nationally coordinated services such as epidemic control,



co-ordination of health research and monitoring and evaluation of the overall sector performance. The AHIP is most interested in the role of MOH in epidemic control. The national policy on health shall be guided by a number of principles which include community participation, decentralization, sustainability, integrated health care delivery, and mainstreaming health in all policies. Health services shall be delivered within the framework of decentralization and any future reforms therein. The Policy shall provide a framework to support sustainable development. Curative, preventive and promotion services shall be provided in an integrated manner. Health shall be mainstreamed in all relevant policies. MOH shall guide other government ministries, departments and the private sector on health issues. Primary Health Care (PHC) shall remain the major strategy for the delivery of health services in Uganda, based on the district health system, and recognising the role of hospitals as an essential part in a national health system. Greater attention and support shall be given to health promotion, education, environmental health, enforcement and preventive interventions as defined in the Uganda National Minimum Health Care Package (UNMHCP).

Individuals and communities shall be empowered for a more active role in health development. Community participation and empowerment with respect to health service delivery has been inadequate. Government shall continue to actively promote community participation in health service delivery and management. The policy objective is to ensure that communities, households and individuals are empowered to play their role and take responsibility for their own health and well being and to participate actively in the management of their local health services. Communities shall be encouraged and supported to participate in decision making and planning for health services provision through Village Health Teams (VHTs) and Health Unit Management Committees (HUMCs). This will be attained by Government expanding VHTs to all local governments and exploring ways of sustaining the VHTs which constitute the first point of contact for the majority of people in rural areas.

The first policy objective stated is strengthening the organisation and management of national health systems. In order to achieve this policy objective, Government shall ensure that all relevant levels of the health system carry out their core functions effectively and efficiently. The District Health System shall be strengthened including community healthcare initiatives so that both public and private partners jointly carry out their responsibilities. Government shall support the functionality of Health Sub-Districts (HSDs) which will be responsible for management of routine health service delivery at lower levels including, planning and management of health services and fostering community involvement in the planning, management and delivery of healthcare. A regional level of administration of health services to serve as a link between the national and District Health Systems shall be established.

The second policy objective addresses the minimum health care package in Uganda which shall consist of the most cost-effective priority healthcare interventions and services addressing the high disease burden that are acceptable and affordable within the total resource envelope of the sector. The package shall consist of four clusters that include health promotion, environmental health, disease prevention and community health initiatives, including epidemic and disaster preparedness and response; and prevention, management and control of communicable diseases. The composition of the package shall be re-visited periodically. Through inter-governmental cooperation mechanisms including the OPM, AHIP would need to ensure that matters related to avian influenza are and remain within the total resource envelope of MOH. The Policy itself provides for inter-sectoral and inter-ministerial partnership in recognition of the role played by different sectors including government ministries and departments in contributing to promoting health. Consequently, the MOH shall take the principal role in advising, mobilising and collaborating with other government ministries and departments on health matters.

Strategies to achieve the UNMHCP include improving people’s awareness about health and related issues in order to bring about desired changes in knowledge, attitudes, practices and behaviour regarding the prevention and control of major health and nutrition problems in Uganda. Gradually strengthen responsible self-care, especially at primary care level, for selected health problems and patient categories through carefully planned and evaluated pilot phases and strengthen community health services. Awareness of avian influenza and the precautionary measures that communities can take could be built through this strategy. Community participation is, in addition, a key feature of any early warning system that would curtail the ability of disease developing to epidemic levels. The policy recognises that effective supervision and monitoring are an essential aspect of the health system and are critical in improving the quality of health services and care. The policy objective is to build a harmonised and coordinated national health information system with the MOH Resource Centre as national



custodian, in order to generate data for decision making, programme development, resource allocation and management at all levels and among all stakeholders. The strategies include building sustainable capacity at all levels of MOH, local governments, the private sector, facilities and communities to carry out supportive supervision, monitoring and evaluation of health interventions and disease surveillance; and facilitating the establishment and operation of a community-based health information system. Health infrastructure comprises buildings, plant, equipment (medical devices, other equipment for health facilities and IT equipment), transport and health care waste management. Government shall provide the necessary resources to ensure provision and maintenance of adequate infrastructure over the next decade, with priority being given to consolidation of existing facilities. The policy objective is to provide and maintain functional, efficient, safe, environmentally friendly and sustainable health infrastructure including laboratories and waste management facilities for the effective delivery of the UNMHCP, with priority being given to consolidation of existing facilities. The policy strategies include Government prioritising renovation, maintenance and rational use of health infrastructure; and ensuring appropriate medical and related waste disposal. The Health Sector Strategic & Investment Plan 2010/2011-2014/2015 The Health Sector Strategic & Investment Plan (HSSIP) is the medium term plan giving strategic direction and guiding sector focus, towards attainment of the policy objectives as outlined in the Second National Health Policy. The HSSIP, therefore, is aligned towards supporting attainment of these sector objectives and Government wide strategic approaches, informed by the situation of the sector at the end of Health Sector Strategic Plan (HSSP) II. The National Development Plan (NDP) 2010/11 – 2014/15 sets Uganda’s medium term strategic direction, development priorities and implementation strategies under the theme ‘Growth, Employment and Socio-economic transformation for Prosperity”. The aim of the NDP is to accelerate transformation of Ugandan society from a peasant to modern and prosperous country within 30 years. With this guidance, the health sector led by the Ministry of Health elaborated the Second National Health Policy 2010 and the HSSIP 2010/11 – 2014/15 to define Uganda’s medium term health agenda. The HSSIP not only addresses the key challenges facing Uganda’s health system but also sets out priorities and key areas on which to focus health investment in the medium term, for both public and private partners, in order to optimally contribute to the attainment of both the health sector goals and the national goals as outlined in the NDP. The implementation of the HSSIP shall be through a strong collaborative partnership. The HSSIP groups interventions in clusters. Cluster one which includes health promotion education aims at increasing health awareness and promoting community participation in health care delivery and utilisation of health services. Under the same cluster, environmental health, disease prevention and community health initiatives including epidemic and disaster preparedness and response are dealt with. The strategies identified include the promotion of individual and community responsibility for better health; and the prevention, detection, and prompt response to health emergencies and other diseases of public health importance. The use of VHTs and mass media are major tools in cluster one interventions. VHTs, where functional (60 out of 112 districts have trained VHTs), have helped in increasing health awareness, demand and utilization of health services. However, a significant proportion of the country is yet to have trained and functional VHTs. In addition to VHTs, health inspectors and professionals within the national and district health care delivery system would play an important role in cluster one interventions. Six key areas for investment have been agreed as the main focus during the HSSIP and these include human resources for health; health infrastructure; essential medicines, health supplies, and other health commodities; health information systems; preventive health / health promotion and education; and management and coordination of sector activities. The cost of the agreed interventions have been estimated for these key investment areas. These costs will be used to guide the sector in resource mobilization and resource allocation. The health promotion and education component has planned activities for the 5-year period, and on average, the activities relating to nutrition would take up the biggest proportion (51%) of the total cost (Uganda shillings 669 billion over the 5-year period). VHT activities relating to community and household supervision would take up about 22%, while environmental health would take about 7% of total cost.



2.1.3 Animal Management Related Policies The National Policy for the Delivery of Veterinary Services 2001 The vision of the livestock sub-sector is to increase the production and productivity of the livestock resource on a sustainable basis. This is to be attained inter alia by the development and maintenance of a viable livestock industry through cost effective control of diseases; establishing cost effective and sustainable animal health services delivery systems; and preservation and development of natural resources in conformity with the National Environment Action Plan 1995. Poultry is one of the major livestock species in Uganda and its performance has been affected by various factors including diseases. The goal of the Policy is to improve the delivery of the veterinary services with an overall goal of increasing production and productivity of livestock on small holder farms in Uganda. With regard to notifiable and emerging diseases, the policy goal is to ensure effective control of notifiable and emerging diseases; and the objectives include the reduction of the risk of disease outbreaks and minimising economic losses, and participation in international campaigns for the control and eradication of epidemic and emerging diseases. Various strategies are set out to achieve these objectives. Government is required to ensure prompt reporting of outbreaks of notifiable diseases through continuous sensitisation of all stakeholders on the dangers posed by all these diseases; and in with local governments is responsible for the surveillance and monitoring of notifiable and emerging diseases. Government shall test, slaughter, dispose off and where appropriate compensate farmers for losses due to epidemic diseases. One of the purposes of the policy is the effective control of zoonoses with the objectives of ensuring and promoting public health standards; and reducing economic losses associated with condemnation of animal products. The strategies include the promotion, by Government, of awareness of health hazards due to zoonotic diseases; and national surveillance, monitoring and evaluation of zoonotic diseases associated with high externalities. The provision of diagnostic health facilities with the aim of ensuring provision of efficient and cost effective facilities for diagnosis and disease investigation is a purpose of the policy. It is observed that diagnostic facilities are essential in disease investigation for effective disease control. The proposed activities include the provision of a central reference laboratory, district and private laboratories, recruitment of human resources, ensuring effective communication and quality assurance with the objective of providing quality country wide diagnostic facilities for disease investigation. MAAIF is required to set standards, inspect, licence, register and monitor all diagnostic laboratories. Provision of veterinary drugs, biologicals, vaccines and other veterinary supplies is a policy initiative that recognises the importance of these interventions as essential in supporting animal health in order to enhance production and productivity. The strategies include the importation and distribution, by Government, of vaccines for notifiable diseases as and when and where emergency disease control situations warrant. The provision of animal quarantine and primary livestock marketing infrastructure is aimed at effective disease control. One of the policy objectives is to monitor and regulate livestock marketing activities in the country as a tool of animal disease control. The National Veterinary Drug Policy 2002 The vision of the policy is access to quality veterinary drugs by all stakeholders for sustainable animal health and production; while the overall policy objective is to provide an enabling environment for the manufacture, procurement and proper usage of good quality veterinary drugs by all stakeholders in the country. The policy areas addressed are animal drugs supply, quality assurance, safe disposal of expired or otherwise unwanted veterinary drugs and materials, research in veterinary drugs and ethnoveterinary medicines, veterinary drug information system, correct and safe use of veterinary drugs and licensing of persons handling veterinary drugs. The primary responsibility for implementation of the policy rests in MAAIF while aspects of a regulatory nature shall be implemented by the National Drugs Authority. The Compensation Policy for Avian Influenza, 2007 The constitutional provision articulated in Article 26 of the Constitution of the Republic of Uganda 1995 stipulates that all persons are protected from deprivation of their property. Compulsory acquisition of property is permissible for, inter alia, public health reasons and the compulsory taking must be done under a law which makes provision for prompt payment of fair and adequate compensation prior to the taking of



possession or acquisition of property. Avian influenza was declared a disease under section 1(d) of the Animal Diseases Act, Cap 38. The Compensation Policy was developed taking into account the constitutional provisions and specific sectoral and inter-sectoral livestock policies that are relevant to the poultry sub sector. The National Policy for Delivery of Veterinary Services, 2001 aims at improving the delivery of veterinary services within the overall goal of increasing production and productivity of livestock on smallholder farms in Uganda; while the National Veterinary Drug Policy, 2002 aims at providing an enabling environment for the manufacture, procurement and proper usage of good quality veterinary drugs by all stakeholders in the country. The National Meat Policy, 2003 aims at ensuring an increased supply and access to good quality meat on the domestic, regional and international markets, diversification of exports and income generation. The National Health Policy, 1999 which as part of the public health intervention, stipulates that health education, information and communication must be intensified in order to improve health and create awareness to effect changes in knowledge, attitude and behaviour directed towards prevention and control of major health problems including establishing plans for preparedness and capacities to respond to emergencies. The new national health policy i.e. the Second National Health Policy 2010 continues to encourage community participation in healthcare and response systems and reiterates the role of health education in awareness creation and better health care provision and management. The World Organisation for Animal Health (OIE) has as some of its mission targets ensuring transparency in the the global animal disease situation; and the provision of expertise and encouraging international solidarity in the control of animal diseases. The OIE Terrestrial Code lays down the modalities for prevention of spread of animal diseases as well as facilitating international trade in live animals, semen, embryos and animal products. The OIE Manual gives the standards for diagnostic tests and vaccines for animals as a contribution towards the international harmonisation of methods for the surveillance and control of the most important animal diseases. The Code and the Manual give guidelines to users on zoning, regionalisation and compartmentalisation, surveillance & monitoring and diagnosis respectively in reference to handling avian influenza. Uganda subscribes to the OIE principles and the Compensation Policy draws support and benefit from the OIE mission. The Policy is a guiding framework for compensation of losses associated with avian influenza and is part of the overall National Livestock Disease Control Strategy. It provides for containment and control of the avian influenza disease in Uganda and is specially designed as an incentive for farmers to report any suspected disease outbreak. Although the policy provides for a compensation fund, functional animal health and laboratory services, logistical, administrative and operational regulations and plans must be in place. While it may not be feasible to implement all the strategies at a go, they are attainable overtime. The overall policy goal is to minimize the risk and spill over effects of the avian influenza virus infection in domestic poultry, migratory birds and humans through improved prevention and management of the disease before, during and after an avian influenza outbreak. The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) shall put in place and implement strict sanitary measures (including a ban on importation of all unchecked live birds and poultry products where need arises) at all entry and movement points including the Entebbe International Airport. The Ministry will also work with relevant agencies to establish monitoring centres for migratory birds and develop a data base for all information on avian influenza. This Policy will therefore help to improve awareness of the disease, trigger willingness to report early, and encourage owners to present birds for investigation and culling instead of selling them to the unsuspecting public. The Policy seeks to strengthen the existing mechanisms of early detection and responsiveness to disease reporting as part of disease monitoring and surveillance programs. It gives a framework in which citizens whose birds would have been culled during disease containment can be compensated for their losses to reward compliance and present a livelihood safety-net following the outbreak. The Compensation Policy is a mechanism of compensating part but not all direct and indirect costs incurred by the citizens. It will not cover any livelihood losses and neither shall it replace the social safety nets. Persons eligible for compensation shall be poultry farmers, poultry breeders, individuals or groups owning poultry which will have reported a suspicion of or any form of avian influenza disease outbreak and is directly or indirectly affected by animal culling activities undertaken, to contain and/or prevent the spread of the avian influenza disease. Compensation rates shall be established before the disease outbreak. Losses incurred and average prevailing poultry market prices shall form the basis for calculating compensation rates. Government shall ensure effective awareness and communication of the necessary information



including bio-security, disease reporting, emergency and preparedness measures for avian influenza and ensuring behavioural change amongst stakeholders. Government shall institute an Emergency Preparedness Compensation Fund to which government, development partners and the private sector will contribute and shall establish mechanisms for its management. The Development Strategy & Investment Plan 2009/10-2015/16 The National Development Plan (NDP) prioritises agriculture among the key productive sectors driving the economy. The Development Strategy & Investment Plan (DSIP) is the vehicle for implementing the agricultural sector vision under the NDP. The objective of the DSIP revision has been to produce a definitive new document that provides a ‘roadmap’ to assist government, civil society and donor partners in defining interventions to meet the key objectives in the agricultural sector. As such DSIP is a combination of policies and programmes around which stakeholders can form a consensus and mobilise the resources needed. The vision of the agricultural sector as stated in the DSIP is to have: “a competitive, market-oriented agro-industrial sector that accommodates both small and large scale farming in different agricultural production zones”. The Ministry of Agriculture Animal Industry and Fisheries (MAAIF) head office shall concentrate on agricultural policy formulation, support supervision especially of Local Governments (LGs), national planning, regulation, sector monitoring and guidance. MAAIF is also responsible for setting standards and ensuring quality assurance. At district level, the LGs are responsible for the implementation of national policies, execution of divested and decentralised functions which include provision of advisory services through NAADS as well as regulatory services covering pest and disease control; and regulation. LGs have the powers to formulate bylaws and ordinances and provision of services to farmers. Activities to support LG agricultural development include mobilisation, monitoring, supervision and guidance to farmers, farmers’ groups and other stakeholders. The DSIP makes provision for investments in the livestock sector including disease, vector and pest control that is a sub programme under the thematic investment area of enhancing production and productivity. Control of diseases, pests and vectors are important not only in stemming the losses in production and productivity of agricultural products but is a pre-requisite for accessing international markets for virtually all commodities and products. Strategic diseases, pests and vectors that are a threat to the agricultural sector and require vigilance and required intensified control effort include: trypansomiasis, foot and mouth disease, new castle, coffee wilt disease, bacterial wilt and tsetse flies (avian influenza is not specifically mentioned in the (DSIP). The major outputs under this sub-programme are institutional and staff capacity for disease control strengthened; policies and regulations on pest, disease and vector control reviewed/formulated; strategies for control of pests, diseases and vectors formulated; strategic epidemic disease and vectors controlled; surveillance and monitoring of pests, diseases and vector outbreaks strengthened; infrastructure for disease control developed and strengthened; and disease-free export/promotion zones established for livestock; and collaboration with national, regional and international organisations in control of diseases strengthened. 3.1.4 Other Related Policies The National Development Plan 2010/11-2014/15 Agriculture is recognised as a primary growth sector in the National Development Plan (NDP) and is defined to include the livestock sub-sector, which includes poultry. The livestock census (UBOS 2008) estimated the poultry population in Uganda at 37.4 million birds spread out in all the regions of Uganda. The constraints to growth in the livestock sub-sector are reported to mainly relate to diseases, lack of good breeds and lack of quality feeds for livestock. The strategies for intervention highlighted in the NDP include control of diseases, pests and vectors to ensure that communicable diseases are managed in order to promote animal health as a means to greater productivity; develop a policy on pests and disease control; set and operationalise standards for diagnostics, surveillance and control of pests and diseases. Further, the capacity of local governments to effectively manage pest and disease control is to be strengthened while infrastructure for pest and disease control including laboratories for livestock is to be developed.

A situational analysis on the environment as an enabling factor reveals that poor disposal of waste including medical waste is a challenge; and though there is in place an elaborate environmental legal regime, the level of compliance with these laws is very low leading to misuse and degradation of the environment. In addition, the environmental mainstreaming measures in the ministries, departments and agencies of central government and in the local governments are weak partly due to inadequate capacity and funding.



The Uganda Wildlife Policy 1999 The overall aim of the policy is to promote the long term conservation of the country’s wildlife and biodiversity in a cost effective manner which maximises the benefits to the people of Uganda. Problem animal control is provided for in the policy. It is noted that problem animals including vermin may cause damage to crops and livestock and injury to human beings. The policy objective is to control wild animals that pose a threat or cause injury to human life or which cause damage to property. The policy strategies include building the capacity of farmers and district authorities to manage problem animals and minimise damage to crops, livestock, property and loss of human life; and provide districts with awareness, technical assistance and capacity to monitor and conduct problem animal and vermin control. Migratory birds which are identified as one of the vectors of avian influenza constitute part of the wildlife resources of Uganda while they are part of the animal life of the country. In the instances where they are carriers of avian influenza, they would be managed as problem animals/vermin within the wildlife management regime.

3.2 Legislative Framework The Constitution of the Republic of Uganda 1995 (as amended) The Constitution of the Republic of Uganda is the supreme law of Uganda. It provides, amongst other things, for matters pertaining to the environment; for protection of property; and the system of governance.

It is a national objective and directive principle of State policy that the State shall protect important natural resources including land, water, wetlands, minerals, oil, flora and fauna on behalf of the people of Uganda (objective XIII). In accordance with objective XXVII, the State shall promote sustainable development and public awareness of the need to manage air, land and water resources in a balanced and sustainable manner for the present and future generations. In particular, the State shall take all possible measures to prevent or minimise damage and destruction to land, air and water resources resulting from pollution or other causes.

Protection from deprivation of property is enshrined in article 26. No person shall be compulsorily deprived of property except in circumstances stipulated under the article which includes compulsory acquisition in the interest of public health. Such taking must be made under a law that makes provision for prompt payment of fair and adequate compensation prior to the taking or acquisition of the property. The law must provide for the right of access to court by any person who has an interest or right over the property. The right to a clean and healthy environment is enshrined in article 39 and Parliament is enjoined in article 245 to provide measures intended to protect and preserve the environment from abuse, pollution and degradation; and manage the environment for sustainable development. The National Environment Act is the principal enabling law.

Article 176 of the Constitution establishes the system of local governance in Uganda which shall be based on the district as a unit under which there shall be local governments and administrative units as Parliament may provide. Regional governments are introduced in article 178 but these may be established at the instance of two or more districts that wish to cooperate in forming such government with the exception of Buganda, Bunyoro, Busoga, Acholi and Lango that are deemed to have agreed to form regional governments for the purposes of this article.

The local governance system established under article 176 shall be based on the principle of decentralisation which shall ensure that functions, powers and responsibilities are devolved and transferred from the Government to local government units in a coordinated manner. The functions of Government and districts councils are stipulated in article 189 which specifies the functions of Government in the Sixth Schedule to the Constitution. District councils have responsibility for any functions not specified in the Sixth Schedule. Accordingly, the functions and services for which Government is responsible include agricultural policy, health policy, control and management of epidemics and disasters, land, mines, mineral and water resources and the environment. Parliament is enjoined to make laws relating to local government for the purpose of giving full effect to the aforementioned provisions (article 206). The Local Government Act, Cap 243 is such law.

The National Environmental Act Cap 153 The National Environment Act is the principal law governing environmental management in Uganda and its main objective is the promotion of sustainable development. It establishes the National Environment Management Authority (NEMA) as the agency responsible for the management of the environment whose



functions include the review and approval of environment impact assessments (EIAs) and environment impact studies submitted in accordance with the Act and any other law. EIA is the systematic examination conducted to determine whether or not a project will have any adverse impact on the environment. According to the third schedule to the Act, waste disposal including sites for the disposal of solid waste and sites for hazardous waste disposal; and any activity out of character with its surroundings are activities that would require an EIA. The National Environment (Environment Impact Assessment) Regulations (SI 153-1) give further detail on the EIA process and provide that an EIA must be undertaken by experts whose names and qualifications are approved by NEMA. The National Environment (Audit) Regulations, 2006 (12/2006) makes further provision for environmental audits. An environmental audit would determine the compliance status with environmental regulatory requirements, the environmental management system and the overall environmental risk of the facility. The audit regulations apply to environmental audits under the National Environment Act, environmental audits under the EIA regulations, voluntary environmental audits by the owner and any other audits as may be required or prescribed. It is the responsibility of NEMA and the lead agencies to ensure the proper management and classification of dangerous materials and processes (section 51-53). The Act prohibits the importation of classified waste; and the discharge of hazardous substances, chemicals, oil or mixtures containing oils in any waters or any other segment of the environment is prohibited unless authorised by NEMA. The National Environment (Waste Management) Regulations (SI 153-2) applies to all categories of waste, to the storage and disposal of waste and to all waste disposal facilities. Waste is defined to include any matter prescribed as waste, and any radioactive matter whether liquid, solid or gaseous or radioactive which is discharged, emitted or deposited into the environment in such volume, composition or manner as to cause an alteration of the environment. A person who generates waste is duty bound to minimize the waste generated by adopting cleaner production methods. The characteristics of hazardous wastes are stipulated in the second schedule to the regulations and include explosive, flammable, spontaneous combustion, oxidizing, acute toxicity, ecotoxic, radioactive, persistent waste, corrosive and carcinogenic waste. Guidelines for the determination of hazardous characteristics are contained in the third schedule to the regulations. Wastes considered hazardous are listed in the fifth schedule. All discharge of effluent is governed by the National Environment (Standards for Discharge of Effluent into Water or on Land) Regulations SI 153-3 which stipulates that effluent or wastewater should be discharged in accordance with the standards prescribed in the schedule to the regulations. It is the general obligation of every industry or establishment to mitigate pollution by installing at the premises anti pollution equipment for the treatment of effluent and chemical discharge emanating from the industry or establishment. Records must be kept on the waste discharged and submitted to NEMA and any relevant lead agency every three months from the commencement of the activity for which the permit was issued. In implementing the Effluent Discharge Regulations, NEMA has delegated its authority with regard to the discharge of effluent into water to the Director of Water Development (now administered by the Directorate of Water Resources Management) through the National Environment (Delegation of Wastewater Discharge Functions) Instrument (SI 153-4). The delegated function must be undertaken in accordance with the provisions of the Environment Act and any regulations, guidelines or directions issued under it. The delegated function may be withdrawn in writing by the Executive Director, NEMA, for breach of any of the terms of delegation. Wastewater permits must be obtained to authorise any person discharge wastewater. The permits are administered by the Directorate of Water Resources Management in accordance with the provisions of the Water (Waste Discharge) Regulations SI 152-4 and the permit holder is required to comply with the stipulations of the Effluent Discharge Standards.

The purpose of the National Environment (Noise Standards and Control) Regulations, 30/2003 is to ensure the maintenance of a healthy environment for all people in Uganda, the tranquillity of their surroundings and their psychological well being by regulation of noise levels. Consequently, construction and operation of facilities that may generate noise should be undertaken within the prescribed permissible noise levels.

The Local Governments Act Cap 243 The Act establishes a form of government based on the district as the main unit of administration. Sections 35-44 of the Act give planning and legislative powers to the districts. Districts are also enjoined to plan for the conservation of the environment within their local areas and the District Environmental Committees



established under Section 14 of the National Environment Act are supposed to guide the district authorities in that regard. The Government bears the primary responsibility for the control and management of epidemics and disasters, health policy and agricultural policy (sections 30-31 of the Act, Part 1, Second Schedule) while the district council is responsible for medical and health services including hospitals with the exception of referral hospitals and those providing medical training, health centres, dispensaries and first aid posts, the control of communicable diseases, control of the spread of disease in the district, primary health care services, vector control, environmental sanitation and health education; animal husbandry extension services; entomological services and vermin control; and assisting the Government to preserve the environment through protection of forests, wetlands, lake shores, streams and prevention of environmental degradation (Part 2, Second Schedule). Under Part 3 of the Second Schedule, urban councils are responsible for clinics, dispensaries, health and inoculation centres within their jurisdiction; slaughterhouses, cold storage facilities and premises for the inspection or processing of meat; markets; pounds for stray animals and clinics for the treatment of sick animals; and sanitary services for the removal and disposal of carcasses of dead animals and all kinds of refuse and effluent. Lower local governments are responsible for the control of vermin in consultation with the Ministry responsible for wildlife and any other ministry; the provision of hygiene services and health units other than health centres, and community based health care services; markets establishment, management and control; and the enforcement of proper methods for the disposal of refuse (Part 4, Second Schedule). The Kampala Livestock Ordinance 2009 is an example of a local government seeking to develop and regulate the livestock industry within its jurisdiction. The Animal Breeding Act, 2001 The Act establishes the National Animal Genetic Resources Centre and Data Bank and provides for the promotion, regulation and control, and quality assurance of animal and fish genetic materials. It further provides for the implementation of the national breeding policy in Uganda. An animal is defined to mean livestock, camels, poultry and other animals. The definition of disease does not include a poultry disease though the saving clause empowers the Minister responsible to by statutory instrument declare any other disease a ‘disease’ under the Act. The Director Animal Resources is empowered under section 4 to promote optimal animal genetic resource management, conservation and sustainable use commensurate with Uganda’s needs and environmental protection. The Animal Diseases Act Cap 38 (as amended) Animals are defined under the Act to include all stock while stock is defined to include poultry. Poultry means all domestic or domesticated fowls, ducks, geese, turkeys, guinea fowl, peafowl, pheasants, pigeons, ornamental or caged birds. The definition of disease does not include avian influenza but the Minister responsible is authorised by statutory instrument to declare any other disease as one to be included in the term disease for the purposes of the Act. Persons in possession of diseased animals or animals suspected to be diseased shall as soon as possible separate and confine such animal from other animals and report the disease or suspected disease to a veterinary or administrative officer nearest to his vicinity. On satisfaction that a disease affecting stock is existent in his administrative area, the administrative officer shall cause all owners and occupiers of farms and of stock in the neighbourhood to be notified of the disease. Such animals may be slaughtered and their carcasses are the property of the Government to be disposed of as the Government representatives deem fit. Such disposal may include burial, destruction of the carcass, dung or fodder. A veterinary officer is empowered to take blood samples from animals for the purposes of detecting or diagnosing disease. The commissioner responsible for livestock and entomology may prohibit the exhibition or sale of stock in open markets or private yards for the purposes of preventing the spread of any disease. Similarly, the commissioner may prohibit the slaughter of cattle for food or sale of meat or carcasses or of any part of the meat or carcasses (provision specific to cattle not stock). Compensation of an amount equal to the market value of the animal as assessed by a veterinary officer may be paid to any person whose animal is slaughtered under this Act. However, where the owner of any animal has been guilty of any breach of this Act or any rule, direction or order issued under it, compensation may be wholly or partially withheld. No compensation is payable for an animal that was affected by disease when imported into Uganda or before it



was passed by an inspecting officer at the port of entry into Uganda or if the animal was imported in breach of the Act or any rules, orders or directions issued under it. The Minister may by statutory instrument declare any area within Uganda to be an infected area for the purposes of this Act. In cases of urgency, the commissioner may declare any area provisionally infected pending such statutory order. The rules regarding infected areas shall be applicable to any area declared infected, whether provisionally or otherwise. Such rules include quarantine, branding of infected animals and disposal of infected animals. Any person negligently allowing an animal to escape from an infected area shall be deemed to have moved the animal from the area. The Animal Diseases (Amendment) Act 2006 introduces the currency point and amends section 25 of Cap 38 by substituting the offences and penalties therein. In accordance with Section 3 of the Amendment, any person who contravenes the provisions of the Act commits an offence and is liable to a fine not exceeding one hundred currency points or imprisonment for a term not exceeding two years or both. Section 1 stipulates that the Amendment Act shall be read as one with the Animal Diseases Act Cap 38. The Animals (Prevention of Cruelty) Act Cap 39 It is an offence to permit an animal suffering from an infectious or contagious disease to be at large in any public place. An authorised officer may seize such animal and any court may order it to be destroyed. The Veterinary Surgeon’s Act Cap 277 The Act makes provision for the registration of practitioners of veterinary surgery and for other matters connected with the practice of veterinary surgery. The practice of veterinary surgery is the performance of any operation and the giving of any treatment, advice, diagnosis or attendance in respect of an animal for gain or reward. Whenever in any written law there is any reference to a legally qualified veterinary surgeon or a duly qualified veterinary surgeon or to any person recognised by law as a veterinary surgeon, or to a member of the veterinary profession, the reference shall be construed to mean a reference to a person registered or licenced under this Act. The Uganda Wildlife Act Cap 200 The Act stipulates that every person responsible for the administration of the Act shall ensure that any measures taken or instituted under the Act are based on the results of scientific investigation, insofar as it is economical, including the monitoring of species status and habitat conditions, as well as taking into account the views of the affected communities. Uganda Wildlife Authority (UWA) is established as the principal agency responsible for the sustainable management of the wildlife resources of Uganda. UWA’s functions include monitoring and control of problem animals and providing technical advice on the control of vermin. An animal is defined to include any member of the animal kingdom excluding human beings. Any animal or class of animals may be declared vermin by the Board of UWA on the advice of the Executive Director. The declaration may be effective for the whole of Uganda or such part or parts of Uganda as may be specified in the notice. Such declaration shall be published in the Gazette and local newspapers having wide circulation in the areas affected. The Public Health Act Cap 281 The Act consolidates the law regarding the preservation of public health. An infectious disease is defined as any disease which can be communicated directly or indirectly by any person suffering from it to any other person; and infected means suffering from, or in the incubation stage of, or contaminated with the infection of any infectious disease. Local authorities are authorised to take all lawful, necessary and reasonable practicable measures for preventing the occurrence of, or for dealing with any outbreak or prevalence of any infectious, communicable or preventable disease; to safeguard and promote public health and to exercise the powers and perform the duties in respect of public health conferred or imposed by this Act or any other law. The Minister responsible has the power to declare any disease a notifiable disease to which the provisions of the Act become applicable. A medical officer has powers to enter into any premises to inspect the premise or persons suspected to be suffering from an infectious disease; and may cause such premises to be disinfected in order to contain the infection. Buildings or articles contaminated by infection may be destroyed by lawful order and reasonable compensation shall be given by the local authority. Compensation



shall not be payable in respect of deprivation of the occupation or use of any building or part of a building or of the use of any article occasioned by disinfection, if no undue delay has occurred. Any local authority may provide means of disinfection and means of conveyance for infected persons and things. Persons certified as infected by a medical practitioner if not accommodated in a manner as adequately to guard against the spread of the disease may be removed at the instance of the local authority to any hospital or temporary place which in the opinion of the medical officer is suitable for reception of the infectious sick and to be detained there until discharged by an authorised medical practitioner. Special provisions are made for epidemic disease. The Minister may by statutory instrument declare any disease to be a formidable epidemic disease for the purposes of this part of the Act; and declare the affected area an infected area. Any person who becomes aware of sickness or mortality in animals suspected to be a formidable epidemic disease shall immediately report the fact to a local authority or medical officer. Every local authority shall immediately report by expeditious means such case or suspected case of a formidable epidemic disease to the nearest medical officer or the chief medical officer. The Minister has powers to enforce precautions at Uganda’s borders for the purposes of preventing the introduction of infectious diseases into the country. Except as may be specifically provided in this Act, the provisions of the Act shall be deemed to be in addition to and not in substitution for any provisions of any other Acts which are not in conflict or inconsistent with this Act. The National Drug Policy and Authority Act Cap 206 The Act establishes the national drug policy and the National Drugs Authority (NDA) with the purpose of ensuring the availability at all times of essential, efficacious and cost effective drugs to the entire population of Uganda as a means of providing satisfactory health care and safeguarding the appropriate use of drugs. The definition of drug includes substances intended for use by humans and animals either in the treatment or prevention of disease or for improving physiological functions, or for agricultural or industrial purposes. Both human and veterinary drugs are the responsibility of NDA. The National Drug Policy provides inter alia for the continuous review of the needs, knowledge and resources of essential drugs; intensifying research in all types of drugs including traditional medicines; and the regulation of the importation, production, distribution, marketing, exportation and use of pharmaceuticals in the public and private sector. The membership of NDA includes representation from the human and veterinary medicine disciplines. NDA is charged with implementing the national drug policy and in this regard shall deal with the development and regulation of the pharmacies and drugs in Uganda. Workers’ Compensation Act Cap 225 The Workers Compensation Act makes provision for financial compensation for work related injury or illness. An employer shall be liable to pay compensation if personal injury by accident arises out of and in the course of a worker’s employment. Compensation shall be payable whether or not the incapacity or death of the worker was due to the recklessness or negligence of the worker or otherwise. Every employer shall insure and keep himself or herself insured in respect of any liability which he or she may incur under this Act to any worker employed by him or her. Section 27 of The Workers' Compensation Act states that, “Where a medical practitioner grants a certificate that a worker is suffering from a scheduled disease causing disablement or that the death of a workman was caused by any scheduled disease; and the disease was due to the nature of the worker's employment and was contracted within the twenty-four months immediately previous to the date of such disablement or death, the worker or, if he or she is deceased, his or her dependants shall be entitled to claims and to receive compensation under this Act as if such disablement or death had been caused by an accident arising out of and in the course of his or her employment.” The act further stipulates, “If on the hearing of an application for compensation in terms of subsection (I) of this Section the court is satisfied on the evidence that the allegations in the certificate are correct, the workman or his dependants, as the case may be, shall be entitled to compensation under this Act as if the contracting of disease were an injury by accident arising out of and in the course of the workman's employment.” The provision of personal protective equipment (PPE) to employees in minimizing accidents and injuries is emphasised.



The Employment Act, 2006 The Employment Act 2006 is the governing law for the recruitment, contracting, deployment, remuneration, management and compensation of workers. The Act is based on the provisions of article 40 of the Constitution of Uganda 1995. It mandates labour officers to regularly inspect the working conditions of workers to ascertain that the rights of workers and basic provisions are provided and workers’ welfare is attended to. The Act also provides for the freedom of association of workers permitting workers to join labour organizations. This provision is also supported by the Labour Unions Act 7, 2006, which provides elaborate guidelines and regulation for membership. The Occupational Safety and Health Act 2006 The Occupational Safety and Health Act of 2006 consolidates, harmonizes and updates the law relating to occupational safety and health in Uganda. Sections 45-55 of the Act make provision for the health, safety, welfare and appropriate training of persons employed in work places. The management of work places are enjoined to ensure the safety and health of employees and equipment through provision of safety and health measures, appropriate machine guarding, and personal protective equipment (PPE) like respirators, overalls and gloves. The Act emphasises the duty of work place managers in ensuring that all workers comply and use the PPE in order to fulfil the provisions of this Act.

3.3 The World Bank Safe Guard Policies The World Bank safeguard policies are designed to help ensure that projects proposed for Bank financing are environmentally and socially sustainable, and thus improve decision-making. The relevant operational policy is OP 4.01 on Environmental Assessment. Environmental Assessment OP 4.01 This policy is triggered by any project that is likely to have potential adverse environmental impacts in its area of influence. The policy covers the natural environment, cultural resources and human health and safety. A project that triggers this policy is classified as category A, B, or C according to the nature and magnitude of potential environmental impacts. This Project will impact the environment. A preliminary screening indicates that the Project will be constructed along an already built up environment that is avian influenza laboratories and hospital isolation wards. This is likely to have minimal or no adverse environmental impacts and is ranked as Category B according the World Bank OP 4.01. The appropriate instrument to prepare is the Environmental Management Plan (EMP) which would recommend measures to prevent, minimize, mitigate, or compensate for adverse impacts.

Natural Habitats OP 4.04 This policy may be triggered if any activity takes place in wildlife conservation areas and emphasises that the conservation of natural habitat is essential for long-term sustainable development. The World Bank supports, and expects borrowers to apply, a precautionary approach to natural resources management to ensure environmentally sustainable development. The Project, as indicated, will be situated in built up areas and as such will not have an impact on natural habitats. This policy is mentioned for information in the event that any activities are planned that may impact migratory birds or any species found in the wild.

3.4 International Agreements Uganda has ratified various treaties that are related to the environment. The provisions of these treaties have been domesticated in the laws of Uganda concerning the environment earlier discussed. Some treaties will be listed for information purposes. International environmental law principles developed through the practice of States have been incorporated in the environmental laws of Uganda. These include principles like the precautionary principle; the polluter pays principle; the concept of sustainable development; the duty to notify or provide information of any likely environmental harm and the duty to avoid harm.

The African Convention on the Conservation of Nature and Natural Resources, 1968 (Algiers Convention) seeks to encourage action for the conservation, utilisation and development of soil, water, fauna and flora for the present and future welfare of mankind. All State Parties are required to undertake to adopt all measures necessary to realize the objectives of the Convention.



The Convention Wetlands of International Importance Especially as Waterfowl Habitat, 1971(Ramsar Convention) has as its main objective the conservation of wetlands taking into account their ecological, economic, cultural, scientific and recreational value. Of particular import is the protection of wetlands as habitats for waterfowl. Accordingly, the Convention enjoins State Parties to consider their international responsibilities for conservation, management and wise use of migratory stocks of waterfowl. The Convention Concerning the Protection of the World Cultural and Natural Heritage, 1972 (The World Heritage Convention) which establishes a system of collective protection of cultural and natural heritage sites listed as world heritage sites due to their outstanding universal value. Parties undertake to assist each other in the protection of the cultural and natural heritage. The Convention on International Trade in Endangered Species of Wild Fauna and Flora, 1973 (CITES) protects endangered species from over exploitation through a system of permits that allow export or import. Appendix I species are endangered species in which trade is strictly controlled while Appendix II species are likely to become threatened species if trade in the species is not regulated. The Convention on Biological Diversity, 1992 recognises the value of biological diversity and seeks to conserve it while promoting the sustainable use of its components and encouraging equitable sharing of the benefits arising out of the utilisation of genetic resources. An obligation is placed on State Parties to provide for environmental impact assessment of projects that are likely to have significant adverse impacts on biological diversity. State Parties are required to exchange information and undertake consultation with other States in all cases where proposed national projects are likely to have adverse effects on biological diversity in other States.



4 UGANDA’S ENVIRONMENTAL BASELINE CONDITIONS 4.1 General location Uganda is a land locked country, which lies between latitudes and longitudes 4.20 N and 1.50 S and 280 E and 350 W respectively. Its neighbours are Kenya to the East, Tanzania and Rwanda to the South and Southwest respectively, the Sudan to the North and the Democratic Republic of Congo (DRC) to the West. The country covers an estimated total area of 241,020 km2, of which approximately 15.1 per cent is open water, 11 per cent national parks and game reserves or protected areas (PAs) and about 5.9 per cent forest reserves. Traversing most of its borders with its neighbours are a number of transboundary natural resources such as Lakes Victoria and Albert; River Nile and Mountains Rwenzori and Elgon. 4.2 Bio-Physical Environment 4.2.1 Climate The climate of East Africa is broadly controlled by large-scale easterly trade winds, which are responsible for the transport of moisture from the neighbouring oceans (advection of moisture inland). The moisture transported from the neighbouring oceans makes up over 75 per cent of the moisture forming the inland rainfall. The space-time state and reliability of weather and climate within the East African region in general and Uganda in particular is controlled by a number of large to medium scale atmospheric meteorological systems which include: The Inter Tropical Convergence Zone (ITCZ), Monsoons, Meso–Scale Circulations, and Teleconnections (El Nino/ Southern Oscillation) ENSO. There are particularly two important climatic variables; rainfall and temperature and they have been fairly monitored and recorded over the years. 4.2.2 Rainfall Rainfall is the most sensitive climate variable as it affects many social and economic activities in Uganda. The wettest districts are located within the lake basin areas and include the districts of Kalangala, Kampala, and parts of Masaka, Mpigi, Mukono, Jinja and Bugiri (UBOS, 2006). The western and northern districts occasionally experience long droughts, which are recently becoming more frequent. The eastern region including the districts of Pallisa, Mbale, Kapchorwa, Kumi, Soroti, Tororo, and Busia receive moderate rainfall. The average long-term annual rainfall for Uganda is 1,318 mm. March to May is the main stable rain season over most parts of the country. The probability of normal range of rainfall is generally over 80 percent except over the extreme north eastern areas where the probability drops below 70 percent. 4.2.3 Temperature Uganda experiences moderate temperatures throughout the year. The country is pleasantly cool with a long-term mean temperature of 210C. Over a year, mean temperatures range from a minimum of 150C in July to a maximum of 300C in February. In the highlands and around mountains, the elevated landmass exerts a local influence in climate producing rainfall and temperatures that are unique from the lowlands. The mean daily temperature is 280C. Extreme temperatures as low as 40C are experienced in Kabale District while temperatures below 00C are registered on the higher mountain ranges of Rwenzori and Elgon situated, respectively, in the western and eastern regions of the country. Rwenzori has a permanent ice cap, whose size is currently reducing due to the global warming. Highest temperatures of over 300C are experienced in Gulu, Kitgum and Moroto in the north and north eastern parts of the country (UBOS, 2006).



Figure 4.1 Maximum and minimum temperature over selected regions of Uganda, 2003-2005 (Source: UBOS 2006) 4.2.4 Geology and soils Uganda is made up of predominantly old rocks from the Pre-Cambrian era (3 000 – 6 000 million years ago). There are also younger rocks, mainly of sedimentary and volcanic origin, from the cretaceous era (135 million years ago). The larger part of the country that is more than two thirds has poor ferralitic soils. These soils have nearly lost all their mineral content through prolonged weathering. They need proper management to give reasonable crop yields. The rest of the country has mostly richer ferruginous and highly productive volcanic soils. A number of parameters define the soils of Uganda and these include parent rock, age of soil and climate. The most dominant soil type is ferralitic soil, which accounts for about two-thirds of the soils found in the country. Based on studies carried out in the past, Uganda’s soils are divided into six categories according to productivity: a) very high to high productivity; b) moderate productivity; c) fair productivity; d) low productivity; e) negligible productivity; and, f) zero productivity. The high productivity soils cover 8 per cent of the area of Uganda. Considering the country’s size, this is indeed a small area. Therefore, fair and low productivity soils must be effectively managed in order to sustain Uganda’s agriculture. 4.2.5 Topography and drainage The greater part of Uganda consists of a plateau 800 to 2,000 m in height. Along the western border, in the Ruwenzori Mountains, Margherita Peak reaches a height of 5,109 m, while on the eastern frontier Mount Elgon rises to 4,321 m. By contrast, the Western Rift Valley, which runs from north to south through the western half of the country, is below 910 m on the surface of Lake Edward and Lake George and 621 m on the surface of Lake Albert (L. Mobutu Sese Seko). The White Nile has its source in Lake Victoria; as the Victoria Nile, it runs northward through Lake Kyoga and then westward to Lake Albert, from which it emerges as the Albert Nile to resume its northward course to the Sudan. Uganda has a dense drainage system, which is mainly concentrated in the South of River Nile. The system comprises of different networks that include numerous lakes, rivers, streams and wetlands. Wetlands cover 13 per cent of the country’s total area, of which two thirds located in the south of the country, are always



permanently flooded (FAO 2005). However, River Nile whose basin has eight subdivisions namely; Lake Victoria Basin, Lake Kyoga Basin, Victoria Nile Basin, Lake Edward Basin, Lake Albert Basin, Albert Nile Basin, Aswa Basin and Kidepo Basin accounts for 98 per cent of the country’s total drainage. Besides the major lakes: Lakes Victoria, Albert, Kyoga, Edward and George, there are over 160 minor water bodies, covering a total of 1 707 km2. 4.2.6 Flora and fauna The diverse landscapes and climate that characterise Uganda support a variety of flora and fauna. Apart from great diversity of fauna, there are some 94 recognizable plant communities. These include, among others, closed canopy high tropical forests, montane bamboo, heather and moorland, swamps and wetlands, moist and dry woodlands, and thickets. In the north of the country, the dominant vegetation cover is the moist deciduous forest while rainforest runs throughout the central region. The north eastern and south western parts of the country have pockets of tropical mountain ecosystems. Overall, Uganda has four distinct ecosystem types, which include:

∗ shrubs, savanna and grasslands covering 44 per cent of the total land area; ∗ cropland/natural vegetation mosaic covering 35 per cent; ∗ water bodies (lakes, rivers, wetlands and swamps) covering approximately 16 per cent; ∗ Forests covering 20 per cent. One percent of the land lies barren and is characterised by sparse

vegetation cover. The site specific vegetation/biodiversity will be identified during the study. However the scoping exercise noted that there were no endangered species at any of the proposed sites. 4.3 Socio-Economic Environment 4.3.1 Population and Demography Uganda is one of the countries with the highest population growth rates in the world. The country’s population pyramid is broad based, which is an indicator of high levels of fertility. The 2002 population and Housing Census, estimates the population of Uganda at 24.4 million people, of which 12,512,281 and 11929,803 were females and males, respectively. The sex ratio of the country was as thus 95 males per 100 females in 2002. The estimated average household size is 4.8 to 4.2 persons and 4.9 persons, in the urban and rural areas respectively (UBOS, 2005). This population is estimated to have grown to about 31, 784,600 and 32939,800 people, respectively, at an average growth rate of 3.3% per annum. Kampala is the most populous district in the country with an estimated population of 1,659,700 people by mid 2011 (UBOS, 2010). The population density of the country in 2002 was moderately high, standing at 124 persons per square kilometre. Kampala district stood out as the most dense with a rate of 211 persons per square kilometre. The population of the country is young. Children below 18 years constitute about 56 % of the country’s population This together with a significant number of orphans has created a high dependency ratio amongst the population (UBOS, 2005). There are at least 46 indigenous tribes in Uganda. While these various ethnic groups share a common African culture, there are regional differences in traditions that, among others, govern production and consumption patterns. Differences in production and consumption have varied influences on the environment depending on the region (Uganda State of Environment Report, 2006).



Figure 4.1: Population Estimates of Uganda

4.3.2 Health Infrastructure The health infrastructure of the country is relatively developed. The health delivery system is decentralised, with various levels of health facilities (NHP, 1999). The total number of health facilities in the country was 11,130, in 2010. Of these 62.3% were public, 19.2% Private for profit while 18.4% were PNFP (Private Not For Profit) (MOH, 2010). According to Health Sector Strategic Plan I (2000/01- 2004/2005) the number of health facilities by level were; 746 HC IIs, 679 HC IIIs, 127HC IVs, 87 general hospitals, 10 Regional Referral Hospitals and 2 National Referral Hospitals. The households that were living within 5 kilometers from a health facility by the beginning of the implementation of HSSP I in 2000/2001 were only 49%, but by 2004/05 the proportion had increased to 72% which demonstrated that a lot of health facilities were constructed during the implementation of HSSP I. The proportion of the population living within 5 kilometers of a health facility is however still at 72% because of the limited resource envelope. Integrated disease surveillance and response reports are used in tracking the trends of epidemic potential diseases in the country. However, timely (within 24 hours) reporting of diseases is mainly hampered by the lack of community based disease surveillance, poor communication means and lack of adequate knowledge on the part of peripheral health facility staff. Only 68% of disease outbreaks were responded to by the MOH within 48 hours between 2009-2010 (MOH, 2010). 4.3.3 Transport and communication As the number of vehicles on the roads keep rising every year, transportation has increasingly become easier. For instance, in 2005, the number of vehicles on the roads increased by 12.8 per cent compared to 9.2 per cent in 2004 (UBOS, 2005). Similarly, air transport has greatly improved with more frequent international flights. The road network is improving and the environmental effects of road construction and maintenance are lessened using the EIA guidelines for the Roads Sub-Sector and several guidelines to address other crosscutting concerns. Recently, both road and air transport have improved but rail and water transport remain poor and insufficiently developed. Considering the current statistics, Uganda in the last ten years made significant progress in improving and expanding its communication network. The most dramatic increase has been in the number of cell phone owners from few individuals since the publication of the first SOER in 1994 to currently over 1.9 million subscribers. By 2004, there were approximately 8 000 Internet subscribers from almost none in the last decade. While communications will facilitate the dissemination of environmental messages, expanded cell phone use comes with some significant environmental problems. For instance, the indiscriminate disposal of the non-biodegradable plastic air time cards including scrap phones and their parts degrades the environment.



4.3.4 Burden of disease

According to the Burden of Disease Study in Uganda (Ministry of Health, 1995), over 75% of the life years lost due to premature death were due to ten preventable diseases. Perinatal and maternal conditions (20.4%), malaria (15.4%), acute lower respiratory tract infections (10.5%), AIDS (9.1%) and diarrhoea (8.4%) together account for over 60% of the total national death burden. Others at the top of the list include tuberculosis, malnutrition (with 38% of under-5s stunted, 25% underweight for age and 5% wasted), trauma/accidents and measles. Communicable diseases account for 54% of the total burden of disease in Uganda with HIV/AIDs, tuberculosis (TB) and Malaria being the leading cause of ill health (Ministry of Health, 1999).

Apart from the heavy burden of infectious disease, Uganda is also simultaneously experiencing a marked upsurge in the occurrence of non-communicable diseases such as hypertension, cancer, diabetes, mental illness and chronic heart disease. Uganda has therefore, already entered the early phase of the epidemiological transition. While infectious diseases must be given priority, selective attention should be given to all the key determinants of ill health in Uganda, including unhealthy lifestyles, and the rising toll of accidents.

In the recent past Uganda has experienced out breaks of diseases like Ebola, Cholera and Marburg. This high burden of disease has been accompanied by poor access to health facility where by about 49% of the population, i.e. population living within five kilometers of a health service unit (Health Facilities Inventory 1992). Rural communities are particularly affected, mainly because health facilities are mostly located in towns along main roads

4.4 Project Site Specific Baseline Conditions

4.4.1 Upgrade of the NADDEC Laboratory Due to the severe outbreaks of major epizootic diseases and the need by Government to fulfil its mandate of disease control, an Animal Disease Epidemiology Unit and Veterinary Diagnostic Laboratory were established and are operated and maintained by MAAIF. The National Animal Disease Diagnostic and Epidemiology Centre (NADDEC) has been operational with the existing structure since 1995 and is composed of two blocks, one of which (Diagnostic Lab 1) accommodates the serology, haematology, microbiology laboratories and offices, while the second block (Diagnostic Lab 2) accommodates the virology, pathology laboratories, JICA storage and office, DNA lab and electrophoresis room. Other buildings include an administration block, stores and a dilapidated incinerator. The infrastructure (buildings, road, animal yard, incinerator, stores) at the Centre are in a sorry state of repair. The photos in Fig 4.1 below show some of the infrastructure at the Centre.

4.4.2 Baseline Conditions (Physical and Biophysical Environment) at the Proposed Site for the NADDEC Laboratory

The site for the construction of the HPAI diagnostic laboratory is located within the National Animal Disease Diagnostic and Epidemiology Centre, at Universal Transverse Mercator (UTM) coordinates 36 N 438331 003933 (WGS 84 (World Geodetic System 1984) in Old Entebbe Cell, Kigungu Ward, Division B, Entebbe Municipality, Wakiso District. The Center is located at about 390m off the Kampala-Entebbe road. The Figure 4.2 gives an overview of the proposed site location.



One of the diagnostic blocks at the National Animal Diagnostic and Epidemiology Centre, Entebbe

One of the Bio-safety cabinets in place

One of the Labs at the Animal Diagnostic and Epidemiology Centre

Personal Protective Equipment used when dealing with hazardous components

Figure 4.1: Infrastructure at the National Animal Disease Diagnostic and Epidemiology Centre

Figure 4.2: Overview of the NADDEC project site location



The site is bordered by diagnostic laboratories to the north and north-east, the administration block to the east at about 30m, bushy neighbourhood to the west, some staff quarters to the northwest, a livestock farm to the far south over 800m and a plane runway to the west at about 450m across Tunnel Road. The site is generally flat, gradually sloping southwards, draining into Lake Victoria, which is over a kilometer away. Figure 4.3 below shows the proposed site and its immediate environs. Detailed site plan and architectural drawings are given in Appendix A.

Figure 4.3: The NADDEC laboratory site and surrounding infrastructure 4.4.2.1 Vegetation at NADDEC Laboratory Site The project site is mainly composed of weeds dominated by Lantana camara, Bidens pilosa, Amaranthus sp and grasses such as Cynodon dactylon, Panicum maximum and Paspalum sp among others. There are a few scattered trees such as Antiaris toxicaria and Ficus natalensis identified within the site. The vegetation communities and species identified are not of any significant conservation value because they are found throughout the country.

Figure 4.4: Vegetation at the NADDEC site dominated by Lantana camara

The proposed site for construction of the HPAI Diagnostic laboratory



4.4.2.2 Geology and soils The geology of Wakiso District where the project is situated is underlain by both old and recent rock systems. These include pre-cambrian, cenozoic and laterite rocks (Wakiso, 2004). All the three major divisions of rocks i.e. sedimentary, igneous and metamorphic are represented in the region. The cainozoic rocks extend towards the Lake Victoria shores and river valleys. These include mainly swamp, alluvium and lacustrine deposits. The deposits have been laid during the period that extends from Pleistocene up to the present day. They consist of superficial strata of sand, silt, clay and pebbles alternating with one another above the present level of rivers and lakes. The predominant soil types in the area are mainly ferrallitic with sandy clay-loams as the main constituents. Geo-technical results of two test trial pits dug on the project site show that the soils are mainly silts, clays & with some gravels as you move deeper into the soil profile Fig 4.5. Allowable bearing capacities were generally low. An overall average allowable bearing capacity of 168.15 kPa was registered.

Figure 4.5: Soil types at the NADDEC site 4.4.2.3 Topography and drainage The site is generally flat, at an elevation of 1180m above sea level as taken from the Global Positioning System (GPS) readings but gradually slopes southwards with a difference in elevation of about 2m, increasing to over 42m as one moves further south. This therefore defines the natural drainage pattern within the project area, draining into the Entebbe Bay of Lake Victoria. Measures to avoid laboratory effluent discharge into the drainage channels should be ensured. 4.4.2.4 Climate The Municipality lies in the Lake Victoria Basin and has a bimodal climate with two rainy seasons between March to May and September to November. The municipality receives an average rainfall of 1820 mm and mean temperatures of 25.2oC to 26.3o C (UN-Habitat, 2010).



4.4.2.5 Baseline Noise Levels Noise measurements were taken during the study, to identify the baseline noise levels in the project area. The sound level range used was A-Lo (Lo) weighting 35-100dB and A-Hi (High) weighting 65-130dB and readings taken at intervals of 5 minutes and averaged. The instrument used has a frequency range of 30Hz-10kHz, a maximum hold of Decay<1.5dB/3min and an accuracy of ± 3.5dB at 94dB sound level, 1KHX sine wave (Environmental Meter, CEM Model). The average noise level at the project site (using both high and low weightings) was recorded at 51.2dB (A), going to over 92.4dB (A) when airplanes are taking off from Entebbe International Airport runway which about 1km away. 4.4.2.6 Waste Management at NADDEC The Centre has several activities that generate various wastes including chemical, biological, biohazard, carcinogenic, radioactive and domestic wastes. There are waste collection bins in some of the laboratories and biohazard collection bags. Carcinogenic and radioactive wastes are disposed of in an engineered waste pit, while the rest are incinerated at the dilapidated brick incineration (Fig 4.6).

Worker in PPE displaying the biohazard waste collection bags

Dilapidated brick incinerator in place

Some of the bins used to collect hazardous waste in the laboratories

Sign of previous open burning practiced

Figure 4.6: Waste management practices at NADDEC

4.4.3 The Upgrade of the National Influenza Centre The proposed upgrade of the NIC will involve an extension of the existing laboratory, which is located within the identified space and is connected to the existing Ebola laboratory. The Site Plan and Architectural Drawings are in Appendix A. The proposed site is located within the UVRI premises at UTM coordinates 439614E 8406 N in Nakiwogo Village, Virus Sub-ward, Division A, Entebbe Municipality and is bordered by the National Influenza Centre (NIC) Laboratory BSL 2 to the South, Ebola Laboratory to the north and depositary rooms/stores for freezers to the west and northwest. The BSL 3 laboratory will be constructed with a ventilation system that ensures that air is not re-circulated to other areas within the building. Air may be filtered to trap particulates, reconditioned and re-circulated within that laboratory and air-ducting systems constructed to permit gaseous decontamination as recommended by the Centre for Disease Control and Prevention (CDC).



Figure 4.7: Overview of the NIC site for the Laboratory extension The proposed site for the NIC laboratory is covered by well maintained grass and a concrete walkway connecting the NIC and Ebola labs. The walkway/ramp will be demolished and the ground cleared to allow for the proposed laboratory extension that will accommodate the Bio-safety Level-3 Lab. The geology and climate at this site is considered to be similar to that around the NADDEC since they are within the same area. The average baseline noise level taken at the site was 60.4dB (A), influenced by wind movement and fans at the air chillers installed outside the Ebola Lab block. 4.4.3.1 Topography and drainage The The global Positioning System (GPS) readings indicated that the NIC site lies at an elevation of 1205m above sea level and is generally flat, draining westwards through the existing drainage channels towards the Nakiwogo Road, and finally flowing naturally into Lake Victoria, which is only about 1km west of the site. The proposed extension may affect the drainage within the Institute Fig. 4.8. Measures to ensure continuous flow of storm water out of the facility should be ensured.

Figure 4.8: Drainage channel along the existing NIC laboratory

The block housing the NIC laboratory and site for the extension

The Ebola & Marburg laboratory

Freezers deposit store to the west



4.4.3.2 Geo-technical Results at NIC Geo-technical results show that the soils at the site are consistently very stiff. The soils are mainly silt gravels and chalk as you move deeper into the soil profile (Fig.4.9). Allowable bearing capacities were generally high. An overall average allowable bearing capacity of 338.2 kPa was registered; this is stiff enough to accommodate most building infrastructure. No water table was encountered at 3m the maximum depth of two test trail pits.

Figure 4.9: Geo technical Investigations at NIC laboratory 4.4.3.3 Waste Management at NIC (UVRI) The National Influenza Centre is a BSL 2 laboratory, with several waste bins and autoclaves used to disinfect materials before disposal. The Institute has incinerators both brick and electrical that are used to handle waste generated at the institute including the decontaminated waste from the NIC lab. The brick incinerator has a capacity of about 200kg of waste while the electrical one has a capacity of about 100kgs and operates at a temperature of up to 1200o C. There is also an ash pit where waste from the incinerators is buried. Figure 4.10 shows some of the waste management practices at the NIC/UVRI.



One of the waste collection bins in the lab

The electrical incinerator

The brick incinerator

The Ash pit in place Figure 4.10: Waste management practices at NIC/UVRI 4.4.4 The Entebbe AI Isolation Ward The isolation ward in Entebbe is proposed to be constructed at the TB isolation ward, at UTM coordinates 442672E 8072N in Kitubulu Village/Cell, Katabi Sub-ward, Division B, Entebbe Municipality. The Site Plan and Architectural Drawings are given in Appendix A. The proposed site is about 45m east of the TB ward, within a neighbourhood characterised by several sand beaches (Lake Victoria is 60m to the south), hotels and residential houses. Figure 4.11 gives an over view of the site location while Figure 4.12 shows the site’s immediate neighbourhood.



Figure 4.11: Overview of the proposed Entebbe Isolation ward site and area land use

Figure 4.12: Pictorial view of the Entebbe Isolation ward site and immediate neighbourhood.

4.4.4.1 Vegetation and drainage at the Entebbe Isolation Ward The proposed site has had its original vegetation changed through deforestation, cultivation and urban agriculture of small gardens of Musa sp, Manihott esculenta and fruit trees such as Artocarpus

Ebola isolation room within the site

Structure under construction to the south of the site

Structure bordering the site to the immediate east

The TB wards to the west of the site

Staff quarters within the TB Isolation centre



heterophylus, Mangifera indica and pawpaw. Along the access road to the south are woody plants dominated by Leonitis nepetifolia, Bidens pilosa and Amaranthus sp. Some of the trees identified along the southern boundary of the isolation unit premises include three Markhamia lutea trees and some grasses such as Cynodon sp, Pannicum maximum. The vegetation communities and species identified are not of significant conservation value and are found throughout the country.

Mixed Musa sp and manihott esculenta garden

Grass species and trees along the southern boundary

Figure 4.13: Vegetation at the Entebbe Isolation ward site The site is located at an elevation of 1147m above sea level, reducing to 1145m above sea level southwards, creating a slope of about 2m and increasing to over 6m towards the lake. This therefore defines the drainage around the area, draining into Lake Victoria located at about 65m southwards. The siting of the isolation ward should be in such a way that it is at a reasonable distance from the lake to enable effluent management and the prevention of soil erosion. The geology and climate is considered similar to that at the NADDEC since they are located within the same district. The soils at the site were found to have similar characteristics as sandy clay-loams. The baseline noise levels recorded indicated an average of 45.3dB (A) mainly emanating from birds around the site.

4.4.4.2 Geo-technical Results at the Proposed AI Isolation Ward at Entebbe Hospital Geo-technical results show that the soils at the site are consistently very stiff. The soils are mainly silts & sands as you move deeper into the soil profile (Fig.4.14). Allowable bearing capacities were generally high. An overall average allowable bearing capacity of 295.95 kPa was registered; this is stiff enough to accommodate most building infrastructure. No water table was encountered at 4.2m the maximum depth of two test trail pits.



Figure 4.14: Geo-technical investigations the proposed Entebbe Hospital Isolation Ward 4.4.5 The Isolation Ward at Mulago National Referral Hospital The site identified for the Mulago isolation unit has been used as the infectious diseases isolation centre, located within the hospital at UTM coordinates 452842E 37108N in Kimwanyi Zone, Wandegeya Parish, Kawempe Division, Kampala City Council Authority. It is composed of temporary structures used for cholera patients, make-shift toilets and a dilapidated bathroom. To the immediate north of the site is a church, a car park lot to the east, Binaisa Road/ North Kitante Road to the west and the National Drug Authority, National Drug Quality Control Laboratory to the southeast located at over 200m from the site. Figure 4.15 shows the proposed site for the Mulago Hospital Isolation Ward. The Site Plan and Architectural Drawings are given in Appendix A.



Figure 4.15: Overview of the location and neighbourhood at the Mulago Isolation Ward site 4.4.5.1 Geology and soils Except for the tiny portions underlain by recent deposits of alluvial and lacustrine formations, the rest of Kampala District is underlain by the precambrian rock system. The largest portion of Kampala District is underlain by the Basement Complex System of mainly un differentiated gneisses with some granites (NEMA, 1997). The area is generally thickly covered with ferralitic soils with no minerals and mainly Buganda catena and Kabira/Cantena and Kaku series (Kampala City Council Central Division, 2008). Background backfilling was evidenced by the stony murrum at the proposed isolation site in Mulago. Geo-technical results show that the soils at the site are consistently very stiff. The soils are mainly predominantly underlied by clays & silts as you move deeper into the soil profile (Fig.4.16). Allowable bearing capacities were generally high. An overall average allowable bearing capacity of 107.4 kPa was registered. However, it must be noted this is not parent rock (backfill) therefore when building firm ground has to be reached for building foundations. No water table was encountered at 3.0m the maximum depth of two test trail pits.



Figure 4.16: Geo-technical investigations the proposed Entebbe Hospital Isolation Ward 4.4.5.2 Climate Rainfall around the proposed site is typical of that of Kampala District. Rainfall occurs throughout the year, but follows bi-modal patterns with a long term annual average of 1180mm (Figure 2.14 ). The rainfall levels were slightly higher than the long term average during the months of March, April and May in Kampala (UBOS, 2010). The highest level was 138 mm recorded in April and the lowest was 35 mm as recorded in both January and February 2009 (Fig. 2.14).

Figure 4.17: Monthly Rainfall for Kampala in Millimetres 4.4.5.3 Temperature and Humidity Temperature of the subject area is moderate averaging between 17.6 and 28.70C (UBOS 2010). The relative humidity is highest in the month of May and lowest in January, following the temperature pattern. For Kampala, the minimum and maximum long term average humidity recorded was 53 and 89 in January and May, respectively.



4.4.5.4 Topography and Drainage The proposed site for Mulago isolation unit lies at an elevation of 1195m above sea level as indicated on the GPS readings and gradually slopes southwards towards the North Kitante/Binaisa Road at 4m difference in elevation and follows the city storm water drainage around the area ending up in the Lubigi wetland system. 4.4.5.5 Vegetation The site currently accommodates temporary infectious disease isolation structures; therefore its vegetation has been modified to grasses dominated by Pannicum maxim and Cynodon dactylon interspersed with Amanthus dubias, Bidens pilosa and Umbrella trees. The vegetation species identified are not of significant conservation value because they are found throughout Uganda.

Overgrown grass dominated by Pannicum maximum

Amaranthus dubias vegetation along the fence

Figure 4.18: Vegetation at the proposed Mulago Hospital isolation unit site 4.4.5.6 Waste Management at Mulago Hospital The National Referral Hospital, Mulago generates significant amounts of waste from its varied operations but contracted a firm, Norema Services Ltd, that cleans the hospital and collects and delivers all waste within the hospital to the incinerator. Waste sorting is practiced to a small extent especially by the medical personnel. The hospital incinerator uses both electrical and diesel handling about 2,000kg of waste per day. The new and unused incinerator would use about 80 litres of diesel per hour. There is a proposal to carry out modifications for it to use less fuel. The ash and domestic waste generated at the hospital are transported to the Kitezi Landfill. Figure 2.16 shows the incinerator and waste handling practices at Mulago Hospital.

Waste collection bins at the incinerator area

Mineral water bottles sorted out of the collected waste

Overview of the incinerator block and chimney

The existing incinerator

Figure 4.19: Waste handling practices and incinerator at Mulago hospital



5 INSTITUTIONAL ARRANGEMENTS

5.1 AHIP Implementation The 1995 Constitution devolved administrative governance in Uganda from the Central Government (the Republic) to Local Governments (Districts). The Avian and Human Influenza Preparedness and Response Project (AHIP) is implemented through these existing government structures. Responsibility for implementation of different project components rests mainly with MAAIF and MOH. These implementing agencies at central and district levels all have a vital role in planning, organizing, communication and control functions and in monitoring and evaluation processes. At the district level, while project implementation involves a number of sectoral organizations, major responsibilities for managing project activities rests with the local government in particular the District Veterinary Officer, District Health Officer and District Disaster Management Committees (DDMC’s). Overall coordination, and follow-up of the project however rests with OPM through its Department of Disaster Management.

5.2 Central Government Level At the Central Government level, the primary implementation responsibility for the project rests with three Ministries, namely Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), Ministry of Health (MOH) and Office of the Prime Minister (OPM). A Project Coordination Team (PCT), comprising senior and experienced officials nominated by the OPM, MAAIF, and MOH to serve as Focal Point Officers, has been established to implement and coordinate the project activities, including the technical components, communication, financial management, procurement, safeguards, monitoring and reporting. The focal point officer from the OPM is the Project Coordinator for the project. The PCT will be guided by a National Project Steering Committee (NPSC), comprising Ministers and Permanent Secretaries of the implementing ministries and a number of other relevant ministries/agencies. The NPSC will report to the Cabinet though the OPM. Below the NPSC, the project will have a National Task Force on Avian Influenza (NTF/AI), comprising senior technical officials nominated by the Permanent Secretaries and Heads of relevant GOU ministries and agencies. Both the NPSC and the NTF/AI have been in existence since 2006 when the NTF/AI was asked to prepare the National Plan of Action for Preparedness and Response to Avian Influenza in Uganda. The organizational chart for the project is shown in Fig 5.1 below.



Figure 5.1: The Institutional Arrangement for the AHIP

5.3 Local Government District Disaster Management Committees (DDMC’s) were established at district level with the involvement of district administration and relevant technical sectors. These district committees ensure the essential close coordination, collaboration and communication between Ministry of Agriculture and Health. The DDMC’s are at the front line of the outbreaks response at district and community level. They involve the Local Councils (LCs), the Chief Administrative Officers (CAO), the District Health Officers (DHO), the District Veterinary Officers (DVO), the Local NGOs and others sectors such as communication, education, social welfare, police, religious and community organizations. The DDCM are responsible for: • Contributing to the preparation of the plan of action for epidemic preparedness and response at district

level • Mobilizing human, material and financial resources for epidemic prevention and control • Coordinating the implementation of the plan of action • Coordinating public information and education during outbreaks/epidemics • Guiding the implementation of outbreak/epidemic control actions • Coordinating assistance for epidemic prevention and control from various partners.

National Project Steering Committee

OPM, MAAIF, MOH, MTTI, URA, MOIA, MOLG, Poultry Association

of Uganda

Rt. Hon. Prime Minister

Project Coordination Team: OPM (Depts. Of Disaster

Management & Refugees; Information; and Coordination &

Monitoring) MAAIF & MOH

National Task Force on Avian & Human Influenza

(NTF/AI)



6 PUBLIC CONSULTATION AND DISCLOSURE

6.1 Rationale The World Bank Safeguard such as OP/BP 4.01 on Environmental Assessment, The National Environmental Act, Cap 53, the EIA Regulations S.I. 153-1 National Environment (Certification and Professional Conduct of Environmental Practitioners) Regulations (2003) and Guidelines for EIA in Uganda; require that individuals, groups and entities with a stake in any proposed project should not only be informed about the proposed project but also consulted for their views about the likely impacts and any other concerns about the proposed project. In conformance with the above regulations, a stakeholder analysis was conducted. The identified stakeholders were derived from micro, meso and macro levels. These included communities neighbouring the proposed project sites; membership associations; small, medium and large scale commercial units whose activities are related to the theme of the proposed project; civil society organisations whose mandate is related to the proposed project; resourceful persons/ technocrats working within public institutions and multilateral institutions with a stake in the proposed project; and a few district officials under whose jurisdiction the proposed project activities fall. The specific individuals, groups and institutions that were contacted during the consultation process include: - WHO, FAO, ACODE, Nature Uganda, UVA, UMA, UNFF, UPA, NDA, UWA, the DMO, DEO and DVO of Kampala District, Ugachick Poultry Breeders Limited, a small scale urban backyard poultry farmer, a free range poultry farmer, the community of Kimwanyi Zone, Katanga, Entebbe Sailing Club and residents living close to the proposed project sites. Details of stakeholders’ views and a list of the people that were consulted are provided in Appendix A.

6.2 Approach and methodology The major objective of the public disclosure and consultation process was to provide insights on the views and concerns of the key stakeholders with regard to the proposed project activities. The consultation and disclosure process was conducted within the qualitative approach framework. The flexibility of the qualitative approach enabled the Consultant to gain deep insights in to the views, concerns and feelings of the various stakeholders. All the stakeholders were selected purposively. The main modes of data collection that were employed during the process were key informant interviews, Focus Group Discussions (FGD) and informal conversational interviews (Burke and Larry, 2000; Neuman, 2004). For purposes of disclosing the findings of the Environmental Impact Assessment process, a half day workshop was organised for key stakeholders. The participants in the workshop were selected purposively. During the workshop, the stakeholders were given opportunity to interact with the EIA consulting team not only to seek clarifications about the findings of the EIA study but also to input more views about the proposed projects.

6.3 Stakeholders’ views of the project impacts 6.3.1 Positive Impacts Employment opportunities Stakeholders at community level, expect several employment opportunities (both technical and casual) at the construction and operational phases of both the laboratories and isolation units. Several community members expect to benefit from the anticipated job opportunities. One key informant noted that the MAAIF National Animal Disease Diagnostic and Epidemiology Centre is understaffed. He expects the ministry to employ more technicians for purposes of enhancing the effective and efficient utilisation of the new facilities. Easy access to quality services Stakeholders at community level, who are residing or working close to the proposed sites for the isolation units, expect to access the services easily, when the need arises. Those who often utilise laboratory services such as the Veterinary and Medical doctors expect to access quality services domestically without having to send samples abroad. Improved disease surveillance, response and management Key resource persons at district and national levels perceive the proposed projects as landmarks in the process of building the capacity of the country to manage Avian and Human Influenza outbreaks. The



laboratories are expected to reinforce disease surveillance and to facilitate the reduction of the time lag between detection and response to disease outbreaks in the country. Currently concrete actions in case of a disease outbreak have to await the results from confirmatory tests from samples sent to international referral laboratories outside the country. The isolation units on the other hand are expected to improve the management of highly pathogenic diseases in the country, in cases of outbreaks. Some stakeholders expect them to be very effective in curtailing the spread of infections. Cost reduction The proposed upgrade of laboratories to Bio-safety level 3 is expected to result in the reduction of costs incurred by groups, institutions and the nation at large in the process of seeking for more advanced tests of samples from international and regional referral laboratories. Several key informants noted that samples are usually sent to Nairobi, South Africa, Netherlands, USA and Spain before any disease outbreak is confirmed. This process is estimated to cost about 2000 US dollars per sample. Improved ambience of the area Residents of the veterinary quarters of the MAAIF National Animal Diagnostic and Epidemiology Centre expect the project to uplift the outlook of the area. The existing laboratories are considered to be in a sorry state of disrepair. Some residents argued that the new structure would persuade the management of the diagnostic and epidemiology centre to invest more resources in the compound which they considered bushy and neglected. The proposed isolation unit at Mulago National Referral Hospital will provide more permanent and quality services to the affected individuals. It is also expected to increase the ambience of the site that is filled with makeshift temporary structures that render it rugged in appearance. Security of tenancy Some of the residents of the veterinary quarters of the National Animal Diagnostic and Epidemiology Centre attribute their residence to the existence of this unit. The latter perceive the proposed new laboratory as an assurance that they will stay much longer without being antagonised by CAA. Increased awareness about Avian and Human Influenza The proposed projects are expected to facilitate the sensitisation of the neighbouring communities and the country at large about the symptoms, risks and prevention measures of Avian and Human Influenza. The current level of awareness among the local populace and the larger expanse of institutional staff of the stakeholder institutions that were consulted is reported to be still very low. The stakeholders expect to benefit from sensitisation workshops and IEC materials that will be displayed at the proposed units. 6.3.2 Negative impacts Health risks to the surrounding communities Community members residing or working within the vicinity of the proposed sites for the isolation units expressed concern that the isolation units would expose them to the highly pathogenic infections that are the target for the proposed isolation units. Some of them perceive the proposed sites as not ideal for the location of the proposed projects, due to their proximity to inhabited neighbourhoods. Some residents reported that they utilise the footpath close to the proposed site for the isolation unit at Mulago, to access the hospital easily. In their opinion they risk contracting the infection if the isolation unit is built. The management of the National Quality Control Laboratories of NDA, also considers the location of the isolation unit at Mulago as inappropriate. In their opinion the proposed site puts the health of the staff and patients within the hospital, the community of Kimwanyi Zone and the staff of NDA at risk. Environmental pollution The poor management of wastes from both the isolation units and laboratories is expected to culminate in to the release of highly pathogenic wastes in to the environment. This may pose health risks to the workers, patients and surrounding communities. The poor management of chemicals (with regard to disposal and storage) within the laboratory is expected to result in to inconveniences to the surrounding communities. Security threats The poor management of samples in the laboratories may facilitate bio-terrorism activities that are a threat to the security of the nation and world. Some stakeholders indicated that cases of bio-terrorism have been noted in countries such as USA.



Exposure to Occupational hazards Some stakeholders noted that the poor management of samples and wastes in both the laboratories and isolation units and poor facilitation of the employees in both units with standard operating gadgets will expose the workers to occupational hazards. Such incidences are expected to compromise the health of the employees. Exclusion of the poor from the services Some stakeholders expect the services of the isolation units to be costly and therefore prohibitive for patients in the lowest wealth quintile. This view was based on their experiences with the services of Mulago National Referral hospital, which are supposed to be free, but are not really free. Such people are ultimately expected to be excluded from the services offered within the isolation units. The Consultant however made it very clear that all contagious disease outbreaks nationally and internationally are treated free of charge. Noise This is expected to be more of a threat during construction. Residents currently living close to existing laboratories cited no cases of inconvenience from the operations of these laboratories. Disincentive to residence in the area Some of the stakeholders residing and working close to the proposed site at Entebbe Hospital isolation ward, expressed anxiety over the likelihood that the risks associated with the proposed isolation ward may discourage many people from settling in the area or utilising businesses located close to the site, to the detriment of land owners and entrepreneurs in the area. They noted that similar effects had ensued from the installation of the TB isolation ward in the area.

6.4 Proposed measures to minimise the identified negative impacts The respondents proposed a number of strategies to mitigate the expected negative impacts. These include the following: reinforcement of bio-safety and bio-security within the laboratories; installation of modern waste management facilities at the proposed units; training of staff handling wastes to enhance effective management and reduction of risks; effective and appropriate storage of laboratory chemicals; fencing off of the isolation units to minimise exposure of pathogens to the surrounding communities; extensive and regular sensitisation of the masses about the symptoms and preventive measures of avian and human influenza and good poultry rearing practices; relocation of the proposed isolation units to uninhabited areas; and the enforcement of compliance to existing standards and guidelines for the operation of the proposed facilities.

6.5 Other concerns These largely focused on issues related to the management of the projects and were mainly derived from the various stakeholders’ experiences with other government projects. They included questions about the availability of ambulances at the isolation facilities; relegation of duties to students on internship by senior staff; the likelihood that the units may be diverted to other uses, rather than the intended one; the likely neglect and delays in the treatment of patients within the isolation units. The stakeholders generally perceive the proposed projects as potential sources of several benefits, provided the requisite measures to mitigate the anticipated negative impacts and address the identified concerns are implemented effectively. Details of stakeholders’ views and a list of the people that were consulted are provided in Appendix A.

6.6 Specific Concerns from National Drug Quality Control Laboratory The National Drug Quality Control Laboratory (NDQCL), which is a department of the National Drug Authority, raised pertinent issues with regard to the construction of the proposed Isolation Ward at Mulago National Referral Hospital. The opinion of the management of the Laboratory is that the proposed site is not an appropriate location for a unit that is expected to handle highly pathogenic diseases. Their opinion is premised on the view that the proposed site is located close to the Katanga slum which is a densely populated area; a hospital with patients whose immunity is compromised and key institutions such as NDA, which employ highly technical staff whose role, is critical to the functioning of the country’s health service. In their submission they argue that AI is airborne and sewage from the Isolation Ward passing through their compound is likely to expose them to AI infection (see Appendix D) and a reply is given in Appendix E. As explained in Appendix E AI is not air borne. For infection to take place one has to come in direct contact with droplets or secretions containing viral loads of the virus. The construction and operation of an Isolation



Ward with negative pressure and a vent fitted with filters through which air exits will mitigate the perceived threat. Sewage from the Isolation Ward should be disinfected through three containment chambers. The first chamber will have chlorine dosed into the sewage; the second chamber will be a contact tank to allow enough time for the chlorine to disinfect the sewage. The third chamber will be a correction chamber to restore the pH of the sewage before its release into the public sewer that passes through NDQCL compound.

6.7 Disclosure of the Draft ESMP/EIA Report A half-day workshop was held on 26th September, 2011 at Hotel Africana to facilitate the dissemination of the information gathered by the EIA team during the Environmental Impact Study to the key Stakeholders. The participants in the workshop were generally satisfied by the findings that were presented in the draft EMSP/ EIA report. They however considered some sections of the report inconsistent, weak and shallow in depth. These included the recommendations for carcass disposal, incineration, mitigation measures, recommendations, site-specific baseline indicators and the specific views expressed by Stakeholders consulted during FGDs and interviews. The Workshop Participants requested the EIA Team to provide more comprehensive information and concrete recommendations with regard to appropriate types of incinerator(s) and carcass disposal options. They also asked the Team to incorporate the baseline indicators of the project sites in the report, edit the inconsistencies, incorporate some international treaties that Uganda has ratified in the legal section of the report and include more statistical evidence to give a more empirical background to the project and the Environmental Impact Study. The Workshop Participants recommended the isolation wards should accommodate other infectious disease like cholera. typhoid, ebola and marburg. The Workshop Participants generally perceived the proposed projects as potential sources of several benefits to the country. Nevertheless, for the expected benefits to be accentuated the requisite measures to mitigate the anticipated negative impacts and address the identified concerns should be proactively and effectively implemented by the responsible parties. Details of the stakeholders’ views collected before the workshop and a list of the people that were consulted are provided in Appendix B.



7 IMPACTS, MITIGATION AND ENVIRONMENTAL MANAGEMENT PLAN

It is anticipated that this project will have both positive and negative environmental impacts. The identified impacts and ranking is given below.

7.1 Impact Identification, Quantification and Ranking Impact identification, quantification and ranking are the essence of an EIA. In this ESMP/EIA project impacts were analysed for their significance. They were ranked according to the Rapid Impact Assessment Matrix developed by Christopher M. R. Pastakia of VKI, Horsholm, Denmark (Pastakia, 2004). The Ranks range from -5 to +5 and are given in Table 7.1. Table 7.1: Impact Ranking according to the Rapid Impact Assessment Matrix

No. Impact Rank

Rank Description of the Rank

1 +5 Major positive change/impact A ‘major change’ will occur at a point when the condition extends to a regional/national boundary and is of major importance. Such a change would also be permanent, irreversible, though it could be non-cumulative.

2 +4 Significant positive change/impact The lower limits of ‘significant change’ can be taken as the point when a condition is outside local boundaries but is of major importance, yet is temporary, reversible and non-cumulative.

3 +3 Moderate positive change/impact A condition of moderate change will lie between the limits of ‘change’ and ‘significant change’.

4 +2 Positive change/impact A condition of ‘change’ will occur up to a condition of local importance with significant magnitude, which is permanent, irreversible and cumulative.

5 +1 Slightly positive change/impact A condition that is local in importance and a slight change from the status quo, yet is permanent, irreversible and cumulative, represents the upper limit of the ‘slight change’ condition.

6 0 No change/status quo Conditions that have neither importance nor magnitude will score a zero, and can be banded together. Any condition in this band is either of no importance, or represents the status quo, or a no change situation.

7 -1 Slightly negative change/impact A condition that is local in importance, and a slight change from the status quo, yet is permanent, irreversible and cumulative, represents the upper limit of the ‘slight change’ condition.

8 -2 Negative change/impact A condition of ‘change’ will occur up to a condition of local importance with significant magnitude that is permanent, irreversible and cumulative.

9 -3 Moderate negative Change/impact A condition of moderate change will lie between the limits of change’ and ‘significant change’.

10 -4 Significant negative change/impact The lower limits of ‘significant change’ can be taken as the point when a condition is outside local boundaries but is of major importance, yet is temporary, reversible and non-cumulative.

11 -5 Major negative change/impact A ‘major change’ will occur at a point when the condition extends to a regional/national boundary and is of major importance. Such a change would also be permanent, irreversible, though it could be non-cumulative.

7.2 Positive Impacts The project will tremendously improve Uganda’s institutional capacity to prepare and respond to Avian Human Influenza outbreaks. The project has used lessons learnt from Uganda’s experience in handling other contagious diseases like Ebola, Marburg and Cholera to strengthen its capacity. This impact is ranked as +5, Major positive change/impact. The project will enable Uganda to set up an elaborate functional implementation mechanism and administrative apparatus that meets the standards of the World Organization of Animal Health (OIE) in the control of zoonotic diseases and World Health Organization in the control of infectious human diseases. This impact is ranked as +5, Major positive change/impact. Avian Influenza laboratories at the National Animal Disease Diagnostic and Epidemiology Centre, Entebbe and Uganda Virus Research Centre, National Influenza Centre, Entebbe will be upgraded from BSL 2 to BSL 3. This means Uganda will no longer need to send some of the samples outside the country for AI confirmatory tests. This impact is ranked as +5, Major positive change/impact. Uganda lacks modern isolation hospital wards for the containment of air borne contagious diseases. The project will build ultra modern wards, which will replace the open-air isolation ward at Mulago National Referral Hospital and build a new ward at Entebbe General Hospital. This impact is ranked as +5, Major positive change/impact.



The project will facilitate advocacy for and public awareness about the disease. It is anticipated that with the level of awareness increased the public will easily detect the disease at the farm and personal infection level. This will enable immediate intervention by veterinary and healthcare personnel before the disease spreads. This impact is ranked as +5, Major positive change/impact. The project will reinforce the risk assessment capacity of both public and private veterinarians in high-risk districts in the detection , prevention, containment and treatment of the disease. This impact is ranked as +5, Major positive change/impact. The project will improve the technical competence of the National Veterinary Services (NVS) staff in the emerging and re-emerging zoonotic diseases preparedness, detection and control departments. This impact is ranked as +5, Major positive change/impact. The project will build the capacity of healthcare workers in AI infectious disease detection, prevention and control in regional referral hospitals, District Rapid Response Teams (DRRT) and develop a training manual for disease outbreak surveillance, preparedness and control. This impact is ranked as +5, Major positive change/impact. The project will provide funds for the regular inspection of the market and monitoring of zoonotic diseases and enforcement of market hygiene regulations in Uganda. This impact is ranked as +5, Major positive change/impact. Food Safety Guidelines for Prevention and Control of AI and other Zoonoses of Public Health Concern in Uganda will be prepared to contribute to the improvement in personal and environmental hygiene in the poultry vending sector. The guidelines will also address, inter alia, the issue of standard handling procedures and best practices in food hygiene, safety and waste management. This impact is ranked as +5, Major positive change/impact.

7.3 Negative Environmental Impacts The implementation of AHIP is divided into two stages: - (i) Preparedness and Prevention; and (ii) Response and Recovery. No significant negative impacts were identified at the Preparedness Stage. However, significant impacts were identified at the Prevention, Response and Recovery Stages. The major environmental impacts are related to the construction of BSL 3 laboratories, quarantine spots and isolation wards; disposal of expired drugs; and the exposure of the public, animal and human healthcare providers to viral agents through contamination and cross contamination. Further, environmental impacts were identified at the culling, transportation and disposal of both poultry and wild birds during AI outbreaks, decontamination of facilities, laboratory bio-safety and bio-security. The detection of the disease outbreak, isolation and treatment of patients poses a great risk to the spread of the disease. Other negative impacts will arise from project vehicles and computers. These will release green house gases, petroleum waste, solid waste, electronic waste and electromagnetic fields, respectively. Site specific impacts are mainly associated with the construction phase activities leading to increased noise and dust emissions which could become a nuisance to the neighbouring communities at the respective sites, loss of vegetation, erosion of exposed loose soils which could lead to siltation of sensitive receptors and/or blockage of drainage channels, handling and disposal of generated debris from demolitions, sanitary waste disposal, effects on the structural integrity of the existing structures at the NIC/UVRI on which the proposed structures are to be attached and occupational hazards during construction. The identified negative impacts are given in the Environmental Management Plan in Table 7.2 below.

7.4 Negative Environmental Impacts for Project Specific Activities • Activities under Sub Component 1.1 Strengthening Capacity for Animal Health Surveillance,

Monitoring and Emergency Disease Control pose a very big threat to the staff who will be involved in investigating wild bird deaths and poultry die-offs. Staffs are susceptible to viral infection by either contamination or cross contamination. This impact is ranked as -5 a major negative impact. Poor laboratory management at the onset of the viral epidemic may lead to viral infection of laboratory staff either through contamination or cross contamination. This impact is ranked as -5 a major negative impact.



• The construction of a new infrastructure at NADDEC is one of the activities under Sub-component

1.2: Strengthening of National Veterinary Services (NVS) which is likely to have negative environmental impacts. These impacts include construction noise, dust, vegetation clearance/removal, construction debris/litter, exhaust fumes (particulate matter, green house gases), soil erosion and accidents. The production of exhaust fumes from the combustion of fossil fuels will produce green house gases, which will lead to the green house effect, which will then add to the global warming phenomenon and ultimately cause climate change is classified as a -5 major impact. The other impacts are small and localised and are classified as -1 slightly negative impacts.

• Implementation of an active HPAI surveillance program and upgrading of laboratories at NADDEC

are the two activities under Sub-component 1.4: A Balanced Veterinary Epidemio-surveillance Programme Capable of early Detection of Emerging Infectious Diseases and other TADs that are likely to have negative environmental impacts. An active HPIA surveillance program involves the integration of ARIS and WAHIS in wild birds, markets, small holder systems and high risk border areas into the overall national surveillance system. This route surveillance will expose both field and laboratory staff to viral infection through contamination and cross contamination. It is -5 major negative impact.

The upgrading of laboratories at NADDECwill involve the demolition, rehabilitation and remodelling of existing laboratories. These activities are construction related hence it is anticipated there will be construction noise, dust, vegetation clearance/removal, construction debris/litter, exhaust fumes (particulate matter, green house gases), soil erosion and accidents. The production of exhaust fumes from the combustion of fossil fuels will produce green house gases, which will lead to the green house effect, which will then add to the global warming phenomenon and finally cause climate change is classified as a -5 major impact. The other impacts are small and localised and are classified as -1 slightly negative impacts.

• Subcomponent 1.5: Evidence-Based Veterinary Rapid Response Capacity for Emerging Infectious Diseases Preparedness, Detection and Control has an activity on the Strengthening Veterinary Services (VS) quarantine capacity. This activity involves construction of quarantine areas where animals may be held as tests are carried out to confirm if the animals are infected. The activities in this sub component are construction related hence it is anticipated that there will be construction noise, dust, vegetation clearance/removal, construction debris/litter, exhaust fumes (particulate matter, green house gases), soil erosion and accidents. The production of exhaust fumes from the combustion of fossil fuels will produce green house gases, which will lead to the green house effect, which will then add to the global warming phenomenon and finally cause climate change is classified as a -5 major impact. The other impacts are small and localised and are classified as -1 slightly negative impacts.

• Activities under Sub-Component 1.7 Part 2: Response and Recovery are undertaken once an

outbreak is confirmed. Details of the specific activities are given in Table 7.2. The main subdivisions are two and are give below: -

(i) Immediate reaction to an outbreak. This involves performance of an out break investigation and sampling to verify the rumour of the disease outbreak in the suspected outbreak places, collection of infectious samples and transportation to NADDEC laboratories for test and laboratory analysis for outbreak confirmation. Any mistake made during the performance of these activities will expose the virus to staff, the public, wildlife, poultry and the environment through contamination and cross contamination. Once the virus is in the environment its ability to spread and cause havoc is imminent and the impacts are classified as -5 major impacts.

(ii) Immediate sanitary measures of confirmed outbreak activities include collection and disposal of wild birds, culling of infected birds, transportation of infective materials and dead birds, disposal of farm waste (manure, eggs, feathers and contaminated equipment), decontamination and disinfection and operating quarantine centres. All these activities are carried out in the full knowledge that the



virus does exist. Any mistake may lead to contamination and cross contamination hence exposing the virus. The impact of these activities is classified as -5 major impacts.

• Activities under Sub-Component 2.1: Strengthening of Surveillance of humans for influenza that

have negative environmental impacts include the (i) the expansion and strengthening of sentinel sites for surveillance and (ii) strengthening of laboratory diagnostics. These activities expose health care providers and laboratory staff to the AI virus and any mistake may lead to contamination and cross contamination. Once the virus spreads, its impact may lead to an outbreak of the disease hence this impact is classified as a -5 impact.

• The strengthening and upgrading of laboratory facilities at the National Influenza Centre (NIC) of the Uganda Virus Research Institute (UVRI) is the activity under Sub-Component 2.2: Strengthening the Capacity of the Uganda National Health Research Organization that will have negative environmental Impacts. It will involve the construction/ extension of the laboratory. These activities are construction related hence it is anticipated there will be construction noise, dust, vegetation clearance/removal, construction debris/litter, exhaust fumes (particulate matter, green house gases), soil erosion and accidents. The production of exhaust fumes from the combustion of fossil fuels will produce green house gases, which will lead to the green house effect, which will then add to the global warming phenomenon and finally cause climate change is classified as a -5 major impact. The other impacts are small and localised and are classified as -1 slightly negative impacts.

• The activity of setting up isolation facilities at Entebbe Hospital and Mulago National Referral

Hospital under Sub-Component 2.3: Consolidation of preparedness for AHI Prevention, Containment and Control will have negative environmental impacts. It will involve the construction of ultra modern isolation wards. These activities are construction related hence it is anticipated there will be construction noise, dust, vegetation clearance/removal, construction debris/litter, exhaust fumes (particulate matter, green house gases), soil erosion and accidents. The production of exhaust fumes from the combustion of fossil fuels will produce green house gases, which will lead to the green house effect, which will then add to the global warming phenomenon and finally cause climate change is classified as a -5 major impact. The other impacts are small and localised and are classified as -1 slightly negative impacts.

• Regular medical examination and certification of poultry vendors under Sub-Component

2.4:Improving Food Safety and Environmental Hygiene is likely to generate health care waste that may be infectious if poorly handled. The spread of the virus may result into an epidemic. The impact is ranked as -5 major impact.

• Sub-Component 2.6: Preparation for Effective Case Management involves creating and

strengthening surge capacity of government and private hospitals to handle increased patient load and ensuring availability of pharmaceuticals (tamiflu and other antibiotics). The stocking of pharmaceutical products may reach their expiry dates if there is no epidemic. Their disposal may be an environmental hazard. The impact is ranked as -2 impact.

• Activities under Sub-Component 2.8: Part 2: Response and Recovery are the most precarious.

This is when it is confirmed that there is an outbreak. Activities that may expose the virus include the detection of the first outbreak, isolation and treatment of patients, quarantine and restriction of movement of people and burial of victims. The greatest risk of the virus spreading may be due to contamination or infections caused by viral agents due to poor management of infectious health care wastes and laboratory wastes. This impact is ranked as -5 impact.

7.5 Mitigation Measures Most of the key potential negative environmental impacts identified above can be avoided or minimized by integrating environmental and public health safety aspects in the preparation/design and implementation of project activities as elaborated in Table 7.2 below. Some of the recommended mitigation measures include: -



∗ Implementation of good construction practices by the contractors to ensure minimal impairment on air quality, minimal noise and disruption of activities within the respective site neighbourhood especially since all the sites are in sensitive areas. Good construction practices should be based on: -

(vi) FIDIC, the International Federation of Consulting Engineers (the acronym stands for the French version of the name) represents the global consulting engineering industry and promotes internationally accepted construction standards for works – details can be found at http://www.fidic.org/.

(vii) The Building Rules and Regulations of the Public Health Act Cap 281 (viii) Appendix E: General Conditions for the Contractor (ix) Appendix F: Occupational and Safety Management Plan (x) Kampala Capital City Authority and Entebbe Municipal Council building approval

permits. ∗ Construction activities should be restricted to day-time hours only, to avoid inconveniencing the

neighbouring residents and road users; ∗ Vegetation clearance is recommended since the species found in the project sites are found all

over Uganda and have no conservation value. However, clearance should be limited to the required construction area to limit the extent of vegetation loss and soil exposure. Furthermore landscaping, planting of trees and grass should be done to enhance the scenic beauty of the project sites;

∗ Construction activities will be controlled to ensure that emitted noise meets the permissible levels provided for in the First Schedule of the National Environment (Noise Standards and Control) Regulations 2003. The Table 7.2 provides for levels permissible at construction sites.

Table 7.2: Maximum Permissible Noise Levels for Construction Site Column 1 Column 2 Facility Maximum noise level permitted (Leq)

in dB (A) Day Night

(i) Hospital, schools, institutions of higher learning homes for the disabled, etc

60 50

(ii) Buildings other than those prescribed in paragraph

75 65

∗ Proper handling of generated debris and associated waste during construction/demolition. These

wastes should be disposed to designated sites approved by Kampala Capital City Authority and Entebbe Municipal Council. Proper handling may include but not limited to the following: -

(v) Sort waste by type (vi) Proper storage to avoid scattering/littering on the project sites (vii) Recycle waste that is reusable (viii) Covering disposal trucks to prevent scattering of waste while en-route to the dump

site; ∗ Minimize dust generation during construction works by applying dust control measures including

sprinkling water on the bare ground of the project site after soil excavation is undertaken; and, ensure that trucks ferrying gravel/soil are properly covered with tarpaulin material, in order to limitdust nuisance and littering in the immediate neighbourhood.

∗ Good housekeeping and short storage duration are the best ways to avoid vector attraction. Access to disposal sites should be restricted to keep people from stealing carcasses of dead infected poultry;

∗ The facilities, especially isolation units, should be well sited in such a way as to minimise public exposure. The facilities should be designed in accordance with international standards.

∗ Thorough decontamination of trucks and equipment used in disposal operations. The disinfectants (soaps and detergents) used should be bio-degradable and should be disposed of in a safe manner. Transport distances should be minimal and loads must be covered to minimize the risk of virus spread;



∗ Biosafety in a BSL 3 laboratory needs a Class III Bio Safety Cabinet (Figure xx) that has the following specifications as recommended by the U.S. Department of Health and Human Services et al 2009: - (i) A gas-tight (no leak greater than 1x10-7 cc/sec with 1% test gas at 3 inches pressure Water Gauge enclosure with a non-opening view window; (ii) Access for passage of materials into the cabinet should be through a dunk tank, that is accessible through the cabinet floor, or double-door pass-through box (e.g., an autoclave) that can be decontaminated between uses. Reversing that process allows materials to be removed from the Class III BSC safely; (iii) Both supply and exhaust air should be HEPA filtered on a Class III cabinet. (iv) Exhaust air must pass through two HEPA filters, or a HEPA filter and an air incinerator, before discharge directly to the outdoors. Class III cabinets should not be exhausted through the general laboratory exhaust system. Airflow is maintained by an exhaust system exterior to the cabinet, which keeps the cabinet under negative pressure (minimum of 0.5 inches of water gauge). Depending on the design of the cabinet, the supply HEPA filter provides particulate-free, albeit somewhat turbulent, airflow within the work environment. Laminar airflow is not a characteristic of a Class III cabinet; (iii) Long, heavy-duty rubber gloves are attached in a gas-tight manner to ports in the cabinet to allow direct manipulation of the materials isolated inside. Although these gloves restrict movement, they prevent the user’s direct contact with the hazardous materials. The trade-off is clearly on the side of maximizing personal safety.

Figure 7.1: The Class III Bio Safety Cabinet

(A) glove ports with O-ring for attaching arm-length gloves to cabinet; (B) sash; (C) exhaust HEPA filter; (D) supply HEPA filter; (E) double-ended autoclave or pass-through box. Note: A chemical dunk tank may be installed which would be located beneath the work surface of the BSC with access from above. The cabinet exhaust needs to be hard connected to an exhaust system where the fan is generally separate from the exhaust fans of the facility ventilation system. The exhaust air must be double HEPA-filtered or HEPA-filtered and incinerated.



∗ AI diagnostic laboratories should have biosecurity measures designed to prevent the loss, theft, misuse, diversion or intentional release of pathogens and toxins (U.S. Department of Health and Human Services 2009; WHO, 2004). The following are expected of a good laboratory biosecurity system: - (i) A qualitative risk assessment to define risks that a security system should protect against; (ii) A defined acceptable risks and incidence response planning parameters; (iii) A securely locked building when unoccupied; (iv) Doors and windows should be break-proof; (v) Rooms containing hazardous materials and expensive equipment should be locked when unoccupied; (vi) Access to rooms, equipment and materials with hazardous materials should be controlled and documented (WHO, 2004).

∗ Disinfection of generated waste will minimise the possibility of infection and/or pollution at the disposal facility;

∗ In order to avoid contamination and cross contamination appropriate investigative methods should be used in the collection of samples and laboratory analysis. Participating laboratories should develop their own SOPs along those recommended by (WHO, 2004) listed below: -

(i) Safe handling of specimens; (ii) Good methods of using pipettes and pipetting aids; (iii) Avoiding the dispersal of infectious materials; (iii) Use of biological safety cabinets; (iv) Avoiding ingestion of infectious materials and contact with skin and eyes; (vi) Avoiding injection of infectious materials; (vii) Good methods of separation of serum; (viii) Good methods of using centrifuges; (ix) Good methods of using homogenizers, shakers, blenders and sonicators; (xi) Good methods of using tissue grinders; (xii) Care and use of refrigerators and freezers; (xiii) Opening of ampoules containing lyophilized infectious materials; (xiv) Storage of ampoules containing infectious materials; (xv) Standard precautions with blood and other body fluids, tissues and excreta; (xvi) Precautions with materials that may contain prions.

∗ Ensure that adequate and appropriate Personal Protection Equipment (PPE) is provided and its use should be supervised.

(iii) Appropriate PPE for construction should include safety helmets, latches, hand gloves, overalls, gumboots, nose masks and earmuffs, eye goggles etc,

(iv) Appropriate PPE for handling viral agents should include but is not limited to gumboots, coveralls- disposable, clean non sterile gloves, fluid resistant gowns, fluid resistant apron/mackintosh, N95 respirator mask, eye protection/face mask /goggles, side shields etc (WHO, 2004);

∗ The incinerators must meet the incineration temperatures above 800oC where dioxins and furans

are destroyed. The location of incinerators should be close to the isolation wards and BSL 3 labs so as to reduce the distance of disposal in order to eliminate contamination en-route to the incinerator. The stack height should meet guidelines for Good International Industrial Practice (GIIP) and emissions from the incinerator should comply to air quality standards set by NEMA;

∗ Wastewater from BSL 3 laboratories and isolation wards should be pre-treated before it is discharged into public sewers. A three-treatment chamber process is recommended. The first chamber should have chlorine dosed into it. The second chamber should be a contact tank to allow enough time for chlorine to disinfect the wastewater. The third chamber should be a pH correction tank before the wastewater is discharged into a public sewer Appendix G.

∗ Public awareness and education of the disease and its consequences to both human and animal health should continue throughout the project lifecycle. This would reduce the possible public outcry at the culling and disposal of infected poultry. Disposal sites should be secured and restricted;

∗ Gaseous discharge from vehicles that include green house gases, smoke, particulate matter can be mitigated by gas filters, catalytic converters and the use of non lead fuel;



∗ Computer impacts like electronic waste should be handled by NEMA licensed waste handlers and low electromagnetic emission computers with screens should be procured to protect users from electromagnetic exposure;

∗ Infectious waste and solid waste should be handled by NEMA licensed waste handlers; ∗ The diagnostics laboratories (both at NADDEC and NIC) should be designed to meet the

requirements of Bio-safety Level-3 laboratory. The designs should be based on standards recommended by Centre for Disease Control and Protection (CDC) for the case of medical laboratories; World Health Organisation (WHO) and World Organisation of Animal Heath (WOAH) for the case of animal laboratories. The following should be incorporated in the project set-up: -

(vii) Provision of double-door zone and sealed penetrations, (viii) Provision of ventilation system that ensures the air is not re-circulated to other

areas within the building and that filters are installed to trap particulates which allow for re-conditioning and re-circulation of air within the laboratory,

(ix) Install double filtration systems, that is, high efficiency particulate air (HEPA) filter to prevent the spread of airborne contaminants and to allow only clean un-contaminated air out of the bio-safety cabinets,

(x) Provision of fire escape routes, fire detection and fire suppression equipment, (xi) Provision of first aid kits and equipment with first aid instructions which should be

posted in a visible and easily accessible location for use in case of emergency treatment,

(xii) Provision of baths on strategic entrances to the laboratories.

Table 7.3 below gives some of the recommended design features for the proposed BSL 3 laboratories, while Figure 7.2 is a graphical image of a typical BSL-3 laboratory. Table 7.3: Some of the recommended design features for BSL3 Laboratory

Source: Reno et al (2008). Bio-safety in Microbiological and Biomedical Laboratories; 51st Annual Biological Safety Conference, American Biological Safety Association October 22nd, 2008.)



Figure 7.2: A typical Bio-safety Level 3 laboratory (The laboratory is separated from general traffic flow and accessed through an anteroom (double door entry or basic laboratory). An autoclave is available within the facility for decontamination of wastes prior to disposal. A sink with hands-free operation is available. Inward directional airflow is established and all work with infectious materials is conducted within a biological safety cabinet (WHO, 2004).

∗ Household-based quarantine and case isolation should be undertaken to limit morbility of the virus and hence the mortality rate;

∗ Movement of affected patients, housekeeping and use of adequate protection should be emphasised;

∗ The design of the isolation units should meet the following design criteria as set out by Yuguo et al (2007):

§ Maintain similar air temperature and pressure between adjacent areas in the ward to prevent the transfer of air and infectious agents to prevent bi-directional air flow;

§ Frequently replace or remove exhaust filters to ensure negative pressure is maintained in patient rooms (i.e., air flows into but not out of patient isolation rooms);

§ Prevent uneven exhaust patterns in isolation rooms with more than one bed which may result in the transfer of infectious agents from one patient to another;

§ Transfer air diffusers placed away from exhaust grilles to ensure proper system performance;

§ Encourage regular maintenance checks to ensure that isolation ward airflow direction and air exchange rates are functioning properly.

§ Provision of natural day and night-lighting system that is adequate, to safeguard the health and safety of the workforce and patients who will utilise the isolation units;

7.6 Environmental Management Plan Adverse environmental, social and health impacts could result from an emergency operation involving the containment of a HPAI outbreak. Table 7.2 presents the EMP for all the components of the AHIP. The EMP considers the respective project activities, their potential impacts and proposed mitigation measures and cost estimates. It also identifies ways to reduce potentially significant adverse environmental impacts and safety considerations associated with various disposal measures to acceptable levels.



Table 7.4: Environmental Management Plan to mitigate potential impacts of AHIP No. Project Activity Potential

Environmental Impacts

Proposed Mitigations Institutional Responsibility

Cost Estimates

1. Construction Related Activities (Animal and Human Health Components)

(i) Sub-component 1.2: Strengthening of National Veterinary Services (NVS) involves the construction of a new BSL 3 laboratory at the National Animal Disease and Epidemical Centre (NADDEC). (ii) Sub-component 1.4: A Balanced Veterinary Epidemio-surveillance programme capable of early detection of emerging infectious diseases and other TADs includes upgrading of laboratories at NADDEC by demolition, rehabilitation and remodelling of the existing laboratories. (iii) Sub-Component 2.2: Strengthening the Capacity of the Uganda National Health Research Organization involves the construction/extension and upgrading of laboratory facilities at the National Influenza Centre (NIC) of the Uganda Virus Research Institute (UVRI) to BSL 3. (iv) Sub-Component 2.3: Consolidation of preparedness for AHI Prevention, Containment and Control, involves the construction of new ultra modern isolation wards at Entebbe and Mulago National Referral Hospital. (v) Subcomponent 1.5: Evidence-Based Veterinary Rapid Response Capacity for Emerging Infectious Diseases Preparedness, Detection and Control has an activity on the Strengthening Veterinary Services (VS) quarantine capacity. This activity involves construction of quarantine areas where animals may be held as tests are carried out to confirm if the animals are infected.

Vegetation clearance/removal

- Limit vegetation clearance only to the construction site. - Landscape the project site by levelling soil, planting of trees and grass - All construction activities should follow national construction guidelines and regulations under the Public Health Act Cap 281 and International recommended environmental Construction Standards i.e. FIDIC1 Standards and Appendices E &F.

- The Contractor - The Supervising

Engineer

US $ 60,000

Noise and vibrations from construction works

- Construction should be confined to normal working hours - The construction site should be hoarded with iron sheets - Ear muffs should be provided to construction workers - Silencers should be placed on construction equipment and vehicles


Engineer

US $ 100,000

Dust - Strict use of masks by construction workers - Sprinkle construction site with water particularly during hot, dry and windy conditions


Engineer

US $ 20,000

Soil erosion - Fertile topsoil should be removed, stored in an isolated place and covered with plastic to prevent runoff/erosion. After construction it should be returned and landscaped to revegetate with native vegetation.


Engineer

US $ 40,000

Exhaust fumes from construction equipment and vehicles

- Exhaust filters - Catalytic converter


Engineer

US $ 40,000

Construction debris/litter - Waste Management Plan - Use of Municipal Waste Dump Site

- The Contractor US $ 40,000

1FIDIC, the International Federation of Consulting Engineers (the acronym stands for the French version of the name) represents the globally the consulting engineering industry and promotes internationally accepted construction standards for works – details can be found at http://www.fidic.org/.



No. Project Activity Potential Environmental Impacts


Cost Estimates

Accidents - Occupational Safety and Health Plan (Appendix F). - Provision of first aid kits - Medical scheme and insurance for workers

- The Contractor

US $ 100,000

Traffic Management - Construction of humps - Traffic Signs - Placing signallers - Deployment of traffic management plan

- The Contractor

US $ 100,000

2 Avian Influenza Field Based and Laboratory Surveillance Activities (Preparedness and Prevention Animal Component) Sub-component 1.1: Strengthening Capacity for Animal Health Surveillance, Monitoring and Emergency Disease Control a Strengthen the national veterinary epidemio-

surveillance network 1. Investigation of wild bird deaths, sampling of migratory birds and investigation of poultry die-offs pose a threat of viral infection and cross contamination to MAAIF staff. 2. Poor laboratory management and handling of laboratory waste may lead to viral infection and cross contamination of staff.

- Use appropriate investigative methods. - Use appropriate PPE. - Follow appropriate Bio-safety and Bio-security Level Standards2.

- Follow internationally accepted lab waste management practices3.

MAAIF, UWA, Local Governments, collaborating institutions like Makerere University, The Water Reed Project

US $ 500,000

b Strengthen the surveillance capacity of MAAIF and other institutions in general.

c Strengthen the animal disease surveillance capacity of Local governments

d Strengthen the surveillance capacity of Uganda Wildlife Authority (UWA)

Sub-component 1.4: A Balanced Veterinary Epidemio-surveillance Programme Capable of early Detection of Emerging Infectious Diseases and other TADs a Implement active HPAI surveillance program

integrated into overall national surveillance system, including integration into ARIS and WAHIS, in wild birds, markets, smallholder systems and high risk boarder areas

1. Routine surveillance activities expose field sample collection staff to viral infection and cross contamination. 2. Laboratory staff are exposed to viral infection and cross contamination. 3. Inappropriate laboratory

- Use appropriate surveillance methods. - Use appropriate PPE. - Follow appropriate Bio-safety Level Standards.

- Follow internationally accepted lab waste management practices.

MAAIF, UWA, Local Governments, collaborating institutions like Makerere University, The Water Reed Project

US $ 500,000

2Details on bio-safety in microbiological and biomedical laboratories can be found at cdc website http://www.cdc.gov/od/ohs/pdffiles/4th%20bmbl.pdf and guidelines for environmental infection control in health-care facilities (recommendations of cdc and the healthcare infection control practices advisory committee - hicpac) can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm .The project implementing laboratories should develop their own SOP’s. 3http://www.who.int/csr/resources/publications/biosafety/Biosafety7.pdf. The project implementing laboratories, hospitals, isolation wards and carcasus disposal should use the National Policy on Injection Safety and Health Care Waste Management (2004) and the National Environment (Waste Management) Regulations (SI 153-2). The project should develop its own SOPs.





Cost Estimates

waste handling may lead to viral infection and cross contamination.

3 Avian Influenza Field Based and Laboratory Surveillance Activities (Preparedness and Prevention Human Health Component) Sub-Component 2.1: Strengthening of Surveillance of Humans for Influenza a Expand and strengthen sentinel sites for surveillance 1. Exposure of Health

Workers to viral infection

2. Cross contamination

3. Poor laboratory management and handling of lab waste

- Use appropriate methods of handling suspected cases. - Use appropriate PPE. - Follow appropriate Bio-safety Level Standards.

- Follow internationally accepted lab waste management practices - Use the Occupational Health and Safety Plan (Appendix F)

MOH, UVRI US $ 500,000

Sub-Component 2.4: Improving Food Safety and Environmental Hygiene d Regular medical examination and certification of

poultry vendors 1. Generation of health care waste that may be infectious. 2. Poor handling of health care waste.

- Use appropriate methods for healthcare waste collection, storage, transportation and disposal. - Use appropriate PPE. - Keep hygiene at healthcare provision facilities.


MOH, UVRI, Collaborating Institutions

US $ 500,000

Sub-Component 2.6: Preparation for Effective Case Management b

Ensuring availability of pharmaceuticals (tamiflu and other antibiotics), SOPs and operation expenses

Disposal of expired drugs. - Use appropriate methods of disposal of expired drugs by incineration at the Luwero Industries Limited incinerator

MOH US $ 100,000

4 Avian Influenza Outbreak Response and Recovery Activities (Animal Component) a Immediate reaction to an outbreak (i) Performance of an Out Break investigation and

sampling to verify the rumour of the disease outbreak in the suspected outbreak places.

1. Exposure of staff to viral infection 2. Cross contamination

- Use appropriate investigative methods. - Use appropriate PPE.

MAAIF, UWA, Local Governments, Collaborating Institutions, District Veterinary Staff

US $ 500,000

(ii) Collection of infectious samples and transportation to MAAIF and UVRI diagnostic laboratories for test

1. Exposure of staff to viral infection 2. Cross contamination

- Use appropriate collection, packing and transportation methods.

MAAIF, UWA, Local Governments, Collaborating Institutions, District Veterinary Staff





Cost Estimates

- Use appropriate PPE. - Follow appropriate Bio-safety and Bio-security Level Standards.

(iii) Test samples for outbreak confirmation 1. Exposure of staff to viral infection 2. Cross contamination

- Use appropriate PPE. - Follow appropriate Bio-safety Level Standards.

- Follow internationally accepted lab waste management practices. - Follow appropriate Bio-safety and Bio-security Level Standards.

MAAIF, MOH, UNBS, NEMA, District Public Health Officers, Collaborating Institutions, UWA.

Immediate sanitary measures of confirmed outbreak (Adapted from FRN, 2007) (i) Collection and disposal of wild birds

1. Poses risks of spreading the virus 2. Exposure of personnel to viral infection.

- Policy and operating procedures,

- manual for collecting dead wild birds,

- use of personnel protective equipment (PPE),

- decontamination equipment and procedures in place.

UWA MAAIF

US $ 1,000,000

(ii) Carry out culling of infected birds 1. Poses risks of spreading the virus and of exposure of personnel to viral infections. 2. Risks of intoxication when using chemicals for culling.

- Follow FAO/OIE guidelines on culling - Use PPE. - Code of conduct on distribution, handling and use of chemicals. - Material Safety Data Sheets (MSDS) of each chemical should be used.

MAAIF and Collaborating Institutions

(iii)Transportation of infective materials and dead birds

1. Pose risks of spreading the virus 2. Exposure of personnel

- Collection and transportation in closed containers. - Only use trained and certified personnel that have access to and use the recommended protective gear. - Only use personnel that have been vaccinated.





Cost Estimates

(iv) Disposal of culled birds

1. Poor choice of disposal options. 2. Disposal sites may pose risk of spreading the virus.

- See Chapter 8 on different disposal options (Burial, Composting, Land filling, Alkaline, Hydrolysis, Rendering, Open Air Burning, Incineration).

MAAIF District Veterinary Staff

(v) Disposal of farm waste (manure, eggs, feathers, contaminated equipment

1. Risk of dissemination of the virus during movement and transport of manure. 2. Risk of dissemination of virus when handling contaminated eggs and hatchery waste and/or equipment. 3. Risk of groundwater pollution.

- Composting, burning or burial on site (not accessible to other animals) when feasible. - Use of PPE and limit aerosols. - Site selection (away from residences, lakes, ponds, streams and high water tables).


(ii) Undertake decontamination and disinfection 1. Risk of virus dissemination. 2. Risk of groundwater pollution. 3. Risk of intoxication when using chemicals.

- Procurement of disinfectants and detergents. - Verify procedures and training manuals


b Quarantine and movement control 1. This activity declares quarantine areas, bans the movement in and out of animals, products and material from infected areas. 2. Places transport, market restrictions and disinfection of vehicles from affected farms. Close down of markets and slaughterhouses.

- Policy and operating procedures, - use of personnel protective equipment (PPE), - decontamination equipment and vehicles


c Strengthen surveillance 1. Investigation of wild bird deaths and sampling of migratory birds and investigation of poultry die-offs pose a threat to viral infection and cross contamination to staff. 2. Poor laboratory management and handling of

- Use appropriate investigative methods. - Use appropriate PPE. - Follow appropriate Bio-safety Level Standards.


- MAAIF - UWA - Local Governments - Collaborating Institutions





Cost Estimates

laboratory waste. e Improve Bio -security 1. This Activity involves

provision of technical assistance in the improvement of bio-security for backyard farmers, commercial farmers and markets commercialised places. 2. Cross Contamination during vaccination.

- Use appropriate PPE. - Follow appropriate Bio-safety Level Standards. - Proper vaccination procedures

MAAIF Collaborating Institutions Public Poultry Famers

g Reinforce active surveillance 1. Investigation of wild bird deaths and sampling of migratory birds and investigation of poultry die-offs pose a threat of viral infection and cross contamination to staff. 2. Poor laboratory management and handling of laboratory waste that poses risks of viral infection and cross contamination of staff.

- Use appropriate investigative methods. - Use appropriate PPE. - Follow appropriate Bio-safety Level Standards.

- Follow internationally accepted laboratory waste management practices.

MAAIF, UWA, Local Governments, Collaborating Institutions

5 Avian Influenza Outbreak Response and Recovery Activities (Human Health Component) Sub-Component 2.8:Part 2: Response and Recovery - Human Health a Intensify Disease surveillance 1. The most risky activities

are the detection of the first outbreak, isolation and treatment of patients. 2. Burial of victims. 3. Quarantine and restriction of movement of people. 4. Cross contamination or infections caused by viral agents due to poor management of: infectious health care wastes and laboratory wastes

- Appropriate investigative methods. -Appropriate methods of patient isolation and treatment. - Implementation of hospital/health clinic specific comprehensive laboratory waste management and health care waste management plans. - Use appropriate PPE

- MOH - Collaborating Institutions

US $ 2,000,000 b Increased Collaboration with veterinary services c Activate Human Health Rapid Response Teams d Pre-position drugs and PPE e Control human outbreak and treat human cases f Implement peoples’ movement restriction measures g Implement recovery activities Activate RRTs



8 CARCASS DISPOSAL OPTIONS Disposal of dead or culled birds as a result of outbreaks of HPAI poses a great threat to environmental integrity and must be approached with a great deal of caution. The primary objective of disposal of carcasses, animal products, materials and wastes is to prevent the dissemination of infection. Carcasses are much easier to handle before decomposition has set in. An excellent review of disposal of carcasses is given in FRN (2007). Carcasses and other items awaiting disposal should be guarded to prevent unauthorized access and to prevent domestic pets, wild animals and birds from removing potentially infectious material. Control of insects should be considered if there is a risk of passive transmission by insects to nearby susceptible species. If disposal is delayed, carcasses should be thoroughly sprayed with an approved disinfectant. The disposal of H5N1 infected bird carcasses is primarily determined by the volume of birds, logistics of disposal as well as environmental and economic factors.

8.1 Available Technologies for Carcass Disposal The overall approach for an avian influenza outbreak is a three-pronged strategy of depopulation (also known as culling), followed by proper quarantining and disposal of animal carcasses, and disinfection of farms and equipment used in the response. The overall goal of disposal operations is to eliminate, in a timely, bio-secure, aesthetically acceptable, and environmentally responsible manner, all animal carcasses that result from the response to an avian influenza outbreak. Common methods used to manage infected animal carcasses and associated materials include: -

• Burial • Composting • Land filling • Alkaline Hydrolysis • Rendering • Open Air Burning • Incineration

8.1.1 Burial This method involves depositing carcasses below ground level and covering them with soil, with no additional inactivation of pathogens. It is an established procedure reported to be convenient, logistically simple and relatively quick. If performed on site, it eliminates the need for transportation of infectious materials. It does however require an environmental assessment because of the potential contamination of groundwater aquifers if leachate is not controlled. It is low cost and practically feasible. However the carcasses have to be covered in a thin layer of slake lime to prevent carnivores, scavengers and worms from exhuming the carcass which may lead to dissemination of the virus. This option is recommended in situations of massive bird did offs, but precaution should be taken to avoid contamination of soils and water sources. We recommend addition of lime to the pits before and after putting the carcasses to further limit the potential contamination of soils and the environment. This method can be used both for carcasses from infected farms and those culled within the recommended radius around the infected foci. 8.1.2 Composting Carcass composting is a natural biological decomposition process that takes place in the presence of air (oxygen). The carcasses should be incorporated within 24 hours of death and promptly covered with bulking material. In this phase, the temperature of the compost pile increases, organic materials break down into relatively small compounds, soft tissue decomposes, and bones soften partially. In the second phase, the remaining materials, mainly bones, break down fully to dark brown or black humus containing primarily non-pathogenic bacteria and plant nutrients. This method has advantages of being on site, hence no transport costs and exposure of the virus is restricted to the outbreak area. It converts potential pathogenic waste into a resource when it is converted into manure. However, this option has limitations in that AI may not be completely eliminated hence causing a risk of contamination once it is exhumed and applied as manure. This option is not recommended for Uganda.



8.1.3 Land filling The land filling process involves the deposition of carcasses in licensed commercial sites. Because the sites have been previously licensed, all environmental variables such as leachate management, gas management, engineered containment, flooding and aquifers have already been considered. However, if the area is open and uncovered for extended periods of time, there is potential dissemination of the virus. Commercial landfills are frequented by people trying to salvage municipal waste and usually these dump sites have many scavengers which will exhume the carcasses. This will increase the exposure of the virus. Lorries which take municipal waste to the dump site may spread the virus into the municipal community. Due to public health considerations this method is not recommended for Uganda. 8.1.4 Rendering Rendering of animal mortalities involves the conversion of carcasses into three end products-namely, carcass meal (proteinaceous solids), melted fat, and water using mechanical processes (grinding, mixing, pressing, decanting and separating), thermal processes (cooking, evaporating, and drying), and sometimes chemical processes (e.g., solvent extraction). It produces an effective inactivation of all pathogens with the exception of prions (an infectious viral protein particle) where infectivity is only reduced. The main processes involve size reduction followed by cooking and separation of fat, water, and protein materials using techniques such as screening, pressing, sequential centrifugation, solvent extraction, and drying. Resulting carcass meals can sometimes be used as an animal feed ingredient, fertilizer and tallow can be used in livestock feed, production of fatty acids, or can be manufactured into soaps.

This method has an advantage that infected materials are thermal heated hence killing pathogens. It has the disadvantage that factories have to be built which is expensive for a developing country like Uganda. Other disadvantages include contamination of transport trucks and exposure of the virus to the environment on the way to the rendering factory. Most rendering factories are located close to other poultry operations like slaughter houses and poultry canning hence there is a possibility of cross contamination. This method is not recommended for Uganda because the country does not have rendering facilities. 8.1.5 Alkaline Hydrolysis Alkaline hydrolysis uses sodium hydroxide or potassium hydroxide to catalyse the hydrolysis of biological material (proteins, nucleic acids, carbohydrates, lipids) into a sterile aqueous solution consisting of small peptides, amino acids, sugars, and soaps. Heat is applied (150o C) to accelerate the process. The only solid by-products are the mineral constituents of the bones and teeth of animals. This residue (2% of the original weight of the carcass) is sterile and easily crushed into a powder. The temperature and alkali conditions of the process destroy the protein coats of viruses and the peptide bonds of prions. Both lipids and nucleic acids are degraded. This option is high tech, needs the establishment of a factory, it requires technical and managerial skills. This facility is not in Uganda. It also has the disadvantage of exposing the virus as the carcasses are brought to the facility. This option is not feasible for Uganda conditions. 8.1.6 Open Air Burning This involves burning of carcasses either on-site (farm) or off-site (collective facility) fuelled by additional materials of high energy content e.g. wood, charcoal, kerosene, petrol etc. This procedure can be conducted on-site with minimal logistics and is cheap (low cost) compared to incineration. However, it could adversely impact on the environment (air, water and soil). It takes an extended period of time to complete and has no verified pathogen inactivation capacity. There is also a possibility of particulate transmission from incomplete combustion. These negative impacts can be solved by pouring adequate fuel like petrol or kerosene to allow complete combustion. This method is recommended where other options such as incineration and burying are not feasible. 8.1.7 Incineration Incineration thermally decomposes matter through oxidation, thereby reducing and minimizing the wastes, and destroying pathogens. This is reliable, safe and efficient if properly designed and operated. The incineration temperature is recommended to be not less than 8000C, where dioxins and furans are destroyed. There are three broad categories of incineration techniques: Fixed and mobile facility incineration and air-curtain incineration.



• Fixed Incineration Fixed Incinerators are built facilities where whole carcasses or carcass portions can be completely burned and reduced to ash. Fixed-facility incinerators include (a) small on-farm incinerators, (b) small and large incineration facilities (c) crematoria, and (d) power plant incinerators. A fixed facility incineration is wholly contained and usually highly controlled. It is typically fuelled by diesel, natural gas, or propane. This method is effective in inactivation of pathogens and attains 95% waste reduction of incinerated carcasses. The method has a problem of exhaust emissions which may cause air pollution. Exhaust fumes can be subjected to air scrubbing procedures to meet environmental standards or the incinerator chimney may be fitted with afterburner chambers to completely burn hydrocarbon gases and particulate matter from the main combustion chamber. This option is complex technology which has to be imported in the country. It has high investment and operational costs particularly fuel. Uganda has only one industrial incinerator at Luwero Industries Limited in Nakasongola District. The cost of transporting carcasses to this remote place and the possibility of transport contamination along the way makes this option not feasible for Uganda. It is worthwhile to note that most incinerators in Uganda are of the fixed type and made out of brickwork. Unfortunately, hardly do they ever operate above 550O C. This is because clay a slow heating material compared to steel/iron and the size of the brickwork takes long time to heat up.

• Mobile Incineration This method is based on thermal destruction of infective pathogens, animal carcasses and other wastes in an incinerator. It involves transporting the mobile incinerator to the culling site and collecting residues (bottom ash/slag and fly ash) for disposal at the sanitary landfill. Mobile incinerators are manufactured by the Technology Development and Transfer Centre, Makerere University. The materials and expertise needed to manufacture these incinerators is available in Uganda. The technology is low cost and appropriate to Uganda’s local conditions. The method attains complete destruction of infective pathogens, reduces waste to over 95% of the original weight and avoids the need to transport the infective pathogens, carcasses and other wastes to the incinerator (i.e. reduced risk of disseminating the virus to other sites compared to the fixed incineration case). This option is better than the fixed incinerator and is recommended for Uganda. Therefore in the case of an outbreak, mobile incinerators can be transported (on pick-ups or lorries) and strategically stationed within the area. The residue of incineration is ash which can be safely buried nearby.

• Controlled Burning (Air Curtain) Incineration Controlled Burning incineration is improved incineration which involves a machine that fan-forces a mass of air through a manifold, thereby creating a turbulent environment in which incineration is accelerated up to six times faster than open-air burning. The equipment for this process can be made mobile which can be taken on-site but the potential of fire hazard must be considered. Because it can be used on site, there is no requirement for transportation of the animal material. It also produces effective inactivation of pathogens and may actually achieve very high temperatures (1000 0C). This option is effective in killing pathogens and reduces carcasses to 95% of fresh weight. It can be moved to site hence reducing the spread of the disease. However, it is high tech, expensive in terms of initial investment and operational costs particularly fuel, needs technical and management skills. This type of incinerator is not readily available in Uganda. It has to be imported into the country. It is not recommended as a viable option in a massive emergency operation if there was to be an outbreak of the disease. In general we recommend fixed incinerators for institutional facilities such as laboratory and isolation facilities and large commercial farms. The size and specifications will be dependent upon the size of the wastes and should be agreed upon with the manufacturers. We also recommend at least smaller mobile incinerators for MAAIF to take care of carcasses disposed in urban centers with space limitations to ensure limited movement of infected carcasses and to avoid contamination.

• Environmental considerations when setting up an Incinerator in Uganda In Uganda a separate EIA should be undertaken, prior to the establishment of incinerators and the necessary information provided on the locations of the incinerators as in the case of fixed incinerators, collection points for the hazardous waste like ash and also relevant information provided on the technological specifications of the incinerators. Environmental impacts arising from their use, including suitable mitigation measures should be presented in the EIA report. A Developer is required to apply for and obtain operation licenses from NEMA for the establishment and operation of incinerators in accordance with the National Environment (Waste Management) Regulations, 1999, Sections 13 and 14.



• Locally manufactured incinerators from Uganda

A local company Technology for Tomorrow www.T4Tafrica.co manufactures local made batch type incinerators with a trade name Mak. They come in three sizes: small (20 kg/hour), medium (30 kg/hour) and large (40 kg/hour) Fig. 8.1. When considered over an operating period of say 12 hours, the destruction would be: small (240 kg), medium (360 kg) and large (480 kg). It should be understood that efficient incineration is achieved by batch-loading and not bulk loading. Therefore in the event of an outbreak requiring higher volume handling (massive culling), more mobile incinerators would be deployed preferably as close as possible to the affected area. This would be advantageous as compared to transportation of carcasses to large, centralized incinerators. One great advantage is that they do not require fuel; by design they are self-fueling only requiring 3 kg of wood or paper as startup fuel. Their operating temperature range from 850 to 1,0100C. The incinerators normally have smokeless gas emissions, with a small percentage of carbon dioxide at startup and run down.

Small size Medium size Large Size Figure 8.1: Local manufactured Mak Incinerators

8.2 Technology and Site Selection Guidelines The major factors that may influence the choice of technique for carcass disposal include: − Availability of capacity - where the number of carcasses to be disposed of is high, the capacity of the adopted technologies could be inadequate. An assessment of possibilities and capacities is very important to be able to take quick decisions in emergency situations. − Cost - technologies for carcass disposal and specially those using sophisticated equipment are very costly. − Environmental concerns - the different technologies for carcass disposal have different effects on the environment. For instance open burning will produce smoke and smells; burial might lead to gas production, risk of contamination of air, soil, surface and sub surface water. − Pathogen inactivation - the chosen disposal procedure must give optimal safety as regards to the inactivation of the pathogen. − Occupational health safety - carcasses in decomposition are potential health risk for the persons handling them during the disposal process. Workers should be sufficiently protected (protective clothing, gloves, face masks, spectacles, vaccination, anti viral medicines, regular health checks) against infection with a zoonotic pathogen such as avian influenza The major determining factors in selecting a site for carcass disposal include the volume of birds, bio-security concerns over the movement of infected animal and environmental conditions of the proposed site. Other factors include the topography, proximity of human communities, soil type, groundwater depth, and accessibility (condition of roads).



9 ENVIRONMENTAL MONITORING PLAN The environmental monitoring program for the implementation of the AHIP will serve as an integral part of the project operational activities and is expected to generate the requisite information for environmental management and environmental information dissemination. It is expected that monitoring will be conducted during all activities of the project.

This plan will play a pivotal role in ensuring that the trends for specific parameters are tracked and it will provide information on compliance with legislative norms, set guidelines and form the basis for corrective actions and modification of activities if necessary. Table 9.1 presents the monitoring plan including the institutions responsible.

9.1 Monitoring Objectives The aim of the monitoring is to establish appropriate monitoring criteria to verify the predicted impact of AI infected carcasses disposal and to ensure that any unforeseen impacts are detected and the mitigation adjusted at an early stage, where necessary. This plan will also ensure that relevant records are kept to verify compliance with the recommended environmental procedures. Other specific objectives of the monitoring plan are to:-

• check the effectiveness of suggested mitigative measures; • demonstrate that the project activities are carried out in accordance with the prescribed mitigation

measures and existing compliance regulatory procedures; and • provide early warning signals whenever an impact indicator approaches a critical level.

Implementation of the EMP will allow OPM to control and manage the timing, location and level of impacts and provide the cause and effect data for validation of various predictive models of action/impact relationships.

9.2 Monitoring Requirements The monitoring plan requires the following components to ensure effective results:

• Relevant baseline data against which to monitor project results; • Verifiably objective indicators for each project component; • An independent body responsible for monitoring; • Institutional capacity for monitoring; • An effective reporting mechanism including feedback and commitment to action on monitoring

results and recommendations.

9.3 Monitoring Procedure The MAAIF will monitor carcass disposal at various disposal sites in each district and provide periodic report on carcass disposal activities to the national project component coordinator. Monthly and quarterly reports will also be copied to OPM.

All monitoring components will be subject to audit, internally by the MAAIF/MOH and externally by NEMA. Each monitoring programme will follow the established schedule; monitoring may be weekly or monthly, depending upon the resource, regulatory requirements, and the project-specific requirements.

9.4 Responsibility of Implementing the Monitoring Plan The responsibility of implementing the Monitoring Plan is primarily with Local Authorities like the Districts and Lead Agencies. The include but not limited to; NEMA, District Officers, the Department of Occupational Health and Safety.



Table 9.1: Monitoring Plan No. Potential Impacts Mitigation measures Indicator/Parameters Method Frequency Duration Responsibility Cost (US $)/month 1 Construction a Vegetation

clearance/removal - Limit vegetation clearance only to the construction site. - Landscape the project site by levelling soil, planting of trees and grass - All construction activities should follow national construction guidelines and regulations under the Public Health Act Cap 281 and International recommended environmental Construction Standards i.e. FIDIC Standards and Appendices E & F.

- Clearing techniques - Relocation procedures utilised

- Visual inspection - Comparison of pre-construction and construction photos

- Monthly throughout construction

- During Construction

- District Building Inspector - District Environmental Officer - NEMA - Ministry of Works

200

b Noise and vibrations - Use silencers on construction equipment - Use ear protection PPE for construction workers - Build hoarding fence around the construction site - Construction during the day

- Noise level - Noise meter - Monthly throughout construction

- When construction equipment are operational

-- District Building Inspector - District Public Health Officer - District Environmental Officer - NEMA

500

c Exhaust fumes - Exhaust filters - Catalytic converter

- Green House Gases (CO, CO2, CH4, NO, NO2)

- Green House Gas Meter



- District Building Inspector - District Public Health Officer - District Environmental Officer - NEMA

4,000

d Dust - Masks - Particulate matter - Suction pressure though filter paper



- District Building Inspector - District Public Health Officer - District Environmental Officer - NEMA

1,000

Accidents - See Appendix E and F General Conditions for Contractors and Occupational Health and Safety Plan

- No. of accidents - Type of accidents

- Accident forms as recommended in the Appendix E


- Monthly - District Building Inspector - District

500



No. Potential Impacts Mitigation measures Indicator/Parameters Method Frequency Duration Responsibility Cost (US $)/month and F Public Health

Officer - NEMA

e Transport management - Construction of humps - Traffic Signs - Placing signaller - Deployment of traffic management plan

- No. of Humps, - No. of Traffic signs - Presence of a signaller - Documentation of Traffic Management Plan and Records

- Site visit and inspection


- During excavation and construction.

- District Building - District Environmental Officer - District Public Health Officer - NEMA

500

2 Sampling, collection, storage, transportation, analysis and disposal of samples in the routine surveillance and detection (for both Animal and Human Health Component) a Virus transfer to human

through Contamination and Cross Contamination

- Use appropriate investigation methods - Good hygiene methods -Good Housekeeping - Good bio-safety methods - Use of appropriate PPE - Training Personnel on safety measures - Ensure emergency response measures and first aid kits are readily available

- Training Certificate - Health status/record of the workers - Reports from nearby health care centres - Reports documenting all activities carried out

- Monitoring to ensure that only trained employees are employed - Monitoring the adequacy and proper use of PPE - Monitoring the health status of the workers - Surveillance of human illness; such as common flue infections

- Monthly - Throughout the entire period of the project

MAAIF & MOH 100,000

3 Handing, transporting, treating AI suspects, patients and the dead and disposal of contaminated wastewater, materials and equipment (Response and Recovery Human Health Component)

a Virus transfer to human through Contamination and Cross Contamination

- Use appropriate investigation methods - Good hygiene methods -Good Housekeeping - Good bio-safety methods - Use of appropriate PPE - Training Personnel on safety measures - Ensure emergency response measures and first aid kits are readily available

- Training Certificate - Health status/record of the workers - Reports from nearby health care centres - Reports documenting all activities carried out

- Monitoring to ensure that only trained employees are employed - Monitoring the adequacy and proper use of PPE - Monitoring the health status of the workers - Surveillance of human illness; such as common flue infections

- Monthly - Throughout the entire period of the project

MOH 100,000



No. Potential Impacts Mitigation measures Indicator/Parameters Method Frequency Duration Responsibility Cost (US $)/month 4 Transportation of bird carcass a Air Pollution - Store in bags and transport in

leak-proof containers - Vehicle used for transportation should be easy to load and unload, not have sharp edges that could tear storage bags & highly secured - Documentation of events (loading, unloading and accidents)

-Odour - Dumped carcasses along the route -Record of events

- Odour - Dumped carcasses along the route record of events

- Monitoring odour by perception - Appoint trained supervisors to monitor every trip. Provide mobile communication devices and motor bikes -Design and Implement a simple and regular reporting system

- During transportation

MAAIF 30,000

b Water Pollution - Disinfect wastewater generated from cleaning of vehicles/ containers before disposal

BOD, COD, TDS, NH4-N, Chloride, Nitrate, Conductivity, total coliforms and E. coli of nearby surface water

- Conduct baseline assessment of the nearby surface water prior to wastewater discharge - Conduct post-discharge surface water quality assessment

- Prior to wastewater discharge - Monthly

- Prior to wastewater discharge - During operation

MAAIF $100,000

c Virus transfer to Human through contamination and cross contamination

- Training personnel on safety measures - Ensure adequate and proper use of personal protection equipment - Ensure emergency response measures and first aids are readily available

- Training Certificate - Health status/record of the workers - Report from nearby health care centres

- Monitoring to ensure that only trained employees are employed - Monitoring the adequacy and proper use of PPE - Monitoring the health status of the workers

- Daily - Every trip - At induction and thereafter weekly

- During transportation

MAAIF $100,000

d Odour - Transport carcass to disposal site as soon as possible in well covered truck

- Odour - Odour by perception

- Every trip - During transportation

MAAIF N/A



No. Potential Impacts Mitigation measures Indicator/Parameters Method Frequency Duration Responsibility Cost (US $)/month e Vehicle exhaust fumes,

Green House Gases, expired batteries, old tyres, used oil, spillage of petroleum products

- Engine maintenance to allow complete combustion - Use catalytic converter on the exhaust pipe -Take old Batteries to Uganda Batteries Ltd for recycling - Handover used oil to a NEMA Licensed Oil and Petroleum Disposal Contractor

- CO, CO2, CH4, NO, NO2

- No. of old batteries - No. of litres of used oil - No. of petroleum spillage

- Green House Gas Meter - Environmental Monitoring petroleum spillage and disposal of old batteries

Quarterly - During the out break

- NEMA - District Environmental Officer

1,000

5 Burial and Composting Options a Water and soil

contamination - Ensure environmental and safety requirements are considered during site selection. - Avoid locations with high water table area or near surface water - Construct containment systems (pit liners with compacted soil or polyethylene, leachate and gas collection and treatment systems

BOD, COD, TDS, NH4-N, Chloride, Nitrate, Conductivity, total coliforms and E. coli, Campylobacter, Salmonella, Leptospira, Cryptosporidium, Giardia

- Conduct assessment of the Groundwater, nearby surface water and soil within the site - Monitoring of the ground water, nearby surface water and soil within the site during the operation phase - Post-closure monitoring of the site

- Once, prior to the carcass disposal Every month Quarterly

- Before carcass disposal - Continuous during the operational phase of the site - Minimum of 24 months after closure

MAAIF $100,000

b Air Pollution - Carcasses should be covered first with 400 mm soil, lime and 2m of soil

CO2,CO, NO

2, SO

2,

HCl, CH4,

HF. Monitoring of gases within and around the site

Daily Continuous during the operational phase of the site

MAAIF $30,000

c Transfer of virus to Human - Site facility away from residential areas and ensure adequate security - Training of personnel. Possibly vaccination of personnel Proper use of PPE - Ensure emergency response measures and first aids are readily available - Document any accident, treat with first aids and seek the advice of medical personnel immediately - Decontaminate site immediately after disposal

- Health status/record of the workers. - Report from nearby health care centres - Reports (documenting all activities carried out)

-Monitoring to ensure that only trained employees are employed - Monitoring the adequacy and proper use of PPE Monitoring the health status of the workers. - Surveillance of human illness, such as gastrointestinal infections

- Daily - During very trip made Monitoring the health status of the workers. Every month - Daily

Continuous as long as carcass disposal is on-going

MAAIF $20,000



No. Potential Impacts Mitigation measures Indicator/Parameters Method Frequency Duration Responsibility Cost (US $)/month Design and Implement a simple and regular reporting system - Check report to ensure all trips and events are documented.

d Scavenging - Fence the site and ensure adequate security Avoid proximity to human settlement

Scavengers - Surveillance for scavengers

Daily Throughout the active life of the site

MAAIF 100,000

6 Incineration Option a Air pollution - Consider environmental and

safety requirements during site selection. - Avoid location close to human settlement - Ensure that the prevailing wind direction do not support smoke spread to sensitive areas carcasses should not be stored in PVC bags to avoid dioxins or furans emission

HCl, SO2, CO, CO

2,

NOx, Dioxin, Furan and Hydrocarbons

- Air quality monitoring during incineration operation - Post-closure air monitoring of incineration site

- Hourly - Daily

- Continuous during the operational phase - Two weeks

MAAIF $100,000

b Soil and Water contamination

- Disposal of resultant ash and residues in properly designed and monitored landfills

Heavy metals - Conduct ground water, surface water and soil monitoring within and around the site - Ground water, surface water and soil monitoring during operation phase - Post-closure monitoring of site

- Prior to the carcass disposal - Monthly - Quarterly

- Prior to carcass disposal - During the operational phase - 24 months post- closure

MAAIF $50,000

c Smoke inhalation - Use of proper PPE - Availability of emergency response measures and equipment for safety breaches - Carry out personnel and site decontamination

- Report from nearby health care centres - Reports (documenting all activities carried out)

- Monitoring the adequacy and use of PPE - Monitoring occupational health status Surveillance of human respiratory illness

- Daily - Monthly - Monthly

As long as carcass transportation is on-going

MAAIF $5,000



No. Potential Impacts Mitigation measures Indicator/Parameters Method Frequency Duration Responsibility Cost (US $)/month - Check report ensure all trips and events are documented



10 CONCLUSION AND RECOMMENDATIONS The following conclusions and recommendations are proposed: -

• AI is a highly pathogenic disease and very infectious. Therefore, the AHIP should continue to be implemented in order to prepare the country for an avian influenza outbreak.

• Uganda is at high risk of having an AI epidemic because it is situated along the corridor of migratory birds, which are suspected to be the main natural reservoir of the disease.

• Sentinel surveillance show that the less pathogenic H1N1 hit Uganda at the beginning of July 2009, three months after it had been first reported in the North America. However, the most pathogenic H5N1 virus has not yet been detected up to date.

• Influenza surveillance in poultry and pigs show negative results for Influenza Type A up to date. • The specific project activities like building BSL 3 diagnostic laboratories and isolation wards have

slightly significant impacts because they will be constructed in an already built up environment. The proposed mitigations are adequate to address all environmental impacts identified at the construction phase.

• The project should improve on the public awareness campaigns in the Communication Component. • The project should incorporate early warning systems to alert the public in case of an outbreak.

This system should consider other countries in the African region because of the trans-boundary nature of the disease.

• The activities and operations of diagnostic laboratories and isolation wards are considered safe once bio-safety, bio-security, the environmental management plan, the occupational health and safety plan are put in place and adhered to as recommended by the Centre for Disease Control and Prevention (CDC), World Health Organisation (WHO) and World Organisation of Animal Heath (WOAH).

• MAAIF and MOH should strengthen already exiting relevant policies, guidelines, manuals, standard operating procedures for all strategic activities of the project. The project should carry out a gap analysis to find missing tools. Then it should fund consultancies so that the missing policies, guidelines, manuals and standard operating procedures are written and distributed to stakeholders.

• The implementing agencies i.e. OPM, MAAIF and MOH and their Consultants, Architects, Supervisors, Contractors and Sub-contractors should implement the environmental management plan, the environment monitoring plan, occupational health and safety plan.

• NEMA, District Local Governments and the Department of Occupational Health and Safety should enforce construction, environmental, occupational health and safety standards.

• The project should use the Material Safety Data Sheet for each chemical. Hazardous waste should be handled according to the The National Environment (Waste Management) Regulations (SI 153-2).

• The Architects hired by the project should carry out geo-technical investigations of the soils to determine soil characteristics and type of building foundations needed.

• The project implementers should provided the Architects design specifications for BSL 3 laboratories based on the recommended Centre for Disease Control and Prevention standards and standards for Bio-safety in Microbiological and Biomedical Laboratories approved by the American Biological Safety Association.

• Wastewater from BSL 3 laboratories and isolation wards should be pre-treated before it is discharged into public sewers. A three-treatment chamber process is recommended. The first chamber should have chlorine dosed into it. The second chamber should be a contact tank to allow enough time for chlorine to disinfect the wastewater. The third chamber should be a pH correction tank before the wastewater is discharged into a public sewer.

• Both the BSL 3 laboratories and isolation wards should have negative pressure. Air exit in both facilities should be in one direction. The exits should have vents fitted with filters to trap air droplets, which may contain viruses.

• The Disclosure Workshop participants recommended that the isolation wards should also accommodate other infectious diseases like ebola, marburg, cholera and typhoid.

• The Clauses in Conditions for Contractors (Appendix E) should form a benchmark for the environmental management plan during construction and Occupational Safety and Health Plan (Appendix F) should be included in the contract for Contractors.



• The Architect, the contractor and sub-contractors should follow physical plans and construction guidelines of local authorities.

• There are several methods of carcasses disposal. However, burial, open air burning and incineration are the most feasible options of choice recommended for Uganda.

• The MAAIF should develop Standard Operating Systems (SOP’s) for each of the recommended Carcass Disposal Method.

• New Fixed Incinerators should be installed at NADDEC, Mulago and Entebbe isolation wards. The brick incinerators at UVRI and NADDC should be decommissioned. The electricity incinerator at UVRI was satisfactory.

• Only incinerators that reach temperature above 800O C are recommended. This is because carcinogenic dioxins and furans are destroyed at this temperature.

• The construction and operation of incinerators should be in accordance with the National Environment (Waste Management) Regulations, 1999, Sections 13 and 14. Incinerators constructed outside project site-specific locations in Entebbe and Kampala will need a separate and independent EIA. Ash and other hazardous material that may be generated from incineration should be appropriately handled, preferably given to a NEMA licensed hazardous waste handlers for proper disposal.

• The use of brick incinerators should be discouraged because they ever go beyond 5500C. This leaves carcinogenic dioxins and furans in the smoke. Incinerators that attain a temperature above 8000C where all dioxins and furans are completely destroyed are recommended.

• The project benefits out weigh the negative environmental impacts. It is recommended that NEMA approves the ESMP/EIA and grants incinerator operation licences to the project site-specific locations in Entebbe and Kampala, so that Uganda can be prepared to respond effectively in the event of an AI outbreak.



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Prepared by Butungi S C, Byarugaba D. K, and Rutebarika C, S. Kampala Uganda. 13. FAO (2009a). A review of the current poultry disease control strategies in smallholder poultry

production systems and local poultry populations in Uganda. Prepared by Terence OdochAmoki, CloviceKankya, Eunice L Kyomugisha, Denis K. Byarugaba, Nicoline de Haan and Karin Schwabenbauer. AHBL – Promoting strategies for prevention and control of HPAI. Rome. http://www.fao.org/docrep/013/al687e/al687e00.pdf.

14. FAO (2009b). Influence of awareness campaigns conducted in Uganda regarding prevention of

HPAI in poultry in three districts of Kampala, Lira and Kanungu; Prepared by Adolf Mbaine, Denis K. Byarugaba and Karin Schwabenbauer. AHBL -Promoting strategies for prevention and control of HPAI. Rome. http://www.fao.org/docrep/013/al688e/al688e00.pdf.

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Denis K. Byarugaba and Nicoline de Haan. AHBL - Promoting strategies for prevention and control of HPAI. Rome. www.fao.org/docrep/013/al691e/al691e00.pdf.



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Namagambo, Mark A. Katz, and Aimee L. Geissler (in preparation). Establishment and Implementation of Clinic- and Hospital-based Sentinel Surveillance for Influenza in Uganda.

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Agriculture, Animal Industry Fisheries. 22. MAAIF & MOH (2010). End of Project Report 2008- 2010. Support Programme to Integrated

National Action Plans for Avian and Human Influenza. Ministry of Agriculture, Animal Industry and Fisheries and Ministry of Health.

23. Mitamura K, Sugaya N (2006). "[Diagnosis and Treatment of influenza—clinical investigation on

viral shedding in children with influenza]". Uirusu 56 (1): 109–16. doi:10.2222/jsv.56.109. PMID 17038819.

24. National Water and Sewerage Corporation (2011a). Water Quality Data Bank Entebbe

06/10/2011). 25. National Water and Sewerage Corporation (2011b). Water Quality Data Bank Gaba Water Works

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Cell Res. 20(1): 51-61. 28. Neuman, L 2004, Basics of social research: a qualitative and quantitative approach, University of

Wisconsin- White water, Pearson education, Inc. 29. Pastakia, C. M. R. (2004) Rapid Impact Assessment Matrix. VKI, Horsholm, Denmark

30. Perez, D. R., R. J. Webby, E. Hoffmann, and R. G. Webster. 2003. Land-based birds as potential disseminators of avian mammalian reassortant influenza A viruses. Avian Dis 47:1114-7.

31. Reno, N.V., Scott S. and Leed (2008). 51st Annual Biological Safety Conference; Integration of

BSL-3 Laboratories into Existing Facilities, American Biological Safety Association October 22nd, 2008.

32. RVR and ILRI, 2010: Risk mapping for HPAI H5N1 in Africa, improving surveillance for bird flu.

User guide for bird flu risk maps. 33. Simulundu, E.,Abdel Clafar A. Ishii, et al. (2008). "Characterization of influenza A viruses isolated

from wild waterfowls in Zambia." J Gen Virol.



34. Smith, G. J., T. S. Naipospos, et al. (2006). "Evolution and adaptation of H5N1 influenza virus in avian and human hosts in Indonesia and Vietnam." Virology 350(2): 258-268.

35. Stallknecht, D.E. and Shane, S.M. (1988). Host range of avian influenza virus in free-living birds.

Vet. Res. Commun. 12, 125-141. 36. Swayne, D. E., and D. L. Suarez. 2000. Highly pathogenic avian influenza. Rev Sci Tech 19:463-

82. 37. Taylor, L.H., Latham, S.M. and Woolhouse, M.E.J. (2001). Risk factors for human disease

emergence. Phil.Trans. R. Soc. Lond. B (2001) 356, 983-989. 38. UBOS (2010). Statistical Abstract; Uganda Bureau of Statistics. 39. UN-HABITAT (2010). Entebbe Municipal Draft Profile; Lake Victoria City Development Strategies

for Improved Environment and Poverty Reduction.

40. U.S. Department of Health and Human Services (2009). Biosafety in Microbiological and Biomedical Laboratories, 5th Edition, HHS Publication No. (CDC) 21-1112. United States Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention and National Institutes of Health. Washington.

41. Wakiso District Local Government (2004) District State of Environment Report & Entebbe Municipality Profile.

42. World Health Organization (2004) Laboratory Biosafety Manual. Third edition, Geneva. 43. Yuguo Li, W. H. Ching, and H. Qia (2007). Ventilation Effectiveness in Isolation Wards;

Department of Mechanical Engineering, the University of Hong Kong.

Legislation

1. The Constitution of the Republic of Uganda, 1995 (as amended) 2. The Animal Diseases Act, Cap 38 3. The Animals (Prevention of Cruelty) Act, Cap 39

4. The Local Government Act, Cap 243

5. The National Drug Policy and Authority Act, Cap 206

6. The National Environment Act, Cap 153 7. The Public Health Act, Cap 281

8. The Uganda Wildlife Act, Cap 200

9. The Veterinary Surgeon’s Act, Cap 277 10. The Workers’ Compensation Act, Cap 225

11. The Animal Breeding Act, 2001

12. The Animal Diseases (Amendment) Act, 2006 13. The Employment Act,2006



14. The Occupational Safety & Health Act,2006

International Agreements

1. The African Convention on the Conservation of Nature and Natural Resources, 1968

2. The Convention on Wetlands of International Importance Especially as Waterfowl Habitat, 1971

3. The Convention Concerning the Protection of the World Cultural and Natural Heritage, 1972

4. The Convention on International Trade in Endangered Species of Wild Fauna and Flora, 1973

5. The Convention on Biological Diversity, 1992 Policies and Plans

1. Ministry of Agriculture, Animal Industry & Fisheries, Development Strategy & Investment Plan,

2009/10-2015/16, November 2008 2. Ministry of Agriculture, Animal Industry & Fisheries, The Compensation Policy for Avian Influenza,

November 2009

3. Ministry of Agriculture, Animal Industry & Fisheries, The National Policy for the Delivery of Veterinary Services, 2001

4. Ministry of Agriculture, Animal Industry & Fisheries, The National Veterinary Drug Policy, 2002

5. Ministry of Health, National Policy on Injection Safety & Health Care Waste Management, July 2004

6. Ministry of Health, National Medical Equipment Policy, 4th Edition, 2009 7. Ministry of Health, Annual Health Sector Performance Report, 2009/10 8. Ministry of Health, Second National Health Policy, 2010 9. Ministry of Health, The Health Sector Strategic & Investment Plan, 2010/2011-2014/2015

10. Ministry of Natural Resources, National Environment Management Policy, 1994 11. Ministry of Natural Resources, National Environment Action Plan, 1995

12. Ministry of Tourism, The Uganda Wildlife Policy, 1999

13. The Republic of Uganda, National Development Plan, 2010/11-2014/15

14. World Bank Safe Guard Policy. Environmental Assessment OP 4.01. 15. World Bank Safe Guard Policy. Natural Habitats OP 4.04.



APPENDIX A: SITE PLANS AND ARCHITECTURAL DRAWINGS OF SITE SPECIFIC PROJECTS

Site Plan National Animal Disease Diagnostic and Epidemiology Centre

Architectural Drawings of ground Floor National Animal Disease Diagnostic and Epidemiology Centre



Architectural Drawings of National Animal Disease Diagnostic and Epidemiology Centre



Site Plan for Entebbe Hospital Isolation Ward

Architectural Drawing of the Ground Floor Entebbe Hospital Isolation Ward



Site Plan for Mulago National Referral Hospital Isolation Ward

Architectural Drawings of the Ground Floor Mulago National Referral Hospital Isolation Ward



Architectural Drawings of the Office Block Mulago National Referral Hospital Isolation Ward

Architectural Drawings of the Mulago National Referral Hospital Isolation Ward



Architectural Drawings of the Morgue Mulago National Referral Hospital Isolation Ward



Architectural Drawing Biosafety Laboratory Level 3, Uganda Virus Research Institute, Ground Floor



APPENDIX B: PUBLIC CONSULTATIONS AND ATTENDANCE LIST Focus Group Discussions (FGD) at Kimwanyi Zone Katanga Community FGD 1: Youths Name of assignment: Avian and Human Influenza Preparedness Project Subject: Environmental Impact Assessment/ Environmental and Social Management Implementation Plan District: Kampala Date: Saturday 20th August, 2011 Place: Kimwanyi Zone L.C.1 office premises Village: Kimwanyi Zone Time: 11:00a.m Attendance List

Objectives of the meeting The main objective of the Focus Group Discussions was to inform the youths working or residing within Kimwanyi Zone about the proposed construction of an isolate ward for patients suspected to be infected with the Avian and Human influenza virus, ebola, cholera and other infectious diseases at the space currently utilised as a Cholera camp, within the Mulago National Referral Hospital Complex. The Consultant also sought to capture the views of the respondents about the positive and negative impacts they anticipated to emerge from the project and the mitigation measures they recommended to be employed to deal with the identified negative impacts. Agenda Opening Remarks Presentation of the Project to the FGD participants/ respondents Capturing the expectations of the participants Capturing the proposed mitigation measures Other concerns



Closing remarks Opening Remarks The L.C.1 Chairperson of Kimwanyi Zone Hassan Wasswa welcomed the participants and the consultants and introduced the consultants to the participants, and further urged the latter to cooperate with the former. The Consultant welcomed the participants and thanked them for accepting to join the FGD. She also thanked the L.C.1 Chairperson for mobilising and organising the participants, as well as offering his office as a venue for the activity. The Consultant gave each participant an identification number and explained that the purpose of the numbers was to aid easy identification of the participants. Presentation of the project to the participants The Consultant briefly described the proposed project and informed the participants about its intended purpose, target population, the activities that will be involved in the project at the various phases, the proposed location, the coordinator and implementers of the project and the possible implementation time line. She also informed the participants about the regulations of the World Bank and National Environmental Management regulations of Uganda that obligate EIA practitioners to consult key stakeholders in any proposed project, who include individuals, groups and entities operating or residing close to the proposed project site. She noted that the purpose of the consultations was to inform, but also to capture the views of the stakeholders about the project for incorporation in to the EIA. She urged the participants to give their objective views about the positive and negative impacts they anticipate from the proposed project and further suggest measures to mitigate the negative impacts they will identify. Participants’ expectations Positive benefits The participants identified a number of benefits they expect to accrue from the proposed project. These include the following: -

• A permanent structure will be a better idea for controlling the spread of air borne diseases such as Avian and Human influenza.

• It will ease the access to the service for some of us who live very close.

Negative impacts • Such an expensive venture is likely to translate in to very expensive services. Low income earners

may not be able to access the services. Our experiences with Mulago hospital indicate that free services are not free. We pay money to be treated quickly. Much as the you say that the services of the isolation unit will be free, we are not sure that the hospital will not charge money for the isolation unit services.

• They charge money for parking within the hospital premises. People without money will be prohibited from taking patients to the isolation unit.

Other concerns • The size of the isolation ward is very small. This may force the administration to divert the isolation

ward to other uses other than the primary objective.

• Will this ward have an emergency ambulance to fasten the transportation of suspected patients to the hospital? Delays may culminate in to death.

• There is a sewer line that passes beneath the project site. Won’t it be built on top?

• There is a tendency for the senior medical personnel to relegate duties to the students on internship. We hope this will not happen when the isolation ward starts operations. The students are very slow; patients with avian and human influenza may die.

• It is common for medical services to be excluded to only the rich. This is likely to happen when the isolation ward opens.



Proposed Mitigation Measures • The whole country should be sensitised about the symptoms of the disease and what they should

do in case they identify any case. Many people do not know about any of the preventive measures. But we also constantly forget. We need constant reminders

• They should employ senior doctors and not interns;

• The patients should be given ample care and treatment to save their lives;

• The poor should be given extra attention and care;

• The services of the isolation unit should be open to all.

Closing Remarks In response to some of the participants’ concerns the Consultant informed them that plan of the project was to construct but also facilitate and equip the isolation units with all the necessary resources including the human resource. There would be no reason for the isolation units to fail to function. The isolation unit is very important to the country. We apparently do not have one, so it cannot be diverted to other uses. The unit that will be constructed will be big enough to accommodate a good number of patients. Besides it does not have to be too big, because the cases of patients with infectious diseases are normally few because the medical team normally responds quickly and controls their spread. The consultant then thanked the participants for their insightful contributions, asked them to register their names and wished them a good day. The FGD was then closed. FGD 2: Women Name of assignment: Avian and Human Influenza Preparedness Project Subject: Environmental Impact Assessment/ Environmental and Social Management Plan District: Kampala Date: Saturday 20th August, 2011 Place: Kimwanyi Zone L.C.1 office premises Village: Kimwanyi Zone Time: 12:00 noon Attendance List



Objectives of the meeting The main objective of the Focus Group Discussions was to inform the women working or residing within Kimwanyi Zone that participated in the FGD about the proposed construction of an isolation ward for patients suspected to be infected with highly pathogenic diseases such as Avian and Human influenza, cholera, ebola at the space currently utilised as a Cholera camp, within the Mulago National Referral Hospital Complex. The Consultant also sought to capture the views of the respondents about the positive and negative impacts they anticipated to emerge from the project and the mitigation measures they recommended to be employed to deal with the identified negative impacts. Agenda Opening Remarks Presentation of the project to the FGD participants/ respondents Capturing the expectations of the participants Capturing the proposed mitigation measures Other concerns Closing remarks Opening Remarks The L.C.1 Chairperson of Kimwanyi Zone, Hassan Wasswa, welcomed the participants and the Consultant, and introduced the consultants to the participants, and further urged the latter to cooperate with the former. The Consultant welcomed the participants and thanked them for accepting to join the FGD. The Consultant gave each participant an identification number and explained that the purpose of the numbers was to aid easy identification of the participants. Presentation of the project to the participants The Consultant briefly described the proposed project and informed the participants about its intended purpose, target population, the activities that will be involved in the project at the various phases, the proposed location, the coordinator and implementers of the project and the possible implementation time line. She also informed the participants about the regulations of the World Bank and National Environmental Management regulations of Uganda that obligate EIA Practitioners to consult key stakeholders in any proposed project, who include individuals, groups and entities operating or residing close to the proposed project site. She noted that the purpose of the consultations was to inform, but also to capture the views of



the stakeholders about the project for incorporation in to the EIS. She urged the participants to give their objective views about the positive and negative impacts they anticipate from the proposed project and further suggest measures to mitigate the negative impacts they will identify. Participants’ expectations Positive Impacts The participants identified a number of benefits they expect to accrue from the proposed project. These include the following:

• It will be easy to access the facility.

• Employment opportunities will be created for qualified individuals some of whom may be residents of Katanga.

• The community expects to be sensitised more about avian and human influenza.

Negative Impacts • The location is not necessarily a perfect choice for an isolation ward, because it is close to a foot

path that many people from Kimwanyi Zone and other areas find convenient to access the hospital. Some Taxis drop off passengers from the same point. Within the hospital, the proposed site is close to places of worship. The location of the site may expose such individuals to the disease.

Proposed mitigation measures • The location of the project should be changed to an area without any inhabitants.

• The masses should be sensitised about the symptoms of avian and human influenza, as well as the preventive measures.

• The masses should be sensitised about good chicken rearing practices.

• The sensitisations should be regular to keep the memories of the population always fresh.

Other concerns • How else will the project benefit the community of Kimwanyi Zone?

Closing Remarks In response to the concern of the participants, the Consultant informed the group that the project was targeting the whole country including them. They would definitely benefit from all the programmes targeting the nation at large. The Consultant thanked the participants for their insightful contributions, asked them to register their names and wished them a good day. The meeting was then closed. FGD 3: Men Name of assignment: Avian and Human Influenza Preparedness Project Subject: Environmental Impact Assessment/ Environmental and Social Management Plan District: Kampala Date: Saturday 20th August, 2011 Place: Kimwanyi Zone L.C.1 office premises Village: Kimwanyi Zone Time: 1:00 p.m Attendance List



Objectives of the meeting The main objective of the Focus Group Discussions was to inform the men working or residing within Kimwanyi Zone that participated in the FGD about the proposed construction of an isolation ward for patients suspected to be infected with highly infectious diseases such ebola, cholera and Avian and Human influenza, among others, at the space currently utilised as a Cholera camp, within the Mulago National Referral Hospital Complex. The Consultant also sought to capture the views of the respondents about the positive and negative impacts they anticipated to emerge from the project and the mitigation measures they recommended to be employed to deal with the identified negative impacts. Agenda Opening Remarks Presentation of the project to the FGD participants/ respondents Capturing the expectations of the participants Capturing the proposed mitigation measures Other concerns Closing remarks Opening Remarks The L.C.1 Chairperson of Kimwanyi Zone, Hassan Wasswa, welcomed the participants and the Consultant, and introduced the Consultants to the participants, and further urged the latter to cooperate with the former. The Consultant welcomed the participants and thanked them for accepting to join the FGD. The Consultant gave each participant an identification number and explained that the purpose of the numbers was to aid easy identification of the participants. Presentation of the project to the participants The Consultant briefly described the proposed project and informed the participants about its intended purpose, target population, the activities that will be involved in the project at the various phases, the proposed location, the coordinator and implementers of the project and the possible implementation time line. She also informed the participants about the regulations of the World Bank and National Environmental Management regulations of Uganda that obligate EIA practitioners to consult key stakeholders in any proposed project, who include individuals, groups and entities operating or residing close to the proposed



project site. She noted that the purpose of the consultations was to inform, but also to capture the views of the stakeholders about the project for incorporation in to the EIS. She urged the participants to give their objective views about the positive and negative impacts they anticipate from the proposed project and further suggest measures to mitigate the negative impacts they will identify. Participants’ expectations Positive Impacts The participants identified a number of benefits they expect to accrue from the proposed project. These include the following: -

• It will be easy to access the facility.

• Employment opportunities will be created

Negative Impacts • The community of Kimwanyi Zone is at the threat of getting infected because they live in close

proximity to the proposed project site

• There is a high possibility that the operations of some of the hospital will be changed when the project commences. These will disorganise and inconvenience the users of the hospital.

• The foot path close to the project side that many residents of Kimwanyi use to access the hospital may be sealed off. The patients will have to move longer distances to access the hospital.

Proposed mitigation measures • There is need to sensitise the community of Kimwanyi about the symptoms of the disease and

prevention measures. Majority of them are not aware about them.

• The foot path should not be removed. It is easier to access the hospital through it than through other entrances.

• Treatment should offered equitably and free of charge.

Other concerns • We are worried that the proposed project may not be implemented as has been communicated.

• The unit will be very expensive. People within the lowest quintile may not easily access it.

• They are likely to charge the patients within the isolation units a lot of money. It may not be affordable to all. They always charge services that should be free.

Closing Remarks In response to their questions and concerns the Consultant informed the respondents that the isolation unit would be free of charge, all epidemics in the country are handled free of charge, and that there was a task force composed of credible members who would ensure that the project is implemented as planned. The Consultant then thanked the participants for their insightful contributions, asked them to register their names and wished them a good day. The FGD was then closed. Residents living close to the National Diagnostic and Epidemiological laboratory Name: Tonko Wilson Place of Interview: Veterinary Quarters Date: 1/09/ 2011 Time: 11:00am Agenda Opening Remarks



Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that he had been identified as a key stakeholder in the proposed project, by virtue of living close to the proposed project site Presentation of the project The Consultant informed the respondent about the proposed construction of a new laboratory at the project site. This laboratory was part of a larger AHIP. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project, and the recommended mitigation measures of negative impacts. The Consultant asked him to cooperate and to give their objective views. Expected Impacts: Positive

• I expect that jobs will be created;

• The health of the animals will be improved through advanced tests and advice from animal healthcare providers.

Negative Impacts • I have not got any problems with the existing laboratory. I have been here for the last 9 years. So I

do not expect any negative impacts.

Other Comments • The laboratory is not going to affect us negatively, it has no disadvantages

Closing remarks The Consultant thanked the respondent for his contributions and closed the meeting. Name: Rwothomio Jonathan and Ochola Florence Place of Interview: Veterinary Quarters Date: 1/09/ 2011 Time: 11:30 am Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondents, introduced herself and presented the respondents with identification documents from both OPM and Savvimax Limited. She then informed the respondents that they had been identified as key stakeholders in the proposed project, by virtue of living close to the proposed project site. Presentation of the project The Consultant informed the respondents about the proposed construction of a new laboratory at the proposed project site. The Consultant informed the respondents that they were expected to give views about the proposed impacts of the project, and the recommended mitigation measures of negative impacts. The Consultant asked them to contribute objectively. Expected Impacts:



Positive • That building is quite old. A new building would improve the outlook of the area.

• More jobs for technicians will be created

Negative Impacts • Some of us are likely to be chased out of the houses

• Vegetation cover will be lost during the clearing process. Some birds may be affected.

Other Comments • We have not had any problem with the existing laboratory. So we do not expect much effect from

the proposed one.

Closing remarks The Consultant thanked the respondents for their contributions and closed the meeting. Name: Mrs Flora Oree and Ekiru Bob Place of Interview: Veterinary Quarters Date: 1/09/ 2011 Time: 11:45 am Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondents, introduced herself and presented the respondents with identification documents from both OPM and Savimaxx Limited. She then informed the respondents that they had been identified as key stakeholders in the proposed project, by virtue of living close to the proposed project site Presentation of the project The consultant informed the respondents about the proposed construction of a new laboratory at the proposed project site as part of the AHIP which has other components. The Consultant informed the respondents that they were expected to give views about the proposed impacts of the project, and the recommended mitigation measures of negative impacts. The Consultant asked them to contribute objectively. Expected Impacts: Positive

• Employment for our children.

• If the laboratories are still in the area, then we shall also be safe. Civil Aviation Authority would have already chased us had the laboratories not been there.

• A new building will make the area look good. It looks abandoned. The place is not as smart as it used to be. A new structure will compel them to put in more effort.

Negative Impacts • We are okay with the project. We do not expect any negative impacts.

Other Comments • We have not had any problem with the existing laboratory.



Closing remarks The Consultant thanked the respondents for their contributions and closed the meeting. Name: Mubiru Emmanuel Place of Interview: Veterinary Quarters Date: 1/09/ 2011 Time: 12:15 pm Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondents, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that he had been identified as key stakeholders in the proposed project, by virtue of living close to the proposed project site Presentation of the project The Consultant informed the respondents about the proposed construction of a new laboratory at the proposed project site. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project, and the recommended mitigation measures of negative impacts. The consultant asked him to cooperate and give objective views. Expected Impacts: Positive

• We the old ones will get casual jobs.

• More jobs for technicians will be created.

• The area will get developed and more visible.

Negative Impacts • A laboratory is a development venture. I do not see any negative impacts from it. We need it.

Closing remarks The Consultant thanked the respondent for his contributions and closed the meeting. Name: Aliyo Andrew Place of Interview: Veterinary Quarters Date: 1/09/2011 Time: 1:00 pm Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that he had been identified as key stakeholders in the proposed project, by virtue of living close to the proposed project site



Presentation of the project The Consultant informed the respondent about the proposed construction of a new laboratory at the proposed project site as part of the larger AHIP. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project, and the recommended mitigation measures of negative impacts. The Consultant asked them to cooperate objectively. Expected Impacts: Positive

• The laboratory will improve the testing of samples.

Negative Impacts • If the chemicals are not handled well, they will get to us through the food chain or directly.

• They may also smell, if not well disposed off

Mitigation measures

• The main concern is storage. If they are not stored well, we may get exposed to them through pollution or directly through inhalation, eating, etc

Closing remarks The Consultant thanked the respondent for his contributions and closed the meeting. Stakeholders living or working close to the proposed site for the Isolation Unit in Entebbe Entebbe Sailing Club, Uganda Place of Interview: Entebbe Sailing Club Date: 1st/09/ 2011 Time: 12:00 noon Members Present Kasirye Robert Godfrey Semwanje Monica Fred Model Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondents, introduced herself and presented the respondents with identification documents from both OPM and Savimaxx Limited. She then informed the respondents that Entebbe Sailing Club had been identified as key stakeholder by virtue of being close to the proposed site for the isolation unit. The Consultant informed the respondents that the project also included other components other than the isolation units. They were expected to give views about the proposed impacts of the project and the recommended mitigation measures, and asked them to cooperate and give their objective views. Expected Impacts: Positive

• Ease of access to the isolation unit in case we get a patient.

• It will be easy to isolate passengers from abroad.



• Employment opportunities for those who qualify will be created. Casual jobs which many of us can do will also be up for grabs.

Negative Impacts • We are scared that we shall get infected with the disease. We work very close to the proposed site

• Many people may be discouraged from coming to utilise our services because they will associate the area with the threats of catching the disease.

Proposed Mitigation measures • The area should be fenced off to minimise any interaction of the patients in the unit with the rest of

us.

Other Comments • Some people used to fear coming here because of the TB isolation unit. But some of us have lived

here all our lives and have never contracted the disease. It is okay. Let them initiate the isolation unit.

Closing remarks The consultant thanked the respondents for their contributions and closed the meeting. Key Informant Interviews Ahimbisibwe B.E – Treasurer of Uganda Veterinary Association/ District Veterinary Officer Kampala District. Place of Interview: Uganda Veterinary Association Offices, Kampala Date: 17/08/ 2011 Time: 12:00 noon Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that UVA had been identified as a key stakeholder in the proposed project. Presentation of the project The Consultant informed the respondent about the different components of the project, and that the construction of the isolation units and the laboratories would be implemented first. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project and the recommended mitigation measures, and asked him to cooperate objectively. The respondent opted to comment about the proposed laboratory at the National Diagnostic and Epidemiological Laboratory. Expected Impacts: Positive

• The laboratory will enhance the timely detection of diseases.

• The laboratory will be upgraded to international standards. It will become a referral laboratory. This will save the country from spending millions of shillings to transport samples to international reference laboratories in USA, Spain, South Africa, United Kingdom etc

• The time lag between the detection of diseases and responses will be reduced. This will enhance timely response and effective management of diseases.



Negative Impacts • No negative impacts are expected from a laboratory.

Other Comments • We expect the project to extend to other areas. The laboratories that are in existence should be

strengthened and new ones constructed at regional level. The proposed laboratory should be a referral point.

Closing remarks The Consultant thanked the respondent for his contributions and closed the meeting. Mwendya Augustine- Director Agri-business Development Uganda National Farmers’ Federation Place of Interview: Uganda National Farmers’ Federation Head Offices, Kampala Date: 17/08/ 2011 Time: 2:00 pm Agenda Opening Remarks Presentation of the project Level of awareness/ preparedness of the farmers Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that Uganda Farmers’ Federation had been identified as a key stakeholder in the proposed project. Presentation of the project The Consultant informed the respondent about the different components of the project, and informed the respondent that the construction of isolation units and the laboratories was going to be the first component of the project to be implemented. The consultant informed the respondent that he was expected to give views about the proposed impacts of the project, the recommended mitigation measures of negative impacts and to give an overview about the levels of awareness about and preparedness to respond to an outbreak of the disease, amongst the farmers. Levels of awareness/ preparedness of farmers

• The Executive of the Federation heard about the disease and expressed concern when they heard that it was in South Sudan

• Farmers are not aware about the disease. They know nothing about its symptoms and implications.

• The Federation has no programme to sensitise the farmers about the disease, although it has structures up to the grassroots.

Expected Impacts: Positive

• Farmers will be equipped with information about prevention. This may help them to control the spread of the disease.

• The laboratories will increase the diagnosis and detection of the disease. This will facilitate the timely response and management of the disease. A number of farmers’ may be saved from infection.

• The laboratories will be upgraded to international standards and accredited. Many of our laboratories are of low standard and not accredited.

Negative Impacts



• The possibility of wastes from the laboratories and isolation units being infectious.

Mitigation measures • The farmers should be sensitised about the disease.

• Wastes from the laboratory should be properly handled.

• They should form a surveillance team that can detect and report any outbreaks through the country.

Other Comments • Majority of the farmers are subsistence. They primarily rely on the birds for livelihood. So the

negative impacts of an outbreak would be largely economic.

• We have a structure up to the grassroots. We can therefore play an effective role in sensitising the farmers. We implemented a HIV/AIDS project under the stewardship of the the global fund.

Closing remarks The Consultant thanked the respondent for his contributions and closed the meeting. Dr Atimnedi Patrick- Veterinary Coordinator Uganda Wildlife Authority Place of Interview: Uganda Wildlife Authority Offices, Kampala Date: 18th/08/ 2011 Time: 11:00 am Agenda Opening Remarks Presentation of the project Level of awareness/ preparedness of the Authority Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that UWA had been identified as a key stakeholder in the proposed project. She talked about the various components of the project, but informed the respondent that the Isolation units and laboratories were going to be implemented first. Presentation of the project The Consultant informed the respondent about the different components of the project, the isolation units and the laboratories. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project, the recommended mitigation measures of negative impacts and to give an overview about the levels of awareness about and preparedness to respond to an outbreak of the disease, amongst the farmers. The Consultant asked him to cooperate objectively. Dr. Atimnedi opted to comment about the animal component of the project (the laboratory at the National Animal Diagnostic and Epidemiology Centre) rather than case management which he considered more human. Levels of awareness/ preparedness of the Authority

• As an Institution, we are part of the national task force. Information flows from the NTF, at institutional level. IEC materials were provided from the NTF, and were distributed to the field staff. Even the fisher folk communities’ resident within the national park received the messages as well.

• As members of the NTF we were asked to sensitise our institutions. We run talk shows such as on Radio West, Endigito, Gulu FM, Radio Persis etc.

• During the sensitisations of our field staff we always ask our health service providers IHN to accompany the staff of UWA to tackle the human aspects of the disease.



• Specific trainings targeted to the staff with the highest risk of contracting the disease are conducted. They have been equipped with gadgets and taught how to use them.

• We have created Rapid Response Teams, for preparedness purposes

• The level of preparedness depends on the available resources; much as we are not at the epitome, we have the basic package


• All the laboratories in the country don’t reach bio -security level 3. The capacity of all laboratories in the country has been found wanting. Uganda is nowhere with regard to regional referral laboratories, Nairobi takes everything. The project will enable the improvement of laboratory standards in the country.

Other Comments

• The disease has not come, but the fear of the disease has cost us. Tourism is so fragile. Tourists save a lot and they don’t want any restrictions. Disease and security issues affect us a lot and the nation at large to which tourism is a substantial source of revenue. People who work in the tourism related industry also lose a lot.

• Ipact on environmental contamination in water which affects bio-diversity in the water.

Environmental contamination with regard to Avian Influenza is real where migratory birds roost and nest

Closing remarks The consultant thanked the respondent for his contributions and adjourned the meeting Dr Okot- Officer in Charge of epidemic preparedness and Response- WHO Uganda Country Office Place of Interview: WHO Uganda Country Office, Kampala Date: 24th/08/ 2011 Time: 3:00pm Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that WHO had been identified as a key stakeholder in the proposed project. Presentation of the project The consultant informed the respondent about the different components of the project, and noted that the construction of isolation units and the laboratories was going to be implemented first. The consultant informed the respondent that he was expected to give views about the proposed impacts of the project and the recommended mitigation measures of negative impacts. Expected Impacts: Positive Impacts

• The impacts in my opinion are largely positive. Avian flu is highly pathogenic and kills instantly. Management of such a disease requires appropriate facilities which are quite often sophisticated. The flow of air within an isolation unit for such a disease has to be in a specific direction, air doesn’t circulate, it moves with negative pressure. With these diseases infection control is very important. It is very good if the project will put up such an isolation facility.



• Entebbe has an international airport. The spread of such diseases is facilitated by international trade and travel which has increased in volume in the 20th Century. The risk of importing the disease in the country has also increased. In Entebbe, health issues need to be specially handled. This is a permanent requirement. All international airports should have a health desk to check diseases such as yellow fever, swine flu, avian and human influenza. When such cases are picked, it is our duty to isolate them for monitoring purposes. Where would such patients be taken, Entebbe currently has no facility to handle such cases. The isolation unit is as thus very important

Negative Impacts • Accumulation of highly pathogenic waste.

• Bio security and bio safety issues for the laboratories.

Mitigation measures • Any health facility is presumed to accumulate waste-especially highly infectious pathogens. Mulago

should have a fairly established system for handling all types of waste. We need to think about waste management in Entebbe. It is not about the incinerator, the training of staff including cleaners and others who get in to contact with the waste should be emphasised.

• For bio safety aspects, the specimen, waste should be properly managed and disposed off. The facilities in the laboratories should meet certain standards that make the environment safe.

• Biosecurity- certain measures should be employed to ensure that highly pathogenic material is not used to harm people. Anthrax was used to kill people in the USA. The specifics of things to be put in place are known.

• Laboratories generate waste, there should be mechanisms put in place to handle those wastes to make them non infectious. There are standard guidelines and procedures which should be followed strictly.

Closing remarks The Consultant thanked the respondent for his contributions and closed the meeting. Dr Paul D’Arbella- Uganda Medical Workers’ Association Place of Interview: Kampala Date: 15/09/ 2011 Time: 12:00 noon Agenda Opening Remarks Presentation of the project Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The Consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that he had been recommended by the chairperson of UMA to respond on behalf of the association. Presentation of the project The Consultant informed the respondent about the different components of the project, and noted that the construction of isolation units and the laboratories were going to be the first components of the project to be implemented. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project and the recommended mitigation measures, and asked him to cooperate objectively.




• Avian Influenza may come at one time or the other. It usually occurs within 10 years. The virus changes its characteristics such that the virus developed at any one time may not work later on.this time there will be a state of alertness in case of any outbreak. This will build the capacity of the country to detect the diseases and take action.

• To the community the benefits may be marginal. Internationally other countries will be alerted to take preventive measures. It is easier to detect the disease at the source.

• Farmers will be much more alert about the poultry and animals and restrict their movements such that infections will not spread to other areas.

Negative Impacts • I do not expect anything negative because the personnel managing the units will be equipped with

protective gear, unless there are serious outbreaks and a breakdown in precaution

Mitigations

• The staff must be thoroughly trained.

Other Comments • We expect the project to extend to other areas. The laboratories that are in existence should be

strengthened and new ones constructed at regional level. The proposed laboratory should be a referral point.

Closing remarks The Consultant informed the respondent that there were plans to expand the project country wide in the long term. She then thanked the respondent for his contributions and closed the meeting. Sekabembe Hadad and Paul Mutebi- Uga Chick Poultry Breeders Uganda Ltd Place of Interview: Uga Chick farm and office premises- Gayaza Date: 22nd/08/ 2011 Time: 1:00 pm Agenda Opening Remarks Presentation of the project Level of awareness/ preparedness of the Company Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondents that Ugachick Poultry Breeders had been identified as a key stakeholder in the proposed project, because they deal in poultry on a large scale. Presentation of the project The Consultant informed the respondent about the different components of the project, the isolation units and the laboratories. The Consultant informed the respondent that he was expected to give views about the proposed impacts of the project, the recommended mitigation measures of negative impacts and to give an overview about the levels of awareness about and preparedness to respond to an outbreak of the disease by the organisation. The Consultant asked him to cooperate objectively. Levels of awareness/ preparedness of the Authority



• The level of awareness about Avian and human influenza amongst the staff is very low. There was training back then when we heard that Avian Influenza was in Netherlands, Egypt and South Sudan.

• Our preparedness is mainly focused on other chicken diseases such as New castle, Brucellosis, and not necessarily Avian influenza.

• But we strengthen our bio security. The farm is not very easy to access by intruders. The fence is electric. The workers who enter the farm have to take a shower, and wear specific uniforms, head scarves and gumboots that are provided at the farm. The uniforms worn differ in colour. It is easy to tell who can access the farm and not.

• We are in the process of setting up our own laboratory.


• We basically utilise the Makerere University laboratory to test our samples. We also take samples to South Africa, Spain and the Netherlands. With the proposed facility, we shall cut the costs we have been incurring to send samples to international laboratories outside the country.

Other Comments • Will the project facilitate the sensitisation and training of key staff such as ours?

Closing remarks The Consultant informed the respondent that the Information dissemination component of the project would cater for the sensitisation of all crucial entities about AI. She then thanked the respondent for his contributions and closed the meeting. Annet Nakanwagi- Small Backyard Urban Poultry Farmer Place of Interview: Kikulu Zone, Kisaasi, Kampala Date: 2nd/09/ 2011 Time: 10:00 a.m Agenda Opening Remarks Presentation of the project Level of awareness about Avian Influenza Expected impacts Proposed mitigation measures for the identified negative impacts Other comments Closing remarks Opening Remarks The consultant greeted the respondent, introduced herself and presented the respondent with identification documents from both OPM and Savimaxx Limited. She then informed the respondent that she had been randomly selected to provide information about her activities and her views would be incorporated in to the EIS report of the AHIP. Presentation of the project The Consultant informed the respondent about the different components of the project. The Consultant informed the respondent that she was expected to respond to a few questions from the Consultant, concerning her poultry rearing practices but also give views about the proposed impacts of the AHIP project, the recommended mitigation measures of the negative impacts. The Consultant asked her to be open. Poultry rearing activities of the farmer



• I rear about 100 chicken. It is not an easy task, because it is too demanding. I have to ensure that their shelter is clean so that they do not catch any diseases. I have heard about several chicken diseases, especially brucellosis and new castle, even flu. It is easy to tell when the chicken is sick. They become inactive, dose a lot and fail to eat. In many cases I seek the services of a Veterinary Doctor to treat the diseases. When a chicken dies, I pull it out of the shelter and burn it. I have heard of Avian Influenza, but do not know much about its symptoms and treatment. The people who supply me with chicks say that they immunise them, but I do not know the diseases against which they immunise them.


• I do not think I will benefit much from the laboratories. I do not use them. May be from the information dissemination programme. I expect to learn more about Avian Influenza as a poultry disease and what I should do to prevent it. I don’t expect any negative impacts.

Other Comments • We really need sensitisation.

Closing remarks The Consultant thanked the respondent for her contributions and closed the meeting.



Institution People consulted and their

Designation Comments

MAAIF

Dr. Chris. S. Rutebarika- Coordinator of the Avian and Human Influenza Preparedness Project Animal Component Dr. Deo B. Ndamu- Senior Veterinary Officer Bahati Milton-Laboratory Technician Michael Omodo-Laboratory Technician Esau Martin-Laboratory Technician

• We need to upgrade the laboratory to make it a one stop centre. We have not yet decided as to whether we should build a completely new structure or simply renovate/expand the existing structures.

• We need advice on how to manage the effluent from the laboratory. Solid and liquid waste, biological waste and fumes from the incinerator.

• We have enough laboratory space, but it will all depend on the advice of the consultants hired.



Institution People consulted and their Designation

Comments

Mary L-Senior Laboratory Technician

• But laboratories are the most environmentally friendly entities. This place is rather isolated, it can’t affect neighbourhood settlements

Uganda Virus Research Institute

Lutwama J. J -SPRO Virus Research Institute John Kayiwa-Senior Technician Kiconco Busingye-Senior Laboratory Technician Kiwanuka James -Technician

• We have different systems in different labs.

• We got money to expand the influenza laboratory. The current influenza laboratory is squeezed. The space is not enough. We hope to shift the influenza laboratory to the new building.

• We need to upgrade the lab to BSF Level 3 so as to handle live materials.

• Our role is advisory. We conduct tests and advise government on what should be done. We also report internationally on a weekly basis and to the NTFI on a quarterly basis.

• Viruses can begin anywhere in the world, and the risk of Uganda with regard to Avian Flu are high. The disease is almost endemic in Egypt.

• We really need better capacity to detect the virus and so the project is important. We would also have loved facilitation for field visits as well.

Entebbe General Hospital

Kalibwani Sanyu - Senior Hospital Administrator Entebbe General Hospital Robert Mpanga - Hospital Administrator Entebbe General Hospital

• We are not excited about that news. We are not aware. I wonder why we were never told. But that is how they start and take the land. Many things happen without our prior knowledge. That is how NWSC put up a water pump and took a big piece of the same land where they are proposing to put the isolation unit and we could not stop them. The PS was consulted but he told us to leave them.

• We have a T.B isolation ward, but when that one comes where shall we put it.

• We have plans to construct staff quarters in that place, about 80 units. The plans are already out. So we don’t know what is going to happen.




Comments

• Otherwise we need a storied building, that land is prime and should not be wasted.

Mulago Hospital

Wafula Kenneth-Ag Principal Administrator Mulago Hospital Julius Mukiibi-Hospital Engineer

• The unit we need is a multipurpose one.

• It should be 3 in one. The isolation unit, laboratory and hostels.

• We think the money we were allocated will be enough.

• The laboratory is really necessary because the disease in contagious, and it would not be right to shift people to the general wards of Mulago. The hostels will enable us to accommodate caretakers from the patients and perhaps the patients that may be still under investigation.

• The current isolation unit for cholera patients is not fit to be at a referral hospital. We need something big enough to accommodate patients with different diseases. Even when there is no influenza, the isolation unit should be operational to handle other common epidemics.

Mulago Hospital

Kizza Brooks- Foreman of Works In charge of incinerator- Mulago Hospital

• We are trying to modify the incinerator. It consumes about 80 litres of fuel per hour to burn about 50 kgs. It is not efficient; it is automated and needs to be reprogrammed to make it burn a higher volume.

• We have two more incinerators, which are improved but also need reprogramming.

• We have the capacity to consume even more waste. The isolation unit does not need another incinerator. All we need is an autoclave so that the waste is disinfected before it is shifted here.

MOH

Kaboyo Winyi- Assistant Commissioner MOH; Secretary NTFI

• The Environmental Impact Assessment part of the project is behind schedule. We want it to be completed so that the project may go foreword.

• Overall the project impacts




Comments

can be mitigated because it is construction of isolation wards in two hospitals and upgrading two AI laboratories.

MOH

Okwi Richard- Health Education

• We look forward to a speedy completion of the physical infrastructure of the project so that in case there is an break of AI the nation is ready to handle it.

• We have been involved in the software part of the project that is development of tools, Standard Operation procedures and public dissemination materials.

Uganda Veterinary Association

Ahimbisibwe B.E- Treasurer • We think that the existing laboratories at all levels should be strengthened. Those that are not there should be constructed, especially at regional level. These will assist in the surveillance of the disease. The laboratories at Entebbe should only be for referral purposes.

• With the impending project, timely detection of diseases and therefore responses will be possible. We need an upgraded laboratory that meets international standards. We normally refer samples to the regional referral in Nairobi, even South Africa, USA, Spain and United Kingdom.

• If the laboratory is upgraded to a level that does not necessitate referral of samples to far places where it takes over a week to detect diseases, then the time lag between detection and responses will be reduced. This will enhance the effective management of diseases and timely response.




Comments

• No negative impacts are expected from such a project.

Uganda National Farmers’ Federation

Mwendya Augustine- Director Agri Business Development

• We heard about the disease and held a few meetings and expressed concern because the disease had reached South Sudan.

• The farmers are generally not aware about the disease. It is only a few of us who are privileged to get some of that information.

• We expect first of all that there will be an awareness campaign to sensitise the public and especially the farmers about the symptoms and signs of the disease, the threat, modes of transmission etc.

• Is the money enough to upgrade the laboratory? We need accredited laboratories such that no one can question the authenticity of their results at international level. I know of only one laboratory that is accredited

• Positively we expect the project to help the farmers get access to information about the prevention and management of the disease. This will save their livestock and even human life.

• We have a structure up to the grassroots. We can play an effective role in disseminating information about the disease if funded. We have done it before during the the global fund. We sensitised farmers about prevention and




Comments

mitigation of HIV/ AIDS.

• The negative impacts would be economic. Farmers would lose all their livestock. I hear in most cases, all the stock has to be destroyed. Majority of our farmers are subsistence. They rely on the birds for their entire livelihood.



A summary of the Individuals and organisations Consulted during the Public Consultation Process Name of the Person Institution/organisation/Residence Contact

Ahimbisibwe B.E UVA/KCCA 0772429371

Dr Patrick Atimnedi UWA 0772607341

Paul Mutebi Ugachick Poultry Breeders 0772322343

Sekabembe Hadad Ugachick Poultry Breeders 0772473724

Toko Wilson Entebbe Veterinary Quarters 0782132388

Rwothomio Jonathan Entebbe Veterinary Quarters 0778090102

Ochola Florence Entebbe Veterinary Quarters 0791289453

Mubiru Emmanuel Entebbe Veterinary Quarters 0751620961

Andrew Aliyo Entebbe Veterinary Quarters 0772567189

Ekiru Bob Entebbe Veterinary Quarters 0777941896

Mrs Florence Oree Entebbe Veterinary Quarters 0782822506

Kasirye Robert Entebbe Sailing Club 0782751740

Monica Entebbe Sailing Club 0712235126

Godfrey Ssemwanje Entebbe Sailing Club

Fred Entebbe Sailing Club 0754944674

Model Entebbe Sailing Club 0752787717

Dr Paul D’Arbella UMA 0772979705

Dr Sr Antonio Nakamya NDQCL 0312261679

Annet Sekindu NDQCL 0312261679

Tarsis Byamugisha NDQCL 0312261679

Annet Nakanwagi Kikulu Zone Kisaasi, Kampala 0773140098

Dr Okot WHO 0772721975



APPENDIX C: CONSTRUCTION OF AN ISOLATION WARD IN A DENSELY POPULATED AREA.



APPENDIX D: REPLY OF AN ISOLATION WARD IN A DENSELY POPULATED AREA As part of the Stakeholder consultations the Environment Impact Assessment (EIA) Consultant Team on 19/09/2011 received a formal written letter from the National Drug Authority, National Drug Quality Control Laboratory (NDQCL) protesting the construction of the Isolation Ward within their neighbourhood (see Appendix B). In their 15 points of concern it is unequivocally evident that the staff of the NDQCL do not want an Isolation Ward in their neighbourhood because of two main reasons: - (i) AI is air borne (ii) Sewage from the Isolation Ward passes through NDQCL compound. Hence, this renders the staff of the NDQCL, immune suppressed patients at Mulago National Referral Hospital and inhabitants of a nearby overcrowded Katanga slum susceptible to contracting the infectious disease. In order, to support their protest NDQCL staff backed their argument with a scientific article by J. S. Malik Peiris, Menno D. de Jong and Yi Guan (2007). Avian Influenza Virus (H5N1): a Threat to Human Health. Clinical Microbiology Reviews. 20(2):243-267. This scientific article was attached as support document. The EIA Consultant Team studied both the contents of the letter from NDQCL and the scientific article by Peiris et al (2007). The Team hereby, dispels the perceived problems associated with the construction of the proposed Isolation Ward in the area.

(i) The argument that AI is airborne is not true. If we quote the same scientific paper, page 251, second paragraph, it is clearly spelt out that, “Most human cases of H5N1 infection were associated with the direct handling of infected poultry, slaughtering or preparing sick poultry for consumption, consumption of uncooked poultry products such as raw blood, or close contact with live poultry.” Therefore for a person to contract AI they must have direct contract with secretions or droplets infected with viral loads of the virus. The EIA Consultant Team does not expect people who are 200m away from a negative pressure Isolation Ward with air coming out through one exit with a vent fitted with filters, to be infected with AI.

In the same scientific article page 245, paragraph four, the paper further goes to relay the fears of contracting AI by stating, “Avian influenza viruses do not efficiently infect humans or nonhuman primates.” In the same breadth the same paper on page 251, paragraph 5 goes on to state, “Similar studies of persons at risk for H5N1 exposure during the recent H5N1 outbreaks have shown little or no evidence of human-to-human transmission in unprotected health care workers exposed to H5N1 patients. Similarly, villagers, poultry workers, and poultry cullers in Vietnam, Thailand, Indonesia and Cambodia who are heavily exposed to infected poultry rarely have clinical or asymptomatic (serological) evidence of infection.” In the same paper page 246, paragraph 5 it is stated, “During the large-scale 2003 outbreak of H7N7 virus in Dutch poultry, active case finding among exposed persons and their close contacts identified a total of 89 laboratory-confirmed infections in humans, amounting to approximately 2% of the estimated number of people potentially exposed to the virus. The highest infection rates were observed in veterinarians and persons involved in the culling of chickens. During the same outbreak, human-to-human transmission of H7N7 virus was suggested for three individuals who had not been in direct contact with infected poultry but were family members of poultry workers with symptomatic H7N7 infections.” The paper clearly shows that it is only 2% of the heavily exposed people who get infected. So people 200m from an Isolation Ward with negative pressure and a single vent air outlet fitted with filters are unlikely to get infected. The paper ends up posing the question, “Why humans get infected with H5N1 disease but why so many who are heavily exposed to the virus in areas where the virus is endemic fail to be infected symptomatically or asymptomatically by a virus that seems to be ubiquitous?”

(ii) On the issue of sewage from the Isolation Ward passing through NDQCL compound and exposing them to the AI virus and consequent infection; the proposed Isolation Ward is in the place where other infectious diseases like Cholera, Typhoid, Ebola and Marburg have been handled before. There are no reported cases of the above diseases infecting staff at the NDQCL, the immune suppressed patients in Mulago National Referral Hospital nor the nearby over crowded



slum coming from this site despite it being an open air isolation area, with polythene tents as the infrastructure. However, the EIA Consultant Team proposes that the sewage system at the proposed Isolation Ward should have three containment chambers. The first chamber should have chlorine dosing to disinfect the sewage, the second chamber should be a contact tank where the chorine is given enough contact time to kill off the virus and the third chamber should be a stabilization tank where pH will be corrected before it is discharged into the public sewer.

In conclusion the construction and operation of the Isolation Ward with negative pressure and air exit through a vent fitted with filters and the disinfection of sewage before it is discharged in the public sewer will address the issues of concern raised by the NDQCL staff.



APPENDIX E: GENERAL CONDITIONS FOR THE CONTRACTOR General Environmental Management Conditions General 1. In addition to these general conditions, the Contractor shall comply with any specific Environmental Management Plan (EMP) for the works s/he is responsible for. The Contractor shall inform himself about such an EMP, and prepare his work strategy and plan to fully take into account relevant provisions of that EMP. If the Contractor fails to implement the approved EMP after written instruction by the Supervising Engineer (SE) to fulfill his obligation within the requested time, the Owner reserves the right to arrange through the SE for execution of the missing action by a third party on account of the Contractor. 2. Notwithstanding the Contractor’s obligation under the above clause, the Contractor shall implement all measures necessary to avoid undesirable adverse environmental and social impacts wherever possible, restore work sites to acceptable standards, and abide by any environmental performance requirements specified in an EMP. In general these measures shall include but not be limited to: (a) Minimize the effect of dust on the surrounding environment resulting from earth mixing sites, asphalt mixing sites, dispersing coal ashes, vibrating equipment, temporary access roads, etc. to ensure safety, health and the protection of workers and communities living in the vicinity dust producing activities. (b) Ensure that noise levels emanating from machinery, vehicles and noisy construction activities (e.g. excavation, blasting) are kept at a minimum for the safety, health and protection of workers within the vicinity of high noise levels and nearby communities. (c) Ensure that existing water flow regimes in rivers, streams and other natural or irrigation channels is maintained and/or re-established where they are disrupted due to works being carried out. (d) Prevent bitumen, oils, lubricants and wastewater used or produced during the execution of works from entering into rivers, streams, irrigation channels and other natural water bodies/reservoirs, and also ensure that stagnant water in uncovered borrow pits is treated in the best way to avoid creating possible breeding grounds for mosquitoes. (e) Prevent and minimize the impacts of quarrying, earth borrowing, piling and building of temporary construction camps and access roads on the biophysical environment including protected areas and arable lands; local communities and their settlements. In as much as possible restore/rehabilitate all sites to acceptable standards. (f) Upon discovery of ancient heritage, relics or anything that might or believed to be of archeological or historical importance during the execution of works, immediately report such findings to the SE so that the appropriate authorities may be expeditiously contacted for fulfillment of the measures aimed at protecting such historical or archaeological resources. (g) Discourage construction workers from engaging in the exploitation of natural resources such as hunting, fishing, collection of forest products or any other activity that might have a negative impact on the social and economic welfare of the local communities. (h) Implement soil erosion control measures in order to avoid surface run off and prevents siltation, etc. (i) Ensure that garbage, sanitation and drinking water facilities are provided in construction workers camps. (j) Ensure that, in as much as possible, local materials are used to avoid importation of foreign material and long distance transportation. (k) Ensure public safety, and meet traffic safety requirements for the operation of work to avoid accidents.



3. The Contractor shall indicate the period within which he/she shall maintain status on site after completion of civil works to ensure that significant adverse impacts arising from such works have been appropriately addressed. 4. The Contractor shall adhere to the proposed activity implementation schedule and the monitoring plan / strategy to ensure effective feedback of monitoring information to project management so that impact management can be implemented properly, and if necessary, adapt to changing and unforeseen conditions. 5. Besides the regular inspection of the sites by the SE for adherence to the contract conditions and specifications, the Owner may appoint an Inspector to oversee the compliance with these environmental conditions and any proposed mitigation measures. District environmental authorities may carry out similar inspection duties. In all cases, as directed by the SE, the Contractor shall comply with directives from such inspectors to implement measures required to ensure the adequacy rehabilitation measures carried out on the bio-physical environment and compensation for socio-economic disruption resulting from implementation of any works. Worksite/Campsite Waste Management 6. All vessels (drums, containers, bags, etc.) containing oil/fuel/surfacing materials and other hazardous chemicals shall be bunded in order to contain spillage. All waste containers, litter and any other waste generated during the construction shall be collected and disposed off at designated disposal sites in line with applicable government waste management regulations. 7. All drainage and effluent from storage areas, workshops and camp sites shall be captured and treated before being discharged into the drainage system in line with applicable government water pollution control regulations. 8. Used oil from maintenance shall be collected and disposed off appropriately at designated sites or be re-used or sold for re-use locally. 9. Entry of runoff to the site shall be restricted by constructing diversion channels or holding structures such as banks, drains, dams, etc. to reduce the potential of soil erosion and water pollution. 10. Construction waste shall not be left in stockpiles along the road, but removed and reused or disposed of on a daily basis. 11. If disposal sites for clean spoil are necessary, they shall be located in areas, approved by the SE, of low land use value and where they will not result in material being easily washed into drainage channels. Whenever possible, spoil materials should be placed in low-lying areas and should be compacted and planted with species indigenous to the locality. Material Excavation and Deposit 12. The Contractor shall obtain appropriate licenses/permits from relevant authorities to operate quarries or borrow areas. 13. The location of quarries and borrow areas shall be subject to approval by relevant local and national authorities, including traditional authorities if the land on which the quarry or borrow areas fall in traditional land. 14. New extraction sites: a) Shall not be located in the vicinity of settlement areas, cultural sites, wetlands or any other valued ecosystem component, or on on high or steep ground or in areas of high scenic value, and shall not be located less than 1km from such areas. b) Shall not be located adjacent to stream channels wherever possible to avoid siltation of river channels. Where they are located near water sources, borrow pits and perimeter drains shall surround quarry sites.



c) Shall not be located in archaeological areas. Excavations in the vicinity of such areas shall proceed with great care and shall be done in the presence of government authorities having a mandate for their protection. d) Shall not be located in forest reserves. However, where there are no other alternatives, permission shall be obtained from the appropriate authorities and an environmental impact study shall be conducted. e) Shall be easily rehabilitated. Areas with minimal vegetation cover such as flat and bare ground, or areas covered with grass only or covered with shrubs less than 1.5m in height, are preferred. f) Shall have clearly demarcated and marked boundaries to minimize vegetation clearing. 15. Vegetation clearing shall be restricted to the area required for safe operation of construction work. Vegetation clearing shall not be done more than two months in advance of operations. 16. Stockpile areas shall be located in areas where trees can act as buffers to prevent dust pollution. Perimeter drains shall be built around stockpile areas. Sediment and other pollutant traps shall be located at drainage exits from workings. 17. The Contractor shall deposit any excess material in accordance with the principles of the these general conditions, and any applicable EMP, in areas approved by local authorities and/or the SE. 18. Areas for depositing hazardous materials such as contaminated liquid and solid materials shall be approved by the SE and appropriate local and/or national authorities before the commencement of work. Use of existing, approved sites shall be preferred over the establishment of new sites. Rehabilitation and Soil Erosion Prevention 19. To the extent practicable, the Contractor shall rehabilitate the site progressively so that the rate of rehabilitation is similar to the rate of construction. 20. Always remove and retain topsoil for subsequent rehabilitation. Soils shall not be stripped when they are wet as this can lead to soil compaction and loss of structure. 21. Topsoil shall not be stored in large heaps. Low mounds of no more than 1 to 2m high are recommended. 22. Re-vegetate stockpiles to protect the soil from erosion, discourage weeds and maintain an active population of beneficial soil microbes. 23. Locate stockpiles where they will not be disturbed by future construction activities. 24. To the extent practicable, reinstate natural drainage patterns where they have been altered or impaired. 25. Remove toxic materials and dispose of them in designated sites. Backfill excavated areas with soils or overburden that is free of foreign material that could pollute groundwater and soil. 26. Identify potentially toxic overburden and screen with suitable material to prevent mobilization of toxins. 27. Ensure reshaped land is formed so as to be inherently stable, adequately drained and suitable for the desired long-term land use, and allow natural regeneration of vegetation. 28. Minimize the long-term visual impact by creating landforms that are compatible with the adjacent landscape. 29. Minimize erosion by wind and water both during and after the process of reinstatement.



30. Compacted surfaces shall be deep ripped to relieve compaction unless subsurface conditions dictate otherwise. 31. Revegetate with plant species that will control erosion, provide vegetative diversity and, through succession, contribute to a resilient ecosystem. The choice of plant species for rehabilitation shall be done in consultation with local research institutions, forest department and the local people. Water Resources Management 32. The Contractor shall at all costs avoid conflicting with water demands of local communities. 33. Abstraction of both surface and underground water shall only be done with the consultation of the local community and after obtaining a permit from the relevant Water Authority. 34. Abstraction of water from wetlands shall be avoided. Where necessary, authority has to be obtained from relevant authorities. 35. Temporary damming of streams and rivers shall be done in such a way avoids disrupting water supplies to communities down stream, and maintains the ecological balance of the river system. 36. No construction water containing spoils or site effluent, especially cement and oil, shall be allowed to flow into natural water drainage courses. 37. Wash water from washing out of equipment shall not be discharged into water courses or road drains. 38. Site spoils and temporary stockpiles shall be located away from the drainage system, and surface run off shall be directed away from stockpiles to prevent erosion. Traffic Management 39. Location of access roads/detours shall be done in consultation with the local community especially in important or sensitive environments. Access roads shall not traverse wetland areas. 40. Upon the completion of civil works, all access roads shall be ripped and rehabilitated. 41. Access roads shall be sprinkled with water at least five times a day in settled areas, and three times in unsettled areas, to suppress dust emissions. Blasting 42. Blasting activities shall not take place less than 2km from settlement areas, cultural sites, or wetlands without the permission of the SE. 43. Blasting activities shall be done during working hours, and local communities shall be consulted on the proposed blasting times. 44. Noise levels reaching the communities from blasting activities shall not exceed 90 decibels. Disposal of Unusable Elements 45. Unusable materials and construction elements such as electro-mechanical equipment, pipes, accessories and demolished structures will be disposed of in a manner approved by the SE. The Contractor has to agree with the SE which elements are to be surrendered to the Client’s premises, which will be recycled or reused, and which will be disposed of at approved landfill sites. 46. As far as possible, abandoned pipelines shall remain in place. Where for any reason no alternative alignment for the new pipeline is possible, the old pipes shall be safely removed and stored at a safe place to be agreed upon with the SE and the local authorities concerned.



47. AC-pipes as well as broken parts thereof have to be treated as hazardous material and disposed of as specified above. 48. Unsuitable and demolished elements shall be dismantled to a size fitting on ordinary trucks for transport. Health and Safety 49. In advance of the construction work, the Contractor shall mount an awareness and hygiene campaign. Workers and local residents shall be sensitized on health risks particularly of AIDS. 50. Adequate road signs to warn pedestrians and motorists of construction activities, diversions, etc. shall be provided at appropriate points. 51. Construction vehicles shall not exceed maximum speed limit of 40km per hour. Repair of Private Property 52. Should the Contractor, deliberately or accidentally, damage private property, he shall repair the property to the owner’s satisfaction and at his own cost. For each repair, the Contractor shall obtain from the owner a certificate that the damage has been made good satisfactorily in order to indemnify the Client from subsequent claims. 53. In cases where compensation for inconveniences, damage of crops etc. are claimed by the owner, the Client has to be informed by the Contractor through the SE. This compensation is in general settled under the responsibility of the Client before signing the Contract. In unforeseeable cases, the respective administrative entities of the Client will take care of compensation. Contractor’s Environment, Health and Safety Management Plan (EHS-MP) 54. Within 6 weeks of signing the Contract, the Contractor shall prepare an EHS-MP to ensure the adequate management of the health, safety, environmental and social aspects of the works, including implementation of the requirements of these general conditions and any specific requirements of an EMP for the works. The Contractor’s EHS-MP will serve two main purposes:

• For the Contractor, for internal purposes, to ensure that all measures are in place for adequate EHS management, and as an operational manual for his staff.

• For the Client, supported where necessary by a SE, to ensure that the Contractor is fully prepared for the adequate management of the EHS aspects of the project, and as a basis for monitoring of the Contractor’s EHS performance.

55. The Contractor’s EHS-MP shall provide at least:

• a description of procedures and methods for complying with these general environmental management conditions, and any specific conditions specified in an EMP;

• a description of specific mitigation measures that will be implemented in order to minimize adverse impacts;

• a description of all planned monitoring activities (e.g. sediment discharges from borrow areas) and the reporting thereof; and

• the internal organizational, management and reporting mechanisms put in place for such. 56. The Contractor’s EHS-MP will be reviewed and approved by the Client before start of the works. This review should demonstrate if the Contractor’s EHS-MP covers all of the identified impacts, and has defined appropriate measures to counteract any potential impacts. EHS Reporting 57. The Contractor shall prepare bi-weekly progress reports to the SE on compliance with these general conditions, the project EMP if any, and his own EHS-MP. An example format for a Contractor EHS report is given below. It is expected that the Contractor’s reports will include information on:



• EHS management actions/measures taken, including approvals sought from local or national authorities;

• Problems encountered in relation to EHS aspects (incidents, including delays, cost consequences, etc. as a result thereof);

• Lack of compliance with contract requirements on the part of the Contractor; • Changes of assumptions, conditions, measures, designs and actual works in relation to EHS

aspects; and • Observations, concerns raised and/or decisions taken with regard to EHS management during site

meetings. 58. It is advisable that reporting of significant EHS incidents be done “as soon as practicable”. Such incident reporting shall therefore be done individually. Also, it is advisable that the Contractor keep his own records on health, safety and welfare of persons, and damage to property. It is advisable to include such records, as well as copies of incident reports, as appendixes to the bi-weekly reports. Example formats for an incident notification and detailed report are given below. Details of EHS performance will be reported to the Client through the SE’s reports to the Client.

Training of Contractor’s Personnel 59. The Contractor shall provide sufficient training to his own personnel to ensure that they are all aware of the relevant aspects of these general conditions, any project EMP, and his own EHS-MP, and are able to fulfil their expected roles and functions. Specific training should be provided to those employees that have particular responsibilities associated with the implementation of the EHS-MP. General topics should be:

• EHS in general (working procedures); • emergency procedures; and • social and cultural aspects (awareness raising on social issues).

Cost of Compliance 60. It is expected that compliance with these conditions is already part of standard good workmanship and state of art as generally required under this Contract. The item “Compliance with Environmental Management Conditions” in the Bill of Quantities covers these cost. No other payments will be made to the Contractor for compliance with any request to avoid and/or mitigate an avoidable EHS impact. Example Format: EHS Report Contract: Period of reporting: EHS management actions/measures: Summarize EHS management actions/measures taken during period of reporting, including planning and management activities (e.g. risk and impact assessments), EHS training, specific design and work measures taken, etc. EHS incidents: Report on any problems encountered in relation to EHS aspects, including its consequences (delays, costs) and corrective measures taken. Include relevant incident reports. EHS compliance: Report on compliance with Contract EHS conditions, including any cases of non-compliance. Changes: Report on any changes of assumptions, conditions, measures, designs and actual works in relation to EHS aspects. Concerns and observations: Report on any observations, concerns raised and/or decisions taken with regard to EHS management during site meetings and visits. Signature (Name, Title Date):



Contractor Representative •

Example Format: EHS Incident Notification •

Provide within 24 hrs to the Supervising Engineer Originators Reference No: Date of Incident: Time: Location of incident: Name of Person(s) involved: Employing Company: Type of Incident: Description of Incident: Where, when, what, how, who, operation in progress at the time (only factual) Immediate Action: Immediate remedial action and actions taken to prevent reoccurrence or escalation Signature (Name, Title, Date): Contractor Representative Example Format: Detailed EHS Incident Report The Incident Notification should be follow-up by a Detailed EHS Incident Report containing the following information where applicable 1. Incident Summary 2. Specific Details

• Date • Time • Place • Weather/Visibility • Road conditions

3. Persons Involved

• Name/s • Age/s • Experience • Date joined Company • Last Medical Check • Current Medical Treatment • Evidence of Drugs/Alcohol • Last Safety Meeting attended • Infringements/Incidents record

4. Equipment Involved 5. Description of Incident 6. Findings of Investigation Team Interim/Final

• Investigation Team Members • Persons Interviewed



• Recommendations & Remedial Actions • Investigation Methodology

7. Signature (Name, Title, Date): 8. Attachments

• Photographs • Witness Statements and Incident Notification Report



APPENDIX F: OCCUPATIONAL AND SAFETY MANAGEMENT PLAN Purpose It is the purpose of this procedure to define the responsibility and obligations of the Implementers, Contractor and Sub-contractors under the Avian Human Influenza Project (AHIP) EMP implementation for the occupational health and safety of employees engaged on project activities including surveillance, handling of patients, rehabilitation, carcasses disposal, civil works etc in Uganda and control occupational hazards on the job site. Terms Implementers - Project Implementers include OPM, MOH, MAAIF, Districts, Private and Public Health and Veterinary Services Providers. Contractor – civil engineering construction companies, waste management companies etc. Subcontractors - are all Contractors or Vendors working under contract to Contractors. Occupational health and hazard - is defined as the management of occupational health of the workers and the controlling of occupational illness and exposures in the work environment. This is apart from and not related to routine health care and health maintenance which is the normal and routine health care of the employees’ health unrelated to the employees work on the job. Serious injury - “Serious injuries and death of workers” are require to be reported. For the purpose of this plan a serious injury is defined as an injury resulting in the loss of a body part or resulting in a permanent physical disability of the employee which prevents the employee from attaining gainful employment. Hazardous materials - are deemed to be any material that is defined as ‘hazardous’ by the National Environment Law Cap 153 and regulations. Medical emergencies - are defined as life threatening illness and injuries that require evacuation off the site to an offsite hospital or clinic. Minor first aid - is defined as an injury that does not result in one or more lost work days. First aid treatment that results in only a few hours of lost work time where the employee is back to work immediately after treatment, or the next day is a minor first aid case. Responsibilities Implementers, contractors and sub-contractors are responsible for the occupational health of their employees and hazard control of their job site. Subcontractors shall report occupational health and safety statistic to the Project Component Coordinator. Contractor is responsible for the occupational health of his employees and the control of occupational hazard at its site (and has oversight of subcontractor employees’ occupational health and hazard control). The Project Component Coordinator will compile occupational health and job site occupational hazard statistics for contractor employees. The following are the specific responsibilities of implementers, contractors and subcontractors: • Implementers, contractors will have a first aid clinic at the site. The clinic will be manned by at least a nurse during operating hours. • Contractors camp clinic will serve the health maintenance needs of people carrying out project activities. • Implementers, contractors, subcontractors shall have manned first aid stations on the site during working hours. • Implementers, contractors, subcontractors are responsible for the health of their employees, regardless of where located. • Implementers, contractors, subcontractors are responsible for all job related injuries, including



emergencies for all work locations, and are responsible for minor first aid for job-related injuries for all employees regardless of location. Subcontractors are responsible for reporting of all injuries. Procedures for Occupational Health and Safety

• Implementers, contractor and subcontractor will establish and staff a first aid clinic for occupational health maintenance of its employees who are assigned to a job site.

• Injuries and illnesses requiring a hospital stay and hospital facilities and illnesses requiring

extensive examination will be treated in an appropriate hospital.

• Emergency cases will be stabilised in first aid clinic, then transferred to an appropriate hospital or clinic.

• The Project Component Coordinator will establish reporting requirements for clinics and will

regularly inspect all contractor and subcontractor clinics. The following occupational health statistics, at a minimum, will be reported to the Project Component Coordinator weekly and monthly: -

• Number of workers given entry physical examination at each clinic, number of workers passing the examination, and number of potential workers failing the examination and reasons for failure.

• Number of visits for job related injuries or illnesses.

• Nature of the visit or complaint(s) for each visit.

• Diagnosis(es) of the doctor or nurse for each visit.

• Treatment given and drugs prescribed.

• Length of illness if involving time away from work.

• Referrals to other hospitals for further examination or treatment.

• Emergencies, nature of emergency, and action taken.

• Pharmacy and medical supply inventories – monthly only

Clinics will maintain adequate medical records for all workers who are or have been on job site. Medical records will be audited periodically by the Project Component Coordinator. All visits to the first aid clinics or stations will be recorded in a log, details of which will be forwarded weekly and will be kept in the clinic office. Subcontractors shall file with the appropriate government agencies, work-related serious injury or death of a worker, and shall send a copy to the HSE Manager. The Form shall be filed immediately after the employee is hospitalized or they are declared dead by a doctor. Implementers and contractor reserves the right to require substance abuse testing of all employees, including Subcontractor employees, as a condition of employment and on demand when employed. The possession or use of mood-altering drugs, both stimulants and depressants are strictly forbidden on the job site except for legitimate medical treatment provided by the medical staff. Hazardous Materials Management All hazardous materials will be transported, stored, and handled in conformance with the MSDS. A hazardous material inventory shall be continuously maintained. The inventory shall show the location of all hazardous material and the quantities stored at that location.



Implementers, contractors, subcontractors shall keep inventories of hazardous materials and show its location and shall give these updated inventories to the HSE manager monthly. If Implementers, contractors, subcontractor needs to change location of hazardous material storage, prior approval must be obtained from HSE Manager. Training of workers in the proper handling, storage, and transport of hazardous materials, is safety issue which is the responsibility of the implementers, contractors contractor and subcontractors.



APPENDIX G: DRAWING OF THE WASTEWATER PRE-TREATMENT PLANT

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