50391-001: Demonstration of Guangxi Elderly Care and Health Care

Initial Environmental Examination (Draft)

Project Number: 50391 May 2019

People’s Republic of China: Demonstration of Guangxi Elderly Care and Health Care Integration and Public-Private Partnership Project

Prepared by the Guangxi Zhuang Autonomous Region for the Asian Development Bank. CURRENCY EQUIVALENTS (as of 6 May 2019) Currency Unit - Yuan (CNY) CNY1.00 = $0.148497 $1.00 = CNY 6.73415

ABBREVIATIONS ADB - Asian Development Bank AHs - Affected households AP - Affected people BOD5 - 5-day biochemical oxygen demand CAB - Civil affairs bureau CDRC - County Development and Reform Commission COD - Chemical oxygen demand CSC - Construction Supervision Companies DO - Dissolved oxygen EC - Elderly care ECS - Elderly care system EHS - Environmental health and safety EIA - Environmental impact assessment EMP - Environmental management plan EPB - Environmental Protection Bureau FSR - Feasibility study report FYP - Five-Year Plan GDOF - Guangxi Department of Finance GDP - Gross domestic product GGH - Guangxi Guidong Hospital GGZAR - Guangxi Provincial Government GPLG - Guangxi Project Leading Group GPMO - Guangxi Foreign Loan Project Management Office GRM - Grievance redress mechanism HMG - Hezhou Municipal Government HPH - Hezhou People’s Hospital IA - Implementing agency ICT - Information and communications technology IEE - Initial environmental examination LIEC - Loan implementation environment consultant LRB - Land and Resources Bureau MEE - Ministry of Ecology and Environment NMG - Nanning Municipal Government NTCMH - Nanning Traditional Chinese Medicine Hospital NSWI - Nanning Social Welfare Institute PIE - Project Implementing Entity PPE - Participating private enterprise PRC - People’s Republic of China REA - Rapid environmental assessment SPS - Safeguard Policy Statement TrTA - Transaction Technical Assistance

WEIGHTS AND MEASURES oC - Degree centigrade dB - Decibel km - Kilometer km2 - square kilometer kW - Kilowatt GJ - 103TJ m - Meter mu - 1/15 hectare m2 - square meter m3/a - cubic meter per annum m3/d - cubic meter per day mg/kg - milligram per kilogram mg/l - milligram per liter mg/m3 - milligram per cubic meter t - metric ton t/a - ton per annum

NOTE In this report, "$" refers to US dollars.

This initial environmental examination is a document of the borrower. The views expressed herein do not necessarily represent those of ADB's Board of Directors, Management, or staff, and may be preliminary in nature. Your attention is directed to the “terms of use” section of this website.

In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

TABLE OF CONTENTS

I. EXECUTIVE SUMMARY ...... 1 II. POLICY, LEGAL AND ADMINISTRATIVE FRAMEWORK ...... 9 A. Policy and Planning Framework for Project Implementation ...... 9 B. Legislative Framework for Environment Impact Assessment in the People’s Republic of China ...... 10 C. International Agreements...... 11 D. Asian Development Bank’s Safeguards Policies ...... 11 1 Environmental Impact Assessment Requirements of ADB ...... 11 2 Prohibited investment activities...... 12 E. Applicable PRC and ADB Safeguards Policies and Assessment Categories ...... 12 F. Equivalence of International Best Policies in Infrastructure Development ...... 13 G. PRC Environment Quality Standards ...... 13 1 Environmental Quality Evaluation Standards ...... 14 2 Discharge Standard ...... 18 III. DESCRIPTION OF THE PROJECT ...... 21 A. Rational ...... 21 B. Impact and Outcome ...... 22 C. Outputs ...... 23 D. Design of Engineering Components ...... 24 1.Subproject 1: Nanning Traditional Chinese Medicine Hospital (NTCMH) ...... 28 2.Subproject 2: Nanning Social Welfare Institute Phase I Upgrading (NSWI) ...... 31 3.Subproject 3 (site one): Hezhou No.1 Elderly Nursing Center...... 32 4.Subproject 3 (site two): Hezhou No.2 Nursing Center ...... 34 5.Subproject 4: Hezhou Huanan National Medical Nursing Home (HHNH) ...... 35 E. Availability of Public Utilities ...... 37 F. Implementation Arrangements ...... 38 G. Overall Project Implementation Plan ...... 39 IV. DESCRIPTION OF THE ENVIRONMENT (BASELINE) ...... 42 A. Overview of Guangxi Zhuang Autonomous Region ...... 42 B. Reginal Setting of Nanning City ...... 42 C. Regional Setting of Hezhou City ...... 43 D. Environmental Quality Baseline ...... 43 E. Ecological Resources ...... 46 F. Physical Cultural Resources ...... 47 V. ANTICIPATED IMPACTS AND MITIGATION MEASURES...... 48 A. Project Area of Influence and Sensitive Receptors ...... 48 B. Anticipated Project Benefits and Positive Impacts ...... 49 C. Mitigation Measures during Pre-Construction Phase ...... 49 D. Anticipated Environmental Impacts and Mitigation Measures during Construction Phase ...... 52 1. Physical Impacts...... 52 2. Impacts on Ecological Resources ...... 57 3. Impacts on Physical Cultural Resources ...... 57 4. Risks to community health and safety ...... 57 5. Occupational health and safety ...... 58 6. Temporary disconnection of Utilities ...... 58 E. Anticipated Environmental Impacts and Mitigation Measures during Operation Phase 58 F. Climate Change ...... 62 VI. ANALYSIS OF ALTERNATIVES ...... 63 A. No Project Alternative ...... 63 B. Alternatives Considered for each Subproject ...... 63 VII. INFORMATION DISCLOSURE, CONSULTATION, AND PARTICIPATION ...... 65 i A. Legislative Framework ...... 65 B. Information Disclosure to Date ...... 65 C. Public Consultation to Date ...... 66 D. Future Information Disclosure and Public Consultation ...... 73 VIII. GRIEVANCE REDRESS MECHANISM ...... 74 IX. ENVIRONMENTAL MANAGEMENT PLAN ...... 76 X. CONCLUSION ...... 77 APPENDIX 1: ENVIRONMENTAL MANAGEMENT PLAN (EMP) ...... 80 A. Introduction ...... 80 B. Institutional Arrangement and Responsibilities ...... 80 C. Summary of Potential Impacts and Mitigation Measures ...... 86 D. Project readiness Assessment ...... 107 E. Monitoring Requirements...... 107 F. Environmental Safeguards Reporting Requirements ...... 113 G. Institutional strengthening and training ...... 114 H. Grievance Redress Mechanism ...... 117 I. Public Consultation ...... 119 J. Cost Estimates for Environment Management ...... 121 K. Mechanisms for Feedback and Adjustment ...... 123

LIST OF TABLES Table I.1: Key construction features and environmental issues for each sub-project ...... 2 Table II.1: Applicable Environmental Laws ...... 10 Table II.2: Applicable National and Local Administrative Regulations ...... 10 Table II.3: Applicable Technical Guidelines for Environmental ...... 11 Table II.4: Applicable International Agreements ...... 11 Table II.5: Environment Safeguards Categorization: Definition ...... 12 Table II.6: Type of reporting ...... 12 Table II.7: Applicable Environmental Standards ...... 14 Table II.8: Surface Water Quality Standards (mg/L, pH excluded) ...... 14 Table II.9: Comparison of the PRC’s GB 3095-2012 and World Bank Group EHS Ambient Air Quality Standards ...... 16 Table II.10: Environmental quality standards for noise (Equivalent Sound Level: LAeq: dB) 17 Table II.11: Applied Soil Quality Standard for Medical and Social Warfare Facility Land Use 18 Table II.12: Atmospheric Pollutant Discharge Requirement for Wastewater Treatment Station of Medical Institutions ...... 18 Table II.13: Integrated Wastewater Discharge ...... 18 Table II.14: Water Pollutant Emission Standards for Medical Institutions ...... 19 Table II.15: Construction site noise limits. Unit: LAeq [dB (A)] ...... 19 Table II.16: Vertical Vibration Standard Value for Various Urban Areas (Unit: dB) ...... 19 Table II.17: Air Conditioning Design Parameters ...... 20 Table II.18: Ventilation design parameters ...... 20 Table II.19: Smoke control design parameters ...... 20 Table III.1: Summary of Sub-projectsa ...... 25 Table III.2: Major Indicators of NTCHM Nursing Center Civil Works ...... 30 Table III.3: Major Indicators of NTCHM Clinic Complex Building Civil Works ...... 31 Table III.4: Major Indicators of NSWI Civil Works ...... 31 Table III.5: Major Indicators of Hezhou No.1 Nursing Center Civil Works ...... 34 Table III.6: Major Indicators of Hezhou No.2 Nursing Center Civil Works ...... 34 Table III.7: Indicators of Hezhou Hunan National Medical Nursing Home Civil Works ..... 35 Table III.8: Implementation Arrangements ...... 39 Table III.9: Implementation Plan ...... 40 Table IV.1: Noise Monitoring Results ...... 44

ii Table IV.2: Air Quality Monitoring Results ...... 45 Table IV.3: Soil Quality Monitoring Results ...... 46 Table IV.4: Existing Land Use and Surrounding Environment of Each Subproject ...... 46 Table V.1: Environmentally Sensitive Receptors ...... 48 Table V.2: Attenuation distance required for noise compliance in construction site ...... 54 Table V.3: Construction and Demolish Waste Generated from Construction of Each Subproject 55 Table V.4: Wastewater Generation and Treatment of each Subproject during Operation 59 Table V.5: Noise Level and Mitigation Measures ...... 60 Table V.6: Solid Waste Generation of each Subproject during Operation ...... 61 Table VI.1: Comparison of Alternatives for Hezhou No.1 Nursing Center ...... 64 Table VII.1: Respondents of 1st Round Questionnaire Survey ...... 67 Table VII.2: Results of public survey statistics ...... 67 Table VII.1: Basic Information of the Forum Attendees ...... 68 Table VII.2: Key Issues and Responses from the Discussion Forums ...... 69

LIST OF FIGURES Figure III.1: Overall Location Map of each Subproject ...... 28 Figure III.2: Site Boundary of Nanning Chinese Traditional Medicine ...... 29 Figure III.3: Layout of the proposed Building ...... 29 Figure III.4: Design of Nanning Chinese Traditional Medicine Nursing Center ...... 30 Figure III.5: Layout of the Hezhou No.1 Nursing Center ...... 33 Figure III.6: Layout of the Hezhou No.2 Nursing Center ...... 35 Figure III.7: Hezhou City Master Plan and Propose Site ...... 36 Figure III.8: Layout of the Hezhou Hunan National Medical Nursing Home ...... 37 Figure III.9: Hezhou Wastewater Collection and Treatment Infrastructure Plan ...... 38 Figure VI.1: Alternative Layout of NTCMH ...... 63 Figure VI.2: Alternative Layout of Hezhou No.1 Nursing Center ...... 64 Figure VII.1: Information Disclosure by Posting on PIE Websites ...... 66 Figure VII.2: Second Round of Information Disclosure by Community Poster ...... 66

iii

I. EXECUTIVE SUMMARY

1. This Initial Environmental Examination (IEE) is prepared for the proposed Demonstration of Guangxi Elderly Care-Health Care Integration and Public-Private Partnership (PPP) Project in Nanning and Hezhou Cities, Guangxi Zhuang Autonomous Region (GZAR), the People's, Republic of China (PRC). It is prepared in accordance with the requirements of the Asian Development Bank’s (ADB’s) Safeguard Policy Statement (SPS, 2009), and is based on (i) domestic environmental impact assessment (EIA) report prepared by the domestic EIA Institute, (ii) project Feasibility Study Reports (FSRs), social and economic assessments conducted under the Transaction Assistance (TrTA), (iii) project city urban development master plans; and (iv) discussions between the ADB missions, TrTA consultants, GZAR, the Implementing Agency (s) (IA) Nanning Municipal Government and Hezhou Municipal Government.

2. The objective of the project is the integration of elderly care and health care established in GZAR.1 The project will have the following outcome: utilization of coordinated health care and elderly care services in GZAR increased. The project, in cooperation of Project Implementing Entities (PIEs)2, will create four elderly care institutions and hospital in the municipalities of Hezhou and Nanning of GZAR besides strengthening capacity of the elderly care institutions and the hospitals. Another facility at elderly care institution in Hezhou municipality of GZAR (the Hezhou PPP Subproject. 3 ), will include transaction advisory services (TAS) to prepare the PPP subproject4 covering the construction, operation, and maintenance of the facility.

3. These newly built Elderly Care (EC) facilities along with associated hospitals will provide local people who want to stay in the EC residential institutions with more and better EC services including daily care, health care, rehabilitation, entertainment, and psychiatric and social support. The centers will provide services to all the elderly in the project area both in urban and rural communities. They will provide the elderly living in the nearby communities with improved EC service, including nutritious meals, health screening rehabilitation, escorting, home delivery, and respite care.

4. Anticipated impacts and benefits. The project will improve the living environment of the community by demolishing old buildings and constructing new modernized elderly care facilities, with updated water supply, treatment facilities for wastewater and solid/medical wastes, and electricity connections at Nanning municipality. Similarly, the subprojects in Hezhou municipality will involve construction of new elderly care facilities after demolition of rural homes, home steads in low population areas and agricultural fields.

5. The IEE report comprises of baseline information on the existing condition of the physical, logistical and socio-economic environment, the anticipated environmental impacts, proposed mitigation measures, monitoring frameworks, grievance procedure and public consultations. The consultant team undertook field surveys to sub-project sites to assess the

1 The Government of Guangxi Zhuang Autonomous Region. 2016. The People’s Republic of China. Opinions on Elderly Care and Health care Integration Promotion (Circular No. 82). Nanning. 2 The project implementing entities (s) include (i) Nanning Chinese Traditional Medicine Hospital, (ii) Hezhou People’s Hospital, (ii) Guangxi Guidong Hospital, and (iv) Nanning Social Welfare Institute (NSWI). The first three PIEs are public hospitals. The NSWI is a public entity, providing long-term care, and has its internal clinic. 3 ADB and the executing agency will agree to the scope of TAS and reflect that in the relevant loan and project documentation. 4 TAS includes the preparation of PPP pre-feasibility study, PPP options and business case analyses, development of a financeable transaction structure, and assistance with drafting and negotiating tender documents, etc.

1 physical and biological environment – factors such as site ecology, management of construction, sanitation, use of equipment and machineries, environmental health and safety, occupational hazard etc. The environment management and monitoring plan have been dealt with in detail in the respective sections of the report. The environment management plan has been attached separately as Appendix 1 Table EMP-2.

6. Table I.1 below gives key features, including environmental issues (if any) for the sub-projects:

Table I.1: Key construction features and environmental issues for each subproject Sub-Project Key features of sub-project No components component Environmental Mitigation issues 1 Nanning Proposed No of Elderly care Demolition of old buildings, new Chinese beds: 200. Hospital beds for construction of civil works, Traditional 150 outpatients. electrical works, large quantity of Medicine Total land area of 14,466.7 m2, waste removal; design of Hospital combined 21.7 acres. EC foundations, water drainage, linked (NCTMH) facility- project construction utility facilities such as existing Elderly care and area of 16,215 m2 area of 9765 roads, power, water supply, waste outpatient m2, underground construction water, and solid waste and hospital area of 2822 m2. hazardous wastes etc. Noise and Hospital-proposed gross floor dust issues with residents in area of 17,655.08 m2, including neighborhood, greening and the basement of 4770 m2; landscape works. 44 trees will be ground floor area of 12,885.08 affected during construction. m2. Building density is 35% and greening rate is 30%. 2 Nanning Social Proposed no of beds: 500 and Demolition of about 5512.61 m2- Welfare Institute upgrade to 750 comprising apartment complex (NSWI) Elderly Construction area of 30136.96 area # 1, # 2, # 3, # 4 buildings, Care facility m2, including the ground floor apartment complex II # 1, # 2, # 3 area 19760.42m2, 2 # elderly old buildings and 193 basement apartment building on the motor vehicle parking spaces. ground floor area 4110.58m2, # Large quantity of waste removal; 4 elderly apartment building on design of foundations, water the ground floor area drainage, linked utility facilities 14444.48m2, social workers such as existing roads, power, and care workers training water supply, wastewater, and complex building ground floor solid waste and hazardous wastes area of 1205.36m2 and capacity etc. Noise and dust issues with building area 10376.54m2. residents in neighborhood. Building density is 23.9%, floor area ratio of 1.28, 9578.92m2, green area, green space rate of 35.8%. 4 Hezhou No.1 Proposed no of beds: 400. The Adjacent to proposed hospital Nursing Home total land area of 7,098.86 m2 (DEIA approved for hospital) under (10.64 acres), total construction construction that is located near an building area 22,463,72 m2, industrial plant 5 . Water from the ground floor area 18,903.06 municipal water pipe network,

5 Ceramic factory located about 120 m in north of the project. Details provided later.

Sub-Project Key features of sub-project No components component Environmental Mitigation issues m2, basement area 3560.66 domestic sewage through septic m2, building density of 21.36%, tanks into the drainage collection green area 2,371.74 m2 riser using anaerobic treatment (33.40%), and sent to sewers. Medical sewage treated separately at sewage treatment station discharged after compliance into municipal sewer network. 4 Hezhou No.2 Proposed no of beds: 400. Land involved resettlement Nursing Home The total land area of (discussed in RP) is located east of 49,431.60 m2 (74.14 acres), the park land (bamboo/dense trees total construction area area on east), residential land for 25,102,38 m2, ground floor farmers (south and west) and in area 19,188.30 m2, basement north is agricultural land for area 5,914.08 m2, building farmers. The proposed project site density of 8.15%, green area is adjacent a proposed hospital 20266.96 m2 (41%), Municipal pipeline, roads, drainage, sewage construction carried out simultaneously by Municipal government. 5 Hezhou Hunan Proposed no of beds: 450 Located at Hezhou within the National Medical Two buildings, Total land of under development electronic Nursing Home 80,419.15 m2 (120.63 acres) of technology eco-park. Land as (PPP) which project land area of green open space, involving 21,786 m2 (32.68 acres), shrubs, tree lined woodland, small construction area of farmland etc. 29,298.7m2, Ground floor area Municipal pipeline, roads, of 22,096.76 m2, basement drainage, sewage construction will area of 7200 m2. Development be carried out simultaneously by of green belt separating venues Municipal government. and parking. Building density is 12.07% and green area is 7755.98 m2 (rate 35.6%)

7. Domestic Clearances: The IEE incorporates the results of the domestic environment impact assessments (EIAs) that were submitted for approval by the local Nanning/Hezhou Protection Bureaus (GEPB). Even if the domestic EIA and EMP are enforced by local municipalities, the ADB SPS compliant EMP shall prevail.

8. EA will ensure all domestic Environment Impact Assessments (DEIAs) are approved by local competent environment protection agency before start of construction at each of the sub-projects. Environmental baseline values for water quality, air quality, and noise at all subproject sites were sampled by domestic EIA Institutes to assess compliance with relevant national standards.

9. EA shall ensure all requisite clearances from local government/municipal authorities for demolition, new building construction plans, connectivity to utilities such as power, water supply, sewage and drainage as well as disposal of waste from demolition of buildings, construction waste, waste from operational medical facilities are procured before start of construction for each of the sub-projects.

3 10. New Building Design features will include: (i) Building materials conforming to codes and standards; (ii) Earthquake resistance; (iii) Design for fire, accident and disorientation prevention; (iv) Energy efficiency; (v) Design for noise reduction, (vi) Design for surface and groundwater protection, (vii) Development of green buildings, and climate risk.

11. Green buildings. The project targets the implementation of green building as a national two-star green building built by application of energy-saving technology, high-quality low-cost principle (based on "Green Building Evaluation Standard" GB/T 50378-2014). For the design to be low-carbon, environmentally friendly, the project design to follow the local geographical and climatic conditions, focusing on low-carbon, energy-saving envelope from the layout, architectural form for the building and surrounding landscaping. To save on air- conditioning/heating costs, natural ventilation is also encouraged as a building design feature.

12. GHG reduction of project activities. The renewable energy installations and energy efficiency measurements integrated in green building are considered as investment for climate change mitigation. In the project FSR, 6.15% of the total budget is allocated for improved energy efficiency and for increased renewable energy. The project emissions baseline is 2,887 t CO2/year. This is well below the significant level of 100,000 t/year used as a threshold level by the ADB SPS to require continuous monitoring.

13. Climate risk. The project has been classified a medium climate risk and a Climate Risk and Vulnerability Assessment (CRVA) was prepared. No subproject site is located in flood-prone land or land vulnerable to sea level rise. Modem PRC building codes for structural safety and seismic resistance will ensure that the project buildings are designed for weather events likely to occur in the GZAR. Features included in designs such as storm- water/sewage separation systems, high grade materials to improve the heat insulation, moisture reduction and building layout to maximize the utilization of the sunlight, natural cooling and airflow will contribute to the facilities resilience to climate change.

14. Hazardous materials. The use of VOC-emitting materials (including paints, coatings, adhesives, carpet and furniture’s) will be strictly prohibited to ensure high indoor air quality for elderly people and working staff, including caregivers. No asbestos6 or asbestos- containing material will be used in construction of the facilities. To ensure that no work or community hazards exist on any subproject site before work commences, a survey of all buildings planned for demolition and all buildings planned for renovation will be undertaken to discover and report on the presence or absence of asbestos or asbestos-containing material. Where asbestos or asbestos-containing material is found, the IA and contractor will develop and implement an asbestos removal and disposal plan in conjunction with an accredited specialist contractor to safely remove the material before work commences or during construction. The plan will focus on, as a priority, the health and safety of workers and the community during the removal and long-term disposal.

15. Construction impacts. Construction of new EC centers and hospitals will involve site leveling of land, demolitions at existing project sites, preparation of earthworks and the full range of civil construction activities, requiring mitigation measures to address dust, noise, traffic, solid waste and construction wastewater (liquid and solid wastes) and safety risks to community members and workers.

16. Dust, noise and community health and safety are potential impacts during

6 If any asbestos containing materials (ACM) are found during demolition of old facilities, the executing agency shall engage services of certified agency capable to handle and dispose ACM in accordance with international best practices

construction period because major work will be undertaken near community facilities. There will be no workers’ camps, as workers would be normally commuting from local villages and/or town/townships, can readily access the sites by road and stay in off-site accommodation. All construction sites are either cleared or within existing buildings for refurbishment.

17. The major sources of noise pollution are movement of construction vehicles, the haulage of construction materials to the construction sites and the noise generating activities at the sites to suit the special conditions of construction, work is restricted to 06: 00am- 21:00pm only and will require an agreement with PIEs management and nearby residents regarding the timing of heavy machinery work. Ambient noise levels at all Project sites meet Grade II of the national standard, which is for residential area, commercial and mixed industrial areas. During construction at EC centers and hospital sites at Nanning, additional noise protection (such as installation of noise screens) is required to be installed near residential areas due to their close proximity.

18. Potentially affected people will be informed through advanced and meaningful consultations. Construction dust at this scale has a small impact area usually within a range of 50m outside the construction site boundary, and its major impacts are usually felt within approximately 30m. Perimeter fencing, water spraying, covering truckloads and regularly consulting nearby residents to identify concerns will all be implemented in mitigation. The community will be protected from construction hazards by a traffic control plan within and around each subproject site, site security, safety barricades around trenches and excavations, and public consultation.

19. No subproject will use groundwater. All the domestic water will be supplied from local water supply plant, and all the wastewater will be discharged after pretreatment to match the wastewater discharge standards into the local wastewater treatment plant. It is confirmed that, no subproject sites have been used for any industrial purpose, including chemical plant, insecticide factories or other chemical processing or storage. Soil sampling has shown that the sites comply with soil quality standards suitable for residential development, with no contamination.

20. Impacts on flora and fauna will be minimal. There are no reports of physical cultural resources in or around any of the sites, though a chance finds procedure will be put in place. The project site does not involve any protected areas such as natural reserves, national park, wetland, source water protection areas, or other areas needing special protections.

21. Potential construction phase impacts are identified as with building demolitions, leveling of land besides normal impacts such as soil erosion, increased noise and dust levels, liquid and solid wastes, and safety risks to community. Impacts on flora and fauna are expected to be minimal in Nanning City but at Hezhou City, in rural area that encompasses agricultural crops and some trees will be cleared of vegetation. The tree replantation within the subproject areas have been designated by FSR consultants which will be used for green belts around these EC care facilities and hospitals.

22. Overall, environmental impacts during construction are expected to be localized, temporary, and can be effectively mitigated through the application of sound construction site management practices. The community will be protected from construction safety hazards by measures such as a traffic control plan within and around each subproject site, site security, safety barricades around trenches and excavations, and through public consultation.

23. Linked Facilities. No significant environmental impacts are anticipated during the

5 operation of project facilities. Most operational impacts can easily be addressed by connecting the Project facilities to the existing/planned municipal utilities and services (water supply, solid waste and wastewater collection and disposal), and by ensuring compliance with relevant building codes (e.g., earthquake resistance, fire safety, ventilation and air conditioning).

24. Water supply. At Nanning City, all buildings will be connected to the municipal water supply network. The increase in water demand on the local supplies as a result of the new buildings is small and the consumption can be easily met through the existing municipal water supply services. However, at some project sites at Hezhou City, the new infrastructure for municipal water supply, waste management, waste water, electricity supply, roads infrastructure is being constructed which will also provide connections to the EC facilities being constructed by this project.

25. Municipal wastewater. The wastewater from EC facilities cannot be connected directly to the municipal Waste Water Treatment Plant (WWTP) since on-site pretreatment is needed which allows the WWTP to function most efficiently. This will be achieved by a period of anaerobic digestion of the wastewater solids in a septic tank. The wastewater from canteen will be pre-treated by oil trapper. The pretreatment tank is impermeable with no seepage function, and with internal facility monitoring on its O&M (operation and maintenance). After this the sewage will be piped to existing centralized municipal WWTP for complete treatment. The volumes of wastewater produced by the facilities can be easily met through the existing municipal wastewater treatment services.

26. Medical wastewater. The medical wastewater from the Project facilities will not be connected directly to the municipal WWTP. The on-site medical sewage treatment station uses the process of regulation tank, anaerobic tank, biological contact oxidation, chlorine dioxide disinfection to treat medical wastewate to meet the pretreatment standard of Sewage Control Standard for Medical Institutions (GB18466-2005), and then discharged into the municipal wastewater system and further treated by municipal WWTP.

27. The volumes of wastewater generated by the Project facilities can be handled through existing municipal wastewater treatment services and will not cause any incremental impact on any receiving water body. Municipal WWTPs will have adequate capacity and direct piping for the pretreated wastewater.

28. The projects are not located within any water bodies and located in catchment areas; however, the PIEs will take proper measures to prevent leakage of wastewater to surface or groundwater.

29. Solid waste. For all the project facilities, the solid waste volumes generated will constitute a small proportion of the overall daily municipal waste managed by the city; and the project facilities can be served by the current capacities of these facilities. The solid waste volumes generated by the facilities (kitchen waste and office solid waste are a minute proportion of the daily municipal waste going to existing waste-to-energy incineration plant. - Hezhou: the landfill site has remaining capacity of 350000 m3 and the remaining lifetime is 3 years. A waste-to-energy incineration plant is under construction with capacity of 500 tons per day, which is expected to in operation in 2019. - Nanning: the landfill site has been closed in 2018. The domestic solid waste will be sent to the waste-to-energy incineration plant, which came into operation in 2016 with capacity of 2000 tons per day and will be expanded 3500 tons per day by 2021. - Any construction waste generated at these sites is routed to different construction waste management sites designated by the municipal governments.

30. Medical Solid waste. Medical waste shall be managed in accordance with the

Medical Waste Management Regulation. The medical waste shall be packed in accordance with the requirements of Standard on Packaging, Container and Warning Labels for Hospital Wastes for sorting and collection. Disinfection is carried out on the same day before packing. Medical waste temporarily stored in special storage room cannot be more than 2 days. The project implementing entities (PIEs) shall entrust qualified units to carry out the collection and disposal work. During transferring of the hazardous wastes, the provisions of the Management Methods for Transferring Hazardous Waste shall be strictly implemented, and the hazardous waste transfer joint form (triple list) shall be filled out. - For subprojects in Hezhou (Huanan Nursing Center, No.1 and No.2 Nursing Centers), the medical waste will be sent to Hezhou Medical Waste Disposal Center. The Hezhou Medical Waste Disposal Center with capacity of 3t/d was built in 2015 and received environmental completion inspection acceptance on November 2016. - For subprojects in Nanning City, the medical waste will be sent to the Guangxi Hazardous Waste Disposal Center. Guangxi Hazardous Waste Disposal Center was built in 2013 with a capacity of 40000 t/a and received the environmental completion inspection acceptance on November 2013.

31. Emergency Response planning. An Emergency Response Program will be prepared by Construction Contractors in consultation with Loan Implementation Environment Supervision consultants, construction supervision consultants. ERP training will be provided to all stakeholders in the project construction and operations stage.

32. Public Consultation and Grievance Redress Mechanism. Public consultation was conducted for the project by TrTA team and domestic EIA institutes. Meetings with project local government agencies and nearby residents have also been conducted. A grievance redress mechanism (GRM) has been developed in compliance with ADB’s SPS requirement to address environmental, health, safety, and social concerns associated with project construction and operation. The PIEs and the loan implementation environment consultant (LIEC) will work with affected persons along with contractors, the construction supervision companies and the GPMO in resolving any conflicts or complaints.

33. Environmental Management Plan. Potential impacts are mostly temporary, predictable, and reversible, and can be mitigated through adherence to national 7 and international standards 8 , design criteria, and/or implementation of project Environment Management Plan (EMP). The project EMP (Appendix 1 Table EMP-2) developed for the design, construction and operation phases of the project includes details on institutional responsibilities, training needs, reporting schedules, operational management prescriptions, monitoring and reporting requirements, costs for EMP implementation, and GRM. Public consultation was conducted by the EIA institutes and the PPTA team. Meetings with local government agencies and residents have also been conducted. A GRM has been developed in compliance with ADB’s SPS requirement to address environmental, health, safety, and social concerns associated with the project, and was shared during public consultation and documented.

34. Implementation arrangements. Measures will be implemented in the preconstruction phase to ensure the project's environment management readiness. These include: • (a) appointment of a qualified environment and social safeguards officer (GPMO-SO) within the Guangxi PMO for the implementation phase; and (b) hiring of at least one loan implementation environment consultant (LIEC) within loan implementation consultant services by the GPMO; hiring of construction supervision consultant for each PIE, • all tender documents will include the EMP obligations, including the environmental

7 Relevant PRC Standards mentioned in Chapter II later 8 World Bank/IFC Environment Health and Safety guidelines 2007

7 monitoring program. This will be the responsibility of the IA and PIEs, and checked by the LIEC; updating the EMP based on based on final technical designs; • ensure that all PIEs have arranged contractual agreements with qualified Local Environment Monitoring Agency (LEMA) to conduct the environmental monitoring described in the EMP; and • IAs and PIEs develop reports for preparing and sending annual Environment Monitoring Reports to ADB as well as assist external monitoring experts in ensuring implementation of EMP; • The LIEC, in conjunction with the Guangxi Project Management Office Safeguards Officer (GPMO-SO), loan implementation consultants (LIC), construction supervision companies (CSC) in collaboration of local EPBs, will provide training on implementation and supervision of environmental mitigation measures to PIEs and their contractors. • PIE staff is responsible for EMP implementation and supervision. Each PIE will assign a member in staff, who will be responsible for implementation of GRM, and EMP. Each Construction Supervision Company (CSC) shall have at least one environment engineer on each construction site. Each contractor shall assign onsite environment engineer to be direct contact person for PIEs and the community. • About PPP subproject: Guangxi Guidong Hospital is PIE for this subproject, and GGH will take the responsibility of PIE as follows - Review the implementation of EMP by the private entity and ensure compliance, conduct public consultations, and redress grievance during construction and operations.

35. The EMP has been prepared to mitigate and manage the potential environmental impacts of project construction and operation which defines mitigation measures, monitoring requirements and institutional responsibilities to ensure proper environmental management throughout the project design, construction and operation. No major environmental impacts are anticipated during the operation of project facilities. These are local facilities catering towards serving mainly local communities. All project buildings will be connected to the municipal water supply network. The increase in water demand on the local supplies as a result of the new buildings is expected to be not remarkable and the consumption can be easily met through the existing municipal water supply services.

36. Capacity Development. Environmental management Plan is supported by capacity development and institutional strengthening activities under the project as listed in Appendix 1 Table EMP-7 on training. Component 3 has additional capacity building measures available on operation issues supported under the loan9. Utilization of the best available technology and best management practices are built-in to the project design and listed through EMP.

37. The IEE concludes that with strict implementation of the environmental mitigation and management measures defined in the EMP, all anticipated adverse environmental impacts associated with the project will be prevented or mitigated to an acceptable level. The project’s environmental categorization of "Category B" is supported.

9 Listed in Project Administration manual.

II. POLICY, LEGAL AND ADMINISTRATIVE FRAMEWORK

38. This section discusses the national and the local legal and institutional framework within which the environmental assessment is carried out. It also identifies project-relevant international environmental agreements to which the country is a signatory.

A. Policy and Planning Framework for Project Implementation 39. This project is conceptualized within the framework of the following plans and policies:

• Outline of the Thirteenth Five-Year Plan for National Economic and Social Development of the People's Republic of China (2016-2020); • China Health Care Industry Development Report (2016); • "Healthy China" 2030 Planning Outline; • Several Opinions of the State Council on Accelerating the Development of the Aged Care Service Industry (Guo Fa [2013] No. 35); • Guiding Opinions on Promoting the Construction of a Healthy and Livable Environment" (National Ageing Office [2016] No. 73); • Elderly Education Development Plan (2016-2020)"; • Notice of the Ministry of Civil Affairs on the Pilot Work on Comprehensive Reform of the Elderly Care Service (Ci Da Fa [2014] No. 24); • Outline of the 13th Five-Year Plan for the Development of China's Aging Industry (Preliminary Draft); • Guidance on Promoting the Combination of Health Care and Aged Care Services (Guo Ban Fa [2015] No. 84); • Guiding Opinions Promoting and Regulating the Development of Big Data Applications for Health Care (Guo Ban Fa [2016] No. 47); • Comprehensively Opening the Endowment Service Market to Improve the Quality of Endowment Services (Guo Ban Fa [2016] No. 91); • Social Pension Service System Construction Plan (2016-2020); • Notice on Further Improving the Work Related to the Development of the Aged Care Service Industry (Development and Reform Office Social [2015] No. 992); • Implementation Opinions of the People's Government of Guangxi Zhuang Autonomous Region on Accelerating the Development of the Aged Services Industry (Gui Zheng Fa [2014] No. 58); • "Opinions of the People's Government of Guangxi Zhuang Autonomous Region on the Construction of a Comprehensive Reform Pilot Area for the Aged Services Industry" (Gui Zheng Fa [2015] No. 33); • Notice on Printing and Distributing the Implementation Plan for Accelerating the Construction of Health and Aged Services Projects (Guifa Reform Society [2015] No. 193); • Outline of the Thirteenth Five-Year Plan for Guangxi's National Economic and Social Development; • Implementation Opinions of the General Office of the People's Government of Guangxi Zhuang Autonomous Region on Promoting the Combination of Health Care and Aged Care Services" (Gui Zheng Ban Fa [2016] No. 82); • Guangxi Elderly Service Industry Comprehensive Reform Pilot Area Plan" (2016-2020); • 13th Five-Year Plan for Civil Affairs in Nanning; • 13th Five-Year Plan for Population Development in Nanning; • Nanning City Master Plan (2011-2020); • Outline of the Thirteenth Five-Year Plan for National Economic and Social Development of Nanning City; • Nanning Land Use Master Plan (2006-2020);

9 • Nanning Medical and Health Service System Planning (2016-2020);

B. Legislative Framework for Environment Impact Assessment in the People’s Republic of China 40. The PRC has a range of laws, regulations, technical guidelines and standards that govern the way in which environmental protection and environmental impact assessment for projects must be implemented, including for pollution prevention and control on air, noise, water, ecology and solid waste, and technical guidelines on assessing ambient air, noise, surface water, groundwater, and ecological impacts.

41. The primary national laws and regulations that governed the domestic EIA (DEIA) of the proposed project are provided in Table II.1 and Table II.2 respectively.

Table II.1: Applicable Environmental Laws No. Title of the Law Year 1 Environmental Protection Law 2015 2 Urban and Rural Planning Law 2008 3 Solid Waste Pollution Prevention and Control Law 2016 4 Water Pollution Prevention and Control Law 2018 5 Air Pollution Prevention and Control Law 2016 6 Noise Pollution Prevention and Control Law 2018 7 Environmental Impact Assessment Law 2018 8 Land Administration Law 2004 9 Wild Animal Protection Law 2017 10 Water and Soil Conservation Law 2011 11 Water Law 2016 12 Flood Control and Prevention Law 2016 13 Cultural Relics Protection Law 2017

Table II.2: Applicable National and Local Administrative Regulations No. Regulation Year 1 Decision of the State Council on Amending the Regulations on 2017 Environmental Protection Management for Construction Project 2 Industrial Structure Adjustment Directory 2013 3 Opinions of the State Council on Strengthening the Key Work of 2012 Environmental Protection 4 Water Pollution Prevention and Control Action Plan 2015 5 Air Pollution Prevention and Control Action Plan 2013 6 Interim Measures for Environmental Completion Acceptance of 2017 Construction Project 7 Measures for Public Participation in Environmental Impact Assessment 2019 8 Directory of Environmental Impact Assessment Classification for 2018 Construction Project 9 Regulation on Medical Waste Management 2003 10 Regulation on Environmental Protection of Guangxi Zhuang 2016 Autonomous Region

42. The implementation of environmental laws and regulations is supported by associated management and technical guidelines (Table II.3).

Table II.3: Applicable Technical Guidelines for Environmental No. Technical Guideline Code 1 Technical Guideline on EIA-Outline HJ 2.1-2016 2 Technical Guideline on EIA Regarding Surface Water HJ/T 2.3-93 3 Technical Guideline on EIA Regarding Atmospheric HJ 2.2-2018 Environment 4 Technical Guideline on EIA Regarding Acoustic HJ 2.4-2009 Environment 5 Technical Guideline on EIA Regarding Ecological HJ 19-2011 Environment 6 Technical Specification on Water and Soil GB 50433-2008 Conservation Plan 7 Technical Guideline on Environmental Risk HJ/T 169-2004 Assessment for Construction Project 8 Technical Specification for Urban Dust Prevention HJ/T 393-2007 9 Jilin Provincial Surface Water Functional Zone DB 22/388-2004

C. International Agreements 43. The PRC is signatory to major international agreements dealing with biodiversity, wetland protection, and climate change. Relevant agreements are listed in Table II.4.

Table II.4: Applicable International Agreements Agreement Year Purpose 1 Ramsar Wetland Convention 1975 Promote ‘wise use’ of wetlands 2 Convention on Biological Diversity 1993 Wetland ecology 3 UN Framework Convention on Climate 1994 Carbon sink from re-vegetation Change 4 Kyoto Protocol to UN Framework 2005 Climate change and carbon sink Convention on Climate Change 5 Montreal Protocol on Substances That 1989 Protect ozone layer (as above) Deplete the Ozone Layer 6 UN Convention to Combat Fight desertification and soil Desertification in Countries Experiencing 1996 erosion control Serious Drought and/or Desertification

D. Asian Development Bank’s Safeguards Policies 44. The ADB’s SPS 2009 sets out policy principles and outlines the delivery process for ADB’s safeguard policy in relation to environmental safeguards. The ADB has adopted a set of specific safeguard requirements that borrowers/clients are required to meet in addressing environmental and social impacts and risks. ADB will ensure that borrowers/clients comply with these requirements during project preparation and implementation.

1. Environmental Impact Assessment Requirements of ADB 45. The safeguard policies are operational policies that seek to avoid, minimize or mitigate the adverse environmental and social impacts of projects including protecting the rights of those people likely to be affected or marginalized by the development process. ADB’s safeguard policy framework in the SPS consists of three operational policies on the environment, indigenous people and involuntary resettlement. ADB has developed Operational Procedures to be followed in relation to the SPS policies and these are included in the ADB Operations Manual.

46. The ADB’s Safeguard Policy Statement (SPS), 2009 is applicable to all projects. These projects can be categorized as A, B, C or FI. Table II.5 below provides a list of categorization of the activities related to Environment, Safeguards, as per ADB’s Safeguard

11 Policy Statement 2009 requirements:

Table II.5: Environment Safeguards Categorization: Definition Category Environment A — Significant Investments that anticipate significant adverse environmental impacts that are irreversible, diverse, or unprecedented. These impacts may affect an area larger than the sites or facilities subject to physical works. B — Less Investments with potential adverse impacts that are site-specific, few if Significant any of them are irreversible, and in most cases mitigation measures can be more readily designed than for Category A investments. C — Minimal or Investments that have minimal or no adverse environmental impacts. impact FI — Financial Investment of ADB funds through financial intermediaries (FI) Intermediation

47. All projects considered for loans and investments by ADB are subject to classification for the purposes of determining environmental assessment requirements. The determination of the environment category is to be based on the most environmentally sensitive component of the project. Within this system, projects are screened for their expected environmental impacts and reporting prepared as follows in Table II.6:

Table II.6: Type of reporting ADB No Category Type of Impact Type of reporting required. 1 Category A Projects with potential for An environmental impact assessment significant adverse (EIA) is required to address significant environmental impacts. impacts. 2 Category B Projects judged to have some An initial environmental examination adverse environmental impacts, (IEE) is required to determine whether but of a lesser degree and/or or not significant environmental significance than those of impacts warranting an EIA are likely. If category A projects. an EIA is not needed, the IEE is regarded as the final environmental assessment report 3 Category C Projects unlikely to have No EIA or IEE is required, although adverse environmental impacts. environmental implications are still reviewed. 4 Category Projects are classified as The financial intermediary must apply FI category FI if they involve a an environmental management credit line through a financial system, unless all subprojects will intermediary or an equity result in insignificant impacts. investment in a financial intermediary.

2. Prohibited investment activities. 48. Pursuant to ADB’s Safeguard Policy Statement (2009), ADB funds may not be applied to the activities described on the ADB Prohibited Investment Activities List set forth at Appendix 5 of the Safeguard Policy Statement (2009). NM and HM, the implementing agencies and PIEs will ensure that their investments are in compliance with applicable national laws and regulations and will apply the prohibited investment activities list (PIAL) (Appendix 5 of SPS 2009 guidelines) to subprojects financed by ADB.

E. Applicable PRC and ADB Safeguards Policies and Assessment Categories 49. In accordance with the PRC Guideline on EIA Classification for Construction Projects (2018 updated), the engineering subprojects with medical facilities are classified as PRC

Category B, requiring preparation of EIA Tables (TEIAs) and the subprojects without medical facilities are classified as PRC Category C, requiring registered at local EPB through online portal (http://221.7.197.150:8080/REG). Four separate TEIAs were prepared by a local certificated EIA institute and they are expected to be approved by the Nanning/Hezhou City Environmental Protection Bureau before the end of April 2019.

50. All projects funded by ADB must comply with the Safeguard Policy Statement (SPS 2009). The purpose of the SPS is to establish an environmental review process to ensure that projects undertaken as part of programs funded under ADB loans are environmentally sound, are designed to operate in line with applicable regulatory requirements and are not likely to cause significant environment, health, or safety hazards. The project underwent appraisal during project preparation and was classified as Category B by ADB, requiring an initial environmental examination (IEE), including environmental management plan (EMP). This project IEE has been prepared based on information in the Feasibility Study Reports (FSR) and PRC TEIAs for engineering each component, other TrTA assessment reports, as well as site visits to the components by the TrTA environment team.

51. Compared with the PRC’s EIA requirements, the ADB’s SPS 2009 guidelines has additional requirements for \project IEE preparation, including (i) a project-specific GRM; (ii) definition of the project area of influence; (iii) assessment of direct, indirect, induced, and cumulative impacts; (iv) due diligence of project associated facilities; (v) protection of physical cultural resources; (vi) climate change mitigation and adaptation; (vii) occupational and community health and safety requirements (including emergency preparedness and response); (viii) impacts on livelihoods through environmental media; (ix) biodiversity conservation; and (x) ensuring that the EMP includes an implementation schedule and measurable performance indicators. With the assistance of the TrTA consultants, the project IEE has been prepared to fill in the above gaps and comply with the SPS guidelines.

F. Equivalence of International Best Policies in Infrastructure Development 52. The Project is required to meet the ADB SPS guidelines as well as international standards of the IFC, which is part of the World Bank Group. The international environmental and social safeguard policies of these organizations are outlined below.

(i) World Bank Group’s Environment, Health and Safety (EHS) Guidelines, 2007 (currently under revision). (ii) Environmental, Health, and Safety Guidelines for Waste Management Facilities. (iii) Environmental, Health, And Safety Guidelines for Water and Sanitation. (iv) Environmental, Health, And Safety Guidelines for Health Care Facilities. (v) ADB’s Environmental Safeguards: A Good Practice Sourcebook-Draft Working Document (November 2012). (vi) ILO Core Labor Standards.

G. PRC Environment Quality Standards 53. The environmental standard system that supports the implementation of the environmental protection laws and regulations in the PRC can be classified by function- ambient environmental quality standards, and by pollutant emission and/or discharge standards.

54. Environmental quality standards are technical specifications of a legal nature, which are used in formulating environmental objectives and in environmental planning. They are also the statutory basis for judging whether the environment is polluted and to formulate pollutant emission standards.

55. Environmental standards can be divided into four categories, namely, environmental quality standards, pollution emission standards, basic standards and method standards. The

13 environmental standards relevant to the Project are listed below in Table II.7.

Table II.7: Applicable Environmental Standards # Standard Code A Environmental Quality Standards 1 Environmental Quality Standards for Surface Water GB 3838-2002 2 Underground Water Quality Standard (Ground Water) GB/T 14848-1993 3 Environmental Quality Standard for Soil GB15618-1995 4 Ambient Air Quality Standard GB 3095- 1996/2012 5 Urban Ambient Acoustic Quality Standard (Environmental Quality GB 3096-2008 Standard for Noise) B Pollution Emission Standards 1 Discharge Standard of Pollutants for Municipal Wastewater GB 18918-2002 Treatment Plant 2 Integrated Emission Standard of Air Pollutants GB 16297-1996 3 Integrated Wastewater Discharge Standard GB 8978-1996 4 Domestic Drinking Water Quality Standard GB 5749-2006 5 Emission Standard of Environmental Noise for Boundary of GB 12523-2011 Construction Site 6 Noise Limit of Industrial Enterprises GB 12348-2008 7 Standard for pollution control on hazardous waste storage GB 18597-2001 8 Pollution control for storage and disposal site for industrial solid GB18599-2001 wastes 9 Emission Standards for Odor Pollutants GB 14554-93

56. ADB’s SPS requires projects to apply pollution prevention and control technologies and practices consistent with international good practices such as the World Bank Group’s Environmental, Health and Safety. Guidelines (EHS)10. For this assessment, where EHS standards exist for parameters and are relevant, they are used in parallel with PRC standards in this assessment.

1. Environmental Quality Evaluation Standards 57. Surface water. For water quality assessment, the determining standard is PRC’s Environmental Quality Standards for Surface Water (GB 3838-2002). It defines five water quality categories for different environmental functions. Category I is the best, suitable for head waters and National Nature Reserves. Category II is suitable for drinking water sources in Class I protection areas, habitats for rare aquatic organisms, breeding grounds for fish and crustaceans and feeding grounds for juvenile fish. Category III is suitable for drinking water sources in Class II protection areas, wintering grounds for fish and crustaceans, migration. United Nations Environment Programme (UNEP) standard is also listed for reference.

Table II.8: Surface Water Quality Standards (mg/L, pH excluded) GB 3838-2002 UNEP standard Category Category High Extreme Integrity Impairment Parameter I II III IV V (Category 1) (Category 4) pH 6 ~ 9 6 ~ 9 6 ~ 9 6 ~ 9 6 ~ 9 6.5 ~ 9.0 <5 Dissolved oxygen 90% ≥6 ≥5 ≥3 ≥2 7.3-10.9 3 or >13.6

10 World Bank Group. 2007. Environmental, Health and Safety Guidelines General EHS Guidelines. Washington: World Bank.

GB 3838-2002 UNEP standard Category Category High Extreme Integrity Impairment Parameter I II III IV V (Category 1) (Category 4) (DO) [mg/L] saturation or ≥7.5 Permanganate ≤2 ≤4 ≤6 ≤10 ≤15 - - index (IMn) [mg/L] Chemical oxygen ≤15 ≤15 ≤20 ≤30 ≤40 - - demand (COD) [mg/L] 5-day Biochemical ≤3 ≤3 ≤4 ≤6 ≤10 -- >10 oxygen demand (BOD5) [mg/L] Ammonia nitrogen ≤0.15 ≤0.5 ≤1.0 ≤1.5 ≤2.0 0.015 0.1 (NH3-N) [mg/L] Total phosphorus ≤0.02 ≤0.1 ≤0.2 ≤0.3 ≤0.4 <0.02 >0.190 (as P) [mg/L] Lakes & reservoirs ≤0.01 ≤0.025 ≤0.05 ≤0.1 ≤0.2 <0.01 >0.125 Total nitrogen ≤0.2 ≤0.5 ≤1.0 ≤1.5 ≤2.0 <0.5 >2.5 (lakes, reservoirs, as N) [mg/L] Copper (Cu) [mg/L] ≤0.01 ≤1.0 ≤1.0 ≤1.0 ≤1.0 0.001 0.0025 Zinc (Zn) [mg/L] ≤0.05 ≤1.0 ≤1.0 ≤2.0 ≤2.0 0.008 0.05 Fluoride (as F-) ≤1.0 ≤1.0 ≤1.0 ≤1.5 ≤1.5 - - [mg/L] Selenium (Se) ≤0.01 ≤0.01 ≤0.01 ≤0.02 ≤0.02 - - [mg/L] Arsenic (As) [mg/L] ≤0.05 ≤0.05 ≤0.05 ≤0.1 ≤0.1 0.01 0.15 Mercury (Hg) ≤0.0005 ≤0.0005 ≤0.0001 ≤0.001 ≤0.001 0.00005 0.001 [mg/L] Cadmium (Cd) ≤0.001 ≤0.005 ≤0.005 ≤0.005 ≤0.01 0.00008 0.001 [mg/L] Chromium (Cr, ≤0.01 ≤0.05 ≤0.05 ≤0.05 ≤0.1 0.001 0.04 hexavalent) [mg/L] Lead (Pb) [mg/L] ≤0.01 ≤0.01 ≤0.05 ≤0.05 ≤0.1 0.002 0.005 Cyanide (CN) ≤0.005 ≤0.05 ≤0.2 ≤0.2 ≤0.2 - - [mg/L] Volatile phenol ≤0.002 ≤0.002 ≤0.005 ≤0.01 ≤0.1 - - [mg/L] Total petroleum ≤0.05 ≤0.05 ≤0.05 ≤0.5 ≤1.0 - - hydrocarbon (TPH) [mg/L] Anionic surfactant ≤0.2 ≤0.2 ≤0.2 ≤0.3 ≤0.3 - - [mg/L] Sulfide [mg/L] ≤0.05 ≤0.1 ≤0.2 ≤0.5 ≤1.0 - - Fecal coliform ≤200 ≤2000 ≤10000 ≤20000 ≤40000 - - bacteria [number/L] Key: BOD5= 5 days biochemical oxygen demand, CODcr = chemical oxygen demand, CODMn = permanganate index, NH3-N=ammonia nitrogen; TN = total nitrogen; TP = Total Phosphorus.

58. Air Quality. The PRC ranks air quality into two classes according to its Ambient Air Quality Standard (GB 3095-2012). Class I is applicable for nature reserves, scenic spots and other areas that require special protection, Class II is applicable to residential area, commercial area, industrial area and rural area.

59. The World Bank Group adopted the World Health Organization (WHO) standards for its EHS standards for air quality11.The WHO set up air quality guideline (AQG) standards for various air quality parameters for the protection of public health. Yet recognizing that progressive actions are needed to achieve these standards and the financial and technological limitations of some countries, cities or localities especially in developing countries, the WHO also established interim targets as intermediate milestones towards achieving the AQG. Table II.9 compares the PRC’s GB 3095-2012 Class II standards with the World Bank Group’s EHS standards.

Table II.9: Comparison of the PRC’s GB 3095-2012 and World Bank Group EHS Ambient Air Quality Standards Averaging GB 3095-2012 World Bank Group EHS No. Item Period Class II Interim Targets AQG 1 SO2 1-year 0.06 n/a n/a 24-hour 0.15 0.050-0.125 0.020 1-hour 0.50 n/a n/a 2 PM10 1-year 0.10 0.030-0.070 0.020 24-hour 0.15 0.075-0.150 0.050 3 PM2.5 1-year n/a 0.015-0.035 0.010 24-hour 0.15 0.0375-0.075 0.025 1-hour 0.35 n/a n/a 4 NO2 1-year 0.04 n/a 0.040 24-hour 0.08 n/a n/a 1-hour 0.20 n/a 0.200 5 CO 24-hour 4.0 n/a n/a 1-hour 10.0 n/a n/a 6 O3 Daily 0.1 n/a n/a maximum 8- hour average 1-hour 0.16 n/a n/a 7 TSP 1-year 0.2 n/a n/a 24-hour 0.3 n/a n/a

60. Longer averaging period such as 1-year as shown in Table II-6 is more applicable to assessing impacts from multiple as well as regional sources; while shorter averaging periods such as 24-hour and 1-hour are more applicable to assessing short term impacts from project related activities, such as from peak hour traffic or daily or peak construction activities.

3 3 61. Class II standards of 24-hour SO2 (0.15 mg/m ) and PM2.5 (0.15 mg/m ) are higher than the upper limit of the World Bank Group’s interim standards (0.125 mg/m3 and 0.075 mg/m3 respectively); while 24-hour PM10 (0.15 mg/m3) and 1-hour NO2 (0.20 mg/m3) are the same as the upper limit of the World Bank Group’s upper limit of interim standard and guideline standard, respectively.

11 World Health Organization. 2005. WHO air quality guidelines global update 2005. Report on a Working Group meeting, Bonn, Germany, 18-20 October 2005.

62. According to the Technical Specifications to Determine the Suitable Areas for Environmental Noise of Urban Area (GB/T 15190-94), the area within 200 m on both sides of road or road junction should comply with the corresponding provisions in Acoustic Environment Quality Standard (GB 3096-2008).

63. Acoustic Environment Quality. GB 3096-2008 categorizes five functional areas based on their tolerance to noise pollution: from Class 0 to Class 4. Class 0 is for areas with convalescent facilities that are the least tolerant to noisy environments and therefore have the most stringent day and night time noise standards. Class 1 is for areas predominated by residential areas, hospitals and clinics, educational institutions and research centers. Class 2 is for areas with mixed residential and commercial functions. Class 3 is for areas with industrial production and storage and logistics functions. Class 4 is for regions adjacent to traffic noise sources such as major roads and highways, and is subdivided into 4a and 4b with the former applicable to road and marine traffic noise and the latter applicable to rail noise. Standards for various functional area categories and are compared with the World Bank Group’s EHS guidelines as listed in Table II.10. This shows that the World Bank Group has lower noise limits for residential, commercial and industrial mixed areas but higher noise limits for industrial areas and night time noise near trunk roads.

Table II.10: Environmental quality standards for noise (Equivalent Sound Level: LAeq: dB) Noise GB 3096- World Bank Functional 2008 Group EHS12 Area Category Applicable Area Day Night Day Night 0 Areas needing extreme quiet, such as 50 40 55 45 convalescence areas 1 Area mainly for residence, cultural and 55 45 educational institutions 2 Residential, commercial and industrial 60 50 mixed area 3 Industrial area 65 55 70 70 4a Area on both sides of urban road traffic 70 55 trunk line Note: Functional Area 4 is divided into 4a for trunk roads and 4b for railway lines.

64. Soil Quality. According to the Soil Quality Standard-Soil Contamination Risk Control and Management for Construction Land (GB36600-2018), the construction land is divided into two categories according to the different exposure conditions of the projected objects. The first type of land includes residential land, primary and secondary school land, medical and health facility land and social warfare land, as well as community parks in park green space or children’s park land. The second type of land includes industrial land, logistic storage land, commercial service facility land, road and transportation facility land, and utility land, other public service land and green space land expect for the lands included in the first land.

65. The risk screening value of soil pollution risk of construction land means that under specific land use mode, the pollutant content in the soil of construction land is equal to or lower than this value, and the risk to human health can be neglected; if it exceeds this value, there may be risks to human health. Further detailed investigations and risk assessments should be carried out to determine specific pollution ranges and risk levels. The intervention value of soil pollution risk of construction land means that under specific land use mode, if

12 World Bank Group 2007.

17 the pollutant content in the soil of construction land exceeds this value, there is usually unacceptable risk to human health, and risk management or repair measures should be taken.

Table II.11: Applied Soil Quality Standard for Medical and Social Warfare Facility Land Use First Type (mg/kg) Item Screening value Intervention Value As 20 120 Cd 20 47 Cr (VI) 3.0 30 Cu 2000 8000 Pb 400 800 Hg 8 33 Ni 150 600

2. Discharge Standard 66. Air Quality. Fugitive emission of particulate matter (such as dust from construction sites) is regulated under PRC ‘s Air Pollutant Integrated Emission Standard (GB 16297- 1996), which sets 120 mg/m3 as the maximum allowable emission concentration and ≤ 1.0 mg/m3 as the concentration limit at the boundary of construction sites, with no specification on the particular matter ‘s particle diameter.

67. The concentration of air pollutants around the sewage treatment station shall comply with the Table 3 of Sewage Discharge Standard for Medical Institutions (GB18466-2005). Table 3. The maximum allowable concentration standards for atmospheric pollutants around the sewage treatment station is given in Table II.12.

Table II.12: Atmospheric Pollutant Discharge Requirement for Wastewater Treatment Station of Medical Institutions Discharge to Water Body Pollutant (mg/L) 3 NH3(mg/m ) 1.0 3 H2S(mg/m ) 0.03 Odor (dimensionless) 10 3 Cl2 (mg/m ) 0.1 CH4 (highest volume percentage % ) 1

68. Wastewater. Discharge of wastewater from construction sites is regulated under PRC‘s Integrated Wastewater Discharge Standard (GB 8978-1996). Class I standards apply to discharges into Category III water bodies under GB 3838-2002. Class II standards apply to discharges into Categories IV and V water bodies. Class III standards apply to discharges into municipal sewers going to municipal WWTPs with secondary treatment.

Table II.13: Integrated Wastewater Discharge Parameter Class I Class II Class III For discharge into For discharge into Category For discharge into Category III water body IV and V water bodies municipal sewer pH 6–9 6–9 6–9 SS mg/L 70 150 400 BOD5 mg/L 20 30 300 COD mg/L 100 150 500 TPH mg/L 5 10 20 Volatile phenol mg/L 0.5 0.5 2.0

NH3-N mg/L 15 25 --- 2- PO4 (as P) mg/L 0.5 1.0 --- LAS (= anionic 5.0 10 20 surfactant) mg/L

69. The sewage from medical institutions shall comply with the Table II.14 of the “Water Pollutant Emission Standards for Medical Institutions” (GB18466-2005).

Table II.14: Water Pollutant Emission Standards for Medical Institutions Discharge to Water Body Discharge to Municipal Pollutant (mg/L) WWTP(mg/L) SS 20 60 BOD5 20 100 CODcr 60 250 NH3-N 15 － Number of fecal coliforms 500 5000 (MPN/L)

70. Construction noise will be assessed against the standards in Emission Standards of Ambient Noise for Boundary of Site Noise (GB 12523-2011) and Class II of Emission Standard for Industrial Enterprises Noise at Boundary (GB 12348-2008), which are set out in Table II.15. There are no EHS targets of guidelines for transient construction noise.

Table II.15: Construction site noise limits. Unit: LAeq [dB (A)] Noise Limit Period Major Noise Source Day Night Construction Bulldozer, excavators and loader; pile 70 55 driving machines; concrete mixer, vibrator and electric saw; hoist and lifter. Operation Pumps 60 50

71. Vibration. Construction activities are likely to cause vibration impact, and should comply with the Standard for Urban Area Environmental Vibration (GB 10070-88). The details are shown in Table II.16. The project works are located on villages and communities, where standard 2 applies.

Table II.16: Vertical Vibration Standard Value for Various Urban Areas (Unit: dB) Scope of applicable area Day Night Special residential area 65 65 Residential, cultural and educational area 70 67 Mixed area and commercial center 75 72 Industrial centralized area 75 72 Both sides of traffic trunk line 75 72 Both sides of railway main line 80 80

72. Safety Considerations. PRC requirements on life and fire safety measures are consistent with those of general EHS “Community Health and Safety” Guidelines. According to Fire Prevention Law of PRC, the design unit should design the project pursuant to the state technical standards for the fire prevention of engineering construction, and the construction unit should submit the blueprints and relevant information of fire prevention design of the project to the public security fire fighting department for examination and verification. “For a project without undergoing such examination and verification or failing to qualify upon examination and verification, the approving department must not issue the construction permit and the construction unit must not proceed with the construction”.

73. Design parameters of air conditioning, ventilation and smoke control (Source: FSR 2019) - Air conditioning: central air conditioning system design, special medical room to be set at constant temperature and humidity, clean air conditioning systems. - Ventilation: underground garage and equipment room, public toilets on the ground outside the window of the room. - Smoke: underground garage natural smoke control using pressurized air supply (the pressurizing blower are used mixed flow fan).

Table II.17: Air Conditioning Design Parameters Summer Winter Fresh Air Standard voice Room Temperatur Relative Temperatur Relative sound dB Name e ℃ humidity% e ℃ humidity% standard (A) Office 25~27 ≤65 18~20 ≥30 30m3/h • 45~55 people Meeting 25~27 ≤65 18~20 ≥30 15m3/h • 40~50 room people (Source: FSR 2019)

Table II.18: Ventilation design parameters Power Room Name Chiller plant Pump House distribution bathroom Air changes 12 6 12 12 (Source: FSR 2019)

Table II.19: Smoke control design parameters Room Name Interior walkway Smoke stairwell Shared room Air volume or pressure 12kn3 / h. M2 40-50 Pa 25-30 Pa (Source: FSR 2019)

III. DESCRIPTION OF THE PROJECT

74. The proposed project aims to support Guangxi Zhuang Autonomous Region (GZAR), the People's Republic of China (PRC) to strengthen the Integration of elderly care and health care to provide continued services of elderly care and health care for those in need." It will be the first project to be supported by international financial institutions for GZAR to strengthen elderly care services and structure a public-private partnership (PPP) project.

A. Rational 75. The PRC faces a serious change in its demographic structure. In 2017, the number of the elderly people aged 65 years and older was 158 million and its proportion to the total population (the aging rate) was 11.4%. The aging rate is expected to reach 14% in 2025 and 21% in 2035.13 The PRC has a substantial number of elderly people, and the number is rapidly increasing.

76. The rapid population aging increases aging-associated diseases. Elderly people typically have chronic diseases and experience multi-morbidity. The primary cause of care dependence of elderly people is the loss of physical function, resulting from chronic diseases and age-associated impairments.14 Further, many of the elderly people have complex cases of multi-chronic diseases and physical and/or cognitive disabilities. Such complex cases require a continuity of services for both health care and elderly care. Coordination of care between the health sector and the elderly care sector is necessary to provide seamless care services for elderly people in need, and to reduce avoidable hospitalization.

77. It is common in an aging society that elderly people tend to be readmitted to hospitals due to lack of appropriate elderly care institutions where they could be transferred after hospitalization. For example, research estimated that such readmission of the elderly costed about $10 billion of unnecessary medical expenditures in Japan in 2002.15 However, if those elderly people cannot be readmitted, they would have to return to their homes soon after the treatment of acute phases of various medical conditions at hospitals. It would be difficult for family caregivers to provide adequate care for the elderly who are discharged from hospitals, and still require continued medical and elderly care services. Inadequate care at home might cause further health problems which may require readmission to hospitals. Frequent transitions between hospitals and homes or long duration of stay in hospitals further reduce functional abilities of elderly people.

78. In the PRC, more than 100 million elderly people had at least one chronic disease in 2013. Burdens from chronic diseases are expected to increase by 40% in 2030. Further, it is projected that approximately 110 million people will require care for activities of daily living (ADL) by 2050, and of which more than 60% will be the elderly people.16 The number of the elderly people with multiple chronic conditions is greatly increasing in PRC. Those elderly people require (i) post-acute care and rehabilitation to restore or stabilize their functionality after discharged from hospitals, i.e., transition care, and (ii) supports for coordination between hospitals, elderly care institutions and homes, i.e., coordinated care. A functional scheme, linking the acute phase care, the transition care and the coordinated care, is the

13 United Nations Development Programme. 2016. Asia-Pacific Human Development Report: How Changing Demographics Can Power Human Development. New York; and Government of Japan, Cabinet Office. 2017. Kourei Syakai Hakusho (White Paper on Aging Society). Tokyo. 14 World Health Organization. 2015. China Country Assessment Report on Aging and Health. Switzerland. 15 T. Hatano. 2004. Costs of Hospitalization for Non-Medical Reasons. Journal of Health Economics and Policy. Tokyo. 16 ADL is defined as basic self-care tasks, such as eating; toileting or actions associated with personal hygiene; bathing; and transferring or ability to sit, stand, and walk independently.

21 core of the integrated health care and elderly care services. This scheme has to ensure the connection between two sectors, i.e., the health sector and the elderly care sector; and further to specify the pathways for each elderly people to access care services across those sectors based on his or her care needs.

79. To establish such scheme, a functional hospital discharge management system needs to be built in a hospital. The discharge management system will (i) clarify care needs after hospitalization, including needs for medical care, medication, rehabilitation and elderly care, and (ii) identify where and how an elderly person can access his or her needed care. Such individualized care plan should be prepared based on the discussions among the elderly people, their families, medical experts, elderly care experts, such as care managers and care givers, therapists and social workers, etc. Further, it is necessary to strengthen the capacity of elderly care service provisions to meet such care needs in the scope of the health and elderly care integration. A proper integration of health and elderly care will provide proper care services across the two sectors based on needs and avoid using medical resources for the elderly care service provision.

80. Further, enhancement of the private sector’s involvement is essential to fill the gap in supplying integrated elderly care and health care services. Considering the substantial increase of care needs due to the rapid population aging in PRC, it would not be realistic for the public sector to be the major provider for care services. Meanwhile, the public sector needs to take responsibility in setting and managing the care needs assessment and monitoring service quality. The private sector could bring their knowledge and experiences to better design facilities, engage skilled staff, and provide services efficiently under the guidelines and regulations set by the public sector. Such responsibility alignment has not been clearly established yet in the PRC elderly care sector.

81. The PRC central government has recognized the importance of integrated elderly care and health care services to respond to its rapid aging population. The central government issued the policy of elderly care and health care integration in 2015.17 Following the central guidance in 2016, the Government of Guangxi Zhuang Autonomous Region Government (GGZAR) issued the policy on implementation of elderly care and health care integration,18 and the policy on enhancing the involvement of the private sector in care services provision for the elderly people.19 The municipalities of Nanning and Hezhou were selected as pilot cities of elderly care and health care integration in 2017.20 Although the GGZAR has issued those policies, its experience in promoting the integration of elderly care and health care has been substantially limited. Its experience is also limited in promoting the private sector’s involvement in the provision of these services. Furthermore, the integration of elderly care and health care requires close coordination across bureaus and agencies such as civil affairs bureau and health commission; however, such inter-sectoral coordination has not been established in GZAR.

B. Impact and Outcome 82. The project is aligned with the following impact: integration of elderly care and health care established in GZAR. 21 The project will have the following outcome: utilization of

17 Government of the PRC, State Council. 2015. Notice [84] on the Integration of Elderly Care and Health Care. Beijing. 18 GZARG. 2016. Opinion [82] on Implementation of Elderly Care and Health care Integration Promotion. Guangxi. 19 GZARG, Department of Civil Affairs. 2016. Promote Involvement of Private Sector in the Elderly Care Sector. Guangxi. 20 Hezhou Municipal People’s Government. 2017. Notice [90] on Pilot of Promoting Elderly Care and Health Care in Hezhou City. Hezhou; and People’s Government of Nanning Municipality. 2017. Notice [235] on Implementation of Elderly Care and Health Care Integration Promotion. Nanning. 21 The Government of Guangxi Zhuang Autonomous Region. 2016. The People’s Republic of China.

coordinated health care and elderly care services in GZAR increased.22

C. Outputs 83. The proposed project will help GZAR develop an integrated elderly care and health care services through delivering three outputs.

• Output 1: Coordinated care services and facilities improved. This output will (i) strengthen the coordination between the medical institutions and the elderly care institutions, by focusing on a hospital discharge management system to be built in the target hospitals, i.e., project implementing entities (PIEs);23 (ii) create four elderly care institutions and a hospital in the municipalities of Hezhou and Nanning of GZAR; (iii) strengthen capacity to provide rehabilitation (physical therapy and occupational therapy) appropriately; (iv) strengthen capacity of the elderly care institutions and their relevant staff to adequately provide care services, such as care for ADL, dementia care, and terminal care; and (v) develop a capacity building plan of those institutions to further strengthen their capacity to ensure the proper and sustainable provision of care services.

• Output 2: Public–private partnership (PPP) model for integrated elderly care and health care service provision developed. The output will be an elderly care institution to support the integrated elderly and health care services provision in Hezhou municipality of GZAR (the Hezhou PPP subproject), established under a PPP modality which will define certain implementation arrangement for its construction, operation, and maintenance as identified feasible during the PPP preparation stage. The PPP model will define a risk allocation between the public and private sectors based on internationally accepted PPP norms and principles for bankability and sustainability in PPP implementation.

• Output 3: Management and policy development capacities in promoting the integrated elderly and health care services developed. This output will provide consulting services to (i) support the executing agency, the implementing agencies and the PIEs to manage and implement the project; (ii) ensure the design of elderly care-related facilities, functions, and services to be delivered under each elderly care institution are technically appropriate; (iii) support to enhance the private sector’s involvement in the elderly care service provision, including transaction advisory services (TAS) to prepare the PPP subproject24, and (iv) support the local governments’ domestic and international study visits to strengthen their knowledge on elderly care development. Through Office of Public–Private Partnership (OPPP), ADB will provide the TAS to GZAR to develop and successfully tender the Hezhou PPP Subproject.25 TAS will be provided to prepare business case analysis, identify a proper PPP modality, and select qualified private partner with necessary agreements between the public and private sector.

Opinions on Elderly Care and Health care Integration Promotion (Circular No. 82). Nanning. 22The design and monitoring framework is in Project Administration Manual for the project. 23 The project implementing entities (s) include (i) Nanning Chinese Traditional Medicine Hospital, (ii) Hezhou People’s Hospital, (ii) Guangxi Guidong Hospital, and (iv) Nanning Social Welfare Institute (NSWI). The first three PIEs are public hospitals. The NSWI is a public entity, providing long-term care, and has its internal clinic. 24 TAS includes the preparation of PPP pre-feasibility study, PPP options and business case analyses, development of a financeable transaction structure, and assistance with drafting and negotiating tender documents, etc. 25 ADB and the executing agency will agree to the scope of TAS and reflect that in the relevant loan and project documentation.

23 D. Design of Engineering Components 84. There are our subprojects involves physical elderly care and medical care facilities in Nanning and Hezhou City Error! Reference source not found.) that summarized in Table III.1 and elaborated in this section.

Table III.1: Summary of Sub-projectsa Project Implementing Planned Target Staffing (for 750 Capacity Entity Estimated Scale and Facilities Elderly Planned Target Care Services estimated beds) Development Nanning 500 beds (750 in total including • Aged elderly: those • Long-term care (including care for Doctor 25 • Rehabilitatio Social Welfare own expansion) could not go back activities for daily living) Nurse 60 n Institute 9F+7F+3F Undergroud2F home and will stay • Dementia care (including (rehabilitatio 19760.42+B10376.54=30136.96 in the facility until • Rehabilitation (non-intensive team n care and (building area m2) the end of life rehabilitation) leaders) 200 support for • 50–70%: full- • Terminal care (counseling and pain Caregivers 10 procurement disabled management) Therapist 3 ) • About 60 beds: • Terminal care (counseling and pain Nutritionist 10 • Dementia Dementia elderly management) Social care • Counseling (for families and elderly to workers • Terminal adapt to becoming resident of the care facility, while retaining family • Counseling relationships with the resident elderly) • Trainers’ • Training on caregivers (from other training institutions) Nanning Medical facility • Aged elderly: those • Long-term care (including care for Doctor 1 • Discharge Traditional 150 beds could not go back activities for daily living) Nurse 12 management Chinese 13F 12731m2 (building area) home and will stay • Rehabilitation (non-intensive (including (incl4) • Rehabilitatio Medicine Elderly care institution in the facility until rehabilitation) team n (intensive Hospital 200 beds the end of life • Terminal care (counseling and pain leaders) 47 and non- (NTCMH) 7F + Underground 2F; • 30%: full-disabled management) Caregivers 3 intensive 9277+B7592=16869 m2 • Activities/recreation (to retain remaining Therapist 1 rehabilitation (building area) physical and cognitive capability and for Nutritionist 2 for NTCMH quality of life) Social staff and workers elderly care staff) • Terminal care • On-the-job training for caregivers Hezhou 400 beds • Target elderly: • Long-term care (including care for Doctor 3–4 • Discharge

25 Project Implementing Planned Target Staffing (for 750 Capacity Entity Estimated Scale and Facilities Elderly Planned Target Care Services estimated beds) Development People’s 12F + Undergroud2F those could not go activities for daily living) Nurse 25 management Hospital 18903.06+B3560.66=22463.72 back home and will • Rehabilitation (intensive and non- (including (incl7) • Rehabilitatio (HPH) (site 1- m2 (building area) stay in the facility intensive rehabilitation) team n (intensive Hezhou No.1 until the end of life • Dementia leaders) 95 and non- Nursing • 30%: full-disabled, • Terminal care (counseling and pain Caregivers 6 intensive Center) including 40 beds management) Therapist 2 rehabilitation for elderly with • Activities/recreation (to retain remaining Nutritionist 4 for HPH staff dementia (one floor physical and cognitive capability and for Social and elderly for dementia) quality of life) workers care staff) • Dementia • On-the-job training for caregivers • Support to design the activities/ recreation programs Hezhou 400 beds • Target elderly: • Long-term care (including care for Doctor 1–2 • Discharge People’s 3F+6F +Undergroud1F semi-disabled activities for daily living) Nurse 32 management Hospital 19188.30+B5914.08=25102.38 • Dementia (one • Rehabilitation (intensive and non- (including (incl 7) • Rehabilitatio (HPH) (site 2- m2 (building area) floor with 52 beds) intensive rehabilitation) team n (intensive Hezhou No.2 • Light physical • Dementia leaders) 88 and non- Nursing needs with high • Activities/recreation (to retain remaining Caregivers 6 intensive Center) social needs 5% physical and cognitive capability and for Therapist 2 rehabilitation quality of life) Nutritionist 4 for HPH staff Social and elderly workers care staff) • Dementia • On-the-job training for caregivers • Support to design the activities/

Project Implementing Planned Target Staffing (for 750 Capacity Entity Estimated Scale and Facilities Elderly Planned Target Care Services estimated beds) Development recreation programs Guangxi 450 beds • Target elderly: • Long-term care (including care for Doctor 1–2 • Discharge Guidong 9F+7F + Undergroud1F semi-disabled 20% activities for daily living) Nurse 19 management Hospital 22096.76+B7200=29296.76m2 • Full-disabled 70% • Rehabilitation (intensive and non- (including for GGH and (GGH)b (building area) • Dementia 5% (one intensive rehabilitation) team the new (Huanan floor) • Dementia leaders) 128 hospital Nursing • Light physical • Terminal care Caregivers 4 • Rehabilitatio Center) needs with high • Activities/recreation (to retain remaining Therapist 2 n (intensive social needs 5% physical and cognitive capability and for Nutritionist 4 and non- quality of life) Social intensive workers rehabilitation ) for GGH and the new hospital • Terminal care a Target elderly people, Target care services and needed staffing would be reassessed before each elderly care institution will begin its operation, considering the actual needs at the time. Capacity development will be provided under the project to the relevant staff of the respective PIEs and/or each elderly care institution which will be created under the project. b This is the public–private partnership subproject. The private concessionaire will design and build the facility and operate the elderly care institution. Therefore, details of the facility and target elderly and target care services will be further assessed and specified under the transaction advisory services which will support the overall development and tendering of public–private partnership subproject. The capacity development under this project will be provided for the PIE (Guangxi Guidong Hospital).

Figure III.1: Overall Location Map of each Subproject 1. Subproject 1: Nanning Traditional Chinese Medicine Hospital (NTCMH)

85. This subproject is located at the former campus of Nanning Health School at No.3 Shizhuling Road, Jiangnan District, Nanning City. This subproject includes Nursing Center and one clinic building. The Nursing Center can provide 200 beds for elderly people. The proposed Nursing Center building consists of a 7-story main building and a 3-story annex building (Figure III.3). The clinic complex building has 14 floors above ground and 2 floors basement. The major works are presented in Table III-1.

Figure III.2: Site Boundary of Nanning Chinese Traditional Medicine

Note: orange square= disabled elderly care area; light green square=semi-disabled elderly care area; yellow square= medical area. Figure III.3: Layout of the proposed Building

Figure III.4: Design of Nanning Chinese Traditional Medicine Nursing Center

Table III.2: Major Indicators of NTCHM Nursing Center Civil Works Code Project Unit Amount Note 1 Total land Area m2 7,233.35 10.85 acres

2 Total floor Area m2 12,587

3 Including Underground Garage Area m2 2822 If two-story underground (6450) garage, ground 2 floor:3287.33 m 2 4 Floor capacity area m 9765 2 2 5 Ground construction Section m m 2 6 Including Check-in service room m 164 2 7 Living room m 5619 2 8 Health Care Room m 550 2 9 Rehabilitation Room m 275 2 10 Entertainment Room m 334 2 11 Social Work Room m 511 2 12 Administrative Office Room m 426 2 13 Auxiliary room m 1421 14 Featured rooms for Traditional m 2 465 Chinese medicine 2 15 Volumetric ratio m 1.35 16 Building density % 35 17 Green space Rate % 30 18 Parking space Car 233 (294) 19 Including Motor vehicle Car 89 (147) 20 Including Ground parking Car 30 (20) 21 Underground Car 59 (127)

Code Project Unit Amount Note parking spaces 22 Non-motorized set 147 23 Total number of beds Bed 200

Table III.3: Major Indicators of NTCHM Clinic Complex Building Civil Works Code Project Unit Amount 1 Total land Area m2 7,233.35 2 Total floor Area m2 17,655.08 3 Including Underground Garage Area m2 4,770 4 Floor capacity Area m2 12,885.08 5 Ground construction Section m2 12,885.08 6 Including Inpatient Dept. m2 4,276.4 7 Outpatient department m2 4,703.46 8 Emergency department and registered toll hall m2 742.38 9 ICU and medical Record room m2 1,051.28 10 Administration m2 1,051.28 11 Academic Conference m2 1,060.28 12 Volumetric ratio m2 1.78 13 Floor Area m2 1074 14 Building density % 35 15 Green space Rate % 30 16 Parking space Car 304 17 Including Motor vehicle Car 122 18 Including Ground parking Car 40 19 Underground parking spaces Car 82 20 Non-motorized Car 182 21 Total number of beds Bed 150

2. Subproject 2: Nanning Social Welfare Institute Phase I Upgrading (NSWI)

86. The upgrading and renovation of Nanning Social Welfare Institute is divided into one phase and two phases, with a total floor area of 44,615.96 m2 (of which total of 14,479 m2 existing building will be reserved). The Phase one is included in the proposed project. This subproject can provide 500 beds and the capacity of NSWI can reach 750 beds.

87. The phase one is proposed to build a total floor area 30,136.96 m2, including 19,760.42 m2 above ground. The above ground floor areas of No.2 and No. 4 Elderly Care Apartment are 4,110.58 m2 and 14,444.48 m2 respectively. The social workers and care workers training building is1,205.36 m2. Total of 5,512.61 m2 existing elderly care apartment will be demolished.

Table III.4: Major Indicators of NSWI Civil Works Name Unit Amount Note 2 Total land Area m 31,555.05 Including Area of the first phase of land m2 26,746.40 use 2 Phase II land Area m 4,808.65 Not included in the project 2 Total floor Area m 44,615.96 2 Including Retain part of total floor area m 14,479 Proposed part of total floor m2 19,760.42

31 Name Unit Amount Note area Floor capacity area m2 34,239.42 Excluding capacitance area m2 10,376.54 Including older disabled orphans love apartment building basement 553.82 2 m 2 New 2# Elderly apartment building m 4,110.58 construction 2 4# Elderly apartment building m 14,444.48 Integrated building for social m2 1,205.36 and nursing workers training 2 Reserved 1# Elderly apartment building m 4,960 existing 2 Business Complex Building m 2,300 building Canteen m2 1,619 Love apartment building for m2 5,600 Not counted in the old age older and disabled orphans room, basement area (excluding actual room size 553.82 m2 for the elderly) 2 Land area of the building m 6399.42 Volumetric ratio - 1.28 Building density % 23.9 2 Green area m 9,578.92 Green space Rate % 35.8 Underground motor vehicle Parking car 193 Meet 2% of accessible spaces parking spaces Ground motor vehicle parking spaces car 100 Non-motorized parking spaces set 150 Demolition m2 5,512.61 Elderly care apartment Beds No 500 On completion go up to 750 beds 3. Subproject 3 (site one): Hezhou No.1 Elderly Nursing Center

88. The Hezhou No.1 Nursing Center subproject is located in the east side of Chengdong Branch of Hezhou People’s Hospital, which is under construction and is expected into operation in 2024. A ceramic factory called Meiyi Porcelain Company is in about 120 m in the north side of the proposed site. Meiyi ceramic factory has high-voltage electrostatic precipitator to control the flue gas and buffer cushions to reduce noise pollution. This plant is designed to satisfy with the GB9078-1996 "Emission Standard for Air Pollutants in Industrial Furnace and Kiln" and GB12348-2008 "Environmental Noise Emission Standard for Industrial Enterprises Boundary. Under normal operation condition, the exhaust gas and noise of Meiyi Porcelain Company have little impact on the project. The emergency response plan of Meiyi Porcelain Factory (document no. 451102-2017-5-L) was approved by Babu District Environment Protection Bureau of Hezhou City on April 20 2017. In order to provide patients with a good living environment, a green belt will be planted to further reduce the impact from the ceramic factory.

89. This subproject is designed to provide 400 beds. The planned land area for the subproject is 7,098.86 m2 (10.64 acres) for a 12-story nursing complex with a total construction area of 22,463.72 m2, of which the above-ground construction area is 18,903.06 m2, and the basement construction area is 3,560.66 m2; the nursing complex building is mainly set up for the elderly, administrative office and auxiliary facilities.

Figure III.5: Layout of the Hezhou No.1 Nursing Center

33 Table III.5: Major Indicators of Hezhou No.1 Nursing Center Civil Works Item Unit Amount Note Planning Land Area m2 7,098.86 10.64 acres Total floor Area m2 22,463.72 Including Nursing Complex Building m2 18,903.06 Basement m2 3,560.66 Land area of the building m2 1,516.40 Building density % 21.36% Volumetric ratio 3.16 Green area m2 2,371.03 Green space Rate % 33.4% Basement parking car 44 Underground Garage Parking Beds No 400

4. Subproject 3 (site two): Hezhou No.2 Nursing Center

90. The complex building of the new Nursing Center has six floors above ground of north part and three floors of south part and one floor of basement. The complex building covers an area 49431.60 m2 (about 74.14 acres). The total floor area is 25,102.38 m2 with 400 beds. The height of the basement is 3.9 m. The first floor is 4.2 m in height. The rest floors are 3.2 m in height.

Table III.6: Major Indicators of Hezhou No.2 Nursing Center Civil Works Name Area Unit Planning Land Area 49,431.06 m2 Total floor Area 25,102.38 m2 Including Ground main building 19,188.30 m2 Basement 5,914.08 m2 Floor area of the building 4,030.21 m2 Building density 8.15 % Volumetric ratio 0.39 - Green area 20,266.96 m2 Parking space 198 Car Including Ground parking 100 Car Underground Garage Parking 98 Car Old-Age beds 400 Bed Including Semi-incapacitated aged 380 Bed Self-care old-aged 20 Bed

Figure III.6: Layout of the Hezhou No.2 Nursing Center

5. Subproject 4: Hezhou Huanan National Medical Nursing Home (HHNH) 91. This subproject is located in Hezhou Ecological Development Zone in Figure III.7 depicting the Hezhou City Masterplan (brown color refers to industrial land; yellow color refers to residential land; red color refers to commercial land). The Hezhou Ecological Development Zone has a total planned area of 48.139 km2) is designed to develop a complex with high-tech industry, research and development, residential and commercial zone, which is divided into Hezhou High-tech Eco-Industrial Park (planned area of 18 km2) and residential part separated by Hejiang River. As shown in Figure III.7, the subproject is located in the residential part and is about 3 km to the industrial park. The emergency response plan of Hezhou Electric Eco-Industry Park (document no. 451100-2016-009-L) was approved by Hezhou City Environment Protection Bureau on December 30 2016. The subproject includes a 9-story (7-story podium) frame structure elderly care building with a planned gross floor area of approximately 29,296.76 m2, of which the above-ground floor area is approximately 22,096.76 m2 and the basement area is approximately 7,200 m2. This subproject can provide 450 beds for the elder people.

Table III.7: Indicators of Hezhou Hunan National Medical Nursing Home Civil Works Item Unit Amount Note Total planned land area m2 80,419.15 About 120.63 acres Including NET land area of the project m2 21,786.47 Approx. 32.68 acres Reserved development land m2 58,632.68 Equal to 87.95 acres, not Area included in this project 2 Planning Total Floor Area m 29,296.76 2 Including Floor Area m 22,096.76 2 Underground Floor Area m 7,200 2 Floor area of the building m 2,629.63 Building density % 12.07

2 Outdoor event Venues m 533.12 2 Cloth/sheet drying venues m 548.67 Volumetric ratio - 0.98 2 Green area m 7,755.98 Green space Rate % 35.6 Total number of beds Bed 450 Motor Vehicle Parking spaces Car 188 Including Ground motor vehicle Car 8 parking spaces Underground motor vehicle Car 180 Parking spaces

Figure III.7: Hezhou City Master Plan and Propose Site

Figure III.8: Layout of the Hezhou Hunan National Medical Nursing Home

E. Availability of Public Utilities

92. The elderly care facilities to be built by NTCMH and NSWI are in built-up area that will be connected to the existing water supply, sewage and power supply system.

93. Subprojects of Hezhou are located in the area under development in the absence of existing infrastructure. The infrastructures are planned (as see in Figure III.9. The water supply pipes will be laid in similar alignment that not repeated in the figure) and are expected to be operated by 2023. EA shall cause the IA to ensure that all necessary public utilities will be available prior to the operation of project facilities.

Figure III.9: Hezhou Wastewater Collection and Treatment Infrastructure Plan

F. Implementation Arrangements

94. The Government of Guangxi Zhuang Autonomous Region (GGZAR) through Guangxi project management office (GPMO) is the executing agency. It is responsible for overall planning and implementation of the project, and has substantial experience in the preparation, implementation, and management of projects funded by ADB. The project leading group, chaired by the vice governor of GGZAR, has also been set up to facilitate the cross-sectoral coordination.

95. Nanning Municipality Government (NMG) and Hezhou Municipality Government (HMG) are the implementing agencies and responsible to oversee the implementation for the subprojects in their respective municipalities.

96. The project covers four subprojects (one with two components): two are located in Nanning and other two are in Hezhou. One of the four subprojects, [the Hezhou PPP subproject], will be pursued under a PPP modality. The following four PIEs will be responsible for each of the subprojects: (i) Nanning Social Welfare Institute (NSWI), (ii) Nanning Traditional Chinese Medicine Hospital (NTCMH), (iii) Hezhou People’s Hospital (HPH), and (iv) Guangxi Guidong Hospital (GGH). The first three PIEs will be responsible for day-to-day project administration. GGH will be responsible for the Hezhou PPP subproject, and following the PPP concession agreement, will monitor/supervise the implementation of the Hezhou PPP subproject. The HPH subproject has two project sites while all other subprojects have one. The NTCMH subproject includes an elderly care facility and a medical facility. The GGP subproject is a PPP subproject. Each PIE will manage their own financial accounts; and retain all project-related documents and statements of respective subprojects for project administration, auditing, and evaluation.

97. The implementation arrangements are summarized in Table III.8 and described in

detail in the project administration manual.26

Table III.8: Implementation Arrangements Aspects Arrangements Implementation period May 2020–May 2026 Estimated completion date November 2026 Estimated loan closing date May 2027 Management (i) Oversight body Project Leading Group led by Vice Governor of GZAR (ii) Executing agency GGZAR (GPMO) (iii) Key implementing agencies NMG, NMG (iv) Project Implementing a. Nanning Social Welfare Institute entities b. Nanning Traditional Chinese Medicine Hospital c. Hezhou People’s Hospital d. Guangxi Guidong Hospital

G. Overall Project Implementation Plan 98. The project will involve survey work, land clearance, design and engineering of plant equipment, floating tenders for procurement, civil work and testing and commissioning of buildings. Total project work in is costing USD 191.74 million (including IDCs and contingencies).

99. The two Nanning and Hezhou People Hospital sub-projects are proposed to be start in Q42019 and complete Q4 2023 whereas the Hezhou Hunan National Medical Nursing Home (PPP) tasks will start Q4 2020 and complete by Q4 2024. The overall draft project implementation schedule for Outputs 1-3 under the project is attached Table III.9.

26 Project Administration Manual.

39 Table III.9: Implementation Plan 2019 2020 2021 2022 2023 2024 2025 2026 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 Output 1: Coordinated care services and facilities improved Nanning Municipality: Nanning Social Welfare Institute (demolish and expansion for residential care) Detailed design Procurement Building works and outfitting Nanning Municipality: Nanning Traditional Chinese Medicine Hospital (create elderly care institution) Detailed design Procurement Building works and outfitting Hezhou Municipality: Hezhou People’s Hospital (site 1: create elderly care institution) Detailed design Procurement Building works and outfitting Hezhou Municipality: Hezhou People’s Hospital (site 2: create elderly care institution) Detailed design Procurement Building works and outfitting Output 2: Public–private partnership (PPP) model for integrated elderly care and health care service provision developed Hezhou City: Hezhou Huanan National Medical Nursing Home (PPP)) Scheme design and approvals Procurement Building works and outfitting Operation Output 3: Management and policy development capacities in promoting the integrated elderly and health care services developed Project implementation support Recruit firm and consultants Implementation support TAS provision Elderly care services support Recruit firm and consultants Training on care, rehabilitation

2019 2020 2021 2022 2023 2024 2025 2026 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 Capacity development for discharge management Project Management Recruit procurement agent Procurement agent Recruit consulting firm(s) Consulting firm(s) Inception/Annual/Midterm review Loan closing procedures Note: Project implementation starts from domestic approval of feasibility study reports and ends at the completion of works, goods, or consulting services. Source: Asian Development Bank

41 IV. DESCRIPTION OF THE ENVIRONMENT (BASELINE)

A. Overview of Guangxi Zhuang Autonomous Region

100. Location. The Guangxi Zhuang Autonomous Region is located in the southern part of the People’s Republic of China (PRC) between 104°28′north - 112°04′ east longitude and 20°54′ north - 26°24′ east latitude. It is bordered by Guangdong Province in the east, Beibu Gulf in the south and Hainan Province across the sea. It is adjacent to Yunnan Province in the west, Hunan Province in the northeast, Guizhou Province in the northwest, and Vietnam in the southwest. The administrative area has a land area of 237,600 square kilometers, and the jurisdiction of the Beibu Gulf is about 40,000 square kilometers.

101. Demography. As of the end of 2017, the total registered population of Guangxi was 56 million, an increase of 210,000 compared with the end of 2016. At the end of the year, the resident population of the district was 48.85 million, an increase of 470,000 from the end of 2016, of which the urban population was 24.04 million, accounting for 49.21% of the total population (the resident population urbanization rate), an increase of 1.13% from the end of 2016. The urbanization rate of the registered population is 31.23%, which is 0.56% higher than the end of 2016. The annual birth population was 817,000, the birth rate was 15.14%; the death population was 316,000, the mortality rate was 6.22%; the natural growth rate was 8.92%.

102. Economic Conditions. In 2017, Guangxi achieved a gross domestic product (GDP) of 2,039.625 billion CNY, an increase of 7.3% over 2016. Among them, the added value of the primary industry was 290.687 billion CNY, an increase of 4.1%; the added value of the secondary industry was 929.784 billion CNY, an increase of 6.6%; the added value of the tertiary industry was 819.154 billion CNY, an increase of 9.2%. The added value of the primary, secondary and tertiary industries accounted for 14.2%, 45.6% and 40.2% of the regional GDP respectively, and the contribution rates to economic growth were 8.3%, 41.9% and 49.8%, respectively. The per capita GDP of 2017 is 41,955 CNY calculated by resident population.

B. Reginal Setting of Nanning City 103. Location. Nanning is the capital and largest city by population of the Guangxi Zhuang Autonomous Region in southern China. It is known as the "Green City" because of its abundance of lush subtropical foliage. Nanning has a total area of 33,112 square kilometers and a land area of 22,112 square kilometers.

104. Climate. Nanning has a warm, monsoon-influenced humid subtropical climate, with an annual mean temperature of 21.83°C. Summers are hot and humid with July, the hottest month, having a 24-hour average temperature of 28.4°C. Winters are mild and somewhat damp with January, the coolest month, averaging 12.9 °C. From February to August, rain is most frequent and relative humidity consistently averages above 80 percent; the annual rainfall is 1,290 mm. Extreme temperatures have ranged from −2.1 to 40.4°C. With monthly percent possible sunshine ranging from 17 percent in March to 51 percent in September, the city receives 1,585 hours of bright sunshine annually.

105. Seismicity. According to the Seismic Peak Acceleration Zoning Map of the PRC (GB18306-2001) (1:400) (prepared by State Seismological Bureau, 2001), the peak acceleration of ground motion is 0.10g, and corresponding seismic basic intensity is VII degree. All buildings and structures will be designed in accordance with the Code for Seismic Design of Buildings (GB 50011-2010) (2016 revised), and other codes for anti- seismic design of special structures, as relevant.

106. Economic Conditions. In 2017, the total production value of Nanning was 411.883

billion CNY, calculated at comparable prices, an increase of 8% over the previous year. Among them, the added value of the primary industry was 40.418 billion CNY, an increase of 4.1%; the added value of the secondary industry was 159.95 billion CNY, with an increase of 8.6%, of which the industrial added value was 118.989 billion CNY, with an increase of 9.5%; the added value of the tertiary industry was 211.515 billion CNY with growth rate of 8.4%. The proportion of the three industries is 9.8:38.8:51.4. Compared with 2016, the proportion of the primary industry decreased by 1%. The proportion of the secondary industry increased by 0.2 %, and the proportion of the tertiary industry increased by 0.8%.

107. Demography. At the end of 2017, the registered population of Nanning City was 7,568,700, an increase of 51,300 over the previous year by 0.7%, of which the urban population was 3,753,800, an increase of 52,900 by 1.4%. About 332,200 population is over 60 years old. The birth rate of the city was 15.2%, an increase of 1.7 thousand points over the previous year; the mortality rate was 5.7 % an increase of 0.4 thousand points over the previous year; the natural population growth rate was 9.5%, an increase of 1.3 thousand points over the previous year. At the end of the year, the resident population was 7,153,300.

C. Regional Setting of Hezhou City 108. Location. Hezhou is located in northeastern Guangxi. It borders Hunan to the north and Guangdong to the east. The area is 11,854 km2. The average elevation is 800 m and the highest is 1,731 m above sea-level.

109. Climate. The city has a monsoon-influenced humid subtropical climate with mild, damp winters and hot and wet summers. The yearly average temperature is 20.2°C, and annual precipitation is 1,562 mm.

110. Seismicity. According to the Seismic Peak Acceleration Zoning Map of the PRC (GB18306-2001) (1:400) (prepared by State Seismological Bureau, 2001), the peak acceleration of ground motion is 0.05g, and corresponding seismic basic intensity is VI degree. All buildings and structures will be designed in accordance with the Code for Seismic Design of Buildings (GB 50011-2010) (2016 revised), and other codes for anti- seismic design of special structures, as relevant.

111. Economic Conditions. In 2017, Hezhou City achieved a regional GDP of 54.883 billion CNY, with an increase of 5.3% over the previous year. The fiscal revenue of 5.311 billion CNY, with an increase of 4.3% over the previous year; the rural residents' per capita disposable income of 10,498 CNY, with an increase of 9.9% over the previous year. The per capita consumption expenditure of urban residents was 16,335 CNY, with an increase of 7.4%.

112. Demography. As of the end of 2017, the total population of Hezhou City was 2,435,300, with an increase of 10,100 over the end of the previous year; the resident population was 2,056,700, an increase of 18,000 from the end of the previous year, of which the urban population was 929,500. The annual birth rate was 15.53%; the mortality rate was 6.01%; the natural growth rate was 9.52%.

D. Environmental Quality Baseline 1. Nanning

113. The two subprojects in Nanning are located in the urban area. The regional environmental quality dada from 2017 Environmental Status Bulletin were collected and reviewed. Project specific baseline monitoring will be conducted prior to construction as defined in the monitoring plan of EMP.

114. Acoustic Environment. The acoustic environment in Nanning is generally good in

43 2017. The daytime noise of all kinds of functional areas can reach the national standard. The nighttime noise of the Class 3 and Class 4 functional zones exceed the national standard. Compared with 2016, the nighttime noise of Class 1 and Class 4 functional areas and the nighttime noise of Class 2 functional areas decreased in 2017, and the daytime noise of Class 3 functional areas and the Class 2 function day and night noises all increased; The noise compliance rate of functional areas in Nanning in 2017 was 75.7%, decreased 1.2% from the previous year. The daytime noise compliance rate was 88.4%, decreased 5.6% from the previous year; the nighttime noise compliance rate was 50.4%, increased 7.5% from the previous year.

115. The average daytime noise from road traffic was 68.0 decibels, which was 0.3 decibels lower than that of the previous year. The non-compliance rate of monitored road sections was 18.3%, decreased 3.4% from the previous year.

116. The noise from traffic and living noise accounted for 76.3%. Other noise sources are construction and industry that accounted for 23.7%.

117. Air Quality. In 2017, the number of days with good air quality in Nanning (air pollution index AQI≤100) reached 337 days, accounting for 92.3% of the whole year. From March to September, the air quality in urban areas kept at good for 7 consecutive months; Mild pollution (100

118. The annual average concentrations of sulfur dioxide, nitrogen dioxide, respirable particulate matter and fine particulate matter in urban ambient air were 11 μg/m3, 35 μg/m3, 56 μg/m3 and 35 μg/m3, respectively. Among them, the annual average concentration of sulfur dioxide and nitrogen dioxide met the requirements of the Class I standard of the Ambient Air Quality Standard (GB3095-2012); the inhalable particulate matter and fine particulate matter met the requirements of the Class II standard.

2. Hezhou

119. Acoustic Environment. Acoustic environmental at each boundary of the proposed site and the sensitive receptors nearby were monitored for two consecutive days. The monitoring results showed comply with the Class II of Ambient Acoustic Environment Standard (GB3096-2008).

Table IV.1: Noise Monitoring Results Applicable Monitoring Results Standard (dB(A)) (dB(A)) Subproject Location Date Daytime Nighttime Daytime Nighttime Huanan 1# East 2019.03.08 42.1 38.2 60 50 Boundary 2019.03.09 41.6 39.0 2# South 2019.03.08 42.0 39.5 60 50 Boundary 2019.03.09 40.8 40.4 3# West 2019.03.08 41.5 39.6 60 50 Boundary 2019.03.09 42.3 40.3 4# North 2019.03.08 41.7 40.9 60 50 Boundary 2019.03.09 42.6 39.8 5# Dongmuyuan 2019.03.08 54.3 43.8 60 50 Community in 2019.03.09 52.9 42.6

Applicable Monitoring Results Standard (dB(A)) (dB(A)) Subproject Location Date Daytime Nighttime Daytime Nighttime Southwest Hezhou 1# East 2018.12.25 53.2 44.3 60 50 No.1 Boundary 2018.12.26 51.9 43.8 Nursing 2# South 2018.12.25 48.6 44.1 60 50 Center Boundary 2018.12.26 49.3 44.8 3# West 2018.12.25 50.5 43.9 60 50 Boundary 2018.12.26 50.1 44.4 4#North 2018.12.25 48.3 43.7 60 50 Boundary 2018.12.26 48.2 44.6 Hezhou 1# East 2019.03.20 47.7 39.7 60 50 No.2 Boundary 2019.03.21 46.5 40.2 Nursing 2# South 2019.03.20 48.0 41.6 60 50 Center Boundary 2019.03.21 49.4 42.8 3# West 2019.03.20 47.3 41.3 60 50 Boundary 2019.03.21 48.1 41.9 4#North 2019.03.20 46.7 39.9 60 50 Boundary 2019.03.21 46.1 39.4 5# Xiadao 2019.03.20 52.8 43.8 60 50 Village 2019.03.21 51.3 44.4 6# Guanbeidong 2019.03.20 45.9 44.0 60 50 Community 2019.03.21 45.2 43.5

120. Air Quality. Hezhou city has set up two automatically air quality monitoring station. Seven consecutive daily average monitoring data were cited for reference. The monitoring results showed compliance with Class II of Ambient Air Quality Standard (GB3095-2012).

Table IV.2: Air Quality Monitoring Results SO2 NO2 PM10 PM2.5 CO O3 Location Date ug/m3 ug/m3 ug/m3 ug/m3 mg/m3 ug/m3 Zhengxie 2019.1.14 17 17 34 27 1.186 23 Building 2019.1.15 15 14 29 23 1.073 45 2019.1.16 13 15 36 30 1.029 50 2019.1.17 16 18 31 28 1.442 60 2019.1.18 21 35 53 39 1.639 50 2019.1.19 18 15 75 57 1.919 25 2019.1.20 13 15 28 25 1.249 44 Class II of ≤150 ≤80 ≤150 ≤75 ≤4 ≤160 GB3095- 2012 Compliance? Yes Yes Yes Yes Yes Yes Huanbao 2019.1.14 17 17 34 27 1.244 22 Community 2019.1.15 15 14 29 23 1.139 46 2019.1.16 13 15 36 30 1.005 54 2019.1.17 16 15 31 28 1.188 66 2019.1.18 21 18 53 39 1.067 66 2019.1.19 18 35 75 57 1.250 38 2019.1.20 13 15 28 25 0.922 45 Class II of ≤150 ≤80 ≤150 ≤75 ≤4 ≤160 GB3095-

45 2012 Compliance? Yes Yes Yes Yes Yes Yes

121. Soil Quality. Soil samples were taken at different depth at the proposed site of Hezhou No.1 Nursing Center on 22 January 2019 as there is a ceramic factory in the 120 m north of the proposed site. The testing results showed that all indicators were below the screening level except for arsenic. Based on literature review, the background arsenic in Hezhou ranged from 19.46 mg/kg to 105 mg/kg2728. The high arsenic content in the project site is mainly due to the background value of the quaternary red soil. The arsenic contents were below the intervention level so no intervention measure is needed.

Table IV.3: Soil Quality Monitoring Results (Unit: mg/kg) GB36600- Total 2018 As Cd Cr Cu Pb Hg Ni Screening Level 20 20 - 2000 400 8 150 Intervention Location Level 120 47 - 8000 800 33 600 1# 0~0.2m 60.9 1.30 128 58 40.8 0.461 122 0.2~0.6m 49.2 4.72 119 58 46.9 0.511 120 0.6~1.0m 42.4 1.47 111 57 30.7 0.565 134 2# 0~0.2m 32.0 1.04 99 42 33.2 0.262 100 0.2~0.6m 27.4 1.10 88 30 42.8 0.193 74 0.6~1.0m 24.7 0.49 77 44 33.0 0.185 86 3# mixed 28.4 0.65 92 43 31.6 0.238 94 4# mixed 24.6 0.55 94 45 31.8 0.172 93 5# mixed 38.0 0.31 96 54 43.2 0.511 101

E. Ecological Resources 122. The subprojects are located in build-up urban area (Nanning) or human modified habitat (farmland or orchard). There are no protected areas in the project area and no known records of rare, threatened, or protected flora or fauna. There are no habitats which meet the ADB definition of “critical habitats” (SPS 2009) in the project area.

Table IV.4: Existing Land Use and Surrounding Environment of Each Subproject Code Subproject Site Description Site Photos Nanning City 1 Nanning Social The site is within the Welfare Institute existing Nanning Social Welfare Institute with a few landscaping trees and small garden.

27 Investigation on the Background Value of Some Metal Elements in Agricultural Soil in Northeast Guidong, Guangxi. Guangzhou Agricultural Environmental Monitoring Station; 28 EIA for the Guangxi Hezhou Water Environment Improvement and Urban Development Project

Code Subproject Site Description Site Photos 2 Nanning traditional The site is within the Chinese medicine former campus of Nanning hospital Health Care Technical and Vocational School. There are some banyan trees for landscaping purpose.

Hezhou City 3 Hezhou No.1 Nursing The current land use is Center basketball yard for construction workers and construction camp, which is set up for the construction of Chendong Branch of Hezhou People’s Hospital.

4 Hezhou No.2 Nursing The current land use type Center is farmland with crops and vegetables.

5 Hezhou Huanan The vegetation is Nursing Center artificially planted eucalyptus, pine and cedar trees. The main wild animals are common voles, frogs, birds, insects and a small number of reptiles. Due to the frequent influence of human activities, there were no large-scale wild animals in the evaluation area.

F. Physical Cultural Resources 123. No cultural heritage or archaeological sites are recorded within the project area.

47 V. ANTICIPATED IMPACTS AND MITIGATION MEASURES

A. Project Area of Influence and Sensitive Receptors 124. To define the geographic scope of the impact assessment, the “project area of influence” and “sensitive receptors” were identified. The project area of influence is defined as the total area which might be subjected to adverse impacts of the project. This is based on the locations of sensitive receptors, defined as settlements and/or environmental values that might be affected by the project construction and/or operation. The receptors comprise: (i) villages, communities and/or public buildings (e.g. schools, offices) potentially subject to construction or operational noise and/or vibration, air pollution, altered water quality or supply, pollution e.g. water source protection areas and reservoirs; (iii) vegetation, fauna habitats, and agricultural lands of project sites.

125. The following distances were applied to identify the sensitive receptors: (i) for construction and/or operational noise-receptors within 200 m of the noise generating source; (ii) for construction-related air quality impacts-receptors within 200 m of the source; (iii) for ecological resources-the footprint of the project site. These distances, combined with the direct construction sites, were assumed to encompass the total project area of influence.

Table V.1: Environmentally Sensitive Receptors Persons Subproject Sensitive Receptors Description Affected Protection Level NTCHM Nursing Nanning Health 30-50 m east 96 Air quality: Class II of Center and School Community residents Ambient Air Quality Jiangnan Branch Standard (GB3095- Hospital Guangxi Federation 30-150 m 2012). of Trade Unions south 800 Noise: Class 2 of Cadre School persons Acoustic Environment Standard (GB3096- Aohai-Lanwan 2008) Community 70-200 m west 960 Jiangnan Community residents

Nanning Industry and 60-200 m Trade Technical east 1000 School residents 60-150 m east 1800 students NSWI Nursing Nanning Mingxiu 20 m south 1200 Air quality: Class II of Center School students Ambient Air Quality 100-300 m Standard (GB3095- Wanli Community west 4280 2012). residents Noise: Class 2 of Jinxiu-Haoting Acoustic Environment Community 100-150 m Standard (GB3096- south 354 2008) residents Hezhou No.1 Inpatient Building 67 m 680 Air quality: Class II of Nursing Center (under construction) southwest persons Ambient Air Quality Standard (GB3095- 2012). Noise: Class 1 of Acoustic Environment Standard (GB3096- 2008) Hezhou No.2 Xiadao Village 20 m north 1000 Air quality: Class II of

Persons Subproject Sensitive Receptors Description Affected Protection Level Nursing Center Guanbeidong Village 120 m persons Ambient Air Quality 100 Standard (GB3095- persons 2012). Noise: Class 2 of Acoustic Environment Standard (GB3096- 2008) Hezhou Huanan Dongbenyuan Village 80 m south 50 Air quality: Class II of Medical Nursing persons Ambient Air Quality Home Standard (GB3095- 2012). Noise: Class 2 of Acoustic Environment Standard (GB3096- 2008) Hejiang River 503 m west - Category III of Ambient Surface Water Quality Standard (GB3838- 2002)

B. Anticipated Project Benefits and Positive Impacts 126. The project may significantly ease the elderly pension bed situation in Nanning and Hezhou Cities, relieve the pressure of the local government and the families with elders, provide added values to the pension market, and improve the physical (and mental) health of thousands of project beneficiaries through innovative management/care for the elderly, thereby enhancing overall societal utilities and harmony. Implementation of the project may also relieve the current workload of families with elderly members, freeing up societal resources for more productive development of the economy.

C. Mitigation Measures during Pre-Construction Phase 127. Land Acquisition. The project requires 169.79 mu of land comprising 74.14 mu of collectively-owned land and 96.65 mu of state-owned land. 29 Collectively-owned land comprises 56.16 mu of farmland, 10.91 mu of forest land, and 7.07 mu of construction land. Twenty-six rural houses will be demolished, in an area of 7,481.2 square meter (m2). The second site for the Hezhou People’s Hospital’s subproject will affect 56 households with 296 persons in Xiadao village of Ertang Town, Pinggui District. Of them, 30 households with 144 persons will be affected by land acquisition, 11 households with 88 persons by house demolition, and 15 households with 64 persons by land acquisition and house demolition. The required state-owned land (96.65 mu) has already been acquired and allocated to other subprojects.

128. About 234 elderly people live in seven old buildings of NSWI. These seven buildings will be demolished as they are old and unstable. NSWI notified the elderly and their families in August 2018 to vacate the premises before the end of June 2019. i) The 114 residents without family support and the 20 totally disabled elderly will be transferred to other buildings within NSWI or to government hospitals. ii) A few residents have chosen to move to improved elderly care facilities as they require better services. iii) Others plan to move to their own homes temporarily until the new elderly care facilities are built at NSWI. NSWI will provide transport and nursing staff to help them to move

29 A mu is a Chinese unit of measurement (1 mu = 666.667 square meters).

49 out. After the construction of the new elderly care facilities, all of them will have priority in getting accommodation at the new facilities.

129. Linked facilities. The PIEs must confirm from concerned authorities of various linked facilities such as landfills to accept solid waste, and power, water, wastewater facilities to each of the Hospitals / Elderly Care Centers on their ability to deliver required services and without interruptions.

130. GPMO through NMG and HMG will ensure that any existing wastewater treatment and solid waste management facilities will have the adequate capacity to handle all waste resulting from the operation of the Project facilities, in accordance with all applicable laws, regulations and standards of the PRC. Prior to the operation of any Project facility, NMG and HMG will ensure that the PIE appoints a certified third party (treatment company) to remove, store, and treat all medical waste generated from such facility, in accordance with all applicable laws, regulations and standards of the PRC

131. Landscaping. Adequate green belt shall be designed for Hezhou No.1 Nursing Center to prevent any potential risk of air pollutant/noise exposure from the Meiyi ceramic factory in the north.

132. Temporary Use of Land. The mobilization of construction equipment and construction materials will require space for storage and parking of construction vehicles and equipment, construction material storage yards, disposal sites, and labor camps for human resource to avoid environmental impact and public inconvenience.

133. These locations must comply with the local laws and regulations and need approval from authorities to utilize these facilities (access roads, telecommunication, and pipe borne water supply). It is important that selection of temporary lands does not infringe upon adjoining residential areas, water bodies, natural flow paths, and access roads to Hospital/Elderly Care Centers and other amenities in the area. Removal of trees should be minimized during preparation of construction area, access road and other facilities.

134. Restoration: Associated impacts on any public area outside each Hospital/Elderly Care Center buildings inside its premises used for storage and workmen office will be restricted to the construction phase and will be temporary in nature. After construction is complete, the common areas or any other parking areas within the premises will be repaired and can be used again.

135. Banned Substances (Asbestos). No asbestos30 or asbestos-containing material will be used in construction of the facilities. To ensure that no work or community hazards exist on any subproject site before work commences, a survey of all buildings planned for demolition and all buildings planned for renovation will be undertaken to discover and report on the presence or absence of asbestos or asbestos-containing material. Where asbestos or asbestos-containing material is found, the IA and contractor will develop and implement an asbestos removal and disposal plan in conjunction with an accredited specialist contractor to safely remove the material before work commences or during construction. The plan will focus on, as a priority, the health and safety of workers and the community during the removal and long-term disposal.

136. Noise, dust and effluents from Demolition. The demolition of old buildings will create need for special protection of neighboring community living in the area to protect

30 If any asbestos containing materials (ACM) are found during demolition of old facilities, the executing agency shall engage services of certified agency capable to handle and dispose ACM in accordance with international best practices

them from noise, emission of dust and effluent from demolition by the EPC contractor. The disposal arrangements of the same would be required.

137. The EPC contractor has to ensure enough precautions such as noise and dust prevention screens are installed before demolition starts 31 . Locations for storage of demolished material so that no emissions of dust, noise etc. occurs during its disposal. The disposal arrangements of the demolition waste will require sending these wastes to a municipality approved designated landfill site within municipal area. The PIE is required to submit application for the construction solid waste to sanitation administration department prior to construction. The routes for transportation of demolished material has to be planned in advance to avoid inconvenience to local public and road users. Proper approvals from local authorities have to be there to ensure the inert material goes to prescribed landfill whereas the recyclable material is removed from the site by approved recyclers only.

138. Volatile Organic Compounds: Only low or no volatile organic compound (VOC) emitting materials shall be used (including paints, coatings, adhesives, carpet and furniture’s) to ensure high indoor air quality. Water-based nontoxic, no allergenic paint for drywall or plaster surfaces shall be preferred to latex or oil-based paints.

139. Green Building and Energy Efficiency. The new building design must include green building and energy efficiency features. Use of more energy efficient equipment have been mandated in bidding documents. The project design must take full account of energy savings, adhere to the principle of sustainable development, rely on scientific and technological progress and actively promote use of new materials, new technology, new technology, and achieve high standards, low-power, high-performance, and low-pollution goals.

140. Specific measures are as follows: - using suitable size rooms i.e. avoid large spaces to avoid excessive waste of energy. - using the orientation of outdoor to weather and terrain conditions for reduced energy consumption, a well-organized natural ventilation, the control architectural shape factors. Building southern and northern orientation, to lighting and ventilation, have a major role in reducing energy consumption, compact overall layout of the building plan, while paying attention to protect and beautify the environment. - control window in the wall by providing shade and using reasonable envelope forms and materials. - Use outer wall decorative materials using weather resistant finishes green, moon roof with squeeze plate. - promote the use of new wall materials, prohibit the use of clay bricks. - focus on green landscaping, planting trees surrounding setting, ground green squares and public spaces, green spaces, garden architecture can improve the microclimate. - in accordance with the "public building energy efficiency design standards" (GB50189-2015) energy-saving design. - Air conditioning system (cooling and heating) and emergency evacuation and protection facilities must be installed in project buildings as climate change adaptation measurement. The average budget for air conditioning (cooling and heating) is approximately 15 USD per m2. Green Buildings shall save 20% energy compare to traditional buildings. - Consider more extensive usage of wood as it is more environment friendly construction material than concrete or bricks. The design will comply with the Green Building Design Code of Guangxi (DBJ/T45-049-2017), including requirements on construction materials, energy saving etc.

31 Affected persons will be consulted on the timing of demolition activities.

141. Emergency Response and planning. PIEs will be required to implement the following measures in order to ensure high levels of on-site emergency response preparedness: - Ensure compliance with relevant health and safety regulations pertaining to ventilation, indoor air quality, lighting, noise, fire-fighting and fire survival equipment and fire escapes. - Establish readiness plan and operational plan under emergency conditions, for as fire, flood, earthquake, wind, storm, water contamination, air contamination, and explosion to ensure safe environment for all elderly people and staff and visitors. - Develop anti-infection protocols and response plans, including quarantine and evacuation procedures for epidemic, pest infestation, and food safety to ensure safe environment for all elderly people and staff and visitors.

D. Anticipated Environmental Impacts and Mitigation Measures during Construction Phase 1. Physical Impacts 142. Impacts on Air Quality. The pollution sources which affect the air quality during construction period mainly come from the fugitive dust generation in and around the Nursing Center, the exhaust gas of transportation trunks and construction machinery (gaseous CO, CH and NO2) and decoration. The quantity of dust generated will depend on wind, humidity of the material and earth, and state of site. For the project area it is estimated that under general on-site conditions (average wind speed 2.5 m/s, and average humidity of 80%) dispersion distance is 100 m downwind. For dust generated by transporting earth and other construction materials, the impact zone may exceed 60 m each side of the route. As indicated in Table V-1, the nearest sensitive points in the vicinity of the project are located in 20m of the project sites.

143. The following measures will be taken to control fugitive dust from the construction site:

• Timely cleaning within 50 meters of the site boundary32 to ensure clean and dust- free. • Closed cover transportation. Materials, slag and garbage transport vehicles entering and leaving the construction site shall be sealed with effective sealing. The loading surface shall not be higher than the guardrail of the vehicle. The surface of the loaded material shall be sprayed and tarpaulin before leaving the work site. • Set the fence. The masonry wall of not less than 1.8m shall be set around the construction site. • Set the vehicle flushing platform. The main entrance and exit roads of the construction site shall be paved with concrete with a strength grade not lower than C25, and the thickness shall not be less than 20cm. A vehicle wash platform shall be installed on the inside and outside of the construction site. The specification shall be not less than 3.5m×5m. Before the vehicle leaves the construction site, the tires and the body of the vehicle shall be cleaned on the car wash platform. Surroundings of the car wash platform shall be provided with overflow prevention, waste water drainage channels, wastewater collection pools, grit chambers and other control facilities to collect waste water and mud generated during car washing, construction and dust reduction. • During the construction phase, effective dust reduction measures shall be taken, and facilities such as sprinkling, spraying and spraying shall be arranged to implement

32 As per standardized practice set out in Hezhou/Nanning Dust Control Plan

dust suppression equipment such as tower crane spray, small fog gun and sprinkler. An automatic spray dust-reducing device is arranged on the fixed enclosure, and the spray dust-reducing equipment should be opened every two hours on sunny days, each time not less than half an hour. • Closed cover building materials. Building materials such as cement, lime, sand, paint, paving materials, etc., which are prone to dust, must be sealed, covered with dust-proof cloth, fenced or stacked. • Spoil, abandonment and other construction waste generated during construction shall be cleared and transported in time. If it is stacked on the construction site for more than one week, measures such as covering the dust-proof cloth, dust-proof net, and regularly spraying water and dust should be taken. • The main roads on the construction site are dust-proof. The roads in the construction site shall be provided with anti-dusting materials, supplemented by watering and spraying dust suppressants to keep the road surface clean and prevent motor vehicles from dusting. • Dust-proof measures for conveying operations. When transporting dusty materials, muck or waste from the upper layer of the building, it should be transported from the elevator tunnel, the internal pipeline of the building or the closed transport pipeline, or carry it in the package. • Dust-proof measures for demolition construction sites. Before the construction of the demolition, a fence shall be provided around the construction site. When demolition work is carried out, it shall be supplemented with continuous pressurized watering to suppress the dust from scattering. • Strengthen the remediation of the stockyard. Temporary material piles, muck piles, waste slag, building materials, etc., which are easy to generate dust, shall be covered with dust-proof nets and dust-proof cloth, and sprayed and solidified if necessary. • Install video surveillance. Video surveillance devices are installed at the entrances and exits of construction sites, and supervision is implemented to ensure that the vehicles entering and exiting are clean and free of mud. The surveillance system is connected to the Nanning/Hezhou Municipal Housing and Construction Bureau. • The exposed plot is dust-proof. For the exposed land in the construction site, various dustproof measures such as covering are adopted.

144. The vehicles and construction machineries shall be maintained to a high standard to ensure efficient running and fuel-burning and compliance with the PRC emission standards (GB18352-2005, GB17691-2005, GB11340-2005, GB2847-2005, and GB18285-2005).

145. In order to improve the quality of the indoor air environment, the decoration materials should meet the requirements of Limits for Indoor Decoration Materials (GB18580-2001, GB18588-2001 and GB6566-2001). The benzene-free environmental thinners and paints will be used to reduce the emission of pollutants.

146. Noise. The noise sources during the construction period of the project mainly come from noises such as excavators, bulldozers, scrapers, oscillators, pile drivers, diesel generators, chainsaws, grinders, welding machines, and equipment transportation. The impact of construction noise on the acoustic environment in the surrounding area is evaluated using GB12523-2011 Construction Site Boundary Environmental Noise Emission Standard (ie, 70 dB (A) for the day and 55 dB (A) for the night). The compliance distance is predicted as given in Table V.2.

53 Table V.2: Attenuation distance required for noise compliance in construction site Daylight Night Compliance Compliance Sound Attenuation Attenuation Strength Daylight Distance Night Distance Construction at Source Standard Required Standard Required phase Mechanical type dB (A) dB (A) (M) dB (A) (m) Bulldozer 110 100 562 Excavator 110 100 562 Loader 110 100 562 Rammed earth 110 100 562 Machine Earthwork Roller 108 79 447 Pneumatic Crushing 108 79 447 Machine Air Compressor 102 40 224 Piling Hit Pile Machine 110 100 562 Concrete Vibration 110 100 562 Converter Tower Start-up 110 100 562 machine 70 55 Concrete Pump 109 89 501 Truck Structure Concrete Transmission 109 89 501 Pump Air Compressor 102 40 224 Lift 95 18 100 Banging Concrete 95 18 100 catheters Cutting machine 110 100 562 Chainsaw 110 100 562 Electric drill 110 100 562 Decoration Electric Grinding 110 100 562 Wheel Grinding Stone 105 56 316 Machine

147. According to the noise prediction results, when no environmental protection measures are taken, the biggest impact of a single machine is bulldozers, excavators, loaders, etc., the daytime impact range can reach 100 m and 562 m during daytime and nighttime respectively. If the two machines with the largest noise are operating at the same time and at the same location, the impact range of the accumulated noise is 141m during daytime and 794m during nighttime.

148. In addition, transportation of building materials will lead to increased traffic, resulting in traffic noise to the transport route along the sound environment to bring a certain impact.

149. The nearest noise sensitive points in the vicinity of the project are located in 20m of the project site. In order to reduce the impact of construction noise on the surrounding environment in this project, the following control measures should be taken:

• Reasonably arrange construction progress and time, strengthen the supervision and management of the construction sites, and take corresponding time-limited operations for high-noise equipment to avoid the impact of construction noise on the surrounding environment; • When constructing, construction machinery with low noise should be used as much as possible to strengthen the management of construction operations. To control the noise of construction machinery, it must first start with equipment selection, choose a new type of low-noise equipment, and reduce the noise by installing silencing devices and isolating the vibration components of the machine; in the course of the operations, it must strengthen the maintenance of all kinds of machinery, and reduce noise due to mechanical wear; • Effective dispatch schedule of construction machinery and transport vehicles and traffic diversion, reduce vehicle whistle, and reduce traffic noise; • Strictly control the construction time, no night-time construction allowed. The construction time should be controlled from during daytime waking hours (6:00 am to 9:00 pm).

150. Solid waste management. Inadequate disposal of construction wastes could have adverse impacts on soil, water and health of workers and the community. Waste streams will include inert construction wastes (soil, debris, concrete etc.), municipal type wastes (construction workers’ food and packaging wastes from construction consumables) and hazardous wastes (fuel containers, oil filters, oily rags etc.).

151. Three Nursing Centers requires to demolish existing old buildings. Demolition waste will mainly include concrete, bricks, glass and woods. If any asbestos containing materials (ACM) are found during demolition of old facilities, the executing agency shall engage services of certified agency capable to handle and dispose ACM in accordance with international best practices.

152. In compliance with “Construction Waste Management in Nanning” and “Hezhou City Urban Construction Waste Disposal Management Measures”, construction waste shall be transported by licensed agencies and the transport vehicles should be cleaned timely. The construction and demolish (C&D) solid waste generation are summarized in Table V.3. The PIE is required to submit application for the construction solid waste to sanitation administration department prior to construction.

Table V.3: Construction and Demolish Waste Generated from Construction of Each Subproject New Estimated Building Construction Demolished amount of Structure of Area Waste Floor Area solid waste demolished Subproject (m2) (t) (m2) (t) buildings NTCM 33870 2946.7 3266 392 Brick Nursing structure Center and Jiangnan Hospital NSWI 44615 3881.5 5512.61 661 Brick Nursing structure Center Hezhou 29296.76 2549 / / / Huanan Nursing Center

55 New Estimated Building Construction Demolished amount of Structure of Area Waste Floor Area solid waste demolished Subproject (m2) (t) (m2) (t) buildings Hezhou No.1 21463.72 1867 / / Brick Nursing structure, Center earth brick structure Hezhou No.2 25102.38 2183.9 9126.72 1095 Brick Nursing structure Center

153. Domestic solid waste. Averagely 50 workers are required for each subproject during construction. Each worker will generate 0.5 kg/d solid waste. The total amount of domestic garbage generated by construction workers during the entire construction period is about 8.25 t/a of each subproject, which need to intermittently stored and commissioned for sanitation transportation and sanitary landfill.

154. The following waste management and impact mitigation measures have been defined in the EMP, which shall be defined in construction contracts and the site-EMPs, to be developed by Contractors: • Maximize reuse/recycling of construction and demolition wastes (e.g. iron, bricks, windows, doors, steel bars etc.); • Provide appropriate waste storage containers for workers’ municipal garbage and hazardous wastes; • Install confined storage points of solid wastes away from sensitive receptors, regularly haul to an approved disposal site; • Use licensed contractors to remove wastes from the construction sites; • Prohibit burning of waste.

155. Impacts on Surface Water. Wastewater is mainly generated from the following construction activities: washing construction machinery and vehicles; pouring of concrete; storm water from construction sites during rain; and domestic wastewater of construction workers.

156. Construction wastewater mainly comes from drainage of foundation pits excavation, drainage of bored cast-in-place piles, drainage of building maintenance, cleaning of equipment, and flushing water of vehicles, the main content of suspended solids in wastewater is mud water, and the concentration of SS is high. If such wastewater is discharged without treatment, it will inevitably cause the inundation of sewage in the surrounding area and adversely affect the receiving water, at the same time, it may also be deposited in the sewer, blocked the sewers and caused damage to the sewer system in the surrounding areas. Measures must be taken to treat the construction wastewater by the construction unit by building a sedimentation tank on the project sites.

157. After pre-treatment the supernatant can be reused and sprayed on the exposed topsoil, on the one hand, it plays a role in dust reduction, and in the compaction and settlement of the site and avoids it, the discharge of construction wastewater causes pollution of the water environment. After the construction is completed, the impact of the construction wastewater on the surrounding environment can be eliminated immediately, and the impact caused during the construction period will be restored to the pre-construction level within a short time.

158. Total of 50 workers are required during construction peak season. According to the “Construction Water Reference Quota”, the daily water consumption of the construction

workers is 100~120 L/d. The domestic sewage discharge coefficient is 0.8. The maximum amount of sewage generated is 4.8m3/d and 1752 m3/a. The main pollutants are COD, BOD5, SS, and NH3-N. Existing buildings on site of NN SWI and NN CTM will be used as dormitory for construction workers. The domestic wastewater will be discharged to the existing municipal sewers. For subprojects in Hezhou, construction camps will be set up on site. The domestic sewage is pretreated by grease traps and septic tanks and transported to the sewage treatment plant of Pinggui District of Hezhou City by suction trucks.

159. Impacts on Groundwater. Considering the characteristics of the project, the project will not use groundwater resources, nor cause groundwater level changes or groundwater pollution. Thus, the risk of contaminating groundwater is considered low. However, considering piling activities during construction period may create pathway for contaminants contacting groundwater, a robust construction site management plan is included before any construction activities are conducted where pilling is involved.

160. Impacts on soil. The construction sites in the 4 nursing and medical care homes targeted by the project are relatively small. The potential impacts on soil include:

(i) Soil contamination: Contamination of soil in the construction phase may result from the inappropriate transfer, storage, and disposal of petroleum products, chemicals, liquids and solid waste. (ii) Spoil disposal: Significant spoil disposal will not be required, and potential impacts will be short-term and localized. (iii) Soil erosion: May be caused by construction, excavation, and borrow pits, stockpiles and spoils from earthwork during construction of buildings and grading but is not an important factor in the project.

161. For soil contamination prevention (a) store chemicals/hazardous products and waste on impermeable surfaces in secure, covered areas; (b) remove all construction wastes from the site to approved waste disposal sites; (c) provide spill cleanup measures and equipment at each construction site; and (d) conduct training in emergency spill response procedures. The impacts on soil contaminated will be mitigated through a number of remedial measures which are defined in the EMP, which shall be defined in construction contracts and the site- EMPs, to be developed by Contractors.

2. Impacts on Ecological Resources 162. Field investigations have established that there are no threatened or endangered flora and fauna species within the project’s direct area of influence. The current land uses of NSWI, NTCMH and Hezhou No.1 Nursing Center are concrete ground open space or with old buildings that will be demolished. The existing eucalyptus trees in NTCMH site will be reserved for landscaping. The sites for Hezhou Huanan Nursing Center and No.2 Nursing Center hare human modified secondary ecosystem with crops, weeds and small pine trees. All sites will be re-vegetated after construction.

3. Impacts on Physical Cultural Resources There is no record of important heritage or archaeological sites on the propose sites. Contractors will be required to establish chance-find procedure for physical cultural resources. If a new site is unearthed, work will be stopped and the PIE and local cultural relics bureau notified.

4. Risks to community health and safety 163. Construction sites will be located close to existing school buildings and residential areas, representing a potential risk to public health and safety, especially to students and staff. This risk will be mitigated through a number of measures defined in the EMP, which shall be defined in construction contracts and the site-EMPs, to be developed by

57 Contractors: • Prepare traffic control plan within and around project sites during construction, to be approved by the local traffic management administration. The plan shall include provisions for diverting or scheduling construction traffic to avoid peak traffic hours, main teaching activities, such as exams, regulating traffic at road crossings with an emphasis on ensuring public safety through clear signage; • Ensure that all sites are secure, discouraging access through appropriate fencing; place clear signs at construction sites in view of the people at risk (including students, staff and nearby communities), warning people of potential dangers such as moving vehicles, hazardous materials, excavations, and raising awareness on safety issues; • Return machinery to its overnight storage area/position; • Held a public meeting prior to commencing construction to discuss issues associated with ensuring the safety of nearby communities in vicinity of the construction site.

5. Occupational health and safety 164. The leading safety hazards on site are falls from height, excavation accidents, electrocution. The following measures have been defined in the EMP to ensure high level of occupational health and safety: • Appoint one staff to implement and supervise the implementation of the Site-EMP and the performance of subcontractors; • Provide safe supply of clean water and an adequate number of latrines and other sanitary arrangements at the site and work areas, and ensure that they are cleaned and maintained in a hygienic state; • Provide garbage receptacles at construction site; • Provide personal protection equipment (PPE) for workers in accordance with relevant health and safety regulations; • Develop an emergency response plan to take actions on accidents and emergencies; document and report occupational accidents, diseases, and incidents; organize fully equipped first-aid base at each construction site; • Establish Records Management System that will store and maintain easily retrievable records on occupational accidents, diseases, and incidents. • Train all construction workers in basic sanitation and hygiene issues, general health in basic sanitation and hygiene issues, general health and safety maters, and on the specific hazards of their work; • Posters drawing attention on site safety, rescue and industrial health regulations shall be made or obtained from the appropriate sources and will be displayed prominently in relevant areas of the site

6. Temporary disconnection of Utilities 165. At the construction sites, construction may require relocation of local municipal utilities such as power, water, sewers and communication cables. Contractors will be required to assess potential disruption to services and identify risks before starting construction. If temporary disruption is unavoidable, contractors will develop a plan to minimize the disruption and communicate the dates and duration in advance to all affected people, in conjunction with the school management.

E. Anticipated Environmental Impacts and Mitigation Measures during Operation Phase

166. Impact on air quality. The main sources of air pollution during the operation period include cooking fume from canteen, parking lot exhaust and smell from sewage treatment station.

(i) Cooking fumes from canteen. After purification of the cooking fume purification system with more than 85% purification efficiency, the discharge concentration is low to 2 mg/m3, which can meet the requirements of Standard of Dietetic Fume Emission (Trial) (GB18483-2001). (ii) Exhaust gas from the parking lot. The underground garage will be equipped with mechanical ventilation. The air exchange frequency is more than 6 times/h through special exhaust vent. The pollutant emission concentration of underground garage involved in this project can be controlled within the limit standard of Table 2 of Comprehensive Emission Standard for Air Pollutants (GB16297-1996). (iii) Odor from the sewage treatment station. In the operation of the sewage treatment equipment, the odor pollutants are produced by the metabolism of microorganisms, protozoa and micelles. The main components are H2S and NH3, and the emission form is unorganized. The generated odor is treated by the ion deodorization method and discharged through a 3m high exhaust cylinder, and the general treatment efficiency can reach more than 90%. These treatment stations will be operated by PIE or the O&M Contractor.

167. Wastewater. The domestic sewage mainly includes the administrative management and medical staff of the Nursing Center, the flushing water generated by the elderly housing, the washing water, the shower water, the kitchen oily wastewater, etc. The main pollutants are CODCr, BOD5, SS, NH3-N, and vegetable oil, etc. Central air conditioning cooling water will be recycled. Medical sewage mainly includes wastewater discharged from medical treatment rooms. The pollutants contained in medical sewage mainly include CODCr, BOD5, SS, NH3-N, and microorganisms such as bacteria and pathogens.

168. The wastewater generated is calculated as 80% of water consumption. Water consumption of the proposed project is estimated according to the water quota in the Code for Design of General Hospitals (GB51039-2014) and the Code for Design of Building Water Supply and Drainage (GB 50015-2003 (2009 Edition)). The wastewater generation and treatment of each subproject is summarized in Table V.4.

- Municipal wastewater. The wastewater from EC facilities cannot be connected directly to the municipal Waste Water Treatment Plant (WWTP) since on-site pretreatment is needed which allows the WWTP to function most efficiently. This will be achieved by a period of anaerobic digestion of the wastewater solids in a septic tank. The wastewater from canteen will be pre-treated by oil trapper. The pretreatment tank is impermeable with no seepage function, and with internal facility monitoring on its O&M (operation and maintenance). After this the sewage will be piped to existing centralized municipal WWTP for complete treatment. The volumes of wastewater produced by the facilities can be easily met through the existing municipal wastewater treatment services. - Medical wastewater. The medical wastewater from the Project facilities will not be connected directly to the municipal WWTP. The on-site medical sewage treatment station uses the process of regulation tank, anaerobic tank, biological contact oxidation, chlorine dioxide disinfection to treat medical wastewater. The medical wastewater pretreatment via on-site sewage treatment station is required to meet the pretreatment standard of Sewage Control Standard for Medical Institutions (GB18466-2005), and then discharged into the municipal wastewater system. After treatment, the sewage will be piped to existing centralized municipal WWTPs for complete treatment.

Table V.4: Wastewater Generation and Treatment of each Subproject during Operation Wastewater Generation Treatment Facilities Subproject (m3/d) NTCMH 147.9 m3/d from Jiangnan Septic tank # and sewage Hospital treatment station on site with

59 111 m3/d from elderly care capacity of 300 m3/d. nursing home NSWI 213.21 Septic tank # and sewage treatment station on site with capacity of 300 m3/d. Hezhou Hunan 180.61 Septic tank # and sewage Medical Nursing treatment station on site with Center capacity of 250 m3/d. Hezhou No.1 233 The sewage treatment station of Nursing Center Chengdong Branch of Hezhou People’s Hospital Hezhou No.2 222.74 Septic tank and sewage treatment Nursing Center station on site with capacity of 300 m3/d. # Septic tank is only for normal domestic waste water. The medical wastewater will be treated by on- site sewage treatment station. The on-site medical sewage treatment station uses the process of regulation tank, anaerobic tank, biological contact oxidation, chlorine dioxide disinfection.

169. For Hezhou Huanan Medical Nursing Center, the sewage collection network is planned according to the Hezhou City Master Plan (2016-2035). If the municipal sewage collection network is not completed when the subproject come into operation as expected in 2024, the sewage will be treated by the on-site facility before discharge into Hejiang River.

170. Hezhou No.1 Nursing Center is adjacent to the Chengdong Branch of Hezhou People’s Hospital. The sewage treatment station of Chengdong Branch is under construction and has a capacity of 1500 m3/d, which will receive 566.24 m3/d from its clinic buildings and there is still a margin of 933.76. The expected volume of No.1 Nursing Center is 233 m3/d so it has adequate capacity. The sewage station is expected to complete construction in 2022. The Hezhou No.1 Nursing Center is expected to be completed in 2024. Therefore, it is feasible to make use of the sewage treatment station of Chengdong Branch of Hezhou People’s Hospital.

171. Noise. The noise source during the operation period of the project mainly comes from the central air conditioner, underground parking lot fan and the aerator noise of the sewage treatment station, such as various pumps and fans, and traffic noise from vehicle entering and leaving the Nursing Center.

Table V.5: Noise Level and Mitigation Measures Sound source strength Mounting Measures to be taken to Code Noise Source Name dB (A) locations reduce noise 1 Central Water- 80~85 Underground Low noise products, the Air cooled room use of flexible joints, conditioning Unit indoor placement, Frozen underground installation water Pump Hot and cold- water pump Cooling water Pump

Sound source strength Mounting Measures to be taken to Code Noise Source Name dB (A) locations reduce noise Cooling 72 Elderly Care Take sound insulation, tower Building Roof muffler, vibration reduction, distance attenuation 2 Ventilation 70~75 Underground Low noise products, the Garage use of flexible joints, indoor placement, foundation damping, duct installation muffler 3 Water supply Pump 80~85 Basement Indoor placement, foundation damping, indoor insulation 4 Sewage Treatment 80~90 Sewage Indoor placement, Station Aeration treatment foundation damping, Room indoor insulation 5 Car driving 66.2~85 Internal road Speed limit driving, prohibition of sirens

172. After taking these measures, the noise level at project site boundary can satisfy with the Noise Emission Standard for Industrial Enterprises Boundary" (GB 22337-2008).

173. Solid Waste. The solid waste generated during the operation period of the project mainly includes general solid waste and hazardous waste. The general solid waste is mainly domestic garbage, and the hazardous waste is mainly medical waste generated during the diagnosis and treatment process and medical waste treatment station sludge. The solid waste generation is summarized in 174. Table V.6.

Table V.6: Solid Waste Generation of each Subproject during Operation Sludge from Septic tank and sewage Municipal Solid Medical Waste treatment station Subproject Waste (kg/d) (kg/d) (kg/d) NTCMH 413 70 71.4 NSWI 590 100 102 Hezhou Hunan 515 90 87 Nursing Center Hezhou No.1 528 80 98.4 Nursing Center Hezhou No.2 472 80 81.6 Nursing Center

175. According to the National Hazardous Waste List, medical waste and sludge from hospital are classified as hazardous waste (HW01). Medical waste shall be managed in accordance with the Medical Waste Management Regulation.

176. The medical waste shall be packed in accordance with the requirements of Standard on Packaging, Container and Warning Labels for Hospital Wastes for sorting and collection. Disinfection is carried out on the same day before packing.

177. Medical waste temporarily stored in special storage room cannot be more than 2 days. The project implementing entities (PIEs) shall entrust qualified units to carry out the collection and disposal work During transferring of the hazardous wastes, the provisions of the Management Methods for Transferring Hazardous Waste shall be strictly implemented, and the hazardous waste transfer joint form (triple list) shall be filled out.

178. The septic tank sludge shall be disposed by a qualified unit after being treated with lime and disinfected. Sludge disposal shall strictly follow the provisions of Sewage Control Standard for Medical Institutions (GB18466-2005) to ensure that no pollution is caused to the surrounding environment.

179. For subprojects in Hezhou City (Huanan Nursing Center, No.1 and No.2 Nursing Centers), the medical waste will be sent to Hezhou Medical Waste Disposal Center. The Hezhou Medical Waste Disposal Center with capacity of 3t/d was built in 2015 and received environmental completion inspection acceptance on November 2016.

180. For subprojects in Nanning City, the medical waste will be sent to the Guangxi Hazardous Waste Disposal Center. Guangxi Hazardous Waste Disposal Center was built in 2013 with a capacity of 40000 t/a and received the environmental completion inspection acceptance on November 2013.

181. Domestic garbage. The collection of domestic garbage shall be stored in a designated location and entrusted to the local sanitation department for transportation and disposal.

182. Hezhou: the landfill site has remaining capacity of 350000 m3 and the remaining lifetime is 3 years. A waste-to-energy incineration plant is under construction with capacity of 500 tons per day, which is expected to in operation in 2019.

183. Nanning: the landfill site has been closed in 2018. The domestic solid waste will be sent to the waste-to-energy incineration plant, which came into operation in 2016 with capacity of 2000 tons per day and will be expanded 3500 tons per day by 2021.

F. Climate Change 184. The renewable energy installations and energy efficiency measurements integrated in green building are considered as investment for climate change mitigation. In the project FSR, 6.15% of the total budget is allocated for improved energy efficiency and for increased renewable energy usage (Green Building Additional feathers 0.61% + Heating System with solar energy 4.22% + Sponge City Budget 0.44% + Solar and Air heating pumps 0.73% + Green Building Design Fee 0.15%). The average budget for isolation layer is approximately 5.5 USD per m2. Average budget for construction of 1 m2 hospital is approximately 250 USD. Air conditioning system (cooling and heating) and emergency evacuation and protection facilities are installed in project buildings as climate change adaptation measurement. The average budget for air conditioning (cooling and heating) is approximately 15 USD per m2. The project emissions baseline is 2,887 t CO2/year. This is well below the significant level of 100,000 t/year used as a threshold level by the ADB SPS to require continuous monitoring.

185. Climate risk. The project has been classified a medium climate risk and a Climate Risk and Vulnerability Assessment (CRVA) was prepared. No subproject site is located in flood-prone land or land vulnerable to sea level rise. Modem PRC building codes for structural safety and seismic resistance will ensure that the project buildings are designed for weather events likely to occur in the GZAR. Features included in designs such as storm- water/sewage separation systems, high grade materials to improve the heat insulation, moisture reduction and building layout to maximize the utilization of the sunlight, natural

cooling and airflow will contribute to the facilities resilience to climate change.

63 VI. ANALYSIS OF ALTERNATIVES

A. No Project Alternative 186. The “No Project” alternative would be shortage of elderly care facilities and the potential socioeconomic benefits of implementation of this project will not be achieved so that the “No Protect” alternative is not considered.

B. Alternatives Considered for each Subproject 187. Site selection. The site selected shall satisfy with the requirements of the “Building Standards for Elderly Nursing Homes” (Jingbiao 144-2010): i) flat terrain; ii) engineering geological and hydrogeological conditions shall avoid any natural disaster-prone areas; iii) convenient transportation municipal conditions such as power supply, water supply and drainage, and communications; iv) it is convenient to use social public service facilities such as living, medical care, etc.; v) avoid commercial prosperity areas and public entertainment places, and the protection distance from high noise and pollution sources complies with relevant safety and health regulations. Considering these factors, there is no other alternative sites for the subprojects. All sites are defined as land for medical care facilities in the city master plan.

188. Alternative of Layout for NTCMH. For option A, the outpatient complex is located in the west of the site. The ventilation and lighting conditions are good due to the absence of tall buildings nearby. For option A, there are a large flow of people in and out of the hospital that will have adverse impact on the elderly people. Therefore, option A is selected.

Option A Option B Figure VI.1: Alternative Layout of NTCMH

189. Alternative for Hezhou No.1 Nursing Center. The two alternative layouts as shown in Figure VI.2 are considered. As option B can provide extra134 beds than option A, option B is selected.

Option A Option B Figure VI.2: Alternative Layout of Hezhou No.1 Nursing Center

Table VI.1: Comparison of Alternatives for Hezhou No.1 Nursing Center Aspects Considered Option A Option B Comparison Total land 7098.86 m2 7098.86 m2 Same area Gross area Total floor area 15722.16 m2 floor; Total floor Option A has more (square Above ground floor area 22463.72 square 189.64 m2 meters) area:12146.26 m2, underground meters, above ground building area 3575.90 m2 floor area:18903.06 m2, underground building area 3560.66 m2 Number of 8+2F 12+2F floors Ground 1516.40 1516.40 Same area of the building Building 21.36% 21.36% Same density Volumetric 1.71 3.16 Meet the requirements ratio of the planning target Green 35.23% 33.4% Option A has more space Rate green space Building 30.15 m 43.50 m Meet the requirements height of the planning target (tallest building) Refractory Grade I, Level two Grade I, Level two All meet the Grade requirements of the specification Seismic 7 Degrees 7 Degrees All meet the fortification requirements of the Intensity specification Number of 266 Beds 400 Beds Option B has can beds provide more beds

65 VII. INFORMATION DISCLOSURE, CONSULTATION, AND PARTICIPATION

A. Legislative Framework 190. Relevant provisions in the Environmental Protection Law (2015) of PRC and Environmental Impact Assessment Law (2018 amendment) require the construction unit shall solicit public’s opinions for project that has significant adverse environmental impacts. The Measurement for Public Consultation during Environmental Impact Assessment (2019) specifies the requirements of information disclosure and stakeholder opinion survey.

191. ADB’s Safeguard Policy Statement also requires meaningful participation, consultation and information disclosure. The objective of ADB’s Access to Information Policy (2019) is to promote stakeholder trust in ADB and to increase the development impact of ADB activities. It requires transparency, accountability, and participation by stakeholders in ADB-supported development activities in Asia and the Pacific. The policy is led by overarching principal of clear, timely, and appropriate disclosure. The policy recognizes the right of people to seek, receive, and impart information about ADB operations. It supports information and ideas sharing and enables participatory development or two-way communications with affected people and other stakeholders. The policy is based on a presumption in favor of disclosure unless there is a compelling reason for nondisclosure. It commits ADB to disclose subproject-related information proactively on its website, in a timely manner, and provides mechanisms to handle responses and complaints.

B. Information Disclosure to Date 192. Relevant information on the proposed project and potential project impacts has been made available, in a timely manner and before project appraisal, in an accessible place, and in a form and language(s) understandable to project-affected people and other stakeholders.

193. The first public announcement was conducted via the website of the PIE on December 2018 to February 2019. Disclosed information included (i) name and overview of the project; (ii) name and contact of the construction unit; (iii) the major proceedings to collect public opinions; (vi) links of comment form; and (vi) the way for the public to deliver and submit opinions.

194. The second public announcement was conducted during March 2019 through community poster and website of the PIE. Information included: (i) overview of the project; (ii) key conclusions drawn in the project IEE and domestic EIA documents; (iii) the major proceedings to collect public opinions; and (iv) the way for the public to deliver and submit opinions.

First round Second round http://www.hzsrmyy.com.cn/ http://www.gxgdyy.com/yiyuangonggao/zhaobiaogongshi/2019-03-28/1391.html Figure VII.1: Information Disclosure by Posting on PIE Websites

Figure VII.2: Second Round of Information Disclosure by Community Poster

C. Public Consultation to Date 195. First Round Public Consultation. A total of 87 questionnaires were distributed by the PIEs with the support of EIA TrTA consultant to potential affected persons from different age groups and educational backgrounds and project affected organizations (Table VII.1) on March 7-10 2019. Of these, 87 questionnaires were returned with a return rate of 100%. The survey result is summarized in Table VII.2).

196. If the mitigation measures are effectively implemented, 94.3% of the consulted APs and organizations support the project, while 5.7% are not sure. Of the consulted APs and organizations 94.3% believe that the proposed project will contribute to the socio-economic development of the region. Major concerns raised by the public are noise (77.2%) and air pollution (77.3%) during construction and solid waste (43.2%) during operation.

67 Table VII.1: Respondents of 1st Round Questionnaire Survey Serial number Project Number Percentage (%) 1 Gender Male 63 71.6 Woman 25 28.4 3 Degree Bachelor Degree or above 12 13.6 Specialist 9 10.2 Technical secondary school 9 10.2 High school 5 5.7 Junior high school 45 51.1 Below Primary School 8 9.1 4 Age <20 6 6.8 21-30 7 7.9 31-40 36 41.0 41-50 25 28.4 51-60 10 11.4 Above 60 10 11.4 Groups Municipal People's Government, Municipal Development and Reform Commission, consulted Municipal Health and Family Planning Commission, Municipal Planning Bureau, Municipal Housing and Urban-Rural Construction Bureau, Municipal Bureau of Land and Resources, Municipal Environmental Protection Bureau, Municipal Public Security Bureau Traffic Police Detachment, Municipality Traffic Management Bureau, Municipal Education Bureau

197. The results of the Project Public Participation survey are shown in the Table VII.2.

Table VII.2: Results of public survey statistics Number of Choice of answer people Proportions Content of the survey content (persons) (%) Understand 16 18.2 Do you know the project? Know something 54 61.4 Don't know 17 19.3 Very Good 13 14.8 What do you think of the status of Good 36 41.0 local environmental quality? Normal 30 34.1 Poor 9 10.2 Do you think the construction of the Favorable 35 39.8 project is conducive to the economic Some Benefits 48 54.5 development of the surrounding Adverse 4 4.5 areas? Construction dust 68 77.2 What do you think is the main impact Construction noise 65 73.9 of the project construction process on Solid waste impact 41 46.6 the surrounding Ecological landscape 12 13.6 environment? (Multiple options) destruction No 3 3.4 Air pollution 26 29.5 What aspects of environmental Water pollution 34 39.8 problems do you think will result from Solid Waste 38 43.2 the operation of the project (Multiple Noise pollution 22 25 options) Ecological damage 11 12.5 Other 12 13.6 What aspects of environmental Air pollution 29 33.0 pollution control do you think the Water pollution 30 34.1 project should enhance? (Multiple Solid Waste 50 56.8 options) Noise pollution 24 27.3

Number of Choice of answer people Proportions Content of the survey content (persons) (%) Ecological damage 10 11.4 Other 8 9.1 Positive impact 30 34.1 Negative impact 9 10.2 What impact will the project have on Negative impact but your life when it is completed? 18 20.5 acceptable No impact 42 47.7 Do you think the location of the Reasonable 79 89.8 project is reasonable? If it is unreasonable, please state the Unreasonable 9 10.2 reasons. If the environmental mitigation Support 83 94.3 measures will be effectively Not sure 5 5.7 implemented, do you support the project construction? If not supported, Opposite 0 0 please explain why. What are your suggestions and Water pollution, noise pollution, air pollution must be handled requirements for the construction and well, if the project is completed, please give priority to the environmental protection of the employment of villagers project?

198. Second Round Public Consultation. Six discussion forums for the four subprojects involve physical works were organized by the project implementing entities (PIEs) on 12 to 17 April 2019 with the support of TrTA consultant and EIA institutes. Total of 138 residents (including 44.2% female and 55.7% male) from potential affected villages, communities, local health administration department, township government representatives and PMO attended the forums.

199. During the forum, the project design, anticipated impacts and proposed mitigation measures and proposed project-specific grievance redress mechanism (GRM) were introduced to the attendees. The basic information of the form attendees is summarized in Table VII.3. All participants fully supported the project. Specific comments are listed in Table VII.4.

Table VII.3: Basic Information of the Forum Attendees Hezhou Hezhou Aspects NTCHM NSWI No.1 No.2 Huanan Subtotal Age <30 2 1 2 1 2 8 30-50 9 19 23 19 24 94 >50 8 2 4 11 11 36 Gender Female 6 14 13 14 14 61 Male 13 8 16 17 23 77 Grand 19 22 29 31 37 138 Total

69 Table VII.4: Key Issues and Responses from the Discussion Forums No. of Subproject Date Participants Comment/Question Response Photographs NTCHM April 12 19 The apartment of 2019 Nanning Health School is in the corner of the project site. The construction shall not affect the residents in and out the community.

Note: Yellow=construction site; blue=existing living area; purple line=internal transportation route. The layout of the construction site arrangement is presented to the residents. The construction site will be enclosed with fence. A traffic management plan will be developed and implemented to minimize the impact to communities. NSWI April 12 22 Transportation of The weight of transportation vehicles will 2019 construction materials be controlled not exceeding the design shall not damage the load of the road. road surface. The proposed building will have two Construction of floors of basement as garage. basement will cause Construction is not allowed during night vibration. time.

No. of Subproject Date Participants Comment/Question Response Photographs HPH: 16 April 29 The participants In response to the opinions and Hezhou No.1 2019 believed that the main suggestions put forward by the Nursing impacts of the participants, the PIE committed that the Center construction period and project will strictly follow the laws and operation period of the regulations, the requirements of the project were environmental protection department and construction dust, the various prevention measures construction noise, proposed in the EMP. construction waste, medical wastewater and medical waste. Necessary environmental protection measures and management measures during the construction period and operation period shall be taken to alleviate the adverse impact on the environment. The main recommendations are: (1) It is hoped that the construction unit will pay attention to the construction period and will not affect the residents at nighttime. (2) The dust, mud and garbage generated shall be cleaned up in time and disposed of properly.

71 No. of Subproject Date Participants Comment/Question Response Photographs HPH: 31 Measures shall be taken The PIE promises that the project Hezhou No.2 to properly handle the construction will strictly follow the laws Nursing waste and sewage and regulations, the requirements of the Center generated by the environmental protection department and project. the various prevention and control measures proposed in the EIA, and do a good job in prevention and control of atmospheric, water, noise and solid waste pollution during construction and operation. Huanan Pinggui 37 Groundwater is the During the construction period, it is Nursing District: 16 drinking water source of planned to invest 150,000 CNY to build Center April 2019; Dongmuyuan Village. facilities such as sedimentation tanks, Does the project affect grease traps and septic tanks. The Babu groundwater quality? bottom of the tanks will be lined to District: 17 prevent seepage. During the operation April 2019. period, the domestic sewage will be discharged into the municipal pipe network, and finally discharged into the Hejiang River after being treated by the on-site septic tank and sewage treatment station. The above measures can effectively reduce the impact of project construction on surrounding groundwater.

How to ensure the The requirements for various proposed mitigation environmental protection measures will measures will be be included in the bidding documents. effectively Construction Supervision Company and implemented? PIE will supervise the implementation of the project to ensure that all environmental protection measures of the project are implemented. During the

No. of Subproject Date Participants Comment/Question Response Photographs construction period and operation period, the waste emissions and ambient environment quality and sensitive receptors will be monitored.

The construction of the During the construction of the project, project will generate environmental protection measures such dust and construction as dust and construction waste disposal waste, which must be in will be implemented strictly in accordance accordance with the with environmental protection requirements and requirements. During the construction of cannot affect the normal the project, an environmental monitoring life of the surrounding plan will be implemented to monitor the residents. environmental quality of the surrounding environment and ensure the normal life of the surrounding residents.

D. Future Information Disclosure and Public Consultation 200. Dialogue will be maintained with project communities throughout implementation. Future consultation will be undertaken by the GPMO and LIEC and CSCs via questionnaire surveys, household visits, workshops, and public hearings (see Appendix 1 Table EMP-8).

VIII. GRIEVANCE REDRESS MECHANISM

201. During project IEE preparation, the grievance redress mechanism (GRMs) has been developed in the project city in compliance with ADB’s SPS (2009) requirement to address environmental, health, safety, and social concerns associated with project construction, operation, and land acquisition. The GRM is designed to achieve the following objectives: (i) provide channels of communication for local villages and communities to raise concerns about environmental and social-related grievances which might result from the project; (ii) prevent and mitigate adverse environmental and social impacts to villages and communities caused by project construction and operation, including those associated with resettlement; (iii) improve mutual trust and respect and promote productive relationships between the project agencies and local villages and communities; and (iv) build village and community acceptance of the project. The GRM is accessible to all members of the villages and communities, including women, youth, minorities and poverty-stricken villagers and residents. Multiple points of entry are available, including face-to-face meetings, written complaints, telephone conversations, e-mail, and social media33.

202. Public grievances to be addressed by the GRM will most likely include disturbance of traffic, dust emissions, construction noise, inappropriate disposal of construction wastes, damage to private houses, safety measures for the protection of the public and construction workers, and/or water quality deterioration. Grievances related to involuntary resettlement may relate to the lack, or un-timely payment of compensation, other allowances, and/or lease amounts as per entitlements described in the resettlement plan and other associated documents.

203. Grievance redress mechanism. Government of GZAR through Guangxi Project Management Office (GPMO) is the Executing Agency. Nanning Municipality (NM) and Hezhou Municipality (HM) are implementing agencies. A project-specific GRM is needed to be established as part of the EMP to receive and manage any community concerns which may arise due to the project. The GRM is common for both initial environment examination (IEE)/environment management plan (EMP) and the resettlement plan (RP). IAs will ensure that each PIE (Nanning Social Welfare Institute, Nanning Traditional Chinese Medicine Hospital, Guangxi Guidong Hospital, Hezhou People’s Hospital will establish grievance redress mechanism (GRM) at the respective subcomponent levels within 2 months of loan effectiveness date, as detailed in the EMP and RP.

204. The GRMs set out procedures for managing public concerns and complaints and safeguard issues that may arise during project implementation. The GRMs will be established before the start of any construction work of the subprojects. Each GRM will provide a set of procedures to receive, record, and resolve concerns or/and complaints of affected persons and communities. The GPMO will have final responsibility for management, implementation, and reporting of the GRM. The environmental officer, assigned by GPMO, will coordinate the GRM tasks to ensure that a full record is maintained of grievances received (both written and oral) and how these are resolved. This record will be made available to ADB review missions and summary information contained in the annual project progress reports. The circumstances that would trigger corrective action to be taken and requirements for corrective action plan are described in the GRM. It will provide contact details of the focal point at the implementing agencies, PIEs, contractors’ teams, and other relevant safeguard authorities such as municipal government and Environment Protection Bureaus. All contractors will be briefed by GPMO and/or the implementing agency on safeguard requirements of subprojects and the role of GRMs.

33 The entry point information (such as specific contacts, etc.) will be refined before construction and disclosed to the contact through information disclosure boards and consultation workshop.

75 205. Multiple entry points to each GRM will be available including verbal and written complaints, hotline number, anonymous drop boxes, and email contacts. The GRM will be accessible (in Chinese) to diverse members of the villages and community, including more vulnerable groups such as women, minority and poor. Environmental and social safeguard complaints or disputes will be handled in accordance with the grievance redress mechanism established for the project. The GRM procedures, reporting timelines, roles and responsibilities of all agencies, are described in the EMP. GPMO will report on complaints and the degree of their resolution to ADB in project progress reports and annual safeguard monitoring reports.

206. Currently in Nanning City and Hezhou City (and generally in the PRC), when residents or organizations are negatively affected by a construction or development, they may complain, by themselves or through their village or community committee, to the contractors, developers, the local EPB, or by direct appeal to the local courts. The weaknesses of this system are: (i) the lack of dedicated personnel to address grievances; and (ii) the lack of a specific timeframe for the redress of grievances. This project GRM addresses these weaknesses.

207. The GRM meets the regulatory standards of the PRC that protect the rights of citizens from construction-related environmental and/or social impacts. Decree No. 431 Regulation on Letters and Visits, issued by the State Council of PRC in 2005, codifies a complaint acceptance mechanism at all levels of government and protects the complainants from retaliation. Based on the regulation, the Ministry of Environmental Protection (MEP) published updated Measures on Environmental Letters and Visits (Decree No. 15) in December 2010.

208. The details of the GRM, including a time-bound flow chart of procedures, are included in the project EMP (Appendix 1 Figure EMP-2).

IX. ENVIRONMENTAL MANAGEMENT PLAN

209. A project environmental management plan (EMP) has been prepared (Appendix 1). Development of the EMP drew on the five DEIA reports, discussions with the GPMO, IAs, city PMOs and PIEs, and consultations with the local EPBs, other government agencies and local communities.

210. The EMP defines mitigation measures for the anticipated environmental impacts, institutional responsibilities, and mechanisms to monitor and ensure compliance with PRC’s environmental laws, standards and regulations and ADB’s SPS. The EMP specifies major environmental impacts and mitigation measures, roles and responsibilities, inspection, monitoring, and reporting arrangements, training, and the grievance redress mechanism. The EMP will be updated after detailed design, as needed.

77 X. CONCLUSION

211. In accordance with the ADB’s SPS 2009, the proposed project construction classifies under Category B. Thus, an IEE report has been prepared for the project for meeting ADB’s SPS 2009 guidelines. An initial environmental examination (IEE) report, including an environmental management plan (EMP) has been prepared and will be disclosed on the ADB website on May 2019.

212. The project will improve the living environment of the community by demolishing old buildings and constructing new modernized elderly care facilities, with updated water supply, treatment facilities for wastewater and solid/medical wastes, and electricity connections at Nanning municipality. Similarly, the subprojects in Hezhou municipality will involve construction of new elderly care facilities after demolition of some rural houses, home steads in low population areas and agricultural fields.

213. Potential environmental impacts of the project during demolition, construction and operation stages include impacts on air, noise, water quality, land leveling; disposal of demolition/construction waste 34 , solid waste, medical waste and disturbance to local communities and traffic safety. The EMP identified potential environmental impacts and risks for the pre-construction, demolition, construction, and operational phases; and proposed mitigation measures as listed in the IEE and EMP document.

214. The EMP lists safeguard mitigation procedures that must be strictly followed in compliance with the PRC domestic regulations and ADB guidelines, as well as international best practices. The GPMO has confirmed its commitment and capacity to implement the EMP. Further capacity-building measures were proposed in the EMP. The executing agency will assign a safeguards officer to supervise the effective implementation of the EMP. A grievance redress mechanism will be established. The procedures, reporting timelines, and roles and responsibilities of relevant agencies are described in the EMP. The implementing agencies will be fully responsible for the oversight of EMP implementation and compliance.

215. Environment impact analysis have been done with various criteria like demographic factors, climate and natural habitat, community and employee health and safety etc. based on the impact analysis. Impacts are manageable and can be managed cost effectively - Environmental impacts are likely to result from the proposed construction of buildings, internal roads, drainage etc. Careful mitigation and monitoring, specific selection criteria and review/assessment procedures for subprojects have been specified to ensure that minimal impacts take place. The detailed design would ensure inclusion of any such environmental impacts that could not be specified or identified at this stage are taken into account and mitigated where necessary. Those impacts can be reduced through the use of mitigation measures such as correction in work practices at the construction sites, or through the careful selection of sites and access locations. The limited project impacts are associated with demolition, drainage congestion/water logging, dust and noise pollution, occupational health hazards, risk from poor sanitation system, and management of labor at the site. Moreover, most of the associated impacts are expected to be limited to the construction phase, and will therefore be temporary in nature. Regular monitoring of the recommended mitigation measures shall also be carried out during the implementation phase of the project.

216. The Project features a reasonable functional layout in view of its sub-projects. The operation of the Project will bring some impacts on ambient air, water and soil environment and acoustic environment but will not change the local environmental functions. Exhaust,

34 If any asbestos containing materials (ACM) are found during demolition of old facilities, the executing agency shall engage services of certified agency capable to handle and dispose ACM in accordance with international best practices.

noise, solid waste and wastewater, medical wastes arising from the operation of the Project can all be treated with relevant treatment measures. Strictly implementing the requirements in this report can avoid and solve those impacts. All emissions up to standard limits can be realized at each source of pollution.

217. Reliable baseline information of water air and noise /vibration in these areas with respect to Project subcomponents is available in the DEIAs 35 prepared by PIEs. The Construction contractor/PIEs will monitor changes of the quality of water, air, soil and noise during the construction and operation periods as per Appendix 1 Table EMP-4. Domestic EIAs and FSRs have indicated that: • Air Environment: The baseline air quality data showed that Nanning and Hezhou has overall good air quality so air purification facility is not considered in the project at this stage. Such contents as TSP, PM10, SO2, NOx and CO within the evaluation area can meet Ambient Air Quality Standard (GB3095-2012). • Acoustic Environment: All noise background values measured at all monitoring spots at daytime and night meet provisions of Class 2 of Acoustic Environment Standard (GB3096-2008).

218. EMP and Environment Monitoring Plan has been prepared and attached as Appendix 1 Table EMP-2 and Appendix Table EMP-4 respectively. Regular monitoring reports will be prepared by the PIEs and be consolidated by GPMO before submission to ADB. Furthermore, GPMO ensures that a safeguard grievance redress mechanism will be in place to handle any grievance within timeframe and procedures acceptable to ADB. It is anticipated that the Project’s safeguard reputational risks will be minimized through regular monitoring, and strict compliance with the assurances, and EMP implementation.

219. The public consultation conducted during project preparation stage indicated broad support for the project based on perceived economic and social benefits. Proper GRM will have to be implemented through GPMO/IAs/PIEs to overcome public inconvenience during the proposed project activities. The project will ensure that meaningful consultations are continued with communities and affected persons and all relevant information is disclosed in a timely manner, in languages understood by communities and in places easily accessible to them. The project may cause some involuntary land acquisitions as the land required for the project will be obtained through acquisition. The details are provided in the RP and the social details in the Social and Poverty Analysis.

220. Risk associated and assurances required for project implementation, among other things, include: i. EA will ensure all domestic Environment Impact Assessments (DEIAs) are approved by local competent environment protection agency before start of construction at each of the sub-projects. If there is a change in any of the DEIAs, the EA shall seek revise the IEE before board approval. ii. EA shall ensure all requisite clearances by local government/municipal authorities for demolition, new building construction plans, connectivity to utilities such as power, water supply, sewage and drainage as well as disposal of waste from demolition of buildings, construction waste, waste from operational medical facilities is procured before start of construction for each of the sub-projects. iii. If any asbestos containing materials (ACM) are found during demolition of old facilities, the executing agency shall engage services of certified agency capable to handle and dispose ACM in accordance with international best practices. iv. EA shall ensure contractors adhere to proper management of health and safety of workers and the community during demolition and construction at each site; including

35 Even if the domestic EIA and EMP are enforced by local municipalities, the ADB SPS compliant EMP shall prevail

79 implementing proper traffic safety management at and near the work site.

APPENDIX 1: ENVIRONMENTAL MANAGEMENT PLAN (EMP)

A. Introduction

1. This project Environmental Management Plan (EMP) is developed for the Demonstration of Guangxi Elderly Care- Health Care Integration and Public-Private Partnership (PPP) Project (the project) and defines all potential environmental impacts of the project components and the mitigation and protection measures with the objective of avoiding or reducing these impacts to acceptable levels and meeting applicable requirements. The EMP draws on the findings of the initial environmental examination (IEE), project Transaction Technical Assistance (TrTA) and Asian Development Bank (ADB) review mission discussions, and agreements with the relevant government agencies (listed below).

2. The project EMP sets out (i) actions to implement mitigation measures; (ii) a monitoring and reporting program; (iii) institutional/organizational arrangements; (iv) capacity development and training; (v) an implementation schedule; and (vi) cost estimates. The project EMP forms part of the Project Administration Manual (PAM) and will be included as a separate annex in all bidding documents. The contractors will be made aware of their obligations to implement the EMP, to budget EMP implementation costs in their bids, and to develop site-EMPs fully responsive to the project EMP.

3. The effectiveness of the mitigation measures listed in the EMP will be evaluated through environmental monitoring and reporting, and periodic review missions of ADB. Environmental monitoring will be conducted by the government environment monitoring agencies or certified monitoring companies of project components. Assurances for environmental safeguards have been prepared and are included in the loan and project agreements.

B. Institutional Arrangement and Responsibilities

4. Government of Guangxi Zhuang Autonomous Region (GGZAR) through Guangxi Project Management Office (GPMO) is the executing agency. It is responsible for overall planning and implementation of the project, and has substantial experience in the preparation, implementation, and management of projects funded by ADB. The project leading group, chaired by the Vice Governor of GGZAR, has also been set up to facilitate the cross-sectoral coordination.

5. Nanning Municipality Government (NMG) and Hezhou Municipality Government (HMG) are the implementing agencies and responsible for overall project implementation for the respective subprojects in each of the municipalities. The implementing agencies will set up a project financial account; and compile all project-related documents and statements for project administration, auditing, and evaluation.

6. The project covers four subprojects: two are located in Nanning Municipality and other two are in Hezhou Municipality. The following four project implementing agencies (PIEs) will be responsible for day-to-day administration of each of the subprojects: (i) Nanning Social Welfare Institute (NSWI), (ii) Nanning Traditional Chinese Medicine Hospital (NTCMH), (iii) Hezhou People’s Hospital (HPH), and (iv) Guangxi Guidong Hospital (GGH). The first three PIEs are public hospitals. The NSWI is a public entity, providing long-term care, and has its internal clinic.

7. The project organization diagram is in Figure EMP-1.

81 Figure EMP-1: Project Organization Structure

8. Project management roles and responsibilities of the key agencies and bodies involved in the project are summarized in Table EMP-1.

Table EMP-1: Key Parties Involved in Project Implementation and Roles and Responsibilities Project Implementation Organizations Management Roles and Responsibilities 1. Guangxi Project Leading The GPLG, led by Vice Governor of GZAR, includes high- group (GPLG) level officials from GDRC, GDOF, GHC, GDOCA, and other key stakeholders, including vice mayors of Nanning and Hezhou cities. (i) Provide strategic and policy guidance. (ii) Facilitate inter-agency coordination and cooperation, and support cross-agency policy dialogue to ensure smooth and successful project implementation and coordination across departments, bureaus, and agencies to attain the elderly and health care integration. 2. Executing Agency: (i) Supervise implementing agency activities and provide Government of GZAR guidance and support, as needed. (GGZAR) through Guangxi (ii) Coordinate project preparation and implementation project management office activities, including financial and procurement (GPMO) planning. (iii) Supervise the grievance redress mechanism at the implementing agency level during construction and operations. (iv) Recruit and sign contracts for the procurement agency and ADB-financed consulting services. (v) Oversee project procurement. (vi) Monitor and report project progress and performance, including environment, resettlement, and social and gender safeguards and action plans to ADB. (vii) Ensure the detailed consolidated project financial

Project Implementation Organizations Management Roles and Responsibilities statements are audited in accordance with International Standards on Auditing, by an independent auditor acceptable to ADB based on the terms of reference acceptable to ADB (viii) Prepare and submit reports on project activities as required. (ix) Coordinate project evaluation and dissemination activities. (x) Designate GPMO staff as Safeguards officer (GPMO- SO) to supervise, monitor and report all safeguard requirements of the project. Engage external safeguards monitoring experts to ensure compliance with EMP and resettlement plan. (xi) Prepare annual repayment plan. (xii) Communicate and coordinate with ADB. 3. Guangxi Department of (i) Open and manage the project advance account, and Finance (GDOF) liquidate and replenish advances made. (ii) Keep financial records. (iii) Make loan proceeds available to use for GPMO and IAs, and manage the loan disbursement process. (iv) Oversee the financial management of the project (v) Consolidate and submit withdrawal applications to ADB. (vi) Repayment of ADB loan. (vii) Liaison with MOF. 5. Nanning and Hezhou (i) Manage the project account. Municipal Finance Bureaus (ii) Keep financial records. (iii) Make loan proceeds available to use by municipal Municipal Civil Affairs Bureau PIEs, as set forth in the loan and project agreements and in accordance with agreed procedures. Municipal Health Commission (iv) Create separate budgets for environment monitoring, grievance redress mechanism, and fund remedial measures required as per EMP and resettlement plan, if any. (v) Oversee project financial management and provide financial management support to municipal PMOs and PIEs. 4. Implementing agencies: (i) Oversee the implementation of each subproject within its jurisdiction. Nanning Municipal (ii) Facilitate audit of project account. Government (NMG) through (iii) Facilitate interagency coordination and cooperation at Nanning PMO municipal level. (iv) Review, consolidate, and submit withdrawal Hezhou Municipal applications to GPMO and GDOF. Government (v) Supervise the GRM implementation and remedial (HMG) through Hezhou PMO measures as per EMP and resettlement plan at PIE level. (vi) Monitor and report project progress and performance, including environmental, resettlement, and social and gender safeguards and action plans. (vii) Have the project financial accounts. (viii) Prepare and submit reports on project activities, as

83 Project Implementation Organizations Management Roles and Responsibilities required. (ix) Coordinate project evaluation and dissemination activities. 6. Project Implementing (i) Manage specific project bank account to channel and Entities (PIE): use ADB loan proceeds and counterpart funding. (ii) Receive and utilize ADB loan proceeds to finance Nanning Social Welfare project investments under arrangements established Institute (NSWI) by the municipal finance bureau. (iii) Timely provide necessary counterpart funding timely. Nanning Traditional Chinese (iv) Maintain project financial accounts and related Medicine Hospital (NTCMH) financial statements. (v) Prepare withdrawal applications for submission to Hezhou People’s Hospital respective municipal finance bureau and municipal (HPH) PMO. (vi) With project technical consultants, implement capacity Guangxi Guidong Hospital building activities for the relevant staff of PIEs and/or (GGH) the relevant staff of elderly care institutions which will be created under the project. (vii) Ensure quality in project activities necessary to meet objectives. (viii) Create separate budgets for environment monitoring, grievance redress, and fund remedial measures required as per EMP and resettlement plan, if any. (ix) Report project progress and performance, including environmental, resettlement, and social and gender safeguards and action plans, and take actions as needed to implement relevant plans. (x) PIE staff is responsible for EMP implementation and supervision. Each PIE will assign a member in staff, who will be responsible for implementation of GRM, and EMP. Each Construction Supervision Company (CSC) shall have at least one environment engineer on each construction site. Each contractor shall assign onsite environment engineer to be direct contact person for PIEs and the community.

For subprojects of NSWI, NTCMH, and HHP (xi) Day-to-day administration and implementation of each subproject. (xii) Procure and sign contracts for works and goods (with support of procurement agent). (xiii) Review the implementation of EMP and resettlement plan by the contractors and ensure compliance, conduct public consultations, and redress grievance during construction and operations. For subproject of GGH: PPP subproject (xiv) With supports of TAS, procure a PPP concessionaire and sign a PPP concession agreement based on a design-build-operate contract. (xv) Under the PPP concession agreement, monitor day- to-day administration and implementation of the PPP subproject by the PPP concessionaire. (xvi) Review the implementation of EMP and resettlement

Project Implementation Organizations Management Roles and Responsibilities plan by the PPP concessionaire and ensure compliance, conduct public consultations, and redress grievance during construction and operations. Asian Development Bank (i) Monitor compliance with loan covenants including safeguards requirements. (ii) Conduct periodic loan review, midterm review, and project completion missions. (iii) Disburse the loan in accordance with the agreed procedures upon receipt of duly authorized withdrawal applications and necessary supporting documentation. (iv) Provide guidance to GPMO, IAs and PIEs to help resolve any implementation issues that arise. (v) Review project progress reports and monitor implementation of resettlement plans, the EMP, SGAP, and other key project activities. ADB = Asian Development Bank, GDOCA = Guangxi Department of Civil Affairs, GDOF = Guangxi Department of Finance, GDRC = Guangxi Development and Reform Commission, GHC = Guangxi Health Commission, GGH = Guangxi Guidong Hospital, GGZAR = Government of Guangxi Zhuang Autonomous Region, GPLG = Guangxi Project Leading Group, GPMO = Guangxi Foreign Loan Project Management Office, HMG = Hezhou Municipal Government, HPH = Hezhou People’s Hospital, NMG = Nanning Municipal Government, NTCMH = Nanning Traditional Chinese Medicine Hospital, NSWI = Nanning Social Welfare Institute. Source: Asian Development Bank.

9. Environment staff within GPMO and project city PMOs. The GPMO will have main EMP coordination responsibility. The GPMO has designated an environment Safeguards Officer (GPMO-SO) to be responsible for the environmental and social issues during the project implementation. The designated officer will be responsible for (i) ensuring that environmental management, monitoring, and mitigation measures are incorporated into bidding documents, construction contracts and operation management manuals; (ii) directing the PIEs to coordinate planning and implementation of the EMPs; (iii) supervision of implementation of mitigation measures during project design, construction and operation; (iv) coordinating the GRM; and (v) responding to any unforeseen adverse impacts beyond those mentioned in this EMP; (vi) submitting annual EMP monitoring and progress reports to ADB. The GPMO-SO will be technically supported by the loan implementation environment consultant (LIEC). Each of the two-project city PMOs will oversee the overall implementation of provisions of the EMP, and work in close coordination with the GPMO-SO. Each contractor will assign a person responsible for environment, health, and safety, who shall be responsible for developing site specific EMPs (which are ADB’s SPS compliant) and their effective implementation at the site.

10. Each PIE will assign one environmental supervisor from PIE to (i) review and approve contractors’ site-EMP; (ii) conduct site inspections to assess the contractors’ compliance 36 with the site-EMP; (iii) organize periodic environmental monitoring in

36 During the design, construction, and operation of the project the borrower/client will apply pollution prevention and control technologies and practices consistent with international good practice, as reflected in internationally recognized standards such as the World Bank Group’s Environment,

Health and Safety Guidelines. These standards contain performance levels and measures that are normally acceptable and applicable to projects. When host country regulations differ from these levels and measures, the borrower/client will achieve whichever is more stringent. If less stringent levels or measures are appropriate in view of specific project circumstances, the borrower/client will provide full

85 compliance with the approved monitoring plan; (iv) act as local entry point for the project grievance redress mechanism (GRM); (v) review reports by local environment monitoring agency (LEMA) to ensure PRC’s environmental quality standards as listed in the EMP are adhered to; (vi) submit site inspection and monitoring results to the IAs, PMO and contractors for information.

11. About PPP subproject: Guangxi Guidong Hospital is PIE for this subproject, and GGH will take the responsibility of PIE as follows - Review the implementation of EMP by the private entity and ensure compliance, conduct public consultations, and redress grievance during construction and operations.

12. Loan Implementation Environment Consultant (LIEC). A LIEC will be hired under the loan implementation consultant services. The LIEC will advise the GPMO-SO, PMOs, contractors and Construction Supervision Companies (CSCs) on all aspects of environmental management and monitoring for the project. The LIEC will (i) assist in updating the site EMP and environmental monitoring program, as needed; (ii) undertake site visits for EMP inspection as required. (iii) supervise the implementation of the mitigation measures specified in the EMP; (iv) on behalf of the PMOs and GPMO, prepare the annual EMP monitoring and progress reports in English and submit it to ADB; (v) provide training to the GPMO, PMOs, CSCs on the PRC’s environmental laws, regulations and policies, ADB SPS 2009, EMP implementation, and GRM in accordance with the training plan defined in Table EMP-7; (vi) identify any environment-related implementation issues, and propose necessary corrective actions;

13. Construction Contractors and Construction Supervision Companies (CSCs). Construction contractors will be responsible for implementing relevant EMP mitigation measures during construction, under the supervision of the CSCs and PMOs. Contractors will develop site-specific EMPs based on this EMP. CSCs will be selected through the PRC bidding procedure by the PMOs. The CSCs will be responsible for supervising construction progress and quality, and EMP implementation on construction sites. Each CSC shall have at least one environmental engineer on each construction site to: (i) supervise the contractor’s EMP implementation performance; (ii) undertake simple and cost-effective on- site quantitative measurements to regularly check that the construction complies with the environmental monitoring standards and targets; and (iii) prepare the contractor’s environmental management performance section in monthly project progress reports submitted to the PMOs and GPMO.

14. External Environmental Monitoring Experts. GPMO will engage external safeguard monitoring experts 37 to ensure compliance with EMP. If any unanticipated environmental risks and impacts, which may include any change in scope of work or a design change to a subproject arise during construction or operation of the project that were not considered in the IEE and/or EMP, the GPMO should promptly inform ADB in writing of the occurrence of such risks or impacts, with detailed description of the event and the proposed action plan for incorporation in the updated EMP as necessary. The updating of the EMP shall be done by LIEC working in consultation with GPMO-SO and the IAs/PIEs which is required to be approved by ADB before it is implemented.

and detailed justification for any proposed alternatives that are consistent with the requirements presented in this document.

37 External environment monitoring consultant will be engaged under the loan for the Environment monitoring..

C. Summary of Potential Impacts and Mitigation Measures

15. Potential environmental issues and impacts during the pre-construction, construction and operation phases, as defined in the IEE, as well as corresponding mitigation measures designed to minimize the impacts are summarized in Table EMP-2.

87 Table EMP-2: Potential Impacts and Mitigation Measures Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source Preconstruction Stage 1.1 Design Stage Building specifications Avoid all underground utilities during design. Release Local GPMO, Included in and design of effluents in receptors (air, water, land). Design PIEs LDI contract parameters Avoid any building design feature that creates semi- Institute permanent areas for vector breeding (e.g. unreachable s (LDI) rain gutters, uneven surfaces of concrete rooftops and floors resulting in water stagnation, etc.) Design to comply with i. Structural Safety for construction, Seismic, soil type LDI GPMO, Included in relevant applicable specific design of building. Design buildings in PIEs LDI contract health, safety and compliance with relevant design standards and codes environment codes for energy-efficient, safe and green public building and standards, including but not limited to: GB 50011-2010 (Building including energy Seismic Design Code); GB 50016-2006 Code of efficient building Design on Building Fire Protection and Prevention): GB codes and 50189-2005 (Energy Conservation Design for Public specifications Buildings) and other applicable design codes. ii. Ensure no-use of VOC-emitting materials (including paints, coatings, adhesives, carpet and furniture) to protect indoor air quality. iii. Ensure no asbestos or asbestos-containing material is used in construction. iv. Incorporate energy-efficiency measures defined in the FSR and IEEE standards into building design. Landscaping to i. Maintain adequate clearance, construction of LDI GPMO, Included in combine amenity with retaining structures; minimize digging close to the PIEs LDI contract noise reduction and dwellings. dust screening ii. Include landscaping and vegetation planting in detailed design. Impact to the existing i. Construction facilities should be placed at suitable LDI GPMO, Included in surface water distance from water bodies, natural flow paths, PIEs LDI contract

Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source environment. important ecological habitats and residential areas. ii. Careful site selection to avoid existing settlements Interference with drainage patterns iii. Appropriate siting to avoid temporary flooding hazards Discharged Waste i. Procure wastewater quality monitoring devices for LDI GPMO, Included in water to meet real‐time monitoring PIEs LDI contract relevant ii. Establish real‐time monitoring framework requirements/standar ds Preparation for the i. Design waste disposal processes LDI GPMO, Included in proper handling and ii. Design initial collection, safe temporary storage, and PIEs LDI contract disposal of medical loading facilities for medical waste wastes Noise generation Exposure to noise, location/designed to ensure noise LDI GPMO, Included in will not be a nuisance to neighboring properties. PIEs LDI contract Loss of trees. Avoid siting of structures to avoid any permanent loss LDI GPMO, Included in of trees wherever possible. Implement tree replantation PIEs LDI contract or transplantation as the case may be. Plant trees and shrubs along building edges to screen windows from dust and particulates. Impacts from nearby Adequate green belt shall be designed for Hezhou LDI GPMO, Included in industry No.1 Nursing Center to prevent any potential risk of air PIE LDI contract pollutant/noise exposure from the Meiyi ceramic factory in the north. Prepare emergency Develop emergency response plan covering fire, LDI GPMO, Included in planning and earthquake, natural calamities, epidemic, air PIEs LDI contract procedures contamination, infestation, explosion, and food safety to ensure safe environment for all elderly people, staff, visitors and neighboring communities. Involuntary i. Loss of land and structures - Establish a resettlement LDI GPMO, Included

89 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source resettlement or land office comprising local government officials to manage PIEs Resettlemen acquisition. the resettlement process t Plan ii. Conduct community consultation programs and ensure information is disseminated about entitlement based on the Land Administration Law. iii. Ensure that all relocation and resettlement activities are completed before construction starts on any subproject. 1.2 Establish Contract a Loan Implementation Environmental GPMO ADB Included in Implementation implementation Consultant (LIEC), external environment monitoring loan cost Support support positions experts Contract Local Environmental Monitoring Agency PIEs LIEC, Included in during environment parameters measurement during GPMO EMP-9 construction and at commissioning. GPMO to designate Appoint GPMO Safeguard Officer PIEs GPMO, GPMO and staff for safeguards LIEC IA supervision Bidding documents i. Translate EMP into Chinese and distribute to all PIEs GPMO, GPMO and and contractors parties LIEC IA ii. Include an environmental section in the technical specifications forbidders which lists EMP requirements. Ensure that construction contracts are responsive to EMP provisions and that mitigation and monitoring measures are adequately budgeted 1.3 Construction Update EMP Review EMP to assess if the current mitigation LIEC GPMO, GPMO in- Support measures need to be updated due to any changes in ADB kind the final engineering design. For changes in project support, locations, sites, or other changes that may cause new included in or greater environmental impacts or involve additional loan cost affected people: the LIEC will conduct additional environmental assessment and public consultation.

Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source The revised environmental assessment reports will be submitted to the GPMO, Local EPB and ADB for approval and disclosure. Contract documents i. Include clauses referencing this EMP in the terms of PIEs GPMO, Included in reference for bidders for construction contracts. with LDI LIEC LDI contract ii. Prepare environmental contract clauses for contractors, especially the EMP and monitoring plan. Grievance Redress i. Implement the GRM described in EIA/EMP PIEs, ADB, Included in Mechanism (GRM) document. LIEC GPMO EMP-9 ii. Establish complaints recording procedures within GPMO. iii. Publicize GRM at all construction sites. Construction site i. Construction contractor/PIEs prepare Site EMP LIEC PIEs Included in planning (environment management plan) and environment LDI contract monitoring, health and safety plan ii. Contractor to assign onsite environment engineer to be direct contact person for PIEs and community. iii. PIEs review and approve contractor site EMP Ensuring structural i. Conduct safety investigation for buildings requiring LIEC PIEs Included in safety of buildings demolition. LDI contract before demolition ii. Examine structural condition of the buildings, ensuring no environmental, health, and safety risk during demolition period Asbestos i. Survey all buildings for demolition to discover and LIEC PIEs Included in contamination report on presence or absence of asbestos or LDI contract asbestos-containing material. ii. Where asbestos or asbestos containing material is found develop asbestos removal and disposal plan in conjunction with accredited specialist contractor Environmental Provide training on implementation of this EMP to all LIEC, GPMO, EMP-9 Protection Training relevant agencies, especially the PIEs, IAs and Local ADB

91 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source contractors. Includes training in GRM and EPB environmental protection and monitoring. Construction Phase 2.1 Water Domestic wastewater Contractor to provide portable toilets 38 at day time Contract PIEs, CSC Included in from construction construction sites. Toilets to be emptied regularly and ors construction sites sewage transported to WWTP. contracts Construction Site planning, management and safeguards Contract PIEs, CSC Included in wastewater i. Interception of all construction wastewater and site ors construction (washing aggregates, runoff water contracts pouring / curing ii. Sediment from construction wastewater and site concrete, machinery runoff water to be separated in sedimentation traps repairs) is managed before discharge of water iii. Sediment to be disposed at suitable spoil dumping site iv. Site runoff water containing hazardous and harmful materials (if any) to be treated separately from site runoff. Handling of Site planning, management and safeguards: Contract PIEs, CSC Included in hazardous and i. Storage facilities for fuels, oil, and other hazardous ors construction harmful materials materials within (constituting 110% volume) secured contracts areas on impermeable surfaces, and provided with bunds and cleanup installations; ii. Fuel supplier is properly licensed and follows the proper protocol for transferring fuel, and complies with JT 3145-88 (Transportation, Loading and Unloading of Dangerous or Harmful Goods). iii. Vehicles and equipment are properly parked in designated areas to prevent contamination of soil and surface water.

38Toilets also include women’s facilities at the project sites.

Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source iv. Vehicle, machinery, and equipment maintenance and refueling are carried out so that spilled materials do not seep into the soil or into water bodies. v. Fuel storage and refilling areas are located at least 50 m from storm water drains. vi. Oil traps for service areas, and parking areas. 2.2: Air Generation of dust by i. Timely cleaning within 50 meters of the site boundary Contract PIEs, CSC Included in construction activities to ensure clean and dust-free. ors construction ii. Closed cover transportation. Materials, slag and contracts garbage transport vehicles entering and leaving the construction site shall be sealed with effective sealing. The loading surface shall not be higher than the guardrail of the vehicle. The surface of the loaded material shall be sprayed and tarpaulin before leaving the work site. iii. Set the fence. The masonry wall of not less than 1.8m shall be set around the construction site. iv. Set the vehicle flushing platform. The main entrance and exit roads of the construction site shall be paved with concrete with a strength grade not lower than C25, and the thickness shall not be less than 20cm. A vehicle wash platform shall be installed on the inside and outside of the construction site. The specification shall be not less than 3.5m×5m. Before the vehicle leaves the construction site, the tires and the body of the vehicle shall be cleaned on the car wash platform. Surroundings of the car wash platform shall be provided with overflow prevention, waste water drainage channels, wastewater collection pools, grit chambers and other control facilities to collect waste water and mud generated during car washing,

93 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source construction and dust reduction. v. During the construction phase, effective dust reduction measures shall be taken, and facilities such as sprinkling, spraying and spraying shall be arranged to implement dust suppression equipment such as tower crane spray, small fog gun and sprinkler. An automatic spray dust-reducing device is arranged on the fixed enclosure, and the spray dust-reducing equipment should be opened every two hours on sunny days, each time not less than half an hour. vi. Closed cover building materials. Building materials such as cement, lime, sand, paint, paving materials, etc., which are prone to dust, must be sealed, covered with dust-proof cloth, fenced or stacked. vii. Spoil, abandonment and other construction waste generated during construction shall be cleared and transported in time. If it is stacked on the construction site for more than one week, measures such as covering the dust-proof cloth, dust-proof net, and regularly spraying water and dust should be taken. viii. The main roads on the construction site are dust- proof. The roads in the construction site shall be provided with anti-dusting materials, supplemented by watering and spraying dust suppressants to keep the road surface clean and prevent motor vehicles from dusting. ix. Dust-proof measures for conveying operations. When transporting dusty materials, muck or waste from the upper layer of the building, it should be transported from the elevator tunnel, the internal pipeline of the building or the closed transport pipeline, or carry it in

Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source the package. x. Dust-proof measures for demolition construction sites. Before the construction of the demolition, a fence shall be provided around the construction site. When demolition work is carried out, it shall be supplemented with continuous pressurized watering to suppress the dust from scattering. xi. Strengthen the remediation of the stockyard. Temporary material piles, muck piles, waste slag, building materials, etc., which are easy to generate dust, shall be covered with dust-proof nets and dust- proof cloth, and sprayed and solidified if necessary. xii. Install video surveillance. Video surveillance devices are installed at the entrances and exits of construction sites, and supervision is implemented to ensure that the vehicles entering and exiting are clean and free of mud. The surveillance system is connected to the Nanning/Hezhou Municipal Housing and Construction Bureau. xiii. The exposed plot is dust-proof. For the exposed land in the construction site, various dustproof measures such as covering are adopted. Air emission from i. Equipment and machinery is maintained to a high Contract PIEs, CSC Included in vehicles and standard to ensure efficient running. ors construction equipment ii. Avoid leaving machinery running or trucks and other contracts vehicles idling when not in use; iii. The vehicles and construction machineries shall be maintained to a high standard to ensure efficient running and fuel-burning and compliance with the PRC emission standards (GB18352-2005, GB17691-2005, GB11340-2005, GB2847-2005, and GB18285-2005).

95 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source Toxicity and air i. Use of low or no volatile organic compounds – water Contract PIEs, CSC Included in contamination inside based nontoxic etc. ors construction building ii. Improve the quality of the indoor air environment, the contracts decoration materials should meet the requirements of Limits for Indoor Decoration Materials (GB18580-2001, GB18588-2001 and GB6566-2001). The benzene-free environmental thinners and paints will be used to reduce the emission of pollutants. 2.3 Noise and Noise from vehicles i. Noise levels from equipment and machinery conform Contract PIEs, CSC Included in vibrations and construction to PRC standard GB12523-2011. ors construction machinery ii. Install portable noise shields near sensitive receptors contracts such as neighboring residences. iii. When work is planned near sensitive receptors, residents will be notified by the PIEs and any site- specific concerns or working arrangements addressed. iv. Avoid minority religious activities or festivals (i.e., no construction allowed within 50 meters of any schools, hospitals. v. no construction is allowed during the night. Noise and vibrations Selection of construction techniques and machinery to Contract PIEs, CSC Included in minimize ground disturbance. ors construction contracts 2.4 Soil Foundation soil i. All spoil material will be stacked at a location near Contract PIEs, CSC Included in Excavations designated green belt area or storage areas ors construction ii. Vacant land areas will be reinstated following contracts completion of construction. iii. Contract clauses specifying careful construction practices. 2.5 Soil surface Surface runoff from i. Construct interception ditches and drains to prevent Contract PIEs, CSC Included in runoff construction sites runoff entering construction sites, and to divert runoff ors construction from sites to existing drainage. contracts

Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source ii. Limit construction and material handling during periods of rains and high winds. iii. All earthwork disturbance areas shall be stabilized within 30 days after earthworks have ceased at the sites. iv. Preserve existing vegetation where no construction activity is planned. Green Belt Adhere to greening areas identified in construction Contract PIEs, CSC Included in establishment drawing ors construction contracts 2.6 Solid Waste Domestic waste from i. Provide appropriate waste storage containers; Contract PIEs, CSC Included in construction site ii. Trash collection bins are regularly sprayed with ors construction pesticides to reduce flies; contracts iii. Wastes are stored away from water bodies and regularly hauled to a suitable landfill or designated dumping site. Construction i. Demolition wastes will be regularly transported off- Contract PIEs, CSC Included in demolition wastes site for disposal, and not allowed to accumulate on site ors construction causing adverse over long periods. contracts impacts on ii. Demolition wastes are stored away from water surrounding bodies and regularly hauled to a suitable landfill or environments. designated dumping site. Loss of vegetation Marking of trees, vegetation to be removed prior to Contract PIEs, CSC Included in and trees at site. clearance, and strict control on clearing activities to or construction ensure minimal clearance. Construction contractor will contracts replant trees to be cut within the subproject premises along green belts. 2.7 Social and Traffic management – A traffic control and operation plan must be prepared Contract PIEs, Included in Culture all components by the contractor in consultation with the local traffic ors GPMO, construction management authority prior to any construction. local traffic contracts The plan will include: police

97 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source i. Selection of haulage routes to reduce disturbance to regular traffic. ii. Trucks hauling construction material and waste to be fully covered. iii. Divert or limit construction traffic at peak traffic hours. iv. PIE to work with local highways authority and traffic police to carry out road maintenance work during the construction process. v. Construction units to strengthen traffic safety education for construction vehicle drivers vi. Construction vehicles on designated routes or locations such as in the crossing of villages, densely populated areas and near sensitive locations (schools, health facilities and other social services) to drive slowly and according to designated speed limits (e.g. 30 km/h); Work camp health i. Ensure awareness of communicable diseases for the Contract PIEs, CSC Included in and construction work forces and nearby communities. ors construction hygiene conducting regular information, education and contracts communication (IEC) campaigns addressed to all site staff and labor and the immediate local communities concerning project risks and impacts; iii. Ensure worker day time camp meet international health and safety standards to mitigate environmental, health and safety risks. Ensure construction sites, canteens, food, water and food handling, and toilets, are maintained under hygienic conditions as outlined by international standards for worker accommodations. There are no night accommodations for workers at sites.

Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source Community safety (all i. At all times during construction, safe and convenient Contract PIEs, CSC Included in sites) passage must be given for community vehicles, and ors construction pedestrians to and from side roads. contracts ii. Place signs around the construction areas to facilitate traffic movement, provide directions to various components of the works, and provide safety advice and warnings. iii. At the end of each day, all sites and equipment will be made secure (through fencing and/or lock-down of equipment) to prevent public access. iv. Provide medical services to the construction workforce as well as the community through hospital medical facilities. Construction site i. To the extent possible, protect all persons and nearby Contract PIEs, CSC Included in safety (all sites) property from construction accidents. ors construction ii. Comply with all national and local safety contracts requirements and any other measures necessary to avoid accidents. iii. Provide protective equipment and clothing (goggles, gloves, respirators, dust masks, hard hats, steel-toed boots) for construction workers and enforce their use. iv. Ensure sites and machinery are sealed or closed at night and off-limits to the general public. v. Erection of noise barriers for residents next to construction site. Ensure residents are aware of the duration and nature of works, potential hazards, and offer to provide ear plugs/dust masks/other basic safety equipment. vi. During heavy rains / emergencies, suspend all work. Construction site Trenches will be dug, pipes laid, and the trenches Contract PIEs, CSC Included in safety (pipe-laying) closed, in the same operation. ors construction

99 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source outside construction This will ensure that open trenches are not left over an contracts area extended period to pose a safety risk or to erode and cave-in. Loss of power supply Advance notice to the public about the time and the Contract PIEs, CSC Included in to the local duration of the utility disruption. ors construction community when contracts distribution lines Restore the utilities immediately to overcome public crossing the new inconvenience. subprojects are switched off. Cultural, physical and If a chance-find or a cultural artifact is unearthed, stop Contract PIEs, CSC Included in natural heritage work and immediately report the matter to the IAs, ors construction protection GPMO and local Cultural Relics Preservation Bureau contracts for guidance on next steps. 2.8 Capacity Improve standards of Training of city PMOs, PIEs and stakeholders. LIEC PIEs, CSC Included in Building implementation and construction monitoring. contracts 2.9 Unexpected If unexpected environmental impacts occur during LIEC PIEs, CSC Included in environmental project construction phase, immediately inform the construction impacts GPMO; assess the impacts; and update the EMP contracts Operations Stage Air-conditioning 3.1 Air Protecting elderly i. Regularly maintain air conditioning system, including PIEs Local EPB O&M Cost residents from the cleaning and replacement of all filters. Ensure proper negative health moisture control. effects of poor air ii. Implement air quality protection plan and revert to quality from EC and fully air-conditioned facility (no natural ventilation) on hospital facilities39 trigger days.

39 The baseline air quality data showed that Nanning and Hezhou has overall good air quality so air purification facility is not considered in the project at this stage.

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Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source 3.2 Noise Noise Prevention Monitor Noise pollution from the air conditioning plan to PIEs Local EPB O&M Cost During Operation of adhere to PRC standards Machinery and - Installation of silencer Equipment - Set soundproof hood and assist with shock absorption - Pipe dressing - Low noise equipment, rubber cushion - Inlet and outlet installation silencer - Ventilation installation muffler - Porous sound-absorbing material Parking/Canteen 3.3 Air Exhaust emissions i. The underground park of the project uses mechanical O&M PIEs, Included in from parking exhaust fans to extract exhaust gas and conduct forced operator Local EPB operations lots/garages mechanical ventilation. Ventilation openings are cost provided with shutter-type fans and air filtration devices are provided to reduce pollutant emissions. ii. The frequency of ventilation is more than 6 times/h, and it is discharged through special exhaust outlets, vehicle import and export, etc. iii. Exhaust outlet location as far away from the crowded area. Ventilation outlets are combined with the landscape, and some trees that absorb toxic and harmful gases are planted around the exhaust outlets. iv. The entrance and exit of underground garages are set with speed-limit signs to keep the flow of traffic in and out of the vehicles. The logistic department regularly overhauls and maintains to ensure the normal operation of the exhaust system of underground garages. Canteen fume i. Canteen uses natural gas as clean energy for O&M PIEs, Included in collection and cooking and prohibits the use of coal. operator Local EPB operations

101 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source treatment ii. The emission concentration of the canola fume after cost treatment by the fume purifier (purification efficiency greater than 85%) is less than 2 mg/m3, and it can meet the requirements in GB18483-2001 “The fume emission standards of the drink industry (for trial implementation)” 3.4 Noise Noise impact from Implementation of mitigation measures, including noise PIE Local EPB Included in parking on sensitive barriers and noise-proofing of buildings, where levels project receptors exceed PRC standard components Wastewater treatment (Domestic and Medical Wastewater) 3.5 Air Odor from sewage i. Equip odor generating facilities with ventilation or O&M PIEs, Included in treatment station odor containment. operator Local EPB operations ii. Implement timely sludge cleanup by a qualified cost company for centralized disposal. iii. Sludge is treated as a hazardous waste after dehydration treatment by a centrifugal dehydrator. iv. Institute daily check, repair and maintenance of all wastewater treatment facilities/equipment. 3.6 Noise Noise produced i. Design and implement noise absorbing, noise O&M PIEs, Included in during wastewater reduction, noise insulation and vibration reduction operator Local EPB operations treatment measures during operation. Adopt low noise level cost (mechanical equipment. equipment ii. Create green buffer zone >50m. 3.7 Domestic Waste water i. The wastewater from canteen will be pre-treated by O&M PIEs, Included in Wastewater discharged without oil trapper. operator Local EPB project meeting relevant ii. Normal domestic sewage will be pre‐treated by components standards septic tank before discharging into municipal sewage network;. 3.8 Medical Hospital Medical The medical wastewater and pre-treatment via on-site O&M PIEs, Included in wastewater wastewater directly sewage treatment station is required to meet the operator Local EPB operating flowing into city drains pretreatment standard of Sewage Control Standard for costs

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Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source Medical Institutions (GB18466-2005), and then discharged into the municipal wastewater system. The wastewater from canteen will be pre-treated by oil trapper. The on-site medical sewage treatment station uses the process of regulation tank, anaerobic tank, biological contact oxidation, chlorine dioxide disinfection. 3.9 Waste from Disposal of sludge Develop and implement a sludge handling plan which O&M PIEs, Included in sewage treatment from Sewage includes: operator Local EPB operations station settlement ponds i. Periodically monitor (visual inspection) sludge cost accumulation in septage tanks, and contract licensed company to de-sludge as needed. ii. Treatment for disposal in landfill 3.10 Health and Health and safety of i. Compulsory use of safety equipment and clothing as sewag PIEs, Included in Safety sewage treatment necessary, including shoes or boots with non-slip e Local EPB operating station operating staff soles, protective and chemical resistant clothing, safety treatm costs goggles. ent ii. Wearing of respiratory mask in the sludge O&M dewatering and de-odor workshops and when moving Unit and transporting sludge. iii. Posting and briefing on safety instructions for the storage, transport, handling or pouring of chemicals, and entry into confined spaces. Hazardous materials i. The duty room will be equipped with gas masks, O&M PIEs, Included in handling oxygen breathing apparatus and other rescue operator Local EPB operations materials. cost iii. An emergency response plan will be developed and implemented. Solid Waste Collection at all EC and Hospital Facilities 3.11 Air Garbage i. All haulage vehicles will be covered, and O&M PIEs, Included in transportation progressively enclosed as the fleet is new. operator Local EPB operations

103 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source garbage to disposal ii. Retaining fences will be erected around the cost collection site to prevent the waste from spreading during windy or rainy season. 3.12 Solid Waste Unsegregated i. Proper segregation and storage in collection centers O&M PIEs, Included in domestic center in all buildings, and stored in waste bins to be collected operator Local EPB operations waste lying in open. by city municipal waste collection vehicles. cost Accumulation of ii. Implement ongoing contracts with specialized packaging bottles, contractors for this purpose. syringes and iii. All elderly waste to be stored separately and not incontinence pads segregated for recycling. used by residents 3.13 Medical Unsegregated i. The medical waste shall be packed in accordance O&M PIEs, Included in Solid Waste hospital waste lying in with the requirements of Standard on Packaging, operator Local EPB operations open Container and Warning Labels for Hospital Wastes for cost sorting and collection. Disinfection is carried out on the same day before packing. ii. Medical waste temporarily stored in special storage room cannot be more than 2 days. The project implementing entities (PIEs) shall entrust qualified units to carry out the collection and disposal work During transferring of the hazardous wastes, the provisions of the Management Methods for Transferring Hazardous Waste shall be strictly implemented, and the hazardous waste transfer joint form (triple list) shall be filled out. iii. The septic tank sludge shall be disposed by a qualified unit after being treated with lime and disinfected. Sludge disposal shall strictly follow the provisions of Sewage Control Standard for Medical Institutions (GB18466-2005) to ensure that no pollution is caused to the surrounding environment. For subprojects in Hezhou City (Huanan Nursing

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Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source Center, No.1 and No.2 Nursing Centers), the medical waste will be sent to Hezhou Medical Waste Disposal Center. For subprojects in Nanning City, the medical waste will be sent to the Guangxi Hazardous Waste Disposal Center. 3.14 Health and Odors and pests i. To reduce the breeding of flies, mosquitoes, rats and O&M PIEs, Included in safety (waste collection other vermin, and to prevent odor and wind-borne operator Local EPB operations areas) dispersal of garbage. cost ii. Periodic spraying with approved pesticide will further control the breeding of flies and mosquitoes. Training of Staff 3.15 Solid waste Unsegregated Solid Training of hospital personnel in proper segregation PIEs, Local EPB, Included in waste transported to and storage and medical and solid waste. O&M PIEs operating landfill site operator costs and EMP-9 3.16 Emergency Ensuring readiness of i. Establishment of emergency command organization; PIEs, Local EPB Included in preparedness staff and residents to ii. Emergency response plan prepared and put in place; O&M operating and response respond to iii. Preparation of emergency equipment and training. operator costs and emergencies iv. Publicize, train and practice emergency response , EMP-9 plans. Security Bureau 3.17 Health and Lack of awareness for Training of hospital personnel on safety and PIEs, Local EPB, Included in safety and health and safety emergency response in compliance with City’s O&M PIEs operating emergency procedure and Emergency Management Agency requirements operator costs and response emergency response. EMP-9 Health and Safety, Emergency Response 3.18 Health and Operation of electrical Maintenance of charging electrical switchbox located PIEs, PIEs Included in Safety- Fire safety systems, fire within secure casings. O&M operating safety systems. operator costs Fire and explosion Regular inspection of transformer, storage tanks and PIEs, Office of Included in

105 Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source hazard at electric record-keeping; O&M Public operating stations Control of ignition sources; operator Security costs Emergency response plan prepared and put in place; Preparation of emergency equipment and awareness training. Promote community - For fire protection, maintain (i) fire separation PIEs, PIEs Included in health and safety- distance(access for timely fire-fighting and rescue) O&M operating Elderly Care Center not only from the adjacent buildings but also any operator costs residents and staff. combustible surroundings; (ii) secured sectors(fire compartment, smoke compartment)both horizontally or vertically; (iii) fire and smoke detection and alarm systems; (iv) fireproof dividing walls, doors and windows between rooms; (v) emergency lighting. - For accident prevention, maintain all: (i) alarm-help devices; (ii) appropriate bed heights and other furniture; (iii) wall and staircases hand rails: (iv) avoidance of slippery surfaces; and (v) safe kitchens in assisted-living areas. - For disorientation prevention for dementia patients, maintain: (i) design features, colors, signs photos and internal landmarks; (ii) surveillance at entrances, exits and reception areas. - Ensure janitorial staff are employed and properly trained for hygiene control. - Regularly inspect toilet and bathroom facilities for cleanliness. - Regularly inspect kitchens and food storage for cleanliness and food safety. 3.19 Emergency Flood warning and Review flood emergency preparedness and response PIEs, PIEs, Included in preparedness emergency system system for the project area, and identify improvement O&M GPMO operating

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Cost (CNY Potential Who x 103)) and Environmental implem Who Fund Activity Issues and Impact Mitigation Measure ents Supervises source and response opportunities. operator costs 3.20 Unexpected All areas If unexpected environmental impacts occur during PIEs, PIEs, Included in environmental project operations, immediately inform the GPMO; O&M GPMO, operating impacts assess the impacts; and update the EMP operator ADB costs ADB=Asia Development Bank; LIEC=Loan Implementation Environmental Consultant; GPMO=Project Management Office; EMP=Environmental Management Plan; LEPB= Local Environment Protection Bureau. Source: Asian Development Bank.

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D. Project readiness Assessment

16. Before construction, the LIEC and city PMOs will assess each PIE’s readiness in terms of environmental management based on a set of indicators (Table EMP-3) and report to ADB and the GPMO. This assessment will demonstrate that environmental commitments are being carried out and environmental management systems are in place before construction starts or suggest corrective actions to ensure that all requirements are met. The assessment will be repeated at regular intervals to account for new works contracts, and documented in the annual environment monitoring reports to ADB.

Table EMP-3: Project Readiness Assessment Indicators Indicator Criteria Assessment EMP update The EMP updated after detailed design, and Yes approved by ADB No Environmental LIEC is in place and has trained environment Yes Supervision in place consultants No Qualified external environmental monitoring Yes consultant contracted by the PIE. No Environment specialists assigned by PMO Yes (GPMO-SO) No Compliance with loan The borrower complies with loan covenants related Yes covenants and to project design and environmental management No assurances planning Potential contaminated Proper contaminated land investigation and Yes land investigation and assessment carried out and detected No assessment contamination removed during pre-construction period, or re-select site if removal is in-feasible Public involvement Meaningful consultation completed; construction Yes effectiveness activities publicized at construction sites No GRM established with entry points publicized Yes No Chinese version EMP EMP translated and distributed by GPMO to all Yes distributed to all parties implementing agencies No Contracts with Bidding documents and contracts incorporating the Yes environmental environmental activities and safeguards listed as No safeguards loan assurances Site construction Site Environment Management Plan prepared for Yes planning (environmental) each work site by the contractors and cleared by No the implementing agencies EMP financial support EMP budget established, and required funds set Yes aside for EMP implementation by each No implementing agency LIEC=Loan Implementation Environmental Consultant; PMO=Project Management Office. Source: Asian Development Bank.

E. Monitoring Requirements

17. Environmental monitoring. Two types of project monitoring will be conducted under the EMP.

18. Internal monitoring will be conducted by the LIEC, contractors and construction supervision companies supervised by GPMO-SO. It includes the monitoring of construction

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activities such as the dust and noise at all construction sites that require demolition of buildings, land levelling as well as ensure proper disposal of demolition waste, the quality of discharged construction wastewater, and erosion control etc. It also includes daily inspection and internal compliance assessment with the approved site management plans of contractors, including construction site health and safety for the community and the workers. During operations, internal monitoring reports during operations will monitor the environment management of facilities and the emergency response preparedness. During construction, the periodicity of internal monitoring is quarterly i.e. the internal project monitoring report is to be submitted to the IAs and PIEs from the contractor every quarter. During operations, the internal monitoring report periodicity will be annual from the IAs and PIEs until the project completion report is submitted.

19. Monitoring for environment parameters. During construction, local environmental monitoring agency will be contracted by the PIEs to measure the effects and monitor the values of noise, dust, water and soil contamination in the project area, which extends from the construction site boundary to any nearby sensitive receptors under the supervision of GPMO-SO as per the periodicity specified in the Environment Monitoring Plan (EMoP). The testing results of the environment data monitoring by the agency shall adhere to requirements of the EMP and shall meet all PRC, ADB standards as well as international best practices. Any non-compliance will be highlighted in the above-mentioned environment testing results provided by the local environment monitoring agency to the PIE. For air, noise, and water, monitoring during construction and operation will be contracted by PIEs to local environment monitoring agencies. The GPMO shall, based on inputs from PIEs, incorporate these results in the annual environmental monitoring reports with support from the Loan Implementation Environment Consultant (LIC) and submitted to ADB for review.

20. Internal compliance monitoring or auditing. EMP compliance monitoring is the systematic evaluation of the overall progress of the implementation of EMP measures (Table EMP-2). Evaluation of the compliance with the EMP will be undertaken regularly by the GPMO-SO and the LIEC, who will report EMP implementation progress and compliance through semi-annual project progress reports and annual environmental monitoring reports (Table EMP-6). The LIEC will support the GPMO-SO in developing the annual environmental monitoring reports (EMR). The reports will identify environment-related implementation issues and necessary corrective actions and reflect these in a corrective action plan. The reports will also include safeguards aspects of the operation and performance of the project, GRM, environmental institutional strengthening and training, and compliance with all covenants under the project.

21. External monitoring. GPMO will retain qualified and experienced experts40 to verify the safeguards monitoring reports. These external experts will report on an annual basis directly to ADB to verify if sound environmental management practices were followed during implementation. In case the implementation of EMP measures is not satisfactory, the external experts safeguard monitoring experts will recommend actions to enhance environmental compliance. External environment compliance auditing reports will be submitted annually, 3 months after the internal environment progress and monitoring reports are submitted by the GPMO; and as needed when compliance/grievance issues occur.

22. Table EMP-4 shows the environmental monitoring program designed for this project, defining the scope, location, parameter, duration and frequency, and responsible bodies, for monitoring during the construction and operational stages. Monitoring costs are estimates based on the experience of the TrTA team on other projects elsewhere in the PRC. ADB will oversee project compliance on the basis of the annual environmental monitoring reports

40 Not mandatory. External expert who is not involved in day-to-day project implementation or supervision

109 provided by the GPMO and site visits as required.

Table EMP-4: Environmental Monitoring Program for Project Duration Monitoring Who Who Monitoring Frequency and Implem Supervi Item Parameter Location Duration ents ses Cost CNY Preconstruction Stage Dust and TSP, PM10 and At each Once prior to Contract CSC, Included in noise LAeq construction site construction as or PIE constructio boundary baseline n budget (NCTMH and conditions NSWI) Noise LAeq At sensitive Once prior to Contract CSC, Included in receptors construction as or PIE constructio identified baseline n budget (NCTMH and conditions NSWI) Construction Stage Dust and TSP, PM10 and At each Automatic real- Contract CSC, Included in noise LAeq construction site time monitoring or PIE constructio boundary n budget Noise LAeq At sensitive Quarterly, 2 Contract CSC, Included in receptors consecutive days or PIE constructio identified (daytime and n budget nighttime), or earlier based in public complaint Dust TSP, PM10 At sensitive Quarterly, 2 Contract CSC, Included in receptors days/time, or or PIE constructio identified earlier based in n budget public complaint Surface SS, petroleum Construction Quarterly, or Contract PIE, Included in water products wastewater earlier based in or PMO constructio quality released from public complaint n budget construction sites Soil run- (i) adequacy Visual inspection Daily during Contract CSC, Included in off and of soil of the construction or PIE constructio contamin runoff construction period; Every ten n budget ation prevention sites. days during peak measures; construction (ii) adequacy period, and of soil monthly after contaminati on prevention techniques. Solid and (i) adequacy Visual inspection Daily during Contract CSC, Included in liquid of solid and of the construction or PIE constructio waste liquid construction period; Every ten n budget manage waste sites. days during peak ment manageme construction nt, storage period, and and monthly after.

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Monitoring Who Who Monitoring Frequency and Implem Supervi Item Parameter Location Duration ents ses Cost CNY containmen t system; (ii) presence of solid waste dumps, waste fires. Construct Site inspection Visual inspection Daily during Contract CSC, Included in ion site of OHS, CHS and interviews construction or PIE constructio health checklist in with workers and period; Every ten n budget and Site EMP contractors at days during peak safety construction construction sites and period, and community living monthly after. nearby Incidents Occupational All facilities Ongoing, record O&M CSC, Included in record and once incidents Units/ PIE, constructio Community occur PIEs local n budget health and EPB safety incidents during construction to be recorded with respect to near miss, minor incident, lost time incident, fatal accident, and incidences of work-related disease. Operational Stage Outdoor Check for All facilities Monthly, or earlier O&M PIEs, Included in air quality PM2.5 triggers based in public Units/ local O&M in AQI complaint PIEs EPB budget forecasts for limiting natural ventilation Indoor air Check for All facilities Monthly, or earlier O&M PIEs, Included in quality PM2.5, PM10, based in public Units/ local O&M VOCs, complaint PIEs EPB budget benzene, toluene, xylene and ammonia Landscap Survival of All facilities Semi-annually for O&M PIEs, Included in e landscape and first 1 years of Units/ local O&M screening operation. PIEs EPB budget vegetation

111 Monitoring Who Who Monitoring Frequency and Implem Supervi Item Parameter Location Duration ents ses Cost CNY planting. Wastewa Volume of All Facilities Ongoing, to O&M PIEs, Included in ter and influent and provide data for Units/ local O&M solid effluent quarterly and PIEs EPB budget waste wastewater. yearly totals for Weight of non- each center medical solid waste Toilets Cleanliness of All facilities Monthly O&M PIEs, Included in and these areas to Units/ local O&M bathroom promote health PIEs EPB budget s and hygiene Energy Check and All facilities Monthly O&M PIEs, Included in Consump record all Units/ local O&M tion energy PIEs EPB budget consumption mainly including electricity Water Volume of All facilities Monthly O&M PIEs, Included in consumpt water Units/ local O&M ion consumed PIEs EPB budget Incidents Occupational All facilities Ongoing, record O&M PIE, Included in record and once incidents Units/ local O&M Community occur PIEs EPB budget health and safety incidents during operation to be recorded with respect minor incident, fatal accident etc. Monitoring for Environment parameters Construct As required by Approval / Following IAs Local PMO Standard ion local EPB inspection formal EPB fee-borne completio requirement procedure by applications to by PIEs n local EPB local EPBs Air HN3, H2S Boundary of the Semi-Annually for Certifica PMO, Included in quality/od project facility the first 1 year of ted EPB monitoring or operation monitori budget ng agency Wastewa pH, chemical Inlet and outlet Semi-Annually for Certifica PMO, Included in ter oxygen of the on-site the first 1 year of ted EPB monitoring demand, five- sewage operation monitori budget day treatment station ng biochemical agency oxygen demand,

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Monitoring Who Who Monitoring Frequency and Implem Supervi Item Parameter Location Duration ents ses Cost CNY ammonia nitrogen, suspended solids, ammonia nitrogen, total mercury, total residual chlorine, anionic surfactant, petroleum, volatile phenol, fecal coliform LEPB=Local Environment Protection Bureau; O&M=Operation and Maintenance; GPMO=Project Management Office; PIE=Project Implementing Entity; OHS= Occupational Health and Safety, CHS=Community Health and Safety. Source: Asian Development Bank

23. The results of the environmental monitoring will be compared with EMP requirements site management plans, and relevant PRC standards as defined in Table EMP-5. Noncompliance will be highlighted in the monitoring reports. Monitoring results will be submitted to the GPMO and then reported by the GPMO to ADB in annual environmental monitoring reports prepared with the support of the LIEC (reporting plan shown in Table EMP-6).

Table EMP-5: Monitoring Indicators and Applicable PRC/WHO Standards Phase Indicator Standard Construction Dust and noise at Emission Standard of Environmental Noise for construction site Boundary of Construction Site (GB 12523-2011); boundary EHS standards of WHO/World Bank Group Environmental, Health, and Safety Guidelines Dust and noise at Ambient Air Quality Standard (GB 3095-2012) sensitive receptors Acoustic Environment Standard (GB3096-2008); Code for Sound Insulation Design of Civil Buildings (GB50118-2010); EHS standards of WHO/World Bank Group Environmental, Health, and Safety Guidelines Surface water quality Surface Water Ambient Quality Standard (GB3838- 2002) Construction Technical Guideline for Construction Project Environmental Risk Environmental Risk Assessment (HJ/T 169-2004) Decoration materials Limits for Indoor Decoration Materials GB18580- 2001 ~ GB18588-2001 and GB6566-2001 Operations Dust and noise at Ambient Air Quality Standard (GB 3095-1996); sensitive receptors Acoustic Environment Standard (GB3096-2008) Odor (NH3, H2S) from on- Sewage Discharge Standard for Medical Institutions site sewage treatment (GB18466-2005) station Treated wastewater from Sewage Discharge Standard for Medical Institutions on-site sewage treatment (GB18466-2005)

113 Phase Indicator Standard station Street trees and Survival rate of planted vegetation >75% screening vegetation Hazardous Waste Standard for Pollution Control on Hazardous Waste Storage Storage (GB 18597-2001)

F. Environmental Safeguards Reporting Requirements

24. Environmental monitoring and inspection activities and findings shall be documented for purposes of reporting, recording, verifying, referring on and evaluating the environmental performance of the Project. ADB will oversee project compliance based on the quarterly project progress reports and annual environmental monitoring reports provided by GPMO and review missions (generally 1-2 times per year). Disclosure of safeguards monitoring reports will be done both locally and on the ADB website. The documentation shall also be used as basis in correcting and enhancing further environment safeguards reporting requirements are defined below.

i. Internal progress reports by the Contractors during construction, submitted to the implementing agencies. These quarterly reports will include: (i) physical construction progress; (ii) mitigation measures implemented; (iii)grievances received, resolved, closed and/or directed to other mechanisms; (iv) emergencies responded to; (v) internal monitoring conducted by the contractors and CSC’s, and (vi) corrective actions taken.

ii. EMP compliance verification and reporting. EMP compliance monitoring will be undertaken by the GPMO, with support of the loan implementation environment consultant (LIEC). The GPMO will report to ADB the project’s adherence to the EMP, information on project implementation, environmental performance of the contactors, and environmental compliance through the quarterly project progress reports and annual EMP progress and monitoring reports (Table EMP-6). Semi-annual progress reports by the GPMO to ADB will include a summary of EMP implementation progress. The LIEC will support the GPMO in developing the annual EMP progress and monitoring reports. The reports should confirm the project’s compliance with the EMP, local legislation such as PRC EIA requirements, and identify any environment related implementation issues and necessary corrective actions, and reflect these in a corrective action plan. The performance of the contractors will also be reported on with respect to environmental protection and impact mitigation. The operation and performance of the project GRM, environmental institutional strengthening and training, and compliance with all covenants under the project will also be included in the report.

iii. External Environment Compliance Audit Report. The external environment monitoring expert will report on an annual basis directly to ADB to verify if sound environmental management practices were followed during implementation. In case the implementation of EMP measures is not satisfactory, the external environment monitoring expert will recommend actions to enhance environmental compliance. External environment compliance audit report will be submitted annually, 3 months after the internal environment progress and monitoring reports are submitted by the GPMO; and as needed when compliance/grievance issues occur.

iv. Environmental Completion Acceptance Report. Following the PRC Regulation on Project Completion Environmental Audit (MEP, 2001), within three months after the

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completion of all project components, an environmental acceptance report for each shall be prepared by a licensed environmental monitoring institute. The report will be reviewed and approved by the relevant local EPB and the approval reported to ADB.

Table EMP-6: Reporting Plan Reports From To Frequency Pre-construction Phase Project Readiness LIEC, PMO ADB 1st EMR Environmental clearances LEPB PIEs Once before start of construction Construction Phase Internal project progress report Contractor, CSC PIEs Quarterly (during by construction contractors, construction season) including monitoring and inspection results y CSCs. Project Progress reports GPMO ADB Semi-Annually (including section on EMP implementation and monitoring) Internal environment progress GPMO ADB Annually and monitoring reports External environment External environment GPMO, Three months after the compliance auditing report monitoring expert ADB submission of internal environment progress and monitoring reports. Operational Phase Environmental acceptance LEPB PIEs Within 3 months of completion of physical works Internal environment progress GPMO ADB Annually and monitoring report External environment External environment GPMO, Three months after the compliance auditing report monitoring expert ADB submission of internal environment progress and monitoring reports. EMP implementation GPMO, LIEC ADB At PCR stage completion ADB=Asian Development Bank; CSC Construction Supervision Companies; GPMO= Project Management Office; LEPB= Local Environment Protection Bureau; LEMA= Local Environmental Monitoring Agency; LIEC =Loan Implementation Environment consultant; PIE=Project Implementing Entity. Source: Asian Development Bank.

G. Institutional strengthening and training

25. The capacity of the project implementing entities, implementing agencies and the PIE staff responsible for EMP implementation and supervision will be strengthened. The project will address any lack of capacities and expertise in environmental management through (i) institutional strengthening, and (ii) training.

26. Institutional strengthening. The capacities of the GPMO, project city PMOs and PIEs to coordinate environmental management will be strengthened through the following measures: • The appointment of a staff member within the GPMO (GPMO-SO) in charge of EMP

115 coordination, including GRM; • The appointment of one national environmental consultant under the loan implementation consultancy (the LIEC) to guide GPMO and project city PMOs in implementing the EMP and ensure compliance with ADB’s Safeguard Policy Statement (SPS 2009): and • PIEs to conduct regular site inspections and coordinate local environment monitoring agencies periodic reports.

27. Training. The executing agency, GPMO, city PMOs and PIEs will receive training in EMP implementation, supervision, and reporting, and on the Grievance Redress Mechanism. (Table EMP-7). Training will be facilitated by the LIEC with the support of other experts under the loan implementation consultant services.

Table EMP-7: Training Program - Summary of Training Needs Summary of training purpose and Recipients/ Frequency or Training topic: content Participants target date Induction to EMP Overview of EMP including site All PIE, CSC At beginning of information, pollution risks and engineers / project controls, and programs. Preparation contractors of site specific EMPs and training on implementation to staff of Contractor (s) Review of EMP, EMP monitoring, supervision, PMOs, PIEs, One year after Refresher training on reporting, procedures, Review of CSC project start, or EMP EMP including new changes and Engineers/C more frequently updates. ontractors if required Grievance Redress GRM roles and responsibilities, PMOs, PIEs, Once prior, and Mechanism procedures CSC once after the Engineers/C first year of ontractors project implementation Training on specific pollution risks and controls Emergency case To identify on-site “potential accident All PIE, CSC During the response planning scenario” and how to plan potential Engineers project emergency response actions. /contractors/ implementation, Emergency response plan for fire, Local Once prior to earthquake and natural calamities. residents, commissioning Include both readiness plans and operational plans under emergency condition; O&M on new equipment and procedures. Air Quality Monitoring Procedures for responding to poor All PIE, CSC During the indoor and outdoor air quality triggers Engineers project Also training on Ambient Air Quality, /contractors, implementation, Volatile Organic Compounds (VOCs), Once prior to Particulate Matter (PM), Ozone commissioning Depleting Substances (ODS), Greenhouse Gases (GHGs) Water Conservation Water Monitoring and Management, All PIE, CSC During the Process Water Reuse and Recycling, Engineers project Heating Systems /contractors implementation, Once prior to commissioning

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Summary of training purpose and Recipients/ Frequency or Training topic: content Participants target date Waste water and Liquid Effluent Quality, Discharge to All PIE, CSC During the Ambient Water Surface Water, Discharge to Sanitary Engineers project Quality Sewer Systems, Land Application of /contractors implementation, Treated Effluent, Septic Systems, Once prior to Wastewater Management commissioning Hazardous Materials General Hazardous Materials All PIE, CSC During the Management Management, Hazard Assessment, Engineers project Management Actions /contractors implementation, Once prior to commissioning Asbestos Education/ training with regard to the All PIE, CSC During the Management location of ACM, the use of individual Engineers project protective equipment and appropriate /contractors/ implementation techniques for working with and hospital staff cleaning up ACM, surveillance during work involving ACM to ensure that prevention measures are implemented, and finally, periodic inspection of the condition of the ACM. Fire safety Fire, and Explosion Prevention, All PIE, CSC During the Control Measures, Engineers project /contractors implementation, Once prior to commissioning Occupational Safety, Occupational Health and Safety All PIE, CSC During the Health and Safety Emergency Preparedness and Engineers project Response, Community Involvement /contractors implementation and Awareness Waste Management General Waste Management, Waste All PIE, CSC During the Management Planning, Recycling and Engineers project Reuse, Treatment and Disposal, /contractors, implementation, Waste Storage, Transportation, Once prior to Treatment and Disposal, Commercial commissioning or Government Waste Contractors, Health Care Waste Monitoring and evaluation Participatory M&E of Simple methods for recognizing Local During the impacts. adverse impacts on environment residents, project Methodology of monitoring and Hospital/ implementation evaluation on the water quality Health Center managemen t /Contractor Energy Efficiency Introduction to energy efficiency, heat Local During the and Green Buildings loss, green concept residents, project Hospital/ implementation Health Center managemen t

117 Summary of training purpose and Recipients/ Frequency or Training topic: content Participants target date Project management M&E, Implementation assessment the All IA, PIE, At the and implementation program. Principle of donor CSC beginning of the organizations’ support to local Engineers project beneficiaries. /contractors AQI=Air quality index, CSC = Construction Supervision Companies, MEE=Ministry of Ecological and Environmental Protection, O&M=Operation and Maintenance, PIE= Project Implementing Entity (All Senior staff of Elder Care and Hospital facilities), MEE=Ministry of Ecology and Environment. Source: Asian Development Bank.

H. Grievance Redress Mechanism

28. A Grievance Redress Mechanism (GRM) has been established as part of the project EMP to receive and manage any public environmental and/or social issues which may arise due to the Project. The GPMO will ensure that potentially affected communities are informed about the GRM at an early stage of the project. During the project preparation phase, the PIEs, PMOs and Nanning/Hezhou City EPB personnel received training on the GRM from the TrTA team.

29. The GPMO is the lead agency responsible for overall management, implementation, and reporting of the GRM. The GPMO-SO coordinates the GRM and: (i) instructs the IAs and contractors on their responsibilities in the GRM; (ii) establishes a simple registry system, to document and track grievances received (including forms to record complaints and how they have been resolved); and (iii) reports on progress of the GRM in the annual environmental monitoring and progress reports (EMR) to ADB.

30. Each PIE will assign a member of staff, who is responsible for implementation of the GRM and other relevant aspects of the EMP. Tasks include keeping a record of complaints. At least two months before construction commences, these contacts will be publicized at each construction site and forwarded to local village committees to ensure that entry points to the GRM are well known. The entry point information (such as specific contacts, etc) will be refined before construction and disclosed to the contact through information disclosure boards and consultation workshop.

31. GRM readiness procedures prior to start of construction. To be successful and reduce the likelihood of public concerns, the following measures will be implemented before any construction: - On-site procedures: (i) all contractors and CSC staff will be briefed by the GPMO-SO and PIEs on the GRM. Contractors and workers will be instructed to be courteous to local residents and, in the event they are approached by the general public with an issue, to immediately halt their work and report the issue to the foreman; (ii) at least one sign will be erected at each construction site providing the public with updated project information (the purpose of the project activity, the duration of disturbance, the responsible entities on-site), the GRM process, and contact names and details for the GRM entry points. - Non-project agencies: Prior to project construction, the GPMO-SO will notify all relevant agencies about the project and GRM, so that if these agencies receive complaints, they know to contact the GPMO-SO and follow up as necessary. This will include, but not be limited to, the Local EPB, and local police. 32. The procedure and timeframe for the GRM is shown in Figure EMP-2 and is as follows.

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Stage 1 (maximum 10 working days): Affected persons can submit a written or oral complaint to the contractor, CSC or PIE. Complaints received by any other institutions will be referred back to the PIE for action. The PIE will notify the GPMO-SO of the complaint within two days. The GPMO-SO will enter the complaint in the Complaints Register. - The contractor, in consultation with the PIE, attempts to resolve the issue directly with the affected person. Within five working days of receiving the complaint, the agency will provide clear advice to the affected person on the proposed corrective action and by when it will be taken. The corrective action will be implemented not later than 10 working days from receipt of the complaint. The GPMO-SO will enter the resolution in the Complaints Register. - If quick corrective action is not possible, or the PIE is unsure how to proceed, or the complainant is not satisfied by the initial corrective action, then the complaint will be referred to the GPMO-SO for Stage 2.

Stage 2 (maximum 5 working days): For complaints not resolved in Stage 1, Stage 2 is initiated. The GPMO-SO, contractor, CSC and PIE will meet with the affected person and together discuss the issue and identify possible solutions. At the meeting, a possible solution will be agreed upon. The contractor or PIE, as appropriate, will implement the agreed solution and report the outcome to the GPMO-SO.

Stage 3 (maximum 10 working days): If Stage 2 is unsuccessful (i.e. no solution can be identified or the affected person is not satisfied with the proposed solution) the GPMO-SO will convene a multi-stakeholder meeting and involve the Project Leading Group to ensure that any needed inputs from other project agencies are coordinated. The workshop will identify a solution acceptable to all. The agreed solution will be implemented and a report on the outcome provided to the PMO and ADB. - The above steps relate to the construction phase where most complaints will be directed in the first instance to the contractor, CSC or PIE. During initial operations, complaints will be received by the operations and maintenance (O&M) units of the facilities. - PMO will inform ADB of all complaints and actions under the GRM and include all relevant documents in its progress reports to ADB.

33. The above GRM procedure, at any time, does not restrict the access of the Affected Person (s) or a group of community/entity to approach a Court of Law to seek redress.

34. Any costs incurred to receive and document grievances will be paid by the PIE. The grievance procedures will remain valid throughout the duration of project construction and the first two years of project operation.

35. The tracking and documenting of grievance resolutions by the GPMO and PIEs will include the following elements: (i) tracking forms and procedures for gathering information from project personnel and complainant(s); (ii) regular updating of the GRM database by the GPMO-SO; (iii) processes for informing stakeholders about the status of a case; and (iv) a simple but effective filing system, so that data can be retrieved for reporting purposes, including reports to ADB.

36. If the above steps are unsuccessful, people adversely affected by the project may submit complaints to ADB’s Accountability Mechanism 41 . The Accountability Mechanism provides an independent forum and process whereby people adversely affected by ADB- assisted projects can voice, and seek a resolution of their problems, as well as report alleged violations of ADB‘s operational policies and procedures. Before submitting a complaint to the Accountability Mechanism, affected people should make a good faith effort

41See: https://www.adb.org/site/accountability-mechanism/main

119 to solve their problems by working with the concerned ADB operations department (in this case, the ADB East Asia Department). ADB, through its project design and implementation procedures, makes every effort to prevent problems and ensure compliance from the outset. Only after doing that, and if they are still dissatisfied, should they approach the Accountability Mechanism. The Accountability Mechanism is a last resort.

37. The Accountability Mechanism has two functions. The problem-solving function is led by the Special Project Facilitator (SPF), and the compliance review function by the Compliance Review Panel (CRP). Project-affected people can choose whether they want to go to the problem-solving or the compliance review function.

Figure EMP-2: The Project Grievance Redress Mechanism

* Stakeholders involved will depend upon the nature of the complaint and will include as a minimum the affected person(s), PMO, Nanning/Hezhou Note: AP = Affected Person, LEPB = Local Environmental Protection Bureau, O&M = Operation and Maintenance, GPMO = Project Management Office; PIE =Project Implementing Entity.

I. Public Consultation

38. Prior to construction, the PIEs will inform the affected people42 of the planned project interventions and the likely disturbances through information disclosure in the local

42 The term “affected people” do not require a person to be affected negatively only, but rather any one that will be impacted in his/daily life by the project, both positively or negatively.

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newspaper. The GRM was briefed by the IEE public consultation teams to ensure that information is disseminated to project affected areas. During construction, affected people will be consulted at least once a year through formal questionnaire surveys and a public workshop. The surveys and the public workshop will be conducted by the implementing agencies supported by environment consultant. On-site environmental engineers of the construction contractors or construction supervision companies will conduct informal interviews with affected people on a regular basis. Public consultation will focus on complaints about community disturbances from construction activities, such as construction noise, dust, solid waste and wastewater, as well as public concerns about soil erosion, air pollution and water pollution.

39. Plans for public involvement during the detailed design, construction and operation phases have also been developed during project preparation. These plans include public participation in: i) monitoring impacts and mitigation measures during the construction and operation stages, ii) evaluating environmental and economic benefits and social impacts, and(ii)interviewing the public after the sub-components are completed.

40. Plans for public involvement during construction and operation stages were developed during project preparation. These include public participation in (i) monitoring impacts and mitigation measures during the construction and operation stages; (ii) evaluating environmental and economic benefits and social impacts; and (iii) interviewing the public after the project is completed. These plans will include several types of public involvement, including site visits, workshops, investigation of specific issues, interviews, and public hearings (Table EMP-8).

Table EMP-8: Public Consultation Plan Organizer Format No. of Times Subject Attendees Construction Stage PIE Public 4 times: 1 time Adjusting of mitigation Residents consultation & before measures, if necessary; adjacent to site visit construction construction impact; subproject commences and comments and suggestions sites, 1 time each year representatives during of social construction sectors Operational Stage PIE, O&M Public Once in the first Effectiveness of mitigation Residents Units consultation and year measures, impacts of adjacent to site operation, public opinions subproject sites, Notes: PIE = Project Implementing Agency; O&M = Operation and Maintenance.

41. Public participation plans are part of the project implementation and management plan. The implementing agencies are responsible for public participation during project implementation and operation. Costs for public participation activities during construction are covered by project funding.

Disclosure of Public Consultation 42. Information disclosure and public consultations were conducted with key stakeholders in accordance with the PRC Guideline on Public Consultation in EIA (2006) and ADB’s SPS. Public concerns about noise, and dust due to land leveling, demolition/construction waste; solid waste, wastewater, sludge, odor, traffic safety, medical

121 waste storage and transport, and indoor air qualities during construction will be documented and shall be addressed during implementation by the loan implementation consultants, the CSC, contractors under supervision of the PIEs.

J. Cost Estimates for Environment Management

43. The GPMO shall make available the necessary budget and human resources through each of PIEs and the implementing agency to fully implement the EMP. The total estimated cost of EMP implementation is USD 0.895 million. EMP implementation will be scheduled to precede the project design and construction schedules. Under the supervision of GPMO, the PIEs will ensure that such funds are made available on a timely manner.

Table EMP-9: Estimated EMP budget costs Cost Estimates # Type of expenses US$ Source of fund 1 Awareness activities for EMP* 5,000 Loan Implementation Consultants budget 2 Support the implementation of mitigation activities** 713,000 Contractors Cost (Based on Table EMP-10 below) 3 Reviewing and revising of EMP*** 20,000 Loan Implementation Consultants budget 4 Environment Parameters testing (regularly 26,000 Construction quarterly) Included in civil works contract (based on Supervision budget Table EMP-11 below) /PMO budget 5 Training and Consultancy **** 20,000 Loan Implementation Consultants budget 6 Budget for the Monitoring activities document) 81,000 Loan Implementation (based on Table EMP-12 below) Consultants budget 7 Budget for public consultation and feedback (One 10,000 Construction consultation per year up to PCR submission and Supervision/PMO Grievance Redress) budget 8 External Safeguards Monitoring consultant # 20,000 Loan Monitoring budget TOTAL 895,000 * Include activities to provide awareness on EMP to relevant stakeholders and public communities in surrounding areas of construction sites as well as informing them of the roles and responsibilities of various parties involved. ** Mitigation activities are approximately 0.5% for individual package. Cost for Asbestos Management to be exclusive from the budget. *** Revision of IEE/EMP, if major scope of project activities change during implementation (estimate two times). **** Training costs for items @100 participants x $200/person # One specialist $200/day for 100 days

Table EMP-10: Cost Estimate for Mitigation Measures (USD) Amount Description Unit Quantity Rate USD USD Included in Civil Works Contract

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Amount Description Unit Quantity Rate USD USD Planting, maintenance and Watering (during Pieces 250 20 5,000 construction stage) of trees Preparation of Construction EMP Lumps 10,000 um Clearing of Construction Area Lumps 120,000 um Removal and Storage of Topsoil Lumps 12,000 um Monitoring of safe demolition of buildings Lumps 4 50,000 200,000 um Protection of Land/Water Resource Lumps 6,000 um Management of Solid Waste and Sewage Waste Lumps 4 sites/day 1000/mont 100,000 from the Construction Camp um for 25 h months Potential restoration of Work and Storage Site Lumps 32,000 um Dust suppression measures during dry period Period 3 times 3000 x 30,000 (water spraying) s daily during $10 demolition and 2 times during constructio n period) Securing of Storage and Equipment Lumps 50,000 Maintenance Areas. um Contractor’s Safeguard Specialist month 24 2,000 48,000 Noise protected screens at neighborhood for m² 1000 100 USD 100,000 Nanning. Delivery and installation. per m² Asbestos Management and Disposal handling The costs will be covered by contractor s - to be included in the Project Costs Total Mitigation Measures * 713,000 *Additional cost for handling and disposal of Asbestos in Construction materials may will be incorporated by contractor in bid.

Table EMP-11: Cost Estimate for Baseline Monitoring (USD) Description Unit Quantity Rate USD Amount USD Baseline Included in Civil Works Contract Noise Monitoring. Baseline Number 2 years: 30 3,900 measurement 5 locations each multiplied by 13. (1 baseline measurement

123 Description Unit Quantity Rate USD Amount USD and12 construction period measurement s) Vibration Monitoring over Number As above 30 3,900 construction period, Dust and air pollutants Number 5x13x 2 years 140 18,200

Measurement over construction period Total Monitoring Measures 26,000

Table EMP-12: Cost Estimate for Loan Implementation Consultant’s (LIC) Monitoring (USD) Amount Description Unit Quantity Rate USD USD Included in Design and Supervision Consultant’s Contract LIC’s National Environment month 24 3,000 72,000 Specialist HIV/AIDS Seminar Every 4 months 9 1,000 9,000 during construction time Total Monitoring Measures 81,000

K. Mechanisms for Feedback and Adjustment

44. Based on site inspections and monitoring reports, including internal and external environmental monitoring reports, the GPMO with the assistance from the LIEC will decide whether (i) EMP is adequate and effective and further mitigation measures are required as corrective actions, or (ii) some improvements are required for environmental management practices.

45. The effectiveness of mitigation measures and monitoring plans will be evaluated by the external environment monitoring expert’s report on EMP implementation. The need to update and adjust the EMP will be reviewed when there are design changes, changes in construction methods and program, negative environmental monitoring results or inappropriate monitoring locations, and ineffective or inadequate mitigation measures.

46. GPMO will play a critical role in the feedback and adjustment mechanism with the support from the LIEC and external environment monitoring expert. Where unanticipated environmental impacts become apparent during project implementation, GPMO shall update the environmental assessment and EMP or prepare a new environmental assessment and EMP to assess the potential impacts, evaluate the alternatives, and outline mitigation measures and resources to address those impacts.

47. Adjustment to the EMP will be made, if necessary. In such cases, the GPMO will inform ADB promptly on any changes to the project and needed adjustments to the EMP. The updated EMP will be submitted to ADB for review and approval, and will be disclosed on the ADB project website. GPMO will assess whether further mitigation measures are required as corrective action, or improvement in environmental management practices are required with the support from the LIEC and external environment monitoring expert.

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