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Draft Initial Environmental Examination Sri Lanka: Health System Enhancement Project – Additional Financing

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Draft Initial Environmental Examination Sri Lanka: Health System Enhancement Project – Additional Financing Draft Initial Environmental Examination July 2021 Sri Lanka: Health System Enhancement Project – Additional Financing Prepared by Project Management Unit (PMU) of Health System Enhancement Project (HSEP), Ministry of Health, Colombo, Sri Lanka for the Asian Development Bank. CURRENCY EQUIVALENTS (As of 1 June 2021) Currency unit – Sri Lanka Rupee/s (SLR/SLRs) SLR1.00 = $0.005046 $1.00 = SLR198.73 ABBREVIATIONS ADB – Asian Development Bank AF – Additional Financing CEA – Central Environmental Authority DH – district hospital DS – divisional secretary EA – executing agency EHS – environment, health & safety EMP – environmental management plan EMoP – environmental monitoring plan EPL – environmental protection license GN – grama niladhari GoSL – Government of Sri Lanka GRM – grievance redress mechanism H&SP – health and safety plan HCF – healthcare facility HCW – health care waste HCWM – health care waste management HSEP – Health System Enhancement Project IEE – initial environmental examination MOH – Ministry of Health NEA – National Environmental Act O&M – operation and maintenance PD – project director PDHS – provincial director of health services PIU – project implementation unit PMCU – primary medical care units PMU – project management unit PPE – personal protective equipment PS – Pradeshiya Sabha SKS – saukya karya sahayaka SPS – Safeguard Policy Statement SWL – scheduled waste license 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 on ADB’s 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 Bank does not intend to make any judgments as to the legal or other status of any territory or area. ii Table of Contents Executive Summary .............................................................................................................. v I. INTRODUCTION ........................................................................................................... 1 A. Project Background ..................................................................................................... 1 B. Objectives of the Projects and Additional Financing .................................................... 1 C. Objectives of the Initial Environmental Examination .................................................... 2 D. Approach, Methodology and Personnel Involved ........................................................ 2 II. DESCRIPTION OF THE PROJECT ............................................................................... 3 A. Project Impacts and Outcomes ................................................................................... 3 B. Scope of Civil Work ..................................................................................................... 3 C. Project Components Proposed Under Additional Financing ........................................ 3 D. Financing Plan for Additional Financing ...................................................................... 7 III. ALTERNATIVE ANALYSIS ............................................................................................ 8 A. No project alternative .................................................................................................. 8 B. With project alternative ............................................................................................... 8 IV. ASSESSMENT OF THE LEGAL FRAMEWORK AND INSTITUTIONAL CAPACITY ..... 8 A. Existing Health Care Waste Management Framework in the Country ......................... 8 B. Environmental Legislation ......................................................................................... 12 C. Safeguard Requirements of ADB .............................................................................. 14 D. Project Relevant International Agreements and Conventions .................................... 15 E. Review of Institutional Capacity of Executing Agency ............................................... 16 V. DESCRIPTION OF THE ENVIRONMENT ................................................................... 17 A. Rathnapura District ................................................................................................... 17 B. Kegalle District .......................................................................................................... 28 C. Anuradhapura District ............................................................................................... 36 D. Polonnaruwa District ................................................................................................. 45 E. Kandy District ............................................................................................................ 52 F. Matale District ........................................................................................................... 59 G. Nuwara Eliya District ................................................................................................. 67 H. Uva Province (Badulla and Monaragala Districts) ..................................................... 75 VI. KEY ANTICIPATED ENVIRONMENTAL IMPACTS AND PROPOSED MITIGATON MEASURES ................................................................................................................ 84 A. Planning and pre-construction and location-related impacts ..................................... 84 B. Impacts anticipated during the construction phase and mitigation of impacts ............ 90 C. Impacts during the operational stage of newly constructed facilities ........................ 107 D. Procedures for Dealing with Chance Finds ............................................................. 129 VII. Institutional Arrangements and Environmental Monitoring Plan ................................. 130 iii A. Institutional Arrangements ...................................................................................... 130 B. Institutional Capacity Development ......................................................................... 131 C. Environmental Management Plan ........................................................................... 131 D. Environmental Monitoring Plan ............................................................................... 131 VIII. INFORMATION DISCLOSURE, CONSULTATION, PARTICIPATION AND GRIEVANCE REDRESS MECHANISM ........................................................................................... 132 A. Consultation and Participation During Project Preparation ...................................... 132 B. Disclosure of Information ........................................................................................ 132 C. Grievance Redressal Mechanism ........................................................................... 133 IX. Conclusion and Recommendations............................................................................ 135 A. Conclusion .............................................................................................................. 135 B. Recommendations .................................................................................................. 136 List of Annexes ANNEXURE 1: ENVIRONMENTAL SCREENING CHECKLIST ........................................ 138 ANNEXURE 2: DETAILS OF SELECTED APEX HOSPITALS AND AMBULANCE FACILITIES ....................................................................................................................... 146 ANNEXURE 3: GUIDELINE FOR MANAGEMENT OF COVID-19 INFECTIOUS WASTE 167 ANNEXURE 4: GUIDELINES FOR REMOVING ASBESTOS CEMENT (AC) SHEETS FROM BUILDINGS ........................................................................................................... 169 ANNEXURE 5: RECORDING AND MONITORING THE PROCEDURES ADOPTED BY THE CONTRACTORS TO ENSURE HEALTH AND SAFETY TO PREVENT THE SPREADING OF COVID-19 ................................................................................................................... 173 ANNEXURE 6: ENVIRONMENTAL MANAGEMENT PLAN .............................................. 174 ANNEXURE 7: ENVIRONMENTAL MONITORING PLAN................................................. 202 ANNEXURE 8: FORMS TO BE USED FOR ENVIRONMENTAL MONITORING .............. 209 ANNEXURE 9: LIST OF PERSONS CONSULTED ........................................................... 215 iv Executive Summary (i) Strengthening Primary Health Care (PHC) –– both primary medical care and preventive health services — in Sri Lanka needs priority attention to tackle the rising costs of health care as well as to improve primary health services to lagging populations to meet the emerging public health challenges. The current health system under-invests in primary care and limited government funds mostly cater to higher-level hospitals. Given this background, the government has begun reforms to rationalize health care utilization with increased focus and orientation towards PHC to meet the emerging challenges in the health sector. (ii) The Government of Sri Lanka (GoSL) implemented the Health System Enhancement Project (HSEP) to address these issues. Financed by ADB through a concessional loan of $37.5 million from ADB’s ordinary capital resources and a $12.5 million grant from ADB’s Special Funds resources, the project was approved on 23
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