51035-001: Health Services Sector Development Program

Social Safeguards Due Diligence Report

July 2020

PNG: Health Services Sector Development Program Subproject: Bitokara Community Health Post

Prepared by the Department of Health for the Asian Development Bank.

This social safeguards due diligence report 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.

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.

Social Safeguards & Land Assessment Report

Bitokara Community Health Post West New Britain Provincial Health Authority

Health Services Sector Development Project National Department of Health

CURRENCY EQUIVALENTS (as of 17 June 2020)

Currency unit – Kina (K) K1.00 = $0.29 $1.00 = K3.46

ABBREVIATIONS ADB – Asian Development Bank AP – Affected Persons CCHS – Catholic Church Health Services CEO – Chief Executive Officer CHP – Community Health Post (a level 2 health facility in NHSS) DDA – District Development Authority DDR – Due Diligence Report DHM – District Health Manager DH – District Hospital GRC – Grievance Redress Committee GRM – Grievance Redress Mechanism GoPNG – Government of PNG ha – Hectare HC – Health Centre HSSDP – Health Services Sector Development Project IPPF – Indigenous Persons Planning Framework LARF – Land Acquisition Resettlement Framework LLG – Local Level Government MOU – Memorandum of Understanding NDOH – National Department of Health NGO – Non Government Organisation NHIS – National Health Information System NHSS – National Health Service Standards OCR – Ordinary Capital Resources PFM – Public Financial Management PHA – Provincial Health Authority PMU – Project Management Unit PNG – Papua New Guinea RP – Resettlement Plan RPHSDP – Rural Primary Health Service Delivery Project SPS – Safequards Policy Statement WNBPHA – West New Britain Provincial Health Authority

NOTE{S} (i) In this report, "$" refers to United States.

This Social Safeguards Due Diligence Report 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.

TABLE OF CONTENTS

I. INTRODUCTION ...... 7 II. ABOUT THE SUBPROJECT ...... 8 III. LAND OWNERSHIP AND SOCIAL SAFEGUARDS ...... 14 IV. COMMUNITY CONSULTATIONS ...... 15 V. GRIEVANCE REDRESS MECHANISM ...... 17 VI. POLICY FRAMEWORK ...... 18 VII. MONITORING AND REPORTING ...... 20 VIII. CONCLUSION ...... 20

Annexure Annex 1 Certificate Authorising Occupancy Annex 2 Memorandum of Understanding between the People of Bitokara and the Church Annex 3 Memorandum of Understanding between WNBPHA and CCHS and NDOH Annex 4 Indigenous Peoples Impact Screening Checklist

EXECUTIVE SUMMARY

The Health Services Sector Development Project (HSSDP) is an initiative of the Government of Papua New Guinea (GoPNG) using a loan from the Asian Development Bank (ADB) and a grant from the Australian Government. The Project will enhance rural health service delivery through building new health facilities, provision of professional development for clinicians and managers, remodelling the medical supply and distribution system, improving clinical, corporate, and financial governance, and completing the delivery to all health facilities of the electronic health information system (eNHIS).

This due diligence report (DDR) documents the HSSDP sub-projects compliance with the ADB Social Safeguards Policy (SPS), the Land Use and Resettlement Framework (LARF), the Indigenous Peoples Planning Framework (IPPF) and the Grievance Redress Mechanism (GRM). The sub-project is to build a new community health post at Bitokara in West New Britain Province in partnership with the West New Britain Provincial Health Authority (WNBPHA) and the Catholic Church Health Services Kimbe Diocese. An MOU has been signed between the WNBPHA, the NDOH and the Catholic Church Health Services who are providing the land and contributing funds towards the construction. The existing health facility dates from the 1950s and is structurally unsound due to white ant damage and age. All new buildings will be designed and constructed in accordance with the PNG National Health Service Standards (NHSS), the PNG Building Code, and comply with Seismic Zone 2 building requirements.

Compliance with the ADB SPS and LARF were confirmed for the Bitokara CHP sub-project through viewing the Certificate Authorising Occupancy 012/017 (IR) in the name of the WNBPHA published in the PNG Government Gazette G774 Monday 2nd October 2017 in relation to Portion 306 Milinch Gurua Fourmil Talasea (Land File number 19108/0306). Community consultation was undertaken with users of the health service and descendants of the original customary land owners who agreed to provide their land for use by the Catholic Mission in 1924, reaffirmed in 1942, 1965, and most recently in 2014. A grievance redress mechanism (GRM) was established through adding this function to an existing active Mission Board Health Committee.

The new health facility will be built on the same site as the previous facility which will be demolished. The land available for the health facility extension encompasses a small section of a regrowth disused garden. In compliance with the ADB SPS, no people will be forced to move or be displaced nor does any person rely on the dis-used garden for sustenance.

I. INTRODUCTION

1. The Health Services Sector Development Program (HSSDP) will improve the delivery of public health services to mostly rural populations in Papua New Guinea. HSSDP is expected to make health services affordable, accessible and equitable. It will provide high-quality health services for all citizens by ensuring adequate public expenditure for health, strengthening the subnational health system in PNG, and rehabilitating health care infrastructure, improving availability of medical supplies, building capacity in clinical governance, supporting new partnerships and strengthening information systems through digitalization. The majority of the rural population will be the main beneficiaries. Improved public health services in the rural areas will reduce the burden of disease and reduce maternal and infant mortality rate. These will significantly improve the health and economic conditions of the population particularly women. 2. The HSSDP will be implemented for a period of 7 years. The Program will cost $395 million equivalent with $375 million from ADB’s ordinary capital resources (OCR) and (ii) $20 million from ADB’s Special Funds resources. 3. The Health Services Sector Development Project, a project within the Program, will be implemented over a period of 7 years and commenced in July, 2018. HSSDP (Project) financing is structured on the Government of PNG investment of $9.5 million, a grant from the Australian Government of $38 million and the ADB loan of $95 million to support the following outputs: (i) national frameworks and Public Financial Management (PFM) enhanced, (ii) subnational health system management strengthened, and (iii) health service delivery components strengthened including upgrading of rural health infrastructures such as community health posts, health centres and district hospitals. 4. The Project’s planned investment component includes upgrading of up to 2 district hospitals, 7 health centres and 5 community health posts in selected sites during the program’s implementation. Each health facility, including staff housing, will require an area of between 2.0 ha to 6.0 ha of land. Similar to RPHSDP, and as one of the funding criteria, each of the proposed health infrastructure under HSSDP will be upgraded or constructed on land owned by the government or a long term Church lease. The Project is also not expected to cause land acquisition or resettlement impacts. The policy component of the program has also been assessed and confirmed that no involuntary resettlement impacts are associated with its policy actions. Hence, the program has been classified as Category C on involuntary resettlement within ADB’s safeguards policies. 5. A land acquisition and resettlement framework (LARF) has been developed with a focus on the project investment components to guide how screening and categorization of succeeding sub-projects will be undertaken and required safeguards documents will be prepared. It also includes the scope for any unanticipated LAR issues and how it will be addressed in accordance with pertinent PNG laws and regulations and ADB’s Safeguards Policy Statement (SPS) 2009. This Due Diligence Report for the Bitokara Community Health Post subproject has been prepared following the requirements set out in the LARF. The due diligence reports will be cleared by ADB and uploaded to the ADB website prior to the commencement of civil works for the subproject.

II. ABOUT THE SUBPROJECT

6. The Bitokara Community Health Post subproject activities involve redevelopment of the existing health facility at Bitokara Mission Talasea District in West New Britain Province to meet the National Health Service Standards (NHSS). The civil works design is the standard approved Community Health Post (CHP) as per the CHP Policy and will include construction of the main health facility building with 6 acute beds, support buildings including a waiting house for expectant mothers, amenities for guardians, generator and incinerator sheds and 3 staff residences. All buildings will be constructed within the grounds of the existing Catholic mission campus. The current facility is a neglected Health Centre which has not been functioning at Level 3 if assessed against the NHSS. Although the proposed replacement facility is a Level 2, the functionality and standard of care available at commissioning will be significantly improved. 7. All buildings will be designed and constructed in accordance with the NHSS and the Building Code of PNG having regard to engineering, environmental, security and spatial efficiency aspects of the facilities. The design facilitates person centred care including infection prevention and control, fire control, accident prevention and disabled access through ramped entrances and adapted amenities such as bathrooms. Low-carbon and energy efficient measures, including solar power generation and solar hot water supplies will be adopted.

Figure 1.1 Location Map of the Bitokara Community Health Post

Bitokara

A. Subproject Location

8. Figure 1.1 above shows the West New Britain Provincial Health Authority (WNBPHA) rural health facilities; a green dot is an open Aid Post, a red dot is a closed Aid Post and a white dot is a Health Centre. Bitokara is located on the north coast on the eastern side of the peninsular, opposite Garua Island. Bitokara is reached via a mostly sealed yet potholed road from Kimbe the provincial capital past Numundu Beef and Oil Palm plantations. The travel time is 60 minutes due the deteriorating road surface because of the combination of heavy palm oil trucks, the consistent rainfall, and seismic activity. 9. The population for Talasea Rural Local Level Government (LLG) in 2020 is estimated at 35,888 people (16,311 female and 19,577 male) who live in the 10 wards of the LLG. The more than expected number of males compared to females is most likely due to the additional male workforce employed in the agricultural industry. Wards in the Talasea LLG include Nalabu, Boge, Gabuna, Bola, Warou, Tabekemeli, Bulu, Valupai, Baliondo, and Bunga. Bola Health Centre is the closest health centre, although it has been closed since November 2019 due to community conflict with health centre staff who are now working in other facilities.

Figure 1.2: Bitokara Mission Campus

High School Primary School North Coast Road Alternate Access

Day Clinic Cemetery Church

Hospital

Staff Houses

Entrance Steep Driveway

10. Figure 1.2 shows the existing Bitokara health facility satellite image from Google Earth. The health facility is a registered health centre albeit functioning as an Aid Post with provision of basic outpatient services utilising a cadre of Community Health Workers. There is no nursing officer of midwife and therefore, no inpatient, delivery or post natal care provision. Management and supervision is provided by the Catholic Church Health Services (CCHS) Kimbe Diocese.

B. Existing Facility

11. The original hospital building, constructed in the 1950s is no longer operational due to white ant damage and being structurally unsound. A newer two room day clinic built in the 1990s while requiring maintenance is serviceable and can be retained and repurposed. There is currently no capacity for inpatient or maternity care except basic antenatal and postnatal checks due to no toilets or potable water inside the facility. The size and layout of the original building points to a once large inpatient and outpatient facility delivering care to many people. Bitokara now requires a significant investment in both infrastructure and equipment before the health service is able to offer safe and reliable outpatient and inpatient care. 12. The 2 room outpatient building will be retained and new buildings constructed that are suitable for the delivery of Level 2 Health services. Comprehensive primary health care services will be delivered, inclusive of general outpatient and inpatient care and referral, rural doctor clinics, accident and emergency care, maternal, newborn, child and adolescent care, health promotion and other public health interventions will be provided from new purpose-designed health facilities on site.

Figure 1.3: Existing Facilities at Bitokara

Original Health facility constructed in the 1950s; requires demolition.

Current Outpatients (Aid Post) built in the 1990s showing external and internal perspectives.

13. The CCHS and West New Britain Provincial Health Authority (WNBPHA) have committed to ensure the delivery of essential healthcare services is maintained during the construction period. Considering the size of the available land, this should not present a problem on the proviso of adequate clear signage, temporary safety fencing and functioning Health Committee / Grievance Redress Mechanism.

C. Proposed Works and Activities

14. Overview. The National Department of Health (NDOH), CCHS and the WNBPHA propose to redevelop the existing Bitokara health facility to function as a Level 2 with 6 acute beds as detailed in Table 1.1 below. These numbers do not include delivery beds in the labour ward, antenatal beds, observation beds in the emergency room, or observation beds in outpatient area. Table 1.1: Details of Proposed Improvements to Bitokara Health Facility Department Current Beds Proposed Beds General Adult Ward 0 4 Post Natal Ward 0 2 Total 0 6

15. Subproject components and works. The investment component under the loan will include redevelopment of the Bitokara health facility from functioning as a Level 1 (if assessed against the NHSS) in order to operate as a Level 2. The scope of upgrading will include: • Civil works for the CHP including staff housing, water supply, renewable energy sources, and sanitation; • On site solid waste (including medical waste) management facilities; • On site water supply and wastewater treatment facilities at the CHP; and • Small-scale construction works including access, fencing, drainage, and landscaping works. 16. One existing building will be retained and repurposed by the CCHS while the 1950s buildings will require demolition. New buildings will be constructed in accordance with PNG design standards and codes. All CHP facilities are designed to meet the National Health Standards for a Level 2 facility and will include staff accommodation. 17. Bitokara is connected by both the main North Coast road and an additional access road to the rear of the mission for potential use by the construction teams. The driveway from the main road is a steep reinforced concrete driveway which has several sharp ‘hairpin’ bends and is mostly serviceable but with some deterioration on the corners and where it joins the main road which are easily repaired with concrete patching. Large trucks or trailers would be advised to use the alternate more direct route to the rear of the property. 18. The subproject will involve construction works limited to a small footprint of approximately 1.2 ha. The site is shown on the satellite image Figure 1.2 and Figure 1.4 shows the outline of the available state land for the proposed redevelopment. 19. Design standards. The new CHP will comply with the ‘Design Standards for Health Facilities in PNG’ published as Volume 3 of the National Health Service Standards, 2011 and endorsed by the National Health Board on 11th March 2011 and in compliance with the National Community Health Post Policy 2013. 20. These design standards also prescribe optimization of available natural light and ventilation for patient, guardian and staff comfort and to minimize transmission of air borne pathogens. The Bitokara CHP will be the same design which has been completed in 32 other sites in PNG, including 4 in West New Britain Province. 21. In addition, the site is in Seismic Zone 2 (steam sulphur vents visible on the beach down from the site) therefore PNG 1001-1982 Part 4; “General Structural Design Loadings for Building – Earthquake Loading” will be complied with in the design for building in seismic zones.

22. Cost and implementation schedule. The total cost of the subproject is estimated at $1.65 million for civil works and procurement of equipment with construction work being carried out over a period of 18 months under a single civil works contract. Currently the subproject is at design stage and scheduled to commence tendering, mobilization and construction in the 3rd quarter of 2020.

Figure 1.4 Land available for proposed redevelopment of Bitokara

Figure 1.5 Proposed Site Plan of Bitokara CHP

Figure 1.6 Proposed Layout Design of Bitokara CHP

III. LAND OWNERSHIP AND SOCIAL SAFEGUARDS

23. A Certificate Authorising Occupancy 012/017 (IR) in the name of the WNBPHA was published in the PNG Government Gazette G774 Monday 2nd October 2017 in relation to Portion 306 Milinch Gurua Fourmil Talasea (Land File number 19108/0306) for the purposes of health services. A copy can be seen in Annex 1. 24. Bitokara Mission was established in 1924 on the ground known locally as Dapupu which was occupied by the Catholic mission with the consent of Lohomaruma and Karia clans at the time. In 1942 a formal agreement was signed by representatives of Karia and Lohomaruma clans. A subsequent endorsement was signed in 1965 by the next generation validating their predecessors’ decision and most recently a memorandum of understanding was signed in 2014 endorsing agreements made in 1942 between customary land owners and the Catholic Church. The MOU is attached as Annex 2. 25. An additional MOU has been signed between the WNBPHA, the NDOH and the CCHS outlining intent to work together to ensure the new health facility meets the NHSS and the serves the needs of the people. The CCHS will contribute $700,000 towards the building costs and will provide the land. This MOU is attached as Annex 3. 26. There is a cemetery between the old hospital and the road, which is marked on Figure 1.2 and there will be no impacts from the project on this cemetery. There is a grotto with a statue of Mary in the courtyard of the old hospital which will be removed and relocated by the mission prior to demolition of the old buildings. There are no other artefacts of cultural significance in the 1.2 hectare site allocated for the health facility as per figure 1.4. There is additional land inside the Bitokara mission campus adjacent to the existing facility which is elevated and covered in a mix of banana, gardens and regrowth forest. It is also available for the redevelopment as per Figure 1.4. The affected garden trees are owned by the Catholic Church Mission and are not relied upon by anyone for subsistence food or livelihoods. Compensation will not be paid. 27. Construction workers accommodation during the build time will be located within the existing site. The construction site is required to be fenced for safety purposes and the building contractors can be accommodated in one of the existing buildings on site. No land outside the proposed site will be occupied. The majority of the work force will be local hire who have their own accommodation in the surrounding villages. Building site supervisors and specialist artisans will be accommodated on site. 28. Indigenous Peoples (IPs). The HSSDP is categorized as C for Indigenous Peoples (IPs) according to ADB’s SPS. In accordance with the Indigenous Peoples Planning Framework (IPPF), the sub-project has been carefully assessed to determine if IP safeguards are triggered. According to the assessment undertaken by international safeguard specialists, the sub-project is not expected to impact on any distinct and vulnerable people as defined under ADB’s Safeguard Policy Statement. The sub-project is expected to have significant benefits for the local community. The community living near the Bitokara CHP is composed of different clans and tribes that are distinct from others in PNG, with their own language (Bola). There is also a history of anthropological studies conducted in the area, with studies documenting their distinct cultural, economic, social and political practices. Yet the assessment concludes that the clans in the subproject area have not been historically, socially or economically marginalized or disempowered, nor have they been excluded or discriminated against. None of these clans are considered vulnerable within the broader PNG Nation State. While there is customary ownership of land in and around the site, the selected site is recognized as Church owned land. As a result, an Indigenous Peoples Plan for this sub-project. Refer to Annex 4 for Indigenous Peoples Impact Screening Form completed for the Bitokara site.

IV. COMMUNITY CONSULTATIONS

29. Community consultation was undertaken at Bitokara Mission on the 28th February 2020. Representatives of the Bitokara Catholic Parish, WNBPHA, CCHS Kimbe Diocese and Health Services Sector Development Project (HSSDP) officers met with the host community leaders, comprising 20 women and 10 men, including members of the Mission Board and health committee as well as many students from both primary and high schools. All present were enthusiastic in their support for the new health facility, which has been discussed as a priority need for the Parish since 2012, and agreed that the land was uncontested Church land. 30. Community leaders requested their people be employed as much as possible during the demolition of the old hospital and construction of the new facility. Baseline health surveys were conducted through separate focus group discussions (convenience sampling) of 20 women and 16 men. The men included 3 grandfathers, 3 fathers, and 10 were young men. Discussions were held with married and older women and a separate discussion was held with young single women. One on one interviews were held with 11 women to ascertain their health care seeking beliefs and activities and the types of health care received.

Figure 1.7 Community Consultation Bitokara Parish

Photographs of people inside and outside during the community consultation meeting

V. GRIEVANCE REDRESS MECHANISM

31. The HSSDP has formed a program-level grievance redress mechanism (GRM). A part of the GRM is the establishment of grievance redress committees (GRC) in each sub-project site for hearing and resolving any complaints. A meeting was held with existing health committee members comprising 5 women and 6 men to discuss the Grievance Redress Mechanism and their role during the construction phase. This committee was established following a recent restructure of the mission board. Their structure meets the ADB requirements for a GRM and they have decided to add the head girl and head boy from the high school as youth representatives. 32. Other than disputes relating to legal rights, grievances will be redressed within one month from the date of lodging the complaints. The legal cases will be referred to respective courts. The key functions of the GRCs are to (i) record, categorize and prioritize the grievances; (ii) settle the grievances in consultation with complainant(s) and other stakeholders; (iii) inform the aggrieved parties about the solutions; and (vi) forward the unresolved cases to higher authorities. 33. If the issue cannot be resolved by the GRC, then the International Social Safeguards/Gender Specialists will assist APs in registering their complaints with NDOH / PMU, field office or provincial health administration. The PMU Project Manager will consider the complaint and within one month will convey a decision to the APs. The PMU staff, along with local government officials, will assist the Project Manager in reviewing and addressing the complaint. The safeguards officers at the PHA will facilitate communication between the APs and the PMU in this process. If the APs are not satisfied with the PMU’s decision, they may then take the grievance to the PNG judicial system. The Land Disputes Settlement Act (2000) establishes judicial procedures for resolution of landownership disputes on customary land. It has a mediation process followed by court proceedings. Any health facility building sites involving a dispute requiring a lengthy legal process, will not be considered for funding under the project. 34. ADB’s Accountability Mechanism. People who are, or may in the future be, adversely affected by the project may submit complaints to ADB’s Accountability Mechanism. 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 an effort in good faith to solve their problems by working with the concerned ADB operations department. Only after doing that, and if they are still dissatisfied, should they approach the Accountability Mechanism.

VI. POLICY FRAMEWORK

35. About the Framework. The LARF is a government document reflecting GoPNG‘s relevant laws and policies and ADB‘s specific requirements under the ADB Safeguard Policy Statement, 2009. It is uploaded on the ADB website (https://www.adb.org/projects/documents/png-51035-001-rf). 36. The LARF provides a compensation/rehabilitation framework detailing agreed upon compensation / rehabilitation provisions that are shared by the government and the ADB. The LARF contains the process of resettlement impact assessment, preparation of the social safeguards documents required and implementation of compensation and income restoration measures for APs, if required. The LARF provides guidelines that cover both physical displacement (relocation, loss of residential land, or loss of shelter) and economic displacement (loss of land, non-land assets, access to land and non-land assets, income sources, or means of livelihoods) resulting from projects under the program through (i) land acquisition, (ii) restriction on land use, or (iii) on access to parks and protected areas. The LARF also contains the process of preparing for a Due Diligence Report for government-owned/church-leased lands, as is the situation for the Bitokara Community Health Post subproject. 37. Program Policy Principles. The implementation of the HSSDP will seek to avoid land acquisition and resettlement impacts to the extent possible; minimize resettlement impacts by exploring project and design alternatives to enhance, or at least restore, the livelihoods of all affected persons (APs) relative to pre-project levels; and improve the standards of living of the low income APs and other vulnerable groups. In compliance with PNG laws and ADB SPS, the program adopts the following policy principles for its project investment components: (i) Priority for construction will be given to district hospitals (DH) health centres (HC) or community health posts (CHP) that are to be constructed on state land, free of customary or private uses or claims. (ii) The Project will not finance health facility construction that involves compulsory land acquisition and/or involuntary resettlement impacts and any site acquisition that would significantly impact the income source and livelihood of affected persons. (iii) If a suitable state land is not available in the proposed area and the non-state land is only the available suitable option, such land will be obtained through voluntary land use agreement or negotiated purchase. It will be ensured that the failure of the negotiation will not result in compulsory acquisition. (iv) Local communities, stakeholders and any APs, regardless of their legal status including lack of title to land, will be meaningfully consulted over the project cycle. (v) If the project involves land purchase the state will offer compensation based on existing market rate for affected land and assets to ensure that APs will not be financially disadvantaged. Such compensation will be paid to APs prior to commencement of civil works. For voluntary agreement on land use (without purchasing land) or any voluntary waiver of compensation claims by landowner communities, it will be documented through an agreement and verified by an independent third-party. (vi) The project will employ a third-party (e.g. NGO), acceptable to both parties, to document and verify the voluntary land use agreement and purchase through negotiated agreement. (vii) Absence of formal title will not be a bar to compensation and assistance for loss of non-land assets. Particular attention will be paid to women, women-headed households, elderly and other vulnerable people.

(viii) A due diligence report (DDR) or a Resettlement Plan (RP), as applicable, will be prepared and submitted to ADB for clearance before start of the civil works involving use of non-state land. The DDR or RP will document the process and outcome achieved for the respective health facilities according to its requirements and appropriate land arrangement. (ix) The DDR or RP will be disclosed locally and posted on government and ADB websites. (x) All costs related to land assessment, development of agreements for voluntary land use agreement or negotiated purchase will be included in the project cost and funded by the project. The cost of land purchases will be borne by the state or its agents. (xi) The project will monitor implementation of land aspects, submit semi-annual reports to ADB and address any unforeseen impacts that may occur during implementation in line with LARF and ADB SPS.

38. If land acquisition/resettlement impacts are identified for any sub-projects under the program, NDOH will follow the policies and procedures described in the LARF in compliance with the applicable laws of GoPNG and the safeguard policy requirements of ADB on involuntary resettlement. The LARF applies to all land owners and affected persons (APs), should there be any, with land status affected permanently or temporarily due to the construction, including purchase and temporary use during construction. It also applies to people whose use of land, registered or not, changes as the result of the investment. The LARF does not apply to State land that is transferred from one authority to another, or is used for construction, unless third parties are adversely affected by the transfer or its use.

VII. MONITORING AND REPORTING

39. The PMU safeguards staff will assist the NDOH and relevant PHA in monitoring the progress of the subproject. The PMU will submit to ADB quarterly progress reports, and semi- annual safeguard monitoring reports. The safeguard monitoring reports will be disclosed on the ADB website. If there are any unanticipated impacts, these will be reported to ADB in a timely manner, and either documented in the subsequent semi-annual safeguard monitoring report or a corrective action plan will be prepared and submitted to ADB.

VIII. CONCLUSION

40. The site selected for redevelopment of the Bitokara health facility to be a functional level 2 (community health post) in compliance with the PNG NHSS is existing Catholic Church owned land known as Dapupu and has been the site of the Catholic Mission and hospital since 1924. The sub-project will not result in physical or economic displacement, nor will it impact Indigenous People, as defined by ADB’s SPS. People from the Bitokara Catholic Parish and surrounding wards are enthusiastic supporters of the proposed redevelopment of their health facility and voiced their commitment to ensure the safety of the asset and staff both during and after the construction. The land is uncontested and owned by the Catholic Church Kimbe Diocese. An agreement has been made between the NDOH and the Catholic Church Health Services about provision of health services using church land.

Annex 1

Annex 2

Annex 3

Annex 4

Indigenous Peoples Impact Screening Checklist

KEY CONCERNS NOT (Please provide elaborations on YES NO Remarks the Remarks column) KNOWN

A. Indigenous Peoples Identification 1. Are there socio-cultural groups present in or use  PNG has >800 the project area who may be considered as "tribes" distinct (hill tribes, schedules tribes, tribal peoples), language "minorities" (ethnic or national minorities), or groups. "indigenous communities" in the project area? 2. Are there national or local laws or policies as  well as anthropological researches/studies that consider these groups present in or using the project area as belonging to "ethnic minorities", scheduled tribes, tribal peoples, national minorities, or cultural communities?  Every PNG person 3. Do such groups self-identify as being part of a identifies with a distinct social and cultural group? distinct ethnicity 4. Do such groups maintain collective attachments to  distinct habitats or ancestral territories and/or to the natural resources in these habitats and territories? 5. Do such groups maintain cultural, economic,  social, and political institutions distinct from the dominant society and culture? 6. Do such groups speak a distinct language or  Bola dialect? 7. Has such groups been historically, socially and  economically marginalized, disempowered, excluded, and/or discriminated against? 8. Are such groups represented as "Indigenous  Peoples" or as "ethnic minorities" or "scheduled tribes" or "tribal populations" in any formal decision-making bodies at the national or local levels?

B. Identification of Potential Impacts 9. Will the project directly or indirectly benefit or  target Indigenous Peoples? 10. Will the project directly or indirectly affect  Improved Indigenous Peoples' traditional socio-cultural and Access to belief practices? (e.g. child-rearing, health, Health Services education, arts, and governance) 11. Will the project affect the livelihood systems of  Indigenous Peoples? (e.g., food production system, natural resource management, crafts and trade, employment status) KEY CONCERNS NOT (Please provide elaborations on YES NO Remarks the Remarks column) KNOWN  Ancestral land 12. Will the project be in an area (land or territory) yes, however occupied, owned, or used by Indigenous Peoples, was given to the and/or claimed as ancestral domain? Catholic Church No claim. C. Identification of Special Requirements Will the project activities include: 13. Commercial development of the cultural  resources and knowledge of Indigenous Peoples? 14. Physical displacement from traditional or  customary lands? 15. Commercial development of natural resources  (such as minerals, hydrocarbons, forests, water, hunting or fishing grounds) within customary lands under use that would impact the livelihoods or the cultural, ceremonial, spiritual uses that define the identity and community of Indigenous Peoples? 16. Establishing legal recognition of rights to lands  and territories that are traditionally owned or customarily used, occupied or claimed by indigenous peoples ? 17. Acquisition of lands that are traditionally  owned or customarily used, occupied or claimed by indigenous peoples?

Anticipated project impacts on Indigenous Peoples

Project component/ Anticipated positive effect Anticipated negative effect activity/ output Improved access to health Increased traffic and people from other New Hospital services districts and provinces Reduced costs to travel for health Increased population mixing & potential services infectious disease transmission

Reduced mortality Population increase

Increased health and well being