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53291-001: Improving the Quality of Health Care Project

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53291-001: Improving the Quality of Health Care Project Initial Environmental Examination June 2020 Lao PDR: Improving the Quality of Health Care Project Prepared by the Ministry of Health of Lao People’s Democratic Republic for the Asian Development Bank CURRENCY EQUIVALENTS (as of 03 May 2020) Currency unit – kip (LAK) LAK1.00 = $0.000112 $1.00 = LAK8,893.41 ABBREVIATIONS ADB - Asian Development Bank ADPC - Asian Disaster Preparedness Center CEMP - Contractor’s Environmental Management Plan CQI - Continuous quality improvement DHO - District Health Office DONRE - District Environment and Natural Resources Office DPC - Department of Planning and Cooperation EHS - environment, health and safety EIA - environmental impact assessment EMP - Environmental Management Plan GOL - Government of Lao PDR GRM - grievance redress mechanism HSR - Health Sector Reform HSRS - Health Sector Reform Strategy IBAT - Integrated Biodiversity Assessment Tool IEE - initial environmental examination IUCN - International Union for Conservation of Nature Lao PDR - Lao People’s Democratic Republic MOH - Ministry of Health MONRE - Ministry of Natural Resources and Environment MPWT - Ministry of Public Works and Transport NDMO - National Disaster Management Office NES - national environment specialist NIP - national implementation plan NTFP - non-timber forest product OCHA - UN Office for the Coordination of Humanitarian Affairs PBL - policy-based loan PCP - ADB Public Communications Policy (2011) PCR - project completion report PMU - Project Management Unit POP - persistent organic pollutant PPE - post-primary education PUCDA - Provincial Unit for Construction And Development Assistance REA - rapid environmental assessment SDP - sector development program SPS - ADB Safeguard Policy Statement (2009) UHC - universal health coverage UNDP - United Nations Development Program UNFCC - United Nations Framework Convention on Climate Change UXO - unexploded ordnance VOC - volatile organic compound WASH - water, sanitation, and hygiene WHO - World Health Organization WREA - Water Resources and Environment Administration WEIGHTS AND MEASURES oC - degree Centigrade dBA - decibel ha - hectare hr - hour km - kilometer m - meter mm - millimeter NOTE In this report, "$" refers to United States 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 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 Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or areas. CONTENTS EXECUTIVE SUMMARY 1 I. INTRODUCTION 1 A. Project Concept and Rationale 1 B. Methodology for Environmental Assessment 2 II. POLICY, LEGAL AND ADMINISTRATIVE FRAMEWORK 4 A. ADB’s Environment Safeguards Policies 4 B. Legal and Institutional Framework for Environmental Management in Lao PDR 6 C. Environmental Standards 9 D. International Conventions 10 III. DESCRIPTION OF THE PROJECT 11 A. Facility Design 14 B. Project Management Arrangements 23 IV. DESCRIPTION OF THE ENVIRONMENT 27 A. Overview 27 B. Climate 28 C. Natural Hazard Risks 30 D. Ecological Resources 32 E. Socio-economic Conditions 32 F. Site-specific Information for the Targeted HPEIs and Hospitals 35 V. ANTICIPATED ENVIRONMENTAL IMPACTS AND MITIGATION MEASURES 106 A. Anticipated Benefits from the Project 106 B. Pre-construction Impacts and Mitigation 106 C. Environmentally Sensitive Sites 106 D. Environmental Impacts and Mitigation Measures during Construction 106 E. Environmental Impacts and Mitigation during Operation 107 VI. INFORMATION DISCLOSURE, CONSULTATION, AND PARTICIPATION 108 A. Information Disclosure and Stakeholder Consultations During Project Preparation 108 B. Follow-up Information Disclosure and Stakeholder Consultations 120 VII. GRIEVANCE REDRESS MECHANISM 121 A. Types of Grievances 121 B. Grievance Resolution Process 121 VIII. ENVIRONMENTAL MANAGEMENT PLAN 125 A. Objectives 125 B. Institutional Arrangements for EMP Implementation, Coordination and Supervision 125 C. Works Contractor’s Obligations 126 D. Mitigation Plan 127 E. Reporting 134 IX. CONCLUSION AND RECOMMENDATIONS 138 ANNEXES: 1. Rapid Environmental Assessment (REA) Checklist 139 2. Land Titles 185 3. Environmental Monitoring Checklists 247 4. Template of the Environmental Safeguard Monitoring Report 258 5. Contractor’s Ehs Progress Monitoring Report 266 EXECUTIVE SUMMARY Introduction 1. The proposed project will support the efforts of the Ministry of Health (MOH) in Lao People’s Democratic Republic (PDR) to strengthen the public health system capacity for continuous quality improvement (CQI) to achieve better quality of health services. While the country has made steady progress in improving access to health care through expansion of service networks and financial protection of the poor and vulnerable, health indicators and utilization of health services remain low in comparison with its neighboring countries. The Health 1 Sector Reform Strategy (HSRS)0F was endorsed by the National Assembly in January 2014 and is being implemented in three phases. The strategy aims to achieve universal health coverage (UHC) by 2025 and has updated this to achieve other health-related Sustainable Development Goals (SDGs) by 2030. Phase II of the reform (2016–2020) officially focused on central and provincial hospitals but undertook many reforms to be rolled out in Phase III. The project will deliver three outputs: (i) governance mechanism for CQI enhanced; (ii) health human resources (HHR) strengthened to deliver quality health services; and (iii) quality and management of health facilities boosted. Project Scope and Planned Civil Works 2. The project is in line with the HSRS, Phase III (2021–2025), which has a focus on primary health care (PHC) and aims to expand the availability of quality essential health services, particularly from health centers and district hospitals, in line with the increased needs and expectations of the people. The project is also in line with the Asian Development Bank (ADB) Strategy 2030 operational priorities to: (i) address remaining poverty and reducing inequalities as health improvement is associated with improved economic opportunities; and (ii) 2 accelerate progress in gender equality.1F It also directly contributes to the Country Partnership Strategy for Lao PDR (2017–2020) Strategy Priority 2 (enhanced human development) and is 3 included in the Country Operations Business Plan (2019–2021).2F 3. The project is aligned with the following impact: UHC by 2025: Affordable quality health care for all, especially rural women and children, and will have the following outcome: established quality improvement system in place. The project will deliver three outputs namely: • Output 1: Governance mechanism for CQI enhanced; • Output 2: HHR strengthened to deliver quality health services; and • Output 3: Quality and management of health facilities boosted. 4. Among the three project outputs, Outputs 2 - HHR strengthened to deliver quality health services and Output 3 - Quality and management of health facilities boosted will have potential environmental impacts as the said outputs would involve rehabilitation and construction works. Tables 1 and 2 presents the proposed interventions under the outputs 2 and 3 within the scope of the project. In total, the project will support the rehabilitation or renovation of 13 existing and the construction of 11 new buildings at 24 existing Health Professional Education Institutions (HPEIs), health facilities (provincial and district hospitals) and the renovation of office space for the project 1 Government of Lao PDR. Ministry of Health. 2013. Health Sector Reform Strategy, 2013 to 2025. Vientiane. 2 ADB. Strategy 2030: Achieving Prosperous, Inclusive, Resilient, and Sustainable Asia and the Pacific. Manila. 3 ADB. Country Partnership Strategy: Lao People’s Democratic Republic, 2017–2020: More Inclusive and Sustainable Economic Growth. Manila; ADB. Country Operations Business Plan: Lao People’s Democratic Republic 2019–2021. 2 management unit (PMU) at MOH in Sisattanack District, Vientiane Capital. Table 1: Proposed Health Professional Education Institutions (HPEIs) Province Facility Champasak College of Health Science Savannakhet College of Health Science Xieng Khouang School of Public Health Oudomxay School of Public Health Table 2: Proposed Health Facilities, District and Provincial Hospitals Province District Facility Phongsaly Mai District Hospital Oudomxay Xay Provincial Hospital Beng District Hospital Houn District Hospital Luang Prabang Luang Prabang Provincial Hospital Nambak District Hospital Phoukhoun District Hospital Houaphanh Houamuang District Hospital Sayaboury Paklay District Hospital Boten District Hospital Xieng Khouang Mok District Hospital Phaxay District Hospital Savannakhet Kaysone Provincial Hospital Nong District Hospital Songkhone District Hospital Salavan Lao-Ngam District Hospital Champasak Paksong District Hospital Moulapamok District Hospital Xaisomboun Hom District Hospital Purpose and Methodology of Environmental Assessment 5. This environmental assessment focuses on the investment component under Output 2 and Output 3, which involves rehabilitation and upgrading or construction of classroom blocks, dormitories, faculty
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