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

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 rooms, and hospitals and health facilities.

6. Environmental category and environmental assessment. The project is Category B for environment. Potential negative environmental impacts are largely related to rehabilitation/ upgrading and construction activities under Output 2 and 3. Impacts from the project can be mitigated. The identified impacts during the construction phase include dust, solid waste, and occupational and community health risks for rehabilitation/upgrading and construction activities, dust and solid waste for small-scale construction activities outside buildings (for example building septic tanks, and drainage and canalization systems), and solid waste for replacement of old equipment. Impacts during operation are also expected, mainly from hospital waste storage and disposal.

7. The Environmental Management Plan (EMP) provides mitigation measures and monitoring requirements and will be included as an appendix in all bidding and contract documents. The Project Management Unit (PMU) will be responsible for EMP implementation and will ensure that the EMP will be adequately included in bidding documents, and all environmental mitigation measures will be included in construction contracts. PMU (which will include a national environment specialist, NES) and the design and construction supervision 3

(DCS) consultant will be responsible for ensuring that the contractor prepares a site-specific Contractor EMP (CEMP), and PMU will approve all CEMPs before the commencement of any construction or civil works.

8. Monitoring of environmental quality and the implementation of mitigation measures will be conducted by PMU, with support from the NES and site superintendents of the DCS consultant, with sufficient terms of reference (TOR) and staff time for this task.

9. The monitoring results will be included in the project quarterly progress reports (QPRs) and semi-annual environmental monitoring reports (SAEMRs) to be submitted to ADB. PMU will be responsible for establishing and implementing the grievance redress mechanism (GRM) in accordance with the initial environmental examination (IEE)/EMP and ADB’s Safeguard Policy Statement (SPS) (2009) and ensure that the contractor follows the procedures. The cost for implementing the EMP will be financed through the loan. Specifically, the costs of mitigation measures will be included in the construction contracts, and the cost for supporting environmental monitoring will be included in the consulting services of the DCS consultant. Mitigation measures and a monitoring plan have been developed and incorporated in the EMP, which will form the basis for the CEMP. PMU will promptly inform ADB of the occurrence of any risks or impacts, with detailed description of the event and proposed corrective action plan, if any unanticipated environmental and/or social risks and impacts arise during pre-construction, construction, implementation, or operation of the project, which were not considered in the IEE.

10. The construction contractors will be responsible for EMP implementation. The contractor will develop procedures for emergency response, sound construction management program, implement occupational and community safety programs (including COVID-19 risk management protocol), develop the site-specific EMP (or CEMP) based on the EMP prior to the commencement of civil works or construction activities. The contract should specify that the contractor should report monthly on the implementation of the CEMP. PMU will have the overall responsibility for supervising the contractor’s environmental performance, coordinating the public consultations and project GRM, and reporting to ADB through the periodic QPRs and SAEMRs. The PMU will assign a National Environmental Specialist (NES) to supervise the implementation of the EMP. Among the responsibilities of the NES are: (i) review and approval site-specific CEMPs; (ii) monitoring of EMP implementation; (iii) establishment and coordination of GRM; (iv) organization of training in environmental management; and (v) updating of the IEE (if necessary).

11. Public consultations were conducted during the project design and will continue throughout project implementation. Regular public consultations during the construction and operation period are required to be conducted by PMU and the supervision consultant’s environment specialist. Any environmental grievance will be handled in accordance with the GRM established for the project. According to the IEE, a project specific GRM will be established to receive and manage any community concerns, which may arise due to project implementation. PMU, working through the NES, will have final responsibility for GRM management, implementation, and reporting.

12. The budget for EMP mitigation, environment training, update of IEE and EMP, environment supervision and monitoring of environmental parameters during construction and operation, public consultations during construction and operation until Project Completion Report (PCR) were included in the project cost (Works, PMU, and Consulting Services). If there are any changes in project scope or unanticipated environmental and/or social risks and impacts that arise during construction, implementation, or operation of the project that were not 4 considered in the IEE and the EMP, PMU should promptly inform ADB. PMU will (i) assess the significance of any unanticipated impacts, (ii) evaluate the options available to address them, and (iii) prepare or update the IEE and EMP to incorporate these impacts.

Environmental Conditions at Project Sites

13. All facilities proposed for rehabilitation or construction are located within existing compounds of HPEIs and district hospitals, and no land acquisition or involuntary resettlement will be required. Based on information from the Integrated Biodiversity Assessment Tool (IBAT), none of the sites of the proposed subprojects are located in restricted zones of protected areas or biodiversity conservation areas. All the HPEIs and district hospitals are in community zones.

14. There are no major industrial or mobile sources of air pollution in the vicinity of the target facilities, except for occasional movement of vehicles along unpaved roads, which generates dust. Burning of garbage by households is practiced by the community to manage solid wastes, which affects air quality. None of the facilities proposed for development, rehabilitation and upgrading are in areas identified as historical or culturally/archeologically significant areas.

Environmental Impacts and Mitigation Measures

15. Benefits of the project. The project is expected to have a positive impact on the quality of health care in Lao PDR. The students and teachers will directly benefit from better classrooms, school facilities, and dormitories while the population within the adjacent areas of the district hospitals will benefit from better and easily accessible health care. There are also expected benefits to health and sanitation because of improvement in toilets as well water supply and drainage facilities in the HPEIs and district hospitals (DHs).

16. Pre-construction impacts. Potential environmental impacts due to location and design are associated with presence of geological hazards, unexploded ordinance (UXO), cultural/heritage sites, proximity to protected areas, as well as availability and requirements for water supply, sanitation, and drainage. The construction and improvement of HPEIs and DHs will be undertaken within the existing footprint of the facilities. None of the selected facilities are in proximity to any restricted protected areas, and hence, are not expected to induce degradation of biodiversity conservation areas. Moreover, all the facilities will not impact any archaeological or historical sites, and there will be no requirement for land use changes. None are in areas prone to landslides and earthquakes, but still, the buildings will be designed to withstand earthquakes and proper soil analysis will be done to ensure the design of a stable foundation.

17. Concerned local authorities and villagers said that they have not encountered UXO or landmines in the area. The construction will occur in existing facility compounds that have been subject to disturbance and as such the screening for presence of UXO is thereby not necessary. The site condition, components, design configuration and sizes of facilities and other infrastructure facilities needed by the HPEIs and DHs will be evaluated further during detailed design. Moreover, the design will take into consideration flood risks from current and future climate conditions. The design and construction supervision consultant, to be hired by the project, will assess onsite solid and liquid waste improvement requirements and include these in the facility design, as needed, during detailed engineering design phase of the project.

18. Environmental impacts. The construction works will have some minor temporary negative impacts. Risks to community and occupational health and safety and other 5 environmental impacts, such as noise, dust, and pollutant emissions, which will arise from civil works will be minimal and localized since these are confined within a small footprint area in existing HPEI and DH compounds. Impacts include risks to occupational and facility user’s health and safety from construction activities, e.g., the population living and working near open excavations or risks of getting hit by a construction vehicle or equipment. Additional potential impacts include an increased level of noise and dust due to vehicle movement and building construction activities. Given the current situation with the COVID 19 Pandemic, a risk management plan for COVID 19 should also be prepared and implemented during the construction period. There will also be a need to properly dispose the construction debris generated during the construction works. All of the existing facilities have tin roofs and no asbestos containing materials were found.

19. No significant impacts or risks are anticipated during project operation. Facilities will be designed and constructed in accordance with Agreement on Sanitation at Public Health Care Facilities (No. 1667/MOH), issued in 15 August 2018. This Agreement defines, among others, requirements for water allocation and supply, wastewater treatment and discharge, sludge treatment and disposal in health care facilities. It is based on international good practice for healthcare facilities, including but not limited to WHO standards and WB guidelines.4 The facilities will generate waste materials that need to be appropriately managed and handled. The HPEIs will generate non-hazardous or general solid waste that does not pose any particular biological, chemical, radioactive or physical hazard while the PHs and DHs will generate small amounts of infectious waste, pathological waste; chemical and pharmaceutical waste. Waste will be segregated at source in accordance with Decree on Waste Management from Health Care Facilities (No. 1706 /MOH). General waste will be collected and disposed through existing formal channels. Infectious and sharp waste will be stored onsite, until collected by authorized entities for transport, treatment and disposal. All facilities will have onsite pre-treatment facilities for wastewater, and effluent will be discharged and disposed of in accordance with the Government of Lao PDR requirements. All facilities will have access to safe and potable water supply and stable power supply. MOH will ensure that the facilities are properly maintained, as stipulated in the operational manual that will be prepared for the facility. Budget for maintenance of the facilities will be allocated by MOH to ensure their long-term sustainability.

20. Environmental management plan. In general, the short-term construction impacts can be prevented or mitigated with good construction management practices in line with the IFC Environment, Health and Safety (EHS) Guidelines (2007). The EMP shown in Appendix 2 outlines the mitigation measures to prevent or minimize construction impacts such as those related to elevated dust, noise, erosion and sedimentation, and public and worker safety. The EMP sets out the standards and procedures which the civil works contractors must adhere to in order to manage the potential environmental impacts of construction works.

21. Unanticipated impacts. The IEE and EMP have been disclosed on the project website in accordance with the ADB Access to Information Policy (2018). If there are any changes in project scope or unanticipated environmental and/or social risks and impacts that arise during project implementation that were not considered in the IEE and the EMP, the PMU should promptly inform ADB. The PMU will (i) assess the significance of any unanticipated impacts, (ii) evaluate the options available to address them, and (iii) prepare or update the IEE and EMP to incorporate these impacts.

4 WHO. 2018. Essential environmental health standards in health care; World Bank. 2003. Environment and Social Guideline for Health Care Facilities.

I. INTRODUCTION

A. Project Rationale and Description

1. The proposed Quality Health Care Project (QHCP) will support the efforts of the Ministry of Health (MOH) in the 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 to the poor and vulnerable, health indicators and utilization of health services remain low in comparison with the 1 neighboring countries. The HSRS3F was endorsed by the National Assembly in January 2014 and is being implemented in three phases. The strategy, originally aimed to achieve UHC by 2025, has been updated to include the achievement of other health-related Sustainable Development Goals (SDGs) by 2030. Phase II of HSRS (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.

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 (DHs), in line with the increased needs and expectations of the people. The project is also aligned 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. 4F 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).5F

3. The proposed project is aligned with the following impact: UHC by 2025: affordable quality health care for all, especially for rural women and children, achieved (footnote 2). The project will have the following outcome: foundations for high quality health care strengthened and utilization of health services increased.

4. Output 1: Governance mechanisms for quality assurance and CQI enhanced. Under this output, the project will promote governance reforms supportive of quality improvement. First, the project will assist Department of Healthcare and Rehabilitation (DHR) institutionalize a coherent regulatory framework and governance mechanism as the foundation for long-term sustainable quality improvement in health service delivery. The project will support: (i) completing the design of 5G1S quality policy, standards and indicators; (ii) capacity building for QHC committees at central, provincial and district levels on 5G1S quality policy, standards, and indicators; and (iii) developing and operationalizing the Dok Champa health facility accreditation system. Second, the project will support the Department of Health 4 Personnel (DHP) develop a new decree on medical civil servants,6F and the associated

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. 3 ADB. Country Partnership Strategy: Lao People’s Democratic Republic, 2017–2020—More Inclusive and Sustainable Economic Growth; ADB. Country Operations Business Plan: Lao People’s Democratic Republic 2019–2021. 4 The proposed new decree is aligned with the government’s social sector reforms being promoted by the Ministry of Home Affairs (MOHA). 2 implementation guidelines such as on the career path for technical positions, and incentives and hardship allowances for posts in remote and undeserved areas. Third, the project will support knowledge work to advance the HSR Phase III, particularly in assessing the experience of public hospital management reforms towards autonomy and its impact on quality, district hospital readiness in key dimensions of management and control capacity, and measures to strengthen district health management under the Three Builds policy.

5. Output 2: HHR strengthened to deliver quality health services. This output will: (i) develop central and provincial HPEIs; (ii) strengthen health professional licensing; and (iii) build the capacity of health professionals. The project will upgrade the facilities of 5 out of the 7

HPEIs and their practical training sites in provincial hospitals, 7F5 and ensure that they have up-to- date equipment to support quality teaching. A feasibility study will be undertaken in 2021 for building the University of Health Sciences (UHS) Faculty of Medicine. Secondly, the project will help the Healthcare Professional Council (HPC) design and operationalize the health professional licensing and continuous professional development systems; support the Department of Health Professional Education (DHPE) to implement HPEI accreditation and strengthen the linkage between classroom education and practicum training. The third area will build health professional capacity in priority clinical specialties by: (i) supporting local and international fellowships and rotational upskilling; and (ii) facilitating technical partnership with international academic institutions.

6. Output 3: Quality and management of health facilities boosted. This output will help health facilities meet MOH’s new quality standards through: (i) upgrading facilities; (ii) operationalizing quality assessment and CQI; and (iii) enhancing health facility management 6 systems. First, the project will upgrade and equip 16 selected district hospitals in 10 provinces 8F to ensure they have the required physical resources to deliver quality health services. In response to COVID-19 and epidemic preparation, the project will specifically support improving isolation facilities at three provincial hospitals. Second, the project will assist selected health facilities in developing a CQI plan to be implemented under the coordination of hospital QHC committees, and eventually meeting the quality requirements for Dok Champa accreditation. Third, the project will build capacity in district hospital management by (i) piloting a facility health information system in two provinces and four districts with interoperability with the District Health Information System 2; (ii) providing a broad range of trainings on district hospital management, including a 3-month program at UHS and other short-term trainings on selected topics; and (iii) rolling out the patient feedback mechanism and conduct information, education, and communication activities for patients on their entitlements and the new QHC standards.

Methodology for Environmental Assessment

7. The project is classified as Category B for environmental safeguards per the ADB Safeguard Policy Statement (2009) as potential adverse environmental impacts are site- specific, largely reversible, and can be mitigated with effective implementation of an environmental management plan (EMP). As per the Ministry of Natural Resources and Environment (MONRE)/8056 of the Lao Government, the construction of the Health Professional Education Institutions (HPEIs) are not covered by the Ministerial Decree and as such will not require preparation or submission of any environmental safeguards documents,

5 This includes the Colleges of Health Science in Champasak, Luang Prabang, and Savannakhet, the Schools of Public Health in Oudomxay and Xieng Khouang. 6 The hospitals were selected based on provincial health development plans and prioritizes underserved populations. The details are in Supplementary Document X. 3 however, the construction of new facilities for the District Hospitals (DHs) are classified as Category 1 Investment Project and as such would require the preparation of an Initial Environmental Examination (IEE) and submission thereof to District Environment and Natural Resources Office (DONRE). This IEE is sufficient for the purpose.

8. The preparation of this IEE and EMP was based on the guidance provided in ADB’s Safeguard Policy Statement (SPS, 2009), Access to Information Policy (AIP, 2018), IFC-World Bank’s Environment, Health and Safety (EHS) Guidelines (2007), as well as the Government of Lao PDR’s Environmental Protection Law (2013) and other environmental laws, policies, rules and regulations applicable for similar projects.

9. This IEE presents the findings from the assessment of identified facilities to be supported under the project, as presented in Tables 1 and 2 below including the renovation of an office space at the MOH compound at Sisattanack District, Vientiane Capital for use as the PMU Office. The Rapid Environmental Assessment Checklists for the identified target facilities are presented in Annex 1.

10. The assessment focused on the existing environmental and socioeconomic conditions in the project sites and the likely positive and significant negative impacts on the physical, biological, and socio-economic environment. Mitigation measures were developed in the EMP to address identified impacts and risks during design, construction, and operation. Environmental monitoring and reporting, institutional arrangements, and capacity development measures to ensure the implementation of the mitigation measures are outlined in the EMP. 4

II. POLICY, LEGAL AND ADMINISTRATIVE FRAMEWORK

A. ADB’s Environment Safeguards Policies

11. The environment safeguards requirements of ADB are presented in the following guidelines: (i) SPS (2009) and (ii) AIP (2018).

7 12. ADB’s Strategy 20309F emphasizes the pursuit of environmentally sustainable and inclusive economic growth for developing member countries (DMCs) and requires mitigation to address environmental and social impacts of projects. The ADB’s SPS (2009) governs the environmental and social safeguards of ADB’s operations. When a project has been identified for ADB financing, it is screened and categorized to determine the following:

• Significance of potential impacts or risks of the project to the environment; • Level of assessment and institutional resources required to address the safeguard issues; and • Information disclosure and consultation requirements.

13. The Environmental Safeguard Requirements 1 (SR1) of the SPS outlines the requirements for borrowers/clients to meet. These requirements include assessing impacts, planning and managing impact mitigation, preparing environmental assessment reports, disclosing information and undertaking stakeholder consultations, establishing a grievance redress mechanism (GRM), and monitoring and reporting. It also includes specific environmental safeguard requirements pertaining to biodiversity conservation and sustainable management of natural resources, pollution prevention and abatement, occupational and community health and safety, and conservation of physical cultural resources.

14. Every project is initially categorized for potential environmental impacts and risks:

• Category A – if a proposed project is likely to have significant adverse environmental impacts that are irreversible, diverse, or unprecedented; impacts may affect an area larger than the sites or facilities subject to physical works. A full-scale environmental impact assesses (EIA) including an EMP is required. • Category B – if a proposed project’s potential environmental impacts are less adverse and fewer in number than those of category A projects; impacts are site- specific, few if any of them are irreversible, and impacts can be readily addressed through mitigation measures. An IEE, including an EMP is required. • Category C – if a proposed project is likely to have minimal or no adverse environmental impacts. No EIA or IEE is required although environmental implications need to be reviewed. • Category FI – is assigned to projects that involve investment of ADB funds to or through a financial intermediary.

15. There are eleven basic principles in the ADB safeguards policy on environment, which are summarized in Table 3 below.

7 ADB. 2018. Strategy 2030: Achieving a Prosperous, Inclusive, Resilient, and Sustainable Asia and the Pacific. Manila. 5

Table 3: Environmental Safeguard Policy Principles in ADB’ SPS (2009) Environment Policy Principle Requirement Screening and categorization Use of a screening process for each proposed project to determine the extent and type of environmental assessment commensurate with the significance or potential impacts and risks. Environmental assessment Conduct of an environmental assessment for each proposed project to identify potential impacts and risks to environment and people. Alternatives examination Examine alternatives to project’s location, design, technology, and components and their potential environmental and social impacts. Also consider the “no project” alternative. Environmental mitigation and Prepare an EMP that includes the proposed mitigation measures, monitoring plans environmental monitoring and reporting requirements, related institutional or organizational arrangements, capacity development and training measures, implementation schedule, cost estimates, and performance indicators. Consultation and GRM Carry out meaningful consultation with affected people and facilitate their informed participation early in the project preparation process and ensure that their views and concerns are taken into account. Establish a GRM to receive and facilitate resolution of the affected people’s (AP’s) concerns regarding the project’s environmental performance. Public disclosure Disclose the environmental assessment, including the EMP, in a form and language understandable to AP and other stakeholders. EMP implementation and Implement the EMP and monitor its effectiveness. Document the monitoring monitoring results, including corrective actions and disclose the monitoring reports. Protection of critical habitats Do not implement project activities in areas of critical habitats unless (i) there are no measurable adverse impacts on the critical habitat, (ii) there is no reduction in the population of any recognized endangered or critically endangered species and (iii) any lesser impacts are mitigated. If a project is located within a legally protected area, additional programs to promote and enhance the conservation aims of the protected area will be implemented. Pollution prevention and control Apply pollution prevention and control technologies and practices technologies consistent with international good practices as reflected in internationally recognized standards such as the World Bank’s Environmental, Health, and Safety (EHS) Guidelines. Occupational health and safety Provide workers with safe and healthy working conditions and prevent accidents, injuries and diseases in the workplace. Minimize adverse impacts and risks to the health and safety of local communities. Preservation of physical cultural Conserve physical cultural resources and provide a “chance find” resources procedure and conservation approach for materials that may be discovered during project implementation. AP = affected people, EHS = Environmental, Health, and Safety; EMP = environmental management plan, GRM = grievance redress mechanism.

16. Aside from the SPS (2009), ADB also prescribes the Access to Information Policy (2018), which requires consultations, participation, and disclosure of information to enhance stakeholders’ trust in, and ability to engage with, ADB. The policy promotes transparency, 6 accountability, and participatory development. It establishes the disclosure requirements for documents produced or to be produced through ADB assistance. The IEE, EMP, and the environmental monitoring reports (EMRs) of the project are to be disclosed on the ADB website in accordance with the AIP (2018).

17. As a Category B project, the draft IEE report should be available to interested stakeholders before project approval and posted on the ADB’s website upon Board approval of the project, in compliance with the SPS (2009) and the AIP (2018).

B. Legal and Institutional Framework for Environmental Management in Lao PDR

18. The law governing the protection of the environment, including the assessment and management of projects in Lao PDR, is the Environmental Protection Law (EPL), which was issued in 1999 and amended in 2013.

1. Law on Environmental Impact Assessment of Development Projects

19. Decree on Environmental Assessment, No.21/PM, January 2019. The decree is the country’s principal environmental legislation regarding IEE and EIA. It was enacted to implement Part III of the Law on Environment Protection in relation to environmental protection and environmental assessment. The MONRE is the central authority to coordinate with the local agencies and administration to disseminate and enforce this decree. Key features of the decree include the following:

• Each development project in Lao PDR must carry out environmental assessment (EA) in accordance with the content determined in the regulation and any regulation of the concerned line ministry. • All projects must prepare mitigation measures, environmental management and monitoring plan (EMMP), and social management and monitoring plan (SMMP). • Large-scale or complex project with significant impact need to conduct EIA. • Small-scale projects or those with minor environmental impact need to conduct IEE. • Investment projects not listed in the Ministerial Decree MONRE/8056 are not subject to the requirements.

20. Stakeholder consultation is an integral part of the domestic EIA process. The guidelines in the conduct of stakeholder and community consultations, as part of the environmental and social assessment process, are outlined in the Ministerial Instruction on Public Involvement (2012). The guidelines provide the principles and process of engaging and consulting with project stakeholders and project-affected persons (PAPs) in project preparation, design, and implementation. It aims to ensure that stakeholders and PAPs are adequately consulted and provided with the opportunity to articulate their feedback and suggestions on project design and implementation to avoid or mitigate potential impacts on their livelihood and environment.

21. The rehabilitation of existing healthcare facilities and construction of new medical faculty and classroom blocks are not among the investment and development projects and activities requiring an EA, as per Lao PDR environmental regulations. Any project located in protection forests, protected areas, conservation zones, and cultural and historical heritage sites are required to prepare a comprehensive EIA report.

22. During discussions with officials from the DONRE district offices and subsequent clarifications, it was mentioned that the proposed development works (rehabilitation and 7 upgrading of existing health professional education institutions ) under Outputs 2 will not require an EIA or IEE by the MONRE/DONRE as stipulated in MONRE/8056 Investment Project List but all activities must comply with other laws, regulations, and standards on environment, health, and safety. At the minimum, MONRE/DONRE requires the submission of an EMP for the civil works. The EMP included in this IEE has been prepared to comply with MONRE/DONRE requirements. The construction of facilities for the provincial/district hospitals are classified as Category 1 Investment Projects and would require the preparation of an Initial Environmental Examination (IEE) and submission thereof to DONRE. This IEE is sufficient for the purpose.

2. Law on Hygiene, Disease Prevention, and Health Promotion No. 08/NA (2011)

23. This law relates to the organization of activities on hygiene, disease prevention, and promotion of health in order to maintain good health, quality of life, reduce the rates of morbidity and mortality, and ensure access to networks of hygiene and disease prevention for the people.

24. Article 10 of the law provides that the element of hygiene should be present in schools and other educational institutions. Article 18 (Hygiene of Schools and Educational Institutes) prescribes that location of schools and institutions should be kept clean and orderly and that locations should be away from external nuisance, sources of infectious diseases, and other hazards.

25. Under the law, the educational facilities should have:

• sufficient spaces for the number of students; • sufficient light and air ventilation; • sufficient tables and chairs for students; • regular maintenance to ensure cleanliness; • drinking and domestic water coming from water sources such as urban water supply systems, dug wells, rainwater, boreholes, gravity-fed systems, springs, hot springs, rivers, streams, and other sources with assured terms of cleanliness and safety (Article 14); • Water for handwashing; and • Sports grounds and places of rest.

26. The law also prescribes systematic health examinations for pupils and students at least once a year. Article 35 (Health Education) prescribes that organizations involved in health, education, and other organizations (both public and private) are responsible for disseminating and providing health education and knowledge to the population on a regular basis by various means, including inclusion of health education in the school curriculum.

3. Law on Forestry No. 06/NA (2007)

27. This law determines the basic principles, regulations, and measures on sustainable management, preservation, development, utilization, and inspection of forest resources and forest lands. It promotes regeneration and tree planting, increase of forest resources in the country, aiming at maintaining a balance of nature, making forests and forest lands stable sources of living and use for the people, ensuring a sustainable condition and protection of the environment, water resources, protection from soil erosion and maintenance of soil quality, protection of plants, tree species, wildlife, and aquatic life, as well as contributing to national socioeconomic development. 8

28. The Forest Law classifies forests into: (i) conservation forests; (ii) protection forests; and (iii) production forests. The first two are relevant to biodiversity conservation and watershed protection. Protected forests are defined as forests and forest lands classified for the protection of watershed areas to prevent soil erosion. They also include areas of forest land that are significant for national security and areas for protection against natural disaster and protection of the environment. Conservation forests aim to maintain biodiversity and natural forests and landscaped for the development of national parks appropriate for tourism and scientific research. Protected and conservation forests are zoned into: (i) total protection zones, which are closed to entry or harvesting of forest products, plants, or animals; (ii) controlled use zones; and (iii) corridor zones.

4. Decree on Protected Area No. 134/G (May 2015)

29. This decree determines the principles, regulations, and standards related to the establishment, allocation, protection, development, utilization, and inspection of protected areas in order to make the areas become abundant and sustainable by focusing on environmental protection, watershed protection, prevention from erosion, protection of soil quality, protection of strategic zones for national defense and security, adaptation and reduction of climate change, solutions to global warming, contributing to the improvement of the living condition of people of all ethnic groups and the development of the national economy.

30. The government allows the use of protected areas only in an allocated zone which must be used in accordance with related regulation to ensure that there are no negative impacts on forests, quality of soil, and the natural and social environment. The use of protected areas for public benefit are for research and testing, recreation and tourism, source of medicines, and for protection of the watershed, biodiversity, natural and historical environmental and cultural resources. The use of protected areas for the public benefit is permitted by MONRE. Local people who reside in and around protected areas and contribute to the protection and regeneration of forest and non-timber forest products (NTFPs) in the protected areas have the right to use the forest and forest products as determined in the allocation plan of the protected area and related regulation.

5. Law on National Heritage No. 08/PDR (2005)

31. This law provides the regulations and measures for the administration, use, protection, conservation, restoration, and rehabilitation of national cultural, historical, and natural heritage. Any individual is prohibited from causing damage to the national cultural and historical heritage, such as archaeological and anthropological sites, encroaching onto historical sites, occupying land in national heritage conservation areas, and changing the original condition of any heritage.

32. Under the law, the protected area of heritage sites is divided into three zones:

• Zone 1, or the central area where the heritage is located and which must be protected and where no construction is permitted; • Zone 2, or the area surrounding the central area where some activities are permitted to increase the value of zone 1, provided that no damage is caused to the surrounding area; and • Zone 3, or the administrative area where construction is permitted to serve zones 1 and 2 for the accommodation of tourists. 9

6. Law on Water Resources (2013)

33. This law prescribes the regulations related to the protection, administration, exploitation, use, and development of water and water resources, protection against damage to water or water resources, and rehabilitation of affected areas to assure quality and quantity of water to respond to the people’s living requirements. It also prescribes the protection of natural and social environment, river basin management, and flood management. The law covers water diversion, abstraction, impoundment, wastewater discharge, construction along river banks, return of water after use into natural water sources, emergency response during drought, flood, and reservoir safety.

7. Wildlife and Aquatic Law No. 07/NA (2008)

34. The law prescribes the regulations to promote sustainable regeneration and utilization of wildlife and aquatic life, without any harmful impact on natural resources or habitats. It restricts anthropogenic pressure on decreasing species and the extinction of wildlife and aquatic resources by encouraging people to understand and recognize the significance of managing, monitoring, conserving, protecting, developing, and utilizing wildlife in a sustainable manner.

8. Law on Construction No. 197/NA (November 2009)

35. This law prescribes the requirements of all construction activities, including requirements for public works and transportation sector, water supply and sanitation, and flood protection, among others. Individuals or organizations intending to construct, install, repair, or demolish any structure are required to obtain a permit for construction of the project (Article 31) prior to implementation. Article 34 also specifies the requirements on safety during project execution, such as provision of tools for workers (helmets, shoes, gloves, and glass) and measures to be implemented in case of natural calamities at the construction site.

9. Labour Law (2013)

36. This law defines the principles, regulations, and measures on administration, monitoring, labor skills development, recruitment, and labor protection. Section IV of the law prescribes the regulations related to labor protection, safety, and the rights of employees.

10. Law on Handling Petitions 012/NA (December 2014)

37. The Revised Law on Handling Petitions 012/NA or the Grievance Redress Law was approved by the National Assembly on 5 December 2014 and by the President in 2015. The law provides the objectives, principles, and process of applying and handling different types of grievances, petitions, and complaints that may be raised by citizens.

C. Environmental Standards

38. The national environmental standards in Lao PDR are based on the Environmental Protection Law No. 29/NA (December 2012) and PM Decree No. 2734/PMO.WREA (December 2009). The standards on water, soil, air, and noise are set under the decree as basis for environmental monitoring and pollution control. The limits set in these national standards are aligned with international standards such as the World Health Organization (WHO) noise guidelines shown in Table 4. 10

Table 4: Noise Standards in Lao PDR and WHO Guideline Values WHO/EHS Noise Level Lao PDR Noise Standards Guidelines No. Area Daytime Nighttime 06h00 – 18h00 – 22h00 – 07h00 – 22h00 – 18h00 22h00 06h00 22h00 07h00 1. Quiet areas: hospitals, libraries, kindergarten, and 50 45 40 schools 55 45 2. Residential areas: hotels and 55 55 45 houses 3. Commercial and service 70 70 50 areas 70 70 4. Small industrial factories 70 70 50 located in residential areas EHS = Environment, Health, Safety, Lao PDR = Lao People’s Democratic Republic; WHO = World Health Organization.

D. International Conventions

39. Lao PDR is signatory to a number of international conventions, such as:

• Stockholm Conventions on Persistent Organic Pollutants (POPs): Lao PDR signed the Stockholm Convention in 2002 and ratified it in June 2006. The MONRE (previously the Water Resources and Environment Administration or WREA) serves as contact for the Stockholm Convention. A National Implementation Plan (NIP) was prepared with assistance from UNIDO. • Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and their Disposal. Lao PDR became a signatory to the Basel Convention on 21 September 2010. • RAMSAR Convention on Wetlands. Lao PDR is a contracting party to the Ramsar Convention to which it acceded in 2010. It has two sites designated as wetlands of international importance, i.e., Being Kiat Ngong wetlands in Champasak and the Xe Champone wetlands in Savannakhet. Lao PDR pursues an active policy in biodiversity conservation and has taken initiatives to support wetlands conservation and sustainable use. • Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). Lao PDR was a signatory to CITES, which entered into force on 1 July 1975. • Kyoto Protocol and the United Nations Framework Convention on Climate Change (UNFCC). The latter was ratified by Lao PDR in 1995 and the Kyoto Protocol in 2003. The national strategy of Lao PDR on climate change builds on the country’s commitment to the UNFCC. • Rotterdam Convention on Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade. Lao PDR became the 157th party to the Rotterdam Convention on 10 September 2010. • Vienna Convention for the Protection of the Ozone Layer. Lao PDR became a signatory to the Vienna Convention on 19 November 1998. 11

III. DESCRIPTION OF THE PROJECT

40. Improving attitudes and raising the standard of service delivery and clinical care among health professionals is a priority for improving the health of the Lao PDR population. While there are now national indicators in Lao PDR, the majority of them have focused, to date, on structural elements of care, such as staffing levels and infrastructure.

41. Building on the work already carried out under the Health Sector Governance Program (HSGP), the proposed Lao Quality Health Care Project (QHCP) will provide continued support to Phase III of the Health Sector Reform (HSR) with a focus on the improvement of quality of care and patient satisfaction with health services.

42. The QHCP will contribute to the SDGs of improving the health status and reducing poverty of the Lao PDR population by (i) improving Primary Health Care (PHC) delivery in eight Northern provinces, and (ii) strengthening capacity for health system development. 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.

43. The infrastructure development works proposed in the project consist of the upgrading of existing facilities and/or construction of new facilities and will contribute to one of the three expected outputs in the QHCP, specifically Output 2: HHR strengthened to deliver quality health services and Output 3: Quality and Management of Health Facilities Boosted. Tables 5 and 6 presents the target facilities that Is within the scope of the project and a summary of the proposed development works that will be undertaken in the target facilities. It is also proposed that an office at the MOH Compound at Sisattanack District, Vientiane Capital be renovated for the 8 Project PMU Office10F . Annex 2 presents the land titles to the sites where the development works in the target facilities will be undertaken.

Table 3: Health Professional Education Institutions (HPEIs) and Summary of Works Province Facility Civil Works Champasak College of Health Science Demolish and construct 21 room teaching block (Ban Saphanxay Campus) Savannakhet College of Health Science Repair campus library Demolish and construct 18 room dormitory Xieng Khouang School of Public Health New auditorium and staff office Construct 17 room dormitory Oudomxay School of Public Health Construct 17 room dormitory

Table 4: Health Facilities, District and Provincial Hospitals and Summary of Works Province District Facility Civil Works Phongsaly Mai District Hospital Construct DH Oudomxay Xay Provincial Hospital Renovate hospital - Construct isolation and treatment facility in existing PH

8 The proposed development would involve the renovation of existing office including minor works such as replacement of doors, electrical system, toilets and repainting of the office. These will done within the premises of the existing facility without requiring any additional land. 12

Province District Facility Civil Works Beng District Hospital Renovate hospital, refurbish technical block Houn District Hospital Renovate hospital, refurbish technical block Luang Prabang Luang Prabang Provincial Hospital Construct isolation and treatment facility in existing PH Nambak District Hospital Renovate hospital, refurbish technical block 9 Phoukhoun District Hospital (Type B)11F Renovate hospital, refurbish technical block Houaphanh Houamuang District Hospital Construct DH Sayaboury Paklay District Hospital Renovate hospital, refurbish technical block Boten District Hospital Construction DH Xieng Khouang Mok District Hospital Renovate hospital, refurbish technical block Phaxay District Hospital Renovate hospital, refurbish technical block Savannakhet Kaysone Provincial Hospital Construct isolation & treatment facility in existing PH Nong District Hospital Renovate hospital, refurbish technical block 10 Songkhone District Hospital (Type A)12F ; Renovate hospital, refurbish technical block Salavan Lao-Ngam District Hospital Construct DH Champasak Paksong District Hospital Renovate hospital, refurbish technical block Moulapamok District Hospital Renovate hospital, refurbish technical block Xaisomboun Hom District Hospital Construct DH DH = District Hospital, PDD = Priority Development District, PH = Provincial Hospital.

44. The location map of the target facilities is in Figure 1.

9 District Type B hospitals are not yet capable of providing basic emergency obstetric care (BEmOC) and have a more limited capacity to provide minor surgery. 10 District Type A hospitals are resourced and capable of providing basic emergency obstetric care (BEmOC) and have the capacity to provide surgery requiring anesthesia. 13

Figure 1: Location Map of Target Facilities

P.PHONGSALI

M.Mai Ñ P.LUANGNAMTHA M.Xai Ñ;; MÑ .Nambak P.BOKEO M.Beng P.HOUAPHAN Ñ P.OUDOMXAI M.Hoon Ñ Ñ P.LOUANGPHABANG # ;Ñ # M.Phoukhoun M.Pek Ñ # Ñ; # Ñ M.Mok-Mai M.Phaxai Ñ Sayso#mboun P.BOLIKHAMXAI P.XAYABURY Ñ P.VIENTIANE M.Hom M.Paklai Ñ # # Ñ P.KHAMMOUAN M.Sisattanak M.Boten VIENTIANE Capital

P.SAVANNAKHET M.Nong M.KaysoneÑ; Ñ Ñ M.Songkhon P.SALAVAN M.Lao-Ngam Ñ P.XEKONG M.Pakse Ñ P.CHAMPASAK M.Khong M.Pakxong Ñ P.ATTAPU

Provincial Hospital Isolation Ward District Hospital Provincial Hospital Isolation Ward and Health Professional Education Institution Health Professional Education Institution PCU Office

A. Facility Design

45. The site layout plan for the Project is based on the analysis of the entire composition of the facility, giving full consideration to site conditions, such as the natural conditions, the conditions of the existing facilities and the surrounding area. The results of the physical inspection of the existing facilities shall also be considered for the new site layout plan.

46. Common elements in the layout plan for all sites must include (i) harmony of the scenery with the surroundings; (ii) no obstruction in the existing flow line; (iii) smooth flow and ease in the use of the completed facility; (iv) no negative impact on the surrounding environment; and (v) safety during the construction period.

47. The following matters are the basic concept for the zoning and flow plan of the facilities.

(i) The layout and flow between the classroom block and the auditorium shall be considered for a rational layout plan ensuring the functions incorporated with each facility. (ii) In some of the HPEIs, dormitories mingle with academic facilities, within the target sites. It has been considered to rearrange the zoning and separate academic and non-academic areas within the range of possibility, to improve the educational environment. (iii) The site layout of the facilities needs to be designed with consideration of the climate in Lao PDR, to incorporate proper ventilation and natural lighting without using mechanical devices, as well as controlling strong sunlight throughout the year by the use of louvers.

1. Key design codes*

• Compliance standards

The architectural plan must comply with Lao's building standards and with international standards such as BS and Japanese standard that are generally applied to Lao design.

• Facility standards, Environment and safety standards

Facilities will be designed and constructed in accordance with Agreement No. 1667 of Ministry of Health, issued in 15 August 2018. This Agreement defines, among others, requirements for water allocation and suppl, wastewater treatment and discharge, sludge treatment and disposal in health care facilities. It is based on international good practice for healthcare facilities, including but not limited to WHO standards and WB guidelines.11 Waste will be managed in accordance with Decree on Waste Management from Health Care Facilities (No. 1706 /MOH).

*As this is the concept design stage of the architectural design, this IEE can only describe outlines of the requirement complying with some major codes.

11 WHO. 2018. Essential environmental health standards in health care; World Bank. 2003. Environment and Social Guideline for Health Care Facilities. 15

2. Flood risks, seismic risk, and design adjustment

48. As a result of the field survey, it can be judged that there is no significant flood risk in each area. According to the interviews conducted with each target facilities, there was no flood in the past.

49. According to the record, Lao PDR did not have a measurable earthquake. Other loads and imposed loading will be set according to the meteorological condition and soil conditions of each site. For new construction works, the superstructure shall be made of reinforced concrete frames, and the walls are to be made of brick, which are economical and materials widely used in Lao PDR. For renovation works, only buildings judged as structurally sound are selected. Therefore, the basic structure will not be changed, and reinforcement will be considered if required.

3. Key green design features

50. Lao PDR is hot and humid being located in the temperate monsoon zone, on the south side of the Tropic of Cancer. Therefore, it is essential to secure natural ventilation and mitigate severe sunlight for the building design. For the planning of elevation and cross-section of the building, the following basic policies are considered:

• The roof should be sloped to provide protection from sun radiation and direct sunlight, and to have positive protection from heavy rainwater. • Deep eaves and louvers can help to protect rooms from direct sunlight and intense rainfall.

51. Adequate openings to facilitate room ventilation and provide balanced natural lighting, and also to reduce the running cost of electrical lighting and equipment shall be secured. In order to achieve natural ventilation during the heavy rains, ventilation blocks and louvers shall be used.

52. Figures 2 to 6 show the standard design/drawings for health facilities while Figures 7 to 8 presents the standard design/drawings for Health Professional Educational Institutions (HPEIs). The standard design/drawings will be revised during the detailed engineering design to adapt to individual site conditions. 16

Figure 2: Standard Design/Drawings for Health Facilities

Figure 3: Standard Design/Drawings for Health Facilities

Figure 4: Standard Design/Drawings for Health Facilities

Figure 5: Standard Design/Drawings for Health Facilities

Figure 6: Standard Design/Drawings for Health Facilities 21

Figure 7: Standard Design/Drawings for HPEIs 22

Figure 8: Standard Design/Drawings for HPEIs

B. Project Management Arrangements

1. Project Implementation Organizations

a. Executing Agency

53. MOH, through the Department of Planning Cooperation (DPC), will be the executing agency (EA) for the QHCP, responsible for overall implementation and coordination. The MOH Steering Committee, chaired by the Minister of Health and comprising vice-ministers and director generals of MOH departments, will provide overall guidance in project implementation. The Ministry of Finance (MOF), the Ministry of Planning and Investment (MPI), and other ministries will be invited to the steering committee, as required.

b. Project Management and Implementation

54. The Project Director will be the Director of DPC, who will be assisted by a Project Deputy Director and a Project Management Unit (PMU). The MOH will establish the PMU in the DPC. The PMU will: (i) provide overall project coordination; (ii) coordinate with departments and other agencies; (iii) coordinate with IAs in the preparation of project annual plans and budgets; (iv) provide guidance, support, and capacity building to the IAs; (v) monitor social and environmental safeguards; (vi) ensure that ADB requirements are being complied with; (vii) monitor project implementation progress; (viii) submit quarterly progress and financial reports; (ix) process the procurement of major civil works and goods and services; (x) hire consulting services (including a national environment specialist and site superintendents); (xi) coordinate the project grievance redress mechanism (GRM); and (xii) handle administrative and financial management. The project will support the recruitment of a planning, budgeting, and M&E officer and one private firm for accounting services. It will also recruit administrative and office staff including a chief administrator, an administrative assistant, a procurement assistant, a cashier, a secretary, a driver, and a cleaner.

55. Within MOH, project implementation will be under the responsibility of concerned departments acting as the national implementing agencies (IAs), including Cabinet, DHR, Department of Health Personnel (DHP), Department of Health Professional Education (DHPE), Department of Finance (DOF), Department of Planning and Cooperation (DPC), UHS, and HPC. Provincial health offices (PHOs) in the five provinces of Oudomxay, Luang Prabang, Xieng Khouang, Savannakhet, and Champasak will act as provincial IAs. The IAs will assign department staff to the project and will be responsible for planning, budgeting, implementing, and reporting on project activities within their responsibilities including financial management. The PMU will provide project management and financial training and will provide guidance to IAs, as required. Monthly meetings between the EA and IAs will be conducted to review project implementation and report progress to the MOH Steering Committee (SC). The PMU and IAs will prepare a project management manual establishing project management and implementation procedures and responsibilities. The accounting firm will prepare a project financial management manual (FMM).

56. Table 7 presents the project implementation organizations and their respective roles and responsibilities while Figure 9 presents the organizational structure.

Table 7: Project Implementation Organizations – Roles and Responsibilities Project Implementation Organizations Management Roles and Responsibilities (i) Establish a Project Management Unit (PMU); (ii) Coordinate and disburse resources and oversee the execution of the investment activities; (iii) Identify staff to support project implementation; (iv) Approve annual operation plans; (v) Consolidate accounts and submit withdrawal applications (WAs); (vi) Manage the advance accounts; (vii) Facilitate the recruitment of international and national consultants in accordance with ADB and Government procedures; (viii) Provide the key MOH departments/IAs with training in project budgeting and financial management as part of capacity building support for the IAs; (ix) Submit all audited project accounts and financial statements to ADB within six months after the end of each fiscal year; (x) Ensure compliance with covenants and safeguards; (xi) Undertake M&E of project activities on a regular basis and submit to ADB a quarterly progress report; (xii) Update procurement plan and monitor procurement processes; (xiii) Supervise the design and implementation of the baseline and endline Ministry of Health (MOH) through survey and submit to ADB a project completion report by project the Department of Planning and closing; Cooperation (DPC) – Executing (xiv) Coordinate among MOH, ADB, development partners, and other Agency stakeholders (e.g. civil society organizations, Lao Women’s Union). (i) Oversight of project implementation; (ii) Overall guidance on efficient and effective project implementation; (iii) Convening six-monthly meetings to review project implementation progress and resolve constraints to project implementation; MOH Steering Committee (SC) (iv) Inviting MOF, MPI, and other ministries to participate in SC meetings, chaired by the Minister of Health as required. Implementing Agencies: (i) Prepare annual project operational plan of action and budget; MOH – Cabinet, DHR (including (ii) Implement project activities; HPC), DHP, DHPE, DOF, DPC (iii) Participate in monthly project meetings and report on progress, UHS constraints, issues; PHOs in Oudomxay, Luang (iv) Prepare monthly activity reports and quarterly progress reports; Prabang, Xieng Khouang, (v) Manage project funds and prepare financial reports submitted to the Savannakhet, and Champassak finance unit of the PMU. (i) Strengthen district health management under the Three Builds policy; (ii) Assess the experience of public hospital management reform towards autonomy and its impact on quality; Cabinet (iii) Develop a strategy and roadmap for the reforms. (i) Strengthen governance for QHC by operationalizing inclusive health quality committees for CQI at appropriate levels, standards and indicators to measure quality, and the health facility accreditation system; (ii) Provide training on the 5G1S quality standards and helping each facility DHR (including HPC) to develop a quality improvement plan for implementation under the coordination of hospital quality committees; (iii) Roll out of the health facility accreditation system. (iv) Raise the standards of new and existing health professionals through professional licensing, requirements for CPD, and license renewal (v) Operationalize the health professional licensing and the design of the CPD system. 25

(i) Promote HHR reforms aligned with the government’s social sector reforms being promoted by Ministry of Home Affairs (MOHA), such as the design a career path for technical positions, attaching posts to facilities, improve staff distribution, institutionalize mechanisms for retrenchment and contractual staff, and place performance-based incentives and hardship allowance for remote district hospital and health center posts in effect; DHP (ii) Upgrade health personnel MIS functions. (i) Coordinate capacity building in specific clinical specialties by supporting local and international fellowships and facilitating technical partnership with international academic institutions; (ii) Coordinate development of central and provincial HPEIs; DHPE (iii) Roll out of HPEI accreditation. Strengthening PFM through provision of capacity development and enhancement in financial management system (DOF training of health DOF institutions in accounting). (i) Exercise overall project management and coordination with PMU; (ii) Manage the sub-account for the project; (iii) Renovate, upgrade, equip central and provincial health HPEIs in collaboration with DHPE; (iv) Upgrade selective facilities to improve access to quality health services in underserved populations in the five provinces and procure necessary equipment for the delivery of essential health care services in collaboration with DHR; (v) Pilot a facility health information system (FHIS) with interoperability with DPC the District Health Information System 2 (DHIS2). (i) Develop continuous professional development (CPD) competency- based curriculums; (ii) Train of teachers in HPEIs and teaching hospitals; (iii) Develop Teaching Management Committee (TMC) and Medical UHS Teaching Unit (MTU). (i) Produce annual operation plans for project activities; (ii) Implement activities supported by the project regarding development of provincial HPEIs, capacity building of health professionals, CQI, and upgrade of health facilities to deliver quality health services; (iii) Administer sub-accounts; PHOs in Oudomxay, Luang The organization of the project in the PHOs will follow their organizational Prabang, Xieng Khouang, chart. The Provincial Director will be Project Director. The PHO departments Savannakhet, and Champassak will conduct the project activities. (i) Oversee all aspects of project administration, issuing no-objection letters (NOLs) to procurement requests from the EA, monitoring contract awards and disbursements, reviewing work plans and progress reports; (ii) Undertake six-monthly and midterm reviews of the project; (iii) Monitor the selection of consultants, including in the preparation of terms of reference, advertisement, and selection, and provide ADB assistance during contract negotiations. 5G1S = 5 goods 1 satisfaction, ADB = Asian Development Bank, CPD = continuous professional development, CQI = continuous quality improvement, DHP = Department of Health Personnel, DHR = Department of Healthcare and Rehabilitation, DOF = Department of Finance, DPC = Department of Planning and Cooperation, EA = executing agency, FFM = fact finding mission, HPC = Healthcare Professional Council, HPEI = health professional education institution, HPMIS = health personnel management information system, IA = implementing agency, MOF = Ministry of Finance, MOH = Ministry of Health, MOHA = Ministry of Home Affairs, MPI = Ministry of Planning and Investment, MTU = Medical Teaching Unit, PMU = project coordination unit, PFM = public financial management, PHO = Provincial Health Office, SC = steering committee, TMC = Teaching Management Committee Source: Asian Development Bank.

Figure 9: Project Organizational Structure

MPI MOH MOF Executing Agency through DPC

MOH Steering Committee Chair: MOH Minister Members: DGs of MOH Departments DPC DG is Project Director

PMU in in DPC Government staff • Project director • Project deputy director • Technical staff • Administrative staff • Coordinators

Consultants • Project management • Procurement • Civil works • Finance • Safeguards and Gender

Implementing Agencies, Central Level Departments of Cabinet, DHR (including HPC), DHP, DHPE, DOF, DPC, UHS Implementing Agencies, Provincial Level Provincial Health Offices of Government staff in each IA for project management ODX, LPB, XKH, SVN, CPS • 1 IA executive staff • 2 IAs technical staff Government staff in each IA for project management Department staff conduct project activities • Provincial Director • 2 IAs technical staff Project support staff PHOs staff conduct project activities • Finance staff if required Project support staff Consultants • Finance staff if required • International and national technical consultants posted in IAs

IV. DESCRIPTION OF THE ENVIRONMENT

A. Overview

57. Lao People’s Democratic Republic (Lao PDR), a landlocked country in Southeast Asia, located between latitudes 14° and 23°N and longitudes 100° and 108°E. The nation, which shares borders with five other countries, lies in the lower Mekong basin of the Indochina Peninsula. The country stretches 1,700 km from north to south and 100 to 400 km from east to west, with a total surface area of 236,800 km2. About 80 percent of the country's land area is mountainous. The remaining 20% is low lying plain along the Mekong River and threatened by annual floods. The altitude ranges from 104 m above sea level in Attapeu to 2,820 m in Xieng Khouang, at Phoubia Mountain. More than two-thirds of Lao PDR's people live in the southern and central parts of the country.

58. Lao PDR is endowed with abundant natural resources, such as water, forests, minerals and biodiversity. Relative to other Asian nations many of these assets remain in a comparatively healthy state. However, since the turn of the 21st century development and exploitation of natural resources has accelerated, including construction of a cascade of new hydropower dams on the Mekong and its tributaries.

59. Lao PDR’s topographic, landlocked, location makes the country heavily dependent on road transportation for trade and economic growth. Notably through East-West and North-South economic corridors connecting Lao PDR with its Southeast and East Asian neighbors.

60. Lao PDR is classified as a lower middle-income country with a GDP of $17 billion and a total population of 6.9 million people in 2017. According to the Ministry of Planning and Investment, the per-capita income grew from $490 in 2005 to $1,069 in 2010, highlighting the pace of change. There is an evident shift from agricultural towards the service sector, but agriculture remains the dominant employer, accounting for 73% of the labor force in 2012.

61. Flood and drought events occur frequently in Lao PDR. Poverty and malnutrition remain prevalent (Table 8) and with such a large proportion of Lao PDR’s population relying on agricultural activities as the primary source of livelihood, climate change is likely to impact on the country and its inhabitants strongly. In 2016, Lao PDR ratified its Nationally Determined Contribution (NDC) to the Paris Climate Agreement and launched its climate change action plan.

Table 8: Key indicators for Lao PDR Indicator Value Source Population undernourisheda 17.1% (2014–2016) FAO, 2017 National poverty rateb 23.2% (2012) ADB, 2018a Share of wealth held by bottom 20%c 7.6% (2012) World Bank, 2018 Net annual migration rated -0.55% (2010–2015) UNDESA, 2017 infant mortality rate (between age 0 and 4.73% (2010–2015) UNDESA, 2017 1)ERROR! BOOKMARK NOT DEFINED. average annual change in urban populatione 1.93% (2010–2015) UNDESA, 2018 Dependents per 100 independent adultsERROR! B 93.5 (2015) UNDESA, 2017 OOKMARK NOT DEFINED. Urban population as % of total populationf 35% (2018) CIA, 2018 external debt ratio to GNIg 93.1% (2016) ADB, 2018b 28

Indicator Value Source government expenditure ratio to GDPERROR! B 21.6% (2017) ADB, 2018b OOKMARK NOT DEFINED. ADB = Asian Development Bank, CIA =Central Intelligence Agency, FAO = Food and Agriculture Organization, GNI = gross national income, UNDESA = United Nations Department of Economic and Social Affairs. a FAO, IFAD, UNICEF, WFP, WHO (2017) The state of food security and nutrition in the world. Building Resilience for peace and food security. FAO. Rome. b ADB (2018a) Basic Statistics 2018. Available at: https://www.adb.org/publications/basic-statistics-2018 (accessed 11/01/19). c World Bank (2018) Income share held by lowest 20%. Available at: https://data.worldbank.org/indicator/SI.DST.FRST.20 (accessed on 11/01/19). d UNDESA (2017) World Population Prospects 2017. Available at: https://population.un.org/wpp/Download/Standard/Population/ (accessed on 11/01/19). e UNDESA (2018) World Urbanization Prospects 2018. Available at: https://population.un.org/wup/Download/ (accessed on 11/01/19). f CIA (2018) The World Factbook. Central Intelligence Agency. Washington DC. g ADB (2018b) Key Indicators for Asia and the Pacific 2018, 49th Edition. Asian Development Bank.

B. Climate

62. Lao PDR is characterized by a tropical climate, influenced by the southeast monsoon which brings 70% of annual rainfall and high humidity. Two distinct seasons are evident: the rainy season, or monsoon, from May to mid-October, which is followed by a dry season from mid-October to April (Figure 10). Average rainfall can be as high as 3,000 mm per year. Mean annual temperatures of 20°C are observed in the northern and eastern mountainous areas and the plateaus, whereas temperatures are higher in the plains at 25-27°C.

16 Figure 10: Average Monthly Temperature and Rainfall in Lao PDR (1901–2016)13F

63. Based on the country’s altitude, Lao PDR can be divided into three different climatic zones. The northern mountainous areas above 1,000m have a montane temperate and hilly sub-tropical climate. Here, temperature ranges are lower than the rest of the country. The central mountainous areas in the Annamite Chain vary in altitude between 500 to 1,000 m and are characterized by a tropical monsoonal climate with high temperatures and average rainfall totals. More than 50% of the population lives in the tropical lowland plain and floodplains along the Mekong River and its main tributaries.

16 World Bank Climate Change Knowledge Portal (2018). Climate Data: Historical. URL: https://climateportal.worldbank.org. 29

64. Temperature and precipitation rates have been shown to be sensitive to El Niño Southern Oscillation, but generally to a lesser extent when compared to other Southeast Asian 17 nations.14F

65. Temperate trend, future projections. Lao PDR’s Second National Communication to the UNFCCC reports that data limitations obscure and add uncertainty to the evaluation of historical temperature changes. Utilizing the Berkeley Earth Dataset, the rise in temperatures in the vicinity of Vientiane can be estimated at around 1.03oC between the periods 1900–1917 and 2000–2017. The dataset suggests warming has accelerated rapidly since the turn of the 21st century in all regions of Lao PDR.

66. Temperature rises in Lao PDR are expected to be broadly in line with the global average. Recent climate models point to a rise of around 3.6oC by 2080–2099 over the 1986– 2005 baseline under the highest emissions pathway (RCP8.5). This reduces to 1.2oC under the lowest emissions pathway (RCP2.6). Rises in monthly and annual minimum and maximum temperatures are expected to be more rapid than the rise in average temperature, with monthly minimum temperatures typically rising 10–20% faster. While uncertainty in the seasonal variation of temperature rises remains high, rises are projected to be greatest in the hottest months of April and May.

67. Precipitation trend, future projections. Lao PDR’s Second National Communication to the UNFCCC reports a transition in the country’s precipitation regime over the 20th century towards more intense precipitation periods, with the frequency of months of more than 600 mm rainfall increasing. Patterns of precipitation remain influenced by the complex relationship 18 between Southeast Asian climate and El Niño Southern Oscillation. 15F

68. While considerable uncertainty surrounds projections of local long-term future precipitation, some global trends are evident. The intensity of sub-daily extreme rainfall events appears to be increasing with temperature, a finding supported by evidence from different 19 regions of Asia and already documented in Lao PDR. 16F Recent climate models suggest that the average largest 5-day cumulative rainfall could increase from around 135 mm to over 150 mm under RCP6.0 and RCP8.5. However, as this phenomenon is highly dependent on localized geographical contexts and has a complex relationship with the El Niño Southern Oscillation, further research is required to constrain its impact in Lao PDR.

69. Air quality. There are no major industrial or mobile sources of air pollution in the vicinity of the hospitals and HPEIs, except for occasional movement of vehicles along unpaved roads which generates dust. Burning of garbage by households is practiced by the communities to manage solid wastes which affects air quality.

17 Villafuerte, M. Q., & Matsumoto, J. (2015). Significant influences of global mean temperature and ENSO on extreme rainfall in Southeast Asia. Journal of Climate, 28(5), 1905–1919. Thirumalai, K., DiNezio, P. N., Okumura, Y., & Deser, C. (2017). Extreme temperatures in Southeast Asia caused by El Niño and worsened by global warming. Nature Communications, 8, 15531. 18 Räsänen, T. A., Lindgren, V., Guillaume, J. H. A., Buckley, B. M., & Kummu, M. (2016). On the spatial and temporal variability of ENSO precipitation and drought teleconnection in mainland Southeast Asia. Climate of the Past, 12(9), 1889–1905. 19 Westra, S., Fowler, H. J., Evans, J. P., Alexander, L. V., Berg, P., Johnson, F., Kendon, E. J., Lenderink, G., Roberts, N. (2014). Future changes to the intensity and frequency of short-duration extreme rainfall. Reviews of Geophysics, 52, 522–555. 30

70. Noise. Similarly, there are no major sources of noise in the vicinity of the hospitals and HPEIs.

C. Natural Hazard Risks

71. Lao PDR faces high disaster risk levels and is ranked 74 out of 191 countries by the 2019 Inform Risk Index (Table 9). Lao PDR has extremely high exposure to flooding (ranked 6th), including, riverine and flash flooding. Lao PDR also has some limited exposure to tropical cyclones and their associated hazards (ranked 47th). Drought exposure is lower (ranked 115th) but must be monitored as hydropower development on the Mekong river significantly alters the hydrology of the region. Lao PDR’s overall ranking on the INFORM risk index is somewhat exacerbated by its lack of coping capacity and to a lesser extent the vulnerability of its population.

Table 9: Selected indicators from the INFORM 2019 Index for Risk Management for Lao PDR Lack of Overall Tropical Flood Drought Vulnerability Coping Inform Rank Cyclone Capacity Risk Level (0–10) (0–10) (0–10) (0–10) (0–10) (0–10) (1–191) 9.1 [4.5] 3.5 [1.7] 2.5 [3.2] 3.7 [3.6] 6.1 [4.5] 4.2 [3.8] 74 Note: For the sub-categories of risk (e.g. “Flood”) higher scores represent greater risks. Conversely the most at- risk country is ranked 1st. Global average scores are shown in brackets.

72. Heat waves. Lao PDR regularly experiences high temperatures, with an average monthly maximum of around 28oC and an average May maximum of 31°C. The current median probability of a heat wave (defined as a period of three or more days where the daily 20 temperature is above the long-term 95th percentile of daily mean temperature) is around 3%.17F

73. Droughts. Two primary types of drought may affect Lao PDR, meteorological (usually associated with a precipitation deficit) and hydrological (usually associated with a deficit in surface and subsurface water flow, potentially originating in the region’s wider river basins). At present Lao PDR faces an annual median probability of severe meteorological drought of around 4%, as defined by a standardized precipitation evaporation index (SPEI) of less than -2. Climate models point towards an increased annual likelihood of drought, potentially rising to 6– 11% by 2080–2099.

74. Floods. The World Resources Institute’s AQUEDUCT Global Flood Analyzer can be used to establish a baseline level of river flood exposure. As of 2010, assuming protection for up to a 1-in-25-year event, the population annually affected by flooding in Lao PDR is estimated at 48,000 and the expected annual damages is $159 million. There are eight rivers that have been identified to have past history of flooding in Lao PDR. These rivers include Nam Ou, Nam Ngum, Nam Ngiep, Nam Xan, Xe Bang Fai, Xe Banghiang, Xe Don, and Xe Kong. Districts located in these eight river basins are prone to flooding with different water levels and areas of 21 inundation.18F

20 World Bank Climate Change Knowledge Portal (2018). Climate Data: Projection. URL: https://climateportal.worldbank.org. 21 Ibid. 31

75. The hospitals and HPEIs are not located in close proximity to any of these major rivers. There are also no hospitals or HPEIs located less than 1 km from the Mekong River. There are other hospitals and HPEIs close to small rivers only, some of which have intermittent flows. The risks of flooding at project facilities is considered low and there is no history of floods at these sites. This will be evaluated further by the technical team during detailed design.

76. Earthquake: The areas in Xayabury, Bokeo, Oudomxay, Luang Namtha and Phongsaly provinces are in the high earthquake hazard zone. About 30% of the country is located in 22 moderate earthquake hazard zone and 43.62% falls in the low earthquake risk zone.19F

77. The provinces of Oudomxay and Luang Namtha are located in the moderate to high seismic risk zones with earthquake intensity VII of the Modified Mercalli scale. Parts of Luang Prabang, Houaphan, and Vientiane are in the moderate-low seismic risk zone which may expect intensity V and less. The remaining regions fall under the low seismic risk. Given these information, the soil subsurface structure of the hospital sites in Oudomxay, Luang Namtha, Luang Prabang, Houaphan and Vientiane will be evaluated further during detailed design to ensure the stability of the foundation and that the structures are able to withstand strong magnitude earthquake.

78. A map of seismicity and other hazards in Lao PDR from the UN Office for the Coordination of Humanitarian Affairs (OCHA) is in Figure 11.

Figure 11: Seismicity and Other Hazards in Lao PDR

22 National Risk Profile of Lao PDR. National Disaster Management Committee. Government of Lao PDR. November 2010. 32

79. Landslide. About 5.24% of the country is susceptible to landslides and a large part is located in low to medium landslide susceptibility zones. The areas highly prone to landslides are 23 localized in the southeast and central part of Lao PDR. 20F No HPEI or hospital targeted by the project reported occurrences of landslides in the vicinity of their compounds.

D. Ecological Resources

80. Forests. Lao PDR’s forests consist of a set of different forest types. There are subtropical montane forest areas in the north, lowland semi-evergreen dipterocarp forest on the 24 Mekong River Plain, and dry dipterocarp forest in the southern area. 21F The ecosystem services provided by forests have been noted as particularly important to poorer smallholder farmers. Forests provide resilience to the high inter-annual variability in success of rain-fed agriculture by 25 diversifying incomes.22F

81. Lao PDR’s forests are still exploited in an unsustainable way, particularly through both poorly managed legal and illegal logging. Another barrier towards sustainable forestry is the culture of deforestation, which compromises the long-term sustainability of the landscape and 26 the livelihoods of rural communities, especially in the context of climate change impacts.23F Recent years have seen rapid expansion of rubber monocultures and associated declines in 27 farmer income diversification.24F This is an example of a transition which reduces resilience to 28 climate and other shocks25F as well as degrading the biodiversity of the ecosystem.

82. Ecological resources, protected sites. Based on information from the IBAT, none of the hospitals or HPEIs targeted by the project is located in any restricted zones of protected area or biodiversity conservation areas.

E. Socio-economic Conditions

83. Human health. The World Food Programme estimates that without adaptation the risk of hunger and child malnutrition on a global scale could both increase by 20% by 2050.29 Springmann et al. assessed the potential for excess, climate-related deaths associated with malnutrition.30 The authors identify two key risk factors that are expected to be the primary drivers: a lack of fruit and vegetables in diets, and health complications caused by increasing prevalence of people underweight. The authors’ projections suggest there could be

23 Ibid. 24 FAO. 2010. Global Forest Resources Assessment 2010. 25 Russell, A., Foppes, J., Behr, D., Ketphanh, S., Rafanoharana, s.. 2015. How Forests Enhance Resilience to Climate Change: The Case of Smallholder Agriculture in Lao PDR. Washington DC: Program on Forests (PROFOR) 26 IDA. 2014. Country Partnership Strategy Progress Report for Lao People's Democratic Republic. 27 Fox J., Castella Jean-Christophe, Ziegler A.D., W. S. B. (2014). Expansion of rubber mono-cropping and its implications for the resilience of ecosystems in the face of climate change in Montane Mainland Southeast Asia. In Trends and directions of land change sciences towards regional and global sustainability. Global Environmental Research 28 Brown, P. R., Afroz, S., Chialue, L., Chiranjeevi, T., El, S., Grünbühel, C. M., … Williams, L. J. (2018). Constraints to the capacity of smallholder farming households to adapt to climate change in South and Southeast Asia. Climate and Development, 0(0), 1–18. 29 WFP (2015) Two minutes on climate change and hunger: A zero hunger world needs climate resilience. The World Food Programme. 30 Springmann, M., Mason-D’Croz, D., Robinson, S., Garnett, T., Godfray, H. C. J., Gollin, D., … Scarborough, P. (2016). Global and regional health effects of future food production under climate change: a modelling study. The Lancet: 387: 1937–1946 33 approximately 53.8 climate-related deaths per million population linked to lack of food availability in Lao PDR by the year 2050 under RCP8.5.

84. Heat-related mortality. Research has placed a threshold of 35°C (wet bulb ambient air temperature) on the human body’s ability to regulate temperature, beyond which even a very short period of exposure can present risk of serious ill-health and death.31 Temperatures significantly lower than the 35°C threshold of ‘survivability’ can still represent a major threat to human health. Climate change is expected to push global temperatures closer to this ‘danger zone’ both through slow onset warming and intensified heat waves. As shown in Figure 12, the number of days during which ambient temperatures exceed 35°C is projected to increase considerably under all emissions pathways.

85. Disease. Malaria is a particular threat in Lao PDR, and an increase in the population at risk of around 400,000 is projected by 2041–2070.32 Leptospirosis is among several diseases linked to flooding in Lao PDR.33 Global research has also linked both drought and flood to increased incidence of diarrheal disease.34 As of 2016, diarrheal disease was responsible for 11% of all under-5 deaths in Lao PDR.35

86. Poverty and inequality. Research suggests that inequalities have been widening in Lao PDR since the turn of the 21st century. An income gap between rural and urban areas of 18.6% had opened by 2013, and both real and absolute income growth has accrued proportionately more to the rich than to the poor.36 The growth in inequality in Lao PDR is in affect slowing progress in tackling poverty, which remains high at 23% in 2012.

87. UXO contamination. According to estimates from the Asian Disaster Preparedness Center (ADPC) and National Disaster Management Office (NDMO) of Lao PDR, there are about 78 million anti-personnel sub-munitions that are still at large in rural areas. These are most densely located along the south and central border with Viet Nam as well as in the northern provinces of Houphan and Xieng Khouang. Figure 12 shows the map of potentially UXO- contaminated sites where bombing routes occurred during the war. Although construction will occur in existing hospital compounds that have been subject to disturbance, the screening for presence of UXO needs to be confirmed to ensure safety and security of the students, teachers, and the community.

31 Im, E. S., Pal, J. S., & Eltahir, E. A. B. (2017). Deadly heat waves projected in the densely populated agricultural regions of South Asia. Science Advances, 3(8), 1–8 32 WHO (2015) Climate and Health Country Profile: Lao People’s Democratic Republic. World Health Organization. Geneva 33 Lau, C. L., Smythe, L. D., Craig, S. B., & Weinstein, P. (2010). Climate change, flooding, urbanisation and leptospirosis: Fuelling the fire? Transactions of the Royal Society of Tropical Medicine and Hygiene, 104(10), 631–638. 34 Wu, X., Lu, Y., Zhou, S., Chen, L., & Xu, B. (2016). Impact of climate change on human infectious diseases: Empirical evidence and human adaptation. Environment International, 86, 14–23. 35 WHO and Maternal and Child Epidemiology Estimation Group (MCEE) estimates 2018 36 United Nations in Lao PDR (2019). SDG 10: Inequalities. http://www.la.one.un.org/sdgs/sdg-10-inequalities (accessed on 26/02/2019) 34

Figure 12: UXO-contaminated Sites in Lao PDR

88. Historical and Cultural Resources. None of the hospitals or HPEIs are in areas identified as historical or culturally significant areas.

89. Presence of Asbestos and Other Hazardous Materials. None of the hospitals or HPEIs have any asbestos-containing materials and hazardous materials. Roofs are either made of galvanized iron or bricks. Hazardous materials were also not found in the hospital premises that were visited. 35

F. Site-specific Information for the Targeted HPEIs and Hospitals

1. College of Health Sciences, Ban Saphanxay Campus, Champasak Province

90. The proposed development will be located in Champasak Province which is the southernmost province of Lao PDR. The proposed new teaching block for the College of Health Sciences will be located within the existing compound at Ban Saphanxay, Pakse District and will not require new land acquisition and resettlement. The estimate allocated land area for the new development is 9,546 m2.

91. The climate in the proposed site is influenced by the annual monsoon cycle, with the wet monsoon from May to October bringing around 80% of the total annual rainfall. The wet season tends to build gradually from April or May to its peak during the months of July and August.

92. Air quality in the proposed location of the new development is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

93. Based on information from the IBAT, the proposed College of Health Sciences is not located in any restricted zones of protected area or biodiversity conservation areas.

94. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

95. Plate 1 shows the existing conditions in the proposed development area while Figure 13 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 1: Existing Conditions, College of Health Sciences, Ban Saphanxay Campus, Champasak Province

Figure 13: Location of College of Health Sciences, Ban Saphanxay Campus, Champasak Province

2. College of Health Sciences, Kaysone Campus, Savannakhet Province

96. The proposed subproject will be located in Kaysone District, Savannakhet Province. Located in the central part of the country. Savannakhet borders Khammouane Province to the North, Quảng Trị and Thừa Thiên–Huế provinces of Viet Nam to the East, Salavan Province to the South, and Nakhon Phanom and Mukdahan provinces of Thailand to the West.

97. The proposed renovation of the library and construction of a new 18 room dormitory will be located within the existing compound of the College of Health Sciences, Kaysone Campus at Savannakhet Province in a built-up area. The new development has an estimated total allocated land area of 5,792 m2 and will not require acquisition of new land.

98. Air quality in the proposed location of the new development is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

99. Based on information from the IBAT, the proposed College of Health Sciences is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites. There are no UXO present in the proposed site for the new development.

100. Plate 2 shows the existing conditions in the proposed development area while Figure 14 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 2: Existing Conditions, College of Health Sciences, Kaysone Campus, Savannakhet Province

Figure 14: Location of College of Health Sciences, Kaysone Campus, Savannakhet Province

3. School of Public Health, Xieng Khouang Province

101. The proposed subproject will be located in Ban Phonsaatt Neua, Peak District, Xieng Khouang Province. Xieng Khouang Province is a mountainous area covering some 16,850 km2 but is sparsely populated with less than 250,000 people. The province is located between 500 to 2,280 m above sea level. The average altitude is around 1300 m, and the highest peak is Phou Bia at 2,820m, which is also the highest in Lao PDR.

102. The Peak District where the proposed new development will be located experiences two seasons, mainly influenced by the monsoons, a dry and a rainy season. The dry season lasts from October to March and the rainy season is from April to September with the heaviest rain from June to August. The average temperature is 20.5°C, the rainfall is 1,500 mm/year, the humidity averages around 40 percent.

103. The air quality and noise levels in the proposed area of the subproject are relatively of good quality while there are the usual short-duration impacts from road traffic in the vicinity of the existing roads, in the form of dust and vehicle emissions.

104. Based on information from the IBAT, the proposed SPH is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites. Presence of UXO at the proposed site for the new development is unlikely.

105. Plate 3 shows the existing conditions in the proposed development area while Figure 15 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 3: Existing Conditions, School of Public Health, Xieng Khouang Province

Figure 15: Location of School of Public Health, Xieng Khouang Province

4. School of Public Health, Pek Campus, Oudomxay Province

106. The proposed construction of a new 17 room dormitory will be constructed at Ban Don Yor within the boundaries of the Pek Campus of the School of Public Health, Oudomxay Province. There will be no new land acquisition required for the proposed new development. The land allocation for the new development is estimated at 1,600m2.

107. Oudomxay Province, where the proposed new development will be implemented, is located in northern of Lao PDR. The province is approximately 583 km from Vientiane, and has a total area of 15,370 km2. It is bounded on the North by Phongsaly Province, South by Sayaboury Province, Luang Prabang to the East and Luang Namtha to the West.

108. The topography of the area, which is characteristic of the province, is mountainous with elevations ranging from 300 to1,800 masl. The proposed new development has a moderate monsoon climate. The yearly amount of rain is about 1,900–2,600 millimeters. Temperatures in February and March average between 18 and 19°C, from April to May temperatures climb over 31°C. Due to high altitudes there are more variations in temperature during the year and a colder dry season in northern Lao PDR as in the rest of the country.

109. As is characteristic of areas similar to the proposed site, the air quality is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

110. There are no components of the proposed development that will be located within a protected, conservation or biodiversity area. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

111. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

112. Plate 4 shows the existing conditions in the proposed development area while Figure 16 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 4: Existing Conditions, School of Public Health, Pek Campus, Oudomxay Province

Figure 16: Location of School of Public Health, Pek Campus, Oudomxay Province

5. Mai District Hospital, Phongsaly Province

113. The proposed Mai District Hospital will be located in Ban Na Kang in Mai District situated southeast of Phongsaly province. The proposed site has an estimated area of 7,193 m2 for the construction of a new isolation ward and treatment facility. The area is within the compound of the existing District Hospital.

114. Characterized by mountainous terrain and narrow river valleys, this region is typical of the northern uplands of Lao PDR. The province and district has a mountainous topography with elevations about 500–2,280 m AMSL.

115. Air quality in the proposed location of the district hospital is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

116. The climate in the Northern part is characterized by two seasons, the dry and wet seasons. The dry season occurs between October and March while the wet season occurs between April and September. The climate in Lao PDR is highly influenced by the southeast monsoon with significant rainfall and high humidity. The average rainfall is about 1.245 mm/year and an average temperature is about 21.4°C.

117. Based on information from the Integrated Biodiversity Assessment Tool (IBAT), the proposed Mai District Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

118. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

119. Plate 5 shows the existing conditions in the proposed development area while Figure 17 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 5: Existing Conditions, Mai District Hospital, Phongsaly Province

Figure 17: Location of Mai District Hospital, Phongsaly Province

6. Provincial Hospital, Oudomxay Province

120. The proposed subproject will be implemented in Ban Don Yor, Xay District, Oudomxay Province. It is located in the north of Lao PDR and is 583 km from Vientiane. It bounded on the North by Phongsaly on the South by Sayaboury Province on the east by Luang Prabang and in the West by Laung Namtha. 121. The proposed development will entail the construction of a new isolation ward and treatment facility within the existing compound of the Provincial Hospital at Ban Don Your, Xay District, Oudomxay Province. There will be no new land needed to be acquired for the said development. There will be 480 m2 to be allocated for the proposed upgrading of the isolation ward and treatment facility.

122. The topography of area where the proposed subproject will be implemented is very mountainous. Altitudes vary between 300–1,800 meters above sea level. The proposed project area has a moderate monsoon climate. The yearly amount of rain is about 1,900–2,600 millimeters. Temperatures in February and March average between 18 and 19°C, from April to May temperatures climb over 31°C. Due to high altitudes there are more variations in temperature during the year and a colder dry season in northern Lao PDR as in the rest of the country.

123. Based on information from the IBAT, the proposed Provincial Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. Further, there are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

124. Plate 6 shows the existing conditions in the proposed development area while Figure 18 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 6: Existing Conditions, Provincial Hospital, Oudomxay Province

Figure 18: Location of Provincial Hospital, Oudomxay Province

7. Beng District Hospital, Oudomxay Province

125. The proposed development in the subproject will involve the rehabilitation of the existing hospital and the refurbishment of the technical block. All works will be undertaken within the boundaries of the existing facilities at Ban Houy La, at Beng District, Oudomxay Province. The toal allocated area for the development is approximately 1,600m2.

126. Air quality and noise levels are relatively good in the proposed area. There are no stationary sources of air pollution and noise generation within the area of the proposed development.

127. Based on information from the IBAT, the proposed Beng District Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. Further, there are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

128. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

129. Plate 7 shows the existing conditions in the proposed development area while Figure 19 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 7: Existing Conditions, Beng District Hospital, Oudomxay Province

Figure 19: Location of Beng District Hospital, Oudomxay Province

8. Houn District Hospital, Oudomxay Province

130. The proposed development in the subproject will involve the rehabilitation of the existing hospital and the refurbishment of the technical block. All works will be undertaken within the boundaries of the existing facilities at Ban Houy La at Beng District, Oudomxay Province. The total allocated area for the development is approximately 1,600m2.

131. Similar to the other target sites, the air quality and noise levels in Ban Houy La at Beng District, Oudomxay Province where the proposed development works will be implemented are relatively good as there are no industrial establishments in the area which can be a source of pollution and increased noise levels.

132. Based on information from the IBAT, the proposed Houn District Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. Further, there are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

133. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

134. Plate 8 shows the existing conditions in the proposed development area while Figure 20 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 8: Existing Conditions, Houn District Hospital, Oudomxay Province

Figure 20: Location of Houn District Hospital, Oudomxay Province

9. Luang Prabang Provincial Hospital, Luang Prabang Province

135. Luang Prabang Province is situated in the center of northern Lao PDR, bordering the provinces of Oudomxay, Phongsaly and Houaphanh to the north, Vientiane the capital and Sayaboury to the south and south west and Xieng Khouang to the east. The town is built on a peninsula formed by the Mekong and the Nam Khan River.

136. The subproject involves the construction of an isolation ward and treatment facility at Ban PhouNoak, Luang Prabang District, Luang Prabang Province. The total land allocated for the new development is estimated at 6,228 m2. The proposed development will be constructed within the existing boundaries of the Provincial Hospital and will not require acquisition of new land.

137. The climate in the proposed subproject is humid tropical, being situated between 19.0 and 21.5 degrees north of the equator. Average temperatures are generally in the range of 15 to 30°C throughout the year in the valleys. Temperature declines with elevation, to the extent that the high land at the heads of the mountain catchments have temperature regimes about five to eight degrees cooler than the valley bottoms.

138. Air quality in the proposed location of the provincial hospital is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion.

139. Based on information from the IBAT, the proposed Provincial Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

140. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

141. Plate 9 shows the existing conditions in the proposed development area while Figure 21 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 9: Existing Conditions, Luang Prabang Provincial Hospital, Luang Prabang Province

Figure 21: Location of Luang Prabang Provincial Hospital, Luang Prabang Province

10. Nambak District Hospital, Luang Prabang Province

142. The proposed subproject, which will be situated in Nam Bak District is at the Northeast of Luang Prabang Province and approximately 100 km northeast of the provincial capital. It is bordered to the North by Khoua District and Phongsaly Province; Pak Ou to South, Ngoi to East and Xay, La and Nga Districts and Oudomxay province to the west.

143. The proposed development will involve the rehabilitation of the district hospital and the refurbishment of the technical block. The development works will all be undertaken within the boundaries of the existing Nambak District Hospital and will not require the acquisition of additional land.

144. Characterized by mountainous terrain and narrow river valleys, this region is typical of the northern uplands of Lao PDR. Nam Bak District has a mountainous topography with elevations of 380m AMSL to 700m AMSL.

145. Air quality in Nambak District is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season. This is an intermittent problem with a minor effect over a limited area of 5 to 10 meters either side of the road. The locations of the project components are relatively far from noise generating activities. There are no industries within the proposed sites so ambient noise levels can be considered very well.

146. The climate in the District is characterized by two seasons, the dry and wet seasons. The dry season occurs between October and March while the wet season occurs between April and September. The climate in Lao PDR is highly influenced by the southeast monsoon with significant rainfall and high humidity.

147. There are no components of the proposed development that will be located within a protected, conservation or biodiversity area. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

148. Interviews and discussions with the local residents also validated the information that there are no known occurrences of UXO in the vicinity of the subproject area or of knowledge of ground or air strikes from which UXO may remain.

149. Plate 10 shows the existing conditions in the proposed development area while Figure 22 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 10: Existing Conditions, Nambak District Hospital, Luang Prabang Province

Figure 22: Location of Nambak District Hospital, Luang Prabang Province

11. Phoukhoun District Hospital, Luang Prabang Province

150. The proposed subproject involves the rehabilitation of the hospital and the refurbishment of the technical block in an allocated area of 4,844 m2. The development works will be undertaken within the existing compound of the Phoukhoun District Hospital located at Ban Samyek, Phoukhoun District, Luang Prabang Province and will not require acquisition of additional land.

151. Air quality in the proposed location of the district hospital is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion.

152. Based on information from the IBAT, the proposed Phoukhoun District Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

153. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

154. Plate 11 shows the existing conditions in the proposed development area while Figure 23 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 11: Existing Conditions, Phoukhoun District Hospital, Luang Prabang Province

Figure 23: Location of Phoukhoun District Hospital, Luang Prabang Province

12. Houamuang District Hospital, Houaphanh Province

155. The proposed construction of a new District Hospital will be undertaken in Ban Boamngam, Houameuang District, Houaphan Province within the existing compound of the existing district hospital. The new development will not require new land as the required 9,684 m2 is available in the said compound. The proposed subproject will be located in Houaphanh Province Northeast of the Lao PDR, about 650 km from Vientiane. It is bounded on the East by Thanh Hoa, Viet Nam, on the Northwest with Son La Province, Viet Nam, to the West by Luang Prabang Province, and to the South by Xieng Khouang Province.

156. The climate in the subproject area is divided into two seasons: dry season and rainy season. The dry season is from November to early March, with an average temperature of 14°C to 18°C. The rainy season is from April to October.

157. Based on information from the IBAT, the proposed Houameuang District Hospital is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

158. Interviews and discussions with the local residents validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

159. Plate 12 shows the existing conditions in the proposed development area while Figure 24 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 12: Existing Conditions, Houamuang District Hospital, Houaphanh Province

Figure 24: Location of Houamuang District Hospital, Houaphanh Province

13. Paklay District Hospital, Sayaboury Province

160. The proposed subproject will be implemented at the existing Paklay District Hospital at Ban Xayyamoungkoun, Paklay District, at, Sayabouly Province. The subproject area is located in the northwest of the Lao PDR. The province of Sayabouly is bounded on the North by Bokeo province the Southwest by Thailand and the East by Luang Prabang.

161. The proposed subproject entails the renovation of the district hospital and the refurbishment of the technical block. These will be undertaken within the boundaries of the existing district hospital and will not require additional land as the 16,728 m2 required for the upgrading works is available in the compound.

162. The project area has a humid climate, being situated between 17.0 and 21.5 degrees north of the equator. Average temperatures are generally in the range of 15 to 30°C throughout the year in the valleys.

163. There are no components of the proposed development that will be located within a protected, conservation or biodiversity area. There are no sensitive environmental receptors within and in the surroundings of the proposed development.

164. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

165. There are no sites within or around the subproject area where UXO has been identified to still exist. Interviews and discussions with the local residents also validated the information that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

166. Plate 13 shows the existing conditions in the proposed development area while Figure 25 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 13: Existing Conditions, Paklay District Hospital, Sayaboury Province

Figure 25: Location of Paklay District Hospital, Sayaboury Province

14. Boten District Hospital, Sayaboury Province

167. The proposed development involves the renovation of the existing District Hospital within the same compound. There will be no land acquisition required as the works will be undertaken within the boundaries of the existing Boten District Hospital.

168. The project area has a humid climate, being situated between 17.0 and 21.5 degrees north of the equator. Average temperatures are generally in the range of 15 to 30° throughout the year in the valleys.

169. There will no sensitive environmental receptors that will be affected by the proposed development. Further, there will be no site of archeological, historical or cultural importance that within and around the area of the proposed subproject.

170. It was confirmed from the village authorities and DHO officials that there are no UXO still existing in the area of the proposed development.

171. Plate 14 shows the existing conditions in the proposed development area while Figure 26 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 14: Existing Conditions, Boten District Hospital, Sayaboury Province

Figure 26: Location of Boten District Hospital, Sayaboury Province 77

15. Mok District Hospital, Xieng Khouang Province

172. The proposed subproject will involve the renovation of the district hospital within the boundaries of the existing compound. No additional land is required to be acquired for the development as land is available in the compound.

173. The Xieng Khouang Province, where the proposed renovation and refurbishment of the technical block for the existing Mok District Hospital will be implemented, is characterized as a mountainous topography. The province is located between 500 to 2,280 m above sea level. The average altitude is around 1300 m, and the highest peak is Phou Bia at 2,820 m, which is also the highest in Lao PDR.

174. The subproject area experiences two seasons, a dry and a rainy season. The dry season lasts from October to March and the rainy season is from April to September with the heaviest rain from June to August. The average temperature is 20.5°C, the rainfall is 1,500 mm/year, the humidity averages around 40 percent.

175. There are no records of air and noise quality measurements, while there are the usual short-duration impacts from road traffic in the vicinity of the existing roads, in the form of dust and vehicle emissions, but traffic levels are usually very low.

176. Discussions and interviews with the local authorities confirmed that there is no existing UXO in the area and surroundings of the Mok District Hospital. The proposed site is also not within any protected or conservation/biodiversity area and there are no sensitive environmental receptors within the vicinity of the area.

177. Plate 15 shows the existing conditions in the proposed development area while Figure 27 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 15: Existing Conditions, Mok District Hospital, Xieng Khouang Province

Figure 27: Location of Mok District Hospital, Xieng Khouang Province

16. Phaxay District Hospital, Xieng Khouang Province

178. The proposed renovation and refurbishment of the technical block of the subproject will be undertaken within the compound of the existing Phaxay District Hospital located at Ban Namounladkhai, Phaxay District, Xieng Khoung Province.

179. The subproject area is characterized as a mountainous topography. The province is located between 500 to 2,280 m above sea level. The average altitude is around 1300 m, and the highest peak is Phou Bia at 2,820 m, which is also the highest in Lao PDR.

180. The climate in the subproject area is mainly influenced by the monsoons with the dry season from October to March and the rainy season from April to September. The period with the heaviest rainfall is during the months of June to August. The average temperature is 20.5°C, the rainfall is 1,500 mm/year, the humidity averages around 40 percent.

181. There are no components of the proposed development that will be located within a protected, conservation or biodiversity area. There are no sites of archaeological significance within and around the subproject area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

182. There are no sites within or around the existing Phaxay District Hospital, where the proposed subproject will be implemented, where UXO has been identified to still exist as per interviews and discussions with the local residents. It also validated the information that there are no known occurrences of UXO in the vicinity of the subproject area or of knowledge of ground or air strikes from which UXO may remain.

183. Plate 16 shows the existing conditions in the proposed development area while Figure 28 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 16: Existing Conditions, Phaxay District Hospital, Xieng Khouang Province

Figure 28: Location of Phaxay District Hospital, Xieng Khouang Province

17. Savannakhet Provincial Hospital, Savannakhet Province

184. The subproject will involve the construction of an isolation ward and the refurbishment of the technical block within the existing Provincial Hospital compound at Ban Nongvilay, Kaysone District, Savannakhet Province. The proposed development will not require additional land as land is available within the existing compound

185. Air quality in the proposed location of the new development is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

186. Based on information from the IBAT, the proposed subproject area is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites. There are no UXO present in the proposed site for the new development.

187. Plate 17 shows the existing conditions in the proposed development area while Figure 29 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 17: Existing Conditions, Savannakhet Provincial Hospital, Savannakhet Province

Figure 29: Location of Savannakhet Provincial Hospital, Savannakhet Province

18. Nong District Hospital, Savannakhet Province

188. The proposed renovation and refurbishment of the technical block of the Nong District Hospital will be located within the existing compound at Ban Ban Nongvilay, Savannakhet Province.

189. Air quality in the proposed location of the new development is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

190. Based on the result of the provincial interviewing and discussions with the local residents, it was validated that there are no known occurrences of UXO in the vicinity of the subproject area. Based on information from the IBAT, the proposed subproject area is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

191. Plate 18 shows the existing conditions in the proposed development area while Figure 30 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 18: Existing Conditions, Nong District Hospital, Savannakhet Province

Figure 30: Location of Nong District Hospital, Savannakhet Province 89

19. Songkhone District Hospital, Savannakhet Province

192. Located in the central part of the country, SavannakhetProvinc where the proposed renovation and refurbishment of the technical block of the Songkhone District Hospitalislocated, borders Khammouane Province to the north, Quảng Trị and Thừa Thiên–Huế provinces of Viet Nam to the east, Salavan Province to the south, and Nakhon Phanom and Mukdahan provinces of Thailand to the west.

193. Air quality in the proposed location of the new development is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

194. Based on information from the IBAT, the proposed subproject is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological significance within and around the town area. The project components will not affect any historical and archaeological sites such as temples and burial sites. There are no UXO present in the proposed site for the new development.

195. Plate 19 shows the existing conditions in the proposed development area while Figure 31 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 19: Existing Conditions, Songkhone District Hospital, Savannakhet Province

Figure 31: Location of Songkhone District Hospital, Savannakhet Province 92

20. Lao-Ngam District Hospital, Salavan Province

196. The proposed construction of the new District Hospital will be undertaken at Ban Houynamxun, Lao-Ngam District, Province of Salavan. The total land area allocated for the proposed development is 1,700m2 within the compound of the existing District Hospital. There will be no new land acquisition required for the said development.

197. Based on information from the IBAT, the proposed subproject area is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sensitive environmental receptors within and the vicinity of the proposed subproject area.

198. There are no sites of archaeological, cultural or historical significance within and around the project area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

199. Interviews and discussions with the local residents confirmed that there are no known occurrences of UXO in the vicinity of the town or of knowledge of ground or air strikes from which UXO may remain.

200. Plate 20 shows the existing conditions in the proposed development area while Figure 32 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 20: Existing Conditions, Lao-Ngam District Hospital, Salavan Province

Figure 32: Location of Lao-Ngam District Hospital, Salavan Province

21. Paksong District Hospital, Champasak Province

201. The climate in the proposed site is influenced by the annual monsoon cycle, with the wet monsoon from May to October bringing around 80% of the total annual rainfall. The wet season tends to build gradually from April or May to its peak during the months of July and August.

202. Air quality in the proposed location of the new development is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion. The only detrimental effect on air quality is the dust arising from the passage of vehicles over unsealed roads during the dry season.

203. Based on information from the IBAT, the proposed subproject is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

204. Plate 21 shows the existing conditions in the proposed development area while Figure 33 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 21: Existing Conditions, Paksong District Hospital, Champasak Province

Figure 33: Location of Paksong District Hospital, Champasak Province

22. Mounlapamok District Hospital, Champasak Province

205. The proposed development will involve the renovation and refurbishment of the technical block of the existing district hospital. The allocated land area for the proposed development is approximately 3,923 m2. The said area will be within the boundaries of the existing district hospital.

206. The air quality and noise levels in the proposed area of the subproject are relatively of good quality while there are the usual short-duration impacts from road traffic in the vicinity of the existing roads, in the form of dust and vehicle emissions.

207. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites

208. Based on information from the IBAT, the proposed subproject is not located in any restricted zones of protected area or biodiversity conservation areas. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

209. Plate 22 shows the existing conditions in the proposed development area while Figure 34 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 22: Existing Conditions, Mounlapamok District Hospital, Champasak Province

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Figure 34: Location of Mounlapamok District Hospital, Champasak Province

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23. Home District Hospital, Xaisomboun Province

210. The proposed development works in Home District Hospital will be located at Ban Nam Kieng, Xaisomboun province. The proposed location is situated on a plateau and has an estimated allocated area of 26,800 m2. Home District, Xaisomboun Province is located in the central region of Lao PDR. The proposed site lies in the subtropical region which is mainly influenced by the monsoons with the rainy season from April – October.

211. As is the case in areas similar to Mai District, air quality in the proposed location of the district hospital is generally good. There are no industries producing discharges/emissions which result in atmospheric pollution and pollution from vehicular exhaust emissions are not significant given the low levels of traffic and absence of any traffic congestion.

212. Based on information from the IBAT, the proposed Home District Hospital is not located in any restricted zones of protected area or biodiversity conservation areas.

213. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

214. Plate 23 shows the existing conditions in the proposed development area while Figure 35 shows satellite imagery of the location of the proposed development showing the land use and cover.

Plate 23: Existing Conditions, Home District Hospital, Xaisomboun Province

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Figure 35: Location of Home District Hospital, Xaisomboun Province

24. PMU Office, Vientiane Capital

The proposed development works would involve the renovation of the existing office located at the MOH compound at Sisattanack District, Vientiane Capital. The minor works would involve the replacement of the electrical system, doors and toilets and the repainting of the new office.

215. Based on information from the IBAT, the proposed PMU Offcie is not located in any restricted zones of protected area or biodiversity conservation areas.

216. There are no sites of archaeological or cultural significance within and around the proposed target area. The project components will not affect any historical and archaeological sites such as temples and burial sites.

217. Plate 24 shows the existing conditions in the proposed development area while Figure 36 shows satellite imagery of the location of the proposed development showing the land use and cover.

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Plate 24. Existing Conditions, Proposed PMU Office - MOH Compound at Sisattanack District, Vientiane Capital

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Figure 36. Location of Proposed PMU Office - MOH Compound at Sisattanack District, Vientiane Capital

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V. ANTICIPATED ENVIRONMENTAL IMPACTS AND MITIGATION MEASURES

218. Potential environmental impacts were evaluated in the areas of influence of the subproject sites. At the proposed sites, temporary disruption and nuisance impacts will be experienced, mainly during the construction period. These affected areas may experience direct impacts associated with temporary disturbances from construction activities, for example, localized increases in noise and fugitive dust emissions. The potential environmental impacts were identified based on the project activities that may occur in each component and on the evaluation of the environmental and social baseline situation in the subproject areas. The identification of environmental impacts was based mainly on the technical information related to project component design and operation, field visits, and information from stakeholders.

A. Anticipated Benefits from the Project

219. The project is expected to have a positive impact on the quality of health care in Lao PDR. The project will provide better health care and medical educational facilities. Local residents will be given access to PHC facilities and will not have to travel to the major city centers for their basic health care requirements.

B. Pre-construction Impacts and Mitigation

220. Historical and cultural resources. All of the proposed development works will not have any impact on historical cultural sites or temples. Should there be unanticipated discoveries of cultural or historical artifacts or human remains, the EMP will require the contractor to take all necessary steps to protect and report the chance finds to concerned authorities.

C. Environmentally Sensitive Sites

221. The new facilities will be constructed within the footprint of the existing compounds and there are no sensitive areas (conservation, protected, natural habitats and waterways) within the area of influence. (Figures 2 to 24 shows the current land use and land cover of the target sites).

D. Environmental Impacts and Mitigation Measures during Construction

222. Construction activities that may be undertaken for the proposed development works include demolition of existing structures, land clearing, excavation and grading, filling, disposal of excavated soil, and movement of construction vehicles, operation of heavy equipment, and operation of worker camps. The works for the proposed subproject could produce the following adverse impacts:

• Loss of vegetation as a result of clearing and grubbing; • Generation of excavated material; • Occurrence of acute increase in ambient noise; • Acute increase in generation of dust; • Generation of wastes, i.e., domestic wastewater, demolition waste, solid and hazardous wastes; • Community hazards as a result of open excavations; and • Hazards to occupational health and safety. 107

223. Construction activities will be restricted to available land within the existing facility footprint. There will be no land acquisition and/or resettlement and no temporary or permanent loss of land or other assets.

224. The construction works will have some minor temporary negative impacts. Adverse health and safety or other environmental impacts that will arise from civil works will be minimal and localized since these are confined within a small footprint area in existing compounds. Impacts include risks to occupational and HPEI and hospital users’ health and safety from construction activities, e.g., children playing near open excavation or risk of getting hit by a construction vehicle or equipment. COVID-19 risk management protocols will be required to minimize the risk of infections for workers, staff and visitors. Additional potential impacts include soil runoff during rain events, an increased level of noise and dust due to vehicle movement and building construction activities, and sanitation issues due to the presence of a worker’s camp during the construction period. There will also be a need to properly dispose of construction debris generated during the construction works. Sand and gravel will be sourced from permitted quarries or commercial suppliers only. The commercial suppliers are located at the town nearest the project facilities.

225. There will be an increase in dust and noise caused by movement of construction vehicles to the site and construction activities. The material requirement for civil works is not significant, but the haulers need to institute measures, such as reducing speeds when passing through settlement areas and water sprinkling within the construction site on areas prone to dust, such as piles of materials, excavated soil, and unpaved roads.

226. Based on the condition of existing facilities visited, there are no hazardous materials, such as asbestos or asbestos containing materials or toxic paints at the target sites. Construction of structures will avoid using hazardous materials, particularly asbestos, and this will be specified in the bidding documents. During construction, only low or no volatile organic compound (VOC) containing materials will be used in paints, coatings, adhesives, and furniture to ensure that indoor air quality is not adversely affected.

227. In general, the short-term construction impacts can be prevented or mitigated with good construction management practices. The environmental management plan (EMP, Section VIII) includes mitigation measures to prevent or minimize construction impacts in line with the relevant provisions of the Environmental Health and Safety Guidelines of the World Bank Group (2007) for guidance of MOH, PMU, and the contractor in addressing environmental issues during construction. The EMP includes mitigation measures on dust and noise control, erosion and sedimentation, waste management, site management, provision of clean water and sanitation facilities, public and worker health and safety including COVID-19 risk management. The bid specifications and contracts for civil works will include the requirement for an EMP.

E. Environmental Impacts and Mitigation during Operation

228. During the operational phase, the facilities will generate waste materials that need to be appropriately managed and handled. The HPEIs will generate non-hazardous or general waste that does not pose any particular biological, chemical, radioactive or physical hazard while the PHs and DHs will generate the following waste:

• Infectious waste: waste contaminated with blood and other bodily fluids (e.g. from discarded diagnostic samples), cultures and stocks of infectious agents from laboratory work (e.g. waste from autopsies and infected animals from laboratories),

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or waste from patients with infections (e.g. swabs, bandages and disposable medical devices). This also includes used PPE and other materials potentially contaminated with the COVID-19 virus; • Pathological waste: human tissues, organs or fluids, body parts and contaminated animal carcasses; Sharps waste: syringes, needles, disposable scalpels and blades, etc.; • Chemical waste: for example, solvents and reagents used for laboratory preparations, disinfectants, sterilants and heavy metals contained in medical devices (e.g. mercury in broken thermometers) and batteries; and • Pharmaceutical waste: expired, unused and contaminated drugs and vaccines;

229. Waste will be segregated at source in accordance with Decree on Waste Management from Health Care Facilities (No. 1706 /MOH) and Agreement No. 1667 of Ministry of Health issued in 15 August 2018, article 15. Health-care waste will be separated into 3 fractions (Infectious, Sharp and General Waste). General waste will be collected and disposed through existing formal channels. Infectious and sharp waste will be stored onsite, until collected by authorized entities for transport, treatment and disposal.

230. Wastewater will be managed in accordance with Agreement No. 1667 of Ministry of Health issued in 15 August 2018. All facilities will have onsite pre-treatment facilities for wastewater, and effluent will be discharged and disposed of in accordance with the Government of Lao PDR requirements.

231. All facilities will have access to safe and potable water supply and stable power supply. MOH will ensure that the facilities are properly maintained, as stipulated in the operational manual that will be prepared for the facility in accordance with Agreement No. 1667 of Ministry of Health issued in 15 August 2018. Budget for maintenance of the facilities will be allocated by MOH to ensure their long-term sustainability.

VI. INFORMATION DISCLOSURE, CONSULTATION, AND PARTICIPATION

A. Information Disclosure and Stakeholder Consultations During Project Preparation

232. Consultation meetings and focus group discussions (FGDs) were conducted in January, February and May 2020. The participants during the consultations/FGDs included representatives from the PHOs, DHOs, public works district officials, DONRE, and hospital management. The consultations were conducted to present the proposed project to the stakeholders and elicit the environmental concerns/issues of the community on the proposed project. Information about environmental clearance requirements, presence of protected forests, cultural heritage sites, and natural hazards was also gathered. The summary of the consultations/FGDs undertaken by the TRTA consultants is in Table 10 below.

Table 10: Summary of Consultations Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility Consultation meeting with • PIU Presentation: Provincial Hospital, Luang • PHO • General introduction of the Proposed Project. Prabang Province • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. 109

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility Comments, Questions, and Answers: • The PHO and related sectors in the provincial and community level are willing to support TRTA project team with any request for gathering information and assessment. • This proposed project will be one of the supported programs at the local community and will support the local capacity to serve more patients on time. • The proposed project could support the 5G1S at the local community and provincial hospital. • Infectious and hazardous wastes will be treated by the existing incinerator and autoclave, which were financed by GOL and NGOs. The wastewater treatment plant has not been operational since 2012, and the wastewater from the hospital flows to the drainage channel via a pre-treatment system. • General wastes are collected daily by the nurses, and cleaners will pick them up weekly for the waste collection service, while hazardous and infectious wastes are treated in the hospital. • The existing wastewater treatment plant needs to be maintained, while the PHO is considering to request support from the DHO and central level. • A ‘smart’ hospital is being considered by the PHO, and other relevant projects could be proposed for joint support. • The capacity of technical staff needs improvement. • Local patients do not dare to openly share their comments on the quality of hospital services, while some community members have provided some verbal comments. Consultation with Phoukhoun • PIU Presentation: District Hospital, Luang • DHO • General introduction of the Proposed Project. Prabang Province • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers:

• The DH has a limited area, insufficient all service rooms and equipment/ medical facilities vis-à-vis current patient numbers. • The current limitations of the hospital services are insufficient to treat patients on time and constrain the achievement of 5G1S, which is one of the PHO’s requirements. • Overall, the DH welcomes the proposed project and expects to implement it soon. • The existing electric line supplies power 24 hours a day, and water supply (Namlin) is available and accessible at the hospital. • Waste collection by the district waste collection service is done on a regular (monthly) basis, while infectious/hazardous wastes are disposed of in an underground dumpsite pit. • There is no stabilization equipment for infectious/hazardous waste, which is collected in a plastic box before transferring to the dumpsite. The need for an incinerator was raised during this consultation. • The existing wastewater drains into an underground septic tank and is freely discharged to the natural channel along the hill. • The DH requested completed facilities for the new hospital, including a laboratory and OR, x-ray, large patient room, drugstore, ambulances, and motorbikes for small hospitals. • They also requested for a capacity building and training program for all units. • The site for the construction of a new hospital has been provided, but will need clearing and excavation work to flatten

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Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility the area. For this purpose, an IEE/REA may be required. Consultation with Nambak • PIU Presentation: District Hospital, Luang • DHO • General introduction of the Proposed Project. Prabang Province • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers:

• The DHO is supportive of the proposed subproject and will support the implementation. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is state land. • There is no sensitive environmental receptor within the vicinity of the proposed facility. • It was confirmed by the hospitals officials that the necessary services and support facilities such as water supply, power supply, wastewater and solid waste management are available in the existing facilities. District coordination and • PIU Presentation: consultation meeting in • DHO • General introduction of the Proposed Project. Mounlapamok District Hospital, • TRTA Champasak Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers:

• Overall, the DH is supportive of this project and wants it implemented as soon as possible. • The project will include a capacity building plan for hospital staff. • The existing electric line supplies power for 24 hours. However, there are times when the power supply becomes unstable. Support for the maintenance of the existing generator is needed. • Will the diagnostic staff be included in this proposed project? • Will the proposed project provide medical equipment? • The monthly waste collection is supported by the district waste collection service, while the infectious/hazardous are handled in the hospital. There is a need to improve the quality of the existing incinerator and waste storage. • An awareness program on infectious wastes should be provided by the project. • A safety box and infectious waste bin should be provided for proper waste treatment. • Well water may cause the lime sedimentation in toilets and water sinks and need physical treatment. Consultation with the PHO, • PIU Presentation: Champasak Province • PHO • General introduction of the Proposed Project. • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers: • The PHO welcomes the support to be provided by the project and expects to implement it as soon as possible. • This proposed project will serve the local community and support the provincial hospital and increase its capacity to serve more patients on time. • The proposed project could support the 5G1S at the local community, the provincial hospital, and the national health 111

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility services. • Local capacity could be improved with the provision of medical equipment and facilities at the district and provincial hospitals. • The PHO and related sectors in the provincial and community level are willing to support the TRTA members in order to complete the proposal as soon as possible. Consultation with DONRE, • PIU Presentation: Champasak Province • DONRE • General introduction of the Proposed Project. • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • Clarification and agreement on coordination and public consultations related to environmental concerns and regulations. • The renovation of the health buildings and facilities require an environmental management and monitoring plan (EMMP). • New construction falls under the List of Investment Projects (Ref.No.8056/MONRE) and requires IEE preparation or Rapid Environmental Assessment (REA) and an environmental monitoring plan to be in place for at least three years. • The current wastewater discharge from the health services, particularly from large hospitals and industrial zones, are of concern to DONRE as they require mitigation. • The proper treatment of the infectious and hazardous waste was requested previously and consists of a dumpsite pit. • The DONRE office welcomes the support of the project and is willing to provide any assistance needed to fulfil the project’s requirements. • For the relevant regulations for construction of health education buildings, the related sector should be consulted. • The project facilities for construction or upgrade/rehabilitation are existing on government land and will not damage the resources and environment. Regardless, mitigation measures for potential adverse impacts are required. Consultation with Public Works • PIU Presentation: and Transport Office (PWTO), • PWTO • General introduction of the Proposed Project. Champasak province. • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers: • The current standards for general building construction were provided; specific guidelines for building operation will depend on the institution or department. • Accessibility to the Mounlapamok DH is being improved by the PWTO and is expected to completed by the end of 2020. • The PWTO welcomes the support of the proposed health project and is willing to assist the TRTA in their requirements. • The proposed program has available water supply, telecommunication line, waste collection service, and electric line and two accessibilities. • The low land may occur the short flood during the rainy season and during the unforeseen disaster happen. Consultation with College of • PIU Presentation: Health Sciences Ban • PC Saphanxay Campus, • TRTA • General introduction of the Proposed Project. Champasak Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations

112

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility Comments, Questions, and Answers: • The existing condition of the female dormitory and related facilities of the dormitory were discussed. A new building is proposed for construction to house the training rooms, final examination hall, meeting hall, and additional practice room for the final class. • A waste collection service, water supply (Nampapa), and electric line are available at the site. • The road condition is good, and a septic tank is available. • As the proposed project site is near a community, accessibility might be hampered during working hours by the construction works. • There are 52 students, most of whom are in the final year of their course and would finish the course in 2020 and 2021. • The Provincial College and related units are willing to support the TRTA team and will share the required information as needed. They hope to get the project approved soon. District coordination and • PIU Presentation: consultation meeting in Paksong • DHO • General introduction of the Proposed Project. District Hospital, Champasak • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers:

• It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • There is no sensitive environmental receptor within the vicinity of the proposed facility. • The DHO is supportive of the proposed subproject and will support the implementation. • It was confirmed by the hospitals officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The concern in the existing facility is the absence of the appropriate wastewater treatment facility. It is requested that such can be considered in the design of the new facilities. Consultation with the Provincial • PIU Presentation: Hospital, Savannakhet • PHO • General introduction of the Proposed Project. Province • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers: • The PHO welcomes to support of the project and expects its implementation soon. • The proposed project will address the needs of the local community and support the provincial hospital by increasing its capacity to serve more patients on time. • The proposed project will also support the 5G1S at the local community, the provincial hospital, and the national health services. • The capacity of the district and provincial hospitals could be improved by the provision of medical equipment and facilities. • The PHO and related sectors at the provincial and community level are willing to support the TRTA in order to get the project approved soon. District coordination and • PIU Presentation: 113

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility consultation meeting in • DHO • General introduction of the Proposed Project. Songkhone District Hospital, • TRTA • General introduction on ADB’s environmental safeguards and Savannakhet Province GOL’s environmental regulations Comments, Questions, and Answers:

• The current situation at the DH is characterized by a limited area, inadequate service rooms, equipment, and medical facilities for the number of patients. These limitations result in long waiting time for patients and prevent the achievement of 5G1S, one of the PHO’s requirement. • Overall, the DH welcomes the support to be provided by the project and expects that it will be implemented soon, • The existing electric line functions 24 hours, and water supply (Nampapa) is available and largely accessible. • Waste collection by the district is done regularly, on a monthly basis, while the handling and treatment infectious/hazardous wastes needs improvement, particularly the existing incinerator and waste storage. • Wastewater flows to the septic tank. • The DH requested the following: (i)10 beds for the delivery room and two operating rooms, separate patient rooms for the outpatient department (OPD) and inpatient department (IPD), and a diagnostic and ultrasound room; (ii) ambulances; (iii) capacity building and training for all units; and (iii) improved IT system including software programs for the hospital. District coordination and • PIU Presentation: consultation meeting in Nong • DHO • General introduction of the Proposed Project. District Hospital, Savannakhet • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • The DHO is supportive of the proposed subproject and will support the implementation. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • There is no sensitive environmental receptor within the vicinity of the proposed facility. • There are no UXO present in the proposed area for the subproject. • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply wastewater and solid waste management are available in the existing facilities. Consultation meeting with • PIU Presentation: College of Health Sciences, • CHS • General introduction of the Proposed Project. Savannakhet Province • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • As the renovation of the roof may disturb the classes, the PC will arrange for the classes to be held temporarily at available rooms in the nearby building. • It was proposed to replace an existing building by a new female dormitory building. • Waste collection service, water supply (Nampapa), and electric line are available in the area. • Hazardous wastes will be transferred to the provincial hospital.

114

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility • The road condition is good, and the septic tank is available. • Construction activities will have to be managed well so as not to disturb classes. • There is one family of PC staff who are staying temporarily in the PC. That family could be transferred to the nearby female dormitory during the project’s operational period. • The PC and related units are willing to support the TRTA team and will share the required information in order to have the project approved soon. District coordination and • PIU Presentation: consultation meeting in Home • DHO • General introduction of the Proposed Project. District Hospital, Xaisomboun • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

• As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • There are no UXO present in the proposed area for the subproject. • It was expressed by the DHO that they will support the proposed development and will assist in the implementation. • The DHO raised the issue of lack of a reliable water supply, wastewater treatment and management and an appropriate solid waste management in the existing facilities. It was strongly suggested that these basic requirements be considered and provided for the new facilities. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. Consultation with School of • PIU Presentation: Public Health Ban Pek Campus, • SPH Oudomxay Province Officials • General introduction of the Proposed Project. • General introduction on ADB’s environmental safeguards and • TRTA GOL’s environmental regulations Comments, Questions, and Answers:

• It was confirmed by the school officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The school officials raised the concern of non-establishment of an appropriate wastewater treatment and management for the existing facilities and that this should be considered in the design for the proposed subproject. • The school officials are supportive of the proposed subproject and will support the implementation. • It was confirmed by the school officials that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • There are no UXO present in the proposed area for the subproject. • There are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • The school officials further verified that there are no 115

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility environmental issue/concerns in the existing and proposed facilities. Consultation with the Provincial • PIU Presentation: Hospital, Oudomxay Province • PHO • General introduction of the Proposed Project. • TRTA • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations. Comments, Questions, and Answers: • The proposed project will address the needs of the local community and support the provincial hospital by increasing its capacity to serve more patients on time. • The proposed project will also support the 5G1S at the local community, the provincial hospital, and the national health services. • The capacity of the district and provincial hospitals could be improved by the provision of medical equipment and facilities. • The PHO and related sectors at the provincial and community level are willing to support the TRTA in order to get the project approved soon. • As confirmed from the PHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • It was confirmed by the PHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • The PHO confirmed that there are no environmental issues and concerns in the existing and proposed development area. • It was expressed by the PHO that they will support the proposed development and will assist in the implementation. • The PHO raised the issue of lack of an appropriate wastewater treatment and management and an appropriate solid waste management in the existing facilities. It was strongly suggested that these basic requirements be considered and provided for the new facilities. • There are no UXO present in the proposed area for the subproject. District coordination and • PIU Presentation: consultation meeting in Beng • DHO • General introduction of the Proposed Project. District Hospital, Oudomxay • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

116

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility vicinity/surrounding area of the proposed facility. • There are no UXO present in the proposed area for the subproject. District coordination and • PIU Presentation: consultation meeting in Houn • DHO • General introduction of the Proposed Project. District Hospital, Oudomxay • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

• The DHO expressed support for the proposed development and will assist in the implementation • As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development • The DHO confirmed that the proposed subproject will be implemented within the footprint of the existing compound and is on government owned land. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • The DHO further informed the Team that there are no environmental issues and concerns that need to be addressed in the existing and proposed target facility. • The DHO raised the issue of the lack of an appropriate wastewater treatment facility, water supply, power supply and solid waste management for the existing facilities and that this should be considered in the design for the proposed subproject. • There are no UXO present in the proposed area for the subproject. Consultation with PHO, Xieng • PIU Presentation: Khouang Province • PHO • TRTA • General introduction of the Proposed Project. • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

• The PHO welcomes the support of the project and expects to implement it soon. • The proposed project will address the needs of the local community and support the provincial hospital by increasing its capacity to serve more patients on time. It will also support the 5G1S at the local community, the provincial hospital, and the national health services. • The proposed new construction of the college hall and female dormitory are priority programs of the PHO, which will allow the enrolment of more students from the northern part of Lao PDR, including Houaphan, Luang Prabang, Sayabouly, and Xieng Khouang provinces. • The college hall should be big enough to accommodate a large number of students during activities, such as graduation, as well as its use as a practice hall, training hall, and others. • The female dormitory will be used mainly by students from other provinces and/or from out of town, who are in difficult living conditions. • DONRE has been consulted by the Team and provided the information that investment programs listed in Ref.No.8056/MONRE, which will involve new construction, require the preparation of a rapid environmental assessment 117

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility (REA) or IEE. • The detailed design of the proposed facilities has to be endorsed by the PWTO before project operation. • The PHO and related sectors at the provincial and community levels are willing to support the TRTA in order to get the project approved soon. Consultation at School of Public • PIU Presentation: Health, Xieng Khouang • SPH Province Officials • General introduction of the Proposed Project. • General introduction on ADB’s environmental safeguards and • TRTA GOL’s environmental regulations. Comments, Questions, and Answers: • The local capacity of the SPH could be improved with the provision of equipment and facilities. • Empty government land has been provided for the new construction of a female dormitory. • The college hall, as well as the existing well, tank, pump and toilet, require renovation, which could temporarily disturb the classed and dormitory. An EMP is required to include mitigation measures for the potential adverse impacts. • A waste collection service, water supply (Nampapa), and electric line are available at the site. • The road condition is good, and a septic tank is available. • A health awareness program is lacking. • Budget is insufficient compared to the actual conditions. • The SPH and related units are willing to support the TRTA and will share the required information, as needed, in order to get project approval soon. District coordination and • PIU Presentation: consultation meeting in Mok • DHO • General introduction of the Proposed Project. District Hospital, Xieng Khouang • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

• It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the concern of a reliable wastewater treatment and management for the existing facilities and that this should be considered in the design for the proposed subproject. • The DHO is supportive of the proposed subproject and will support the implementation. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • There are no UXO present in the proposed area for the subproject. • There are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. District coordination and • PIU Presentation: consultation meeting in Phaxay • DHO • General introduction of the Proposed Project. District Hospital, Xieng Khouang • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

• The DHO is supportive of the proposed subproject and will support the implementation.

118

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the concern of an appropriate wastewater treatment facility for the existing facilities and that this should be considered in the design for the proposed subproject. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • There are no UXO present in the proposed area for the subproject. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. District coordination and • PIU Presentation: consultation meeting in Lao • DHO • General introduction of the Proposed Project. Ngam District Hospital, Salavan • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • It was expressed by the DHO that they will support the proposed development and will assist in the implementation. • As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • There are no UXO present in the proposed area for the subproject. • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the concern of an appropriate wastewater treatment facility for the existing facilities and that this should be considered in the design for the proposed subproject. District coordination and • PIU Presentation: consultation meeting in • DHO • General introduction of the Proposed Project. Houamuang District Hospital, • TRTA Houaphanh Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers:

• It was expressed by the DHO that they will support the proposed development and will assist in the implementation • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. 119

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the concern of an appropriate wastewater treatment facility for the existing facilities and that this should be considered in the design for the proposed subproject. • There are no UXO present in the proposed area for the subproject. District coordination and • PIU Presentation: consultation meeting in Mai • DHO • General introduction of the Proposed Project. District Hospital, Phongsaly • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • The DHO informed the Team that they will support the proposed development and will assist in the implementation of the subproject. • It was confirmed by the DHO that the proposed subproject will be implemented within the footprint of the existing compound and is government owned land. • As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development. • There are no UXO present in the proposed area for the subproject. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the concern of an appropriate wastewater treatment facility for the existing facilities and that this should be considered in the design for the proposed subproject. District coordination and • PIU Presentation: consultation meeting in Boten • DHO • General introduction of the Proposed Project. District Hospital, Sayaboury • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • It was expressed by the DHO that they will support the proposed development and will assist in the implementation • The DHO confirmed that the proposed subproject will be implemented within the footprint of the existing compound and is on government owned land. • As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the concern of an appropriate wastewater treatment facility for the existing facilities and that this should be

120

Discussion / Responses / Outcomes and Type of Meeting and Location Participants Follow-Up Actions with Responsibility considered in the design for the proposed subproject. • There are no UXO present in the proposed area for the subproject. • The DHO further informed the Team that there are no environmental issues and concerns that need to be addressed in the existing and proposed target facility District coordination and • PIU Presentation: consultation meeting in Paklay • DHO • General introduction of the Proposed Project. District Hospital, Sayaboury • TRTA Province • General introduction on ADB’s environmental safeguards and GOL’s environmental regulations Comments, Questions, and Answers: • As confirmed from the DHO, the proposed facilities will be constructed within the boundaries of the existing facilities and that there will be no new land that will be acquired for the new development • The DHO expressed support for the proposed development and will assist in the implementation • The DHO confirmed that the proposed subproject will be implemented within the footprint of the existing compound and is on government owned land. • It was confirmed by the DHO that there are no sensitive environmental areas within and in the vicinity/surrounding area of the proposed facility. • The DHO further informed the Team that there are no environmental issues and concerns that need to be addressed in the existing and proposed target facility. • It was confirmed by the DHO officials that the necessary services and support facilities such as water supply, power supply and solid waste management are available in the existing facilities. • The DHO raised the issue of the non-establishment of an appropriate wastewater treatment facility for the existing facilities and that this should be considered in the design for the proposed subproject. • There are no UXO present in the proposed area for the subproject. G1S = 5 goods 1 satisfaction; ADB = Asian Development Bank; CHS = College of Health Sciences; DH = district hospital; DHO = district health Office; DONRE = District Environment and Natural Resources Office; EMP = Environmental Management Plan; GOL = Government of Lao PDR; IEE= Initial Environmental Examination; IPD = inpatient department ; MONRE = Ministry of Natural Resources and Environment; NGO = nongovernment organization; OPD = outpatient department; PC = Provincial College; PHO = Ministry of Natural Resources and Environment; PIU = Project Implementation Unit; PWTO = Public Works and Transport Office; REA = rapid environmental assessment; TRTA = transaction technical assistance.

B. Follow-up Information Disclosure and Stakeholder Consultations

233. Prior to project implementation, a copy of the approved IEE and EMP will be submitted by MOH to the DONRE in the respective provinces and the district governors. The IEE will also be posted on the ADB and MOH websites. During construction and operation, communities within the impact area of the subprojects will be kept informed of construction activities through billboards or information boards about the construction activities and schedules. The details of the PIU, GRM focal contact persons (see Section VII), and construction managers will be prominently displayed in the respective construction areas for the reference of the affected communities/persons.

234. Consultations will be undertaken on a need basis with the date, time, and venue to be agreed with the village heads and concerned government officials. Complaints and grievances 121 can be directly filed, both written and verbal, with the concerned entities. This will be an alternative to the village complaint system. All suggestions, opinions, and responses from the community on the project should be taken into account, and feedback provided on how concerns and recommendations have been addressed.

VII. GRIEVANCE REDRESS MECHANISM

235. Article 13 of Decree 192/PM and the ADB SPS require the subprojects to establish an effective mechanism for grievance resolution. The Government of Lao PDR’s (GOL’s) legal requirements for this mechanism are further described in Part VI of the decree’s implementing regulations and in detail in the Technical Guidelines. The loan covenants stipulate the grievance redress mechanism (GRM) requirements of the ADB for the project. The mechanism to address any grievances on environmental safeguards issues is the same as that designed to address grievances related to land acquisition and compensation.

236. The objective of the GRM is to resolve complaints as quickly as possible at the local level through a process of conciliation, and if that is not possible, to provide clear and transparent procedures for appeal. All affected persons will be made fully aware of their rights, and the detailed grievance redress procedures will be publicized through an effective public information campaign. An aggrieved AP or affected household (AH) will be free from any fees in connection with the lodging and resolution of complaints, as the costs will be borne by the executing agency (EA) and the appointed contractors.

A. Types of Grievances

237. Complainants are entitled to lodge complaints regarding any aspect of the project. Any affected person will be able to submit a grievance if they believe a practice is having a detrimental impact on the community, the environment, or on their quality of life. Eligible grievances or complaints include:

• Negative impacts on a person or a community (e.g., financial loss such as from loss of water, loss of roadside trees, health and safety issues, nuisances, etc.); • Dangers to health and safety or pollution of the environment; • Hazards due to construction activities (e.g. noise, dust, disruption of access, etc.); • Impacts on social infrastructure; • Failure to comply with standards or legal obligations; • Improper conduct or unethical behavior of contractor leading to nuisance of PAPs; • Misuse of funds and other irregularities; • Grievances due to land acquisition, resettlement, compensation, relocation, and unaddressed losses; and • Complaints related to gender issues.

B. Grievance Resolution Process

238. Complaints can be made verbally or in written form. It is recognized that, in many cases, complainants do not have the writing skills or ability to express their grievances verbally, however, complainants are encouraged to seek assistance from family members or village heads, to have their grievances recorded in writing and to ensure that where disputes do occur and all the details have been recorded accurately enabling all parties to be treated fairly. In the case of verbal complaints, a written record of the complaint will be made during the first meeting with the complainant. Complainants who present their complaints within the prescribed

122 procedures will be exempt from all administrative fees incurred. In addition, complainants who lodge complaints and appeals to district courts will be provided with free legal representation.

239. Grievances are issues, concerns, or complaints that may be raised by stakeholders about the implementation of the project. The GRM provides a systematic process for receiving, validating, and resolving complaints from AP and is designed to achieve the following:

• Serving as an open channel for effective communication of environmental and social issues arising from the project; • Allowing prompt action or resolution of any complaint or adverse impacts that may occur during project construction and operation; • Serving as a means to hear community suggestions on the project; and • Promoting transparency in project implementation.

240. Any PAP may raise and submit a grievance if the activity has a detrimental impact on the environment, the community, or the quality of life of people. Examples of grievances are hazards to community health and safety; construction-related nuisances, such as noise and dust and improper disposal of wastes; adverse changes on way of life and livelihood; peace and order problems due to presence of migrant workers; and failure of the project to comply with environmental policies, safety clearance requirements, and other legal obligations.

1. Arbitration Committees

241. The subproject’s GRM will rely on the existing village arbitration units that have already been established in the villages. The Village Development Committee (VDC) generally consists of the village chief, deputy chief, village secretary, and village representative of the Lao Women’s Union, Lao Front for National Construction, village elders, youth, and village land taxation unit. The VDC is responsible for settling disputes between villagers through conciliation and negotiation. In the absence of these units, the members of the village committee (if formed) or the village leaders will act as grievance officers. Moreover, the details of the PMU, Design and Construction Supervision Consultants (DCS), GRM focal contact persons and construction manager will be prominently displayed in the respective construction areas for the reference of the affected communities/persons. Complaints and grievances can be directly filed, both written and verbal, to the concerned entities. This will provide alternative entry points to the village complaint system. The APs may present their complaints to the concerned local administrative officials and resettlement committees. The complaint can be filed first at the village level and can be elevated to the highest or provincial level if the APs are not satisfied with the decisions made by the VDC at village level. At the district and provincial levels, the district and provincial steering committees of the project will act on grievances or complaints that have not been resolved at the VDC.

2. Grievance Redress Procedures

242. All complaints and resolutions will be properly documented by the concerned committee and be available for public review and for monitoring purposes. As a general policy, the PMU will work proactively toward preventing grievances through the implementation of impact mitigation measures and community liaison activities that anticipate and address potential issues before they become grievances. Nonetheless, during construction and operation it is possible that unanticipated impacts may occur if the mitigation measures are not properly implemented, or unforeseen issues occur. The procedures for the grievance resolution process for the subproject are detailed in Table 11. 123

Table 11: Grievance Redress Procedures No. Stages Stage 1 (Subproject Area). In the first instance, complainants will raise complaints or grievances to the concerned HPEIs/DHs authorities and/or DCS consultant, the PMU-NES or Contractor. The HPEIs/DHs authorities and/or DCS consultant with the PMU-NES or Contractor will organize 1. a meeting with the complainants to resolve the issue. The meeting will be held in a public place and will be open to members of the community to ensure transparency, if wished so by the complainant. The primary objective of the meeting is to clarify and agree on an amicable solution with the complainant. This mediation aims at an internal immediate solution agreed with the subproject. If the complaint cannot be solved at this stage, the next step will apply. Stage 2 (District Implementing Level). If within five days of lodging the complaint and no understanding or amicable solution can be reached with the HPEIs/DHs authorities and/or DCS 2. with the PMU-NES or Contractor, the complainant can bring the complaint to the District Project Steering Committee (DPSC). The DPSC will meet with the complainant to discuss the complaint and provide a decision within 10 days of receiving the appeal. Stage 3 (Provincial Implementing Level). If the complainant is not satisfied with the decision of the DPSC or in the absence of any response, the complainant can appeal to the Provincial 3. Project Steering Committee (PPSC) with contribution of authorities and village representative/s. The PPSC will meet the complainant to clarify the complaint and will inform the complainant about its decision aiming to solve the complaint. The PPSC will provide a decision on the complaint within 10 days. Stage 4 (Ministerial Project Executive Level). If the AP is still not satisfied with the decision of the PPSC, or in the absence of any response within the stipulated time, the complainant can 4. submit his/her grievance to the MOH, who will verify with the PPSC and DPSC. MOH might consider an independent external opinion in this matter. The MOH will render a decision within 10 days of receiving the complaint. Before the next stage is applied, additional efforts should be made to find an agreement with the AP. Stage 5 (Country Level). As a last resort, the complainant may submit his/her case to the Court 5. of Law. The complaint will be lodged with the Court of Law. The Court will take note and register the case and will provide the final juristic decision. The MOH will be responsible for forwarding the complaint and ensuring its process in the courts. AP = affected person; DHO = District Health Office; DPSC = District Project Steering Committee; MOH = Ministry of Health; PPSC = Provincial Project Steering Committee; VDC = Village Development Committee.

243. Normally, complaints related to construction and environmental issues are resolved at the subproject level, where the conciliation and negotiation are promptly attended to by the HPEIs/DHs authorities, PMU-NES, DCS and contractors. Complaints related to resettlement and land disputes are normally elevated to the district and provincial levels, and at times to the Court. At each stage of the grievance redress process, written records will be maintained. The DCS will submit reports to the PMU documenting: (i) complaints received; (ii) names and other pertinent information about complainants; (iii) dates of the original complaint, meetings and any other actions; and (iv) outcomes and/or resolution. The records of grievances with a full inventory of the complaints received will be incorporated in regular progress reporting, including the SAEMR, on the subproject.

244. If efforts to resolve complaints or disputes remain unresolved and unsatisfactory following the GOL GRM, the APs/AHs have the right to send their concerns or problems directly to ADB’s Operations Department, i.e., Human and Social Development Division, Southeast Asia Department (SERD) or through the ADB Lao PDR Resident Mission (LRM). If the AP is still not satisfied with the responses of SERD, he/she can directly contact the ADB's Office of the Special Project Facilitator (OSPF) as outlined in the Information Guide to the Consultation Phase of the ADB Accountability Mechanism. The Information Guide can be downloaded through this link: https://www.adb.org/documents/information-guide-consultation-phase-adb-accountability-

124 mechanism. Those who want to make a complaint with the ADB can refer to the sample letter of complaint adapted from the Information Guide as shown in Figure 36.

Figure 36: Sample Complaint Letter

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VIII. ENVIRONMENTAL MANAGEMENT PLAN

A. Objectives

245. An EMP has been prepared for this project to provide mitigation and monitoring measures for identified impacts. It outlines the mitigation and monitoring programs to be taken to avoid, reduce, and minimize adverse environmental impacts to acceptable levels. The EMP was developed based on discussions with MOH, site assessment, and the results of the public consultation activities.

246. The mitigation measures are divided into those that will be implemented during the design and pre-construction phase, construction phase, and during the operation and maintenance (O&M) phase of the health professional education institutions and district/provincial hospitals. The EMP matrix also identifies the units that will be in-charge of implementing and monitoring the identified measures.

247. The EMP will be included in the bid and contract documents for the civil works to ensure that the contractors are made aware of these obligations during the construction phase and to guide MOH in supervising and monitoring safeguard performance during construction.

B. Institutional Arrangements for EMP Implementation, Coordination and Supervision

1. Ministry of Health (MOH)

248. MOH, through the Department of Planning Cooperation (DPC), will be the EA for the QHCP, responsible for overall implementation and coordination, including overseeing the implementation of the environmental management and monitoring plan for the civil works components. The MOH Steering Committee, chaired by the Minister of Health and comprising vice-ministers and directors-general of MOH departments, will provide overall guidance in project implementation.

2. Project Management Unit (PMU)

249. The Director of DPC will be Project Director, who will be assisted by a Project Deputy Director and the PMU. MOH will establish the PMU in the DPC. The PMU will: (i) provide overall project coordination; (ii) coordinate with departments and other agencies; (iii) coordinate with IAs in the preparation of project annual plans and budgets; (iv) provide guidance, support, and capacity building to the IAs; (v) monitor environmental and social safeguards; (vi) ensure that ADB requirements are being complied with; (vii) monitor project implementation progress; (viii) submit quarterly progress and financial reports; (ix) process the procurement of major civil works and goods and services; (x) hire consulting services; and (xi) handle administrative and financial management. The NES will be recruited by the PMU and work within the unit (see below).

250. The PMU will engage a National Environmental Specialist (NES) to supervise the implementation of the EMP. Among the responsibilities of the NES are: (i) review and approval site-specific CEMPs; (ii) monitoring of EMP implementation; (iii) establishment and coordination of GRM; (iv) organization of training in environmental management; and (v) updating of the IEE (if necessary); (vi) prepare semi-annual environment monitoring reports.

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3. Design and Construction Supervision Consultant (DCS Consultant)

251. The DCS Consultant will be engaged by the PMU and will be responsible for reviewing design, overseeing construction and the implementation of the EMPs in all the subprojects. The DCS Consultant will include site superintendents who will conduct regular site visits and inspections of the works in the subprojects as part of the monitoring requirements and to ensure that the civil works contractors are complying with the safeguards requirements of the GOL and ADB.

4. Civil Works Contractors

252. The civil work contractors will have principal responsibility for environmental management during construction. They will: (i) ensure that bids respond to environmental management requirements of the EMP; (ii) develop CEMPs for each subproject (HPEIs and DHs) based on the EMP, to be approved by the PMU upon recommendation of the NES prior to physical works; (iii) assign or hire a qualified Environmental, Health and Safety (EHS) Officer to coordinate CEMP implementation, including community and occupational health and safety and COVID-19 risk management, on site; (iv) ensure that adequate resources are available to implement the CEMP throughout the construction period; (v) secure appropriate permits and licenses before undertaking the works; (vi) establish a telephone hotline as simplified GRM, staffed at all times during working hours; (vii) disseminate information on construction progress, including anticipated activities that might cause safety risk, in a timely manner; (viii) inform the health professional education institutions and district hospitals, PMU, and ADB in case of complaints; and (ix) complete the monthly environmental monitoring checklist (See Annex 3) and submit to MOH/DPC through the PMU.

C. Works Contractor’s Obligations

253. To address potential impacts and risks to environment, health and safety of workers and communities, each works contractor must:

(i) appoint a qualified environment, health, and safety (EHS) specialist to supervise construction works in compliance with this EMP and the Lao PDR regulatory and policy framework for environment, health and safety; (ii) execute works and all associated operations on the work sites or off-site in conformity with statutory and regulatory environmental requirements of the Government of Lao PDR and the ADB SPS 2009; (iii) take all measures and precautions to avoid any nuisance or disturbance arising from the execution of construction works and their related activities. This will, wherever possible, be achieved by suppression of the nuisance (or unwanted effects to the physical environment and people) at source rather than abatement of the nuisance once generated; (iv) compensate for any damage, loss, spoilage, or disturbance of the properties and health of affected people during execution of the construction works as specified in the bidding documents; (v) keep the construction site clear of stagnant water, food residuals, or any other waste or material that can attract pests and disease-carrying vectors like mosquitoes and rodents; (vi) recruit local skilled and unskilled labor to increase the direct benefits in the subproject area(s) and to minimize potential environmental issues related to construction camps, disease transmission and socio-cultural disputes; 127

(vii) ensure that the International Labor Organization (ILO) Core Labor Standards and the applicable laws and regulations of Lao PR are applied to the contractor’s workers (including workers employed by sub-contractors), including laws related to their employment, health, safety, and welfare during the construction of the facilities. More specifically, each contractor shall: (a) comply with the Borrower’s applicable labor law and regulations and incorporate applicable workplace occupational safety norms; (b) do not use child labor; (c) do not discriminate workers in respect of employment and occupation; (d) do not use forced labor; and (e) allow freedom of association and effectively recognize the right to collective bargaining; (viii) Establish and implement a COVID-19 risk management protocol as part of the Health and Safety Plan. Such risk management protocol shall be fully aligned to regulatory requirements and policies of Lao PDR and following international good practice; (ix) establish a system to receive, register, and address community concerns and complaints. Contact number of the contactor including name, position and telephone number will be shared with local authorities and PMU; and (x) demonstrate how the impacts associated with the construction works as defined in Table 12 below are complied with. For that purpose, conduct weekly monitoring of compliance with the EMP, and include section in the monthly report to the PMU. The report format defined in Appendix 4 can be used for monthly reporting to the PMU.

254. The following activities are strictly prohibited on or near the project site:

(i) cutting of trees for any reason outside the approved construction area; (ii) hunting, fishing, wildlife capture, or plant collection; (iii) use of unapproved toxic materials, including lead-based paints and asbestos- containing materials; (iv) discharge of chemicals, sanitary wastewater, spoil, waste oil, and concrete agitator washings or any liquid requiring treatment in water courses, drainage/runoff systems, or municipal wastewater collection facilities; (v) disturbance to anything with architectural or historical value; (vi) employment of workers under the age of 16; persons between age 16-18 can only work in non-hazardous environment; and (vii) discrimination regarding recruitment, wages and compensation.

D. Mitigation Plan

255. The environmental mitigation measures to be implemented to address potential adverse impacts of the proposed project are presented in Table 12 below. The project EMP may require updating to address unanticipated impacts not included in the table. The EMP will be included in the bid documents so that the mitigation and monitoring requirements can be evaluated and included in the specifications and cost proposals submitted for the proposed project.

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Table 12: Environmental Management Plan Environmental Responsible Mitigation Measures Monitoring Budget Impact Office Pre-Construction Impact on land The HPEIs and DHS will be N/A c/o PMU PMU-NES/DCS acquisition and constructed on state-owned land operations community assets within the footprint of the existing cost facilities. The access roads will be Loss of community designed to the minimum assets due to land necessary width within the right of acquisition and way (ROW) when feasible. damage to properties. Safe, inclusive and Ensure compliance with relevant N/A c/o DED PMU-NES/DCS environmentally design standards for healthcare contract friendly facility facilities, schools or other design buildings as relevant, based on the requirements of the Lao PDR and guidelines from the WHO and IFC. Review existing liquid and solid waste collection, pre-treatment and disposal provisions at project sites, include in the design necessary works and equipment to ensure adequate liquid and solid waste management capacities in compliance Decree on Waste Management from Health Care Facilities (No. 1706 /MOH) and with Agreement No. 1667/MOH issued in 15 August 2018. The detailed design of the proposed facilities has to be endorsed by the PWTO before construction. Environment Secure the Building Permit, N/A Included in PMU-NES/DCS clearances and Sanitary Permit, Electrical Permit, civil works construction and other clearances from the contract permits local government prior to start of construction works. Secure environment clearance from the concerned DONRE regional office. Impact on historical The contractor will ensure that the Accidental finds c/o PMU PMU-NES/DCS and archaeological work force is briefed that in the operations sites event of accidental finds of relics, cost they should immediately cease Damage to relics and any works in the area and artefacts during the promptly report the find to their conduct of the works. supervisor. Maintains Contractor prepares CEMP that Included in PMU-NES/DCS environmental establishes the contractor’s contract integrity of the management and compliance price subproject requirements with the construction section EMP. Contractor prepares site specific 129

Environmental Responsible Mitigation Measures Monitoring Budget Impact Office Contractor’s Environmental Management Plan (CEMP) Construction Temporary Walking access will be Weekly inspection Included in Contractor/PMU disruption of maintained to the affected by DCS. civil works existing community properties and access routes Periodic monitoring cost and roads, pathways, shall will be temporarily lined with and reporting by DCS and access to areas timber or similar material. NES. contract in the vicinity of Particular attention will be given Any complaint schools, village to ensuring safety along roads received from the offices, market places and paths used by pedestrians, community to PMU and meeting halls students, faculty and staff of the and will be reported school. and documented in Side street parking of the safeguard construction vehicles on monitoring reports. prolonged basis will not be allowed. The contractor will be required to immediately rehabilitate the excavated areas and any damaged road and path sections. Air pollution: dust The contractor will be required to Weekly inspection Included in Contractor/PMU and air emissions cover materials with tarpaulin or by DCS. civil works from earthworks and other suitable materials while in Periodic monitoring cost and movement of vehicles transit to avoid spillage of and reporting by DCS materials. NES. contract Earthen roads, particularly roads Any complaint near residences and through the received from the town core area, will be moistened community to PMU during dry and dusty conditions. and will be reported and documented in Speed limits will be imposed on the safeguard construction vehicles. monitoring reports. Construction equipment and vehicles will be regularly maintained to control air emissions during vehicle operation. Noise and vibration Construction activities, Weekly inspection Included in Contractor/PMU caused by the particularly operation of noise by DCS. civil works operation of generating equipment, will be Periodic monitoring cost and construction limited to the daytime. and reporting by DCS equipment will cause NES. contract Stationary equipment producing excessive noise, Any complaint resulting in nuisance high noise levels, such as diesel generators, will be positioned as received from the to surrounding community to PMU communities. far as practical from sensitive receptors and will be reported and documented in Temporary barriers will be the safeguard erected around construction sites monitoring reports. Noise suppression devices will be installed in noise generating equipment.

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Environmental Responsible Mitigation Measures Monitoring Budget Impact Office Drivers will be required to minimize blowing of horns and to comply with speed limits. Clearing of Cutting of trees will be Weekly inspection Included in Contractor/PMU vegetation undertaken as per approved by DCS. civil works design and only upon approval of Periodic monitoring cost and Poor planning and relevant authorities. The cutting of and reporting by DCS execution of tree trees will be avoided as much as NES. contract clearing/vegetation possible and damage to native Any complaint removal in the vegetation minimized. subproject sites can received from the result in loss of Landscaping and planting of community to PMU vegetation and a trees/vegetation will be and will be reported deterioration of the implemented at the sites of the and documented in general landscape. proposed facilities. the safeguard monitoring reports.

Location of camps Recruit local skilled and unskilled Weekly inspection Included in Contractor/PMU and Employment of labor to increase the direct by DCS. civil works local labor, social benefits in the subproject area(s) Periodic monitoring cost and protection, core and to minimize potential and reporting by DCS labor standards environmental issues related to NES. contract construction camps, disease There is a potential Any complaint transmission and socio-cultural received from the for conflict to develop disputes; with local community to PMU communities should Ensure that the International and will be reported they be marginalized Labor Organization (ILO) Core and documented in by the introduction of Labor Standards and the the safeguard outside workers who applicable laws and regulations of monitoring reports. then enjoy an Lao PDR are applied to the enhanced economic contractor’s workers (including status in comparison workers employed by sub- to the local contractors), including laws communities. related to their employment, health, safety, and welfare during The risk of the construction of the facilities. contracting and Workers from the local spreading of HIV and communities will be preferentially STI’s is also a offered employment as unskilled projected impact of labor. the proposed development. Workers will also be required to undergo provided, free of charge, Poor health of regular health check-ups to workers; minimize the risk of contracting COVID-19 infection and spreading of HIV and STI’s risk infectious diseases such as COVID-19. Loss of worker Camps will be sited a good productivity may distance away from nearby result from the settlement areas to avoid social absence of conflicts. appropriate living conditions within the Workers will be provided with project area; adequate housing, sanitation and recreational facilities. Camp water heating and cooking – use of The contractor will provide wood for fuel. acceptable camp facilities with potable water, gender-segregated 131

Environmental Responsible Mitigation Measures Monitoring Budget Impact Office sanitation and washing facilities, kitchen and adequate cooking facilities, nutritionally adequate food rations and recreational facilities to either meet requirements of the relevant labor regulations of GOL or an acceptable international standard, whichever is the higher. The contractor will provide gas and kerosene for water heating and cooking. The collection and use of fuel wood will be restricted. Sanctions will be imposed on workers. not complying Camp water heating The contractor will provide gas Weekly inspection Included in Contractor/PMU and cooking – use of and kerosene for water heating by DCS. civil works wood for fuel and cooking. Periodic monitoring cost and and reporting by DCS The collection and use of fuel NES. contract wood will be limited. Any complaint Sanctions will be imposed on received from the workers not complying. community to PMU and will be reported and documented in the safeguard monitoring reports. Chance discovery of No known sites. PMU/DHO will Weekly inspection Included in Contractor/PMU archaeological and be notified immediately of chance by DCS. civil works cultural sites discoveries and the relevant GOL Periodic monitoring cost and agency advised. and reporting by DCS Loss of cultural NES. contract values Any complaint received from the community to PMU and will be reported and documented in the safeguard monitoring reports. Use of Hazardous Ensure that safe storage of fuel, Weekly inspection Included in Contractor/PMU Materials other hazardous substances. by DCS. civil works Periodic monitoring cost and Contamination of the Fuel and other hazardous and reporting by DCS soil and nearby water substances shall be stored in NES. contract courses may result areas provided with roof, from the utilization of impervious flooring and Any complaint hazardous materials. bund/containment wall to protect received from the Improper handling, these from the elements and to community to PMU storage or utilization readily contain spilled fuel/ and will be reported of hazardous lubricant. and documented in materials poses a the safeguard Segregate hazardous wastes (oily monitoring reports. significant health risk wastes, used batteries, fuel to the workers and drums) and ensure that storage, residents of nearby transport and disposal shall not settlement areas; cause pollution and shall be Damage to vegetation undertaken consistent with

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Environmental Responsible Mitigation Measures Monitoring Budget Impact Office and crops may occur national and local regulations. as a result of contamination from The contractor will be required to the hazardous display Material Safety Data materials; Sheets (MSDS) in all work areas and to train workers in the safe use of these materials, including the provision of protective equipment for handling these substances. The contractor shall designate properly trained staff in-charge of storage sites for hazardous materials. Entry will be allowed only under authorization. The use of asbestos or asbestos- containing materials is strictly prohibited. Generation of Surplus excavated material/cut Weekly inspection Included in Contractor/PMU construction waste - soil from construction will be used by DCS. civil works Generation of as backfill material for low-lying Periodic monitoring cost and excavated soil areas identified by local and reporting by DCS authorities. NES. contract Any complaint received from the community to PMU and will be reported and documented in the safeguard monitoring reports. Generation of Appropriate segregation bins or Weekly inspection Included in Contractor/PMU construction wastes areas for construction wastes will by DCS. civil works – solid and inert be provided. Periodic monitoring cost and and reporting by DCS Solid wastes, inert The storage of all hazardous NES. contract construction wastes, materials including fuels will be demolition waste secure and controlled. Any complaint during construction received from the and demolition could Recyclable construction wastes, community to PMU result in the pollution such as wood, steel, and and will be reported of land and receiving scaffoldings, will be reused or and documented in water bodies. sold to junk shops. the safeguard Solid waste will be collected and monitoring reports. disposed in the approved disposal site in the district. Community health That trucks and other vehicles are Weekly inspection Included in Contractor/PMU and safety maintained in a safe operating by DCS. civil works condition, Periodic monitoring cost and Accidents to and reporting by DCS surrounding All drivers and machinery NES. contract communities from operators act responsibly, vehicles passing Any complaint through the All loads are to be secured and all received from the subproject area. loads with fugitive materials (e.g. community to PMU excavated soil and sand) are to and will be reported be covered with tarpaulins. and documented in the safeguard monitoring reports. 133

Environmental Responsible Mitigation Measures Monitoring Budget Impact Office Occupational health The contractor will be required to Weekly inspection Included in Contractor/PMU and safety develop and implement the by DCS. civil works construction health and safety Periodic monitoring cost and Hazards from plan in accordance with the World and reporting by DCS operating and using Bank EHS Guidelines NES. contract machinery. (http://www.ifc. org/ehsguidelines) Direct hazards to the as a minimum standard. The machine operators contractor will appoint an and to workers environment, health, and safety working in the vicinity (EHS) officer to ensure of the machine; implementation of the plan. The plan will include the following at a Hazards to workers minimum: exposed from heavy • Provision of first aid facilities materials being lifted readily accessible by workers; by cranes; • Provision of personal Refueling hazards; protective equipment (PPEs), such as hard hats, gloves, Exposure to rubber boots, etc.; hazardous chemical materials; • Mandatory wearing of PPEs while working on-site; Traffic accident hazards; • Establishment of safety signs/reminders in strategic

areas within the construction area; • Installation of sufficient lighting at night; • Ensuring that vehicle and equipment operators are properly licensed and trained; COVID-19 risk Develop and implement a Weekly inspection Included in Contractor/PMU management COVID-19 risk management plan. by DCS. civil works Such plan shall be developed in Periodic monitoring cost and Reduce risk of compliance with most relevant and reporting by DCS workers and nearby GOL regulations and policies, or NES. contract communities being in the absence thereof, in infected or spreading accordance with international COVID-19 good practice as issued by the World Health Organization. Disseminate information on COVID-19 risk management plan and provide training to workers on necessary risk mitigation and management measures/procedures.

Construction Remove all unused or discarded Weekly inspection Included in Contractor/PMU completion, site construction materials from the by DCS. civil works rehabilitation site before hand-over. Periodic monitoring cost and and reporting by DCS Hazardous waste Landscape surroundings to NES. contract materials, reinstate original site conditions. unprotected latrines Remove all temporary dwellings, and waste remaining cook houses, and latrines upon after construction will completion of the construction; pose a risk to human clean the site. Secure a fire safety inspection

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Environmental Responsible Mitigation Measures Monitoring Budget Impact Office health and safety. certificate from the city/municipal fire authorities. Secure an occupancy permit from the local government. Operation

Solid waste Establish and implement MOH, DONRE MOH HPEIs, DH, PH management healthcare waste management system in line with Decree on generation, Waste Management from Health segregation, storage Care Facilities (No. 1706 /MOH) and disposal and Agreement No. 1667/MOH, article 15. Waste shall be segregated at source into 3 fractions (Infectious, Sharp and General Waste).

Wastewater Wastewater shall be collected MOH, DONRE MOH HPEIs, DH, PH management and pre-treated on site in generation, collection, accordance with Agreement No. treatment and 1667/MOH. disposal On-site pre-treatment facilities shall be periodically maintained (i.e. quarterly removal of oil&grease layer; annual desludging, or as advised by relevant environment protection authorities). General facility Develop operational manual (OM) MOH MOH HPEIs, DH, PH maintenance for facilities. Properly maintain facilities in accordance with approved OM. Allocate adequate budget for maintenance of the facilities to ensure their long-term sustainability.

E. Reporting

256. Throughout the construction period, the contractor will submit monthly progress reports to PMU. The quarterly project progress reports (QPRs) prepared by the PMU for ADB should include a short summary of EMP implementation progress and any grievances raised/resolved in the reporting period. The NES will support the PMU to prepare and submit semi-annual environmental monitoring reports (SAEMRs) to ADB. The SAEMR will include progress of construction, results of site inspections, progress made in EMP implementation, status of compliance with GOL’s environmental regulatory requirements and other clearances, record of community complaints, unforeseen environmental impacts, and suggested corrective actions for the next monitoring period.

257. The PMU-NES will conduct regular site inspections to check the status of civil works and mitigation measures. The DCS Consultant will place site superintendents in each province to conduct at least weekly construction site inspections including EMP implementation verification. The Provincial Unit for Construction and Development Assistance (PUCDA) will conduct site 135 inspections every quarter, or as often as possible. Annex 4 presents a template of the environment safeguard monitoring report.

258. Operational phase. EMP monitoring during the operational phase of the project will be undertaken by MOH/DHO. The O&M of the project GRM, environmental institutional strengthening and training, and compliance with all covenants under the project will also be included in the report.

259. The SAEMRs will be prepared by PMU-NES and submitted to ADB until the Project Completion Report (PCR) is prepared. Within three months after completion of each contract package, environmental acceptance monitoring and audit reports for the completed package will be prepared by the contractor and submitted to PMU through the NES. Tables 13 and 14 presents the proposed reporting plan for the project.

Table 13: EMP Reporting Plan Type of Report Basic Content Prepared by Submitted to Frequency Construction Phase Construction Progress of Contractors, PMU-NES Monthly Progress Report construction, including signed by DCS EMP monitoring consultant results37 Project Progress Project status Including PMU ADB Quarterly report a summary paragraph on EMP implementation and any grievances raised Environmental EMP implementation, PMU ADB Semi-annual Monitoring Report environmental monitoring, compliance with GOL environmental requirements, complaints received, and actions undertaken Operational Phase Project progress Project status including PUCDA PMU Semi-annual until reports section on EMP PCR implementation and monitoring Reports to ADB Subproject progress PMU through ADB Semi-annual until report, including section NES PCR on EMP implementation and monitoring ADB = Asian Development Bank; EMP = environmental management plan; NES = National Environment Specialist; PCR = project completion report; PMU =project management unit; PUCDA = Provincial Unit for Construction and Development Assistance.

Table 14: Environmental Monitoring Plan Parameters Means of Monitoring Location Frequency/ Responsibility Source of Schedule Fund A. Pre-Construction Phase Inventory of Inspection and tagging Area for Once PMU Part of design

37 Inspection checklist provided in Appendix 2 can be used for that purpose.

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Parameters Means of Monitoring Location Frequency/ Responsibility Source of Schedule Fund affected trees of trees based on construction cost detailed project plans Update of EMP Submission of updated - Prior to DCS Part of DCS EMP to PMU, ADB and construction contract DONRE to include detailed plans and budget for environmental management. Orientation and Orientation training MOH Prior to PMU-NES Part of PMU Induction on conducted for PMU, construction (Consultant) budget environment DPWO, medical (US$3,000) safeguards and learning facilities EMP authorities, DCS implementation consultant (site superintendents) Facility design Review of DED for MOH Prior to PMU, DCS Part of PMU facilities, confirming that design budget these comply with approval Decree on Waste Management from Health Care Facilities (No. 1706 /MOH) Agreement No. 1667/MOH. B. Construction Phase Health and Ocular inspection of Construction Weekly Contractor, DCS Water potability sanitation at condition of temporary camps (through sampling will be construction toilets at camp checklist in included in the camps and work Appendix 3) contractor’s sites Check water supply in contract. terms of sufficiency and Estimated cost potability of monthly sampling and Ocular inspection of laboratory drainage, waste analysis is collection US$600 per monitoring period. Air quality Ocular observation of Construction During dry Contractor, DCS Part of civil dust generation. site and windy works and DCS periods contracts Check efficiency of dust Weekly emission control (through method checklist in Appendix 3) Noise Use sound level meter Construction Weekly DCS Noise - LAdn site (through monitoring will - LAmax checklist in be included in Appendix 3) the DCS contract. In case of complaints. Monitoring to be conducted in compliance with IFC EHS guidelines. Waste Field observation Construction Weekly Contractor/DCS art of civil works management site (through and DCS 137

Parameters Means of Monitoring Location Frequency/ Responsibility Source of Schedule Fund checklist in contracts - Segregation of Appendix 3) biodegradable and non- biodegradable wastes and proper disposal of wastes

- Inspection of waste oil and grease and hazardous waste storage area Safety incidents Recording of safety Construction Weekly Contractor/DCS art of civil works and accidents incidents and accidents site and DCS during construction contracts Recording of H&S trainings conducted (including toolbox meetings) Community Recording of Construction Continuous Contractor/DCS art of civil works complaints complaints/grievance site and DCS received on the project contracts and actions taken to resolve complaints Construction Ocular inspection and New facilities, Prior to DCS, PMU Part of DCS completion verification to confirm construction demobilization contract, PMU that facilities are site of contractor mandate constructed in line with approved plans, that facility OM is established, that solid waste and liquid waste management systems are in place, and that sites are cleaned and fully rehabilitated.

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IX. CONCLUSION AND RECOMMENDATIONS

260. This IEE for the proposed Quality Health Care Project was undertaken to determine the environmental issues and concerns associated with the proposed civil works activities under Output 3 of the project. The assessment confirms the project’s classification as Category B for environment based on ADB SPS (2009). The project will have beneficial impacts on health and well-being of the people as a result of the rehabilitation/upgrading of, and accessibility to, medical facilities in DHs and HPEIs.

261. Most of the environmental impacts are expected to occur during the construction phase. The environmental impacts are not expected to cause irreversible and significant adverse environmental impacts and are easily controllable by appropriate and conventional mitigation measures. Based on the assessment of environmental impacts, the anticipated adverse impacts during project implementation are related to nuisances, which may happen during the construction of the subproject components such as temporary alienation of access, temporary disruption of community facilities, noise, and sediment runoff, release of dust and engine gas emissions. Recommendations formulated in the EMP, its inclusion in the contractual framework, and an effective inspection of construction sites will reduce these risks to an acceptable level.

262. Environmental mitigation measures have been designed as outlined in the project EMP to address any adverse impacts during the various phases of project implementation. The EMP also presents the institutional responsibilities for implementing the mitigation measures. All project activities prior to construction, during construction, and during operation will be managed as provided in the EMP, and the contractor’s compliance and implementation of the mitigation measures will be monitored.

263. No further environmental assessment is required given the adequacy of information collected during the IEE conducted during the TRTA, unless the project description, location etc. change significantly.

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RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST

INSTRUCTIONS:

(i) The project team completes this checklist to support the environmental classification of a project. It is to be attached to the environmental categorization form and submitted to the Sustainable Development and Environmental Safeguards (SDES) for endorsement by the Director, SDCC and for approval by the Chief Compliance Officer.

(ii) This checklist focuses on environmental issues and concerns. To ensure that social dimensions are adequately considered, refer also to ADB's (a) checklists on involuntary resettlement and Indigenous Peoples; (b) poverty reduction handbook; (c) staff guide to consultation and participation; and (d) gender checklists. (iii) Answer the questions assuming the “without mitigation” case. The purpose is to identify potential impacts. Use the “remarks” section to discuss any anticipated mitigation measures.

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) College of Health Sciences, Ban Saphanxay Campus, Champasak Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment into historical area; disfiguration of landscape by X or cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes from worker-based camps and X chemicals used in construction?

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SCREENING QUESTIONS YES NO REMARKS Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and crushers. There may be cut and fill works but X chemicals from construction site? this would be minimal and may cause minimal localized air pollution concerns. Requirements for disposal of fill, The proposed site is located on a flat terrain excavation, and/or spoil materials? X and would require minimal cutting and is not projected to generate surplus materials. Noise and vibration due to blasting and The project will not involve blasting. The noise other civil works?? X from other civil works may cause acute, short- term, and temporal elevated levels. Community safety risks due to both The EMP prescribes measures to mitigate, or accidental and natural hazards, if at all possible, eliminate the risks from especially where the structural elements accidental and natural hazards. or components of the project are accessible to members of the affected X community or where their failure could result in injury to the community throughout project construction, operation and decommissioning? Other social concerns relating to Temporary in nature. inconveniences in living conditions in the project areas that may trigger cases X of upper respiratory problems and stress? Poor sanitation and solid waste disposal Appropriate waste management will be in construction camps and work sites, ensured. and possible transmission of X communicable diseases from workers to local populations? Creation of temporary breeding habitats Appropriate arrangements will be provided. X for mosquito vectors of disease? Dislocation and compulsory The project will not displace or dislocate any resettlement of people living in right of X person. way? Disproportionate impacts on the poor, There are no disproportionate impacts on women and children, Indigenous People X poor, women and children, indigenous or other vulnerable groups? peoples, or other vulnerable groups. Accident risks associated with increased It is not projected that such risks will be vehicular traffic, leading to accidental X present during the implementation of the spills of toxic materials and loss of life? proposed development. Increased noise and air pollution The operation of heavy equipment and service resulting from traffic volume? vehicles during the project implementation X may cause acute, short-term and temporal elevated levels of ambient noise and suspended particulates Risks to community safety caused by It is not projected that such risks will be fire, electric shock, or failure of the present during the implementation of the X buildings safety features during proposed development. operation? Annex 1 141

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) College of Health Sciences, Savannakhet Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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SCREENING QUESTIONS YES NO REMARKS chemicals from construction site? this would be minimal and may cause minimal localized air pollution concerns. Requirements for disposal of fill, The proposed site is located on a flat terrain excavation, and/or spoil materials? X and would require minimal cutting and is not projected to generate surplus materials. Noise and vibration due to blasting and The project will not involve blasting. The noise other civil works?? X from other civil works may cause acute, short- term, and temporal elevated levels. Community safety risks due to both The EMP prescribes measures to mitigate, or accidental and natural hazards, if at all possible, eliminate the risks from especially where the structural elements accidental and natural hazards. or components of the project are accessible to members of the affected X community or where their failure could result in injury to the community throughout project construction, operation and decommissioning? Other social concerns relating to Temporary in nature. inconveniences in living conditions in the project areas that may trigger cases X of upper respiratory problems and stress? Poor sanitation and solid waste disposal Appropriate waste management will be in construction camps and work sites, ensured. and possible transmission of X communicable diseases from workers to local populations? Creation of temporary breeding habitats Appropriate arrangements will be provided. X for mosquito vectors of disease? Dislocation and compulsory The project will not displace or dislocate any resettlement of people living in right of X person. way? Disproportionate impacts on the poor, There are no disproportionate impacts on women and children, Indigenous People X poor, women and children, indigenous or other vulnerable groups? peoples, or other vulnerable groups. Accident risks associated with increased It is not projected that such risks will be vehicular traffic, leading to accidental X present during the implementation of the spills of toxic materials and loss of life? proposed development. Increased noise and air pollution The operation of heavy equipment and service resulting from traffic volume? vehicles during the project implementation X may cause acute, short-term and temporal elevated levels of ambient noise and suspended particulates Risks to community safety caused by It is not projected that such risks will be fire, electric shock, or failure of the present during the implementation of the X buildings safety features during proposed development. operation? Annex 1 143

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) School of Public Health, Xieng Khouang Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) School of Public Health, Qudomxay Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

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SCREENING QUESTIONS YES NO REMARKS localized air pollution concerns. Requirements for disposal of fill, The proposed site is located on a flat terrain excavation, and/or spoil materials? X and would require minimal cutting and is not projected to generate surplus materials. Noise and vibration due to blasting and The project will not involve blasting. The noise other civil works?? X from other civil works may cause acute, short- term, and temporal elevated levels. Community safety risks due to both The EMP prescribes measures to mitigate, or accidental and natural hazards, if at all possible, eliminate the risks from especially where the structural elements accidental and natural hazards. or components of the project are accessible to members of the affected X community or where their failure could result in injury to the community throughout project construction, operation and decommissioning? Other social concerns relating to Temporary in nature. inconveniences in living conditions in the project areas that may trigger cases X of upper respiratory problems and stress? Poor sanitation and solid waste disposal Appropriate waste management will be in construction camps and work sites, ensured. and possible transmission of X communicable diseases from workers to local populations? Creation of temporary breeding habitats Appropriate arrangements will be provided. X for mosquito vectors of disease? Dislocation and compulsory The project will not displace or dislocate any resettlement of people living in right of X person. way? Disproportionate impacts on the poor, There are no disproportionate impacts on women and children, Indigenous People X poor, women and children, indigenous or other vulnerable groups? peoples, or other vulnerable groups. Accident risks associated with increased It is not projected that such risks will be vehicular traffic, leading to accidental X present during the implementation of the spills of toxic materials and loss of life? proposed development. Increased noise and air pollution The operation of heavy equipment and service resulting from traffic volume? vehicles during the project implementation X may cause acute, short-term and temporal elevated levels of ambient noise and suspended particulates Risks to community safety caused by It is not projected that such risks will be fire, electric shock, or failure of the present during the implementation of the X buildings safety features during proposed development. operation?

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RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Mai District Hospital, Phongsaly Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

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RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Oudomxay Xay Provincial Hospital, Oudomxay Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Oudomxay Beng District Hospital, Oudomxay Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Oudomxay Houn District Hospital, Oudomxay Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Luang Prabang Provincial Hospital, Luang Prabang Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Nambak District Hospital, Luang Prabang Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Phoukhoun District Hospital, Luang Prabang Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Hoamuang District Hospital, Houaphanh Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Paklay District Hospital, Sayaboury Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Boten District Hospital, Sayaboury Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Mok District Hospital, Xieng Khouang Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Phaxay District Hospital, Xieng Khouang Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Savannaketh Provincial Hospital, Savannakhet Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

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Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Nong District Hospital, Savannakhet Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

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Annex 1 175

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Songkhone District Hospital, Savannakhet Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

176 Annex 1

Annex 1 177

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Lao Ngam District Hospital, Salavan Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

178 Annex 1

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Paksong District Hospital, Champasak Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

180 Annex 1

Annex 1 181

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Moulapamok District Hospital, Champasak Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize X crushing, cutting and filling works, and crushers. There may be cut and fill works but

182 Annex 1

Annex 1 183

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Hom District Hospital, Xaisomboun Province Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There may be cut and fill works but chemicals from construction site? this would be minimal and may cause minimal

184 Annex 1

RAPID ENVIRONMENTAL ASSESSMENT (REA) CHECKLIST INSTRUCTIONS:

Country/Project Title: Lao PDR: TA 9723-REG: Support for Human and Social Development in Southeast Asia – Preparing the Lao Improving the Quality of Health Care Project (52335-001) Proposed PMU Office, Vientiane Capital Sector Division: SERD SCREENING QUESTIONS YES NO REMARKS Project Site Is the Project area adjacent to or within any of the following environmentally sensitive areas? Cultural heritage site X Protected area X Wetland X Mangrove X Estuarine X Buffer zone of protected area X Special area for protecting biodiversity X Underground utilities X Potential Environmental Impacts Will the Project cause … Encroachment on historical / cultural There will be no encroachment on historical or area; disfiguration of landscape by X cultural areas. construction? Encroachment on precious ecology (e.g. The proposed development will not encroach sensitive or protected areas)? X on precious ecology or environmentally sensitive areas. Alteration of surface water hydrology of Not applicable waterways resulting in increased (no waterways in project area impact area) sediment in streams affected by X increased soil erosion at construction site? Deterioration of surface water quality Not applicable due to silt runoff and sanitary wastes X from worker-based camps and chemicals used in construction? Increased local air pollution due to rock The proposed development will not utilize crushing, cutting and filling works, and X crushers. There will be no cut and fill works to chemicals from construction site? be undertaken as the development mainly

186 Annex 2

SCREENING QUESTIONS YES NO REMARKS would be renovation/rehabilitation works.. Requirements for disposal of fill, X excavation, and/or spoil materials? Noise and vibration due to blasting and The project will not involve blasting. The noise other civil works? X from other civil works may cause acute, short- term, and temporal elevated levels. Community safety risks due to both The EMP prescribes measures to mitigate, or accidental and natural hazards, if at all possible, eliminate the risks from especially where the structural elements accidental and natural hazards. or components of the project are accessible to members of the affected X community or where their failure could result in injury to the community throughout project construction, operation and decommissioning? Other social concerns relating to Temporary in nature. inconveniences in living conditions in the project areas that may trigger cases X of upper respiratory problems and stress? Poor sanitation and solid waste disposal Appropriate waste management will be in construction camps and work sites, ensured. and possible transmission of X communicable diseases from workers to local populations? Creation of temporary breeding habitats Appropriate arrangements will be provided. X for mosquito vectors of disease? Dislocation and compulsory The project will not displace or dislocate any resettlement of people living in right of X person. way? Disproportionate impacts on the poor, There are no disproportionate impacts on women and children, Indigenous People X poor, women and children, indigenous or other vulnerable groups? peoples, or other vulnerable groups. Accident risks associated with increased It is not projected that such risks will be vehicular traffic, leading to accidental X present during the implementation of the spills of toxic materials and loss of life? proposed development. Increased noise and air pollution The operation of heavy equipment and service resulting from traffic volume? vehicles during the project implementation X may cause acute, short-term and temporal elevated levels of ambient noise and suspended particulates Risks to community safety caused by It is not projected that such risks will be fire, electric shock, or failure of the present during the implementation of the X buildings safety features during proposed development. operation?

Annex 2 187

LAND TITLES

LAND CERTIFICATE – COLLEGE OF HEALTH SCIENCES, CHAMPASAK PROVINCE

188 Annex 2

Annex 2 189

LAND CERTIFICATE – COLLEGE OF HEALTH SCIENCES, SAVANNAKHET PROVINCE

190 Annex 2

Annex 2 191

LAND CERTIFICATE – SCHOOL OF PUBLIC HEALTH, XIENG KHOUANG PROVINCE

192 Annex 2

Annex 2 193

LAND CERTIFICATE – SCHOOL OF PUBLIC HEALTH, OUDOMXAY PROVINCE

194 Annex 2

Annex 2 195

196 Annex 2

LAND CERTIFICATE – MAI DISTRICT HOSPITAL, PHONGSALY PROVINCE

Annex 2 197

198 Annex 2

Annex 2 199

200 Annex 2

Annex 2 201

202 Annex 2

LAND CERTIFICATE – XAY PROVINCIAL HOSPITAL OUDOMXAY PROVINCE

Annex 2 203

204 Annex 2

LAND CERTIFICATE – BENG DISTRICT HOSPITAL, OUDOMXAY PROVINCE

Annex 2 205

206 Annex 2

LAND CERTIFICATE – HOUN DISTRICT HOSPITAL, OUDOMXAY PROVINCE

Annex 2 207

208 Annex 2

Annex 2 209

LAND CERTIFICATE – LUANG PRABANG PROVINCIAL HOSPITAL, LUANG PRABANG PROVINCE

210 Annex 2

Annex 2 211

LAND CERTIFICATE – NAMBAK DISTRICT HOSPITAL, LUANG PRABANG PROVINCE

212 Annex 2

Annex 2 213

214 Annex 2

LAND CERTIFICATE – PHOUKHOUN DISTRICT HOSPITAL, LUANG PRABANG PROVINCE

Annex 2 215

216 Annex 2

Annex 2 217

218 Annex 2

Annex 2 219

LAND CERTIFICATE – HOUAMUANG DISTRICT HOSPITAL, HOUAPHANH PROVINCE

220 Annex 2

Annex 2 221

LAND CERTIFICATE – PAKLAY DISTRICT HOSPITAL, SAYABOURY PROVINCE

222 Annex 2

Annex 2 223

LAND CERTIFICATE – BOTEN DISTRICT HOSPITAL, SAYABOURY PROVINCE

224 Annex 2

Annex 2 225

LAND CERTIFICATE – MOK DISTRICT HOSPITAL, XIENG KHOUANG PROVINCE

226 Annex 2

Annex 2 227

LAND CERTIFICATE – PHAXAY DISTRICT HOSPITAL, XIENG KHOUANG PROVINCE

228 Annex 2

Annex 2 229

230 Annex 2

LAND CERTIFICATE – KAYSONE PROVINCIAL HOSPITAL, SAVANNAKETH PROVINCE

Annex 2 231

232 Annex 2

LAND CERTIFICATE – NONG DISTRICT HOSPITAL, SAVANNAKETH PROVINCE

Annex 2 233

234 Annex 2

LAND CERTIFICATE – SONGKHONE DISTRICT HOSPITAL, SAVANNAKETH PROVINCE

Annex 2 235

236 Annex 2

LAND CERTIFICATE – LAO-NGAM DISTRICT HOSPITAL, SALAVAN PROVINCE

Annex 2 237

238 Annex 2

Annex 2 239

240 Annex 2

Annex 2 241

LAND CERTIFICATE – PHAKSONG DISTRICT HOSPITAL, CHAMPASAK PROVINCE

242 Annex 2

Annex 2 243

LAND CERTIFICATE – MOUNLAPAMOK DISTRICT HOSPITAL, CHAMPASAK PROVINCE

244 Annex 2

Annex 2 245

LAND CERTIFICATE – HOME DISTRICT HOSPITAL, XAISOMBOUN PROVINCE

246 Annex 3

Annex 3 247

ENVIRONMENTAL MONITORING CHECKLISTS

CHECKLIST 1 Construction Camps

(N.B. There is no specific regulation for this activity. "Good Housekeeping" must be observed and "General Industry Practice" followed)

Project Site: Observer:

Frequency: Check weekly during preparation of camp, at opening of camp, then weekly or in response to complaint.

Date: Time:

Location:

Weather Condition:

Checklist Question Yes No Additional Data needs Is the camp/yard located in a protected area, next to a community water source or any other ecologically or otherwise sensitive area?

If yes, comment on the adverse impacts on the environment:

Is the camp/yard being properly maintained?

If no, list what is not being done properly:

Is the wastewater being disposed of properly?

If no, comment on how it is being disposed and what are the impacts:

If no, comment on. Have septic tanks been installed? Are they working correctly, that is not overflowing, or emitting smell?

Is the solid waste being disposed off properly?

If no, comment on how it is being disposed and the impacts of such disposal:

Is attention being paid to "Good housekeeping"?

248 Annex 3

If no, comment on what is not being done:

Checklist Question Yes No Additional Data needs Are the contractor's vehicles being maintained at the campsite / yard?

If yes, are appropriate precaution taken to avoid water and land contamination?

Is the waste from vehicle maintenance being disposed off properly?

If no, comment on how it is being disposed:

Is the fuel storage area properly surfaced and has a containment kerb around it?

If no, comment on how the surrounding area is being affected:

Are occupational health and hygiene precautions being taken?

If no, comment on where they are being neglected:

Does the community have any issues with the camp?

If yes, what are the issues?

Any additional comments:

Inspector’s name and signature: Annex 3 249

CHECKLIST 2 Air Pollution

(N.B. The contractor must carry out his activities to ensure compliance with the regulations stated in draft Sub Decree on Air and Noise Pollution Control)

Project Site: Observer:

Frequency: Check weekly or in response to complaint.

Date: Time:

Location:

Weather Condition:

Checklist Question

What is the nature of air pollution?

Dust from road Dust from stock piled materials Generator, batching plant emissions Vehicular emissions Checklist Question Yes No Additional Data needs Is the problem significant enough to warrant attention?

If yes, did the contractor take appropriate measure to mitigate the problem?

What is/are the measures taken? Periodic water sprays on road surface/borrow pits Vehicle tire washing facilities at borrow pits and other locations Speed limit enforced on project vehicles Vehicles speeding checked by posting signs on roads, and awareness raising of staff and local communities Covering of stock piled materials Vehicles regularly maintained Equipment regularly maintained

Is air pollution creating problems for the surrounding communities?

If yes, what type of problems?

Inspector’s name and signature:

250 Annex 3

CHECKLIST 3 Water Pollution

(N.B. The contractor must carry out his activities to ensure compliance with the regulations stated in ______)

Project Site: Observer:

Frequency: Check weekly or in response to complaint. Date: Time:

Location:

Weather Condition:

Checklist Question

What is the nature of water contamination?

1.1 Surface Water (stream, pond etc.) disposal of cut spoil into water body or on slope leading to water body discharge of wastewater from camp into fresh water body road run-off into water body discharge of used oil, fuel, grease, etc. into water body

1.2 Groundwater leakage of oil, fuel, wells, etc. on land resulting in contamination of ground water and wells any other reason

Checklist Question Yes No Additional Data needs Is the impact significant enough to warrant mitigatory measures?

If yes, provide necessary details:

Is the impact long term?

If yes, comment:

Can it be ratified by mitigatory measures?

If yes, what type of mitigatory measures should be taken?

Did community bring the problem to the notice of authorities?

Has action been taken to counter the problem? Is it effective?

Additional comments:

Inspector’s name and signature: Annex 3 251

CHECKLIST 4 Land Contamination

(N.B. There is no specific regulation for this activity)

Project Site: Observer:

Frequency: Check weekly or in response to complaint.

Date: Time:

Location:

Weather Condition:

Checklist Question

What are the impacts of project activities on land? run-off of oil, grease and fuel contaminating land fuel oil / used oil / grease spill on land in equipment yards / camps sites indiscriminate discharge of waste water on land indiscriminate disposal of solid waste any other project activities resulting in land contamination

Checklist Question Yes No Additional Data needs Is the impact significant enough to warrant mitigatory measures?

If yes, provide necessary details:

Is the impact permanent?

If permanent, could it have been avoided by taking appropriate mitigatory measures?

If yes, what type of mitigatory measures should have been taken?

Is the impact temporary?

If yes, when and how could it be corrected?

252 Annex 3

Checklist Question Yes No Additional Data needs Is the community satisfied with the measures taken by the contractor to protect agricultural activities?

If no, how and with what measures can it be improved?

Is the local administration satisfied with the measures taken by the contractor to protect agricultural activities?

If no, what is being suggested by the local administration?

Did the community allow the use of their land for borrow pit or any other purpose?

If yes, what was the motivation behind it?

If no, did the contractor take permission from the land owner and local administration for the specific use?

Any additional comments:

Inspector’s name and signature:

Annex 3 253

CHECKLIST 5 Cultural Heritage

(N.B. The contractor must carry out his activities to ensure compliance with the regulations stated In ______)

Project Site: Observer:

Frequency: Check weekly or in response to complaint.

Date: Time:

Location:

Weather Condition:

Checklist Question Yes No Additional Data needs Does the project area have any cultural heritage, archaeological, historical or religious sites?

If yes, are they affected in any way by the project activities?

If yes, how?

Did the concerned authorities and the contractor take any appropriate measures to protect the site?

If yes, what are the measures taken?

Are the communities satisfied with the measures taken?

Is the community satisfied with the measures taken by the contractor to protect land?

If no, how and with what measures can it be improved?

Is the local administration satisfied with the measures taken by the contractor to protect land?

If no, what is being suggested by the local administration?

Any additional comments:

Inspector’s name and signature:

254 Annex 3

CHECKLIST 6 Noise Pollution

(N.B. The contractor must carry out his activities to ensure compliance with the regulations stated in draft Sub Decree on Air and Noise Pollution Control)

Project Site:

Observer:

Frequency: Check weekly or in response to complaint.

Date: Time:

Location:

Weather Condition:

Checklist Question

What is the nature of noise pollution? vehicles on road Generators, construction plant Construction vehicles vibration from equipment vibration from road vehicles vibration from explosive blasting

Checklist Question Yes No Additional Data needs Is the problem significant enough to warrant attention?

If yes, did the contractor / consultant take appropriate measure to mitigate the problem?

What is / are the measures taken? vehicles regularly maintained and silencers checked speed limit enforced on project vehicles construction equipment maintained and silenced compressors and generators operated with silencing panels closed awareness raising of staff over causing nuisance to local communities blasting at fixed times and communities notified Avoid undertaking construction activities and blasting close to communities at night

Is noise pollution creating problems (health, aesthetic & nuisance) for the surrounding communities?

If yes, what type of problems?

Inspector’s name and signature: Annex 3 255

CHECKLIST 7 Drainage and Flooding

(N.B. There is no specific regulation for this activity)

Project Site:

Observer:

Frequency: As required

Date: Time:

Location:

Weather Condition:

Checklist Question Yes No Additional Data needs Is the flooding extensive or not?

If yes, give details:

Have contractors activities caused flooding or blocked drains?

If yes, give details:

Have cross drainage structures been built in correct location as shown in contract?

If no, give details:

Are cross drainage structures "as built" same as in "detailed design"?

If no, give details:

Any other issues

If yes, give details

Inspector’s name and signature:

256 Annex 3

CHECKLIST 8 Construction Camps Closure

(N.B. There is no specific regulation for this activity)

Project Site:

Observer:

Frequency: Check at closure of camp.

Date: Time:

Location:

Weather Condition:

Checklist Question Yes No Additional Data needs Is the camp / yard located in a protected area, next to a community water source or any other ecologically or otherwise sensitive area?

If yes, comment on the adverse impacts on the environment:

Has the camp/yard been properly cleared of all debris and revegetated?

If no, list what was not done properly:

Was the wastewater disposed of properly?

If no, comment on how it was being disposed and what were the impacts:

Were septic tanks installed? Have they been removed?

If no, why not?

Was solid waste disposed of properly?

If no, comment on how it was being disposed and the impacts of such disposal:

Was attention being paid to housekeeping?

Annex 3 257

If no, comment on what was not being done:

Checklist Question Yes No Additional Data needs Have all the contractor equipment being removed from the campsite/yard?

If yes, have all appropriate precautions been taken to avoid water and land contamination?

Has the scrap metal from vehicle maintenance being disposed of properly?

If no, comment on how it is to be disposed:

Has all fuel storage been removed from the site?

If no, comment on how the surrounding area is being affected:

Have all general offices and staff dwellings been removed?

If no, comment on if they are to be handed over to new owner or other plans:

Does the community have any issues with the camp closure?

If yes, what are the issues?

Any additional comments:

Inspector’s name and signature:

258 Annex 4

TEMPLATE OF THE ENVIRONMENTAL SAFEGUARD MONITORING REPORT

Safeguards Monitoring Report

# Semiannual/Annual Report xxx {month} 20xx

Lao PDR: Quality Health Care Project

Prepared by the Project Coordination Unit of the Department of Planning Cooperation for the Ministry of Health and the Asian Development Bank.

Annex 4 259

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

This safeguards monitoring 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.

260 Annex 4

I. EXECUTIVE SUMMARY

{Read and delete: Provide short summary of the following items:

• Summary of EMP/RP Implementation

• Description of monitoring activities carried out (e.g. field visits, environment effect monitoring, survey questionnaire, public consultation meetings, focus group discussions, etc.)

• Key issues, any corrective actions already taken, and any grievances

• Key activities planned in the next reporting period

• Recommendations

{Use the paragraph numbering format provided below throughout the report}

1. xxx

2. xxx

II. PROJECT OVERVIEW, GENERAL SAFEGUARD MATTERS

A. Project Overview

{Read and delete: Briefly describe project objectives, scope and components – can be taken from PAM or other relevant document}

3. xxx

4. xxx

B. Project Progress

{Read and delete: Using most recent project progress report, describe status of project implementation, including full list of contracts, status of contract awarding and implementation, name of contractor, Engineer, Project Supervision Consultant.}

5. xxx

6. xxx

Annex 4 261

Table 1: Project Overview, Snapshot of Project Progress

Project Number and Title:

Environment

Safeguards Category Indigenous Peoples

Involuntary Resettlement

Reporting period:

Last report date: {Read and delete: This section should include, among others, the following:} Key subproject activities Contract awarding since last report: Progress of Work (% physical completion) Status of Safeguard Approvals / Permits / Consents Report prepared by:

3. Safeguard Plans Implementation Arrangements

{Read and delete: Describe institutional arrangements and responsibilities for EMP implementation, internal and external monitoring, and reporting, defining roles of PMU, Implementation Consultant, Contractors. (Table format as needed)}

7. xxx

8. xxx

4. Domestic clearances, Updated EMP, Incorporation of Safeguards Requirements into Project Contractual Arrangements

{Read and delete: Report on status of securing domestic approvals of IEE/EMPs, building permits, etc. Define manner by which EMP requirements are incorporated into bidding documents, contracts. Indicate when updated EMPs were submitted for clearance by ADB; confirm if/when contractor’s CEMPs were approved (Table format appropriate).}

9. xxx

10. xxx

III. ENVIRONMENTAL PERFORMANCE MONITORING

A. Status of EMP implementation (Mitigation Measures)

{Read and delete: Summarize main mitigation/protection measures implemented in the reporting period (narrative section). Structure in accordance to phases (detailed design, construction preparation, construction, and operation).}

11. xxx

12. xxx

262 Annex 4

{Read and delete: Include EMP table or updated EMP table if applicable. Assess compliance of environmental management activities with the original or updated EMP. For that purpose, include additional columns entitled “Compliance Status”, "Comment or Reasons for Non- Compliance", and "Issues for Further Action". Example is provided below.}

Table 2: Compliance with EMP Requirements (Environmental Performance) Compliance Status Comment or Reasons for EMP Requirements Issues for Further Action (Yes, No, Partial) Non-Compliance Use environmental impact Use EMP list as basis for as main heading and EMP rating/evaluating as listing compliance

Table 3: Issues for Further Action Issue Required Action Responsibility and Timing Resolution Old Issues from Previous Reports List of EMP measures or activities not completed

(last column of previous table)

New Issues from This Report

2. Health and Safety

{Read and delete: Provide narrative of occupational and community health and safety issues that occurred during the reporting period. Any accident involving injury or death of workers or community members must be reported. Any case of COVID-19 should be reported. Provide details in the Table below}.

13. xxx

14. xxx

Table 4: Health and Safety Issues Issue Required Action Responsibility and Timing Resolution Old Issues from Previous Reports

Annex 4 263

New Issues from This Report

3. Environmental Monitoring

15. Monitoring plan. xxx {Read and delete: Present the environment effect monitoring plan as defined in the EMP or the updated monitoring plan. Describe monitoring responsibilities}

16. Monitoring activities in the reporting period. Xxx {Read and delete: Describe the environment monitoring activities in the reporting period, including number of monitoring campaigns, etc. Confirm compliance with the monitoring plan, or justify any deviation from the plan}

Table 5: Environment Effect Monitoring Results in the Reporting Period {Read and delete: Present monitoring result in a Table (see example below, adjust as needed). Any non-compliance should be highlighted for attention and follow-up.} Relevant government Location Parameter Date Monitoring value standard, standard value

17. Assessment. Xxx {Read and delete: Compare monitoring results with baseline conditions (if baseline data is available) and relevant government standards in qualitative terms. Additional explanatory comments should be provided as necessary. Possible reasons for non- compliance should be identified.}

VI. COMPLIANCE WITH SAFEGUARDS RELATED PROJECT COVENANTS

{Read and delete: List all environment, health and safety related loan covenants, and assess project’s compliance with the covenants (Table format is appropriate, with concluding statement on compliance, partial compliance or non-compliance, and corrective actions as needed)

Remarks/Issues Schedule Para No. Covenant (Status of Compliance) Schedule 5 xxx Complied with / Partially complied with / Not complied with. {Identify reason for partial or non- compliance}

264 Annex 4

IV. PUBLIC CONSULTATION, INFORMATION DISCLOSURE, CAPABILITY BUILDING

{Read and delete: Describe public consultation activities during the reporting period. Confirm compliance with consultation plan defined in the IEE/EMP, or justify deviation from these plans. Present planned consultation activities in next reporting period. Use Tables as appropriate.}

• Field Visits (sites visited, dates, persons met) • Public Consultations and meetings (Date; time; location; agenda; number of participants disaggregated by sex and ethnic group, not including project staff; Issues raised by participants and how these were addressed by the project team) • Training (Nature of training, number of participants disaggregated by gender and ethnicity, date, location, etc.) • Press/Media Releases • Material development/production (e.g., brochure, leaflet, posters) • Information disclosure

V. GRIEVANCE REDRESS MECHANISM

{Read and delete: Describe mechanisms established to address and redress public complaints and grievances related to social and environment safeguards. Summarize grievances received, if any, and measures implemented to redress them.}

• Number of new grievances, if any, since last monitoring period: ____ • Number of grievances resolved: _____ • Number of outstanding grievances: _____

Details Required Action, (Date, person, address, Responsibility and Type of Grievance contact details, etc.) Timing Resolution Old Issues from Previous Reports

New Issues from This Report

VI. CONCLUSION

{Read and delete: Highlight important results from the implementation of EMP monitoring; recommendations to improve EMP management, implementation, and monitoring; key activities planned in next reporting period}.

22. xxx

Annex 4 265

23. xxx

VII. ATTACHMENTS

• Consents / permits • Monitoring data (water quality, air quality, etc.) • Inspection checklists • Photographs • Others

266 Annex 5

CONTRACTOR’S ENVIRONMENT, HEALTH AND SAFETY PROGRESS MONITORING REPORT

Contract (Insert Contract ref/number) Completed by (Insert name of Contractor’s Environmental Health and Safety Officer) Company name (Insert name of Company)

Reporting Frequency: Monthly

Date of this report DD-MM-YY Reporting Period MM/YY – MM/YY Permits and licenses • Xxx secured (e.g. • Xxx environment • Xxx clearance, • xxx construction permits, licenses) Key construction activities since last report Planned construction activities in next reporting period

Progress with EHS Activities this month • Total number of construction workers as of DD-MM-YY: Xxx women, xxx men; xxx% unskilled labor • Number of new recruitments in reporting period: xxx women, xxx Recruitment of men construction workers • We confirm the following: Compliance with labor ☐ Adherence to the International Labor Organization (ILO) laws and regulations Core Labor Standards ☐ Compliance with Labor Code of Lao PDR

Trainings Undertaken EHS Training Provided: (type, date) – all training related to Nos. Participants: xxx women, xxx men EHS Who provided the training: New construction PPEs issued this month: Personal Protective

Equipment Number of incidents of workers not wearing adequate construction PPE: Emergency Response Accidents reported: Use of site accident Book Description and Actions taken: Outcome: Number of spills: Spillages Description and Actions taken: Impact of spill: Number of incidents: Other incidents Description and Actions taken: Impact of incident:

Annex 5 267

Concerns and Complaints Number of complaints: Action taken for each complaint: Outstanding complaints: Describe COCP Compliance Issues, Problems or Other issues PMU should be aware of

Prepared by: ______Verified by: ______(Contractor) (authorized DHO staff)