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Armenia Health Systems Modernization Project

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Armenia Health Systems Modernization Project ARMENIA HEALTH SYSTEMS MODERNIZATION PROJECT Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized THE NEW MEGHRI REGIONAL MEDICAL CENTER FULL SCALE ENVIRONMENTAL IMPACT ASSESSMENT REPORT AND ENVIRONMENTAL MANAGEMENT PLAN Public Disclosure Authorized Yerevan, August 2012 Table of Contents EXECUTIVE SUMMARY ........................................................................................................... 1 1. Introduction ............................................................................................................................... 4 2. Methodology...............................................................................................................................5 3. Legal and Administrative Framework .................................................................................... 5 3.1 National Legislation .............................................................................................................. 5 3.2 Permits and agreements required prior to commencement of construction works and during operation of a medical center ......................................................................................... 10 3.3 International Agreements .................................................................................................... 11 3.4 The World Bank Safeguard Policies ................................................................................... 12 3.5 Administrative Framework .................................................................................................. 13 4. Legal and Administrative Framework .................................................................................. 14 4.1. Location description ........................................................................................................... 14 4.2. Climate ............................................................................................................................... 16 4.3. Water resources .................................................................................................................. 17 4.4. Air Quality .......................................................................................................................... 18 4.5. Biodiversity ........................................................................................................................ 19 4.6. Specially protected nature areas ......................................................................................... 20 5. Social and Economic Conditions ........................................................................................... 20 6. Project Description ................................................................................................................. 22 7. Project Aternatives..................................................................................................................26 7.1. “No Action” alternative ...................................................................................................... 26 7.2. The initial option ................................................................................................................ 27 7.3. The selected option ............................................................................................................. 27 8. Environmental Impacts of the Project .................................................................................. 28 8.1 Consturction Phase..............................................................................................................28 8.2. Operation Phase .................................................................................................................. 33 9. Mitigation of the Expected Risks ........................................................................................... 36 9.1 Construction Phase .............................................................................................................. 36 9.2 Operation Phase ................................................................................................................... 37 10. Affected Parties and Public Consultations .......................................................................... 38 11. Environmental Management Plan ....................................................................................... 38 11.1 Responsibilities and Institutional Arrangements ............................................................... 38 11.2 Responsibilities of Construction Contractor ..................................................................... 38 11.3 Monitoring of EMP implementation ................................................................................. 38 Annex I. References ..................................................................................................................... 39 Annex 2. Environmental Management Matrix ......................................................................... 41 Annex 3 Calculation of Emissions, Water Use and Water Discharge .................................... 53 Annex 4. Calculation of Economic Damage .............................................................................. 58 Annex 5. Waste Generation........................................................................................................60 Annex 6 Public Consultation ...................................................................................................... 61 Annex 7. Certificate of Absence of the Known Historical and Archeological Monuments from the Project Site.................................................................................................................... 64 Annex 8. Land Certificate Issued for the Allocated Site .......................................................... 65 LIST OF ABBREVIATIONS MAC - Maximum Admissible Concemtration MPE - Maximum Permissible Emission MPE - Maximum Permissible Discharge SNCO - State Non Commercial Organization WB - World Bank RA - Republic of Armenia MoH - Ministry of Healthcare MNP - Ministry of Nature Protection UN - United Nations UNDP - United Nations Development Program EIA - Environmental Impact Assessment PM - Particulate Matter VOC - Volatile Organic Compaund DRR - Daily Regulated Reservoir ENA – Elektric Networks of Armenia CJSC - Closed Joint Stock Company GEF – Global Environment Facility BOD – Biological Oxygen Demand HPIA – Health Project Implementation Agency EXECUTIVE SUMMARY Health System Modernization Project-2 (HSMP-2) is the second phase of two-phase Adaptable Lending Program (APL) provided by the World Bank in support to the Government’s health sector reform program. The development objective of the HSMP-2 is to strengthen the Ministry of Health’s (MoH's) capacity for more effective system governance, scaling up family medicine- based primary health care and upgrading selected healthcare service delivery networks in marzes to provide more accessible, quality and sustainable health care services to the population. HSMP-2 continues supporting the Government of Armenia (GOA) to: (i) complete the family medicine based Primary Health Care (PHC) reform that was launched in 1996 so to ensure that every Armenian citizen and legal resident will have access to a qualified and well motivated family doctor and nurse of his/her choice; (ii) consolidate the hospital sector to minimize waste of scarce resources and improve quality of care; and (iii) strengthen GoA’s competencies for effective stewardship in policy making, regulation, oversight and public accountability ensure effective and targeted use of public resources in accordance with the health and healthcare needs of the population, especially the poor. HSMP-2 started in 2007, before the completion of the first phase of the Program, in view of the progress made toward meeting the trigger conditions of the program. HSMP-2 was scheduled for the period of five years ending December 2012. In July 2011, though, the Additional Financing was provided for the Project, which covers financing gaps of ongoing activities and scales them up. With the AF included, the HSMP-2 is expected to end in December, 2014. The decree of the Government of Armenia #1911-N of Nov 2, 2006 approved the master-plans of optimization of regional health care delivery systems developed in the scope of the first phase of the project. Modernization activities cover Hrazdan MC of Kotayk marz, Ijevan MC of Ijevan marz, Armavir MC of Armavir marz, Ararat MC of Ararat marz, Aparan MC of Aragatsotn marz, Goris MC of Syunik marz, Gavar MC of Gegharkunik marz, and the Gyumri new MC of Shirak marz. Currently the 8 hospitals are renovated/constructed, provided with modern medical equipment and furniture. The Government of Armenia adopted a revised optimization plan (amendment to Government decree N 1172 from 03.09.2010) which includes construction of a new building for Meghri Regional Medical Center to serve the entire population of the Meghri region and provide all kinds of hospital and polyclinic services. This would result in vacation of Agarak hospital, Meghri hospital, and several polyclinic buildings. The Meghri region currently has hospital facilities at two locations – in Meghri and in Agarak cities. The conditions of all existing buildings are not satisfactory and significant investment is required in infrastructure of each of them to bring them in line with modern standards of hospital and polyclinic care and create acceptable conditions of
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