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Environmental and Social Management Framework for the Andhra Pradesh Health Systems Strengthening Project Final Report Volume

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Environmental and Social Management Framework for the Andhra Pradesh Health Systems Strengthening Project Final Report Volume Environmental and Social Management Framework for the Public Disclosure Authorized Andhra Pradesh Health Systems Strengthening Project Final Report Public Disclosure Authorized Volume -1: Main Report Public Disclosure Authorized February 2019 By Public Disclosure Authorized Strategic Planning and Innovations Unit (SPIU) Department of Health, Medical and Family Welfare (DoHMFW) ABBREVIATIONS AH Area Hospital ANC Antenatal Care ANM Auxiliary Nurse Midwife AP Andhra Pradesh APPCB Andhra Pradesh Pollution Control Board APTWD Andhra Pradesh Tribal Welfare Department APVVP Andhra Pradesh Vaidya Vidhana Parishad ASHA Accredited Social Health Activist AWC Anganwadi Centre BMWM Bio-Medical Waste Management BPL Below Poverty Line CBMWTF Common Bio-Medical Waste Treatment Facility CFM Community Forest Management CH&FW Commissionerate of Health and Family Welfare CHC Community Health Centre CPCB Central Pollution Control Board, Govt. of India DCHS District Coordinator of Hospital Services DH District Hospital DMHO District Medical and Health Officers DoHFW Department of Healthand Family Welfare DQC District Quality Consultant DQM District Quality Manager EA Environmental Assessment EHR Electronic Health Record EHS Environmental Health and Safety ESMF Environmental and Social Management Framework ETP Effluent Treatment Plan ETP Effluent Treatment Plant GAP Gender Action Plan GoAP Government of Andhra Pradesh GoI Government of India HCF Health Care Facility HDI Human Development Index HDS Hospital Development Society IMR Infant Mortality Ratio IP Indigenous People ITDA Integrated Tribal Development Agency JFPC Joint Forest Protection Committees JSY Janani Suraksha Yojana LHV Leady Health Visitor MCH Maternal and Child Health MCP Mother and Child Protection MMR Maternal Mortality Rate MPDO Mandal Parishad Development Officers MRO Mandal Revenue Officer NCD Non-Communicable Diseases NHM National Health Mission NHSRC National Health Systems Resource Centre i NQAS National Quality Assurance Standards PA Protected Area PDO Project Development Objectives PESA The Panchayat (Extension to the Scheduled Areas) Act, 1996 PHC Primary Health Centre PMMVY Pradhan Mantri Matritva Vandana Yojana PMU Project Management Unit PRI Panchayati Raj Institution QA Quality Assurance SC Scheduled Cates SC Sub-Centre SERP Society for Elimination of Rural Poverty SOP Standard Operating Procedure SPIU Strategic Planning and Innovations Unit ST Scheduled Tribes TDF Tribal Development Framework TFR The Fertility Rate TPPF Tribal Peoples Planning Framework TRY Tribal Reform Yardstick TSP Tribal Sub Plan VHND Village Health Nutrition Day VSS VanaSamrakshanaSamities WHS Worker‟s Health and Safety ii TABLE OF CONTENT EXECUTIVE SUMMARY............................................................................................................................... v 1 INTRODUCTION .................................................................................................................................... 1 1.1 A Brief Profile of Andhra Pradesh ..................................................................................................... 2 1.1.1 Socio-Economic Status ............................................................................................................. 2 1.2 Scheduled Tribes in Andhra Pradesh.................................................................................................. 5 1.3 Health Status in Andhra Pradesh ........................................................................................................ 6 1.4 Health Care Facilities (HCF) in Andhra Pradesh ................................................................................ 8 1.5 The Proposed Project ....................................................................................................................... 10 1.5.1 The Project Development Objectives....................................................................................... 10 1.5.2 Key Result Areas .................................................................................................................... 11 1.6 The Project Area .............................................................................................................................. 16 2 THE ENVIRONMENTAL AND SOCIAL MANAGEMENT FRAMEWORK(ESMF) .................... 18 2.1 Need for Environment and Social Management Framework (ESMF) ............................................... 18 2.2 Scope and Objectives of the ESMF .................................................................................................. 18 2.3 Methodology Adopted for ESMF Preparation .................................................................................. 19 3 ENVIRONMENTAL AND SOCIAL BASELINE ................................................................................ 21 3.1 Environment Profile of AP .............................................................................................................. 21 3.2 Physical and Cultural Resources in Andhra Pradesh ........................................................................ 26 3.3 Status of Biomedical Waste Management System in AP .................................................................. 26 3.3.1 Segregation and Collection of Waste ....................................................................................... 27 3.3.2 Storage and Transportation of Bio-medical Waste ................................................................... 27 3.3.3 Treatment and Disposal of Bio-medical Waste ........................................................................ 28 3.4 Current Practice of Infection Management in AP ............................................................................. 31 3.4.1 Worker‟s Health and Safety .................................................................................................... 32 3.5 Infrastructure Condition and Access ................................................................................................ 33 3.6 Current Information Education and Communication (IEC) Activity ................................................. 35 4 ENVIRONMENTAL AND SOCIAL POLICIES AND REGULATIONS .......................................... 39 4.1 Environmental Laws, Policies and Regulations ................................................................................ 39 4.2 Social Legal Framework .................................................................................................................. 46 4.3 World Bank Safeguard Policies ....................................................................................................... 49 4.4 Conclusion ...................................................................................................................................... 52 5 STAKEHOLDER CONSULTATIONS ................................................................................................ 53 5.1 Key Stakeholders ............................................................................................................................. 53 5.2 Stakeholder Consultation Process Adopted ...................................................................................... 53 5.3 Key Outcome of Stakeholder Consultations ..................................................................................... 56 6 ENVIRONMENTAL AND SOCIAL ASSESSMENT .......................................................................... 61 6.1 Environmental Risks and Impact ..................................................................................................... 61 6.2 Social Risk and Impact .................................................................................................................... 70 7 ENVIRONMENTAL MANAGEMENT PLAN .................................................................................... 76 7.1 The Process of Preparing Site Specific EMP .................................................................................... 76 iii 7.1.1 Screening of the Site Proposed Activities ................................................................................ 76 7.2 Key Environmental Risks and Potential Mitigation Measures .......................................................... 77 7.3 Environment Management Plan ....................................................................................................... 79 8 SOCIAL MANAGEMENT PLAN ........................................................................................................ 85 8.1 Key Social Risks Identified and Potential Mitigation Measures ....................................................... 85 8.2 Tribal (Indigenous People) Development Framework ...................................................................... 86 8.2.1 Socio-economic context of the state ........................................................................................ 86 8.2.2 Tribal Health Issues ................................................................................................................ 87 8.2.3 Tribal Reform Yardstick ......................................................................................................... 88 8.3 Inclusion Matrix .............................................................................................................................. 97 9 CITIZEN ENGAGEMENT AND GRIEVANCE REDRESS MECHANISM ................................... 104 9.1 Citizen Engagement and Outreach Strategies ................................................................................
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