Social Due Diligence Report Project Number: 53291-001 June 2020 LAO: Improving the Quality of Health Care Project Prepared by the Ministry of Health of Lao People’s Democratic Republic for the Asian Development Bank This Social Due Diligence Report is a document of the borrower. The views expressed herein do not necessarily represent those of ADB's Board of Directors, Management, or staff, and may be preliminary in nature. In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area. ABBREVIATIONS ADB - Asian Development Bank CQI - continuous quality improvement HHR - health human resource HPEI - health professional education institution IP/EM - Indigenous people/ethnic minority Lao PDR - Lao People’s Democratic Republic MOH - Ministry of Health PCIU - Project Coordination and Implementation Unit QHCP - Quality Health Care Project SQM - square meter TA - technical assistance CONTENTS Page I. Introduction and Project Background 1 II. Scope of the Due Diligence and Subproject Hospitals and Schools 2 III. Findings of the Social Due Diligence 6 IV. Consultation, Participation, and Disclosure 15 V. Grievance Redress Mechanism 15 VI. Institutional Arrangements 16 VII. Conclusion and Recommendation 17 ANNEXES 1 Land Certificate – Mai District Hospital, Phongsaly Province 18 2 Land Certificate – Oudomxay Provincial Hospital, Xay District 26 3 Land Certificate – Beng District Hospital, Oudomxay Province 28 4 Land Certificate – Houn District Hospital, Oudomxay Province 30 5 Land Certificate – Oudomxay School of Public Health, Xay District 32 6 Land Certificate – Luang Prabang Provincial Hospital, Luang Prabang Province 34 7 Land Certificate – Nambak District Hospital, Luang Prabang Province 36 8 Land Certificate – Phoukhoun District Hospital, Luang Prabang Province 39 9 Land Certificate – Houamuang District Hospital, Houaphanh Province 44 10 Land Certificate – Paklay District Hospital, Sayaboury Province 45 11 Land Certificate – Boten District Hospital, Sayaboury Province 46 12 Land Certificate – Mok District Hospital, Xieng Khouang Province 47 13 Land Certificate – Phaxay District Hospital, Xieng Khouang Province 48 14 Land Certificate – Xieng Khouang School of Public Health Province, Pek District 50 15 Land Certificate – Hom District Hospital, Xaisomboun Province 51 16 Land Certificate – Savannakhet Provincial Hospital, Kaysone District 52 17 Land Certificate – Nong District Hospital, Savannakhet Province 53 18 Land Certificate – Songkhone District Hospital, Savannakhet Province 54 19 Land Certificate – Savannakhet College of Health Science, Kaysone District 55 20 Land Certificate – Lao-Ngam District Hospital, Salavan Province 56 21 Land Certificate – Paksong District Hospital, Champasak Province 59 22 Land Certificate – Moulapamok District Hospital, Champasak Province 60 23 Land Certificate – Champasak College of Health Science (Ban Saphanxay Campus), Pakse District 61 I. INTRODUCTION AND PROJECT BACKGROUND 1. The Asian Development Bank (ADB) approved a transaction technical assistance (TA9723) (the TA) to the Government of the Lao People’s Democratic Republic (PDR), through the Ministry of Health (MOH), for the preparation of the Improving the Quality of Health Care Project (QHCP), which will support MOH in improving its health system capacity to deliver high- quality health care services. The transaction technical assistance (TRTA) facility, Support for Human and Social Development in Southeast Asia which funded the TA was approved on 4 April 2019. The TA mobilized on 13 January 2020. The cost of the TA is $750,000 to assist the Government in preparing the project. The TA’s primary purpose is to conduct a feasibility study and design the project pipelined for 2021. ADB completed a TA inception mission in Lao PDR on January 2020. 2. The project is in line with the Health Sector Reform Strategy (HSRS), Phase III (2021– 2025), which focuses on primary health care (PHC), through the Three Builds policy (also known 1 as the Sam Sang directive)0F , and aims to expand the availability of quality essential health services, particularly from health centres and district hospitals, in line with the increased needs and expectations of the Lao people. The project is also in line with the operational priorities of ADB’s Strategy 2030 to: (i) address remaining poverty and reducing inequalities, as health improvement is associated with improved economic opportunities; and (ii) accelerate progress in gender equality. It also directly contributes to the Country Partnership Strategy for Lao PDR (2017–2020), Strategy Priority 2 (enhanced human development) and is included in the Country Operations Business Plan (2019–2021). 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 Personnel (DHP) develop a 2 new decree on medical civil servants,1F and the associated 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. 1 The Sam Sang (Three Builds) directive on devolution, featured in the Resolution of the 9th Party Congress, calls for provincial, district, and village authorities to formulate socioeconomic development plans based on local capacity. 2 The proposed new decree is aligned with the government’s social sector reforms being promoted by the Ministry of Home Affairs (MOHA). 2 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, 2F3 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 4 systems. First, the project will upgrade and equip 16 selected district hospitals in 10 provinces 3F 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