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 ’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

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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, 18 2 Land Certificate – Oudomxay Provincial Hospital, Xay District 26 3 Land Certificate – Hospital, 28 4 Land Certificate – Houn District Hospital, Oudomxay Province 30 5 Land Certificate – Oudomxay School of Public Health, Xay District 32 6 Land Certificate – Provincial Hospital, 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, 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 – Hospital, Xieng Khouang Province 48 14 Land Certificate – Xieng Khouang School of Public Health Province, Pek District 50 15 Land Certificate – Hospital, 51 16 Land Certificate – Provincial Hospital, Kaysone District 52 17 Land Certificate – Hospital, 53 18 Land Certificate – Hospital, Savannakhet Province 54 19 Land Certificate – Savannakhet College of Health Science, Kaysone District 55 20 Land Certificate – Lao-Ngam District Hospital, Province 56 21 Land Certificate – Hospital, Province 59 22 Land Certificate – Moulapamok District Hospital, 60 23 Land Certificate – Champasak College of Health Science (Ban Saphanxay Campus), 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 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).

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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 the new QHC standards.

5 7. This project has been screened and categorized as C 4F for both involuntary resettlement and indigenous peoples per the Asian Development (ADB) Safeguard Policy Statement (SPS) (2009), as the proposed civil works will all take place within existing hospital compounds without requiring any land acquisition or without having any impact on IR. The proposed project will broadly benefit all persons in the project provinces regardless of their ethnic affiliations by enhancing QHC. This due diligence is prepared to ensure that there is no impact on IR and IP and to recommend that no subprojects having any involuntary resettlement or indigenous peoples impacts (category A and Category B) will be taken up in the future under this ADB funded project.

II. SCOPE OF THE DUE DILIGENCE AND SUBPROJECT HOSPITALS AND SCHOOLS

8. The project has various civil works and non-civil works components. The scope of this social due diligence report is only for the components with construction works which are for the

3 This includes the Colleges of Health Science in Champasak, Luang Prabang, and Savannakhet, the Schools of Public Health in Oudomxay and Xieng Khouang. 4 The hospitals were selected based on provincial health development plans and prioritizes underserved populations. The details are in Supplementary Document X. 5 A proposed project is classified as category C if it has no involuntary resettlement impacts. A proposed project is classified as category C if it is not expected to have impacts on Indigenous Peoples

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proposed 19 provincial, and district hospitals, 4 schools/training centers, and 1 MOH building in the head office in which will house the Project Management Unit (PMU) office. The Luang Prabang College of Health Science (not included in the list below but included in the map) is the only subproject without civil works. This due diligence report has been prepared in consultation with the MOH, the executing, and implementing agency and especially with the hospital, and school authorities in collecting necessary data. The 24 subprojects covered under the social due diligence report grouped by province and the location maps are presented below:

I. Phongsaly Province

1. Mai District Hospital

II. Oudomxay Province

2. Oudomxay Provincial Hospital, Xay District 3. Beng District Hospital 4. Houn District Hospital 5. Oudomxay School of Public Health*, Xay District

III. Luang Prabang Province

6. Luang Prabang Provincial Hospital 7. Nambak District Hospital 8. Phoukhoun District Hospital

IV. Houaphanh Province

9. Houamuang District Hospital

V. Sayaboury Province

10. Paklay District Hospital 11. Boten District Hospital

VI. Xieng Khouang Province

12. Mok District Hospital 13. Phaxay District Hospital 14. Xieng Khouang School of Public Health*, Pek District

VII. Xaisomboun Province

15. Hom District Hospital

VIII. Savannakhet Province

16. Savannakhet Provincial Hospital, Kaysone District 17. Nong District Hospital 18. Songkhone District Hospital 19. Savannakhet College of Health Science*, Kaysone District 4

IX.

20. Lao-Ngam District Hospital

X. Champasak Province

21. Paksong District Hospital 22. Moulapamok District Hospital 23. Champasak College of Health Science (Ban Saphanxay Campus)*, Pakse District

XI. Vientiane Capital

24. PMU office, Vientiane Capital, Sisattanack District

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Figure 1: The 25 Subprojects under QHCP Mapped and Grouped by Province

Map Source: Lao PDR 2015 Census Based Poverty Map – June 15 QHCP Project identification of location by Lao PDR Ministry of Health, 28 May 2020 6

III. FINDINGS OF THE SOCIAL DUE DILIGENCE

9. The summary table below shows the nature of civil works to be done with the subprojects:

Table 1: Summary table of subproject type and civil works to be done Construct New or Replace through Upgrade through Total Subproject Constructing New Renovation Subproject Health profession educational institutions 4 - 4 (HPEIs) District hospitals (DH) 7 9 16 Provincial hospitals (PH) - 3 3 Project Management Unit (PMU) - 1 1 Total by type of civil works 11 13 24* *Not included is the Luang Prabang College of Health Science where no civil works will be done.

21. Upgrading through construction, renovation, and repair for civil/physical works for the subproject hospitals and schools will not entail site clearing as these will improve on the existing structures. Construction of new buildings in 11 subproject sites will however need to clear the sites of old existing buildings, and/or possibly standing signages, trees, and other vegetation. All these clearing will take place inside the existing hospital and school complexes that are owned by the MOH. One subproject the Luang Prabang College of Health Science has no civil works involved but will be provided with equipment for training, and furniture. During the design engineering design, details on the renovation needs and design of the hospital, and school buildings will be determined. In total, 24 subprojects spread over 10 provinces will be implemented by the project.

22. The project is classified as category C for involuntary resettlement impacts. QHCP will support mainly capacity-building of medical service management and workers, upgrading of equipment, as well as improvement of health care infrastructure within existing provincial, and district hospitals and school complexes as well as construction of a replacement building in MOH compound in Vientiane capital. All the construction will not require any additional land. All hospitals and schools have sufficient space available within the existing boundaries and compounds to accommodate all civil works. MOH will be responsible to ensure that all civil works are carried out within the existing hospital, and school premises. Land allocated for subprojects are not used by any informal settlers.

23. The project is classified as category C for indigenous people’s impacts. While indigenous people are living in the districts that cover subproject areas, subprojects will have no negative impacts on them. No impacts on indigenous communities are envisaged as it will not require any land acquisition nor lead to any resettlement impacts. The project is not expected to have any direct or indirect impacts on the dignity, human rights, livelihood systems, or culture of indigenous peoples or the territories or natural or cultural resources that indigenous peoples own, use, occupy, or claim as an ancestral domain or asset. The indigenous people’s communities will not be specifically targeted and will benefit from the general interventions to improve the quality of local health care services.

24. Impacts on land acquisition, involuntary resettlement and indigenous peoples of each subproject hospitals, and schools are detailed in Table 1 below.

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Table 2: Summary Findings on Involuntary Resettlement and Indigenous Peoples Due Diligence on Each Subproject Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks I. Phongsaly Province 1 Mai District Hospital Replace, and Total area of the With land 21°10'17.04"N, Nil Nil The construction will construct District compound is 7,193 certificate 102°43'59.18"E be done within the hospital sqm and there is indicating existing premises of still available 2,000 ownership of existing facilities sqm to construct MOH (please see without requiring any the district hospital Annex 1) additional land. The existing and available land is not used by any informal settlers. No impact on IP is envisaged. II. Oudomxay Province 2 Oudomxay Provincial Upgrade through Total area of the With land 20°42'13.50"N, Nil Nil The construction will Hospital, Xay District construction of compound is certificate 101°59'52.89"E be done within the isolation and 63,500 sqm and indicating existing premises of treatment facility there is still ownership of existing facilities for covid 19 in available 1,600 MOH (please see without requiring any existing provincial sqm for the Annex 2) additional land. The hospital isolation and existing and available treatment facility land is not used by any informal settlers. No impact on IP is envisaged. 3 Beng District Hospital Upgrade through Total area is 8,276 With land 20°17'27.96"N, Nil Nil The construction will renovation of sqm and certificate 101°37'56.96"E be done within the hospital, refurbish renovation will be indicating existing premises of technical block done on 1,600 sqm ownership of existing facilities of the existing MOH (please see without requiring any hospital structure Annex 3) additional land. The existing and available land is not used by any informal settlers. No impact on IP is envisaged. 8

Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks 4 Houn District Hospital Upgrade portions Total area of the With land 20° 8'49.24"N, Nil Nil The construction will through compound is certificate 101°27'55.76"E be done within the renovating 30,000 sqm while indicating existing premises of hospital, refurbish renovation will be ownership of existing facilities technical block done within the MOH (please see without requiring any existing 2,000 sqm Annex 4) additional land. The area of the hospital existing and available building land is not used by any informal settlers. No impact on IP is envisaged. 5 Oudomxay School of Construct new 17 Total land area is With land 20°41'53.22"N, Nil Nil The construction will Public Health*, Xay room dormitory 18,609 sqm while certificate 101°59'48.42"E be done within the District 480 sqm of indicating existing premises of available open ownership of existing facilities space will be used MOH (please see without requiring any to construct the Annex 5) additional land. The dormitory existing and available land is not used by any informal settlers. No impact on IP is envisaged. III. Luang Prabang province 6 Luang Prabang Upgrade through Total land area of With land 19°51'50.28"N, Nil Nil The construction will Provincial Hospital construction of the compound is certificate 102° 7'9.83"E be done within the isolation and 6,228 sqm and indicating existing premises of treatment facility construction will be ownership of existing facilities for COVID 19 in carried out in the MOH (please see without requiring any existing provincial 2,000 sqm floor Annex 6) additional land. The hospital area of the hospital existing and available land is not used by any informal settlers. No impact on IP is envisaged. 7 Nambak District Upgrade through Total area of the With land 20°37'49.21"N, Nil Nil The construction will Hospital renovation of compound is certificate 102°28'1.98"E be done within the hospital, refurbish 32,073 sqm while indicating existing premises of technical block renovation will be ownership of existing facilities

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Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks done in 270 sqm MOH (please see without requiring any floor area of the Annex 7) additional land. The hospital existing and available land is not used by any informal settlers. No impact on IP is envisaged. 8 Phoukhoun District Replace portions Total land area of With land 19°26'19.53", Nil Nil The construction will Hospital by renovating the compound is certificate 102°26'3.50"E be done within the hospital; refurbish 4,844 sqm while indicating existing premises of technical block renovation will be ownership of existing facilities done within the MOH (please see without requiring any 2,000 sqm floor Annex 8) additional land. The area of the hospital existing and available land is not used by any informal settlers. No impact on IP is envisaged. IV. Houaphanh province 10 Houamuang District Replace old Total land area of With land 20°11'36.74"N, Nil Nil The construction will Hospital district hospital the compound is certificate 103°53'18.20"E be done within the building by 9,684 sqm while indicating existing premises of constructing new the construction of ownership of existing facilities the hospital will MOH (please see without requiring any occupy 2,000 sqm Annex 9) additional land. The of open space existing and available land is not used by any informal settlers. No impact on IP is envisaged. V. Sayaboury province 11 Paklay District Upgrade by Total land area of With land 18°11'47.30"N, Nil Nil The construction will Hospital renovating the compound is certificate 101°23'57.54"E be done within the hospital, and 16,728 sqm while indicating existing premises of refurbish renovation project ownership of existing facilities technical block will be on existing MOH (please see without requiring any 270 sqm of the Annex 10) additional land. The hospital floor area existing and available 10

Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks land is not used by any informal settlers. No impact on IP is envisaged. 12 Boten District Replace old, and Total area of With land 17°46'56.93"N, Nil Nil The construction will Hospital construct new compound is certificate 101°10'31.95"E be done within the District hospital 27,034 sqm while indicating existing premises of construction of ownership of existing facilities district hospital will MOH (please see without requiring any be in the open Annex 11) additional land. The space area of existing and available 2,000 sqm land is not used by any informal settlers. No impact on IP is envisaged. VI. Xieng Khouang province 13 Mok District Hospital Upgrade through Total land area of With land 19° 4'15.70"N, Nil Nil The construction will renovating compound is certificate 103°57'19.36"E be done within the hospital building, 11,359 sqm while indicating existing premises of and refurbishing renovation project ownership of existing facilities technical block will be on 270 sqm MOH (please see without requiring any within the existing Annex 12) additional land. The floor area of the existing and available hospital land is not used by any informal settlers. No impact on IP is envisaged. 14 Phaxay District Upgrade through Total land area of With land 19°17'31.20"N, Nil Nil The construction will Hospital renovating compound is 7,320 certificate 103° 8'7.93"E be done within the hospital, and sqm while indicating existing premises of refurbish renovation project ownership of existing facilities technical block will be on the 270 MOH (please see without requiring any sqm within the Annex 13) additional land. The existing floor area existing and available of the hospital land is not used by any informal settlers. No impact on IP is envisaged.

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Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks 15 Xieng Khouang Build new Total area of the With land 19°26'59.46"N, Nil Nil The construction will School of Public auditorium and compound is certificate 103°12'7.48"E be done within the Health*, Pek District staff office; 11,129 sqm while indicating existing premises of construct 17 room the new structures ownership of existing facilities dormitory will be built on the MOH (please see without requiring any 1,900 sqm open Annex 14) additional land. The spaces within the existing and available compound land is not used by any informal settlers. No impact on IP is envisaged. VII. Xaisomboun province 16 Hom District Hospital Replace old and Total area is With land 18°40'53.72"N, Nil Nil The construction will construct new 26,800 sqm while certificate 103°10'50.30"E be done within the District hospital project area for the indicating existing premises of hospital to be ownership of existing facilities constructed on is MOH (please see without requiring any 2,000 sqm open Annex 15) additional land. The space existing and available land is not used by any informal settlers. No impact on IP is envisaged. VIII. Savannakhet province 17 Savannakhet Upgrade hospital Total area of With land 16°33'2.67"N, Nil Nil The construction will Provincial Hospital, by constructing compound is 5792 certificate 104°44'47.15"E be done within the Kaysone District isolation and sqm while project indicating existing premises of treatment facility area for isolation ownership of existing facilities as a response to and treatment MOH (please see without requiring any covid 19 in facility construction Annex 16) additional land. The existing provincial is an available 800 existing and available hospital sqm of space land is not used by any informal settlers. No impact on IP is envisaged. 18 Nong District Hospital Upgrading Total area is With land 16°22'33.22"N, Nil Nil The construction will existing hospital 11,406 sqm while certificate 106°29'39.79"E be done within the through area for renovation indicating existing premises of 12

Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks renovation and is 1,406 sqm of the ownership of existing facilities refurbishing existing hospital MOH (please see without requiring any technical block Annex 17) additional land. The existing and available land is not used by any informal settlers. No impact on IP is envisaged. 19 Songkhone District Upgrading Total area is With land 16°13'42.13"N, Nil Nil The construction will Hospital existing hospital 30,000 sqm while certificate 105°11'59.90"E be done within the through project area for indicating existing premises of renovation and renovation is 567 ownership of existing facilities refurbishing sqm of the existing MOH (please see without requiring any technical block hospital Annex 18) additional land. The existing and available land is not used by any informal settlers. No impact on IP is envisaged.

20 Savannakhet College Repair campus Total area of With land 16°32'54.80"N, Nil Nil The construction will of Health Science*, library (no new dormitory property certificate 104°44'48.87"E be done within the Kaysone District construction for is 5,792 sqm (land indicating existing premises of library), and shared with the ownership of existing facilities demolish and provincial hospital) MOH (please see without requiring any construct 18 room while project area Annex 19) additional land. The dormitory for construction of existing and available dormitory is 500 land is not used by sqm of old dorm any informal settlers. No impact on IP is envisaged. IX. Salavan province 21 Lao-Ngam District Replace and Total area is 60000 With land 15°27'49.66"N, Nil Nil The construction will Hospital construct District sqm while 1700 certificate 106° 9'30.10"E be done within the hospital sqm of open space indicating existing premises of is allocated to ownership of existing facilities construct the MOH (please see without requiring any hospital Annex 20) additional land. The

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Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks existing and available land is not used by any informal settlers. No impact on IP is envisaged. X. Champasak province 22 Paksong District Upgrade by Total area is With land 15°10'42.44"N, Nil Nil The construction will Hospital renovating 23,103 sqm while certificate 106°13'50.61"E be done within the hospital, and project area to indicating existing premises of refurbishing renovate is 270 ownership of existing facilities technical block sqm of the existing MOH (please see without requiring any hospital Annex 21) additional land. The existing and available land is not used by any informal settlers. No impact on IP is envisaged. 23 Moulapamok District Upgrade by Total area of the With land 14°21'55.17"N, Nil Nil The construction will Hospital renovating compound is certificate 105°50'28.21"E be done within the hospital, and 34,511 sqm while indicating existing premises of refurbishing project area to ownership of existing facilities technical block renovate is 270 MOH (please see without requiring any sqm of the existing Annex 22) additional land. The hospital existing and available land is not used by any informal settlers. No impact on IP is envisaged. 24 Champasak College Demolish and Total area is 3,900 With land 15° 7'49.31"N, Nil Nil The construction will of Health Science construct new 21 sqm while project certificate 105°47'19.38"E be done within the (Ban Saphanxay -room teaching area for indicating existing premises of Campus)*, Pakse block construction of a ownership of existing facilities District new classroom MOH (please see without requiring any building is 682 sqm Annex 23) additional land. The existing and available land is not used by any informal settlers. 14

Land Availability Subproject and Current Impact Impact No. Province/Subproject Component Status Land Ownership Coordinates on IR on IP Remarks No impact on IP is envisaged. XI. Vientiane Capital 25 PMU Vientiane Upgrade through Data in the process Land certificate in 17°57'23.62"N, Nil Nil The construction will Capital, Sisattanack renovation of 1 of request the process of 102°36'59.53"E be done within the District office building request existing premises of existing facilities without requiring any additional land. The existing and available land is not used by any informal settlers. No impact on IP is envisaged.

IP = indigenous people, IR = involuntary resettlement, MOH = Ministry of Health, PMU = project coordination unit, sqm = square meter. *All colleges/schools shall have Clinical Skills Laboratory Set for Teaching Equipment

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IV. CONSULTATION, PARTICIPATION, AND DISCLOSURE

25. Meaningful consultations with provincial, and district hospital, and school officials as well as with the local governments of the provinces and districts covering the subprojects were carried out by the Project team. Prior coordination was done by the Project for schedule, participants, and venues at least 1 week before the meeting. Meeting agenda were likewise communicated where the offices had the opportunity to comment on, and suggest revisions as well as confirm participants’ availability on the schedule proposed. Requests for data and information were also sent during the coordination enabling the offices to prepare beforehand and provide the documents/information to the team during the meeting. Site visit follows every meeting, after which another meeting session is held for another round of discussions about the Project for clarificatory questions, additional information, and way forward. The meeting-consultations and site visits were held intermittently in the 10 provinces and corresponding concerned districts covered by the Project from February 2020 to May 2020. However, prior to February 2020, initial discussions with officials, and a number of visits to the nominated project sites were already done by the project team.

26. For the DED, construction, and operation phases of the Project, consultations will be continued with residents of the community within which the subproject is located and with other local stakeholders. This is upheld under the ADB SPS (2009) to ensure that issues, concerns, and voice of the people are incorporated in project preparation, implementation, monitoring, and reporting. Meaningful consultations have the following features:

• It begins early in the project preparation stage and is carried out on an ongoing basis throughout the project cycle. • It provides timely disclosure of relevant and adequate information that is understandable and readily accessible to the community • It is undertaken in an atmosphere free of intimidation or coercion. • It is gender inclusive and responsive, tailored to the needs of disadvantaged, and vulnerable groups. • It enables the incorporation of all relevant views of people and other stakeholders into decision making, such as project design, mitigation measures, sharing of development benefits and opportunities, and implementation issues.

27. MOH will conduct meaningful consultations with the subproject host communities, and with the different sectors represented in the meetings.

28. Project disclosure and consultations will be carried out by the MOH representatives, and the Consultants through focus group discussions, and public meetings. Basic information will be translated into the local language and shall be placed in public offices that will be easily accessible to the community. A project information brochure (PIB) will be distributed which shall include the project profile, project impacts, and grievance redress mechanism, among others.

29. MOH will be guided by the ADB Public Communications Policy (2012) and Accountability Mechanism (2012).

V. GRIEVANCE REDRESS MECHANISM

30. Unanticipated impacts may happen in the course of project implementation. While IR and IP impacts are expectedly nil in this FS stage, it may be possible that settlements surrounding the Project sites may complain about the project during the construction, and operation of the hospital

16 and school facilities. For this, it is deemed important that meaningful consultations (described in the previous section) with the residents of the community within which the subproject is located, and other stakeholders - provincial and district officials, and sectoral representatives (e.g. business, non-government/civil society organizations, women, IP/EM, and other vulnerable groups, etc.) are met periodically throughout the project cycle to know their views and opinions about the Project.

31. Grievance redress shall be anchored on several principles to guide process, decisions, resolutions, and way forward: (i) confidentiality; and (ii) clarity in disseminating the GRM procedure and cases. Where necessary, the local language will be used as well as layman’s terms to further understanding; (iii) transparency during the grievance procedure upholding gender responsiveness and cultural appropriateness; and (iv) accessibility of GRM to complainants at no costs and without retribution.

32. The following steps will be taken for grievance redress:

Step 1. Complainant approaches the village chief to lodge the complaint. The village chief formally acknowledges the complaint by recording it in a log book. The complainant will be asked to sign the complaint logged. The village chief will explain the whole process of grievance redress to the complainant. The village chief will convene other village officials assigned to address residents’ concerns about planned or ongoing projects in the community. It shall be ensured that the village officials committee be aware/familiar with the project. They shall be given a maximum of working 10 days to resolve the complaint. If the complainant is not satisfied with the decision of the village chief and committee, he/she shall take the next step. The village chief assists the complainant in filing the complaint to the District with a formal letter.

Step 2. Complainant files the complaint to the District – level government office. The District formally accepts the complaint by providing the complainant a received copy of the letter of complaint. The District coordinates with the Province in addressing the complaint and is given a maximum of 10 working days to act, and resolve the complaint. If the complainant is not satisfied with the District and Province solution, he/she will take the next step. The District assists the complainant in filing a letter of complaint to the Project Coordination and Implementation Unit (PCIU) headed by the MOH.

Step 3. Complainant files the complaint to the PCIU. The PCIU formally accepts the complaint by providing the complainant a received copy of the letter of complaint. PCIU is given a maximum of 10 working days to act, and resolve the complaint. If the complainant is not satisfied with the PCIU decision to resolve the issue, the complainant can file a case in the National Assembly or appropriate court of law.

VI. INSTITUTIONAL ARRANGEMENTS

33. MOH will both be the executing and implementing agency of the Project. It will ensure that the 24 subprojects composed of hospitals, and schools will have open and/or available spaces for construction of new hospital buildings, dormitories, and other facilities. For the Project’s HHR capacity - building component, MOH shall commit to identify, and mobilize hospital officers to train in the area of health care management, as well as staff in all levels, and students to train for technical knowledge and skills that will be provided under QHCP. A PCIU comprising individual consultants (health specialist, architect, engineers, safeguards specialist, gender expert, financial management specialist, and procurement specialist), to be financed under ADB

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will support the MOH in managing all activities of this Project including procurement, financial management, safeguards, contract administration and other monitoring activities. ADB will provide additional support through its staff resources to supplement the PCIU’s capacity.

VII. CONCLUSION AND RECOMMENDATION

34. While the Project during its inception and feasibility study has sought subprojects with Category C for IR and IP/EM, it is agreed that any additional or replacement subproject hospitals and schools with category A or B, will be not be considered for ADB financing in this Project. When subprojects with IR and/or IP impacts are considered, these may be packaged as another project where social safeguards planning will be required, and carried out along with other project planning requisites of ADB. The MOH and PCIU will hold continuous consultations with the concerned stakeholders during the project implementation. All contractors will be required to monitor and submit monthly progress reports. MOH through the PCIU consolidates these to quarterly progress reports on the status of construction, and training in each subproject. The MOH as the executing agency will be responsible to ensure, through monitoring reports that all the subproject construction, renovation, and refurbishment are carried out within the existing hospital, and school premises and no project activities lead to any impact on involuntary resettlement and indigenous peoples. MOH will submit periodic progress reports to ADB for approval and disclosure purposes.

18 Annex 1

LAND CERTIFICATE – MAI DISTRICT HOSPITAL, PHONGSALY PROVINCE

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Mai District District Office of Land Management Ref. No: 13/DOLM

State Land Usage Permission Certificate

- With reference to the Decision of Minister to the Prime Minister’s Office/Director General of National Land Management No. 62/NLM dated 5 January 2007 on the Establishment and Roles of Office of Provincial Office of Land Management; - With reference to the Decision of Minister to the Prime Minister’s Office/Director General of National Land Management No. 63/NLOM dated 5 January 2007 on the Establishment and Roles of Office of Provincial Office of Land Management; - With reference to the Decision of District Governor No. 409/DG dated 22 July 2008 on issuance of state land for the line ministries.

Office of Land Management agreed:

District provincial Health Office situated in Nakang village, Phongsaly Province has been authorized to use the state land for the construction

The details of land scope are as following:

To the North: is attached to Mr. Khamseng’s land, with the Length of 102.4 meters.

To the South: is attached to main road, with the length of 69 meters.

To the East: is attached to CHICK and Chankham pond, with the length of 112.2 meters.

To the West: is attached to irrigation, with the length of 72 meters.

- The land composed of 5 houses with total land of 7,193.5 square meters (7,193.5 m2).

- The User of the authorized state land must manage and protect the land in a good manner, causing no damage to the land and no impact on environment; the land user may build the house and the building on the land, however, it needs to be conformed with rules and obligations which has been enter into force periodically.

- Payment for land tax is required as it is stipulated in the law.

- It is forbidden for any entity to take the ownership of the authorized state land (prohibited for sales, transfer, exchange, leasing, deposit, stock guarantee, and rental purpose) without the permission from concerned District Authorities.

Annex 1 19

- Any changes on the usage of the land must be immediately declared to the concerned Land Officer.

- This Permission Certificate is valid from date of signature.

Dated: 28 October 2008

Director of Mai District Office of Land Management

(Seal and Signature)

Circulation:

- Provincial Office of Land Management 1 copy - District Office of Land Management 1 copy - Village Headman 1 copy - Concerned party 1 copy - Filling 1 copy

20 Annex 1

Annex 1 21

22 Annex 1

Annex 1 23

24 Annex 1

Annex 1 25

26 Annex 2

LAND CERTIFICATE – OUDOMXAY PROVINCIAL HOSPITAL, XAY DISTRICT

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Oudomxay Province Finance Division Office of State Property Management Ref. No: 67/SPM

State Land Map

Owned by: New Hospital of Don Keo Village Based on reference document: Oudomxay Provincial Health Office District: Xay, Don Keo Village Location of Land and House: - No. …. Donkeo Village…..with house.… No of House…… - Land area of 63.500 square meters………….Land area: 6.35 hectares

Date of Survey and Measure: 6 June 2001 …………………………………………………………………

Survey and measure by: ……………………………………………………………….. Oudomxay, dated 31 July 2001

Land user signature Director General of the Office of Natural Resource and (Seal and Signature) Environment

Dr Khamphan Xayyavong (Seal and Signature)

Chantay Inphakhouan

Annex 2 27

28 Annex 3

LAND CERTIFICATE – BENG DISTRICT HOSPITAL, OUDOMXAY PROVINCE

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Oudomxay Province Beng District, Office of Natural Resource and Environment Office of State Property Management Ref. 113/

State Land Map

Managed and Owned by: Beng District Health Office Based on reference document: …………………………. Reference:………………………………………………Dated…………………………… Land Location: - Road No. 2, Unit………………….Houyla Village………… - Beng District, Oudomxay Province - Book No……………………………………. Map No. ……………………. - Land area of 63.500 square meters………….Land area: 6.35 hectares - Existing House area: 0 meter. Land area; 8,276.4 square meters.

Date of Survey and Measure: 12 May 2016 ………………………………………………………………

Survey and measure by:

Khamdeng Inthavong ………………………………………………………………..

Director General of the Office of Natural Resource and Environment

(Seal and Signature)

Thongphet Chanthavong

Annex 3 29

30 Annex 4

LAND CERTIFICATE – HOUN DISTRICT HOSPITAL, OUDOMXAY PROVINCE

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Houn District District Governor Ref. No: 131/DG Houn District, dated 7 May 2019

District Governor’s Decision on State Land Permit for Houn District, Oudomxay province for management and use

- With reference to the Land Law No. 04/ NA dated 21 October 2003; - With reference to the request of Office of National Resource Environmental and Environment No. 20/NRE dated 22 April 2019. The District Governor issued the agreement:

Article 1. approved one plot of land in Nafang, Houn District, Oudomxay province for management and use, as follows:

To the North: is attached to small road, with the Length of 86 meters. To the South: is attached to small road, with the length of 72 meters. To the East: is attached to small road, with the length of 384 meters. To the West: is attached to small road, with the length of 382 meters. The total land area is 3 hectares. (For details the land title is attached herewith)

Article 2. The office of Natural Resource and Environment in corroboration with concerned district parties to prepare document in accordance with the law.

- Related stakeholders and village organizations that have been granted land use rights implement this agreement in good faith. - Do not use the land inappropriately for intended purpose.

Article 3. This agreement is valid from date of signature.

Houn District Governor (Seal and Signature) Bountiem Souphanthong Circulation: - ………………… 1 copy - …………………. 1 copy

Annex 4 31

- Filling 1 copy

32 Annex 5

LAND CERTIFICATE – OUDOMXAY SCHOOL OF PUBLIC HEALTH, XAY DISTRICT

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Oudomxay Province Finance Division Office of State Property Management Ref. No: 67/SPM

State Land Map

Owned by: New Hospital of Don Keo Village Based on reference document: Oudomxay Provincial Health Office District: Xay, Don Keo Village Location of Land and House: - No. ……. Donkeo Village……..with house……… No of House………… - Land area of 63.500 square meters………….Land area: 6.35 hectares

Date of Survey and Measure: 6 June 2001 …………………………………………………………………

Survey and measure by: ……………………………………………………………….. Oudomxay, dated 31 July 2001

Land user signature Director General of the Office of Natural Resource and (Seal and Signature) Environment

Dr Khamphan Xayyavong (Seal and Signature)

Chantay Inphakhouan

Annex 5 33

34 Annex 6

LAND CERTIFICATE – LUANG PRABANG PROVINCIAL HOSPITAL, LUANG PRABANG PROVINCE

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Luang Prabang Province Finance Division Office of State Property Management Ref. No……

State Land Map

Managed and Owned by: Luang Prabang Provincial Health Department Right of use: Gained by State Land Reference: The agreement of Governor No.570/LPB Governor dated 3 October 2006 Land Location: - Road…………, Unit…………………Village………… - Land area: 08 hectares, 9546 sqm2

Date of Survey and Measure: 20 February 2007 ………………………………………………………………

Survey and measure by:

Somchit Singlorkham-Souliyet ………………………………………………………………..

Issued at:…………………………………… Dated: 22 April 2007

Director General of Finance Division Director General of the Office of State Property Management

(Seal and Signature) (Seal and Signature)

Somnith Khomthavong Lorvanking Bongsa

Annex 6 35

36 Annex 7

LAND CERTIFICATE – NAMBAK DISTRICT HOSPITAL, LUANG PRABANG PROVINCE

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Luang Prabang Province Nambak District Ref. No: 369/PA Phonsaat Village Unit 1 Declaration of Land Specification and Construction during Survey and evidence prof

1. Name and last name: Mr. Somphone Phommalath Nationality: Lao Occupation: State officer Unit: 1 Present Address: Phonsaat Village, Nambak District, Luang Prabang province Relationship to the land owner: Representative 2. Name and last name of Land owner: Land managed by the state 3. Form of land use: Nambak District Hospital 4. ID card holder No. 54830 dated 12 June 2001 Phonsaat Village, dated 12 June 2001

Inspector Declarer Village Headman (Seal and Signature) (Seal and Signature)

Dalavanh Bounmeung

Annex 7 37

38 Annex 7

Annex 8 39

LAND CERTIFICATE – PHOUKHOUN DISTRICT HOSPITAL, LUANG PRABANG PROVINCE

Unofficial Translation

Lao People’s Democratic Republic Peace Independence Democratic Republic Unity and Prosperity

Phoukhoun District District Office of Natural Resources and Environment Ref. No: 168/DNRE Dated: 20 August 2018

State Land Usage Permission Certificate

- With reference to the Decision of Minister of Natural Resources and Environment No. 1467/MONRE dated 9 March 2012 on the Establishment and Roles of Office of Natural Resources and Environment; - With reference to the Law of Land No. 04/NA dated 21 October 2003; - In accordance to the request of Head of District Health Office dated 14 June 2018.

District Health Office situated in Sam Yek Village has been authorized to use the State Land for the construction of Phoukhoun District Community Hospital. The concerned land located at Road No. 07, (opposite the District Hospital, in the middle of the land of Mr. Vandy and Mr. Kuaneng), Sam Yek Village, Phoukhoun District, Luang Prabang Province.

The details of land scope are as follows: To the North: is attached to the Road No. 07, with the Length of 70 meters. To the South: is attached to down-hill, with the length of 114 meters. To the West: is attached to Mr. Kuaneng’s land, with the length of 43 meters. To the East: is attached to Mr. Vandy’s land, with the length of 133 meters. - The total Land area is: 5,977 square meters (5,977 m2).

- The User of the authorized sate land must manage and protect the land in a good manner, causing no damage to the land and no impact on environment; the land User may build the house and the building on the land, however, it needs to be conformed with rules and obligations which has been put into force periodically.

- It is forbidden for any entity to take the ownership of the authorized state land (prohibited for sales, transfer, exchange, leasing, deposit, stock guarantee, and rental purpose) without the permission from concerned District Authorities.

- Any changes on the usage of the land must be immediately declared to the concerned Land Officer.

- This Permission Certificate is valid from date of signature.

40 Annex 8

Director Deputy Head of Sam Yek Village Office of Natural Resources and Environment (Seal and Signature) (Seal and Signature)

Somphet Huangmanee Bounyoung Phongsavath

Phoukhoun District Governor (Seal and Signature) Viengthong Hatsachanh

Annex 8 41

42 Annex 8

Annex 8 43

44 Annex 9

LAND CERTIFICATE – HOUAMUANG DISTRICT HOSPITAL, HOUAPHANH PROVINCE

Annex 10 45

LAND CERTIFICATE – PAKLAY DISTRICT HOSPITAL, SAYABOURY PROVINCE

46 Annex 11

LAND CERTIFICATE – BOTEN DISTRICT HOSPITAL, SAYABOURY PROVINCE

Annex 12 47

LAND CERTIFICATE – MOK DISTRICT HOSPITAL, XIENG KHOUANG PROVINCE

48 Annex 13

LAND CERTIFICATE – PHAXAY DISTRICT HOSPITAL, XIENG KHOUANG PROVINCE

Annex 13 49

50 Annex 13

LAND CERTIFICATE – XIENG KHOUANG SCHOOL OF PUBLIC HEALTH PROVINCE, PEK DISTRICT

Annex 14 51

LAND CERTIFICATE – HOM DISTRICT HOSPITAL, XAISOMBOUN PROVINCE

52 Annex 15

LAND CERTIFICATE – SAVANNAKHET PROVINCIAL HOSPITAL, KAYSONE DISTRICT

Annex 16 53

LAND CERTIFICATE – NONG DISTRICT HOSPITAL, SAVANNAKHET PROVINCE

54 Annex 17

LAND CERTIFICATE – SONGKHONE DISTRICT HOSPITAL, SAVANNAKHET PROVINCE

Annex 18 55

LAND CERTIFICATE – SAVANNAKHET COLLEGE OF HEALTH SCIENCE, KAYSONE DISTRICT

56 Annex 20

LAND CERTIFICATE – LAO-NGAM DISTRICT HOSPITAL, SALAVAN PROVINCE

Annex 20 57

58 Annex 20

Annex 21 59

LAND CERTIFICATE – PAKSONG DISTRICT HOSPITAL, CHAMPASAK PROVINCE

60 Annex 22

LAND CERTIFICATE – MOULAPAMOK DISTRICT HOSPITAL, CHAMPASAK PROVINCE

Annex 22 61

LAND CERTIFICATE – CHAMPASAK COLLEGE OF HEALTH SCIENCE (BAN SAPHANXAY CAMPUS), PAKSE DISTRICT