Social Due Diligence Report on Involuntary Resettlement

Home , Gangaw, Gangaw District, Mogok, Myingyan, Tamu District, Tanintharyi Township

Project Number: 48118-004 September 2020

Republic of the Union of Myanmar: Greater Mekong Subregion Health Security Project (Additional Financing)

Prepared by Ministry of Health and Sports for the Asian Development Bank.

This safeguards 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 CDC - communicable disease control COVID-19 - coronavirus disease DOMS - Department of Medical Services GMS - Greater Mekong Subregion GRM - grievance redress mechanism MOHS - Ministry of Health and Sports PMU - project management unit SPS - Safeguard Policy Statement WHO - World Health Organization

CONTENTS I. INTRODUCTION AND PROJECT BACKGROUND 4 A. Introduction 4 B. Background and Project Rationale 4 II. SCOPE OF THE DUE DILIGENCE AND SUBPROJECTS/HOSPITALS 5 III. FINDINGS OF THE DUE DILIGENCE 4 IV. INSTITUTIONAL ARRANGEMENTS 4 V. CONCLUSIONS AND RECOMMENDATIONS 5

I. INTRODUCTION AND PROJECT BACKGROUND

A. Introduction

1. This is a social due diligence report on Involuntary Resettlement prepared for the proposed Greater Mekong Subregion (GMS) Health Security Project (Additional Financing).

2. As per ADB’s Safeguard Policy Statement (SPS 2009), project screening and categorization are undertaken to (i) determine the significance of potential impacts or risks that a project might present with respect to the environment, involuntary resettlement, and Indigenous Peoples; (ii) identify the level of assessment and institutional resources required to address safeguard issues; and (iii) determine the information disclosure and consultation requirements. Using environment, involuntary resettlement, and Indigenous Peoples screening checklists, the project is categorized. A proposed project is assigned to one of the following categories depending on the significance of the probable involuntary resettlement impacts:

Category A. A proposed project is classified as category A if it is likely to have significant involuntary resettlement impacts. A resettlement plan, including assessment of social impacts, is required.

Category B. A proposed project is classified as category B if it includes involuntary resettlement impacts that are not deemed significant. A resettlement plan, including assessment of social impacts, is required.

Category C. A proposed project is classified as category C if it has no involuntary resettlement impacts. No further action is required.

3. A project’s involuntary resettlement category is determined by the category of its most sensitive component in terms of involuntary resettlement impacts. The involuntary resettlement impacts of an ADB-supported project are considered significant if 200 or more persons will experience major impacts, which are defined as (i) being physically displaced from housing, or (ii) losing 10% or more of their productive assets (income generating). The level of detail and comprehensiveness of the resettlement plan are commensurate with the significance of the potential impacts and risks. A screening has been done (Refer to Annexure-1) for the project and based on the screening, the additional financing is categorized as “C” for involuntary resettlement. Therefore, this due diligence has been prepared to conform the category “C” on involuntary resettlement.

B. Background and Project Rationale

4. ADB approved the GMS Health Security project on 22 November 2016 for $125 million equivalent from its ordinary capital resources.1 Building on ADB’s prior investments in

1 The ongoing project comprises (i) loans to Cambodia (SDR15,012,000 [$21 million]), the Lao PDR (SDR2,856,000 [$4 million]), Myanmar ($12 million), and Viet Nam (SDR56,946,000 [$80 million]); and (ii) a grant to the Lao PDR ($8 million). ADB also provided project preparatory technical assistance of $1.3 million to Cambodia, the Lao PDR, Myanmar, and Viet Nam. ADB. Regional: Greater Mekong Subregion Health Security Project; and ADB. Technical Assistance: Greater Mekong Subregion Health Security Project.

communicable disease control (CDC) in the GMS,2 the ongoing project aims to strengthen regional cooperation and subnational CDC systems, particularly in border areas. The impact of the ongoing project is strengthened GMS public health security. The outcome is GMS health system performance regarding health security improved.

5. The additional financing for Myanmar will support implementation of the government’s Health Sector Contingency Plan for coronavirus disease (COVID-19).3 It will expand the overall project scope to encompass 31 district and township hospitals requiring immediate investment for upgrading clinical care, infection prevention and control, and human resource capacity for responding to COVID-19 and other future public health threats. These 31 hospitals are located across the country’s 14 states and regions and 1 union territory. Target hospitals are in areas that are highly vulnerable because of poverty, ethnicity, and inadequate access to essential services, including health care.4 The target hospitals have also been selected with reference to the investments of other development partners, ensuring complementarities across projects.5

6. The project impact and outcome will remain the same. Activities under the additional financing will be consolidated and delivered through output 4 that is aligned with, and contributes to, the original project outcome. Output 4 will be rephrased as “emergency preparedness and response capacity for COVID-19 strengthened”. The main activities under output 4 will strengthen capacity across three core areas of district and township hospital service delivery, namely (i) clinical management and medical care services, (ii) hospital infection prevention and control, and (iii) human resources.

II. SCOPE OF THE DUE DILIGENCE AND SUBPROJECTS/HOSPITALS

7. The project has various components having physical and non-physical intervention. The physical intervention is very minimal and is confined to minor renovation work. The scope covered under the due diligence is 31 existing district and township hospitals. The due diligence report has been prepared in due consultation with the executing agency which is Ministry of Health and Sports (MOHS) and in consultation with the respective hospitals. The subprojects/hospitals covered under the due diligence report are described below in Table 1 and the location map is provided in Figure-1:

2 ADB. GMS Regional Communicable Diseases Control Project; and ADB. Second GMS Regional Communicable Diseases Control Project. 3 Ministry of Health and Sports (MOHS). 2020. Health Sector Contingency Plan. Outbreak Response on COVID-19 and Other Emerging Respiratory Diseases in Myanmar. The plan is aligned with WHO’s Strategic Preparedness and Response Plan for COVID-19. WHO. 3 February 2020 (Draft). 2019 Novel Coronavirus (2019 nCoV): Strategic Preparedness and Response Plan. Geneva. 4 The MOHS has identified more than 100 hospitals requiring upgrading to respond to COVID-19. Hospitals that are accessible to ethnic populations and to populations in hard-to-reach and border areas were prioritized for ADB support. Hospital selection was coordinated with other development partners involved in MOHS’s COVID-19 response. 5 ADB and other development partners ensures alignment of COVID-19 support through the health cluster coordination mechanism, established by MOHS. The World Bank will provide investment for 61 provincial, state, and district hospitals in locations not supported under the ADB additional financing.

Table 1: List of Hospitals under the Due Diligence for Additional Financing

No. Name of Subproject/Hospital Name of Township Name of District 1 Pharkant Township Hospital Pharkant Mohnyin 2 Puta-O Township Hospital Puta-O Puta-O 3 Bawlakhae District Hospital Bawlakhae Bawlakhae 4 Kamamaung Township Hospital Kamamaung Hpa pun 5 Myawaddy District Hospital Myawaddy Myawaddy 6 Htantalan Township Hospital Htantalan Phalan 7 Toungup Township Hospital Toungup Thandwe 8 Namhkham Township Hospital Namhkham Muse 9 Mong Set District Hospital Mong Set Mong Set 10 Kalaw District Hospital Kalaw Kalaw 11 Mine Shu township Hospital Mine Shu Loilin 12 Ye Township Hospital Ye Mawlawmyaing 13 Tanintharyi Township Hospital Tanintharyi Kawthaung 14 Boatbyin Township Hospital Boatbyin Dawei 15 Homalin District Hospital Homalin Homalin 16 Tamu District Hospital Tamu Tamu 17 Kathar District Hospital Kathar Kathar 18 Kawlin Township Hospital Kawlin Kathar 19 Satote Tayar Township Hospital Satote Tayar Minbu 20 Mindone Township Hospital Mindone Thayet 21 Gangaw District Hospital Gangaw Gangaw 22 Thayarwady District Hospital Thayarwady Thayarwady 23 Shwe Kyin Township Hospital Shwe Kyin Bago 24 Tontay Hospital Tontay Yangon South 25 Taikkyi Hospital Taikkyi Yangon North 26 Mawlamyaing Kyun Township Hospital Mawlamyaing Kyun Labutta 27 Bogalay Township Hospital Bogalay Phyapon 28 Tat Kone Hospital Tat Kone Nay Pyi Taw 29 Myingyan District Hospital Myingyan Myingyan 30 Yamethin Hospital Yamethin Yamethin 31 Mogok Hospital Mogok Mandalay

Figure 1: Location of of Hospitals

III. FINDINGS OF THE DUE DILIGENCE

8. The project under the additional financing is classified as category C for involuntary resettlement impacts. It will primarily support the procurement of equipment and minor renovation work. The additional financing will procure equipment and consumables for 31 additional district and township hospitals. Specifically, equipment will be procured for the emergency department, isolation ward, the pediatric units for comorbidity, the high dependency unit, and laboratory diagnosis of participating hospitals. Small scale renovation works will ensure emergency departments, isolation wards, and medical and high dependency care units have infrastructure or facilities for effective separation of infectious patients, for supply of required services (e.g. oxygen lines, electricity, water), and for onsite infectious waste treatment (autoclaves, septic tanks and neutralization).

9. All hospitals have sufficient space available within the existing boundaries and compounds to accommodate all works to be undertaken under the additional financing components. There will be no land acquisition under the additional financing. The intervention will be undertaken within existing 31 hospitals and space is available. All the intervention under the additional financing will be confined to the existing hospitals and its premises. Therefore, there will be no impact on land acquisition and involuntary resettlement. Impacts on land acquisition and involuntary resettlement of each subprojects/hospitals are detailed in Table-2.

Table 2: Summary Findings on Land Acquisition and Involuntary Resettlement

No. Name of Year Name of the Name of the Activities to Total Owner Whether Approxi Name of Impact Remarks Subproject/Hospital Location Township be Area of ship of Additional mate the on IR undertaken the land land number Ethnic under hospital required for of Groups Additional (Sqft) activities Beneficia living in Financing under ries of the area additional the financing hospital 1 Pharkant Township 1960 Pharkant Pharkant Provision of 10 Acres MOHS Not required 240,706 Kachin, No Installation of Hospital Township Hospital medical and Kayah Impacts equipment laboratory Shan, on and equipment Kayin involunta construction 2 Puta-O Township 1926 Puta-O Township Puta-O and supplies 5 Acres MOHS Not required 69,281 Kachin ry will be done Hospital Hospital resettle within the 3 Bawlakhae District 2009 Bawlakhae District Bawlakhae Minor 5 Acres MOHS Not required 11,372 Kayah, ment as existing Hospital Hospital renovations Kayin there will premises of 4 Kamamaung 1966 Kamamaung Kamamaung of hospital 5 Acres MOHS Not required 29,786 Kayin, be no existing Township Hospital Township Hospital wards, Kayah, land facilities emergency Mon acquisiti without 5 Myawaddy District 1963 Myawaddy District Myawaddy wards, 10 Acres MOHS Not required 170,000 Kayin, on and requiring any Hospital Hospital laboratories, Kayah, physical additional Isolation Mon displace land. The 6 Htantalan Township 2015 Htantalan Htantalan wards, ICU 5 Acres MOHS Not required 54,331 Chin, ment existing and Hospital Township Hospital and waste Rakhine available 7 Taungup Township 2013 TaungupTownship Taungup management 5 Acres MOHS Not required 167,559 Rakine, land is not Hospital Hospital Burma used by any 8 Namhkham 1980 Namhkham Namhkham Renovation 10 Acres MOHS Not required 100,239 Shan, informal Township Hospital Township Hospital of utilities, AKhar, settlers. water and Koekant, electricity Wa, Palaung 9 Mong Set District 1960 Mong Set District Mong Set Capacity 10 Acres MOHS Not required 90,700 Shan, Hospital Hospital building for Koekant, hospital Lishaw, staffs Wa, Palaung 10 Kalaw District 1919 Kalaw District Kalaw 10 Acres MOHS Not required 183,435 Shan, Pa Hospital Hospital Oh 11 Mine Shu Township Mine Shu Mine Shu 5 Acres MOHS Not required Shan, Hospital Koekant, Lishaw,

No. Name of Year Name of the Name of the Activities to Total Owner Whether Approxi Name of Impact Remarks Subproject/Hospital Location Township be Area of ship of Additional mate the on IR undertaken the land land number Ethnic under hospital required for of Groups Additional (Sqft) activities Beneficia living in Financing under ries of the area additional the financing hospital Wa, Palaung 12 Ye Township 2014 Ye Ye 5 Acres MOHS Not required 170,000 Kayin, Hospital Kayah, Mon 13 Tanintharyi Township Tanintharyi Tanintharyi 5 Acres MOHS Not required Mon, Hospital Kayin, Dawe 14 Boatbyin Township 1974 Boatbyin Boatbyin 5 Acres MOHS Not required 87,348 Mon, Hospital Township Hospital Kayin, Dawe 15 Homalin District 2008 Homalin District Homalin 10 Acres MOHS Not required 210,192 Chin, Hospital Hospital Naga, Kachin 16 Tamu District 1966 Tamu District Tamu 10 Acres MOHS Not required 123,794 Chin, Hospital Hospital Naga 17 Kathar District 1957 Kathar District Kathar 10 Acres MOHS Not required 174,282 Kachin Hospital Hospital 18 Kawlin Township 1992 Kawlin Township Kawlin 5 Acres MOHS Not required 156,717 Kachin Hospital Hospital 19 Satote Tayar 1982 Satote Tayar SatoteTayar 5 Acres MOHS Not required 48,400 Chin Township Hospital Township Hospital 20 Mindone Township 1963 Mindone Mindone 5 Acres MOHS Not required 65,387 Chin, Hospital Township Hospital 21 Gangaw District 2007 Gangaw District Gangaw 10 Acres MOHS Not required 144,762 Yaw Hospital Hospital 22 Thayarwady District 1890 Thayarwady Thayarwady 10 Acres MOHS Not required 167,336 Hospital 23 Shwe Kyin Township 2002 Shwe Kyin Shwe Kyin 10 Acres MOHS Not required 109,172 Kayin Hospital 24 Tontay Hospital 1981 Tontay Tontay 5 Acres MOHS Not required 223,801 25 Taikkyi Hospital 1979 Taikkyi Taikkyi 10 Acres MOHS Not required 287,459 26 Mawlamyaing Kyun 2009 Mawlamyaing Mawlamyaing 10 Acres MOHS Not required 310,000 Township Hospital Kyun Kyun

IV. CONSULTATION AND GRIEVANCE REDRESS MECHANISM

10. The due diligence report has been prepared with due consultation with the hospital authorities, though it was restricted due to COVID-19. However, the consultation process will be continued during project implementation. The grievance redress mechanism (GRM) has already been established and operational since the effectiveness of the ongoing loan. The additional financing will follow the existing GRM and consultation process.

11. “Regular meetings and consultation will seek to minimize dissatisfaction among project- affected people. Local stakeholders’ opinions and concerns will be part of the project planning and implementation. The participatory approach will encourage people to raise any concerns before conflicts may appear in the design and implementation of Project activities. The beneficiaries can address their concerns through their representative. The complaint will be assessed and negotiated into a solution between the project representative (focal point or IA) and local authorities, and then fed back to the communities as part of the participatory planning process. If the conflict is not solved amicably, it will be taken to the project management unit (PMU) or MOHS Steering Committee under the MOHS. The project representatives at various levels will be responsible for reporting any grievances up to the appropriate level. The particular activities will be carried out after such conflict is resolved satisfactorily. In cases where AHs do not have the writing skills or are unable to express their grievances verbally, AHs are allowed to seek assistance from any recognized local group, non-governmental organization, family member, village heads or community chiefs to have their complaints or grievances written for them. Throughout the grievance redress process, the responsible committee will ensure that the concerned AHs are provided with copies of complaints and decisions or resolutions reached”

12. The additional financing components is beneficiaries driven and there will be no affected persons. However, any unanticipated impacts will be mitigated in accordance with ADB’s SPS 2009.

V. INSTITUTIONAL ARRANGEMENTS

13. The MOHS through the Department of Medical Services (DOMS) is the executing agency for the additional financing. The director general of DOMS will be the project director. The new PMU will be established under DOMS to support the project director in management, monitoring, and administration of the additional financing. The PMU will be supported by ten national consultants. In a further variation from the implementation arrangement of the original project, the 31 district and township hospitals will act as implementing agencies.6 The medical superintendents of each hospital will oversee the planning and implementation of project activities in their respective facility.

6 In the ongoing project, the National Health Laboratory and 13 state, regional, and township hospitals are the implementing agencies.

VI. CONCLUSIONS AND RECOMMENDATIONS

14. The MOHS through DOMS, as the executing agency, will be responsible to ensure that all the minor civil works are carried out within the existing hospital premises. Construction will be done within the existing premises of existing facilities without requiring any additional land. The existing and available land is not used by any informal settlers. Therefore, no category ‘A’ or category ‘B’ IR subprojects will be selected, in accordance with ADB’s SPS 2009. MOHS will hold continuous consultations with the concerned stakeholders during the project implementation. A national safeguards consultant will be engaged to assist MOHS for implementation and monitoring. MOHS will be responsible to ensure, through submission of monitoring report/progress report, that all the minor civil works are carried out within the existing hospital premises and no project activities lead to any impact due to land acquisition or involuntary resettlement impacts. MOHS will submit periodic progress reports to ADB.