Due Diligence Report Project Number: 41509-013 February 2017

PNG: Rural Primary Health Services Delivery Project (Loan 2785 and Grant 0259)

Prepared by the Department of Health for the Asian Development Bank.

This 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. Your attention is directed to the “terms of use” section of this website. 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 judgements as to the legal or other status of any territory or area.

Rural Primary Health Services Delivery Project

DUE DILIGENCE REPORT MUSAVE CHP SITE

Eastern Highlands Province

February 2017

INDEX

EXECUTIVE SUMMARY

PROJECT AND COMMUNITY HEALTH POST DESCRIPTION

MUSAVE COMMUNITY HEALTH POST SITE – DESCRIPTION AND AREA SCOPE OF LAND USE/PURCHASE

SOCIOECONOMIC INFORMATION

INFORMATION DISCLOSURE, CONSULTATIONS AND PARTICIPATION

GRIEVANCE REDRESS MECHANISM

APPLICABLE POLICIES AND LAWS

AGREEMENTS ON LAND USE

COMPENSATION AND BENEFITS

BUDGET AND SOURCES OF FUNDS

INSTITUTIONAL ARRANGEMENTS

IMPLEMENTATION SCHEDULE

MONITORING AND REPORTING

ANNEXURES (Available Upon Request)

Annex One: Reports of Community Consultations

Annex Two: Land survey of site

Annex Three: Land Investigation Report

Annex Four: Valuation by the Office of the Valuer-General

Annex Five: Certificate of Alienability

Annex Six: Sale & Transfer of Land

Annex Seven: Deed of Release

Annex Eight: Approved Layout Plan for Community Health Post

MUSAVE COMMUNITY HEALTH POST

A. EXECUTIVE SUMMARY

Musave, soeties spelled Musabe, Village is located about eighteen (18) kilometres southwest of Township in the of Eastern Highlands. It is accessible by road but can take up to 1 hour and 45 minutes travelling time dependent upon prevailing weather conditions. The road is unformed in places and in poor condition. The catchment population of the proposed Musave Community Health Post is derived from 14 separate villages and hamlets in the area known collectively as the Izevinonta community with a total population in excess of 7,600 at the time of the 2011 National Census. About 40% of this population living in the eastern area is served by an Aid Post at Sonofi or the Onamuga Health Centre. However, it is estimated that there were 4620 people living in the immediate Musave area and to its west at the end of 2013. Some of those live across the District border in but access Kainantu Township via the road which passes through Musave. It is estimated that there were 1650 infants and children under the age of 15 years and 1350 women of child bearing age i.e. 15-44 years living in the immediate catchment area. The population in the Kainantu District is growing at a faster rate than that of any other rural District in PNG. The site at Musave, acquired for the State by the Hon Johnson Tuke, Member for Kainantu, for the construction of the Community Health Post and three (3) staff houses satisfies all of the criteria required for construction to proceed.

The former customary owners of the land, registered as Portion 340C Milinch of Okapa, Fourmil of Markham, Kainantu District, Eastern Highlands Province and known locally as Yauvifante, consented to sell their land to the State through an agreement dated 9th August, 2016 through the Land Investigation Report dated 9th August, 2016.) The area of the land acquired is 2.40 hectares which had been used in the past for production of vegetable crops. The entire area on which the Community Health Post and staff houses are to be constructed has been cleared of significant trees for many years.

The land was owned by members of the Irafo and Kampefona Clans and had been inherited by them through Clan membership. The Clans are aed i the “hedule of Oes, “tatus and Rights to the Lad setio of the Lad Iestigatio ‘epot as haig elusie ights as the land owners. They have nominated Mr. Ken Keriba, Mr Fugonto Nae, Mr Jovaka Beafa, Mr. Joseph Silliyuo, Mr. Folken Tobofa, Mr. Ontobura Korepe, Mr. Koni Tomave and Mr. Arimpa Antene to be their representatives and agents for the purpose of executing a Transfer to the Administrator over that piece of land known as Yauifate Potio C containing approximately 2.40 hectares and situated near Kainantu Town in the District of Kainantu of Easte Highlads. The futhe authoised the above agents to accept, on behalf all, moneys and considerations paid by the said Administrator in connection with the proposed Transfer of the said piee of lad.

The extent of the site was determined by the customary owners and the owners of adjoining land in the company of the Surveyor, Mr. Damake Murio, prior to survey. The boundaries are clearly marked and are consistent with the decision of the local landowners. The owners of contiguous land have also declared that they have no interest in or rights by native custom to the surveyed land.

The site was selected by the customary owners because it is central to the surrounding villages of Benega, Una, Kafe, Katipro, Taaku, Avaninofiu, Namo and Sisimega which have no other health facilities and because of its proximity to the road leading to Kainantu Township.

The value of the land provided for the Community Health Post was assessed by the Valuer- General to be K490,000.00 inclusive of planted crops and two derelict houses which had been removed following the survey but prior to the valuation assessment.

The Certificate of Alienability No. 5/5-2017 was issued by the Secretary of the Department of Provincial and Local Government Affairs.

Payment of K100,000 was made to the authorised agents by the member for Kainantu, Hon. Johnson Tuke on behalf of the State in Musave Village on 24th March, 2017. This was accepted as full and final payment and a Deed of Release and Sale and Transfer documents were signed by the Agents and witnessed by an Officer of the Customary Lands Division of the Department of Lands & Physical Planning and the CEO of the Kainantu District Development Authority.

The process of obtaining the Title on behalf of the State is now complete and tenders have been invited for construction of the proposed Community Health Post.

Officers of the Provincial Health Authority, the Eastern Highlands Provincial Administration and the Rural Primary Health Service Delivery Project have followed both Government of PNG and standard ADB safeguards processes including extensive consultation with the local community, use of applicable National land laws and regulations, and due diligence to ensure that local people would not experience significant adverse impacts by relinquishing this land.

B. PROJECT AND COMMUNITY HEALTH POST DESCRIPTION Background 1. The Rural Primary Health Services Delivery Project will strengthen the rural health system in PNG by increasing the coverage and quality of primary health care in partnership with State and non-state service providers by supporting the Government of PNG to implement the National Health Plan 2011-2020 as it relates to rural health. The Project operates in two districts in each of the following eight Provinces nominated by the Government of PNG: Eastern Highlands, East Sepik, Eastern Highlands, Milne Bay, Morobe, Western Highlands, West New Britain and the Autonomous Region of Bougainville.

2. The Project will make health service improvements on both the supply and demand sides and strengthen the policy and legal framework for health services at all levels. The Project has six (6) clearly articulated outputs: Output 1 – National policies and standards: assisting the National Department of Health in developing policies, standards, and strategies for new Community Health Posts, and human resource strengthening of the rural health sector. This will result in the development of Provincial health service development plans, and improvements in the health information systems. Output 2 – Sustainable partnerships between provincial governments and non-state actors: Partnership Committees have been established to improve coordination and efficiency among providers, (churches and NGOs) and to increase consistency and accountability. Partnership arrangements have been formalized through Memoranda of Agreement with most non-state health service providers. Output 3 – Human resource development in the health sector. The Project will increase the skills of health personnel in rural communities, focusing on the existing workforce. It will help Provinces to address staff performance and retention issues. Output 4 – Community health facility upgrading: The Project will build thirty-two (32) new Community Health Posts, with ninety-six (96) staff houses as well as providing medical equipment and small vehicles (cars, boats or motorbikes). It will also install or upgrade sanitation facilities, provide waste management facilities, and establish renewable energy supplies for those health facilities. The Community Health Post is deemed a Level 2 Health Facility under the PNG National Health “eie “tadads, s ‘ole Delieatio Mati ad it oe functions are to provide maternal and child primary health clinics within the facility and through outreach to communities within the catchment area. Provision is also made for birthing and postnatal inpatient care, short term paediatric and adult inpatient services and for triage and stabilisation of critically ill patients prior to referral to higher level facilities. A modest Poedue ‘oo is poided to allo eege ae of taua o seious edial conditions prior to referral to a health facility of higher clinical capability. Discrete consultation rooms are provided to ensure privacy for clients seeking care or advice for their conditions. The Musave Community Health Post is expected to provide outpatient consultation services for up to fifty (50) persons per day and to supervise up to 100 births per annum. Output 5 – Health promotion in local communities: The Project will support village health olutees, ad iease oes ioleet i delieig health seies ased o the National Depatet of Healths Healthy Islands framework. Output 6 - Project monitoring, evaluation and management: The Project has established a Project Support Unit (PSU) as part of the National Department of Health, which will be used by the National Department of Health as part of its health system strengthening activities. 3. Sites selected by the Provinces, are required to satisfy the following criteria:

(i) The facility or site is located in a participating Province and participating District and will serve a predominantly rural dwelling population;

(ii) The proposed works will be identified and designed by the relevant implementing agency in a participatory manner with input from the community;

(iii) Extensive community consultation for selection of the site will be conducted;

(iv) The proposed works are integrated into a comprehensive Provincial health plan;

(v) The proposed facility/site has available/earmarked budget for recurrent cost from the health functional grant;

(vi) The proposed facility/site has sufficient human resources/staff and supervision capacity;

(vii) Institutional and financial arrangements for construction, operation and maintenance of the facility and access to the facility have been agreed upon by the Partnership Committee/Provincial Health Authority Board;

(viii) The proposed works comply with all requirements of relevant National laws and regulations and ADB's Safeguard Policy Statement (2009), the Environment Management Plan, Environment Assessment and Review Framework, and Land Assessment Framework;

(ix) the Independent State of Papua New Guinea through the Eastern Highlands Provincial Health Authority has clear and unencumbered access to the associated land portion on which the Community Health Post is to be located, without claims of third parties, and the Province has supplied adequate written confirmation of the same from the relevant authorities and community participants, as applicable, including either a relevant Customary Land Transfer Agreement or a formal exchange of title to the State and a letter authorizing commencement of construction from the sole Executive/Agent nominated by the landowners. In the case of Musave the land has been formally acquired by the State.

(x) Access to and from the site and proposed facility for vehicles or other means of transport is in place.

4. Within each participating Province, the Districts to participate in the Project were required to satisfy the following criteria:

(i) The District is selected with a view to maximizing the delivery of health services for rural populations that are most underserved at the outset of the Project such as the percentage of the population accessible to health facilities within 2 hours traveling time.

(ii) The District is selected with due consideration for the ability to absorb and utilise the proposed investment of resources, taking into account levels of security, law and order, governance, and administrative capacity.

5. Each of the sites chosen for the construction of a new Community Health Post usually requires less than one hectare of land to accommodate the health facility and three staff houses. In the case of the Musave site 2.40 hectares was provided. The boundaries were clearly identified with the customary landowners at the time that the survey was conducted and are clearly and permanently marked with concrete survey pegs.

6. The Pojets ipat is liited to opesale loss of land use, any existing structures on the site and, where applicable, crops and trees. The landowners and local communities are expected to benefit from improved access to health services and short-term employment opportunities from infrastructure construction and maintenance.

7. The acquisition of small plots of land for the Community Health Posts is based on the las, egulatios, ad poliies of the Goeet of PNG ad the ADBs “afeguad Poli Statement (2009). The Project will not finance Community Health Post construction that involves compulsory land acquisition and/or involuntary resettlement impacts. The Project is building on State or church leased land, or in some cases, on land where there has been a previous aid post and that land remains available without contest from customary owners.

C. EASTERN HIGHLANDS PROVINCE – GEOGRAPHY, POPULATION DISTRIBUTION & ACCESS TO SERVICES

8. The folloig aps of Easte Highlads Poie ae deied fo the PNG ‘ual Deelopet Hadook of developed by LW Hansen, BJ Allen, RM Bourke and TJ McCarthy and published by the Land Management Group, Department of Human Geography of the Australian National University. The depiction of occupied and unoccupied lands for Eastern Highlands Province remains accurate and clearly indicates the concentration of the population in the arable valleys of the Province. The population of the Kainantu District has increased by approximately 37.6% since the 2000 National Census upon which these depictions relied. Access to services for residents of some areas has improved with better and more roads being provided in some areas. Real income levels have not improved significantly since the time of publication.

9. Eastern Highlands Province occupies 11,000 square kilometres in the PNG central highlands. Altitude varies from 3500m above sea level in the rugged Bismarck Range in the north to just 300 metres in the upper Ramu Valley in the northeast of the Province. Agriculture is conducted over an altitudinal range of 300-2400 metres. The Asaro, Benabena, Karmanuntina, Gafutina and upper Ramu Valleys have highly productive soils for gardening and support large concentrations of population. The southern half of the Province is more mountainous with more than 50% of the land unoccupied. Image 1: Occupied/Unoccupied Land in Eastern Highlands Province – 2001

MUSAVE

10. The total Provincial population reported at the time of the 2011 National Census was 578242 with the population heavily concentrated in the arable valleys which are some of the most densely populated and intensively cultivated areas in PNG. Musave, soeties spelled Musabe, Village is loated aout eighteen (18) kilometres southwest of Kainantu Township in the Kainantu District of Eastern Highlands. It is accessible via an unformed road but can take up to 1 hour and 45 minutes travelling time dependent upon prevailing weather conditions. The following image depicts the areas of greatest population density in Eastern Highlands Province.

Image 2: Population Density in Eastern Highlands Province, PNG

MUSAVE

11. The area around Musave is closely settled with up to 100 persons/square kilometre living in small villages and scattered hamlets. However, the land is sufficiently fertile to support this high concentration of population. The area is also served by a dry weather road access to Kainantu.

12. The catchment population of the proposed Musave Community Health Post is derived from 14 villages i the aea ko olletiel as Izeiota ouit ith a total population in excess of 7600 persons at the time of the 2011 National Census. About 40% of this population is living in the eastern area and has reasonable access to the Sonofi Aid Post and/or the Onamuga Health Centre. It is estimated that there were 4620 people living in the immediate Musave area at the end of 2013. Some of those live across the District border in neighbouring Henganofi District but they access Kainantu Township via the road which passes through Musave. It is estimated that there were 650 infants and children under the age of 15 years and 1350 women of child bearing age (15-44 years) living in the immediate catchment area. The population in the Kainantu District is growing at a faster rate than that of any other rural District in PNG.

The following image depicts the level of access to major centres and services for the people of Eastern Highlands. Image 3: Access to services for people of Eastern Highlands Province.

MUSAVE

D. MUSAVE CHP SITE: DESCRIPTION AND AREA

13. Tiokae as iitiall idetified i the Easte Highlads Poiial Health Authoits “tategi Health “eie Deelopet Pla - as the site fo futue deelopet of a Community Health Post in the area and was nominated by the Authority as one of two Rural Primary Health Service Delivery Project sites for the Kainantu District. Irreconcilable disputes about ownership of the proposed site at Tirokave and the prospect of tribal conflict led the Authority to reconsider its nomination. Similar disputes arose when Tingifeo/Krufi was proposed as the alternative site to Tirokave.

14. The Authority has now nominated Musave in the Kainantu District as the preferred alternative site. The Musave facility will have two (2) postnatal beds and two (2) general beds which are deemed sufficient to provide Level 2 health services to the potential catchment population of 5000-6000 persons.

15. The site at Musave, acquired for the State by the Hon Johnson Tuke, Member for Kainantu, for the construction of a Community Health Post and three (3) staff houses by the Rural Primary Health Service Delivery Project satisfies all of the criteria required for construction of the proposed Community Health Post to proceed:

 The land is in Kainantu District of the Province  The Chief Executive Officer of the Eastern Highlands Provincial Health Authority has endorsed the concept plan, the site plan and the final design of the Community Health Post after consulting with the local communities that it will serve.  Landowners of the area have been consulted extensively about their healthcare needs and voluntarily offered land for the project. They were prepared to allow occupation of the site without recompense in order to secure a Community Health Post within their village.  The Poies “tategi Health “eie Deelopet Pla, eoeds construction of a Level 2 Community Health Post in the area to serve the health needs of the 4620 people living in the immediate area. That Plan has been endorsed by the Board of the Provincial Health Authority.  The Chief Executive Officer has entered a Memorandum of Agreement with the Secretary for Health confirming the availability of recurrent budget for operation of the facility  The Chief Executive Officer has nominated the three staff members to be assigned to the facility and those staff have undergone extensive upskilling in maternal and child health service provision. The nominated Officer in Charge has completed the Rural Health Facility Management Course delivered by Divine Word University.  The Community Health Post design has been certified by the Manager, Health Facilities Branch as consistent with the National Health Service Standards, 2011  The Environmental Management Plan was endorsed by the relevant officers of the Asian Development Bank on 14th November, 2016  The former customary owners of the land, registered as Portion 340C Milinch of Okapa, Fourmil of Markham, Kainantu District, Eastern Highlands Province and known locally as Yauvifante, consented to sell their land to the State through the Land Investigation Report dated 9th August, 2016.  The area of the land acquired is 2.40 hectares which had been used in the past for production of vegetable crops. The entire area on which the Community Health Post and staff houses are to be constructed has been cleared of significant trees for many years.

E. SCOPE OF LAND USE/PURCHASE

16. The land offered voluntarily by local landowners for acquisition by the State for the construction of the proposed Community Health Post is cleared, flat and well drained clay and loam and was formerly used for subsistence gardening as the location for an Aid Post. The land was owned by members of the Irafo and Kampefona Clans and had been inherited by them through Clan membership. The Land Investigation Report indicates that there is sufficient alternative land available for gardening and that their rights to the land are not contested.

17. The Clans are aed i the “hedule of Oes, “tatus ad ‘ights to the Lad setio of the Lad Iestigatio ‘epot as haig elusie ights as the lad oes. The have nominated Mr. Ken Keriba, Mr Fugonto Nae, Mr Jovaka Beafa, Mr. Joseph Silliyuo, Mr. Folken Tobofa, Mr. Ontobura Korepe, Mr. Koni Tomave and Mr. Arimpa Antene to be their representatives and agents for the purpose of executing a Transfer to the Administrator over that piece of land known as Yauifate Potio C containing approximately 2.40 hectares and situated near Kainantu Town in the Distit of Kaiatu of Easte Highlads. The futhe authoised the above agents to accept, on behalf all, moneys and considerations paid by the said Administrator in connection with the proposed Transfer of the said piee of lad.

18. The extent of the site was determined by the customary owners and the owners of adjoining land in the company of the Surveyor, Mr. Damake Murio, prior to survey and is quantified at 2.40 hectares by him. The boundaries are clearly marked and are consistent with the decision of the local landowners. The owners of contiguous land have also declared that they have no interest in or rights by native custom to the surveyed land.

19. The site chosen for the Community Health Post was selected by the customary owners because it is central to the surrounding villages of Benega, Una, Kafe, Katipro, Taaku, Avaninofiu, Namo and Sisimega which have no other health facilities and because of its proximity to the road leading to Kainantu Township.

20. The value of the land provided for the Community Health Post was assessed by the Valuer-General to be K490,000.00 inclusive of planted crops and two derelict houses which had been removed following the survey but prior to the valuation assessment.

21. The Certificate of Alienability No. 5/5-2017 was issued by the Secretary of the Department of Provincial and Local Government Affairs.

22. Payment of K100,000 was made to the authorised agents by the member for Kainantu, Hon. Johnson Tuke on behalf of the State in Musave Village on 24th March, 2017. The landowners accepted this as full and final payment and a Deed of Release and Sale and Transfer documents were signed by the Agents and witnessed by an Officer of the Customary Lands Division of the Department of Lands & Physical Planning and the CEO of the Kainantu District Development Authority.

23. The process of obtaining the Title on behalf of the State is now complete and tenders have been invited for construction of the proposed Community Health Post.

24. Officers of the Provincial Health Authority, the Eastern Highlands Provincial Administration and the Rural Primary Health Service Delivery Project have followed both Government of PNG and standard ADB safeguards processes including extensive consultation with the local community, use of applicable National land laws and regulations, and due diligence to ensure that local people would not experience significant adverse impacts by relinquishing this land.

E. SOCIOECONOMIC INFORMATION

25. The people of Eastern Highlands Province are of Austronesian origin. Most Eastern Highlanders are fluent in and many younger people also speak English. However, literacy rates, at just 43.9%, are amongst the lowest in the country.1 Literacy rates in the Musave area amongst those aged between 15 and 35 are lower since most children did not attend schools during the tribal conflict which occurred in the area between 1997 and 2014.

26. Life expectancy for people living in Eastern Highlands was just 54.6 years for males and 56.3 years for females in 2011. At the same time the total fertility rate was 4.4 and the infant mortality rate was 54/10002.

27. Aodig to the Natioal Depatet of Healths “eto Pefoae Aual Report for Kainantu District 22.92% of children under 5 years of age were suffering some level of malnutrition which is just below the National average and 7.14% of infants were born with a birthweight of less than 2500gms. Measles vaccination rates were just 23.43%, pentavalent vaccination coverage rates were just 28.65% and attendances for outpatient care at reporting health facilities were just 6.25% of what should be expected of a rural population.

28. By accepted indicators of maternal health, Kainantu District health services are performing very poorly. The supervised delivery rate is just 19.33% whilst the national average is 44% and the National target is 80%. Attendance for antenatal care is just 41.23% whilst the National average is 66.5%. The take up rate for modern family planning methods was just 38 couple years of protection/1000 in 2015 which is almost the lowest rate in PNG.

29. The need for a local Community Health Post to serve the population of the Musave area is clearly demonstrated by these very low access/take up rates for basic maternal and child health care.

30. Some people living in close proximity to derive relatively high cash incomes from the sale of fresh foods at local markets and others living in areas where coffee can be grown derive very high incomes. However, on average, the people are generally poor with average annual cash incomes of less than K200 per person.

31. Most people living in the Musave area are reliant upon subsistence gardening of sweet potatoes, eglish potatoes, beans, yams, corn, cabbage and broccoli. Some local vending is undertaken by women of the villages but transport to markets beyond Kainantu Township such as Goroka or and elsewhere is difficult and costly due to the distance and therefore uneconomic. Local farmers also raise pigs and chickens for local consumption to provide the majority of their protein requirements. Generally, average cash incomes for the people of the Musave area are relatively high when compared to those of other Districts and Provinces.

1 National Health Plan 2011-2020, Volume 2 2 National Health Plan 2011-2020, Volume 2 32. The following image 4 clearly indicates that average annual cash incomes per capita for people living throughout the Kainantu District are relatively high although there are people living in the north of the District who earn very low or no cash income at all.

Image 4: Average Annual Cash Income per capita for people living in Eastern Highlands Province.

MUSAVE

33. There are only small areas of land in the Province which are considered to have high agricultural potential and most of the arable land in the Province is already under strong or very strong agricultural pressure. Continuing population growth since 2001 has increased the pressure with fallow periods necessarily reducing. As a result of rapid population growth, 4.56% per annum as measured between to 2000 and the 2011 Census in the Kainantu District, when coupled with changing climatic conditions, is increasing pressure on the arable land. The following image 5 shows that there was already strong agricultural pressure on the land in the Musave area by 2001 and this will have been compounded by the rapid population growth experienced in the area since that time.

34. However, the Land Investigation Report records that the former customary owners of the land provided for the Community Health Post at Musave own sufficient land and that the provision of the land will not be detrimental to the interest of the customary owners or of their descendants either now or in the foreseeable future.

Image 5: Map of Eastern Highlands Province depicting areas of Agricultural Pressure

MUSAVE

E. INFORMATION DISCLOSURE, CONSULTATIONS, AND PARTICIPATION

35. There were visits and discussions with local landowners by Provincial Lands Officers and Provincial Health Authority Officers during May, 2016 to discuss acquisition of the land for the proposed Community Health Post when it became apparent that the sites at Tirokave, Tingifeo and Krufi were not going to be available.

36. On 20th July, 2016 Mr. Damake Murio, Consultant Surveyor, visited the site in conjunction with Officers of the Provincial Health Authority and conducted cadastral and topographical surveys with the assistance of the local customary landowners who identified the proposed boundaries and the extent of the land which they proposed to make available for the Community Health Post project.

37. On 8th and 9th August, 2016 Mr. Immanuel Soer, ILG Officer with the Regional Office of the Department of Lands &m Physical Planning, visited the site and met with the customary landowners in order to prepare the Land Investigation Report after further consultation with local people and confirmation of their genealogy.

38. I Otoe, the Pojets Ahitet atteded the site ith the Pojets Geotechnical Surveyor to undertake soil testing and to discuss the proposed site plan with the villagers of the area. 39. Provincial Health Authority Officers, the Pojets Communication Specialist and the Safeguards Officer visited Musave between 10th and 14th October, 2016 to gauge support for and to promote awareness of the proposed Community Health Post. They conducted couit osultatio, aaeess ad a health eeds aalsis thoughout the villages of the catchment area. Villagers representing Benega, Musave, Una, Kafe, Katipro, Taaku, Ananinofiu, Namo and Sisimega villages participated enthusiastically. Separate group consultations were held with mothers and older women, fathers and elderly men, young girls and young boys to encourage discussion of issues which might not otherwise be raised.

40. The health issues consistently identified were malaria, toothache, deteriorating eyesight, tuberculosis, joint pain (arthritis), diarrhoea and other respiratory complaints. The social problems consistently identified were alcohol and drug consumption, domestic violence, child abuse, sorcery and deteriorating road conditions. The absence of a clean and reliable water supply was acknowledged as a major issue.

41. I espose to the health eeds aalses the Pojet ill fud the deelopet of a spring fed community water supply to alleviate the incidence of diarrhoea and typhoid which consistently ranked in the top three conditions for which local people seek health services.

42. Communities and affected people visited by the Project staff have been encouraged to discuss any issues of concern to them. All staff working on the various components have consistently stressed that the tender and contracting process will be conducted in an open and transparent way, so that all eligible firms can bid for the work provided that they qualify according to the tender criteria.

F. GRIEVANCE REDRESS MECHANISM (GRM)

43. The Project will establish a GRM, which will be accessible (considering literacy levels), predictable (known procedures, within a set timeframe), and transparent. The Provincial Safeguards Officer (PSO) will be the grievance redress focal point to address Project related concerns that may arise during implementation. Through public meetings, communities and affected people have been informed by the Rural Primary Health Service Delivery Project that they have a right to grievance resolution, and are told how they can have access to the GRM. Complaints and grievance procedures will be based on those outlined in the Land Assessment Framework. These ensure communities are easily able to register any complaints at the local level, and that there is a publicly acceptable forum to deal with them. A Grievance Registration book will be established to be held and administered by the local Health Facility Management Committee which has been formed. Anyone can approach this Committee to lodge a complaint or grievance. After the tender is awarded and before construction starts the ‘ual Pia Health “eie Delie Pojets health pootio ad gede tea ill visit communities to conduct HIV/AIDS awareness training for community members and contracting staff. During this, the Grievance Registrar will be identified and trained as part of the Health Committee.

44. The Grievance Registration book will record who is making the complaint, the substance of the complaint, to whom it has been referred for action, and the date. Grievance procedures may address benefits, contractor compliance, social and environmental concerns and other issues, apart from disputes relating to legally contestable land ownership rights. These will be referred to the District or Provincial Land Officers, who will institute a process to resolve land disputes and grievances based on accepted procedures of mediation. As required, the participation of appointed and traditional leaders will be facilitated to achieve a satisfactory resolution of any land issues at the local level. Every attempt will be made to ensure that women as affected persons, irrespective of traditional constraints, are included in the mediation processes. Any disputes arising over alienated land or compensation will follow the procedures set out in the Land Disputes Settlement Act 2000, (explained in Section G, paragraph 51), and if mediation fails, will be referred to an appropriate court of law.

45. The Grievance Registrar in the village will, in the first instance, contact the Provincial Safeguards Officer, whose key function in relation to the GRM is (i) to record, categorize and prioritize the grievances and inform the Project Support Unit; (ii) in consultation with the Project Coordinating Committee and complainant, settle the grievances; (iii) to inform the aggrieved parties about the solution or, if a solution is not found (iv) to forward unresolved ases to the ‘ual Pia Health “eie Delie Pojets Pojet Maage o to highe authorities.

46. The Grievance Registrar will forward any complaint to the Provincial Safeguards Officer within five days of receiving it. The Provincial Safeguards Officer will discuss with the Project Coordinating Committee members and endeavour to find a solution within two weeks of receiving the complaint. For unresolved complaints, the Project Manager will consider the complaint and within one month will convey a decision to the Affected Persons. The Project Support Unit staff, along with local health officials, will assist the Project Manager in reviewing and addressing the complaint. If the Affected Person(s) are not satisfied with the Project “uppot Uits deisio, the a the take the gieae to the PNG judiial sste.

G. APPLICABLE POLICIES AND LAWS

47. The PNG Constitution adopts customary law as part of the underlying law of the country and recognizes the property rights attached to customary land. According to the 2000 Underlying Act, customary law comprises the rules, rights and obligations pertaining to an individual or group by custom and tradition. Customary law applies and the courts recognize it where it is not inconsistent with written law. The Constitution also guarantees the right of the citizens to protection from unjust deprivation of property. No land or interest in land may be acquired compulsorily by the Government, except as it is required for public purposes or other justifiable reasons. In the event of expropriation of land, just compensation must be made, by the expropriating authority.

48. While the Constitution does allow for compulsory acquisition for building infrastructure for health, the Rural Primary Health Service Delivery Project has stipulated that no land will e auied ithout the ladoes full ageeet. Moeoe, this ageeet ust e secured through a transparent process following the FPIC principles (free, prior and informed consent). To ensure that these principles are adhered to, the Project Safeguards staff have made joint field visits with the Department of Lands and Physical Planning staff to the proposed CHP sites. The Government has recently introduced a new policy requiring that all land for building new state infrastructure should be bought outright, rather than, as in the past, being built on gifted customary land, or through leasing land from landowners.

49. The Land Act (1996) deals with ownership and use rights of customary land.3 It also sets out the procedures for the government to acquire customary land required for public purposes. The key provisions of the Act are (i) the government may acquire land, including improvements on land; (ii) usually the government negotiates agreements with the customary landowners for purchase of required land, but it can also compulsorily acquire the land; and (iii) the acquisition process involves several steps, including initial investigation, land survey, land investigation report (including genealogies of owner groups), determination of compensation value of land and any improvements, payment of compensation, registration of land for state ownership and transfer of title.

50. This process is being followed by the Rural Primary Health Service Delivery Project, working closely with officers of the Department of Lands and Physical Planning who are required to do the initial investigation including documenting genealogies of clans, valuing the land and its assets, registering the surveys and providing file numbers. Once this is done and approved, the file is sent to the Department of Provincial and Local Government Affairs so that a Certificate of Alienability can be issued for the title to be registered as State land. At the same time as the Government land acquisition process is proceeding, the Project is preparing standard safeguard documents for ADB approval.

51. The Land Disputes Settlement Act (2000) sets out the procedures for resolution of disputes involving customary land. The Act provides for a land disputes committee at provincial level and land courts at local, district and provincial levels. The committee can appoint land mediators. The Act promotes resolution of disputes through mediation based on the principles of traditional dispute settlement. If mediation fails, it is followed by appeal to the courts. The registration of customary landowners as an Incorporated Land Group (ILG) has been used a lot in private sector projects in PNG. While it is not a mandatory requirement for acquisition of land in case of public sector projects, registration of ILGs may be helpful in dispute resolution and negotiation with landowners. On the other hand, ILGs in the past have often been fraudulently used for the interests of a small group, rather than the whole clan. The Rural Primary Health Service Delivery Project will not insist on registration of landowners into an ILG unless there is a specific reason why it may be necessary to secure land.

52. The Fairness of Transaction Act of 1993 relates to the effect of certain transactions, to ensure that they operate fairly without causing undue harm to, or imposing too great a burden on, any person, and in such a way that no person suffers unduly because he is

3 The customary land includes land owned, used or occupied by a person or community in accordance with current customary usage. Access to land and resources is embedded in social relationships and expressed as customary land rights to utilize resources. Small clan-based groups live in the villages, managing their own resources, and exercising the right to utilize them. These groups (matrilineal or patrilineal clans which are composed of sub-clans, lineage groups, and at the lowest level extended households) ae tpiall ade up of pia ights holdes – the recognized traditional leaders of the group – who collectively have the authority to allocate secondary use rights through their spokesperson(s). Different cultures have different ways of allocating land between primary and secondary rights holders.

economically weaker than, or is otherwise disadvantaged in relation to, another person. The purposes of this Act are to (a) ensure the overall fairness of any transaction which (i) is entered into between parties in circumstances where one party is for reasons of economic or other advantage predominant and the other is not able to exercise a free choice; or (ii) for one reason or another, without attaching any evil design or bad faith, appears to be manifestly unfair or not to be genuinely mutual; and (b) allow for the re-opening and review of any transaction irrespective of fault and validity, enforceability or effect of any agreement; and (c) ensure the fair distribution and adjustment of rights, benefits, duties, advantages and disadvantages arising out of a transaction. Transaction means any contract, promise, agreement, dealing or undertaking of an economic or commercial nature whether supported by consideration or not entered into between parties, and includes (a) an informal, complete or incomplete transaction; and (b) a transaction governed by customary law.

53. Land Group Incorporation (Amendment) Act (2009) and Land Registration (Amendment) Act (2009). These Acts were brought into effect in 2011, following recommendations from the National Land Development Taskforce. The Acts recognize the corporate nature of customary groups and allow them to hold, manage and deal with land in their customary names, and for related purposes. These also facilitate the voluntary egistatio of ustoa lad, to e ko as egisteed la lad, ad akes that lad available for development through the use of Incorporated Land Groups (ILGs). These laws encourage (a) greater participation by local people in the national economy by the use of the land; (b) better use of such land; (c) greater certainty of title; (d) better and more effectual settlement of certain disputes; (e) legal recognition of the corporate status of certain customary and similar groups, and (f) conferring on them, as corporations, of power to acquire, hold, dispose of and manage land, and of ancillary powers; and (g) encouragement of the self-resolution of disputes within such groups.

54. As noted above, the Rural Primary Health Service Delivery Project does not require landowners to register as an ILG, but may negotiate with these groups, where they exist, or encourage groups to register if they want to further develop their land in future.

H. AGREEMENTS ON LAND USE

55. The series of consultations, which were held with landowners and affected people regarding the land at Musave has been described in Section E. The teams visiting emphasised the benefits the community would gain by having a fully functioning Level 2 health service in the area, in return for providing land to the State. Environmental and social impacts were discussed, and the measures to control these were explained.

56. The process to acquire the land followed that laid out in the Land Assessment Framework which consists of the following steps for land purchase through negotiated agreement4:  National Department of Health/Project Support Unit requested the Department of Lands and Physical Planning to issue an official land file number for the site to be purchased

4 Land Assessment Framework (Revised), 11 September 2013, PNG: Rural Primary Health Services Project, prepared by the National Development of Health, GoPNG, p.11  The Local Member commissioned Consultant Surveyor, Mr. Damake Murio, to undertake both cadastral and topographic surveys to identify the boundaries, location and area of the land to be purchased in consultation with customary landowners. The cadastral survey was then lodged with the Office of the Surveyor-General for registration and the topographic survey was provided to the Project Support Unit to allow preparation of site plans and structural design.  Once the surveys were lodged the Provincial Health Authority and the Project Support Unit requested the Valuer-Geeals Offie to sed a egisteed Value to alue the lad and any improvements such as garden crops, food trees, timber trees, and structures. His report was sent directly to the Office of the Valuer-General.  The Provincial Health Authority and Project Support Unit concurrently requested the District Lands Officer to prepare a Lands Investigation Report including ownership genealogy, rights and interest held in the land, and, estimated value of improvements to land in consultation with the landowners, the Valuer-General and other relevant government offices.  The Land Investigation Report was then endorsed by the Provincial Administrator and forwarded to the Department of Lands and Physical Planning on 30th September, 2016 to progress the process to obtain a Certificate of Alienability as a prerequisite for purchase by the State.  The Department of Lands and Physical Planning prepared a comprehensive file consisting of the Land Investigation Report and Cadastral Survey and forwarded it to the Secretary, Department for Provincial and Local Level Government Affairs (DPLGA) who issued a Certificate of Alienability confirming that there was no impediment to land purchase.  The Certificate of Alienability was issued by the Secretary, Department of Provincial and Local Government Affairs and returned to the Department of Lands and Physical Planning to pepae the puhase douets iludig the Deed of ‘elease to e siged, upo receipt of the purchase funds, by the customary landowners.  The Member for Kainantu, the Honourable Johnson Tuke set aside funds to compensate the customary owners for their land once the Certificate of Alienability was issued and the valuation established.

57. The project at Musave includes construction of the standard four-bed design for a Community Health Post and will include provision of equipment, drugs and allocation of three (3) staff. The Province has committed to providing the required staff and the Project has ensured that they have received the relevant training to ensure that the facility operates at the required standards for Level 2 health facilities in PNG.

58. The land acquisition process will be reviewed and verified by an independent third-party consultant contracted by the Project Support Unit for this purpose. She will provide verification that (i) the local community and landowners support the Community Health Post construction and have agreed to provide their land; (ii) consultations and negotiations with landowners have been undertaken meaningfully, freely and in good faith and the landowners have made informed decisions on use of the land, and (iii) terms and conditions of the agreements have been explained to and understood and agreed by the landowners.

I. COMPENSATION AND BENEFITS

59. The Musave landowning families were prepared initially to give their land voluntarily for the building of the Community Health Post. However, ultimately, permanent use of the land was obtained through negotiated purchase following the Land Act and Land Assessment Framework. Once the Government of PNG land acquisition process had been completed and the title transferred to the Eastern Highlands Provincial Health Authority the landowners received compensation from the State for both the value of the land and the value of their garden plantings. Affected landowners and land users were consulted according to the Land Assessment Framework requirements, and the costs were calculated by a registered Valuer from the Department of Lands and Physical Planning using the Department of Lands and Phsial Plaigs Valuatio “hedule takig ito aout the eplaeet alue. This was then reviewed and approved by the Valuer-General. The valuation of land and other productive assets by Department of Lands and Physical Planning was based upon accepted replacement costs which include (i) adequate information about any recent land transactions in the area; (ii) land value by types; (ii) cropping patterns and crop production; and, (iv) availability of land in the sub-project areas. The Valuer-General ensures that any compensation is based on prevailing market rates or replacement cost principles.

60. Affected persons at Musave will benefit by having access to some short-term employment opportunities, mainly unskilled work, as a result of the project during the construction phase. The requirement to hire local labour, where possible, will be part of the otatos otatual oligatios. While suh eploet oppotuities o thei o do not ensure sustainable livelihoods, being paid at least the minimum wage, and enjoying working conditions as per ILO Core Labour Standards (a recognized requirement for ADB financing of the Project), Project Management is confident that affected persons will be slightly better off financially as a result of the project, and certainly better off in terms of health services.

61. The Rural Primary Health Services Delivery Project recognizes that gender considerations apply to all public infrastructure projects. In conducting this due diligence exercise, women who will be affected by this project have been consulted, both in mixed groups with men and exclusive groups of women. Measures proposed to ensure gender equitable practices and outcomes include:

 Iterative consultations with women throughout all stages of the project cycle when preparing for and constructing the CHP  That women clan members be recorded in the Land Investigation Report and valuation processes conducted by the Valuer-Geeals Offie ad iluded i a suseuet benefits  Women being informed about how they can lodge grievances with the Project (and ultimately ADB) if they are dissatisfied with any aspects of the Project  Ensuring that women affected persons are offered priority waged employment during construction, and are afforded equal pay and opportunities  Addressing concerns women affected persons might have with safety and security issues, in contexts where they have to relocate their gardening activities  Ensuring that all socio-economic data collected for the project is gender disaggregated in order to analyse the differential impacts at intra-household, intra-inter clan, and community level.  Social risks associated with HIV/AIDS and other STIs will be mitigated to a large extent by employing as many local people on construction activities as possible and by awareness and prevention programmes designed to empower women and inform both women and men of the risks. All contracted staff will undertake a Rural Primary Health Service Delivery Project course designed for the purpose.

J. BUDGET AND SOURCES OF FUNDS

62. The Government of PNG has declared its intention to increase the proportion of land oed the “tate though its Visio pla ad has a aual udget to pa fo the land needed for public service infrastructure. The Government therefore funds all land acquisition activities involving landowner compensation while the Project finances consultant services to oversee the land acquisition and monitoring of land activities. In the case of Musave project the State paid for the land through the Member for Kainantu District, the Honourable Johnson Tukes Distit “eie Ipoeet Poga D“IP alloatio which is managed by the Kainantu District Development Authority.

K. INSTITUTIONAL ARRANGEMENTS

63. The National Department of Health is the Executing Agency for this Project and the participating Provinces are the Implementing Agencies. The day-to-day implementation activities related to land acquisition are undertaken by the Province with support from the Project Support Unit of the Rural Primary Health Service Delivery Project. These activities include:

 Collaboration with and assistance to the Provincial/District Land Officer at the Community Health Post site to undertake their work and comply with Government poedues, the Pojets poliies ad ADB requirements

 Provision of resources to allow Provincial staff to accompany Project Support Unit (PSU) safeguards staff to sites

 Collaboration with and assistance to the Provincial/District Land Officer, Provincial Safeguards Officer, and PSU Safeguards consultants in consulting and negotiating agreements with affected landowners and users

 Facilitation of consultations with Ward Development Councils and affected communities and ensuring that all stakeholders are informed about the Project, its policies and procedures

 Ensuring the requirements concerning public disclosure of the provisions for land acquisition and compensation are followed

 Informing communities about the grievance redress mechanism, and overseeing and monitoring the process

 Signing a Memorandum of Agreement with the National Department of Health agreeing to manage, operate, support, staff, and provide budgets and supplies for the new facility.

 Ensuring that cadastral land surveys and Land Investigations Reports are completed and registered with the Surveyor-General and Department of Lands and Physical Planning in a timely manner.

64. Provincial Safeguards Officers, and other Government staff who are involved in ipleetig the Pojets lad poliies hae ee poided ith taiig i the ADBs soial safeguard policies and procedures

65. The Provincial Safeguards Officer is also responsible for monitoring of land acquisition activities, and will be the focal point for the Grievance Redress Mechanism. He is assisted and supported the Pojet “uppot Uits “afeguads “peialists.

L. IMPLEMENTATION SCHEDULE

66. The implementation schedule for land access and facility design processes at Musave was as follows:

LAND ACCESS/ACQUISITION/DESIGN PROCESSES DATE

Community Consultation/Community Health Post and GRM 10th-14th October, advocacy completed 2016

Cadastral and Topographic Surveys undertaken with Landowner 20th July, 2016 participation and endorsement Land Portion Number issued by Department of Lands & Physical 30th September, Planning 2016

Land Investigation Report lodged 30th September, 2016

Valuation completed and lodged 30th January, 2017

Certificate of Alienability Issued 9th May, 2017

Sale & Transfer of Land signed by Customary Owners 24th March, 2017 Deed of Release signed by Customary Owners 24th March, 2017

M. MONITORING AND REPORTING:

67. The ‘ual Pia Health “eie Delie Pojets “afeguads staff hae suitted Environmental Management Plans and Due Diligence reports to ADB detailing the land acquisition processes. The Provincial Safeguards Officer will be responsible for on-going monitoring of the land activities, supported by Project Support Unit staff, including assisting in the monitoring of contractor compliance with the Environmental Management Plan. The Project Support Unit will prepare semi-annual progress reports for ADB as part of project performance monitoring. An external consultant has been appointed to undertake third-party monitoring and verification of the land acquisition processes.

ANNEXURES (Available Upon Request)

Annex One: Reports of Community Consultations

Annex Two: Land survey of site

Annex Three: Land Investigation Report

Annex Four: Valuation by the Office of the Valuer-General

Annex Five: Certificate of Alienability

Annex Six: Sale & Transfer of Land

Annex Seven: Deed of Release

Annex Eight: Approved Layout Plan for Community Health Post

ANNEXURES (Available Upon Request)