112327 REV Public Disclosure Authorized China Health Reform Program For Results (P154984) Public Disclosure Authorized Environmental and Social Systems Assessment (ESSA) Public Disclosure Authorized Public Disclosure Authorized April, 2017 Prepared by the World Bank Acronyms and Abbreviations CHSI Center for Health Statistics and Information DLI Disbursement-Linked Indicator EHS Environmental, Health and Safety EIA Environmental Impact Assessment EPB Environmental Protection Bureau HCF Health Care Facilities HFPC Health and Family Planning Commission HRH Human Resources for Health IDS Integrated Health Service Delivery System MOF Ministry of Finance MoHRSS Ministry of Human Resource and Social Security NDRC National Development and Reform Commission NHFPC National Health and Family Planning Commission PAP Program Action Plan PforR Program for Results PHC Primary Health Care PTF Program Task Force QA Quality Assurance SCHRO State Council Healthcare Reform Office THC Township Health Center WHO World Health Organization Table of Contents Executive Summary ................................................................................................................................... 1 1. Introduction ........................................................................................................................................ 8 1.1. Background.................................................................................................................................... 8 1.2. Anhui and Fujian Provincial Context ............................................................................................ 8 1.3. Purpose and Approach of Environmental and Social System Assessment .................................... 9 1.4. Methodology of Environmental and Social System Assessment ................................................... 9 1.5. Borrower’s Past Experience relevant in the PforR ...................................................................... 10 2. Program Description ........................................................................................................................ 11 2.1. Program Contents ........................................................................................................................ 11 2.1.1. National Health Reform Agenda ............................................................................................. 11 2.1.2. Anhui and Fujian Health Reform Masterplans ........................................................................ 13 2.1.3. China Health Reform PforR (the “Program”) ......................................................................... 15 3. Potential Environmental and Social Effects ..................................................................................... 18 3.1. Environmental and Social Screening ........................................................................................... 18 3.2. Potential Environmental Benefits and Risks ............................................................................... 18 3.2.1. Potential Environmental Benefits ............................................................................................ 18 3.2.2. Environmental Effects and Risks ............................................................................................ 18 3.2.3. Occupational Health and Safety Effects .................................................................................. 23 3.3. Potential Social Benefits and Risks ............................................................................................. 24 3.3.1. Potential Social Benefits ......................................................................................................... 24 3.3.2. Potential Social Effects and Risks ........................................................................................... 26 4. Assessment of Environmental Management Systems ...................................................................... 29 4.1. Legal and Regulatory Framework ............................................................................................... 29 4.1.1. General Environmental Protection, Pollution Control and Medical Waste Management ....... 29 4.1.2. Occupation Health and Safety ................................................................................................. 34 4.2. Implementation of Environmental Management System ............................................................ 37 4.2.1. Environmental Impact Assessment .......................................................................................... 37 4.2.2. Medical Waste Management of Health Projects ...................................................................... 39 4.2.3. Occupational health and safety, and radiation management .................................................... 40 4.2.4. Supervision of the Implementation of the Environmental, Health and Safety Measures ........ 42 4.2.5. Summary of the Implementation of the Legal System for EHS at the program level ............. 42 4.3. Institutional Capacity and Performance of the Provincial Environmental Management System 45 4.3.1. Medical waste management .................................................................................................... 45 4.3.2. Radiation risk management ..................................................................................................... 48 4.4. Assessment of Environmental Management System against Bank PforR Policy and Directives 49 4.5. Summary of Key Issues ............................................................................................................... 49 5. Assessment of Social Management Systems and Performance ....................................................... 51 5.1. Legal and Regulatory Framework ............................................................................................... 51 5.1.1. Land Acquisition ..................................................................................................................... 51 5.1.2. Accessibility and equity .......................................................................................................... 56 5.1.3. Public Participation ................................................................................................................. 58 5.1.4. Ethnic Minorities ..................................................................................................................... 58 5.2. Implementation of Social Management Systems......................................................................... 59 5.2.1. Land acquisition practice ......................................................................................................... 59 5.2.2. Management of Other Social Issues ........................................................................................ 61 5.2.3. Institutional Arrangement for Implementing the PforR........................................................... 62 5.3. Institutional Capacity and Performance ....................................................................................... 63 6. Summary of Assessment of Environmental and Social Systems ..................................................... 64 7. Consultation and Disclosure ............................................................................................................ 65 8. Recommendations for the Program Environmental and Social Systems ......................................... 69 Annex 1 - List of Applicable Laws and Regulations ............................................................................... 71 Annex 2 - Assessment of Environmental and Social Systems based on the Bank Policy and Directive for PforRs ...................................................................................................................................................... 73 Annex 3 - Environmental and Social Risk Screening Worksheet ............................................................ 80 Annex 4 - Review of Land Acquisition for Selected HCFs in Fujian and Anhui..................................... 82 Annex 5 - A Summary of SARS Crisis (2003) and the Development of Medical Waste and Medical Radiation Management in China .............................................................................................................. 84 Annex 6 - Summary of Public Consultation Meetings for ESSA ............................................................ 86 Executive Summary i. The PforR is expected to bring about positive environmental, social and health benefits in terms of providing improved health services to the public and communities, particularly in rural poor areas. Along with these, it is expected that standardized hospital management practices for medical waste, occupational safety and health, and that the collection and transportation of medical wastes in rural areas will be improved. ii. Nonetheless, some of the activities supported under the PforR have potential negative impacts and risks. Medical waste management and radiation risks are considered the main issues from environment, health and safety perspective. This Environment and Social Systems Assessment (ESSA), prepared by the Bank team, provides a comprehensive review of relevant environmental and social management systems and procedures in China and the two provinces, identify the extent to which the country/local systems are consistent with PforR Bank Policy, and Directive, and recommend necessary actions to