Due Diligence Report Project Number: 41509-013 August 2016 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. Papua New Guinea Rural Primary Health Services Delivery Project DUE DILIGENCE REPORT Brigiti Community Health Post Site AUGUST, 2016 1 INDEX Executive Summary Project and Community Health Post Description Brigiti 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 Annex One: Site Plan Annex Two: Land Survey Annex Three: Land Investigation Report Annex Four: Valuation Report Annex Five: Voluntary Land Use Agreement Annex Six: Certificate of Alienability Annex Seven: Deed of Release Annex Eight: Sale & Transfer of Land 2 EXECUTIVE SUMMARY The village of Bigiti, soeties efeed to i offiial douets as Apagai, is i the Albiges Mablep Local Level Government (LLG) area of Maprik District in East Sepik Province, PNG. The LLG had a population of 14,657 at the time of the 2011 census with an annual growth rate over the previous ten (10) years of 2.7%. Bigiti is situated appoiatel 5 iutes die est fo Mapik to ad a futhe kiloetes (1½ hours) from the Provincial capital of Wewak. Whilst the people of the Brigiti area have relatively good access to commercial services the condition of the health infrastructure in the remote rural areas of the Maprik District is poor with most people required to travel to Maprik town or beyond to the Provincial General Hospital in Wewak for treatment of all but low acuity health conditions. The rate of private vehicle ownership is very low with the majority of the population dependent upon public motor vehicles when health care is required. Since public transport generally only operates during daylight hours this further constrains access to healthcare. In 2010, the mortality rates were 79/1000 for infants under one year and 115/1000 for children under five years of age. (National Research Institute Health Report, 2010). The 2015 Health Sector Performance Annual Review (SPAR) records that only 29.80% of projected deliveries by mothers of Maprik District were supervised in a health facility despite 62.28% of expectant mothers accessing antenatal care at a health facility in the District. This reflects the unavailability of health services outside of normal public servant working hours. The supervised delivery rate is well below the National target of 80% and the National average of 37.0%. The 2015 SPAR also records that 10.81% of infants delivered in a health facility in 2015 in the District had a birth weight of less than 2.5 kilograms and that 28.31% of children under the age of 5 years examined in District health facilities were suffering some level of malnutrition. Immunisation rates for measles amongst children less than 5 years of age were just 36.50% and pentavalent immunisation rates were 48.95%. The National targets for these rates are 90%. These high infant and child mortality rates and other very poor indicators of health make a compelling case for the development of additional, more accessible health facilities within Maprik District. The proposed Community Health Post at Brigiti will be classified as a Level 2 Health Facility under the PNG National Health Serie “tadads, s ‘ole Delieatio Mati. It will be required to provide maternal and paediatric primary health clinics. Provision will also be made for 24/7 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 Procedure Room will be provided to allow emergency care of trauma or serious medical conditions prior to referral. Discrete consultation rooms will be provided to ensure privacy for clients seeking care or advice for their conditions. The Brigiti Community Health Post will have five (5) inpatient beds and is expected to provide health services for up to fifty (50) persons per day. The Community Health Post staff will also have a major role in health education and promotion in the area and will coordinate the activities of Village Health Volunteers working in the catchment area to generate demand for antenatal care, supervised deliveries, family planning and immunisation. 3 The site proposed fo the Couit Health Post the ustoa oes is ko offiiall as Lo Ap, is registered as Portion 120C, Milinch of Suain, Fourmil of Wewak and District of Maprik and consists of 0.887 hectares of flat, recently cleared land and is partially occupied by three (3) derelict buildings used in the past as an Aid Post and staff accommodation respectively. The site is partially fenced and is adjacent to the Brigiti Primary School and fronted by the main Drekikir/Maprik Road. The land was formerly owned by five (5) land owning clans and was inherited by them from their forefathers. The Clans are the Kwambakum, Toskum, Gaikum, Mungokum and Kambakum and each Clan publicly nominated oe seio ee to e ou epesetaties ad agets fo the pupose of executing a transfer to the Administrator over that piece of land known as Brigiti (Lo Ap) containing 0.887 hectares and situated at Brigiti Primary School in the District of Maprik, Province of East Sepik and we do authorise our 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 nominations were made on 16th July, 2015 at the time of compilation of the Land Investigation Report. The Brigiti landowning clans agreed 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. This is in accordance with GoPNG policy, that all State infrastructure should be built on State land. The acquisition by the State of a small plot of land for the construction of the Brigiti Community Health Post was based on the las, egulatios, ad poliies of the PNG Goeet ad the ADBs “afeguad Poli Statement (2009). The Brigiti landowners say that they have ample remaining land for gardens and there will be no adverse impacts on the village economy or on individual household incomes due to the alienation of land for the Community Health Post construction. Apart from minor disturbances to the environment during construction, there are unlikely to be any adverse socio-economic impacts on the affected households and they will benefit from the land payments made for the purchase of clan land. The land was valued by the Valuer-General at K181,000 and Certificate of Alienability No. 24/10-2016 was granted by the Secretary, Department of Provincial and Local Government Affairs on 5th October, 2016. The Maprik District Development Authority formally acquired the land on behalf of the State on 13th September, 2016 he the Deed of ‘elease as siged the ladoes agets at a puli ceremony held on the site. A. 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 to support the Government of PNG to implement the National Health Plan as it relates to rural health. The Project covers two (2) Districts in each of the following eight (8) Provinces selected by the Government of PNG: Eastern Highlands, East Sepik, Enga, Milne Bay, Western Highlands, West New Britain, Morobe and the Autonomous Region of Bougainville. 2. The Project will make improvements in both the supply and demand sides, and strengthen the policy and legal framework for health services at all levels. There are six outputs: 4 Output 1 – National policies and standards. Assisting the National Department of Health (National Department of Health) to develop 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 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 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 performance and retention issues. Output 4 – Community health facility upgrading. The Project will build 32 new Community Health Posts with 96 staff houses as well as providing medical equipment and small vehicles (cars, boats, or motorbikes). It will also provide sanitation facilities, waste management facilities and establish renewable energy supplies for those health facilities Output 5 – Health promotion in local communities.