Initial Environmental Examination Project Number: 51107-002 Loan & Grant Numbers: 3727& 0618 September 2020 SRI: Health System Enhancement Project Sub-projects proposed for Round 2, Phase I in the Uva Province Prepared by the Project Management Unit, Health System Enhancement Project, Ministry of Health for the Asian Development Bank. This Initial Environmental Examination 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. CURRENCY EQUIVALENTS (as of 1 September 2020) Currency unit – Sri Lanka Rupee/s (SLR/SLRs) SLR1.00 = $0.0054 $1.00 = SLR184.61 ABBREVIATIONS ADB – Asian Development Bank CEA – Central Environmental Authority DH – district hospital DS – Divisional Secretary EA – executing agency EHS – environment, health & safety EMP – environmental management plan EMoP – environmental monitoring plan EPL – environmental protection license GN – grama niladhari GoSL – Government of Sri Lanka GRM – grievance redress mechanism H&SP – health and safety plan HCF – healthcare facility HCW – health care waste HCWM – health care waste management HSEP – Health System Enhancement Project IEE – initial environmental examination MOH – Ministry of Health NEA – National Environmental Act O&M – operation and maintenance PD – project director PDHS – provincial director of health services PIU – project implementation unit PMCU – primary medical care units PMU – project management unit PPE – personal protective equipment PS – Pradeshiya Sabha SKS – saukya karya sahayaka SPS – Safeguard Policy Statement SWL – scheduled waste license This initial environmental examination 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 on ADB’s 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 Bank does not intend to make any judgments as to the legal or other status of any territory or area. i Table of content Executive Summary .............................................................................................................. iii I. INTRODUCTION ........................................................................................................... 1 A. Project Background ..................................................................................................... 2 C. Objectives of this initial environmental examination .................................................... 3 D. Environmental Category.............................................................................................. 5 II. Policy, Legal, and Administrative Framework ................................................................. 6 A. Applicable Laws, Regulations, Standards, and Requirements ............................ 6 B. ADB Policy on Environmental & Social safeguards ............................................ 17 C. Administrative Framework .............................................................................. 19 III. Description of the Project ............................................................................................. 21 A. Sub-projects in Badulla District ................................................................................. 21 B. Sub-projects in Monaragala District .......................................................................... 55 IV. Description of the Existing Environment ....................................................................... 91 A. Methodology Used for the Baseline Study ................................................................ 91 B. Description of the physical environment .................................................................... 91 C. Biological environment .............................................................................................. 98 D. Socio-economic Characteristics .............................................................................. 109 V. Anticipated Environmental Impacts and Mitigation Measures..................................... 119 A. Location impacts ..................................................................................................... 119 B. Design and pre-construction impacts ...................................................................... 120 C. Impacts during construction and mitigation measures ............................................. 124 D. Impacts during the operational stage of newly constructed facilities ........................ 140 VI. Consultation, Participation and Information Disclosure .............................................. 152 A. Consultation and participation during project preparation ........................................ 153 B. Disclosure of Information ........................................................................................ 153 VII. Grievance Redress Mechanism ................................................................................. 154 VIII. Institutional Requirements and Environmental Monitoring Plan .................................. 155 A. Implementation arrangements ................................................................................ 155 B. Institutional Capacity Development ......................................................................... 156 C. Environmental Management Plan ........................................................................... 156 D. Environmental Monitoring Plan ............................................................................... 156 IX. Conclusion and Recommendations............................................................................ 154 A. Conclusion .............................................................................................................. 154 B. Recommendations .................................................................................................. 154 ii Executive Summary i. Strengthening primary healthcare (PHC) –– both primary medical care and preventive health services — in Sri Lanka needs priority attention to tackle the rising costs of health care as well as to improve primary health services to lagging populations to meet the emerging public health challenges. The current health system under-invests in primary care, and limited government funds mostly cater to higher-level hospitals. The underinvestment at the primary care level has led to inadequate facilities and generally poor utilization of primary care level institutions and increased burden on higher-level health care facilities. As health care is costly, overuse of hospital services creates inefficiency in the use of government health expenditures. The cost pressures arising from increased non-communicable diseases and population ageing, however, have catalyzed the beginning of government reforms to rationalize health care utilization with increased focus and orientation towards PHC. However, the actual reform model is still evolving, and there is a need for external assistance to inform further and help operationalize PHC reform initiatives. ii. Given this background, the government has begun reforms to rationalize health care utilization with increased focus and orientation towards PHC to meet the emerging challenges in the health sector. The actual reform model is still evolving, and there is a need for external assistance to inform further and help operationalize PHC reform initiatives. To address this, the health sector enhancement project (HSEP), financed by ADB through a concessional loan of $37.5 million from ADB’s ordinary capital resources and a $12.5 million grant from ADB’s Special Funds resources, was approved on 23 October 2018. iii. The impact of the proposed investment in the project will lead to improved primary health care management in selected lagging regions for Sri Lanka’s health system to adapt to emerging challenges and deal with shifting disease burdens. Some of the key outputs of the project will include (i) development of primary medical care and preventive outreach infrastructure, (ii) improved service support in PHC facilities and increased service utilization (iii) enhanced capacity of preventive health care institutions for better public health and disease surveillance and (iv) policy reforms to facilitate PHC development. iv. In compliance with the ADB Safeguard Policy Framework, the sub-projects involving civil works included in the HSEP have been classified as environmental assessment Category B, which requires to conduct an Initial Environmental Examination (IEE). The Rapid Environmental Assessment (REA) carried out at the outset of the IEE study confirmed that the overall categorization of the project, which is Category B, based on the ADB SPS is still valid. This IEE report covers the physical interventions proposed by the HSEP is carried out as a requirement of the Safeguard Policy Framework of the ADB as outlined in the EARF prepared for the HSEP. This IEE covers the sub-project areas of 10 health