Initial Environmental Examination September 2018 Tajikistan: Maternal and Child Health Integrated Care Project Prepared by the Ministry of Health and Social Protection for the Asian Development Bank ABBREVIATIONS AND ACRONYMS ACBA Agency for Control of Building and Architecture ADB Asian Development Bank ADF Asian Development Fund AP Affected Person/ People CDH Central District Hospital CEP Committee for Environment Protection C-EMP Contractor’s Environmental Management Plan CWWTP Central Wastewater Treatment Plant DHC District Health Center EA Executing Agency EARF Environment Assessment and Review Framework EASC Euro-Asian Council for Standardization, Metrology and Certifi- cation EIA Environmental Impact Assessment EIC Information, Education, and Communication EMoP Environmental Monitoring Plan EMP Environmental Management Plan EMR Environmental Monitoring Report GoT Government of Tajikistan GRM Grievance Redress Mechanism IA Implementing Agency IEE Initial Environmental Examination LAR Land Acquisition and Resettlement M&E Monitoring and Evaluation MET Ministry of Environment and Tourism MCH Maternal and Child Health MOF Ministry of Finance of the Republic of Tajikistan MOHSPP Ministry of Health and Social Protection of the Republic of Ta- jikistan NGO Non-Governmental Organization PAM Project Administration Manual PHC Primary Health Care PAG Project Administration Group REA Rapid Environmental Assessment RRP Report and Recommendation of the President SPA Special Protection Area SPS Safeguard Policy Statement VOC Volatile Organic Compound WHO World Health Organization Notes 1. The fiscal year of the Government ends on 31 December. 2. In this report, "$" refers to US dollars unless otherwise stated. Currency Equivalents (as of August 28, 2018) Currency Unit – Tajik Somoni (TJS) TJS 1.00 = $0.106053 $1.00 = 9.42924 TJS Weights and Measures 1 Cusec : Measure of flow rate (28.317 liters per second) 1 ha. (hectare) : 10,000 sq m 1 km (kilometer) : 1,000 m 1 kV : kilovolt (1,000 volts) 1 kW : kilowatt (1,000 watts) 1 kWh : 1 kilowatt-hour = 1000 watts Glossary of Terms Used General Terms Hukumat : Municipality/local administration Jamoat : Local self-government Dehkan : Peasant Construction Drawings : Technical and detailed drawing for construction of building For the Purposes of this IEE Sub-project : Individual Hospitals / Health Centers selected and included in the project for expansion and new construction This Initial Environment Examination (IEE) is a document of the grantee. The views ex- pressed herein do not necessarily represent those of ADB's Board of Directors, Manage- ment, 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 des- ignation 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. Table of Contents A. Introduction ................................................................................................................ 1 B. Components and Summary Environmental Issues ..................................................... 1 A. Background ................................................................................................................ 5 B. Outputs, Outcomes and Impact .................................................................................. 5 C. Implementation Arrangements ................................................................................... 7 D. Scope of Work and Methodology Adopted ................................................................. 7 A. Environmental Clearance Requirements .................................................................... 9 B. Tajikistan Environmental, Health and Safety Standards ............................................15 C. Environmental Impact Assessment Procedure ..........................................................24 D. International Agreements ..........................................................................................27 A. Overview ...................................................................................................................29 B. Project Components .................................................................................................30 C. Scale and Magnitude of Sub-Projects (Scope of Civil Works) ...................................31 D. Existing infrastructure at subproject locations ...........................................................31 E. Proposed infrastructure measures at subproject locations ........................................65 A. Physical Environment of Tajikistan ............................................................................72 B. Ecological Resources ...............................................................................................81 C. Socioeconomic Environment .....................................................................................83 D. Land Use ..................................................................................................................87 E. Receptor Details in sub-project areas .......................................................................93 A. Alternatives for Sub-project Components ................................................................ 120 B. Methodology for Sub-project Site Selection: Environmental View ........................... 120 A. Consultation Proce .................................................................................................. 122 B. Consultation Details ................................................................................................ 122 C. Information Disclosure ............................................................................................ 125 A. Grievance Channels (Framework) .......................................................................... 127 B. Time Frame ............................................................................................................ 127 C. The Grievance Redress Mechanism ....................................................................... 127 A. Emergency Preparedness and Response Plan ....................................................... 131 B. Disaster Management ............................................................................................. 131 C. Health and Safety Issues Management ................................................................... 131 D. Training Programs .................................................................................................. 132 E. Environmental Management Plan ........................................................................... 133 F. Environmental Monitoring Plan (EMoP) .................................................................. 141 G. Development of Site-specific Environmental Management Plan (S-EMP) ............... 145 H. Monitoring and Reporting ........................................................................................ 145 I. Environmental Management Plan Budget Costs ..................................................... 146 J. Institutional Arrangements ...................................................................................... 148 K. Implementation Plan ............................................................................................... 152 Annex 1: Relevant Environmental Quality and Health and Safety Standards .................. 157 Annex 2: General Environmental, Health and Safety Guidelines – IFC-EHS ................... 167 Annex 3: Document Checklist for Environmental Safeguards Due Diligence ................... 169 Annex 4A: Standard Construction Contract Environmental Safeguard Clauses .............. 173 Annex 4B: Environmental Safeguard Clauses for Civil Works Contracts ......................... 177 Annex 4C: Environmental Site Inspection and Monitoring Checklist ................................ 179 Annex 5: Sample Environment Monitoring Report ........................................................... 181 Annex 6: Grievance Registration and Update Forms ....................................................... 182 Annex 7: Details of Public Consultation (Environment) .................................................... 184 Annex 8: Terms of Reference for Noise Measurements .................................................. 198 Annex 9: Terms of Reference for Occupational Health Asbestos Action Plan, Asbestos and Debris estimation for Demolition or Refurbishment........................................... 199 Annex 10: Health Care Waste (HCW) Management ........................................................ 203 Annex 11: Existing and Proposed Health Care facilities at each site ............................... 210 List of Tables Table 1: Indicative Implementation Arrangements .............................................................. 7 Table 2: Environment Safeguards Categorization: Definition .............................................. 9 Table 3: Relevant Environmental, Health and Safety Laws in Tajikistan ........................... 11 Table 4: Tajikistan Noise Standards .................................................................................. 18 Table 5: Water Quality Standards ..................................................................................... 18 Table 6: Air Quality Standards .........................................................................................