Updated Initial Environmental Examination June 2020 CAM: Greater Mekong Subregion Health Security Project Prepared by the Ministry of Health, Cambodia for the Asian Development Bank. This is an updated version of the draft originally posted in October 2016 available on https://www.adb.org/projects/documents/gms-health-security-project-cam-oct-2016-iee 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 Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area. 1 CURRENCY EQUIVALENTS (as of 9th August 2019) Currency unit – riel/s (KR) KR1.00 = $0.000244 $1.00 = KR4,085 ABBREVIATIONS ADB – Asian Development Bank AIDS – Acquired Immune Deficiency Syndrome APSED – Asia Pacific Strategy for Emerging Diseases BOD – Biological oxygen demand CDC – Communicable Diseases Control CEP – Commitment on Environmental Protection COD – Chemical oxygen demand CPMU – Central Project Management Unit EA – Environmental assessment / Executing Agency EARF – Environmental Assessment and Review Framework EIA – Environmental Impact Assessment EIAR – Environmental Impact Assessment Report EID – Emerging Infectious Diseases EMP – Environmental Management Plan GOL – Government of Lao People’s Democratic Republic GMS – Greater Mekong Subregion HIV – Human Immunodeficiency Virus GMS-HSP – Greater Mekong Sub-region-Health Security Project IEE – Initial Environmental Examination IHR – International Health Regulations IP – Indigenous peoples IPC – Infection Prevention and Control Lao PDR – Lao People’s Democratic Republic MEVs – Migrants and mobile populations, ethnic minorities, and other vulnerable groups MOE – Ministry of Environment MOH – Ministry of Health PCU – Project Coordination Unit PHD – Provincial Health Department PIA – Provincial Implementing Agency PPMU – Provincial Project Management Unit REA – Rapid Environmental Assessment SWM – Solid Waste Management WHO – World Health Organization NOTE In this report, "$" refers to US dollars. 2 Table of contents Page CURRENCY EQUIVALENTS .................................................................................................................................... 2 ABBREVIATIONS ................................................................................................................................................... 2 I. INTRODUCTION ..................................................................................................................................... 5 A. Background of the Project ........................................................................................................................... 5 B. Purpose and Structure of the Report ......................................................................................................... 5 II. POLICY AND LEGAL FRAMEWORK ......................................................................................................... 6 III. DESCRIPTION OF THE PROJECT ............................................................................................................... 9 A. Project Rationale ......................................................................................................................................... 9 B. Project Design .............................................................................................................................................. 9 C. Regional cooperation and CDC in border areas ....................................................................................... 10 D. Surveillance and Response ........................................................................................................................ 10 E. Laboratory services and Hospital Infection Prevention and Control ....................................................... 10 F. Project Location ................................................................................................................................... 11 G. Project Outputs ................................................................................................................................... 11 H. Project Outputs of Environmental Concern ............................................................................................. 12 I. Project Category ........................................................................................................................................ 14 J. Subproject Descriptions, Proposed Scope of Works and Environmental Baseline ................................. 18 IV. DESCRIPTION OF THE ENVIRONMENT.................................................................................................. 31 A. Physical Resources .............................................................................................................................. 31 B. Reference Baseline Data for Health Care Waste Management in Cambodia ......................................... 50 1. Healthcare Waste Generation .................................................................................................................. 52 2. Healthcare Waste Prevention and Minimization ..................................................................................... 53 3. Healthcare Waste Segregation ................................................................................................................. 53 4. Healthcare Waste Storage ........................................................................................................................ 53 5. Healthcare Waste Collection ..................................................................................................................... 54 6. Healthcare Waste Transportation ............................................................................................................ 54 7. Healthcare Waste Treatment .................................................................................................................... 54 8. Healthcare Waste Disposal ....................................................................................................................... 55 9. Wastewater Collection and Treatment .................................................................................................... 55 V. SCREENING OF POTENTIAL ENVIRONMENTAL IMPACTS AND MITIGATION MEASURES ........................ 56 A. Rapid Environmental Assessment ............................................................................................................ 56 B. Environmental Assessment Methodology ............................................................................................... 56 3 C. Potential Environmental Impacts and Mitigating Measures ................................................................... 57 D. Screening of Environmental Impacts of Project Components ................................................................. 57 E. Findings of the Environmental Assessment ............................................................................................. 58 VI. INSTITUTIONAL REQUIREMENTS AND ENVIRONMENTAL MONITORING PLAN ................................... 59 B. Environmental Management Plan ....................................................................................................... 60 C. Environmental Monitoring Plan ........................................................................................................... 69 D. Environmental Monitoring and Reporting ................................................................................................ 72 E. Environmental Management Budget ........................................................................................................ 72 VII. PUBLIC CONSULTATION AND INFORMATION DISCLOSURE ................................................................ 73 A. Public Consultation Undertake ................................................................................................................. 73 B. Future Public Consultation and Disclosure ............................................................................................... 73 C. GRIEVANCE REDRESS MECHANISM .......................................................................................................... 74 VIII. FINDINGS AND RECOMMENDATIONS .................................................................................................. 75 A. Findings ...................................................................................................................................................... 75 B. Recommendations .................................................................................................................................... 76 IX. CONCLUSIONS ....................................................................................................................................... 77 X. REFERENCES ............................................................................................................................................... 78 Appendix 1: Environmental Screening of Project Sub-Components ................................................