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Project Number: 48118-004
September 2020
Republic of the Union of Myanmar: Greater Mekong
Subregion Health Security Project (Additional
Financing)
Prepared by Ministry of Health and Sports for the Asian Development Bank.
This safeguards 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.
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.
Social Due Diligence Report on Involuntary Resettlement
2
ABBREVIATIONS
ADB - Asian Development Bank
CDC - communicable disease control
COVID-19 - coronavirus disease
DOMS - Department of Medical Services
GMS - Greater Mekong Subregion
GRM - grievance redress mechanism
MOHS - Ministry of Health and Sports
PMU - project management unit
SPS - Safeguard Policy Statement
WHO - World Health Organization
CONTENTS
I. INTRODUCTION AND PROJECT BACKGROUND 4
A. Introduction 4 B. Background and Project Rationale 4
II. SCOPE OF THE DUE DILIGENCE AND SUBPROJECTS/HOSPITALS 5
III. FINDINGS OF THE DUE DILIGENCE 4
IV. INSTITUTIONAL ARRANGEMENTS 4
V. CONCLUSIONS AND RECOMMENDATIONS 5
I. INTRODUCTION AND PROJECT BACKGROUND A. Introduction
1. This is a social due diligence report on Involuntary Resettlement prepared for the
proposed Greater Mekong Subregion (GMS) Health Security Project (Additional Financing).
2. As per ADB’s Safeguard Policy Statement (SPS 2009), project screening and categorization are undertaken to (i) determine the significance of potential impacts or risks that a
project might present with respect to the environment, involuntary resettlement, and Indigenous
Peoples; (ii) identify the level of assessment and institutional resources required to address
safeguard issues; and (iii) determine the information disclosure and consultation requirements.
Using environment, involuntary resettlement, and Indigenous Peoples screening checklists, the
project is categorized. A proposed project is assigned to one of the following categories
depending on the significance of the probable involuntary resettlement impacts:
Category A. A proposed project is classified as category A if it is likely to have significant involuntary resettlement impacts. A resettlement plan, including assessment of social impacts, is required. Category B. A proposed project is classified as category B if it includes involuntary resettlement impacts that are not deemed significant. A resettlement plan, including assessment of social impacts, is required. Category C. A proposed project is classified as category C if it has no involuntary resettlement impacts. No further action is required.
3. A project’s involuntary resettlement category is determined by the category of its most sensitive component in terms of involuntary resettlement impacts. The involuntary resettlement
impacts of an ADB-supported project are considered significant if 200 or more persons will
experience major impacts, which are defined as (i) being physically displaced from housing, or (ii)
losing 10% or more of their productive assets (income generating). The level of detail and
comprehensiveness of the resettlement plan are commensurate with the significance of the
potential impacts and risks. A screening has been done (Refer to Annexure-1) for the project and
based on the screening, the additional financing is categorized as “C” for involuntary resettlement. Therefore, this due diligence has been prepared to conform the category “C” on involuntary resettlement.
B. Background and Project Rationale 4. ADB approved the GMS Health Security project on 22 November 2016 for $125 million
equivalent from its ordinary capital resources.1 Building on ADB’s prior investments in
1 The ongoing project comprises (i) loans to Cambodia (SDR15,012,000 [$21 million]), the Lao PDR (SDR2,856,000
[$4 million]), Myanmar ($12 million), and Viet Nam (SDR56,946,000 [$80 million]); and (ii) a grant to the Lao PDR ($8 million). ADB also provided project preparatory technical assistance of $1.3 million to Cambodia, the Lao PDR, Myanmar, and Viet Nam. ADB. Regional: Greater Mekong Subregion Health Security Project; and ADB. Technical Assistance: Greater Mekong Subregion Health Security Project.
communicable disease control (CDC) in the GMS,2 the ongoing project aims to strengthen
regional cooperation and subnational CDC systems, particularly in border areas. The impact of
the ongoing project is strengthened GMS public health security. The outcome is GMS health
system performance regarding health security improved.
5. The additional financing for Myanmar will support implementation of the government’s Health Sector Contingency Plan for coronavirus disease (COVID-19).3 It will expand the overall
project scope to encompass 31 district and township hospitals requiring immediate investment for
upgrading clinical care, infection prevention and control, and human resource capacity for
responding to COVID-19 and other future public health threats. These 31 hospitals are located
across the country’s 14 states and regions and 1 union territory. Target hospitals are in areas that are highly vulnerable because of poverty, ethnicity, and inadequate access to essential services,
including health care.4 The target hospitals have also been selected with reference to the
investments of other development partners, ensuring complementarities across projects.5
6. The project impact and outcome will remain the same. Activities under the additional
financing will be consolidated and delivered through output 4 that is aligned with, and contributes
to, the original project outcome. Output 4 will be rephrased as “emergency preparedness and response capacity for COVID-19 strengthened”. The main activities under output 4 will strengthen capacity across three core areas of district and township hospital service delivery, namely (i)
clinical management and medical care services, (ii) hospital infection prevention and control, and
(iii) human resources.
II. SCOPE OF THE DUE DILIGENCE AND SUBPROJECTS/HOSPITALS
7. The project has various components having physical and non-physical intervention. The
physical intervention is very minimal and is confined to minor renovation work. The scope covered
under the due diligence is 31 existing district and township hospitals. The due diligence report
has been prepared in due consultation with the executing agency which is Ministry of Health and
Sports (MOHS) and in consultation with the respective hospitals. The subprojects/hospitals
covered under the due diligence report are described below in Table 1 and the location map is
provided in Figure-1:
2 ADB. GMS Regional Communicable Diseases Control Project; and ADB. Second GMS Regional Communicable
Diseases Control Project. 3 Ministry of Health and Sports (MOHS). 2020. Health Sector Contingency Plan. Outbreak Response on COVID-19
and Other Emerging Respiratory Diseases in Myanmar. The plan is aligned with WHO’s Strategic Preparedness and Response Plan for COVID-19. WHO. 3 February 2020 (Draft). 2019 Novel Coronavirus (2019 nCoV): Strategic Preparedness and Response Plan. Geneva.
4 The MOHS has identified more than 100 hospitals requiring upgrading to respond to COVID-19. Hospitals that are accessible to ethnic populations and to populations in hard-to-reach and border areas were prioritized for ADB support. Hospital selection was coordinated with other development partners involved in MOHS’s COVID-19 response.
5 ADB and other development partners ensures alignment of COVID-19 support through the health cluster coordination mechanism, established by MOHS. The World Bank will provide investment for 61 provincial, state, and district hospitals in locations not supported under the ADB additional financing.
https://www.who.int/publications/i/item/strategic-preparedness-and-response-plan-for-the-new-coronavirushttps://www.who.int/publications/i/item/strategic-preparedness-and-response-plan-for-the-new-coronavirus
Table 1: List of Hospitals under the Due Diligence for Additional Financing
No. Name of Subproject/Hospital Name of Township Name of District 1 Pharkant Township Hospital Pharkant Mohnyin 2 Puta-O Township Hospital Puta-O Puta-O
3 Bawlakhae District Hospital Bawlakhae Bawlakhae
4 Kamamaung Township Hospital Kamamaung Hpa pun
5 Myawaddy District Hospital Myawaddy Myawaddy
6 Htantalan Township Hospital Htantalan Phalan
7 Toungup Township Hospital Toungup Thandwe
8 Namhkham Township Hospital Namhkham Muse
9 Mong Set District Hospital Mong Set Mong Set
10 Kalaw District Hospital Kalaw Kalaw
11 Mine Shu township Hospital Mine Shu Loilin
12 Ye Township Hospital Ye Mawlawmyaing 13 Tanintharyi Township Hospital Tanintharyi Kawthaung
14 Boatbyin Township Hospital Boatbyin Dawei 15 Homalin District Hospital Homalin Homalin
16 Tamu District Hospital Tamu Tamu
17 Kathar District Hospital Kathar Kathar
18 Kawlin Township Hospital Kawlin Kathar
19 Satote Tayar Township Hospital Satote Tayar Minbu
20 Mindone Township Hospital Mindone Thayet
21 Gangaw District Hospital Gangaw Gangaw
22 Thayarwady District Hospital Thayarwady Thayarwady
23 Shwe Kyin Township Hospital Shwe Kyin Bago
24 Tontay Hospital Tontay Yangon South
25 Taikkyi Hospital Taikkyi Yangon North
26 Mawlamyaing Kyun Township Hospital Mawlamyaing Kyun Labutta
27 Bogalay Township Hospital Bogalay Phyapon
28 Tat Kone Hospital Tat Kone Nay Pyi Taw
29 Myingyan District Hospital Myingyan Myingyan
30 Yamethin Hospital Yamethin Yamethin
31 Mogok Hospital Mogok Mandalay
Figure 1: Location of of Hospitals
III. FINDINGS OF THE DUE DILIGENCE
8. The project under the additional financing is classified as category C for involuntary
resettlement impacts. It will primarily support the procurement of equipment and minor renovation
work. The additional financing will procure equipment and consumables for 31 additional district
and township hospitals. Specifically, equipment will be procured for the emergency department,
isolation ward, the pediatric units for comorbidity, the high dependency unit, and laboratory
diagnosis of participating hospitals. Small scale renovation works will ensure emergency
departments, isolation wards, and medical and high dependency care units have infrastructure or
facilities for effective separation of infectious patients, for supply of required services (e.g. oxygen
lines, electricity, water), and for onsite infectious waste treatment (autoclaves, septic tanks and
neutralization).
9. All hospitals have sufficient space available within the existing boundaries and
compounds to accommodate all works to be undertaken under the additional financing
components. There will be no land acquisition under the additional financing. The intervention will
be undertaken within existing 31 hospitals and space is available. All the intervention under the
additional financing will be confined to the existing hospitals and its premises. Therefore, there
will be no impact on land acquisition and involuntary resettlement. Impacts on land acquisition
and involuntary resettlement of each subprojects/hospitals are detailed in Table-2.
Table 2: Summary Findings on Land Acquisition and Involuntary Resettlement
No. Name of Subproject/Hospital
Year Name of the Location
Name of the Township
Activities to be
undertaken under
Additional Financing
Total Area of
the hospital
(Sqft)
Ownership of
land
Whether Additional
land required for
activities under
additional financing
Approximate
number of
Beneficiaries of
the hospital
Name of the
Ethnic Groups living in the area
Impact on IR
Remarks
1 Pharkant Township Hospital
1960 Pharkant Township Hospital
Pharkant Provision of medical and laboratory equipment and supplies Minor renovations of hospital wards, emergency wards, laboratories, Isolation wards, ICU and waste management Renovation of utilities, water and electricity Capacity building for hospital staffs
10 Acres MOHS Not required 240,706 Kachin, Kayah Shan, Kayin
No Impacts
on involunta
ry resettlement as there will
be no land
acquisition and
physical displace
ment
Installation of equipment and construction will be done within the existing premises of existing facilities without requiring any additional land. The existing and available land is not used by any informal settlers.
2 Puta-O Township Hospital
1926 Puta-O Township Hospital
Puta-O 5 Acres MOHS Not required 69,281 Kachin
3 Bawlakhae District Hospital
2009 Bawlakhae District Hospital
Bawlakhae 5 Acres MOHS Not required 11,372 Kayah, Kayin
4 Kamamaung Township Hospital
1966 Kamamaung Township Hospital
Kamamaung 5 Acres MOHS Not required 29,786 Kayin, Kayah, Mon
5 Myawaddy District Hospital
1963 Myawaddy District Hospital
Myawaddy 10 Acres MOHS Not required 170,000 Kayin, Kayah, Mon
6 Htantalan Township Hospital
2015 Htantalan Township Hospital
Htantalan 5 Acres MOHS Not required 54,331 Chin, Rakhine
7 Taungup Township Hospital
2013 TaungupTownship Hospital
Taungup 5 Acres MOHS Not required 167,559 Rakine, Burma
8 Namhkham Township Hospital
1980 Namhkham Township Hospital
Namhkham 10 Acres MOHS Not required 100,239 Shan, AKhar, Koekant, Wa, Palaung
9 Mong Set District Hospital
1960 Mong Set District Hospital
Mong Set 10 Acres MOHS Not required 90,700 Shan, Koekant, Lishaw, Wa, Palaung
10 Kalaw District Hospital
1919 Kalaw District Hospital
Kalaw 10 Acres MOHS Not required 183,435 Shan, Pa Oh
11 Mine Shu Township Hospital
Mine Shu Mine Shu 5 Acres MOHS Not required Shan, Koekant, Lishaw,
No. Name of Subproject/Hospital
Year Name of the Location
Name of the Township
Activities to be
undertaken under
Additional Financing
Total Area of
the hospital
(Sqft)
Ownership of
land
Whether Additional
land required for
activities under
additional financing
Approximate
number of
Beneficiaries of
the hospital
Name of the
Ethnic Groups living in the area
Impact on IR
Remarks
Wa, Palaung
12 Ye Township Hospital
2014 Ye Ye 5 Acres MOHS Not required 170,000 Kayin, Kayah, Mon
13 Tanintharyi Township Hospital
Tanintharyi Tanintharyi 5 Acres MOHS Not required Mon, Kayin, Dawe
14 Boatbyin Township Hospital
1974 Boatbyin Township Hospital
Boatbyin 5 Acres MOHS Not required 87,348 Mon, Kayin, Dawe
15 Homalin District Hospital
2008 Homalin District Hospital
Homalin 10 Acres MOHS Not required 210,192 Chin, Naga, Kachin
16 Tamu District Hospital
1966 Tamu District Hospital
Tamu 10 Acres MOHS Not required 123,794 Chin, Naga
17 Kathar District Hospital
1957 Kathar District Hospital
Kathar 10 Acres MOHS Not required 174,282 Kachin
18 Kawlin Township Hospital
1992 Kawlin Township Hospital
Kawlin 5 Acres MOHS Not required 156,717 Kachin
19 Satote Tayar Township Hospital
1982 Satote Tayar Township Hospital
SatoteTayar 5 Acres MOHS Not required 48,400 Chin
20 Mindone Township Hospital
1963 Mindone Township Hospital
Mindone 5 Acres MOHS Not required 65,387 Chin,
21 Gangaw District Hospital
2007 Gangaw District Hospital
Gangaw 10 Acres MOHS Not required 144,762 Yaw
22 Thayarwady District Hospital
1890 Thayarwady Thayarwady 10 Acres MOHS Not required 167,336
23 Shwe Kyin Township Hospital
2002 Shwe Kyin Shwe Kyin 10 Acres MOHS Not required 109,172 Kayin
24 Tontay Hospital 1981 Tontay Tontay 5 Acres MOHS Not required 223,801
25 Taikkyi Hospital 1979 Taikkyi Taikkyi 10 Acres MOHS Not required 287,459
26 Mawlamyaing Kyun Township Hospital
2009 Mawlamyaing Kyun
Mawlamyaing Kyun
10 Acres MOHS Not required 310,000
No. Name of Subproject/Hospital
Year Name of the Location
Name of the Township
Activities to be
undertaken under
Additional Financing
Total Area of
the hospital
(Sqft)
Ownership of
land
Whether Additional
land required for
activities under
additional financing
Approximate
number of
Beneficiaries of
the hospital
Name of the
Ethnic Groups living in the area
Impact on IR
Remarks
27 Bogalay Township Hospital
2010 Bogalay Bogalay 10 Acres MOHS Not required 322,549 Kayin
28 Tat Kone Hospital Tat Kone Tat Kone 5 Acres MOHS Not required 220,000
29 Myingyan District Hospital
1961 Myingyan Myingyan 10 Acres MOHS Not required 300,022
30 Yamethin Hospital 1994 Yamethin Yamethin 10 Acres MOHS Not required 272,244
31 Mogok Hospital 2007 Mogok Mogok 5 Acres MOHS Not required 181,000 Shan, Lisu, Lishaw
IR = involuntary resettlement, MOHS = Ministry of Health and Sports, Sqft = square foot.
IV. CONSULTATION AND GRIEVANCE REDRESS MECHANISM
10. The due diligence report has been prepared with due consultation with the hospital
authorities, though it was restricted due to COVID-19. However, the consultation process will be
continued during project implementation. The grievance redress mechanism (GRM) has already
been established and operational since the effectiveness of the ongoing loan. The additional
financing will follow the existing GRM and consultation process.
11. “Regular meetings and consultation will seek to minimize dissatisfaction among project-affected people. Local stakeholders’ opinions and concerns will be part of the project planning and implementation. The participatory approach will encourage people to raise any concerns
before conflicts may appear in the design and implementation of Project activities. The
beneficiaries can address their concerns through their representative. The complaint will be
assessed and negotiated into a solution between the project representative (focal point or IA) and
local authorities, and then fed back to the communities as part of the participatory planning
process. If the conflict is not solved amicably, it will be taken to the project management unit
(PMU) or MOHS Steering Committee under the MOHS. The project representatives at various
levels will be responsible for reporting any grievances up to the appropriate level. The particular
activities will be carried out after such conflict is resolved satisfactorily. In cases where AHs do
not have the writing skills or are unable to express their grievances verbally, AHs are allowed to
seek assistance from any recognized local group, non-governmental organization, family
member, village heads or community chiefs to have their complaints or grievances written for
them. Throughout the grievance redress process, the responsible committee will ensure that the
concerned AHs are provided with copies of complaints and decisions or resolutions reached” 12. The additional financing components is beneficiaries driven and there will be no affected
persons. However, any unanticipated impacts will be mitigated in accordance with ADB’s SPS 2009.
V. INSTITUTIONAL ARRANGEMENTS
13. The MOHS through the Department of Medical Services (DOMS) is the executing agency
for the additional financing. The director general of DOMS will be the project director. The new
PMU will be established under DOMS to support the project director in management, monitoring,
and administration of the additional financing. The PMU will be supported by ten national
consultants. In a further variation from the implementation arrangement of the original project, the
31 district and township hospitals will act as implementing agencies.6 The medical
superintendents of each hospital will oversee the planning and implementation of project activities
in their respective facility.
6 In the ongoing project, the National Health Laboratory and 13 state, regional, and township hospitals are the
implementing agencies.
VI. CONCLUSIONS AND RECOMMENDATIONS 14. The MOHS through DOMS, as the executing agency, will be responsible to ensure that all
the minor civil works are carried out within the existing hospital premises. Construction will be
done within the existing premises of existing facilities without requiring any additional land. The
existing and available land is not used by any informal settlers. Therefore, no category ‘A’ or category ‘B’ IR subprojects will be selected, in accordance with ADB’s SPS 2009. MOHS will hold continuous consultations with the concerned stakeholders during the project implementation. A
national safeguards consultant will be engaged to assist MOHS for implementation and
monitoring. MOHS will be responsible to ensure, through submission of monitoring
report/progress report, that all the minor civil works are carried out within the existing hospital
premises and no project activities lead to any impact due to land acquisition or involuntary
resettlement impacts. MOHS will submit periodic progress reports to ADB.