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.