Initial Environmental Examination (Including Environmental ...

Improving Access to Health Services for Disadvantaged Groups Investment Program: Initial Environmental Examination (Including Environmental Management Plan)Initial Environmental Examination (Including Environmental Management Plan) Project number: 49173-003 May 2019
MON: Improving Access to Health Services for Disadvantaged Groups Investment Program (Tranche 1) Prepared by the Municipality of Ulaanbaatar for the Asian Development Bank.
CURRENCY EQUIVALENTS
Currency unit – tugrik (MNT) MNT1.00 = $ 0.00038
$1.00 = MNT2,645.00
AP – Affected Person/People ACM – Asbestos Containing Materials ADB – Asian Development Bank ADF – Asian Development Fund ASI – Agency for Specialized Inspection C- SEMP – Contractor’s Site-specific Environmental Management Plan CDC – Community Development Council CWWTP – Central wastewater treatment plant DPR – Detailed Project Report DSC – Design supervision consultants EA – Executing Agency EARF – Environment Assessment and Review Framework EIA – Environmental Impact Assessment EIC – Information, Education, and Communication EMoP – Environmental Monitoring Plan EMP – Environmental Management Plan EMR – Environmental Monitoring Report ESM – Environmental and Social Management System ERP – Emergency Reponse Plan FAM – Facility Administration Manual FHC – Family Health Clinic GASI – General Agency for Specialized Inspection GoM – Government of Mongolia 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 MFF – Multi-tranche Financing Facility MoF – Ministry of Finance MOH – Ministry of Health NGOs – Nongovernment Organizations PC – Public Consultation PHC – Primary Health Care PIU – Project Implementation Unit PPTA – Project Preparatory Technical Assistance REA – Rapid Environmental Assessment RRP – Report and Recommendation of he President to the Board SGHP – Shallow-ground Heat Pump SHC – Soum Health Center
SME – Small and Medium-Sized Enterprise SPA – Specially Protected Area SPS – Safeguard Policy Statement USUG – Ulaanbaatar Water Supply and Sewerage Authority VOC – Volatile Organic Compound WHO – World Health Organization
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
Aimag – Province Soum – Smallest administrative unit of Aimag Bagh – Smallest administrative unit of Soum District – Smallest administrative unit of Ulaanbaatar city Khoroo – Smallest administrative unit of District Ger area – Area in the cities which residents use traditional
dwellings like as herders’ tent (sometimes called as “yurt”)
Khashaa Plot – Fencing around Ger owned by households Construction Drawings – Technical and detailed drawing for construction
of building For the Purposes of this IEE Sub-Project
– Individual Family health clinics (FHC)/ Soum health center (SHC)/Hospitals selected and included in the project for new construction
NOTE
In this report, "$" refers to US dollars.
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.
TABLE OF CONTENTS
C. Tranche 1: Multi Tranche Financing Facility 2
D. Proposed Financing Plans 3
E. Implementation Arrangements 3
II. POLICY, LEGAL AND ADMINISTRATIVE FRAMEWORK 5
A. ADB’s Safeguard Policy Statement (SPS 2009) 5 1. Environmental Impact Assessment Requirements of ADB 5 2. ADB SPS Requirements (SR1): Environment Policy 6 3. Standards, guidelines and good practice in ADB SPS 6
B. National Mongolian Legislation 7 1. Mongolia’s Environmental Policy 7 2. Relevant Mongolian Government Acts, Rules, Strategies and Guidelines. 8 3. Mongolian Environmental, Health and Safety Standards 12 4. Mongolian Health Care Waste Standards 13 5. Environmental Assessment Requirements of Mongolia 14 6. Environment Compliances Relevant to the Project and time frames 18 7. Mongolia FHC/SHC/Hospital building Environmental Infrastructure 21 8. Green Building Concept 21
C. International Treaties 23
D. Equivalence of International Best Policies in Infrastructure Development 24
III. DESCRIPTION OF THE PROJECT 26
A. Overview 26
B. Project Components 26
C. Scale and Magnitude of SubProjects (Scope of Civil Works) 27
D. Existing Infrastructure at Subproject Locations 29
1. Health Center Status 29 2. Plot Size on Land available 32 3. Distance from Various Receptors 32 4. Distance from Reserve Forest/Protected Areas/National Park/Sanctuary 35 5. Ulaanbaatar city: Infrastructure development condition 36 6. Khovd: Infrastructure development condition 42 7. 5 Soum health centers: Infrastructure development condition 46
E. Proposed Environmental infrastructure for subprojects 49 1. Hospital/FHC/SHC/Buildings 50 2. Design of buildings 51 3. Equipment: 53 4. Water, Wastewater, Solid Waste, Sewage infrastructure 53 5. Health Care Waste Management 55 6. Operational procedures 56
IV. DESCRIPTION OF ENVIRONMENT (Baseline Data) 57
A. Environment of Mongolia 57 1. Topography 57 2. Climate 57 3. Ecosystems 58 4. Water Resources 59 5. Natural disasters 59 6. Seismology 59 7. Biodiversity 60 8. Protected areas in Mongolia 62 9. Cultural heritage 65
B. Environment at Tranche1 subproject areas 66
C. Topography 68 1. Topography of Ulaanbaatar city 68 2. Topography of Khovd City 70 3. Topography of Erdenemandal Soum 70 4. Topography of Tarialan Soum 71 5. Topography of BayanUndur Soum 72 6. Topography of Erdene Soum 73 7. Topography of Dashinchilen Soum 74 8. Topography of Ulaangom 75
D. Climate 76 1. Climate Condition in Ulaanbaatar City 76 2. Climate condition in Khovd city 80 3. Climate condition in Erdenemandal Soum 84 4. Climate condition in Tarialan Soum 85 5. Climate condition in BayanUndur Soum 87 6. Climate condition in Erdene Soum 88 7. Climate condition in Dashinchilen Soum 89 8. Climate condition in Ulaangom city 91
E. Air Quality (AQ) 92 1. Air quality condition in Ulaanbaatar city 93 2. Air Quality in Khovd city 96 3. Air quality condition in the 5 Soums 98 4. Air quality condition in Ulaangom city 100
F. Noise Condition 100
G. Soil, Geology and Seismology 103 1. Soil, Geology and Seismology in Ulaanbaatar City 103 2. Soil, geology and seismology in Khovd city 105 3. Soil, geology and seismology in Erdenemandal Soum 107 4. Soil, geology and seismology in Tarialan Soum 108 5. Soil, geology and seismology in BayanUndur Soum 108 6. Soil, geology and seismology in Erdene Soum 109 7. Soil, geology and seismology in Dashinchilen Soum 110 8. Soil, geology and seismology in Ulaangom 111
H. Surface Water Resources and Quality 112 1. Surface water resources in Ulaanbaatar city 112 2. Surface water resources in Khovd city 115 3. Surface water resources in Erdenemandal Soum 118 4. Surface water resources in Tarialan Soum 118 5. Surface water resources in BayanUndur Soum 119 6. Surface water resources in Erdene Soum 120 7. Surface water resources in Dashinchilen Soum 120 8. Surface water resources in Ulaangom city 121
I. Groundwater Resources and Quality 122 1. Ground water resources in Ulaanbaatar 123 2. Ground water resources in Khovd area 129 3. Ground water resources in the 5 Soums 131
J. Biodiversity 136 1. Biodiversity in Ulaanbaatar area 136 2. Biodiversity in Khovd area 140 3. Biodiversity in the 5 Soums 143 4. Biodiversity in Ulaangom area 145
K. Protected Areas 146 1. Protected areas around Ulaanbaatar city 146 2. Protected areas around Khovd city 149 3. Protected areas around the 5 Soums 150 4. Protected areas around Ulaangom city 151
L. SocioEconomic Condition 152 1. Economic Development 152 2. Demography 154 3. Ethnic minorities 155 4. Education 156 5. Health Service in Mongolia 157 6. Employment and Poverty 157 7. Land Use Pattern 159 8. Cultural Heritage 162 9. Climate Change in Mongolia 163
V. ANTICIPATED ENVIRONMENTAL IMPACTS AND MITIGATION MEASURES 165
A. Impacts and Mitigation Measures During Project Location and Design 165
B. Impacts and Mitigation Measures During PreConstruction Stage 167 1. Land acquisition 167 2. Temporary Use of Land 167
3. Banned substances – Asbestos 168 4. Demolition 168 5. Volatile Organic Compounds 169 6. Equipment replacement Xrays etc. 169 7. Shallowground heat pump pilot project 169
C. Impacts and Mitigation Measures During Construction Stage 170 1. Impact on Physical Resources 171 2. Impact on Environmental Resources 172 3. Impact on Ecological Resources 178 4. Impact on Terrestrial Ecology 178 5. Human Environment 180 6. Socio Economics 185 7. Waste Disposal 186
D. Impacts and Mitigation Measures During Operational Stage 187 1. Hospital / Health Center Environment 187 2. Disadvantaged Patients/children 188 3. Increased demand of utilitieselectricity, heating, sewage and drinking water 188 4. Health Care Waste (HCW) Management 188 5. Emergency response during operations 190 6. Occupational Health and safety (OHS) during operations 190 7. Electric Shock 191 8. Noise Generation 191
E. Cumulative Impact Analysis of subprojects 191 1. Densification of area 192 2. Influence zone of each FHC/SHC/Hospital 192 3. Noise Amplification 192 4. Greenhouse Gas emissions 192
F. Summary of Impacts 193 1. Impacts on key environmental parameters (Air, water, soil and Noise) 194
VI. ANALYSIS OF ALTERNATIVES 196
A. MOH Approach for Planning of a subproject 196
B. Alternatives for Subproject Components 196 1. No “Build” Alternative 196 2. To “Build” Alternative 196
C. Methodology for subproject site selection: environmental view 196 1. Development of Alternate Access Route 198
VII. INFORMATION DISCLOSURE, CONSULTATION, AND PARTICIPATION 200
A. Consultation Process 200
C. Information Disclosure 205
B. Time Frame 206
IX. ENVIRONMENTAL MANAGEMENT PLAN 210
A. Critical Environmental Review Criteria 210 1. Loss of irreplaceable resources 210 2. Accelerated use of resources for shortterm gains 210 3. Endangering of species 210 4. Promoting undesirable ruralto urban migration 210 5. Increase in affluent/poor income gap 210
B. Emergency Response, Disaster Management, Health and Safety 210 1. Emergency 210 2. Disaster Management 211 3. Health and Safety Issues Management 211
C. Training Programs 212
E. Environmental Management Plan 220
F. Environmental Monitoring Plan (EMoP) 221
G. Development of Sitespecific Construction Environmental Management Plan (SEMP) 222
H. Monitoring and Reporting 223
I. Monitoring and Reporting 223 1. Responsibilities 223 2. Construction Contracts 223 3. Monitoring of Sitespecific EMPs 223 4. Performance indicators 225 5. External Monitoring 226 6. Reporting 226
J. Environmental Management Plan Budget Costs 226
K. Institutional Arrangements 231 1. Project Implementation Organizations: Roles and Responsibilities 231 2. Project Organizational Structure 232 3. EMP implementation arrangements. 232
L. Implementation Plan 235
ANNEXURES 240
Annexure – 1: Environmental quality and health and safety standards relevant to the subprojects under the program during construction and operation 240
Annexure – 2: General Environmental, Health and safety Guidelines IFCEHS 247
Annexure – 3: Inventory of FHC/SHC/Hospital 252
Annexure 3b: Google Earth Images of FHC/SHC/Hospital Identified 263
Annexure – 4: Environment Management Plan (EMP) 275
Annexure – 5: Environment Monitoring Plan (Environmental Parameters) 286 5a. Environmental Safeguard Clauses for Civil Works Contracts 289
5b. Environmental Site Inspection and Monitoring Checklist 291
Annexure 6: Sample Environment Monitoring Report 293
Annexure 7: Details of Public Consultation (Environment) 295
Annexure – 8: Grievance Registration Form 341
A. Plant species around Ulaanbaatar area 343
Annexure – 10: Specialized Inspection Agency 354
List of Tables
TABLE 0.1: SUMMARY IMPACTS ON KEY ENVIRONMENT PARAMETERS I
TABLE 0.2: KEY FEATURES AND ENVIRONMENTAL ISSUES FOR EACH SUBPROJECT II
TABLE I.1: INDICATIVE FINANCING PLAN 3
TABLE I.2: INDICATIVE IMPLEMENTATION ARRANGEMENTS 3
TABLE II.1: ENVIRONMENT SAFEGUARDS CATEGORIZATION: DEFINITION 5
TABLE II.2: RELEVANT ENVIRONMENTAL, HEALTH AND SAFETY LAWS IN MONGOLIA 8
TABLE II.3: CLASSIFICATION OF PROJECTS FOR WHICH GEIA IS LEGALLY MANDATORY 15
TABLE II.4: DETAILS OF GEIA AND DEAI REQUIREMENTS FOR TRANCHE 1 18
TABLE II.5: SUMMARY OF ENVIRONMENTAL COMPLIANCE REQUIREMENTS FOR EARF CONSIDERATION FOR
TRANCHE1 COMPONENTS 19
PROJECT IMPLEMENTATION PLAN BY PIU 19
TABLE II.7: CRITERIA OF THE MGBC’S GREEN BUILDING RATING SYSTEM 22
TABLE II.8: RELEVANT INTERNATIONAL ENVIRONMENTAL CONVENTIONS 23
TABLE III.1: SUBPROJECT COMPONENTS AND THEIR KEY FEATURES 27
TABLE III.2: DOCTORS, NURSES AND PATIENTS FOR THE SUBPROJECT IN ULAANBAATAR CITY 31
TABLE III.3: SUMMARY OF APPROXIMATE DISTANCE OF SUBPROJECTS FROM MAJOR RECEPTORS 33
TABLE III.4: DISTANCE FROM PROTECTED AREAS (NATIONAL PARKS, SANCTUARIES AND FOREST RESERVES)
FOR ALL SUBPROJECTS 35
TABLE III.5: INFRASTRUCTURE CONDITION FOR TRANCHE1 SUBPROJECT IN ULAANBAATAR CITY 38
TABLE III.6: INFRASTRUCTURE CONDITION FOR THE SOUM HEALTH CENTERS 48
TABLE III.7: EXISTING AND SUGGESTED INFRASTRUCTURES AT EACH SUBPROJECT SITE 55
TABLE IV.1: LIST OF PROTECTED AREAS OF MONGOLIA 63
TABLE IV.2: NUMBER OF HERITAGE, CULTURAL AND RELIGIOUS SITES IN MONGOLIA 65
TABLE IV.3: SUBPROJECT LOCATIONS FOR TRANCHE1 66
TABLE IV.4: MONTHLY MEAN AIR TEMPERATURE IN ULAANBAATAR CITY, 20032017, °C 77
TABLE IV.5: MONTHLY MAX AIR TEMPERATURE IN ULAANBAATAR CITY, 20102017, °C 77
TABLE IV.6: MONTHLY MIN AIR TEMPERATURE IN ULAANBAATAR CITY, 20032017, °C 78
TABLE IV.7: MONTHLY PRECIPITATION LEVEL IN ULAANBAATAR CITY, 20032017 78
TABLE IV.8: MONTHLY AVERAGE WIND SPEED, M/SEC 79
TABLE IV.9: MONTHLY MAX. WIND SPEED, M/SEC 79
TABLE IV.10: MONTHLY MEAN AIR TEMPERATURE, KHOVD CITY, °C 80
TABLE IV.11: MONTHLY MAXIMUM AIR TEMPERATURE, KHOVD CITY, °C 81
TABLE IV.12: MONTHLY MINIMUM AIR TEMPERATURE, KHOVD CITY °C 81
TABLE IV.13: MONTHLY PRECIPITATION LEVEL, KHOVD CITY MM 82
TABLE IV.14: AVERAGE WIND SPEED BY MONTHS, M/SEC 83
TABLE IV.15: MAXIMUM WIND SPEED BY MONTH, KHOVD CITY, M/SEC 83
TABLE IV.16: MEAN AIR TEMPERATURE BY MONTHS, 20132017, 0C 84
TABLE IV.17: MAXIMUM AIR TEMPERATURE BY MONTHS, 20132017, 0C 84
TABLE IV.18: MINIMUM AIR TEMPERATURE BY MONTH, 20102017, 0C 84
TABLE IV.19: MONTHLY TOTAL PRECIPITATION, MM, 20132017 85
TABLE IV.20: AVERAGE WIND SPEED IN EACH MONTH, M/SEC 85
TABLE IV.21: MAXIMUM WIND SPEED IN EACH MONTH, M/SEC 85
TABLE IV.22: MEAN AIR TEMPERATURE BY MONTH, 20132017, 0C 85
TABLE IV.23: MAXIMUM AIR TEMPERATURE BY MONTH, 20132017, 0C 86
TABLE IV.29: MAXIMUM AIR TEMPERATURE BY MONTH, 20132017, 0C 87
TABLE IV.34: MAXIMUM AIR TEMPERATURE BY MONTH, 201320170C 88
TABLE IV.35: MINIMUM AIR TEMPERATURE BY MONTH, 201320170C 89
TABLE IV.39: MONTHLY AVERAGE AIR TEMPERATURE IN DASHINCHILEN, 20132017, 0C 90
TABLE IV.40: MONTHLY MAXIMUM AIR TEMPERATURE IN DASHINCHILEN, 20132017, 0C 90
TABLE IV.41: MONTHLY MINIMUM AIR TEMPERATURE IN DASHINCHILEN, 20132017, 0C 90
TABLE IV.42: PRECIPITATION LEVEL BY MONTHS, 20132017, MM 90
TABLE IV.44: MONTHLY MEAN AIR TEMPERATURES, 20132017,0C 91
TABLE IV.45: MONTHLY MAXIMUM AIR TEMPERATURES, 20132017,0C 91
TABLE IV.46: MONTHLY MINIMUM AIR TEMPERATURES, 20132017,0C 91
TABLE IV.47: TOTAL MONTHLY PRECIPITATION LEVEL IN ULAANGOM, 20132017, MM 92
TABLE IV.49: MONTHLY AVERAGE VALUES OF SULPHUR DIOXIDE, MG/M³ 94
TABLE IV.50: MONTHLY AVERAGE VALUES OF NITROGEN DIOXIDE, MG/M³ 95
TABLE IV.51: MONTHLY AVERAGE DUST CONCENTRATION PM10, MG/M³ 95
TABLE IV.52: MONTHLY AVERAGE DUST CONCENTRATION LEVEL PM2.5 MG/M³ 96
TABLE IV.53: AIR QUALITY, NOISE MEASUREMENT AND SAMPLING ANALYSIS RESULTS 96
TABLE IV.54: MONTHLY AVERAGE VALUE OF SULPHUR DIOXIDE, MG/M³ 97
TABLE IV.55: MONTHLY AVERAGE VALUE OF NITROGEN DIOXIDE, MG/M³ 97
TABLE IV.56: DUST CONCENTRATION LEVEL BY MONTHLY AVERAGE VALUE, MG/M³ 98
TABLE IV.57: AIR QUALITY MEASUREMENT DEVICES 98
TABLE IV.58: AIR QUALITY MEASUREMENT RESULTS AT ERDENEMANDAL SOUM HOSPITAL 99
TABLE IV.59: AIR QUALITY MEASUREMENT RESULTS IN TARIALAN SOUM CENTER 99
TABLE IV.60: AIR QUALITY MEASUREMENT RESULTS AT BAYANUNDUR SOUM HOSPITAL 99
TABLE IV.61: AIR QUALITY MEASUREMENT RESULTS AT ERDENE SOUM HOSPITAL 100
TABLE IV.62: AIR QUALITY MEASUREMENT RESULTS AT DASHINCHILEN SOUM HOSPITAL 100
TABLE IV.63: AIR QUALITY MEASUREMENT RESULTS AT UVS HOSPITAL 100
TABLE IV.64: MEASUREMENT OF DAYTIME NOISE LEVEL AT SUBPROJECTS IN ULAANBAATAR CITY, APRIL, 2018 102
TABLE IV.65: NOISE MEASUREMENTS IN KHOVD AND UVS HOSPITALS 102
TABLE IV.66: MEASUREMED DAYTIME NOISE LEVELS IN THE 5 SOUMS 103
TABLE IV.67: HEAVY METALS CONTAMINATION LABORATORY TEST RESULTS, MG/KG 103
TABLE IV.68: HEAVY METAL CONTENTS IN SOIL SAMPLES (MG/KG) 106
TABLE IV.69: SOIL CHEMICAL ANALYSIS 107
TABLE IV.70: SOIL CONTAMINATION ANALYSIS 107
TABLE IV.71: CHEMICAL CONTENTS IN THE SOIL SAMPLE 108
TABLE IV.73: CHEMICAL ANALYSIS RESULTS 109
TABLE IV.75: SOIL CHEMICAL ANALYSIS 110
TABLE IV.81: LONGTERM MEAN RUNOFF DATA OF ALTANBULAG RIVER STATION, THE TUUL RIVER 112
TABLE IV.82: LONG TERM MEAN RUNOFF OF THE TUUL RIVER AT ULAANBAATAR – ZAISAN STATION 113
TABLE IV.83: AVERAGE WATER QUALITY IN THE TUUL RIVER IN ULAANBAATAR CITY (20072017) 114
TABLE IV.84: HEAVY METALS IN TUUL RIVER WATER AND AROUND TUUL RIVER AREA 115
TABLE IV.85: MONTHLY MEAN WATER FLOW DATA FOR BUYANT RIVER 116
TABLE IV.86: BUYANT RIVER WATER QUALITY (GAUGING STATION NORTH OF KHOVD CITY) 117
TABLE IV.87: BUYANT RIVER WATER QUALITY (GAUGING STATION SOUTH OF KHOVD CITY) 117
TABLE IV.88: TUUL BASIN ALLUVIAL GROUND WATER DEPOSITS NEAR ULAANBAATAR CITY 123
TABLE IV.89: NEWLY DISCOVERED GROUND WATER DEPOSITS AROUND ULAANBAATAR CITY 124
TABLE IV.90: LABORATORY RESULTS FOR WATER SAMPLES, CENTRAL WATER SUPPLY SYSTEM 125
TABLE IV.91: LABORATORY RESULTS FOR WATER SAMPLES AT WELL USED BY FHC IN 14TH KHOROO OF KHAN
UUL DISTRICT 125
TABLE IV.92: LABORATORY RESULTS FOR WATER SAMPLES AT WELL TAKEN FROM THE GER AREA WATER
DISTRIBUTION SYSTEM, USED FHC IN 10TH KHOROO OF KHANUUL DISTRICT 126
TABLE IV.93: LABORATORY RESULTS FOR WATER SAMPLES AT WELL TAKEN FROM THE GER AREA WATER
DISTRIBUTION SYSTEM, USED FHC IN 19TH KHOROO IN CHINGELTEI DISTRICT 126
TABLE IV.94: LABORATORY RESULTS FOR WATER SAMPLES AT WELL WATER USED BY KHANUUL DISTRICT
HOSPITAL 126
TABLE IV.95: GROUNDWATER RESOURCES IN THE PROJECT AREA 131
TABLE IV.96: LABORATORY TEST RESULTS FOR GROUNDWATER SAMPLE 131
TABLE IV.97: TOTAL RENEWABLE GROUNDWATER RESERVES FOR THE 5 SOUMS 132
TABLE IV.98: GROUND WATER WELL LABORATORY TEST RESULTS, ERDENEMANDAL SOUM 132
TABLE IV.99: GROUND WATER WELL LABORATORY TEST RESULTS, TARIALAN SOUM 132
TABLE IV.100: GROUND WATER WELL LABORATORY TEST RESULTS, BAYANUNDUR SOUM 133
TABLE IV.101: GROUND WATER WELL LABORATORY TEST RESULTS, ERDENE SOUM 133
TABLE IV.102: GROUND WATER WELL LABORATORY TEST RESULTS, DASHINCHILEN SOUM 134
TABLE IV.103: GROUNDWATER DEPOSITS IN UVS LAKE BASIN 135
TABLE IV.104: GROUND WATER WELL LABORATORY TEST RESULTS, ULAANGOM 136
TABLE IV.105: TREES PLANTED WITHIN THE YARDS OF THE 5 SOUM HEALTH CENTERS 144
TABLE IV.106: SPECIAL PROTECTED AREAS IN THE VICINITY OF ULAANBAATAR CITY 147
TABLE IV.107: SPA’S AROUND 5 SOUM CENTERS 151
TABLE IV.108: MONTHLY AVERAGE INCOME PER HOUSEHOLD 158
TABLE IV.109: CLASSIFICATION OF LAND USE OF MONGOLIA 160
TABLE V.1: TEMPORARY USE OF LAND AT HOSPITALS/FHC/SHC 167
TABLE V.2: CONSTRUCTION MACHINERY NOISE 174
TABLE V.3: POTENTIAL NOISE SCREEN LOCATIONS 175
TABLE V.4: SUMMARY ANALYSIS OF POSITIVE AND ADVERSE IMPACTS 193
TABLE V.5: SUMMARY ANALYSIS OF POSITIVE AND ADVERSE IMPACTS 194
TABLE VI.1: LOCATIONS OF PROPOSED FHC/SHC/HOSPITALS IN ULAANBAATAR/OTHER PROVINCES AND LAND
STATUS 197
TABLE VII.2: SUMMARY OF RECOMMENDATIONS BY THE CONSULTEES 203
TABLE VII.3: LOCATION AND NUMBER OF PARTICIPANTS OF CONSULTATIONS 204
TABLE VIII.1: CONSTITUTION OF GRIEVANCE REDRESS COMMITTEE 206
TABLE IX.1: SAFETY IMPLICATION AND MITIGATION 211
TABLE IX.2: TRAINING PROGRAMME SUMMARY OF TRAINING NEEDS 212
TABLE IX.3: MAGNITUDE OF ENVIRONMENTAL IMPACTS MATRIX 215
TABLE IX.4: CONSTRUCTION PHASE MONITORING 224
TABLE IX.5: OPERATIONS PHASE MONITORING 224
TABLE IX.6: PERFORMANCE INDICATORS OF ENVIRONMENTAL MANAGEMENT PRIOR TO CONSTRUCTION.225
TABLE IX.7: ESTIMATED COSTS FOR IMPLEMENTING EMP FOR THREE TRANCHES 228
TABLE IX.8: DETAILS OF EMP COSTS FOR THREE TRANCHES 229
TABLE IX.9: INSTITUTIONAL ROLES AND RESPONSIBILITIES FOR EMP IMPLEMENTATION ACTIVITIES 235
TABLE IX.10: OVERALL PROJECT IMPLEMENTATION SCHEDULE 236
List of Figures
FIGURE II.1: ENVIRONMENTAL IMPACT ASSESSMENT PROCESS IN MONGOLIA 17
FIGURE III.1: MAP OF MONGOLIA AND LOCATION OF SUBPROJECT IMPLEMENTING AIMAGS 26
FIGURE III.2: LOCATION OF PROJECT SITES IN ULAANBAATAR CITY 27
FIGURE III.3: SOLID WASTE COLLECTION POINT 39
FIGURE III.4: MEDICAL WASTE COLLECTION ROOM AT KHANUUL HOSPITAL. 40
FIGURE III.5: DISINFECTION UNIT AT THE MEDICAL WASTE FACILITY OF ELEMENT LLC 41
FIGURE III.6: LANDFILL POINT AT THE MEDICAL WASTE FACILITY OF ELEMENT LLC 41
FIGURE III.7: MEDICAL WASTE TRANSPORT TRUCK OF ELEMENT LLC 42
FIGURE III.8: SOLID WASTE COLLECTION POINT AT KHOVD HOSPITAL 43
FIGURE III.9: SOLID WASTE COLLECTION PLACE AT UVS HOSPITAL 43
FIGURE III.10: MEDICAL WASTE COLLECTION FACILITY AT KHOVD HOSPITAL 43
FIGURE III.11: MEDICAL WASTE COLLECTION FACILITY AT UVS HOSPITAL 44
FIGURE III.12: MEDICAL WASTE TRANSPORT VEHICLES 44
FIGURE III.13: MEDICAL WASTE TRANSPORT VEHICLES OF UVS HOSPITAL 45
FIGURE III.14: WASTE LANDFILL SITE FOR KHOVD HOSPITAL 45
FIGURE III.15: LABELLED MEDICAL AND NONMEDICAL WASTE BINS AT UVS HOSPITAL 46
FIGURE III.16: MEDICAL WASTE COLLECTION HOUSE, ERDENE SOUM HEALTH CENTER 49
FIGURE III.17: SEPTIC TANK AT ERDENE SOUM HEALTH CENTER 49
FIGURE III.18: ARCHITECTURAL PLANNING DESIGN APPROVAL 50
FIGURE IV.1: EARTHQUAKE RISK IN MONGOLIA: MODIFIED MERCALLI SCALE 60
FIGURE IV.2: VEGETATION ZONE MAP OF MONGOLIA SHOWING FOREST AREAS 62
FIGURE IV.3: LOCATION OF TRANCHE1 COMPONENTS IN MONGOLIA 67
FIGURE IV.4: LOCATION MAP OF TRANCHE1 COMPONENTS IN ULAANBAATAR CITY 68
FIGURE IV.5: TOPOGRAPHY MAP OF ULAANBAATAR CITY 69
FIGURE IV.6. TOPOGRAPHICAL MAP OF KHOVD 70
FIGURE IV.7. TOPOGRAPHICAL MAP OF ERDENEMANDAL SOUM 71
FIGURE IV.8. TOPOGRAPHICAL MAP OF TARIALAN SOUM 72
FIGURE IV.9: TOPOGRAPHICAL MAP BAYANUNDUR SOUM CENTER 73
FIGURE IV.10. TOPOGRAPHICAL MAP OF ERDENE SOUM 74
FIGURE IV.11. TOPOGRAPHICAL MAP OF DASHINCHILEN 75
FIGURE IV.12. TOPOGRAPHICAL MAP OF ULAANGOM CITY 76
FIGURE IV.13. AIR QUALITY AND NOISE CONTROL STATIONS IN UB CITY 93
FIGURE IV.14: NOISE POLLUTION ESTIMATION OF ULAANBAATAR CITY 101
FIGURE IV.15: EARTHQUAKE ZONES MAP ULAANBAATAR AND SUBPROJECT LOCATIONS 105
FIGURE IV.16: SOIL SAMPLING LOCATION IN THE ERDENEMANDAL SOUM HOSPITAL 107
FIGURE IV.17: SOIL SAMPLING LOCATION 108
FIGURE IV.18: SOIL SAMPLING LOCATION 109
FIGURE IV.19: SOIL SAMPLING LOCATION AT THE SOUM HOSPITAL 110
FIGURE IV.20: FLOOD PRONE AREAS OF ULAANBAATAR 114
FIGURE IV.21: LOCATION OF THE KHOVD AIMAG HOSPITAL AND THE BUYANT RIVER 116
FIGURE IV.22: SURFACE WATER NETWORK MAP OF ERDENEMANDAL SOUM 118
FIGURE IV.23: SURFACE WATER NETWORK MAP OF TARIALAN SOUM 119
FIGURE IV.24: SURFACE NETWORK MAP OF BAYANUNDUR SOUM 120
FIGURE IV.25: SURFACE WATER MAP OF DASHINCHILEN SOUM 121
FIGURE IV.26: SURFACE WATER MAP OF ULAANGOM CITY 122
FIGURE IV.27: DISTRIBUTION OF PERMAFROST IN THE AREA OF ULAANBAATAR 128
FIGURE IV.28: PERMAFROST MAP, KHOVD 130
FIGURE IV.29: RENEWABLE GROUNDWATER RESERVE MAP OF MONGOLIA 135
FIGURE IV.30: VEGETATION ZONES OF MONGOLIA 137
FIGURE IV.31: POPULUS TREES AND BUSHES AT THE EMERGENCY CALL CENTER 137
FIGURE IV.32: POPULUS TREES AT THE PROPOSED CONSTRUCTION SITE THAT NEED TO BE REPLANTED AT
KHANUUL DISTRICT HOSPITAL 138
FIGURE IV.33: POPULUS AND PINE TREES AND BUSHES AT THE PROPOSED CONSTRUCTION SITE THAT NEED TO
BE REPLANTED. FHC IN 10TH KHOROO OF KHANUUL. 138
FIGURE IV.34: WILDLIFE ZONES IN MONGOLIA (A.G. BANNIKOV) 139
FIGURE IV.35: POPULUS TREES AT THE PROPOSED CONSTRUCTION SITE THAT NEED TO BE REPLANTED. KHOVD
HOSPITAL. 141
FIGURE IV.37: PLANTGEOGRAPHICAL MAP OF MONGOLIA 143
FIGURE IV.38: TREES IN THE YARD OF TARIALAN SOUM HEALTH CENTER THAT NEED TO BE REMOVED 144
FIGURE IV.39: WILDLIFEGEOGRAPHICAL ZONES OF MONGOLIA (A.G. BANNIKOV) 145
FIGURE IV.40: LOCATION OF SPA’S AND SUBPROJECT COMPONENTS 147
FIGURE IV.41: BOGD KHAN MOUNT SPA AND ITS BUFFER ZONE 148
FIGURE IV.42: SPECIAL PROTECTED AREAS AROUND THE KHOVD CITY AND LOCATION OF SUBPROJECT 149
FIGURE IV.43: SPA LOCATION MAP OF MONGOLIA 151
FIGURE IV.44: PROTECTED AREAS AROUND ULAANGOM CITY 152
FIGURE IV.45: LAND USE PATTERN IN ULAANBAATAR 161
FIGURE VI.1: ALTERNATE ACCESS ROUTE FOR FHC 199
FIGURE VIII.1: FLOW CHART SHOWING GRIEVANCE REDRESS MECHANISM FOR ENVIRONMENT 208
FIGURE IX.1: PROJECT ORGANIZATION STRUCTURE 232
EXECUTIVE SUMMARY
1. The project will help to sustain the health status of Mongolian people, through better quality and inclusiveness of healthcare services and enhanced system for healthcare financing, improved. The investment program will deliver four major outputs to address the key constraints identified above. The project will Urban and rural primary healthcare strengthened; (ii) District and Aimag hospital services improved, (iii) Strategic purchasing model strengthened; (iv) Ministry of Health capacity in procurement and financial management for sector development strengthened. The project is expected to be implemented from September 2019 to June 2029.
Components and Summary Environmental Issues
2. The IEE report comprises of baseline data on the existing condition of the physical and biological environment, the anticipated environmental impacts, proposed mitigation measures, monitoring frameworks, grievance procedure and public consultations. The consultant team undertook field surveys to sub-project sites to assess the physical and biological environment – factors such as site ecology, management of construction, sanitation, use of equipment and machineries, environmental health and safety, occupational hazard etc. The environment management and monitoring plan have been dealt with in detail in the respective sections of the report. A Tranche-1 environment management plan has been attached separately. However, a summary list of key impacts on environment parameters are briefly enumerated in Table 1 below:
Table 0.1: Summary Impacts on key environment parameters
# Environmental Parameter
Reason Proposed Mitigation Measures
1 Air Quality Medium Significant air emission from the construction activity during stacking/storage of soil, construction material at site
Sprinkling of water, proper handling of excavated soil, construction material, banned substances/VOCs etc.
2 Water Quality Low The project will require small quantity of water for construction. No hazardous effluent is envisaged to be discharged during construction
The required water will be sourced from tankers by the construction company.
Domestic effluent shall be discharged in holding tanks which will be cleaned regularly and waste is safely stored, transported and disposed at urban body’s solid waste management site.
3 Soil Quality Low Land is available. FHC/SHC/Hospital has open/vacant areas within the premises for
Construction company to ensure proper housekeeping, sanitation and cleanliness at work site.
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construction of additional buidling1 and government land for new FHC/SHC/Hospital.
4 Noise Quality Low The construction activity may lead to noise pollution during concreting –steel cutting, bending, casting using vibrators, operation of mechanised equipment and drills etc. that will affect the patients, residents of the area.
Noise monitoring will be done at regular intervals. If any night construction activity that is noise intensive is undertaken, staff and neighbourhood must be consulted to determine suitable timings.
5 Hazardous Substance – eg. Asbestos, VOCs
Minimal The sub-projects will not impact the main buildings of the FHC/SHC/Hospital/Health Center
Sections of buildings, if they contain any hazardous material will not be selected for improvement actions.
6 Terrestrial Ecology
Low No ecologically sensitive place (protected area/reserved forest/Important flora and fauna species) within 5 km radius from each subproject site
Tree replantation/transplantation to be carried out inside premises if any trees are cut by the construction company
3. Table 2 below gives key features, including environmental issues (if any) for the sub-
projects:
Table 0.2: Key features and environmental issues for each Sub-project
No Compon ents
Key Environmental Issues
Hospital Khan Uul District, Yarmag
Connected to centralized heating, water, sewage and electricity systems, no land acquisition or resettlement issues for new building
Location within the SPA buffer zone, replanting of 59 Populus trees, emission of dust and noise, traffic safety precaution required, waste generation during both construction and operation period
2 Khovd, Hospital
Khovd Province, Jargalant Soum
Connected to centralized heating, water, sewage and electricity systems, medical waste collection site needs to be replaced with closed bins and concrete/ lined flooring, no land acquisition or resettlement issues for new building.
Replanting of 7-8 Populus trees, emission of dust and noise, traffic safety precaution required, waste generation during both construction and operation period
3 Uvs hospital
Ulaango m city
Connected to centralized heating, water, sewage and electricity systems, medical
Emission of dust and noise, traffic safety during construction, waste generation
1 Construction of additional buildings to expand services.
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waste collection disposal site needs to be replaced with closed bins and concrete/lined flooring. 1200m2 additional building will be built inside boundary of Hospital land.
during both construction and operation period. There are kindergartens and middle schools (in 150-350m distance) surrounding the hospital.
4 Emergen cy Health Center
Sukhbaat ar district,1 st Khoroo
Connected to centralized heating, water, sewage and electricity systems. The Specialised Agency for Inspection has confirmed there is no asbestos present in the building built in 1970. There is an office building and a private house right next to the proposed construction site, no land acquisition or resettlement issues for construction of new building.
Replanting of 23 trees and bushes, emission of dust and noise, traffic safety precaution required during construction, waste generation during both construction and operation period.
5 FHC 10th Khoroo in Khan-Uul district
Connected to centralized heating, water, sewage and electricity systems, demolish existing 119m2 building built in 2000, there is kindergarten locating nearby the construction site, no land acquisition or resettlement issues for new building.
Replanting of 28 trees and bushes, potential relocation of heating pipeline to nearby kindergarten, emission of dust and noise, traffic safety precaution required during construction, waste generation during both construction and operation period.
6 FHC 14th Khoroo in Khan-Uul district
Not connected to any centralized network except for electricity, has own water well and septic tank, electric heating, land permission to be obtained in May 2018, no land acquisition and resettlement issues for new building, there is kindergarten located nearby the construction site.
Relocation of water supply pipeline for the kindergarten, make an alternate access road for the kindergarten, emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period.
7 FHC 19th Khoroo in Chingelte i district
Not connected to any centralized network except for electricity, has own septic tank, heating from own HOB using coal, flood channel nearby construction site, no land acquisition and resettlement issues for new building.
Emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period. For the purposes of the IEE, the water well samples were tested and meets national drinking water standard of Mongolia.
8 FHC 17th Khoroo in Bayanzur kh district
Connected to centralized water and electricity systems, has own septic tank, heating from own HOB, demolish existing 203 m2 building built in 2001, no land acquisition and resettlement issues for new building.
Emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period.
9 SHC Erdenem andal Soum
Not connected to any centralized network except for electricity, has own septic tank, heating from own HOB, a new additional building (800m2) inside the boundary of the hospital land will be built.
The proposed construction site is currently a parking space for the Soum health center, thus a new parking space and entrance point shall be planned, an old heating pipeline is very close to the proposed construction site (it will not be used for this facility). Emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period.
10 SHC Tarialan Soum
Connected to centralized water, heating and electricity networks, has own septic
Emission of dust and noise, traffic safety during construction, waste generation
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tank, new additional building (800m2) inside the boundary of the hospital land will be built, a small wooden house (with size 3m x 4m) needs to be demolished.
during both construction and operation period, 44 trees in the hospital premise needs to be removed and re-planted, 4 households are located at 40-60m distance from the construction site on the southern side that will be affected.
11 SHC Bayan- Undur Soum
Connected to centralized heating and electricity networks, deliver water from nearby water well in the Soum center, has own septic tank, new additional building (800m2) inside the boundary of the hospital land will be built.
Emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period, a middle school is located at 150m distance from the construction site on the northern side.
12 SHC Erdene Soum
Connected to centralized water, heating and electricity networks, will be connected to centralized sewage pipeline later this year, new additional building (800m2) inside the boundary of the hospital land will be built.
Emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period. Waste collection point in the hospital yard needs to be replaced with closed lid bins with proper concrete/lined flooring. The Soum health center currently does not have fencing around it.
13 SHC Dashinchi len Soum
Not connected to any centralized pipelines: heating, electricity and water. Domestic use is supplied from its own well and drinking water is transported from the well in the Soum center. Has own septic tank, new additional building (800m2) inside the boundary of the hospital land will be built.
Emission of dust and noise, traffic safety during construction, waste generation during both construction and operation period. The closest ger area is only 100m from the construction site.
4. Potential impacts are mostly temporary, predictable, and reversible, and can be mitigated
through adherence to national2 and international standards3, design criteria, and/or implementation of Environment Management Plan (EMP). FHC/SHC/Hospital are proposed on government land and the location of FHC/SHC/Hospital avoided any sanctuary/protected areas or any other environmentally-sensitive areas. Utilization of the best available technology and best management practices are built-in to the project design and listed through the Environment Management Plan (EMP) and more specifically through the site specific EMPs to be developed by the Construction company.
5. The Khan-Uul District hospital is located about 1.4 km distance from Bogdkhan Mount Special Protection Area (SPA) buffer zone. Bogd khan Mount SPA where the Khan-Uul hospital is located is a settlement area having built-up apartments etc. and is not a biodiversity site. The construction and rehabilitation will take place inside the existing land area of Khan-Uul Hospital. Construction activities are not prohibited within the SPA buffer zone but it needs to have DEIA and EMP approved by MET. Draft domestic DEIA reports for Khan-Uul and Khovd hospitals are already made by a local professional firm and available
2 Relevant Mongolian Standards mentioned in Section 2 later 3 World Bank/IFC Environment Health and Safety Guidelines 2007
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now. However, approval process of the domestic DEIA reports by Ministry of Environment requires the project to have approved detailed design.
6. IEE including EMP has been prepared to mitigate the potential adverse impacts of construction. The new FHC/SHC/Hospitals are proposed only on land owned by the Government and therefore acquisition of land will not be required from the surrounding communities. The proposed additional buildings4 of FHC/SHC/Hospitals will be located on existing government lands or those lands that are allotted to MOH by Government of Mongolia. All proposed new FHC/SHC/Hospitals have been identified to have possession of vacant land area; whereas the FHC/SHC/Hospitals where construction is to be done in their existing land, there is no need to acquire land.
7. Current facilities for two FHCs and NECC will be shifted to temporarily to properties on rent nearby for continuous functioning during construction therefore minimising nuisance to the patients and staff. All other facilities do not require closure during operations as these are separate buildings or new buildings.
8. Modern state of the art buildings with equipment and building infrastructure fitted with firefighting and alarm systems, electric shockproof designs, seismic resilience, storm and flooding resilient structures are being designed by architects. Buildings will be designed having provisions for energy efficiency and green design. Demolition of two FHC’s comprising of 119 m² each (10th Khoroo of Khan-Uul, 17th Khoroo of Bayanzurkh). The mortuary and kitchen at Khan-Uul District hospital will also be demolished. No asbestos is involved in all of the 2 of FHC buildings and Khan-Uul hospital that will be demolished. The 2 storied NECC building measuring 816 m2 will be demolished. Specialized Inspection Agency of the Municipality Authority of Ulaanbaatar city has confirmed that there is no asbestos present in the National Emergency Health Call Center Building by issuing a certificate no 02- 03/4170 dated 31 October 2018 (attached as Annexure 10). The detailed “asbestos inspection” at the National Emergency Health Call Center was conducted in June 2018. Asbestos containing material (ACM) will not be used as a new material in rehabilitation works or new buildings.
9. During site visits, the hospital managements have assured no hazardous materials would be involved in demolition and disposal of debris to designated waste sites planned. Specialized Inspection Agency of the Municipality Authority of Ulaanbaatar city has confirmed that there is no asbestos (or asbestos containing materials [ACM]) present in the National Emergency Health Call Center Building by issuing a certificate no 02-03/4170 dated 31 October 2018 (attached as Annexure 10). The detailed “asbestos inspection” at the National Emergency Health Call Center was conducted in June 2018. For all other facilities, existence of any hazardous materials, such as asbestos shall be determined prior to development of design. If renovation or refurbishment for any component requires removal of asbestos containing materials (ACM), the particular activity will be dropped from funding.
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10. At existing hospital areas, no hydrology will change. FHC at 19th Khoroo in Chingeltei is located nearby a flood channel. The digging and drilling (if required) must be done to understand the depth of rock from top or presence of any permafrost.
11. For most of the proposed new FHC/SHC/Hospital, the construction drawings (technical reports) will be finalized after conducting detailed physical survey of the land through architect firms engaged by the EA under the project. The construction of additional buildings5 will be done avoiding existing apartment/housing, other buildings, trees or any other existing settlement directly related with the livelihood of people. As assessed, the project benefits outweigh the negative impacts.
12. The negative environmental impacts that are likely to be associated with construction activities of the FHC/SHC/Hospitals include - noise and dust during construction, transportation of construction material to site, disposal of waste soil, and inconvenience to neighbouring communities due to increased traffic due to new building construction activities. Constant movement of vehicles that transport construction materials will cause increased level of dust and noise during the construction period. There will be a minor increase of traffic during the construction activities. The impact will be negligible as sprinkling of water, proper handling of excavated soil, and proper construction material storage would be done at the sub-project sites. Effective traffic management and accident management plan will be prepared by Construction Company under guidance of PIU.
13. Construction activities may require a camp for construction staff and/or machinery parking area and additional space for heavy machinery movement; in this regard the hospital and clinic administrations will be required to host the camps and to provide additional space for machinery movement. Most workers will be local residents at the project sites in Ulaanbaatar city. But for construction of Khovd hospital, Uvs hospital and SHC’s, some of the workers might come from other regions. Most workers may stay in nearby accommodation planned by the construction company. The construction company to develop occupation health and safety plan for those workers from other regions as per EMP.
14. Spoil accumulation points and disposal to be identified – inert material to go to waste fill site, other clinical/ medical waste will go to medical waste site during operations. Any hazardous material will be handled as per national Mongolian environmental laws. At existing hospital areas, the drainage plans will be prepared and disclosed by Construction Company which will be approved by the city/province level specialized agency before construction.
15. During the site visits, the officials and consultants made numerous observations and held discussions with FHC/FHC/SHC/Hospital managements concerned to assist in proper design of new FHC/SHC/Hospital with respect to the following: (i) location of proper access roads, laydown area for materials to be used by the construction companies to use without disturbing the working and minimizing utilization of public and playground areas, (ii) avoidance of underground existing pipes for water, heating, sewage etc. at these proposed work sites, (iii) right of way for construction vehicles and provide traffic safety during construction to local residents living adjoining these FHC/SHC/Hospital, (iv) traffic caused by
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construction of new buildings by use of concrete, dump trucks etc. transporting materials inside FHC/SHC/Hospital premises; traffic safety for patients during operations of FHC/SHC/Hospital in normal work hours; (vi) lack of safety equipment such as smoke alarms in most old buildings and the need for adequate firefighting extinguishers and imparting evacuation drills and emergency response procedures training, (vii) distances of these FHC/SHC/Hospital from non-sensitive biodiversity areas and cultural heritage sites to ensure no impact, (viii) dust and noise emissions from the construction subprojects and their impacts on patients and apartment dwellers adjoining the FHC/SHC/Hospital area, (ix) noises from any surroundings areas during construction and operations, (x) avoid any shadow projection onto adjoining buildings due to new structures to be constructed as part of this project, (xi) any banned substances generated as part of any construction project such as asbestos etc., (xii) emissions from coal based heating and water boilers (some cases), (xiii) if insulation works are required in FHC/SHC/Hospital to ensure energy efficiency, i.e. loss of heat due to old walls, (xiv) check presence of any associated or linked facilities, and (xv) determine potential climate change impacts of project activities, if any.
16. The team along with district officials and FHC/SHC/Hospital managements conducted group consultation and discussions with the apartment dwellers/public residing in these sub-project areas to sensitize them about project activities, their impacts and get their suggestions.
17. Very small numbers of trees exist in the sites selected for subprojects. There are about 59 Populus trees at Khan-Uul District hospital site, about 7-8 Populus trees at Khovd hospital site, 10 Populus trees at National Emergency Health Call Center (NECC), and about 25 trees and bushes at the FHC in 10th Khoroo of Khan-Uul district that need to be removed and re-planted. Populus tree does not have any protected status both domestically and internationally.
18. No endangered or protected species of flora or fauna are reported at any of the subproject sites. Locational orientation of the FHC/SHC/Hospital will be finalized in a manner so as to avoid or minimize the shadow falling on adjoining structures. Before start of construction, the construction company shall procure all requisite regulatory approvals from all concerned authorities. Adequate provisions have been made for the environmental mitigation and monitoring of predicted impacts, along with their associated costs in the IEE. Adverse impacts if noticed during implementation will be mitigated using appropriate design and management measures as per the EMP by the construction company.
19. Before start of construction, the construction company shall prepare a construction site specific EMP and procure all requisite regulatory approvals from all concerned authorities. Adequate provisions have been made for the environmental mitigation and monitoring of predicted impacts, along with their associated costs in the IEE. Adverse impacts if noticed during implementation will be mitigated using appropriate design and management measures as per the EMP by the construction company.
20. Some risks expected during construction (for hospital personnel, patients and nearby residents), but can be addressed through sound construction site management such as sound proofing noise, construction yard protection fencing, proper traffic management during construction material movements. The Construction Company and
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Hospital/FHC/SHC/National Emergency Health Call Center (NECC) sites will plan and implement disaster management plan, emergency site accident remedial measures and information disclosure etc.
21. Hospitals, FHC’s, SHC’s and NECC will generate hazardous, infectious and chemical waste during its operation that can be managed properly following to EMP. No other significant risks are anticipated during operation. An Emergency Response Program (ERP) will be prepared by Contraction Company in consultation with Environment safeguard specialist of the PIUs. ERP training will be provided to all stakeholders in the project construction and operations stages.
22. For some FHC/SHC/Hospital sub-projects, the construction drawings development is underway. The data regarding soil, topography, contour, land cutting and filling required, distance from water body and distance from major roads, details of trees can be affected; land details will be collected by engineering firms. If sites are changed other than those indicated in the IEE, supplementary information will be supplied for each of new location for these subprojects by MOH to ADB for prior approval before finalizing detailed design. IEE/EMP will be updated once the detailed design is approved by EA. This updated IEE/EMP will be reviewed and disclosed as per procedure detailed in the EARF.
23. According to the MET regulation requires development of a Tranche-1 Environment Impact Assessment (EIA). According to Government of Mongolia’s (GoM) EIA Notification, projects are not listed as environmental sensitive projects and hence no clearance is required from Ministry of Environment and Tourism (MET); however, clearance from General Agency for Specialized Inspection (GASI) and urban bodies is would be taken by the EA at advanced stages of project preparation.
24. Since the project does not involve activities that have significant adverse impacts and no banned substances are present, an IEE has been developed comprising development of an environmental management plan and monitoring plan as per ADB’s Safeguard Policy Statement (SPS) 2009. The IEE report conforms to national environmental regulations and is also consistent with ADB SPS 2009. Accordingly, the environmental classification for the project is “Category B” as per ADB SPS 2009.
I. INTRODUCTION
A. Background
25. The current population of Ulaanbaatar is about 1.38 million (2016), of which, around 60% reside in poorer ger (traditional tent) areas with limited access to basic socioeconomic services (e.g., water supply and wastewater treatment, roads and transportation, heating, roads, primary health clinics (PHC)/family health clinics (FHC)/Hospitals, primary schools and kindergartens. Further exacerbating the situation is the sharp decline of the gross domestic product (GDP) growth from 17.3% in 2011 to 1% in 2016, increasing levels of air pollution, and rising poverty levels nationwide. People’s access and utilization of healthcare in Mongolia remain inequitable. Since 1997, the Asian Development Bank (ADB) has been a major player in the health sector supporting reforms and investing in primary and hospital care, health insurance, access to pharmaceuticals, health human resources development, and sector governance. On-going health reforms are targeted at increasing the availability and access to health services in urban and rural areas, maintaining high health insurance coverage and expanding the health insurance benefit package.
26. The infrastructure situation of district hospitals in Ulaanbaatar is poor. Most district hospitals were not designed as hospitals, providing a narrow range of services; often poorly maintained; and faced with severe deficiencies in waterproofing, electrical installations and heating, ventilation, and air conditioning systems. District hospitals with a larger range of services, as mandated by the revised health law 2011, have not been established due to lack of technical capacity and funding shortages.6 A limited number of private hospitals are operational, though unaffordable for most of the population. MOH capacity to effectively govern, manage, and supervise health service delivery requires improvements; a conducive environment for private sector investment in health needs to emerge, combined with safety nets for the disadvantaged; and cooperation with nongovernment entities needs to be mainstreamed.
27. Strategic context. The proposed investment program is in line with ADB’s country partnership strategy for Mongolia, 2017–2020 and ADB’s Operational Plan for Health, 2015– 2020, which both underscore the importance of improving the quality of health services, the efficiency of health systems, and the reduction of health-related expenditures.7
B. Outcome and impact.
28. These solutions will result in the following outcome: access to affordable quality primary and secondary health services in Khovd Aimag (province), Ulaanbaatar ger areas, and other selected Aimags improved. The investment program will be aligned with the following impact: the health status of Mongolians, through better quality and inclusiveness of healthcare
6 ADB has been supporting the development of a new district general hospital with a comprehensive set of services
in Songinokhairkhan. (ADB. 2012. Report and Recommendation of the President to the Board of Directors: Pro- posed Loan to Mongolia for the Fourth Health Sector Development Project – Additional Financing. Manila.)
7 ADB. 2017. Country Partnership Strategy: Mongolia, 2017–2020—Sustaining Inclusive Growth in a Period of Economic Difficulty. Manila; ADB. 2015. Operational Plan for Health, 2015–2020: Health in Asia and the Pacific— A Focused Approach to Address the Health Needs of ADB Developing Member Countries. Manila.
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services and enhanced system for healthcare financing, improved. The investment program will deliver four major outputs to address the key constraints identified above:
Urban and rural primary healthcare strengthened.
District and Aimag hospital services improved.
Strategic purchasing model strengthened.
Ministry of Health capacity in procurement and financial management for sector development strengthened.
29. Innovations. The investment program includes the following key innovations: (i) PPP models for hospital maintenance will be tested to address the severe neglect of facilities and equipment maintenance; (ii) expanded and integrated services, including information and communication technology, of FHCs (e.g., laboratory facility, rehabilitation) and district hospitals (e.g., surgery, obstetrics and maternity, linking outpatient and inpatient departments) will be designed and implemented; and (iii) a strategic purchasing model will be designed and carried out to shift state funding for health from financing budget lines to purchasing services.
C. Tranche 1: Multi Tranche Financing Facility
30. These solutions are best delivered by a program of investments under an MFF to achieve the outcome. The policy framework is clearly stated and requires sustained investments and policy dialogue through a long-term commitment and partnership. A project implementation unit with strong capacity to transfer evidence-based practices to subsequent tranche processing and implementation will be established to (i) achieve the expected reforms spanning over several tranches (e.g., strategic purchasing for improved health delivery), (ii) implement major health infrastructure development benefiting from previous tranche design and implementation (district and provincial general hospitals), and (iii) pilot PPP for maintenance and integrated service models that will be upscaled throughout subsequent tranches. The investment program will be implemented from January 2019 to June 2029, project 1 from 2019 to 2024, project 2 from 2022 to 2026, and project 3 from 2025 to 2029.
31. The scope of project 1 (Tranche 1) includes the same four outputs as the MFF. Output 1 will design and construct six FHCs with expanded services and five client-friendly SHCs, pilot an integrated primary and secondary care model, reform PHC financing and contracting, introduce an electronic health record system for PHC, introduce low-carbon technology, and strengthen UCHD’s planning and management capacity. Output 2 will expand hospital in Khan-Uul district and in Khovd and Uvs Aimags, strengthen hospital autonomy, and introduce low-carbon technology in hospital building construction. Output 3 will design and initiate reforms of the strategic purchasing systems. Output 4 will assess needs and implement a capacity building program for MOH’s procurement, financial, and risk management, which will continue during the entire duration of the program.
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D. Proposed Financing Plans
32. The MFF is estimated to cost $161.6 million equivalent. A loan of $160 million equivalent from ADB’s ordinary capital resources, Mongolia country and regional allocations, is proposed, consisting of three tranches amounting to $60 million, $40 million, and $40 million, respectively.
Table I.1: Indicative Financing Plan
Source
(%) ($ million)
Government 1.6 0.8 1.0
Total 161.6 80.8 100.0
E. Implementation Arrangements
Aspects Arrangements
Management
(i) Executing agency MOH
(ii) Key implementing agencies MOH for policy-related indicators of outputs 1, 2, 3, and 4 and the investments in Khovd and other Aimags; and Ulaanbaatar City Mayor’s Office for investments in Ulaanbaatar
MFF = multi-tranche financing facility, MOH = Ministry of Health. Source: Asian Development Bank. 33. The Ministry of Health (MOH) will be the project executing agency. The implementing
agencies will be MOH. It was also agreed that a project implementation unit will be established by MOH to manage day-to-day activities of the project. The project will be implemented from September 2019 to June 2029.
F. Scope of Work and Methodology Adopted
34. The broad scope of the Environmental Assessment study is:
To conduct field visits to collect data relevant to the study area and also collect secondary data so as to establish the baseline environmental status of the study area;
To assess the impacts on environmental attributes due to the location, design, construction and operation of the proposed project;
To prepare a mitigation plan outlining the measures for protecting the environment including institutional arrangement and environmental monitoring;
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To identify critical environmental attributes required to be monitored subsequent to the implementation of the proposed project;
To carry out consultation with local people to identify the public perception of the project; and
To establish the Environment Monitoring Plan (EMoP) for the MOH to submit environmental monitoring reports to ADB at regular intervals.
35. Each proposed FHC/SHC/Hospital on the list was further examined for conformance to ADB’s safeguards and technical due diligence confirmed for support before the design of the project is finalized in June 2018. Accordingly, transect walks and field surveys were undertaken to assess physical and biological environment in April/October 2018. However, the exact physical location within the site for some FHC/SHC/Hospitals may vary after the exact demarcation of locations by the Architects preparing construction technical drawings and General Agency for Specialised Inspection (GASI) requirements.
36. The IEE report comprises baseline data on existing condition of physical, ecological, economic, and social information, together with the anticipated environmental impacts and proposed mitigation measures. This report is prepared on the basis of preliminary survey, field study and consultations with the help of available secondary data of different sites, articles and report.
37. Detailed assessment of secondary source baseline environmental data for Ulaanbaatar and concerned Aimags/Soums was done to support the findings of the field survey by consultants. Public consultations were held with affected persons such as apartment dwellers, other stakeholders, and government officers of the project area. Annexure 7 gives details of places and persons who attended these consultations. The field studies were supported by data collected from secondary sources such as internet, forest atlas, published data from GoM documents, population census statistics data, as well as documents from MOH and documents from other government departments etc.
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II. POLICY, LEGAL AND ADMINISTRATIVE FRAMEWORK
38. The Tranches, Projects and components pertaining to this IEE are subject to both ADB and National environmental safeguard policies and legislation. This section specifies the ADB requirements and those set out in Mongolian law, which prescribe the principles governing the implementation of all components.
A. ADB’s Safeguard Policy Statement (SPS 2009)
1. Environmental Impact Assessment Requirements of ADB
39. The safeguard policies are operational policies that seek to avoid, minimize or mitigate the adverse environmental and social impacts of projects including protecting the rights of those people likely to be affected or marginalized by the development process. ADB’s safeguard policy framework in the SPS consists of three operational policies on the environment, indigenous people and involuntary resettlement. ADB has developed Operational Procedures to be followed in relation to the SPS policies and these are included in the ADB Operations Manual.
40. The ADB’s Safeguard Policy Statement (SPS), 2009 is applicable to all projects. These projects can be categorized as A, B, C or FI. Table II-1 below provides a list of categorization of the activities related to Environment, Safeguards, as per ADB’s Safeguard Policy Statement 2009 requirements:
Table II.1: Environment Safeguards Categorization: Definition
Category Environment Type of reporting required.
A — Significant Projects that anticipate significant adverse environmental impacts that are irreversible, diverse, or unprecedented. These impacts may affect an area larger than the sites or facilities subject to physical works.
An environmental impact assessment (EIA) is required to address significant impacts.
B — Less Significant Projects with potential adverse impacts that are sitespecific, few if any of them are irreversible, and in most cases mitigation measures can be more readily designed than for Category A investments.
An initial environmental examination (IEE) is required to determine whether or not significant environmental impacts.
C — Minimal or impact Projects that have minimal or no adverse environmental impacts.
Environmental due diligence report or any other document that reviews environmental implications is required,
FI — Financial Intermediation
Projects of ADB funds through financial intermediaries (FI) An environmental and social management system (ESMS) report is required.
41. At an initial stage of identifying project activities, the ADB's Prohibited Investment Activities List (described in Asian Development Bank’s Safeguards Policy Statement 2009.) will apply.
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If the investment involves any prohibited activity, EA will not consider the investment. However, in this project, there are no prohibited activities being undertaken. 8
2. ADB SPS Requirements (SR1): Environment Policy
42. ADB’s SPS sets out the policy objectives, scope and triggers, and principles for the environmental safeguards. To achieve the policy objectives and deliver the policy principles, ADB carries out the actions described in the Policy Delivery Process (subsection B of the SPS). To help borrowers/clients and their projects achieve the desired outcomes, ADB adopts a set of specific safeguard requirements that borrowers/clients are required to meet in addressing environmental and social impacts and risks. ADB staff, through their due diligence, review, and supervision, will ensure that borrowers/clients comply with these requirements during project preparation and implementation.
43. The objective of ADB’s due diligence for the Project loan is that EA ensures the environmental soundness and sustainability of projects and to support the integration of environmental considerations into the project decision-making process.
44. Environmental safeguards are triggered if a project is likely to have potential environmental risks and impacts. For the MFF, Project 1 has been evaluated as a Category B Project, requiring an IEE. Guidelines on the ADB’s requirements for environment due diligence in are in accordance to the Safeguard Policy Statement (June 2009).
3. Standards, guidelines and good practice in ADB SPS
45. The Appendix 1 of the ADB SPS Policy Statement 2009 (SPS) states, "During the design, construction, and operation of the project, the borrower/client will apply pollution prevention and control technologies and practices consistent with international good practice, as reflected in internationally recognized standards such as the World Bank Group’s Environment, Health and Safety Guidelines. These standards contain performance levels and measures that are normally acceptable and applicable to projects. When the host country regulations differ from these levels and measures, the borrower/client will achieve whichever is more stringent. If less stringent levels or measures are appropriate in view of specific project circumstances, the borrower/client will provide full and detailed justification for any proposed alternatives that ae consistent with the requirements presented in the SPS 2009.”
46. For this purpose, IFC EHS guidelines are recommended. The Environmental, Health, and Safety (EHS) General Guideline9 (April 30, 2007) will be applicable for this Project. The Section 4 on Construction and Demolition of the guidelines are important for consideration. These standards are listed in Annexure 2 for reference.
8 No production of, trade in, or use of unbonded asbestos fibers 9 These standards contain performance levels and measures that are normally acceptable and applicable to pro-
jects. When host country regulations differ from these levels and measures, the borrower/client will achieve whichever is more stringent. If less stringent levels or measures are appropriate in view of specific project circumstances, the borrower/client will provide full and detailed justification for any proposed alternatives that are consistent with the requirements presented in this document.
7
47. The following IFC/World Bank guidelines will also be used for guidance for development of health care facilities:
- Environmental, Health, and Safety Guidelines for Waste Management Facilities. - Environmental, Health, And Safety Guidelines for Water and Sanitation. - Environmental, Health, And Safety Guidelines for Health Care Facilities.
B. National Mongolian Legislation
1. Mongolia’s Environmental Policy
48. Mongolia has enacted a comprehensive policy and legal framework for environmental assessment and management. It has policies, legislation and strategies in place to manage the protected areas such as national parks, to satisfy its international obligations, and to protect the quality of the environment for the health and well-being

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