RP1313. AZERBAIJAN Health Sector Reform Project (HSRP) Resettlement Policy Framework (RPF) May 03, I. Project Background

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Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized I. Project Background A. Country and Sector Context AZERBAIJAN Health Sector Reform Project (HSRP) Resettlement Policy Framework (RPF) May 03, 2012 1. Health sector reforms that were started in 2006 are beginning to show some results in health outcome improvements and access to health services. Recent trends in Azerbaijan s health indicators point to gradual progress (HSPA 2011, Ibrahimov et al 2010) but there remains significant scope for improvement. Life expectancy has edged upward while infant and maternal mortality rates have declined, although these rates, when based on international definitions remain quite high for Azerbaijan s income level. Despite ongoing reforms in the health sector as well as increased financing, there is substantial inequality in health status and healthcare use between the rich and poor and a lack of financial protection from high out-of-pocket expenditures. In 2009, the incidence of impoverishing and catastrophic health payments in Azerbaijan was among the highest in the world. B. Project Background RP1313 2. The original credit for the HSRP in the amount of SDR 34.3 million (US$ 50 million equivalent) was approved on June 5, 2006, and became effective on December 20, 2006, with an original closing date of December 31, 2012. In addition, the Government of the Republic of Azerbaijan (GoA) allocated the amount of US$ 28.25 million, bringing the total cost of the project to US$ 78.25 million. 3. The GoA formally requested on May 12, 2011 the Bank to provide an additional financing loan to scale-up the activities initiated by the on-going HSRP and to finance remaining activities that cannot be finished under the HSRP due to cost-overruns. 4. In addition to the cost-overruns, the government requested an AF to improve availability and quality of health services to other districts. The master-plan to rationalize health infrastructure and human resources was developed and approved in 2009 under Component B of the project. The HSRP initiated the implementation of the master-plan in the 4 (Agdash, Gakh, Ismayilli, and Sheki) out of 5 pilot districts (Absheron, Agdash, Gakh, Ismayilli, and Sheki). In January 2009, the GoA endorsed the master-plan to be rolled-out nationwide. The AF would support the establishment of health infrastructures through reconstructing 17 new primary and 3 village hospitals in ten additional districts (Aghsu, Balakan, Barda, Gabala, Imishli, Khachmaz, Kurdemir, Oghuz, Shamakhi, and Ujar) identified during implementation of the National Master Plan across the country. As a result, the project will cover 4.2 percent of PHCs and 5.2% of village hospitals 1

nationwide. In addition, the project will construct 23% of PHCs in accordance with the 2012-2015 investment program of the MoH. 5. The proposed AF maintains largely the original project development objectives, albeit simplified, and the major activities. The original Project Development Objectives (PDOs) are to improve overall health system stewardship and financing, and enhance equitable access to, and technical and perceived quality of essential health services, in the selected districts in a fiscally responsible and sustainable manner with a view to improving health outcomes. The PDO would be simplified and the results framework adapted to make it more directly linked to the project activities and what the project can realistically achieve. The original targets to lower out of pockets spending and increase public health expenditures are unrealistic for an investment loan and would be much more appropriately addressed through continued technical assistance and policy dialogue. In addition, the implementation of the health insurance reform is slow due to the pending decision by the Government on establishing the Agency that would be responsible for the management of the Health Insurance Fund and the implementation modalities of the law, making these targets difficult to achieve. 6. The AF would be used to: (i) finance the cost-overrun of the HSRP by reconstructing the remaining 8 PHC facilities in the previously selected 4 pilot districts; (ii) expand the coverage in the 10 additional districts by reconstruction of 17 PHCs and 3 village hospitals; (iii) support health system stewardship by building capacity in MoH and investing in health care management and the information system; (iv) provide trainings for PHC physicians and nurses on family medicine across the country beyond the selected pilot districts, trainings abroad and in-country for narrow specialists and managers in selected hospitals; (v) provide technical assistance for the already launched reforms particularly in the under- and post-graduate medical education and certification of health professionals; and (vi) support the ongoing health finance reforms. 7. The proposed scaled-up activities are strategically aligned and operationally consistent 1 with the Country Partnership Strategy. The ongoing HSRP also meets the criteria and conditions of OP/BP 13.20 for AF that require that: (a) the Project objectives continue to be achievable; (b) the performance of the Borrower and implementing agencies be satisfactory; (c) the implementing agencies have an action plan satisfactory to the Bank for the completion of the original Project; and (d) there be no outstanding audit reports and audit reports have been unqualified. II. Project Objective 8. The Project Development Objective (PDO) of the Health Sector Reform Project is to to improve quality and availability of health-care services and strengthen the capacity of the 1 Country Partnership Strategy Progress Report for Republic of Azerbaijan for the Period FY09- FY13, May 2011. 2

Health authorities to manage the system (stewardship). The PDO would be achieved through building MoH capacity for stewardship, improving delivery of healthcare services and developing human resources. 9. The project has four components and five sub-components: (i) Component A: Building MOH Capacity for Stewardship - This component will continue to assist the MoH to build its capacity in policy making, planning, and regulation by financing consultancy services, training and goods; (ii) Component B: Improving Delivery of Healthcare Services - This component will finance consultancy services, civil works and goods in fourteen districts of Agdash, Aghsu, Balakan, Barda, Gabala, Gakh, Imishli, Ismayilli, Khachmaz, Kurdemir, Oghuz, Shamakhi, Sheki and Ujar. The component will (i) reconstruct 9 primary health care facilities in HSRP original districts that were not finalized due to cost-overruns, (ii) reconstruct 17 primary health care facilities and 3 village hospitals in the nine additional districts; and (iii) rehabilitate 1 children s hospital in Sheki; (iii) Component C: Human Resources Development - This component would support the effective implementation of human resources reforms through financing consultancy services, training, and minor civil works and goods. This component also includes the training of health workers; (iv) Component D: Project management, monitoring and evaluation - This component would ensure effective administration and implementation of the project by supporting the operation of the Project Implementation Unit (PIU) which is responsible for the day-to-day management and coordination of project activities. III. Rationale, principles and objectives for preparing the Resettlement Policy Framework 10. All the projects implemented under the World Bank (WB) assistance are subject to careful scrutiny to ensure their environmental and social sustainability. Large scale land acquisition and involuntary resettlement is not anticipated under the HSRP Additional Financing. However during preparation of the HSRP AF it was considered expedient to trigger the Operational Policy on involuntary resettlement (OP 4.12), largely as a precautionary measure. The OP 4.12 of the WB is designed to include safeguards to address and mitigate social, environmental and economic risks caused by the involuntary resettlement under the WB financed development projects. In the HSRP AF, the following activities may cause a resettlement and/ or land acquisition: Potential permanent land acquisition for construction of healthcare facilities Potential sporadic instances during construction and rehabilitation of removal and subsequent replacement of economic assets (such as trees/fencing), located on government and/ or private-owned land along on-farm irrigation canals. 3

Temporary occupation/use of mostly government but at times private lands for machinery used during construction and rehabilitation. 11. To address the impacts of the project activities, the OP 4.12 requires preparing a Resettlement Policy Framework. The RPF is a framing tool to guide principles, the policies, and follow right institutional arrangements in guiding involuntary resettlement and land acquisition. This framework will secure stakeholders from imparting negative social and economic effects on the persons affected by the project (PAP). 12. Under the unavailability of specific information on the land type, size and the exact location of the land to be acquired, the Resettlement Policy Framework (RPF) has been prepared as a benchmark for the appraisal. In case resettlement and land acquisition does occur under the project, Resettlement Actions Plans (RAPs) will be prepared. It is expected that with the application of RPF provisions, and process, the RAP will ensure that the negative impacts associated with the land requirements for the project will be addressed systematically. RAP will be subject to approval by the World Bank and will be publically disclosed. Principles of Mitigating Land acquisition related impacts 13. This RPF is prepared keeping in view of the World Bank s Operational policy-4.12 principles on involuntary resettlement and these principles will be adhered during mitigation of the impacts. The principles that will apply to this project include but not limited to: The impacts associated with the land acquisition will be avoided wherever feasible or minimized by exploring all viable alternative designs; All the affected people will be meaningfully consulted and provided with opportunities to participate in the planning and mitigation of impacts; Any compensation and assistance to the affected people will be provided at replacement costs and prior to taking over of their assets and as appropriate they will be assisted to improve or at least restore their living standard to the pre-project level; Particular attention will be paid to assist the vulnerable among those affected people; All affected people irrespective of their legal tenure will be provided assistance and support during the transition period as needed and appropriate. IV. Potential temporary and/or permanent social impact 14. The project envisions making an investment in four out of five initial and ten additional regions (Agdash, Aghsu, Balakan, Barda, Gabala, Gakh, Imishli, Ismayilli, Khachmaz, Kurdemir, Oghuz, Shamakhi, Sheki and Ujar) through building 26 primary healthcare facilities and 3 village hospitals, as well as rehabilitating a Children s Hospital in Sheki. The project investments will be spent mainly on institutional development and capacity 4

strengthening in the healthcare sector of the country and construction of healthcare facilities identified by the Ministry of Health based on the National Master Plan. 15. In most cases, state land will be used for the construction as most of the facilities already exist but are operational in bad conditions. Therefore, at this point, no physical resettlement or infrastructure demolition is planned by the project. However, the achievement of the project objectives of healthcare network improvement (construction and rehabilitation of healthcare facilities) might involve minor temporary or permanent land acquisition and/or removal of economically valuable assets which are currently owned by individuals. 16. During the rehabilitation potential sporadic instances of removal and subsequent replacement of assets (such as trees) with an economic benefit, located on government and/ or private owned land along on-farm irrigation canals might occur. 17. In case the existing healthcare facilities will not have a spare piece of land, the land plots will be identified and allocated by the local Executive Powers together with local land and cartography departments. The Municipal land plots in each village are planned to be provided for construction of healthcare facilities. The initial agreement on the provision of land will be reached with the Local Municipality. It is also possible that the construction of healthcare facilities could necessitate the acquisition of small parcels of private land. List of ineligible activities 18. However any sub-projects or activities involving physical displacement of people, demolition of structure used for residence or livelihood purposes or acquisition of agricultural lands amounting to more than 10 percent of productive land owning or damages to cultural priorities, will be excluded from financing under this project. V. Legal framework / Laws in Azerbaijan and WB policy and regulations 19. Land issues, land acquisition, and compensation for property losses in the Azerbaijani legislation are regulated by the following documents: 1. The Civil Code, December 1, 1998, with amendment in April 2012; 2. The Land Code, June 25, 1999; 3. Cabinet of Ministers Resolution No. 110, June 28, 1999; 4. Cabinet of Ministers Resolution No. 42, March 15, 2000; All of these documents provide a firm basis to deal with the issues of land acquisition for public purpose, and for compensating land owners with legal titles. 5

20. Land Code (1999) is the most important document, regulating the rights and responsibilities of the land owners in the context of public land acquisition and involuntary resettlement. It recognizes the right of land owners with legal titles for compensation at market prices in the event their property is acquired for public intentions and, in the event of a disagreement, their right to appeal to the court for the resolution of this dispute. The acquiring party can also approach the law courts to legitimize the acquisition if the owner opposes the acquisition or to the amount of compensation. The Land Code also allows land-for-land compensation. Where a pertinent local executive branch solves a land case, the decision shall come into force instantly and this decision cannot be stopped by the filing a complaint with the appropriate court. Article 70.5 of the Land Code stipulates reimbursement payment to the legally recognized possessors of the property in advance, i.e. in advance of the acquiring authority take over the possession of the purchased property. Articles 110 and 111 of the Land Code state that unauthorized occupation of land plots and unlawful construction on land plots constitute a violation of the land legislation. The articles stipulate that such land plots will be given back to the commensurate authorities without compensation of the operating costs incurred during the unlawful usage. Rehabilitation of the lands, where obligatory, should also be implemented by the unlawful occupants with their own resources. 21. Civil Code (1998) is also an important document, regulating land issues, ownership and usage of land. Registration certificate issued by the Real Estate Land Registry Service based on the cadastral information (survey numbers) obtained from the SLCC (State Land and Cartography Committee) where the land is located, establishes the legal ownership of the land and all of the rights that this ownership gives. District/Municipal authorities may issue provisional ownership certificates. However, according to the Civil Code all of the pieces of real estate should be registered in public agencies. For the purposes of public needs, including the construction of ways and communication lines, identification of borders and construction of national security facilities, can be obtained providing that the market price of the relevant property be calculated and be paid to its owner in advance (Article 157.9). If it is not included in the public needs, the state can obtain any pieces of real estate belonging to private owners through purchasing (Article 207.1). 22. Cabinet of Ministers Resolution No. 42 (2000). Sections I and II of this Resolution make it mandatory for the purchasing authority to reimburse the legal owners when their land is purchased for public use (whether temporary or permanent), and for the damages to their productive assets and crops. The resolution is important in outlining the formal steps for the obligatory purchase of land for state or municipal uses. To procure private land for state needs, the purchasing agent should obtain the consent of owners and of the local district executive powers. The land acquiring party (client) should be responsible for the provision of detailed maps, for consulting the owners and negotiating compensation prices, including cooperation to address all of the outstanding issues with the district/municipal authorities and the local Land and Cartography department (SLCC). The approval of the land acquisition emanates from the raion branch of the local executive power. In case if the latter does not have proper jurisdiction to solve the 6

situation, the land acquisition is approved by the SLCC at the highest level. The approval requires further endorsement from the Cabinet of Ministers. However, actual ownership transfer comes into force only after the client provides another set of documents confirming the details of the design of the proposed facility, availability of funds for the work and a guarantee of payment of the agreed compensation to the owners, lessees and users. When the agreement with the owner of the land cannot be achieved, only then recourse to compulsory land acquisition is taken. Such action requires approval of the relevant court of law. 23. Cabinet of Ministers Resolution No. 110 (1999). The Resolution No. 110 outlines measures for the purchase and valuation of building/immovable properties for public needs. It also refers to the Cabinet of Ministers Decree No. 158 that is to be used as the framing guide for the assessment of land. 24. Compensation for lost assets and real properties may be granted either in cash or in-kind. Importantly, the Resolution also establishes a stipulation that the compensation for the acquired land should amount to market prices, the latter established by one of the following ways: Sale prices of the immovable assets in the corresponding administrative district over the preceding 90 days earlier than the census date or public pronouncement of the decision on immovable property purchase, whichever of them comes earlier; Replacement value of the assets and land, if there have not been adequate numbers of immovable property deals in the project area to establish a just price for the land, or if land for land compensation is provided; or In case sales price or replacement costs cannot be identified to establish a fair and real value of land, any price which is no less than the normative price of the corresponding plot. 25. In case the affected people need to be physically relocated and/or alternative sources of livelihoods need to be established for them, the following should also be included into the compensation package of them: In case of acquisition of agricultural land, costs related to the preparation of lands for sowing, as well as any fees and taxes mandatory for the purchase and register new agricultural land. Expenses connected with restoration of facilities such as utilities and connecting roads if such facilities are not provided by the expropriators. If a person is obliged to be physically relocated or leave current jobs, transport and other expenses that result should be provided. Income loss from agricultural or commercial activities will be compensated based on the income of the most recent year. Any fees, taxes and duties required for the registration of new properties. Building materials and other productive assets left for owners after the demolition of buildings. 7

26. In order to compensate damages resulting from the purchase of property, as well as lost income and loss connected with the pre-termination of commitments against third parties, the President Decree (2007) establishes that 20% additional compensation will be added to the market price of affected land. VI. Gaps with World Bank's OP on Involuntary Resettlement and the mechanisms for bridging the gaps 27. Many of the crucial stipulations of the WB s OP 4.12 are covered in full or in part by current Azerbaijani legislation. These are the following: The obligation to provide compensation beforehand where land is compulsorily acquired (Land Code, Article 70.5 and Civil Code, Article 207.1); The requirement to reimburse based on full market price or through donation of another land plot or building of equal quality, size, and value (Land Code Articles 8 and 70.5, Civil Code, Article 207.1); The need to evade, wherever likely, effects on agricultural land and forests (Cabinet of Ministers Decree No. 42, section I, article 2); The obligation to compensate for losses, whether temporary or permanent, in output or damage to productive assets and crops (Cabinet of Ministers Decree No. 42, Sections I and II) 28. The following World Bank OP 4.12 requirements are not reflected in Azerbaijani law: Land acquisition (and/or resettlement), preparation, and technical requirements; Public consultation and participation of project-affected communities; Amount of compensation and types of support to be accessible; Categories of citizens qualified for compensation; Income restitution; Support to all affected people irrespective of title to the affected properties; Support during the transition period. Resettlement Preparation and Requirements 29. The Azerbaijani legislation does not require the preparation of formal Resettlement Action Plan (RAP), nor to address other important aspects of the resettlement like a census, socio-economic survey, and consultation with project-affected people (PAP), monitoring, or reporting. The legislation does not refer specifically to involuntary resettlement either. The current legislation of the Azerbaijani Republic does not regulate or have inferences to community participation in the resettlement planning process and the requirement to improve or enhance the living standards and income and production levels of PAP. 8

30. Actions that will be undertaken under the project to guarantee the compliance with OP4.12 provisions such as: Consultation with PAPs to wherever possible avoid the inclusion of infrastructure that might lead to land acquisition under the project-financed civil works; Consultation with likely project-affected people on realistic actions for land acquisition if applicable; Outlining and executing a full public consultation strategy and disclosure plan prior to land acquisition process; Implementing a social screening for each sub-project to discover the need for an RAP if appropriate; Preparing RAP as appropriate to mitigate the impacts associated with the land acquisition, which will describe the compensation and assistance based on the nature and magnitude of impacts; Full disclosure of the approved and agreed RAP; Informing PAP of their rights to help and clarifying this plainly, with supporting information and material, if suitable. Public Consultation and Participation 31. OP 4.12 notes that PAP should be informed about their alternatives and rights dealing with to land acquisition consulted on, offered choices and provided prompt and effective compensation at full replacement. (Clause 6 (i), (ii)). Currently there are no precise consultation prerequisites in the Azerbaijani law. 32. Steps that will be taken under the project to guarantee fulfillment of OP4.12 will embrace: A public consultation gathering that will be implemented after social screening to (i) jointly with the health authorities and PAPs review the list of proposed infrastructure for rehabilitation and adapt the list to remove any infrastructure that might lead to land acquisition which might potentially have negative impact on PAPs; (ii) inform PAPs of the essence of the project, anticipated result, entitlements for compensation, and steps for complaint redress; Disclosure of the project environmental and social information as an essential part of the public consultation process, with information disclosed about both advantages and disadvantages of the project; Information plainly presented in suitable local languages and dialects and in ways that are of high importance to local communities; Information shared in places that are available to the public and that are readily reachable by PAP. Special measures to make sure that women are well represented in consultation and participation processes. 9

Compensation Eligibility 33. The categories or types of citizens who must be compensated under the Azerbaijani laws are narrower than those outlined under OP 4.12. Under the legislation, the only citizens and agents entitled to reimbursement are those with registered property rights, for example, registered landowners, leaseholders, users and those with registered third-party rights, and those who have legally achieved the right to register their title but who have not finished registration. This potentially prevents many types of affected citizens that would be eligible for reimbursement under WB Group policies. These categories of affected people that would be entitled to compensation under the WB polices include: Farmers who use land based on an informal agreement often with a relative or extended family member; Owners who occupy land that was transferred by informal agreement from another owner; Owners who have not registered a change in ownership following a family death, marriage annulment or similar situation; Internally Displaced People (IDPs) (who have no rights to land); People who make use of communal resources to which they have no formal title; Informal dwellers. Income Restitution 34. Some types of compensation fully or partly have been covered by the Civil Code. WB OP 4.12 specifies special compensation is planned for all those people, who might lose income because of loss of land or annual crops or perennial crops/plants loss because of resettlement. In this case, the farmers will be compensated from the government counterpart funds. The special assessment will identify the amount of income loss in case of the loss of perennial crops/plants. In addition to compensation, suitable assistance will be extended to improve or at least restore their incomes to pre-impact levels. VII. Institutional Framework 35. The HSRP will be implemented by the PIU under the Ministry of Health of the Azerbaijan Republic. MoH will be responsible for the RPF and for any land acquisition issues that might occur in any of their project regions in Azerbaijan. Depending upon the magnitude of impacts, necessary steps will be taken to strength the PIU to implement the land acquisition related impacts. MoH will use counterpart funds to make the payment of compensation, with assistance of the regional local land commission and the local Executive Power authority and Municipality of the specific rayon, as planned in the RAP and approved by the Cabinet of Ministers. 10

VIII. Process for addressing Land Acquisition/ use and/or Resettlement issues. 36. The project will provide funds for the construction of 26 primary healthcare facilities and 3 village hospitals as well as the renovation of on hospital in the selected regions. These construction and rehabilitation works will serve to the effective implementation of the National Master Plan with improving the network of healthcare facilities and expand the infrastructure development activities across 14 regions. 37. The PIU with the help of a consultant on social issues/resettlement who is part of the team of the design and construction supervision technical assistance will undertake social screening for each civil works contracts prior to invitation of bids to screen the potential impacts related to land acquisition and resettlement. In addition, the social screening will verify if any non-title owners are likely to be affected. Based on the screening, an appropriate abbreviated Resettlement Action Plan will be prepared if required. The Resettlement Action Plan will describe the affected persons, the potential negative impacts and the proposed compensation and assistance in line with the principals outlined in this RPF. The screening reports and RAP will be shared with World Bank for review and endorsement prior to invitation of bids for respective civil works contracts. Following the World Bank s endorsements, appropriate approvals within the Government will be obtained for the RAP to secure necessary budget support for its implementation. 38. The screening process includes the following steps: (i) the PIU the specialist on social issues together with the design team and health authorities will do a social screening of the sites prior to construction/ rehabilitation works. For this, they will visit potential sites. Sites without any PAPs will be selected, and if this is not feasible, (ii) the specialist on social issues and health authorities will make an inventory of encumbrances on the proposed site and will discuss these encumbrances with local possibly affected people; (iii) health authorities under supervision of the specialist on social issues and PIU will record all encumbrances in the screening format and will, for two weeks, publish list of all affected people in the area in which a healthcare facility will be constructed; ( iv) during these weeks, each health authority is responsible to conduct a public consultation meeting with affected person(s); (v) afterwards health authorities will modify the list of infrastructure to be rehabilitated and the construction schedule based on comments during the consultation and prepare a protocol, which will be signed by each affected beneficiary. This list of PAP will be considered the final census for the purposes of RAP preparation and the day it is signed will be the cut-off date, the baseline date for RAP preparation; (vi) in case significant resettlement issues are foreseen, the project will not be eligible for funding of the intended construction works; (vii) in case of minor impacts, a brief RAP will be prepared in line with the RPF provisions to mitigate the impacts and losses. Wherever, land acquisition impacts are triggered based on the social screening, a brief RAP will prepared in consultation with the affected people and the draft will be submitted to the World Bank for prior review in advance to the bidding process for the respective civil works contract. All actions entailed in the RAP will be completed before commencement of the civil works. 11

39. The following steps summarize the selection and review (approval) of each healthcare facility for rehabilitation (R-HCF), followed by design, contract procurement, implementation, and completion: a) Preliminary Assessment (rapid appraisal) carried out by a small team headed by the PIU Engineer and relevant Coordinator, design engineer and the specialist on social issues from the design and construction supervision technical assistance team and representatives of health authorities. The aim is to explore the health authorities readiness, willingness, and competence (financial, administrative and technical) to participate in the rehabilitation program. The assessment will include a walk through reconnaissance survey of the system, determine preliminary feasibility and costs, and ensure compliance with selection criteria. It may sometimes be necessary to abandon the healthcare facility. b) Technical Review: preparation of a brief preliminary rehabilitation form (under ten pages) to provide sufficient justification for MoH and the Bank to approve the healthcare facility for inclusion in the program. The form will include summary rehabilitation proposals, a schematic map, and an economic assessment of the tentative costs and benefits. c) Surveys and Engineering Design. Following MoH and Bank s approval, the R-HCF will be included in the program and a Rehabilitation Agreement will be signed. The required surveys and preparation of detailed engineering designs, including quantities and costs and submission these to PIU for approval will be undertaken. In addition to the preparation of designs, project engineering consultants will draw up bidding documents, act as technical advisors in the tendering process, and be responsible for the direct supervision of contractors executing the works. d) Procurement of a contractor to execute the works will be through competitive bidding following procedures acceptable to the GOA and the Bank. Some R-HFC contract packages for healthcare facility rehabilitation works may qualify for international competitive bidding (ICB), but national companies are expected to predominate. e) Contract Implementation: There will be a tripartite relationship between the PIU, consultants and contractors for execution of civil works contracts. Prior to handing over of the land to the contractors, PIU will provide all compensation and assistance to the affected people as proposed in the RAP, if any. There will be a specific reference in the civil works contracts that any unforeseen permanent or temporary impacts related to land and displacement are encountered by the contractors; they will bring to the notice of PIU promptly for necessary action in line with RPF provisions. The project will engage two Construction Engineers as the PIU s direct engineering representatives. These engineers will carry out joint inspections with consultants, a representative of the relevant healthcare authority, and the contractor with regard to approval of contractors claims for completed works. The engineering consultants will have direct control over contractors and a role in monitoring, inspection and liaison. The flow of project funds will be 12

controlled and authorized by the PIU, with the project manager, consultants representative, Construction Engineer(s), as co-signatories for payments to contractors. f) Contract Completion: The final progress payment will be released after inspection of the completed works. It is anticipated that many healthcare facility works will be completed over three-year period. 40. The following actions for the project activities will be carried out in partnership with the healthcare authorities: 1. During the walk-through, the design engineer, the PIU Coordinator jointly with the healthcare authorities will determine the preliminary identification of infrastructure to be rehabilitated, the preliminary construction schedule, and the location of the healthcare facility. The selected healthcare facility with guidance of the design team and the specialist on social issues/resettlement will identify all the potential impacts and prepare a comprehensive list of PAPs. 2. The healthcare authority with assistance of the specialist on social issues/resettlement will prepare a list of affected beneficiaries with details of impacts. Two weeks time will be provided to hear any grievances of non-inclusion of affected people for compensation and assistance. The healthcare authority will conduct a public consultation meeting with the affected beneficiary, modify the list of infrastructure to be rehabilitated and the construction schedule based on comments during the consultation, and will prepare a protocol, which will be signed by each affected beneficiary. This protocol will state that the affected people: a. Agree with the selected list of infrastructure and rehabilitation schedule. b. Agree that the scheduled construction/rehabilitation does not temporarily or permanently occupy their land or causes economic damage. c. Are explained the process for establishing any compensation and assistance proposed for mitigating adverse impacts, if any. d. Are informed about the grievance procedure. 3. The protocol signed by all affected beneficiaries will be attached to the Rehabilitation Agreement signed by MoH and health authorities. This list will be considered the final census of the affected people for purposes of RAP preparation. All grievances will be referred to the independent grievance committee who will consult the affected people and implementing agency and resolve in line with the policy provision and principles. 41. RAP and Compensation mechanisms in case of eligible affected beneficiaries will be as follows: The specialist on social issues/resettlement and the respective PIU coordinator will determine the needs and scale of land acquisition and/or temporary land use based on social screening, and assessment of the affected properties. Then the results of assessments will be reported to the Cabinet of Ministers, sending also the details of the land under acquisition/use to the Land and Cartography Committee. 13

The Cabinet of Ministers will assess the process and establish the normative prices/compensations for land, property and income loss. MoH will define the budget for compensation allocated from project money. MoH will pay the compensation out of the government part of the project money, if needed. MoH will inform on the land acquisition/use dynamics in their project report. Periodical progress reports will be submitted to the World Bank on implementation of land acquisition impacts. The Bank team will also monitor during the supervision mission thorough field visits and interactions with the affected people and those responsible for implementation. MoH will be accountable for monitoring of the progress and effectiveness of the land acquisition/use process. Public Consultation and Grievance Redress 42. To address possible grievances of the beneficiaries, affected by the project, a public consultation will be launched for them and their representatives. The specialist on social issues/ resettlement Specialist and the respective PIU Coordinator will provide detailed project-related data and outline project impact dynamics for all those who need information of this kind. They will pay particular attention to individuals, who have no prior experiences in consultation. Information on compensation procedures as per the RPF as well as a grievance system nuances will be explained to people affected by the HSRP. Important aspect of the work with affected people is the explanation to them of the most direct procedures for the handling of grievances. In addition, the respected community leader will be selected in each community to represent the interests of affected people and redress of grievances. The respected community leader will be a part of the grievances redress committees. MoH/PIU will follow-up to ensure the grievances have been adequately resolved. The World Bank will be informed about the grievance handling performance on request. 43. Basically the redress a grievance process will: Offer affected people with direct and easily reachable ways for suiting a complaint or deciding any disagreement that may arise through the progress of the project; Guarantee that suitable and mutually satisfactory remedial actions are identified and immediately carried out to address grievances; Permit confirmation that grievances are satisfied with results of remedial actions; Evade the need to turn to judicial or pre-judicial measures. Costs and budget allocation 44. The costs and specifications of the land acquisition and compensation for crops (lost during the period of construction and rehabilitation) are difficult to determine at this point, because the exact locations of the healthcare facilities to be constructed have not been determined yet. In addition, the price for the land and crops tends to fluctuate 14

seasonally and region-wise. Based on the impacts identified in the social screening, the compensation will be determined based on the principals outlined in this RPF. IX. Monitoring and Evaluation 45. The supervision and monitoring, as crucial components of the resettlement/land acquisition plan, should be carried out by MoH/PIU during and after the project implementation. The project objective and purpose will guide land acquisition specifications. If the need arises, modifications to the plan can be made. What follows is a summary of the key elements needed for a good monitoring process: Internal performance monitoring Monitoring will involve checking that physical progress has been made in conducting the required actions. The specialist on social issues/resettlement will produce monthly reports on progress and submit it to PIU/MoH and World Bank team. The key indicators to be checked are as follows: Public consultation meetings held; Census, asset inventories, assessments and socio-economic studies completed; Grievance and redress procedures in place and functioning; Compensation payments disbursed; Land acquisition, if needed, completed; Income restoration activities initiated; Monitoring and evaluation reports submitted. Impact monitoring The impact monitoring will be used to assess the effectiveness of the RAP and its implementation in meeting the needs of the affected individual(s). The key indicators to be checked are as follows: Employment and income opportunities provided; Training and other support provided; Awareness and concerns of people regarding the resettlement process, their entitlements and rehabilitation through interviews with a random sample of the affected people from different sites; Compliance with RAP assessed through observations at public consultation with affected people and monitoring of the function of land acquisition operation; Types of grievance issues and the effective functioning of grievance redress mechanisms by aggrieved affected people interviewed through reviewing grievance and appeals processing; Living standards of affected people after the implementation of the land acquisition assessed through surveys to check whether living standards have been improved or maintained compared to baseline information. 15

46. External monitoring and evaluation should be implemented by an independent third party. The monitoring and evaluation should include all the elements of resettlement/ land acquisition. The indicators identified for monitoring will include timely compensation of screening prior to invitation bids, timely payment of compensation and assistance prior to taking over of the affected assets, handing over of unencumbered land to the contractor s timely redress of grievances, etc. The impact evaluation should reflect changes in social and economic situation of PAP, the use of land, terms of compensation, timing to resume farming during rehabilitation works, etc. 2 47. Disclosure. This RPF will be disclosed in local language on the web site of MoH and other public places accessible to the local people in the project area. This RPF will also be disclosed by the World Bank in their Info Shop. Subsequently, if any abbreviated RAPs are prepared, those will also be disclosed in the web-site and other public places accessible to the local people. 16

Annex A: Impacts & Entitlements Matrix The following matrix addresses impacts anticipated at the time of the preparation of the RPF, and may not include all impacts that may actually occur, which will be addressed under site-specific RAPs. Project Impacts Project activities Project Affected Persons Entitlements/ Types of compensations Permanent land acquisition Land owners /IDPs Land for land compensation with plots of equal value and productivity to the plots lost (OR); Temporary land acquisition/ use Removal / replacemen t of Construction of primary healthcare facilities and village hospitals Rehabilitation and repair works (use of machinery and/ or location of temporary contractors camps on private or state lands plots) Construction and repair works on private owned Farmers who use/lease land but have no rights to land Owners with land use rights, farmers who use/ lease land but have no rights to land/idps Households/ Owners with land use rights, farmers who use/ lease Cash compensation for land (equivalent to market price ) with 20% additional compensation in line with the provisions of President Decree-2007; Cash compensation for expenses related to the preparation of land for sowing, any fees and taxes for the purchase and register new agricultural land; Cash compensation for annual crop production. Cash compensation for annual crop production for one year; Cash compensation for transport and other expenses that resulted due to physical relocation and / or loss of current jobs. Upon works completion, the land will be restored to its pre-project condition and returned to the owner/user; Cash compensation for loss of crop production for the period of construction; Cash compensation for loss of immovable assets and land attachments. Cash compensation reflecting asset and income replacement. If trees, assets will be valued based on age category and market value of one year income times the number of years to grow a new tree with similar 17

Project Impacts economical ly valuable assets Unforeseen impacts Project activities land Project Affected Persons land but have no rights to land/ IDPs Entitlements/ Types of compensations productivity and expenses for seedlings. Impacts will be mitigated in accordance with RPF principles an provisions 18

Annex B: Outline of a Resettlement Action Plan Each site-specific RAP will consist but not limited to the following parts: 1. Project Description: a. Project background; b. Project objectives; c. Project activities; d. Policy Provisions (summary of RPF and cross references as needed). 2. Social Impacts Assessment: a. Scope of land acquisition/resettlement impacts; b. Results of census/socio economic surveys; c. Baseline socio-economic characteristics of the affected people. 3. Land acquisition and resettlement Process: a. Public consultation and participation; b. Entitlements and compensations. 4. Implementation Arrangements: a. Institutional arrangements; b. Grievance redress Mechanisms (Registration complaints Communication, Judicial or pre-judicial measures if needed); c. Compensation and Assistance Distribution Process; d. Coordination between RAP implementation and Civil works time table; e. Budget and costs; f. Monitoring and Evaluation arrangements Annexes: List of Different categories of affected people and other relevant supporting data. 19