HEALTH PROJECT IMPLEMENTATION UNIT



HEALTH PROJECT IMPLEMENTATION UNIT

Environmental Management Framework

NON-COMMUNICABLE DISEASE

PREVENTION AND CONTROL PROJECT

Yerevan, December 2012

List of Acronyms

ANC - Anti-Natal Care

AOC - Armenia Oncology Center

BOD - Biological Oxygen Demand

CJSC - Closed Joint Stock Company

EIA - Environmental Impact Assessment

EMP - Environmental Management Plan

HPIA - Health Project Implementation Agency

MAC - Maximum Admissible Concentration

MC - Medical Center

MCH - Maternal and Child Health

MPE - Maximum Permissible Emission

MPD - Maximum Permissible Discharge

MNP - Ministry of Nature Protection

MoH - Ministry of Health

MoNP - Ministry of Nature Protection

NDPC - Non-communicable Disease Prevention and Control

PAD - Project Appraisal Document

PIP - Project Implementation Plan

PHC - Primary Health Care

PM - Particulate Matter

RA - Republic of Armenia

SHA - State Health Agency

SNCO - State Non Commercial Organization

SPA - Specially Protected Areas

VOC - Volatile Organic Compound

WB - World Bank

Table of Contents

1. INTRODUCTION 4

2. PROJECT DESCRIPTION 5

2.1. Project Development Objective 5

2.2. Project Components 5

2.3. Infrastructural elements to be provided 6

2.4. Work site locations 8

3. LEGAL AND POLICY FRAMEWORK 9

3.1. National Legislation 9

3.2. Licenses and permits to be obtained by the project proponent and by works contractor to carry out project activities 12

4. TECHNICAL AND ENVIRONMENTAL STANDARDS AND REGULATIONS 13

4.1. National Technical standards 13

4.2. The World Bank Safeguard Policies 13

4. ENVIRONMENTAL AND SOCIAL SCREENING 15

6. SENSITIVE RECEPTORS AND POTENTIAL IMPACTS 15

6.1. Sensitive Environmental and Social receptors 15

6.1.1. Ambient Air 15

6.1.2 . Water Resources 16

6.1.3. Land Resources 17

6.2. The Main Environmental and Social Risks 17

7. IMPACT MITIGATION 18

7.1. Construction Phase: Short Term Impacts

7.2. Operation Phase: Long Term Impacts 20

8. STAKEHOLDER CONSULTATION 20

9. SITE SPECIFIC ENVIRONMENTAL IMPACT ASSESSMENT AND MANAGEMENT 21

ANNEXES

1. INTRODUCTION

Armenia faced enormous difficulties after the collapse of the Soviet Union. It led to the crisis in the provision of public services, including health care system. Main issues accumulated in the health sector of Armenia since independence were considered to be the following: low access and use of health services; under-funded healthcare system with poorly and inequitably used resources; high out-of-pocket informal payments; low perceived quality of care, especially in regions; excess capacity of physical infrastructure of hospitals and polyclinics; and geographic mal-distribution of health workforce between Yerevan and the regions of the country.

Challenges of the health sector were ensuring equitable access to essential health services on a sustainable basis; managing public health threats and prevent avoidable mortality; reducing substantial overcapacity in the hospital sector while improving the role and quality of primary care and strengthening key functions of the State in health sector - particularly in the areas of governance and quality assurance.

The reform process, initiated in the mid-1990s, aimed at enhancing efficiency and ensuring accessibility and quality of essential health services, particularly for vulnerable groups. The Government of Armenia has undertaken changes in the health care sector in the following main directions:

• Improvement and strengthening of the primary health care system, emphasizing health promotion and disease prevention measures accompanied by introduction of family medicine, to increase accessibility and efficiency of the health care services.

• Optimization of oversized and overstaffed health care services aimed at meeting the health care needs of population and improving the quality and accessibility of services.

• Development of a health care financing model to address weaknesses in the financing of public-funded health care services, introduce and formalize alternative sources of funding to strengthen the official financing systems and eliminate informal payments.

• Strengthening government institutional capacity, and improving governance and financial accountability arrangements of health facilities.

The first WB supported Armenia Health Finance and Primary Health Care Development Project was implemented in the years of 1997-2003 and significantly contributed to the success of the country health reforms and developments. The Health Systems Modernization Project (HSMP) is an ongoing two phase Adaptable Lending Program (APL) with a lifetime of approximately eight years. The rationale behind the HSMP is to support the reform of the health sector in Armenia in the three main areas: (i) development of primary health care, (ii) hospital optimization and modernization, (iii) and strengthening of the government institutional capacities. The first phase of HSMP started in December 2004 and closed in June 2010. The second phase of the project started in June 2007 and is expected to end in December 2012. An on-going APL2 activity started in 2011 and is expected to end in December 2014. The aim of the APL 2 project is to (i) support quicker transition to family medicine based on PHC, (ii) complete the marz hospital modernization process, and (iii) facilitate further institutional strengthening of the system.

Since 2004, Government has successfully implemented a hospital optimization and modernization reform agenda with the support of the WB and other development partners. In most of the regions (marzes), notable efficiency and productivity gains have been achieved through consolidation of hospital infrastructure and services and reduction of duplications. The bed occupancy rate has increased in all marzes and in Yerevan and is now well over 60 percent. The hospital optimization program in Yerevan and the marzes was matched with large investments in infrastructure, equipment and staff training.

The Government of Armenia is now preparing to launch a new WB-financed Non-communicable Disease Prevention and Control (NDPC) Project. NDPC Project will provide technical assistance and will invest in the provision of adequate premises for several clinics.

It will support the national priorities in health sector aimed at further modernization of the regional medical centers, as well as prevention, early detection and control of Non Communicable Diseases.

2. PROJECT DESCRIPTION

2.1. Project Development Objective

The NDPC Project Development Objective is to improve:

i) Maternal and Child Health (MCH) services and the prevention, early detection, and management of selected non-communicable diseases at the Primary Health Care (PHC) level; and

ii) The efficiency and quality of selected hospitals in Armenia.

2.2. Project Components

The proposed Project will comprise three components as follows:

Component 1: Performance based incentives to improve MCH and NCD services in primary care facilities

This component will support the strengthening of the on-going primary health care P4P program in Armenia as well as expanding its scope. This will be done through:

a. adding performance indicators (especially quality of ANC visits, screening for cervical cancers, screening for hypertension and high cholesterol),

b. increasing the frequency of verification of results and payment,

c. enhancing SHA verification of results by turning them into supportive supervision visits with technical feedback for individual health facilities,

d. introducing counter-verification of results by an independent third-party (which involves checking with a random subset of patients if they actually received the services reported),

e. standardizing all the procedures for self-reporting, verifications and counter-verifications of results with the development and use of instruments, protocols and manuals,

f. strengthening the HMIS to accommodate the reporting of the new indicators,

g. introducing mechanisms for peer learning and peer competition,

h. putting in place mechanisms to ensure the poor’s access to treatment after screening (such funding will be provided by the Government).

Component 2: Improving efficiency and quality of selected hospitals

This component will finance further upgrading and refurbishing of the marz hospital network in Lori marz, particularly in Vanadzor city, namely: civil works, provision of medical and waste management equipment, TA and training activities aimed at improving the management system of Vanadzor Medical Center (MC) as well as increasing professional skills and competencies of medical staff. This component will also improve the quality of specialized in-patient and out-patient hematological services in Armenia by financing reconstruction of the Center of Hematology in Yerevan and creation of a Bone Marrow Transplantation Unit at the Center. Furthermore, this component will support the establishment of a new Armenia Oncology Center (AOC), which would allow for the provision of integrated oncology services for the Armenian population through the construction of a single building that would house all related services and that would replace or combine current services and their related budgets/expenditure. Technical assistance to be delivered through this component will assist the Government with the creation of a comprehensive cancer registry system for Armenia; development of the clinical guidelines and standards for hospitals; and the scale-up of the Quality Improvement Program in all marz hospitals of the country.

Component 3: Project Management

This component will support day-to-day project management, including fiduciary tasks, and monitoring and evaluation. It will finance project operating costs, including translation, interpretation, equipment, supervision costs (transportation and per diem), salaries of the HPIU staff, and incremental operating costs at the MoH.

2.3. Infrastructural elements to be provided

The proposed NDPC Project will finance investments into the improvement of health sector infrastructure and the technical assistance. Investments into the hard infrastructure will include:

i) Construction of a new building for Vanadzor MC in Lori marz;

ii) Construction of a new building for the AOC in the city of Yerevan; and

iii) Reconstruction of the Center of Hematology named after prof. R.H. Yeolyan in the city of Yerevan.

Construction of a new building for Vanadzor Medical Center

Governmental Decree N 699-N was issued on April 24, 2011, according to which optimization of Vanadzor health care system shall include merging Vanadzor Hospital N2 and Vanadzor Hospital N1 named after L. Areshyan. As a result the new Vanadzor MC CJSC was founded.

In addition, in accordance to the 4th point of the mentioned Decree the Government of the RA assigned the Minister of Health to start negotiations with World Bank for allocation of funds for construction of a new Vanadzor MC. Feasibility study for this new construction was carried out in October 26, 2011. Outcomes of this study justified new construction due to excessively high estimated costs of capital reconstruction of the existing two buildings which carry structural damages unacceptable in the seismically active area of Lori marz. Costs of the new construction were estimated to be some 1,148,000 USD less than works required for fundamental reconstruction of the two existing buildings. The new Vanadzor MC will provide all kinds of hospital and polyclinic services on one equally accessible location for the entire population of the Lori marz. The implementation of this plan will result in vacation of the Vanadzor Hospital N2 (except the Tuberculosis department block) and of the Vanadzor Hospital N1.

The new building of the Vanadzor MC will be of approximately 9.000 square meters (detailed design is yet to be developed) and will consist of the following departments:

• Admission and emergency

• Diagnostic department and polyclinic

• 190-bed in-patient hospital including surgery, pediatrics, obstetrics-gynecology, children’s intensive care, general therapy, oncology, adults’ intensive and hemodialysis.

• Support services, including sterilization, laundry, engineering, logistics, etc.

Construction of a new building for Armenia Oncology Center

The existing National Oncology Center (NOC) is located in Yerevan and is a 500-bed public facility with a capacity of 7.500 patients per annum, providing specialized in-patient and out-patient diagnostic and treatment services, including surgery, radiotherapy and chemotherapy. It serves the capital city of Yerevan and all regions of Armenia. The proposed modernization of the cancer diagnostics and treatment services aims at the improvement of the quality and accessibility of oncological treatment services in the RA. Towards this end a new building will be construction for the AOC next to the Radiation Treatment Center with modern radiological equipment, which is already under construction. The two will comprise the Armenian Center of Excellence in Oncology.

The AOC will be located in Yerevan, in 5-6 km distance from the city center, in the areas where other hospital facilities are currently under construction. In that regard the proposed AOC nicely blends into the government’s long-term plan for the creation of a hospitable multi-profile zone of medical services, based on the principles of medical exchange, mobility of patients between facilities, and multidisciplinary consultation.

The AOC building is expected to be of about 2700 square meters. The structure will accommodate in-patient department, ambulatory hospitalization department, consultation, training facilities for the medical and ancillary staff, laboratories for immuno-hematology and pathology, as well radiotherapy. The basic core will include the administration, reception, consultation rooms and laboratories.

Modernization of the Center for Hematology named after prof. R.H. Yeolyan

Center of Hematology is a republican specialized tertiary care facility for management of blood malignant and non-malignant diseases, as well as providing blood collection, lab examination, central blood bank and transfusion services to the population of Armenia. Center of Hematology also provides health care to women with anti-erythrocyte antibodies, and production and quality control of immunoglobulin with the purpose of prevention of rhesus-conflicting pregnancy, immunization of donors for obtaining of high-titer immunized plasma, etc. The Center of Hematology is a 75-bed (50 adults and 25 pediatric beds) facility combining conduct of scientific research and provision of public medical services.

The analysis of the hematological services in Yerevan showed that the premises of the Center for Hematology require general reconstruction/renovation, as well as provision of modern medical equipment and furniture. Also, because transplantation of the bone marrow and the peripheral stem cells is considered an effective modern method for treating hematological diseases, the establishment of Intensive Chemotherapy and Bone Marrow Transplantation department is part of the Center’s modernization program.

The NDPC Project will invest in renovation/reconstruction of sub-buildings of the Center and the provision of modern medical equipment, supplies and furniture. Works will be performed within the perimeter of the existing buildings and will use conventional technologies. There will be no need for the establishment of a work-site camp and/or installation of a concrete missing plant. Temporary storage of the construction materials and waste will be possible within the fenced land plot around the Center for Hematology. Overall, the scope and nature of the proposed works are well known upfront and their environmental and social risks are minimal. A site-specific Environmental Management Plan (EMP) for this investment is already prepared, including impact mitigation measures and arrangements for monitoring their application. Therefore, the present EMF does not cover reconstruction of the Center for Hematology.

2.4. Work site locations

Vanadzor Medical Center

The new building of Vanadzor MC will be located at Nzhdeh Str. 2/42, next to the existing hospital N1. The allocated land plot is 3.172 ha. It is State-owned and is currently not in any formal or informal use. There are several dilapidated buildings of the former military hospital on this plot. Other than the hospital N1, there is a military base in the neighboring area, while some land is staying idle.

The selected location is convenient, because it is well accessible by public transport and at the same time it is close to the green zone surrounding the town. The plot is easily connectible to the water supply and sewage networks, power supply grid, and gas supply system of the Vanadzor municipality.

State registration certificate of rights to the real estate (cadastre code 06-001-0347-0130) with the right of using it was granted to Vanadzor Medical Centre LLC on the 24th of May, 2012 (this and other documents on the land plot are attached) by Vanadzor municipality and the former user have no land rights .

Armenia Oncology Center

The AOC will be located in Yerevan, in 5-6 km distance from the city center. The total area of ​​the AOC premises are estimated to be about 15.000 square meters, including the main building (12,300 square meters) and the building for radiotherapy unit with four bunkers (2,700 square meters). It is planned that the main building will comprise three levels - 4,100 square meters each. The radiotherapeutic sub-building planned to have two levels - 1,350 square meters each. The isotope production sub-building, to be located on the same land plot, will have two levels and its total area will make 3,000 square meters. So it is anticipated, that the first floors of all buildings will occupy area of approximately 7,000 square meters.

Decree of the RA Government N 1447 dated November 15, 2012 recalled user rights to the State owned land plot allocated for the AOC from the National Scientific Laboratory after A.I. Alikhanyan (former Institute of Physics; later renamed by Government Decree N 758 dated June 2010) and passed them back to the Ministry of Economy of the RA (see attached). The land plot allocated for the AOC is within a large fenced and guarded area carrying several buildings of the National Scientific Laboratory after A.I. Alikhanyan registered at Halabyan str.38/7 (Alikhanyan Brothers str. 2), which is closed for public access at present. Since the land plot is located between the Halabyan and Alikhanyan Brothers streets and the exact location of the planned buildings is not decided yet, the two addresses are mentioned in the Government Decree.

Other than the premises of the National Scientific Laboratory after A.I. Alikhanyan, the ongoing construction of a new building for the radioisotope production is on the land plot allocated for the AOC. This facility will be operated by the Center of Isotope Production - a Closed Joint Stock Company, 100% State owned. The Center was founded through the Government decree N 1424, dated October7, 2010. Beyond the fenced area there are some residential buildings to the south, and a couple of operating medical institutions to the west. Hrazdan River Canyon is 0.5km away to the south-east. The territory of the National Scientific Laboratory is served by the water supply, sewage, power supply, and gas supply utilities.

3. LEGAL AND POLICY FRAMEWORK

3.1. National Legislation

The 10th Article of the Constitution of the Republic of Armenia (adopted in 1995 and amended in 2005) states the State responsibility for environmental protection, reproduction, and wise use of natural resources. Since 1991 more than 25 codes and laws as well as numerous by-laws and regulations have been adopted to protect the environment.

- Land Code (2001)

The Land Code defines the main directives for management use of the state lands, included those allocated for various purposes, such as agriculture, urban construction, industry and mining, energy production, transmission and communication lines, transport and other purposes. The Code defines the lands under the specially protected areas as well as other reserved lands. It also establishes the measures aimed to the lands protection, as well as the rights of state bodies, local authorities and citizens towards the land.

- Water Code (2002)

The main purpose of the Water Code is to provide the legal basis for the protection of the country’s water resources, the satisfaction of water needs of citizens and economic sectors through effective management of water resources, and safeguarding the protection of water resources for future generations. The Water Code addresses the following key issues: responsibilities of state/local authorities and public, development of the National Water Policy (2005) and National Water Program (2006), water cadastre and monitoring system, public access to the relevant information, water use and water system use permitting systems, trans-boundary water resources use, water quality standards, hydraulic structures operation safety issues, protection of water resources and state supervision.

- Mining Code (2011)

The code defines principles and rules of mining in the RA, the relations related to preservation and use of the deposits, conditions and requirements of efficient use, complex use and preservation of deposits, security of mining and protecting the environment from its negative impacts, as well as protection of rights of the state, citizens and users of deposits. According to the Code, natural deposits areas under the exclusive ownership of the state. They may be given out for use for a certain period of time, and cannot be privatized. The law also determines conditions, requirements and peculiarities of the natural resources and deposits. It also establishes payment principles, compensation, monitoring, and limitation for mining activities.

- Law on Environmental Impact Assessment (1995)

The Law on Environmental Impact Assessment (EIA), passed in 1995, provides legal basis for implementation and introduction of State expertise of planned activities and concept frameworks as well as presents the standard steps of the EIA process. The Law establishes general legal, economic, and organizational principles for conducting mandatory State EIA of various types of projects and concepts of sectoral development. Construction of the AOC premises fall under the category of activities requiring EIA and the Government’s positive conclusion on its outcomes.

- Law on Ensuring Sanitary-epidemiological Security of the RA Population (1992)

The Law “On Ensuring Sanitary-Epidemiological Security of the RA Population” was adopted in 1992, which sets legal, economic and institutional bases for ensured sanitary and epidemiological safety of the population, as well as other guaranties provided for by the State to exclude influence of adverse and hazardous factors on human organism and ensure favorable conditions for vital capacity of the present and future generations.

- Law on Atmospheric Air Protection (1994)

The objective of the Law is to provide the cleanness of the atmospheric air, elimination and prevention of the negative impact on the atmospheric air, as well as regulation of public relations in this field. The Law defines norms of permissible amount of concentrations and physical negative impact as well as norms of permissible pollution from movable and unmovable sources.

- Law on Medical Care and Services to the Population (1996)

The Law on Medical Care and Services to the Population establishes the legal, economic ad financial guidelines for medical care and service delivery, which ensures the realization of people’s constitutional right to preserve their health.

- Law on the Protection and Use of Fixed Cultural and Historic Monuments and Historic Environment (1998)

This Law provides the legal and policy basis for the protection and use of such monuments in Armenia and regulates the relations between protection and use activities. Article 15 of the Law describes procedures for, among other things, the discovery and state registration of monuments, the assessment of protection zones around them, and the creation of historic-cultural reserves. Article 22 requires the approval of the authorized body (Department of Historic and Cultural Monuments Preservation) before land can be allocated for construction, agricultural and other types of activities in areas containing monuments.

- Law on Environmental and Nature Use Charges (1998)

This Law regulates calculation of payments for various types of nature protection and nature utilization activities (hereinafter payments), the order of their processing, liability in case of violation of the law, and other relations.

- Law on Rates of Nature Protection Payments (2006)

This Law sets rates for nature protection payments and the mechanism of their calculation. The law specifies the rates of the payments for emission of harmful substances to the air from the cars, tracks used and owned by RA individuals and legal entities. Higher rates are set for Yerevan and specially protected areas. The law defines the rates of the payments for emission of harmful substances and combinations to the water basin.

- Law on Flora (1999)

The law defines RA state policy in the field of maintenance, protection, usage and regeneration of flora. The law defines objectives of flora examination, state monitoring, state inventory, requirements and approaches of red book preparation on flora, conditions, peculiarities, limitations of allocation of flora objects for purposeful usage, basis of termination of the right to use, provisions on flora maintenance, and economic encouragement of usage and implementation of supervision.

- Law on Fauna (2000)

The law defines RA state policy in the field of maintenance, protection, usage and regeneration of fauna. The law defines the objectives of survey of the fauna, state monitoring, state inventory, requirements and approaches of red book preparation on fauna, conditions, peculiarities, limitations of allocation of fauna objects for purposeful usage, basis of termination of the right to use, provisions on fauna maintenance, and economic encouragement of usage and implementation of supervision.

- Law on Wastes (2004)

The law regulates legal and economic relations connected to the collection, transfer, maintenance, development, reduction of volumes, prevention of negative impact on human health and environment. The law defines objects of waste usage, the main principles and directions of state policy, the principles of state standardization, inventory, and introduction of statistical data, the implementation of their requirements and mechanisms, the principles of wastes processing, the requirements for presenting wastes for the state monitoring, activities to decrease the amount of the wastes, including nature utilization payments, as well as the compensation for the damages caused to the human health and environment by the legal entities and individuals, using the wastes, as well as requirements for state monitoring and legal violations.

- Law on Environmental Oversight (2005)

This Law regulates the issues of organization and enforcement of oversight over the implementation of environmental legislation of the Republic of Armenia, and defines the legal and economic bases underlying the specifics of oversight, the relevant procedures, conditions and relations, as well as environmental oversight in the Republic of Armenia.

- Law on Specially Protected Natural Areas (2006)

This Law defines legal basis and relations of state policy for development, restoration, maintenance, reproduction and use of natural complex and separate objects, as well as ecosystems of specially protected natural areas of the Republic. According to the law, specially protected natural areas are divided into four categories, National parks, State Reserves, Natural museums and the forth category is divided into three separate types: areas of international, republican and local importance.

- Law on Compensation Rates for Damage Caused as a Result of Environmental infringements to flora and fauna (2005)

This Law defines the rates of damage compensation caused as a result of environmental infringements to flora and fauna, as well as the calculation and collection procedure of these tariffs.

3 Licenses and permits to be obtained by the project proponent and by works contractor to carry out project activities

• Civil license in the area of the capital construction, including development of documents for urban development, engineering research and expertise to be held by the design company.

• Civil license in the area of capital construction to be held by the construction company providing works.

• Positive conclusions for construction of AOC and Vanadzor MC issued by State Environmental Expertise SNCO of the Ministry of Nature Protection. Such conclusion is required in accordance with the Law on Environmental Impact Assessment.

• Agreements from the Yerevan and Vanadzor municipalities for disposal of excavated materials and construction wastes in the approved dump sites shall be obtained by Construction Contractors prior to transportation and disposal of construction concrete rubbles, debris and spoils as well as excessive excavation materials in such dump sites;

• Permit for water supply and waste water discharge for AOC and Vanadzor MC issued by the MNP.

• Technical passports for medical wastes approved by the MNP. Technical passports should be developed by AOC and Vanadzor MC.

4. TECHNICAL AND ENVIRONMENTAL STANDARDS AND REGULATIONS

4.1. National Technical standards

- The RA Health Minister’s N 138 order as of May 6, 2002 on approving N2 – III – 11.3 sanitary norms on Noise at Workplaces, Public and Residential Buildings, and Residential Construction Areas.

- The RA Health Minister’s N 01-N order as of January 25, 2010, on Approving Sanitary Rules and Norms of Soil Quality Hygiene Requirements N 2.1.7.003-10.

- The RA Health Minister’s N 533-N order as of May 17, 2006, on Approving HN N 2.2.4-009-06 Vibration Hygiene Norms at Workplaces, Residential and Public Buildings.

- The RA Government Decision N 750-N as of May 29, 2006 on Establishment of Technical Regulations for Requirements on Re-cultivation and for Classification of Disturbed Lands Which Are Subject to Re-cultivation.

4.2. The World Bank Safeguard Policies

The World Bank OP/BP 4.01 Environmental Assessment is considered to be an umbrella policy for the Bank's environmental safeguard policies. There are also a number of social safeguards and other safeguard policies, which a WB-supported project may trigger. The safeguard policies and the triggers for of them are provided in the table below:

|Operational Policy |Triggers |

|Environmental Assessment (OP 4.01) |If a project is likely to have potential (adverse) environmental risks and impacts|

| |in its area of influence. |

|Forests |Forest sector activities and other Bank sponsored interventions which have |

|(OP 4.36) |potential to impact significantly upon forested areas. |

|Involuntary Resettlement |Physical relocation and land loss resulting in: (i) relocation or loss of shelter;|

|(OP 4.12) |(ii) loss of assets or access to assets; (iii) loss of income sources or means of |

| |livelihood, whether or not the affected people must move to another location. |

|Indigenous Peoples (OP 4.10) |If there are indigenous peoples in the project area, and potential adverse impacts|

| |on indigenous peoples are anticipated, and indigenous peoples are among the |

| |intended beneficiaries. |

|Safety of Dams |If a project involves construction of a large dam (15 m or higher) or a high |

|(OP 4.37) |hazard dam; If a project is dependent upon an existing dam, or dam under |

| |construction. |

|Pest Management |If procurement of pesticides is envisaged; If the project may affect pest |

|(OP 4.09) |management in the way that harm could be done, even though the project is not |

| |envisaged to procure pesticides. This includes projects that may (i) lead to |

| |substantially increased pesticide use and subsequent increase in health and |

| |environmental risk, (ii) maintain or expand present pest management practices that|

| |are unsustainable, not based on an IPM approach, and/or pose significant health or|

| |environmental risks. |

|Physical Cultural Resources |The policy is triggered by projects which, prima facie, entail the risk of |

|(OP 4.11) |damaging cultural property (e.g. any project that includes large scale |

| |excavations, movement of earth, surface environmental changes or demolition). |

|Natural Habitats (OP |The policy is triggered by any project with the potential to cause significant |

|4.04) |conversion (loss) or degradation of natural habitats whether directly (through |

| |construction) or indirectly (through human activities induced by the project). |

|Projects in Disputed Areas (OP 7.60) |The policy is triggered if the proposed project will be in a “disputed area”. |

|Projects on International Waterways |If the project is on international waterway such as: any river, canal, lake, or |

|(OP 7.50) |similar body of water that forms a boundary between, or any river or body of |

| |surface water that flows through, two or more states ( or any tributary or other |

| |body of surface water that is a component of this waterway); any bay, gulf, |

| |strait, or channel bounded by two or more states or, if within one state, |

| |recognized as a necessary channel of communication between the open sea and other |

| |states-and any river flowing into such waters. |

ENVIRONMENTAL AND SOCIAL SCREENING

NDPC Project carries investment components in support to provision of premises for medical facilities and therefore triggers OP/BP 4.01 Environmental Assessment. None of the project supported activities are expected to have significant, long term, or irreversible impacts on the natural environment, therefore the project is classified as environmental Category B.

The present Environmental Management Framework (EMF) is prepared to guide conduct of site-specific Environmental Impact Assessments (EIAs) of the construction works for the Vanadzor Medical Center and the Armenia Oncology Center, because detailed designs for these centers will not be available in the project preparation phase. A site-specific Environmental Management Plan (EMP) is developed for the reconstruction of the Center of Hematology, sufficient for adequate mitigation of minor environmental risks associated with this intervention, which are typical for rehabilitation of a medium-sized existing building in an urban setting. Therefore, the present EMF does not cover rehabilitation of the Center of Hematology.

None of the proposed NDPC Project sites are located within or in immediate proximity to the designated natural protected areas, wildlife habitats, or other sensitive natural receptors. Hence the OP 4.04 Natural Habitats is not triggered.

Land plots selected for the construction of the Vanadzor MC and the AOC are located in densely developed urban settings and encountering any unknown cultural property in the course of their construction is unlikely. OP 4.11 Physical Cultural Heritage is not triggered. Nonetheless, EMF carries instructions for the course of action in case chance finds are encountered during earth works.

The Project Does not trigger Op 4.12 Involuntary Resettlement, because its implementation will not require any land take or cause physical relocation. Land plots considered for the construction of new buildings for the Vanazor MC and the AOC are State-owned and are not under any type of informal land use.

6. SENSITIVE RECEPTORS AND POTENTIAL IMPACTS

6.1. Sensitive Environmental and Social receptors

6.1.1. Ambient Air

In Soviet times the town of Vanadzor had a developed industry significantly polluting air. However, in the last few years the industrial production dropped dramatically and so has the level of emissions. At present mobile point source pollution from automobiles is the only main contributor to the air pollution in Vanadzor.

Air quality in Vanadzor is monitored by Environmental Impact Monitoring Center of the MoNP. Based on the data of 2011 obtained from 24 observation stations installed in the town, the average annual concentrations of sulfur dioxide and nitrogen dioxide are found to be under the permitted ceilings.

The city of Yerevan was a major industrial center also in Soviet times. In 1980s the city regularly suffered from smog. After the break-down of the Soviet Union the significant part of industry collapsed, and currently the air quality in Yerevan is considerably better, through contents of some pollutants are still higher than the established sanitary norms.

Air quality in the city of Yerevan is being monitored by Environmental Impact Monitoring Center of the MoNP, which implies measuring contents of dust, sulfur dioxide, nitrogen dioxide, and the ground-level ozone. Average concentrations of nitrogen dioxide and dust exceed the permitted limits by 1.3 and 4.1 times respectively. Based on the data of 2011 obtained from 15 observation stations of the city, contents of sulfur dioxide and nitrogen dioxide are found to be undwer the prmitted ceilings.

6.1.2 . Water Resources

Pambak River is the largest hydrographic unit in the vicinity of Vanadzor. The river basin comprises 1.370 square kilometers. It is surrounded by Bazum mountain range in the north and Pambak mountain range in the south. The river valley is a vast ravine, changing into a deep canyon at the river mouth.

Characteristics of the Pambak River flow are as follows:

|River |Flow rate, |Annual flow, |Flow module, |Height of flow layer, mm |Flow coefficient |

| |m3/sec |million.m3 |l/sec km2 | | |

|Pambak |8.96 |283 |8.37 |264 |0.42 |

River pollution is monitored by the Environmental Impact Monitoring Center of the MoNP.

High pollution with ammonium ion has been observed in Pambak River downstream of Vanadzor town. The average annual concentration exceeded the permitted limit by 10.4 times. In the upper section of Pambak River the average annual concentration of manganese also exceeds maximum permitted limit by 2.6 times, while in the bottom part of Vanadzor town the concentration of nitrite ion exceeds the norm by 3.7 times and concentration of chrome exceeds the norm by 3.0 times. Contents of the other pollutants are found to be within the permitted limits.

For the city of Yerevan the main water source of the city is Hrazdan River, which passes in the vicinity of the area designed for the construction of the AOC. River pollution is monitored by the Environmental Impact Monitoring Center of the MoNP. The lower section of Hrazdan River is highly polluted. In samples taken from Hrazdan River basin the permitted norm of nitrite ion is exceeded by 1.4-3.1 times, the morm of ammonium ion is exceeded by 1.6-5.3 times, and the BOD is over the permitted ceiling by 1.2-1.9 times. TKP exceeds the permitted levelts by 1.3 times in the section of river ranging from Arzni HPP of Hrazdan River up to the vicinity of Darbnik village, including Lake Yerevan. Content of the other pollutnats are found to be within the permitted limits.

6.1.3. Land Resources

Land plots allocated for the construction of Vanadzor MC and the AOC are located in the highly transformed urban settings. Their vegetative cover is represented by grass, shrubs, and artificially planted trees, the buck of which is likely to survive the new construction. The land plot allocated for the construction of the Vanadzdor MC was previously used by the military hospital and the land plot allocated for the construction of the AOC was used until recent past by the National Scientific Laboratory. Both types of previous land use do not exclude possibility of encountering unregistered and unknown types of hazardous waste in the course of earth works.

6.1.4. Social Environment

Land plot allocated for the construction of Vanadzor MC is located within the residential area, the existing hospital N1 and the military base. There are no schools and kindergardens nearby.

The location and connectivity of the sites selected for the construction of both – Vanadzor MC and the AOC are highly convenient for potential users of their services and will amplify social benefits of the provision of these new premises.

Staff and patients of the Vanadzor MC and the AOC will be under immediate direct health impacts from the design of the buidlings and from the materials used for their construction and finishing, as well as from the operation of some medical devices, and management of the medical waste.

6.1.5. Cultural Resources

There are no known and registered physical cultural resources located in the vicinity of the land plots allocated for the construction of Vanadzor MC and the AOC. Though due to the need of earth excavation works, encountering of change finds cannot be entirely excluded.

6.2. The Main Environmental and Social Risks

Based on the above description of the sensitive environmental and social receptors to be affected by NDPC Project implementation, the estimated risk of negative impacts is modest. Nonetheless, in the process of site-specific EIAs due attention should be given to deeper examination of the below possible negative impacts and to elaboration of measures for their mitigation:

- Air pollution with dust and emissions generated from drilling, excavation, loading/unloading operations, and operation of equipment and machinery at the construction phase, and air pollution from heating and hot water supply systems at the operation phase;

- Surface and ground water pollution from liquid discharge at the construction and operation phases;

- Soil pollution with construction waste at the construction phase as well as from the medical and household waste at the operation phase;

- Damage of physical cultural resources accidentally encountered in the course of earth works during construction;

- Nuisance to local communities due to movement and operation of the construction vehicles and machinery at the operation phase;

- Impact on the health of workers at the construction phase from the use of unsafe construction materials and/or incompliance with the safety rules and procedures;

- Impact on the heath of hospital patients and personnel at the operation phase from improper natural and artificial illumination and ventilation of the buildings, from operation of power supply and heating systems, from operation of specialized medical equipment (especially using radioactive technologies), and from waste management.

7. IMPACT MITIGATION

Below is a generic set of mitigation measures proposed for the construction and operation phases of the NDPC Project. Site-specific EIAs to be carried out for the Vanadzor MC and the AOC are expected to adjust this menu of mitigation measures to the needs of individual investments.

7.1. Construction Phase: Short Term Impacts

Emissions, noise and vibration originate during construction works when drilling foundations, loading/unloading/transporting materials, operating construction equipment and vehicles, etc. For minimizing these negative impacts:

- keep construction equipment and machinery in an adequate technical condition;

- avoid idling of engines;

- do not use sub-standard fuel.

Excessive and unmanaged water use at the construction sites may result in waterlogging of the site, runoff from the site, pollution of the ground water with oil and lubricants. For minimizing these negative impacts:

- do not allow spillage of water over the construction sites;

- do not wash equipment and machinery on-site.

Earth works, especially excavation of foundations may result in encountering chance finds or hazardous items and materials left over from the previous land use on the construction plots. In case of chance finds:

- immediately take all excavation activities on hold and communicate to the State Agency for Historical and Cultural Monuments Protection, and the Yerevan or Vanadzor municipalities respectively;

- do not resume works until having received written permission from the above authorities.

In case of encountering any unidentified objects and/or substances beneath the soil:

- immediately take all construction activities on hold and communicate to the national authorities responsible of handling emergency situations;

- do not resume works until having received formal permission from the above authorities.

Clearing of the site allocated for the construction of Vanadzor MC will require demolition of several dilapidated construction formerly used as the military hospital premises. These buildings are roofed with asbestos-containing material and are likely to carry asbestos containing pipes inside as well as to have some internal parts covered with lead containing paints. To avoid health hazards of workers and environmental pollution with hazardous waste:

- ensure proper use of personal protective gear by all workers and personnel exposed to hazardous materials;

- avoid unnecessary fragmentation of asbestos containing parts of the buildings while demounting and sprinkle them in advance;

- keep asbestos containing construction waste in separate and especially isolated location of the work site and timely remove it to the formally designated disposal site using covered vehicles.

Non-toxic construction waste, including excess excavated material may hinder works and pollute environment if mismanaged. In order to minimize negative impacts from generated construction waste:

- organize temporary on-site storage of waste in especially designated locations and timely remove it to the location of permanent disposal;

- use covered vehicles for waste transportation;

- timely obtain written permission from municipal authorities for permanent disposal of waste and ensure that all waste is disposed exclusively in such formally designated locations.

Accidents leading to health damage and even casualties may occur in the course of construction. To minimize risk of negative health impact and accidents:

- ensure that workers are provided and use personal protective gear;

- ensure that construction equipment is used strictly following its operation instructions;

- keep first aid medical kits and fire-fighting equipment on site.

Construction works, especially operation of machinery, may cause nuisance to nearby residents caused with noise, dust, and vibration. Vanadzor MC will be construction next to the operational clinic and the AOC will be construction next to the premises of the National Scientific Laboratory. Therefore, construction may cause nuisance to the patients and personnel of the Vanadzor hospital and to the staff of the research laboratory. To minimize this impact:

- keep construction equipment and machinery in an adequate technical condition;

- avoid idling of engines;

- water work sites in the course of dusty works or in case of especially hot and dry weather conditions;

disallow on-site activities beyond the working hours.

7.2. Operation Phase: Long Term Impacts

Operation of hot water supply and heating systems as well as running of emergency back-up systems of power generation emit to the ambient air. In order to minimize negative impacts of emission:

- install and operate high quality and energy efficient cooling/heating units;

- provide adequate insulation of buildings to decrease energy consumption;

- keep boiler and other equipment in good working condition to avoid excessive fuel use and emissions.

Operation of clinics will generate variety of wastes, including medical, household, liquid, and hazardous wastes. Waste management system must include:

- separate wastes;

- provide adequate containers for separated collection of waste, provide safe on-site waste storage facilities, and convenient access to such facilities by waste transportation vehicles;

- elaborate and implement arrangements for on-site thermal and chemical deactivation of certain types of medical and hazardous waste;

- conclude contractual arrangements with specialized companies licensed for the removal, deactivation, and disposal of medical and hazardous waste;

- connect the clinics to the municipal waste water collection systems and provide adequate maintenance to ensure flawless operation of internal sewerage;

- elaborate and implement arrangements for on-site deactivation of certain types of liquid wastes prior to discharge to the municipal sewage network;

- elaborate, formally adopt, and strictly adhere to the operational rules for the units involved with the production of radionucleids, radiodiagnostics, and radiotherapy.

8. STAKEHOLDER CONSULTATION

According to the law of Armenia on the Expert Review of Environmental Impact Assessment, the design documents and the EIA reports for the proposed construction works shall be submitted to the Ministry of Nature Protection of the RA (MoNP). The construction company, together with the MoNP and respective municipalities will organize public hearings, notifying stakeholders in advance through the media. The EIA reports must be available for all interested parties and will therefore be posted on the websites of the MoNP and MoH.

Public disclosure of the present EMF as well as of the site-specific EIA reports is a requirement of the WB as well. Minutes of the stakeholder consultation over the present EMF will be attached below once available. Documents of the stakeholder consultation process will be attached to the final versions of the site-specific EIA reports of Vanadzor MC and the AOC.

9. SITE SPECIFIC ENVIRONMENTAL IMPACT ASSESSMENT AND MANAGEMENT

According to the national legislation of the RA and the requirements of the WB OP 4.01 Environmental Assessment, construction of new premises for the Vanadzor MC and the AOC requires environmental impact assessment.

Responsibilities of MoH

MoH, as an implementing entity of the NDPC Project and acting through the HPIU, will be responsible for carrying out site-specific EIAs of these investments, sharing draft EIA reports with the national stakeholders and the WB, conducting public consultation meetings, finalizing EIA reports, and re-disclosing them through the national media and the electronic database of the WB. EIA reports, including EMPs, will be developed and disclosed in the Armenian and English languages, and will be made available for local stakeholders in a form suitable for these stakeholders. After allowing time sufficient for meaningful acquaintance with the reports and for meeting the requirements of the national legislation, consultation meetings will be held to generate comments and answer questions of the affected population. EIA reports will be finalized and re-disclosed after incorporation of relevant comments. Final reports will carry minutes of public consultation meetings.

MoH, through HPIU, will ensure that EMPs are included into the tender documents for civil works, so that potential providers of works are able to incorporate costs related to EMP implementation into their bids. EMPs will be integrated into the works contracts and be mandatory for implementation like any other clause of works contracts.

MoH, through HPIU will have overall responsibility for implementation of site-specific EMPs. Towards this end, directly, or acting through a hired technical supervisor, HPIU will carry out on-site environmental supervision of works, including monitoring of EMP implementation. Technical supervisor will be responsible for identifying any issues which may arise from inadequate application of mitigation measures provided in EMPs, and recommending corrective actions. HPIU must oversee timely and adequate conduct of such corrective actions. Failure of a works contractor to address identified issues in the established time and manner will lead to penalty sanctions as established in the contract terms.

Responsibilities of the Ministry of Nature Protection

MoNP is responsible for the protection, sustainable use, and regeneration of natural resources in the RA. MoNP’s authority includes participation in the national policy making in the respective field, development of environmental standards and guidelines, and enforcement.

MoNP, through the State Environmental Inspectorate, which includes 11 Regional Environmental Inspectorates, will exercise the authority of conducting environmental inspections at worksites to oversee compliance with the terms of environmental permits as well as other formal permissions and licenses.

Responsibilities of Municipalities

Municipalities approve the technical proposal for construction and issue construction permits. Municipalities regulate transportation, disposal, and utilization of the household and construction waste as well.

Responsibilities of Works Contractors

Contractors will be responsible for due incorporation of works and related costs of EMPs implementation into the BoQ and adherence to all requirements of EMPs throughout the contract term. Contractors shall cooperate with technical supervisors through furnishing of relevant documents (licenses and permits) and facilitating their on-site work.

Gaps and Weaknesses

Institutional capacity of the State Environmental Inspectorate is weak, mostly due to scarcity of funding, lack of staff and equipment, which does not allow the Inspectorate to carry out meaningful control over the construction activities. This adds to the responsibility of HPIU to carry out close technical supervision of works for ensuring acceptable end results.

Monitoring of EMP implementation

HPIU carries overall responsibility for the implementation of EMP and for organizing environmental monitoring of works. Environmental monitoring of works will be undertaken according to the Environmental Monitoring Plans which will be developed as part of the site-specific EIA work. Monthly monitoring of EMP implementation will be followed using the field environmental monitoring checklist, which is a convenient tool of environmental supervision already tested and being used by HPIU for the purposes of the ongoing projects.

Cumulative analytical reports on the outcomes of environmental supervision will be developed by HPIU and furnished to the MoH and the WB as part of the regular project progress reporting.

Annex 1to EMF. Proposed Structure of the site-specific EIA reports

EXECUTIVE SUMMARY

Introduction

Technical and Environmental Standards and Regulations

Environmental Screening

Public Participation

Sensitive Environmental Receptors and Potential Impacts

Project Alternatives

Project Description

Environmental Impact Assessment Methodology

Environmental and Social Baseline

Expected Impacts and Mitigation

Environmental Management Plan

Operation of the Irrigation Schemes

(Not more than 10 pages)

CHAPTER 1. Introduction

CHAPTER 2. Legal and Policy Framework

CHAPTER 3. Technical and Environmental Standards and Regulations

CHAPTER 3. Environmental Screening

CHAPTER 4. Physical and Natural Environment

CHAPTER 5. Sensitive Receptors and Potential Impacts

CHAPTER 6. Impact Mitigation

CHAPTER 7. Environmental Management Plan

Annex 1 Environmental Management Matrix

Annex 2. Public Consultation

Annex 3. References

Annex 4. Maps, Graphs, Pictures

Attachment I to EIA report. Environmental Management Guidelines for Contractors

Roads and footpaths

In order to carry out the rehabilitation works, it may be necessary to close or divert certain motorways and/or footpaths, either permanently or temporarily during the construction period. The contractor should arrange diversions for providing alternative route for transport and/or pedestrians in the course of works.

After breaking up, closing or otherwise interfering with any street or footpath to which the public has access, the Contractor shall make such arrangements as may be reasonably necessary so as to cause as little interference with the traffic in that street or footpath during construction of the rehabilitation works as shall be reasonably practicable.

Wherever the rehabilitation works interfere with existing public or private roads or other ways over which there is a public or private right of way for any traffic, the Contractor shall construct diversion ways wherever possible. The standard of construction and lighting shall be suitable in all respects for any class of traffic using the existing ways, and the widths of the diversions shall not be less than that of the existing way wherever possible. Diversion ways shall be constructed in advance of any interference with the existing ways and shall be maintained to provide adequately for the traffic flows.

The Contractor shall be responsible for supplying, erecting and maintaining for the requisite periods all statutory and public information notices.

Movement of trucks and construction machinery

The Contractor moving solid or liquid construction materials and waste shall take strict measures to minimize littering of roads by ensuring that vehicles are loaded in such a manner as to prevent falling off or spilling of construction materials and by sheeting the sides and tops of all vehicles carrying mud, sand, other materials and debris.

The Contractor shall also take all reasonable measures to avoid to the extent possible that delivery vehicles park on the highways prior to entering the construction site.

Traffic safety measures

The Contractor shall provide, erect and maintain such traffic signs, road markings, lamps, barriers and traffic control signals and such other measures as may be necessary for ensuring traffic safety around the rehabilitation site. The Contractor shall not commence any work that affects the public motor roads and highways until all traffic safety measures necessitated by the work are fully operational.

Access across the construction site and to frontages

In carrying out the rehabilitation works, the Contractor shall take all reasonable precautions to prevent or reduce any disturbance or inconvenience to the owners, tenants or occupiers of the adjacent properties, and to the public generally. The Contractor shall maintain any existing right of way across the whole or part of the rehabilitation site and public and private access to adjoining frontages in a safe condition and to a standard not less than that pertaining at the commencement of the contract. If required, the Contractor shall provide acceptable alternative means of passage or access to the satisfaction of the persons affected.

Protection of the existing installations

The Contractor shall properly safeguard all buildings, structures, works, services or installations from harm, disturbance or deterioration during the concession period. The Contractor shall take all necessary measures required for the support and protection of all buildings, structures, pipes, cables, sewers, railways and other apparatus during the concession period. In case of damage incurred in the course of works to the existing infrastructure, the Contractor must absorb responsibility for its restoration.

Use of existing structures

The Contractor shall not locate stockpiles for materials, stores, plant or temporary works upon or adjacent to or under existing structures such as bridges, viaducts, towpaths, walls and embankments in such a way as to endanger these structures.

Noise and dust control

The Contractor shall take all practicable measures to minimize nuisance from dust and noise from the rehabilitation sites. This includes:

• Respecting normal working hours in or close to residential areas;

• Maintaining equipment in a good working order to minimize extraneous noise from mechanical vibration, creaking and squeaking, as well as emissions or fumes from the machinery;

• Shutting down equipment when it is not directly in use.

Water supply conflicts

The Contractor must ensure that the workforce have adequate access to a safe water supply, which is not provided to the detriment of services to the local population. If there is a risk of competition for limited water resources, then the Contractor must ensure that the local supply is not affected, and that workforce is provided with an alternative source if necessary (e.g. tankered and stored water).

Waste disposal

The Contractor must agree with the Client municipality about arrangements for construction waste disposal. The municipality shall designate a dumping site or landfill for the disposal of solid waste. Should any hazardous waste be involved and unexpectedly encountered, the Contractor must inform the Client municipality on the above and strictly follow the Client’s guidance for disposal of such waste.

Soil protection

The Contractor must take all practicable measures to avoid degradation and erosion of soil. The use of heavy machinery must be limited to the extent possible for avoiding land compaction. Soil erosion and slope instability should be addressed through hillside terracing, tree planting and construction of check dams.

Protection of trees and other vegetation

The Contractor shall avoid loss of trees and damage to other vegetation wherever possible. Adverse effects on green cover within or in the vicinity of the rehabilitation site shall be minimized by adequate selection of access routes, piling and storage locations for construction materials and parking lots for heavy machinery.

Emergency contacts and procedures

The Contractor shall prepare and maintain emergency contact information for each rehabilitation site which shall be displayed prominently and accessible for all personnel. Emergency contact information shall contain phone numbers and the method of notifying local authorities/services for action in case of fire, health emergencies, disorder in communications, emergency release of hazardous materials, etc.

Clearance of rehabilitation site on completion

The Contractor shall clear up all working areas both within and outside the rehabilitation site and accesses as work proceeds and when no longer required for the carrying out of the Rehabilitation works. All surplus soil and materials, temporary roads, plant, sheds, offices and temporary fencing shall be removed, post holes filled and the surface of the ground restored as near to its original condition as conditions permitting.

Attachment II to EIA report. Monthly Field Environmental Monitoring Checklist

|Site location | |

|Name of contractor | |

|Name of supervisor | |

|Date of site visit | |

|Status of civil works | |

|Documents and activities to be examined |Status |Comments |

|Contractor holds license for extraction of natural resources |Yes |Partially |No |N/A | |

|Contractor holds agreement for final disposal of waste | | | | | |

|Contractor holds agreement with service provider for removal of household waste from site | | | | | |

|Work site is fenced and warning signs installed | | | | | |

|Works do not impede pedestrian access and motor traffic, or temporary alternative access | | | | | |

|is provided | | | | | |

|Working hours are observed | | | | | |

|Construction machinery and equipment is in standard technical condition (no excessive | | | | | |

|exhaust and noise, no leakage of fuels and lubricants) | | | | | |

|Construction materials and waste are transported under the covered hood | | | | | |

|Construction site is watered in case of excessively dusty works | | | | | |

|Contractor’s camp or work base is fenced; sites for temporary storage of waste and for | | | | | |

|vehicle/equipment servicing are designated | | | | | |

|Contractor’s camp is supplied with water and sanitation is provided | | | | | |

|Contractor’s camp or work base is equipped with first medical aid and fire fighting kits | | | | | |

|Workers wear uniforms and protective gear adequate for technological processes (gloves, | | | | | |

|helmets, respirators, eye-glasses, etc.) | | | | | |

|Servicing and fuelling of vehicles and machinery is undertaken on an impermeable surface | | | | | |

|in a confined space which can contain operational and emergency spills | | | | | |

|Vehicles and machinery are washed away from natural water bodies in the way preventing | | | | | |

|direct discharge of runoff into the water bodies | | | | | |

|Construction waste is being disposed exclusively in the designated locations | | | | | |

|Extraction of natural construction material takes place strictly under conditions | | | | | |

|specified in the license | | | | | |

|Excess material and topsoil generated from soil excavation are stored separately and used | | | | | |

|for backfilling / site reinstatement as required | | | | | |

|Works taken on hold if chance find encountered and communication made to the State | | | | | |

|agencies responsible for cultural heritage preservation | | | | | |

|Upon completion of physical activity on site, the site and contractor’s camp/base cleared| | | | | |

|of any remaining left-over from works and harmonized with surrounding landscape | | | | | |

Attachment III to EIA report. Minutes of the Public Consultation Meeting

(To be provided after consultation on a site-specific EIA)

Annex 2 to EMF. Minutes of Public Consultation Meeting

Public Consultation Meeting on NDPC Project

Environmental Management Framework and

Environmental Management Plan for the Reconstruction of the Center of Hematology

Date 24 December, 2012

Place of Meating National Institute of Health, Yerevan city

List of participants:

1. Vram Tevosyan Local consultant, environmental management specialist

2. Menua Brurtyan Lori Marz Residents’ Association, Charity NGO

3. Khoren Vardanyan Member, Vanadzor city community local Parliament

4. Marta Simonyan Reginal Cooperation, NGO

5. Melkon Garaseferyan Head of Department, Hematology Center

6. Eduard Kabasakalyan Medical doctor, Hematology Center

7. Karen Meliksetyan Medical doctor, Hematology Center

8. Hayrapet Galstyan Director, National Oncology Center

9. Armen Tananyan Deputy Director, National Oncology Center

10. Arthur Avetisyan Oncologist, National Oncology Center

11. Artak Edoyan Deputy Director, Vandazor MC

HPIU

12. Nelson Zuloyan HPIU, Acting Director

13. Davit Meli-Nubaryan Coordinator, Hospital network optimization component

14. Naira Kalantaryan Specialist, Hospital network optimization component

15. Ruzanna Astvatsatryan Assistant Coordinator, Hospital network optimization component

Summary

The public consultation was conducted On 24 December 2012 in the National Institute of Health regarding to the new WB- financed "Non-communicable diseases prevention and control" project EMF and EMP of the construction works of the Center of Hematology under the same Project, with participation of local NGOs, stakeholders, community members, representatives of local government, MoH and HPIU.

In the opening speech HPIU Director Nelson Zuloyan made a brief presentation on the main components and goals of "Non-communicable diseases prevention and control" project. He noted that the early detection of NCD will be implemented through mass screening program. Besides, a new building for Vanadzor MC of Lori marz will be constructed and modernization of the Center of Hematology with the establishment of BMT department will be implemented, as well as new Oncology center will be established with construction of new building.

Afterwards, ecologist Vram Tevosyan presented "Non-communicable diseases prevention and control" EMF and the EMP of the Hematology Center renovation works. He noted that these documents have been developed based on the requirements of the World Bank Operational Manual, which presents the WB environmental policy. Then Mr. Tevosyan noted that possible environmental impacts and risks for three projects were preliminary studied and assessed in the mentioned documents. The expert told that the expected environmental impact is predicted to be minimal.

- Director of National Oncology Center asked about the potential impacts of the ground water on the building of the new oncology center at the operation phase.

Ecologist Vram Tevosyan answered that the norms and environmental safeguard requirements must be taken into account, while design and construction of the radiotherapy center.

- There were no other questions concerning the environmental issues. The discussion was continued concerning mass screening activities, planned in the scope of the new project. Director of National Oncology Center Galstyan was concerned about the choice of selection of screenings. On his opinion the breast cancer screening is more important in Armenia, but it is not included in the list.

Coordinator Melik- Nubaryan answered that in the initial version of the new project breast cancer screening was included in the list of screenings, but due to financial restrictions this item was excluded from the list of screenings.

At the end HPIU Director Nelson Zuloyan thanked the participants for taking part in the discussion.

Scanned signatures of the participants:

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Annex 3 to EMF. Location and ownership of land plots allocated for construction under NDPC Project

Vanadzor MC – plan of the land plot and the proposed building

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Vanadzor MC – view of the land plot from space (Google map)

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Vanadzor MC – According to Vanadzor city Community Chief’s decrees N 394-A and N 347-A dated April 4, 2012, “Vanadzor MC” CJSC received free user right for  3.172 hectares land plot. The mentioned right has been registered on  May 24, 2012  by the State Committee of the Real Property Cadastre of the Lori marz. Address is 2/42 Njdeh street, Vanadzor, marz of  Lori, RA.

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Vanadzor MC – photo of the site dated December 2012: a fenced land plot carrying dilapidated premises of the former military hospital

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Annex 4

Armenia Oncology Center - RA Government Decree 1424-N, dated October 2, 2010 which recalls user rights to the land plot of 13.500 sq m, located at Alikhanyan brothers str.2, Yerevan city, RA , from the National Scientific Laboratory after A.I. Alikhanyan, a State Non-Commercial Organization, and passes them back to the Ministry of Economy of the RA.

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Armenia Oncology Center - view of the land plot from space (Google map)

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Armenia Oncology Center – Photo of the site taken in December 2012. Construction of the premises for radioisotope production unit is underway.

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