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HEALTH IMPACT ASSESSMENT IN THE ENVIRONMENTAL IMPACT ASSESSMENT PROCEDURES.

A Report of a Two-day Training Workshop

Phnom Penh 27 and 28 April 2017

In brief

A two-day training workshop entitled Health Impact Assessment in the Environmental Impact

Assessment Procedures was held in Phnom Penh, Cambodia on 27 and 28 April 2017. The workshop was

organized as part of the implementation of Asian Development Bank’s technical assistance project

Results for Malaria Elimination and Control of Communicable Disease Threats in Asia and the Pacific

(RECAP/TA 8763, Output 4, Health Impact Assessment (HIA), capacity development stream). The

training, with 53 participants, was a response to needs identified and interest expressed by the

Cambodian health and environment authorities at regional HIA consultations for the DMCs in the

Greater Mekong Sub-region organized by ADB in April and November 2016.

The training workshop was a first introduction to the concept, rationale and objectives of HIA, to the

essential functions to be performed for an HIA (with a focus on the regulatory functions of Government)

and to some key aspects of HIA policy and practice, including the formulation of national guidelines and

the creation of conducive institutional arrangements.

The program consisted of a mixture of presentations, plenary discussions and group work. The expected

outputs were achieved, in spite of constraints as, in terms of number of participants, the workshop

turned out rather over-subscribed. Professional simultaneous interpretation by Mr Ly Bunheang

facilitated the dialogue between presenters and participants. The workshop created good opportunities

for follow-up activities with both ministries, and for engaging with consultants in future HIA practice.

Certificates of attendance were forwarded to the participants after the course.

Introduction

Output 4 of ADB’s technical assistance (RECAP) foresees a reduction of the risk, to the region and

globally, from both communicable (particularly malaria) and non-communicable diseases, by

strengthening, embedding and mainstreaming the assessment and effective mitigation of the

community and worker health impacts of large infrastructure projects, with special reference to malaria

endemic areas.

The components under Output 4 of the TA include strengthening the Bank's HIA tools, applications and

project screening, strengthening and supporting the policy dialogue on HIA in the Developing Member

Countries (DMCs) in the Greater Mekong Sub-region (GMS), and working with infrastructure project

owners (the Bank and private sector) to develop, in collaboration with civil society organizations (CSOs),

malaria screening and treatment activities linked with workers and communities involved in

infrastructure projects.

These components have led to the establishment of an ADB HIA initiative, with four interconnected sets

of tasks addressed by an Advisory Team of international consultants. One of these tasks is capacity

development, which covers both the creation of an enabling policy/institutional environment, and the

strengthening of the human resources base for HIA in the countries.

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This training workshop follows half-day information seminars in Hanoi, Viet Nam, and Nay Pyi Taw,

Myanmar, and a six-day training course in Viet Nam, all in 2016. Another, three-day training workshop

was held in Mandalay two weeks after this Phnom Penh workshop.

Objectives

The training workshop program was designed with the following objectives in mind:

o To provide an introduction to EIA and HIA in Cambodia: policies and laws, key players, the

nature of EIA, and EIA experiences thus far.

o To present the concept of HIA, its rationale and objectives, and the components in an HIA

procedure, from screening to implementing a Public Health Management Plan.

o To learn about impact assessment essential functions: the functions of the MOE in EIA, the

potential functions of MOH in HIA.

o To discuss the various key aspects of HIA: policy- versus project-oriented HIA, the links between

EIA and HIA, strategic IA in Special Economic Zones.

o To discuss plans for the formulation of national HIA guidelines, options for decision making

criteria to decide on the scale of HIA integration with EIA, and options for institutional

arrangements between the MOH, the MOE and other relevant partners in support of HIA.

Expected outputs

The concept note for the training workshop defined the following expected outputs:

o Between 30 and 40 staff of the MOH and the MOE informed about EIA and HIA in general and

their (potential) application in Cambodia

o A better understanding among environment sector and health sector staff of the concept and

potential of HIA, and the needs for its scaling up

o Enhanced awareness of in the environment and in the health sector of EIA and HIA and of the

need to strengthen inter-sectoral collaboration in support of HIA

o Options discussed for decision-making criteria EIA/HIA integration, institutional arrangements

and the modalities for HIA guidelines development

o A report of the training workshop and training materials available to all participants

Program changes

The original concept note for HIA training in Cambodia foresaw a one-day training workshop for MOH

staff (staff from the different departments in the MOH) and a two-day training workshop for MOH and

MOE staff together. The one-day workshop was intended for MOH staff from across the Ministry, the

create awareness of HIA and the associated essential functions, and to help establish a ministry/sector-

wide platform for HIA in the MOH/health sector. The two-day workshop was intended to focus on the

links between EIA and HIA, and the collaboration required between the two ministries on issues of EIA

and HIA, on a coordinated implementation of environmental management plans and public health

management plans, and on criteria to make HIA fit for purpose. The premise would be that HIA would

remain within EIA, but with different profiles according to the nature and magnitude of the

infrastructure project under scrutiny.

Shortly before the workshops were to take place the MOH communicated that the one-day event for

the MOH had to be cancelled because of an unforeseen MOH briefing event with the Prime Minister.

The two-day training workshop program was then adapted to reflect the objective of highlighting the

essential functions in HIA and to ensure a dialogue on coordination and cooperation between the two

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ministries. The mobilization of EIA consultants by the MOE to attend the workshop added an extra

dimension to these discussions.

Because there were no resource persons from Lao PDR and Thailand, the originally planned agenda item

on experiences from other countries in the region was suppressed. The presentations on SDGs, the

Cambodia National Strategic Development Plan 2014-2018, the criteria for HIA integration into EIA and

the memorandum of understanding were merged into one block on the second day (not reflected in the

program in Annex 2).

At the special request of participants at the end of day 1, a half hour presentation and discussion session

on HIA practice (i.e. what is it consultants do when they perform an HIA) was inserted, using the work

done for the Lao PDR Nam Theun 2 Hydropower Project as an example. This change is not reflected in

the Annex 2 program either.

Participants

A total of 53 people participated in the training workshop, with a good gender balance (about 55%

males, 45% females). Not all participants were able to attend both days. Details are presented in

Annex 1. The breakdown of the participants was as follows: 20 staff from the Ministry of Environment

(MOE), 18 staff from the Ministry of Health (MOH) and 15 consultants active in the area of

Environmental Impact Assessment (EIA). The originally planned maximum of 40 participants was

exceeded by about 20%, mainly because, in addition to MOE and MOH staff, some 15 EIA consultants

had been invited through the MOE’s network. This unexpectedly high number of participants put some

strains on the facilities, but tasks were carried out in five groups of ten participants each, and there was

active engagement in the discussions by all. Participants were seated at five round tables, and MOE,

MOH and consultancy participants mixed from the start without having been instructed to do so

explicitly. This facilitated the intersectoral dialogue and learning process. Both on day 1 and day 2, all

those in attendance stayed until the end of the day and motivation remained high throughout the

workshop.

Program

The training workshop started with an official, formal opening session. Statements by Ms Lydia

Domingo, on behalf of ADB, and Dr Kol Hero, on behalf of the Ministry of Health, were followed by an

official opening address by Mr Dan Serey, Director EIA Department in the Ministry of Environment.

Ms Domingo welcomed the participants on behalf of the ADB, and she referred to ADB’s Operational

Plan for Health 2015-2020, which is the foundation for the bank’s work in public health, including HIA.

Even in periods when the Bank’s program had less focus on health, the consideration of health in

infrastructure projects was always on its agenda. She also referred to the various regional events in 2016

– the organization of this training workshop was based on the consultations with the Cambodian

authorities and the HIA needs identified.

She emphasized the need for regional harmonization of HIA policy and practice to address

transboundary projects (such as Special Economic Zones, and transport corridors) and national

infrastructure projects with cross-border impacts.

Dr Kol Hero welcomed the participants and expressed his Ministry’s interest in Health Impact

Assessment as an important development planning tool. Through the WHO, various HIA capacity

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development activities had been promoted in Cambodia in the past decade. The need for preventive

approaches and for environmental health interventions had been highlighted again recently at the

Regional Ministerial Forum on Environment and Health in Manila. The existing MoU between the MOH

and the MOE on the implementation of a National Environmental Health Action Plan provided a solid

context for the promotion of HIA. He also pointed to the need to extend the capacity for HIA to the level

of provincial health authorities, as for many smaller development projects planning and decision making

on design and management occurred at that level.

In his opening address, Mr Dan Serey presented the situation of EIA in Cambodia today. There is a

strong legal framework in place for environmental protection. This is expected to be further enhanced

when the new EIA law that has been formulated takes effect. This law contains a specific section

referring to the need for health impact assessment in the EIA context. His Ministry welcomes a

strengthening of collaboration with the Ministry of Health; on issues of occupational health already a

productive collaboration exists with the Ministry of Labour. Mr Serey also welcomed the collaboration

with the ADB and expressed the expectation that the Bank’s technical assistance would help strengthen

policy and practice for HIA in EIA in Cambodia.

The detailed program of the training workshop is presented in Annex 2. The program was divided into

six parts:

Part 1 Learning about EIA and about HIA, and their status in Cambodia

Part 2 Screening and scoping of a demonstration project

Part 3 Terms of Reference

Part 4 Appraisal of an HIA report

Part 5 Creating the framework for intersectoral collaboration

Part 6 The Public Health Management Plan

For the group task work in the component on scoping, the ADB Rural Water Supply and Sanitation

Sector Project served as the context. A brief introduction and description were provided. Two phases of

this project have already been completed (Phase 1: 2006-2010; Phase 2: 2010-2015) – the project

currently is in a transition phase, with the third Phase in the pipeline. The third phase is expected to

start in 2020.

For the discussions on the appraisal of an HIA report, the 2004 HIA report of the Nam Theun 2

Hydropower Project in Lao PDR was used. At the end of day one, several participants expressed their

interest in the actual practice of HIA, especially the consultants participating. While the objectives of

this two day training workshop focused on the regulatory procedures and the essential function of MOE

and MOH staff, a half hour segment on this topic was improvised to address the request from the

participants.

The discussion on institutional arrangements for HIA was guided by the 2006 Policy Decree issued by the

Prime Minister’s office in Lao PDR (as an example from another country in the region) and participants

reviewed a 2007 Memorandum of Understanding between the Cambodian MOE and MOH, covering

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collaboration under a National Environmental Health Action Plan (NEHAP). The scope of this MoU

includes many HIA-relevant topics, but not HIA itself.

Resource documents included a 2006 article on Health Impact Assessment and Health Promotion from

the Bulletin of the World Health Organization, notes from the draft HIA Sourcebook under preparation

by the ADB HIA Advisory Team (Note 3: Health additions to sample Terms of Reference for initial Poverty

and Social Analysis during the reconnaissance mission; Note 4: health additions to sample Terms of

Reference for initial poverty and social analysis in project design), and a Task Guide to support the group

work on developing generic terms of reference.

Part 1 Learning about EIA and about HIA, and their status in Cambodia

The presentation by Mr Samkeat on EIA focused on the evolution of EIA as a practice in Cambodia. The

criteria for screening were highlighted, and the legal framework for EIA explained. There currently is a

new EIA law waiting formal adoption, with a specific section (section 5) on HIA.

The introduction of HIA started with a few stories of health impacts of different infrastructure projects

in the Asia/Pacific region. Definitions were given, and the economic, social and good governance

rationale for HIA was highlighted. The need to look at both positive (health opportunities, followed by

health promotion) and negative (risks, followed by health risk mitigation) was made clear. There was

also an explanation of what HIA is not:

HIA is NOT:

o Health Risk Assessment (HRA), but HRA (as a quantitative approach) can be part of HIA

(which combines quantitative and qualitative approaches)

o Health Impact Evaluation (HIE is done once the project is finished and the impacts are

measurable)

o Focused on one disease: a single disease focus contradicts the comprehensive approach

sought at the screening and scoping stage of the HIA process

o Exclusively looking at environmental determinants of health (all determinants of health

need to be considered, the mix will be different from one project to another)

o Exclusively focused on strengthening health services – hierarchically, the HIA focuses first on

preventive measures that can be included in project design and management

o An instrument to stop or delay development

Part 2 Screening and scoping of a demonstration project

The purpose and procedure of screening were explained. Boundary determination, identification of

vulnerable groups and health profiling were covered under scoping. A brief group exercise was carried

out to check whether the participants had understood the concept of health determinants and were

able to come up with positive and negative health impacts in the context of the third phase Rural Water

Supply and Sanitation Sector Development project.

Part 3 Terms of Reference

The objectives of Terms of Reference (TOR) were presented, together with the characteristics of “good

TOR”. Terms of Reference were flagged as the most important and central aspect of the consulting

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recruitment process. Questions addressed in the presentation included: What is the link between

screening/scoping and TOR? Why do we need a good TOR? Why should we avoid bad/inadequate

TORs? How do we prepare a good TOR? And, how do we assess a good TOR? In the HIA procedures

there may be several TORs for different assessment components. Once an HIA has been initiated there

should be continued communication between the project owner, the HIA consultants and consultants

for other aspects of project planning and design (including the EIA consultants) and the TOR should

evolve through a process of adaptive management.

The information was then applied in a task on specifying the components of a generic TOR. This task was

carried out by the five groups, and the group results were presented and discussed.

Part 4 Appraisal of an HIA report

Using the Final HIA report of the Nam Theun 2 Hydropower project as an example, first HIA practice was

discussed – using the procedure of activities followed by the NT2 consultants, but emphasizing that this

was not a typical HIA: it had been performed right before construction started, and there had been

severe time constraints on the HIA performance.

The outcome of the appraisal exercise should be a recommendation to accept the HIA report as it is or

with minor modifications, to return it to the consultants for major modifications or to reject the HIA

report. In order to arrive at this recommendation, the appraisal team should:

o Decide whether the assessment conforms to the original TOR and whether the TOR were

adequate

o Verify the objectivity of the assessment and identify any important biases or unforeseen

obstacles

o Decide whether the assessment procedure allowed for data and their interpretation to be

sufficiently comprehensive and credible to support the conclusions

o Decide whether the conclusions follow logically from the data collected and whether they are

accurate, comprehensive and probable

o Write an appraisal report of the procedures and conclusions – the report must be evidence-

based.

Once the report has been appraised and accepted, then the Public Health management Plan has to be

appraised for economic feasibility, social acceptability and technical soundness.

These issues were further discussed in the plenary session that followed.

Part 5 Creating the framework for intersectoral collaboration

Presentation of the HIA perspectives on the SDGs and a review of the Cambodian National Strategic

Development Plan 2014-2018 served as the basis for group work on institutional arrangements. A

detailed account of this session is presented in Annex 3, including a summary of the group presentations

and ensuing discussions. The group discussions included a review of the existing 2007 MoU between the

MoH and the MOE (Annex 4).

Part 6 The Public Health Management Plan

The options for interventions to be included in a PHMP were discussed following an introductory

presentation to the subject. The discussion was put in the context of a fictitious agricultural (irrigation)

development project: a medium sized rice irrigation scheme taking water from the river and returning

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drainage water to the same river, with resettlement of farmers to live close to the forest fringe, and

various resettlements downstream, relying on the river as a drinking water source. Options for

environmental engineering works, for environmental manipulation, for strengthening of agricultural

extension workers (focus on safe use of pesticides), development of alternative sources of drinking

water and strengthening of health services all were raised in the plenary discussion.

There was no time to carry out a proper workshop evaluation, but in a brief final plenary reflection the

participants showed satisfaction with the event, they were keen to apply the knowledge gained in their

jobs and hoped there would be further training events going more in-depth on specific HIA components.

Certainly, further training on HIA practice remained a priority for them.

Outcomes, observations and follow-up

The expected outputs of the training workshop were achieved. Almost 40 staff of the MOH and the MOE

were informed about EIA and HIA in general and their (potential) application in Cambodia. Moreover,

also some 15 EIA consultants/practitioners received the same information. They will be the core of

people putting HIA to practice. Both the Ministry of Environment and the Ministry of Health expressed

their willingness to cooperate more intensely in the area of EIA and HIA. The workshop created a better

understanding among environment sector and health sector staff of the concept and potential of HIA,

and the needs for its scaling up, and this will support the process of strengthening cooperation. There

now is an enhanced awareness of in the environment and in the health sector of EIA and HIA and of the

need to strengthen inter-sectoral collaboration in support of HIA. Options were discussed for

institutional arrangements to pursue EIA/HIA integration. It was agreed that the two ministries would

revisit the existing 2007 MoU and update it to include HIA. It was also agreed that the MOH would have

a seat in the EIA Review Commission convened by the MOE. The issue of national HIA guidelines

development should be given priority and will be followed up under the national HIA plan that will be

eligible for ADB technical assistance. The training materials have been made available to all participants

and this report of the training workshop will also be distributed to all.

The event proved an excellent opportunity to become acquainted with the EIA consultants’ community

in Cambodia. A list of interested consultants with their brief CVs will be composed for future reference,

and this will also serve as an information source for the recruitment of two HIA national consultants to

implement the national HIA plan proposed by the MOE and MOH. This plan will include the formulation

of draft national HIA guidelines, the implementation of a strategic HIA for the third phase of the Rural

Water Supply and Sanitation Sector Development Plan, the first rapid screening of an ADB supported

irrigation development project (tentative), and the drafting of a sub-decree text on HIA, to be proposed

for the EIA Law once it has become effective.

Terms of Reference for the national consultants will shortly be formulated by the HIA Advisory Team.

Further capacity development, in terms of human resources development, will have to follow three

pathways. One is the further training at the national level, in a hands-on approach, to develop the

expertise and skills needed to oversee and guide the HIA process – this will require the organization of

seminars and other events around the implementation of HIA for infrastructure projects such as the 3rd

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phase of the Rural Water Supply and Sanitation Sector Development Project. The second is the

development of training materials and the training-of-trainers to bring HIA knowledge and skills to the

provincial level: health departments and environmental departments in the provincial capitals. Third,

the initiative of University curriculum development initiated as part of the ADB HIA initiative should

include the development of practical training courses for EIA consultants, to develop the knowledge and

skills they will need to perform HIAs. These courses should provide certificates of competency that can

be meaningfully used in the selection of consultants for future HIA assignments in Cambodia, in

accordance with the competency framework presented in the ADB HIA Sourcebook.

Finally: this training workshop has created a new momentum for HIA in Cambodia, with interest and

willingness in both the critical ministries to further develop and implement the concept in a coordinated

way. Intersectoral collaboration remains a challenging issue in Cambodia, as is also recognized in the

National Strategic Development Plan 2014-2018, and significant effort will have to go into keeping this

momentum and establishing a sustainable basis for HIA in Cambodia’s future infrastructure

development.

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Annexes

ANNEX 1. List of participants

Attendance: * 27 April only ** 28 April only For phone numbers Cambodia country code is +855

Ministry of Environment

Name Division Position Email address Phone Number

Chea Leng DEIA Deputy Director lengmoe@gmail.com

Uong Bunal DOHM Deputy Director Bunal.uong@gmail.com 012644655

Yav Net DEIA Technical Officer Yavnet2011@gmail.com 092664097

So Kunthy EIA Officer Kunthy_S09999@yahoo.com 011646264

Men Uonmalin EIA Deputy Officer menuonmalin1986@gmail.com 015078665659

Duong Samkeat* EIA Deputy Director d_samkeat@yahoo.com 012880240

Khuon

Sokhanndy

EIA Technical Officer sokhanndy@gmail.com 012784042

Thean

Sovannarin

EIA Technical Officer theansovannarin@gmail.com 098990950

Hong Ly* EIA Officer Hongly.moe@gmail.com 077853535

Nguon Sokha* DEIA Nguonsokha8@yahoo.com 012772396

Chhun Samnang DEIA Samnangchhun2010@gmail.com 012258050

Lay Chanthy EIA Vice Officer Laychanthy7@gmail.com

092333076

Chhim Sophanny EIA Technical Officer Sophannychhim@yahoo.com 017454507

Touch Narun EIA Technical Officer Touchnarun88@gmail.com 078797007

Chheang Sarak EIA Sarak_bro@yahoo.com

012698220

Long Navanny EIA Technical Officer navannylong@gmail.com 011721177

Danh Serey* EIA danhserey@yahoo.com 016821353

Chhour Sokcheng EIA Officer sokchengchhour@yahoo.com 011640664

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Name Division Position Email address Phone Number

Chhoeung

Sothearith

EIA sothearithchhoeung@gmail.com 012295558

Prum Samban EIA Technical Officer Prumsamban168@gmail.com 092830022

Ministry of Health

Name Division Position Email address Phone Number

Vong Sathiarany DPM Health Officer sathiarany@gmail.com 012331905

Chin At DPM Health Officer Chinsamart9@gmail.com 095360036

Chhoeunchhay

Visal

DDF Health Officer Chhoeunvisal@gmail.com 012893637

Prak Sophonneary NMCHC Deputy Director sophonprak@gmail.com 012965368

Sam Bunleng CNM/DHF Chief of EPI sambunleng@gmail.com 078696946

Len Rotha* CDE Vice Chief of

Bureau

rothaede@yahoo.com

Son Thyda* DPHI HIS staff Sonthyda289@gmail.com

Rin Boran HD staff rinboran@yahoo.com 092999429

Chea Phalla University of

Health Sciences

Staff/Research

Unit

cphalla@uhs.edu.kh 012718253

Kol Hero* Preventive

Medicine

Director herokol@yahoo.com

Nyeth Sovann Deputy Director Sovann_pmd@yahoo.com

Sin Touch Hospital

Department

Vice Chief of

Bureau

Sintouch358@gmail.com 012335579

Ly Touch CDC Officer lytouchCDC@yahoo.com 0112020289

Kim Sok Keng* DPHI Keng_kim@ymail.com

Tol Bunkea CNM Epidemiologist tolbunkea@ymail.com 016690999

Leang Supheap NIPH Officer leangsupheap@yahoo.com

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Name Division Position Email address Phone Number

Thol Dawin NIPH Officer winnathol@gmail.com

Chhorn Sophea* University of

Health Sciences

ird@uhs.edu.kh 011516063

Consultants and other participants

Name Agency Position Email address Phone

Number

Yim Savuth CES Co.

Ltd.

EIA Team

Specialist

Yim.savuth@gmail.com

092280066

Sao Vibol* E&A saovibol@yahoo.com 0126262006

Hay Dalino GEG dalinohay@gmail.com 099926667

Uch

Sereykosal

SAWAC Assistant

Engineer

Uch_sereykosal@yahoo.com 093232431

Lay Darith Sustinat

Green Co.

Ltd.

Laydarith.rupp@gmail.com 010903012

Chhun

Bunmeng

KCC Bunmeng_chhun@yahoo.com 017587385

Neth

Sopheanith

RCBCC Co.

Ltd.

sopheanithneth@gmail.com 0969552222

Chay

Panhaleak

PPIC Co.

Ltd.

Socioeconomic

specialist

Chay_panhaleak@yahoo.com 017661182

Sor Buntha GIGB Senior

Technician

buntha.sor@gigbcambodia.com 077653525

Som Piseth Sustinat

Green

Vice Chief

Officer

Piseth05@gmail.com 092369594

Mao

Phearun

CGD Phearun003@gmail.com 069259611

Ham

Kimkong*

E & A MD kimkonghamk@gmail.com 012406716

Ear

Unsovath**

PKDC Assistant Earunsovath97@gmail.com 085500040

Noan

Sereroth**

SBK Staff Noan.sereyroth@gmail.com 089733681

Huon

Sopheak**

SBK Staff huonsopheak@gmail.com 012477126

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ANNEX 2. Training workshop Programme

08:15 Registration of participants

08:45 Opening of the training workshop: statements by ADB, representatives of the ministries of

health and of the environment

09:00 Objectives, course programme, round of introductions

09:15 Part 1 Learning about EIA and about HIA, and their status in Cambodia

09:15 What is EIA? And how does it address health? What is the EIA

policy context in Cambodia? Duong Samkeat, Deputy Director, EIA Department

Q&A; Plenary discussion to explore people’s understanding and perceptions of HIA

09:40 What is HIA: concept, rationale objectives of HIA. Why do we

perform HIAs? Robert Bos, ADB Consultant

Q&A; Group discussion on the nature of health determinants in development in

Cambodia, and their management; feed back to the plenary

10:15 Refreshments

10:35 What is the context to perform HIAs as part of development planning?

Q&A; Discussion on economic, social, environmental aspects; the national and

international development agenda SDGs; private vs public sector Robert Bos, ADB Consultant

11:00 Part 2 Screening and scoping of a demonstration project

11:00 Introduction to screening and scoping

11:15 Introduction to a project (third phase of the Rural Water Supply and

Sanitation Sector project) Robert Bos, ADB Consultant

11:25 Group work screening and scoping

12:00 Feedback reporting from groups to the plenary

12:30 Lunch

14:00 Part 3 Terms of Reference

14:00 What do good terms of reference for HIA look like? Robert Bos, ADB Consultant

Q&A; discussions

14:20 Group work: listing the components of terms of reference for HIA

14:40 Reporting back from the groups and discussion

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15:00 Regional experiences of linking HIA with EIA Thailand, Lao PDR, Viet Nam

15:15 Refreshments

15:35 Part 4 Appraisal of an HIA report

15:35 Appraisal: what are the objectives and expected outputs

Q&A; discussions

15:55 Steps in the appraisal of HIA

Q&A; discussions

16:15 Group work appraising an HIA report

16:50 Quick update from the groups

17:00 Closure of today’s sessions

Day 2, 28 April 2017

08:30 Recapitulation of day 1, plenary discussion

09:00 Part 4 Appraisal of an HIA report (continued)

09:00 Group work (continued)

09:45 Reporting back from the groups to the plenary

10:15 Refreshments

10:25 Part 5 Creating the framework for intersectoral collaboration

10:25 Health impact assessment: different dimensions for different projects

Q&A; discussions

10:45 Group work on criteria development

11:05 Reporting back from groups

11:25 What are institutional arrangements, what form can they take and how do they

promote the harmonization and integration of EIA and HIA? Robert Bos, ADB Consultant

Q&A; discussions

11:45 Formulating arrangements for cooperation under the MoU between MOE

and MOH Robert Bos, ADB Consultant

12:00 Lunch

13:30 Part 5 Creating the framework for intersectoral collaboration (continued)

13:30 Group work on formulating arrangements for cooperation under the

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existing MoU

14:30 Groups report back to the plenary

15:00 Refreshments

15:30 Part 6 The Public Health Management Plan Robert Bos, ADB Consultant

Q&A; discussion

16:00 Plenary discussion: reflections on the two days, and the way forward

16:30 Closure of the training workshop

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ANNEX 3

Discussion on institutional arrangements for HIA in Cambodia, at the training workshop « Health

Impact Assessment in the Environmental Impact Assessment Procedure ».

The group discussions on institutional arrangements for HIA were preceded by two presentations: HIA in

relation to the SDGs and HIA-relevant issues in the Cambodia National Strategic Development Plan

2014-2018

SDGs

The first presentation focused on the international policy framework: HIA in relation to the Sustainable

Development Goals (SDGs). It referred to the implicit links to HIA in several of the SDGs. Obviously,

several of the targets under SDG3: Ensure healthy lives and promote well-being for all at all ages, are

relevant to HIA –

3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and

combat hepatitis, water-borne diseases and other communicable diseases

3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through

prevention and treatment and promote mental health and well-being

3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents

3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air,

water and soil pollution and contamination

Of the other SDGs, a number are particularly relevant to HIA: SDG5 (gender equality), SDG6 (water and

sanitation), SDG7 (affordable and clean energy), SDG9 (industry, innovation and infrastructure), SDG11

(sustainable cities and communities), SDG12 (responsible consumption and production) and SDG15

(climate action).

The second presentation focused on the HIA-relevant passages and items in the Cambodia 2014-2018

National Strategic Development Plan (NSDP), summarized here below.

The NSDP 2014-2018 Report

o presents a summary of major achievements and challenges faced in the implementation of

NSDP Update 2009-2013

o outlines the Macroeconomic Framework for NSDP 2014-2018

o presents RGC’s key policies and actions that the concerned line ministries and agencies will

undertake (in conjunction with the sub-national administrative authorities) to implement these

policies

Cambodia needs to address the following shortcomings: The Cambodian economy hinges on a narrow

base of 4 sectors: agriculture, garment manufacture, tourism and construction. The depth of activity in

terms of technological sophistication, vertical integration, and value addition is limited […] The growth

process has been restricted to a few provinces causing large interprovincial gaps.

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The infrastructure spread is low and costs are high:

o Transport network (both roads and vehicle services) is limited and there is no railway yet. The

unit cost of transport remains high compared to that in the neighbouring countries.

o Electricity supply is limited, some areas are yet not connected to the grid, and the unit cost

remains relatively high compared to that in the neighbouring countries.

o Irrigation systems are yet short of the demand, especially for multiple cropping.

o Populations covered by safe drinking water and sanitation do not exceed the 50% mark. […]

The governance systems are yet not comprehensive; the legal knowledge and law enforcement capacity

is below the required level, and the organizational structures and functions are not fully responsive to

the needs. Additionally, there is little interministerial/departmental coordination and limited

coordination between the national and sub-national levels, resulting in less than optimal service

delivery.

Managing the environment and natural resources requires the highest attention for sustainable

development. In addition, global climate change has been adversely impacting on Cambodia’s

ecological system and hence, socio-economic development, for which Cambodia has to brace itself. […]

Some key challenges facing the planners and other stakeholders at this juncture at the time of drafting

this plan may be grouped into the following:

o The Cambodian economy, now with a per capita GDP exceeding US$1,000, will become a low-

middle income country. As a result, it will be less eligible for grants and will have to rely on

(concessional or other) loans. (Note: this has meanwhile happened in 2015, and hence the

Cambodian Government cannot longer rely on grants. For example, ADB support for the third

phase of the Rural Water Supply and Sanitation Sector Development Project will be in the form of

a loan, not a grant).

o In the new reality of the post-2009 global economy, Cambodia will need an entirely different set

of strategies, including diversifying markets, both for exports and investments. New

partnerships would also imply newer forms of institutional arrangements, for which there is

need for internal preparedness. Cambodia has integrated into ASEAN by 2015, with

consequences for free movement of skilled workers, of capital, and other receding trade

barriers.

o Good governance continues to assume a central position and will require a rapid expansion of e-

services, ‘electronic-wiring’ of the whole country, development of on-line databases, providing

e-services, and associated human resource development

o The Industrial Development Policy (IDP) of the RGC is a key roadmap for this in support of a

greater integration into ASEAN. More resources and concerted effort (to guide investments) in

the human capital sector are essential requirements.

o For Cambodia to have a greater control over its economy (esp. the monetary policy),. De-

dollarization, thus, is to assume primacy to make the Cambodian currency acceptable to its

people and to the countries in the region.

o Finally, the environmental issues must also assume centrality, which currently not that it does

not presently, but there is scope to step up efforts to save especially the Tonle Sap (and other

water systems) and forests for sustainable development, sustainable livelihoods of people in

rural areas, and sustainable agriculture.

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Chapter IV: Key Priority Policies and Actions 2014-2018 – IV.4 Environment

MOE will prepare the following legislation (HIA relevant items bold):

o Prepare the climate change legal framework including updating institutional arrangements,

financing arrangements and mainstreaming of climate change across sectors.

o Developing a Law on the Management of Environmental Pollution.

o Developing a Law on Environmental Impact Assessment.

o Developing a Law on Green Growth.

o Developing a Law on Biodiversity.

o Developing a Law on Chemicals Management.

o Developing a Law on Ratification on Minamata Convention on Mercury.

o Developing a Sub-decree on the Establishment of Funds for Natural Protected Areas.

o Developing a Ministerial Order on adjusting the management structure of the natural protected

areas.

o Amending the Sub-decree on the environmental impact assessment.

o Developing a Sub-decree on Social Funds.

o Establishing a M&E unit for LMSSP.

o Developing a Sub-decree on the management of electric and electronic appliances within

waste management.

o Issuing a circular on management of waste water, to municipal and provincial authorities.

o Issuing circular on scientific collection, transportation, recycling and disposal of solid waste

and rubbish.

In the area of environmental impact assessment, MOE will in collaboration with concerned the

ministries and agencies, ensure sustainable use of natural resources by conducting environmental

impact assessments, prior to the implementation of development projects.

It would undertake the following:

o Develop guidelines for environmental impact assessment in the sector of oil and gas,

agriculture, tourism and infrastructure.

o Strengthen technical capacity of technical staff at all levels on environmental impact

assessment.

o Monitor implementation of environmental management plan presented in the environmental

impact assessment report, and implement environmental protection agreements with project

owners.

With respect to urban drinking water supply:

Improve water source protection and enforcement of regulations:

o Collaborate with relevant agencies to protect water quality at source to ensure appropriate

volumes of raw water and reduce the cost of water treatment.

o Water supply development will protect public health and the environment, gradually reducing

the quantities of wastes from water treatment facilities discharging into the natural

watercourses without effective treatment.

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o Development projects will have clear environmental impact assessments to ensure that

projects have environmental impacts within legal limits.

Development will comply with national technical standards and use appropriate technologies to ensure

affordable water tariffs and sustainable levels of service.

In conclusion

As the nation embarks upon the next phase of its development (National Strategic Development Plan

“NSDP” 2014-2018), the RGC will carrying forward the achievements of the past and also gearing up to

face emerging challenges and complete the unfinished tasks. The key challenges stem from Cambodia’s

full integration into the ASEAN and the reduction in external concessional assistance. In the next cycle of

planning, the 3 main processes that will need promoting are:

1. Raising budget revenues collection from both taxes and non-tax sources significantly and sustainably

beyond present levels.

2. Scaling-up the quality of human capital both for industrialisation and human wellbeing, and both

within and outside the government.

Improving capacities within the government (both at the national and subnational levels) to deliver

quality services through better inter-ministry/agency communication and sharing of information,

improved (vertical) integration between the sub-national levels and the apex ministries/agencies, and

promoting e-governance.

Outcome of the group discussions on institutional arrangements

The discussion in groups was held in the context of the existing Memorandum of Understanding

between the ministries of environment and health of 4 April 2007, in which the two partners agree upon

the principles, goals and objectives, actions and structures of the National Environmental Health Action

Plan (NEHAP) set forth as the basis for their joint commitment, and call upon their international partners

to support the implementation of this action plan in the areas of water supply and water quality,

hygiene and sanitation, solid waste (domestic and industrial), toxic chemicals and hazardous wastes, air

quality and air pollution (indoor and outdoor), disasters and emergencies, occupational health and

climate and ecosystem changes through providing knowledge management and technical support,

progress reporting, coordination and advocacy, and resource mobilization (signed by HE Dr Nuth

Sokhom, Minister of Health, and HE Dr Mok Mareth, Minister of Environment).

Group 1 pointed out that in order to strengthen the collaboration between the two ministries for HIA, it

was critically important to define the roles and responsibilities in this area. This could be done through

existing inter-ministerial committees and working groups, in particular the inter-ministerial working

groups on Environmental Health (under the Inter-ministerial Committee on Environmental Health), and

the EIA review committee. Part of the process of defining roles and responsibilities would be to review

the existing legal framework, the draft legal framework (in particular the new EIA law with its Chapter 4,

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section 5 on HIA) and to recommend the formulation of additional legislation (such as a sub-decree on

HIA once the new EIA law became effective).

Once roles and responsibilities in HIA had been defined and agreed, additional administrative measures

could be taken based on a clear needs assessment. However, first the possibility of using existing

administrative and institutional arrangements should be investigated. The Inter-ministerial Committee

on Environmental Health, chair by the MOH, had been in existence since 2009. All 27 ministries were

represented in this Committee (including the Ministry for Religious Affairs) and it operated in technical

working groups (TWGs). This Committee had full competence to address HIA issues. From the side of the

MOE it was remarked that it would be helpful if, in this context, the balance between environment and

health in this Committee could be redressed – in order to deal with HIA in EIA it is now too much health-

oriented.

In response to the issue of Technical Working Groups, I raised the issue of mechanisms at the regional

level, in particular the Regional Forum on Environment and Health, which recently met in Manila, and the

fact that there was a TWG for HIA as part of that Forum, chaired by Dr Chandanachulaka from Thailand.

I also pointed to the need for regional coordination and harmonization, a major aim of the ADB HIA

initiative, to deal with transboundary project, with national projects with a transboundary impact and

with Special Economic Zones.

Group 2, in which Ms Rani (MOH) and Mr Leng (MOE) participated, observed that EIA and HIA were not

specifically mentioned in the MoU, even though many of the items mentioned implicitly referred to HIA.

Currently, the EIA department of the MOE was not linked to the Inter-ministerial Committee on

Environmental Health, and the Ministry of Health was not linked to the EIA review Committee (in this

review committee health was covered by the Ministry of Labour, focusing on the health of the

workforce). It was stated that the MOH, as the national authority in matters of public health, should be

involved in HIA, certainly with respect to community health. The priority was to establish functional

institutional arrangements at the national level, linked to solid capacity development. Taking HIA

capacity development to the provincial level was premature, but eventually Training-of-Trainers courses

should be prepared to first raise awareness at the provincial and lower levels, as appropriate, and to

develop the knowledge and skills to oversee the performance of HIAs. It was agreed that this capacity

development at the sub-national level should aim to foster collaboration between the environment and

health offices. Representatives from both ministries expressed their interest and willingness to engage.

Observations were also made with respect to research for HIA. HIA needs to be properly evidence-

based, but time constraints on the HIA process often implied reliance on secondary or existing data only.

However, whenever feasible time-wise, HIA should be sufficiently resourced to collect primary data. The

coordination between MOE and MOH on EIA and HIA would allow for efficient data collection, with

some data serving both types of impact assessment.

With respect to the demonstration project, questions were raised about the timeliness of an HIA if the

project was already going into its third phase. Some pointed out it was too late for an HIA and that the

emphasis should be on monitoring and evaluation; others pointed out that the third phase was, in

principle, a new project, and therefore deserved an HIA, and that the HIA would be facilitated by the

already available data from the first two phases. The MOE indicated that the criterion to do an EIA for

water and sanitation projects is project with over 10,000 new connections – that leaves the question

why the RWSSSD project has not been subject to an EIA.

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For the MOH to engage with the EIA review committee, it would have to appoint a focal point. The MOH

would have to explore whether it can establish a TWG on HIA under its Inter-ministerial Committee on

Environmental Health.

Some issues came up that needed a response. The fact that there has been no EIA by the MOE of the

RWSSSD project can have one of two reasons: (1) the ADB safeguards procedures were considered

sufficient and the Government of Cambodia considered no further EIA was needed; or (2) for purposes of

project streamlining, it was subdivided into small projects with each under 10,000 new connections,

therefore not needing an EIA.

Capacity development at lower administrative levels (provinces) should be based on a clear definition of

the HIA functions that need to be performed by government at those levels, so that training is geared to

needs.

With respect to evidence, I made the observation that the health sector tends to be obsessed with

evidence, and that was correct in biomedical science (double blind trials etc), but that in HIA different

types of evidence supported the conclusions. This could be scientific evidence, but with the reliance on

experiences from similar projects in similar settings, legal evidence (ie witness reports for example)

would also count as evidence, certainly if the communities would be involved in the HIA processes.

Group 3 supported what had been said by the first two groups and in addition argued in favour of a

step-wise approach to building capacity at the provincial level. Any TOT approach aimed at staff at the

sub-national should be preceded by an awareness creation approach so the receptivity to HIA training

would be enhanced. It was also stressed that reaching out to the communities in capacity development

and guidelines formulation was very important. First priority is to ensure firm institutional arrangements

are in place at the national level. Finally an observation was made that over the past 15 years a lot of

know-how and experience had developed with respect to emergency response and disaster

management.

I clarified that disaster preparedness and emergency responses were fundamentally different from HIA.

Emergencies and disaster happened unexpectedly, and their exact nature and magnitude were hard to

predict – so in fact only a response was feasible. HIA is a tool that fits within the orderly planning process

of development projects, when there is a rapid change in environmental and social determinants of

health and where there is an opportunity to manage those changes, based on evidence, to minimise

adverse health impacts and maximize health opportunities.

Group 4 also supported earlier statement, but drew attention to the need to strengthen the links

between departments in the Ministry of Health. Clearly, there had been little overall awareness of HIA in

the MOH thus far, and the Ministry had therefore not been in a position to engage in HIAs. However, it

is clear that if the strengthening of collaboration between MOE and MOH is to be successful, there

should be an internal HIA platform within the MOH that facilitates all departments to contribute

effectively. The group also emphasized that “re-inventing the wheel” should be avoided – if there is an

existing MoU between the MOE and MOH, then this should be updated to accommodate HIA as a new

area of collaborative activities. The same holds true for existing mechanisms for communication and

deliberation between the two ministries – the existing Inter-ministerial Committee Environmental

Health, and the EIA Review Committee should address HIA issues. Finally, the group argued that the

formulation of national guidelines was a priority, not only for the ministries, but also to support the

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many NGO and private sector entities that should engage in HIA. Standardized procedures and a clear

definition of roles and responsibilities were essential to keep all stakeholders engaged on the same

wavelength.

Group 5 had little to add to what had been said by the previous groups, but re-emphasized the need to

use the existing MoU to further the cause of HIA. The group did bring up one issue it felt had not been

covered by the previous groups, the fact that MOH and health sector-related projects also needed an

EIA. This was very obvious in the case where new hospitals were built, to ensure safe management of

medical waste, but another example mentioned was that of establishing new pharmaceutical industry:

production, packaging, storage and waste management were all issues requiring EIA and HIA. Similarly,

some of the operational activities of the MOH should also be considered for their impacts on

environment and health.

= = =

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ANNEX 4. 2007 MOU between the Cambodian ministries of health and environment.

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