Healthy Design at ADB

How to Design Health into Development Projects

Dr. Beverly Lorraine Ho
Consultant, SDCC

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies
of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the
accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminologies used may not
necessarily be consistent with ADB official terms.

Outline

Why HIA matters

What are current HIA practices
How can HIA practices be improved
Key Takeaways

Outline

Why HIA matters

What are current HIA practices
How can HIA practices be improved
Key Takeaways

Population

Health &
Safety

Development projects change

determinants that impact health.

3
2
1
Story 1: Health Impacts of Energy Development
positives: affordable, lighting, refrigeration, time saving
negatives: resettlement, ecosystem disruption, malaria

dam

irrigation

resettlement
land compensation

suicide
facilitated by easy
access to pesticides

depression

unsustainable
livelihoods

sale of land to
urban residents
STORY 2: Health Impacts of Agriculture Development
positives: food security, food to sell at market, farming resilience
negatives: Japanese encephalitis, malaria, plus the above

Health Impact Assessment anticipates health

gains and losses and manages these.
Gains

Losses

Effective HIA has four elements

Definition of health is clear & complete
Properly-timed
Fit for purpose not HIA for HIA sake
Upstream at the policy level or downstream at project
level
Part of EIA or stand-alone
Consider short and long-term time horizon

Accountable public health management plan

Health promotion measures, health mitigation
measures

Health experts are required for HIA

Assistance in the screening and scoping of project options

Drawing up the HIA Terms of Reference
Appraising the HIA report
Preparing an intersectoral Public Health Management Plan
Setting up a framework for intersectoral action (e.g. MoU)
Preparing a solid evidence-based position for negotiations
Monitoring compliance with the recommended measures
Monitoring the health status of local communities

Outline

Why HIA matters

What are current HIA practices
How can HIA practices be improved
Key Takeaways

HIA in ADB
Some health
in EIA and
SPRSS
Efforts are
fragmented

Definition of
Health

Ownership
and Capacity

Health is viewed
as a sector
(medical
services)
instead of
theme
Emphasis on
occupational &
environmental
health

Neither health,
environment,
nor social sector
feels
accountable

ADB EIA: occupational, injuries,

pollution-related
SCREENING QUESTIONS

YES

NO

REMARKS

risk to human health and safety

(e.g.
from

generation, storage, or disposal of

hazardous wastes, inappropriate

public health risks from discharge of wastes and poor
air quality;
noise and foul odorhealth
from plant emissions?
occupational
and safety measures,
occupational health hazards due to fugitive dust,

violation
of
ambient
water
or
air
quality
materials handling, noise or other process operations?
disruption
of transit patterns creation of noise and

standards
B. Potential Environmental Impacts
Will the project cause..

congestion, and pedestrian hazards aggravated by heavy

trucks?
disease transmission from inadequate waste
disposal?

ADB PSA: communicable disease focus

B. Affordability
C. Communicable Diseases and Other Social Risks
1. Indicate the respective risks, if any, and rate the impact as high (H), medium
(M), low (L), or not applicable (NA):
Communicable diseases
Human trafficking
Others (please specify) ______________
2. Describe the related risks of the project on people in project area.
VI.

MONITORING AND EVALUATION

Source: ADB SPRSS template, Page 2, section B

Malaria
STIs

Cardio-vascular
disease

Road traffic
injuries

Diabetes

Stress and
anxiety, isolation

Malaria

Lung Disease

Electrocution

Wasting

Stress and
anxiety

Flu
STIs

Hypertension
Asthma

Communal
violence related
injuries

Obesity

Dementia,
alcoholism,
suicide

Dengue
Ascariasis

Poisoning

Drowning

Goiter

Cretinism

Pesticide
poisoning

Skeletomuscular
conditions, heat
stroke

Stunting and
wasting

Domestic
violence

Leptospirosis
Trichinella
Japanese
encephalitis

HIA in ADB
Some health
in EIA and
SPRSS
Efforts are
fragmented

Definition of
Health

Ownership
and Capacity

Health is viewed
as a sector
(medical
services)
instead of
theme
Emphasis on
occupational &
environmental
health

Neither health,
environment,
nor social sector
feels
accountable

DMC Policies on HIA

Cambodia
Law on Environmental Protection and Natural Resources 1996 + Subdecrees
Draft law on Environmental Impact Assessment with Section on HIA

Lao PDR
National Policy on HIA 2006, all projects

Myanmar
Environmental Conservation Law 2012
EIA Procedure 2015

Thailand
Enhancement and Conservation of National Quality Act 1992, specified 12
projects

Vietnam
Law of Environmental Protection 2014
EIA with public health component

Vietnam: Project cycle Strategic

Environmental Assessment (SEA) and EIA

Outline

Why HIA matters

What are current HIA practices
How can HIA practices be improved
Key Takeaways

TA 8763 RECAP Output 4

RMTF

TA 8763 RECAP Output 4

HIA Advisory Group

Salim Vohra MBChB MSc PhD | Martin Birley BSc MSc PhD
Robert Bos BSc MSc | Yanyong Inmuong BSc MSc PhD
Filipe Silva BSc MSc | Astrud Lea Beringer MA
Genandrialene Peralta BS, PhD

TA 8763 RECAP Output 4

ADB level

Tools/Checklists
Capacity Strengthening
4 Demo HIA + PHMP

Hierarchy of Tools
Stand alone
HIA
Expand
definition in
PSA & EIA
Sector-specific
tools

Public Health
Management
Plan

TA 8763 RECAP Output 4

DMC level

Health

Environment

Planning

HIA Policy
Decree or
Regulation

Screening
checklist

Advocacy
Tools

Scoping
checklist

HIA best
practice
guidelines

Training
manual

TA 8763 RECAP Output 4

Regional level

FOURTH MINISTERIAL REGIONAL FORUM

on ENVIRONMENT and HEALTH in
SOUTHEAST and EAST ASIAN COUNTRIES
Manila, Philippines
October 8-9 2016

Outline

Why HIA matters

What are current HIA practices
How can HIA practices be improved
Key Takeaways

Key Takeaways
ADB
Entry point to discuss
health with DMCs
Introduce health as a
theme (relevant for ADB
project classification)
Count health/PHMP in
infra project for health
sector lending

Need health staff to

support HIA efforts in RDs

DMCs & Regional Work

Policy framework exists
Strength implementation
capacity
Promote co-ownership (health
and environment) but clear
accountability
DMCs will have to report on
SDGs, health determinants
important part of it