IFC requires that this document is made available through the World Bank InfoShop and to the locally affected community no less than 30 days prior to project consideration by the IFC Board of Directors. The Summary of Project Information (SPI) also provides details of where the ERS has been made available to the locally affected community. The SPI must be sent to World Bank InfoShop no less than 30 days prior to project consideration by the IFC Board of Directors.

This is a Category B project according to IFC’s Procedure for Environmental and Social Review of Projects because a limited number of specific environmental and social impacts may result which can be avoided or mitigated by adhering to generally recognized performance standards, guidelines or design criteria. The review of this project consisted of discussions with AHEL management; a limited appraisal of technical, environmental, social and occupational safety and health information made available for review by the company; and a site visit to the Indraprastha Apollo Hospital in Delhi, in which AHEL has a 14% shareholding. The following potential environment, health and safety and social impacts of the projects were analyzed. - corporate environmental, social, hygiene, and health and safety management systems; - national and local government permitting requirements; - air emissions and noise; - water and wastewater; - power (including fuel storage); - hazardous materials management and occupational health and safety (including transportation, storage , handling and disposal); - safety measures for housekeeping, radiation, kitchen and other at-risk employees; - minimization, recycling and disposal of solid and hazardous wastes; - fire and life safety and emergency response; - corporate social responsibility efforts, including HIV/AIDS awareness; and - timely reporting on environmental, social, health and safety management.

AHEL has implemented systems to ensure that the facilities in which it has a majority shareholding comply with applicable Government laws and regulations. On the basis of the appraisal, IFC is satisfied that the systems in place are capable of managing and facilitating the monitoring of key ESHS issues in a manner consistent with relevant World Bank Group environment and social policies and environmental, health and safety guidelines. Specific information about how potential impacts are being addressed is summarized in the paragraphs that follow. - Corporate environmental, social, and health and safety management systems: AHEL is sensitive to environmental, social development and occupational health and safety aspects of its operations. The Company has obtained ISO 9000 quality management certification for the Apollo Chennai Hospital, and plans to extend this certification in future to other facilities in which it has a majority shareholding. Further, the Company is in the process of obtaining, in phases, certification of Apollo Chennai Hospital against the requirements of Joint Commission International (the accrediting arm of the US-based Joint Commission for Accreditation of Healthcare Organizations). - National and local government permitting requirements: AHEL ensures that its majority shareholding facilities comply with relevant Government requirements. As an example, Apollo Chennai has obtained consent under the following legislation: Year: 1974 - The Water (Prevention and Control of Pollution ) Act amendments (1988) 1975 - The Water (Prevention and Control of Pollution ) Rules 1977 - The Water (Prevention and Control of Pollution ) Cess Act 1978 - The Water (Prevention and Control of Pollution ) Cess Rules 1981 - The Air (Prevention and Control of Pollution ) Act Amendment 1987 1982 - The Air (Prevention and Control of Pollution ) Rules 1986 - The Environment (Protection ) Act amendments (1989,1990, 1993, 1996, 1997, 1998, 1999, 2000) 1992 - E (P)Act Notification – Environmental statement 1989 - The Hazardous Wastes (Management & Handling ) Rules amendments (2000) 1998 - The Bio-medical Waste (M & H) Rules 1999 - Regulation on recycling of waste oil and non-ferrous scrap 2000 - Noise Pollution (Regulation and Control) Rules 2000 - Ozone Depleting Substances (Regulation and Control) Rules 2001 - Batteries (Management & Handling ) Rules Air emissions and noise: The principal source of air emissions at most facilities is standby diesel generator (DG) sets and facilities must monitor emissions to demonstrate compliance with Government norms. At Apollo Chennai, for example, the hospital has two DG sets (1000 KVA and 750 KVA), compressors, chillers and boilers; and undertakes ambient noise levels monitoring. The hospital has switched its refrigerant in chillers from R11/12 to R134a in accordance with Montreal Protocol and Government of India requirements. Water and wastewater: Facilities draw water from a combination of municipal sources and bore-wells. In most cases, water is further treated prior to use to meet the Indian Standard (IS) for potable water, which generally involves sand and carbon filter through chlorinated process. The laboratory wash water, floor cleaning, and housekeeping water are chemically disinfected and discharged into the municipal sewerage system together with domestic sewage. Power (including fuel storage): The principal source of power for most facilities is grid electricity. However, each facility is equipped with full DG set back-up power. Fuel is typically stored in tanks with secondary containment. At Chennai Apollo Hospital, the Company has undertaken an energy audit and is implementing audit recommendations like capacitor bunks, panel boards, switch boards and air conditioning chillers. Hazardous materials management: Hospitals use several hazardous materials for medical, laboratory and utility uses and AHEL facilities generally have plans in place to manage the types of emergencies that can arise from the use of these materials. Pressure vessels (for storage of pressurized gases and liquid oxygen etc.) are located outside the building and secured. At Apollo Chennai and other facilities, programs have been established to reduce the risks associated with hazardous material use. Personal protective equipment (PPE) is made available to workers handling hazardous materials, training is provided to these employees, and washing stations are available in material handling areas. Other hazardous materials (such as oil and lubricants) are stored in appropriately contained areas. Apollo Chennai has instituted a process for Clinical Governance which includes risk management of both clinical and environmental, occupational health and safety risks. Fire and life safety and emergency response: Facilities have installed appropriate equipment for prevention, detection and control of fire, electrocution and spills in accordance with acceptable engineering practices and Government laws and regulations. These typically include smoke detectors, building section isolation mechanisms, fire hydrant systems, fire extinguishers, sprinkler systems, fire isolation doors and a centralized fire control facility for remote detection and control of fire incidents. Emergency response procedures have been developed and are displayed at prominent locations in each facility. Employees are trained on these procedures, and fire drills are conducted periodically. Minimization, recycling and disposal of solid and hazardous wastes: The principal hazardous waste is bio-medical waste, which is managed in accordance with the following legislation: 1989 – The Hazardous Wastes (Management & Handling) Rules amendments 2000 1998 – The Bio-medical Waste (M & H) Rules 1999 – Regulation on recycling of waste oil and non-ferrous scrap 2001 - Batteries (Management & Handling) Rules Bio-medical waste is collected in color coded bins, records of waste generated are maintained, some of the biomedical wastes are shredded and disposed of to an authorized disposal entity, and the others (combustible wastes) are directly disposed of to an authorized incineration entity. Used oil and lubricants are stored in contained areas and sold to an authorized regeneration entity. Non-hazardous solid wastes (e.g., kitchen wastes) are removed in accordance with municipal requirements for safe disposal. Corporate social responsibility efforts, including HIV/AIDS awareness: AHEL encourages corporate social responsibility work. Recent efforts include programs such as the “Save a Child’s Heart” awareness campaign on World Heart Day; conducting various medical camps in and around Tamil Nadu; making subsidized medical consumables available; free camps on diabetes, asthma and respiratory disorders; and consultation camps on drug addiction and rehabilitation, stress, insomnia, nervous disorders, depression etc. AHEL’s program against HIV/AIDS is made available to employees, contractors and nearby communities, in a culturally appropriate manner. Timely reporting on environmental and social performance to IFC: The Hospital will submit an Annual Environmental and Social Monitoring Report (AMR) to IFC within 90 days of the end of its financial year.

This ERS contains the full environmental and social documentation prepared for the project.

Accordingly, IFC concludes that the Company has systems in place capable of ensuring that the facilities in which it has a majority shareholding meet host country regulations and applicable World Bank/IFC environment and social policies and the environmental, health and safety guidelines.

IFC will evaluate the project's compliance with the applicable environmental and social requirements during the lifetime of the project by reviewing the annual monitoring reports (AMRs) prepared for the project covering: ongoing performance of project-specific environmental, health and safety and social activities as reflected in the results of periodic monitoring programs. Periodic site supervision visits will also be conducted.