Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 01/07/2011 Report No.: AC5751 1. Basic Project Data Country: Uzbekistan Project ID: P113349 Project Name: Health System Improvement Project Task Team Leader: Susanna Hayrapetyan Estimated Appraisal Date: December 9, 2010 Estimated Board Date: April 7, 2011 Managing Unit: ECSHD Lending Instrument: Specific Investment Loan Sector: Health (98%);Compulsory health finance (2%) Theme: Health system performance (33%);Other communicable diseases (17%);HIV/AIDS (17%);Nutrition and food security (17%);Child health (16%) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 93.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 8.00 8.00 Environmental Category: B - Partial Assessment Simplified Processing Simple [] Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) or OP 8.00 (Rapid Response to Crises and Emergencies) Yes [ ] No [X] 2. Project Objectives The overall Project Development Objective (PDO) is to: (1) improve access to quality health care at the primary and first referral level, and (2) strengthen the Government's public health response to the rise in NCDs. 3. Project Description The project design envisages the following four components: Component 1: Improving Health Service Delivery (estimated total cost US$82.17 million equivalent). This component will focus on improving service planning at RMUs, refurbishing them with modern biomedical equipment, and improving skills and competencies of clinical staff in disease case management and treatment while focusing on most frequently occurring pediatric and non-communicable disease conditions. This component will also advance PHC reforms by expanding general practice PHC model to urban areas, strengthening the referral system and improving skills and competencies of medical personnel in early diagnosis, screening and treatment of priority NCDs. Page 2 Sub-component 1.1: Hospital Services Improvement This sub-component will finance: (i) the provision of diagnostic, waste management equipment and supplies to the 100 central rayon hospitals; (ii) provision of medical furniture; (iii) foreign and local technical assistance on hospital service planning and revision of norms and standards for hospital construction; (iv) development of health service referral guidelines and mechanisms; (v) development of systematized medical equipment maintenance for these hospitals; (vi) study tour for health administrators to countries, which have successfully implemented hospital optimization/modernization programs and (vii) operational support to the Oblast Hospital Oversight Committees. Sub-component 1.2: Primary Health Care Development This sub-component aims at providing further support to general practice based PHC established and supported under the Health I and II projects. The sub-component will support (i) the completion of GP re-training for rural health facilities; (ii) the extension and institutionalization of urban primary care general practice model in three oblasts: Fergana, Syrdarya, Samarkand, and in Tashkent and (iii) the continuing professional development of PHC doctors and nurses through short courses. Sub-component 1.3: Clinical Quality Enhancement The key aim of the sub-component is to strengthen the quality of secondary health care through improvement of the clinical skills and competence of health personnel. Component 2: Strengthening Health Financing and Management Reforms (estimated total cost: US$4.45 million equivalent). This component aims at: (i) strengthening per capita based PHC financing and management reforms that were rolled out nationwide under Health II; (ii) strengthening leadership role of the Ministry of Health in health financing policy formulation and oversight; (iii) implementing hospital payment system reforms at rayon level; and (iv) develop a Health Financing Information System to support the implementation of the hospital financing pilot. Component 3: Institutional Strengthening for NCD Prevention & Control (estimated total cost US$2.98 million equivalent). The overall aim of this component is to strengthen the capacity of Uzbekistan#s public health institutions in effective prevention and control of non communicable diseases. Sub-component 3.1: Health Promotion and NCDs Prevention This sub-component would focus on increasing awareness of and changing behaviors associated with increased risk for hypertension, diabetes and other chronic diseases among the population. Sub-component 3.2: Strengthening Health Surveillance Systems This sub-component would support the development of epidemiological surveillance (including behavioral risk factors) for NCDs, which would be piloted initially in the two oblasts with later expansion to routine national level monitoring. Component 4: Project Management (estimated total cost US$3.40 million equivalent). This component will support the management of the financing, administrative, and Page 3 overall fiduciary requirements, including providing expertise in project coordination, monitoring and evaluation, procurement and financial management. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will be implemented in six Oblasts. Environmental OP 4.01 is triggered as the Project would indirectly support the rehabilitation of health facilities financed by the Government budget (100 hospitals) with potential improvements in health care waste management. In accordance with WB regulations on OP 4.01, the project facilities belonging to Category B that requires preparation of EMP for each individual facility, as far as rehabilitating works will be implemented within the existing hospital territory and there no land acquisition for construction is anticipated. 5. Environmental and Social Safeguards Specialists 6. Safeguard Policies Triggered Yes No Environmental Assessment (OP/BP 4.01) X Natural Habitats (OP/BP 4.04) X Forests (OP/BP 4.36) X Pest Management (OP 4.09) X Physical Cultural Resources (OP/BP 4.11) X Indigenous Peoples (OP/BP 4.10) X Involuntary Resettlement (OP/BP 4.12) X Safety of Dams (OP/BP 4.37) X Projects on International Waterways (OP/BP 7.50) X Projects in Disputed Areas (OP/BP 7.60) X II. Key Safeguard Policy Issues and Their Management A. Summary of Key Safeguard Issues 1. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts: There are no large scale construction activities associated with this project all activities will be within the existing facilities and most of the activities will be of rehabilitation works on existing hospital buildings. There may be few small new construction on existing foot print which are not significant nor have irreversible environmental impacts. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: There are no potential indirect or long term impacts on these activities. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. No project alternatives are considered as the project activities will be in existing locations. Page 4 4. Describe measures taken by the borrower to address safeguard policy issues. Provide an assessment of borrower capacity to plan and implement the measures described. The borrower has prepared a Framework Environmental Management Plan (FEMP) to screen sub-projects during implementation. During implementation sub-project specific EMPs will be prepared by environment-engineer of Central Project Implementation Bureau (CPIB) in accordance with the WB policy for Safeguards and Local Environment Law. For minor rehabilitation works the borrower will use Checklist EMP. The environmental-engineer will be responsible for: # development of EMP for each individual sub-projects; # tracking of EMP involvement to the bidding documentation for construction works; # providing the further monitoring on EMP implementation during construction works; # preparing six-monthly report on project implementation; # assisting in adaptation of medical wastes management system, For installing the incinerators, the managers of hospitals will be responsible for preparing EA as well as its approval in accordance with Environmental Legislation of the RUz, by involving appropriate project organizations. After construction works and medical equipments being completed and installed, the hospital administration will be responsible for equipment operation and wastes treatment. External monitoring on medical wastes treatment will be conducted on established schedule by representatives of District Sanitary and Epidemiological Station (SES), District MOH and District Committees for Nature Protection. The Project would provide clear environmental management guidelines and training, as deemed necessary, for contractors hired for rehabilitation and outfitting of health care facilities. All the activities are in existing facilities therefore, Resettlement Policy OP4.12 is not triggered. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The key stakeholders are hospital employees, and local population. Prior to consultation FEMP was disclosed at the official website of the ministry of health and the public consultations were advertised in the national newspaper. The participants (around 58) were representatives of various medical institutions of Tashkent city and regions of the Republic, State Sanitary and Epidemiological services, State Nature Protection Committee and citizens of Tashkent. During project design and implementation, a consultation plan will be developed to include local communities and non-governmental organizations (NGOs) in the development of the project. The site-specific EMPs will be shared with NGOs and local communities. Environmental Engineer of CBPI will be responsible and reporting for Page 5 conducting these consultations. Consultation activities will also include community and NGO participation in facility design, scheduling construction hours, traffic management, effects on local businesses, and establishing a system for the public to register complaints related to project activities. The plan should include an approach to public liaison so that NGOs and communities are engaged with the facilities throughout their operating life. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 11/15/2010 Date of "in-country" disclosure 11/20/2010 Date of submission to InfoShop 11/30/2010 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors Resettlement Action Plan/Framework/Policy Process: Was the document disclosed prior to appraisal? N/A Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Indigenous Peoples Plan/Planning Framework: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Pest Management Plan: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop * If the project triggers the Pest Management and/or Physical Cultural Resources, the respective issues are to be addressed and disclosed as part of the Environmental Assessment/Audit/or EMP. If in-country disclosure of any of the above documents is not expected, please explain why: n/a C. Compliance Monitoring Indicators at the Corporate Level (to be filled in when the ISDS is finalized by the project decision meeting) OP/BP/GP 4.01 - Environment Assessment Does the project require a stand-alone EA (including EMP) report? Yes If yes, then did the Regional Environment Unit or Sector Manager (SM) review and approve the EA report? Yes Page 6 Are the cost and the accountabilities for the EMP incorporated in the credit/loan? N/A The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank's Infoshop? Yes Have relevant documents been disclosed in-country in a public place in a form and language that are understandable and accessible to project-affected groups and local NGOs? Yes All Safeguard Policies Have satisfactory calendar, budget and clear institutional responsibilities been prepared for the implementation of measures related to safeguard policies? Yes Have costs related to safeguard policy measures been included in the project cost? N/A Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures related to safeguard policies? N/A Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? Yes D. Approvals Signed and submitted by: Name Date Task Team Leader: Ms Susanna Hayrapetyan 11/30/2010 Environmental Specialist: Mr Johnson Appavoo 12/01/2010 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Approved by: Sector Manager: Mr Abdo S. Yazbeck 01/07/2011 Comments: