INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 12/14/2012 Report No.: AC6714 1. Basic Project Data Country: Afghanistan Project ID: P129663 Project Name: Afghanistan: System Enhancement for Health Action in Transition Project Task Team Leader: Ghulam Dastagir Sayed Estimated Appraisal Date: December 3, Estimated Board Date: February 28, 2013 2012 Managing Unit: SASHN Lending Instrument: Emergency Recovery Loan Sector: Health (70%);Public administration- Health (30%) Theme: Health system performance (40%);Nutrition and food security (20%);Population and reproductive health (15%);Other communicable diseases (15%);Child health (10%) IBRD Amount (US$m.): 0 IDA Amount (US$m.): 100 GEF Amount (US$m.): 0 PCF Amount (US$m.): 0 Other financing amounts by source: BORROWER/RECIPIENT 30.00 Afghanistan Reconstruction Trust Fund 270.00 Health Results-based Financing 8.00 308.00 Environmental Category: B - Partial Assessment Simplified Processing Simple [] Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) Yes [X] No [ ] or OP 8.00 (Rapid Response to Crises and Emergencies) 2. Project Objectives The project development objectives are to expand the scope, quality and coverage of health services provided to the population, particularly for the poor, in the project area and to enhance the stewardship functions of the Ministry of Public Health (MOPH). 3. Project Description The proposed project has 3 components: Component 1: Sustaining and improving the Basic Package of Heatlh Services (BPHS) and Essential Package of Hospital Services (EPHS): The project will support the implementation of the BPHS and EPHS through Performance-based Partnership Agreements (PPAs), i.e. contracts between the MOPH and non-governmental organizations (NGOs) which will deliver the health services of these packages. It will also support the government's efforts in delivering the BPHS and EPHS through contracting in management services in designated provinces, and the implementation of an urban version of the BPHS in Kabul city and possibly to other cities. Component 2: Building the stewardship capacity of the MOPH and system development including: a) provincial budgeting and decentralization; b) health care financing; c) regulatory system development for pharmaceutical sub-sector; d) private sector; e) public hospital reform; f) building/strengthening human resources management systems including appropriate use of TA, and expanding/creating training capacity for community midwifery and community nursing; g) governance and accountability; h) strengthening fiduciary system; i) strengthening monitoring and evaluation including surveillance, Health Information Management System, surveys, operational research, to improve evidence-based decision making; j) building capacity for effective health promotion especially regarding nutrition and healthy lifestyles; k) development and testing of innovative financing models for the sector; and l) strengthening sub-national Planning and Budgeting and operations and maintenance. Component 3: Strengthening program management: The project will support central and provincial management, including incremental operating costs and technical assistance for the MOPH. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will be implemented in two-thirds of the country over a five year period. The focus of the program is on the public sector with health facilities located within both urban and rural areas. Almost sixty percent of the population of the country lives in the proposed project area. The provinces have geographical variations with mostly mountainous hard to reach terrain and population density varies across the provinces. Disposal of medical waste, which would be the prime focus from the environmental safeguards perspective, could therefore have implications both from geographical variation and population density. 5. Environmental and Social Safeguards Specialists Ms Asta Olesen (SASDS) Mr Mohammad Arif Rasuli (SASDI) 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: The proposed project is designated as "Category B" and triggers OP/BP 4.01 (Environmental Assessment). The minor construction work under the project is not expected to cause any significant negative environmental impact. Since the details and location of construction work is not known at appraisal, a framework approach has been applied to address environmental and social impacts. An Environmental and Social Management Framework (ESMF) has been prepared to provide guidelines for avoiding, reducing or mitigating negative impacts. Likewise, the proposed project is not expected to entail significant negative environmental impact if the proper management of health care waste is undertaken to reduce risks associated with exposure to medical waste. The proposed project is not expected to cause significant adverse environmental and social impacts. No land acquisition will be funded under the project and in the case of new construction; these will either be built on existing health facility land or on other government or public land, or in rare cases, on minor land plots donated voluntarily or through community contribution. The ESMF includes guidelines for compensation in the rare case that negative livelihood impact may be suffered by project affected people (PAPs). The ESMF when properly implemented will take care of some of the minor environmental impact issues. The Ministry of Public Health (MOPH) will update the present Health Care Waste Management Plan (HCWMP) under the SHARP project for SEHAT. During the first year of SEHAT implementation, the MOPH will conduct an in-depth review of the HCWMP plan in order to incorporate lessons learned and further strengthen the plan. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: The SEHAT project will finance minor civil works, such as modification or rehabilitation of existing healthcare infrastructure over the 5 year period. The proposed work is not anticipated to cause significant adverse social or environmental impacts. The identified potential adverse impacts would be localized in spatial extent and short in duration, and would be manageable by implementing proper mitigation measures. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. N/A 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 overall responsibility of the safeguards implementation with the MoPH and the ministry has designated for the task the Environmental Health Department. The Department will have an Environmental and Social Focal Officer at the Ministry level and will be closely working with the Grants and Contracts Management Unit of MoPH with responsibility for fulfilling the safeguard requirements of the proposed project throughout the duration of the project The Safeguard Focal Officer will conduct trainings for the relevant staff of MoPH and contractors on implementation of ESMF. Such training will include capacity-building of the Environmental Health Department of MOPH whose capacity remains limited. The implementation of the HCWMP is also the responsibility of the Environmental Health Department and the department will have Focal Officers with relevant ToRs in the Ministry as well as at the hospital levels. 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 the Ministry of MoPH, MoF, National Environmental Protection Agency (NEPA) and the relevant provincial department of MoPH, and the contracted NGOs and especially the local communities and their Shura-e Sehi/Health Shuras. The HCWMP will be widely disseminated to all relevant stakeholder groups across medical facilities in the format and languages that suit the stakeholders. The ESMF and draft HCWMP will be disclosed in all the relevant locations and MoPH website in English, Dari and Pashto as well as in WB Infoshop. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 11/28/2012 Date of "in-country" disclosure 11/28/2012 Date of submission to InfoShop 11/30/2012 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? 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: 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? No If yes, then did the Regional Environment Unit or Sector Manager (SM) N/A review and approve the EA report? Are the cost and the accountabilities for the EMP incorporated in the N/A credit/loan? The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank's Yes Infoshop? Have relevant documents been disclosed in-country in a public place in a Yes form and language that are understandable and accessible to project-affected groups and local NGOs? All Safeguard Policies Have satisfactory calendar, budget and clear institutional responsibilities Yes been prepared for the implementation of measures related to safeguard policies? Have costs related to safeguard policy measures been included in the project Yes cost? Does the Monitoring and Evaluation system of the project include the Yes monitoring of safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed with the Yes borrower and the same been adequately reflected in the project legal documents? D. Approvals Signed and submitted by: Name Date Task Team Leader: Mr Ghulam Dastagir Sayed 11/26/2012 Environmental Specialist: Mr Mohammad Arif Rasuli 11/26/2012 Social Development Specialist Mr Mohammad Yasin Noori 11/26/2012 Additional Environmental and/or Ms Asta Olesen 11/26/2012 Social Development Specialist(s): Approved by: Regional Safeguards Coordinator: Mr Sanjay Srivastava 12/10/2012 Comments: Sector Manager: Ms Julie McLaughlin 12/14/2012 Comments: Approved