INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE . Report No.: ISDSC523 Date ISDS Prepared/Updated: 13-February-2012 I. BASIC INFORMATION A. Basic Project Data Country: Afghanistan Project ID: P129663 Project Name: Afghanistan: System Enhancement for Health Action in Transition Project (SEHAT) (P129663) Task Team Leader: Ghulam Dastagir Sayed Estimated Appraisal Date: 17-Sep-2012 Estimated Board Date: 24-Jan-2013 Managing Unit: SASHN Lending Instrument: Specific Investment 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 dis eases (15%), Child health (10%) Financing (in USD Million) Financing Source Amount BORROWER/RECIPIENT 30.00 International Development Association (IDA) 50.00 Afghanistan Reconstruction Trust Fund (ARTF) 270.00 Financing Gap Total 350.00 Environmental Category B - Partial Assessment Is this a Repeater project? No . B. Project Objectives 1. The proposed project will expand the scope and coverage of the services provided to the population, particularly for the poor, and will enhance the stewardship functions of the Ministry of Public Health. . C. Project Description 2. The SEHAT1Project will build upon the ongoing Bank support,increasing the focus on systems development of the regular structures in MOPH at central and provincial level in order to make these more responsive to the present and emerging needs of the sector. 3. SEHAT is proposed as a 5-year program to be funded through IDA and ARTF. The current understanding with the EU is that its financing for BPHS and EPHS and possibly technical cooperation and HR development will be channeled through the ARTF for three years from May 2013 onwards. Since the 1 Afghan term for “health” World Bank is the administrator of the ARTF, the proposed project will include support for BPHS and EPHS services in provinces traditionally supported by the Bank as well as the 10 provinces2currently financed by the EU. Given the excellent opportunity provided by the ARTF for the donor coordination. Other development partners will be kept informed as they may join the partnership. 4. A specific Investment Loan will be employed, but Disbursement-Linked Indicators will support the reforms under the systems development components of the project. Components: 5. Component 1. Sustaining and improving BPHS and EPHS services (US$ 270 million): The project will support the implementation of the BPHS and EPHS through current Performance-based Partnership Agreements (PPAs), i.e. contracts between the MOPH and the implementing non-governmental organizations (NGOs). It will also support the government’s efforts at delivering the BPHS through contracting in management services in designated provinces, and the implementation of the urban BPHS in Kabul city (the urban BPHS may be extended to other cities). It will include support to improve access to and quality of BPHS/EPHS services, and training of additional community midwives and community nurses. In addition, financing will be made available for marginalized populations such as prisoners and Kuchis. HIV/AIDS prevention services will be supported for targeted population sub-groups. Building on the pilot under SHARP, the contracting of NGOs will be based on a results-based approach. 6. Component 2: Building the stewardship capacity of the MOPH and system development(US$ 50 million), including: a) public hospital reform and regulation both public and private; b) building regulatory frameworks and capacity to conduct quality assurance of pharmaceuticals; c) building capacity for effective health promotion especially regarding nutrition and lifestyle; d) development and testing of innovative financing models for the sector; e) building/strengthening human resources management systems including appropriate use of TA, and expanding/creating training capacity for community midwifery, community nursing and hospital management; f) strengthening fiduciary system; g) strengthening monitoring and evaluation including surveillance, HMIS, surveys, operational research, to improve evidence-based decision making. The SEHAT project will benefit from the CBR support to the health sector. . D. Project location and salient physical characteristics relevant to the safeguard analysis (if known) The project will be implemented in two-third 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. The population density worries across the provinces. Disposal of medical waste, which would be the prime focus from environmental safeguards perspective, could therefore have implications both from geographical variation and population density. . E. Borrowers Institutional Capacity for Safeguard Policies The institutional arrangements that already exist to implement the safeguard requirements of the MOPH will be reviewed during preparation for the proposed project. These arrangements work under the Director General of Primary Health Care. A focal person however will be identified as the environmental and social focal point, with overall responsibility for fulfilling the safeguard requirements of the proposed project in the Grants and Contracts Management Unit for safeguard compliance. Capacity-building for implementing the safeguard policies will be one of the key functions of the focal person. Currently the MoPH does not have proper institutional set up and arrangements for the biomedical waste management at the central and local levels. The capacity of the Environmental Health Department of the MOPH and its outreach to health facilities especially 2EU financed provinces are as follows: Kunar, Nangarhar, Laghman, Nooristan, Logar, Zabul, Urozgan, Ghor, Kundoz and Daikundi. in the provinces remains limited. Given the potentials of the Community Based Health Care Department (CBHC) with vast country-wide network both at the health facilities as well as the communities, could be a good vehicle to be used as an outreach arm for the Environmental Health Department of the MOPH in the provinces. . F. Environmental and Social Safeguards Specialists on the Team Ms Asta Olesen (SASDS) Mr Mohammad Arif Rasuli (SASDI) Mr Mohammad Yasin Noori (SASDS) . . II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Explanation Environmental Assessment OP/BP 4.01 X This project has triggered OP 4.01 Environmental Assessment due to the potential Adverse environmental impacts of healthcare waste as the project will be working with HIV positives, sex workers, and vulnerable sections of the society as well as with the hospitals in biomedical waste management. The project will need to engage competent consultant to prepare based on the current available documents and practices a Medical Waste Management Plan that will be part of the appraisal document. 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 . The proposed project interventions are environmentally benign, safe disposal of medical waste could be integrated into the project design. Safe disposal of medical waste both in the urban and rural areas has remained a major issue and borrowers’ attention will be focused towards adequate and safe management by integrating it into the project design. Some good existing practices at some health facilities will be show-cased as replication models to non-practicing medical facilities. There will be no negative impact of this project in terms of land acquisition, involuntary resettlement or indigenous people. In addition, there will be no construction of health facilities associated with the project and it will not cause any damages to private and public assets, therefore, social safeguard policies will not trigger. No indirect or long term negative impacts are expected associated with the proposed interventions, other than those related to the disposal of safe medical wastes from the health facilities for which OP4.01 is triggered. However, MoPH should put in place effective complaint handling system at all facilities to ensure community concerns over health care services can be addressed in a proper and timely manner. MOPH should maintain records of complaints in a database to enable complaint tracking and review III. SAFEGUARD PREPARATION PLAN . A. Tentative target date for preparing the PAD Stage ISDS: N/A C. Time frame for launching and completing the safeguard-related studies that may be needed. The specific safeguards related studies, e.g., assessment of current biomedical waste management practices, finding gaps and preparation of the updated version of the biomedical waste management plan should be prepared, approved and disclosed prior to appraisal stage. . IV. APPROVALS Signed and submitted by: Task Team Leader: Name: Ghulam Dastagir Sayed Date: Approved By: Regional Safeguards Coordinator: Name: Sanjay Srivastava Date: Comments: Sector Manager: Name: Julie Mclaughlin Date: Comments: . 1 Reminder: The Bank's Disclosure Policy requires that safeguard-related documents be disclosed before appraisal (i) at the InfoShop and (ii) in country, at publicly accessible locations and in a form and language that are accessible to potentially affected persons.