Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 05/15/2009 Report No.: AC4395 1. Basic Project Data Country: Congo, Republic of Project ID: P116637 Project Name: HIV/AIDS & Health - Additional Financing Task Team Leader: Khama Odera Rogo Estimated Appraisal Date: May 14, 2009 Estimated Board Date: June 16, 2009 Managing Unit: AFTH3 Lending Instrument: Specific Investment Loan Sector: Other social services (45%);Central government administration (20%);Sub- national government administration (20%);Health (15%) Theme: HIV/AIDS (40%);Other public sector governance (20%);Decentralization (20%);Health system performance (20%) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 5.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 10.00 10.00 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 project's development objectives remain unchanged: (i) limiting the spread of HIV/AIDS and STIs; (ii) mitigating the health and socioeconomic impact of HIV/AIDS and STIs on persons infected with or affected by HIV/AIDS and STIs; and (iii) building strong and sustainable national capacity to respond to the HIV/AIDS epidemic. 3. Project Description The proposed additional grant would finance the scaling up of the project over an additional three year period. While progress toward the development objectives has been satisfactory under the original project, the additional financing would enable the provision of needed additional capacity building to enhance sustainability after project closing, support expansion of activities in key areas (including quality of HIV/AIDS treatment, enhanced community and private sector involvement, and support for high-risk groups such as the armed forces and prisoners), and help further improve the monitoring and evaluation system. Page 2 Under the same original four project components the additional resources will be used to strengthen the important achievements and innovations already in place highlights of which are summarized below: Component 1A: Health Sector Response. Under the ongoing HIV/AIDS & Health Project (PLVSS), health sector response activities comprise HIV prevention within health facilities, HIV/AIDS treatment including clinical monitoring of patients on ARVs, prevention of vertical transmission from mother to child, screening of blood for transfusion, voluntary counseling and testing for HIV (VCT), treating sexually transmitted infections (STI) and management and disposal of medical waste from health facilities. The PLVSS through close collaboration between the Ministry of Health (MSASF) and the Permanent Executive Secretariat of the National AIDS Council (SEP/CNLS) developed and instituted a monitoring and evaluation (M&E) framework for these activities. During the period covered by the additional grant, PLVSS activities under this sub- component would focus on the efficient transfer of capabilities, implementation, and M&E tools from the SEP/CNLS to decentralized MoH units within the PDSS supported by key partners and co-financed with the Government. During this phase, activities by SEP/CNLS funded under this grant would comprise the coordination of activities at the national level to revise and standardize HIV/AIDS response tools, training programs and manuals, establishment of regional HIV/AIDS training teams and the integration of HIV/AIDS activities into the package of essential health services of PDSS. Laboratories in all health facilities would be upgraded and staff trained for decentralized VCT, IST and ARV treatment and follow up. Activities would include staffing and organizing major hospitals all over the Congo to efficiently care for women who and victims of sexual violence. Component 1B: Other Sectors' Response. The ongoing PLVSS under the original grant supports HIV/AIDS activities in 14 sector ministries ranging from HIV prevention education, behavior change communication for staff and family members, and integration of HIV/AIDS into curricula of primary and secondary education and in training programs of technical, professional and higher institutes of learning in Congo. These activities also included VCT education and condom use education. Under the additional financing, activities would specifically target 6 ministries which demonstrated satisfactory program implementation supported by results (Defense, Women's Affairs, Directorate General of Social Affairs (MSASF), Justice, Education and Communication). Integrated support and coordination of HIV/AIDS activities in the two education ministries would be within the framework of the IDA Education project while support to Ministry of Defense would center on training for police officers and for the special task force for managing sexual violence cases. HIV/AIDS activities within the Women's Affairs Ministry in collaboration with the Directorate General of Social Affairs (MSASF) would support the network of associations teenage mothers set up in the past three years in major towns to support professional training, income generation activities and improved access to micro-credit for own business initiatives, health care support, Page 3 psychosocial and legal support (by the association of women lawyers) to victims of sexual violence and ostracized women. Support to the Communication Ministry would intensify and expand ongoing BCC campaigns through multi media including local radios targeting pygmies out of school youth and other vulnerable groups. Component 2: Civil Society Response. PLVSS has supported HIV/AIDS community initiatives focusing on prevention, treatment, assistance to PLWHA in nutrition, medical care and psychosocial counseling. In the process, the SEP/CNLS developed a manual for selecting, evaluation, financing, supervising and monitoring of these community initiatives targeting vulnerable groups in each region. The additional financing would support activities to consolidate these initiatives drawing from lessons learnt and adjustments made. In particular, increased resources would be directed to most vulnerable and high risk groups (youth working in night clubs, in restaurants, in video clubs, prostitutes, gays, teenage mothers, pygmies and vulnerable minors). The focus here would be in developing alternative employment for these groups while educating them to effectively manage risks of HIV infection they face. During the extension, PLVSS would carry out an evaluation of the efficacy of the social marketing strategy for condom distribution to improve the strategy. Activities to be funded would include the development and institutionalization of HIV/AIDS training and information centers to be managed by communities themselves in regional urban centers. Training in sub-project management and evaluation would be provided to NGOs and associations of PLWHA as well as women community leaders combating abuse of women and girls. Component 3: Investments in Orphans and Other Vulnerable Children. This component supported a successful pilot covering 500 orphans in 2004. The initial focus on AIDS orphans was found to be restrictive and discriminatory vis a vis other OVCs. The support strategy was modified to support all eligible OVC and to decentralize support activities to involve village and community leaders and committees as well as CBO and associations of PLWHA in all stages of selection, support and monitoring to reduce overhead costs to companies and out region NGOs. Under the additional financing, support would continue to cover school fees and supplies, health care costs, school uniforms, nutrition support to foster family and psychosocial counseling by trained local community social workers. Out of school OVC heads of households would be supported through professional/vocational training and micro-credit initiatives to create income generation activities to be closely supervised and evaluated. Component 4: Management and coordination, capacity-building, and monitoring and evaluation. The PLVSS has built and sustained the institutional capacities of SEP/CNLS to coordinate the HIV/AIDS national response. Drawing on implementation lessons, the SEP/CNLS initiated activities under the project to decentralize the national response and institute regional HIV/AIDS coordination units (UDLS).The project financed the training of UDLS staff and operational costs with a view to accelerating the building of partners and stakeholders in the fight against AIDS at regional level. Its coordination capacity, Page 4 strengthened through its M&E and operational units, facilitated the institution of Congo's joint annual reviews and common M&E framework for all partners, especially IDA, AfDB, Global Fund, EU and UN agencies. During the additional financing period, activities under this component would include the strengthening of SEP/CNLS' multi-sector and multi-partner national AIDS response, especially in the Education and Health sector which now have HIV/AIDS activities funded directly by sector projects. These activities would include design and implementation of frameworks to monitor, track resource use and evaluate results and impact. Monitoring and evaluation data relating to outcomes will be collected with greater frequency. The additional financing also includes activities to intensify stakeholder involvement in implementation and monitoring and evaluation. The four components described above would be monitored and evaluated using the results framework spelled out in the Project Paper. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will continue to be implemented in the same six regions (Point-Noire, Kouilou, Niari, Lékoumou, Brazzaville, and Sangha). It will not involve any physical displacement of populations and will comply with existing safeguards. 5. Environmental and Social Safeguards Specialists Mr Paul Jonathan Martin (AFTEN) Mr Mbaye Mbengue Faye (AFTEN) 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 project does not have any major environmental impacts. No civil works are to be supported. Page 5 The project includes activities entailing utilization of health services that may have adverse impacts on the environment if they are not well managed. The risk of negative impact on the environment would result from poor management of medical wastes at the level of health facilities. The safeguard policies on Indigenous Peoples (OP/BP 4.10) will apply as the additional financing will support enhanced HIV/AIDS prevention efforts among indigenous peoples (Pygmies). The Pygmies are identified as potentially vulnerable and therefore given special attention in the planned interventions under the additional financing. This is in line with the Government of Congo's policy to promote their issues and respect their rights within the Congolese society. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: Activities financed by this project should not have any long term impact in the project area. 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 Environmental and Social Management Framework (ESMF) updated and revised for this additional financing will guide environmental and social management of project activities and compliance with national legislation and the World Bank Safeguard Policies. The ESMF includes (i) an analysis of national institutional and legal framework within which the project will be implemented, and (ii) an analysis of the pertinence of all World Bank Safeguard Policies for the Project. An essential component of the ESMF is the Screening Process of sub-projects which underlines the environmental norms and standards that will be applied in the sub-projects and the environmental evaluation procedures that may be needed, with special emphasis given to measures addressing the requirements of the Safeguard Policies. The ESMF will allow the project implementers and local communities, to monitor in a comprehensive and progressive manner, the environmental and social impacts, based on monitoring check-list. At the time of the original grant, the Government prepared a Medical Waste Management Plan, which was submitted to the Bank in December 2003. Implementation of the plan has been rated Satisfactory in the latest ISR, reflecting an improvement from the Moderately Satisfactory rating in the previous ISR as a result of the positive findings of the safeguards evaluation conducted during the preparation of the Health Sector Services Development Project, which became effective on February 2, 2009. Based on the satisfactory performance, the team is confident in the capacity of the counterpart to continue to plan and implement the measures described in the ESMF in an acceptable manner. Page 6 The costs of implementing the ESMF are estimated at CFA Franc 345,000,000 (approximately US$730,000). Actions to address concerns relating to Indigenous Peoples will be undertaken through the Indigenous People#s Planning Framework (IPPF) which has been prepared after extensive consultations under the IDA supported health project. Major elements of this framework include a study to identify barriers to service delivery, participation and equity for these groups, including the Pygmies; a law for Pygmy protection and integration; building the capacity of the Pygmies to participate in articulating their special needs; and specific indicators that will be monitored on a continuous basis to inform on progress among the Pygmies and other vulnerable groups. The existing funding arrangements for the IPPF are adequate and no changes to the IPPF will be required as a result of the additional financing. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The additional financing aims to ensure equitable access to services to vulnerable and undeserved groups, especially the Pygmies, commercial sex workers, women, children and youth. The national HIV/AIDS strategy has already identified key vulnerable groups to be targeted, including the Pygmies. The Pygmies are identified as part of the vulnerable groups to be targeted by the project, in line with the Government of Congo policy to integrate the Pygmies in the Congolese society. Component 2 aims to build local ownership and community participation in all interventions. The needs assessment study under the IPPF will actively seek input from the Pygmies and ensure that they are able to participate and articulate their special needs. The establishment of outreach services and strengthening of health education and behavior change communication will be based on the needs identified by the Pygmies in the assessment study. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 05/11/2009 Date of "in-country" disclosure 05/13/2009 Date of submission to InfoShop 05/15/2009 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? Yes Date of receipt by the Bank 02/28/2008 Page 7 Date of "in-country" disclosure 05/15/2009 Date of submission to InfoShop 05/15/2009 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? Yes If yes, then did the Regional Environment Unit or Sector Manager (SM) review and approve the EA report? Yes Are the cost and the accountabilities for the EMP incorporated in the credit/loan? Yes OP/BP 4.10 - Indigenous Peoples Has a separate Indigenous Peoples Plan/Planning Framework (as appropriate) been prepared in consultation with affected Indigenous Peoples? Yes If yes, then did the Regional unit responsible for safeguards or Sector Manager review the plan? Yes If the whole project is designed to benefit IP, has the design been reviewed and approved by the Regional Social Development Unit or Sector Manager? Yes 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? Yes Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures related to safeguard policies? No Have satisfactory implementation arrangements been agreed with the Yes Page 8 borrower and the same been adequately reflected in the project legal documents? D. Approvals Signed and submitted by: Name Date Task Team Leader: Mr Khama Odera Rogo 05/13/2009 Environmental Specialist: Mr Paul Jonathan Martin 05/13/2009 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Approved by: Regional Safeguards Coordinator: Mr Warren Waters 05/14/2009 Comments: Sector Manager: Ms Lynne D. Sherburne-Benz 05/13/2009 Comments: