Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 11/13/2007 Report No.: AC3226 1. Basic Project Data Country: Chad Project ID: P105724 Project Name: Additional Financing for the Chad Second Population and HIV/AIDS Project Task Team Leader: Maryanne Sharp Estimated Appraisal Date: December 3, 2007 Estimated Board Date: January 15, 2008 Managing Unit: AFTH3 Lending Instrument: Specific Investment Loan Sector: Health (60%);Other social services (20%);Central government administration (20%) Theme: Other communicable diseases (P);Population and reproductive health (P);Participation and civic engagement (P);HIV/AIDS (P);Gender (S) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 7.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 0.00 0.00 Environmental Category: B - Partial Assessment Simplified Processing Simple [X] Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) or OP 8.00 (Rapid Response to Crises and Emergencies) Yes [ ] No [ ] 2. Project Objectives The project's development objective remains unchanged: to contribute to changing the behavior of the Chadian population to reduce the risk of: (i) HIV infection; and (ii) too closely spaced and/or unwanted pregnancies. 3. Project Description The proposed project would continue to finance the mobile and existing health centers in Logone Occidental and Ndjamena, including drugs, medical supplies, reagents, STI kits and condoms, to provide quality STI and voluntary counseling and testing (VCT) services. The project would finance 64 community-based organizations (CBO) undertaking peer education, social mobilization, condom promotion, and social support to people living with HIV/AIDS (PLWHAs) and orphans. In addition, the project would extend these activities to the existing health centers in Logone Oriental, put in place two mobile units to provide the same set of comprehensive STI and VCT services, and finance 25 CBOs. Finally the proposed project would extend population and reproductive Page 2 health services to cover all health districts in Moyen Kebbi Ouest through the continued support of two mobile units and existing health centers and finance a third mobile unit to provide integrated reproductive health services, including family planning and vaccination. This support would include vehicles, equipment, drugs, medical supplies, contraceptives, training and financing of 19 CBOs. No new construction and/or rehabilitation of facilities will take place under the proposed additional financing operation. The implementation of the National Medical Waste Management Plan will be supported under component 5. 4. Project Location and salient physical characteristics relevant to the safeguard analysis Project local response activities will take in Ndjamena, Logone Occidental and Logone Oriental. Population activities will take place in Moyen Kebbi Ouest. Community interventions will continue throughout the country. 5. Environmental and Social Safeguards Specialists Mr Serigne Omar Fye (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 original project was given a "C" rating since it was not expected to generate any adverse environmental effects. The proposed additional financing project is rated as a "B" as is the case for all HIV/AIDS projects, due to the risks associated with the handling and disposal of medical waste. As a result, the only safeguard triggered is the environmental assessment, because a medical waste management plan (MWMP) is required. Issues & Impacts Associated with the Proposed Project: In Chad, as in other African Countries, inappropriate handling of infected materials by an inappropriate management of biomedical wastes (collection, control, storage and disposals) constitutes a risk, not only for hospital personnel and people frequenting the health facilities, but also for agents in charge of collecting solid wastes from healthcare Page 3 areas. The Biomedical Waste Management Plan evaluates the actual management of biomedical wastes within the country’s health structures, proposing waste management systems technically feasible, economically viable, and socially agreeable, while respecting the environment standards and the Chadian culture. The national strategy of waste management will also allow the country to indicate the options to be taken for the global health structure (national, regional, districts hospitals, health centers, private clinics, etc.). It will allow a clarification of the institutional arrangements among the concerned actors involved in medical waste management and the costing of the budget for the priority action plan to be proposed in the second phase of the project. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: The population lives in a very insalubrious environment. More than 71% of the population does not have hygienic toilets. This situation encourages the outbreak of many diseases, particularly diarrhoeal diseases. The disposal of household wastes constitutes a major problem with the absence of waste elimination and removal systems, and the proliferation of illegal tipping. The evacuation of rain and used waters also causes major public health problems. The country epidemiological profile includes mainly malaria, tuberculosis, acute respiratory diseases, HIV/Aids, diarrhoeal diseases. No new construction and/or rehabilitation of facilities will take place under the proposed additional financing operation. The implementation of the National Medical Waste Management Plan will be supported under component 5. With an efficient implementation of the Biological Waste Management Plan, most risks associated with the biological wastes can be prevented. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Several alternatives have been considered and are described in the Medical Waste Management Plan dated July 2007. The approach of the National Strategy of BWMP (stated on page 24 of the BWMP) looks more appropriate. National Biological waste Management Strategy: The NBWMS strategy aims to contribute to the welfare of all Tchadians by improving the actual waste management methods keeping in check good hygiene conditions and sustainability. The global objective is to establish a sustainable BWMP by putting in place systems that are viable, technically feasible, socially acceptable and able to guarantee a healthy and clean environment. The specific objectives of the intervention strategy are as follows: Objective 1: Build the institutional and legal framework of the BWMP Objective 2: Train health personnel/create environmental awareness for citizens Objective 3: Support private initiatives in BWM Objective 4: Improve the management of BW in the health training centers Page 4 Objective 5: Support the implementation of the BWMP 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's institutional capacity for implementing safeguard is somewhat weak as they do not have much experience. Capacity building on safeguards, particularly medical waste management, has been built into the additional financing under component 5, to address this weakness. Following an important risks assessments, in conformity with the socio- cultural and religious beliefs, a national biological waste management strategy has been elaborated taking into account the communities’ preferences and practices. Because of budget’s constraints, priority activities will be financed through the Project. A legislative document with directives on waste management will be distributed. The project will support the health centers in the management of medical wastes. It will support the training of medical personnel, population awareness on risks associated with biological/medical wastes. It will support health training centers with the provision of thrash cans, protective materials, incinerators, particularly in Ndjamena and Mandoul where the Project’s mobile healthteams will be based. The Project will also ensure the monitoring and evaluations of the action plan at national and district levels. The cost of this support is estimated at US$420,000. The BWMP implies several categories of actors, mainly: The Ministry of Health is responsible for the elaboration and the implementation of the National Health Policy, including hospitable hygiene, and the management of wastes. The Ministry of Environment and Water is responsible for the elaboration and the implementation of the environmental policy. The health training centers (hospitals and health centers), the principal sources of production of BW, are to use clear BWM manuals and train their personnel. The municipalities are responsible for the household waste management and public hygiene. The private Sectors and the NGOs, the development partners (WHO, WB, FC), for example, Doctors Without Borders, can also contribute in raising communities awareness. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. Key stakeholders include key center and hospital personnel. The medical waste plan has been distributed and a module on medical waste management has been included in the local response training sessions. Page 5 The proposed project would continue to finance the mobile and existing health centers in Logone Occidental and Ndjamena 64 community-based organizations (CBO) undertaking peer education, social mobilization, condom promotion, and social support to people living with HIV/AIDS (PLWHAs) and orphans. In addition, the project would extend these activities to the existing health centers in Logone Oriental, put in place two mobile units to provide the same set of comprehensive STI and VCT services, and finance 25 CBOs. Finally the proposed project would extend population and reproductive health services to cover all health districts in Moyen Kebbi Ouest through the continued support of two mobile units and existing health centers and finance a third mobile unit to provide integrated reproductive health services, including family planning and vaccination. This support would include vehicles, equipment, drugs, medical supplies, contraceptives, training and financing of 19 CBOs. No new construction and/or rehabilitation of facilities will take place under the proposed additional financing operation. The implementation of the National Medical Waste Management Plan will be supported under component 5. Key stakeholders include key health centers and hospital personnel. The medical waste plan has been distributed and a module on medical waste management has been included in the local response training sessions. The awareness campaign aims at the population in general. Awareness will be raised on the risks linked with the handling of medical/biological wastes, the danger of potentially contaminated objects, food, animal wastes and other hazardous wastes. Mass media campaigns (radio, TV, pamphlets) linked to the larger STD/HIV/AIDS campaign will be conducted at the community, sector, regional and national levels. As much as possible, the campaign will be integrated in the existing policies and programs, particularly at the Ministry of Health’s level. This information will aim at positively influencing the population’s behavior in the handling of medical and hazardous wastes. The BWMP includes all the concerned actors and describes their specific responsibilities and commitment. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 07/20/2007 Date of "in-country" disclosure 08/15/2007 Date of submission to InfoShop 07/30/2007 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors * 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: Page 6 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 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? 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 Maryanne Sharp 11/09/2007 Environmental Specialist: Mr Serigne Omar Fye 11/12/2007 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Approved by: Sector Manager: Mr John A. Elder 11/13/2007 Comments: Cleared with: Serigne Omar Fye.