Page 1 Integrated Safeguards Data Sheet (ISDS) Section I – Basic Information Date ISDS Prepared/Updated: February 25, 2005 Report No.:AC1160 A. Basic Project Data A.1. Project Statistics Country: Viet Nam Project ID: P082604 Project: Vietnam HIV/AIDS Prevention TTL: Maryam Salim Total project cost (by component): COMPONENT ONE: Implementation of Provincial HIV/AIDS Action Plans: US$21.616 million COMPONENT TWO: National HIV/AIDS Policy and Program Implementation: US$ 8.2 million COMPONENT THREE: Project Management: US$ 5.184 million Appraisal Date: December 6, 2004 Loan/Credit amount($m): IDAH: 35 Board Date: March 29, 2005 Other financing amounts by source: ($m.) Managing Unit: EASHD Sector: Health (80%); Other social services (20%) Lending Instruments: Specific Investment Loan Is this project processed under OP 8.50 (Emergency recovery? Yes? [ ] No? [X ] Environmental Category: B A.2. Project Objectives The overall goal of the proposed project is to reduce transmission of HIV/AIDS and to ensure that HIV prevalence remains below .3% -- this is a key objective of the Government of Viet Nam’s National HIV/AIDS Strategy. Government of Viet Nam’s (GVN) strategy also seeks to increase awareness and change attitudes and behaviors, including among policy makers, of the risks and appropriate responses to HIV/AIDS. Achieving this objective will only be possible if Viet Nam is able to identify and interrupt the transmission dynamics that promote the spread of the epidemic. HIV transmission in Viet Nam is currently heavily concentrated among IDUs and CSWs. Experience in other countries shows that halting the spread of the infection among these groups significantly attenuates wider scale heterosexual transmission. Successfully reaching these populations is thus strategically vital, and requires action from multiple sectors and actors as well as locally driven programs and responses. The specific objective of this project is to support programs designed to halt transmission of HIV/AIDS among vulnerable populations (PLWHA, IDUs, CSWs, and their clients and sexual partners) and between these vulnerable populations and the general population. Key outcome indicators include: · Percent of vulnerable groups in participating provinces reporting safer injection practices (from an estimated 20% at baseline to 70% at project end) · Percent of vulnerable groups in participating provinces reporting condom use in sexual intercourse (from an estimated 40% at baseline to 80% at project end) The World Bank's Country Assistance Strategy (CAS) Progress Report (2004) for Viet Nam calls for more Page 2 effective policy responses to address the growing HIV/AIDS epidemic. Viet Nam’s National Strategy on H IV/AIDS Prevention and Control calls for the rapid scale up of action to address Viet Nam’s HIV/AIDS epidemic. The IDA Grant aims to reduce the transmission of HIV/AIDS, which is key for meeting the goal of the National Strategy and the CAS. A.3. Project Description The Project will support 3 main Components to be implemented at the National and Provincial Levels. COMPONENT ONE: Implementation of Provincial HIV/AIDS Action Plans (US$21.616 million) will provide sub-grants to 18 provinces and two cities to support the design and implementation of Annual Provincial Action Plans (PAPs). The provinces and cities will be allocated block grants based on specific criteria to determine the size of each year’s base allocation. The support from the project will complement and build on existing systems for allocating and monitoring the use of resources for HIV/AIDS, and will focus on supporting the process of preparing, reviewing, implementing and assessing the success of provincial specific plans. Proposed activities are expected to reflect the diversity of the province needs as well as diversity in appropriate response. Plans are to be prepared by October of each year for allocations to cover the period between January – December. Grants will be disbursed in tranches after the provincial plans are approved. Progress toward accomplishment of PAPs will be monitored. COMPONENT TWO: National HIV/AIDS Policy and Program (US$ 8.2 million): · Subcomponent 1: Policy and Program Development and Implementation will strengthen capacity at national and provincial levels and promote the development of innovative, effective prevention and treatment approaches and models among vulnerable groups through: (i) demonstration sites that will explore a community- based treatment model to integrate harm reduction with comprehensive HIV treatment and care; (ii) policy studies and research; (iii) knowledge sharing and training; and (iv) other innovations. · Subcomponent 2: Monitoring and Evaluation will support the development of a national monitoring and evaluation results framework, operational plan and system. · Subcomponent 3: Behavior Change Communication Focused on Reducing Stigma and Discrimination will support a 5-year nationwide BCC campaign to reduce stigma and discrimination against vulnerable groups. COMPONENT THREE : Project Management (US$ 5.184 million) will provide support to the set up and management of the Central Project Management Unit (CPMU) as well as the Provincial Project Management Units (PPMUs) located in the 18 provinces and two cities. A.4. Project Location and salient physical characteristics relevant to the safeguard analysis: The Project will provide sub-grants to 18 provinces (An Giang, Bac Giang, Ben Tre, Cao Bang, Dong Nai, Hau Giang, Khanh Hoa, Kien Giang, Lai Chau, Nam Dinh, Nghe An, Son La, Thai Binh, Thai Nguyen, Page 3 Thanh Hoa, Tien Giang, Vinh Long, and Yen Bai) and two cities (Hai Phong and Ho Chi Minh City). Viet Nam has 53 ethnic minority groups, 1 belonging to different family and language groupings. They comprise about 14 percent of the total population or 10.5 million people. T he project’s 20 participating provinces and cities are homes to over 3 million ethnic minorities. Almost 70 percent of them are located i n the project’s 8 northern provinces. The high illiteracy rate, low level of education among adults and the pervasiveness of socio-cultural barriers, language and cultural differences, and women’s limited role and low standing contribute to their being disadvantaged when it comes to economic and social progress. These are the same factors that influence many aspects of health care, particularly preventive care. Possible demonstration sites for treatment could include Hanoi, Khanh Hoa, and Hai Phong. B. Check Environmental Category A [ ], B [X], C [ ], FI [ ] Comments: C. Safeguard Policies Triggered Yes No Environmental Assessment ( OP / BP / GP 4.01) [X] [ ] Natural Habitats ( OP / BP 4.04) [ ] [X] Pest Management (OP 4.09) [ ] [X] Cultural Property (draft OP 4.11 - OPN 11.03 -) [ ] [X] Involuntary Resettlement ( OP / BP 4.12) [ ] [X] Indigenous Peoples ( OD 4.20 ) [X] [ ] Forests ( OP / BP 4.36) [ ] [X] Safety of Dams ( OP / BP 4.37) [ ] [X] Projects in Disputed Areas ( OP / BP / GP 7.60) * [ ] [X] Projects on International Waterways ( OP / BP /GP 7.50) [ ] [X] 1 Ethnic minority is the term used in this Policy Framework for Ethnic Minority groups for which the World Bank’s policy OD 4.20 on Indigenous Peoples applies. * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas Page 4 Section II – Key Safeguard Issues and Their Management D. Summary of Key Safeguard Issues . D.1. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts. Environmental Assessment Management of health care wastes was identified as a possible area of concern in this HIV/AIDS Prevention Project. In addition to the safety of blood supply, the specific concerns are associated with the disposal of contaminated blood, used needles, and other wastes generated at health care facilities. A health care waste management (HCWM) study undertaken as part of project preparation indicates that solid health care wastes are required to be segregated, with incineration or landfilling to be used as treatment/disposal technologies for infectious (“clinical”) wastes. However, the actual practice is that many health care facilities in Vietnam lack the necessary resources to procure even simple supplies such as colored bins or plastic bags. Therefore, in many instances, wastes are not properly segregated, and the unsegregated health care wastes are either landfilled on-site or offsite (under contract by URENCO), incinerated, or undergo open-air burning on hospital premises. It is reported that only one third of the health care wastes are incinerated and that incinerators, which do not perform up to standards, are likely to emit such hazardous compounds as dioxins, furans, and heavy metals. These practices present health risks to the patients and their visitors, the health care facility personnel, workers who handle health care wastes, and the general community. Indigenous People’s Policy – Ethnic Minority Framework The HIV/AIDs rate among ethnic minority is lower than for other social groups. However, in some ethnic minority communities, especially near border areas, HIV is prevalent and spreading quickly among injecting drug users and commercial sex workers. Awareness of these health risks is still limited among some ethnic minority communities. Three major vulnerabilities exist among ethnic minority groups that could exacerbate this situation: (i) The long history of opium use among those living in the northern provinces is seen to have created a sense of tolerance for drug use. The traditional means of consumption of the mountainous regions are gradually being transformed and replaced by a drug scene closer to the urban practices in the country. Drug users tend to be younger, preferring heroin and, to a lesser degree, amphetamines while older drug users tend to use opium. High-risk behaviors are prevalent among IDUs. VCT and harm reduction activities are not apparent. (ii) There is evidence that point to the increasing participation of young ethnic girls in the sex trade, working as CSWs in their home province, especially in the tourist areas. Minors from ethnic minority groups residing in border provinces are subject to cross-border trafficking. (iii) Ethnic minority women suffer from a high rate of reproductive tract infections Page 5 including gynecological diseases and sexually transmitted diseases (STDs). Experience from neighboring countries indicates that ethnic minority groups are disproportionately vulnerable when it comes to diseases such as HIV/AIDS and that they have been marginalized in national efforts to combat such diseases. The Project includes provisions to ensure participating provinces evaluate the extent to which ethnic minorities have high incidence of HIV/AIDS and/or high risk groups. The results of these efforts would then be reflected in provincial plans. The safeguards review meeting noted that while an IPDP was not necessary for the project, project activities ought to actively benefit ethnic minorities and ensure their special targeting if such efforts are warranted by the situation on the ground. D.2 Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area. N/A D.3. Describe the treatment of alternatives (if relevant) D.4. Describe measures taken by the borrower to address safeguard issues. Provide an assessment of borrower capacity to plan and implement the measures described. Environment Assessment – Health Care Waste Management Plan During project preparation, a study was conducted to identify relevant environmental issues relevant to the concerns raised above and recommendations were made on the appropriate mitigation measures to be taken during project implementation. Based on these recommendations, the following activities have been incorporated into the design of this project. These activities include drafting of HCWM regulation and technology standards and strengthening of three rehabilitation centers (RCs) in the area of health care waste management. · Drafting HCWM regulation and technology standards . The proposed HIV/AIDS Prevention and Control Project covers three RCs (Hanoi RC, Hai Phong RC, and Khanh Hoa RC). As the national HCWM legislation and associated technical standards will form the basis of HCWM at these RCs, preparation of the draft HCWM legislation and technical standards will be undertaken under this project. · Bringing the incinerator at Hanoi RC under compliance . The incinerator at Hanoi RC will be assessed in light of the technical standards. The assessment should specify if the existing incinerator complies with the proposed technology standards, and if not, should identify the deficiencies and make recommendations for improvement (and compliance) with a specific action plan, schedule, and budget. The recommendations should be based on life-cycle cost analyses for operating this incinerator (with or without upgrading) versus investing in and operating an alternative technology (such as autoclave or microwave). Implementation of the recommendations will be carried out under this project. · Bringing wastewater discharges from the three RCs under compliance . A study Page 6 will be undertaken to bring wastewater discharges from each of the three RCs under compliance through low-cost solutions. Specific action plans and designs, implementation schedules and budgets will be prepared. The proposed investments will be carried out under this project. · Implementing sound HCWM at three RCs . A HCWM organization will be established and a HCWM plan will be prepared and implemented at all three RCs. The implementation will include procurement of goods and services (supplies like personal protection equipment, equipment like needle destroyers, construction materials like cement and iron, consulting services for the preparation of plans and training of RC personnel and awareness and information education communication), and arrangement for waste disposal. Indigenous Peoples – Ethnic Minority Framework In line with the World Bank’s Operational Directives on Indigenous People (OP 4.20) this Policy Framework (PF) is developed to guide the preparation and implementation of provincial/city action plans, taking into account its ethnic minority population. The PF sets out policy objectives and guidelines for the design and implementation of the provincial/city action plan provisions regarding ethnic minorities. The PF will also provide guidance in the overall implementation and monitoring and evaluation of the Project. Viet Nam’s legal policy concerning ethnic minority groups is similar in content to the World Bank policy on Indigenous Peoples OD 4.20, and no supplementary policy provisions will be necessary in the proposed Project. This policy framework will apply to all provincial/city action plans under the Project. Guidelines for the Development of Provincial/City Action Plans. The objective of the guidelines for the development of provincial/city action plans is to ensure that under the proposed Project ethnic minority groups are informed, consulted and mobilized to participate in its project activities. Notably, the guidelines will guarantee equity in representation, reduce social disparities, and overcome any obstacles such as language and cultural sensitivity for guaranteeing equal rights for ethnic minority women, men, adolescents and children in participating and achieving benefits from the Project. Their participation will enable the provinces/cities to design better delivery and provision of information and services suited to ethnic minority needs and circumstances. D.5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The consultant’s HCWM report (including the recommendations) has been disclosed to all 20 provinces, and is also made available at the Ministry of Health as well as the World Bank’s Infoshop. Indigenous Peoples – Ethnic Minority Framework In order to gather ethnic minority group insights on the development of the PF, and to get initial information from them on paramount issues and concerns related to HIV/AIDS prevention control, Focus Group Discussions (FGD) were conducted in 2 northern provinces. In Thai Nguyen, the FGD was held in the village of Pham Ko, Hau Teung Page 7 commune among female and male members of the Tay, Nung and San Dui ethnic minority groups. In Bac Giang, it was at Nghia Phuong commune among female and male members of the Cao lan ethnic minority group. Comments were also sought from the Committee for Ethnic Minorities and Mountainous Areas (CEMMA), an agency directly under the office of the Prime Minister. The Framework has been translated and disclosed in all 20 project provinces. Page 8 F. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Date of receipt by the Bank 12/01/04 or Not Applicable Date of “in-country” disclosure 02/11/05 or Not Applicable Date of submission to InfoShop 12/02/04 or Not Applicable For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors …/…/… or Not Applicable Resettlement Action Plan/Framework/Policy Process: Date of receipt by the Bank …/…/… or Not Applicable Date of “in-country” disclosure …/…/… or Not Applicable Date of submission to InfoShop …/…/… or Not Applicable Indigenous Peoples Development Plan/Framework: Date of receipt by the Bank 12/01/04 or Not Applicable Date of “in-country” disclosure 01/13/05 or Not Applicable Date of submission to InfoShop 12/01/04 or Not Applicable Pest Management Plan: Date of receipt by the Bank …/…/… or Not Applicable Date of “in-country” disclosure …/…/… or Not Applicable Date of submission to InfoShop …/…/… or Not Applicable Dam Safety Management Plan: Date of receipt by the Bank …/…/… or Not Applicable Date of “in-country” disclosure …/…/… or Not Applicable Date of submission to InfoShop …/…/… or Not Applicable If in-country disclosure of any of the above documents is not expected, please explain why. Section III – Compliance Monitoring Indicators at the Corporate Level (To be filled in when the ISDS is finalized by the project decision meeting) OP/BP 4.01 - Environment Assessment: Yes No Does the project require a stand-alone EA (including EMP) report? 2 X If yes, then did the Regional Environment Unit review and approve the EA report? X Are the cost and the accountabilities for the EMP incorporated in the credit/loan? X OP/BP 4.04 - Natural Habitats: Yes No Would the project result in any significant conversion or degradation of critical natural habitats? X If the project would result in significant conversion or degradation of other (non-critical) natural habitats, does the project include mitigation measures acceptable to the Bank? N.A. OP 4.09 - Pest Management: Yes No Does the EA adequately address the pest management issues? N.A. 2 Only a Health Care Waste Management Plan Page 9 Is a separate PMP required? If yes, are PMP requirements included in project design? Draft OP 4.11 (OPN 11.03) - Cultural Property: Yes No Does the EA include adequate measures? N.A. Does the credit/loan incorporate mechanisms to mitigate the potential adverse impacts on physical cultural resources? OD 4.20 - Indigenous Peoples: Yes No Has a separate indigenous people development plan been prepared in consultation with the Indigenous People? X If yes, then did the Regional Social Development Unit review and approve the plan? X If the whole project is designed to benefit IP, has the design been reviewed and approved by the Regional Social Development Unit? N.A. OP/BP 4.12 - Involuntary Resettlement: Yes No Has a resettlement action plan, policy framework or policy process been prepared? N.A. If yes, then did the Regional Social Development Unit review and approve the plan / policy framework / policy process? OP/BP 4.36 – Forests: Yes No Has the sector-wide analysis of policy and institutional issues and constraints been carried out? N.A. Does the project design include satisfactory measures to overcome these constraints? Does the project finance commercial harvesting, and if so, does it include provisions for certification system? OP/BP 4.37 - Safety of Dams: Yes No Have dam safety plans been prepared? N.A. Have the TORs as well as composition for the independent Panel of Experts (POE) been reviewed and approved by the Bank? Has an Emergency Preparedness Plan (EPP) been prepared and arrangements been made for public awareness and training? OP 7.50 - Projects on International Waterways: Yes No Have the other riparians been notified of the project? N.A. If the project falls under one of the exceptions to the notification requirement, then has this been cleared with the Legal Department, and the memo to the RVP prepared and sent? What are the reasons for the exception? Please explain: Has the RVP approved such an exception? OP 7.60 - Projects in Disputed Areas : Yes No Has the memo conveying all pertinent information on the international aspects of the project, including the procedures to be followed, and the recommendations for dealing with the issue, been prepared, cleared with the Legal Department and sent to the RVP? N.A. Does the PAD/MOP include the standard disclaimer referred to in the OP? Page 10 BP 17.50 - Public Disclosure: Yes No Have relevant safeguard policies documents been sent to the World Bank's Infoshop? X 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? X All Safeguard Policies: Yes No Have satisfactory calendar, budget and clear institutional responsibilities been prepared for the implementation of the safeguard measures? X Have safeguard measures costs been included in project cost? X Will the safeguard measures costs be funded as part of project implementation? X Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures? X Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? X Signed and submitted by: Name Date Task Team Leader: Maryam Salim Project Safeguards Specialist 1: Social Lars. C. Lund Project Safeguards Specialist 2: Environment Bekir Onursul Approved by: Name Date Regional Safeguards Coordinator: Glenn Morgan Comments: Sector Manager: Fadia M. Saadah Comments: