INTEGRATED SAFEGUARDS DATA SHEET ADDITIONAL FINANCING Report No.: ISDSA5637 Date ISDS Prepared/Updated: 05-Nov-2013 Date ISDS Approved/Disclosed: 07-Nov-2013 I. BASIC INFORMATION 1. Basic Project Data Country: Kenya Project ID: P144197 Parent P074091 Project ID: Project Name: Kenya Health Sector Support Project - Additional Financing (P144197) Parent Project Health Sector Support (P074091) Name: Task Team Gandham N.V. Ramana Leader: Estimated 24-Oct-2013 Estimated 20-Dec-2013 Appraisal Date: Board Date: Managing Unit: AFTHE Lending Investment Project Financing Instrument: Sector(s): Health (100%) Theme(s): Child health (20%), Health system performance (40%), Population and reproductive health (20%), Other human development (20%) Is this project processed under OP 8.50 (Emergency Recovery) or OP No 8.00 (Rapid Response to Crises and Emergencies)? Financing (In USD Million) Total Project Cost: 30.00 Total Bank Financing: 30.00 Financing Gap: 0.00 Financing Source Amount BORROWER/RECIPIENT 0.00 International Development Association (IDA) 30.00 Total 30.00 Environmental B - Partial Assessment Category: Is this a No Repeater project? 2. Project Development Objective(s) Page 1 of 8 A. Original Project Development Objectives – Parent The proposed project's development objectives are to: (i) improve the delivery of essential health services for Kenyans, especiallythe poor; and (ii) improve the efficiency of pharmaceutical planning, procurement and management. B. Current Project Development Objectives – Parent C. Proposed Project Development Objectives – Additional Financing (AF) To improve (i) the delivery and utilization of quality essential health and nutrition services by women and children especially among the poor and drought affected populations; and (ii) the effectiveness of planning, financing, procurement and distribution of pharmaceutical and medical supplies. 3. Project Description The proposed additional credit from IDA (US$30 million) and HRITF (US$20 million) together with the restructuring of ongoing KHSSP would fall primarily under Component 1. Component 1: (US$50 million): Delivering Kenya Essential Package of Health Services. Theproposed additional financing will enhance ongoing efforts by Government of Kenya and its partners to deliver essential health and nutrition services to women and children by (i) supporting ongoing government policies to improve delivery of quality health services for women and children in rural areas with strong focus on results; (ii) complementing the government's commitment to reduce inequities in access to health care by contributing to the health insurance premiums for the poor; and (iii) building sustainable institutions at the county level to effectively manage the devolved health systems. Component 2: Provision of essential medicines and medical supplies. Considering the continued need for the nutrition supplementation for the drought prone populations, it is proposed to reallocate US$8 million made under the Crisis Response Window for Essential Medicines and Medical Supplies (EMMS) to purchase and distribute nutrition commodities. 4. Project location and salient physical characteristics relevant to the safeguard analysis (if known) NHSSP II, which the Project supports, covers the whole country. As per the descriptions above, implementation will be at all levels of the health system. 5. Environmental and Social Safeguards Specialists Gibwa A. Kajubi (AFTCS) Nyambura Githagui (AFTCS) Svetlana Khvostova (AFTSG) 6. Safeguard Policies Triggered? Explanation (Optional) Environmental Assessment OP/ Yes BP 4.01 Natural Habitats OP/BP 4.04 No Page 2 of 8 Forests OP/BP 4.36 No Pest Management OP 4.09 No Physical Cultural Resources OP/ No BP 4.11 Indigenous Peoples OP/BP 4.10 Yes Involuntary Resettlement OP/BP No 4.12 Safety of Dams OP/BP 4.37 No Projects on International No Waterways OP/BP 7.50 Projects in Disputed Areas OP/BP No 7.60 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 additional financing will not change the environmental category of the KHSSP which is rated Category B. Safeguard policies triggered in the original project were Environmental Assessment (OP/BP 4.01) and Indigenous Peoples (OP/BP 4.10) and no new safeguard policies will be triggered. No exceptions to Bank policies are required. OP 4.01 - Environmental Assessment: The potential negative environmental impacts of the project relate to issues of health care waste management, in particular the risks associated with the handling and disposal of medical waste. For malaria control, the EMMS-pooled fund only supports anti-malarial drugs, bednets and diagnostics. No indoor residual spraying will be supported in the Project. The Project does not support civil works other than maintenance and very minor renovation of existing health facilities under the Health Sector Services Fund (HSSF). The National Health Care Waste Management Plan (NHCWMP) was publicly disclosed by the Ministry of Public Health and Sanitation (MOPHS) and Ministry of Medical Services (MOMS) in Kenya, and in the InfoShop on February 4, 2010, in association with the East Africa Public Health Laboratory Networking (EAPHLN) Project. The plan was re-disclosed again in the InfoShop in May 2010 for Additional Financing done under Crisis Response Window. The Bank did not ask for any revisions to the NHCWMP. Under the new Constitution and Devolution the counties are now responsible for the delivery of essential health services. The KHSSP has been piloting the use of a results based indicator for waste care management in 5 locations and the National MOH will continue to work with the 5 counties to continue implementing the pilot. Further, the Results Based Financing now being scaled up to 20 counties includes this cross cutting indicator for counties to comply with the Health Care Waste Management. The Project does not finance activities involving the involuntary taking of land, loss of assets or Page 3 of 8 access to assets, loss of income sources or means of livelihood or the involuntary restriction of access to legally designated parks and protected areas. OP 4.12 on Involuntary Resettlement is not triggered. OP 4.10 - Indigenous People. The Kenya Health Sector Support Project (KHSSP) aims to improve delivery of essential health services for Kenyans, especially the poor. Although the projects does not anticipate negative impacts on Vulnerable and Marginalized Groups (VMGs), the World Bank Operational Policy (OP4.10) Indigenous Peoples has been triggered to ensure pro-active steps are taken for such groups to benefit from the project. The KHSSP has a Vulnerable and Marginalized Peoples Planning Framework (VMPPF) focusing on a pro-active approach that ensures VMGs are included, mainly through effective targeting and/or assistance in preparing sub-projects. It is generally envisaged that the Vulnerable and Marginalized Populations do not have access to these services in a similar way to other ethnic communities in Kenya. An Indigenous Peoples Planning Framework (IPPF) was developed by the Ministry of Public Health and Sanitation (MOPHS) and Ministry of Medical Services (MOMS) for the EAPHLNP and then updated to include the new health Project too. The documents were reviewed by IDA and found to be acceptable. The MOMS and MOPHS disclosed the documents in the country on February 4, 2010, and the Bank disclosed them in the InfoShop on February 5, 2010. The framework was disclosed again in the InfoShop in May 2010 to ensure clarity about the application of the safeguards documents to the Kenya Health Project. The MOPHS, through its projects: the Kenya Health Sector Support Project (KHSSP), the East African Public Health Laboratory Network (EAPHLN) and the Total War Against AIDS (TOWA) project under the National AIDS Control Council (NACC)in 2011 sought to jointly develop, separately implementable Vulnerable and Marginalized Peoples Plans (VMPPs) to increase the accessibility of health services to the Vulnerable and Marginalized Populations (VMPs). In 2012, the consultant selected undertook a social assessment and developed project specific Vulnerable and Marginalized Peoples Plans (VMPPs) for each of the three projects through free, prior and informed consultations with the local vulnerable and marginalized ethnic groups based on existing VMPP frameworks, that will enable such groups in the project areas to access benefits from each project equitably and in a culturally appropriate manner under the three projects. Specifically, the exercise sought to establish the (i) extent to which the Indigenous Peoples (IPs) are benefiting from the three projects, (ii) the barriers to accessing services provided under the three projects and (iii) to develop action plans which provide implementers with practical measures to guide implementation, monitoring and evaluation of IPs benefits from the project activities given the geographical, financial and socio-cultural factors. Information was collected from thirteen communities in eight Counties/Districts. The 13 communities were: Sengwer, Ngikebotook, IL Chamus, Endorois, Sabor, Ogiek, Konso, LKunono, IL Waana/Malakote, Waata, Boni/Aweer, Saanye and Munyoyaya. Three separate Vulnerable and Marginalized Plans (VMPPs) have been developed with an aim of enhancing access to basic health services including laboratory testing and diagnosis and increased participation of the VMPs in the TOWA grants. The VMPPs made recommendations in the following areas based on the following thematic areas; community empowerment, promotion of good and desirable health practices, making health services affordable, ensuring that health facilities serving the VMP communities have adequate medicines and supplies as well as equipment and infrastructure; and enhancement of social accountability to strengthen governance, Page 4 of 8 representation and information flow to the VMPs with regard to health services delivery. The main recommendations included the following: i) There is need to enhance awareness of the existing health services among the VMG communities ii) Improve utilization of available services by promoting positive health care seeking behavior iii) Put in place plans to enhance access to health services in the communities by adopting the pro-poor strategies in health financing, iv) Continued strengthening of Social Accountability mechanisms to enable proper strategies for grievance resolution and a monitoring mechanism, v) Build the capacity of the VMG communities to participate in health activities, vi) Address the identified gaps in HIV/AIDS service provision among the VMG populations and vii) Enhance service delivery, equipment and infrastructure of East African Public Health Laboratory Network. The VMPPs have been disclosed in-country and at the Ministry of Health’s website on August 6, 2013. The VMPP has been submitted to the Bank for disclosure in the InfoShop. Currently implementation arrangements are being discussed with the counties which will be responsible for delivering essential health services in the devolved health system. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: There are no potential impacts other than medical waste, as discussed above. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Medical waste is inevitable in health care. There were therefore no alternatives considered, other than various methods of managing such waste. 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 Government of Kenya has already prepared a National Health Care Waste Management Plan, which focuses on existing healthcare waste generation as well as segregation, storage, collection, transport, and final disposal practices; technologies for waste disposal; public awareness programs; and relevant national legislation. This plan was reviewed and accepted in the EAPHLNP. Under the new Constitution and Devolution the counties are now responsible for the delivery of essential health services. The KHSSP has been piloting the use of a results based indicator for waste care management in 5 locations. The National MOH will now work with the 5 counties to continue implementing the pilot. Further, the Results Based Financing now being scaled up to 20 counties includes this cross cutting indicator for counties to comply with the Health Care Waste Management. This will be the way forward for improving practices and compliance with the national guidelines as demonstrated in the pilots. Tracking this indicator will the key tool MOH to improve practices and track compliance with the national guidelines as demonstrated in the Samburu pilot. The Kenya Health Sector Support Project has developed a Pilot to Integrate Social Accountability Approaches in the Health Sector Services Fund (HSSF). The pilot will include (i) preparatory activities for holding two health baraza with communities and health staff at each facility, (ii) ) planning and implementing support activities to strengthen social accountability at health facilities and their communities; (iii) providing hands-on training to health staff and Health Facility Management Committees (HFMC) to takeover implementation of social accountability at their facilities and communities; and (iv) preparing reports on lessons learnt from implementing social Page 5 of 8 accountability for further scaling up. A “Draft Operational Manual� with appropriate tools for integrating social accountability (SA) into HSSF has been developed focusing on three aspects of social accountability - transparency, effective complaint redress, and participation. The pilot was successfully implemented at nine (9) locations, reflecting different socio-economic settings in Kenya, which include: arid and semi-arid including pastoral, fishing, agriculture, semi-urban, and coastal. Based on the findings of the pilot a comprehensive manual for scaling up social accountability has been prepared for national scale- up and a national stakeholder consultation is scheduled in August 2013 following which the scale- up will be done in consultation with the Counties. 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 include Ministry of Health, NGOs, private and mission health facilities, municipal councils and health facilities, health workers, patients, and people living near health facilities and dump sites. Consultation for the NHCWMP was through public hearings, stakeholder workshops and meeting of the heads of the implementing agencies. For disclosure, the NHCWMP and related documents were posted on the websites of the Ministry of Health and the National AIDS Control Council (NACC). The plan was also disseminated through local newspapers and radio. In addition, it was disclosed at the World Bank Information Center in Nairobi and the InfoShop in Washington DC. Additional consultations will be done to inform the stakeholders of the new implementation arrangements, relevant roles and responsibilities, and a reminder of the project environmental and social impacts. An Indigenous Peoples Planning Framework (IPPF) was developed by the MOPHS and MOMS for the EAPHLNP and then updated to include the KHSSP Project. The document was reviewed by IDA and found to be acceptable. The MOMS and MOPHS disclosed the document in the country on February 4, 2010, and the Bank disclosed them in the InfoShop on February 5, 2010. The framework was disclosed again in the InfoShop in May 2010 to ensure clarity about the application of the safeguards documents to the Kenya Health Project. A Vulnerable and Marginalized Group Plan has been developed in close consultations with select groups and has been disclosed in country on August 4, 2013 and has been submitted to the Bank for disclosure. . A time bound action plan has been developed for the implementation of the VMGP with assigned agency responsibilities. B. Disclosure Requirements Environmental Assessment/Audit/Management Plan/Other Date of receipt by the Bank 30-Nov-2011 Date of submission to InfoShop 02-Dec-2011 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors "In country" Disclosure Kenya 04-Feb-2010 Comments: Indigenous Peoples Development Plan/Framework Date of receipt by the Bank 15-Oct-2013 Date of submission to InfoShop 15-Oct-2013 Page 6 of 8 "In country" Disclosure Kenya 06-Aug-2013 Comments: If the project triggers the Pest Management and/or Physical Cultural Resources policies, 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 OP/BP/GP 4.01 - Environment Assessment Does the project require a stand-alone EA (including EMP) Yes [ ] No [ ] NA [ ] report? If yes, then did the Regional Environment Unit or Sector Yes [ ] No [ ] NA [ ] Manager (SM) review and approve the EA report? Are the cost and the accountabilities for the EMP incorporated Yes [ ] No [ ] NA [ ] in the credit/loan? OP/BP 4.10 - Indigenous Peoples Has a separate Indigenous Peoples Plan/Planning Framework Yes [ ] No [ ] NA [ ] (as appropriate) been prepared in consultation with affected Indigenous Peoples? If yes, then did the Regional unit responsible for safeguards or Yes [ ] No [ ] NA [ ] Sector Manager review the plan? If the whole project is designed to benefit IP, has the design Yes [ ] No [ ] NA [ ] been reviewed and approved by the Regional Social Development Unit or Sector Manager? The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the Yes [ ] No [ ] NA [ ] World Bank's Infoshop? Have relevant documents been disclosed in-country in a public Yes [ ] No [ ] NA [ ] place in a 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 Yes [ ] No [ ] NA [ ] responsibilities been prepared for the implementation of measures related to safeguard policies? Have costs related to safeguard policy measures been included Yes [ ] No [ ] NA [ ] in the project cost? Does the Monitoring and Evaluation system of the project Yes [ ] No [ ] NA [ ] include the monitoring of safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed Yes [ ] No [ ] NA [ ] with the borrower and the same been adequately reflected in the project legal documents? Page 7 of 8 III. APPROVALS Task Team Leader: Name: Gandham N.V. Ramana Approved By Regional Safeguards Name: Alexandra C. Bezeredi (RSA) Date: 07-Nov-2013 Advisor: Sector Manager: Name: Olusoji O. Adeyi (SM) Date: 07-Nov-2013 Page 8 of 8