Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC3940 Date ISDS Prepared/Updated: 10/31/2008 I. BASIC INFORMATION A. Basic Project Data Country: Afghanistan Project ID: P112446 Project Name: Strengthening Health Activities for the Rural Poor (SHARP) Task Team Leader: Emanuele Capobianco Estimated Appraisal Date: January 20, 2009 Estimated Board Date: March 17, 2009 Managing Unit: SASHD Lending Instrument: Specific Investment Loan Sector: Health (90%);Central government administration (10%) Theme: Health system performance (P);Child health (P);Population and reproductive health (P);Other communicable diseases (S);Gender (S) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 30.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 0.00 0.00 B. Project Objectives [from section 2 of PCN] The development objective of the proposed project is to support the Afghanistan Health and Nutrition Sector Strategy objective to “contribute to improving the health and nutritional status of the people of Afghanistan, with a greater focus on women and children and under-served areas of the country”. C. Project Description [from section 3 of PCN] The Bank will follow the government’s programmatic approach for the health sector by providing flexible financing for interventions not financed by the Government or other partners. Within this approach, the Bank will focus on the following areas: Component 1. Sustaining and Strengthening BPHS Delivery: The project will support the implementation of the BPHS through Performance Partnership Agreements (PPAs), i.e., contracts between the MOPH and the implementing Non-Governmental Organizations (NGOs). It will also support the government’s own efforts at delivering the BPHS through contracting in Page 2 management services in the provinces the government selects. There will be support for expansion of sub-centers, training of additional community mid-wives and of community nurses. Component 2. Strengthening EPHS Delivery: Despite MOPH increased interest on EPHS, there is little evidence of which hospital model may be best for Afghanistan. For this reason, in the initial phase the project will provide technical assistance to support testing of different options including: (i) contracting hospital services to NGOs; (ii) strengthening management autonomy and decision-making authority in public hospitals; and (iii) establishing accountability arrangements and pay for performance (related to component 4 below). In the second phase, upon evaluation of the options above, the project will support the expansion of the preferred model. Component 3. Building Further Capacity for the Stewardship Function of the MOPH: This component will support: (i) the monitoring and evaluation system (through contracting of an independent agency); (ii) the Grant and Contract Management Unit and related line managers; (iii) the health care financing unit; (iv) the communication unit; (v) the MOPH regulatory function; and (v) the provincial health offices. Component 4. Testing Important Innovations: The project will pilot-test supply side interventions (e.g. pay for performance for health workers) on a large scale results-based financing study. The study is financed by a Norwegian grant that the MOPH recently obtained through a competitive process. This component might also finance the expansion of other innovations, such as demand-side financing for women to deliver in institutions and performance-based pay for community health workers D. Project location (if known) In view of the programmatic approach, the project could provide flexible financing for delivery of services throughout the country. However, the project will be primarily implemented in the eleven provinces covered by the previous project. The pilot testing component of the project will be implemented in some of the eleven provinces as well as other provinces not covered under the components 1 and 2. E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] The borrower has developed health care waste management policies and has been following its implementation by service providers through annual facility surveys. However, there is still not yet proper health care waste management system in place in the country. The MOPH has been supportive of an integrated approach to health care waste management across different diseases. The borrower has been building its capacity through time. F. Environmental and Social Safeguards Specialists Mr Mohammad Arif Rasuli (SASDI) Ms Asila Wardak Jamal (SASDI) Page 3 II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X The MOPH had issued sound health care waste management policies which were informed by the environmental assessment carried out in 2003. However, the implementation of these policies has not been appropriately tracked at all levels, especially in public hospitals. Data have been regularly collected at primary health care level through annual facility surveys conducted over the past four years: the results show encouraging improvement in waste management. The country still lacks a sound biomedical waste management system. There is not yet any legislation or regulation in place. The MOPH lacks the handling and disposal methods, facilities and trained staff, without which proper health care waste management would not be possible. The World Health Organization is helping MOPH to assess health care waste management issues and to strengthen the current management system. The proposed project will facilitate a review of the environmental management plan for health care waste management. During the project life, surveys will be conducted and progress on this topic will be assessed on a regular basis. 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 Environmental Category: B - Partial Assessment III. SAFEGUARD PREPARATION PLAN A. Target date for the Quality Enhancement Review (QER), at which time the PAD-stage ISDS would be prepared: N/A B. For simple projects that will not require a QER, the target date for preparing the PAD-stage ISDS: 01/08/2009 C. Time frame for launching and completing the safeguard-related studies that may be needed. The specific studies and their timing 1 should be specified in the PAD-stage ISDS. No safeguards- related studies are anticipated. 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. Page 4 IV. APPROVALS Signed and submitted by: Task Team Leader: Mr Emanuele Capobianco 10/22/2008 Approved by: Regional Safeguards Coordinator: Mr Frederick Edmund Brusberg 10/29/2008 Comments: cleared on understanding that specifics of steps to improve waste management will be clarified by appraisal. Decision to transfer safeguards oversight to SASHD will be made at QER or appraisal stage. Sector Manager: Ms Julie McLaughlin 10/29/2008 Comments: Afghanistan has made relatively substantial progress in health care waste management. As with the many other sector priorities, full-scale implementation will require sustained support.