Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC276 Date ISDS Prepared/Updated: September 15, 2003 I. BASIC INFORMATION A. Basic Project Data Country: Angola Project ID: P083180 Project Name: Angola HAMSET Project Task Team Leader: Jean J. De St Antoine Estimated Appraisal Date: February 23, 2004 Grant amount ($m.): IDAH: 20 Estimated Board Date: May 15, 2004 Managing Unit: AFTH1 Lending Instrument: Sector Investment Loan Sector: Health (80%);Other social services (20%) Theme: Fighting communicable diseases (P); Population and reproductive health (P); Social risk coping (P) Safeguard Policies Specialists in the task team: Omar Serigne Fye B. Project Objective. To control the spread and mitigate the effects of AIDS, TB, and malaria with the goals of: (i) keeping HIV prevalence in pregnant women of the 15-24 age group below 10 percent; (ii) increasing TB case detection rate to 60 percent and cure rate to 75 percent; and (iii) reducing malaria incidence by 25 percent from 13 to 9 per 100,000. C. Project Description. Alternative approaches. The “no project” alternative is not desirable due to the high morbidity and mortality from malaria and TB, and with AIDS advancing rapidly into the top ten causes of death from infectious diseases. Without adequate intervention, the AIDS epidemic in Angola can be expected to follow the same course as neighboring countries, with up to 30 percent of adults becoming HIV positive. An alternative approach would have been a project focused exclusively on HIV/AIDS. The government, however, asked the Bank to also include malaria, the communicable disease with the highest mortality, and TB, a disease with a high incidence that is likely to increase because of the HIV/AIDS epidemic. We believe that the government request is justified. Lending Instrument. This project would be a Sector Investment Loan under IDA’s MAP for the Africa region and is in accordance with the Bank’s regional HIV/AIDS strategy “Intensifying Action Against HIV/AIDS in Africa: Responding to a Development Crisis”. The overall MAP design is using the lending instrument for an APL. A “vertical” APL for individual countries, in combination with the “horizontal” APL for Africa was an alternative proposed and rejected (see MAP PAD for further details). Given the MAP context, no alternative project designs would be appropriate. Project Components. The project would have an estimated cost of about $38.6 million of which Bank financing would be $20 million. The project would have four components as follows: (i) National Response to AIDS: $10.4 million (of which IDA: $4.0 m); (ii) Community Response (all 3 diseases): $ Page 2 11.8 million (IDA: $6.6 m); (iii) Support to MOH (for 3 diseases): $15.1 million (IDA: $8.1 m); and (iv) National Commission Against AIDS and Endemic Diseases (NCAED): $1.3 million. Implementation will start with provinces with the highest population, prevalence of HIV/AIDS, malaria and TB, presence of partners, and ease of access, and expand geographically over time. Some activities such as mass media prevention campaigns or definition of testing protocols would have a national coverage from the outset. Preliminary estimates show that the allocation of IDA financing by disease would be about $7million for AIDS, $8 million for malaria, $3.5 million for TB and $1.5 million for project management. The detailed components would be as follows: (i) National Response to HIV/AIDS This component would support a multisector response from government ministries that would ha ve funds earmarked to them. In addition “innovation grants” would be available for ministries or units within ministries that submit innovative proposals to do work beyond their basic project funding. Priority activities within this component would be behavior change communication (BCC), social marketing of condoms, and VCT. (ii) Community Responses This component would provide funding and technical assistance to NGOs that would present subprojects to prevent and mitigate the effects of the three diseases. They would cover activities such as preventive activities for HIV/AIDS, social marketing of bed nets, and community treatment of malaria, and possibly support to implementation of DOTS for TB. Grants would be provided on a competitive basis with the criteria including potential impact, innovation, and capacity of the organization. NGOs would need to satisfy minimum criteria including standard administrative procedures, and transparency (including audits). (iii) Support to the MOH for HIV/AIDS, malaria and TB . This component would provide funding to the MOH for the prevention and treatment of TB and malaria, as well as for HIV/AIDS activities for which the MOH is directly responsible such as training of MOH staff, VCT and STI management, prevention of MTCT, and treatment of opportunistic infections. It would also include a small pilot project that would help define protocols for testing and treatment, strengthen laboratory capacity, and train doctors and nurses in the use of antiretroviral treatment (ART). That would help build capacity of a core team in Angola and facilitate access to financing of drugs at a later stage. (iv) Support to the National Commission The National Commission is the national body that will set up broad strategic guidelines and review progress in program implementation. Its National Secretariat will provide guidance to line ministries on effective ways to mainstream HIV/AIDS activities and to identify technical support from partners such as UN agencies for these purposes. The project would provide training, and technical assistance to the National Commission and Secretariat to increase its capacity to: (a) manage the program, (b) monitor and evaluate progress in controlling the epidemics; and (c) analyze and act on the resulting data. D. Project location. Implementation will start with provinces with the highest population, prevalence of HIV/AIDS, malaria and TB, presence of partners, and ease of access, and expand geographically over time. Some activities such as mass media prevention campaigns or definition of testing protocols would have a national coverage from the outset. E. Borrower’s Institutional Capacity. The government's capacity is weak, but the government welcomes technical support from the international community. Significant assistance will be required over the coming months to build capacity, and the government has indicated its interest in seeking a Project Preparation Facility of $600,000 to that effect. There is some presence of international NGOs, but local NGOs' capacity appears to be weak. A detailed assessment of their capacity will be undertaken in Page 3 October 2003. Capacity will need to be built up through partnership with international NGOs and training. The October 2003 preparation mission will help define the structure and TORs for key posts and will recommend that the recruitment process be contracted to a private firm. An action plan will be agreed upon including training, development of systems and procedures for financial management, accounting and auditing. This would be financed under the PPF. The project will build the capacity of NGO program intermediaries in provinces to identify and strengthen local institutions at the community level. Promotion will be undertaken to attract local and international NGOs to work on the project. II. SAFEGUARD POLICIES THAT MIGHT APPLY Applicable? Safeguard Policy If Applicable, How Might It Apply? [ Yes] Environmental Assessment ( OP / BP 4.01) [ No] Natural Habitats ( OP / BP 4.04) [ No] Pest Management ( OP 4.09 ) [No ] Involuntary Resettlement ( OP / BP 4.12) [ No] Indigenous Peoples ( OD 4.20 ) [ No] Forests ( OP / BP 4.36) [No ] Safety of Dams ( OP / BP 4.37) [ No] Cultural Property (draft OP 4.11 - OPN 11.03 ) [ No] Projects in Disputed Areas ( OP / BP / GP 7.60) * [No ] Projects on International Waterways ( OP / BP / GP 7.50) Environmental Assessment Category: [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) If TBD, explain follow-up and calendar/steps for the determination of the category: Safeguard Policies Classification: [ ] S 1 [X] S 2 [ ] S 3 [ ] S F [ ] TBD (to be determined) If TBD, explain follow-up and calendar/steps for the determination of the classification: * 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 III. ACTIONS DURING PROJECT PREPARATION A. What actions might be needed during project preparation to assess safeguard issues and prepare to mitigate them? The government will be asked to prepare a Medical Waste Management Plan. The plan will address major adverse environmental effects such as inappropriate handling and disposal of hazardous waste, including sharp needles. The preparation of this plan will be financed by the PPF. Assurances will be sought that the final Medical Waste Management Plan will be disclosed in-country and through the Bank Infoshop upon finalization. B. How might consultation and disclosure requirements be addressed? Consultations on the medical waste management issues to be addressed will be undertaken during the preparation mission in October 2003. Key stakeholders include government ministries, development partners, NGOs, people living with HIV/AIDS and their families, medical personnel, including professional medical organizations and the general population. Special emphasis will be given to involve medical personnel at all levels. During project preparation, consensus building exercises will be conducted to involve major stakeholders to gain consensus around the project concept, design, and implementation arrangements. During project implementation, communities will be able to express their needs through Community response subprojects and to participate as active partners in project implementation, adding ownership, transparency and accountability to the project. IV. AGREEMENTS REACHED ON SAFEGUARDS AT PCN REVIEW [Will include the key agreements reached on follow-up actions to be taken regarding safeguards during project preparation] Agreed target date for Quality Enhancement Review: January 13, 2004