INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: ISDSC608 Public Disclosure Copy Date ISDS Prepared/Updated: 27-Feb-2012 I. BASIC INFORMATION A. Basic Project Data Country: India Project ID: P130299 Project Name: FOURTH NATIONAL HIV/AIDS CONTROL PROJECT (P130299) Task Team Leader: Mariam Claeson Estimated Appraisal Date: 13-Apr-2012 Estimated Board Date: 20-Nov-2012 Managing Unit: SASHN Lending Instrument: Specific Investment Loan Sector: Health (100%) Theme: HIV/AIDS (70%), Health system performance (10%), Population and reproductive health (10%), Other communicable diseases (5%), Child h ealth (5%) Financing (In USD Million) Financing Source Amount BORROWER/RECIPIENT 1596.92 International Development Association (IDA) 250.00 FOREIGN SOURCES (UNIDENTIFIED) 228.48 Total 2075.40 Environmental Category: B - Partial Assessment Is this a Repeater project? No B. Project Objectives The Project Development Objective (PDO) is to contribute to the national goal to reduce HIV incidence by 50 percent by 2017. C. Project Description Public Disclosure Copy The primary goal of NACP IV is to accelerate the process of reversal and further strengthen the epidemic response in India, consolidating the gains made to date. The NACP IV aims to align its efforts with the overall goals of the Twelfth Five Year Plan of inclusive growth and development, by specifically focusing on the marginalized and hard-to-reach population groups not yet accessing HIV prevention, testing and treatment services. The National AIDS Control Program Phase IV (2012- 2017) with an overall budget of US$ 2.5 – 3.1 billion (TBC) has four components: (i) prevention, (ii) care, support and treatment, and (iii) institutional capacity and program management, and (iv) M&E and research. The proposed Bank funding for NACP IV would contribute to accelerate the reversal of the epidemic and integrate the response by focusing primarily on prevention and by supporting program management, taking into account: (i) the Bank's “finance plus� value ; (ii) strategic prioritization and selectivity; (iii) scaling up of innovations and knowledge generation; and, (iv) sustainability of the program through strengthening institutional capacity and integration. In the context of competing priorities and with limited external resources, the decision on where to focus available resources is also based on assessment of: trade-offs, with prioritization based on cost effectiveness analysis and high impact scenarios; efficiency gains; a focus on governance and accountability for results; and, continued strengthening of performance management – including fiduciary performance -- at all levels of the program. Based on a review of alternative options and seeking to complement significant government funding in other areas, the Bank will mainly support the scale up of prevention under NACP IV, with a focus on the high impact targeted prevention interventions to population groups at high risk and related behavior change communications. The project would also support NACO in further strengthening of project management, especially as it moves through a transitional phase with integration and convergence of elements of the program. The process of convergence with the National Rural Health Mission, has started under NACP III with, for example, the management of sexually transmitted infections, prevention of parent to child transmission, provision of safe blood; these and other basic services, including facility based testing and treatment will be further integrated with government health services. Important program components such as treatment, care and support, integrated testing and counseling, prevention of parent to child transmission, other basic services, blood transfusion, testing and laboratory services and strategic information systems, including surveillance will be financed by domestic funding, and by technical and financial contributions from other development partners. The financial support for targeted prevention interventions through the contracting of NGOs and CBOs is the most critical area for which the Government is seeking Bank assistance. Component 1: Prevention (US$230 - 240M): More than 95% of Bank finance will be allocated towards prevention covering targeted interventions for HRG (tentatively about US$200M) and bridge populations, including clients to sex workers, migrants and truckers, (US$10 - 20M) and behavior change communication (about US$ 20M), including a focus on demand generation and stigma reduction. Component 2: Institutional capacity and program management (US$10 – 20M): In support of NACO’s national steering, coordination and managerial role during the transformational phase of NACP IV, funding would support innovations in performance management including fiduciary management, such as the use of the computerized financial management system, at national and state levels and/or other areas to be defined. D. Project location and salient physical characteristics relevant to the safeguard analysis (if known) The national program will be implemented nationwide with targeted prevention interventions among districts and states with highest HIV prevalence and vulnerability, while the project might focus on selected states with the highest rate of new infections and HIV burden (selection of states to be determined). The project focuses on service delivery to high risk groups and their locations identified through mapping. NACP IV aims Public Disclosure Copy to focus specifically on the marginalized and hard-to-reach population groups not yet accessing HIV prevention, testing and treatment services, and therefore in designed to benefit the socially disadvantageous sections of society exposed HIV/AIDS risks. No physical structures or facilities are planned to be undertaken in NCP-IV and therefore, the project is not likely to generate any involuntary resettlement risks. NACP-IV will be implemented in category A and B districts having high risk population groups, some of which are inhabited by tribal communities. E. Borrowers Institutional Capacity for Safeguard Policies Environment: The National AIDS Control Agency (NACO) has successfully implemented three phases of the national AIDS program, with decentralized responsibilities for state annual action plans under the State AIDS Control Societies. NACO has committed leadership and ownership of the program; the program management capacity is high at NACO, while SACS have varied capacity. The NACP III has adhered to safeguard policies and built capacity and awareness around occupational safety and infection control including policy and operational guidelines for waste management. A functioning waste management system is in place at all service delivery centers, blood collection and testing centers and laboratories. Social: The national program has established management capacity to address social inclusion and sustainability issues through mainstreaming and IEC at NACO and SACS levels. In addition, it has established institutional arrangements for ensuring community and civil society participation in policy making and implementation with respect to gender, social inclusion, greater involvement of people living with AIDS (GIPA), outreach to high risk and vulnerable groups including the tribal communities. The Program has already established policy frameworks and institutional capacity at NACO and SACS levels to address social issues and reach out to vulnerable populations – i.e. drug users, sex workers and their clients and men having sex with men, including those living in tribal areas though tribal action plans in compliance with the Bank safeguards policy 4.10. NACP-III has established a policy framework for preparing and implementing tribal action plans (TAPs) at the state levels, with special focus on tribal districts with HRGs. The concerned SACS have prepared and implemented TAPs, which they will continue to implement with improvements informed by the social assessment undertaken for NACP-IV. F. Environmental and Social Safeguards Specialists on the Team Ruma Tavorath (SASDI) Satya N. Mishra (SASDS) II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered? Explanation (Optional) Environmental Assessment OP/BP 4.01 Yes Natural Habitats OP/BP 4.04 No Public Disclosure Copy Forests OP/BP 4.36 No Pest Management OP 4.09 No Physical Cultural Resources OP/BP 4.11 No Indigenous Peoples OP/BP 4.10 Yes Involuntary Resettlement OP/BP 4.12 No Safety of Dams OP/BP 4.37 No Projects on International Waterways OP/BP No 7.50 Projects in Disputed Areas OP/BP 7.60 No III. SAFEGUARD PREPARATION PLAN A. Tentative target date for preparing the PAD Stage ISDS: 12-Mar-2012 B. Time frame for launching and completing the safeguard-related studies that may be needed. The specific studies and their timing1 should be specified in the PAD-stage ISDS: 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. Elaborate Social and Environment Assessments were prepared for the NACP-III, of which NACP-IV is a follow up project. Several additional studies were undertaken on social inclusion and sustainability issues as a part of the implementation process including the Mid Term Review. In addition, NACO has constituted working groups to discuss and provide guidelines for the way ahead in different subject areas including gender and social inclusion and mainstreaming. In view of the fact that this is a follow up project, social and environmental assessments have been commissioned by the client which will compile the lessons learned from NACP III and the findings of these studies will inform the social action plans. The Social Assessment will document the stakeholder consultations held at national and state level including with the civil society and community groups working with HRGs and tribal communities. NACO has established Policy Guidelines for preparing and implementing Public Disclosure Copy tribal action plans (TAP) which shall continue to be applied for NACP-IV with improvements, if any, suggested by the Social Assessment. NACO has started a vulnerability and risk assessment study for the tribal districts under NACP-III; the study shall be completed and based on the findings thereof, the state level TAPs shall be fine tuned as required. The SA and EA will be conducted by 29th March, 2012 and the revised and updated Infection Control and Waste Management plan will be finalized and disclosed by NACO after review by World Bank team by 26th March, 2012. IV. APPROVALS Task Team Leader: Name: Mariam Claeson Approved By: Regional Safeguards Coordinator: Name: Sanjay Srivastava (RSA) Date: 29-Feb-2012 Sector Manager: Name: Julie McLaughlin (SM) Date: 27-Feb-2012 Public Disclosure Copy