Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC1510 Date ISDS Prepared/Updated: 10/27/2005 I. BASIC INFORMATION A. Basic Project Data Country: Burkina Faso Project ID: P093987 Project Name: Health System Strengthening & Multisector HIV/AIDS Program Task Team Leader: Timothy A. Johnston Estimated Appraisal Date: November 21, 2005 Estimated Board Date: February 13, 2006 Managing Unit: AFTH2 Lending Instrument: Sector Investment and Maintenance Loan Sector: Health (75%);Other social services (25%) Theme: HIV/AIDS (P) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 47.70 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 5.30 Financing Gap 0.00 5.30 B. Project Objectives [from section 2 of PCN] The overall objective of the program would be to: (i) contribute to improving the quality and coverage of preventive and curative health services, and strengthen the health system?s capacity to accelerate progress toward the health and nutrition MDGs; (ii) strengthen multi-sector and civil society efforts to reduce HIV/AIDS transmission and to mitigate the socio-economic consequences for those affected by the epidemic; and (iii) strengthen systems for monitoring and evaluating progress toward health sector and HIV/AIDS objectives, including the use of performance-based contracts. C. Project Description [from section 3 of PCN] Proposed program components are organized according to the flow of funds: (a) Strengthening the health sector response ( 50% of funds/$17.5 million) This component would provide global support for improving sector performance through a multi-donor basket funding mechanism, which would finance district, regional, hospital, and Page 2 central action plans based on performance contracts with agreed monitoring indicators and targets. The Ministry of Health?s 10-year health sector development strategy (2001-2010) provides the overall strategic framework for the sector and for the PRSP. The Medium-Term Expenditure Framework (CDMT/sant?) would form the basis for program preparation and for dialogue with both MOH and MFB regarding budget priorities for achieving sector objectives and MDGs. Emphasis would be placed on monitoring progress toward agreed objectives rather than earmarking funds for specific activities, including strengthening performance contracting between the health ministry and both public and private service providers, and strengthening monitoring and evaluation. Program resources would be distributed among central, regional, and district levels of the health system according to a transparent allocation formula (including population, poverty, services delivered). The program would seek to ensure continuity of AIDS treatment programs initiated under the MAP (850 persons under treatment) and the TAP, and place strong emphasis on significantly scaling up malaria prevention and treatment activities (including insecticide treated bednets). (b) Support for Multi-sectoral HIV/AIDS response (50 percent, $17.5 million) This component would provide support to the multi-sectoral HIV prevention and non-medical care and support program, coordinated by the National AIDS Council. This includes continued financing for targeted HIV/AIDS interventions for high-risk vulnerable groups (sex workers, miners, youth); targeted support for action plans of non-health ministries; voluntary counseling and testing; behavior change communications (BCC) campaigns; and support for prevention and care activities within civil society and the private sector. This component would also support provincial AIDS committees and village micro-project, although implementation may be delegated to the CDD mechanism (the PGNT project). As part of the broader social protection strategy, the program would finance non-medical care and support for persons infected and affected, including civil servants, and piloting new approaches and support for policy development with the Ministry of Social Action. More generally, program dialogue would encourage the integration of HIV/AIDS activities into ongoing programs and the national budgets, to the extent possible. For example, school-based HIV/AIDs and reproductive health programs would be integrated into PDDEP and education support, with targeted support for non- school youth programs. A performance-based contract will be signed between the MoF and the National AIDS council which will spell out the objectives to be reached. D. Project location (if known) Burkina Faso : nationwide. E. Borrowe r’s Institutional Capacity for Safeguard Policies [from PCN] While activities financed through the current project and the proposed Credit generate relatively little medical waste directly, proper management and disposal of medical waste is clearly an important issue for avoiding accidental exposure to HIV and other blood-related illnesses by health workers and by persons in surrounding communities. Some laboratory reagents used by hospitals are also toxic, and can have harmful environmental consequences if not disposed of properly. Page 3 A multi-sectoral environmental assessment was completed in November 2002 during the first year of implementation of the current HIV/AIDS Disaster Response Project, but the recommendation were not costed during project design. The current project is financing a workshop to develop an Action Plan for implementation of the Strategy, and is also financing training for health workers on workplace safety and waste management. A supplemental grant would support implementation of the first phase of the medical waste management action plan, including some of the higher cost items not originally budgeted (incinerators, etc.). Further support for implementation and monitoring of medical waste management activities to be provided through this Credit. F. Environmental and Social Safeguards Specialists Mr Amadou Konare (AFTS1) II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X The main environmental and social issues relates to medical waste management. While the project will focus also on malaria control, the government?s vector control program does not involvement insecticide spraying, and the project will not finance insecticides Natural Habitats (OP/BP 4.04) X Forests (OP/BP 4.36) X Pest Management (OP 4.09) X Cultural Property (OPN 11.03) X Indigenous Peoples (OD 4.20) 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: 10/05/2005 B. For simple projects that will not require a QER, the target date for preparing the PAD-stage ISDS: N/A 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. 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 A national medical waste action plan will be finalized at a stakeholder workshop in April 2005, based on the medical waste management assessment was completed in November 2002. The environmental assessment will be re-disclosed in country at the Infoshop following this workshop -- by May 15, 2005. This project and the pending supplemental Credit will focus on implementation of agreed recommendations, based on an action plan prepared and validated by the government prior to project appraisal. AFTH2 accepts the safeguards responsibility from this point onward IV. APPROVALS Signed and submitted by: Task Team Leader: Mr Timothy A. Johnston Approved by: Regional Safeguards Coordinator: Mr Thomas E. Walton Comments: Sector Manager: Mr Alexandre V. Abrantes Comments: