Integrated Safeguards Data Sheet (Initial) Report No: AC190 Section I - Basic Information Date ISDS Prepared/Updated: 08/04/2003 A. Basic Project Data (from PDS) I.A.1. Project Statistics Country: CONGO, REPUBLIC OF Project ID: P077513 Project: HIV/AIDS PROJECT (MAP Program) Task Team Leader: Michele L. Lioy Authorized to Appraise Date: November 30, 2003 IBRD Amount ($m): Bank Approval: March 27, 2004 IDA Amount ($m): IDA GRANT FOR HIV/AIDS: 12 Managing Unit: AFTH3 Sector: Health (75%); Other social services (25%) Lending Instrument: Specific Investment Loan (SIL) Theme: Fighting communicable diseases (P); Other Status: Lending social protection and risk management (S); Gender (S) I.A.2. Project Objectives (From PDS): The proposed project is part of the World Bank's Multi-country HIV/AIDS Program for the Africa Region (MAP2, report No P7497-AFR) approved on February 7, 2002. The overall development objective of MAP2 is to dramatically increase access to HIV/AIDS prevention, treatment, and care and support programs in countries of the region that have not been covered under MAP1, with two additional objectives: (i) pilot testing of Anti-retro-viral Therapy (ART); and (ii) support cross-border initiatives. The ultimate impact of the MAP will be to avert millions of infections, alleviate suffering of tens of millions, and help preserve the development prospects of a large number of African countries.The specific development objectives of this project are based on the national strategic plan and are in accordance with the main goal of the MAP2. They are to assist the Government of the Congo: (i) to slow down the spread of HIV/AIDS; and (ii) to strengthen the support and care provided to individuals and families infected and/or affected by HIV/AIDS. The objectives will be reached through a multi-sector approach in particular by: (i) reducing transmission of HIV/AIDS among high risk groups; (ii) expanding access to treatment of opportunistic infections (OIs) and to care and support for people living with HIV/AIDS (People Living with HIV/AIDS --PLWHA); and (iii) supporting civil society and community initiatives for HIV/AIDS prevention and care. The project will support the implementation of the National Strategic Plan (Plan national stratégique) for the period 2003-2007 and promote civil society and community initiatives for prevention and care put forward by beneficiary groups selected on the basis of the technical quality and likely impact of their proposals. The National Strategic Plan has been completed. There remains to develop regional and sectoral plans. I.A.3. Project Description (From PDS): Project components (see Annex 2 of PAD for a detailed description and Annex 3 for a detailed cost breakdown) The project will support the implementation of the Congo National Strategic Plan through a wide variety of public sector agencies, private and nongovernmental organizations, and community-based organizations. Because the various partners still are in the process of defining their interventions, it is impossible at this early stage of preparation to identify specifically the interventions which will be 2 ISDS covered by the project. However, the type of interventions to be included in the project will probably include: (i) Public sector response; (ii) Civil society response; (iii) Policy Development and Project Management including monitoring and evaluation; and (iv) Demographic and Health Survey . Component 1: Public Sector Response As has been demonstrated in other countries, the fight against HIV/AIDS must take a multi-sectoral approach in order to reach the Priority Vulnerable Groups. As previously mentioned, line ministries outside of the MOH which may develop an HIV/AIDS prevention and care program include the Ministries of Communication, Education, Defense, Interior, Finance, Justice, Transport, Forest, Social Affairs, and Youth and Sport. The Public Sector Response component will aim at improving the capacity of the Ministry of Health and of non-health sector line ministries to respond to the HIV/AIDS epidemic, emphasizing prevention and care. For this, the project will support annual action plans (with performance indicators) prepared by public agencies, i.e. both ministries and provincial and local administrations. The mechanisms to channel funds from the Executive Secretariat to ministries and other public administrative entities will be identified during project preparation. Under the Public Sector Response component, there will be 2 sub-components: a Health sector response and an other sectors than Health response. The Ministry of Health's plan may include HIV sero-prevalence surveys, early detection and correct treatment of STIs and opportunistic infections, prevention of mother-to-child transmission of HIV, Voluntary Counseling and testing (VCT), procurement of condoms, training of health personnel and blood security. In addition, the project may provide equipment, medicines and training for health personnel. The Ministry of Defense's plan will focus on behavioral change (accompanied by condom distribution) and voluntary testing and counselling and care for infected people. Although the multi-sectoral response is presently very weak, several ministries have expressed their interest and are in the process of preparing their strategies and action plans. At least four key ministries are expected to have action plans ready when project financing is available, namely the Ministry of Social Affairs, the Ministry of Communication, the Ministry of Education, and the Ministry of Defense. The Ministry of Communication will disseminate messages promoting behavior change. The Ministry of Education's plan will include IEC activities aimed at changing behaviors of both students and teachers. The anti-AIDS clubs in many secondary schools and colleges, established by PRESIEC (Prévention du SIDA dans les Ecoles du Congo), will contribute to the prevention activities of this ministry. The action plans will be developed during project preparation and will be integrated into the ministries' ongoing operations. They will be targeted towards the staff of line ministries and to the vulnerable priority groups for which they are responsible. They will focus on training staff on issues of HIV/AIDS and STIs, the importance of condoms in the fight against these diseases, and other support mechanisms to encourage a change in behavior practices. In addition, training will be provided to staff to transfer knowledge to their partners and audiences (e.g. parents-teachers associations, dockers' associations, truckers, women's groups, health committees, commercial sex workers), so as to promote effective HIV/AIDS and STIs prevention and good access to health care facilities, treatment, and care. Component 2: Civil Society Response To enlist communities in the fight against HIV/AIDS and provide them with the means to mitigate the impact of the epidemic, resources must be provided at the local level. The Civil Society Response component would finance activities in the areas of: (i) promotion and distribution of condoms; (ii) targeted Information, Education and Communication/Behavior Change Communication (IEC/BCC) campaigns aiming at changing behaviors related to HIV transmission and STI prevention; (iii) interventions aiming at improving the status and the autonomy of women; (iv) psycho-medico-social support and care to PLWHA; (v) economic support to infected persons; (vi) promotion of VCT; (vii) increased accessibility to VCT; and (viii) promotion of protection against mother-to-child transmission. 3 ISDS In addition, a sub-component on orphan care will be included in this component. It could include school fees, a minimum social package (food, health care) and support to families taking care of orphans. The mechanisms to channel funds from the Secretariat to communities will be identified during project preparation, at which time the Government/ IDA team will fully consult other donors. It is expected that financial management will be contracted out to a private firm. It is presently estimated that this component will receive about 30 percent of project funds with which to support action plans and proposals prepared by local communities, youth clubs, women's organizations, PLWA associations, as well as local NGOs and religious groups. Component 3: Policy Development and Program Management, Monitoring and Evaluation This component would aim at strengthening the capacity of the Congo (B) to cope with the spread of HIV/AIDS by supporting: (i) the work of the National AIDS Committee (CNLS); (ii) the finalization and up-dating of the National HIV/AIDS Strategic and Action Plans; and (iii) strengthening of public, private and non-governmental institutions in preparing and implementing HIV/AIDS prevention and care interventions. The major activity categories would be: (a) National Strategic Plan and Action Plans; (b) Project management, coordination, and administration under the responsibility of CNLS Executive Secretariat; and (c) Monitoring and Evaluation (i.e. including behavioral surveys, operational research and pilot testing, and other monitoring and evaluation activities) which will be contracted out as well as procurement. The project management component will support the incremental cost of the central, regional and local units of the Secretariat. Component 4: Demographic and Health Survey (DHS) The project will provide financing to the Direction of Statistics to carry out a DHS. Such a survey is needed to provide baseline data. Other donors are being contacted to determine whether they would be willing to finance part of the DHS. The level of financing by the project will be estimated during the upcoming mission. Components: 1. Public sector response 2. Civil society response 3. Policy Development and Program management, monitoring and evaluation 4. DHS I.A.4. Project Location: (Geographic location, information about the key environmental and social characteristics of the area and population likely to be affected, and proximity to any protected areas, or sites or critical natural habitats, or any other culturally or socially sensitive areas.) The project is national in scope. Health-related activities would take place in district hospitals and ambulatory treatment centers. B. Check Environmental Classification: B (Partial Assessment) Comments: C. Safeguard Policies Triggered (from PDS) (click on for a detailed desciption or click on the policy number for a brief description) 4 ISDS Policy Triggered Environmental Assessment (OP 4.01, BP 4.01, GP 4.01) Yes No TBD Natural Habitats (OP 4.04, BP 4.04, GP 4.04) Yes No TBD Forestry (OP 4.36, GP 4.36) Yes No TBD Pest Management (OP 4.09) Yes No TBD Cultural Property (OPN 11.03) Yes No TBD Indigenous Peoples (OD 4.20) Yes No TBD Involuntary Resettlement (OP/BP 4.12) Yes No TBD Safety of Dams (OP 4.37, BP 4.37) Yes No TBD Projects in International Waters (OP 7.50, BP 7.50, GP 7.50) Yes No TBD Projects in Disputed Areas (OP 7.60, BP 7.60, GP 7.60)* Yes No TBD Section II - Key Safeguard Issues and Their Management D. Summary of Key Safeguard Issues. Please fill in all relevant questions. If information is not available, describe steps to be taken to obtain necessary data. II.D.1a. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts. Safe collection, storage, and disposal of medical wastes is the main environmental issue associated with project activities. This will be examined and addressed in the context of Health Care Waste Management Plan to be elaborated as part of the requirements for the project. In particular, the plan will assess the current policy framework and technical standards as regards HCWM (i.e., deficiencies regarding management procedures as they relate to the collection, storage, transportation, treatment and disposal of HCW etc.) in the country and make relevant recommendations and/or develop plan of action to improve the system. II.D.1b. Describe any potential cumulative impacts due to application of more than one safeguard policy or due to multiple project component. N.A. II.D.1c Describe any potential long term impacts due to anticipated future activities in the project area. N.A. II.D.2. In light of 1, describe the proposed treatment of alternatives (if required) N.A. II.D.3. Describe arrangement for the borrower to address safeguard issues The only potential environmental issue would relate to waste management of medical products. A waste management plan will be developed (along standardized guidelines of other MAP projects) in the course of project preparation. II.D.4. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on 5 ISDS safeguard policies, with an emphasis on potentially affected people. Stakeholders are being extensively consulted during the preparation of the program in all three of the country's regions. Meetings will be held with representatives of public agencies and private enterprises and with local associations. Key stakeholders include relevant sectors of Government, development partners, NGOs and CBOs, people living with HIV/AIDS and their families, medical personnel, people involved in collection, storage, transportation and disposal, and the general public. A major aim of the project preparation the project is to ensure consensus-building among the various stakeholder as regards the design and implementation and monitoring arrangements of project mitigation measures. The draft Health Care Waste Management Plan will be discussed with representative of stakeholders listed above and then incorporate their comments and suggestions, as needed, before disclosure. The Health Care Waste Management Plan will be published in the local press, put, in print, in the Republic of Congo Country Office PIC and sent to the Infoshop prior to Appraisal. E. Safeguards Classification (select in SAP). Category is determined by the highest impact in any policy. Or on basis of cumulative impacts from multiple safeguards. Whenever an individual safeguard policy is triggered the provisions of that policy apply. [ ] S1. ­ Significant, cumulative and/or irreversible impacts; or significant technical and institutional risks in management of one or more safeguard areas [X] S2. ­ One or more safeguard policies are triggered, but effects are limited in their impact and are technically and institutionally manageable [ ] S3. ­ No safeguard issues [ ] SF. ­ Financial intermediary projects, social development funds, community driven development or similar projects which require a safeguard framework or programmatic approach to address safeguard issues. F. Disclosure Requirements Environmental Assessment/Analysis/Management Plan: Expected Actual Date of receipt by the Bank 8/31/2003 Date of "in-country" disclosure 9/30/2003 Date of submission to InfoShop 10/5/2003 Date of distributing the Exec. Summary of the EA to the Executive Not Applicable Not Applicable Directors (For category A projects) Resettlement Action Plan/Framework: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Not Applicable Not Applicable Date of submission to InfoShop Not Applicable Not Applicable Indigenous Peoples Development Plan/Framework: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Not Applicable Not Applicable Date of submission to InfoShop Not Applicable Not Applicable Pest Management Plan: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Not Applicable Not Applicable Date of submission to InfoShop Not Applicable Not Applicable 6 ISDS Dam Safety Management Plan: Expected Actual Date of receipt by the Bank Not Applicable Not Applicable Date of "in-country" disclosure Not Applicable Not Applicable Date of submission to InfoShop Not Applicable Not Applicable If in-country disclosure of any of the above documents is not expected, please explain why. Signed and submitted by Name Date Task Team Leader: Michele L. Lioy 06/26/2003 Project Safeguards Specialists 1: Project Safeguards Specialists 2: Project Safeguards Specialists 3: Approved by: Name Date Regional Safeguards Coordinator: Serigne Omar Fye 06/26/2003 Sector Manager Laura Frigenti 06/26/2003