Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 05/08/2007 Report No.: AC2963 1. Basic Project Data Country: Afghanistan Project ID: P101502 Project Name: Afghanistan HIV/AIDS Prevention Project Task Team Leader: Mariam Claeson Estimated Appraisal Date: April 16, 2007 Estimated Board Date: July 31, 2007 Managing Unit: SASHD Lending Instrument: Specific Investment Loan Sector: Health (70%);General education sector (15%);Media (10%);General public administration sector (5%) Theme: HIV/AIDS (P);Gender (S) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 10.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 0.00 0.00 Environmental Category: B - Partial Assessment Simplified Processing Simple [X] Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) Yes [X] No [ ] 2. Project Objectives The objective of the project is to contribute to the national development goal of maintaining the HIV prevalence below 0.5 per cent in the general population and below 5% among the vulnerable groups at high risk. 3. Project Description To achieve the above objectives the project would be comprise the following four components: Component 1 - Communication and Advocacy: This component will strengthen communication and advocacy for stronger knowledge of HIV prevention, treatment, care, and support to modify attitudes of stigma and discrimination among selected vulnerable groups, the general population, and institutional and community leaders. This will support multi sector and innovative involvement in communication and advocacy for the HIV response. The Communication and advocacy will contribute to creating an enabling environment for HIV prevention and treatment, and result in an increase in general awareness and knowledge of HIV transmission, prevention and care and reduce the stigma associated with HIV and AIDS. Page 2 Component 2 - Strengthen HIV Surveillance: This component will build the NACP's ability to track the magnitude and trajectory of the HIV epidemic in Afghanistan through the adoption of a second generation surveillance (SGS) system. The SGS system includes mapping and size estimation of at risk populations and collection of biological and behavioral data from representative samples of populations contributing the greatest to HIV transmission dynamics. Based on the current understanding of the epidemic, these groups include IDU, SW, prisoners, and truckers. In addition to providing data for monitoring the epidemic, the wide array of knowledge, behavioral, and service utilization data collected through SGS, provides the evidence base for future resource allocation and program management decisions to be made by NACP. Component 3 - Targeted Interventions for High Risk Behaviors: This component will support targeted interventions (TIs)to prevent further spread of HIV among vulnerable groups at high risk, and among the general population. The TIs will support safe practices and reduce unsafe behaviors. The targeted intervention for HIV prevention among IDUs is a comprehensive harm reduction package, including needle and syringe exchange, peer counseling and education, condom promotion, delivered at drop in centers and through other outreach services. The services will be delivered where the HIV transmission is most likely to occurring, based on mapping of high risk and sero prevalence survey data, with flexibility to expand to new sites with outreach services. Proposals will be invited for work with identified groups, such as IDUs, sex workers, and others as appropriate in selected sites, in the major cities. Each organization responsible for one cluster of sites in one city and surrounding area will operate under contract with the MOPH through the GCMU under the technical supervision of the NACP. Component 4 - Program Management, Capacity Building, Monitoring and Innovation Fund: This component will support multi sector HIV coordination through HACCA, strengthen program management, capacity development, and monitoring by NACP. This component will also support an Innovation Fund for the national HIV Response. Membership of HACCA is extensive and includes NGOs as well as ministries. The Innovation Fund for the HIV Response will invite proposals from other line ministries than health. The innovation fund will enable other ministries than health to develop action plans in support of the project development objectives: to achieve behavior change by scaling up prevention of new infections in high risk groups and/or improve knowledge of HIV prevention and modify attitudes of stigma in different population groups. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The main interventions are to be in selected urban centers where the high-risk and vulnerable population groups are usually concentrated. In selected cases second-tier cities would also need to be included, if the mapping exercises show the prevalence of high risk behaviors in those towns. Some interventions like awareness-building activitiees and behavior change communications using the media might be national in scope. 5. Environmental and Social Safeguards Specialists Mr Mohammad Arif Rasuli (SASES) Page 3 6. Safeguard Policies Triggered Yes No Environmental Assessment (OP/BP 4.01) X 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 II. Key Safeguard Policy Issues and Their Management A. Summary of Key Safeguard Issues 1. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts: Environment: AIDS-related activities, even preventive ones, generate wastes such as sharps (infected needles and syringes, intravenous sets) infected blood, HIV test kits used tested centers, blood banks and laboratories, and pharmaceutical wastes. If these wastes are not managed properly, they direct environmental and public health implications. Health Care Workers (HCWs) are at great risk as most of blood-borne occupational infections occur as a result of injuries (due to accidents or unsafe practices) from sharps contaminated with HIV-infected blood. Systematic management of such clinical waste from source to disposal is therefore integral to preventing infections and controlling the HIV epidemic. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: Environment. The possible spread of infection due to poor practices at healthcare facilities and in their environs would conflict with the overall objective of the HIV/AIDS program, which is to prevent and eventually halt the spread of HIV. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Not Valid. 4. Describe measures taken by the borrower to address safeguard policy issues. Provide an assessment of borrower capacity to plan and implement the measures described. The Ministry of Public Health already has a Health Care Waste Management Plan, prepared recently under the Bank-financed Emergency Health Project. The Health Care Waste Management plan will be updated no later than September 30, 2007, especially to take into account of the recently passed Environmental Safety Act. Once updated, the same plan would be applied to the interventions planned under this project as well. Page 4 The MoPH has taken some measures, working on an environmental policy and are trying to identify the right approach among other issues including environmental sanitation to the overall problem of bio-medical waste management issue. The MoPH with the help of NGOs, the WB and others carried some observation and preliminary assessment of the health facilities in Kabul to find what is the current practices and level of understanding concerning medical waste management. As expected there is lack of understanding and appreciation among the nurses and some of the health workers. Institutional arrangement for the HIV/AIDS project is good and the MOPH, despite having some capacity constraints, is moving in the right direction. Some of the measures to help implement the plan are: (i) Development, revision and implementation of the Afghanistan National HIV/AIDS Strategic Framework (2006-2010); (ii) Establishment and management of VCCT centers nation-wide; (iii) Development of national guidelines and protocols for HIV/AIDS management; (iv) Establishment of HIV/AIDS Co-ordination Committee of Afghanistan(HACCA); (v) Supervision of sero-prevalence surveys and KABP studies; and (vi) Fund raising to ensure sustainability of the HIV/AIDS interventions. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. During the initial situation assessment of the waste management issue in the health facilities, the team visited government-run health facilities, blood bank, medical officers and NGOs-run facilities and many other medical officers and health care workers were visited. NGOS will be actively participating in the prevention and awareness raising campaign against the HIV/AIDS epidemic. VCTCs, STI clinics are other important front line partners who were consulted and will continuously play a very active role in the fight against the HIV/AIDS. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Date of receipt by the Bank 03/12/2007 Date of "in-country" disclosure 07/31/2007 Date of submission to InfoShop 07/31/2007 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors * If the project triggers the Pest Management and/or Physical Cultural Resources, the respective issues are to be addressed and disclosed as part of the Environmental Assessment/Audit/or EMP. If in-country disclosure of any of the above documents is not expected, please explain why: Page 5 C. Compliance Monitoring Indicators at the Corporate Level (to be filled in when the ISDS is finalized by the project decision meeting) OP/BP/GP 4.01 - Environment Assessment Does the project require a stand-alone EA (including EMP) report? No If yes, then did the Regional Environment Unit or Sector Manager (SM) review and approve the EA report? N/A Are the cost and the accountabilities for the EMP incorporated in the credit/loan? N/A The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank's Infoshop? No Have relevant documents been disclosed in-country in a public place in a form and language that are understandable and accessible to project-affected groups and local NGOs? No All Safeguard Policies Have satisfactory calendar, budget and clear institutional responsibilities been prepared for the implementation of measures related to safeguard policies? Yes Have costs related to safeguard policy measures been included in the project cost? Yes Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures related to safeguard policies? Yes Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? Yes D. Approvals Signed and submitted by: Name Date Task Team Leader: Ms Mariam Claeson 04/28/2007 Environmental Specialist: Mr Mohammad Arif Rasuli 05/02/2007 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Approved by: Sector Manager: Ms Anabela Abreu 05/08/2007 Comments: