Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 05/19/2010 Report No.: 54662 1. Basic Project Data Original Project ID: P072226 Original Project Name: Second Population and AIDS Project Country: Chad Project ID: P105724 Project Name: Population and HIV AIDS Additional Financing Task Team Leader: Boubou Cisse Estimated Appraisal Date: December 5, 2007 Estimated Board Date: June 24, 2010 Managing Unit: AFTHE Lending Instrument: Specific Investment Loan Sector: Health (60%);Other social services (20%);Central government administration (20%) Theme: Other communicable diseases (23%);Population and reproductive health (22%);Participation and civic engagement (22%);HIV/AIDS (22%);Gender (11%) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 20.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 0.00 Financing Gap 0.00 0.00 Environmental Category: B - Partial Assessment Simplified Processing Simple [X] Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) or OP 8.00 (Rapid Response to Crises and Emergencies) Yes [ ] No [X] 2. Project Objectives The project's development objective remains unchanged: to contribute to changing the behavior of the Chadian population to reduce the risk of: (i) HIV infection; and (ii) too closely spaced and/or unwanted pregnancies. 3. Project Description The proposed additional financing will extend the new integrated and decentralized approach to STI/HIV/AIDS and population and reproductive health services to ten health districts in five regions, in addition to the capital city, Ndjamena. Under this approach, the health sector response would be strengthened and the project will finance, in the ten districts, (i) the supply of a comprehensive package of basic maternal and child health services through mobile teams; (ii) strengthening of the existing public and private health centers and voluntary counseling and testing centers, including for medical waste Page 2 management; and (iii) promotion of demand for services through social mobilization, communication and peer education activities implemented by civil society. Activities focused on STI/HIV/AIDS prevention include, among others, testing and treatment of STIs, HIV testing and counseling, and psycho-social, medical and nutritional support to PLWHAs. Maternal and child health activities include, among others, family planning, pre-natal care, referral for assisted deliveries, and vaccination. The bulk of the financing for this component will go to front-line service delivery with a small amount of financing for supervision by the central level (resulting in an overall reduction of number of activities). The project will continue to finance civil society interventions to stimulate demand through social mobilization, communication and peer education activities implemented by civil society. However, these interventions have also been restructured and their number would be reduced to strengthen the implementation, improve quality of interventions and maximize the impact of those activities that will continue to be financed over the next two years. Moreover, performance-based contracting will be introduced for NGO contracts A RBF approach will be piloted in two additional regions to improve maternal and child health outcomes. The project will provide support to the design of the RBF pilot and contracting of a performance purchase agency (PPA) who will be responsible for undertaking an assessment of the capacity of health facilities, calculating the unit cost of the services, contracting with health centers, and verifying achievement of results. In addition, NGOs and CBOs will be contracted to undertake external reviews through random household surveys to verify that beneficiaries actually received services. Finally, the project will support project management costs and strengthening medical waste management of health centers supported by the project, through provision of equipment, materials and incinerators (where needed). Moreover, monitoring and evaluation capacity will be strengthened, including routine monitoring of project results and data collection, in particular at the regional and district levels, and use of evaluation tools and studies. A household survey will be undertaken after project effectiveness to validate and update existing data and after the first year of project implementation to determine progress. An evaluation of the results of the project will be undertaken at the end of the implementation period. Data from these studies will be complemented by data from Multiple Indicator Cluster Surveys (MICS), a Demographic and Health Survey and a HIV prevalence survey. The project will also finance the third Household Consumption Survey (ECOSIT) to assess progress on key health sector indicators and the reduction of poverty since 2003. No new construction and/or rehabilitation of facilities will take place under the proposed additional financing operation. The implementation of the National Medical Waste Management Plan will be supported under component 5. 4. Project Location and salient physical characteristics relevant to the safeguard analysis Project local response activities will take in Ndjamena, Kanem, Logone Occidental, Logone Oriental, Moyen Kebbi Ouest, and Salamat. The RBF component will be piloted in Guera and Tandjilé. Page 3 5. Environmental and Social Safeguards Specialists Mr Serigne Omar Fye (AFTSP) 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: The original project was given a "C" rating since it was not expected to generate any adverse environmental effects. The proposed additional financing project is rated as a "B" as is the case for all HIV/AIDS projects, due to the risks associated with the handling and disposal of medical waste. In Chad, as in other countries, inappropriate handling of infected materials by an inappropriate management of biomedical wastes (collection, control, storage and disposals) constitutes a risk, not only for hospital personnel and people frequenting the health facilities, but also for agents in charge of collecting solid wastes from healthcare areas. As a result, the only safeguard triggered is the environmental assessment, because a Medical Waste Management Plan (MWMP) is required. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: The population lives in a very insalubrious environment. More than 71 percent of the population does not have hygienic toilets. This situation encourages the outbreak of many diseases, particularly diarrheal diseases. The disposal of household wastes constitutes a major problem with the absence of waste elimination and removal systems. The evacuation of rain and used waters also causes major public health problems. The country epidemiological profile includes mainly malaria, tuberculosis, acute respiratory diseases, HIV/AIDS, and diarrheal diseases. With an efficient implementation of the MWMP, most risks associated with medical waste can be prevented. No new construction and/or rehabilitation of facilities will take place under the proposed additional financing operation. Page 4 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Not applicable 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. Chad has put in place a National Biological Waste Management Strategy to improve waste management methods and hygiene conditions by putting in place systems that are viable, technically feasible, socially acceptable and able to guarantee a healthy and clean environment. The Strategy was elaborated taking into account the communities# preferences and practices. The related MWMP was prepared and disclosed in the Infoshop and in country in August 2007 and remains valid. The Borrower's institutional capacity for implementing safeguard measures is somewhat weak as they do not have much experience. Provision of critical materials and equipment for medical waste management, capacity building and supervision of safeguards is included in the additional financing under Component 5 to address weaknesses and enhance the implementation and systematic monitoring of the MWMP. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. Key stakeholders include key health centers, hospital personnel and the population. The medical waste plan was widely distributed and a module on medical waste management was included in the local response training sessions, including awareness creation of the risks linked with the handling of medical/biological wastes, the danger of potentially contaminated objects, food, animal wastes and other hazardous wastes. The MWMP was disclosed in-country and at the Infoshop and includes all the concerned actors and describes their specific responsibilities and commitment. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 07/20/2007 Date of "in-country" disclosure 08/15/2007 Date of submission to InfoShop 07/30/2007 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors Resettlement Action Plan/Framework/Policy Process: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Indigenous Peoples Plan/Planning Framework: Was the document disclosed prior to appraisal? Date of receipt by the Bank Page 5 Date of "in-country" disclosure Date of submission to InfoShop Pest Management Plan: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop * 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: 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? Yes If yes, then did the Regional Environment Unit or Sector Manager (SM) review and approve the EA report? Yes Are the cost and the accountabilities for the EMP incorporated in the credit/loan? Yes The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank's Infoshop? Yes 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? Yes 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? N/A Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? Yes Page 6 D. Approvals Signed and submitted by: Name Date Task Team Leader: Mr Boubou Cisse 11/09/2007 Environmental Specialist: Mr Serigne Omar Fye 11/12/2007 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Mr Harvey D. Van Veldhuizen 01/28/2010 Approved by: Sector Manager: Mr John F. May 05/17/2010 Comments: Cleared with: Serigne Omar Fye.