INTEGRATED SAFEGUARDS DATA SHEET APPRAISAL STAGE Report No.: ISDSA1424 Public Disclosure Copy Date ISDS Prepared/Updated: 24-Dec-2013 Date ISDS Approved/Disclosed: 10-Jan-2014 I. BASIC INFORMATION 1. Basic Project Data Country: Vietnam Project ID: P131825 Project Name: Health Professionals Education and Training for Health System Reforms (P131825) Task Team Eva Jarawan Leader: Estimated 09-Dec-2013 Estimated 25-Mar-2014 Appraisal Date: Board Date: Managing Unit: EASHH Lending Investment Project Financing Instrument: Sector(s): Health (75%), Tertiary education (25%) Theme(s): Health system performance (75%), Education for the knowledge economy (25%) Is this project processed under OP 8.50 (Emergency Recovery) or OP No 8.00 (Rapid Response to Crises and Emergencies)? Financing (In USD Million) Public Disclosure Copy Total Project Cost: 121.00 Total Bank Financing: 106.00 Financing Gap: 0.00 Financing Source Amount BORROWER/RECIPIENT 5.00 International Development Association (IDA) 106.00 EC European Commission 10.00 Total 121.00 Environmental B - Partial Assessment Category: Is this a No Repeater project? 2. Project Development Objective(s) The PDO are to improve the quality of health professionals' education, strengthen management competencies in the health sector, and improve the competencies of Primary Health Care Teams at the grass-roots level. Page 1 of 9 3. Project Description Component 1: Improve the quality of health professionals’ education (US$ 63 million) Public Disclosure Copy (a) Subcomponent 1.1: Improve the quality assurance system of health professionals’ education (US$20 million) 1. The project will support the establishment, by MOH decision, of a quality assurance (QA) Council initially for medical and nursing education which in time could include other health disciplines such as pharmacy, public health. The Council will be initially housed under the ASTT. The scope of the QA system will be two-folds: (i) setting-up a peer review assessment (PRA) initially for medical and nursing programs; and (ii) setting-up a standardized examination system initially for medical and nursing students. The project will finance expenditures to support the QA Council in meeting the requirements stipulated in Ministry of Education and Training circular 61/2012/TT-BGDDT dated December 28, 2012 regarding the regulation on registration, licensing and organization of an education accreditation entity to become independent sometime in the future. Standards for basic medical and nursing education are being prepared with the active participation of the schools and professional associations. MOET will review and validate both standards which will be used as the basis for establishing the peer review assessment instruments for medicine and nursing. The project will also support the work of two task forces to set up the PRA system. The first task force will work on the PRA policies and procedures, while the second task force will develop and test the PRA instrument and train the assessors. The project will also support the work of a task force under the QA Council in setting up the standardized final examination initially for medical and nursing students. Throughout the course of project implementation, other institutions for health professionals’ training, such as for pharmacy and public health, will learn from the experience of medicine and nursing and, as they become ready, will also establish their QA system. (b) Subcomponent 1.2: Supportive measures to meet the standards of medical and nursing education (US$43million) Public Disclosure Copy 2. The standards for medical and nursing education will be the reference for determining investment needs. Selected medical and nursing schools – and as they become ready, other health professionals’ schools - will receive financial assistance/grants through the project to scale-up their performance and achieve the required standards. Detailed activities covered under the grants program and eligible expenditures are described in Annex 2. Component 2: Strengthen Management Competencies in the Health Sector (US$12 million) (a) Subcomponent 2.1: Strengthen health management training (US$6 million) 3. The project will support Hanoi School of Public Health and Ho Chi Minh City (HCMC) Institute of Hygiene and Public Health to strengthen their capacity in health management training. These centers are expected to be the leading institutions for delivering management training to health managers nationwide. The financial support to the centers will cover: (i) training of trainers; (ii) minor renovation and repair of existing facilities; (iii) provision of training equipment, office equipment and furniture; (iv) local and/or international consulting services for developing training materials including E-learning; and (v) health management learning resources. 4. The training centers are expected to deliver the training to about 4000 managers at various Page 2 of 9 levels. Disbursement of funds under activity (i) of this component will be output-based (all other activities will be input-based) and centers will be paid on the basi s of managers and health inspectors trained. Unit costs have been defined based on experience and consultations within the Public Disclosure Copy MOH and with the provinces and training institutions. They have also been reviewed by the Bank Team and agreed upon (see Table 2.3). A Memorandum of Understanding (MOU) between the Central Project Management Unit (CPMU)/MOH and the training institutions will define roles and responsibilities of the centers as well as the MOH. A draft MOU has been prepared and will be part of the draft POM. 5. Evaluation of the training programs under this component will be carried out by the training centers who will certify the successful completion of the training programs. For payment purposes, the project external auditor will verify the number of trained managers. (b) Subcomponent 2.2: Improve Policy-making in Human Resources for Health (US$6 million) 6. The objectives of this sub-component are to improve coverage and distribution of HRH, particularly in the disadvantaged areas. The project will finance studies leading to improving the HRH policy environment. Studies on HRH management will be conducted to provide policy makers with evidence meant to revise the existing HRH policies. Scientific conferences and consultation workshops will be organized to foster policy dialogue, and inform public opinion on HRH management issues. 7. The project will pilot a program that is meant to improve the distribution of HRH in the disadvantaged areas (about 62 districts). About 500 freshly graduated physicians are expected to volunteer in this program that will finance their training in one of the specialty areas for a district hospital (surgery, pediatrics, ob-gyn, and internal medicine) leading to CK1 (Details in Annex 2). In preparation of the launch of such a program, the MOH needs to conduct the following activities: (i) physician needs assessment in the disadvantaged districts; (ii) information campaign to medical students, young physicians, central hospitals, provincial and district health managers and relevant Public Disclosure Copy stakeholders at the local level; and (iii) drafting a MOU between the MOH and teaching institutions as well as between the MOH and central and provincial hospitals. Finally, the MOH will need to draft the “commitment” form to be signed by the volunteer, the central or provincial hospital as well as the MOH. The project will finance support to selected teaching institutions and/or hospitals to encourage freshly graduated and/or trained physicians to volunteer to work in the disadvantaged areas. It was agreed that the disbursement for this aspect of the program will be output-based, i.e., teaching institutions will be compensated on the basis of number of trained young physicians. Unit costs have been defined based on experience and consultations within the MOH and with the provinces and teaching institutions. They have also been reviewed by the Bank Team and agreed upon (see Table 2.3). Details of such an arrangement with a draft MOU will be in the POM. 8. Evaluation of the training programs under this component will be carried out by the training institution who will certify the successful completion of the training programs. For payment purposes, the project external auditor will verify the number of trained young physicians. Component 3: Improve Competencies of Primary Health Care Teams at the Grass-roots Level (US $41 million) 9. This component will address significant HRH issues particularly: (i) the mismatch between the knowledge/skills competencies of existing health personnel at grass-roots level and the burden of Page 3 of 9 disease in the community; and (ii) lack of modern equipment at Commune Health Stations (CHS). The project will prepare health professionals to deliver integrated preventive, curative, and rehabilitative services to better cope with the double burden of disease – communicable and non- Public Disclosure Copy communicable. It will also improve provision of equipment at CHS to support the delivery of PHC services. (a) Subcomponent 3.1: Train PHC teams at the grass-roots level (US$19 million) 10. This sub-component will support the training of PHC teams at the grass-roots level in the 15 selected provinces, through a combination of long-term and short-term modular training courses and on-the job training. This will be in the form of an MOU between the MOH and the training institutions who will be entrusted to provide the training, financed on the basis of outputs. Training institutions will offer a menu of training options to the health professionals. Unit costs have been defined based on experience and consultations within the MOH and with the provinces and training institutions. They have also been reviewed by the Bank Team and agreed upon (see Table 2.3). As in subcomponents 2.1 and 2,2, the project external auditor will verify the number of staff trained for payment purposes. In addition to the training, the project will finance an independent evaluation of the PHC teams’ performance post-training. The EU has expressed an interest in co-financing this project. While it supports in principle the objectives of the project as a whole, it has expressed an interest in parallel co- financing activities under this sub-component only. Relevant documents to firm-up this co-financing are being prepared. (b) Subcomponent 3.2: Ensure that trained PHC teams have access to basic equipment according to the national benchmarks (US$22 million) 11. In this sub-component, the project will finance the following activities: (i) provisi on of laboratory and medical equipment as well as furniture to PHC teams in project provinces based on national benchmarks for CHS; and (ii) provision of laboratory, medical equipment and medical furniture for clinical training sites. Each project province will prepare an equipment development Public Disclosure Copy plan which will include an assessment of the equipment gap at each CHS as compared with the approved MOH standard list, and the description of the CHS needs. The MOH will prepare the specifications for each equipment item to be procured under the project. In preparing such plans, the province health authorities will take into account the fact that the EU and the Global Fund has financed, or is planning to finance, equipment for CHSs in some of the selected provinces. Delivery of equipment to the CHS is conditional on at least one staff of the center having completed the planned training in the core principles of PHC. Component 4: Project implementation support and coordination (US$5 million) 12. This component will support: (i) the establishment and operation of the Central project implementation unit (CPMU) under the Directorate of Science and Training of the MOH; and (ii) coordination between the MOH and concerned ministries and agencies in the implementation of the project. It will provide the necessary implementation and technical capacity at the Central level to plan and coordinate the implementation of the project. The CPMU will manage the review and approval of grants to training institutions under sub-component 1.2, MOUs between the MOH and the HSPH and the HCMC Institute of Hygiene and Public Health as well as between the MOH, teaching institutions and central and provincial hospitals, under sub-components 2.1 and 2.2 respectively, and MOUs between the training institutions and MOH sub-component 3.1 of the Project. It will also be responsible for monitoring and managing the various studies and TA under the Page 4 of 9 project. This will be done under the oversight of the Steering Committee. The project will finance: support for project management and supervision, procurement, disbursement, financial management, project audit, and project monitoring and evaluation (including training of project coordination staff Public Disclosure Copy and workshops for the preparation of grants; and incremental operating costs). 4. Project location and salient physical characteristics relevant to the safeguard analysis (if known) The project will provide support at nationwide coverage with targeted beneficiaries, including: (i) medical and nursing universities; (ii) nursing colleges; and (iii) PHC personnel and facilities. • Under component 1, the project will provide financial support to the 26 medical and nursing schools. • Under the component 2.1, the project will support 2 health management training centers in Hanoi school of Public Health and Ho Chi Minh city institute of hygiene and Public Health. • Under the component 2.2, the project will support the MOH to train and send young voluntary medical doctor to 62 poorest districts according to the Directive 30a/2008/NQ-CP dated 27/12/2008 of the Prime Minister. • Under the component 3, the project will provide training and basic medical equipment to the primary health care teams at the grass-root level in the following provinces: Lai Châu, Điện Biên, Sơn La, Cao Bằng, Lào Cai, Yên Bái, Hà Giang, Gia Lai, Kontum, Đắc Nông, Thái Bình, Nam Định, Khánh Hòa, Đồng Tháp, Lâm Đồng. It is expected that 60% of PHC teams in these provinces will be trained and equipped. 5. Environmental and Social Safeguards Specialists Nghi Quy Nguyen (EASVS) Thuy Cam Duong (EASVS) 6. Safeguard Policies Triggered? Explanation (Optional) Environmental Assessment OP/ Yes The project may finance simple rehabilitation of Public Disclosure Copy BP 4.01 existing health facilities. Natural Habitats OP/BP 4.04 No Forests OP/BP 4.36 No Pest Management OP 4.09 No Physical Cultural Resources OP/ No BP 4.11 Indigenous Peoples OP/BP 4.10 Yes The project is about improving quality of existing Primary Health Care services and training. It will not finance any new construction. Involuntary Resettlement OP/BP No The project does not plan to finance major civil 4.12 work. There may be financing of simple rehabilitation of existing facilities. Safety of Dams OP/BP 4.37 No Page 5 of 9 Projects on International No Waterways OP/BP 7.50 Public Disclosure Copy Projects in Disputed Areas OP/BP No 7.60 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: Social: The Bank’s safeguard policy on Indigenous People (OP 4.10) is triggered. However the project is expected to have no adverse impacts on ethnic minority groups. It is expected that the project will help to improve the quality of medical and nursing education and the competencies and of Primary Health Care Teams, especially in disadvantaged areas. In line with OP 4.10, a Social Assessment has been done to identify and characterize key stakeholders in terms of their importance to and influence over the project objectives and implementation; to identify potential barriers (cultural, institutional, financial, language etc.) for ethnic minority health staff in the project area to access the project benefits and services; and to document the ‘broad community support’ toward the project’s activities and define the processes for ensuring the consultation and participation of these stakeholders (especially ethnic minority health staff) in project design, implementation, and monitoring and feedback. An Ethnic Minority Planning Framework has been developed for the project. The mechanisms for ensuring culturally appropriate intervention and equal access to project’s benefits are addressed in the operational manual and in the EMPF. The Bank’s OP4.12 on Involuntary Resettlement will not be triggered, given that land/assets acquisition is not envisaged under the proposed project’s components. Public Disclosure Copy Environment: The project triggers OP/BP 4.01 on Environmental Assessment as it consists of investments which may cause environmental impacts related to: (i) minor building renovations and/or refurbishment for some of the 26 medical/nursing schools under component 1.2 and the 2 training centers under component 2.1; and (ii) use of medical equipment purchased for clinical training sites and a number of commune health stations (CHSs) at 15 participating provinces under component 3. This type of investment will potentially generate impacts typically known for small scale renovation works and are in link with healthcare waste management practices at CHSs. These impacts are small, localized and manageable via good management practice. On the positive side, the project will help to raise awareness on environmental protection as it is proposed to include a training module for health workforce on healthcare waste management. The project is not expected to have significant environmental impacts and therefore is classified as a category B. As part of project preparation, a brief Environmental and Social Management Framework has been developed by the Government to address the potential adverse environmental impacts. The ESMF is in accordance with the national regulations on environmental management as well as with Bank’s safeguard policies and requirements on public consultation and information disclosure. Page 6 of 9 More details on environmental assessment, ESMF content, public consultation and disclosure process are described in Annex 3 of the PAD. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities Public Disclosure Copy in the project area: No negative potential indirect and/or long term social and environmental impacts due to future activities are anticipated. The long term positive impacts of the project include improved quality of health services in the project areas. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Social: N/A Environment: N/A 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. Environment: As part of the project preparation, a brief Environmental and Social Management Framework (ESMF) have been developed by the Ministry of Health (MOH) to address the potential adverse impacts. The ESMF is in compliance with the national regulations on environmental management and The World Bank’s safeguard policies. The ESMF comprises of: (i) an ECOP for minor building renovation work to be included in renovation contract; and (ii) a brief waste management plan for PCHs to be followed during implementation. In addition, the ESMF lays out the procedures for safeguard implementation, monitoring and reporting as well as institutional arrangement, training and cost for safeguard implementation. The Central Project Management Unit (CPMU) under the MOH will have the overall responsibility for ensuring safeguard compliance during project implementation. The MOH has carried out several WB funded projects e.g. Mekong Regional Health Support Project, North Public Disclosure Copy Central Regional Health Support Project, Northern Upland Regional Health Support Project, and therefore has experience of the World Bank’s safeguard policies. The health sector is used to environmental procedures of registration, authorization, monitoring. On the one hand, the challenges for compliance to regulations on healthcare waste management include (i) limited management capacity, (ii) lacking financial resource for investment and operation, (iii) improper maintenance. On the other hand, the measures provided in the ESMF are quite simple, and can readily be followed. The capacity of the borrower to implement the safeguard requirements therefore is assessed as medium. The project will provide necessary training to strengthen the capacity of health workforce in safeguard implementation. Social: Ethnic Minority Development Plan. The Borrower conducted rapid social assessment to identify and characterize key stakeholders’ importance in influencing the project objectives and implementation; to identify potential barriers (cultural, institutional, financial, language etc.) for ethnic minority health staff to access the project benefits and services; and to document their support toward the project’s activities and define the processes for ensuring the consultation and participation of these stakeholders (especially ethnic minority health staff) in project design, implementation, and monitoring and feedback. The findings of social assessment were translated into an Ethnic Minority Development Plan (EMDP) in order to (i) ensure an equal access to Page 7 of 9 project benefits of ethnic minority health staff; and (ii) propose specific mitigation measure in minimizing the potential barriers. A social staff will be appointed and will be on board at every CPMU and PPMUs to ensure social safeguards implementation and monitoring are in accordance Public Disclosure Copy with project’s safeguard document (EMDP). Implementing agencies are also responsible for setting up an internal M&E system and external evaluation as well. 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 preparation of the ESMF, meaningful consultations with relevant stakeholders including the participating 27 nursing/medical schools were conducted. The MOH has sent the draft ESMF via emails to all these facilities on September 30, 2013 and requested for their response. 26/27 nursing/medical schools agreed with the proposed measures. The feedback from the remaining 1 training center was taken into account and reflected in the final version of the ESMF. Ethnic Minority Development Plan (EMDP) and the Environmental and Social Management Framework (ESMF) have been disclosed in compliance with the Bank’s safeguards policies (OP4.10) in Vietnamese on the MOH and provincial websites on November 13, 2013 and in English at the World Bank’s Vietnam Development Information Center in Hanoi and on the Bank’s Infoshop on November 13, 2013. Social Consultation: Consultations with stakeholders have been conducted through a number of activities, including discussion sessions with university, research institutes, relevant department of MOH, and health staff. B. Disclosure Requirements Environmental Assessment/Audit/Management Plan/Other Date of receipt by the Bank 07-Nov-2013 Public Disclosure Copy Date of submission to InfoShop 08-Nov-2013 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors "In country" Disclosure Vietnam 07-Nov-2013 Comments: Disclosed on the website of the MOH. Indigenous Peoples Development Plan/Framework Date of receipt by the Bank 07-Nov-2013 Date of submission to InfoShop 08-Nov-2013 "In country" Disclosure Vietnam 07-Nov-2013 Comments: Disclosed on the website of the MOH. If the project triggers the Pest Management and/or Physical Cultural Resources policies, 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 8 of 9 C. Compliance Monitoring Indicators at the Corporate Level OP/BP/GP 4.01 - Environment Assessment Public Disclosure Copy Does the project require a stand-alone EA (including EMP) Yes [ ] No [ ] NA [ ] report? OP/BP 4.10 - Indigenous Peoples Has a separate Indigenous Peoples Plan/Planning Framework Yes [ ] No [ ] NA [ ] (as appropriate) been prepared in consultation with affected Indigenous Peoples? If yes, then did the Regional unit responsible for safeguards or Yes [ ] No [ ] NA [ ] Sector Manager review the plan? If the whole project is designed to benefit IP, has the design Yes [ ] No [ ] NA [ ] been reviewed and approved by the Regional Social Development Unit or Sector Manager? The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the Yes [ ] No [ ] NA [ ] World Bank's Infoshop? Have relevant documents been disclosed in-country in a public Yes [ ] No [ ] NA [ ] place in a form and language that are understandable and accessible to project-affected groups and local NGOs? All Safeguard Policies Have satisfactory calendar, budget and clear institutional Yes [ ] No [ ] NA [ ] responsibilities been prepared for the implementation of measures related to safeguard policies? Have costs related to safeguard policy measures been included Yes [ ] No [ ] NA [ ] in the project cost? Public Disclosure Copy Does the Monitoring and Evaluation system of the project Yes [ ] No [ ] NA [ ] include the monitoring of safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed Yes [ ] No [ ] NA [ ] with the borrower and the same been adequately reflected in the project legal documents? III. APPROVALS Task Team Leader: Name: Eva Jarawan Approved By Sector Manager: Name: Toomas Palu (SM) Date: 10-Jan-2014 Page 9 of 9