Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 04/23/2009 Report No.: AC4360 1. Basic Project Data Country: Mali Project ID: P115491 Project Name: ML-HIV/AIDS MAP Additional Financing Task Team Leader: Amadou Dem Estimated Appraisal Date: April 21, 2009 Estimated Board Date: May 19, 2009 Managing Unit: AFTFP Lending Instrument: Specific Investment Loan Sector: Health (35%);Central government administration (35%);Other social services (30%) Theme: HIV/AIDS (P);Other communicable diseases (S);Population and reproductive health (S) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 6.00 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 [] 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 new project objective is to contribute to the recipient’s national effort to control the spread of HIV/AIDS epidemic by improving access to prevention, treatment and care particularly for most-at-risk-population (MARP) and those infected with or affected by HIV/AIDS . This objective will be achieved by: (a) strengthening the Recipient’s national response to the HIV/AIDS epidemic by improving its evidence base, coordination, implementation, and M&E capacity; (b) raising the level of awareness on HIV/AIDS through the implementation of a comprehensive sensitization plan targeting MARP in particular; (c) providing access to testing and counseling facilities; and (d) providing access to treatment, care and psychosocial support to persons infected with or affected by HIV/AIDS. 3. Project Description Component 1: “Support to public sector response”. ARVs drugs are now more available in Mali with support from the Global Fund but the capacity of health facilities especially outside Bamako and main cities is still insufficient to effectively deliver the drugs to the patients. Support under the Additional Financing is expected to be limited and focus Page 2 mainly on a new activity which consists in the provision of critical equipment and training to a selected and small number of public health facilities to become HIV/AIDS treatment facilities in targeted regions with poor access to ARVs and health services such as Mopti and Kayes. Support will be provided where critically needed and in line with the Government’s health development program (PRODESS) supported by the Bank. This is expected to contribute to increasing the number of patients under ARVs. In the past, the MAP mainly focused on supporting the preparation of action plans of several ministries and providing support for sensitization of Ministries’ staff. The additional financing will identify key line ministries that would have substantial impact on the MARP and will strengthen these ministries capacity such as ministries of education, agriculture, mining, and communication . Resources will also be provide to increase the number of reference centers (CSREF) and community health facilities (CSCOM) which have means to dispose of medical waste. Component 2: “Support to the response of the private sector”. The private sector is now playing a greater role in the multisectoral fight against HIV/AIDS in order to complement public sector’s effort. Its resources and capacity are being leveraged to combat the epidemic. Continued support to this component is needed to consolidate the achievements such as better sensitization of workers and better quality of HIV related health services, and position the private sector as a key partner. The Additional Financing will focus on the following main activities. The Additional financing will continue to support on a declining basis part of the operating costs of the newly established business coalition which is still in its incubation phase. This will enable the coalition to work more effectively with employers’ associations to mobilize a greater number of members/firms, improve its resources base through more membership fees, and with the goal of becoming self-financing. At this stage, member fees do not fully cover the operating costs and do not allow an effective implementation of the Coalition’s action plan which focuses on sensitizing firms’ workers and scaling up isolated successfulinterventions to comprehensive national programs. The coalition’s capacity willalso be strengthened with the recruitment of local consultants when needed to assist in the preparation of comprehensive toolkits to guide the development of customized Mali HIV/AIDS workplace programs, and to assist firms in the preparation of their action plan. Support will also be provided on a declining basis to the successful public private partnership (PPP) arrangement under which a private laboratory has provided quality Page 3 services to monitor the health condition and treatment needs of more than 7000 patients, which allowed them to access ARVs. This PPP is considered by the Government as a way to complement the capacity of the public laboratories, which is improving but remains weak. Before project closing, the Government will prepare a sustainability plan on how to continue to provide the services either through the public sector or through the same PPP arrangement. Technical assistance will be provided to evaluate the PPP arrangement to guide the Government and other development partners in the development of the sustainability plan. Also, Additional funds will be provided, on a declining basis, to strengthen the mechanisms established under the project to enhance access to ARVs for both adults and children through the private sector (import and distribution). Technical assistance will also be provided to evaluate the mechanism and guide the Government in its strategic decision to continue its partnership with the private sector. Finally, the Additional financing will continue to provide basic equipment and training to a small number of major companies with health centers to enable them to provide VCT services to their employees, their employees’ families and the community. The companies will be selected based on a set of criteria including concentration of MARP in the community, geographical location, existence of other donors’ intervention, and poor access to VCT services in the community. Under MAP, such support has been provided to a major textile company in Segou. A special focus will be on two major sectors of the Malian economy, the mining and cotton sectors. Component 3: “Support to the Response of the Civil Society”. Given that Mali isa low prevalence country, the additional financing will focus more on prevention targeting high risk groups and the main drivers of the epidemic. The Additional Financing will provide more support for sensitization and VCT services to the MARP. A particular focus will be on female sex workers, a group which recorded an increase in prevalence rate from 29 to 35 percent between 2001 and 2006. Based on lessons learned under MAP which highlighted that proposals of sub-projects submitted by Civil Society Organizations (CSOs) for financing do not always respond to the priority needs in terms of geographical coverage and targets, the ES/HNAC will be more proactive by preparing terms of reference which clearly target the MARP and cities where sub-projects should be implemented. The terms of reference will be guided by a mapping of other donors’ interventions and the concentration of MARP. Contracts with clear performance indicators will be signed with a core group of experienced CSO to implement result- oriented sub-projects. Support will also be provided to combat stigmatization of people living with HIV/AIDS (PLWHA) by strengthening their associations. Technical assistance will be provided to Page 4 review the relevant legal framework against stigmatization in the workplace, the community and the national levels, with a special focus on both PLWHA and MARP (essentially an audit of relevant laws and policies), disseminating the findings; and implementing an active communication campaign against stigmatization. This is expected to encourage individuals to access to testing, treatment and care, which are important to effectively fight the epidemic. Component 4: “Project Coordination, Monitoring and Evaluation”. The Executive Secretariat of the High National Council on HIV/AIDS (ES/HNAC) in Bamako, created under the project, is effectively leading the fight against HIV/AIDS and the dialogue with all the development partners. The Government recently created regional Executive Secretariats in all the regions to decentralize and better coordinate the fight. The ES/HNAC was assisted by a Financial Management Agency (FMA) which was recruited under the original MAP to manage all the financial aspects of the project. Its responsibility will be reduced to the preparation of the quarterly financial reports of the ES/HNAC given the reduction in the number of sub-projects to be financed under the additional financing. It is expected to assist the ES/HNAC until project closing. The responsibility of the Contract Management Agency (CMA), which was also recruited under the MAP to assist the ES/HNAC in the evaluation and monitoring of all sub- projects, will be phased out given the reduction in the number of sub-projects. The CMA is currently strengthening the capacity of the ES/HNAC to enable it to continue to manage the sub-projects after the end of the CMA’s contract, which is expected no later than July 31, 2010. The Additional Financing will continue to partly support the Executive Secretariat in Bamako to enable it to: (i) continue to coordinate the country’s multi-sectoral effort to combat HIV/AIDS; (ii) promote the mainstreaming of the fight against HIV/AIDS in government programs; (iii) guide and coordinate the activities of the new and still weak regional secretariats; (iv) develop the country capacity to assess and understand the drivers of the epidemic by strengthening its monitoring & evaluation system focusing on the enhancement of the mechanism to collect short term data and conducting selected priority studies required to evaluate the project; and (v) strengthen its financial programming capacity in order to better plan for the medium term, identify gaps and guide the Government in its resources allocation to support the mainstreaming agenda. 42. The Additional Financing will also assess the impact and effectiveness of the governance arrangements, particularly with respect to social accountability.This would help in the efforts to mainstream the activities in Government programs and ensure Page 5 sustainability. Before the end of the project, the Government will prepare and start to implement a strategic plan to sustain the Executive Secretariat and the national program after project closing. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will intervene nationwide, as with the parent project. 5. Environmental and Social Safeguards Specialists Mr Amadou Konare (AFTEN) 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: Health related activities produce a considerable amount of waste on daily basis as a result of preventive and curative service delivery. The composition of waste produced is in the form of sharps (needles, syringes), non- sharps, blood and other body fluids being infected and non-infected, chemicals, pharmaceuticals and medical devises. Health workers, waste handlers, users of health facilities and the community are all exposed to health care related waste as a result of poor management. A good health care waste management plan could result in healthier communities thereby reducing the cost of health care, as well as creating opportunities for recycling. The results of the review of the existing Medical Waste Management Plan (MWMP), prepared under the parent project indicate that the project is in good standing with regards to safeguard requirements. This plan has been re-disclosed, prior to appraisal of the additional financing and its guidelines will be followed during implementation. There will be no new construction or land acquisition which would trigger social policy. Building on the comprehensive set of data on sensitization, VCT, treatment and care services provided by the MAP, the additional financing will provide resource to conduct Page 6 a detailed evaluation of the impact of these services on the targeted communities. This will feed into the implementation completion report 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: The project is expected to deliver significant social benefits by improving the health conditions of people living with HIV/AIDS. No long-term environmental and social impacts are anticipated. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. 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. Mali has reasonable capacity to implement the Medical Waste Management Plan (MWMP) as demonstrated during the period of this project implementation. This has been confirmed by the findings of a recent review of the implementation of the existing MWMP by the Executive Secretariat of the High National Council against HIV/AIDS. Supervision conducted in the regions highlighted that considerable progress has been made since the beginning of the MAP. A total of 60 health centers have been supported by the project to enable them to dispose of medical waste. The additional financing will continue to provide support to more health centers by providing basic equipment and training to selected health centers to enable them to dispose of medical waste adequately. The Bank will remain engage with active implementation support of safeguards-related issues. Also, there is provision under this Additional Financing to further strengthen the capacity of the various actors involved in mitigation of related environmental risks and to fine-tune the institutional arrangements for better implementation of the project by continuing to support sensitization and awareness raising campaigns on environmental issues. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The key stakeholders involved in the preparation and implementation of the MWMP are: (i) the Ministry of Health; (ii) the Ministry of Environment; (iii) The ES/HNAC; (iv) the Regional Health Departments; (v) the Hospitals; (vi) the Health reference centers (CSREF); (vii) the Community Health Center (CSCOM); the National Public Health Research Institute (INRSP). All the these stakeholders are consulted during the preparation of the National Community Development programme which also covers safeguard policies issues. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Page 7 Date of receipt by the Bank 04/15/2009 Date of "in-country" disclosure 04/20/2009 Date of submission to InfoShop 04/16/2009 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 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 Yes Page 8 policies? 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: Mr Amadou Dem 04/20/2009 Environmental Specialist: Mr Amadou Konare 04/20/2009 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Approved by: Sector Manager: Mr Iradj A. Alikhani 04/20/2009 Comments: