Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC2417 Date ISDS Prepared/Updated: 11/29/2006 I. BASIC INFORMATION A. Basic Project Data Country: Cameroon Project ID: P100656 Project Name: Cameroon - Multisectoral Contribution to HIV-AIDS National Program Task Team Leader: Francois Honore Mkouonga Estimated Appraisal Date: February 20, 2007 Estimated Board Date: September 25, 2007 Managing Unit: AFTS3 Lending Instrument: Specific Investment Loan Sector: Health (50%);Other social services (50%) Theme: HIV/AIDS (P) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 40.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 2.00 2.00 B. Project Objectives [from section 2 of PCN] The objectives and outcomes of the National Program are clearly articulated and have been quantified in the National Strategic Plan as follows: (i) reduce the number of new infections by encouraging and assisting 3 million people to get tested and to manage their status; (ii) achieve universal access to treatment and care for PLWAs including children by helping 300,000 PLWHA to access care and treatment and to benefit from psychosocial and economic support, mainly through associations of PLWHA; and (iii) reduce the impact of HIV/AIDS on 100,000 orphans and vulnerable children by assisting communities in identifying the most dramatic situations and accompanying them to access care and support. The overall goal of the proposed operation would be to assist the GOC in implementing the National HIV/AIDS Strategic Plan. The Project Development Objectives are: (i) preventing the spread of HIV/AIDS in the general population and reducing transmission among the high-risk groups by supporting community-based responses; (ii) increasing access to treatment, care and impact mitigation services using VCT and social mobilization activities financed with dedicated funds to identify seropositive cases of adults and children, coordinating their referral to existing health centers for effective treatment and follow up, and increasing support to PLWHA and to Page 2 orphans and vulnerable children; (iii) supporting the response to HIV/AIDS by the Ministry of Health (MOH) including preparation and implementation of a biomedical waste management plan and by selected non-health sector line ministries; and (iv) increasing coordination of the NAHSP, to ensure transparent procurement procedures, fiduciary management of IDA funds and effective programmatic monitoring and evaluation of the NHASP. C. Project Description [from section 3 of PCN] The proposed project would have four components to achieve the project development objectives presented above. Component 1: Demand-driven Grants for Subprojects to Communities. This component would finance social mobilization activities at the community level, using local response subprojects in support of the National Program?s three-pronged balanced strategy of prevention, access to treatment, and support and care for PLWHAs and OVC. About US$18 million would be allocated for local grants at the commune level and would be awarded on a competitive basis to initiatives contributing to the indicators of the national program. Implementation modalities and relations with Health District Committees (COSA) will be defined during project preparation. The implementation manual would direct resources with an emphasis on girls, boys, women and specific high risk groups, identified by recent DHS and seroprevalence studies. Results of these studies were disaggregated by commune level and are available in all 365 communes. The Implementation Manual would strengthen the use of participatory M&E tools such as report cards that are already used in 6,000 communities. Component 2: Coordinating the Local Response with the Health Sector. This component would also be executed at the local commune level and would support coordination by regional and local authorities, including streamlining Local Response activities with health services such as the referral of seropositive cases of adults and children for effective treatment and follow up, at an indicative cost of US$2 million. Specific activities with the health sector are detailed in the next component. Component 3: Scaling up the National Response. This component would enhance the capacity of the Ministry of Health to provide technical guidance on the national response to HIV/AIDS and would strengthen HIV/AIDS related services for prevention, treatment, and care delivered through the health care system. The content of this component will be defined during project preparation. As much as possible, this component would not duplicate activities funded in the health Sector program (SWAp) and would focus on supplies to facilitate universal access to health services in relation with HIV-AIDS. This could include for example subsidizing access to tests and treatment in a coherent framework defined by the National Program. This could also include specific equipment in relation with HIV-AIDS and implementation of the requisite measures for safe medical waste management in relation with HIV-AIDS. There are no plans to either build new health care facilities or to rehabilitate existing ones. This component would also support the response to HIV/AIDS by selected non-health sector line ministries. There are basic cross-cutting HIV/AIDS activities which all participating ministries are expected to implement under their respective sectoral HIV/AIDS programs. These include: development and implementation of workplace HIV/AIDS policies; IEC/BCC for HIV/AIDS and STDs; condom distribution and promotion; advocacy to reduce HIV/AIDS Page 3 stigmatization and discrimination, particularly in the work place; and establishment of a support group for HIV/AIDS patients and their families (either as a single ministry or in collaboration with other ministries). A maximum of five key non-health line ministries would be selected during project preparation, such as for example, those responsible for education, transportation, armed forces, police, and prison inmates. Some HIV/AIDS related interventions are specific to a particular ministry and each ministry will identify its own HIV/AIDS program needs to be supported by this component. For example, populations potentially at risk within the sphere of influence of the Ministry territorial administration are prisoners, delinquent youth, juvenile delinquents and police officers. For the Ministry of Education it will be school age children, unattached youth, and out of school youth. Truck drivers are a high risk group for the Ministry of Transportation. Ministries will appoint their respective HIV/AIDS focal points (person or unit) to coordinate the ministry?s HIV/AIDS planning, implementation, monitoring and evaluation. The indicative cost of this component would be US$11 million allocated as follows: US$6 million for the Ministry of Health, US$4 million for four non-health line ministries, and an additional US$1 million to the MOH dedicated to safe biomedical waste disposal. Component 4: Strengthening Institutional Capacity for Program Management, Monitoring and Evaluation. Under this component the proposed project would allocate US$2 million for ensuring transparent financial management and procurement procedures of IDA funds, and US$2 million to support the unified M&E system and to help finance the next DHS. US$3 million would remain unallocated. D. Project location (if known) Like the former operation, the project will address equally rural, peri-urban and urban areas. E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] CNLS is well supported by UNAIDS and other partners. CNLS has successfully mobilized and managed GFATM grant and HIPC funds. It has performed well in preparing the national strategic plan and the national program setting priorities and indicative costs. The proposed project would be a small part of the national program. CNLS is using the last resources under MAP 1 to build capacities in all communes and all COSAs to prepare them to play a more active role in allocating small grants on a competitive basis to CSOs and CBOs. Ministry of Health (MoH) has a biomedical waste management unit, which started to implement some biomedical waste management activities under the MAP 1 operation. The MAP 1 operation was labeled under category C in 2002 and the DCA did not allocate resources for implementing the medical wase management plan. The next operation will prpare a formal medical waste manangement plan. CNLS will assist MOH to prepare this plan, will disclose it prior to appraisal and will set aside resources to implement it. The medical waste manangement unit in MoH is benefiting from technical assistance from bilateral cooperation with France and from WHO. It has the capacities to prepare and implement a medical waste management plan related with HIV-AIDS activities. Page 4 CNLS has capacities to implement activities in Pygmies areas. During the first operation, it set up a team who worked with NGOs established in Pygmies areas. Implementation of this component woul be part of component 1, using specific social mobilization tools in municipalities with Pygmies population. F. Environmental and Social Safeguards Specialists Ms Yvette Laure Djachechi (AFTS3) Ms Edeltraut Gilgan-Hunt (AFTS2) II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X This OP is triggered due to the generation of medical waste at the health care facilities. 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 The project does not plan to implement specific program for the Indigenous people/pygmies. It plans to adapt its approaches on sensitization, social mobilization and support to access, care and treatment to the Indigenous People. In all municipalities with pygmies population, the project will use specific tools to inform and involve the pygmies. At the project preparation stage, CNLS will prepare this specific approach and tools to involve the pygmies and will test them during the last months of the MAP 1 operation. CNLS will submit this plan to adapt project implementation to the Indigenous people. The Bank task team will review it with safeguards specialists and will evaluate this plan as part of the evaluation mission. Once approved, these specific tools would be formally part of the operational manual. 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 Environmental Category: B - Partial Assessment III. SAFEGUARD PREPARATION PLAN A. Target date for the Quality Enhancement Review (QER), at which time the PAD-stage ISDS would be prepared: 01/31/2007 B. For simple projects that will not require a QER, the target date for preparing the PAD-stage ISDS: N/A Page 5 C. Time frame for launching and completing the safeguard-related studies that may be needed. The specific studies and their timing 1 should be specified in the PAD-stage ISDS. The specific studies and their timing should be specified in the PAD-stage ISDS. The National AIDS committee preparing the project plans to submit a draft plan to involve indigenous people (IP participation plan)and a biomedical waste management plan before January 31, 2007. Both plans will be disclosed in Cameroon and at the Bank's Infoshop prior to appraisal. IV. APPROVALS Signed and submitted by: Task Team Leader: Mr Francois Honore Mkouonga 11/27/2006 Approved by: Regional Safeguards Coordinator: Mr Warren Waters 11/27/2006 Comments: Sector Manager: Mr Francois G. Le Gall 11/27/2006 Comments: 1 Reminder: The Bank's Disclosure Policy requires that safeguard-related documents be disclosed before appraisal (i) at the InfoShop and (ii) in-country, at publicly accessible locations and in a form and language that are accessible to potentially affected persons. Page 6