Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 03/18/2008 Report No.: AC3441 1. Basic Project Data Country: Burundi Project ID: P109964 Project Name: Burundi Second Multisectoral HIV/AIDS Project Task Team Leader: Montserrat Meiro-Lorenzo Estimated Appraisal Date: February 18, 2008 Estimated Board Date: May 13, 2008 Managing Unit: AFTH3 Lending Instrument: Specific Investment Loan Sector: Other social services (65%);Health (25%);General information and communications sector (10%) Theme: HIV/AIDS (P) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 15.00 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 [X] Is this project processed under OP 8.50 (Emergency Recovery) or OP 8.00 (Rapid Response to Crises and Emergencies) Yes [ ] No [ ] 2. Project Objectives The Project objective is to increase the coverage and or utilization of a selected set of preventive and treatment services, among groups highly vulnerable to or affected by HIV/AIDS. The National strategy includes specific indicators for each of these objectives. 3. Project Description Since the financing gap for the National Plan is substantial, both the Government and IDA have selected a limited set of activities for IDA financing. The Grant would be a Specific Investment Loan supporting activities from the National HIV/AIDS Plan (2007- 2011) selected on the bases of appropriateness for Burundi’s epidemic as per ongoing survey results, proven cost-effectiveness, and complementarity to activities financed by other donors, mainly the Global Fund. By focusing on capacity building, development and improvement of processes and systems, and prevention activities for high risk groups, IDA funds would enable the Borrower to use the GF funds more efficiency. The Grant will have a unified category only so that reallocation can be easily done in case potential financing for some critical activity fails to materialize. The team considered a Page 2 programmatic loan and budget support but the weakness of Burundi’s financial management capacity,as experienced in the management of HIPC funds, suggest that a SIL would be more appropriate in current conditions. Project components will follow the four axes of the National Program. Specifically, IDA funds will finance the following selected activities under the following four components: Component 1: Preventive Services Targeted to High Risk Groups (IDA financing: US$8 million). Interventions supported by this component fall under the first axis (or operational Program) of NHAS 2007-2011, and aim at reducing HIV transmission among high risk groups through behavior change and increased access to preventative services, particularly PMTCT services, to the whole territory. Component 2: Performance-Based Preventive Services Targeted to High Risk Groups (IDA financing: US$4 million). This component will support the geographic extension of ARV treatment and opportunistic infection prophylaxis and treatment to HIV+ people in the whole country. To achieve this objective, IDA resources will finance technical assistance to improve existing performance-based service contracts/agreements between the MOH and public and private health facilities to provide clinical care for HIV/AIDS patients. Currently such contact / agreements are between the SEP/CNLS and the service providers. Finally, resources under this component will also help further develop community-based home care services in a limited set of communities. Component 3: Decentralized Financing of Small Grants to Families living with HIV/AIDS and High Risk Groups (IDA financing: US$ 4 million).This component aims at providing limited economic and legal support to the most vulnerable families affected by HIV/AIDS. IDA grant resources will use the mechanisms set-up under the first MAP to finance sub-projects managed by NGOs, developmental commune councils and community-groups, that provide small grants to vulnerable families, and families living with HIV/AIDS to increase treatment compliance; and increase their capacity to nourish themselves in order to improve the impact of drugs. Component 4: Capacity Building for Local Authorities and Key Ministries to Implement HIV/AIDS Activities, and National Program Management (IDA financing: US$ 3 million). The objectives of this component are to build capacity to implement and monitor HIV/AIDS activities in key ministries and local governments, contribute to ensure adequate operation of the SEP/CNLS; Increase the SEP/CNLS capacity to manage the M&E system, in particular carry-out impact assessment of interventions; and implement the National Waste Management plan. The proposed Grant would permit consolidation of recent gains on the ground and allow for the scaling-up of the local integrated response to HIV/AIDS and other well- performing HIV prevention activities. It would also allow the strengthening of the quality of current interventions and the strengthening of key public agencies, in particular the MOH. The support to the MOH would follow the National health strategy, ensuring a coordinated and harmonized approach to health services. The Project will assess whether Page 3 indigenous groups are particularly affected by HIV/AIDS and will ensure that they have adequate access to culturally appropriated services. The implementation arrangements under the additional financing would be virtually the same as for the ongoing project, as they are working well. The only difference will be the creation of a dedicated MOH sub-account. This sub-account would be managed by the general directorate of resources of the MOH. This directorate direction will hire an accountant, an assistant accountant and a procurement specialist to manage those resources in accordance with IDA procedures. Annual disbursements to that account will be agreed upon at the latest in the month of October of the previous year, after approval by the SEP/CNLS and IDA of an annual work plan and performance indicators. In terms of decentralization of local personnel to provincial level, the Project would follow the current practice of provincial accounts to be justified regularly. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The Project will cover the whole country. However, in a concentrated epidemic, targeted interventions in high-risk areas and high-risk groups in Burundi are the most effective way. 5. Environmental and Social Safeguards Specialists Ms Edeltraut Gilgan-Hunt (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: The only Policy triggered under the first Project was related to medical waste management. Progress on medical waste management realized under the first Project was limited by civil conflict and low country capacity. The waste management assessment and action plan carried out under the previous operation has been updated to reflect the changing country situation. The results of the updated assessment and the plan to mitigate potential negative effects have been approved by ASPEN and will be made public prior Page 4 to appraisal. There is a very low probability that the operation includes some minor rehabilitation of existing facilities, which will in no case involve land acquisition and not involuntary resettlement.No rehabilitation is planed for the first year of the Project. If any rehabilitation was included in the plans after the first 12 months, civil works contracts will include, as it has been done in other Projects, clauses for the adequate provision of waste materials, use of non-toxic construction materials and respect for cultural property. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: The results of the updated assessment and the plan to mitigate potential negative effects have been approved by ASPEN was made public in February 8, 2008. There is a very low probability that the operation includes some minor rehabilitation of existing facilities, which will in no case involve land acquisition and not involuntary resettlement. No rehabilitation is planed for the first year of the Project. If any rehabilitation was included in the plans after the first 12 months, civil works contracts will include, as it has been done in other Projects, clauses for the adequate provision of waste materials, use of non- toxic construction materials and respect for cultural property. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. The study assessed current medical waste management practices in Burundi and made general recommendations for improvements. It noted that health care professionals have a very limited understanding of the dangers of medical waste, and the public information campaigns via radio and other channels do not highlight the risks of poor medical waste management. The most serious risk is the potential spread of HIV/AIDS due to improperly handled and disposed medical waste (blood, urine, syringes, sharps, bandages, laboratory waste etc.). The main recommendations centered on the importance of training health center personnel in safe medical waste management and to ensure its safe disposal. The appraisal mission discussed the recommendations of the above study with representatives of the SEP/CNLS; USLS/Sante; Departement de la Promotion de la Sante; and the Ministry of Environment. It was determined that the proposed project would fund the following activities under component 4 (total cost estimate: $105,500). (a) Update of the norms and standards for health centers providing HIV/AIDS services to include safe medical waste management practices (consultant); (b) Identification, quantification and description of materials needed for safe medical waste management in the health centers (consultant); (c) Preparation of a training module on safe medical waste management (consultant); (d) Multiplication and dissemination of the training module to about 500 health centers; (e) Training of health center personnel; and Page 5 (f) Acquisition of protective gear and equipment for health care personnel for safe medical waste management. The SEP/CNLS will be responsible for implementing the above measures. 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 Project Document recognizes that progress on environmental issues realized under the first Project was limited. An action plan for adequate disposal of biologically hazardous materials has been updated. No land will be acquired. The Project is not expected to affect Indigenous People. In an effort to mitigate potential adverse environmental and social impacts effectively, the project has prepared a study: “Etude sur la mise en place de plansde Gestion des Dechets Biomedicaux”, November 2007. This study has been disclosed in Burundi on February 6, 2008, and at the Bank’s Infoshop on February 8, 2008. The study was prepared in consultation with health care personnel, hygiene and sanitation personnel, representatives of the Institut National pour l’Environnement et la Conservation de la Nature (INECN), Bureau Burundais de Normalisation et de Contrôle de Qualité (BBN), Ministry of Public Health, provincial sanitationfacilitities, and environmental health specialists, and involved site visits to several representative health care facilities. Their views have been reflected in the study. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The Project will cover the whole country. However, in a concentrated epidemic, targeted interventions in high-risk areas and high-risk groups in Burundi are the most effective way. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 02/06/2008 Date of "in-country" disclosure 01/14/2008 Date of submission to InfoShop 02/08/2008 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 Page 6 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 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 Page 7 D. Approvals Signed and submitted by: Name Date Task Team Leader: Ms Montserrat Meiro-Lorenzo 02/14/2008 Environmental Specialist: Ms Edeltraut Gilgan-Hunt 02/28/2008 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Mr Serigne Omar Fye Approved by: Sector Manager: Mr John A. Elder 03/18/2008 Comments: