Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC6004 Date ISDS Prepared/Updated: 02/14/2011 I. BASIC INFORMATION A. Basic Project Data Country: Vietnam Project ID: P122629 Project Name: North East and Red River Delta Regional Health System Support Project (NERRDHSSP) Task Team Leader: Bukhuti Shengelia Estimated Appraisal Date: August 30, 2011 Estimated Board Date: April 17, 2012 Managing Unit: EASHH Lending Instrument: Specific Investment Loan Sector: Health (70%);Compulsory health finance (13%);Public administration- Health (12%);Other social services (5%) Theme: Health system performance (90%);Other social development (5%);Other public sector governance (5%) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 180.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 18.00 18.00 B. Project Objectives [from section 2 of PCN] The project development objective is to improve the population#s access to essential health services in the provinces of North East and Red River Delta in accordance to the national health system development strategy. This development objective will be achieved through supporting district level health service capacities in the project provinces. In addition the project will support provinces in increasing population coverage with health insurance and strengthening their capacity for health workforce production C. Project Description [from section 3 of PCN] The proposed project is considered as Specific Investment Lending (SIL) operation in the amount of US$180 million IDA credit. The project will cover 18 provinces in the NERRD Region with the total population of 35.8 million people. The NERRD provinces are very diverse in terms of their economic development and health sector capacities. Even though the project is proposed as a SIL, the bulk of the project funds will be disbursed based on outputs. The outputs Page 2 will be related to some essential health services included in the primary health care package. Selection of the health services and related outputs will be done during the preparation phase. The project will consist of three components. Component One # Output based financing of essential health services (US$100 mln) This component will support through output based financing four types of activities: (a) essential health services, (b) refurbishment of the Community Health Stations (CHS), (c) enrolment of uninsured into the social health insurance scheme, and (d) training of health care professionals. Essential health services # From the list of the essential health services that constitute the primary care package in Vietnam some key health services will be selected for the project support. The exact list of services to be supported by the project will be agreed on during the preparation. For each of the health services one or several specific outputs will be identified. The outputs shall be highly relevant to the selected health services, easily measurable (countable) through the routine health information system, and estimation of the unit cost of the output shall be straightforward and feasible. Refurbishment of the community health stations #The project will consider refurbishment of the CHS as an output eligible for funding through the output based funding. This will include fixing the physical structure of the CHS and supplying lacking medical instruments/equipment and furniture. Enrolment of uninsured population in the social health insurance scheme # Increasing health insurance coverage is high priority goal for the government of Vietnam. The project will provide incentives to the Vietnam Social Security Administration (VSS) to identify and enroll the near- poor and the rest of the eligible population into the scheme. For the purposes of the project, each additional individual enrolled in health insurance will be considered as a project output eligible for financing. Training of health care professionals # The project will finance training of health care personnel based on outputs. Unit of the output will be #one health care professional trained through a short- term training# or #one level-1 specialist trained through two-year training#. The component will be implemented in the following manner: Each province will develop an annual plan where the amount of outputs and the required costs will be specified. The provinces will receive an advance payment (e.g. 40% of the estimated costs) from the Central Project Management Unit (CPMU). At the end of the year verification of outputs will be conducted by an independent verification agent (the exact TORs and institutional profile of such agent to be agreed on during the preparation). Payment of the remaining funds will be executed based on the actual outputs produced and verified. Provinces which demonstrate a higher implementation rate will be allowed a higher budget ceiling during the subsequent Page 3 planning cycles. Those provinces that demonstrate below 70% implementation rate will face a reduction of the budget ceiling amount for the next planning cycle. Component Two # Strengthening provincial level health services (US$65 mln) This component will be implemented through a traditional input based financing. The component will support district hospitals with basic medical equipment in the poorest districts of the region. Only those districts will be selected which have not received adequate funding from the so called #government bond program#. According to the preliminary estimates the total number of such district hospitals will be 60-80. The size of the medical equipment package per district hospital will be about US$200,000, which is in line with the district hospital medical equipment packages financed in the most recently approved project in the Central North region. The proposed project will also support the medical universities (total 5 universities in the NERRD region) and some medical colleges with the educational materials and teaching equipment. This activity will contribute to improving the quality of health care workforce and reducing the shortage of medical professionals in remote districts. This assumption is line with the recent analytical work conducted by the World Bank, which demonstrated that the medical graduates from the provincial level medical schools are more likely to seek employment at the district level facilities then those who receive training in Hanoi or HCMC. Component Three # Management capacity building (US$15 mln) This component will consist of activities aimed at building capacities at the MoH level and Provincial Departments of Health in planning, program budgeting, and monitoring and evaluation. The component will support training in management, health systems analysis, and program monitoring and evaluation. Under the component provinces and the CPMU will receive technical assistance aimed at improving their planning and program management capacities. The component will also support strengthening routine health information reporting systems, and incremental operating costs related to the supervision, coordination and day-to-day management of the project activities. The component will fund the central level Project Management Unit (CPMU), which will be adequately staffed to exercise supervision and monitoring and evaluation of the province level activities. The project will provide technical assistance to the MoH and the Provincial Departments of Health in developing 5-year health sector development plans and medium term expenditure frameworks. Vietnam has joined the multidonor supported global initiative called #Joint Assessment of National Health Strategies#. This initiative envisages provision of technical assistance to the country in order to develop high quality national health strategy. The Project will support expansion of this activity to the NERRD provinces. The bulk of the funds under this component will be devoted to monitoring and evaluation, particularly on the auditing and independent verification of the project outputs. The proposed project design requires very strong monitoring and auditing arrangements. This includes auditing of financial management as well as independent verification of the program outputs. Page 4 D. Project location (if known) Red River Delta: 1. Hanoi 2. Hai Phong 3. Vinh Phuc 4. Bac Ninh 5. Hai Duong 6. Hung Yen 7. Ha Nam 8. Nam Dinh 9. Thai Binh 10. Ninh Binh North East 1. Lao Cai (3 district: Si Ma Cai, Muong Khuong, Bac Ha) 2. Lang Son 3. Tuyen Quang 4. Yen Bai (2 districts: Mu Cang Chai, Tram Tau) 5. Thai Nguyen 6. Phu Tho (1 district: Tan Son) 7. Bac Giang (1 district: Son Dong) 8. Quang Ninh * Note: districts in bracket are among the 61 most disadvantaged districts. The list was excluded 3 districts that are under other Bank's support project E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] Borrower may need local technical assistance in defining safeguards issues and policies. F. Environmental and Social Safeguards Specialists Mr Douglas J. Graham (EASVS) Ms Pilar Larreamendy (EASVS) II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X A range of environmental impacts can be expected during the implementation of this project. As most of the financed investments will be output-based and their location and details will not be known by Appraisal, during preparation an Environmental and Social Management Framework (ESMF) will be prepared. The following sections detail the kinds of expected impacts and how they will be addressed in the ESMF. The various investments of the project are intended to increase the utilization of health services and thus it can be expected there will be an increase in volumes of medical waste at targeted facilities. In order to mitigate potential environmental impacts, all participating hospitals will commit as a criterion of eligiblity to follow agreed guidelines on healthcare waste management, incl uding the development of hospital waste management plans. The plans would Page 5 Safeguard Policies Triggered Yes No TBD have to address issues related to collection and disposal of healthcare wastes. Based on current Vietnamese regulations and World Bank requirements, the guidelines will be defined during project preparation and included in the ESMF. A major parallel project of the World Bank in Vietnam on management of health care wastes has created a wealth of expertise and a range of guidelines for different kinds of waste and institutions that will be drawn on. The project will support rehabilitation of health care facilities which could generate a range of minor impacts during construction. To address typical impacts of such minor investments, the ESMF will include Environmental Codes of Practice (ECOPs), Screening for impacts on physical cultural resources (PCR) and Guidelines for assessment and mitigation of site specific impacts. Natural Habitats (OP/BP 4.04) X The project will support investments in health care institutions that are located in urban areas or in densely populated rural areas that will have been completely converted from original natural habitats. No impacts on natural habitats will result from project investments. Forests (OP/BP 4.36) X The project will not support any investments in forestry and will have no impacts whatsoever on forested areas and therefore this policy is not triggered. Pest Management (OP 4.09) X The project will not procure any pesticides nor support any activities that would result in increased uses of pesticides or herbicides so this policy is not triggered. Physical Cultural Resources (OP/BP 4.11) X Because of the small scale of the investments and the focus on rehabilitation rather than construction, it is unlikely that any investments under the project will result in impacts on physical cultural resources. However, this will be looked at further during preparation to determine if the policy should be triggered. In any event, the ESMF will include a Chance Finds Procedure to ensure that any potential impact on PCR will be fully and adequately addressed during construction. Indigenous Peoples (OP/BP 4.10) X Unlike Northern Upland and Central Highland provinces, ethnic minorities in NERRD provinces constitute a small share of the population and they are for the most part culturally assimilated with the main ethnic Kinh group. However, the project area will likely include some populations of ethnic minorities that would constitute indigenous peoples as defined by the Bank OP 4.10. During project preparation the Social Safeguards Specialist will conduct screening to determine the presence of ethnic minorities in the project provinces. The screening will determine whether social assessment needs to be undertaken. Involuntary Resettlement (OP/BP 4.12) X The project does not plan any new construction and therefore OP4.12 is unlikely to be triggered. However if during the preparation it is decided that some new constructions could be financed, screening will be conducted to determine whether OP 4.12 is triggered or not. As part of the screening the following information will be collected: - Whether the sub - projects require any new land, and whether the land will be acquired by Page 6 Safeguard Policies Triggered Yes No TBD open market purchase or through exercise of eminent domain; - The availability of land on the market ; and - Whether the land to be required is occupied by any users including squatters. If screening determines that OP4.12 is triggered, a Resettlement Plan Framework (RPF) will be prepared and Resettlement Action Plans (RAPs) for any investments whose details are known by Appraisal. Safety of Dams (OP/BP 4.37) X The project does not involve dams in any way and thus this policy is not triggered. Projects on International Waterways (OP/BP 7.50) X The project does not involve emissions into any international waterway nor affect in any way an international waterway so this policy is not triggered. Projects in Disputed Areas (OP/BP 7.60) X No investment under the project will take place in any disputed area so the project does not trigger this policy. 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: 07/20/2011 B. For projects that will not require a QER, the target date for preparing the PAD-stage ISDS: N/A 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. N/A IV. APPROVALS Signed and submitted by: Task Team Leader: Mr Bukhuti Shengelia 02/03/2011 Approved by: Regional Safeguards Coordinator: Mr Panneer Selvam Lakshminarayanan 02/14/2011 Comments: Sector Manager: Mr Juan Pablo Uribe 02/14/2011 Comments: I appreciate the specialized support received from the Country office in this process. 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 7