Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC4520 Date ISDS Prepared/Updated: 10/02/2009 I. BASIC INFORMATION A. Basic Project Data Country: Nepal Project ID: P117417 Project Name: Nepal Second Health and HIV/AIDS Project Task Team Leader: Albertus Voetberg Estimated Appraisal Date: Estimated Board Date: March 22, 2010 Managing Unit: SASHD Lending Instrument: Specific Investment Loan Sector: Health (100%) Theme: Population and reproductive health (25%);Child health (25%);Health system performance (20%);HIV/AIDS (15%);Other communicable diseases (15%) IBRD Amount (US$m.): 0.00 IDA Amount (US$m.): 85.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 15.00 Financing Gap 0.00 15.00 B. Project Objectives [from section 2 of PCN] The Development Objective for the proposed project is to assist the Government of Nepal in improving the equitable delivery of health care services, specifically by increasing access to essential health care services and their utilization by the underserved and the poor. C. Project Description [from section 3 of PCN] The proposed 4-year project will support MoHP#s annual work-plan and budget (AWB) in accordance with the Nepal Health Sector Program Implementation Plan (NHSP-IP), related to the provision of essential health services (component 1) and health systems strengthening (component 2). It will finance a percentage of the NHSP-IP development and recurrent expenditures incurred under component 1 and 2 (disbursement category 1). In addition, the project will, rather than providing targeted financing for specific priority areas, support the achievement of high priority results in the form of performance-based incentives (disbursement category 2). Page 2 Under component 1 the project will support i) the delivery of a specific package of cost- effective interventions which seek to improve reproductive, maternal and child health, ii) the control communicable diseases, and iii) the expansion in access to and use of the various programs contained in the package. Under component 2 the project will provide specific support to health system components preliminary identified as health care financing, human resources for health, monitoring and evaluation, and logistics management and procurement. The resources for the performance incentives would not up-front be allocated to specific interventions but serve as a bonus for programs/facilities/staff during the next FY if specific targets are met. In discussions between the MoHP and the pooled funding partners, priority results and targets would be identified and, if achieved, trigger such financial incentive to be included in the Annual Workplan and Budget for the following FY. Preliminary discussions have identified the areas of Reproductive Health, Nutrition, and HIV/AIDS to be of interest to formulate priority results and targets, and put a bonus on their achievement. The nature of the bonuses and the beneficiaries will be further elaborated during project preparation. The average annual contribution from IDA resources to the NHSP-IP will amount to approximately US$21 million. The program will also be supported by other development partners including DfID and AusAID, who will pool funds with the Government and IDA to support the program through a Sector Wide Approach (SWAp), and GDC/KfW has indicated interest in joining the pooled funding arrangement. The partners who pool their finances with the GON harmonize their support through a Joint Financing Arrangement (JFA). Technical Assistance will be provided, financed by DfID, in parallel to the pooled funding arrangement. The proposed lending instrument is a Specific Investment Loan (SIL); a budget support modality was considered for IDA support and was rejected. With regards to the implementation arrangements for HIV and nutrition, and especially the #non-health# aspect of these key areas, the project will seek to elaborate workable institutional frameworks with the government that are flexible, relevant and realistic in the current environment. D. Project location (if known) The project will be implemented nationwide. The civil works anticipated under the project will mainly involve small structures such as Primary Health Centers, Health Posts and Sub-Health Posts that do not have major environmental footprint. Perhaps the three most important issues include: (i) access to the health facilities for persons with special needs; (ii) environment, water and sanitation issues arising from the need for drinking water and toilet facilities; (iii) the disposal of medical waste at the health facility sites and (iv) earthquake resistant building codes given that Nepal is a seismically active country. E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] The Ministry of Health and Population has the capacity to ensure that the relevant safeguard policies be applied. F. Environmental and Social Safeguards Specialists Mr Chaohua Zhang (SASDI) Mr Ishwor Neupane (SASDT) Mr Drona Raj Ghimire (SASDI) Page 3 II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X An environmental assessment was carried out during the preparation of the current project and the practices of the Health Care Waste Management were reviewed.During the preparation of the proposed project the progress in these practices will be assessed, updated where appropriate, and appraised. 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 Ministry of Health and Population is implementing its #Vulnerable Community health Development Plan# (VCD) and during the preparation of the proposed project an assessment will be carried out on the implementation of this plan. As part of the Social Assessment the VCD will be updated or amended as appropriate and appraised. The need for additional safeguard measures will be established as well. 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: 12/11/2009 B. For simple 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. An environmental assessment was carried out during the preparation of the current health project and the practices of the Health Care Waste Management were reviewed. During the preparation of the proposed project the progress in these practices will be assessed. Similarly, the implementation of the Vulnerable Communities Development Plan will be assessed and adjustments made if and where needed. Both assessments will be done before Decmeber 2009. In addition, the project team plans to integrate social audit mechanisms and 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 4 grievance procedures into the project, including audits on, and grievance procedures for alleged discrimination and exclusion. IV. APPROVALS Signed and submitted by: Task Team Leader: Mr Albertus Voetberg 09/25/2009 Approved by: Regional Safeguards Coordinator: Mr Sanjay Srivastava 09/30/2009 Comments: Cleared. Sector Manager: Ms Julie McLaughlin 10/02/2009 Comments: Cleared.