Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 03/01/2010 Report No.: AC4983 1. Basic Project Data Country: Nepal Project ID: P117417 Project Name: Second HNP and HIV/AIDS Project Task Team Leader: Albertus Voetberg Estimated Appraisal Date: January 11, 2010 Estimated Board Date: April 20, 2010 Managing Unit: SASHN Lending Instrument: Sector Investment and Maintenance 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.): 115.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: BORROWER/RECIPIENT 489.80 AUSTRALIA: Australian Agency for International Development30.00 UK: British Department for International Development (DFID) 80.00 Bilateral Agencies (unidentified) 812.53 1,412.33 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 Development Objective of 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. 3. Project Description The project, which supports the government's five year (2010/11-2014/15) sector program (NHSP 2), comprises two components: (i) Service Delivery and (ii) Health Systems Strengthening. The Service Delivery component will support: (i) increasing access to, and utilization of, an affordable package of essential health services by the underserved and poor in line with MOHP' s Gender and Social Inclusion strategy; (ii) improving the nutritional status of children and pregnant women; (iii) expanding coverage and improving the effectiveness in the response to HIV and AIDS; and (iv) Page 2 further reducing the mortality and morbidity associated with pregnancy and child birth. The Health Systems Strengthening Component will support: (i) improving the availability of human resources for health, especially in under-served areas; (ii) improving the sustainability of financing the sector and towards providing protection against impoverishment due to ill-health; (iii) strengthening and expanding the scope of monitoring and evaluation; and (iv) improving governance and accountability in the health sector. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will be implemented nation-wide. It will support small-scale construction activities, including upgrading of some existing health facilities and services. 5. Environmental and Social Safeguards Specialists Mr Chaohua Zhang (SASDS) Mr Drona Raj Ghimire (SASDI) 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 project triggers Environmental Assessment (OP/BP 4.01), Indigenous Peoples (OP/BP 4.10) and Involuntary Resettlement (OP/BP 4.12). Environmental issues relate to (i) infrastructure development, and (ii) health care/medical waste generated at health facilities. Social safeguard issues involve ensuring equitable and inclusive access to quality health services for all segments of the population in Nepal. The involuntary resettlement policy is triggered due to possible infrastructure activities that may have land acquisition implications. The project is Environmental Category B. Infrastructure Development: The project may support small-scale construction activities including upgrading of some of the existing health facilities and services. Minor and Page 3 localized impacts may arise from construction/upgrading of small buildings and wastes generated during construction and operation. Infrastructure development is expected to be mostly located on government land and within existing health premises. Health Care Waste: Management of health care/medical waste generated at health facilities is an existing problem rather than one to be introduced by the project. As the health services expand with support from the project, additional healthcare waste may be generated. Improper management of healthcare waste can pose risks to both people and the environment. The environmental issues range from increasing the risk of spreading infections to increasing exposure to toxic wastes. A plan for dealing with health care waste management during NHSP 2 has been developed, including an agreed upon set of monitoring indicators for health care waste management. Land Acquisition and Resettlement: A framework has been prepared to provide guidance on possible land acquisition and resettlement through eminent domain in the event that they cannot be avoided. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: No adverse indirect and/or long term impacts due to anticipated future activities in the project areas 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. In order to manage environmental impacts, the Government has prepared an Environmental Management Framework (EMF) for Physical Infrastructure Works which defines procedures/guidelines/criteria for use during development of physical infrastructure under the program. To ensure proper management of medical waste, the Government has also prepared an Environmental Health Impact Assessment Plan (EHIA- Plan) and is revising/updating the Healthcare Waste Management Strategy and Action Plan of the previous program, NHSP 1. At present, capacity at all levels in dealing with health care waste management is limited. The EMF includes recommendations for appropriate capacity building measures in terms of institutional set up and human resources. These include full-time designated staff at center, enhancing environmental and health care waste management competency through technical assistance, organizing training and orientations and ensuring allocation of annual budget. The EHIA-Plan recommends that NHSP II should include strategic approaches and mitigation measures with appropriate distribution of responsibility and costing. Page 4 As part of its emphasis to target vulnerable and excluded communities in Nepal, the Government has prepared a Gender, Equity and Social Inclusion Strategy (GESI) which aims to ensure equitable access to and use of health services by the poor, vulnerable and marginalized castes and ethnic groups. The Government has prepared a framework for Indigenous Peoples Development which further elaborates the objectives and principles of the GESI strategy to enable maximization and delivery of culturally appropriate benefits to the indigenous communities under the project. The government has also prepared a land acquisition framework for the possibility of land acquisition under the program. These will apply to the entire GoN five-year health sector plan (2010/11- 2014/15). 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The Government of Nepal has prepared the following safeguard instruments which were reviewed by the World Bank and disclosed in-country and at the World Bank InfoShop prior to appraisal. 1) Environmental Management Framework for Physical Infrastructure Works 2) Environmental Health Impact Assessment Plan 3) Framework for Land Acquisition and Resettlement 4) Indigenous Peoples Development Framework Internal discussions were held during the preparation of the above mentioned safeguard documents. The GESI has been developed on the basis of the rich feedback from implementation of early health programs. It has been approved and published for distribution. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? No Date of receipt by the Bank 01/25/2010 Date of "in-country" disclosure 01/25/2010 Date of submission to InfoShop 01/28/2010 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? No Date of receipt by the Bank 01/25/2010 Date of "in-country" disclosure 01/25/2010 Date of submission to InfoShop 01/28/2010 Indigenous Peoples Plan/Planning Framework: Was the document disclosed prior to appraisal? No Date of receipt by the Bank 01/25/2010 Date of "in-country" disclosure 01/25/2010 Page 5 Date of submission to InfoShop 01/28/2010 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? No If yes, then did the Regional Environment Unit or Sector Manager (SM) review and approve the EA report? N/A Are the cost and the accountabilities for the EMP incorporated in the credit/loan? N/A OP/BP 4.10 - Indigenous Peoples Has a separate Indigenous Peoples Plan/Planning Framework (as appropriate) been prepared in consultation with affected Indigenous Peoples? Yes If yes, then did the Regional unit responsible for safeguards or Sector Manager review the plan? Yes If the whole project is designed to benefit IP, has the design been reviewed and approved by the Regional Social Development Unit or Sector Manager? N/A OP/BP 4.12 - Involuntary Resettlement Has a resettlement plan/abbreviated plan/policy framework/process framework (as appropriate) been prepared? Yes If yes, then did the Regional unit responsible for safeguards or Sector Manager review the plan? 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 Yes Page 6 cost? 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 Albertus Voetberg 02/23/2010 Environmental Specialist: Mr Drona Raj Ghimire 02/23/2010 Social Development Specialist Mr Chaohua Zhang 02/23/2010 Additional Environmental and/or Social Development Specialist(s): Approved by: Regional Safeguards Coordinator: Mr Sanjay Srivastava 02/24/2010 Comments: Cleared. A resettlement framework is prepared to address potential land acquisition issues during implementation. Sector Manager: Ms Julie McLaughlin 02/24/2010 Comments: I remain surprised that a resettlement plan was required, as the project does not intend any large newly sited construction.