Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC3820 Date ISDS Prepared/Updated: 11/03/2008 I. BASIC INFORMATION A. Basic Project Data Country: Swaziland Project ID: P110156 Project Name: Swaziland HIV/AIDS Project Task Team Leader: Feng Zhao Estimated Appraisal Date: February 9, 2009 Estimated Board Date: July 2, 2009 Managing Unit: AFTH1 Lending Instrument: Specific Investment Loan Sector: Health (60%);Other social services (23%);General public administration sector (10%);Central government administration (7%) Theme: HIV/AIDS (P);Health system performance (P);Participation and civic engagement (P);Other accountability/anti-corruption (S) IBRD Amount (US$m.): 20.00 IDA Amount (US$m.): 0.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: Borrower 3.00 EC: European Commission 27.00 30.00 B. Project Objectives [from section 2 of PCN] The overall objective of the project is to assist the Government of Swaziland in fighting HIV/AIDS by addressing the major gaps in implementing its HIV/AIDS national strategic plan, particularly in health system strengthening and HIV/AIDS related social protection. Specifically, the project aims at improving accessibility and efficiency of health and social protection services for HIV/AIDS affected population particularly the poor and vulnerable. C. Project Description [from section 3 of PCN] To achieve the project objective, the project will adopt the following guiding principles: The project will be in alignment with the overall national strategic plan and adopt a gap-filling approach; it will complement the government and development partners’ ongoing programs and efforts; and it will finance capacity-building and avoid ambitious design in dealing with the weak capacity on the ground. Page 2 Based on these principles and the unique situation in Swaziland, the project did not follow the typical design of the Bank’s MAP. It rather plans to direct most of the resources to support the two weak areas identified by the Government and the Bank team, namely the health system and HIV/AIDS related social protection. The investment project instrument is deemed the most appropriate given the fact that: (i) weak capacity in the country that requires flexible and targeted implementation support; and (ii) the clients are not familiar with the Bank operational procedures and more complicated instruments (e.g. APL, SWAP, etc.) would affect the implementation. However, the project will support the country’s long-term efforts to move to a SWAp in the health sector. The project includes four proposed components with an estimated cost of US$ 50 million (in which EC will contribute about 17.5 million Euro, equivalent to about US$ 27 million) Component 1: Health system strengthening. The health system is the one major weak area in responding to the unprecedented epidemic, with its insufficient capacity, inadequate management, and unmotivated staff. The component intends to provide support to fill in the gaps in management, service delivery, and human resources in the health system, and also to improve performance by introducing a performance-based grant facility. Specifically, this component will: (i) introduce a performance-based grant facility to improve efficiency; (ii) provide technical assistance to the key functions of the MOHSW (including planning, HR management, procurement and financial management, M&E, HIV/AIDS and TB programs; (iii) support the completion and commissioning of three problematic projects: the TB hospital, the national referral laboratory, and the central medical stores; and (iv) address the capacity gaps for those providers who do not qualify for performance grants. Component 2: HIV/AIDS related social protection. The unprecedented increase in the number of PLWAs, and particularly OVCs, coincides with the deterioration of the country’s social fabric and informal social safety nets. The Government is struggling in developing a social protection system that can provide an appropriate and adequate response to the increasing level of national destitution and vulnerability. Although significant external resources have been invested in scaling up the overall impact mitigation of the epidemic, social protection of the vulnerable populations remains a major challenges. This component will support strengthening the social welfare system by: (i) creating a simple and efficient system to implement grant-based interventions with a focus on the demand side (e.g. a unified “Child Support Grant”); (ii) strengthening and expanding the reach of service-based social risk programs; and (iii) helping building an efficient policy-making and administration system to implement social welfare strategies. Component 3: Public-Private Partnership (PPP) for improving health care services. The Government acknowledges that PPPs are being widely used in the health sector and for HIV activities by governments worldwide and in the southern Africa region, specifically South Africa and Lesotho. Several public-managed and financed projects have run into problems due to reasons mostly related to lack of adequate capacity and efficient coordination in the public sectors. The Government has decided to explore the PPP options for improving health services. This component includes support to: (i) identifying and implementing pilot PPP projects that will Page 3 be jointly assisted by IFC and (ii) building capacity needed in the Government to plan and manage PPP projects. IFC will mainly assist the project in the development of management contracts for service delivery. Component 4: Institutional rebuilding. Efficient institutions and their sufficient capacity are a must in making the fight against HIV/AIDS effective and implementing the proposed project. The project will be doomed to failure if institutional capacity issues are not carefully considered. This component details the capacity needs for public sector organizations, public sector staff and private sector organizations (including NGOs) and includes specific supports to fill in the major gaps. D. Project location (if known) The project will address major gaps in implementing the Government's HIV/AIDS national strategic plan; thus activities are expected to be undertaken throughout the country, including cities, peri-urban areas, and rural areas. E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] The existing Environmental Framework in Swaziland includes an Environmental Management Act and an Environmental Audit Assessment and Regulation which are both in place. The Swaziland Environment Authority oversees the implementation and enforcement of the Act. The availability of medical waste management regulations is unknown at this time, and will be determined during preparation. The Ministry of Health and Social Welfare (MOHSW) as implementing agency for the proposed project, will implement the medical waste management plan - to be developed during project preparation and disclosed prior to Appraisal. F. Environmental and Social Safeguards Specialists Ms Lungiswa Thandiwe Gxaba (AFTEN) II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X This policy is triggered due to the potential negative impacts of unsafe medical waste management. There are no anticipated construction and/or rehabilitation activities. 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 Page 4 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: 01/05/2009 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. A National Health Care Waste Management Plan will be completed and disclosed in-country and at the Bank's InfoShop prior to appraisal. As noted above, guidelines to contractors that will be rehabilitating and constructing facilities will also be available before appraisal. The SMU has agreed to accept transfer of the safeguard responsibilities. IV. APPROVALS Signed and submitted by: Task Team Leader: Mr Feng Zhao 11/03/2008 Approved by: Regional Safeguards Coordinator: Mr Warren Waters 11/03/2008 Comments: Sector Manager: Mr Christopher J. Thomas 11/03/2008 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 5