The World Bank Accelerating Maternal And Child Health Outcomes (P180904) Concept Environmental and Social Review Summary Concept Stage ( ESRS Concept Stage) Public Disclosure Date Prepared/Updated: 06/28/2023 | Report No: ESRSC03655 Sep 28, 2023 Page 1 of 7 The World Bank Accelerating Maternal And Child Health Outcomes (P180904) I. BASIC INFORMATION A. Basic Operation Data Operation ID Product Operation Acronym Approval Fiscal Year P180904 Investment Project Financing (IPF) Maternal and Child 2024 Health Program Operation Name Accelerating Maternal and Child Health Outcomes Country/Region Code Beneficiary country/countries Region Practice Area (Lead) (borrower, recipient) Bhutan Bhutan SOUTH ASIA Social Protection & Jobs Borrower(s) Implementing Agency(ies) Estimated Appraisal Date Estimated Board Date KINGDOM OF Ministry of Health 30-Oct-2023 BHUTAN Estimated Concept Total Project Cost Public Disclosure Review Date 2,867,000.00 Proposed Development Objective Enhance utilization of maternal, neonatal, child health and nutrition services (MNCHN) by pregnant and lactating women in all districts of Bhutan B. Is the operation being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project Activities Despite health services being provided free of charge to the users, the poor and the vulnerable in Bhutan have not fully benefitted from the health investments made by the Royal Government of Bhutan (RGoB), as there is in suboptimal utilization of essential services among these population groups. Assessments and surveys conducted in the country have identified economic and financial barriers as key constraints to the utilization, e.g., costs associated with travel, loss of income due to a facility visit. To address this constraint, the proposed project would rely on social and behavior change communications (SBCC) at national, facility, community and household levels, together with conditional cash transfers Sep 28, 2023 Page 2 of 7 The World Bank Accelerating Maternal And Child Health Outcomes (P180904) for the socially and economically vulnerable pregnant and lactating women (PLW), to incentivize use of essential health and nutrition services. These services are essential for improving maternal, newborn and child health outcomes. The provision of conditional cash transfers to selected ones, which will be electronically deposited in equal instalments into a beneficiary's individual bank account during the Golden 1,000 Days period (approximately 33 months), following a predefined calendar of health visits. The conditional cash transfer beneficiaries would remain in the program, receiving cash transfers from detection of pregnancy until the child turns two years of age, subject to compliance with defined co- responsibilities/conditionalities. The conditionalities include antenatal and postnatal check-ups, institutional delivery, birth registration, child growth monitoring and promotion, and immunization of children under two years of age. D. Environmental and Social Overview D.1 Overview of Environmental and Social Project Settings The Project will be implemented in all the Dzongkhags of Bhutan. Bhutan’s physical geography consists mostly of steep and high mountains crisscrossed by a network of swift rivers, which form deep valleys before draining into the Indian plains. The Project locations include places that may not be accessible by road network. Mountainous regions and lack of accessibility may also impact reaching out to beneficiaries for consultation, participation and service deliveries. This may also be acute for the indigenous communities, meeting ESS7 criteria, and living scattered throughout the project intervention areas to be located, consulted and engaged in the project activities. D.2 Overview of Borrower’s Institutional Capacity for Managing Environmental and Social Risks and Impacts Public Disclosure The Ministry of Health would be the primary implementing agency. Its High-Level Committee (existing) would be responsible for steering the proposed project, including undertaking regular progress reviews and addressing implementation bottlenecks. Under the recent reorganization, the Ministry, through the Department of Public Health (DoPH), would provide technical oversight and guidance, and house the Program Management Unit, which would assume day-to-day management, track beneficiaries, provide reporting on progress. In alignment with the JSDF’s principles of strong community engagement, the local government (LG) would play an important role in the program implementation from the district (dzongkhag) to village (Chiwog) level. The local leaders and officials would be engaged in sensitization of the program, community mobilization, door to door visits of beneficiaries and reviewing grievances. MoH is familiar with WB funded COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) which is being implemented under ESF. Bhutan, through MoH has made good socioeconomic progress, with the assistance from United Nations agencies; the Japan International Cooperation Agency; the Japan Children’s Vaccine Initiative; Gavi, the Vaccine Alliance; and the Global Fund in the fight against HIV/AIDS, Tuberculosis and Malaria. To implement these operation’s environment and social due diligence, MoH followed applicable national laws, and relevant provisions of Royal Government of Bhutan (RGB) including provisions of ESF. A Project Management Unit (PMU) housed under the DoPH will be established to coordinate and manage the overall activities under this project. Also, the environmental compliances in Bhutan are overseen by the National Environment Commission (NEC). The NEC has the mandate to guide in the interpretation of laws and policies as well as provide environmental clearances of high- risk projects. It also looks after all issues related to environmental risk management including waste management, emission standards etc. Therefore NEC, though will not put any focal point for the project, will be a guiding entity for the PIU for environmental aspects. To manage ES aspects of the Project, the PIU will nominate an ES focal point to oversee ES management of risk and impacts associated with the activities. A number of training and guidance support Sep 28, 2023 Page 3 of 7 The World Bank Accelerating Maternal And Child Health Outcomes (P180904) has already been provided to the MoH officials during preparation and implementation of the COVID-19 Emergency Response Project. Given the scope of activities for the project and the low risk profile similar support by the Bank ES team will be adequate to manage ES risks of the Project. II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Low A.1 Environmental Risk Rating Low The Project will implement the Conditional Cash Transfer (CCT) to assist about 4,000 poor and vulnerable pregnant and lactating women (PLW) (and their newborns) in all the districts of Bhutan with low uptake of MCHN services. There is provision for procurement of IT equipment under the project. However, purchase of IT equipment will be minimal; hence these will not create significant amounts of e-waste. Further, as use of medical services is expected to increase due to the project intervention, a slight increase in medical waste may be expected. Given the scope of activities, the context, and the Implementing Agency’s capacity, the Environmental risk is rated as Low. A.2 Social Risk Rating Low The main social risk of the project is the inadvertent exclusion of potential beneficiaries, including those belonging to vulnerable and marginalized groups due to limitations in targeting mechanisms, hard to reach locations etc. Concerns of community health and safety from COVID pandemic may be mitigated through following COVID protocols. Given the activities, the SEA/SH risk (using the SPJ risk rating tool) is Low. Stakeholder consultation and grievance redress Public Disclosure mechanism have been included as a part of the project hence will ensure inclusion of all intended beneficiaries by providing project related information to the beneficiaries, receiving feedback and having in place quick and efficient grievance redress mechanisms. The inclusion of the disadvantaged and the vulnerable beneficiaries will be monitored so that they are included in the project benefit. Given the scope of activities, context, and Implementing Agency’s capacity, the social risk is rated as Low. B. Relevance of Standards and Policies at Concept Stage B.1 Relevance of Environmental and Social Standards ESS1 - Assessment and Management of Environmental and Social Risks and Impacts Relevant This Standard is Relevant. There would not be any civil construction activities under this Project and would include CCT for PLW and their children under age two, awareness raising, monitoring and evaluation, grievance redress mechanism development etc. The ES risks have been assessed as low. Given the activities under the Project, an ES screening in the form of ES checklist have been undertaken to identify any ES related risks and impacts including COVID-19 exposure related to the activities. It appeared that no separate ESMP is required for managing the ES risk of the project. An ESCP integrating LMP and SEP has been prepared. ESS10 - Stakeholder Engagement and Information Disclosure Relevant This Standard is Relevant. Consultations and disclosure of information to stakeholders are at the core of planning and implementation of the project. One of the components under this project will include identification and tracking of Sep 28, 2023 Page 4 of 7 The World Bank Accelerating Maternal And Child Health Outcomes (P180904) beneficiaries and service uptake, compliance with conditionalities, monitoring and evaluation activities (including impact evaluation), and a grievance redressal mechanism for beneficiary feedback. The key stakeholders include CCT beneficiaries, pregnant and lactating women (PLW), officials at the Ministry of Health, village health workers, CCT service administrators, counsellors, social mobilizers, NGOs, researchers/academics etc. The borrower is in the process of identifying all relevant stakeholders including the beneficiaries, other interested parties and the disadvantaged and vulnerable groups to carry out consultations/ engage with. The consultation may require going from door to door, focused group discussions, providing means of transportation for the stakeholders to come to a specific venue, arrangement for safe spaces to allow them to freely provide and seek information. The consultation will include overall project activities, including the CCT payment, tracking, awareness raising, capacity development, grievance redress and M&E issues. It will also facilitate the program enrollment and tracking of CCT beneficiaries and handling of pilot related grievances including SEA/SH complaints. The feedback provided by through the consultation will be recorded and will be provided to the project teams to consider during project design. Feedback loop will be completed by providing back information to the stakeholders on how their inputs were taken in the design and if not, what rationale was behind it. Given the ES risk profile and the activities the Stakeholder Engagement Plan (SEP) has been integrated as part of ESCP. ESS2 - Labor and Working Conditions Relevant This Standard is Relevant. The Project will involve civil servants of the IA (who will retain the employment status with the Government) and individual consultants and staffs for capacity building, monitoring and evaluation, CCT administration, programmers etc as Direct Workers for project implementation, IT programming, CCT delivery etc. The workers will also include social mobilisers, who will be local government officials/staffs and Primary Health Care (PHC) Public Disclosure health workers and outreach clinics who would reach out to the beneficiaries for service deliveries. The ES Commitment Plan (ESCP) will integrate the Labor Management Procedures (LMP) incorporating aspects such as applicability of labor laws and existing behavioral standards including workplace harassment, OHS and, non- discrimination and equal opportunity, grievance mechanism for all workers, as well as issues related to COVID-19 pandemic. The integrated LMP will also illustrate how the social mobilisers will be provided with assistance in reaching out to the beneficiaries including transportation as well as mitigation measures such as codes of conduct and behavioral standards to mitigate potential SEA/SH risks. ESS3 - Resource Efficiency and Pollution Prevention and Management Relevant This Standard is Relevant: As the project would support purchase of limited amounts of IT equipment for CCT, limited quantities of e-waste would be generated at the end of their design life which needs to be disposed of properly. Further, as more use of medical services is expected due to the project intervention, a little increment in medical waste may be expected which also needs to be managed properly. The RGoB has laws on management of e-waste. PMU needs to make and agreement with the authorities of the healthcare facilities for proper disposal of hospital waste. ESS4 - Community Health and Safety Relevant This Standard is Relevant. The impact of COVID 19 pandemic is yet to be over. The program personnel associated with the project will work closely with each other and communities that may expose them to health and safety risks such as COVID-19 and SEA/SH. Measures will be taken to ensure COVID protocol adherence during their activities including usage of face mask, washing of hand, temperature monitoring, maintenance of safe distance and reporting to health Sep 28, 2023 Page 5 of 7 The World Bank Accelerating Maternal And Child Health Outcomes (P180904) facilities upon symptoms. SEA/SH awareness, Code of Conducts (CoCs) for prevention of SEA/SH and access to Grievance Redress Mechanism (GRM) that will address SEA/SH issues including those that may emanate from changing social dynamics due to CCT will be implemented. ESS5 - Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Not Currently Relevant This standard is not relevant ESS6 - Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant Resources This standard is not relevant ESS7 - Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Relevant Local Communities This Standard is Relevant. The project will cover all districts and may include community members from the ethnic communities meeting ESS7 criteria. The presence of the ethnic community and the impact on them due to the project intervention will be undertaken through screening. The issue of exclusion of PLW of the ethnic communities may be an issue that needs to be observed and ensured through comprehensive targeting for identification, consultation and information sharing. ESS8 - Cultural Heritage Not Currently Relevant Public Disclosure This standard is not relevant ESS9 - Financial Intermediaries Not Currently Relevant This standard is not relevant B.2 Legal Operational Policies that Apply OP 7.50 Operations on International Waterways No OP 7.60 Operations in Disputed Areas No B.3 Other Salient Features Use of Borrower Framework Borrower framework will not be used Use of Common Approach No No other financing partner Sep 28, 2023 Page 6 of 7 The World Bank Accelerating Maternal And Child Health Outcomes (P180904) C. Overview of Required Environmental and Social Risk Management Activities C.1 What Borrower environmental and social analyses, instruments, plans and/or frameworks are planned or required by Appraisal? III. CONTACT POINT World Bank Task Team Leader: Phillippe George Pereira Guimaraes Title: Senior Social Protection Economist Leite Email: pleite@worldbank.org TTL Contact: Hnin Hnin Pyne Job Title: Lead Economist, Program Leader Email: hpyne@worldbank.org IV. FOR MORE INFORMATION CONTACT The World Bank Public Disclosure 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects V. APPROVAL Task Team Leader(s): Phillippe George Pereira Guimaraes Leite, Hnin Hnin Pyne Practice Manager (ENR/Social) Christophe Crepin Recommended on 28-Jun-2023 at 15:14:39 EDT ADM Environmental Specialist: S. M. Zulkernine ADM Social Specialist: Shabbir Ahsan Sep 28, 2023 Page 7 of 7