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INTEGRATED SAFEGUARDS DATA SHEET 
CONCEPT STAGE 
Report No.:  AC341 
 
Date ISDS Prepared/Updated: October 31, 2003 
 
I.  BASIC INFORMATION 
 
A.  Basic Project Data 
 
Country: Malawi 
Project ID: P083401 
Project Name: Health Sector Support 
Project 
Task Team Leader: Ramesh Govindaraj 
Estimated Appraisal Date: March 1, 2004 
Loan/Credit amount ($m.):  
IDA Grant: 15 
Estimated Board Date: July 1, 2004 
 
Managing Unit: AFTH1 
Lending Instrument: Sector Investment and 
Maintenance Loan 
Sector: Health (100%) 
Theme: Health system performance (P) 
Safeguard Policies Specialists in the task team: Edeltraut Gilgan-Hunt, AFTS2, 
 Kristine Schwebach, AFTS1 
Other financing amounts by source:   
DfID 
NORAD 
AfDB 
($m.) 
60 
25-30 
10 
B.  Project Objective 
To support the GOM’s plans to establish a health delivery system truly responsive to the needs of 
the people of Malawi, by improving the effectiveness and efficiency of health services, and 
providing, through a SWAp, a minimum package of essential health services, with emphasis on 
reaching the poor, women, and children. 
 
Principal outcome(s): 
 
·
Improved access to a quality cost-effective essential health package (EHP) targeted at the 
poor and vulnerable populations through: 
o
Augmented health sector support systems, with emphasis on equitable health 
financing, human resources, pharmaceutical and supplies logistics, and 
monitoring and evaluation. 
o
Enhanced capacity of MOHP in policy development and stewardship 
o
Strengthened district health systems for planning, budgeting and delivering 
quality health services 
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o
A
coordinated development assistance program led by the government, which 
includes a comprehensive budget that captures all inputs, so that gaps and 
overlaps can be avoided.  
 
C.  Project Description 
a)  Project alternatives considered
.
With the need for IDA to help Malawi achieve the MDGs 
through its financial and analytical contributions, the “no project” alternative is not viable.  This 
is particularly so given the high levels of child and maternal mortality rates, the advancing AIDS 
epidemic, and the burden of disease due to infectious diseases like TB and malaria.  The progress 
made by the GOM during the past year, working closely with its development partners, in 
preparing an essential health package, and a program of work for its implementation, provides a 
unique opportunity for the Bank to participate in a collaborative effort aimed at improving health 
outcomes in Malawi.  Another alternative is a ‘stand alone’ investment.  This, however, is 
inconsistent with the regional strategy, which recognizes the benefits of programmatic 
approaches.  Experience in Malawi also indicates that it is difficult to achieve sustainable policy 
reforms through modest sized stand-alone projects.  The proposed project design is based on the 
successful experiences in the region of using a cohesive sector wide program approach with 
annual plans of action supported by all major development partners.  On instruments, an 
Adaptable Program Lending (APL) could be an alternative, but is probably premature given the 
status of the sectoral reform as well as the broader macroeconomic environment.  Our preferred 
instrument is a Sector Investment and Maintenance Loan (SIML). 
 
b)  Key project elements.
 
The GOM is currently revising its operational plan and updating the 
program costs, based on initial feedback received from development partners.  At this early 
stage, it is proposed not to earmark the World Bank’s contribution for particular activities or 
inputs.  The decision on whether to pool funds (as has been done in the Malawi HIV/AIDS 
project) will largely hinge around the GOM’s ability to demonstrate acceptable levels of 
transparency and accountability in its systems.  Sound and transparent financial management, 
procurement, monitoring and evaluation arrangements are the key.  In the event an agreement 
cannot be reached on pooled financing, IDA financing would switch in whole or in part to 
traditional financing methods.    
 
The core elements for the proposed SWAp are:  (a) improving quality and coverage of a well 
defined Essential Health Package of services; (b) institutional development at the central and 
district levels; and (c) innovative community based activities to ensure financial protection for 
the poor and vulnerable populations during sickness.  The focus of the EHP is on quality and 
equity, rather than on physical expansion of infrastructure.  Considering the limited capacities at 
district levels, the proposed decentralization will be phased-in, and will build on the current 
experiences with the NORAD-supported health budgetary enhancement to districts.  Priority 
attention would be given to the emergency plan for ensuring critical human resources for the 
health sector and improving access to essential drugs through community drug revolving funds 
and streamlined procurement and supply systems.  Based on the lessons learned from the Pop/FP 
project, community involvement, provider incentives and further strengthening of partnerships 
with NGOs are proposed to improve access of rural and underserved populations to the EHP. 
 
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D.  Project location (if known) 
 
Nationwide. 
 
E.  Borrower’s Institutional Capacity (for Safeguard implementation) 
Albeit limited as this time, the Borrower has institutional capacity to implement Safeguard 
related issues. 
 
II.  SAFEGUARD POLICIES THAT MIGHT APPLY 
 
Applicable?
Safeguard Policy 
If Applicable, How Might It Apply? 
[Y] 
Environmental Assessment
(
OP
/
BP
4.01) 
The program envisages very little, if any, new construction. Civil works will 
largely be confined to repairs and upgrading at existing sites throughout the 
country.  A National Medical Waste Management Plan, approved by the Bank in 
2002, is under implementation. 
[N] 
Natural Habitats (
OP
/
BP
4.04) 
[N] 
Pest Management (
OP 4.09
)
[X] 
Involuntary Resettlement (
OP
/
BP
4.12)  The RPF would address potential 
issues related land acquisition that might be required for civil works. 
[N] 
Indigenous Peoples (
OD 4.20
)
[N] Forests 
(
OP
/
BP
4.36) 
[N] 
Safety of Dams (
OP
/
BP
4.37) 
[N] 
Cultural Property (draft OP 4.11 - 
OPN 11.03
)
[N] 
Projects in Disputed Areas (
OP
/
BP
/
GP
7.60)
*
[N] 
Projects on International Waterways (
OP
/
BP
/
GP
7.50) 
Environmental Assessment Category:
 
[
]
A
[X] B   [ ] C   [ ] FI   [ ] TBD (to be determined) 
 
*
By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the 
disputed areas
 
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Safeguard Policies Classification:
 
[
]
S
1
[X] S
2
[
]
S
3
[
]
S
F
[X] TBD (to be determined) 
 
III.  ACTIONS DURING PROJECT PREPARATION 
 
A.  What actions might be needed during project preparation to assess safeguard issues 
and prepare to mitigate them? 
 
Following the first preparation mission, the team will know the extent and type of the civil works 
included in the program.  Assuming that there are a small number of locations, where minor civil 
works other than renovation/upgrading is planned, the team will prepare an Environmental and 
Social Management Framework (ESMF) and a Resettlement Policy Framework (RPF). 
 
B.  How might consultation and disclosure requirements be addressed? 
 
The Environmental and Social Management Framework (ESMF) and a Resettlement Policy 
Framework (RPF) will be prepared in consultation with relevant shareholders including 
potentially effected persons, and will be disclosed prior to appraisal. 
 
IV.  AGREEMENTS REACHED ON SAFEGUARDS AT PCN REVIEW 
 
The ISDS and PCN have been updated based on comments received from ASPEN. 
 
Agreed target date for Quality Enhancement Review:  
May 5, 2004