Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC1030 Date ISDS Prepared/Updated: September 22, 2004 I. BASIC INFORMATION A. Basic Project Data Country: Iraq Project ID: P091305 Project Name: Emergency Health Project Task Team Leader: Jean Jacques Frere Estimated Appraisal Date: October 15, 2004 Estimated Board Date: November 30, 2004 Managing Unit: MNSHD Lending Instrument: Emergency Recovery Loan Sector: Health (100%) Theme: Health system performance (P) Safeguard Policies Specialists in the task team: Stefanie Brackmann, Concepcion del Castillo Loan/Credit amount ($m.): Other financing amounts by source: ($m) SPECIAL FINANCING 25 B. Project Objectives The principal objective of the Project is to improve access to quality emergency services in selected health facilities to serve the urgent needs of the Iraqi population. This objective would be achieved through: (i) rehabilitation of priority emergency services, including emergency obstetric care in 10 selected hospitals, (ii) the urgent provision of basic medical and laboratory equipment to the selected rehabilitated hospitals, (iii) the procurement and distribution of a 3 to 6 month supply of up to 30 essential emergency medicines to be used at emergency facilities rehabilitated through this project; (iv) continued support to strengthening of planning and management capacity within the central and provincial health administrations; and (v) support to project management. By the end of this project it is expected that: · Ten carefully selected hospitals will have functioning emergency medical services defined by adequate physical infrastructure, essential equipment and drugs, adequate staffing and well trained emergency teams. · The Ministry of Health will have strengthened its planning and management capacity at both central and regional levels. · These two groups of outcomes can be assessed by the definition of simple quantifiable indicators that will be agreed upon at negotiations. Page 2 C. Project Description The Project would comprise five components, to be implemented over a period of up to 18 months. It will be fully funded as a Grant under the Iraq Trust Fund, operating under OP 8.50, Emergency Recovery Assistance. The five components are described below: Component 1: Rehabilitation of priority emergency services in 10 hospitals (estimated total cost US$ 15.0 million) Priority hospital services, such as Emergency Units, Emergency Obstetric Services, Critical Care Services (operation departments, ICU, CCU, acute radiology, etc) and Support Services (central sterilization departments, laboratories, etc) will be partly or fully rehabilitated and equipped in 10 carefully selected hospitals. Criteria for selection will be determined at a later date by MoH, in conjunction with PAC, WB and other funding agencies. Criteria should take into consideration:: (i) size of population served; (ii) possible duplication with other donors; (iii) existence of other similar medical services within the catchment area; (iv) accessibility for patients and emergency vehicles; (v) utilization; (vi) staff size; (vii) age of facility; (viii) size of facility and land; (ix) preliminary cost estimates for rehabilitation; and (x) justification for rehabilitation vs. reconstruction. To date, the MoH has conducted a self-administered facility-needs survey (for hospitals, primary health care centers and sub centers), collecting the following essential data needed in all 18 Governorates: 1) physical structures of all health facilities; 2) accessibility and extent of catchments areas; 3) needs for expansion and rehabilitation; 4) human resources needs; 5) individual needs of each facility; and 6) functionality of each facility. Collection of this information has been completed. As soon as this data is made available, the MoH can use this tool to identify rehabilitation priorities for emergency services at hospitals and select the neediest facilities throughout the country to be rehabilitated. Amount of funding for each selected facility will be determined based on each facilities needs, assuming that some facilities will need more rehabilitation than others. This first phase of the reconstruction effort will concentrate on establishment of a sustainable model for planning, procurement and financial management. It will allow the development of standards for health facilities and will constitute the most effective way for the MOH to acquire the capacity it needs to manage longer-term reconstruction/rehabilitation activities. Component 2: Provision and distribution of emergency medical services equipment in 10 rehabilitated hospitals (estimated total cost US$ 3.0 million) To the extent possible, hospitals undergoing rehabilitation will not have to be closed, and basic emergency diagnostic and treatment equipment and simple furniture will be supplied as soon as possible to these emergency facilities. To avoid unnecessary delays, there will be no need to complete a detailed inventory of existing equipment. The MOH will agree upon the minimum equipment requirements and will define standard emergency care kits, including emergency obstetric care, which will greatly simplify both procurement and distribution. Page 3 Component 3: Provision and distribution of essential emergency drugs (estimated total cost US$ 5.0 million) The Emergency Health Reconstruction Project will support the procurement and distribution of a 3 to 6 month supply of up to 30 essential emergency medicines to be used at emergency facilities rehabilitated through this project, with particular attention on emergency obstetric drugs. The MoH will select the essential emergency drugs currently included in leading pharmaceutical formularies, which could comprise, but are not limited to, the following: (i) general anesthetics and oxygen; (ii) preoperative medication and sedatives; (iii) anti-infective drugs; (iv) blood products and plasma substitutes; (v) cardiovascular drugs; (vi) oxytocics and anti-oxytocics; and (vii) oral and parenteral solutions. The project will also provide support to the MoH in developing a sustainable plan for procurement and distribution of essential emergency drugs. Component 4: Capacity-building and training of MoH staff (estimated total cost US$ 1.0 million) The Emergency Health Reconstruction Project will continue to support on-going technical assistance in the areas of facilities-based master planning, National Health Accounts, project management, financial management and procurement, much of which began in May 2004. Additional training will be provided in Emergency Medical Services and will focus on the development of a comprehensive national plan for strengthening emergency health care services. A combination of short and long-term training programs, as well as limited physical rehabilitation of existing training institutions, will allow for the constitution of a core group of public health and health management specialists. The initial training will lead to the possibility in Phase II of helping set up the first Iraqi School of Public Health and Health Management 1 . Component 5: Project Management (estimated total cost US$ 1.0 million): Project management support will cover the investment and operating costs of the Project Management Team (PMT), including the provision of furniture, equipment, technical assistance and training necessary for the management of the project activities. Salary costs of the PMT, with the exception of consultants, will be covered by the MoH’s recurrent budget. D. Project location Project location will be determined according to the facilities list proposed by the MoH which meets the selection criteria for selecting facilities eligible for rehabilitation. 1 There are no internationally accredited schools of public health in the MENA region. Institutions that provide some PH training exist however in Egypt, Tunisia, Iran and Jordan, but none of these offer the range or the quality of training available in Europe or in the US. Page 4 E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] The borrower’s institutional capacity will be assessed during the upcoming mission in October 2004. The training on environment will be provided if needed, and the training program will be integrated into project design. II. SAFEGUARD POLICIES THAT MIGHT APPLY Applicable? Safeguard Policy If Applicable, How Might It Apply? [X ] Environmental Assessment ( OP / BP 4.01) [ ] Natural Habitats ( OP / BP 4.04) [ ] Pest Management ( OP 4.09 ) [ ] Involuntary Resettlement ( OP / BP 4.12) [ ] Indigenous Peoples ( OD 4.20 ) [ ] Forests ( OP / BP 4.36) [ ] Safety of Dams ( OP / BP 4.37) [ ] Cultural Property (draft OP 4.11 - OPN 11.03 ) [ ] Projects in Disputed Areas ( OP / BP / GP 7.60) * [ ] Projects on International Waterways ( OP / BP / GP 7.50) Environmental Assessment Category: [ ] A [X] B [ ] C [ ] FI [ ] TBD III. SAFEGUARD PREPARATION PLAN A. Target date for the Quality Enhancement Review (QER), at which time the PAD-stage ISDS would be prepared. * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas Page 5 B. For simple projects that will not require a QER, the target date for preparing the PAD-stage ISDS C. Time frame for launching and completing the safeguard-related studies that may be needed. The specific studies and their timing 2 should be specified in the PAD-stage ISDS. Environmental and social screening and assessment framework will be disclosed in the country before project appraisal. IV. APPROVALS Signed and submitted by: Task Team Leader: Jean Jacques Frere Date Approved by: Regional Safeguards Coordinator: Name Sherif Arif Date Comments Sector Manager: Name Akiko Maeda Date Comments WB23256 D:\91305\PREP\Integrated Safeguards Data Sheet - Concept Stage.doc October 3, 2004 9:17 AM 2 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 6