INTEGRATED SAFEGUARDS DATA SHEET APPRAISAL STAGE Report No.: ISDSA7237 Public Disclosure Copy Date ISDS Prepared/Updated: 17-Jan-2014 Date ISDS Approved/Disclosed: 24-Jan-2014 I. BASIC INFORMATION 1. Basic Project Data Country: Yemen, Republic of Project ID: P144522 Project Name: Maternal and Newborn Voucher Project (P144522) Task Team Alaa Mahmoud Hamed Abdel- Leader: Estimated 27-Jan-2014 Estimated 31-Mar-2014 Appraisal Date: Board Date: Managing Unit: MNSHH Lending Specific Investment Loan Instrument: Sector(s): Health (100%) Theme(s): Population and reproductive health (70%), Child health (15%), Health system performance (15%) Is this project processed under OP 8.50 (Emergency Recovery) or OP No 8.00 (Rapid Response to Crises and Emergencies)? Financing (In USD Million) Public Disclosure Copy Total Project Cost: 20.00 Total Bank Financing: 10.00 Financing Gap: 0.00 Financing Source Amount BORROWER/RECIPIENT 0.00 International Development Association (IDA) 10.00 Health Results-based Financing 10.00 Total 20.00 Environmental C - Not Required Category: Is this a No Repeater project? 2. Project Development Objective(s) The Project Development Objective is to increase the utilization of maternal and newborn health services in the project target areas. Page 1 of 6 The MNVP will contribute to the reduction of maternal and child mortality. It will contribute to meeting the unmet need for family planning, allowing families to plan and space births. This will also contribute to a reduction in population growth and alleviate pressure on Yemen's scarce natural Public Disclosure Copy resources. 3. Project Description This is a five year project with a proposed cost of US$10.0 million equivalent to be implemented using a Specific Investment Loan (SIL) instrument. The overall approach is to have a community- based maternal and newborn health program using demand-side financing, including a voucher for safe delivery services and neonatal care, together with a cash benefit for women living in rural areas to cover transport, food and possibly other opportunity costs. The supply side will be supported by the ongoing World Bank financed Health and Population Project (HPP, Cr.H640) in the same project target governorates, i.e., Ibb and Sana’a Governorates. The HPP, with a Closing Date of September 30, 2017, will be operating in parallel with the proposed project. This is a five year project, which will be financed through a US$10 million equivalent IDA Grant and US$10 million equivalent from the Health Results Innovation Trust Fund (HRITF) using an Investment Project Financing (IPF) instrument. The Project will support the establishment of a community-based maternal and newborn health and family planning program using demand-side financing, and will use a voucher system to provide women with access to safe motherhood services, neonatal care, and family planning services together with a cash benefit for pregnant women living in rural areas to be used for the cost of transport, food and possibly other opportunity costs. Project activities are organized in the following two components: Component 1: Improving Access to Maternal and Newborn Health Services (US$ 17.0 million equivalent total) which would support results-based payments for the marketing, distribution and reimbursement of vouchers and cash benefits for maternal and newborn health services for target beneficiaries. The voucher service package will include Ante-Natal Care (ANC) visits, Normal Public Disclosure Copy delivery with a community midwife or in a health facility, Caesarean Section, Management of any complications related to pregnancy, delivery or post-delivery for the mother or the newborn, Post- Natal Care (PNC) visits, Comprehensive Family planningn counseling, Pregnancy tests, and more. Cash benefits will include reimbursement of transport and accommodation/food costs associated with hospitalization. Services will be provided by contracted for-profit, non-profit, and public providers. Tertiary services that require hospitalization are expected to be provided mainly by public service providers. In remote rural areas, the entry point to the voucher scheme will primarily be the private midwife, with or without a delivery room (but preferably with a delivery room). In rural areas where a functional health facility is available with 24/7 services, this center will be the point of entry for woman. These providers will also be the principal conduit for distributing the cash contribution for transport, food and possibly other opportunity costs for delivery or management of complications at an appropriate health facility. Component 2: Results-Based Monitoring, Voucher Management, Quality Verification, Technical Audit, and Project Management (US$ 3.0 million equivalent total). This component would include support for: (i) capacity building activities for the SFD; (ii) independent technical audit; (iii) quality verification and approval of providers; (iv) communications strategies; (v) monitoring and evaluation; (vi) project management operating costs for SFD; and (vii) external audit. The SFD will establish a special unit to undertake the functions of the Voucher Management Agency (VMA), the Page 2 of 6 proposed payer of the voucher scheme. Fiduciary management, including procurement and financial management, as well as monitoring and evaluation will be carried by the respective departments within the SFD. While capacity is being built at the VMA, an interim strategy may include Public Disclosure Copy contracting of a third party for claims processing. The VMA will develop a Management Information System, which will collect data on different components of the program. 4. Project location and salient physical characteristics relevant to the safeguard analysis (if known) The project will be implemented in Taiz, Hadramout, Sana’a City, Aden, Hodaida and Ibb governorates 5. Environmental and Social Safeguards Specialists Chaogang Wang (MNSSU) Ayala Peled Ben Ari (MNSHH) 6. Safeguard Policies Triggered? Explanation (Optional) Environmental Assessment OP/ No The project’s impact on the environment is BP 4.01 expected to be minor and indirect, given that it will not finance inputs for service providers in the form of goods or works, but rather will pay for services already provided using vouchers. Therefore, the project is classified as an environmental Category C (not requiring assessment). Indirect increased in soil and groundwater contamination from hazardous health care waste (HCW) will be managed by the heath care providers in accordance with mitigation measures Public Disclosure Copy agreed on under the SFD IV HCW Management Plan. The providers will also be required to have valid quality certification from the GIZ-managed Quality Improvement Program (QIP), demonstrating their capacity for HCW management. Monitoring will be carried out under Component 2. Natural Habitats OP/BP 4.04 No The project will not damage natural habitats (land and water areas where most of the native plant and animal species are still present), and will not result in loss or degradation of any Critical Natural Habitats as defined by the Policy. Forests OP/BP 4.36 No The project will not have an impact on the health and quality of forests; will not affect the rights and welfare of people and their level of dependence upon or interaction with forests; and will not bring about changes in the management, protection, or utilization of natural forests or Page 3 of 6 plantations, whether they are publicly, privately, or communally owned. Pest Management OP 4.09 No The project will not require the purchase, Public Disclosure Copy application or storage of pesticides and will not lead to an increased use of pesticides. Physical Cultural Resources OP/ No The project will not involve excavations, BP 4.11 demolition, movement of earth, flooding, or other environmental changes; and will not be located in, or in the vicinity of, a physical cultural resources site recognized by the borrower. Indigenous Peoples OP/BP 4.10 No Indigenous Peoples are not present in, or have collective attachment to, the project area. Involuntary Resettlement OP/BP No The project will not finance any civil works 4.12 therefore the project will not involve in any land acquisition. Safety of Dams OP/BP 4.37 No The project does not involve the construction of new dams and and/or existing dams in the borrower's territory. Projects on International No The project does not involve any hydroelectric, Waterways OP/BP 7.50 irrigation, flood control, navigation, drainage, water and sewerage, industrial, and similar activities which involve the use or potential pollution of international waterways as described in para. 1 of the Policy; and does not include a detailed design and engineering studies of activities under para. 2(a) of the Policy, including those to be carried out by the Bank as executing Public Disclosure Copy agency or in any other capacity. Projects in Disputed Areas OP/BP No The project does not take place in disputed areas. 7.60 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 does not trigger any World Bank safeguard policies. Project impact on the environment is expected to be minor and indirect as a result of increased access to and utilization of health services: while no on the ground interventions are funded, it is likely that more hazardous health care waste will be generated, which could increase soil and groundwater contamination. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: Not applicable (NA) 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Not applicable (NA) Page 4 of 6 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. The borrower was not required to take measures to address the indirect effects of the project. The Public Disclosure Copy SFD IV healthcare waste management plan (approved by the World Bank in 2010) will be utilized by all health care providers to mitigate the indirect project impact. Providers will also be required to have valid quality certification from the GIZ-managed Quality Improvement Program (QIP), proving adequate capacity for health care waste management. As part of the project’s ongoing quality assurance procedures under component 2, potential providers will be checked for their HCW management practices and certification prior to their engagement in project activities. Annual reevaluations will be carried out by SFD as part of its annual environmental audits, in collaboration with the QIP. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. Key governmental stakeholders are the MOPHP–Population Sector and the Reproductive Health Department. A number of development partners, including, inter alia, United Nations Population Fund (UNFPA), WHO, United Nations Children Fund (UNICEF), the Dutch Development Cooperation, Mary Stops International, KfW, and GIZ, have particular interest in reproductive health. The target group of beneficiaries are poor women of reproductive age (15–49 yrs.) in rural and urban areas in the targeted governorates. As no safeguard policies are triggered, safeguard- related consultation was not carried out. B. Disclosure Requirements If the project triggers the Pest Management and/or Physical Cultural Resources policies, 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: Public Disclosure Copy N/A C. Compliance Monitoring Indicators at the Corporate Level OP 7.60 - Projects in Disputed Areas Has the memo conveying all pertinent information on the Yes [ ] No [ ] NA [ ] international aspects of the project, including the procedures to be followed, and the recommendations for dealing with the issue, been prepared Does the PAD/MOP include the standard disclaimer referred to Yes [ ] No [ ] NA [ ] in the OP? The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the Yes [ ] No [ ] NA [ ] World Bank's Infoshop? Have relevant documents been disclosed in-country in a public Yes [ ] No [ ] NA [ ] place in a form and language that are understandable and accessible to project-affected groups and local NGOs? All Safeguard Policies Page 5 of 6 Have satisfactory calendar, budget and clear institutional Yes [ ] No [ ] NA [ ] responsibilities been prepared for the implementation of Public Disclosure Copy measures related to safeguard policies? Have costs related to safeguard policy measures been included Yes [ ] No [ ] NA [ ] in the project cost? Does the Monitoring and Evaluation system of the project Yes [ ] No [ ] NA [ ] include the monitoring of safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed Yes [ ] No [ ] NA [ ] with the borrower and the same been adequately reflected in the project legal documents? III. APPROVALS Task Team Leader: Name: Alaa Mahmoud Hamed Abdel- Approved By Sector Manager: Name: Firas Raad (SM) Date: 24-Jan-2014 Public Disclosure Copy Page 6 of 6