The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) Integrated Safeguards Data Sheet Restructuring Stage Restructuring Stage | Date ISDS Prepared/Updated: 13-Nov-2019| Report No: ISDSR28238 Regional Vice President: Hartwig Schafer Country Director: Junaid Kamal Ahmad Regional Director: Lynne D. Sherburne-Benz Practice Manager/Manager: Trina S. Haque Task Team Leader(s): Mohini Kak The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) . I. BASIC INFORMATION 1. BASIC PROJECT DATA Project ID Project Name P167581 Andhra Pradesh Health Systems Strengthening Project Task Team Leader(s) Country Amith Nagaraj Bathula India Approval Date Environmental Category 15-May-2019 Partial Assessment (B) Managing Unit HSAHN PROJECT FINANCING DATA (US$, Millions) SUMMARY -NewFin1 Total Project Cost 3,440.98 Total Financing 3,440.98 Financing Gap 0.00 DETAILS -NewFinEnh1 World Bank Group Financing International Bank for Reconstruction and Development (IBRD) 328.00 Non-World Bank Group Financing Counterpart Funding 3,112.98 Local Govts. (Prov., District, City) of Borrowing Country 3,112.98 2. PROJECT INFORMATION The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) PROG_INF O Current Program Development Objective The Project Development Objectives are to improve the quality and responsiveness of public health services and increase access of the population to an expanded package of primary health services. . 3. PROJECT DESCRIPTION The US$328 million Andhra Pradesh Health System Strengthening Project (AP HSSP) was approved by the World Bank Board of Executive Directors on May 15, 2019 with the estimated total cost of US$344.98 million. The Loan Agreement was signed on June 27, 2019 and effectiveness declared on September 9, 2019 with a closing date of September 30, 2024. The project aims to improve the quality and responsiveness of public health services and increase access of the population to an expanded package of primary health services. This Project Paper seeks the Country Director’s approval to restructure the Andhra Pradesh Health System Strengthening Project (P167581; Loan No. 8945-IN) to support the state of Andhra Pradesh respond to the COVID-19 surge. 1. The Project is a results-based investment project financing operation, disbursing against the achievement of 10 DLIs, measured by milestones of progress or Disbursement Linked Results (DLRs). The proposed restructuring introduces the following changes: • Add a new sub-component and sub-component costs to include in the project description the provision of COVID- 19 activities • Add a new disbursement category for the COVID-19 expenditures to be financed up to 100% retroactively to the date of the BFP letter • Change relevant DLIs to reduce funds allocated to DLRs and reallocate to a new category for emergency COVID- 19 response • Reallocate financing between disbursement categories to accommodate the new disbursement category • Update/change to the safeguards instruments to reflect new activities 2. Project components and component costs and disbursement categories: It is proposed that a new sub-component 1.5 be created which includes activities related to the COVID-19 Emergency Response of the state and supports activities related to the provision of emergency COVID-19 care. 3. The package of emergency COVID-19 activities includes: a) Oxygen therapy: oxygen concentrators, oxygen cylinders and other oxygen-related supplies; PSA plant enhancement 4. To accommodate the above, it is proposed to introduce a new disbursement category (Category 4) for the COVID-19 expenditures to be financed up to 100% retroactively to the date of the BFP. In addition, it is proposed that IBRD financing allocated for sub-components 1.1, 1.3 and 2.2 be reduced by US$15 million and the amount be allocated to the new sub-component 1.5 (Emergency COVID-19 Care). As discussed above, the proposed changes new category to finance COVID-19 activities, includes adjustments to DLI allocations and unit prices (Category 1. Eligible Expenditure Program (EEP) under the Project) to allocate US$ 15 million under new category (4) that will finance COVID-19 activities. The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) 5. Disbursement Linked Indicators: To accommodate the provision of emergency COVID-19 support, funds allocated to following DLRs will be reduced by US$15 million from existing Sub-components under Component 1 and from Component 2 and reallocated to the new Sub-component 1.5 for the emergency COVID-19 response: a. DLR 1.2: Increase in the number of CHCs and PHCs with quality certification will be reduced from US$19.22 million to US$11.72 million b. DLR 2.1: Number of CHCs that are providing a core package of services contributing to quality of care will be reduced from US$12.95 million to US$9.20 million c. DLR 5.1: System designed and operational in the health facilities will be reduced from US$28.00 million to US$24.25 million. . 4. PROJECT LOCATION AND SALIENT PHYSICAL CHARACTERISTICS RELEVANT TO THE SAFEGUARD ANALYSIS (IF KNOWN) The project aims to benefit the entire 53.6 million population of Andhra Pradesh. Focus is on strengthening approximately 3000 Sub-centers (SCs), 1147 rural Primary Health Centers (PHCs) and 222 Urban Health Centers (UHCs) providing primary health care services; 195 Community Health Centers (CHCs) providing both primary and secondary care (about 30-50 beds); 23 Area Hospitals (about 100 beds), 24 District Hospitals (about 200-400 beds) and 11 Teaching Hospitals providing secondary and tertiary care. The project will support improvements to meet the NQAS certification standards in PHC and CHC facilities. Limited civil works will take place under this project which are being carried out mostly within the premises of the existing health facilities and on government-owned land to improve health facility infrastructure. The state of Andhra Pradesh there are 11 CBMWTFs operational and catering to all 13 districts. While most of the District Hospital, Area Hospital, and CHCs are covered by the CBMWTF, the primary data suggests only few PHCs being covered by the CBMWTF and depend on in-situ treatment and disposal mechanism for solid and liquid waste management through burial pits. Health care and sanitation workers are being provided the necessary protective gear but require trainings to strengthen environmental health and safety practices. No healthcare facilities are located within proximity to sensitive natural habitats or physical and cultural properties, most of health care facilities are connected to all weather road and on government land. The Scheduled Tribes (ST) population at the state level is 5%. The state is divided into 13 districts with presence of scheduled tribes (STs) varying across these districts. Further, five districts have blocks/agencies identified as Schedule Areas as per the Andhra State Order (Cesser), 1955 and A.P Reorganization Act, 2014. There is potential to strengthen delivery basic infrastructure across primary health care facilities, especially in tribal and rural areas across the state. The GoAP has created a multi-departmental Program, the Tribal Reform Yardstick, to prioritize delivery of health services across seven designated Integrated Tribal Development Agencies (ITDAs) and achieve improvement in the health outcomes of tribal communities. implementing agency started using the ESMF for screening the sub-projects and sub-project E&S documents are being prepared accordingly. 5. ENVIRONMENTAL AND SOCIAL SAFEGUARDS SPECIALISTS ON THE TEAM Venkata Rao Bayana, Social Specialist Pradeep Dadlani, Environmental Specialist The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) Sharlene Jehanbux Chichgar, Environmental Specialist SAFEGUARD_TABLE 6. SAFEGUARD POLICIES TRIGGERED Safeguard Policies Triggered Explanation The project is considered as a Category B. OP 4.01 is triggered as the project will include under Components 1 and 3 minor infrastructure refurbishment of CHCs, PHCs and SCs and new construction of small SCs (approx. 73-100 sq. meters as per IPH standards) on government- owned land. The project will also support health systems and service augmentation measures, these interventions will result in greater footfall at the facility level which will result in an incremental increase in bio-medical and other wastes, and risks arising from handling and disposal of healthcare wastes and other products (clinical and infectious waste materials, needles and sharps, and wastewater). This could lead to adverse impacts to the environment and human health if not managed appropriately. There are no potential large-scale, significant or irreversible impacts associated with the proposed project. The risks and impacts associated with minor civil works will be localized and temporary. Environmental Assessment (OP) (BP 4.01) Yes To ensure proper management of environmental impacts that might result from the implementation of the project’s interventions, an Environmental and Social Management Framework (ESMF) has been prepared by DoH, GoAP. Based on the guidance provided in the ESMF, a site-specific screening checklist will be used prior to commencement of any works and improvements at the facility level. The ESMF provides clear environment health and safety management guidelines for health care workers hired under the various service contracts (biomedical waste management, sanitation, and medical equipment servicing). The ESMF also provides the necessary framework for (i) strengthening of the bio-medical waste management system, such that all bio- medical waste generated are collected and disposed in safe and sanitary manner (ii) health facilities have adequate storage for bio-medical waste within the premises, chemicals and The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) wastewater management systems, and the necessary equipment for segregation of wastes for patient and worker safety, (iii) health facilities are connected to a central treatment plant, and where this is not possible, in-situ disposal mechanisms are adopted (iv) labour and healthcare staff will be provided with appropriate vaccinations, personal protective equipment, and trainings on waste handling and infection control, and (iv) all wastewater is treated and disposed to meet applicable water quality standards. The ESMF references the WBG EHS Guidelines and the sector guidance WBG Environmental Health and Safety Guidelines for Health Care Facilities. The ESMF includes detailed budget provisions for mitigation measures and capacity building, monitoring and reporting requirements at all levels of project implementation. For activities proposed under current project restructuring, mostly supply/construction/installation stage risks and impacts associated with purchase of equipment, medical supplies, enhancement of PSA plants and oxygen therapy activities are anticipated. To manage/mitigate potential risks and impacts associated with proposed interventions for responding to COVID-19 crisis, the existing environment and social safeguard instrument/s will be amended, with specific emphasis on: (i) implementation of effective fire safety measures when enhancing PSA plants and/or dealing with oxygen supplies; (ii) appropriate management and disposal of solid, hazardous and potentially infectious/bio-medical waste, including safe disposal of autoclaved refuse & e-wastes; (iii) adequate emission control during incineration and, (iv) proactive communication, outreach towards and engagement of vulnerable communities and responsive grievance redress systems to address inequities or discriminatory practices in the distribution, deployment, and access to COVID 19 related health services, oxygen therapies and equipment and SEA/SH. Performance Standards for Private Sector No Private Sector Activities are envisaged under the No Activities OP/BP 4.03 project and hence OP/BP 4.03 is not triggered The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) OP 4.04 is not triggered as the parent project will not finance any interventions in natural habitats or that would adversely impact natural habitats. Natural Habitats (OP) (BP 4.04) No Interventions under proposed restructuring do not pose any risk related to OP/BP 4.04. OP 4.36 is not triggered for the parent project. The project will not finance any interventions (health care centres including the associated facilities such as access roads, deep burial pits) do not impact forest areas and do not negatively affect local Forests (OP) (BP 4.36) No wildlife and no conversion/degradation of forests is envisaged. Interventions under proposed restructuring do not pose any additional risks related to OP/BP 4.36. OP 4.09 is not triggered as the parent project will not finance or promote the use of large scale/significant qualities of pesticides or chemical pest control methods that would cause adverse Pest Management (OP 4.09) No impacts to human health and the environment. Interventions under proposed restructuring do not pose any risk related to OP/BP 4.09. OP 4.11 is triggered as a preventative measure. All minor civil and renovation works will be restricted to already existing HCF premises, and the project interventions will not impact PCRs. However in the event of unknown PCR within the area, the ESMF includes measures for screening, avoiding and Physical Cultural Resources (OP) (BP 4.11) Yes managing impacts on these PCRs as well as chance- find procedures in the event new resources are discovered in the course of project implementation. Interventions under proposed restructuring do not pose any risk related to OP/BP 4.11. The presence of STs (5% population at the state level) in the project area triggers the World Bank’s Indigenous People’s Policy (OP4.10). An Environment and Social Management Framework has been prepared under the project to a) identify Indigenous Peoples (OP) (BP 4.10) Yes gaps w.r.t to access and utilization of health services amongst tribal and vulnerable communities and b) to enhance outreach and communication strategies, strengthen village health committees, improve patient experience The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) and usage of public health facilities amongst tribal communities and other marginalized groups. The draft ESMF has been consulted upon at district and state level (during development of the instrument, and prior to its disclosure) with relevant stakeholders and government institutions including representatives from tribal communities, officials from the Tribal Welfare Department of GoAP, officials from the Tribal Reform Yardstick initiative of the GoAP, health officers working in tribal areas and civil society organizations working on tribal health issues in the state. The ESMF includes a Tribal Development Framework. Interventions under proposed restructuring do not pose any risk related to indigenous population. However, to ensure equity and access of the proposed interventions, the ESMF adopted for parent project will be followed under the restructuring. The project will support minor civil works including refurbishment of HCFs. Activities that can require land acquisition/resettlement are ruled out. In order to monitor application of the policy during implementation, a checklist is prepared to ensure that no instances of land acquisition and/or encroachment are noticed within the project’s Involuntary Resettlement (OP) (BP 4.12) No scope. The checklist is included in the ESMF. For activities proposed under project restructuring, no impacts related to OP/BP 4.12 are foreseen as activities include only purchase of equipment, enhancement of PSA plants and oxygen therapy related activities. OP 4.37 is not triggered as the project will not Safety of Dams (OP) (BP 4.37) No construct any new dam or carry out any works on existing dams. OP 7.50 is not triggered for this project as there are Projects on International Waterways (OP) No no interventions planned/proposed that would (BP 7.50) impact international waterways. OP 7.60 is not triggered as the project is not Projects in Disputed Areas (OP) (BP 7.60) No proposed in any disputed area KEY_POLICY_TABLE II. KEY SAFEGUARD POLICY ISSUES AND THEIR MANAGEMENT The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) A. SUMMARY OF KEY SAFEGUARD ISSUES 1. Describe any safeguard issues and impacts associated with the Restructured project. Identify and describe any potential large scale, significant and/or irreversible impacts. The project triggers OP 4.01 Environment Assessment, Physical Cultural Resources OP/BP 4.11 and OP 4.10 Indigenous People’s Policy. An Environmental and Social Management Framework (ESMF) has been prepared as all interventions and site-specific details are not defined and will serve as a guideline to manage all environment, health and safety risks and impacts throughout implementation. The project activities supported by the Bank do not include major, indirect or long-term environment or social impacts. No large-scale construction activity is envisaged, and any revamping and construction of health facility infrastructure and processes will be done in the existing premises of the health care facilities and on government-owned land. These may lead to impacts that are site specific, temporary and manageable. All health care facilities financed under the project will be screened under a checklist, and an environmental management plan has been developed which will be applied to all health care facilities in the design, implementation and operations phase of the project. The key environmental safeguard issues related to this project are associated with infection control, bio-medical waste management and wastewater management. The project design by nature addresses the issue of health care waste management and will measure the number of health care facilities meeting the liquid and solid waste management standards as part of NQAS, as required by the Government of Andhra Pradesh. This addresses any potential issues with health care waste management from the outset. Environmental impacts arising from upgradation of health care facilities, and solid and liquid waste management facilities include (i) soil erosion (resulting from excavations of soils for activities such as burial pits); (ii) noise and vibrations from renovation activities (iii) dust and air pollution, (iv) generation of debris and solid waste which have to be disposed appropriately. Some impacts associated with the operation of these facilities (i) exhaust air from ventilation and air conditioning systems, and odour from medical waste storage areas (iii) risks of infections and spread of diseases if appropriate infection control measures are not implemented (iv) risks of water-borne diseases resulting from inadequate treatment of wastewater (v) risks of hazardous health care wastes entering the wastewater stream, including chemicals, disinfectants and pharmaceuticals and (v) accidents and spills in the workplace if worker safety training is not provided effectively. These risks have been identified as part of the ESMF, and appropriate mitigation measures have been provided. The positive impacts of the project include improved health status of populations in AP, improved waste management practices, and hygienic, clean and healthy environments within and around health care centres. The presence of STs in the project area triggers the World Bank’s Indigenous People’s Policy (OP4.10). The state is divided into 13 districts with presence of scheduled tribes (STs) varying across these districts. Further, five districts have blocks/agencies identified as Schedule Areas as per the Andhra State Order (Cesser), 1955 and A.P Reorganization Act, 2014. Project Restructuring: Additional activities proposed under this restructuring (May 2021) include purchase of equipment (oxygen concentrators, cylinders and other oxygen-related supplies) and enhancement of PSA plants. The proposed project restructuring does not trigger new safeguard policies, nor does it entail a change in environment and social risk ratings. Environment: Though the scale and likelihood of environment risks and impacts is likely to be minimal and reversible, the following impacts and risks associated with construction/purchase/ installation and operation may arise: (a) fire safety risk associated with activities involving oxygen concentration, transport and supply, enhancement of PSA plants; (b) OHS risks to employees and health care professionals while using various equipment and supplies such as The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) swabs, antigen kits, x-ray, etc, including risk of COVID19 infections during installation of equipment; (c) community health and safety risks and impacts during transport, unloading and storage (warehousing and/or refrigerated storage) of supplies and their use; (d) impacts on surrounding environment in case of improper storage, collection, treatment and disposal of solid/plastics/packaging wastes, potentially hazardous and infectious/bio-medical wastes (including emissions associated with incineration and from autoclave refuse, pharmaceutical wastes, disposal of used protective gear, e-wastes from equipment and, use of resource intensive equipment). These risks and impacts can be appropriately mitigated following requirements of the World Bank Safeguard Policies, ESMF procedures (to be amended for the activities under proposed restructuring) in addition to national regulations for infection prevention, control and pollution management; guidelines of WHO and GoI on COVID-19; WBG’s EHSGs; good international fire and life safety practices and other relevant Good International Industry Practice (GIIP). These mitigation measures include (i) providing training/building capacity of workers/users/health care professionals; (ii) provision and use of appropriate PPE; (iii) implementation of good international life and fire safety practices linked to oxygen therapy activities; (iv) emergency response arrangements, including protocols and training for safe evacuation in case of and emergency; (v) safe transport and storage of materials and waste management (including segregated storage, collection, transport, treatment, disposal) and (vi) by following hygiene practices and protocols suggested by product manufacturers. Social: Social risks for activities proposed under restructuring relate to equity of access in the distribution, deployment, and access to essential pharmaceuticals, testing, medical and oxygen therapy equipment, and services. In view of the ongoing pandemic there are also limitations and restrictions to face to face consultations. In addition, there could be risk of Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH). To manage risk associated with SEA/SH following measures are suggested: (i) Staff in PIUs/PCUs will sign Codes of Conduct. Codes of conduct need not be signed by other health care personnel during crises as long as information on unacceptable behavior is sufficiently disseminated. Publicly post or otherwise disseminate messages clearly prohibiting SEA/SH during the provision of health care, whether healthcare providers are perpetrators or survivors; (ii) Make information available to health service providers on where GBV psychosocial support and emergency medical services can be accessed (within the health system); and (iii) Promote two-way communication between health authorities and communities that would allow information on instances of SEA/SH to surface and inform strengthening of SEA/SH measures as needed. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area. There are no potential indirect and/or long-term adverse impacts anticipated due to the parent project. Similarly, no long-term environmental and social impacts are expected due to the proposed activities for COVID 19 recovery under current restructuring. 3. Describe any potential alternatives (if relevant) considered to help avoid or minimize adverse impacts. Some investments into decentralized waste and wastewater management systems, and solar rooftop for energy will be made after assessing the available technology options available based on the existing site conditions under the parent project. The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) The proposed restructuring covers essential equipment and supplies to support COVID 19 recovery, and hence project alternatives are not relevant in context of intended interventions. 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. An Environmental and Social Management Framework (ESMF) has been prepared under the project, in accordance with OP 4.01 Category B project requirements. The ESMF ensures appropriate assessment of potential adverse risks and impacts and outlines actions to be followed by the borrower in mitigating potential adverse impacts associated with the project. These include (a) strengthening systems and capacity for overall health care waste management (not only bio-medical wastes), wastewater management in health facilities, and worker health and safety provisions; (b) strengthening basic infrastructure/ refurbishments and equipment facilities at the PHC and sub-center-level to manage bio-medical waste, infection control measures, and provide basic provisions (drinking water, seating space, adequate lighting) to enhance overall user experience, particularly in tribal and rural areas; (c) development of IEC material in audio-visual and interactive format and in local dialects for generating awareness especially amongst the illiterate population, vulnerable and marginalized groups; (d) ensuring the proposed system for capturing patient reported experience includes mechanisms to capture grievances and complaints across facilities and districts, evaluate patterns and enhance the user experience of health care; and (e ) orienting existing Village Health Communities and Women’s Self-Help Groups on basic symptoms of different NCDs and available screening and management services to ensure flow of information at the community level. The institutional capacity assessment carried out as part of the ESMF indicates there is a good level of technical capacity within the existing system of DoHFW for environment and social management. The state level National Health Mission and a Project Coordination Cell (PCC) therein has been designated as the PMU for the project. The PCC includes a dedicated, full-time environment and social safeguards specialist to support and monitor safeguards preparation and implementation. The E&S specialist provides oversight, monitoring and reports back on implementation of ESMF activities. The specialist is supported by District level safeguard specialists which are part of the district quality management teams. Further, at the health care facility (HCF) level, the administrative coordinator will support monitoring of E&S activities on site, as well as the screening checklist, and implementing environment and social mitigation measures at the facility level. The same staff arrangements will continue during the implementation of the restructuring activities. All staff supporting safeguards implementation are provided adequate trainings on Banks safeguards requirements and continued and refresher training programs on specific areas such as (i) worker health and safety (ii) ESMP monitoring and (iii) bio-medical waste management and general waste management. Capacity of HCF level staff will need to be augmented further to manage environment and social risks. This will be assessed on a case to case basis, and preparation of capacity building plan for environment and social for different cadre of HCF staffs and will be part of the regular training calendar being used by the project. The monitoring of ESMF implementation will also be done as per the parameters set under ESMF and will be integrated into the regular monitoring of the project. Data will be collected by the health care facility in charge and collected at district level by District safeguards officer. A monitoring report for the ESMF implementation will also be part of quarterly, six monthly and annual review by the PMU. This will comprise of all trainings, SOPs developed, equipments, EMPs and SMPs implemented at the HCF level. The ESMF includes detailed budget provisions for mitigation measures and capacity building, monitoring and reporting requirements at all levels of project implementation. The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) Proposed Project Restructuring: The AP Health, Medical and Family Welfare Department shall continue to operate and apply all environment and social safeguard instruments agreed under the parent project. There is no change in the safeguard policy triggers on account of proposed project restructuring. To cover new activities related to the proposed project restructuring, the existing environment safeguards instrument/s will be amended and redisclosed. The revision of safeguard instruments will include an update on project status, specific EHS risks and mitigation measures required in the context of the additional activities for responding to COVID-19 crisis. The implementation arrangements for activities proposed under project restructuring will be the same as that agreed for parent project. The project progress reports/E&S monitoring reports will include a section on environment and social performance related to COVID-19 activities. From an EHS perspective, special emphasis will be laid on: (i) the implementation of effective fire safety measures when enhancing PSA plants and/or dealing with oxygen supplies; (ii) appropriate management and disposal of solid, hazardous and potentially infectious/bio-medical waste, including safe disposal of autoclaved refuse and adequate emission control during incineration; (iii) emergency preparedness; and (iv) occupational health and safety aspects, specifically for health care givers and other workers associated with supply, installation, and operation of equipment, towards mitigating/managing likely environmental risks and issues linked to interventions proposed under project restructuring. From a social management perspective, the emphasis will be on proactive communication, engagement of vulnerable communities and responsive grievance redress systems to address inequities or discriminatory practices in the distribution, deployment, and access to COVID 19 related health services, oxygen therapies and equipment and SEA/SH. 5. Identify the key stakeholders and describe the mechanism for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The key stakeholders include community members across all districts and tribal areas, local community-based organizations (CBOs), Panchayati raj Institutions (PRIs), CH&FW along with its directorates including NHM and APVVP, and other collaborating departments such as Andhra Pradesh Tribal Welfare Department (APTWD), and Andhra Pradesh Pollution Control Board (APPCB). This includes staff members of health care facilities (HCFs) at district and below and functionaries and representatives of other departments including ITDA officials and district administration. The draft ESMF has been consulted upon at district and state level during development of the instrument, and prior to its disclosure with relevant stakeholders and government institutions. Initial consultations were done during the primary data collection from about 211 HCFs across all 13 districts of AP, and district level consultations in five districts i.e. East Godavari, Guntur, Prakasam, Nellore and Kadapa. The executive summary of the document was translated in local language and made public at the local level. The draft ESMF was disclosed in country on 5 February 2019, on (http://hmfw.ap.gov.in/).) and on info shop on 5 February, 2019.The district-level consultation process was especially sensitive to the needs of the tribal population and specific efforts were undertaken to ensure adequate representation from tribal communities, civil society organizations working in the area of tribal health, representatives of the Tribal Welfare Department, officials from the Tribal Reform Yardstick of the GoAP and other relevant stakeholders. The revised ESMF for parent project, following restructuring, was re-disclosed on the website of the Department of Health, Medical and Family Welfare, Government of Andhra Pradesh’s (http://hmfw.ap.gov.in/docs/ESMF_Report_1_Latest31032020.pdf) on March 31, 2020. Project Restructuring: The project restructuring for support to COVID-19 relief will add new stakeholders, including Health Department; Hospital Administrators; Health Care Professionals and Workers; Suppliers; Installation Engineers and Workers; Patients and Other Beneficiaries. In view of the ongoing pandemic, there are limitations and restrictions The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) for face to face consultations. However, guidance under available resources [including technical notes by the World Health Organization (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance) and the World Bank on risk and communication during the pandemic] will be used to ensure stakeholders are well informed about project activities. The project would adapt appropriate methods of consultation (including virtual means) that meets the needs of the different stakeholders, including project beneficiaries to ensure effective participation and equity in access and use of project information. Given the relative new nature of this pandemic and the evolving testing, treatment and therapeutic measures, a highly simplified and proactive information and knowledge sharing protocol that is available in local language accessible to literate, illiterate and the differently abled would be fundamental to enhance access to relevant information, including for the most vulnerable and disadvantaged sections of the community . Disclosure: The existing environmental and social safeguard instruments will be amended and re-disclosed by June 30, 2021 or such latter date as may be agreed in writing between the Borrower and the Bank DISCLOSURE_TABLE B. DISCLOSURE REQUIREMENTS ENV_TABLE Environmental Assessment/Audit/Management Plan/Other Date of receipt by the Bank Date of submission for disclosure 04-Feb-2019 05-Feb-2019 For Category ‘A’ projects, date of distributing the Executive Summary of the EA to the Executive Directors “In country� Disclosure INDIG ENOUS_TAB LE Indigenous Peoples Development Plan/Framework Date of receipt by the Bank Date of submission for disclosure 04-Feb-2019 05-Feb-2019 “In country� Disclosure Country Date of Disclosure India 05-Feb-2019 Comments COMPLIANCE_TABLE The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) C. COMPLIANCE MONITORING INDICATORS AT THE CORPORATE LEVEL EA_TABLE OP/BP/GP 4.01 - Environment Assessment Does the project require a stand-alone EA (including EMP) report? Yes If yes, then did the Regional Environment Unit or Practice Manager (PM) review Yes and approve the EA report? Are the cost and the accountabilities for the EMP incorporated in the credit/loan? Yes PCR_TABLE OP/BP 4.11 - Physical Cultural Resources Does the EA include adequate measures related to cultural property? Yes Does the credit/loan incorporate mechanisms to mitigate the potential adverse Yes impacts on cultural property? IP_TABLE OP/BP 4.10 - Indigenous Peoples Has a separate Indigenous Peoples Plan/Planning Framework (as appropriate) Yes been prepared in consultation with affected Indigenous Peoples? If yes, then did the Regional unit responsible for safeguards or Practice Manager Yes review the plan? If the whole project is designed to benefit IP, has the design been reviewed and NA approved by the Regional Social Development Unit or Practice Manager? PDI_TABLE The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank for Yes disclosure? Have relevant documents been disclosed in-country in a public place in a form and language that are understandable and accessible to project-affected groups Yes and local NGOs? ALL_TABLE All Safeguard Policies Have satisfactory calendar, budget and clear institutional responsibilities been Yes prepared for the implementation of measures related to safeguard policies? The World Bank RESTRUCTURING ISDS Andhra Pradesh Health Systems Strengthening Project (P167581) Have costs related to safeguard policy measures been included in the project Yes cost? Does the Monitoring and Evaluation system of the project include the monitoring Yes of safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed with the borrower Yes and the same been adequately reflected in the project legal documents? III. APPROVALS Task Team Leader(s) Amith Nagaraj Bathula Approved By Safeguards Advisor Pablo Cardinale 02-Jun-2021 Practice Manager/Manager Trina S. Haque 02-Jun-2021 . Note to Task Teams: End of system generated content