Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 03/14/2008 Report No.: AC3434 1. Basic Project Data Country: Jamaica Project ID: P106622 Project Name: Jamaica Second HIV/AIDS Project Task Team Leader: Mary T. Mulusa Estimated Appraisal Date: March 17, 2008 Estimated Board Date: May 8, 2008 Managing Unit: LCSHH Lending Instrument: Specific Investment Loan Sector: Health (80%);Other social services (20%) Theme: HIV/AIDS (P);Health system performance (S) IBRD Amount (US$m.): 10.00 IDA Amount (US$m.): 0.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: Borrower 1.00 Financing Gap 0.00 1.00 Environmental Category: B - Partial Assessment Simplified Processing Simple [X] Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) or OP 8.00 (Rapid Response to Crises and Emergencies) Yes [ ] No [X] 2. Project Objectives The project development objectives are to contribute to the Governme nt’s national HIV/AIDS program through support to: (i) deepening prevention interventions targeted at high risk groups and for the general population; (ii) increasing access to treatment, care and support services for infected and affected individuals; and (iii) strengthening program management and analysis to identify priorities for strengthening the health sector capacity to respond to the HIV/AIDS epidemic and other priority health problems. 3. Project Description 1. Component 1 (a): Prevention Activities. Prevention activities are a high priority of the national HIV/AIDS program and need to be scaled up significantly to halt and reverse the spread of the epidemic. Three implementing agencies will scale up prevention activities: the Ministry of Health and the Regional Health Authorities; five non-health line ministries; and civil society including the private sector. 2. Subcomponent 1(a): Prevention Activities By The Ministry Of Health And Environment (MOHE) and The Regional Health Authorities (RHAs). This subcomponent will strengthen the capacity of MOHE and of the RHAs to provide Page 2 technical guidance for the national response to HIV/AIDS and to deliver HIV/AIDS related services for prevention through the health care system. Activities financed would include: (i) Support to behavior change communication (BCC) interventions targeting at- risk groups (CSW, MSM, in and out of school youth, inmates, drug users) and the general population; (ii) Expansion of VCT for scaling up treatment and care and for preventing HIV transmission and expansion of PMTCT Services; (iii) Increased condom use; and (iv) Development of Strategies and activities to promote the health of HIV positive persons: supportive environment for disclosure, promoting peer support groups within the health services, reproductive health services, and ensuring social support. 3. Subcomponent 1. (b): Prevention Activities By The Non-Health Line Ministries. Strengthening Prevention Requires Scaling Up The Contribution Of The Non-Health Line Ministries To Make The National Response Truly Multi-Sectoral. Five key line ministries: (i) Education; (ii) Labor and Social Security; (iii) Tourism; (iv) Local Government, Community Development and Sports; and (v) National Security have been identified because they can reach important segments of vulnerable and/or at risk population groups through their official mandates. Activities would include implementing workplace HIV/AIDS policies; BCC; condom distribution and promotion; advocacy to reduce HIV/AIDS stigmatization and discrimination; training; and, technical and material support for focal points, and their respective ministerial HIV/AIDS Committees. 4. Subcomponent 1. (c): Prevention Activities By Civil Society Organizations (CSOs). The project would finance CSOs through demand- driven “subprojects” thatwould target interventions for: i) Youth that would include sexuality education, risk assessment, behavior modeling and leadership training; ii) Commercial Sex workers (CSWs) interventions that include better access to counseling and health care, skills development for alternative income generation, referral to agencies such as housing and drug addiction/prevention and support to increased involvement of club operators/ and the tourism services in risk reduction interventions including increased condom use; iii) Men having sex with men by continuing training of trainers on risk reduction among the MSMs, referral to STI/HIV test and treatment along with adherence and positive prevention. 5. Component 2: Treatment, Care and Support. This component would provide financing to support the strategy outlined in the NSP to enhance the following services: (i) Laboratory Services. The project would help strengthen HIV diagnostic services at the regional laboratories and the National Public Health Laboratory (NPLH). It would finance testing kits, reagents and supplies for HIV and syphilis. The project would also finance the training of staff, reviewing HIV testing algorithms and quality control mechanisms and a maintenance plan for equipment. (ii) Blood Safety. All blood collected is screened for infectious markers including HIV at the National Blood Bank located in Kingston. Blood donations mainly come from replacement donors. The project will support blood safety including efforts to increase voluntary blood donations. (iii) Treatment: antiretroviral therapy, PMTCT, opportunistic infections (OIs) and sexually transmitted infections (STIs). The project would finance drugs including antiretroviral Page 3 therapy drugs, nutritional supplements, substitution infant feeding formula, and training of health care workers in comprehensive management of HIV, STIs, OIs and PMTCT.(iv) Tuberculosis (TB). The project would support scaling up diagnosis and treatment of TB patients and the detection of HIV in this group through the financing of laboratory equipment and supplies to expand AFB smear in regional laboratories. It would also contribute to other supportive services. 6. Component 3: Strengthening Institutional Capacity for Policy Formulation, Program Management and Monitoring and Evaluation. Subcomponent 3. (a) Policy Formulation for an Enabling Legal and Regulatory Environment and Human Rights. The project will provide technical assistance to support changes to the legislative framework that have been recommended by the legislative review including updating of the Public Health Act to deal with new health challenges such as HIV/AIDS and advocacy for further legislative and policy reform to address stigma and discrimination. Subcomponent 3. (b) Program Management. The project will also support staff costs required for the technical (reviewing work programs from line ministries and proposals from civil society implementing agencies; monitoring and evaluating program progress; and, training its staff and fiduciary functions of the PCU, Line Ministries and CSOs) and fiduciary functions of the PCU. Subcomponent 3. (c) Monitoring and Evaluation. The project will finance technical assistance, equipment and training to strengthen the M&E system and the decision-making process through: staffing; training; preparation of a costed M&E Operational Plan and Map; harmonizing the information flow from multiple data sources for impact, outcomes, outputs and inputs; i.e., biological HIV surveillance; behavioral HIV surveillance; studies on special populations and other small surveys; conducting surveys and surveillance; integrating the five national and sub-national HIV databases; and, prioritizing the evaluation and research agenda. 7. Component 4: Health Sector Development Support. Sub-component 4 (a) Biomedical Waste Management. The project will support upgrading and improved management of the biomedical waste management system. This will include: technical assistance for drafting new National Medical Waste Management Regulation; upgrading medical waste treatment facilities; equipment and capacity building activities: develop and disseminate medical waste management training material; train healthcare workers in medical waste management and post exposure prophylaxis, including regional ‘Training of Trainers’ workshops; share best practices; and train staff for operation and maintenance of new equipment. Subcomponent 4 ( b)Diagnostic Capacity Assessment for the Health Sector. This subcomponent will also finance an assessment of the obstacles that limit the capacity of the health sector to deliver quality health care efficiently. It would prioritize cost effective interventions and finance those that would be most helpful to the NHP to reach its objectives. Activities to be financed could include technical assistance, consultant services, medical equipment and supplies, minor civil works to upgrade and renovate health care facilities, and training of health care personnel. 4. Project Location and salient physical characteristics relevant to the safeguard analysis National Scope Page 4 5. Environmental and Social Safeguards Specialists Mr Gunars H. Platais (LCSEN) Ms Josefina Stubbs (LCSSO) Ms Jean Rutabanzibwa-Ngaiza (AFTHV) 6. Safeguard Policies Triggered Yes No Environmental Assessment (OP/BP 4.01) X Natural Habitats (OP/BP 4.04) X Forests (OP/BP 4.36) X Pest Management (OP 4.09) X Physical Cultural Resources (OP/BP 4.11) X Indigenous Peoples (OP/BP 4.10) X Involuntary Resettlement (OP/BP 4.12) X Safety of Dams (OP/BP 4.37) X Projects on International Waterways (OP/BP 7.50) X Projects in Disputed Areas (OP/BP 7.60) X 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: One safeguard policy, Environmental Assessment (OP/BP/GP 4.01) is triggered due to the biomedical waste that is will be generated in the course treatment. The Government has a bio-medical waste management system in place. A number of investments including upgrading of biomedical waste equipment and staff training have been financed under the ongoing Bank-financed project. The assessment under the ongoing project has been updated and a number of areas identified for further strengthening of health care waste management. Some of the priority actions will be financed under the new project. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: N/A 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. N/A 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 Government has a bio-medical waste management system in place. A number of investments in equipment and staff training have been financed under the ongoing Bank- financed project. The assessment of the system has been updated and specific areas for strengthening biomedical waste have been identified. Most of the project activities under the project are not expected to generate adverse environmental effects. Some medical Page 5 waste is expected to be generated during the administration of HIV tests and in the management of treatment for PLWHA. In relation to construction, there will also be small-scale rehabilitation of existing health care facilities to ensure appropriate provision of HIV/AIDS services. Measures that the Government will take to mitigate potential environmental effects will be detailed in the Project Appraisal Document. The project will support the Government to implement those measures. Of particular importance is the need to ensure that health care workers are adequately trained on medical waste management. The project will provide support for: drafting new National Medical Waste Management Regulation; standardizing waste management procedures in all health care facilities; strengthening capacity of health care waste management including training for health care workers in proper waste management and post exposure prophylaxis; and, upgrading of regional medical waste collection systems and treatment facilities with specialized medical waste collection vehicles and alternative technology. On the management of environmental risks of small-scale construction works, the project’s coordination unit will incorporate the required Bank environmental guidelines in the project’s operations manual and standard bidding documents for civil works. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. N/A B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 03/14/2008 Date of "in-country" disclosure 03/14/2008 Date of submission to InfoShop 03/14/2008 For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors Resettlement Action Plan/Framework/Policy Process: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Indigenous Peoples Plan/Planning Framework: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Pest Management Plan: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Page 6 Date of submission to InfoShop * If the project triggers the Pest Management and/or Physical Cultural Resources, 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: C. Compliance Monitoring Indicators at the Corporate Level (to be filled in when the ISDS is finalized by the project decision meeting) 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 Sector Manager (SM) review and approve the EA report? Yes Are the cost and the accountabilities for the EMP incorporated in the credit/loan? Yes The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank's Infoshop? Yes 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 and local NGOs? Yes All Safeguard Policies Have satisfactory calendar, budget and clear institutional responsibilities been prepared for the implementation of measures related to safeguard policies? Yes Have costs related to safeguard policy measures been included in the project cost? Yes Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures related to safeguard policies? No Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? Yes Page 7 D. Approvals Signed and submitted by: Name Date Task Team Leader: Ms Mary T. Mulusa 03/14/2008 Environmental Specialist: Mr Gunars H. Platais 03/14/2008 Social Development Specialist Additional Environmental and/or Social Development Specialist(s): Approved by: Regional Safeguards Coordinator: Ms Maria Isabel Junqueira Braga 03/14/2008 Comments: Sector Manager: Mr Keith E. Hansen 03/14/2008 Comments: