Page 1 INTEGRATED SAFEGUARDS DATA SHEET CONCEPT STAGE Report No.: AC4191 Date ISDS Prepared/Updated: 02/05/2009 I. BASIC INFORMATION A. Basic Project Data Country: Guinea-Bissau Project ID: P115208 Project Name: National Health Development Plan Support - Second Phase Task Team Leader: Johanne Angers Estimated Appraisal Date: February 12, 2009 Estimated Board Date: March 31, 2009 Managing Unit: AFTH2 Lending Instrument: Specific Investment Loan Sector: Health (100%) Theme: Health system performance (P) SPF Amount (US$m.): 0.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: Borrower 0.00 State and Peace Building Fund 2.04 Financing Gap 0.00 2.04 B. Project Objectives [from section 2 of PCN] Given the limited envelope and timeframe of this grant, the project focuses on key interventions selected on the basis of their potential leveraging effect to strengthen critical areas of the health system and attract additional resources from development partners. The development objective of the grant is to improve the health system capacity to deliver basic health services in three target regions (Bafata, Gabu, and Cacheu). While not an explicit goal, it is also hoped that the project will play a catalytic role in engendering support among other development partners for the implementation of PNDS-II. C. Project Description [from section 3 of PCN] The grant will support activities in four components: (1) improving service delivery in three pilot regions through a better supervision system and greater accessibility of essential drugs at the primary care level; (2) improving the quality and management of human resources through support to the National School of Public Health and to the Directorate of Human Resources of the MoPH; (3) strengthening the health information system (HIS); and (4) improving the financial management of the sector. A fifth component will finance project management. Page 2 1. Improving service delivery in three pilot regions This component will finance activities that should result in better services to the population of Cacheu, Bafata and Gabú regions by making a more effectiveuse of available resources with minimal additional recurrent costs. The focus will be on: (i) improving the performance of health centers staff by strengthening the quality of supervision from the central level, in particular by adopting a formative approach to supervision; and (ii) increasing the availability of drugs and medical supplies by strengthening the supply chain and the existing network of regional storehouses. (i) Supervision • Training and technical assistance in formative supervision; • Production, testing and dissemination of supervision tools; • Operating expenditures (including a vehicle) for formative and integrated supervision by the central to the decentralized levels in the three target regions. (ii) Supply chain • Small-scale building repairs and equipment (air conditioning, painting, masonry work, and shelving) of the existing eight storehouses in the three target regions; • Technical assistance to improve the organization and reliability of the supply chain of drugs and medical supplies; • Procurement of essential drugs and medical supplies for the three target regions with a view to test the supply and distribution chain. 2. Improving the quality and management of human resources This component will support the implementation of key areas of the government Human Resources Development Strategy (2007) and Action Plan by focusing on the production of health personnel in close collaboration with the Oswaldo Cruz Foundation (Brazil) which will train the faculty. The proposed grant will focus on strengthening the two government institutions responsible for human resources in the health sector. It will support: (i) the National School of Public Health (NSPH), responsible for training nurses, midwives, and health technicians, with facility improvements, updated curricula, and provision of textbooks, reference and teaching/learning materials; and (ii) the Directorate of Human Resources (DHR) of the MoPH in planning and managing the Ministry workforce, with an emphasis on improving its distribution and on establishing positive incentive mechanisms through the use of a performance-based approach to attract, motivate and retain staff, particularly in remote areas. The activities that would be financed are as follows. (i) National School of Public Health • Small rehabilitation (e.g. plumbing, sanitation, painting), teaching equipment, basic equipment (e.g., computers, printers) and office supplies; • Technical assistance for curriculum update; • Production and/or procurement of learning and teaching materials to reflectthe updated curriculum. Page 3 (ii) Directorate of Human Resources • Technical assistance for the implementation of the Human Resources Development action plan, including the establishment of a performance-based approach. Trade Unions would be involved throughout the process to ensure their buy-in. Also, given budgetary constraints, care will be taken not to rely on monetary incentives when developing the performance-based approach. • Office supplies. 3. Strengthening the health information system This component will support the strengthening of the health information system (HIS) to produce timely and reliable data, so as to enable timely and strategic decision-making. It will specifically (i) provide support to the Department of Hygiene and Epidemiology (DHE) of the MoPH to improve its capacity to analyze data and to inform the decentralized levels accordingly; and (ii) improve the data collection system at the decentralized level to obtain reliable information and feed it to the central level. Concerning data collection, proposed changes to the system will be piloted in the three target regions of Cacheu, Bafata and Gabú.Technical leadership of the department will also be strengthened to improve the quality of work and ensure better management of its technical team. The activities that would be financed are as follow: (i) Data analysis and information dissemination • Long-term (two years) technical assistance to the DHE/MoPH to (a) help set upa system for timely collection and analysis of data as well as timely dissemination of relevant information to the decentralized levels, and (b) provide on-the-job training in analytical techniques and evidence-based decision-making; • Workshop to update DHE staff epidemiological competence and strengthen managerial skills; • Office supplies for DHE/MoPH. (ii) Data collection • Training on data collection and analysis at the central and decentralized levels; • Support materials for data collection and analysis (e.g., intake forms, datasheets) 4. Strengthening MoPH financial management capacity This component will finance activities drawing from the recommendations of the Public Expenditure Review (PER, 2007), which is one of the key documents underpinning PNDS-II, notably: (i) supporting the MoPH for the effective use of available financing, including reducing disparities in budget allocation among priority areas and in promoting innovative approaches linked to the demand for health care; (ii) improving MoPH budget preparation process; and (iii) strengthening of MoPH capacity to mobilize and coordinate external resources as well as its negotiating skills with the Ministry of Finance to improve budgetary planning, resources allocation and budget execution (with particular attention to the timely payment of staff salaries). The activities that would be financed are as follow: Page 4 • Technical assistance focusing on health budgeting, financing and options for innovative approaches to increase financial resources; • Training and workshops on health budgeting and financing; • Training on advocacy for internal and external resources mobilization. 5. Project Management The grant will also finance support to the MoPH to ensure that the funding provided is used efficiently, transparently and in accordance with Bank fiduciary requirements. To this end, the MoPH Management Unit (MU) will be strengthened to enable it to manage the project (see Implementation Arrangements). Activities to be financed are: • Consulting services to ensure proper fiduciary management (coordination, financial management, accounting, and procurement); • Technical assistance to prepare an end-of-project independent evaluation; • Consulting services for a single grant audit; • Office supplies and other operating expenditures to fulfill management responsibilities. D. Project location (if known) Small repairs in health centers, where needed, in the regions of Gabu, Cacheu, and Bafata, and small repairs at the National School of Public Health. E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN] The Management Unit who will be responsible for fiduciary tasks has proven experience in managing externally-funded operations, including IDA-financed operations. Under the now closed National Health Development Project (closed in December 31, 2007), the following safeguards measure were followed to ensure adequate disposal of waste that may be caused by the small repairs (components 1 and 2 above). The activities will be small-scale and will not generate hazardous materials, such as asbestos- containing demolition waste; and (iii) the Recipient will provide simple guidelines (incorporated into contracts) to the contractors that will be making the repairs. For the small work the contractors will focus on workplace safety and disposal of debris as well as avoidance of asbestos or other hazardous materials in the repair work. The guidelines and checklist used under the IDA-financed health sector operation, which closed on December 31, 2007, will be incorporated into the contracts. The Grant will not be used for activities that may entail involuntary resettlements. The Environmental Assessment is triggered for the following reasons: Small-scale building repairs and small-scale rehabilitation activities (plumbing, sanitation, painting etc.) are typical of category B projects. For this, the Project is rated as a 'Mild' B. Simplified Medical Waste Management Plan and a mini Environmental Management Plan will be prepared and submitted to ASPEN for clearance and disclosure within six months of Grant signature. As such AFTEN will provide the team with relevant models of these documents (in French) so that sample adaptation can quickly be produced by a consultant financed under the Grant and subsequently be made available. Page 5 F. Environmental and Social Safeguards Specialists Mr Warren Waters (AFTQK) Mr Africa Eshogba Olojoba (AFTEN) II. SAFEGUARD POLICIES THAT MIGHT APPLY Safeguard Policies Triggered Yes No TBD Environmental Assessment (OP/BP 4.01) X B-Partial Assessment 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 Environmental Category: B - Partial Assessment III. SAFEGUARD PREPARATION PLAN A. Target date for the Quality Enhancement Review (QER), at which time the PAD-stage ISDS would be prepared: N/A B. For simple projects that will not require a QER, the target date for preparing the PAD-stage ISDS: 02/06/2009 C. Time frame for launching and completing the safeguard-related studies that may be needed. The specific studies and their timing 1 should be specified in the PAD-stage ISDS. Simplified Medical Waste Management Plan and a mini Environmental Management Plan will be prepared, reviewed and disclosed. As such AFTEN will provide the team along with Terms of Reference with relevant models of these documents (in French) so that sample adaptation can quickly be produced by a consultant financed under the Grant and subsequently be made available. These documents should be prepared, reviewed, and disclosed within six months after Grant signature. The SMU has agreed to accept transfer of the safeguard responsibilities. 1 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 IV. APPROVALS Signed and submitted by: Task Team Leader: Ms Johanne Angers 02/02/2009 Approved by: Regional Safeguards Coordinator: Mr Warren Waters 02/04/2009 Comments: Sector Manager: Ms Eva Jarawan 02/02/2009 Comments: Signed hard copy is available in IRIS.