Page 1 Integrated Safeguards Data Sheet (ISDS) Section I – Basic Information Date ISDS Prepared/Updated: June 21, 2004 Report No.:AC891 A. Basic Project Data A.1. Project Statistics Country: Philippines Project ID: P079628 Project: PH-2ND WOMEN'S HEALTH & SAFE MOTHERHOOD TTL: Teresa Ho Total project cost (by component): Appraisal Date: June 21, 2004 Loan/Credit amount($m): IBRD: 30 Board Date: December 16, 2004 Other financing amounts by source: ($m.) Managing Unit: EASHD Sector: Health (100%) Lending Instruments: Specific Investment Loan Is this project processed under OP 8.50 (Emergency recovery? Yes? [ ] No? [ ] Environmental Category: B Safeguard Classification: S2 A.2. Project Objectives Two objectives are proposed for the project: 1) To assist disadvantaged women of reproductive age to gain sustainable access to high quality and cost-effective reproductive health (RH) services and to enable them to safely attain their desired spacing and number of children 2) To assist in the development and implementation of systems within the framework of the Health Sector Reform Agenda (HSRA) that are critical for financing and delivery of reproductive health services. A.3. Project Description Development Objectives: 1. To increase the access of disadvantaged women of reproductive age in selected project sites to acceptable, high quality and cost-effective reproductive health services and enable them to safely attain their desired spacing and number of children. 2. To assist in the development and implementation of sustainable and replicable systems within the framework of the Health Sector Reform Agenda for financing and delivery of reproductive health services. Key Performance Indicators Page 2 1. 75% of deliveries by the poor in BEMOCs and CEMOCs financed through PhilHealth SP 2. 25% of deliveries by the poor in BEMOCs and CEMOCs financed through DOH- LGU performance grant 3. 100% of RHUs have not experienced stock out pills, injectables and IUDs for the past six months 4. 80% births delivered by skilled attendant (health professional), either in a facility or at home. 5. Increase by 100% births delivered in health facility 6. Reduce the unmet needs for FP services by 10 percentage points Project Components: Component A. Local Delivery of the Integrated WHSM Service Package This component would support local governments in mobilizing networks of public and private providers to undertake activities and deliver services in the integrated Women's Health and Safe Motherhood service package (WHSM-SP), with focus on maternal care, family planning and STI/HIV control services. The Project will give priority attention to assuring that disadvantaged women obtain their fair share in access to and use of the WHSM-SP. The component would be implemented in six project sites over a period of six years, starting in the first year of the Project with a first batch of three sites (Sorosogn Province, Surigao del Sur Province and Iloilo City) to be followed in the third year of the Project by a second batch of sites (still to be identified). Project sites were/will be selected using three sets of criteria: (a) need, as measured by maternal mortality, infant mortality and contraceptive prevalence rates; (b) population size, limited to provinces or cities with populations between 200,000 and 800,000, deemed to represent the appropriate scale for implementation of a full and integrated WHSM-SP; and (c) interest and willingness of LGU leadership to participate in the project. In each project site , the Project would undertake an interrelated set of interventions, including: · Critical Capacities to Provide Quality WHSM Services . The Project will help LGUs in the project sites establish the capacity to deliver the integrated WHSM-SP through the establishment and operation of a network of WHSM teams consisting of a Women’s Health Team (WHT) in every barangay and an appropriate number of Basic and Comprehensive Emergency Obstetric Care (BEmOC, CemOC) and NCV/BTL teams, appropriately dispersed throughout the project site. The full maternal care, family planning and STI/HIV service packages will be provided to the general population in all project sites. In addition, on a pilot scale and in selected sites only, the DOH will engage the services of NGOs with relevant experience to help LGUs develop and implement cost-effective and sustainable approaches for reaching three groups at especially high risk – freelance sex workers, OFWs, and young adults. · Reliable and Sustainable Support Systems for WHSM Service Delivery . The Project would facilitate establishment and operation of systems for (a) drug and contraceptive security , by (i) applying market segmentation in the Page 3 financing and distribution of contraceptives; (ii) establishing efficient province/city-wide procurement, logistics and management systems; (iii) supporting the expansion of existing social marketing initiatives for providing contraceptives; (b) safe blood supply , by re-enforcing the network of Blood Service Facilities (BSF) at different levels of the system to meet anticipated needs for safe blood for obstetric (and other) emergencies (c) behavior change interventions , including a combination of: (i) performance-based and other financial incentives for stakeholders; (ii) advocacy and communication to influence stakeholder behavior and increase information among stakeholders; and (iii) improvements in services to respond to non-financial barriers that affect behavior; and (d) sustainable financing of local WHSM services and commodities , by applying the two principles of (i) diversification of funding sources, with focus on PhilHealth and LGUs as growing sources, and (ii) market segmentation, for objective application of user charges to non-poor clients. Component B: National Capacity to Sustain WHSM Services This component would support national-scale policy frameworks and knowledge management mechanisms that would create an operating environment conducive to LGUs managing and sustaining local delivery of the WHSM-SP and facilitate replication of the integrated WHSM service model throughout the country. It consists of three sub- components: Sub-component B.1. Operational and Regulatory Guidelines for the Provision and Use of WHSM Services . This subcomponent will support the research-based formulation, transparent official adoption, thorough field dissemination, and enforcement of technical guidelines that will be critical to the provision and use of WHSM services. Sub-component B.2. Network of Training Providers for the Integrated WHSMP-SP . This subcomponent will support the development of a network of training providers accredited to provide efficiently designed courses on (i) the appropriate delivery of the integrated WHSMP-SP for each category of WHSM worker and (ii) team work and collaboration for each type of WHSM team. Sub-component B.3 Monitoring, Evaluation, Research and Dissemination . This subcomponent will provide the following types of information for project management and impact evaluation: (a) regular assessment of inputs and processes related to the Project Development Objective and sub-components; (b) annual reporting of service delivery performance; (c) changes in key result indicators at mid-term and end of project as measured against baseline status and comparison groups (later for selected sites only); (d) operations research and special studies that evaluate the effectiveness of innovative activities for use in replication and scaling-up; and (e) dissemination of results to support evidence based decision-making processes. The collection and analysis of data generated by these different mechanisms will be embedded within WHSM Project management functions, with emphasis on developing evidence-based decision making capacity. In particular the service delivery performance reporting will utilize rout inely collected Page 4 statistics derived from the DOH information system. A.4. Project Location and salient physical characteristics relevant to the safeguard analysis: Iloilo City and the Provinces of Sorsogon and Surigao del Sur serve as the first batch of project sites. The second batch of project sites has yet to be identified. Selected health facilities in these pilot sites will be rehabilitated or upgraded. There is a possibility that land acquisition will be needed in a few cases. In these cases, the Bank’s Policy on Involuntary Resettlement (OP/BP4.12) will be triggered. The Province of Sorsogon is the home of around 53,000 IPs belonging to the agta-cimaron-tabagnon cultural-minority group. On the other hand, some 170,000 manobo/mandayas have been recorded in Surigao del Sur Province. IPs belonging to the atisulod-bukidnon ethnic groups (estimated at 57,000) reside in certain portions of Iloilo Province. Of the 36 municipalities/cities in the three project sites, indigenous peoples were noted in 12 municipalities. Six of these municipalities are situated in Sorsogon (Bulusan, Donsol, Irosin, Matnog, Pilar and Prieto Diaz), while the other six are in Surigao del Sur (Bislig, Carmen, Cagwait, Lanuza, Lingig and San Miguel). The Social Assessment conducted as part of the preparatory activities covered two areas within the project sites with indigenous peoples: Prieto Diaz in Sorsogon where the Agta-Cimaron-Tabangons reside and Lanuza in Surigao del Sur where the Mamanwas and manobos reside. Prieto Diaz has an estimated population of 19,352. It has 23 barangays with 3,751 households. The Agta/Tabangnons number 356 (191 males and 165 females) and they comprise 63 households. Barangay San Rafael, where the IP community is located, has a land area of 335 hectares, half of which is devoted to agriculture. The major occupation is farming and this allows each family to generate an average monthly income of P2, 500. Health status in the community is poor, as is education (intermediate level on the average). Access to health services of women IPs in the barangay is limited to prenatal services. Childbirth support is very dependent on the support of traditional birth attendant in the community, referred locally as “hilot” or “parabulong”. Birth control is rarely practiced among couples and people generally rely more on herbal plants than commercial medicines. The Manobos and Mamanwas of Lanuza, Surigao del Sur, on the other hand, reside in barangay Pakuan. It mostly consists of 312 hectares of mo untainous and wooden terrain. The community has no electricity and no safe water supply. It also has no access roads, school or health centers. Modern means of communication are non-existent and this has allowed the community to preserve their customs and colorful traditions. Women in the barangay are dependent on the traditional birth attendant in the community for both prenatal and childbirth support. No major adverse social impact to the Indigenous Peoples is anticipated from the various project interventions. Instead, the project can enhance services delivered to the Ips. The central challenge to the project is how effectively it can reach and benefit the vulnerable and high risk groups it has targeted, among which are the indigenous peoples of the area. A draft Indigenous People’s Development Plan (IPDP) was prepared by DOH to guide the preparation of specific IPDPs in the two project sites (Sorsogon and Surigao del Sur) where IPs are known to reside. Page 5 B. Check Environmental Category A [ ], B [X ], C [X], FI [ ] Comments: The rehabilitation, construction and operation of health care facilities to support the local delivery of the WHSM service package is not expected to adversely affect the environment. Most of the civil works activities will involve rehabilitation and upgrading of existing health facilities, with a limited number of new construction.. Wastes generated from operating the facilities are expected to not significantly affect the environment if managed, treated and disposed of properly. To this end, the project is classified as environment Category B because of its short-term, manageable and easily mitigable environmental impacts. C. Safeguard Policies Triggered Yes No Environmental Assessment (OP /BP /GP 4.01) [X ] [ ] Natural Habitats (OP /BP 4.04) [ ] [X ] Pest Management (OP 4.09) [ ] [ X] Cultural Property (draft OP 4.11 - OPN 11.03 -) [ ] [ X] Involuntary Resettlement (OP /BP 4.12) [X ] [ ] Indigenous Peoples (OD 4.20 ) [X ] [ ] Forests (OP /BP 4.36) [ ] [ X] Safety of Dams (OP /BP 4.37) [ ] [ X] Projects in Disputed Areas (OP /BP /GP 7.60) * [ ] [ X] Projects on International Waterways (OP /BP /GP 7.50) [ ] [ X] * By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas Page 6 Section II – Key Safeguard Issues and Their Management D. Summary of Key Safeguard Issues . D.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 environmental assessment (EA) study commissioned by the DOH as part of project preparation identified two environmental issues that need to be addressed by the project. These are the short-term impacts ( e.g ., noise and dust generation) from civil works activities and the potential impacts from waste generation and disposal. The anticipated impacts, however, are not expected to adversely affect the environment. Most of the civil works activities will involve rehabilitation and upgrading of existing health facilities, with a limited number of new construction. Wastes generated from operating the facilities are expected to not significantly affect the environment if managed, treated and disposed of properly. Very limited land acquisition/involuntary resettlement issues are anticipated from the project, since most civil works involve the rehabilitation/upgrading of existing facilities. In year 1, all subprojects are rehabilitation of existing health facilities, except for one subproject in Sorsogon which may involve the construction of a district hospital in a privately-owned site, which the landowner is offering to donate. However, no decision has been made whether to put the facility in this new site or in the present site of the hospital. Project sites for the subsequent years are yet to be determined. To guide the project in dealing with possible land acquisition/resettlement impacts from future subprojects, a Resettlement Policy Framework shall be prepared. No adverse negative impact on the indigenous communities in the project sites is foreseen. The expected impact and objective of the proposed upgrading of facilities and expanded/improved reach of services is the improved access of vulnerable women (including indigenous people) residing within the catchment/service area of such facilities. D.2 Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area. Environmental impacts from the project are manageable and easily mitigable and cumulative impacts are not expected. Impacts from civil works activities are expected to be short-term, highly reversible and last up to the construction phase only. Wastes generated during the operation of the completed facilities will be properly handled, treated and disposed of following the measures and project guidelines on health care waste management. On the other hand, improved access of indigenous people to more effective maternal care and education is expected to result to a sustained and long term improvement in their health. Page 7 D.3. Describe the treatment of alternatives (if relevant) D.4. Describe measures taken by the borrower to address safeguard issues. Provide an assessment of borrower capacity to plan and implement the measures described. A. Environmental Assessment For construction impacts, all contracts will include clauses for proper construction site management and strict adherence to appropriate noise and dust standards, disposal of solid wastes, installation of sanitary facilities for workers and the observance of occupational health and safety standards. For health care wastes, the facility proponent/operator will be required to prepare and implement health care waste management plan as part of the screening and approval processes of the project. The project will support establishment of systems for waste storage, disposal of general wastes, installation of onsite capability for treatment and containment, infectious waste sterilization and treatment capability, and materials acquisition management in project facilities. The capacity of the operators on health care waste management will be built up and/or strengthened through continuous trainings by the DOH in collaboration with the Department of Environment and Natural Resources (DENR), the primary environmental agency in the country. B. Involuntary Resettlement Land acquisition and resettlement measures, if unavoidable, shall be the responsibility of the participating LGU. A Resettlement Policy Framework has been prepared for the project. This shall be made an integral part of the Memorandum of Agreement (MOA) between DOH and the participating LGUs to ensure commitment of the LGUs to the guidelines in the framework. Environment and social safeguards appraisal and monitoring shall be among the functions to be undertaken by the WHSMP PMO under the Unified Project Management Division (UPMD) of the DOH. C. Indigenous People DOH prepared a draft IPDP to guide the preparation of specific IPDPs for the two project sites with known IP population (Sorsogon and Surigao del Sur). This draft has been reviewed and cleared by the EASES Safeguards Committee during the Safeguards Review in June 16, 2004. DOH is set to organize planning sessions in July 2004 with IP communities, the provincial LGUs and NCIP offices in these two areas to develop a more detailed action plan that would help improve the access of IPs to the various project intervent ions in a manner that is Page 8 compatible with their cultural practices and beliefs. A Memorandum of Agreement (MOA) shall be entered into between DOH and NCIP to formalize the agreed roles of each agency in the implementation, monitoring and evaluation of the IPDPs. D.5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The proposed project design is the product of three days of consultations with representatives of DOH units, PHIC, public and private provider institutions, donor institutions and other stakeholder groups held during the project identification mission in August 2002. During the actual preparation of the project, consultative meetings were made among providers of maternal care and adolescent reproductive health services and LGU officials. Focus group discussions were conducted with adolescents, women of reproductive age group and traditional birth attendants enriched the development of the proposed service delivery models. These intensive consultations will continue throughout project preparation and implementation. The EA study was conducted in a consultative and participatory manner, where inputs from the DOH, participating local government units (LGUs), Department of Environment and Natural Resources (DENR) and other stakeholders were sought. The results were disclosed locally through a series of consultation-workshops with the central and regional officials and staff of the DOH, the DENR, participating LGUs, service providers and civil society. In the case of indigenous peoples, the project preparation team coordinated with the Regional Offices of the National Commission on Indigenous Peoples (NCIP) for the conduct of informal discussions and interviews with some indigenous people in Sorsogon and Surigao del Sur in order to obtain initial insights on the practices and views of indigenous people on matters related to maternal health. Subsequent discussions/consultations are being planned with key IP leaders and NCIP to firm up the draft IPDP for the project and clarify the institutional partnership with NCIP. Once finalized, the IPDPs for Sorsogon and Surigao del Sur will be disseminated to the different IP communities in the municipalities in these provinces through the NCIP Provincial Offices and Service Centers for disclosure. Page 9 F. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Date of receipt by the Bank 06/07/04… or Not Applicable Date of “in-country” disclosure 05/26-28/04 or Not Applicable Date of submission to InfoShop 06/21/04 or Not Applicable For category A projects, date of distributing the Executive Summary of the EA to the Executive Directors …/…/… or Not Applicable Resettlement Action Plan/Framework/Policy Process: Date of receipt by the Bank 06/07/04… or Not Applicable Date of “in-country” disclosure 06/15/04 or Not Applicable Date of submission to InfoShop 06/21/04 or Not Applicable Indigenous Peoples Development Plan/Framework: Date of receipt by the Bank 06/07/04… or Not Applicable Date of “in-country” disclosure 06/15/04 or Not Applicable Date of submission to InfoShop 06/21/04 or Not Applicable Pest Management Plan: Date of receipt by the Bank …/…/… or Not Applicable Date of “in-country” disclosure …/…/… or Not Applicable Date of submission to InfoShop …/…/… or Not Applicable Dam Safety Management Plan: Date of receipt by the Bank …/…/… or Not Applicable Date of “in-country” disclosure …/…/… or Not Applicable Date of submission to InfoShop …/…/… or Not Applicable If in-country disclosure of any of the above documents is not expected, please explain why. Section III – Compliance Monitoring Indicators at the Corporate Level (To be filled in when the ISDS is finalized by the project decision meeting) OP/BP 4.01 - Environment Assessment: Yes No Does the project require a stand-alone EA (including EMP) report? If yes, then did the Regional Environment Unit review and approve the EA report? Are the cost and the accountabilities for the EMP incorporated in the credit/loan? OP/BP 4.04 - Natural Habitats: Yes No Would the project result in any significant conversion or degradation of critical natural habitats? If the project would result in significant conversion or degradation of other (non-critical) natural habitats, does the project include mitigation measures acceptable to the Bank? OP 4.09 - Pest Management: Yes No Does the EA adequately address the pest management issues? Is a separate PMP required? If yes, are PMP requirements included in project design? Page 10 Draft OP 4.11 (OPN 11.03) - Cultural Property: Yes No Does the EA include adequate measures? Does the credit/loan incorporate mechanisms to mitigate the potential adverse impacts on physical cultural resources? OD 4.20 - Indigenous Peoples: Yes No Has a separate indigenous people development plan been prepared in consultation with the Indigenous People? If yes, then did the Regional Social Development Unit review and approve the plan? If the whole project is designed to benefit IP, has the design been reviewed and approved by the Regional Social Development Unit? OP/BP 4.12 - Involuntary Resettlement: Yes No Has a resettlement action plan, policy framework or policy process been prepared? If yes, then did the Regional Social Development Unit review and approve the plan / policy framework / policy process? OP/BP 4.36 – Forests: Yes No Has the sector-wide analysis of policy and institutional issues and constraints been carried out? Does the project design include satisfactory measures to overcome these constraints? Does the project finance commercial harvesting, and if so, does it include provisions for certification system? OP/BP 4.37 - Safety of Dams: Yes No Have dam safety plans been prepared? Have the TORs as well as composition for the independent Panel of Experts (POE) been reviewed and approved by the Bank? Has an Emergency Preparedness Plan (EPP) been prepared and arrangements been made for public awareness and training? OP 7.50 - Projects on International Waterways: Yes No Have the other riparians been notified of the project? If the project falls under one of the exceptions to the notification requirement, then has this been cleared with the Legal Department, and the memo to the RVP prepared and sent? What are the reasons for the exception? Please explain: Has the RVP approved such an exception? OP 7.60 - Projects in Disputed Areas : Yes No Has the memo conveying all pertinent information on the international aspects of the project, including the procedures to be followed, and the recommendations for dealing with the issue, been prepared, cleared with the Legal Department and sent to the RVP? Does the PAD/MOP include the standard disclaimer referred to in the OP? BP 17.50 - Public Disclosure: Yes No Have relevant safeguard policies documents been sent to the World Page 11 Bank's Infoshop? 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? All Safeguard Policies: Yes No Have satisfactory calendar, budget and clear institutional responsibilities been prepared for the implementation of the safeguard measures? Have safeguard measures costs been included in project cost? Will the safeguard measures costs be funded as part of project implementation? Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures? Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? Signed and submitted by: Name Date Task Team Leader: Teresa Ho Project Safeguards Specialist 1: Project Safeguards Specialist 2: Project Safeguards Specialist 3: Approved by: Name Date Regional Safeguards Coordinator: Comments: Sector Manager: Comments: