The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) Concept Environmental and Social Review Summary Concept Stage ( ESRS Concept Stage) For Official Use Only Date Prepared/Updated: 03/20/2024 | Report No: ESRSC04193 Mar 22, 2024 Page 1 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) I. BASIC INFORMATION A. Basic Operation Data Operation ID Product Operation Acronym Approval Fiscal Year P181586 Investment Project Financing (IPF) Colombia Digital Health 2025 Transformation Operation Name Digital Health Transformation for Effective Healthcare in Colombia Country/Region Code Beneficiary country/countries Region Practice Area (Lead) (borrower, recipient) Colombia Colombia LATIN AMERICA AND Health, Nutrition & CARIBBEAN Population Borrower(s) Implementing Agency(ies) Estimated Appraisal Date Estimated Board Date Republic of Colombia ADRES (Administrator of the Resources 16-Aug-2024 31-Oct-2024 of the General Social Security Health System), Ministry of Health and Social For Official Use Only Protection (MSPS) Estimated Concept Total Project Cost Review Date 08-Mar-2024 200,500,000.00 Proposed Development Objective To: (i) expand access to effective health care services in priority territories; (ii) enhance health system efficiency and financial sustainability; and (iii) strengthen integrated public health surveillance. B. Is the operation being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project Activities [Description imported from the Concept Data Sheet in the Portal providing information about the key aspects and components/sub-components of the project] The Project’s Development Objectives at the Concept Stage are to: (i) expand access to effective health care services in priority territories; (ii) enhance health system efficiency and (iii) strengthen integrated public health surveillance. To Mar 22, 2024 Page 2 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) achieve these objectives the project will be structured around three components related to expanding access to effective health care services, enhancing health system efficiency, and strengthening integrated public health surveillance. These three components address the main identified challenges of: (i) difficulties to provide access to convenient and timely care, and lack of continuity of care, especially in remote areas; (ii) inefficient use of healthcare resources due to limited access to timely information, strategic planning and managing capacity; and (iii) limited capacity of public health surveillance systems to identify, monitor and prevent climate-related risks and zoonotic diseases. For each component, the Project proposes activities, outputs and outcomes that will be further defined during preparation. Component 1 - Access to Effective Health Services will be implemented through two subcomponents: 1.1 Support the adoption and the Interoperability of Electronic Medical Records (IEMR) in prioritized areas. The activities will be set at three different levels: (a) at national level (b) at the territorial entity level and (c) at selected public health provider level, as the key actor; and 1.2 Development of telemedicine for population with limited accessibility to healthcare. Component 2 - Governance for efficiency and financial sustainability will implemented through two subcomponents: 2.1 Support to ADRES (Administrator of the Resources of the General Social Security Health System) for Intelligent Monitoring, Auditing, and Spending; 2.2 Support to the MSPS for Analytics on Financial Sustainability; Component 3 - aims to integrate key climate-related and environmental determinants, along with animal health considerations under a One Health approach, into the unified system of environmental health surveillance (SUISA), initially focusing on priority territories like the Amazon region.. It will be implemented through two subcomponents: 3.1 Strengthen the capacity of laboratories and information systems at the territorial level for an improved public health threat surveillance affected by climate-related hazards and 3.2 Interoperability for timely reporting of climate and environmental health events. Finally, component 4 will finance the coordination, implementation, and management of For Official Use Only project activities, including fiduciary tasks, environmental and social risk management, and monitoring and evaluation (M&E). D. Environmental and Social Overview D.1 Overview of Environmental and Social Project Settings [Description of key features relevant to the operation’s environmental and social risks and opportunities (e.g., whether the project is nationwide or regional in scope, urban/rural, in an FCV context, presence of Indigenous Peoples or other minorities, involves associated facilities, high-biodiversity settings, etc.) – Max. character limit 2,000] The Project has a nationwide scope, since Colombia's General Social Security Health System (SGSSS, for its acronym in Spanish) has almost universal health coverage. In 2022, over 98% of the population was insured under SGSSS, with out- of-pocket spending at a low 20.6%, below the regional average. This includes urban and rural population, ethnic groups such as indigenous peoples, Afrocolombians, raizales, rrom and palenqueros, and other vulnerable groups, such as people with disabilities, LGTBI+ people, migrants and elders. At this stage localization of interventions under components 1 and 3 are not yet defined. All activities will be performed within the Health Sector facilities, with no impacts in sensitive or protected areas or cultural heritage. The SGSSS is managed by the Ministry of Health and Social Protection (MSPS), Health Promoting Entities (EPS), Health Service Provider Institutions (IPS) and coordinated by territorial health secretariats. The SGSSS currently faces important challenges that require urgent attention to guarantee effective access to health services for its most vulnerable population, including: (i) unequal effective access to health services, especially for the subsidized population; (ii) a rapid aging of the population with greater demand for services and a high burden of non-communicable diseases; (iii) large gaps in the provision of mental health care with limited capacity to meet the needs derived from six decades of internal conflict and the recent pandemic; (iv) additional pressures on the sector due to the massive influx of Venezuelan migrants; (v) inadequate availability of health Mar 22, 2024 Page 3 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) professionals; (vi) performance management systems focused on cost containment rather than on quality of care; (vii) gaps in public health surveillance, zoonotic diseases, and risk communication; and (viii) limited efforts to date to take mitigation and adaptation actions related to the impact of climate change in a highly vulnerable context. D.2 Overview of Borrower’s Institutional Capacity for Managing Environmental and Social Risks and Impacts [Description of Borrower’s capacity (i.e., prior performance under the Safeguard Policies or ESF, experience applying E&S policies of IFIs, Environmental and social unit/staff already in place) and willingness to manage risks and impacts and of provisions planned or required to have capabilities in place, along with the needs for enhanced support to the Borrower – Max. character limit 2,000] The MSPS has a monitoring team that includes an Environmental and Social (E&S) team with experience in the implementation of a PforR Project financed by the World Bank (P169866). The Colombian E&S legislation is considered to have strengths in the management of E&S matters (as it is being identified in the ongoing overview assessment in Colombia of all ESSs except ESS9), and the MSPS has demonstrated sound knowledge of this regulatory framework; however, this will be the first time the MSPS team works with the Environmental and Social Framework (ESF). Therefore, a capacity assessment will be carried out by Appraisal to better understand staffing and training needs for the Project E&S management. The Environmental and Social Commitment Plan (ESCP) will define the required E&S specialists the implementation agency will need to deploy for the Project, along with capacity building measures to develop its E&S management capabilities in accordance with the ESF requirements. II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL RISKS AND IMPACTS For Official Use Only A. Environmental and Social Risk Classification (ESRC) Low A.1 Environmental Risk Rating Low [Summary of key factors contributing to risk rating, in accordance with the ES Directive and the Technical Note on Screening and Risk Classification under the ESF – Max. character limit 2,000] According to the available information the environmental risk rating is Low at this stage. Activities provided under the project scope focus on strengthening government institutions under the Ministry of Health and Social Protection (MSPS), including technological innovations and staff capacity development. Minor civil works renovations; acquisition of data collection terminals; updating of software and hardware infrastructure; and laboratory equipment for analysis are expected to be conducted in some health facilities. These interventions are expected to take place within existent MSPS facilities and will be selected during Project preparation. The project will incorporate the analysis of climate change adaptation and mitigation, including climate consideration into budgeting and the public investment cycle. Relevant environmental risks and impacts identified are those related to: (i) minor electronic waste generation due to IT equipment upgrades, replacement, or its final disposal; and (ii) occupational health and safety risks due to ergonomic challenges for workers implementing digital health, risks of accidents due to sampling and handling of hazardous supplies and waste during and after laboratory analysis. As Project activities are to be implemented within existing facilities, therefore it is not initially foreseen that the project will have any risk or impact to natural habitats or cultural heritage; however, this will be verified and assessed again during Project preparation. As mentioned above in D.2 the Colombian E&S regulatory framework is considered as sufficiently sound to address E&S risks and impacts such as those arising from the implementation of the Project; therefore, noting the minor environmental risk and impacts expected from the proposed interventions, the Bank will support the MSPS to use its Mar 22, 2024 Page 4 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) national E&S regulatory framework. An exclusion list will be developed during Project preparation to ensure the environmental risk level remains Low. A.2 Social Risk Rating Low [Summary of key factors contributing to risk rating, in accordance with the ES Directive and the Technical Note on Screening and Risk Classification under the ESF – Max. character limit 2,000] Social risk is considered Low at the concept stage and Project social impacts are expected to be positive. The expansion of the access to effective health care services in priority territories, the enhancement of health system efficiency and the strengthening of integrated public health surveillance will benefit users of the General System of Social Security in Health (SGSSS, Spanish acronym), that provides health coverage to almost all population through a contributory and a subsidized regime. The subsidized regime includes the most vulnerable population in the country, which is unable to cover their own health costs. Minor physical renovations financed within component 3 will be developed in already existing facilities and will not include land acquisition, nor physical or economic displacement. Most of the Project activities included in component 1 and 2 will be focused on the back end of the healthcare system, with no direct contact with users. Regarding telehealth interventions, the project will consider structural inequities, to ensure that they are not aggravated by the introduction of digital health technologies (principle of 'do no harm'), and that access for certain population groups, such as people with disabilities, digital illiterates or those lacking connectivity, is guaranteed (i.e.: by maintaining current face to face and telephone administrative interactions and developing actions through community healthcare workers). MSPS will prepare a E&S matrix aiming to identify and assess E&S risks and impacts along with the corresponding mitigation measures for each of the Project activities. This E&S matrix will include a social assessment focused on vulnerability that will identify any potential barriers for For Official Use Only vulnerable groups and define consequent mitigation measures. [Summary of key factors contributing to risk rating. This attribute is only for the internal version of the download document and not a part of the disclosable version – Max. character limit 2,000] B. Relevance of Standards and Policies at Concept Stage B.1 Relevance of Environmental and Social Standards ESS1 - Assessment and Management of Environmental and Social Risks and Impacts Relevant [Optional Explanation - Max. character limit 1,000] MSPS will screen potential E&S risks and impacts, propose and adopt mitigation measures to improve Project design and implementation by developing an E&S matrix. Key E&S risks are: (i) production of e-waste; (ii) nuisances resulting from works due to installation of equipment and laboratories; (iii) ergonomic risks of workers and operators; (iv) barriers that ethnic and other vulnerable groups may face to access Project benefits; (v) data protection. The E&S matrix will also describe measures to address the identified E&S risks and impacts based on the mitigation hierarchy, including a social assessment focused on identifying barriers for vulnerable groups and define consequent mitigation measures . The PIU will ensure that each intervention complies with E&S mitigation measures according to the E&S matrix. Also, it will hold its local E&S instrument, where required. Mar 22, 2024 Page 5 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) ESS10 - Stakeholder Engagement and Information Disclosure Relevant [Optional Explanation - Max. character limit 1,000] Project activities are aligned with the National Digital Strategy 2023-2026, the National Development Plan 2022-2026 and the Decennial Public Health Plan 2012–2021. Each of these plans has developed broad consultation strategies, including engagement with diverse stakeholders at a national, departmental, and local level. Given this is a Low-risk Project, additional engagement activities to be developed during Project implementation will be included in the ESCP and POM. Stakeholders identified at this stage include healthcare providers and insurance companies (EPS, IPS), territorial health secretariats and councils, telemedicine users and public laboratories. The MSPS has an effective mechanism for petitions, complaints, claims, requests and reports that allows citizens to freely present their concerns at any time. This Grievance Mechanism will be assessed by appraisal to be used as Project-level GM and, if necessary, strengthened actions will be included in the ESCP and POM. ESS2 - Labor and Working Conditions Relevant [Optional Explanation - Max. character limit 1,000] The Project will need the participation of civil servants, direct workers, and contracted workers as part of the consulting services, the installation of computer equipment and network system, and renovations of laboratories and computer centers. The MSPS will develop Labor Management Procedures (LMP) to outline systems, processes and guidance needed to bridge gaps between the local legislation and the standard. The workers installing the computer For Official Use Only cabling network must be provided with PPE and be trained on the risks, as well as install physical barriers and implement administrative mitigation measures for third parties (laboratories, X-ray rooms and health staff, patients and companions). LMP will include a code of conduct and a consolidated Labor Grievance Mechanism acceptable to the Bank available for all Project workers. LMP will be prepared and disclosed within 90 days of project effectiveness or before contracting any project worker, whichever comes first. ESS3 - Resource Efficiency and Pollution Prevention and Management Relevant [Optional Explanation - Max. character limit 1,000] This standard is relevant. Terminals also called workstations and their monitors will be acquired, equipment for data centers air conditioning required for its operation. To guarantee that the purchased equipment is energetically efficient, energy efficiency labeling of the Energy Star type will be required, and Good practices for the use of low consumption equipment will be promoted. Given the potential generation of Waste from Electrical and Electrical Equipment (WEEE), the Regulatory Framework of the Colombia (Law 1672 of 2013 for WEEE), which created the registry of WEEE Producers and the post consumer recovery program for the Sustainable Management of WEEE, are instruments that guide and organize the management of WEEE. The volume of electronic waste is unknown in this instance; it will be detailed for the A-ESRS. The MSPS has evaluated the planned obsolescence of the equipment for 5 years. ESS4 - Community Health and Safety Relevant [Optional Explanation - Max. character limit 1,000] Mar 22, 2024 Page 6 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) This standard is relevant. Installation of cables and other equipment will ensure adherence to national and regional safety codes. Inspections as needed by regional authorities of installed equipment and refurbished facilities will be followed and any pertinent EH&S standards of the WBG. All installations will ensure not posing a safety concern to workers, patients, and other people involved in the settings where these services are installed and under operation or management. The LMP will include a code of conduct for project workers' engagement with stakeholders, including mitigation measures of the SEA/SH risk. Under this standard, potential risks and measures related to fire safety and human life are addressed, as a consequence of the electrical installations that will be adapted for the installation of medical, laboratory and computer equipment. ESS5 - Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Not Currently Relevant [Optional Explanation - Max. character limit 1,000] This standard is not currently relevant. Activities defined at the concept stage do not generate potential risks and/or impacts relevant to ESS5. Minor physical interventions to be financed under component 3 of the Project will be developed in already existing facilities and will neither require land acquisition, nor restrictions on land or involuntary resettlement as defined under this Standard. ESS6 - Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant Resources [Optional Explanation - Max. character limit 1,000] For Official Use Only This Standard is not currently relevant to the Project. As the Project activities are to be implemented within existing facilities, the outcome of E&S screening did not identify any potential risks and/or impacts relevant to ESS6. ESS7 - Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Relevant Local Communities [Optional Explanation - Max. character limit 1,000] This standard is relevant, due to the national level interventions of the Project. According to the 2018 census, Indigenous peoples (IP) represent 4.4% of the total population. There are 87 recognized IPs living in 717 resguardos (communal lands) distributed throughout 27 departments. The Office of Social Promotion of the MSPS is responsible for implementing the Intercultural Indigenous Health System (SISPI) and monitoring the health situation of IPs and other vulnerable groups. Opportunities to strengthen the implementation of the SISPI and the surveillance of IP health through Project activities will be explored during preparation and consulted with IP representatives. This will be reflected in specific measures to be included in the ESCP. Project activities will not require the implementation of free, prior and informed consent (FPIC) as provided under ESS7. ESS8 - Cultural Heritage Not Currently Relevant [Optional Explanation - Max. character limit 1,000] This Standard is not currently relevant to the Project. As the proposed Project activities will be held within existing facilities and may include very low-scale civil works that should not imply excavations, there are not potential risks Mar 22, 2024 Page 7 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) and/or impacts relevant to ESS8 identified at this stage. Anyhow, during preparation it will be assessed if the Project will intervene in any hospital or building designated as cultural and/or historical site to include particular mitigation measures within the ESCP. ESS9 - Financial Intermediaries Not Currently Relevant [Optional Explanation - Max. character limit 1,000] This Standard is not relevant to the Project. The Project will not involve the use of Financial Intermediaries. B.2 Legal Operational Policies that Apply OP 7.50 Operations on International Waterways No OP 7.60 Operations in Disputed Areas No B.3 Other Salient Features Use of Borrower Framework TBD For Official Use Only [Optional explanation – Max. character limit 1,000] Given the E&S low risk, the use of the national framework is expected as indicated above and will be assessed during Project preparation. Use of Common Approach No [Optional Explanation including list of possible financing partners – Max. character limit 1,000] The use of a common approach will be assessed prior to Appraisal once more information is available regarding implementation arrangements in coordination with IADB and its E&S requirements for this low-risk project. B.4 Summary of Assessment of Environmental and Social Risks and Impacts [Description provided will not be disclosed but will flow as a one time flow to the Concept Stage PID – Max. character limit 5,000] The overall environmental and social risk has been classified as low. The project is national in scope, although it may carry out actions (pilots) in selected regions; which will be determined during preparation. Project activities include the provision and installation of computer equipment, software, training, and coaching. According to the information available at this time, it is possible that very low-scale civil works may be carried out to adapt physical spaces for laboratories and the installation of servers or minor constructions to install the equipment. No infrastructure development or any other type of physical intervention is foreseen. The Project will not finance land acquisitions or involve resettlement. The Project activities will be carried out within health establishments, will not intervene in sensitive or protected areas, and thus will not carry out actions that generate risks on biodiversity or cultural heritage. The MSPS Mar 22, 2024 Page 8 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) has a monitoring team with experience in the implementation of a PforR Project financed by the World Bank (P169866); however, this will be the first time for the MSPS Environmental and Social team working under the Environmental and Social Framework (ESF). The MSPS will prepare an E&S matrix aiming to identify and assess E&S risks and impacts along with the corresponding mitigation measures for each of the Project activities. The Project will include a social assessment to identify any potential barriers that groups like indigenous peoples, Afrocolombians, raizales, rrom y palenqueros, people with disabilities, persons within the LGBTI community, migrants and elders, among others, may face to have access to the benefits of the Project and look for ways to ensure that: (i) these groups are duly consulted during Project implementation to better understand these potential access barriers, as well as opportunities to address them in an inclusive and culturally appropriate manner. The project will ensure that the designed systems have adequate data protection measures for both data storage and transmission between entities (interoperability). The MSPS has an effective mechanism for petitions, complaints, claims, requests and reports (PQRSD) for citizen service that allows them to freely present their concerns or suggestions at any time; it will be assessed as the Project-level GM and, if necessary, strengthened to meet ESF requirements. The project will also screen the activities that will be generating waste, including electronic waste, along with the proposed E&S management measures. Training of the Project implementation team will be promoted through the World Bank's ESF virtual course. C. Overview of Required Environmental and Social Risk Management Activities C.1 What Borrower environmental and social analyses, instruments, plans and/or frameworks are planned or required by Appraisal? For Official Use Only [Description of expectations in terms of documents to be prepared to assess and manage the project’s environmental and social risks and by when (i.e., prior to Effectiveness, or during implementation), highlighted features of ESA documents, other project documents where environmental and social measures are to be included, and the related due diligence process planned to be carried out by the World Bank, including sources of information for the due diligence - Max. character limit 3,000] Environmental and Social Management documents will be developed following the following timeline: Prior to Appraisal: - Prepare, consult, and disclose an E&S matrix identifying the E&S risks and impacts foreseen according to the implementation of the proposed Project activities. The matrix shall contain the respective mitigation measures. - Prepare, consult and disclose an advanced draft of the Environmental and Social Commitment Plan (ESCP). - Prepare, consult, and disclose stakeholder engagement activities (including Project-level GM) as part of the draft version of the ESCP. - Prepare, consult, and disclose an exclusion list aiming to ensure the activities to be financed are of Low E&S risk. After Negotiations: - Disclose the final version of the ESCP. The ESCP will be reviewed periodically, if necessary, during implementation of the activities to reflect adaptive management of changes and unforeseen circumstances related to the activities or in response to evaluation of the performance. The borrower will disclose the updated ESCP. After Project effectiveness: Mar 22, 2024 Page 9 of 10 The World Bank Digital Health Transformation For Effective Healthcare In Colombia (P181586) - Consult and disclose the final version of the E&S matrix no later than 90 days of project effectiveness and thereafter ensure the fulfillment of the mitigation measures throughout the Project implementation. - Develop and disclose Labor Management Procedures 90 days after Effectiveness or prior to hiring workers, whatever occurs first, including workers´ GM and code of conduct. - Ensure that all local E&S instruments have been obtained prior to the bidding process of works to be executed, and in all cases prior to the start of works. - Ensure that the mitigation measures established in the E&S Matrix are included in the bidding documents. III. CONTACT POINT Contact Point Task Team Leader: Jeremy Henri Maurice Veillard Title: Lead Health Specialist Email: jveillard@worldbank.org TTL Contact: Niccolo Comini Job Title: Digital Development Specialist Email: ncomini@worldbank.org For Official Use Only TTL Contact: Gabriel Eduardo Aguirre Martens Job Title: Economist, Health Email: gaguirremartens@worldbank.org IV. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects V. APPROVAL Task Team Leader(s): Jeremy Henri Maurice Veillard, Niccolo Comini, Gabriel Eduardo Aguirre Martens ADM Environmental Specialist: Marco Fernando Ricaurte Paredes ADM Social Specialist: Juan Cambreleng Contreras Mar 22, 2024 Page 10 of 10