The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) Concept Environmental and Social Review Summary Concept Stage (ESRS Concept Stage) Public Disclosure Date Prepared/Updated: 02/02/2024 | Report No: ESRSC04068 Feb 07, 2025 Page 1 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) I. BASIC INFORMATION A. Basic Operation Data Operation ID Product Operation Acronym Approval Fiscal Year P503776 Investment Project Financing (IPF) ARISE 2024 Operation Name Advancing Resilience and Inclusive Health Systems for Everyone (ARISE - KENEYA YIRIWALI) in Mali Country/Region Code Beneficiary country/countries Region Practice Area (Lead) (borrower, recipient) Mali Mali WESTERN AND CENTRAL Health, Nutrition & AFRICA Population Borrower(s) Implementing Agency(ies) Estimated Appraisal Date Estimated Board Date Republic of Mali Ministère de la Santé et du 06-May-2024 28-Jun-2024 Développement Social Estimated Concept Total Project Cost Public Disclosure Review Date 125,000,000.00 Proposed Development Objective To improve accessibility and utilization of quality essential reproductive, maternal, neonatal, child, adolescent health and nutrition services as well as to strengthen preparedness for health emergencies in targeted areas. B. Is the operation being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? Yes C. Summary Description of Proposed Project Activities The ARISE project is a project designed to tackle critical healthcare challenges in targeted areas. By focusing on improving access to essential health services and strengthening health systems, the project aims to address the specific needs of vulnerable populations, including women, children, and adolescents. At its core, the project seeks to enhance accessibility and utilization of quality health services, particularly in the areas of reproductive, maternal, neonatal, child, and adolescent health, as well as nutrition services. Through targeted interventions and the implementation of performance-based financing (PBF) schemes, the project aims to incentivize health facilities and community health Feb 07, 2025 Page 2 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) workers (CHWs) to deliver a defined package of services with a focus on both quantity and quality. This approach not only ensures that essential health services reach those who need them most but also promotes accountability and efficiency within the healthcare system. Furthermore, the project places a strong emphasis on strengthening preparedness and surveillance for health emergencies. By investing in robust surveillance systems, enhancing diagnostic capabilities, and providing training and capacity-building for emergency response teams, the project aims to improve the country's ability to detect, respond to, and mitigate the impact of health crises, including epidemics and natural disasters. The financing structure of the project reflects a collaborative effort, with contributions from the International Development Association (IDA), the Global Financing Facility (GFF), and the Netherlands. This financial support enables the implementation of various project components, including the improvement of health service delivery, support for community health and nutrition initiatives, strengthening of health systems for universal health coverage, and project coordination and monitoring. Component 1: Improve the supply and availability of quality health services for the population This component aims to enhance the overall quality of essential health services, especially focusing on reproductive, maternal, neonatal, child, adolescent health, and nutrition services. Sub-component 1.1: Climate-adaptive horizontal and vertical expansion of PBF Objective: To expand the successful Performance-Based Financing (PBF) approach both horizontally and vertically. Activities: Providing performance-based payments to health facilities, community health workers (CHWs), and schools based on the delivery of defined services. Implementing facility-based, outreach, and referral system activities. Sub-component 1.2: Support to PBF implementation and institutionalization Objective: To support the implementation and supervision of PBF activities and facilitate the institutionalization of PBF. Activities: Setting up a Contract Development and Verification Agency (CDVA), recruiting an external counter- verification agency, and supporting the institutionalization of PBF through training and technical assistance. Sub- component 1.3: Enhance healthcare quality and regulation Objective: To improve healthcare quality evaluation and Public Disclosure regulation, including private health facilities under PBF. Activities: Providing performance-based payments to regulators for quality evaluation, supporting quality evaluation of national hospitals, and acquiring simulation equipment for training. Component 2: Facilitate access to healthcare and nutrition services by removing barriers and supporting community services This component aims to strengthen healthcare and nutritional services, focusing on community, health facilities, and school interventions. Sub-component 2.1: Support for Community Health and Nutrition Objective: To enhance community health and nutrition services, including strengthening CHWs and improving community engagement. Activities: Strengthening CHWs, enhancing community case management, ensuring availability of medical supplies, and conducting communication for development initiatives. Sub-component 2.2: Support for School Health and Adolescent Health Objective: To reinforce support for school nurseries and improve collaboration between schools and health facilities. Activities: Providing incentives for sexual and reproductive health services, strengthening services at secondary schools, enhancing accessibility of education for female students, and increasing demand for youth health services. Component 3: Strengthening Health Systems for Universal Health Coverage This component aims to support institutional strengthening and reforms to improve the quality of spending in the healthcare sector. Sub-component 3.1: Support to Health Financial Management Reforms Objective: To enhance health sector financial management and mobilization capabilities. Activities: Supporting adoption and alignment of the Public Financial Management (PFM) system with PBF principles, capacity-building, and compliance activities. Sub-component 3.2: Support to Health Financing Reforms Objective: To improve health financing mechanisms and promote efficient resource utilization. Activities: Delivering strategic support for health financing reforms, improving beneficiary identification, and strengthening governance practices. Sub-component 3.3: Strengthening the Health Management Information System Objective: To enhance the capacity and effectiveness of the health information system. Activities: Supporting data collection, analysis, dissemination, capacity-building, technology enhancement, and integration with the national statistical system. Sub-component 3.4: Optimizing Surveillance, Preparedness, and Response to Epidemics and climate- Feb 07, 2025 Page 3 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) sensitive diseases Objective: To prevent, detect, and respond to potential health threats. Activities: Strengthening disease surveillance, enhancing diagnostic capabilities, conducting capacity-building activities, promoting public health education, supporting digital health technologies, and facilitating multi-sector coordination. Component 4: Project Coordination, Management, and Monitoring This component ensures effective technical and fiduciary management and implementation of the project. It includes activities such as local consultancy for project coordination, procurement of office equipment, travel and per diem for facility supervision, operating expenses for project coordination, auditing and evaluation, verification, and counter-verification of results in health facilities. Component 5: Contingent Emergency Response Component (CERC) The Contingent Emergency Response Component serves as a mechanism to swiftly and effectively address unforeseen disasters or health crises such as pandemics. It operates on a contingency basis, ready to be activated upon formal declaration of a national emergency or through a formal request from the respective governments. The objective is to ensure rapid and targeted response to emergencies, providing essential funding to meet urgent needs and mitigate adverse impacts on the project's target populations. D. Environmental and Social Overview D.1 Overview of Environmental and Social Project Settings The project will be implemented in 14 regions of Mali and the district of Bamako, the capital of Mali. The project will focus on the 9 regions (Gao, Mopti, Douentza, Bandiagara, San, Segou, Koulikoro, Dioila, and Nara) where the PACSU- (P165534) Program has already been implemented and will extend to 5 new regions such as Timbuktu, Taoudenit, Bougouni, Koutiala, Sikasso, and the district of Bamako. It will be implemented in both rural and urban areas. The country's security situation remains fragile and complex. The northern regions (Gao, Timbuktu, and Taoudenit) are Public Disclosure particularly hard hit. This situation contributes to the vulnerability of the population and their displacement to other parts of the country. PACSU had developed a security management plan for its operations in the center of the country (Mopti, Douentza, and Bandiagara) and in Gao, which enabled the project to implement its activities in these areas. Mali's healthcare supply system exhibits characteristic pyramidal features centered on a central administration, with distinct levels at the regional and district tiers. The "public" supply is structured around four primary types of care providers: frontline care services (CSCOMs), frontline first referral (CSREFs), second-line referral (regional hospitals), and third-line referral (national hospitals and institutions). The country's population is estimated at around 22,593.59 inhabitants in 2022 and is expected to double every 25 years. The population growth rate is estimated at 3.6% per year over the last decade, exceeding regional averages, and is expected to reach 5 million in Bamako by 2030 and 10 million by 2050. The project is aimed primarily at women, adolescents, and children in the target regions. The general public will benefit from communication and behavior change initiatives. Finally, institutions, including other stakeholders, will benefit from institutional and capacity-building interventions. D.2 Overview of Borrower’s Institutional Capacity for Managing Environmental and Social Risks and Impacts The project will be implemented by PACSU's Project Coordination Unit (PCU), under the direction of the Minister of Health and Social Development, who will be responsible for all project components. PACSU has experience in projects funded by multilateral development partners. The PACSU project unit has 1 environmental and social specialist with experience of the Bank's safeguard policies and the Environmental and Social Framework (ESF) through the preparation and implementation of the COVID-19-P164561 Feb 07, 2025 Page 4 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) project. Consequently, the borrower's institutional capacity to implement the project within the environmental and social (ESF) framework is considered average. Current specialists will be assigned to the project during preparation and implementation, and the project's E&S team will be reinforced with a junior specialist. During preparation, a more in- depth capacity assessment will be done by Bank specialists. In addition, an Institutional Capacity Assessment for implementing partners namely CANAM, PBF unit (Agence de développement et de vérification des contrats (CDVA) et agence de contre-vérification), etc. involved in the project will be conducted before appraisal, with the guidance of the World Bank. Any capacity gaps or strengthening measures regarding the implementation of the ESF requirements will be adequately captured in the Environmental and Social Commitment Plan (ESCP). II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Moderate A.1 Environmental Risk Rating Moderate The project’s environmental risk rating is Moderate at the concept stage. The assessment may be revised or confirmed once additional technical details regarding project financed activities and scope are well known. The main environmental concerns is related to the production of infectious medical waste in health centers environment and surround following the increased use of medical health centers, the management of unusable expired products by medical professionals, and the local community health and safety. Others key environmental issues are related to (i) water pollution and noise nuisance ; (ii) Pest management as a result of the popularization of biofortified crops, (ii) occupational health and safety of workers. Digitalization of health data that will involve technological infrastructure Public Disclosure and software needs will be associated with a substantial amount of electricity use and cooling as well as the need of data privacy protection. Moderate A.2 Social Risk Rating The social risk of the project at this stage is moderate. Project activities are expected to have a significant positive social impact, both by strengthening social dynamics and by contributing to increased public participation in improved public service through Performance-Based Financing (PBF). Some limited risks could, however, emerge. These include a) Exclusion of vulnerable groups from various outreach and registration activities and therefore the risk that these groups are unable to access services or do not know about the services (health insurance, CVRS); b) Privacy and data misuse issues due to the transition from written to electronic records; c) some limited impacts related to land acquisition depending on the sites where some rehabilitation/construction works will be done. Security context may also present risks to the effective implementation and supervision of project activities. 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 From the preliminary review carried out at this stage, the project does not involve any activities that could generate significant and irreversible E&S impacts. The potential social impacts and risks on human populations and the environment are likely to be minimal or negligible. Indeed no adverse social risks or impacts related to land access, Feb 07, 2025 Page 5 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) community health and safety, or cultural heritage have been identified for the project. The project will focus more on social dynamics to ensure more involvement in the project. In line with ESF requirements, the Borrower will (i) develop the first ESCP which could be adjusted during the project life keeping with the evolution of E&S risk and impact; (ii) develop an inclusive stakeholder engagement plan (SEP); (iii) Labor Management Procedures (LMP) for project workers and (v) establish and implement accessible grievance mechanism (GM) and (viii) an Environmental and social management framework. ESS10 - Stakeholder Engagement and Information Disclosure Relevant From the preliminary review carried out at this stage, the project activities are not likely to generate significant and irreversible E&S impacts. The potential social and environmental impacts and risks are likely to be limited and localized. The potential risks of exclusion from the improved health services as well as the specific needs of different social groups as well as women, IDPs need to be mitigated through effective stakeholder engagement. In line with ESF requirements, the Borrower will (i) develop the first ESCP which could be adjusted during the project life keeping with the evolution of E&S risk and impact; (ii) develop an inclusive stakeholder engagement plan (SEP); (iii) Labor Management Procedures (LMP) for project workers; (v) establish and implement accessible grievance mechanism (GM); (vi) prepare a security risk assessment that will feed into updating the existing security management plan; (vii) medical waste management plan and (viii) an E&S management framework. ESS2 - Labor and Working Conditions Relevant This standard is relevant. Before the appraisal, the Borrower will prepare a Labor Management Procedures (LMP) that Public Disclosure will address key issues, such as working conditions and the management of worker relationships, occupational health and safety of the workforce, non-discrimination, minimum work age, and measures to prevent forced labor, sexual abuse, and exploitation and sexual harassment. The LMP will include an effective GM for the workers, based on national laws and regulations and the provisions of ESS2. ESS3 - Resource Efficiency and Pollution Prevention and Management Relevant This standard is relevant. The implementation of activities under sub-component 1.2 of the project may involve the construction and/or rehabilitation of health infrastructures, water supply systems, and small drinking water supplies and electrical connections for health centers. These works may require building materials and other raw materials extracted from the natural environment. The environmental impact of infrastructure construction and/or rehabilitation activities will be assessed within the environmental and social management framework, and appropriate measures, as specified in environmental and social guidelines, environmental management plans, and other international good industrial practice (GIIP), will be included in the specific ESIAs and ESMPs during implementation. ESS4 - Community Health and Safety Relevant This standard is relevant at this stage. As the project may involve construction and/or rehabilitation work under component 1.2, this work will mainly take place in urban areas and existing health centers and hospitals. Consequently, risks to community health and safety associated with labor influx or construction, including AES/H, are not expected to be significant. However, the scope and scale of expected infrastructure and workforce requirements will be confirmed during preparation. Given the regions where project activities will be implemented, a safety risk Feb 07, 2025 Page 6 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) assessment will be carried out before appraisal, and the results will be taken into account in updating the existing safety management plan for the PACSU project. During preparation, the project will need to assess the extent to which data protection and security are already implemented and propose measures to close any gaps. Ensuring data security and personal protection will be an integral part of the project design. ESS5 - Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Relevant This standard is relevant at this stage as the project may involve some limited construction and/or rehabilitation works under component 1.2. Such activities could lead to economic resettlement and small-scale land acquisition. If necessary based on an ES screening of activities once project sites have been identified, the Borrower will prepare a Resettlement Action Plan that will be implemented before the start of the activities. ESS6 - Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant Resources The project will not fund any activities that may impact biodiversity. However, the E&S framework will guide screening and mitigation measures to ensure that project activities related to minor civil works do not alter or destroy critical or sensitive natural habitats. ESS7 - Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Not Currently Relevant Local Communities This ESS is not relevant as there are no communities nor peoples who meet the WB citeria for Indigenous Public Disclosure Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities in Mali. ESS8 - Cultural Heritage Not Currently Relevant This ESS is not currently relevant to the project. The project does not have any activities which could impact physical or non-physical cultural heritage. ESS9 - Financial Intermediaries Not Currently Relevant This ESS is not relevant as the project will not involve any 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 No Feb 07, 2025 Page 7 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) Use of Common Approach No A common approach is not being considered for this project. 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? Actions to be completed before Bank Board Approval: The Borrower will develop and disclose the following instruments before Board approval: - Environmental and Social Management Framework (ESMF) ; - Safety risk assessment and a safety management plan ; - Medical waste management plan ; - Environmental and Social Commitment Plan (ESCP) - Stakeholder Engagement Plan (SEP) - Labor Management Procedures (LMP) III. CONTACT POINT World Bank Public Disclosure Task Team Leader: Laurence Elisabeth Marie-Paule Title: Senior Economist, Health Lannes Email: llannes@worldbank.org TTL Contact: Tahirou Kalam Job Title: Senior Financial Management Specialist Email: tkalam@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): Laurence Elisabeth Marie-Paule Lannes, Tahirou Kalam Feb 07, 2025 Page 8 of 9 The World Bank Advancing Resilience And Inclusive Health Systems For Everyone (arise - Keneya Yiriwali) In Mali (P503776) V. APPROVAL ADM Environmental Specialist: Mohamed Youba Sokona ADM Social Specialist: Christophe Bertrand Messina Public Disclosure Feb 07, 2025 Page 9 of 9