The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
Concept Environmental and Social Review Summary
Concept Stage
( ESRS Concept Stage)
For Official Use Only
Date Prepared/Updated: 06/12/2024 | Report No: ESRSC04343
Jun 26, 2024 Page 1 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
I. BASIC INFORMATION
A. Basic Operation Data
Operation ID Product Operation Acronym Approval Fiscal Year
P506083 Program-for-Results Financing (PforR) HEROES 2025
Operation Name Healthcare Efficiency, Reform, and Optimization Enhancement and Support Program
Country/Region Code Beneficiary country/countries Region Practice Area (Lead)
(borrower, recipient)
Ukraine Ukraine EUROPE AND CENTRAL Health, Nutrition &
ASIA Population
Borrower(s) Implementing Agency(ies) Estimated Appraisal Date Estimated Board Date
Ukraine Ministry of Health 06-Sept-2024 20-Feb-2025
Estimated Concept Total Project Cost
For Official Use Only
Review Date
24-Jun-2024 1,250,100,000.00
Proposed Development Objective
Improve the effectiveness of the Program of Medical Guarantees (PMG)
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 objective of the operation is to improve the efficiency of public spending on the Program of Medical Guarantees
(PMG) by channeling funding to cost-effective health services and providing incentives for efficiency-enhancing reforms.
D. Environmental and Social Overview
D.1 Overview of Environmental and Social Project Settings
Jun 26, 2024 Page 2 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
[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 full-scale Russian invasion began as Ukraine was in the early stages of the implementation of ambitious health
system and health financing reform, the Government of Ukraine adopted the Law on Government Financial Guarantees
for Health Care Services (Law 2168), which created the Program of Medical Guarantees (PMG) and the National Health
Service of Ukraine responsible for its management. The PMG pulled fragmented streams of public funding into a single
financing pool, replaced vague constitutional guarantees with a single, explicit set of entitlements, abolished financing
inputs for health care providers and instead introduced a payment model where health providers signed contracts with
the NHSU for delivery of health services based on the logic that the public model should follow the patient, and gave
health care providers managerial autonomy.
The PforR HEROES is nationwide in scope (excluding territories temporarily no longer under the government’s control
and territories close to the frontline ). Its IPF component will finance IT equipment, servers and software licenses as well
as vehicles for the multi-regional departments of the NHSU to enhance their capacity for contract management and
monitoring. In addition it will support capacity building and training for the NSHU staff at the central and regional levels
and help cover operating cost for the NHSU and the MOH related to PforR management, monitoring, and reporting,
including engaging an independent verification agency. The IPF component will not directly support civil works, or the
preparation of feasibility studies or future investment projects.
Environmental and Social Systems Assessment (ESSA) for the associated PforR Operation will be prepared to assess E&S
risk management within the country’s systems and recommend measures to address any gaps in environmental and
For Official Use Only
social screening process and the enhancements in methodologies and capacity could be explored with technical
assistance under this IPF.
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 MoH will manage project, fiduciary, environmental and social aspects of the government expenditure program. The
IPF component aims at strengthening NHSU operational capacity of PMG management.
NHSU has prior experience jointly implementing citizen engagement activities currently carried out by the PIU team in
Ministry of Health in collaboration with the third-party independent non-government organization for the ongoing Bank
financed projects that will continue to be applied for the new project. This helps to involve civil society and patients
organizations in disseminating information about project financed activities and in counselling populations with limited
access to information and/or vulnerable groups.
While MoH has two well established PIU managing three WB financed projects with ES staff in place, NHSU currently
has no E&S staff in place and has limited experience applying Bank's ESSs. Given the project aims to strengthen the
capacity of the NHSU to implement the reforms it will require the hiring of one environmental specialist and one social
specialist to NHSU that will assist NHSU with ES risk management. This commitment will be reflected in the ESCP.
II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL RISKS AND IMPACTS
A. Environmental and Social Risk Classification (ESRC) Moderate
Jun 26, 2024 Page 3 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
A.1 Environmental Risk Rating Moderate
[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]
The Environmental Risk Rating for the IPF component is considered Moderate. The IPF focused on technical support
primarily aim to strengthen operational capacities. These activities involve engaging consultants and potentially
recruiting new government staff. The potential risks include lack of adherence to fair labor practices, as well as health
and safety concerns related to war hazards such as explosive remnants of war and aerial strikes. Also, though the use
of modern IT solutions will increase resource efficiency manifold, this activity can result in an increase in e-waste and
solid waste in the nodal institutions.
A.2 Social Risk Rating Moderate
[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]
The project’s social risk rating is Moderate based on a preliminary social assessment. The project does not envisage
any civil works and no risks related to land acquisition or resettlement are anticipated. IPF component activities will
be limited to enhancing capacity-building in project implementation procedures at both national and local
government levels through training , awareness campaigns, and the provision of relevant IT solutions as well as
purchase of the vehicle. However, there are potential occupational health and safety hazards associated with training
activities, some of those in person particularly in the conflict affected areas as well as potential risks related to labor
For Official Use Only
and working conditions for project workers, therefore social risk is Moderate.
[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]
The IPF component is dedicated to capacity building to support PForR implementation. The direct potential
environmental and social risks of Project activities are related to OHS and community health and safety of in-person
capacity building activities and from war-hazards. The project will prepare War Hazard Emergency Preparedness and
Response Plan that will be applicable to all such activities and provide measures to mitigate the war hazard risks
identified in the context of this project. The IPF does not directly support civil works, or the preparation of feasibility
studies or future investment projects. The capacity building activities themselves do not pose social or environmental
risks.
ESS10 - Stakeholder Engagement and Information Disclosure Relevant
Jun 26, 2024 Page 4 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
[Optional Explanation - Max. character limit 1,000]
The project will ensure that stakeholder engagement is conducted on the basis of timely, relevant, understandable
and accessible information. It will build upon existing communication channels for citizen’s appeals established at the
MoH and NHSU for ongoing complimentary Bank financed operations which will enable stakeholders to channel
concerns, questions, and complaints to the GRMs operated by the MoH and NHSU. As the project activities mainly
relate to training and consultancies as well as the purchase of IT software/hardware and vehicles, the ESCP will
sufficiently set out the requirements for designing such activities to ensure transparency and accessibility, through
stakeholder participation and public information disclosure, consistent with ESS10. No stand alone SEP will be
prepared. Due to the implications of martial law, limited in person consultations are possible, therefore the virtual
consultations will be the modality. The ESCP will make reference to the GRM for PforR.
ESS2 - Labor and Working Conditions Relevant
[Optional Explanation - Max. character limit 1,000]
The project will have direct and contracted workers with the possibility to engage seconded government staff across
the existing health programs that will be responsible to implement the Performance Based Conditions and hence, can
be considered direct workers. There will be a grievance mechanism and code of conduct for workers, which will be
reflected in the ESCP. Ukraine's Labor Code includes measures on equal opportunity and non-discrimination,
regulates hiring and firing procedures and allows for collective organization and bargaining. War Hazard Emergency
For Official Use Only
Preparedness and Response Plan for the Project will be developed and will include measures to protect the safety
and security of project workers and nearby communities from war-related hazards, as well as information on warning
system and designated shelters. Labor risks will be further addressed through the Client’s commitment in the ESCP
and clear guidance provided in the POM to comply with ESS2.
ESS3 - Resource Efficiency and Pollution Prevention and Management Relevant
[Optional Explanation - Max. character limit 1,000]
This standard is relevant considering waste generation and opportunities to bring resource efficiency to activities
supported by the IPF. Though the use of modern IT solutions will increase resource efficiency, this activity can result
in an increase in e-waste and solid waste in the nodal institutions. The project will review (a) the extent of
software/hardware purchase expected, (b) current practices of handling electronic and solid waste; (c) facilities and
arrangements to handle the disposal of IT equipment, (d) opportunities to incorporate resource efficiency in all
purchases, equipment and uses, (e) mechanisms to integrate waste management in all relevant activities. The ToRs
for the selection of vendors will include the requirements for arranging the disposal of equipment (end-of-life and
during repairs) in line with the National Rules and good practices. An E-Waste Management Plan will be prepared
prior to the start of relevant activities and implemented accordingly.
ESS4 - Community Health and Safety Relevant
[Optional Explanation - Max. character limit 1,000]
Jun 26, 2024 Page 5 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
Missile attacks continue to be a threat across the entire country. There is potential for security incidents due to aerial
attacks during the delivery of the trainings supported by the Program. A War-Hazard Emergency Preparedness and
Response Plan will be prepared outlining measures in response to community health and safety risks associated with
the operating context, including measures to promote community awareness. This commitment will be outlined in
the ESCP.
ESS5 - Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Not Currently Relevant
[Optional Explanation - Max. character limit 1,000]
ESS6 - Biodiversity Conservation and Sustainable Management of Living Natural Not Currently Relevant
Resources
[Optional Explanation - Max. character limit 1,000]
ESS7 - Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Not Currently Relevant
Local Communities
[Optional Explanation - Max. character limit 1,000]
ESS8 - Cultural Heritage Not Currently Relevant
For Official Use Only
[Optional Explanation - Max. character limit 1,000]
ESS9 - Financial Intermediaries Not Currently Relevant
[Optional Explanation - Max. character limit 1,000]
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
[Optional explanation – Max. character limit 1,000]
The Draft Law of Ukraine On Electrical and Electronic Waste (meant to be in line with WEEE Directive) is under review
at the Parliament and once adopted it will provide guidance on classification, collection, sorting, recycling and overall
e-waste management, as well as licensing and reporting requirements. However, at the moment the law is not yet in
Jun 26, 2024 Page 6 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
place and existing legislative base does not sufficiently cover the utilization of e-waste and mostly includes generic
provision and methodological guidance.
Use of Common Approach No
[Optional Explanation including list of possible financing partners – Max. character limit 1,000]
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]
Environmental and Social Risks of the IPF Component are rated as Moderate. The IPF component of the PforR comprises
of capacity building activities with minimal environmental and social impacts. The project does not envisage any civil
works and no risks related to land acquisition or resettlement are anticipated. The IPF Component is dedicated to
strengthen the capacity of the NHSU to implement the reforms at the national and local levels by means of trainings and
awareness-raising activities, as well as supporting different associated IT solutions.
The IPF component will focus focused on technical support primarily aim to strengthen operational capacities. These
activities involve engaging consultants and potentially recruiting new government staff. The potential risks include health
and safety concerns related to war hazards such as explosive remnants of war and aerial strikes. However, there are
potential occupational health and safety hazards associated with training activities, some of those in person particularly
For Official Use Only
in the conflict affected areas, Also, though the use of modern IT solutions will increase resource efficiency manifold, this
activity can result in an increase in e-waste and solid waste in the nodal institutions.
Environmental and Social Systems Assessment (ESSA) for the associated PforR Operation will be prepared to assess E&S
risk management within the country’s systems and recommend measures to address any gaps in environmental and
social screening process and the enhancements in methodologies and capacity could be explored with technical
assistance under this IPF.
The ESCP will be prepared and disclosed before Appraisal, specifying appropriate ESF requirements under ESS 2, ESS 4
and ESS 10.
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?
[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]
Draft Environmental and Social Commitment Plan (including requirement for preparation of War-Hazard Emergency
Preparedness and Response Plans) by Appraisal
Jun 26, 2024 Page 7 of 8
The World Bank
Healthcare Efficiency, Reform, And Optimization Enhancement And Support Program (P506083)
III. CONTACT POINT
Contact Point
Task Team Leader: Jakub Jan Kakietek Title: Senior Economist, Health
Email: jkakietek@worldbankgroup.org
TTL Contact: Caryn Bredenkamp Job Title: Lead Economist, Program Leader
Email: cbredenkamp@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
For Official Use Only
Task Team Leader(s): Jakub Jan Kakietek, Caryn Bredenkamp
ADM Environmental Specialist: Oksana Rakovych
ADM Social Specialist: Mariia Nikitova
Jun 26, 2024 Page 8 of 8