INTEGRATED SAFEGUARDS DATASHEET
RESTRUCTURING STAGE
I. Basic Information
Date prepared/updated: 11/19/2012
Report No.: AC6833
1. Basic Project Data
Country: Mozambique
Project ID: P099930
Project Name: Health Service Delivery
Task Team Leader: Humberto Albino Cossa
Estimated Appraisal Date: May 11, 2007
Estimated Board Date: April 16, 2009
Managing Unit: AFTHE
Lending Instrument: Specific Investment
Loan
Sector: Health (60%);Public administration- Health (40%)
Theme: Health system performance (40%);Child health (15%);Malaria (15%);Population
and reproductive health (15%);HIV/AIDS (15%)
IBRD Amount (US$m.):
0
IDA Amount (US$m.):
44.6
GEF Amount (US$m.):
0
PCF Amount (US$m.):
0
Other financing amounts by source:
BORROWER/RECIPIENT
0.00
0.00
Environmental Category: B - Partial Assessment
Simplified Processing
Simple []
Repeater []
Is this project processed under OP 8.50 (Emergency Recovery)
Yes [ ]
No [X]
or OP 8.00 (Rapid Response to Crises and Emergencies)
2. Project Objectives
To increase access to, and utilization of, maternal and child health and nutrition services
in target areas in the Recipients' territory.
3. Project Description
Subsequent to the restructuring and additional financing for nutrition, the project will
have four components described below.
Component I : Improving service delivery (US$ 53.2 million). This component would
support the following activities: (i) Provision of training and technical assistance to
district health staff to enhance their management and planning capacities; (ii) Provision
of training and technical assistance to health workers to improve the quality of maternal
and child health care services; (iii) Training of APEs in each district of the three
provinces; (iv) Strengthening of MOH's health training institutions in the three provinces
through provision of goods, vehicles and technical assistance; (v) Provision of technical
assistance to the Directorate of Human Resources to monitor the implementation of the
training activities under the project and the Human Resources Development Plan in
general; (vi) Provision of goods and training to benefit public health facilities for
purposes of enhancing malaria control activities; (vi) Rehabilitation of up to 22 health
facilities; (vii) Construction of up to eighteen (18) health centers type II and two (2)
houses for MOH health personnel for each health facility newly built; and (viii)
strengthening of MOH's Health Care Waste Management Plan (HCWM) implementation
in the three provinces through provision of goods, training of health staff, and better
supervision of HCWM in health facilities.
The new health centers are designed to provide simply primary healthcare services,
including vaccinations, pre-natal care, routine births, treatment of simple wounds and
distribution of medicines to rural beneficiary populations estimated between 7,500 and
20,000 persons.
Subcomponent Ia: Scaling up of Nutrition Activities (US$ 27.0 million). This
subcomponent will primarily support community based nutrition (CBN) services
implementation in the three Northern provinces through contractual arrangements
between the MOH and eligible Non Government Organizations (NGOs). The specific
nutrition interventions will include: (i) Growth monitoring and promotion every two
months, including referral services for the treatment of severe and moderate acute
malnourished children; (ii) Promotion of exclusive breastfeeding and appropriate
complementary feeding, including cooking demonstration, use of micronutrient powder
(MNP) and deworming for children; (iii) Early identification and mobilization of
pregnant women for ante-natal care services, dietary counseling, including provision of
IFA tablets, and deworming for all pregnant women; (iv) Adapted health and nutrition
counselling for adolescent girls aged 11-19 as well as the provision of IFA tablets and
deworming; and (v) Education on safe water, hygiene, sanitation and referral services for
infectious disease control, including immunization. Dispersible zinc tablets and Oral
Rehydration Salt (ORS) will be distributed to treat diarrhea among children.
Component II: Boosting of national malaria control program (US$15.2 million). This
component would support the following activities: (i) Strengthening the malaria
management program; (ii) Acquisition of essential drugs, and rapid-diagnostic test kits,
microscopes, computer equipment and vehicles; (iii) Design and implementation of a
national training program on malaria monitoring & evaluation; (iv) Strengthening vector
control through the provision of training, technical assistance and good.
Component III: Strategic Planning and Capacity Building (US$ 7.5 million). This
component would support the following activities: (i) Developing the next five year
Health Sector Strategic Plan which will include, inter alia, preparation of a new health
care finance strategy, implementation of a service availability mapping survey, and
operational research in human resources; (ii) Preparing the additional financing for
nutrition (Project number P125477); (iii) Build capacity of health staff to enhance
nutrition program contract implementation and monitoring and evaluation at central,
provincial, district, and facility levels through provision of pre- and in-service training;
(iv) Operational research in the area of nutrition to generate knowledge and foster
innovation; (v) Strengthening the supply chain management, and (vi) Provision of
training to health staff at provincial level to enhance their financial management, and
monitoring and evaluation knowledge.
Component IV: Project Management and Operating Costs (US$1.5 million). This
component would support the following activities: (i) Operating cost necessary to
implement project activities such as fuel, utilities, vehicle maintenance, per diems for
Parts A, B, C, and D of the Project; (ii) Salaries of Community health workers APEs for
the remaining period of the project and non monetary incentive to other community
health agents; (iii) Establishment of a decentralized regional unit at provincial level to
support data processing, filing of key strategic documents and studies, and support
relevant health research; and (iii) Distribution costs, which are defined as: a) temporary
labor (seasonal workers contracted to provide additional labor when necessary); (b)
printing of forms; (c) warehouse supplies; (d) temporary warehouse rental; (e) basic
repair and maintenance costs of materials and handling equipment; and (f) maintenance
and fuel costs for vehicles used in the distribution of health commodities; and ()
Financing of operating costs.
In addition to the rehabilitation of up to 22 existing health centers, under the
restructured project, up to 18 new type II rural health centers will be constructed.
4. Project Location and salient physical characteristics relevant to the safeguard
analysis
The program would be implemented in the three Northern provinces of Cabo Delgado,
Nampula, and Niassa. Construction of new health centers will take place close to existing
settlements within rural areas of these provinces. Land use in the areas where the health
centers will be built is predominantly extensive subsistence agriculture. Some protected
areas and biologically important natural habitats do occur in the three provinces, but not
in the localities where the health centers will be built.
5. Environmental and Social Safeguards Specialists
Mr Cheikh A. T. Sagna (AFTCS)
Mr Stephen Ling (AFTN3)
6. Safeguard Policies Triggered
Environmental Assessment (OP/BP 4.01)
Natural Habitats (OP/BP 4.04)
Forests (OP/BP 4.36)
Pest Management (OP 4.09)
Physical Cultural Resources (OP/BP 4.11)
Indigenous Peoples (OP/BP 4.10)
Involuntary Resettlement (OP/BP 4.12)
Safety of Dams (OP/BP 4.37)
Projects on International Waterways (OP/BP 7.50)
Projects in Disputed Areas (OP/BP 7.60)
Yes
X
No
X
X
X
X
X
X
X
X
X
II. Key Safeguard Policy Issues and Their Management
A. Summary of Key Safeguard Issues
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 HSDP is classified as Category B (a partial environmental and social analysis is
considered appropriate to address specific social and environmental issues) for three
reasons: , (i) the program would involve the provision of medical supplies, and therefore
will generate healthcare waste, (ii) construction of type 2or rehabilitation of rural health
centers involves small-scale civil works which could have localized and site specific
environmental and/or social impacts, and will also lead to generation of relative amounts
of healthcare waste, and (iii) the program would involve some aspects of vector control
under its malaria control component, including provision of bed nets, and training and
monitoring activities in relation to spraying program. The program will not finance any
pesticides or spraying equipment as indoor residual spraying is financed under the
ongoing President's Malaria Initiative, executed by the United States Agency for
International Development (USAID).
No large-scale, significant or irreversible impacts are anticipated.
2. Describe any potential indirect and/or long term impacts due to anticipated future
activities in the project area:
Not anticipated.
3. Describe any project alternatives (if relevant) considered to help avoid or minimize
adverse impacts.
Completion of the project without the inclusion of civil works for construction or
rehabilitation of rural health centers was considered; but these are extremely high
priorities for the effective provision of primary health care in the targeted provinces, and
as the associated site specific potential environmental and social impacts are minor and
easily manageable, it was decided to proceed with their inclusion.
4. Describe measures taken by the borrower to address safeguard policy issues. Provide
an assessment of borrower capacity to plan and implement the measures described.
1) Health Care Waste Management Plan (HCWMP). The Healthcare Waste Management
Plan developed under the previous HIV/AIDS Response Project will be used and
monitored. Selected activities of the national action plan will be supported under this
project to improve implementation of the HCWMP. Emphasis will be placed on the
targeted three provinces under this project. National regulations have already been
strengthened under this HCWMP, awareness of the issues is significantly increased and
routine implementation and monitoring systems are gradually being upgraded. Following
the project Mid-Term Re view, however, it was decided that the restructuring should
provide additional project resources to further accelerate the implementation of national
legislation developed under the HCWMP specifically within the three project provinces.
2) Environment and Social Management Plan (ESMP) for construction or renovation of
rural health centers. Construction of type II rural health centers conforms to a standard
national design. As (i) the nature and scale of the construction activities are therefore
well-characterized and pose minimal risks, and (ii) strict siting criteria have been
established to prevent the location of new centers in environmentally and/or socially
sensitive areas, Borrower developed an ESMP that provides a set of standard social and
environmental mitigation measures for implementing civil works. This is consistent with
both national ESIA regulations as well as World Bank OP/BP 4.01 policy, which require
compliance with established applicable regulations for this type of construction. The
ESMP specifies the health care waste disposal facilities to be provided in the new health
centers, and provides guidance as to how health care waste will be managed in line with
the existing HCWMP and national regulations. The project will recruit a construction
supervision consultant to assure the quality of civil works and compliance with the
ESMP. Implementation of health care waste management systems in new or renovated
health centers will be supported and monitored through the broader project support to
improving healthcare waste management under component 1, and in accordance with the
existing HCWMP.
3) Vector Management Plan (VMP). Although vector management activities supported
by the project are limited to provision of mosquito bed nets, and some training and
monitoring activities, the project formally adopted the Vector Management Plan already
developed for the national indoor residual spraying (IRS) program being implemented by
MISAU. An international development group (RTI International) was selected to
elaborate an environmental assessment for all indoor residual spraying operations. The
EA documents include a programmatic environmental assessment for malaria integrated
vector management programs, an assessment for IRS in Mozambique and a safe use
action plan for the use of DDT, bendiocarb and lambda-cyhalothrin. The environmental
assessment for indoor residual spraying was prepared to address the identified issues
surrounding IRS operations.
This IRS program is part of the President's Malaria Initiative (PMI) in Africa, working
with the World Bank, the Global Fund, and other members of the Roll Back Malaria
Partnership. Within the USAID/Mozambique Integrated Health Sector (HIS) Strategic
Objective Agreement, an initial Environmental Assessment (2005) identified the
distribution, use and re-treatment of Insecticide Treated Nets (ITNs) and Long-Lasting
Insecticidal Nets (LLINs) as a major intervention for malaria control. This intervention
came with a number of conditions, listed in the Safer Use Action Plan, and based on
recommendations from the Programmatic Environmental Assessment for InsecticideTreated Materials in USAID Activities in Sub-Saharan Africa.
Under the PMI, USAID proposes to help the government of Mozambique implement an
Indoor Residual Spraying (IRS) program for malaria vector control. Mozambique is
characterized by perennial malaria transmission, and IRS would be used to reduce
malaria incidence in the seasons of highest transmission. This IRS program will be part
of other vector management measures supported and implemented by the MOH that
include the distribution and use of bed nets.
Because of the potential environmental impact of the pesticides proposed for use, DDT,
bendiocarb and lambda-cyhalothrin, this environmental assessment identifies the
mitigating measures to minimize potential impacts while achieving a significant
reduction in malaria incidence.
The MOH and the Ministry for Coordination of Environmental Affairs (MICOA) will
implement the risk reduction actions outlined in the environmental assessment (EA) and
vector management plan and re-examine the need for DDT while considering other
chemical options for IRS operations to achieve best vector control. The Safer Use Action
Plan is to be implemented with relevant partners as a management tool for dealing with
and accomplishing the objectives. IRS supervisors, team leaders, and spray operators will
be trained according to WHO guidelines as well as Ministry of Agriculture standards.
Insecticide poisoning management training will be provided to health workers.
Pyrethroid, DDT and carbamate poisoning treatment medications and antidotes will be
provided to trained health workers by the MOH. Insecticide storage facility storekeepers
will also be trained on proper store management.
Occupational exposure to insecticides will be minimized through personal protective
equipment (according to WHO guidelines). A public awareness campaign will educate
home owners on their roles and responsibilities during the spray campaign to avoid
exposure, and supervisors will remind residents of these responsibilities during spray
campaigns.
Environmental contamination will be kept to a minimum through strict auditing,
handling, washing, and disposal practices. Each insecticide sachet will be strictly
accounted for, contaminated waste-water and rinse-water will be re-used in subsequent
days of spraying (progressive and pressure rinsing). Empty DDT sachets will be collected
by the MOH and returned to the supplier (if possible) or disposed of in an
environmentally safe manner.
The HSDP team will actively monitor ongoing activities for compliance with the
requirements and recommendations in this assessment, and modify or end activities that
are not in compliance.
Project team will actively monitor ongoing activities for compliance with the
requirements and recommendations in this assessment, and modify or end activities that
are not in compliance. If additional activities are added to this program that are not
described in the EA/VMP document, an amended EA/VMP will be prepared prior to
implementation of those activities. This includes any commodities, pesticide products
being considered under the program but not covered in the present EA/VMP.
5. Identify the key stakeholders and describe the mechanisms for consultation and
disclosure on safeguard policies, with an emphasis on potentially affected people.
The HCWMP was consulted upon and disclosed under the earlier HIV/AIDS Response
Project, and re-disclosed on May 25, 2007 under the present project. The VMP was
reviewed by the Bank and circulated for public consultation on May 25, 2007.
For the construction of new rural health centers, proposed sites have been identified
jointly with local beneficiaries, and extensive discussions have been held with local
communities as part of the process of obtaining DUATs (Government issued legal land
title (DUAT) to certify that the identified pieces of lands in the following districts: Palma,
Mocímboa da Praia, Mueda, Ancuabe, Balama and Chiúre in Cabo Delgado Province;
Malema, Ribaué, Lalaua, Mugovolas, Memba and Nacarôa in Nampula Province; and
Metarica, Cuamba, Mandimba, Lago Niassa, Majune and Marrupa in Niassa province
are each free of any claim and fit for the proposed development activities). In light of the
above, the Bank as ascertained that OP/BP 4.12 policy will not be triggered; nevertheless,
should, for any reason the selection of sites needs to be adjusted, the same process will be
followed, as described in the ESMP, to ensure that local communities are consulted and
that the given land is free of any potential claim that could lead to either physical
resettlement or loss of asset that would require compensation of project affected persons.
The draft ESMP was reviewed and cleared by the Bank and MICOA, a national-level
stakeholders consultation meeting was held on October 30, 2012 in Maputo; and the
ESMF was disclosed both on the MISAU website and in the World Bank InfoShop on
November 16, 2012.
B. Disclosure Requirements Date
Environmental Assessment/Audit/Management Plan/Other:
Was the document disclosed prior to appraisal?
N/A
Date of receipt by the Bank
11/12/2012
Date of "in-country" disclosure
11/16/2012
Date of submission to InfoShop
11/16/2012
For category A projects, date of distributing the Executive
Summary of the EA to the Executive Directors
Resettlement Action Plan/Framework/Policy Process:
Was the document disclosed prior to appraisal?
Date of receipt by the Bank
Date of "in-country" disclosure
Date of submission to InfoShop
Indigenous Peoples Plan/Planning Framework:
Was the document disclosed prior to appraisal?
Date of receipt by the Bank
Date of "in-country" disclosure
Date of submission to InfoShop
Pest Management Plan:
Was the document disclosed prior to appraisal?
N/A
Date of receipt by the Bank
N/A
Date of "in-country" disclosure
N/A
Date of submission to InfoShop
N/A
* If the project triggers the Pest Management and/or Physical Cultural Resources,
the respective issues are to be addressed and disclosed as part of the Environmental
Assessment/Audit/or EMP.
If in-country disclosure of any of the above documents is not expected, please
explain why:
C. Compliance Monitoring Indicators at the Corporate Level (to be filled in when the
ISDS is finalized by the project decision meeting)
OP/BP/GP 4.01 - Environment Assessment
Does the project require a stand-alone EA (including EMP) report?
If yes, then did the Regional Environment Unit or Sector Manager (SM)
review and approve the EA report?
Are the cost and the accountabilities for the EMP incorporated in the
credit/loan?
OP 4.09 - Pest Management
Does the EA adequately address the pest management issues?
Is a separate PMP required?
If yes, has the PMP been reviewed and approved by a safeguards specialist or
SM? Are PMP requirements included in project design? If yes, does the
project team include a Pest Management Specialist?
The World Bank Policy on Disclosure of Information
Have relevant safeguard policies documents been sent to the World 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
Have satisfactory calendar, budget and clear institutional responsibilities
been prepared for the implementation of measures related to safeguard
policies?
Have costs related to safeguard policy measures been included in the project
cost?
Does the Monitoring and Evaluation system of the project include the
monitoring of safeguard impacts and measures related to safeguard policies?
Have satisfactory implementation arrangements been agreed with the
borrower and the same been adequately reflected in the project legal
documents?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
D. Approvals
Signed and submitted by:
Task Team Leader:
Environmental Specialist:
Social Development Specialist
Additional Environmental and/or
Social Development Specialist(s):
Name
Mr Humberto Albino Cossa
Mr Stephen Ling
Mr Cheikh A. T. Sagna
Approved by:
Sector Manager:
Comments:
Mr Olusoji O. Adeyi
Date
11/16/2012
11/02/2012
10/28/2012