INTEGRATED SAFEGUARDS DATA SHEET
CONCEPT STAGE
Report No.: AC1029
Date ISDS Prepared/Updated: October 6th, 2004
I. BASIC INFORMATION
A. Basic Project Data
Country: Congo, Democratic Republic of
Project Name: DRC Health Rehabilitation
Project
Estimated Appraisal Date: January 06,
2005
Managing Unit: AFTH3
Project ID: P088751
Task Team Leader: Eva Jarawan
Estimated Board Date: March 31, 2005
Lending Instrument: Specific Investment
Loan
Sector: Health (100%)
Theme: Health system performance (P)
Safeguard Policies Specialists in the task team: Kristine M. Ivarsdotter
Loan/Credit amount ($m.):
IDA: 60
Other financing amounts by source: Co-Financing
40 ($m)
B. Project Objectives [from section 2 of PCN]
To improve access to, and utilization of, quality essential health care package (preventive and
curative) for the population in targeted geographical areas. This will be achieved by
strengthening the existing public health system at all levels, with special attention paid to the
health zone. Improving geographical access, reducing financial barriers to utilization, and
improving the quality and effectiveness of care are priorities for the project. The project Key
performance indicators (KPIs) will be in line with the MDGs. The project will be in the amount
of US$100 million over a period of 4 years (IDA amount is US$60 million).
C. Project Description [from section 3 of PCN]
Although some donors had chosen to provide support to self-contained disease control programs,
e.g., onchocerciasis and trypanosomiasis control, this project proposes to strengthen the ability of
the health system to address a sizeable proportion of the primary health care needs of its target
groups, at the same time as supporting implementation of specific disease control interventions
in an integrated fashion in targeted areas. In line with the expectations of the Government, and
current modalities of donor coordination, the project has chosen a geographic targeting approach.
Co-financing will be explored, particularly with regard to implementation of disease control
interventions in the project’s targeted areas and with regard to continuation of support to areas
currently assisted by bilateral and international donor humanitarian programs that are scheduled
to end during the course of the proposed project.
SUB-OBJECTIVE 1: INCREASE ACCESS TO AND UTILIZATION OF HEALTH SERVICES
The following strategies are proposed:
Integrated support to targeted geographical areas: This project will provide integrated assistance
principally to the health zone (which incorporates public and private facilities), with necessary
financial and technical assistance to other levels in the health system pyramid. The following
objectives will guide the selection of health zones: i) build on the investments and progress
achieved in zones currently assisted by the EMRRP; ii) continue assistance to health zones where
current donors are withdrawing; and iii) establish, improve and extend basic health services in
poor, isolated, and under-served areas not being assisted by other donors.
Move services to lower levels of the health system: The project will work at increasing the
availability of services as close as possible to households – policy changes, such as allowing
antibiotic treatment for childhood pneumonia by non-physicians, and emergency obstetric care at
the health center level, will be encouraged.
Reduce financial barriers to care: Due to minimal Government funding, health services are
largely financed by household expenditures. This cost represents a considerable barrier to
utilization, especially for the poorest. The project will support a program of operational research
and policy dialogue focused on the question of how to reduce this barrier, with the aim of
changing policies and programs.
Public financing of private health service delivery: The project will build on the Government’s
experience in contracting with NGOs to manage and, in some cases, to provide services on the
basis of performance and results.
SUB-OBJECTIVE 2: INCREASE THE QUALITY, APPROPRIATENESS,
HEALTH SERVICES, IN ORDER TO REDUCE MORBIDITY AND MORTALITY
AND EFFECTIVENESS OF
The following strategies are proposed:
Improve child health services: In accordance with the Government’s minimum package of
activities, the project will improve the quality of preventive and curative interventions aimed at
reducing neo-natal and childhood morbidity and mortality due to pneumonia, malaria, diarrhea,
malnutrition, and vaccine-preventable diseases.
The promotion of community-based
interventions such as exclusive breastfeeding and family planning will be particular areas of
focus. This will be achieved by increasing the capacity of all levels of the health system to
promote appropriate preventive health behaviors, to detect and treat episodes of illness, and to
effectively administer and manage public health programs.
Improve women’s health services: The project will improve the quality of safe motherhood
interventions, including prevention of malaria in pregnancy, improved nutrition, delivery by a
skilled attendant, and emergency obstetrical care. Also important to women’s health are family
planning and the prevention and treatment of gender-based violence. In general, the project will
promote the primary role of women in decisions affecting the health and well-being of
themselves and their children.
Address important endemic and epidemic diseases: In the targeted zones, the project will
improve the ability of health authorities to detect and to respond to important endemic diseases
and diseases of epidemic potential. To do so, it will collaborate with other donors to strengthen
the health information system and to provide technical and material assistance in accordance
with national policies and strategies.
Improve the capacity of the Ministry of Health: The project will provide support to improve the
capacity of the MoH to fulfill its supervisory, regulatory, and stewardship capacities at all levels
– national, provincial, district, and zonal.
D. Project location (if known)
Project activities will take place in health zones (defined as a well defined geographical area of
around 100,000 inhabitants comprising a referral hospital, some 20 satellite health centers and
200 communities) chosen on the basis of needs and poverty level. Number and location of
covered urban and rural health zones have yet to be decided.
E. Borrower’s Institutional Capacity for Safeguard Policies [from PCN]
In 2004, the Ministry of Health developed a National Plan for Medical Waste Management
(Rapport E844 – December 2003 – Plan de Gestion des Déchets Biomédicaux) which, when
submitted* in the context of the MAP project, was found satisfactory to the IDA ISG group.
Government will start implementing this plan in the upcoming months and the MAP will
contribute to the financing of the Plan.
* The MWP has been disclosed in the Democratic Republic of Congo on December 23, 2003 and
at the Bank's Infoshop on December 30, 2003.
II. SAFEGUARD POLICIES THAT MIGHT APPLY
Applicable?
[X ]
[]
[X ]
Safeguard Policy
If Applicable, How Might It Apply?
Environmental Assessment (OP/BP 4.01)
No major environmental or social risks are foreseen for the investment as no new
construction is anticipated. The previously approved Waste Management plan
will be disclosed again in the Information Center.
Natural Habitats (OP/BP 4.04)
[]
Pest Management (OP 4.09)
To be determined: approach for malaria is still under discussion.
Involuntary Resettlement (OP/BP 4.12)
[]
Indigenous Peoples (OD 4.20)
[]
Forests (OP/BP 4.36)
[]
Safety of Dams (OP/BP 4.37)
[]
Cultural Property (draft OP 4.11 - OPN 11.03)
[]
Projects in Disputed Areas (OP/BP/GP 7.60)*
[]
Projects on International Waterways (OP/BP/GP 7.50)
Environmental Assessment Category:
[ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined)
If TBD, explain determinants of classification and give steps that will be taken to determine that
EA category (mandatory):
The project is classified as environmental category B as it is not expected to have significant
environmental or social impacts.
Environmental guidelines for civil works contracts will be prepared.
III. SAFEGUARD PREPARATION PLAN
A. Target date for the Quality Enhancement Review (QER), at which time the PAD-stage ISDS
would be prepared. TBD
B. For simple projects that will not require a QER, the target date for preparing the PAD-stage
ISDS. TBD
C. Time frame for launching and completing the safeguard-related studies that may be needed.
The specific studies and their timing1 should be specified in the PAD-stage ISDS. November
2004
*
By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the
disputed areas
1 Reminder: The Bank's Disclosure Policy requires that safeguard-related documents be disclosed before appraisal (i) at the
InfoShop and (ii) in-country, at publicly accessible locations and in a form and language that are accessible to potentially affected
persons.
IV. APPROVALS