Kenya - Additional Financing for the Health Sector Support Project

 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 11/30/2011 Report No.: AC6579 1. Basic Project Data Original Project ID: P074091 Original Project Name: Health Sector Support Country: Kenya Project ID: P128663 Project Name: Health Sector Support Additional Financing Task Team Leader: Gandham N.V. Ramana Estimated Appraisal Date: October 26, Estimated Board Date: December 19, 2011 2011 Managing Unit: AFTHE Lending Instrument: Emergency Recovery Loan Sector: Health (100%) Theme: Health system performance (50%);Child health (30%);Nutrition and food security (20%) IBRD Amount (US$m.): 0 IDA Amount (US$m.): 56.8 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 Repeater [] Is this project processed under OP 8.50 (Emergency Recovery) Yes [X] No [ ] or OP 8.00 (Rapid Response to Crises and Emergencies) 2. Project Objectives The Project Development Objectives are to improve: (i) the delivery of essential health services for Kenyans, especially the poor and the drought-affected populations; and (ii) the effectiveness of planning, financing and procurement of pharmaceuticals and medical supplies. The key indicators are: (i) Direct Project Beneficiaries (Number of outpatient visits to levels 2&3), (ii) Children fully immunized, (iii) Value fill rate for commodities on KEMSA Essential Drug List, (iv) HSSF facilities meeting the core financial management requirements of the fund, (v) Fiduciary irregularities reported from HSSF and KEMSA acted upon (during the previous quarter), (vi) Level 2 and 3 HSSF facilities displaying information as per Government of Kenya (GoK) guidelines, and (vii) Severely malnourished children under five receiving treatment recovered. 3. Project Description The proposed Project has two components: (i) Component 1 (US$58.8 million) will support the effective and transparent implementation of the Kenya Essential Package for Health (KEPH) through Health Sector Services Fund (HSSF) grants and performance based financing support to increase access to basic quality services; and (ii) Component 2 (US$98 million) will fund the increased Availability of Essential Health Commodities and Strengthening of Supply Chain Management. Both components will support improvements in health sector governance, accountability and performance. The proposed Additional Financing (AF) from the IDA Crisis Response Window (CRW) to the Kenya Health Sector Support Project (KHSSP) would support the emergency response to deliver essential health and nutrition services for the drought affected arid and semi arid regions of Kenya. The AF will include new activities to address the nutrition and health needs of children under five and pregnant and lactating women as well as scale-up of ongoing activities to improve the supply of essential medicines to mitigate the risk for infections and communicable disease outbreaks. 4. Project Location and salient physical characteristics relevant to the safeguard analysis NHSSP II, which the Project supports, covers the whole country. As per the descriptions above, implementation will be at all levels of the health system. 5. Environmental and Social Safeguards Specialists Ms Gibwa A. Kajubi (AFTCS) Ms Svetlana Khvostova (AFTOS) 6. Safeguard Policies Triggered Yes No Environmental Assessment (OP/BP 4.01) X Natural Habitats (OP/BP 4.04) X Forests (OP/BP 4.36) X Pest Management (OP 4.09) X Physical Cultural Resources (OP/BP 4.11) X Indigenous Peoples (OP/BP 4.10) X Involuntary Resettlement (OP/BP 4.12) X Safety of Dams (OP/BP 4.37) X Projects on International Waterways (OP/BP 7.50) Projects in Disputed Areas (OP/BP 7.60) 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: Safeguard policies triggered in the original project were Environmental Assessment (OP/BP 4.01) and Indigenous Peoples (OP/BP 4.10) and no new safeguard policies will be triggered. No exceptions to Bank policies are required. Environment: The main environmental safeguard policy relates to health care waste management, in view of the risks associated with the handling and disposal of medical waste. The GoK prepared a Health Care Waste Management Plan, which focused on medical waste generation, as well as segregation, storage, collection, transport, and final disposal practices; technologies for waste disposal; public awareness programs; and relevant national legislation. The plan was publicly disclosed by the Ministry of Public Health and Sanitation (MOPHS) and Ministry of Medical Services (MOMS) in Kenya, and in the InfoShop in February 2010, in association with the East Africa Public Health Laboratory Networking Project (EAPHLNP). The plan was disclosed again in the InfoShop in May 2010. The EAPHLNP will fund some laboratory investments relating to the waste management plan, and the KHSSP will provide some additional funding for other waste management activities. For malaria control, the Essential Medicines and Medical Supplies (EMMS) pooled fund only supports anti-malarial drugs, bednets and diagnostics. No indoor residual spraying will be supported in the Project. The Project does not support civil works other than maintenance and very minor renovation of existing health facilities under the HSSF. The Project does not finance activities involving the involuntary taking of land, loss of assets or access to assets, loss of income sources or means of livelihood or the involuntary restriction of access to legally designated parks and protected areas. The proposed AF will not change the environmental category of the KHSSP which is rated Category B. The Project also triggered OP 4.10. An Indigenous Peoples Planning Framework (IPPF) was developed by the MOPHS and MOMS for the EAPHLNP and then updated to include the new health Project too. The documents were reviewed by IDA and found to be acceptable. The MOMS and MOPHS disclosed the documents in the country on February 4, 2010, and the Bank disclosed them in the InfoShop on February 5, 2010. The framework was disclosed again in the InfoShop in May 2010 to ensure clarity about the application of the safeguards documents to the KHSSP. The Ministry of Health prepared joint terms of reference for the development of Vulnerable and Marginalized People's Plans (VMPPs) for the three health projects supported by The Bank: Kenya Health Sector Support Project (P074091), Kenya Total War Against HIV and AIDS Project (P081712) and the Kenya East Africa Public Health Laboratory Networking Project (P111556) in May 2011. No negative impacts are anticipated on Vulnerable and Marginalized Groups (VMGs), rather the aim of the plans is to identify pro-active measures to ensure that VMGs benefit from the project.An Expression of Interest (EOI) was issued by MOPHS in July 2011 to undertake a social assessment and develop project specific Vulnerable and Marginalized Peoples Plans (VMPPs) through free, prior and informed consultations with the local vulnerable and marginalized ethnic groups based on existing VMPP frameworks, that will enable such groups in the project areas to access benefits from each project equitably and in a culturally appropriate manner under the three projects. While the scope of the VMPPs will be national, the assessment will be conducted in ten sites across seven districts (Garissa, Marsabit, Wajir, Moyale, Narok, Lamu and Koibatek) with areas mapped as home to Indigenous Peoples. The proposed AF to the KHSSP will focus on Turkana. Garissa, Wajir, Mandera, Marsabit, Isiolo and Tana River the hardest hit areas. The VMPPs will cover three of these seven districts hardest hit by the drought (Garissa, Marsabit, and Wajir). The plans will make concrete suggestions on how to target these hard to reach and underserved groups. This work is currently underway and implementation should start in early 2012. However, the current security situation in Northern Kenya may necessitate revisiting the sites selected. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: There are no potential impacts other than medical waste, as discussed above. 3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. Medical waste is inevitable in health care. There were therefore no alternatives considered. 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. The GoK has already prepared a Health Care Waste Management Plan, which focuses on existing laboratory waste generation as well as segregation, storage, collection, transport, and final disposal practices; technologies for waste disposal; public awareness programs; and relevant national legislation. This plan was been reviewed and accepted under the EAPHLNP. The KHSSP has developed a Pilot to Integrate Social Accountability Approaches in the Health Sector Services Fund (HSSF). The pilot will include (i) preparatory activities for holding two health baraza with communities and health staff at each facility, (ii) ) planning and implementing support activities to strengthen social accountability at health facilities and their communities; (iii) providing hands-on training to health staff and Health Facility Management Committees (HFMC) to takeover implementation of social accountability at their facilities and communities; and (iv) preparing reports on lessons learnt from implementing social accountability for further scaling up. A Draft Operational Manual with appropriate tools for integrating Social Accountability (SA) into HSSF has been developed focusing on three aspects of social accountability - transparency, effective complaint redress, and participation. Training and consultations are already underway at selected health facilities. The pilot will be implemented at nine (9) locations, reflecting different socio-economic settings in Kenya, which include: arid and semi-arid including pastoral, fishing, agriculture, semi-urban, and coastal. The pilot will be implemented from June 2011 to June 2012. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The key stakeholders include Ministry of Health, Non Governmental Organizations, private and mission health facilities, municipal councils and health facilities, health workers, patients, and people living near health facilities and dump sites. Consultation for the NHCWMP was through public hearings, stakeholder workshops and meeting of the heads of the implementing agencies. For disclosure, the NHCWMP and related documents were posted on the websites of the Ministry of Health and the National AIDS Control Council (NACC). The plan was also disseminated through local newspapers and radio. In addition, it was disclosed at the World Bank Information Center in Nairobi and the InfoShop in Washington DC. B. Disclosure Requirements Date Environmental Assessment/Audit/Management Plan/Other: Was the document disclosed prior to appraisal? Yes Date of receipt by the Bank 02/03/2010 Date of "in-country" disclosure 02/04/2010 Date of submission to InfoShop 05/14/2010 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? Yes Date of receipt by the Bank 02/03/2010 Date of "in-country" disclosure 02/04/2010 Date of submission to InfoShop 05/14/2010 Pest Management Plan: Was the document disclosed prior to appraisal? Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop * 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? Yes If yes, then did the Regional Environment Unit or Sector Manager (SM) Yes review and approve the EA report? Are the cost and the accountabilities for the EMP incorporated in the Yes credit/loan?  OP/BP 4.10 - Indigenous Peoples Has a separate Indigenous Peoples Plan/Planning Framework (as Yes appropriate) been prepared in consultation with affected Indigenous Peoples? If yes, then did the Regional unit responsible for safeguards or Sector Yes Manager review the plan? If the whole project is designed to benefit IP, has the design been reviewed Yes and approved by the Regional Social Development Unit or Sector Manager? The World Bank Policy on Disclosure of Information Have relevant safeguard policies documents been sent to the World Bank's Yes Infoshop? Have relevant documents been disclosed in-country in a public place in a Yes 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 Yes been prepared for the implementation of measures related to safeguard policies? Have costs related to safeguard policy measures been included in the project Yes cost? Does the Monitoring and Evaluation system of the project include the Yes monitoring of safeguard impacts and measures related to safeguard policies? Have satisfactory implementation arrangements been agreed with the Yes borrower and the same been adequately reflected in the project legal documents? D. Approvals Signed and submitted by: Name Date Task Team Leader: Mr Gandham N.V. Ramana 10/27/2011 Environmental Specialist: Ms Svetlana Khvostova 11/17/2011 Social Development Specialist Ms Gibwa A. Kajubi 10/31/2011 Additional Environmental and/or Social Development Specialist(s): Approved by: Regional Safeguards Coordinator: Ms Alexandra C. Bezeredi 11/18/2011 Comments: Sector Manager: Ms Miriam Schneidman 11/17/2011 Comments: