Philippines - Second Women's Health and Safe Motherhood Project

26574 December 4, 2002 Integrated Safeguards Data Sheet (Initial) Section I - Basic Information Date ISDS Prepared/Updated: 12/04/2002 A. Basic Project Data (from PDS) .A. 1. Project Statistics Country: PHILIPPINES Project ID: P079628 Project: PH-2ND WOMEN'S HEALTH & SAFE Task Team Leader: Teresa Ho MOTHERHOOD Authorized to Appraise Date: October 15, 2003 IBRD Amount ($m): 30.00 Bank Approval: April 29, 2004 IDA Amount ($m): Managing Unit: EASHD Sector: Health (100%) Lending Instrument: Specific Investment Loan (SIL) Theme: Population and reproductive health (P) Status: Lending I.A.2. Project Objectives (From PDS): 1. Two objectives are proposed for the project: * To assist disadvantaged women of reproductive age to gain sustainable access to high quality and cost-effective reproductive health (RH) services and to enable them to safely attain their desired spacing and number of children * To assist in the development and implementation of systems within the framework of the Health - Sector Reform Agenda (HSRA) that are critical for financing and delivery of reproductive health services. I.A.3. Project Description (From PDS): Component A: Support to Local Delivery of the WHSM Service Package At selected project sites, this component would support local governments in mobilizing networks of public and private providers as well as other community groups in the locality to undertake activities and deliver services included in the Women's Health and Safe Motherhood service package (WHSM-SP), with focus on maternal care, family planning and STI/HIV control services. While local networks are intended to serve everyone in respective communities, the Project activities and inputs would give priority attention to assuring that disadvantaged women obtain their fair share in access to and use of the WHSM-SP. The component would include the following as appropriate for each project site: A. 1. Critical Capacities to Provide Ouality WHSM Services. This subcomponent would ensure that critical organizational, facility, and human resource capacities essential to delivery of currently unavailable elements in the WHSM-SP are installed and maintained at the appropriate levels of the local health care delivery network of the project site. Based on a standard planning protocol to be developed by the Project, Local Government Units (LGUs) within each project site would identify missing critical capacities necessary to deliver the WHSM-SP in terms of specific organizational structures, new service outlets or additional facilities in existing outlets, additional staffing or new skills of existing staff. The needs of each project site would then be assessed and consolidated under this sub-component. The sub-component would provide: (i) technical support to developing models for WHSM service delivery at the local level, with 2 ISDS appropriate variations for delivery of the package to difficult-to-reach disadvantaged groups such as, among others, women in isolated and remote locations, adolescents and unmarried women, or women in the commercial sex industry; (ii) material support to LGUs for the establishment of the service delivery model appropriate in their specific localities. A.2 Accessible and Affordable WHSM Commodities. This subcomponent would ensure an accessible and affordable supply of commodities necessary to deliver the WHSM-SP by: (i) establishing efficient procurement, logistics and management systems to enable coordinated- support to local networks of public and private outlets in terms of mission-essential drugs and commodities; (ii) supporting the expansion of existing commercial and non-governmental initiatives providing affordable contraceptives to public and private outlets and other re-supply points at the community level; and (iii) developing a model blood services system meeting WHO standards for ensuring safe blood supplies to local networks of health outlets that perform transfusions. A.3 Advocacy and Promotion of WHSM. This subcomponent would support mass media and other communications programs at the local level that: (i) promote knowledge, attitudes and behavior consistent with attaining desired WHSM outcomes, including demand and use of appropriate services; (ii) increase popular understanding of the barriers and risks to better women's health and safer motherhood, including greater appreciation of the nature of sexual risks to HIV/AIDS infection; (iii) create broad constituencies for vigorous, enlightened and forward looking local government responses to delivering WHSM services, including public support to assuring availability to all of the full menu of family planning methods. A.4 Integrated Local Financini and Management of WHSM Services. This subcomponent would develop and field test potentially replicable systems for local financing and management of WHSM services delivered by the local networks of providers assisted and supported by sub-components A.1, A.2 and A.3. Models for management systems of local networks would be based on LGUs serving both as administrators of LGU-owned and managed service outlets, and as facilitators of private providers that are sub-contracted, coordinated or linked up with the public system. Models for financing would establish local arrangements for mixing and matching different sources and uses of funds for WHSM services. National government financing would be linked with LGU financing at provincial, city, municipal and/or barangay levels, and this combined government financing would be matched and mixed with social insurance payments and individual payments. The management and financing systems would be linked to the service delivery systems. A focus of the subcomponent is the development of a mechanism for sustainable financing of community-level activities and services for WHSM. The sub-component would include developing a common system for management and supervision of WHSM services delivered by public and private providers within the convergence framework of the HSRA. Component B: National Capacity to Sustain WHSM Services This component would develop national-scale institutional capacities, policy frameworks and knowledge management mechanisms that would create an operating environment conducive to LGUs managing and sustaining local delivery of the WHSM-SP at levels necessary to improve outcomes. The component would support four key channels through which the national government continues to influence the cost, quality, reach 3 ISDS and equity of already locally devolved service delivery. These channels are: (a) promulgation of technical guidance and regulatory standards with which local providers are obliged to comply; (b) provision of staff competencies which are regarded as valuable or attractive by local workers and managers; (c) extension of funding support for goods and services through national government resource transfers or through PHIC payments to local providers; (d) dissemination of monitoring, evaluation or research findings which local providers have to confront or consider. While these channels operate to serve a wide range of health objectives important to the national government, the focus of the Project is to assist in those aspects of navigating these channels that are important to the delivery of the WHSM-SP to all women in general and to disadvantaged women in particular. B. 1 Operational and Regulatory Guidelines for Provision and Use of WHSM Services. This subcomponent will support the research-based formulation, transparent official adoption, and thorough field dissemination and installation of two types of technical guidelines, namely, best-practice advisory operational guidelines which providers need to consider for improved services, and mandatory regulatory standards which providers are obliged to meet. The guidelines themselves may be in various forms such as service delivery standards, clinical practice guidelines, referral protocols, IEC and counseling guidelines, technical specifications of goods and equipment, checklists and procedural manuals, etc. necessary for the provision and use of WHSM services. The subcomponent will build on the already abundant reservoir of documents, prototypes, technical materials and actual experience already available from earlier and ongoing WHSM projects and RH programs. Among the most important options through which this subcomponent would work are the DOH Sentrong Sigla movement, the PHIC provider accreditation program, the successor of the USAID-assisted matching grants program for LGUs, the DOH regulatory functions under BFAD and other licensing units. B.2 HRD Systems for Competencies in WHSM. This subcomponent will provide support for local providers and managers to obtain competencies and capabilities essential to providing the WHSM-SP according to the needs and specifications of Component A. Two key systems would be supported, namely, the health worker training system which extends a range of training opportunities for health workers to acquire critical knowledge and skills; and the public sector health worker appointment, deployment and supervision system which administratively directs the broad function and behavior of civil servants in health. For the health worker training system, the subcomponent would support the creation of basic infrastructure that separates the three functions of training specification, training provision, and trainee selection and payment. The DOH would focus on training specification, accreditation of training providers, and monitoring and evaluation of training programs. A wide range of providers from both public and private sectors would undertake training provision. And Trainee selection and payment for training would increasingly be devolved to LGUs. The subcomponent would support training programs for WHSM service capabilities by (i) identifying the range of skills required and corresponding training needs for health personnel and other individuals involved in the delivery of WHSM services; (ii) rationalizing national programs for training in WHSM services to reduce costs, frequency and duration of training and improve quality (by reducing duplication, combining and integrating programs, etc.); (iii) assessing existing capacity to deliver the necessary training (including public and private training providers) and identifying gaps in existing training programs; (iv) developing a system for accrediting and contracting WHSM training providers and, if appropriate, providing institutional support to training providers on a selective basis; (v) providing support for 4 ISDS development and updating of training modules and (vi) developing a system for sustainable financing of training programs. For the public sector health worker appointment, deployment and supervision system, the subcomponent would provide support to: (i) incorporating key technical competencies in the qualification standards for hiring or promoting health workers including workers in LGUs; (ii) expanding the WHSM service contribution of the "Doctors to the Barrios" program; (iii) developing a "midwife to unserved communities" program; (iv) expanding the utilization of midwives in meeting WHSM needs of communities; (v) increasing the time and effort of public sector health workers devoted to WHSM activities, particularly to family planning. B.3 National Instruments for Financing Local Delivery of WHSM Services. The subcomponent would support Component A through the strengthening of two specific national instruments in terms of their sensitivity to WHSM concerns. One instrument is the DOH annual budget, which can provide the important resource transfers from the national government to local governments on cost items for delivering WHSM services. The DOH budget could provide critical subsidies for some commodities, training, and other goods and services that are of value to integrated local service delivery. The subcomponent would provide support for the development of new WHSM-friendly budgetary provisions and budget execution mechanisms that would be linked to LGU's budget formulation and allocation processes. The other key national instrument is the NHIP policies concerning enrollment coverage, benefit package specification, provider accreditation and provider payment. The subcomponent would support the development of new NHIP policies in these areas, including policies concerning new beneficiary services to be extended by PHIC through Local Health Insurance Offices, which may offer opportunities for more effective support to local WHSM services. B.4 Monitorink, Evaluation, Research and Dissemination. This sub-component would (a) track progress in implementation of the WHSM service package using pre-identified intermediate indicators and performance benchmarks; (b) carry out baseline and evaluation studies in project sites; (c) support policy and operations research on WHSM; and (d) disseminate MER results to relevant stakeholders. I.A.4. Project Location: (Geographic location, information about the key environmental and social characteristics of the area and population likely to be affected, and proximity to any protected areas, or sites or critical natural habitats, or any other culturally or socially sensitive areas.) To be determined during preparation. B. Check Environmental Classification: C (Not Required) Comments: EA Category will be further reviewed and clarified during project preparation. C. Safeguard Policies Triggered (from PDS) (click on 0 for a detailed desciption or click on the policy number for a brief description) Policy Triggered Environmental Assessment (OP 4.01, BP 4.01, GP 4.01) ( Yes ( No 0 TBD Natural Habitats (OP 4.04, BP 4.04, GP 4.04) ( Yes 0 No (9 TBD Forestry (OP 4.36, GP 4.36) (CYes * No U TBD 5 ISDS Pest Management (OP 4.09) OY es *No O TBD Cultural Property (OPN 11.03) ( Yes *No 0 TBD Indigenous Peoples (OD 4.20) *Yes 0 No 0 TBD Involuntary Resettlement (OP/BP 4.12) 7Yes No ( TBD Safety of Dams (OP 4.37, BP 4.37) Yes SNo U TBD Projects in International Waters (OP 7.50, BP 7.50, GP 7.50) ( Yes No ( TBD Projects in Disputed Areas (OP 7.60, BP 7.60, GP 7.60)* (9Yes ONo ( TBD Section II - Key Safeguard Issues and Their Management D. Summary of Key Safeguard Issues. Pleasefill in all relevant questions. If information is not available, describe steps to be taken to obtain necessary data. 1I.D. Ia. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, significant and/or irreversible impacts. The issue of medical waste management will require close attention in the project, in particular because incineration is not legal in the Philippines. The Safeguards review of the proposed Philippine Health Sector Reform Project (minutes dated July 16, 2002) recommended that the project review the country's solid waste legislation, its overall strategy for medical waste, its readiness to respond to the new law, and how the project can contribute to that readiness. It was also suggested that the HSRP could consider piloting alternative technology for the disposal of medical waste. A strategy for medical waste management will be worked out as part of the preparation of the HSRP (also a FY04 operation) with PHRD funds now set aside for this purpose. Recommendations from that study will be applied in this project (WHSMP2), to the extent appropriate. The HSRP Safeguards review also recommended that, "if new construction is planned, then an Environmental Assessment could be needed, depending on the nature and scale of the works. However, if limited construction or rehabilitation is planned, no EA is needed, but construction contracts and bidding documents should included good construction practices. It was recommended that all medical facilities be asked to prepare a medical waste management plan. The Safeguards team recommended that if the exact project locations are not known by appraisal, then a screening process would have to be developed and used to identify potential environmental concerns. However, if project locations are known prior to appraisal, then the task team should notify the safeguards team on the nature and scale of construction so that the most appropriate environmental and social safeguards measures can be determined." For this project (WHSMP2), it is likely that there will be some rehabilitation and small new construction, and that not all locations will be known prior to approval. The task team should be able to inform the safeguards team of the nature and scale of construction by the time of appraisal, as advised for the HSRP. A social assessment will be conducted during project preparation to have a better understanding of the project's impact on the indigenous peoples and land acquisition/resettlement. II.D.1b. Describe any potential cumulative impacts due to application of more than one safeguard policy or due to multiple project component. To be further clarified and reviewed during project preparation. II.D.Ic Describe any potential long term impacts due to anticipated future activities in the project area. To be further clarified and reviewed during project preparation. II.D.2. In light of 1, describe the proposed treatment of alternatives (if required) To be further clarified and reviewed during project preparation. II.D.3. Describe arrangement for the borrower to address safeguard issues For the medical waste issue, pls see para (a) above of this same section. 6 ISDS The applicability of the Indigenous Peoples Policy in project sites identified to have populations of indigenous peoples will investigated during project preparation and applied as appropriate. Likewise, the existing pilot project of the Department of Social Welfare and Development with respect to the Social Integration for Indigenous Peoples will be investigated for possible replication as well as the procedures of the National Commission on Indigenous Peoples to ensure that existing GOP policies and procedures are also complied with. Moreover, the task team will ensure that the project will be compliant with all other safeguard policies of the Bank at all times. To help ensure this, the project implementation manual may include the following provisions as applicable depending on findings during project preparation - * all land acquisition would be done between a willing buyer and seller or a willing donor and the community, all following commercial practices in the area; * an Indigenous Peoples development plan or framework will be developed For this purpose, the World Bank Office Manila's safeguards officer will be engaged to help in investigating the safeguard issues of the project during project preparation. II.D.4. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The proposed project design is the product of three days of consultations with representatives of DOH units, PHIC, public and private provider institutions, donor institutions and other stakeholder groups held during the project identification mission in August 2002. These intensive consultations will continue throughout project preparation and implementation. E. Safeguards Classification (select in SAP). Category is determined by the highest impact in any policy. Or on basis of cumulative impacts from multiple safeguards. Whenever an individual safeguard policy is triggered the provisions of that policy apply. [ 1. - Significant, cumulative and/or irreversible impacts; or significant technical and institutional risks in management of one or more safeguard areas S2. - One or more safeguard policies are triggered, but effects are limited in their impact and are technically and institutionally manageable S3. - No safeguard issues [ ] SF. - Financial intermediary projects, social development funds, community driven development or similar projects which require a safeguard framework or programmatic approach to address safeguard issues. F. Disclosure Requirements Environmental Assessment/Analvsis/Management Plan: Expected Actual Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Date of distributing the Exec. Summary of the EA to the Executive Directors (For category A projects) Resettlement Action Plan/Framework: Expected Actual Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Indigenous Peoples Development Plan/Framework: Expected Actual Date of receipt by the Bank 7 ISDS Date of "in-country" disclosure Date of submission to InfoShop Pest Management Plan: Expected Actual Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop Darn Safety Management Plan: Expected Actual Date of receipt by the Bank Date of "in-country" disclosure Date of submission to InfoShop If in-country disclosure of any of the above documents is not expected, please explain why. Signed and submitted by Name Date Task Team Leader: Teresa Ho Project Safeguards Specialists 1: Project Safeguards Specialists 2: Project Safeguards Specialists 3: Approved by: Name Date Regional Safeguards Coordinator: Sector Manager/Director Emmanuel Y. Jimenez