Ghana - Second Health Sector Program Support Project

Report No. 23385 Date ISDS Prepared/Updated: 12/12/2001 Section I - Basic Information A. Basic Project Data Country: GHANA Project ID: P073649 Project: Ghana- Health Sector Program Support Credit II Task Team Leader: Francois Decaillet Appraisal Date: February 15, 2002 IBRD Amount ($m): Board Date: July 2, 2002 IDA Amount ($m): 50.00 Managing Unit: AFTH3 Sector: HA - HIV/AIDS; HC - Primary Health; Including Reproductive Health; Chi; HO - Hospitals; Secondary & Tertiary; HR - Reform and Financing; HS - Specific Diseases; including Malaria; TB; Others Lending Instrument: Specific Investment Loan (SIL) Status: Lending I.A.2. Project Objectives: The development objective of the proposed Health Sector Program Support Credit II is to support efforts by the Government of Ghana (GOG) to improve the health status of the population while reducing the geographical, socio-economic and gender inequalities. Building on progress achieved in recent years, and with financing of the Health Sector Program Support Project-I (1998-2002), the proposed Credit would support the Ministry of Health to implement its Medium-Term Health Strategy (MTHS) and 2002-2006 Program of Work (POW). To achieve the objectives defined in the POW, the Health Sector Support Program Credit II would finance a portion of the combined Government and external assistance budgets for policy development and operational activities. The Comprehensive Development Framework principles guide the World Bank's support to health sector development in Ghana as follows: A long term vision and strategy: The long term vision and development goals for Ghana are outlined in Ghana-Vision 2020. The process of preparing Ghana-Vision 2020: Second Step is underway. The Interim Poverty Reduction Strategy Paper (2000-2002) also provides important guidance for action. IDA would follow the Government's vision and strategies defined in the Medium-Term Health Strategy. Clear country ownership of development goals and actions: Based on lessons learned from the development and implementation of 1997-2001 POW, the Ministry of Health is developing the next 5-Year POW. The preparation process is highly consultative. IDA financing will be disbursed within the framework of the POW using a sector-wide approach (SWAP) where national institutions and procedures will be followed. Strategic partnership among stakeholders: The Ministry of Health (MOH) has developed a strong partnership with its internal and external partners. This is particularly true for the relationship between the MOH and core group of partners ( WHO, DFID, DANIDA, the World Bank, the Netherlands, the European Union and the Nordic Development Fund) which signed a Memorandum of Understanding in 1997. Guided by the Sector Wide Approach (SWAP), they are partially but increasingly pooling their funds into a common Health Account and use common national procurement and financial procedures. The Bank would work according to the principles and rules spelled out in a Memorandum of Understanding (MOU). Accountability for development results: Since 1998, comprehensive  performance reviews have been conducted annually. The review reports have been discussed at the district, regional and national levels. All review meetings have been opened to representatives from other government sectors, the political minority, civil society and the private sector. The World Bank would use the MOH's monitoring and evaluation system. I.A.3. Project Description: The Medium Term Health Strategy, the 2002-2006 Program of Work, and the annual Programs of Work and Budgets prepared by the Ministry of Healthwill provide the framework under which all stakeholders and the Bank will work. The proposed Credit would finance a portion of the combined Government and external assistance budgets for policy development and operational activities. IDA would provide a baseline financing of US$ 8 million a year which may be adjusted up to 50t at each annual budget agreement. Once the IDA Credit is 75t disbursed, a new Credit will be prepared to finance subsequent phases of the POW. The rationale for adjusting the annual IDA allocation will be based on the following factors: Existence of a gap between budget and available finance that cannot be covered by grant funds, Evidence of increased GOG allocations to the health sector, Evidence of progress in sector performance, in particular an increase in utilization of services and improved health outcomes in the poorest parts of the country. The end-of-previous-year balance in the US$ Health Account not exceeding 30t of the total annual donor contributions. The annual sector financing commitment by IDA would be approved by the Country Director and based on recommendations of the Bank team resulting from the discussions with Government and the Collaborating agencies. Each of the factors influencing the annual IDA allocation would be regularly reviewed by the GOG and the development partners. Estimated IDA disbursements in US$ million- GOG fiscal years 2002 2003 2004 2005 2006 Maximum annual 8 12 12 12 12 Maximum cumulative 8 20 32 44* 56 Low case annual 8 8 8 8 8 Low case cumulative 8 16 24 32 40 *A new credit would be sought after US$ 37.5 million is disbursed Prerequisites for IDA transfers would be: The organization by the Borrower of an annual sector performance review and presentation/discussion of the review report during the April/May health summit and endorsement of the review conclusions; The presentation by the Borrower of a draft annual POW during the September health summit and endorsement of this POW by all core donors; Submission by the borrower of the annual MOH budget that is submitted to the parliament; and Submission of the external independent procurement and financial - 2 -  management audits for the previous year. IDA could postpone its quarterly disbursements into the Health Account if at the end of previous quarter the balance in the US$ Health account exceeds 30? of the donor commitments for the year considered or if funds allocated have not been transferred in due time and according to plans to the Budget Management Centers. In addition to its financial support, in close collaboration with other external partners, the Bank team will contribute to the policy and strategic dialogue and technical discussions and provide day to day implementation support. The Bank team will assess the quality of the reporting on performance indicators through missions organized in collaboration, if not jointly, with other donor agencies and will contribute to the sector performance reviews carried out by the Ministry of Health. Components: 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.) NA. B. Check Environmental Classification: B (Partial Assessment) Comments: An environmental analysis will be performed i) to assess potential environmental and social impacts that could emanate form the program, ii) to assist MOH in defining actions to mitigate the environemental and social adverse effect of its activities and iii) to assist MOh in planning for the buiding up of its capacity on the longer to term to address health related environment issues. C. Safeguard Policies Triggered Policy Applicability Environmental Assessment (OP/BP/GP 4.01) Yes Forestry (OP/GP 4.36) No Natural Habitats (OP/BP 4.04) No Safety of Dams (OP/BP 4.37) No Pest Management (OP 4.09) No Involuntary Resettlement (OD 4.30) No Indigenous Peoples (OD 4.20) No Cultural Property (OP 4.11) No Projects in Disputed Territories (OP/BP/GP 7.60)* No Projects in International Waterways (OP/BP/GP 7.50) No *By supporting the proposed project, the Bank does not intend to prejudice the final determination of the parties' claims on the disputed areas Section II - Key Safeguard Issues and Their Management D. Summary of Key Safeguard Issues. Please fill in all relevant questions. If information is not available, describe steps to be taken to obtain necessary data. II.D.la. Describe any safeguard issues and impacts associated with the proposed project. Identify and describe any potential large scale, -3 -  significant and/or irreversible impacts. II.D.lb. Describe any potential cumulative impacts due to application of more than one safeguard policy or due to multiple project component. II.D.lc Describe any potential long term impacts due to anticipated future activities in the project area. II.D.2. In light of 1, describe the proposed treatment of alternatives (if required) II.D.3. Describe arrangement for the borrower to address safeguard issues 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 MOH ran several workshops and seminars during the development of the health sector reform strategy in which key stakeholders participated intensively. Other such consultations will take place, ensuring that the views and concerns of all stakeholders will be reflected at different stages in the planning, design and implementation of the proposed project. Participatory monitoring and evaluation will be only one of the mechanisms to ensure that beneficiaries are consulted, thereby ensuring sustainability of the proposed project. The participatory review and planning process, established by the MOH and involving, inter alia, BMCs, medical staff, NGOs, the private sector, academia, and donors, has already established participation as the norm and this is expected to continue in the future reach agreement on the proposed project and to assess its performance and allocate funds during project implementation. E. Safeguards Classification. 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. I S1. - Significant, cumulative and/or irreversible impacts; or significant technical and institutional risks in management of one or more safeguard areas [XI S2. - One or more safeguard policies are triggered, but effects are limited in their impact and are technically and institutionally manageable 1 S3. - No safeguard issues I 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/Analysis/Management Plan: Expected Actual -4-  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 ED (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 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 Dam 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: Francois Decaillet 11/08/01 Project Safeguards Specialists 1: Project Safeguards Specialists 2: Project Safeguards Specialists 3: Approved by: Name Date Regional Safeguards Coordinator: Serigne Omar Fye 11/14/01 Sector Manager/Director: Rosemary Bellew 11/08/01 For a list of World Bank news releases on projects and reports, click here Lucy Njuguna M:\InfoShop - Tonya's weekly directories\Dec 21, 2001\I073649.txt December 12, 2001 6:13 PM -5-