Federal Government of Nigeria

FEDERAL GOVERNMENT OF NIGERIA

Federal Ministry of Health

ENVIRONMENTAL AND SOCIAL MANAGEMENT FRAMEWORK (ESMF)

FOR THE

Second Health Systems Development Project (HSDP II)

– Additional Financing

-Final Report-

Submitted to:

Federal Ministry of Health

Federal Secretariat Complex

Central Business District

F.C.T. Abuja, Nigeria

August, 2008

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Earthguards Limited

Submitted by:

Joseph E. Akpokodje

Managing Consultant

Earthguards Limited: Sustainable Development Consultants

Suite 45, (3rd Floor), God’s OwnPlaza, 4 Takum Close,

Area 11, Garki, F.C.T. Abuja, Nigeria

P.O. Box 12428, Garki, F.C.T. Abuja, Nigeria

Website:

Email: ,

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LIST OF ACRONYMS

CBOCommunity Based Organization

COCarbon Monoxide

EAEnvironmental Assessment

EDPEssential Drug Program

EIAEnvironmental Impact Assessment

ELSSEmergency Life-Saving Skills

ESAEnvironmental Sensitive Area/ Environmental and Social Assessment

ESIAEnvironmental and Social Impact Assessment

ESMFEnvironmental and Social Management Framework

ESMPEnvironmental and Social Management Plan

EMPEnvironmental Management Plan

EOCEmergency Obstetric Care

FCTFederalCapitalTerritory

FEPAFederal Environmental Protection Agency

FGNFederal Government of Nigeria

FMEHFederal Ministry of Environment and Housing

FMEH&UDFederal Ministry of Environment, Housing, and Urban Development

FMEnvFederal Ministry of Environment

FMAWRFederal Ministry of Agriculture and Water Resources

HMISHealth Management Information System

HSDPHealth Systems Development Project

HSDP IISecond Health Systems Development Project

HSEHealth, Safety and Environment

IDAInternational Development Association

ISDSIntegrated Safeguards Data Sheet

M&EMonitoring and Evaluation

NGONon Governmental Organization

NPCUNational Project Coordinating Unit

NPSCNational Project Steering Committee

LGALocal Government Area

M & EMonitoring and Evaluation Officer

OP/BPOperation Policy/Bank Policy

PAD Project Appraisal Document

PCNProject Concept Notes

PCUProject Coordinating Unit

PFMUProject Finance Management Unit

PHCNPower Holding Company of Nigeria

PIU Project Implementation Unit

PMUProject Management Unit

SEPAState Environmental Protection Agency

SMOHState Ministry of Health

SSASub Saharan Africa

TDSTotal Dissolved Solids

TSPTotal Suspended Particles

TORTerms of Reference

WBWorld Bank

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TABLE OF CONTENTS

LIST OF ACRONYMS

TABLE OF CONTENTS

TABLE OF FIGURES

LIST OF TABLES

EXECUTIVE SUMMARY

CHAPTER ONE: INTRODUCTION

1.1Background

1.2 Objectives of the Environmental and Social Management Framework (ESMF)

1.3Study Approach & Methodology

CHAPTER TWO: DESCRIPTION OF PROPOSED PROJECT AND WORKS

.CHAPTER THREE: STUDY AREA

3.1The Bio- Physical Environmental Features

3.1.1Physical Environment

3.1.2Biological Environnent

3.2Social -Economics

CHAPTER FOUR: POLICY, LEGAL AND REGULATORY FRAMEWORK

4.1Policy Framework

4.2Legal Framework

4.2.1Assessment of the Legal Framework

4.3International Environmental Agreements

4.4World Bank Safeguard Policies

CHAPTER FIVE: POTENTIAL ENVIRONMENTAL AND SOCIAL IMPACTS

5.0Potential Impacts

5.1.1Environmental Impacts

5.1.2Social and Health Impacts

5.2Mitigation

5.2.1Mitigation Measures

5.2.2Mitigation Funding

CHAPTER SIX: INSTITUTIONAL ARRANGEMENTS FOR ENVIRONMENTAL MANAGEMENT

CHAPTER SEVEN: PUBLIC CONSULTATION PLAN

7.1Objectives

7.2Identifying Stakeholders

7.3Consultation Strategies

ANNEX 1: LIST OF PERSONS MET

ANNEX 2: SUMMARY OF WORLD BANK ENVIRONMENTAL AND SOCIAL SAFEGUARD POLICIES.

ANNEX 3: DRAFT EIA /ESIA TERMS OF REFERENCE

ANNEX 4: CONTRACT PROVISIONS: ENVIRONMENTAL AND SOCIAL IMPACTS

TABLE OF FIGURES

Figure 3.1: Map of Nigeria showing the 36 states of Nigeria

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LIST OF TABLES

Table 3.1: Nigerian Ambient Air Quality Standard

Table 3.2: Air Quality Classification Based on TSP Values

Table 5.1: Potential Environmental and Social Impacts of the HSDP II (Additional Financing) Project

Table 5.3: Summary of Environmental Mitigation Measures

Table 6.1 Institutional Capacity Strengthening Program

Table 7.1: Stakeholder Identification Matrix

EXECUTIVE SUMMARY

The Second Health System Development Project (HSDP II) is currently operating in 36 states of the country. This project is jointly sponsored by the International Development Association (IDA) Credit from the World Bank with counterpart funding from the Federal Ministry of Health and the various State Governments in whose jurisdiction the project will take place.

As a result of the restructuring of the project in 2005 whereby resources were reallocated to cover overspending by 22 out of the 36 states, the Nigerian Authorities through the Federal and State Governments have requested for Additional Financing in order to carry out agreed work plans and complete ongoing activities.

The additional financing would retain the same objectives and implementation procedure of the original project and would be allocated as a supplementary credit to the Federal Government and the 22 states.

The HSDP II Components are as follows:

• Component 1: Rehabilitation and Refurbishment of Schools of Health Technology and Schools of Nursing and Midwifery.
• Component 2: Support of Health Services.
• Component 3: Strengthening Monitoring and Evaluation systems and processes at National and State Levels.

The World Bank’s Safeguard Policy, Environmental Assessment (OP 4.01) is triggered if a project is likely to present some risks and potential adverse environmental impacts in its area of influence. The activities of Components 1 will involve civil works and therefore triggers OP 4.01.

OP 4.01 requires that an Environmental and Social Management Framework (ESMF) be prepared which will establish a mechanism to determine and assess future potential environmental and social impacts of project investments and then to set out mitigation, monitoring and institutional measures to be taken during design, implementation and operation of the subprojects to minimize adverse environmental and social impacts to acceptable levels.

Objectives of the ESMF to the HSDP II are to:

• Assess the potential environmental and social impacts of sub-projects
• Inform the project preparation team and the Nigerian Government of the potential impacts of different of different anticipated sub-projects and relevant mitigation measures and strategies
• Establish clear directives and methodologies for the environmental and social screening of sub-projects to be financed
• Identify potential environmental policies, legal and institutional framework pertaining to the project.

Potential Environmental and Social Impacts:

Therewould be no significant cumulative adverse environmental and social impactsto the HSDP II project, but minimal site specific impacts to the environment and humans might occur which is consistent with category B projects. Since only a minimal part of HSDP II component 1 would involve civil works, there would be no need for a screening mechanism. Therefore appropriate mitigation measures have been identified that would reduce and/ or eliminate potential environmental impacts.

The potential site specific environmental and social impacts that might occur would be addressed through an Environmental and Social Impact Assessment (ESIA) report at the various state Project Implementation Units (PIUs) level with a specific Environmental Management Plan (EMP) developed.

Institutional Arrangement and Implementation of the ESMF:

In terms of implementation of the recommendations of the ESMF, it is recommended that each state PIU recruits the services of an environmental and social specialist or consultant on a part time basis to monitor and evaluate its implementation in each state.

Institutional Capacity Strengthening Program

An institutional and capacity building strengthening on Environmental Management for HSDP II stakeholders should be incorporated at the various state PIUs.

The total estimated cost for capacity building / training of stakeholders for the 15 states is estimated at a lump sum of US $150,000.

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Environmental and Social Management Framework of Health Systems Development Project II – Additional Financing

CHAPTER ONE: INTRODUCTION

1.1Background

The Second Health Systems Development Project (HSDP II) is a project operating in 36 states of the country with the exception of Kano State The development objective is to assist the Health authorities to redress the serious deterioration in the delivery of basic health care services and pave the way for a more sustained development of the Nigerian health care system by: (i) strengthening capacities for system management at the state level and encouraging an environment of broad-based consultation; (ii) supporting improvements in the delivery of primary health care services with a particular focus on maternal and child health and reproductive health services; and (iii) assisting the Federal Government to strengthen its policy formulation and further develop a system to monitor the health sector performance.

Project performance has been rated satisfactory for the past three years. All 36 States have completed over 80% of their agreed annual workplans. The key indicators suggest that the project has met its appraisal targets and has had a positive impact on the delivery of primary health care services to populations that previously had no access. Strategies undertaken by the States to reduce the high maternal mortality and morbidity rates include the building and renovation of basic health facilities in hard to reach areas, the procurement of medical equipment and drugs for these facilities, strengthening health systems, and the training of health personnel in Emergency Obstetric Care (EOC) and Emergency Life-Saving Skills (ELSS). The project has also had a significant impact on revitalizing the health institutions responsible for training midwives, nurses and community health workers through a reactivation of their accreditation, which had previously been denied due to the lack of adequate infrastructure and equipment. With the success, government now wants a second phase prompting the request for an additional financing to the tune of N 50 million.

The proposed additional loan would support the Nigerian authorities in their efforts to redress the serious deterioration in the delivery of basic health care services and provide a more sustained development of the health care system by: (i) strengthening capacities for system management at the state level and encouraging an environment of broad-based consultation; (ii) supporting improvements in the delivery of primary health care services with a particular focus on maternal and child health and reproductive health services; and (iii) assisting the Federal Government to strengthen its policy formulation and further develop a system to monitor the health sector performance.

The additional financing will cover the gap in funding created after the project was restructured in 2005 and resources were reallocated to cover overspending by 15 out of the 36 states. Therefore, states that had previously been promised additional resources during the restructuring were unable to access funds and subsequently unable to complete agreed work plan activities. There are no major changes proposed, instead, the additional financing will ensure the completion of ongoing activities to maximize the achievement of the development

The activities under the proposed project as identified in the project paper will involve civil works especially on rehabilitation and refurbishment of schools of health technology and schools of Nursing and Midwifery

The World Banks Operational Policy (OP) 4.01 requires that an ESMF be prepared which will establish a mechanism to determine and assess future potential environmental and social impacts of project investments and then to set out mitigation, monitoring and institutional measures to be taken during design, implementation and operation of the subprojects to minimize adverse environmental and social impacts to acceptable levels.

1.2 Objectives of the Environmental and Social Management Framework (ESMF)

The primary goal of this ESMF is to improve decision making and to ensure that the design, construction, expansion, upgrading of health infrastructures and other activities being considered under the proposed project are environmentally sound and sustainable. The secondary objective is to ensure that in-country capacity, regulatory framework; principles and procedures are established to provide a basis for environmental assessments of all sub-projects to be carried out under this additional financing

More specifically, the purpose of the framework is to:

iAssess the potential environmental and social impacts of the sub-projects (rehabilitation, extension, or new constructions), whether positive or negative and propose mitigation measures;

iiInform the project preparation team and the Nigerian Government of the potential impacts of different anticipated subprojects and relevant mitigation measures and strategies;

iiiEstablish clear directives and methodologies for the environmental and social screening of sub-projects to be financed by the project; and

ivIdentify potential environmental policies, legal and institutional framework pertaining to the project.

1.3Study Approach & Methodology

The ESMF study was prepared in accordance with applicable World Bank safeguard policies and Nigerian environmental impact assessment guidelines. The distinct phases of the study include:

• Data Gathering;
• Literature review;
• Reconnaissance Surveys and visits to potential sub-projects sites;
• Characterization of the baseline conditions;
• Identification of potential impacts;
• Identification of impact mitigation measures;
• Preparation of an Environmental and Social Management Plan; and
• Preparation of sub-project guidelines

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Earthguards Limited

Environmental and Social Management Framework of Health Systems Development Project II – Additional Financing

• Literature Review

The approach was based on review of available literature and other strategic planning documents at the national and state level. Specifically, the following were reviewed: project concept notes (PCN), draft project appraisal document (PAD), concept-stage Integrated Safeguards Data Sheet (ISDS) of the parent project. In addition, the project paper on the proposed additional financing grant was consulted. Also consulted were the general environmental management conditions for construction contracts; federal and state environmental laws regulations, decrees, acts, policies and guidelines; World Bank safeguard policies and other relevant documents.

• Data Gathering

The consultantassembledandevaluatedrelevantbaselinedatarelatedtothephysical,biological andsocio-culturalenvironment of the country. Thebaselinedatareviewedincluded: topography, soil, water resources, climate and meteorology; biological and socio-economics data.

Field visits were made to Anambra, Enugu, FCT Abuja and Sokoto states. During the field study to the states, discussions were held with officials of relevant state ministries and agencies. (See Annex 1.0 for complete list).

Using the specific circumstances of each state visited, the particular technical operations of each State ministries of health and environment, including related agencies such environmental protection agencies/authorities were studied, their capacity to implement the proposed environmental and social management process and mitigation measures was assessed, and discussions held to determine appropriate recommendations for improvement in service delivery, mitigation, monitoring, institutional requirements and their training and capacity building needs.

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Earthguards Limited

Environmental and Social Management Framework of Health Systems Development Project II – Additional Financing

CHAPTER TWO: DESCRIPTION OF PROPOSED PROJECT AND WORKS

The additional financing proposed (US$50 million) would retain the same objectives and implementation procedures of the original project and would be allocated (on a notional basis) as a supplementary credit to the Federal Government and 15 States. Government has agreed, that, due to the limited resources available and in order to achieve economies of scale and ensure impact, not all of the states will participate in the additional financing. Given the political sensitivities, performance-based criteria have been agreed in order to select the States. Government convened a meeting with all project stakeholders to discuss the criteria which are based on project performance, financing gap, stability of the Project Implementation Units (PIUs) and PFMUs and the timely payment of government contributions.

The additional financing will only support those states that have performed well to date The 15 States selected meet this criteria and based on their current workplan projections indicate that roughly 50% of the funds will go to support civil works (completing construction and rehabilitation of health institutions and primary health centers), 30% for service delivery, including commodities and equipment, and 20% for systems development (e.g. M&E) and capacity building at the State and community level. It is envisaged that the additional funding will support the following sets of activities within the broader context of strengthening primary health care services:

• Rehabilitation and Refurbishment of Schools of Health Technology and Schools of Nursing and Midwifery The objective of this component is to support the health training institutions to secure relevant accreditation in order to improve the quality of pre-training of human resources for health. Renovation/upgrading of equipment and training facilities as well as the provision of basic pedagogic materials will especially improve the supply of skilled attendants at birth
• Support to Health Services The objective of this component is to support activities that would improve the delivery of primary health care services and increase utilization rates. The additional financing would support the refurbishment/re-equipment of primary health facilities and training of health service workers, as well as immunization activities, such as the procurement and repair of cold chain equipment and training of vaccinators. The local health facilities to be rehabilitated are designated in each State’s workplan.
• Strengthening Monitoring and Evaluation Systems and Processes at National and State Levels The objective of this component is to strengthen the processes and systems to ensure evidence-based decision making and confirmation of the impact of government interventions in improving the delivery of basic health services. The lack of baseline data and inconsistent efforts to track results has impeded the project from having the influence to inform policy decisions and build the capacity for managing a robust monitoring system. The challenges of working across 36 states and the weak capacity at all levels for quality data collection should not be underestimated.

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Earthguards Limited

Environmental and Social Management Framework of Health Systems Development Project II – Additional Financing

Therefore, the focus on only 15 states that are already well-performing combined with a revamped monitoring and evaluation framework is expected to support more meaningful use of project data. A rapid assessment of the current Health Management Information Systems (HMIS) will be conducted to ascertain the bottlenecks and remaining data gaps.

The Director of Health Planning and Research will continue to be responsible for Monitoring and Evaluation M&E). But, the additional financing will allocate supplemental funding to contract M&E firms to deliver quality project Monitoring and Evaluation.