INTEGRATED SAFEGUARDS DATASHEET
APPRAISAL STAGE
I. Basic Information
Date prepared/updated: 04/15/2008 / Report No.: AC34241. Basic Project Data
Country: Panama / Project ID: P106445
Project Name: Health Equity and Performance Improvement Project
Task Team Leader: Fernando Montenegro Torres
Estimated Appraisal Date: April 16, 2008 / Estimated Board Date: July 24, 2008
Managing Unit: LCSHH / Lending Instrument: Specific Investment Loan
Sector: Health (100%)
Theme: Child health (P);Health system performance (P);Nutrition and food security (P);Social risk mitigation (S)
IBRD Amount (US$m.): 40.00
IDA Amount (US$m.): 0.00
GEF Amount (US$m.): 0.00
PCF Amount (US$m.): 0.00
Other financing amounts by source:
Borrower 19.20
19.20
Environmental Category: B - Partial Assessment
Simplified Processing / Simple [] / Repeater []
Is this project processed under OP 8.50 (Emergency Recovery) or OP 8.00 (Rapid Response to Crises and Emergencies) / Yes [ ] / No [X]
2. Project Objectives
The Project’s Development Objectives are to: (i) increase access of targeted underserved rural communities to basic health services known to help reduce under-five child mortality; and (ii) support the development of strategic planning, regulatory, and monitoring mechanisms known to improve health system performance.
3. Project Description
The Project would be financed with an Specific Investment Loan and would have four components:
Component 1: Support for ensuring access to primary health care services by the poor in rural areas. The objective of this component is to increase access by targeted underserved communities to basic health services known to help reduce under-five child mortality.
Component 2: Increase responsiveness of primary health services networks to vulnerable populations in rural areas. The objective of this component is to increase capacity of primary health care networks to respond to health care service demand by poor and indigenous rural communities.
Component 3: Enhancing MOH institutional capacity to conduct strategic planning to improve health system performance. This component seeks to improve health system performance by supporting the development of strategic planning, monitoring, regulatory and enforcement mechanisms.
Component 4: Strengthening institutional capacity to manage monitoring and information systems for results-based financing. This component aims to increase MOH institutional capacity to develop and manage monitoring and information systems, and impact evaluation.
4. Project Location and salient physical characteristics relevant to the safeguard analysis
Component 1 will target poor rural areas of Panama. The remaining components are expected to have nationwide benefits.
5. Environmental and Social Safeguards Specialists
Ms Ximena B. Traa-Valarezo (LCSHE)
Ms Amy Faust (LCSDE)
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) / X
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:
Environmental Assessment
The Project triggers OP 4.01 due to possible increases in the production of healthcare waste (HCW) and minor rehabilitation works. The Project is not expected to generate any large scale, significant, or irreversible impacts, but localized impacts are possible from the improper transport, treatment or final disposal of HCW by mobile teams or regional health facilities. In financing the refurbishment of existing health establishments, no new construction will take place, although minor impacts could result from rehabilitation activities and the disposal of construction wastes.
Indigenous Peoples
The present project supports GOP efforts to improve access to basic health services by the poor in targeted communities of rural areas of Panama including some indigenous communities. Therefore, the project triggers OP 4.10 on Indigenous Peoples. Consistent with the latter, the borrower prepared an Indigenous Peoples Plan (IPP) based on the regional consultations carried out by a technical team conformed by representatives of the Planning, Promotion, Services Provision and General Directorates of MINSA. The IPP is part of MINSA’s Indigenous Health Framework (draft) which was consulted with the National Commission of Indigenous Peoples of Panama (CONAPIP).
2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area:
Improper disposal of needles and pathogenic waste could result in indirect impacts on human health and environmental contamination. Mobile health teams perform services in varied locations, from schools to open-air areas, and face difficult transportation logistics to and from the often remote areas in which they work. A lack of proper equipment for treatment, transportation and disposal of wastes coupled with undefined procedures from generation to disposal increase the risks of indirect impacts.
3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts.
N/A
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.
Environmental Assessment
The Panama Social Protection Project, financed by the Bank and approved by the Board in 2007, includes a health component that is also expected to increase access to basic health care in rural areas through extending access to a basic package of ambulatory services with mobile teams (kown as PAISS). A preliminary diagnostic of the regulations and practices for the management of healthcare waste generated by mobile teams was completed in January 2008. This study indicated that, while legislation and guidelines for HCW management exist in Panama and there have been past initiatives to implement rules and regulations, actual management of HCW in the field and in regional health establishments has been inadequate.
As this Project complements and expands work done under the health component of the Panama Social Protection Project, the MOH has carried out additional consultations with mobile health teams and regional health establishments, and has produced a more in-depth analysis of HCW practices from generation to disposal as well as an action plan for the mitigation of potential impactsin order to identify and mitigate environmental impacts of HCW generated by the Project. The action plan includes detailed checklists of procedures, from generation of waste to final disposal, specifically tailored to the unique situations of mobile teams and regional health centers. Given that project activities would also include the refurbishment of existing health centers, the MOH has also conducted an environmental screening of sites of proposed refurbishments and developed procedures for contractors outlining environmental, health and safety guidelines specific to minor works in the health sector that are consistent with national regulations.These guidelines will be included in the Operations Manual, as well as bidding documents for rehabilitation works.
Indigenous Peoples Plan
The Indigenous Peoples Plan seeks to support MOH in the formulation of its own Health and Indigenous Peoples Policy (Politica de Atencion a los Pueblos Indigenas), by means of a number of activities to strengthen health policies to better respond to the particular needs and demands of the different ethnic groups of the country, inside and outside the Comarcas. One of the main objectives of the IPP is to carry out the cultural adaptation of the health care services to improve access and utilization by indigenous people. Most of the IPP activities will be included under Component 2 of the Project. The MOH unit responsible for carrying out the IPP is the Indigenous Planning Office in coordination with the Regional Health Directorates and the Health Services Provision, the Promotion, and Statistics, and General Directorates of MINSA.
5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people.
Environmental Assessment
The key stakeholders include national, regional, and local health authorities, mobile health teams from both MOH and Non-Governmental Organizations (known as Organizaciones Externas - OEs) that deliver basic health services in rural areas. The previous assessment conducted by MOH included consultation with one health region (out of fourteen) and a selection of professionals from mobile health teams. Both the assessment and action plan produced under the Panama Social Protection Project have been published on MOH’s website. For the expanded study under this Project, additional health regions and mobile teams have been consulted and results of these meetings were incorporated into the environmental assessment and action plan. The revised EA and action plan will be disclosed prior to appraisal.
Indigenous Peoples
Consultations with stakeholders and beneficiaries of health care services were carried out by a team composed by staff from the central and regional levels of MOH, with technical assistance from the World Bank. Consultations took place in three indigenous areas of the country: Eastern Panama (Comarca Kuna Madungandi), Comarca Ngobe Bugle, and Bocas del Toro and interviews with Kuna Yala Regional authorities. Focus groups and interviews were conducted with indigenous men and women, midwives, traditional healers and health promoters, staff from health facilities of MOH, and other indigenous representatives, caciques, sahilas, indigenous Congress representatives, hospital directors and staff, casa materna and albergue administrators, and users. The National Commission of Indigenous Peoples of Panama (CONAPIP) was consulted. The main objective of the consultations was to identify together with stakeholders and users, good practices of cultural adaptation of health care services as well as potential geographic and/or cultural obstacles affecting the access and utilization of health care services in indigenous areas. The recommendations were considered in project design.
B. Disclosure Requirements DateEnvironmental Assessment/Audit/Management Plan/Other:
Was the document disclosed prior to appraisal? / Yes
Date of receipt by the Bank / 04/11/2008
Date of "in-country" disclosure / 04/11/2008
Date of submission to InfoShop / 04/15/2008
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 / 04/11/2008
Date of "in-country" disclosure / 04/11/2008
Date of submission to InfoShop / 04/15/2008
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:
N/A
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 AssessmentDoes the project require a stand-alone EA (including EMP) report? / Yes
If yes, then did the Regional Environment Unit or Sector Manager (SM) review and approve the EA report? / Yes
Are the cost and the accountabilities for the EMP incorporated in the credit/loan? / Yes
OP/BP 4.10 - Indigenous Peoples
Has a separate Indigenous Peoples Plan/Planning Framework (as appropriate) been prepared in consultation with affected Indigenous Peoples? / Yes
If yes, then did the Regional unit responsible for safeguards or Sector Manager review the plan? / Yes
If the whole project is designed to benefit IP, has the design been reviewed and approved by the Regional Social Development Unit or Sector Manager? / N/A
The World Bank Policy on Disclosure of Information
Have relevant safeguard policies documents been sent to the World Bank's Infoshop? / Yes
Have relevant documents been disclosed in-country in a public place in a form and language that are understandable and accessible to project-affected groups and local NGOs? / Yes
All Safeguard Policies
Have satisfactory calendar, budget and clear institutional responsibilities been prepared for the implementation of measures related to safeguard policies? / Yes
Have costs related to safeguard policy measures been included in the project cost? / Yes
Does the Monitoring and Evaluation system of the project include the monitoring of safeguard impacts and measures related to safeguard policies? / Yes
Have satisfactory implementation arrangements been agreed with the borrower and the same been adequately reflected in the project legal documents? / Yes
D. Approvals
Signed and submitted by: / Name / DateTask Team Leader: / Mr Fernando Montenegro Torres / 04/08/2008
Environmental Specialist: / Ms Amy Faust / 04/08/2008
Social Development Specialist / Ms Ximena B. Traa-Valarezo / 04/11/2008
Additional Environmental and/or Social Development Specialist(s):
Approved by:
Regional Safeguards Coordinator: / Mr Reidar Kvam
Comments:
Sector Manager: / Mr Keith E. Hansen / 04/15/2008
Comments: