Public Disclosure Authorized. Public Disclosure Authorized. Public Disclosure Authorized. Public Disclosure Authorized. Report No.

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1 Report No: I <--Please check for duplicates! Integrated Safeguards Data Sheet (Initial) Date ISDS Prepared/Updated: 11/16/2001 Report No Section I - Basic Information A. Basic Project Data Country: INDIA Project ID: P Project: RAJASTHAN HEALTH SYSTEMS Task Team Leader: Sadia Afroze Chowdhury Appraisal Date: April 16, 2002 IBRD Amount ($m): Board Date: December 17, 2002 IDA Amount ($m): Managing Unit: SASHD Sector: HB - Basic Health Lending Instrument: Specific Investment Loan (SIL) Status: Lending I.A.2. Project Objectives: The overall goal of the health sector in Rajasthan is to improve the health and nutritional status of its population, in particular the poor, women, children, scheduled castes and scheduled tribes (SC/STs), and nomadic populations, most of whom reside in remote and hard-to-reach hilly terrain and in desert regions. The proposed project would contribute to this goal by achieving the following development objectives: Enhance performance of the health system at the primary and secondary levels Improve efficiency in the allocation of health resources through policy and institutional development I.A.3. Project Description: The proposed project would be a sector investment loan with policy issues addressing key areas at the primary and secondary levels of health care in Rajasthan. Its scope would be limited initially to five years and the project would be developed within the overall program for development of the health sector in the state. It will have three main components: I. Management Development and Institutional Strengthening. This component would focus primarily on strengthening institutions and systems by improving overall planning and strengthening management and implementation capacity (e.g. financial and program management, procurement), improving human resource development for program management as well as clinical care, procurement of drugs and equipment, referral between the primary and secondary levels of care specially for reproductive health and tuberculosis, health care waste management and surveillance; and, improving the institutional framework for policy development. An information system would be established to facilitate sharing and utilization of data in the above-mentioned areas, as well as information derived from health studies and findings, literature, research data, indigenous knowledge, and best practices. It would finance professional services and workshops, studies, training, vehicles, and operational expenses and salaries of incremental staff on a declining basis.

2 II. Improvement of Service Quality and Effectiveness at the Primary and Secondary Level. This component would carry out extension and/or renovation of Primary Health Centers, Community Health Centers, Sub-District and District Hospitals, develop service delivery norms, improve the health care waste management system, upgrade effectiveness of clinical, management and support services, and improve the referral mechanism. It would finance civil works, furniture, equipment, vehicles, drugs and medical supplies, MIS/IEC materials, training, monitoring and supervision, salaries of incremental staff on a declining basis, and operations and maintenance. III. Innovations to Enhance Access and Equity to Disadvantaged Sections. This component would strengthen the capacity of the community, empower them to identify their health needs, demand appropriate services and make the providers accountable for quality services. It will also support public-private partnerships with a special focus on traditional providers and traditional birth attendants (DAIs) for referral of women, children. Innovations in service delivery and health financing though NGOs, and contracting of clinical and non-clinical services will also be piloted. It would finance professional services, contracting, training, IEC, workshops, studies, surveys, operational expenses, and salaries of incremental staff on a declining basis. 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.) Rajasthan is the eighth most populous state in India with a population of over 56 million. It is the second largest state in area, embodying immense regional variations, both in terms of geography and demographics. The north-east consists of plains, the southern region of thick forests and rugged ravine topography inhabited by tribal populations, and the western region of an extreme scarcity of water and poor quality of soil, characterized by small and scattered settlements and nomadic populations. The state possesses only 1 percent of India's total water resources; 80 percent of its land area is classified as arid or semi-arid. This project would benefit the entire population of the state which is over 56 million people. The project investments will target the poor, tribal and migratory populations and women and children. The project will directly benefit approximately 6 million tribal persons living in Rajasthan. B. Check Environmental Classification: B (Partial Assessment) Comments: 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) Yes Indigenous Peoples (OD 4.20) No Cultural Property (OP 4.11) No -2-

3 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, significant and/or irreversible impacts. There are two safeguard issues associated with the proposed project: Environment and Indigenous Peoples. Neither of these have any potential large scale, irreversible or long term impacts. OD 4.20 Indigenous Peoples. Rajasthan has a tribal population of approximately 6 million people which represents 12t of the total population. One of the development objectives of this project is to enhance performance of the health systems, at the primary and secondary level through expansion of access and improvement in quality of health services. The project specifically aims to improve health service delivery to tribal populations. Medical Waste Management. The project is expected to have limited adverse environmental impact. A comprehensive medical waste management plan will be developed for the project. Civil Works*. The civil works under this project include: extension and/or renovation of existing health facilities at the primary and secondary level. No land acquisition is required; if any new facilities are constructed, they will only be built on land in actual possession of the government and where encroachers and squatters issues do not exist. The resettlement policy, therefore, does not apply. The project team will ensure that all civil works will follow applicable construction building codes, including those for water supply, sanitation, ventilation, safety and hygiene, as per relevant Bureau of Indian Standard codes. *According to the Government of Rajasthan's project proposal, this project will only include upgrading and extension of existing facilities. During project preparation, a survey will be conducted to assess whether gaps exist in provision of basic services to dispersed and migratory populations. If the need exists, construction of a few primary level facilities may be warranted. II.D.lb. Describe any potential cumulative impacts due to application of more than one safeguard policy or due to multiple project component. N/A II.D.lc Describe any potential long term impacts due to anticipated future activities in the project area. N/A II.D.2. In light of 1, describe the proposed treatment of alternatives (if required) -3-

4 Addressed below. II.D.3. Describe arrangement for the borrower to address safeguard issues Indigenous Peoples. During preparation for the proposed project, GOR would develop a tribal strategy. This strategy would be in line with the project objectives of improving the health outcomes of the people of Rajasthan with an emphasis on SC/ST and nomadic populations. The tribal strategy would improve the quality of health services in these areas as well as increase access to health services by expanding primary and secondary health services in tribal and remote areas either by enhancing public health services or contracting out NGOs and CBOs depending on feasibility. The project will also strengthen linkages between the primary and secondary care services, strengthen service delivery mechanisms, involve the private sector including traditional healers and build the capacity of communities to address their own needs through increased awareness. Medical Waste Management. The borrower will prepare a draft environmental analysis (EA) report for IDA's review before appraisal. The draft report will address issues related to hospital waste management (liquid and solid) and drinking water quality, as reported below. The EA report will also include a plan and budget to implement the recommended measures. Solid Wastes. The objective is to ensure that all health-care facilities supported by the project comply with the requirements of GOI's Bio-Medical Rules. To achieve this, the EA will include a suitable "hospital waste management" plan for Rajasthan. Such a plan will provide a detailed blueprint for the segregation and management (i.e. types of treatment and disposal technologies) of each waste category specified under the GOI's Bio-Medical Rules. It will also include steps to be followed at different size health-care facilities (including the awareness/training requirements, supply of materials and personal protection equipment, construction of facilities, purchase of equipment) and an implementation plan. The borrower will also be exploring possibilities to provide necessary awareness/training to the state health officials so that they can expand the experience gained in project hospitals to "non-project hospitals" in Rajasthan. Liquid Waste: The objective is to ensure that all newly constructed and existing health-care facilities supported under the project meet the standards for liquid wastes prescribed by the GOI's Bio-Medical Rules. To achieve this, the EA will include proto-type designs (for different groups or types or sizes of facilities) for adequate drainage and on-site disposal (treatment if required) arrangements and a protocol for routine operation and maintenance. Water Quality: In addition to above, EA would include a plan for monitoring the quality of drinking water at the project health care facilities and recommend mitigatory measures to comply with the national drinking water standards. Civil Works. For rehabilitation and extension of health facilities at the primary and secondary levels, the project will strictly follow engineering and civil construction codes that exist for the state during planning and implementation of new health care facilities. Particular attention will be paid to water, sewage and construction-related debris

5 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. Tribal communities, NGOs, private providers, and local government officials working in tribal areas will participate in project preparation through consultation workshops and focus discussions to define performance indicators and plans for monitoring and evaluation during the course of the project and to identify needs and barriers to obtaining quality care and expanding access. Utilization of services of those belonging to scheduled tribes and their satisfaction with health services will be routinely monitored and incorporated into the health management information system and used for local planning and management and performance assessment of the project. 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 Date of "in-country" disclosure 5/31/2002 Date of distributing the Exec. Summary of the EA to the ED (For category A projects) Resettlement Action Plan/Framework: Expected Actual Date of "in-country" disclosure Not Applicable Not Applicable Indigenous Peoples Development Plan/Framework: Expected Actual Date of "in-country" disclosure 5/31/2002 Pest Management Plan: Expected Actual Date of "in-country" disclosure Not Applicable Not Applicable Dam Safety Management Plan: Expected Actual Date of "in-country" disclosure Not Applicable Not Applicable -5-

6 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: Sadia Afroze Chowdhury 11/16/2001 Project Safeguards Specialists 1: Project Safeguards Specialists 2: Project Safeguards Specialists 3: Approved by: Name Date Regional Safeguards Coordinator: L. Panneer Selvam 11/16/2001 Sector Manager/Director: Emmanuel Y. Jimenez 11/15/2001 For a list of World Bank news releases on projects and reports, click here - 6 -