Page 1 INTEGRATED SAFEGUARDS DATASHEET APPRAISAL STAGE I. Basic Information Date prepared/updated: 04/17/2006 Report No.: AC2069 1. Basic Project Data Country: Philippines Project ID: P075464 Project Name: National Sector Support for Health Reform Task Team Leader: Timothy A. Johnston Estimated Appraisal Date: March 6, 2006 Estimated Board Date: June 29, 2006 Managing Unit: EASHD Lending Instrument: Sector Investment and Maintenance Loan Sector: Health (40%);Compulsory health finance (40%);Non-compulsory health finance (10%);Central government administration (10%) Theme: Health system performance (P);Social risk mitigation (S);Administrative and civil service reform (S);Other communicable diseases (S);HIV/AIDS (S) IBRD Amount (US$m.): 110.00 IDA Amount (US$m.): 0.00 GEF Amount (US$m.): 0.00 PCF Amount (US$m.): 0.00 Other financing amounts by source: Borrower 0.00 0.00 Environmental Category: C - Not Required 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 [ ] 2. Project Objectives • Increased financial protection of the poor from the costs of ill health and health care, and increased accuracy and transparency in poverty targeting of the National Health Insurance Program's sponsored indigent program • Improvement in the health MDGs and other priority public health indicators inareas covered by project intereventions • Establishment of performance-based budget mechanisms in the DOH and the Philippines Health Insurance Corporation (PHIC), linking resource allocation to progress towards priority public health and health system reform goals 3. Project Description The Project components are selected priorities from a larger set of “Fourmula One” flagship programs, projects and activities of the DOH: 1. Health Financing (Est. US$50 million loan finance) 1.1 Budget reforms of DOH and attached agencies will be the basis for planning, budgeting, utilizing funds and monitoring other Project components, harmonized with DOH’s own management processes. Page 2 a. Development of a medium term HSEF. b. Establishing a system for budget allocation, utilization and performance monitoring (linked to the DOH’s OPIF nationally, and LGU scorecards at local level). 1.2.Expansion of the National Health Insurance Program. (US$50M) The loan will support equitable expansion of the NHIP Indigent Program and increased support value, by financing the national subsidy for indigent premiums for LGUs that use community based poverty mapping to identify and enroll poor families. 2. Health Service Delivery: Public Health (Est. loan finance of US$48.5 million) Public Health (US$48.5M) a. Disease free zone initiative (US$4.5M). The loan will finance procurement of public health drugs, vaccines and commodities (excluding pesticides) and information/education materials to support eradication of malaria, schistosomiasis, rabies, leprosy and filiarisis. b. Intensified disease prevention and control (US$44M). The loan will finance public health commodities, including EPI and hepatitis B vaccines, tuberculosis control drugs and laboratory supplies, subject to progress in logistics. The loan will finance a pilot performance awards scheme for LGUs that achieve defined performance targets in service agreements with DOH for delivery of immunization and TB control programs. LGUs may use awards for non-devolved expenditures in their public health plans. Budget space for the awards will be generated through the budget reforms under Component A.1. 3: Regulation of pharmaceuticals (US$0.5M) Strengthening of the Bureau of Food and Drugs (BFAD), and development of certification (“Quality Seals”) for pharmacies and for generic drugs. The program will support further capacity building and policy development in BFAD, for a transition to income retention, and further progress in raising BFAD’s service performance standards. 4: Governance (Est. US$10.725M loan finance) 4.1 Sector management a. National Human Resources for Health Program (US$0.5M) The loan will finance training, stipends and salaries for the DOH’s programs for deploying doctors torural areas with shortages, including “doctors to the barrio’s” and resident physician and medical specialist pools programs, which will be integrated and strengthened. b. Sectoral Development Approach for Health (US10.225M). The loan will finance the DOH counterpart contribution for the EC’s Health Sector Reform grant for 16local convergence provinces implementing Fourmula 1 locally over the next five years. The EC grant and the DOH counterpart will jointly finance LGU health reform implementation plans, with DOH funds used for non-devolved activities in the plans (local capacity building, monitoring and evaluation, etc), according to the EC’s Technical and Administrative Provisions for Philippines Health Sector PolicySupport Program as already approved by the ICC in September, 2005. A performance-linked tranche in the EC grant design will be related to substantive milestones and results. c. Sectoral Monitoring and Evaluation (Nil loan finance. Parallel grant finance.) An LGU scorecard system will be implemented in 16 convergence sites, and used as an element of the criteria for the performance-linked tranche of the EC grant program. 4.2 Internal Management Reform in DOH. (Nil loan finance. Parallel grant finance) a. Procurement and logistics reform will address past inefficiencies in materials management to ensure efficient supply of public health commodities under Component 2. Page 3 b. Financial management reform will be consolidated through eNGAS rollout, eBudget systems development, development of the Finance Service, stronger inventory controls, financial and procurement information system integration, development of internal audit. 4. Project Location and salient physical characteristics relevant to the safeguard analysis The project will not fund any civil works, procurement of medical equipment nor activities in health facilities. Procurement of public health goods will be done through the UN agencies and not through domestic pharmaceuticals. 5. Environmental and Social Safeguards Specialists Mr Josefo Tuyor (EASEN) Ms Maria Loreto Padua (EASSD) 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: The Project will not finance any civil works, whether rehabilitation or construction of any health care facilities, and will not purchase any medical equipment. The procurement of public health goods to be supported by the Project is through the UN systems and not from domestic pharmaceutical companies. The Philippines has strong laws and guidelines on the proper handling, collection, transport, treatment, storage and disposal of health care wastes, which the Bank had reviewed during the preparation and appraisal of another Bank-funded project, the Second Women’s Health and Safe Motherhood Project. The review concluded that the country’s guidelines on health care waste management, issued as Joint Administrative Order by the Department of Health and the Department of Environment and Natural Resources, are in compliance with the World Health Organization’s standards and to local laws such as the Toxic and Hazardous Waste Management Act (Republic Act 6969), the Ecological Solid Waste Management Act (RA 9003) and the Clean Air Act (RA 8749). Page 4 On one hand, positive impacts are envisaged for indigenous people (IP) groups, who may benefit from the intensified public health effort by the local government units and the expanded coverage of the Indigent Program of the PHIC. 2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: The long term impacts of the project will be positive, with the reforms in the public health sector, more improved public health outcomes and expansion of the PHIC coverage. 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. There are no safeguard issues in the Project. Positive impacts, however, are anticipated with the increase in coverage of the PHIC, which may include IPs. Related to this, the DOH formulated an IP Planning Framework which outlines the plans for monitoring and evaluating Project impact on IPs. 5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. The Project Team will take affirmative action to ensure that the meaningfully consultations of various stakeholders, including IPs, on the various reforms regarding health financing, regulation, service delivery and governance. B. Disclosure Requirements Date Indigenous Peoples Plan/Planning Framework: Date of receipt by the Bank 03/24/2006 Date of "in-country" disclosure 03/29/2006 Date of submission to InfoShop 03/28/2006 * 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: C. Compliance Monitoring Indicators at the Corporate Level (to be filled in when the ISDS is finalized by the project decision meeting) Page 5 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? Yes 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 Date Task Team Leader: Ms Loraine Hawkins 03/29/2006 Environmental Specialist: Mr Josefo Tuyor 03/29/2006 Social Development Specialist Ms Maria Loreto Padua 03/29/2006 Additional Environmental and/or Social Development Specialist(s): Approved by: Regional Safeguards Coordinator: Comments: Sector Manager: Comments: