THE WORLD BANK GROUP InfoShop Date Prepared/Updated: 10/25/2002 Section I - Basic Information Integrated Safeguards Data Sheet (Initial) 25025 A. Basic Project Data Country: MOLDOVA Project ID: P074122 Project: TB/AIDS PROJECT Task Team Leader: Joana Godinho Authorized to Appraise Date: December 3, 2002 IBRD Amount ($m): Bank Approval: June 10, 2003 IDA Amount ($m): Managing Unit: ECSHD Sector: Health (100%) Lending Instrument: Specific Investment Loan (SIL) Theme: Fighting communicable diseases (P) Status: Lending I.A.2. Project Objectives: The proposed project aims to improve Moldova's health status and assist the country to achieve its health-related Millennium Development Goals (MDG) through reducing mortality, morbidity and transmission of HIV/AIDS, other sexually transmitted infections (STIs) and tuberculosis (TB). Specifically, the project would support Moldova's National Programme for Prevention and Control of HIV/AIDS/STls (NPAS) and National Programme for TB Control (NPTC) through: (i) (ii) (iii) (iv) scaling up HIV/AIDS/STIs prevention programs targeted at high-risk groups as well as the general population; strengthening treatment, care and support for persons living with HIV/AIDS (PLWHA); implementing DOTS strategy for TB control; and strengthening Moldova's institutional capacity to better respond to HIV/AIDS/STIs and TB in a multi-sectoral approach. I.A.3. Project Description: The total project cost is estimated at US$ 15 million, of which the Government of Moldova would finance US$ 0.5 million, IDA US$ 5 million, and donors, including the Global Fund to Fight AIDS, TB and Malaria (GFATM), $ 9.5 million. In June 2002, the GFATM awarded a grant of $1.7 million to finance two years of activities to control HIV/AIDS/STls and TB. The proposed project would include three components. A. HIV/AIIDS/STIs Component (US$ 6.9 million) Al. Strategic Planning & Institutional Capacity Building for HIV/AIDS/STIs control
2 Policy. The project would finance activities to enhance Moldova's capacity in HlV/AIDS/STls policy making and planning. Surveillance and programmatic M&kThe project would support the implementation of a second-generation surveillance system that monitors both WIV infection and risk behaviors (especially among high-risk groups) to inform the trend of the epidemic. Training. The project would finance training for health care workers in Voluntary Testing and Counseling (VCT), syndromic management of STIs, Mother-to-child-transmission (MCTC) interventions, Highly Active Anti-retroviral Therapy (HAART)protocol, treatment and care, etc. It would also support capacity building for NGOs and provide them with training in outreach, counseling, peer education, and home-based care and support. Strengthening Laboratory Capacity for HIV/AIDS/STD. The project would support the improvement in Moldova's laboratory capacity through the provision of laboratory equipments, test kits and training. A2. Scaling up prevention interventions for HIV/AIDS/STIs and STI management Targeted interventions for high-risk group(idu, CSW, men who have sex with men, prisoners, youth, military and STIs clinic attendeesthe project would target groups at risk with prevention interventions which include peer education, VCT, condoms and referrals to other HlV/AIDS/STIs services. MTCT interventions. The project would help disseminate the MTCT protocol, support universal VCT at ante-natal clinics, provide WIV-positive pregnant women with short courses of ARV and infant feeding options. Preventive interventions for the general populationthe project would support IEC and awareness campaigns (at the national and community levels), VCT services and condom social marketing. A3. Treatment, care and support for PLWHA Management of opportunistic infections (01) and palliative caihe project would finance the dissemination of clinical protocols for 01 management (including TB) and care, training of health workers in implementing such protocols. It would also ensure the availability of a package of basic drugs for 01 management in clinics that deal with AIDS patients. Provision of HAART. HAART would be provided free of charge for PLWYHA. The initiative would start on a pilot basis and then be scaled up to cover PLWHA who meet the medical criteria for the therapy. Home and community-based care and support for PLWHA. This would be conducted in partnership with NGOs. Such organizations would be given grants and training to provide home and community-based care for PLWHA. B. Tuberculosis Component ($6.8 million) B1. Strategic Planning & Institutional Capacity Building for TB control Policy making. The project would finance activities to enhance Moldova's capacity in TB policy making and planning. IEC. Awareness campaigns to inform the public about TB and available TB services would be developed and implemented based on the results of social assessments. Training. The project would support training of health care workers in case definition, DOTS, MDRTB, smear microscopy and other laboratory techniques. Laboratory capacity. A network of sputum microcopy laboratories would be established down to the health center levels. The National Reference Laboratory (NRL) would be upgraded and a Quality
3 Assurance program for TB laboratory work throughout the country would be established. Centralized TB drug supply system. The project would help Moldova develop a centralized system for procurement and distribution of first and second-line TB drugs. Surveillance and M&E system.a computerized, uniform information system which reports TB cases, allows assessment of individual patient treatment results, monitors drug resistance, tracks overall coverage and quality of the program would be implemented. B2. Improving DOTS coverage, including in prisons All judets and prisons would use the DOTS protocol for diagnosis and treatment of TB patients. DOTS treatment would be provided free of charge. Special attention would be paid to DOTS implementation in prisons - the hotbed of TB in Moldova. Implementation of DOTS plus (diagnosis and treatment of multi-drug resistance TB) would be tested, and scaled up after obtaining good results in implementation of DOTS and decreases in the costs of pharmaceuticals. C. Project Management and Evaluation (US$ 0.38 million) Project management. The project would finance additional staffing to complement the existing PCU of the Moldova HIF project. Staff with expertise in HlV/AIDS/STIs, TB, procurement, financial management would be recruited.project monitoring and evaluation. This would include baseline and follow-up studies, mid-term review and impact evaluation at project end. The project would finance the required studies and necessary technical assistance. 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.) B. Check Environmental Classification: C (Not Required) Comments: This project does not raise any significant environmental issues, as it does not involve civil works or medical waste. C. Safeguard Policies Triggered Policy Applicability Environmental Assessment (OP/BP/GP 4.01) * Yes 0 No C] TBD Forestry (OP/GP 4.36) 0 Yes * No 0 TBD Natural Habitats (OP/BP 4.04) C) Yes * No 0 TBD Safety of Dams (OP/BP 4.37) 0 Yes 0 No 0 TBD Pest Management (OP 4.09) G Yes * No O TBD Involuntary Resettlement (OP/BP 4.12) 0 Yes * No 0 TBD Indigenous Peoples (OD 4.20) C Yes 0 No 0 TBD Cultural Property (OP 4.1 1) O Yes * No O TBD Projects in Disputed Territories (OP/BP/GP 7.60)* 0 Yes 0 No 0 TBD Projects in International Waterways (OP/BP/GP 7.50) 0 Yes * No 0 TBD *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
4 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.. II.D. I b. Describe any potential cumulative impacts due to application of more than one safeguard policy or due to multiple project component. II.D. I c 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) Il.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. Key stakeholders, which include relevant ministries, NGOs, representatives of vulnerable groups and donors will be consulted during the preparation of the project through consultation workshops. They would also be partners in project implementation, for example: Relevant line ministries would prepare annual work plans in HIV/AIDS/STIs, which can be financed by the project; NGOs would be contracted to provide prevention, care and support services; Stakeholders would also take part in monitoring and evaluation activities, such as in the mid-term review and end-of-project evaluation. E. Safeguards Classif cation. 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. ] SI. - Significant, cumulative and/or irreversible impacts; or significant technical and institutional risks in management of one or more safeguard areas [ ] S2. - One or more safeguard policies are triggered, but effects are limited in their impact and are technically and institutionally manageable [X] S3. - No safeguard issues ] 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
5 Date of distributing the Exec. Summary of the EA to the ED (For category A projects) Resettlement Action Plan/Framework. Expected Actual Indigenous Peoples Development Plan/Framework: Expected Actual Pest Management Plan: Expected Actual Dam Safety Management Plan: Expected Actual 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: Joana Godinho August 21, 2002 Project Safeguards Specialists 1: Project Safeguards Specialists 2: Project Safeguards Specialists 3: Approved by: Name Date Regional Safeguards Coordinator: Jane E. Holt 10/23/02 Sector Manager/Director: Armin H. Fidler 8/29/02 For a list of World Bank news releases on projects and reports, click here LEARCH, L reeo8ack -, srrf MAP - SHOWCASE