World Bank Safeguard Policies Training: Dushanbe, September 28 – October 1, 2009

CASE STUDY #4

BALKANIA:

Medical Welfare Development Project

Project Description

WB has been asked to support the Government program for medium term reform agenda in the health sector, for improving the general state of hospitals and rehabilitation centers all over Balkania.The Ministry of Health estimates that some 70 percent of health institutions in Balkania currently fail to meet basic public health standards. Conditions in some cases have deteriorated to the point that a number of residents / patients in one residential facility died from food poisoning in the past year. A prioritized multi-year infrastructure upgrade program has been developed, based on a professional assessment of investment needs for the improvement in hygiene of the health institutions as well as space to accommodate administrative services, patients and equipment.

Component 1: Improving Medical Service Delivery: The goal of this component is to improve the entire spectrum of medical provision in Croatia, from prevention, to quality of service delivery, to reintegration of patients into the community. The services will be made more inclusive, and efficient through

  • developing and introducing a new organizationalmodel for front line health service administration and service delivery, covering the Emergency Centers and Hospitals
  • transforming residential institutions;
  • enhancing the quality of services, and reducing thetime spent in those services; and
  • implementing incentives that encourage financially responsiblemanagement of public funds for services.

This component will provide Technical Assistance to help improve administration and servicedelivery in three selected counties before national replication. It will also establish an Innovation and Learning Program to finance orco-finance initial costs for the provision of new and innovative community care programs and to disseminate lessons learned with respect to improvements in quality, effectiveness and costs. Fiduciarystrengthening o f MHSW will also be supported under this component.

Component 2. Strengthening of the Medical Management Information System: The goal of the component is to improve the administration of cash and non-cash benefits by implementing a new organizational model and to ensure that the management information system provides timely andhigh quality data to the Ministry staff for designing, monitoring and analyzing health policy. The project will finance Technical Assistance and IT equipment and software for this purpose.

Component 3. Upgrading of Health Facilities: This component aims to upgrade the physical facilities of health institutions and selected residential institutions in Balkania in order to meet basic functional requirements and public health standards, introduce the One-Stop-Office Model by bringing together key administration and service units into the same space, and provide an appropriate environment for installation and operation of new IT equipment. The project will finance renovation and new construction as required. Three sites for infrastructure upgrading/construction have already been identified to begin in Year 1 of the project (additional sites will be identified for Years 2 through 4):

Site #1: In the capital city of Balkania – Libljania, the main hospital does not meet the minimal required conditions regarding size of the rooms and operating rooms . The current heating system (light oil) is inadequate and inefficient, and therefore a new connection to city gas system is envisaged. The poorly fitted windows and leaking roof contribute to high maintenance costs. The electrical installations are old causing regular power outages on different wings of the hospital and requiring the use of expensive backup emergency generators for emergency facilities and the intensive care unit. The hospital is located in the beautiful center of the city (proclaimed UNESCO heritage site) and is a historical building. The hospital is conveniently located as it is very well connected by the public transportation; however additional parking space would be required. An underground garage is envisaged.

Site #2: a new Physical and Mental Rehabilitation Hospital will be builtin a semi-rural area adjacent to the nature park Lonjica. The site was chosen in part for its serene setting (helpful to mental rehabilitation) and for the presence of geothermal springs which will be used to feed pools for physical rehabilitation of patients. A3 km, all-weatheraccess road will be built to connect the new hospital with the main road . The land on which hospital and road will be built is presently used mainly for agricultural purposes (vineyards, orchards and annual crops). There is also one house with an attached small general store located on the intended hospital site.

Site #3: An existing small administration building in a residential suburb of the Capital city will be expanded and renovated to house administration, a HIV/AIDS clinic and a diagnostic laboratory. The expansion will include construction of a second story and a new wing. The extension will be built within a large (5 ha) yard belonging to the administration building. On a recent site visit several tents and small residential structures were found on the northeast corner of the yard. Staff of the administration facility confirmed that these have been in place for about two years and are occupied by an extended Roma family. The clinic and diagnostic laboratory will handle biomedical wastes and some low level radioactive materials.

Implementing Agency:

The Ministry of Health will be the overall implementing agency for the project. It will onlend funds to Municipalities and cities through the semi-autonomous Balkania Health Management Fund. The MoH has no previous experience in running internationally financed projects or in organizing or monitoring the construction of the facilities. The Ministry would require substantial capacity building to be able to carry out the project.

Task # 1: Indicate what is the EA Category for this project, and explain why (what would be the due diligence document – prior to appraisal)

Task #2: Indicate which SG policies are likely to be triggered by this project and why

Task #3: Identify 5 significant potential negative environmental impacts of these sub projects.

Environmental impact/issue / Mitigation Measure / Monitoring Indicator

Task #4: Fill in the following Entitlement Matrix for at least three groups/categories of “Project Affected People,”in accordance with the provisions of OP 4.12, indicating the type of impact/loss on project affected people and their associated entitlement to assistance.

Category of PAP/type of loss / Entitlement