The World Bank Human Capital Investment Project (P166309)

Public Disclosure Authorized Public Disclosure Authorized Combined Project Information Documents / Integrated Safeguards Datasheet (PID/ISDS)

Appraisal Stage | Date Prepared/Updated: 20-May-2020 | Report No: PIDISDSA28174

Public Disclosure Authorized

Public Disclosure Authorized

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

BASIC INFORMATION

OPS_TABLE_BASIC_DATA A. Basic Project Data

Country Project ID Project Name Parent Project ID (if any) P166309 Khyber Pakhtunkhwa Human Capital Investment Project Region Estimated Appraisal Date Estimated Board Date Practice Area (Lead) SOUTH ASIA 19-May-2020 23-Jun-2020 Education

Financing Instrument Borrower(s) Implementing Agency Investment Project Financing Islamic Republic of Pakistan Elementary and Secondary Education Department of Khyber Pakhtunkhwa, Department of Health

Proposed Development Objective(s)

The objective of the Project is to improve availability, utilization, and quality of primary healthcare services and elementary education services in selected districts of Khyber Pakhtunkhwa.

Components Component 1. Improving delivery of quality primary health care services Component 2. Improving availability and quality of education services Component 3. Strengthening community engagement and accountability

PROJECT FINANCING DATA (US$, Millions)

SUMMARY-NewFin1

Total Project Cost 200.00 Total Financing 200.00 of which IBRD/IDA 200.00 Financing Gap 0.00

DETAILS-NewFinEnh1

World Bank Group Financing

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

International Development Association (IDA) 200.00

IDA Credit 137.50

IDA Grant 62.50

Environmental Assessment Category B-Partial Assessment

Decision The review did authorize the team to appraise and negotiate

Other Decision (as needed)

B. Introduction and Context

Country Context 1. Pakistan, the sixth most populous country in the world, is at a crossroads. Periodic macroeconomic crises and a low human capital basis have constrained the country’s growth prospects. Over the last two decades, economic growth in Pakistan has averaged at 4.4 percent a year, below the South Asian annual average of 6.3 percent.1 Low investment in human capital (HC), slow progress of structural reforms, low private investment, and slow export growth due to an overvalued currency, among others, have hindered growth prospects.2 The country was making good progress in stabilizing its economy and implementing much needed structural reforms. However, the global corona virus disease (COVID-19) pandemic will have significant negative impacts on the economy. The closure of businesses and disruption to the supply chains are significantly affecting the services and manufacturing sectors, which account for nearly 80 percent of total gross domestic product (GDP). The impact of the ongoing economic disruption is expected to contract GDP by 1.3 percentage points in FY20.

2. There was a consistent and significant decline in poverty in Pakistan over the 14 years from 2001 to 2015, during which the poverty headcount measured using the national poverty line fell from 64.3 percent to 24.3 percent.3 These gains are likely to be reversed due to the COVID-19 pandemic and its associated containment measures. The challenges of poverty reduction can be further affected by climate change and disaster risk-related vulnerabilities.4 The economic contraction is expected to contribute to a sizeable increase in poverty, reversing the trend of sustained poverty reduction observed over the 14 years. Urban workers employed in the informal sector and daily wage workers employed in

1 World Bank estimate 2 World Bank. 2019. Pakistan at 100: Shaping the Future. Washington, DC: World Bank. https://openknowledge.worldbank.org/handle/10986/31335 License: CC BY 3.0 IGO. 3 World Bank. 2018. From Poverty to Equity - Pakistan at 100. Washington, DC: World Bank. 4 Climate change is expected to exacerbate extreme weather events in Pakistan, thereby increasing the vulnerability of people, assets and infrastructure to-climate induced disasters. is highly vulnerable to major natural disasters and has suffered significantly from various crises, including drought in 2000-02, and Cyclone Yemyin in 2007.

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

the formal sector will bear the brunt of the slowdown. In rural areas, expected decline in off-farm employment opportunities is also likely to increase vulnerability to shocks of households relying on agriculture. It is important that the government prioritizes investments to ensure poverty reduction and human capital losses are quickly offset to bounce back strongly.

3. Human capital accumulation is low and the impact of COVID-19 pandemic puts at risk some of the gains made in recent years. According to the World Bank Human Capital Index (HCI), if no improvements in health and education service delivery take place, a Pakistani child born today is expected to be only 40 percent as productive as s/he could be by age 18. With a large share of births taking place outside health facilities (33.8 percent), and low immunization rates (65.6 percent) children are deprived of a strong start to life. High rates of malnutrition and low learning outcomes contribute to the country’s low HCI: 37.6 percent of Pakistani children under age five are stunted; and learning poverty is very high with 75 percent of Pakistani children not being able to read and understand a short age-appropriate text by age 10.

4. Pakistan has adopted a holistic approach to HC accumulation and protecting HC is at the core of the country’s response plan to address the COVID-19 pandemic. The Government of Pakistan (GoP) embarked on a set of reforms and interventions, including: (a) the launch of a national poverty alleviation program: ‘Ehsaas’; (b) expansion of quality primary health care (PHC) for improved health, nutrition and population outcomes through a ‘life cycle’ approach; (c) a focus on learning in primary education to decrease learning poverty by half in a decade; and (d) revision of legislation for women’s empowerment and increased participation in the labor force. In order to respond to the COVID-19 pandemic, Pakistan has strengthened health service delivery and used safety nets to protect the vulnerable. Ehsaas has been one of the main instruments to mitigate the COVID-19 impact through its cash assistance package. The World Bank is supporting the GoP in this agenda through preparing the Pandemic Response Effectiveness in Pakistan project and repurposing eight ongoing projects to quickly mobilize funding for urgently needed response and mitigation measures. The second phase of the COVID-19 response will focus on interventions to mitigate socio-economic impacts and support for the medium-term reform agenda so that Pakistan can rebound stronger as the COVID-19 crisis subsides. Earlier this year, the Punjab Human Capital project was approved by the World Bank and a similar project is under preparation in Balochistan.

5. Pakistan has had a protracted refugee situation since the 1970s, hosting five million Afghans at its peak in the 1990s. Currently, Pakistan is hosting 1.4 million Afghan refugees, of which nearly half are women. which enable temporary stay in the country and are renewed periodically. Currently, more than 60 percent of refugees live in urban areas with the host community. They are mainly employed in the informal sector and recently have been allowed to open bank accounts as well as being able to access education and health services. 6. Pakistan has invested significantly in designing a refugee protection framework and administrative practices that are consistent with international standards and norms. Pakistan’s Protection Framework for Afghan Refugees includes: (i) implementing administrative and legal measures for refugees, such as the exemption from applicability of the 1946 Foreigners’ Act; (ii) authorizing Afghan refugees to work in the country; (iii) issuing and renewing PoR cards with the support of the UNHCR; (iv) signing of the regional Solutions Strategy for Afghan Refugees (SSAR) in 2012, with Iran and Afghanistan,

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

under UNHCR facilitation; and (v) approving the Repatriation and Management Policy for Afghan Refugees (RMP) in 2017. This Protection Framework has been found to be adequate by the UNHCR and the World Bank.

Sectoral and Institutional Context Human Capital in KP 7. Increasing HC accumulation in the province requires investments early in the life cycle, while supporting children and youth (both boys and girls) to be healthy and develop the necessary skills to become productive individuals. Although progress has been made there are still important challenges in human development outcomes (Table 1). Specific attention is required for girls, given the province’s large gender gap in education, and for refugees as a core vulnerable group. Districts with the largest concentration of refugees tend to lag behind in human development outcomes. On average in such districts, children complete fewer than 5 years of schooling and one in five children are not receiving full immunization. Female refugees face considerable constraints in accessing education and employment. Gross enrollment rate for refugee girls is around 34 percent compared to 87 percent for males. Livelihood opportunities for refugee women are limited, often due to constrained mobility (and social segregation between men and women in the public domain) and lack of financial means to establish and maintain a small business. Women and girls in host communities suffer from similar social and economic vulnerabilities.

Table 1. KP core human development indicators (2010-2019)

Indicator 2010 Most recent Poverty rate 42.3% 27.6% b School participation rate children age 6 to 10 74.1% 75.9% c School participation rate children age 11 to 15 68.2% 70.5% c Percentage of births attended by a skilled birth professional 37.9%a 67.4% d Child immunization rate children age 12 to 23 months 46.9% a 54.7% d Percentage of children under age 5 that is moderately or severely stunted 41.9% a 40.4% d a data are for 2007; b data are for 2013; c data are for 2015; d data are 2018 Source: World Bank (2019). Weathering the Storm: restoring macroeconomic stability. Pakistan Development Update. June 2019

Health Sector Context

8. The GoKP has shown a high level of commitment towards improving the performance of the health sector. The KP Health Policy (2018-2025) provides guidance on five priority areas, with a specific focus on the poor and vulnerable: (i) enhanced coverage and access to essential health services; (ii) measurable reduction in the burden of disease; (iii) improved human resource management; (iv) governance, regulation and accountability; and (v) enhanced health financing for efficient service delivery and financial risk protection. In addition, the Policy emphasizes the implementation of a Minimum Health Service Delivery Package (MHSDP) at primary health care (PHC) level (table 2.) However, despite recent efforts, some health indicators for KP remain especially low and the COVID-19 pandemic can lower health outcomes overall. Use of modern contraception among married women age 15-49, is 23.2 percent

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

and unmet need for family planning (FP) remains at 20.5 percent.5,6 This correlates with a high population annual growth rate of 2.82 percent.7 While the coverage of Antenatal Care (ANC) by skilled providers is 80.1 percent, the proportion of women receiving a postnatal check-up within two days of delivery is only 43 percent5. In addition, mortality as a result of three major non-communicable diseases (NCDs), including cardiovascular disease, diabetes and cancer remains at 25 percent.

Table 2. Minimum Health Services Delivery Package (MHSDP) at PHC level in KP

Primary Health Care Facility Type in KP and Services Provided

Civil Dispensaries Basic Health Units Rural Health Centers • 6-hours opening • 6-hours opening • 24 hours delivery and new-born care • General treatment services • General treatment services • 24-hour inpatient (20 beds) • ANC, PNC, FP • ANC, PNC, FP • 24-hour emergency services • Integrated Management of Newborn • Delivery services-referral of • 24-hour referral and Childhood Illnesses complications • 6-hour selected surgical services • Immunization services • Integrated Management of Newborn • 6-hours opening for planned health education • Nutrition: assessments, prevention, and Childhood Illnesses • ANC, PNC, FP treatment of malnutrition • Adolescent Health • Delivery services–referral of complications • NCDs: Partial no laboratory or • Sexual and Reproductive Health • Integrated Management of Newborn and Childhood imaging, no mental health, no oral services Illnesses health • Immunization services • Adolescent Health • Communicable Diseases: • Nutrition: assessments, prevention, • Sexual and Reproductive Health services management & referral treatment of malnutrition • Immunization services • Referral services • NCDs: partial laboratory and imaging, • Nutrition: assessments, prevention, treatment of • Health education services some mental health referral, no oral malnutrition health • NCDs: laboratory and imaging, ECG services, some mental • Communicable Diseases: health and referral, oral health and dental services management & referral • Communicable Diseases: management & referral • Limited Laboratory services • Laboratory services • Referral service • Referral service • Health education services • Health education services

9. Confidence in primary health care facilities is low, resulting in overcrowding in second and third tier hospitals. Recent assessments found that overall 48 percent of equipment in 24/7 facilities was non- functioning.8 All rural health centers (RHCs) assessed were missing at least one of the four basic requirements for 24/7 functionality including: human resources (93 percent), back-up electricity (19 percent), equipment (93 percent) and maintenance of infrastructure (89 percent).9 Human resource challenges are prevalent in KP with an essential health workforce density of 1.15 per 1,000 population which is less than half of what is internationally recommended.10 Availability of medicine remains inadequate, with only 59 percent of facilities with two weeks stock availability of 25 essential medicines. As a result, only a quarter of KP's population uses public sector PHC facilities, with 14 percent going to RHCs, and even fewer users at the basic health units (BHUs) level, at 7 percent. Consequently, second and third tier hospitals are overcrowded as individuals use them as the first entry point for accessing

5 Pakistan Demographic and Health Survey (2017-18 PDHS) Islamabad. Pakistan Bureau of Statistics. http://www.nips.org.pk/abstract_files/PDHS%20%20201718%20Key%20indicator%20Report%20Aug%202018.pdf 6 Pakistan Demographic and Health Survey (2012-13 PDHS) Islamabad. Pakistan Bureau of Statistics. 7 Pakistan Social and Living Standards Measurement (PSLM) 2014-15 Survey 8 DFID/Technical Resource Facility, Pakistan https://www.mottmac.com/article/6390/technical-resource-facility-pakistan 9 Khyber Pakhtunkhwa Health Roadmap Stock Take 10 Population - Pakistan Bureau of Statistics www.pbs.gov.pk

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

primary health care services. This indicates a need to strengthen PHC facilities and increase the efficiency and effectiveness of PHC services, while increasing utilization, especially among the most vulnerable, such as refugees, women and children. This is even more important now as the COVID-19 pandemic is putting additional pressure on an already weak health system along with the risk of a second wave of infections next winter.

Education Sector Context

10. The GoKP has also been continuously investing in education, however, challenges persist. The education blueprint for the period of 2018-2023 lays out seven core areas of intervention, namely: (i) reforming primary education; (ii) closing the gap in secondary education; (iii) partnering with the private sector; (iv) improving education management in the districts; (v) engaging the community; (vi) special reforms for newly merged districts; and (vii) selected special initiatives.11 However, in elementary education12 alone, it is estimated that an additional 10,000 new classrooms are needed. Many schools do not include restrooms, walls, and clean drinking water. This poses pressure on transitions from primary to lower secondary education, and thus to completion of elementary education, the foundation for literacy and numeracy. Girls are especially negatively impacted by this situation. A recent household survey found that 16 percent of girls’ parents mentioned ‘no school nearby’ as the reason for not sending their girls to school. This percentage was half for the boys’ parents. Khyber Pakhtunkhwa has a very large number of out-school children, and many of those are girls. The participation rate for boys between 5 and 16 years of age is 87 percent compared to 71 percent for girls. Gender parity is higher between 5-9 year olds (0.88) than between 10-16 year olds (0.76). Poverty and gender-related social norms are also important factors in gender gaps in education. 11. Quality of education as measured by student learning outcomes is low, largely due to limited access and low-quality teaching. In 2018, only 47 percent of Grade 3 students could do basic subtraction and only 43 percent of Grade 5 students could read a simple story in . In addition, over 70 percent of primary schools had an average score of less than 35 percent in Grade 5 assessments.13 Contributing factors for this are challenges in effective teacher recruitment and limited opportunities for- and quality of- professional development. The province’s primary school teachers score on average 53 and 54 percent in English and math in teacher assessments - suggesting that on average they master about half of the required content to teach at primary grades. Further, more than 40 percent of teachers did not pass the basic teaching competency criteria. 14 The provincial teacher training program is nascent, mainly focused on primary grades (and key subjects) and limited in terms of skills and topics covered. Several initiatives are underway, but their successful implementation is hampered by the weak capacity of the Provincial and Regional Institutes for Teachers’ Education (PITE and RITE, respectively). 12. Further, there is very limited use of data for planning and evidence-based decision-making which hampers operational effectiveness more broadly as well. A preliminary assessment of the provincial Education and Management Information System (EMIS) suggests the need to (i) integrate various databases to facilitate data analysis; (ii) complement existing data by collecting missing data; (iii) simplify and increase use of data analytics through user-friendly accessible dashboards; (iv) and develop

11 Khyber Pakhtunkhwa Elementary and Secondary Education Department (2018). Education Blueprint 2018-2023. 12 Elementary education includes primary and lower secondary education. 13 Annual Status of Education Report (ASER) 14 The assessment focuses on teacher subject knowledge in Mathematics, English, Urdu and Science at the level of class 3 to 5 student learning outcomes. The first assessment was done in 2016. Revised Induction Program Report, Khyber Pakhtunkhwa Education Sector Program (KESP), April 2019.

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

a human resource management system for the Elementary & Secondary Education Department (E&SED). 13. As with elsewhere in the country, schools are currently closed in KP. As part of the national response to the COVID-19 pandemic, the Ministry of Federal Education and Professional Training launched a distance education Teleschool television channel. Children in KP are also benefiting from it. The need to strengthen quality of education will be even more important to mitigate the lost time of instruction. At the same time, the new Teleschool delivery system can offer an opportunity to reach some of the out- of-school children, such as girls. 14. Khyber Pakhtunkhwa (KP) is the province hosting the highest number of refugees in Pakistan (822,429 Afghan refugees; 38 percent of which are children between the ages of 5-18).15 More than half of the refugees’ population of KP live in the four urban districts of Peshawar, Nowshera, Haripur, and Swabi. Refugees access education and health services in the same way as other residents in KP. Access to public services has been equivalent to that of residents since the shift in national policy to allow refugees to live with host communities.

C. Proposed Development Objective(s)

Development Objective(s) (From PAD) The proposed project development objective is to improve availability, utilization and quality of primary healthcare services and elementary education services in selected districts in Khyber Pakhtunkhwa.

Key Results • Additional classrooms constructed – disaggregated by gender (availability) • Children benefitting from direct interventions to enhance learning – disaggregated by gender (utilization) • Children’s literacy as measured by provincial assessment– disaggregated by gender (quality) • Children’s numeracy as measured by provincial assessment – disaggregated by gender (quality) • Facilities providing 24/7 delivery services in target districts (availability) • Pregnant women delivering in health facilities in target districts (utilization) • Facilities in target districts which had no stock-outs of unexpired essential medicines (quality)

D. Project Description 15. The proposed project will target 4 districts of the province: Peshawar, Nowshera, Swabi, and Haripur. These districts cover close to a quarter of the provincial population (8 million people) and host two-thirds of the Afghan refugee population in KP that is 63 percent or 519,303 refugees. It has 3 main components:

Component 1. Improving delivery of quality primary health care services. 16. This component will strengthen the delivery of quality primary health care services by contributing to improved efficiency and resilience of the health system in selected districts of KP, including supporting those districts dealing with the COVID-19 pandemic. The interventions focus on improving utilization of primary health care as a first point of entry in close proximity to where people live

15 Data on refugees used in this document is from UNHCR and the National Database and Registration Authority (NADRA), and from December 2019.

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

and work. COVID-19 pandemic related interventions will be aligned with the Government of KP COVID- 19 response plan.

Component 2: Improving availability and quality of education services. 17. This component aims to contribute to improved availability and quality of educational opportunities to all children, especially refugees and girls, in selected refugee hosting districts of KP. The proposed interventions would benefit both in- and out-of-school children and take into account the need to cater to for the current school disruptions resulting from COVID-19.

Component 3: Strengthening community engagement and accountability. 18. This component supports carrying out a program of activities to strengthen community engagement and grievance redress mechanisms of the health and education sector in selected districts and includes activities which will be important to help communities in COVID-19 prevention.

E. Implementation

Institutional and Implementation Arrangements 19. The proposed project will be implemented by Government of KP structures with the support of technical assistance as required. The Department of Health will be responsible for overall implementation of Component 1 and several activities under Component 3. The Elementary & Secondary Education Department will have the responsibility for implementing Component 2 and several activities under Component 3. The provincial Department of Communication and Works (C&W) will carry out civil works under the project, however C&W is not an implementing agency for the project. Each implementing agency will be supported by a Project Management Unit which will help with planning of activities and reporting on progress and fiduciary and safeguards related issues. The C&W will manage the requisitioned works procurements through its dedicated project management team who would be responsible for undertaking works procurement, construction supervision, quality assurance and contract management. At the district level, the respective education and health authorities will be responsible for implementation of project activities.

. F. Project location and Salient physical characteristics relevant to the safeguard analysis (if known)

The proposed project is located in the province of Khyber-Pakhtunkhwa (KP), in particular in the districts of Peshawar, Nowshera and Haripur. KP is largely located on the Iranian plateau and Eurasian land plate, while peripheral eastern regions are located near the Indian subcontinent and this has led to seismic activity in the past. Geographically the province could be divided into two zones: the northern one extending from the ranges of the Hindu Kush to the borders of Peshawar basin; and the southern one extending from Peshawar to the Derajat basin. Economic development and social progress are closely linked with the state of health of the population of a country. Health facilities are essential not only to provide disease free atmosphere to live but also to enhance the efficiency and productivity of population. In 2016 there were 1,616 total health institutions in in KP including 166 public sector hospitals and 449 dispensaries (Socio Economics Indicators of KP 2017). Khyber Pakhtunkhwa is in the mid-latitude region on the globe. In the fifth annual report of the IPCC, 2014, mid latitude regions have been warned of extreme weather pattern. According to District-wise

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

Natural Hazards Vulnerability Assessment by National Disaster Management Authority (NDMA), Peshawar and Nowshera Districts are at “very high” risks of floods, while Haripur is at high risk of landslides and avalanches. All the three districts are classified under Zone 2b as per seismic zoning mapping of Pakistan with minor to moderate damage risk. The only protected area in the Project area is Manglot Wildlife Park located in Nowshera District. During the project preparation, the assessment of risks with respect to natural disasters and climate change impacts needs to be considered while selection of facilities. Also, Building Codes of Pakistan (Seismic Provision, 2007) needs to be taken into account during civil works associated with the project activities.

G. Environmental and Social Safeguards Specialists on the Team

Mishka Zaman, Social Specialist Sana Ahmed, Environmental Specialist

SAFEGUARD POLICIES THAT MIGHT APPLY

Safeguard Policies Triggered? Explanation (Optional) The project activities include strengthening of infrastructure, equipment and healthcare commodities (Component 1), comprising mainly of primary care facilities (civil dispensaries/Basic Health Units/Rural Health Centers) and, rehabilitation of selected primary schools to middle schools (Component 2) in selected three districts. The rehabilitation and upgradation of these facilities involves civil works that will lead to temporary environmental impacts due to the generation of dust and noise which may affect workers and nearby Environmental Assessment OP/BP 4.01 Yes communities. The generation of construction waste and wastewater during construction can also contaminate the soil and underground water if not mitigated properly. There are also occupational, health and safety issues to be considered during the rehabilitation/upgradation works. In education facilities, additional health and safety precautions need to be undertaken for children safety, for example cordon off the area and dislocation, to avoid their interaction with construction works and with the contractor’s staff. The project also plans to

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

provide drinking water, sanitation and hygiene facilities in schools where absent and rehabilitate them where they are non-functional. A water quality assessment of the source water, mainly underground in target districts, also needs to be conducted as part of environmental assessment to ensure provision of safe drinking water and to avoid water poisoning. Another major environmental risks associated with the provision of health service delivery package (under Component 1) is the generation of waste which include all kinds of medical waste, immunization waste (sharps, syringes, vaccine vials) solid waste (including plastics, packaging material etc.) and organic waste mainly associated with project operations phase.

Considering the above potential environmental risks associated with the project activities, the project has been categorized as Category B and OP 4.01 is triggered. In line with the OP 4.01 and to assess the potential environmental and social impacts, the GoKP is preparing: (a) an environmental and social management framework (ESMF) for construction- related activities for health and education facilities; and (b) an environmental and health care waste management plan (EHCWMP) for issues related to hospital waste management during construction and operations.

Though most of the construction activities will be implemented in existing health and education facilities, the ESMF includes “chance find” procedures, if required during project implementation. The GoKP will prepare district wise environmental and social management plans (ESMPs) before the implementation starts. The tailored ESMP can then be included in the bidding documents.

The safeguards document will be consulted upon, finalized, and cleared by the World Bank and publicly disclosed in country and on the Image Bank of the World Bank respectively before Appraisal.

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

The proposed project does not involve any private Performance Standards for Private Sector No sector opportunities, therefore the Policy is not Activities OP/BP 4.03 triggered. Most of civil works financed by the project are rehabilitation and upgradation of the existing infrastructures (rehabilitating and upgrading selected health facilities, rehabilitating selected primary schools to middle schools) within the Natural Habitats OP/BP 4.04 No premises of the facilities. All such activities will be done in an already transformed environment. These activities are not expected to convert or degrade natural habitats. Therefore, the Policy is not triggered. Minor civil works comprising rehabilitation and upgradation will be carried out within existing infrastructures, and that will happen in an already Forests OP/BP 4.36 No transformed and built environment. The project is not expected to impact forests and associated ecosystems in the target areas/districts as envisaged in the Policy. Therefore, the Policy is not triggered. The project will not support purchase of any pesticides, and involves only the minor civil works in Pest Management OP 4.09 No existing health care facilities/schools, as such the Policy is not triggered. The Policy is not triggered as the project activities such as rehabilitating and upgrading selected health facilities, rehabilitating selected schools, upgrading Physical Cultural Resources OP/BP 4.11 No them to next level will be executed in existing health facilities and in existing schools. However as a precautionary measure the “Chance Find Procedures” is included in the project ESMF. This Policy is not triggered as the only recognized Indigenous People of Pakistan, the Kalash, reside in Indigenous Peoples OP/BP 4.10 No the Chitral District which is outside the project’s geographical area. The project includes renovation of schools (e.g. repair works, upgrading existing facilities, building bathrooms, new classrooms, etc.). Rehabilitation of such schools may require small scale, permanent economic displacement and/or involuntary Involuntary Resettlement OP/BP 4.12 Yes resettlement if there are encroachments or encumbrances on school property, or if private land is to be acquired for classroom construction. Hence, OP 4.12 on Involuntary Resettlement is triggered and a Resettlement Policy Framework (RPF) will be

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

prepared by appraisal as part of the ESMF. To address such possibilities and provide requisite impact mitigation measures a framework for compensation and livelihood rehabilitation (including screening, mitigation, monitoring and supervision checklists) will be prepared, consulted upon, and publicly disclosed both in-country and on the Bank’s Image bank prior to appraisal. Voluntary Land Donation (VLD) approach will be utilized for minor land acquisition. Site-specific Resettlement Action Plans (RAPs), if required, will be prepared once the design and location of the sub-projects are available. Grievance Redress Mechanism will be included in the RPF and any sub-project ARAPs. This Policy is not triggered as the project activities do Safety of Dams OP/BP 4.37 No not involve dam construction and/or rely on the performance of any existing dam. The proposed project activities such as minor civil works comprising rehabilitation and upgradation will Projects on International Waterways No be carried out within existing facilities and do not OP/BP 7.50 involve/alter any international waterways, hence, the Policy is not triggered. The project activities are restricted to selected three districts of KP province which do not comes under Projects in Disputed Areas OP/BP 7.60 No any disputed area, therefore this policy is not triggered.

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: Project activities include strengthening of infrastructure, equipment and healthcare commodities (Component 1), comprising mainly of primary care facilities (civil dispensaries/Basic Health Units/Rural Health Centers) and, rehabilitation of selected primary schools to middle schools (Component 2) in selected three districts. The rehabilitation and upgradation of these facilities involves civil works that will lead to temporary environmental impacts including deteriorating air quality due to the generation of dust and noise which may affect workers and nearby communities. The generation of construction waste and wastewater during construction can also contaminate the soil and underground water if not mitigated properly. There are also occupational, health and safety issues to be considered during the rehabilitation/upgradation works. In education facilities, additional health and safety precautions need to be undertaken for children safety, for example cordon off the area and dislocation, to avoid their interaction with construction works and with the contractor’s staff. The project also plans to provide drinking water, sanitation and hygiene facilities in schools where absent and rehabilitate them where they are non-functional. A water

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Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

quality assessment of the source water, mainly underground in target districts, also needs to be conducted as part of environmental assessment to ensure provision of safe drinking water and to avoid water poisoning. However, all these risks are reversible, localized in nature (within the premises of health facilities and education facilities) and time- bounded (likely to occur only during the period of construction).

Other than strengthening the infrastructure of health facilities, Component 1 of the Project is supporting Minimum Health Services Delivery Package at primary health care level. The major environmental risk associated with the provision of these service delivery package is the generation of waste which include all kinds of medical waste, immunization waste (sharps, syringes, vaccine vials) solid waste (including plastics, packaging material etc.) and organic waste mainly associated with project operations phase. Therefore, there needs to develop a stringent Environment and Health Care Waste Management Plan to ensure segregation, safe disposal and handling of all waste from the health care facilities during construction and operations of the project. One of the sub-components under Component 1 is already designed to support contracting/outsourcing of renovation and non-clinical services including Health Care Waste Management. It is anticipated that this component will help in building the capacity of the Department of Health to manage contracts of these nature that may help in dealing health care waste in more appropriate manner to reduce the associated environmental and health risks. Component 3 of the Project is to support community engagement and accountability and does not involve any associated environmental impacts.

As noted earlier, the project may include small scale construction to upgrade health facilities and schools which may, in some cases, require small scale land acquisition for extension works. Though every effort will be taken to acquire land using a Voluntary Land Donation process, there may be instances where private land acquisition may be required. Therefore, OP 4.12 Involuntary Resettlement is applicable to the project, and since sub-project locations have not been identified, a Resettlement Policy Framework has been developed. If there is a need for any small-scale land acquisition at the sub-project stage, the relevant project implementation unit will be responsible for preparing an Abbreviated Resettlement Action Plan in line with the RPF. ARAPs will be submitted to the WB for review and clearance and will be consulted on and disclosed prior to sub-project implementation and commencement of sub- project construction activity.

2. Describe any potential indirect and/or long term impacts due to anticipated future activities in the project area: Potential indirect and/or long term impacts due to anticipated future activities in the project area will largely be positive. It is expected that implemented project activities will complement and strengthen any such future education and health sector development, and will further improve the socio-economic conditions of the area because of better and improved health/education facilities.

3. Describe any project alternatives (if relevant) considered to help avoid or minimize adverse impacts. The “No Project” scenario is considered the only alternative option. Under this alternative, the project would not be undertaken in any form. As a result of adopting “No Project” option (alternative), the people would continue to have restricted or even worse access to basic healthcare and early childhood education (ECE) facilities. As a result, poor maternal and child health, weak educational and economic status of women, early marriages and limited heath care services will lead to continued and increased poor educational, health and nutritional outcomes among children. A weak start in the first 1,000 days of a child’s life, followed by inadequate investment in ECE, limits children’s cognitive development, which in turn lowers their school readiness and leads to poor school enrolment and learning outcomes, creating a vicious cycle. As such “No Project” alternative is not a preferred option and hence not adopted.

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The World Bank

Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

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. The project will be implemented in selected three districts of KP, however the exact location of the facilities under the project are not known at this stage. Therefore, a framework approach has been adopted to carry out this assessment to fulfill the Bank’s EA requirements. Under this approach, an Environment and Social Framework (ESMF), and an Environment Health Care Waste Management Plan (EHCWMP), and a Resettlement Policy Framework (RPF) is being prepared.

ESMF is being prepared to identify potential negative environmental and social impacts, propose generic mitigation measures, provide E&S screening criteria, and to guide on the type of safeguard instrument to be developed at sub- project level. The ESMF further assesses the environmental and social institutional capacity of the Departments of Health and Education, identifies training/capacity building requirements; and provides institutional, monitoring, reporting, and documentation requirements for implementing the ESMF. All such safeguard requirements are properly budgeted and proposed to be included in overall project costs. District-wide ESMPs will be prepared, before implementation starts. Further, for ensuring safeguard compliance in the field during execution, the ESMF provides clear guidance and procedures for inclusion in the technical specifications of contracts. The specific clauses propose mandatory requirements such as: the contractor and his staff/employees shall adhere to the mitigation measures set down and take all other measures required by the engineer to prevent harm, and to minimize the impact of his operations on the environment including, among others: removal of surplus material, regular maintenance of machinery and limiting operations during day hours for avoiding excessive noise and air pollution etc.

The EHCWMP comprehensively assesses the current health care waste management situation in the province with particular focus on the waste generated in primary health care facilities. The EHCWMP will provide the detail mitigation and monitoring plan for the health care waste segregation, handling and safe disposal. EHCWMP will also include institutional arrangements for the waste management and how the built in component of the project on health care waste management can be utilized to build capacity of the health departments and strengthen the health care waste management systems in the target areas.

The RPF establishes the resettlement and compensation principles, the organizational arrangements and the resettlement planning for the affected population during the project implementation stage. All efforts will be made to avoid resettlement, prioritize the VLD approach, and reduce disruption at the project implementation stage.

The capacity of the Departments of Education and Health in environmental and social risk mitigation is assessed to be low as these do not have past experience of implementing World Bank Safeguard Policies. The task team will review the existing capacity of these implementing agencies, and propose necessary capacity enhancement measures on safeguards in the ESMF. Such capacity building measures would include but not be limited to hiring dedicated environmental and social safeguard specialists in the implementing agencies, comprehensive environmental and social safeguard training programs particularly focusing on the key environmental and social risks and impacts such as OHS, construction and hospital waste disposal and implementing the relevant safeguard instruments.

5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies, with an emphasis on potentially affected people. Project stakeholders were identified as part of the ESMF process; they were categorized into primary stakeholders,

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The World Bank

Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

defined as people, groups or institutions directly affected by the project and who can influence the project outcome. The communities residing in the proposed project districts are the primary stakeholders of the project. Secondary stakeholders were defined as the people, groups, or institutions that are indirectly affected by the project and can influence project delivery process. The institution working in the health, education, environment and social welfare are the secondary stakeholders. Consultations were undertaken during the preparation of the safeguard instruments and have been documented in the ESMF. The ESMF, RPF and HCWMF will be publicly disclosed on client and World Bank websites before Appraisal, and will be made available in hard copy at PIUs, and to project beneficiaries at district health and education offices.

B. Disclosure Requirements

EnvironmentalOPS_EA_DISCLOSURE_TABLE Assessment/Audit/Management Plan/Other For category A projects, date of Date of receipt by the Bank Date of submission for disclosure distributing the Executive Summary of the EA to the Executive Directors 20-Dec-2019 30-Dec-2019

"In country" Disclosure

OPS_RA_DISCLOSURE_T ABLE

Resettlement Action Plan/Framework/Policy Process

Date of receipt by the Bank Date of submission for disclosure 20-Dec-2019 30-Dec-2019

"In country" Disclosure

Pakistan 30-Dec-2019 Comments

C. Compliance Monitoring Indicators at the Corporate Level (to be filled in when the ISDS is finalized by the project decision meeting)

OPS_EA_COMP_TABLEOP/BP/GP 4.01 - Environment Assessment

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The World Bank

Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

Does the project require a stand-alone EA (including EMP) report? Yes If yes, then did the Regional Environment Unit or Practice Manager (PM) review and approve the EA report? No Are the cost and the accountabilities for the EMP incorporated in the credit/loan? Yes

OPS_IR_COMP_TAB LE

OP/BP 4.12 - Involuntary Resettlement

Has a resettlement plan/abbreviated plan/policy framework/process framework (as appropriate) been prepared? Yes

If yes, then did the Regional unit responsible for safeguards or Practice Manager review the plan? No

OPS_PDI_COMP_TAB LE

The World Bank Policy on Disclosure of Information

Have relevant safeguard policies documents been sent to the World Bank for disclosure? No 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? No

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

CONTACT POINT

World Bank

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The World Bank

Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

Cristina Isabel Panasco Santos Practice Leader

Flora Kelmendi Senior Education Specialist

Kanako Yamashita-Allen Senior Health Specialist

Borrower/Client/Recipient

Islamic Republic of Pakistan

Implementing Agencies

Elementary and Secondary Education Department of Khyber Pakhtunkhwa Nadeem Aslam Secretary Education [email protected]

Department of Health Muhammad Yahya Akhoonzada Secretary Health [email protected]

FOR MORE INFORMATION CONTACT

The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects

APPROVAL

Cristina Isabel Panasco Santos Task Team Leader(s): Flora Kelmendi Kanako Yamashita-Allen

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The World Bank

Khyber Pakhtunkhwa Human Capital Investment Project (P166309)

Approved By

Safeguards Advisor: Agi Kiss 15-Dec-2019

Practice Manager/Manager: Cristian Aedo 16-Dec-2019

Country Director: Melinda Good 20-May-2020

Note to Task Teams: End of system generated content, document is editable from here. Please delete this note when finalizing the document.

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