SFG2064 REPUBLIC OF KENYA Public Disclosure Authorized MINISTRY OF HEALTH Transforming Health Systems for Universal Care Project Vulnerable and Marginalized Groups Planning Framework (VMGPF) March, 2016 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Prepared by Ministry of Health1 with Technical assistance from Julius Muchemi Safeguards and Social Development ERMIS Africa Tel: +254 720 703606 Email: [email protected] This VMGPF for the project has been prepared based on the OP 4.10 of the World Bank and the applicable laws and regulations of the Government of Kenya. The OP 4.10 is triggered when it is likely that groups that meet criteria of OP 4.10 “are present in, or have collective attachment to, the project area”. It is to guide the preparation of subprojects that may affect Vulnerable and Marginalised Groups (VMGs) in the proposed project areas. OP 4.10 ‘contributes to the Bank's mission of poverty reduction and sustainable development by ensuring that the development process fully respects the dignity, human rights, economies, and cultures of Indigenous Peoples. For all projects that are proposed for Bank financing and affect Vulnerable and Marginalised Groups (VMGs), the Bank requires the borrower to engage in a process of free, prior, and informed consultation leading to broad community support. The Bank provides project financing only where free, prior, and informed consultation results in broad community support to the project by the affected vulnerable and marginalised groups’. Such Bank-financed projects include measures to; 1. Avoid potentially adverse effects on the Indigenous Peoples’ communities; or 2. When avoidance is not feasible, minimize, mitigate, or compensate for such effects; 3. Ensure that the vulnerable and marginalised people receive social and economic benefits that are culturally appropriate and gender as well as inter-generationally inclusive; and that the VMGF is based on free, prior and informed consultations with indigenous peoples leading to broad community support. The objectives of the policy are to avoid adverse impacts on vulnerable and marginalised groups, secure broad community support for the project and to provide Vulnerable and Marginalized Groups (VMGs) with culturally appropriate benefits. The Ministry wishes to thank the many health actors from the National, County Governments, VMGs, IPOs and NGOs who participated in the consultations and disclosure workshops. 1 Mr Joachim Mwanza, Dr Omar O.A,, Dr. Valeria Makory, Ms Catherine Ndiso ii LIST OF ABBREVIATIONS ANC Antenatal Care AWPs Annual Work Plans BP Bank Policy BEmONC Basic Emergency Obstetric and Neonatal Care CEmONC Comprehensive Emergency Obstetric and Neonatal Care CoK Constitution of Kenya CPS Country Partnership Strategy CSO Civil society organizations CRA Commission on Revenue Allocation CRD Civil Registration Department CRVS Civil Registration and Vital Statistics DoHCF Division of Health Care Financing DPs Development Partners EAs Environmental Assessments EIA Environmental Impact Assessment EMP Environmental Management Plan ESIA Environmental and Social Impact Assessment ESMP Environmental and Social Management Plan FPICon Free, Prior and Informed Consultation FS Feasibility Study GDP Gross Domestic Product GOK Government of Kenya GRM Grievance Redress Mechanism HCWMP Health Care Waste Management Plan HIS Health Information System HFS Health Financing System IDA International Development Association IP Indigenous Peoples IPOs Indigenous Peoples Organizations KMTC Kenya Medical Training College KNCHR Kenya National Commission on Human Rights KQMH Kenya Quality Model for Health Kshs. Kenyan Shilling M&E Monitoring and Evaluation MDGs Millennium Development Goals MEWNR Ministry of Environment, Water and Natural Resources MSME Micro, Small and Medium-scale Enterprises MoA Ministry of Agriculture MoDP Ministry of Devolution and Planning MoEST Ministry of Education, Science and Technology MoPHS Ministry of Public Health and Sanitation MoU Memorandum of Understanding NCBF National Capacity Building Framework NEMA National Environment Management Authority NGO Non-Governmental Organisation OP Operational Policy PAD Project Appraisal Document iii PAP Project Affected Persons PHC Public Health Care PIU Project Implementation Unit PDO Project Development Objective PIC Public Information Center PICD Participatory Integrated Community Development PIM Participatory Impact Monitoring PIM Project Implementation Manual PMU Project Management Unit PRA Participatory Rural Appraisal RRA Rapid Rural Appraisal RMNCAH Reproductive, Maternal,,Newborn, Child, Adolescent Health SA Social Assessment SIA Social Impact Assessment SLM Sustainable Land Management Sub TWG Sub Technical Working Group TA Technical Assistant THS-UC Transforming Health Systems for Universal Care UHC Universal Health Care UN United Nations UNDRP Declaration on the Rights of Indigenous Peoples US$ United States Dollars VMG Vulnerable and Marginalized Groups VMGF Vulnerable and Marginalized Groups Framework VMGP Vulnerable and Marginalized Groups Plan WB World Bank iv Table of Contents LIST OF ABBREVIATIONS ................................................................................................................ iii EXECUTIVE SUMMARY ................................................................................................................... vi 1.0 BACKGROUND ........................................................................................................................ 1 2.0 POTENTIAL POSITIVE AND NEGATIVE IMPACTS ON VMG ........................................ 17 3.0 PLANS FOR CARRYING OUT SOCIAL ASSESEMENT .................................................... 21 4.0 FRAMEWORK FOR FREE, PRIOR, INFORMED CONSULTATION ................................. 23 5.0 INSTITUTIONAL FRAMEWORK ......................................................................................... 24 6.0 MONITORING AND EVALUATION .................................................................................... 31 7.0 DISCLOSURE .......................................................................................................................... 35 8.0 INDICATIVE BUDGETS FOR IMPLEMENTING THE VMGF ........................................... 36 REFERENCES ..................................................................................................................................... 37 ANNEXES ............................................................................................................................................ 39 Annex 1: Contents of Vulnerable and Marginalized Groups Planning Framework (VMGPF) ........ 39 Annex 2: Criteria for screening VMGs using World Bank OP 4.10 and Constitution of Kenya, 2010 .......................................................................................................................................................... 40 Annex 3: Checklist for Tracking VMGP Implementation ................................................................ 41 Annex 4: Profile of some VMGs in Kenya ....................................................................................... 43 Annex 5: VMGs screening by National AIDS Control Council ....................................................... 51 Annex 6: VMGF Consultation in Kiambu - Dorobo of Kinale......................................................... 54 Annex 7: VMGF Consultation in Endorois, Baringo ........................................................................ 57 Annex 8: VMGF Consultation in Samburu – Ilkonono, Dorobo and Samburu Community ............ 60 Annex 9: VMGF Consultation in Kwale – Wakifundi and Watswaka ............................................. 63 Annex 10: VMGF Consultation in Reproductive Health (Family Planning) .................................... 65 Annex 11: VMGs Comments: National Disclosure Workshop ........................................................ 66 Annex 12: VMG List: National Disclosure Workshop ..................................................................... 70 Annex 13: Kenya Demographic and Health Survey (KDHS - 2015) ............................................... 71 Annex 14: Integration of Citizen Engagement.................................................................................. 72 Annex 15: List of Groups that could meet Criteria for OP 4.10 ....................................................... 75 v EXECUTIVE SUMMARY Project Development Objective 1. The Government of Kenya has requested the World Bank to help fund the Transforming Health Systems for Universal Care (THS_UC) project. The project development objective (PDO) is “to improve utilization and quality of primary health care (PHC) services with a focus on reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services.” The Project will achieve this objective by: (i) improving access to and demand for quality PHC services; and (ii) strengthening institutional capacity in selected key areas to accelerate progress towards universal health care (UHC) in the recently devolved Kenya health system. Project Beneficiaries 2. While the Project is expected to benefit the whole population, its key beneficiaries are women of reproductive age including adolescents and children under five who utilize PHC services most. As development partners (DPs) are already providing different support especially to the underserved counties, the Project will provide flexible funding to all 47 counties to address critical