Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized SFG2871 REV Pakistan SINDH ENHANCING RESPONSE TO REDUCE STUNTING PROJECT Cover Note Environmental and Social Management Framework (ESMF) Directorate of Urban Policy & Strategic Planning, Planning & Development Department, Government of Sindh Addendum of ESMF January 2018 Addendum to Environmental and Social Management Framework (ESMF) Final Report Cover Note Rationale Childhood stunting is one of the most significant impediments to human development. Stunting, or low height for age, generally occurs before age two, and effects are largely irreversible. It is caused by long-term insufficient nutrient intake and frequent infections. Underlying causes of stunting are multiple, including sanitary conditions and hygiene practices, lack of nutrition and health related services. From international literature it is as well-known that low intrauterine growth and low birth weight accounts for 20% of all childhood stunting. Stunting rates are persistently high throughout Pakistan and Sindh has one of the worst nutrition indicators whereby almost half the children are stunted. Recognizing the need of addressing malnutrition as a top priority, the Government of Sindh has adopted an Accelerated Action Plan (AAP) namely “Sehatmand Sindh” for the reduction of stunting and malnourishment by 2021 with an overarching goal for ten years i.e.: to reduce stunting from 48% to 30% in first five years (by 2021) and 15% by 2026 in Sindh by increasing and expanding coverage of multi-sectoral interventions, that are known to reduce stunting in first five years of children’s lives. The Project Development Objective (PDO) of the World Bank funded Sindh Enhancing Response to Reduce Stunting Project (SERRS) is to contribute the reduction of the stunting rate in Sindh from 48% to 43% by the end of the project. Achievement of the PDO relies on a theory of change which links improved child nutrition, growth, and cognition to improved dietary intake and reduced burden of disease, which in turn rely on improved maternal and child care, improved hygiene and sanitation, and improved household food security. The project would support implementation of the AAP with a more modest objective of reducing stunting in Sindh by at least 1% per year from 48% to 43% over the life of the project. Given the inadequate results of previous input-based projects, this project would use a results-based approach to link disbursements to the achievement of agreed-upon, pre-defined indicators. Disbursement-linked indicators (DLI) have been used in other projects in Sindh and contributed significantly to: (i) sector dialogue (by focusing on political ownership of the Government’s program); (ii) technical results (by linking disbursements to planned progress and performance targets); and (iii) donor coordination (by facilitating planning, budgeting, and supervision within a common framework). The project will finance: (i) results contributing to the achievement of the objectives set forth in the Government’s AAP in Sindh; and (ii) technical assistance and other inputs needed by the government to facilitate the implementation of the AAP. Under Component 1 (US$ 50 million), the project will support a multi-sectoral package of services shown to contribute to the PDO by financing results achieved through DLIs under a defined Eligible Expenditure Program (EEP). Under Component 2 (US$ 13 million), the project would finance technical assistance and selected inputs to support: (i) measures for implementing the pilot CCT program for women and children in the poorest quintile to access health and nutrition services; (ii) development and implementation of an overarching multi-sectoral communications strategy for social and behaviour change; and (iii) institutional arrangements for cross-cutting interventions including coordination, strengthening accountability, citizen engagement, integrated multi-sectoral data information systems, monitoring, evaluation, gender and supervision. The project Component 1 would support the GoS by (i) expanding the number of interventions that will have a direct and immediate impact on reducing stunting in the medium to long-term; and (ii) creating an enabling environment and incentives to encourage the required behaviours that need to accompany the expansion of the multi-sectoral interventions in the following sectors: Pakistan - Sindh Enhancing Response to Reduce Stunting Project Cover Note Addendum to Environmental and Social Management Framework (ESMF) Final Report Sanitation and Hygiene: Building on the proposed Multi-Sectoral Actions for Nutrition Project (MSAN) in 15 districts to make villages open defecation free (ODF), the AAP plans to expand coverage across Sindh. In addition to supporting the ODF initiative, project will incentivize an enhanced program on hand washing. Agriculture (including Livestock and Fisheries): Building on a flexible and demand driven approach to be piloted in 20 union councils of 4 districts under the proposed MSAN Project, the department plans to scale up to 10 districts with a high incidence of stunting with nutrition sensitive interventions that would contribute to enhancing household food diversity and access to high nutritive value foods, especially of the poorest and most food insecure households; and to consumption of high nutrition content food, especially by pregnant-nursing women, children under five and adolescents. Scope of Addendum to MSAN ESMF The Environment and Social Management Framework (ESMF) was prepared by the Directorate of Urban Unit of Planning and Development department GoS for the 15 districts of Sindh province targeted under the MSAN project. The existing ESMF has been reviewed and this addendum is prepared to reflect the scale up of activities under the AAP. AAP has targeted all the districts of Sindh including 14 additional districts which are not covered under the existing ESMF i.e. 1) Ghotki, 2) Hyderabad, 3) Khairpur, 4) Matiari, 5) Naushahro Feroze, 6) Shaheed Benazirabad, 7) Sukkur 8) Tando Allahyar 9) Karachi Central 10) Karachi East 11) Karachi West 12) Karachi South 13) Korangi (Karachi) and 14) Malir (Karachi) for implementation. Therefore, this addendum to ESMF of MSAN provides an update for Environmental and social baseline, assessments and consultations with stakeholders for the remaining fourteen (14) districts. Justification of using existing ESMF for AAP Districts The SERRS Project is supporting the Govt of Sindh’s AAP that would support the GoS by (i) expanding the number of interventions that will have a direct and immediate impact on reducing stunting in the medium to long-term; and (ii) creating an enabling environment and incentives to encourage the required behaviors that need to accompany the expansion of the Multi-Sectoral interventions in the following sectors; 1) Sanitation and Hygiene and 2) Agriculture (including Livestock and Fisheries). The existing MSAN project has two components under Inter Sectoral Nutrition Strategy of Sindh (INSS), i) the sanitation component of the project which aims to increase the number of ODF villages through certification while ii) the agriculture for nutrition (A4N) component by adopting nutrition sensitive agriculture (NSA) and these two components are directly linked to the reduction of the stunting rate in Sindh. MSAN project activities are being scaled up in the remaining districts of Sindh as part of SERRS and would be implemented by Sindh Local Government and Sindh Agriculture Department. Therefore, the existing ESMF has been reviewed and this addendum has been prepared for the additional 14 districts under AAP for which the activities are same but the locations are different. As the SERRS project interventions are same as proposed in MSAN project and AAP plans only the scale up of activities in overall Sindh, therefore there impacts, mitigation measures, consultation with institutions (as all the institutions consulted are at provincial level and the scale up activities are applied all over Sindh province), implementation arrangements for environmental and social safeguards, recommendations under environmental and social mitigation plan as proposed in ESMF of MSAN remains same. Therefore, most of the text provided in this addendum is taken from MSAN ESMF. Only environmental and social baseline section and consultation with communities are updated as the scale up of activities will be undertaken in rest of the districts of Sindh not covered under MSAN ESMF. Pakistan - Sindh Enhancing Response to Reduce Stunting Project Cover Note Pakistan SINDH ENHANCING RESPONSE TO REDUCE STUNTING PROJECT Environmental and Social Management Framework (ESMF) Directorate of Urban Policy & Strategic Planning, Planning & Development Department, Government of Sindh Addendum of ESMF Final Report January 2018 Addendum to Environmental and Social Management Framework (ESMF) Final Report Executive Summary The Government of Sindh (GoS) recently adopted an Accelerated Action Plan for Reduction of Stunting and Malnutrition (AAP). The AAP has the ambitious goals of reducing stunting from 48% to 30% by 2021 and to 15% by 2026 by increasing and expanding coverage of multi-sectoral interventions proven to reduce stunting in the first five years of life. The Sindh Enhancing Response to Reduce Stunting Project (hereinafter referred to as SERRS) project would support implementation of the AAP with a more modest objective of reducing stunting in Sindh by