The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) Concept Environmental and Social Review Summary Concept Stage (ESRS Concept Stage) Public Disclosure Date Prepared/Updated: 07/12/2019 | Report No: ESRSC00688 Jul 12, 2019 Page 1 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) BASIC INFORMATION A. Basic Project Data Country Region Project ID Parent Project ID (if any) Cambodia EAST ASIA AND PACIFIC P169629 Project Name Cambodia Pre-Service Training for Health Workers Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 4/8/2020 5/29/2020 Population Financing Borrower(s) Implementing Agency(ies) Kingdom of Cambodia- University of Health Ministry of Health Sciences, Kingdom of Cambodia- Ministry of Health, Kingdom of Cambodia- Ministry of Health Public Disclosure Proposed Development Objective(s) To improve clinical competencies among health care professionals entering the workforce in Cambodia Financing (in USD Million) Amount Total Project Cost 15.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] The proposed project aims to support all key aspects of the pre-service training system in Cambodia, particularly focusing on nurses, midwives and primary care physicians. The project will support the strengthening of pre-service education system, specifically: a. Adequate supply of eligible applicants based on pre-determined criteria for entry qualifications; b. Updated and relevant curriculum leading to competency-based education (Box 3); Jul 12, 2019 Page 2 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) c. Sufficient production capacity in education institutions, including increased provision of infrastructure, equipment and faculty; d. Increased number of clinical practice sites with established partnerships with hospitals; e. Development of institutional mechanisms for greater retention of students, faculty and staff; f. Establishment of quality assurance and performance mechanisms and strengthening of accreditation system; g. Establishment of an enabling regulatory framework and buy-in from leadership in MOH; and h. Strengthening links with the health system with the capacity to employ newly qualified health workers as well as to provide advanced training opportunities for in-service personnel. D. Environmental and Social Overview D.1. Project location(s) and salient characteristics relevant to the ES assessment [geographic, environmental, social] For nearly twenty years, economic growth in Cambodia has been impressive and remained robust. The economy experienced and annual average growth rate of 7.9 percent over 1997-2017, ranking among the top seven fastest growing economies in the world. However, lack of access to quality health services, especially in the more remote and rural areas, and high levels of stunting among under-fives are significant remaining challenges to human capital. Cambodia’s health outcomes have improved steadily since the 1990s and surpassed several better-off countries. Life expectancy increased from 65.6 years in 2000 to 68.3 (66.1 male, 70.2 female) in 2014 and the total fertility rate declined from 3.8 in 2005 to 2.7 in 2014. The country’s progress and innovation in health service delivery contributed to achievement of most health-related Millennium Development Goals. However, Cambodia’s rural, remote, indigenous, and socioeconomically challenged women and children remain disproportionately affected by poor health Public Disclosure and nutritional status. The Third Health Strategic Plan (HSP-3) outlines the Ministry of Health (MOH) mission to “effectively manage and lead the entire health sector to ensure that quality health services are geographically and financially accessible and socio- culturally acceptable to all people in Cambodia” through both public and private services. Despite considerable recent progress, Cambodia continues to face challenges in delivering affordable, quality health services that adhere to clinical practice guidelines and protocols and meet the expectations of the population. Perceived poor quality of some public health services drives health service utilization in the private sector and overseas and out-of-pocket expenditures (estimated at 58 percent of total health expenditures, and high relative to other regional and lower- middle income comparators). Current quality improvement initiatives include an increasing interest around the need to improve pre-service training, accreditation, and licensing of health professionals that would contribute to quality improvements. Cambodia is facing a severe shortage of health workers, with 1.4 doctors and 9.5 nurses and midwives per 10,000 people, only half of the WHO minimum threshold of 23 doctors, nurses and midwives per 10,000 population. Additionally, Cambodia has struggled to enhance the knowledge, skills, and competencies of the health workforce to deliver quality primary health care. The project is aimed at improving the quality of health professional’s skills and competencies, particularly in the area of pre-service education, would focus on curricular reforms, building capacity for competency and skills training, improving testing and evaluation, and strengthening of quality assurance mechanisms and accreditation systems for medical and nursing education. This project is expected to be implemented in 20 health training facilities nation-wide, 7 public and 13 private. They are located in Phom Penh and in 5 provinces. The final exact project locations will be confirmed prior appraisal stage. Jul 12, 2019 Page 3 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) The scope of application of the Environmental and Social Standards (ESSs) to the project will promote the enrollment and inclusion of disadvantaged groups (women, indigenous peoples groups) in health schools, promote entering workforce spaces and imbedding social inclusion and environmental sustainability aspects in the project activities. Specially in relation with ESS1, ESS2, ESS7, ESS8 and ESS10. D. 2. Borrower’s Institutional Capacity The MoH that will host the PIU has experience with the application of the World Bank’s safeguards policies through a number of IDA-financed investment projects that have been implemented during the last years. Currently, MoH is implementing the Health Equity and Quality Improvement Project (H-EQIP). The ES risks associated with the financed activities is expected to require no major management, skills or experience, and it will be possible to be managed by appointing a designated a focal person within the PMU who can be trained supported by the World Bank TT E&S specialists. The MoH has formally assigned a new ESF focal point for this project, with no previous experience in this field. Since this will be one of the first projects in Cambodia applying the new ESF, the focal point will receive training to ensure adequate capacity to implement and monitor all applicable Environmental and Social Standards (ESSs). Assessment of institutional capacity will be conducted during the project preparation. Specific institutional capacity strengthening/ building measures such as the provision of additional resources, training needs will be identified and listed in the Environmental and Social Commitment Plan (ESCP) to ensure ownership and sustainability of the resources. II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS Public Disclosure A. Environmental and Social Risk Classification (ESRC) Low Environmental Risk Rating Low The environment risk rating is classified as Low as the proposed project is not planning investments that have a physical footprint and could cause direct adverse ES risks. Also, it is extremely unlikely that any indirect, downstream environmental or social effects would be caused by the technical assistance and advice provided through the project. The project is focusing on improving the quality of health professional’s skills and competencies, particularly in the area of pre-service education. It will also focus on curricular reforms, building capacity for competency and skills training, and strengthening quality assurance mechanisms and accreditation systems for medical and nursing education. The project will be applying the World Bank’s Environmental and Social Framework (ESF) in a pro-active way to increase the development opportunities associated with the project. Based on the scope and the results of the assessments during further project preparation, this risk rating will be reviewed and revised if needed. Social Risk Rating Low The social risk is categorized as “Low”, because the expected risks and impacts of the project on human populations are expected to be minimal. Even if this project is not initially planning major construction works, applying the ESF in a pro-active way may increase the development opportunities associated with it. Currently there is not realiable data available, however screening activities carried out for the preparation of this project have shown that some disadvantaged and vulnerable groups (women, IPs) are underrepresented as students in health schools (as doctors, nurses or midwifes). This project has a significant potential both to promote the enrollment and inclusion of those groups as health Jul 12, 2019 Page 4 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) studiesand to embed social inclusion and environmental sustainability aspects in the project activities, in line with WB’s ESF standards. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: The project is expected to cause minimal or negible risks to and impacts on human populations and the environment. However, the project will have windows for the opportunities in relation to the enhancement of ESF related behavioral aspects, including gender based violence prevention, improvement on the health and safety conditions of the health workers, hazardous and clinical waste management, gender inclusion, and improvement of equitable access to project benefits to Indigenous Peoples and other disadvantaged and vulnerable groups (e.g., women, children, elderly, sexual and gender identity (SOGI), disabled people, etc.). In order to provide guidance, prior to Appraisal (planned in December 2019), the MoH will prepare the project’s Human Resource Development for Inclusive Service Delivery Assessment and Plan. This assessment and plan will be carried out to seek ways to promote the enrollment and inclusion of disadvantaged groups (women, indigenous population groups) as students in health schools (as doctors, nurses or midwifes), promote entering workforce spaces and imbedding social inclusion and environmental sustainability aspects in the project activities during the Public Disclosure implementation phase. This plan will also include gender based violence prevention, improvement on the health and safety conditions of the health workers, and hazardous and clinical waste management assessment and plan. The World Bank team will coordinate to provide support to MoH during the preparation process of this document, and to review and ensure quality control of outputs. The project’s Human Resource Development for Inclusive Service Delivery Assessment and Plan will consider, in an integrated way, all relevant expected environmental and social risks and impacts of the project. It will include specific provisions for Labor-Management Procedures (under ESS2) and a Stakeholder Engagement Plan and Project Grievance Mechanism (under ESS10). Both documents will be included at the Human Resource Development for Inclusive Service Delivery Assessment and Plan. An additional stand-alone document to be disclosed prior appraisal is the Environmental and Social Commitment Plan (ESCP). Areas where “Use of Borrower Framework” is being considered: The Borrower's E&S Framework is not proposed to be relied on for the Project, in whole or in part. ESS10 Stakeholder Engagement and Information Disclosure A Stakeholder Engagement Plan (SEP) will be prepared prior the appraisal stage, and included at the Human Resource Development for Inclusive Service Delivery Assessment and Plan. The SEP will be implemented, updated and disclosed by the MoH throughout the different phases of the project life cycle. Jul 12, 2019 Page 5 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) The SEP will ensure that beneficiaries and relevant stakeholders (MoH staff, UHS staff, representatives of UHS students, representatives of private health schools, etc.) will be engaged. It will ensure appropriate representation and participation of various groups of stakeholders, including women and minority students and faculty staff. The SEP will include a Project Grievance Mechanism. It will be informed publicly, and it will address complaints and suggestions coming from both project-beneficiaries parties and other interested parties. As part of the information disclosure arrangement, the Human Resource Development for Inclusive Service Delivery Assessment and Plan, the SEP and the ESCP will be disclosed publicly on the MoH website. The meaningful consultation with relevant stakeholders will be conducted before the appraisal stage, and its results adequately recorded and disclosed. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions Activities under the Project are not expected to have any negative impact related to labor and working conditions. The Project will be mainly implemented by Staff from the Ministry of Health (Government Civil Servants) and professional consultants (hired as contracted workers). Most roles envisaged will be highly technical in nature. In this project, there are no expected primary supply workers or community workers. An assessment will be carried out prior appraisal to determine if working conditions of staff working under the project are materially consistent with ESS2, and to seek the opportunities to mainstream the ESS2 into the project’s sub-activities of curricular reforms, building capacity for competency and skills training, and strengthening Public Disclosure quality assurance mechanisms and accreditation systems for medical and nursing education. Labor Management Procedures will be incorporated under the Human Resource Development for Inclusive Service Delivery Assessment and Plan to address key issues for the PIU (working conditions and management of worker relationships, protecting the work force, grievance mechanism, and occupational health and safety). ESS3 Resource Efficiency and Pollution Prevention and Management The project’s activities and components are not expected to result in any pollution issues. Under the Human Resource Development for Inclusive Service Delivery Assessment and Plan, analysis of the existing practices of clinical and hazardous waste management system, and occupational health and safety, and provision of recommendations for inclusion of these aspects in the curricula will be included as a simple “good practices” guide. ESS4 Community Health and Safety The project’s activities and components are not expected to result in any issues related to community health and safety. Good practices of community health and safety aspects will be addressed in the project’s Human Resource Development for Inclusive Service Delivery Assessment and Plan and integrated into the project’s design wherever possible. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Jul 12, 2019 Page 6 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) Since no major construction works are planned for this project and no land acquisition is envisaged, then ESS5 is not expected to apply. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources The demonstrated project will not have any impact on the biodiversity and natural resources. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities The project’s activities and components are not expected to cause any harm to Indigenous Peoples. Instead, the project’s Human Resource Development for Inclusive Service Delivery Assessment and Plan will explore ways to promote both (i) the enrollment and inclusion of Indigenous Peoples as students in health schools (as doctors, nurses or midwives) and (ii) the equitable access to project benefits to Indigenous Peoples (e.g. design culturally competent health training, to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients). ESS8 Cultural Heritage The project’s activities and components are not expected to cause any harm to cultural heritage. Instead, the project’s Human Resource Development for Inclusive Service Delivery Assessment and Plan will explore ways to promote the protection of traditional knowledge related to health issues (intangible cultural heritage). Public Disclosure ESS9 Financial Intermediaries The project will not imply the use of Financial Intermediaries. B.3 Other Relevant Project Risks It is expected that the project will not have other relevant risks. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No The Project will not affect international waterways. So, this is not applicable. OP 7.60 Projects in Disputed Areas No It is not applicable because the Project will not be implemented in areas known to involve disputed areas. III. WORLD BANK ENVIRONMENTAL AND SOCIAL DUE DILIGENCE A. Is a common approach being considered? No Financing Partners NA. Jul 12, 2019 Page 7 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) B. Proposed Measures, Actions and Timing (Borrower’s commitments) Actions to be completed prior to Bank Board Approval: • Human Resource Development for Inclusive Service Delivery Assessment and Plan, including the project’s Labor Management Procedures and Stakeholder Engagement Plan • Environmental and Social Commitment Plan Possible issues to be addressed in the Borrower Environmental and Social Commitment Plan (ESCP): Institutional capacity and strengthening/ building measures. C. Timing Tentative target date for preparing the Appraisal Stage ESRS 15-Dec-2019 IV. CONTACT POINTS World Bank Contact: Somil Nagpal Title: Senior Health Specialist Telephone No: 5781+1365 / Email: snagpal@worldbank.org Public Disclosure Borrower/Client/Recipient Borrower: Kingdom of Cambodia- Ministry of Health Implementing Agency(ies) Implementing Agency: University of Health Sciences Implementing Agency: Kingdom of Cambodia- Ministry of Health Implementing Agency: Kingdom of Cambodia- Ministry of Health V. FOR MORE INFORMATION CONTACT Jul 12, 2019 Page 8 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects Public Disclosure Jul 12, 2019 Page 9 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) VI. APPROVAL Public Disclosure Jul 12, 2019 Page 10 of 11 The World Bank Cambodia Pre-Service Training for Health Workers Project (P169629) Task Team Leader(s): Somil Nagpal Practice Manager (ENR/Social) Christophe Crepin Recommended on 06-Jul-2019 at 15:23:56 EDT Safeguards Advisor ESSA Peter Leonard (SAESSA) Cleared on 12-Jul-2019 at 19:52:15 EDT Public Disclosure Jul 12, 2019 Page 11 of 11