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The World Bank

(P166308)
Public Disclosure Authorized

Combined Project Information Documents /

Integrated Safeguards Datasheet (PID/ISDS)
Public Disclosure Authorized

Appraisal Stage | Date Prepared/Updated: 20-Feb-2020 | Report No: PIDISDSA27826

Public Disclosure Authorized

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BASIC INFORMATION

OPS_TABLE_BASIC_DATA
A. Basic Project Data

Country Project ID Project Name Parent Project ID (if any)

Pakistan P166308 Balochistan Human
Capital Investment
Project
Region Estimated Appraisal Date Estimated Board Date Practice Area (Lead)
SOUTH ASIA 23-Mar-2020 30-Apr-2020 Health, Nutrition &
Population
Financing Instrument Borrower(s) Implementing Agency
Investment Project Financing Economic Affairs Division, Health Department,
Islamic Republic of Pakistan Government of
Balochistan, Secondary
Education Department,
Government of
Balochistan

Proposed Development Objective(s)

To improve utilization of quality health and education services in selected refugee hosting districts of Balochistan.

Components
1. Improving utilization of quality health services
2. Improving utilization of quality education services

PROJECT FINANCING DATA (US$, Millions)

SUMMARY -NewFin1

Total Project Cost 36.00

Total Financing 36.00
of which IBRD/IDA 36.00
Financing Gap 0.00

DETAILS -NewFinEnh1

World Bank Group Financing

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International Development Association (IDA) 36.00

IDA Credit 21.00
IDA Grant 15.00

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

Pakistan, the sixth most populous country in the world, is at a crossroads. The economy accelerated with a gross
domestic product growth rate of 5.3 percent in fiscal year (FY)18 and slowed down to 3.5 percent in FY19 as fiscal and
external imbalances persisted.1 Poverty declined from 64.3 percent in 2001, to 24.3 percent in 2015,2 but inequality
persists. The country ranks low on the 2018 Human Capital Index (HCI), at 134 out of 157 countries. Gender disparities
continue, and female labor force participation was only 26.5 percent in 2018. After the onset of another boom and bust
cycle, a US$6 billion International Monetary Fund program commenced in July 2019. Growth is expected to pick up as
structural reforms take effect and macroeconomic imbalances are addressed. Over the medium to long term, Pakistan
needs to invest more and better in human capital, raise more revenue, simplify doing business procedures, expand
regional trade and exports, and manage its natural endowments sustainably, as articulated in Pakistan@100: Shaping the
Future.3

Pakistan’s aspiration to become a middle-income country by 2047 largely depends on human capital accumulation,
which is very low. According to the 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 (HFs) (33.8 percent) and low immunization coverage (65.6 percent), children are
deprived of a strong start in 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.4 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. Further, 44 percent of
children ages five to 16 years old are out-of-school (22.8 million). More than half of those out-of-school are girls. Provincial

1 World Bank Group (WBG). 2018. Pakistan Development Update 2018 – At a Cross Road.
2 World Bank (WB). 2018. “From Poverty to Equity – Pakistan at 100”. Washington DC: WB.
3 WB. 2019. Pakistan at 100: Shaping the Future. WB, Washington, DC: WB. https://openknowledge.worldbank.org/handle/10986/31335 License:

CC BY 3.0 IGO.
4 National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. Pakistan Demographic and Health Survey (PDHS) 2017-18. Islamabad,

Pakistan, and Rockville, Maryland, USA: NIPS and ICF.

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disparities are also significant. Punjab’s indicators are highest, but still far from what is required for a future productive
society in the province. Sindh and Balochistan have the lowest human capital accumulation, whereas Khyber Pakhtunkhwa
(KP) has the highest gender disparity. The low HCI in Balochistan is partially linked to an astonishing 42 percent poverty
rate5 and socio-cultural norms that affect demand for and utilization of health and education services in the province.

Pakistan has adopted a holistic approach to accelerate human capital accumulation. This entails a set of reforms and
interventions, including: (a) the launch of a national poverty alleviation program, Ehsaas; (b) expansion of quality primary
health care 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 within a decade; and (d) revision of legislation for women’s
empowerment and increased participation in the labor force. Pakistan is also an early adopter of the World Bank (WB)
Human Capital Project. This reform agenda is an intrinsic part of the national dialogue supported by the Moving the Needle
in Human Capital Initiative and Human Capital Summits. The project is one in a set of WB-supported federal and provincial
engagements, which bring together core interventions aligned with the policy reform of the Government of Pakistan.

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. Since 2006, the Government
has issued Proof of Registration cards. These cards enable their temporary stay in the country and are renewed
periodically. While refugees initially lived in special villages, since the 1990s, they have been relatively free to move out
to urban areas and access social services. They are mainly employed in the informal sector and recently have been allowed
to open bank accounts.

Balochistan hosts around 325,000 registered Afghan refugees: 47 percent of them are females, and more than half of
them (53 percent) are less than 18 years of age. Districts with the highest presence of registered refugees include Quetta,
Pishin, Chagai, Loralai, Killa Saifullah, and Killa Abdullah. More than half of the refugees in Balochistan live in urban Quetta
(56 percent), whereas the remaining live in rural settlements (29 percent) and refugee villages (15 percent).

Sectoral and Institutional Context

Human capital in Balochistan is low due to the underlying socio-cultural, economic, and development challenges. Firstly,
multiple socio-cultural and economic barriers, such as low education levels, high poverty rates, and certain socio-cultural
norms, negatively impact utilization and outcomes in health and education. The lack of awareness about the benefits of
utilizing quality health and education services, along with safety concerns, especially for females who are not allowed to
travel alone, results in low utilization of essential services that are critical to achieving better human development
outcomes.6,7 Secondly, the settlement of a large share of dispersed households in a vast province makes service delivery
in remote areas challenging, leaving the most vulnerable population groups behind and exacerbating inequalities. Thirdly,
despite the rapid transition to devolved public services, which led to an increase in government allocation to health and
education, weak institutional capacity coupled with sub-optimal governance has hindered the effective and efficient use
of the resources to maximize the development outcomes for children.8

5 Pakistan Bureau of Statistics. 2017. Household Integrated Economic Survey (HIES) 2015/16 [Data from 2014/15]; WB. Data4Pakistan-District
Development Portal. https://geosdndev.worldbank.org/Data4Pakistan/. Accessed on August 28, 2019.
6 Javed SA et al. 2013. Correlates of preferences for home or hospital confinement in Pakistan: evidence from a national survey. BMC-Pregnancy

and Childbirth. 13:137.

7 Iftikhar ul Husnain et al. 2018. Decision-making for birth location among women in Pakistan: evidence from national survey. BMC Pregnancy and

Childbirth, 18:226. https://doi.org/10.1186/s12884-018-1844-8.

8 Alif Ailaan 2018. 2013-2018 Five Years of Education Reforms in Balochistan. Wins, Losses and challenges for 2018-2023. Islamabad: Alif Ailaan. vi-

33 pp.

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These cross-cutting challenges along with sector specific supply-side and demand-side constraints have resulted in poor
health indicators and large disparities by socio-economic status. Balochistan performs worse than the national average
across reproductive, maternal, newborn, child health and nutrition (RMNCHN) indicators.9 Under-five mortality rate is 78
per 1,000 live births in Balochistan, compared to 74 per 1,000 live births at the national level. The total fertility rate (TFR)
is 4.0 in Balochistan and 3.6 nationally, and almost half of the children under five are stunted in the province, compared
to about one in three at the national level. Differences in service utilization between the province and the national level
are even more striking: 38 percent of deliveries are attended by a skilled birth attendant (versus 69 percent nationally)
and 56 percent of women receive at least one antenatal care from a skilled provider (versus 86 percent nationally). The
use of modern contraceptives is very low, both at the provincial level (14 percent) and at the national level (25 percent),
while the proportion of children immunized against measles is an alarming 33 percent in the province, versus 73 percent
nationally. Vulnerable populations present lower indicators: skilled birth deliveries are 93 percent in the richest quintile
and 22 percent in the poorest quintile, while the share of women receiving at least one antenatal care from a skilled
provider is 77 percent in urban areas, versus 47 percent in rural areas.

Despite the existence of a network of primary and secondary HFs and free access to care for everyone, the lack of critical
inputs, suboptimal stewardship, limited use of evidence-based practices, and fragmented health service delivery
significantly affect the health sector performance. The number of trained health professionals has increased in recent
years,10 but Balochistan still suffers from severe shortages of providers, especially females due to safety concerns in
remote areas, inadequate staff-mix, absenteeism despite allowance to encourage providers in hard to reach areas,11,12
and low providers’ competencies.13 Funding gaps for essential medicines and maintenance and repairs, weak capacity to
quantify needs, and sub-optimal supply chains are key factors leading to high stock-outs of medicines and lack of functional
equipment at public HFs. The main provider of health services is the government; however, there are multiple parallel
service delivery systems, each having their own reporting systems and supply chains, resulting in the duplication of efforts
and inefficiencies. In addition, the GoB lacks health information critical for planning, budgeting, and management
purposes, such as data on the availability of essential inputs for service delivery.

In Balochistan, children suffer from sub-optimal learning outcomes and large disparities by gender. Despite significant
efforts by the Secondary Education Department (SED), Balochistan performs poorly as compared to the national average
across all education outcomes. In FY16/17, 64 percent of boys and 78 percent of girls (between the age of five and 16)
were not enrolled in primary and secondary schools in Balochistan, as compared to 40 percent of boys and 49 percent of
girls at the national level. The overall net enrollment and effective transition rates, from primary to middle school, and
middle to high school, were low compared to national rates, especially among girls. When it comes to student learning
metrics, children in Balochistan also perform poorly in comparing the same age groups in rural Pakistan communities. For
example, approximately 60 percent of children in grade five could not perform a two-digit division problem. The 2018
ASER report also highlighted a wide gender gap in student learning, with 31 percent of boys and 20 percent of girls (aged
five to 16 years) could read second-grade level sentences in Urdu.14 Within the Afghan refugee population aged 12 and
above, only 33 percent are reportedly able to read and write, and female literacy is extremely low at 15 percent, compared

9 NIPS and ICF. 2019. PDHS 2017-18.

10 Since 2014, the GoB hired 659 medical officers, 497 lady medical officers, and 290 nurses, and the DOH recently announced the hiring of
additional 158 medical officer posts (both male and female) to be recruited on a regular basis. Source: GoB, September 2019.
11 Draft Balochistan Comprehensive Development Strategy 2013-2020. 2013. Planning and Development Department, GoB.
12 TAP Workshop, Washington DC. 2010. Extracted from: HOPE and TAP study on absenteeism in the health sector – Pakistan.
13 Ameh CA, Kerr R, Madaj B, Mdegela M, Kana T, Jones S, et al. (2016) Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia

before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care. PLoS ONE 11(12).
14 ASER Pakistan. 2019. Annual Status of Education Report-National 2018.

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to male literary at 50 percent. Afghan refugee children were also shown to have a much lower net enrollment rate
compared to Pakistani children, 29 percent and 56 percent respectively. 15

Key factors that negatively affect learning outcomes, especially for girls, are limited access to education services, quality
of inputs, inadequate student learning assessments to monitor performance, weak governance and limited use of data
to inform decision making. Currently, there are only 565 middle and 332 high schools for girls, compared to 830 middle
and 675 high schools for boys, resulting in high female drop-out rates after grade five. 16,17 Of the total public schools,
around 42 percent of schools have no water, 57 percent have no boundary walls, 71 percent have no toilet facilities, and
79 percent are without electricity – key factors contributing to student, especially female, drop-out from school. Another
major hurdle in attracting and keeping female students is the lack of female teachers. The Provincial Institute for Teacher’s
Education (PITE), the apex teacher training institute in Balochistan, does not include a needs assessment to establish a
baseline of existing competencies, making it difficult to measure the impact of PITE’s teacher trainings.18 The quality of
education services at the local level is characterized by poor ownership, weak accountability of teachers and local
education managers, frequent teacher absenteeism, and poor monitoring and measurement of student learning. SED’s
limited capacity in data analysis is also hampering its ability to make timely decisions and improve planning.

C. Proposed Development Objective(s)

Development Objective(s) (From PAD)

The project development objective (PDO) is to improve utilization of quality health and education services in selected
refugee hosting districts of Balochistan.

Key Results

(a) PDO Indicator 1: Deliveries attended by skilled health personnel (cumulative number);
(b) PDO Indicator 2: Children immunize (cumulative number);
(c) PDO Indicator 3: Students benefitting from direct interventions to enhance learning (cumulative number);
(d) PDO Indicator 4: Targeted schools meeting at least three out of five model-school criteria19 (percent).

D. Project Description

The project aims to achieve the PDO by addressing development barriers affecting both health and education sectors
in the same districts, i.e., by investing to fill supply- and demand-side gaps and improving management and governance
in the sectors. This two-pronged approach will improve utilization and quality of critical public services that support the
accumulation of human capital.

The interventions designed to improve systems will be first implemented in target areas and later scaled up at the
provincial level. The project targets four districts (i.e., Chagai, Quetta, Pishin and Killa Abdullah) with (a) the highest

15 UNHCR. 2011. Population Profiling, Verification and Response Survey of Afghan Refugees in Pakistan
16 SED, GoB. 2013. BESP 2013-2018
17 SED, GoB. 2017. Balochistan Education Statistics 2016-17
18 SED, GoB. 2013. Draft BESP 2020-2025
19 Criteria include: (a) dedicated early childhood education (ECE) class room and ECE teacher; (b) 50 percent of teachers trained using. time tables

and scripted lessons; (c) boundary wall and functional toilets; (d) desk and chair for each student; and (e) trained parents teacher school
management committees (PTSMCs) meeting regularly and endorsing monthly teacher attendance.

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presence of registered refugees; or (b) the main border crossing between Balochistan and Afghanistan constituting a major
entry/exit point for refugees.

Component 1: Improving utilization of quality health services (US$18.25 million equivalent) aims to increase utilization
of essential preventive and curative services by improving service delivery at existing primary and secondary HFs and
strengthening health sector stewardship in Balochistan.

(a) Subcomponent 1.1: Improving delivery of quality health services, with a focus on RMNCHN, through (a)
carrying out rehabilitation and upgradation works, implementing a health care waste management
system, and providing essential inputs (human resources, medical equipment, medicines, and supplies),
necessary to deliver critical health services at selected HFs; (b) improving health service providers’
knowledge and competencies; and (c) carrying out of community-based advocacy, outreach, and
awareness raising activities among health and education service beneficiaries.

(b) Subcomponent 1.2: Strengthening health sector stewardship, through (a) improving availability, quality,
and use of routine health data; and (b) providing training to, and building capacity of, key managerial and
technical staff at provincial, district, and facility level on selected health system strengthening subjects.

Component 2: Improving utilization of quality education services (US$17.75 million equivalent) aims to increase learning
outcomes for children, especially girls, by providing opportunities that can transform lives, improving quality of education
services.

(a) Subcomponent 2.1: Improving delivery of primary and secondary education in selected districts by (a)
upgrading select schools from primary to middle schools and from middle to high schools in the selected
districts, including adding and equipping additional classrooms and hiring additional teachers as necessary
on performance-based contracts; and (b) supporting targeted facilities in meeting the model school
criteria.

(b) Subcomponent 2.2: Strengthening education sector stewardship in selected districts through (a)
carrying out a functional review of selected secondary education institutions as well as developing and
implementing a strategy for upgrading student assessment system; (b) carrying out a functional review of
PITE and developing an action plan to address recommendations proposed; (c) implementing cluster-
based governance and management system20 at schools upgraded under subcomponent 2.1; and (d)
developing and pilot-testing of a technology-based tool to enhance SED’s capacity in regular planning and
budgeting, resource rationalization, and decision making.

E. Implementation

Institutional and Implementation Arrangements

The project will be implemented by multiple implementing agencies in line with the government mandates and through
the existing governance structures. At the provincial level, the Health Department and SED will implement and manage

20It includes (a) DDO code allocated to Cluster Head; (b) LECs preparing cluster plans and budgets; and (c) organizing trainings of head teachers at
the cluster head-level on participatory planning, school-based budgeting, cluster-level procurements, and conducting summative and formative
student assessments; and (d) EMIS Cells gathering cluster data and submitting to the District Education Authority (DEA) and SED.

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activities under Component 1 and Component 2, respectively. Each department will have a lean project management unit
(PMU) to: (a) plan and manage the implementation of project activities; (b) monitor and periodically report progress,
including fiduciary and safeguards requirements; and (c) liaise with the WB and other development partners supporting
the Government of Balochistan (GoB). A project coordination committee will be set up to coordinate project
implementation and a project steering committee will be set up to provide strategic guidance and oversight.

At the district level, the project implementation and progress monitoring will be mainstreamed through the existing
governance structures to the extent possible. Implementation of activities under Component 1 at the district level will
be managed by the district health officer (DHO) with support from the DHO team and People's Primary Healthcare
Initiative District Support Team. The district-level implementation of Component 2 will be led by the Education PMU’s
district teams. Housed within the education department at the district level, district teams, in close collaboration with
the District Education Authority, will develop and implement district-specific implementation plans in line with district
education plans.

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

The project area includes four bordering districts of Balochistan covering an area of 59,209 square
kilometers including Quetta, Chagai, Killa Abdullah, and Pishin. Quetta District is the provincial capital of
Balochistan and is bounded by Ziarat on the east, Killa Abdullah district on the west, Pishin district on the
north, and Mastung district on the south. Chagai is the largest district in Balochistan and has an area of
45,444 square kilometers, Killa Abdullah 3,293 square kilometers ranks as the 6th smallest district of
Balochistan and Pishin has an area of 7,819 square kilometers. Geographically, Quetta District is
mountainous; the mountain ranges are fairly uniform in character and consist of long central ridges from
which frequent spurs descend. Innumerable gorges and torrent beds intersect the spurs, with varied ground
elevation of 1,254 - 3,500 meters. The Mashlakh, Chiltan, Murdar, and Zarghoon are the important
mountain ranges in the district. The topography of the Chagi district includes distinctive highlands, lowlands,
and desert. The Pishin and Killa Abdullah also have similar topography dominated by mountains. Balochistan
is a water-starved and land-rich area of Pakistan. There is no perennial water stream or river in the project
districts. The project districts’ groundwater data is highly variable. The water table fluctuates between 130
and 470 feet in Killa Abdullah, 1,000 to 2,000 feet in Quetta 65 and 360 feet in Chagai. The groundwater
level data of Pishin district could not be obtained. It is estimated that water table in the Quetta Valley is
declining at an average rate of four to five feet per year. Balochistan has been traditionally vulnerable to
natural disasters due to its unique geo-climatic conditions. Earthquakes, floods, droughts, cyclones, and
landslides have been recurrent phenomena. The Cyclone Yemyen, Ziarat Earthquake, and 2010 Floods
sufficiently highlighted Balochistan’s vulnerability to sea-based cyclones, earthquakes, flash and riverine
floods caused by heavy precipitation. Five wetlands in Balochistan are under protection through the Ramsar
Convention and none of them are present in the project districts. There are 27 protected areas in
Balochistan including three national parks, 14 wildlife sanctuaries, eight game reserves, one biosphere
reserve, and one marine protected area. The project interventions are not likely to be implemented in
protected areas of Balochistan.

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G. Environmental and Social Safeguards Specialists on the Team

Zahid Shakeel Ahmad, Environmental Specialist

Najm-Ul-Sahr Ata-Ullah, Social Specialist
Sana Ahmed, Environmental Specialist

SAFEGUARD POLICIES THAT MIGHT APPLY

Safeguard Policies Triggered? Explanation (Optional)

The project activities include rehabilitation and
upgradation of selected health facilities, comprising
mainly primary care facilities and a few secondary-
level hospitals (Component 1); and rehabilitation of
selected primary and middle schools, upgradation to
the next level, and establishing early childhood
education (ECE) classrooms (Component 2). The
rehabilitation and upgradation of these facilities
involves civil works that will lead to temporary
environmental impacts associated with construction
activities. In terms of health care waste
management, major concerns include safety of
syringes, safe use of medicines, and safe disposal of
medical waste. The project intends to provide
medical equipment and medicines to the target
health facilities. The health and safety protocols for
Environmental Assessment OP/BP 4.01 Yes
handling equipment should be devised accordingly.

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 (E&S) impacts,
the GoB has prepared: (a) an environmental and
social management framework (ESMF) for
construction and operations 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

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facilities, the ESMF includes “chance find”

procedures, if required during project
implementation. The GoB will prepare district-wide
environmental and social management plans
(ESMPs) before implementation starts. The ESMPs
can then be included in the bidding documents.

The safeguards documents have been consulted

upon, finalized, and cleared by the World Bank and
publicly disclosed in country by the client on its
website and on the Image Bank of the World Bank.

The scale of construction activity to be undertaken

in the project is not expected to have major adverse
long-term social impacts. The risk of construction-
related impacts associated with gender-based
violence (GBV) is also relatively low. However, the
remoteness of most of the project locations and the
lack of adequate services for GBV survivors creates
challenges for adequate risk mitigation. The ESMF
include screening and mitigation measures to
address any social impacts, including GBV, during
construction and operational phases of the project.
In addition, the building extension and renovation
activities (for example, in health facilities) will be
done in a manner to ensure that the infrastructure
needs of women, children, and the differently-abled
(users and staff) are met (for example, separate
toilets for women with changing area, wheelchair
ramps).

Other social issues associated with the project are

related to contextual factors such as exclusion of
vulnerable groups including women, the poor,
people living in remote locations and scattered
settlements, including lack of access to services and
facilities; lack of or reduced opportunities for ‘voice’,
social accountability, grievance redress, and other
(CE) mechanisms. A qualitative assessment has been
done to examine the wider social issues such as
exclusion, gender, GBV, marginalization etc. The final
findings of the qualitative social assessment have
informed the final project design to ensure that the
wider social issues are addressed adequately in the
project.

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Performance Standards for Private Sector The proposed project does not involve any private
No
Activities OP/BP 4.03 sector opportunities.
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 and middle schools, upgrading them to next
Natural Habitats OP/BP 4.04 No
level, and establishing ECE classrooms). 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 and 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 primary and middle
schools, upgrading them to next level, and
Physical Cultural Resources OP/BP 4.11 No
establishing ECE classrooms 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.
The project will be implemented in Balochistan
province, which is not a home for any indigenous
people. The only recognized indigenous people -the
Indigenous Peoples OP/BP 4.10 No
Kalash- live in Chitral district in Khyber Pakhtunkhwa
province which is outside the boundary of project
activities. Hence the policy is not triggered.
The project may have very small-scale land needs in
few instances, primarily for minor extensions of
existing health and education facilities. Hence, OP.
4.12 is triggered. In the first instance, land needs (if
Involuntary Resettlement OP/BP 4.12 Yes
any) for extending facilities will be met through
voluntary land donation (VLD), the procedure for
which is specified in the Resettlement Policy
Framework (RPF) prepared for the project. In the

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instances VLD is not possible, the project may

undertake very small-scale acquisition of private
land for minor extension works; the RPF also
provides the requisite framework for such cases. The
RPF is included as an annex in the ESMF and has
been consulted upon, cleared by the Bank, and
disclosed both in country and on the Bank system.
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 project activities such as minor civil works
comprising rehabilitation and upgradation will be
Projects on International Waterways
No carried out within existing facilities and as such do
OP/BP 7.50
not involve/alter any international waterways,
hence, the policy is not triggered.
The project activities are restricted to Balochistan
province and there are no disputed areas in the
Projects in Disputed Areas OP/BP 7.60 No
province as defined in the policy. As such, 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:
Low to medium scale adverse environmental impacts are expected from the minor civil works but most of these
potential impacts would be temporary, likely to occur during project implementation phase, localized and reversible in
nature, and can be mitigated through appropriate measures. The project activities include rehabilitation and
upgradation of selected health facilities, comprising mainly primary care facilities and a few secondary level hospitals
(Component 1); and rehabilitation of selected primary and middle schools, their upgradation to next level, and
establishing ECE classrooms (Component 2). The rehabilitation and upgradation of these facilities involves civil works
that will lead to temporary environmental impacts (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 may also contaminate the soil and underground water if not properly mitigated. There are also
occupational, health, and safety issues to be taken into account during the rehabilitation/upgradation works.
However, all these risks are reversible, localized in nature (within the premises of health facilities), and time-bound
(likely to occur only during the period of construction). Additional health and safety precautions need to be taken for
children safety, for example, to avoid their interaction with construction works and with the contractor’s staff.

Increases in demand for health services are expected in target facilities. The GoB will require proper management of
health care waste for health and safety reasons during operations. In terms of health care waste management, major
concerns during operations include safety of syringes, safe use of medicines, and safe disposal of medical waste. The
project intends to provide medical equipment and medicines to the target health facilities. The health and safety

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protocols for handling equipment need to be devised accordingly. The project also plans to provide drinking water,
sanitation, and hygiene facilities in schools where absent and rehabilitate these services where they are non-
functional. As most of the areas in Balochistan use underground water and lack proper drainage system for the safe
disposal of waste, risk of soil and underground water contamination around disposal areas is present. A water quality
testing of the source water, mainly underground in Balochistan, will be conducted before project implementation for
the provision of safe drinking water and to avoid water poisoning. The other project activities, namely institution
strengthening, to improve service delivery in health and education sector are not associated with environmental
impacts.

The project will not build any new facilities and will work on the rehabilitation and upgradation of existing facilities.
Hence, it does not require any large-scale land acquisition and resettlement. In a few instances, there may be very
small-scale land needs, primarily for minor extensions of existing facilities. In the first instance, land needs (if any) for
extending facilities will be met through VLD. In the instances VLD is not possible, the project may undertake very
small-scale acquisition of private land for minor extension works in accordance with the project RPF.

The scale of construction activity to be undertaken in the project is not expected to have major adverse social impacts.
The risk of construction-related impacts associated with GBV is also relatively low. However, the remoteness of most
of the project locations and the lack of adequate services for GBV survivors creates challenges for adequate risk
mitigation, if required. Other social issues relate to potential exclusion of vulnerable groups (including the poor,
Afghan refugees, people in remote communities and scattered settlements).

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
interventions and will further improve the socioeconomic 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 will continue to have
restricted or even worse access to basic healthcare and early childhood education 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 enrollment and learning outcomes,
creating a vicious cycle. As such “No Project” alternative is not a preferred option and hence not adopted.

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 GoB through the Health Department and SED has carried out a detailed E&S assessment. While the exact location
and design of the sub-projects proposed under the Project are known, there may be possibility of change in the
location; therefore, a framework approach has been adopted to carry out the assessment to fulfill the Bank’s
envionmental assessment requirements. Under this approach, an ESMF has been prepared to: identify potential
negative E&S impacts, propose generic mitigation measures, provide E&S screening criteria, and guide the type of
safeguard instrument to be developed at the sub-project level.

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The client capacity to address and manage social safeguards issues is low. While the SED has some experience in
managing social issues, including safeguards (e.g. VLD, construction impacts), citizen engagement (CE), and grievance
redress mechanisms (GRMs) developed under an ongoing Bank-funded project, this capacity needs to be further
enhanced. The health department, on the other hand, has extremely limited social management experience and
needs significant institutional strengthening.

The ESMF prepared further 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 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 contractors and their staff/employees should (a) adhere to the mitigation measures set
down and (b) take all other measures required by the engineer to prevent harm and minimize the impact of their
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 adverse impacts identified include health
and safety-related issues, if the health care waste is not properly managed during facilities’ operation.

The ESMF includes screening and mitigation measures to address any social impacts, including GBV, during the
construction and operational phases of the project.

The ESMF proposes a comprehensive institutional arrangement that has a good synergy with the overall project
implementation arrangements. At the provincial level, the Health Department and SED will implement and manage
activities under Component 1-health and Component 2-education, respectively. Each department will have a PMU,
which is headed by a Project Director and both PMUs will have at least one E&S specialist/officer in their teams. At the
district level, implementation of activities will be managed by the DHO with support from his/her team. District-level
implementation of Component 2 will be led by PMU’s district teams; each will be headed by a district coordinator and
supported by an education officer, school engineer, and M&E officer. The E&S specialists on the Bank’s task team will
also provide additional support for safeguards capacity enhancement, as required.

A qualitative social assessment has also been done to examine wider social issues related to exclusion of women and
marginalized groups, CE and grievance redress, and relations between refugee and host communities. The findings of
this analysis have informed the final project design to ensure that these issues are adequately addressed. The findings
have also provided an initial mapping of GBV support services.

5. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on safeguard policies,
with an emphasis on potentially affected people.
The communities residing in the proposed project districts (refugees and hosts), targeted health and education
facilities, and the Health Department and SED are the primary stakeholders of the project. Non-Governmetal
Organizations (NGOs); GoB departments including women’s development, social welfare, environment protection; and
national (CAR Balochistan) and international agencies focusing on refugees (UNHCR) are also interested in the project
and its implementation. Stakeholder consultation was conducted as part of the preparation of ESMF/EHCWMP. In-
depth focus group discussions with refugees and host communities (both men and women) and institutional
stakeholders were conducted as part of the social assessment.

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While conducting the baseline survey, a description of the project was provided to the communities, and feedback
related to E&S concerns was collected. For the health component, health care administration, doctors, patients, and
communities within a 5 km radius were consulted. Similarly, selected school administrators, teachers, parents, and
community members residing within a 5 km radius of the selected schools were also consulted during the process.

The institutions working in the health, education, environment, and social welfare are the secondary stakeholders of
the project. These institutions were invited for a group consultation session in Quetta on November 21 and 22, 2019.
A description of the project, potential E&S impacts, baseline of sensitive indicators, and mitigation framework were
presented to the stakeholders to solicit their views and feedback.

The qualitative social assessment focused on issues related to CE and grievance redress helped identify the CE and
GRM design specifications required to address the specific needs of and challenges faced by refugees and host
communities for CE (e.g., consultation, inclusion, and participation in parent teacher school management committees
(PTSMCs), and other such mechanisms) and redressal of health and education-related grievances. In light of the
findings of this assessment, the project will also strengthen (as required and suitable) existing CE mechanisms such as
PTSMCs and health sector systems to ensure that the project interventions respond to the needs of project
beneficiaries, both hosts and refugees, when possible.

The GRM design of the project will ensure that there is a fixed time frame for resolution, feedback to complainants
throughout the process, database of complaints, and periodic collection of (qualitative) feedback during community
consultations to ascertain efficacy and satisfaction. The CE and GRM will be monitored, tracked, and reported
regularly and the data will be disseminated to strengthen accountability and improve governance and inclusion of
citizens’ voice and needs.

B. Disclosure Requirements

OPS_EA_DISCLOSURE_TABLE
Environmental 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-Feb-2020 20-Feb-2020

"In country" Disclosure

Pakistan
20-Feb-2020
Comments
http://www.bnpmc.gob.pk/Resource-Material/bnpmc_publication
http://emis.gob.pk/website/InitiativeDOE.aspx
OPS_RA_D ISCLOSURE_T ABLE

Resettlement Action Plan/Framework/Policy Process

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Date of receipt by the Bank Date of submission for disclosure

20-Feb-2020 20-Feb-2020

"In country" Disclosure

Pakistan
20-Feb-2020
Comments
http://www.bnpmc.gob.pk/Resource-Material/bnpmc_publication
http://emis.gob.pk/website/InitiativeDOE.aspx

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_TABLE
OP/BP/GP 4.01 - Environment Assessment

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?
Yes
Are the cost and the accountabilities for the EMP incorporated in the credit/loan?
Yes
OPS_IR_ COMP_TA BLE

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?
Yes
OPS_ PDI_ COMP_TA BLE

The World Bank Policy on Disclosure of Information

Have relevant safeguard policies documents been sent to the World Bank for disclosure?
Yes
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?
Yes

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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

Yi-Kyoung Lee
Senior Health Specialist

Juan Baron
Senior Economist

Laura Di Giorgio
Economist (Health)

Borrower/Client/Recipient
Economic Affairs Division, Islamic Republic of Pakistan
Mr. Noor Ahmed
Secretary, EAD
[email protected]
Implementing Agencies
Health Department, Government of Balochistan
Mr. Hafiz Abdul Majid
Secretary, Health
[email protected]

Secondary Education Department, Government of Balochistan

Mr. Muhammad Tayyab Lehri
Secretary, Education

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[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

Yi-Kyoung Lee
Task Team Leader(s): Juan Baron
Laura Di Giorgio
Approved By

Safeguards Advisor: Agi Kiss 26-Feb-2020

Practice Manager/Manager: E. Gail Richardson 26-Feb-2020

Country Director: Melinda Good 28-Feb-2020

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