<div><h4>Description</h4><p><p>Most of Vanuatu's population has access to basic health services for child and maternal health and for some communicable and noncommunicable diseases (NCDs) (mainly through development partner support). These basic services are, however, not meeting the increasing health needs and complexity of chronic disease management. </p><p>The Ministry of Health is committed to expanding NCD services by delivering specialized NCD services through two clinics: one in Port Vila (opened April 2022) for the population in the south, and one planned for Luganville (on Santo Island, which is the second most populated island) serving the population in the north. The NCD clinics would relieve the burden of NCD management on the hospitals, while retaining a close coordination and referral pathway with the hospital to manage patients requiring surgical interventions. Having two NCD clinics would improve service delivery to local populations especially for patient surveillance, chronic disease management, and allow more targeted local health promotion. </p></p><h4>Impact</h4><p><p>Health seeking behavior improved (National Sustainable Development Plan 2016-2030)</p></p></div>

Northern Provinces Health and Treatment Project

Initial poverty and social analysis project nu mber: 53084 -001 october 2022 vanuatu: promoting healthy lifestyle s project this document is being disclosed to the public in accordance with adb's access to information policy . currency equivalents as of 10 october 2022 currency unit - vatu v t vt1.00 = 0.00 81.00 = vt122.15 abbreviations adb cso ncd - - - asian development bank civil society organization noncommunicable disease ta - technical assistance note in this report, refers to united states dollars , unless otherwise stated. in preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the asian development bank does not intend to make any judgments as to the legal or other status of any territory or area. initial poverty and social analysis country: vanuatu project title: promoting healthy lifestyle s project lendingfinancing modality: project grant departmentdivision pacific departmentsocial sectors and public sector management division i. poverty impact and social dimension s a. links to the national poverty reduction strategy and country partnership strategy the proposed project is aligned with the vanuatu's national sustainable development plan which includes policy objectives of ensuring universal health coverage, reducing the burden of ncds and promoting health lifestyles.a the project is aligned with the pacific approach 2021- 2025, adb's country partnership strategy for the 12 smaller pacific developing member countries including vanuatu, on preparing for, responding to, and improving resilience to health shocks through stronger health systems.b the project supports the adb's strategy 2030's operational priorities of addressing poverty and reducing inequality , accelerating progress in gender equality and building climate resilient infrastructure .c the proposed project promotes economic and social inclusion of the poor and vulnerable groups by providing quality health services and addresses the inequities in access to health services.b. poverty targeting general intervention individual or household ti -h geographic ti -g non-income mdgs ti -m1, m2, etc. the project address health elements of poverty in specific geographic areas. c. poverty and social analysis 1. key issues and potential beneficiaries. vanuatu did not attain the under -five mortality millennium development goal that called for a two- thirds reduction over 1990- 2015; and at the current trend, vanuatu will most likely not meet the 2030 sustainable development goal target of 25 deaths per 1, live births. there has been a demographic shift in the population with more of the population moving to the capital port vila and away from traditional lifestyles , which is increasing the burden of ncds through changes in lifestyle choices. it is estimated that 74 of deaths in vanuatu are due to ncds.d over 15 of the adult population has diabetes.e there are high rates of obesity among the adult and adolescent population, with 56 of women being obese compared to 46 of men. the 2016 global health in schools survey found that 16.5 of girls and 12.1 of boys aged 13- 17 years in vanuatu were overweight.f the health system is not set up to address ncds resulting in low coverage of services available to th e population, especially the rural populations. the only ncd clinic is in port vila therefore requiring rural patients to travel for more extensive health interventions. given the change in disease profile it is important that the population have access to effective health coverage. the expected beneficiaries are the populations of the northern provinces of sanma, penama, and malapa over 150,700 who will have access to ncd care without having to travel to port vila. 2. impact channels and expected systemic changes. the project will improve the patient experience by strengthening management of chronic disease. other impact channels will include health worker management training in health infrastructure maintenance and training in health promotion and screening. by providing training to health workers in managing chronic conditions as part of essential health services, the project will support long-term improvements in quality of health care. gender considerations in ncd health care will ensure that the services are responsive to specific needs and concerns of women improving screening and referral for women .3. focus of and resources allocated in the transaction ta or due diligence. an existing pacific department ta will be used to identify the priority services to be included in the ncd clinic and the location. g these will include an analysis on the type of services to be offered. the project will also invest in improving health service delivery through training of health workers and in health promotion, ncd management, and health facility maintenance. these investments will support vanuatu 's journey towards universal healt h coverage. ii. gender and development 1. what are the key gender issues in the sector andor subsector that are likely to be relevant to this project or program although maternal health outcomes in vanuatu have improved with a maternal mortality ratio of of 72 per 100, in 2017 down from 103 per 100, in 2007, women's participation in their health care is limited, and provision of comprehensive maternal and reproductive health care services is not widely available.h there are no routine cervical cancer screening programs . vanuatu also has one of the highest adolescent birth rates, at 81 per 1 , live births among 15- 19-year -olds footnote f. an assessment of services conducted by the ministry of health and unfpa in 2021 found that while 96 of health facilities provide family planning, only 38 of facilities can provide services, with trained staff and available products. only 5 of facilities provide a full range of prenatal and antenatal care services with trained staff, products , and equipment. while 55 of facilities routinely provide delivery services, very few have 2 safe delivery practices including trai ned staff, availability of medication, and equipment to support routine and assisted deliveries footnote f. there is sex-disaggregated data available on ncd risk factors smoking, obesity , physical activity and prevalence which can support gender targeting. the project proposes to improve gender considerations in ncd health services , and more directly by including gender mainstreaming in health promotion activities .2. does the proposed project or program have the potential to contribute to the promotion of gender equity andor empowerment of women by providing women access to and use of opportunities, services, resources, assets, and participation in decision- making yesno the project will contribute to gender mainstreaming by i investing in improved health services which will benefit women and the wider population, ii support gender considerations in facility and service design , promote in service training in health workers of which the majority are women , and iv developing health promotion campaigns with gender consideration . a gender action pl an with performance indicators will be developed as part of the project. 3. could the proposed project have an adverse impact on women andor girls or widen gender inequality yesno 4. indicate the intended gender mainstreaming category: gen gender equityegm effective gender mainstreaming sge some gender elements nge no gender elements . participation and empowering the poo r 1. who are the main stakeholders of the project, including beneficiaries and affected people explain how they will each participate in the project's design. the populations of the northern provinces of sanma, penama, and malapa are the main beneficiaries as they will have access to improved health services. the population's health needs and health access will be considered during project design. other stakehold ers in the project with the ministry of health a nd the world health organization will be extensively consulted during the design.2. who are the key, active, and relevant csos in the project area save the children and care international both have active programs supporting gender and health in vanuatu . faith -based organizations are active in health delivery. wan smolbag theater is active in the promotion of healthy lifestyles . the red cross also ha ve activities in vanuatu especially in supporting the response to t ropical cyclone harold .3. are there issues during project design for which participation of the poor and vulnerable is important  yes  no if yes, what are these issues 4. how will the project ensure the participation of beneficiaries and affected people, particularly the poor and vulnerable andor csos, during project design to address these issues the project management team will work with communities so that they understand the benefit of upgrading the health facility and determine any specific access criteria. the design team will include a social development health expert who will ensure that the proposed health infrastructure and ncd services adequately meet the needs of the poor, and scope the potential for c sos to assist with health promotion including health awareness campaigns and outreach under output 3 , safeguards and gender action plan imp lementation . 5. what level of cso participation is planned during the project design l information generation and sharing m consultation na collaborationna partnership iv. social safeguards a. involuntary resettlement categorya b c fi 1. does the project have the potential to involve involuntary land acquisition resulting in physical and economic displacement yes no health infrastructure upgrades will take place only on land which has been cleared and leased by the state with no informal settlers. there will be no land acquisition. 2. what action plan is required to address involuntary resettlement as part of the transaction ta or due diligence process resettlement plan resettlement frameworksocial impact matrix environmental and social management system arrangement none 3 b. indigenous peoples category a b c fi 1. does the proposed project have the potential to directly or indirectly affect the dignity, human rights, livelihood systems, or culture of indigenous peoples yes no 2. does it affect the territories or natural and cultural resources indigenous peoples own, use, occupy, or claim, a s their ancestral domain yesno 3. will the project require broad community support of affected indigenous communities yes no 4. what action plan is required to address risks to indigenous peoples as part of the transaction ta or due diligence process indigenous peoples plan indigenous peoples planning framework social impact matrix environmental and social management system arrangement none v. other social issues and risks 1. what other social issues and risks should be considered in the project design creating decent jobs and employmentadhering to core labor standardslabor retrenchment spread of communicable diseases, including hivaidsincrease in human traffickingaffordability increase in unplanned migrationincrease in vulnerability to natural disasters creating political instability creating internal social conflicts others, please specify 2. how are these additional social issues and ri sks going to be addressed in the project design the project will ensure that external contractors adhere to vanuatu's quarantine arrangements to reduce the spread of infectious disease.vi. transaction ta or due diligence resource requirement 1. do the terms of reference for the transaction ta or other due diligence contain key information needed to be gathered during transaction ta or due diligence process to better analyze i poverty and social impact, ii gender impact, participation dim ensions, iv social safeguards, and v other social risks are the relevant specialists identified yes no - tor not yet defined. but they will include poverty, gender and social dimensions. 2. what resources e.g., consultants, survey budget, and workshop are allocated for conducting poverty, social, andor gender analysis ; and the participation plan during the transaction ta or due diligence project design will be done using the existing heal th ta developing the health sector in the pacific which includes consultants, survey and workshop budget footnote g. the design firm will include an international gender specialist and a national social development specialist who will take on poverty and social analysis to support the due diligence. this will include engaging with local communities around the proposed health facility site and with local civil society groups to gather relevant information to reduce any potential project risks. the international gender specialist together with the national consultant will carry out workshops and consultations in country with s upport from the ta. adb = asian development bank , cso = civil society organization, ncd = noncommunicable disease, ta = technical assistance, tor = terms of reference, unfpa = united nations population fund . agovernment of vanuatu. 2017. national sustainable development plan 2016- 2030. port vila. badb. 2021. pacific approach 2021- 2025 . manila. cadb. 2018. strategy 2030: achieving a prosperous, inclusive, resilient, and sustainable asia and the pacific . manila. d the world bank. cause of death, by noncommunicable diseases of total accessed 16 august 2022 . e the world bank. diabetes prevalence of population ages 20 to 79 accessed 16 august 2022. fvanuatu ministry of health. 2021. health facility readiness and service a vailability assessment. port vila. gadb. 2018. technical assistance for developing the health sector in the pacific . manila. hthe world bank. maternal mortality ratio modeled estimate, per 100, live births - vanuatu accessed 19 august 2022. source: asian developme nt bank .

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Promoting Healthy Lifestyles Project: Initial Poverty and Social Analysis

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