Republic of the Philippines Department of Health Philippines COVID-19 Emergency Response Project (P173877) and First and Second Additional Financing Projects (P175953 and P177884) STAKEHOLDER ENGAGEMENT PLAN (SEP) [November 2021] CONTENTS Section Page 1.0 Introduction/Project Description 1 1.1 Philippine COVID-19 Emergency Response Project (PCERP): Parent 1 Project and Additional Financing 1.2 PCERP Proposed Second Additional Financing (PCERP-AF2) 2 1.3 PCERP Project Components 2 1.4 Project Accomplishments 5 1.4.1 Deployment of COVID-19 Vaccines 5 1.4.2 Equipment Procurement 7 1.4.3 Civil Works Project 9 1.5 Stakeholder Engagement Plan (SEP) of PCERP 11 2.0 Stakeholder Identification and Analysis 12 2.1 Methodology 13 2.2 Affected Parties 13 2.2.1 Vaccination of the Population Ages 12 – 17 19 2.3 Other Interested Parties 21 2.4 Disadvantaged / Vulnerable Individuals or Groups 22 3.0 Stakeholder Engagement Program 23 3.1 Summary of Stakeholder Engagements Conducted 23 3.2 Proposed Strategy for Information Disclosure 25 3.2.1 Philippine National Deployment and Vaccination Plan for COVID-19 28 Vaccines (NDVP) 3.3. Stakeholder Engagement Plan – Project Implementation 29 3.4 Proposed Strategy to Incorporate the View of Vulnerable Groups 38 3.5 Summary of Project Stakeholder Needs and Methods, Tools, and 39 Techniques for Stakeholder Engagement 4.0 Future of the Project 41 5.0 Resources and Responsibilities for Implementing Stakeholder Engagement 41 Activities 5.1. Resources 41 5.2 Management Functions and Responsibilities 42 5.2.1 The COVID-19 Vaccine Cluster Organizational Structure 44 6.0 Grievance Mechanism 50 6.1 Description of GRM 51 6.2 Grievance Reporting Channels 51 6.2.1 Reporting of Grievances to Authorities 51 6.2.2 Reporting of Grievances to DOH on the COVID-19 Vaccination 52 through the DOH Hotline 6.2.3 Receiving of Grievances by the Authorities 54 6.2.4 Satisfaction Survey 55 6.3 Resolution/Investigation Process of the Grievance 56 6.3.1 For DOH, CHD, and Health Care Facilities (DOH- Owned/Managed) 56 6.3.2 For CSC, DILG, LGUs, and LGU-Owned Health Care Facilities 57 6.3.3 For Construction- Related Grievance of the Workers 57 6.3.4 Closing of Grievance 57 6.4 Operationalization of the GRM 57 7.0 Monitoring and Reporting 60 7.1 Involvement of Stakeholders in Monitoring Activities 60 7.2. Monitoring Indicators 60 7.3 Monitoring of Adverse Events Following Immunization (AEFI) 62 7.4 Reporting Back to Stakeholder Groups 67 LIST OF TABLES Table No. Page Table 1 Summary of PCERP-Funded COVID-19 Moderna Vaccine 5 Doses Received and Delivered (as of October 24, 2021) Table 2 Deployment of PCERP-Funded Moderna COVID-19 Vaccines 6 per Recipient Facilities Table 3 Reported Progress of the Ongoing CY 2020 Civil Works Project 10 Table 4 Reported Progress of the Ongoing CY 2021 Civil Works Project 11 Table 5 Decision Matrix in Determining Priority Eligible Population 15 Groups Table 6 Priority Eligible Groups for COVID-19 Vaccination 16 Table 7 Strategies for information disclosure per Project stage 26 Table 8 Proposed Dissemination Strategy for the NDVP 29 Table 9 Stakeholder Engagement Strategy 30 Table 10 Overview of the Key Messages Per Phase 32 Table 11 Social Listening Strategy per Geographic Area Level 34 Table 12 Topics for Targeted Stakeholders for Demand Generation of 35 the COVID-19 Vaccines Table 13 Health Promotion Module for COVID-19 Vaccines in the DOH 38 Academy E-Learning Platform Table 14 PCERP Funding (Parent Project and Additional Financing 41 (Loan Nos. 9105-PH and 9220-PH Table 15 Projected Breakdown of Expanded Additional Financing for 42 PCERP (as of October 2021) Table 16 Summary of Task Groups (TGs) 46 Table 17 Functions of The Support Groups to the COVID-19 Vaccine 49 Cluster Table 18 Grievance Reporting Mechanisms 51 Table 19 Government Offices Handling Grievances of Specific Concerns 52 Table 20 Contact Information of Government Offices to Receive 52 Grievances Table 21 Possible Support Area of the COVID-19 Vaccine Hotline 54 Table 22 Summary of Response to the Satisfaction Survey for 55 Vaccination Activities Table 23 Overall Satisfaction Rating Aggregated per LGU 56 Table 24 List of Participants in the GRM Online Consultation 58 Table 25 WHO-recommended safety surveillance activities for all 65 countries introducing COVID-19 vaccine regardless of AEFI surveillance capacity TABLE OF FIGURES Figure No. Page Figure 1 Regional Distribution of PCERP-Funded COVID-19 Moderna 6 Vaccines Figure 2 Distribution Map of PCERP-Funded COVID-19 Moderna 7 Vaccine Recipients Figure 3 Social Listening Framework for the COVID-19 Vaccination 33 Figure 4 Health Promotion Campaign Strategy of DOH for the COVID- 36 19 Response Figure 5 Health Promotion Campaign Strategy of DOH for the COVID- 36 19 Vaccination Figure 6 Pulse Asia Survey on Vaccination Positive Influencers (2018) 37 Figure 7 Vaccination acceptance results during the Town Halls led by 37 the HPB (2021) Figure 8 Institutional Set Up for the Philippine COVID-19 Emergency 43 Response Project (PCERP) Figure 9 COVID-19 Vaccine Cluster Organizational Structure 44 Figure 10 Call Algorithm of the DOH COVID-19 Hotline 53 Figure 11 Process Flow of the DOH COVID-19 Vaccine Hotline 54 Figure 12 Template for the Monitoring of the SEP 60 Figure 13 Template for Monitoring of Published/Broadcasted Materials in 61 the Local, Regional, and National Media Figure 14 Process Flowchart for AEFI Surveillance and Response in the 64 Context Of COVID-19 Vaccine Administration Figure 15 Process Flowchart for Responding to Serious AEFIs of COVID- 64 19 Vaccine Figure 16 AEFI Surveillance Cycle 66 LIST OF ANNEXES Annex Page Annex A Results and summary of key feedback in the National 68 Stakeholders Consultation on the Parent Project conducted on August 18-19, 2020 Annex B Key agreements in the Public Consultation on the National 76 Strategic Policy Framework for COVID-19 Vaccine Deployment on December 7, 2020 Annex C Key agreements in the Public Consultation on the National 78 Strategic Policy Framework for COVID-19 Vaccine Deployment on January 8, 2021 Annex D Results and summary of key feedback of the Consultation with 86 Persons with Disabilities on the PCERP held last 5 October 2020 Annex E Results and summary of key feedback of the Consultation with 88 Gender- Based Groups on the PCERP held last 30 October 2020 Annex F Results and summary of key feedback of the Consultation with 91 Indigenous Peoples on the PCERP held last 23 February 2021 Annex G Results and summary of key feedback of the Community 94 Consultation on the Retrofitting and Refurbishing of the Research Institute for Tropical Medicine (RITM) held on 27 October 2020 Annex H Results and summary of key feedback Retrofitting of the 95 Isolation Rooms of Fourteen (14) Hospitals in the National Capital Region (NCR) held on 28 October 2020 Annex I Results and summary of key feedback Building Completion of 96 the Quirino Memorial Medical Center (QMMC) held on 9 February 2021 Annex J Results and summary of key feedback of the Townhall 97 Consultation with Indigenous Peoples conducted by the DOH HPB last 16 March 2021 Annex K Summary and Feedback from the Community Consultation on 100 Civil Works on July 29-30, 2021 Annex L Summary and Feedback from the Training on the Code of 106 Conduct and Environmental and Social Safeguards for Uniformed Security Personnel – Armed Forces of the Philippines (AFP) on 29 April 2021 Annex M Summary and Feedback from the Training on the Code of 107 Conduct and Environmental and Social Safeguards for Uniformed Security Personnel – Philippine National Police (PNP) on 30 April 2021 Annex N Summary and Feedback from the Orientation and Consultation 108 on the Grievance Redress Mechanism (GRM of the Philippines COVID-19 Emergency Response Project (PCERP) on 24 June 2021 Annex O Summary and Feedback from the Orientation and Consultation 114 on the Grievance Redress Mechanism (GRM of the Philippines COVID-19 Emergency Response Project (PCERP) on 25 June 2021 Annex P Minutes of Construction Coordination Meeting for 14 ongoing 118 Civil Works Projects under CY 2020 conducted on August 04, 2021 Annex Q Minutes of the ESF Training conducted on August 20, 2021 for 121 healthcare facilities and contractors of upcoming Civil Work Projects Annex R Minutes for the 1st ESF Coordination Meeting for ongoing Civil 135 Works projects conducted on October 11, 2021 Annex S Grievance resolution process of grievances within the 141 jurisdiction of the DOH as described in DOH Administrative Order no. 2015-0048 – Revised Procedures on Handling Administrative Disciplinary Complaints in the Department of Health Annex T Grievance Resolution Process for DOLE- Related Cases 146 Annex U Grievance Monitoring Forms and Online Dashboard 147 1.0 Introduction/Project Description An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased thirteenfold and the number of affected countries has tripled. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world. As of March 26, 2020, the outbreak has resulted in an estimated 416,686 cases and 18,589 deaths in 197 countries and territories. COVID-19 is one of several emerging infectious diseases (EID) outbreaks in recent decades that have emerged from animals in contact with humans, resulting in major outbreaks with significant public health and economic impacts. The last moderately severe influenza pandemics were in 1957 and 1968; each killed more than a million people around the world. Although countries are now far more prepared than in the past, the world is also far more interconnected, and many more people today have behavior risk factors such as tobacco use and pre-existing chronic health problems that make viral respiratory infections particularly dangerous. With COVID-19, scientists are still trying to understand the full picture of the disease symptoms and severity. Reported symptoms in patients have varied from mild to severe, and can include fever, cough, and shortness of breath. In general, studies of hospitalized patients have found that about 83% to 98% of patients develop a fever, 76% to 82% develop a dry cough and 11% to 44% develop fatigue or muscle aches. Other symptoms, including headache, sore throat, abdominal pain, and diarrhea, have been reported, but are less common. While 3.7% of the people worldwide confirmed as having been infected have died, WHO has been careful not to describe that as a mortality rate or death rate. This is because in an unfolding epidemic it can be misleading to look simply at the estimate of deaths divided by cases so far. Hence, given that the actual prevalence of COVID-19 infection remains unknown in most countries, it poses unparalleled challenges with respect to global containment and mitigation. These issues reinforce the need to strengthen the response to COVID-19 across all IDA/IBRD countries to minimize the global risk and impact posed by this disease. 1.1 Philippine COVID-19 Emergency Response Project (PCERP): Parent Project and Additional Financing The Philippines COVID-19 Emergency Response Project (P173877), in the amount of US$100 million, was approved by the World Bank on April 22, 2020. It was prepared under the global framework of the World Bank COVID-19 Response financed under the Fast Track COVID-19 Facility, which provided up to US$14 billion in immediate support to assist countries coping with the impact of the global outbreak. The objectives are aligned with the results chain of the Bank’s COVID-19 Strategic Preparedness and Response Program (SPRP). The Project Development Objective (PDO) is to strengthen the Philippines’ capacity to prevent, detect, and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. Despite recent progress, the Philippines remains one of the countries most affected by the COVID-19 in East Asia and Pacific, rendering vaccine purchase and deployment a national priority. With the availability of vaccines, the Philippines now has an opportunity to add a significant new layer to its COVID-19 emergency response. Procuring and administering vaccines is critical to reducing mortality from COVID, opening the economy in earnest and arresting the decline in GDP, employment and incomes. Hence, Additional Financing (AF) was sought by the country. The Additional Financing currently forms part of an expanded health sector response to the COVID-19 pandemic. The AF which is the amount of 1|Page additional US $ 500 million supports the costs of expanding activities of the Philippines COVID-19 Emergency Response Project (P173877, the Parent Project) to enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in the country through enhanced vaccination system strengthening and to further strengthen preparedness and response activities under the parent project. The project development objective of the Parent Project “to strengthen the Philippines' capacity to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness”, with the project’s component structure remains unchanged but new activities are incorporated to scale-up the support related to COVID-19 vaccines procurement and deployment with the additional financing. The Parent Project SEP has been updated to reflect the activities under the Second Additional Financing and the additional issues noted in line with the template provided by the Bank. 1.2 PCERP Proposed Second Additional Financing (PCERP-AF2) The purpose of the proposed second additional funding for PCERP (PCERP-AF2), in the amount of US$300 million, is to support the GOP scaling up the national vaccination program to cover procurement and delivery of: (i) primary doses to children aged 12-17; (ii) additional doses, as part of primary vaccination series, for at-risk population sub-groups, including immunocompromised individuals and senior citizens, who were not fully protected with the initial two dose or single dose regimens; (iii) booster doses for health workers and the wider population in 2022. Subject to vaccine development, regulatory approvals, and data on safety, the PCERP-AF2 will also finance primary doses for children under 12. The PCERP- AF2 is expected to provide approximately 25.6 million vaccine doses. The changes proposed for the expanded AF entail expanding the scope and scale of activities under the PCERP, and there will be no changes to the overall design. The PDO will remain unchanged as the proposed activities to be funded under the expanded AF are aligned with the original PDO. The closing date of the expanded AF will remain aligned with the closing date of the parent project, i.e., December 29, 2023. 1.3 PCERP Project Components The Project is comprised of four components: Component 1: Strengthening Emergency COVID-19 Health Care Response (Total US$ 581,000,000): The aim of this component is to strengthen essential health care service delivery system to be able to respond to a surge in demand as a result of anticipated rise in the number of COVID-19 cases in the coming months. As COVID-19 will place a substantial burden on inpatient and outpatient health care services, support will be provided to equip selected health facilities prioritized by DOH for the delivery of critical medical services and to cope with increased demand. Health system strengthening efforts will therefore focus on provision of medical and laboratory equipment, PPE, medical supplies as well as essential inputs for treatment such as oxygen delivery systems and medicines to selected hospitals and health facilities. Local containment will be supported through the establishment of local temporary isolation units. The component will also finance requirements of infrastructure of quarantine facilities. It is anticipated that any construction involved under this component will be conducted at existing facilities; activities requiring land acquisition or involuntary resettlement are not eligible. This component also supports the Department of Health in preparing a guidance note on standard design for hospital isolation and treatment centers to manage Severe Acute Respiratory Infections (SARI) patients that will be used in health facilities across the country 2|Page to ensure standard and quality of COVID-19 health care services. The component has three sub-components. (a) Sub-component 1.1. Provision of medical and laboratory equipment and reagents2 (current allocation: US$ 34.5 million): This sub-component supports selected DOH hospitals and provincial hospitals with laboratory equipment (e.g. Polymerase Chain Reaction machines), test kits, reagents, as well as to upgrade diagnostics and treatment of COVID-19 infection capacity through procurement of such intensive care unit equipment and devices as mechanical ventilators, cardiac monitors, portable x-ray, extracorporeal membrane oxygenation (ECMO) machine, portable oxygen generator machine, and continuous positive airway pressure (CPAP). The sub-component also supports provision of oxygen, emergency beds, laboratory reagents, and waste management facilities. Moreover, this subcomponent supports short trainings on the use of equipment, devices, and tests for health providers and technicians; and to support the necessary logistics and supply chain to ensure that the equipment will reach frontline health facilities without delays. No new additional activities are proposed but the amount has been revised to be aligned with updated costing of activities by the DOH. (b) Sub-component 1.2. Provision of medical supplies, including Personal Protective Equipment (PPE), COVID-19 vaccines, medicines, and ambulance (current allocation: US$521.3 million): This subcomponent supports the health system with supplies including PPE such as masks, goggles, gloves, gowns, etc. It also supports medical countermeasures and medical supplies for case management and infection prevention, through the procurement of COVID-19 vaccines, drugs such as antivirals, antibiotics, and essential medicines for patients with co-morbidity and complications such as CVDs and diabetes, as well as assistance to support the Borrower’s advance purchase mechanisms. In addition, this subcomponent supports short trainings on the use of medical supplies for health providers and technicians as needed; and support to the necessary logistics and supply chain to ensure that the medical supplies and PPE will reach frontline health facilities without delays. Small part of this sub-component may also support ambulance vehicles to address COVID-19 response, as needed. The AF supports COVID-19 vaccines purchase through this sub- component. (c) Sub-component 1.3. Enhancing isolation/quarantine facilities (current allocation: US$25.2 million): This sub-component supports the establishment, construction, retrofitting/refurbishment of quarantine facilities in major points of entry, increase number of regular isolation rooms in DOH and provincial hospitals as well as establishment of negative pressure isolation rooms in DOH and provincial hospitals. It also supports setting up of first line decontamination facilities in international airports (holding areas) as well as establishing isolation tents for triaging in health facilities. The increased amount for the component restores financing which had been re- allocated to sub-component 1.2 to finance COVID-19 vaccines during the December 2020 restructuring. (d) Sub-component 1.4. Deployment of COVID-19 vaccines (also financed by counterpart funding from the GOP: US$155.5 million). The sub-component is financed primarily through the GOP's counterpart funding to support the deployment of World Bank-financed and eligible COVID-19 vaccines. The sub-component finances the planning and management of the COVID-19 vaccines procured by loan proceeds from 2 Laboratory support under Sub-Component 1.1 is short-term and includes PCR machines and test kits for selected DOH hospitals and provincial hospitals. Component 2 supports strengthening of reference laboratories at both national and sub-national levels to address EIDs in the short and medium term. 3|Page the AF and deemed eligible by the World Bank, as part of the national COVID-19 vaccination campaign, through enhancing systems and capacity for planning, regulation, and M&E. In addition, the sub-component finances safe and effective deployment of COVID-19 vaccines procured by loan proceeds from the AF and deemed eligible by the World Bank, including delivery, cold chain and logistics system, disposal of healthcare wastes, risk and communication, as well as surveillance and adverse events monitoring. Component 2: Strengthening laboratory capacity at national and sub-national level to support Emerging Infectious Diseases (EIDs) Prevention, Preparedness, and Response (Total US$ 11,500,000): The component supports the establishment of national reference laboratories as well as selected subnational and public health laboratories. It includes improving, retrofitting, and refurbishing national reference laboratory – Research Institute for Tropical Medicine (RITM) as well as six sub-national and public health laboratories in Baguio, Cebu, Davao, Surigao City, and Manila.3 The sub-component may also support constructing and expanding laboratory capacity in priority regions that currently do not have necessary laboratory capacity. The sub-component also supports necessary laboratory equipment, laboratory supplies, reagents, as well as capacity building for relevant laboratory staff. It is anticipated that any construction involved under this component will be conducted at existing facilities, and that no new land acquisition or involuntary resettlement are expected. Component 3: Implementation Management and Monitoring and Evaluation (Total US$ 7,500,000): Project Management. The component supports the Department of Health (DOH) as the implementing agency of the project. DOH is responsible for the coordination, management, and implementation of the project at the national and sub-national levels, financial management and procurement. The project is implemented through mainstream DOH processes and does not involve a parallel project implementation unit or secretariat. The Project is strengthened by the recruitment of additional staff/consultants responsible for overall administration, procurement, and financial management under country specific projects. To this end, PCERP would support costs associated with project coordination, management, and implementation. This component also supports costs related to the management of environmental and social risks under the Bank’s ESF, including the implementation of this ESMF and Stakeholder Engagement Plan (SEP). The implementation arrangements of the Parent Project was adjusted to enhance the capacity of DOH for implementation related to vaccine procurement, cold chain strengthening, and vaccination delivery support, as well as human resource strengthening in risk communication and community mobilization and M&E. Additional expertise and capacity was added as required by the initial additional financing. Specifically, the COVID-19 vaccination initiatives were strengthened by the development of the National Deployment and Vaccination Plan (NDVP) and the hiring of a (i) Vaccine Specialist, (ii) M&E Specialist, and a (iii) second Procurement Specialist. Monitoring and Evaluation (M&E). This component would also support monitoring and evaluation of project implementation, prevention and preparedness, building capacity for clinical and public health research, and joint learning across and within countries. Furthermore, the M&E includes a mechanism to review the capacity of the national health systems to deploy vaccines universally and to reach isolated and marginalized communities and those difficult to reach. It includes the maintenance of daily records documenting who received the vaccine from which vial as well records of any adverse vaccination effects. The 3 Subnational and public health laboratories include (i) Lung Center of the Philippines (QC); (ii) San Lazaro Hospital (Manila); (iii) Baguio General Hospital (Baguio); (iv) Vicente Sotto Memorial Medical Center (Cebu); (v) Caraga Regional Hospital (Surigao City); (vi) Southern Philippines Medical Center (Davao). 4|Page M&E system includes data and information disaggregated by gender, demography, race- ethnicity, location-residence, socioeconomic status, and disability. As may be needed, this component would also support third-party monitoring of progress and efficient utilization of project investments. The Philippines COVID-19 Emergency Response Project (the Project) has been prepared under the World Bank’s Environment and Social Framework (ESF). As per the Environmental and Social Standard (ESS) 10 Stakeholder Engagement and Information Disclosure, the implementing agencies should provide stakeholders with timely, relevant, understandable, and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination, and intimidation. Component 4: Contingent Emergency Response Component (CERC) (US$0): In the event of an Eligible Crisis or Emergency, the project would contribute to providing immediate and effective response to said crisis or emergency. A zero-value component has been included to ensure funds. 1.4 Project Accomplishments 1.4.1 Deployment of COVID-19 Vaccines According to the coverage report provided by the National COVID-19 Vaccination Operations Center (NVOC) during the regular NVOC Meeting on October 22, 2021, a total of 77,131,110 doses of COVID-19 vaccines of various brands have been delivered and received by the Philippines. This number include those vaccines donated, procured or sourced through tripartite agreements. As of October 24, 2021 a total of 4.73 million doses of Moderna COVID-19 vaccines have been delivered in the Philippines that were procured through the PCERP fund, staggered in eight tranches. The latest delivery of 885,700 doses were received on October 9,2021. The doses delivered per tranche is shown on Table 1. Table 1. Summary of PCERP-Funded COVID-19 Moderna Vaccine Doses Received and Delivered (as of October 24, 2021) Tranche TOTAL Delivered, Full % Delivered 1st Tranche 150,000 150,000 100% 2nd Tranche 194,400 194,400 100% 3rd Tranche 224,400 224,400 100% 4th Tranche 319,200 319,200 100% 5th Tranche 712,800 697,750 97.9% 6th Tranche 863,800 863,300 99.9% 7th & 8th 2,269,980 2,114,280 93.1% Total 4,734,580 4,563,330 98.7% Almost 99% of the doses delivered were already deployed to the intended warehouse and/or vaccination center recipients for storage and eventual vaccine administration. The remaining 1% serves as a buffer dose present in the Centers for Health Development and NVOC that are still to be delegated to the LGUs. The distribution of the Project funded vaccines followed the national strategy on prioritization and geographical allocation. In terms of regional distribution (Figure 1), Region IVA or CALABARZON received the highest number of doses, followed by Region 3, NCR and Region 6. The regions with the least number of doses are CARAGA, CAR and BARMM. 5|Page Figure 1. Regional Distribution of PCERP-Funded COVID-19 Moderna Vaccines Photo: Arrival of Moderna Vaccines For the distribution of the vaccines per LGU and facility, all regions were deployed with the Project funded vaccine, including all of the 16 administrative regions and BARMM. A total of 14 CHDs received the vaccines, 66 provincial LGUs, 93 city LGUs, and 96 municipal LGUs. There were also 24 health facilities and 14 other agencies that received the vaccines. Other agencies include NGOs like the Philippine Red Cross, Nayong Filipino Foundation, Amosup, and other government agencies like the DFA, DOST and Office of the President. A table of vaccine distribution per facility, per tranche received is summarized in Table 2. A map of the areas reached by the Project funded vaccines is shown on Figure 2 below. Table 2. Deployment of PCERP-Funded Moderna COVID-19 Vaccines per Recipient Facilities No of Direct to Direct to Direct to Direct to Direct to Tranche Recipient Region Province City Municipality Hospital Others Regions (CHD) (PHO) (CHO) (MHO) or BOQ 1st 3 0 1 16 1 9 1 2nd 17 13 10 6 7 5 9 3rd 9 2 7 18 24 4 2 4th 16 4 14 23 1 3 2 6|Page No of Direct to Direct to Direct to Direct to Direct to Tranche Recipient Region Province City Municipality Hospital Others Regions (CHD) (PHO) (CHO) (MHO) or BOQ 5th 16 3 61 58 4 11 2 6th 3 1 5 38 48 0 3 7th & 8th 17 10 23 48 38 8 1 Total 17 14 66 93 96 24 14 Others: NGOs (Amosup, PRC, etc.); military facilities; other government agencies (DFA, OP, DOST, etc.) Total for all facilities are not additive; some areas were allocated with vaccines in multiple tranches. Figure 2. Distribution Map of PCERP-Funded COVID-19 Moderna Vaccine Recipients 1.4.2 Equipment Procurement Provision of medical and laboratory equipment and reagents (Sub-component 1.1) The Project has completed the procurement and delivery of 500 mechanical ventilators. 119 units of portable X-ray machines, and 70 units of infusion pumps. An ocular inspection was done at selected recipient hospitals and it was observed that all equipment are functional and in use. Utilization and performance status of all the equipment will be continuously monitored. The delivery of 50 units of RT-PCR machine and 1.5 million units of RT-PCR testing kits are expected to arrive by October 31, 2021. The latter will include, as consumable items, 1000 microliter filter tips and the magnetic racks. Ten units of GenExpert Machines are currently ongoing the procurement process. Ancillary equipment also to be procured for the machines include 10 units of each of autoclave, biosafety cabinets, biomedical refrigerators for reagents and another 10 refrigerators for the testing kits. 7|Page Photo: DOH Undersecretary Mario Villaverde during his Ocular Inspection of the medical equipment delivered and in use at Quirino Memorial Medical Center (QMMC) Provision of medical supplies, including Personal Protective Equipment (PPE), COVID- 19 vaccines, medicines, and ambulance (Sub-component 1.2) All of the Personal Protective Equipment funded by the Project was successfully delivered to the hospital beneficiaries. This included 1.5 million units of N-95 masks, 17 million units of surgical masks, 1.2 million units of surgical gowns, and 17 million pairs of surgical gloves. Forty three out of the 44 Type 2 Ambulance units procured under the Project were delivered to the recipient hospitals. The remaining 1 unit is scheduled for pick-up on November 05, 2021. The delivery of the 23 units of Type 1 ambulance remains pending due to issues on previous procurement contract. The contract for a new ambulance unit provider is targeted to be issued by the end of November 2021. The construction of the sea-ambulance is still in progress. Photo: DOH Undersecretary Mario Villaverde during his Ocular Inspection of the Type 2 ambulance delivered at Quirino Memorial Medical Center (QMMC) 8|Page Finally, under component 1.2, contract finalization for the construction of swabbing facilities is also underway. The Notice to Proceed is expected to be awarded by the 1st week of November. Photo: Construction of Sea Ambulance 1.4.3 Civil Works Project A total of 21 civil works project are being implemented and monitored by the Project as of October 28, 2021. Included in the projects under ongoing implementation are the 13 isolation facilities and 1 COVID-19 Referral facility, all for construction of with isolation rooms with negative pressure, under the CY 2020 civil works project. They commenced their construction activities between June 28 and July 6, 2021. Five facilities have reported more than 90% completion in their construction activities as of October 25, 2021. There were also some projects that were recorded with negative slippages, in which DOH-HFEPMO issued warning to the contractors to submit a detailed catch-up plan on a weekly and daily basis to eliminate the slippage. HFEPMO conducted site visits and consecutive management meetings with the hospital recipients and contractors last September and October 2021. A summary of the construction progress of the construction work listed under CY 2020 is summarized in Table 3. Three facilities listed under CY 2020 civil works project recipients remain unimplemented. These include 1 National Reference Laboratory waiting for Notice of Issuance, and 2 Isolation facilities which have just started their mobilization. Table 3. Reported Progress of the Ongoing CY 2020 Civil Works Project (as of October 28, 2021) 2020 Civil Works Health Care Start Date of Completion % Contractor Facilities Construction Date Completion1 A. Upgrading of Isolation Rooms to Negative Pressure (13 Facilities) 1. Dr. Jose N. Rodriguez PL Juan Construction August 12, December 33.95 % Memorial Hospital Inc 2021 10, 2021 2. Valenzuela Medical Center November July 14, 2021 94.64 % 12, 2021 9|Page 3. Tondo Medical Center Trilex Builders and November 7, Construction Supply, July 9, 2021 78.71 % 2021 Inc. 4. Jose R. Reyes Memorial November 5, Trilex Builders and July 7, 2021 90.40 % Medical Center 2021 Construction Supply, 5. Dr. Jose Fabella Memorial November 7, Inc. July 9, 2021 94.30 % Hospital 2021 6. Philippine Orthopedic November July 12, 2021 77.06 % Center PL Juan Construction 10, 2021 7. Philippine Children’s Inc November 6, July 8, 2021 66.97 % Medical Center 2021 8. National Kidney and November July 12, 2021 27.14 % Transplant Institute PL Juan Construction 10, 2021 9. Philippine Heart Center Inc November July 15, 2021 93.76 % 13, 2021 10. Amang Rodriguez December July 14, 2021 16.09 % Memorial Medical Center PL Juan Construction 11, 2021 11. National Children’s Inc November July 15, 2021 73.76 % Hospital 13, 2021 12. National Center for Mental November July 12, 2021 88.52 % Health PL Juan Construction 10, 2021 13. Rizal Medical Center Inc November July 13, 2021 92.10 % 11, 2021 B. COVID-19 Isolation Rooms and Intensive Care Unit Facility (1 Facility) 1. Quirino Memorial Medical April 28, Welcome Builders July 12, 2021 44.37 % Center 2022 Note: 1. As reported by HFEP-MO during October 28, 2021 Fortnightly Meeting Photo: DOH Undersecretary Mario Villaverde during his Ocular Inspection of the construction activities at the Quirino Memorial Medical Center (QMMC) 10 | P a g e Photo: Ocular Inspection of the construction activities (L-R) Valenzuela Medical Center, National Center for Mental Health, and Rizal Medical Center Under the CY 2021 civil works projects, 12 out of the 47 target construction sites have commenced with the construction last September 2021. These include 7 isolation facilities for upgrading with isolation rooms with negative pressure; 3 Quarantine Stations for refurbishing; and 2 Sub-national reference laboratories for retrofitting. A summary of the construction progress of the construction work projects listed under CY 2021 is summarized in Table 4. Table 4. Reported Progress of the Ongoing CY 2021 Civil Works Project (as of October 25, 2021) 2021 Civil Works Health Care Start Date of Completion % Contractor Facilities Construction Date Completion1 A. Upgrading of Isolation Rooms to Negative Pressure (4 Facilities) 1. Mariano Marcos Memorial Cisco Engineering October 4, February 8.02 % Hospital and Medical Center Industries 2021 2022 2. Talavera General Hospital Cisco Engineering October 4, February 17.33 % Industries 2021 2022 3. Ospital ng Palawan E.M Abin Trading and September 20, January 23.92 % Construction 2021 2022 4. Governor Celestino Gallares October 3, February Jodans Engineering 23.37 % Memorial Hospital 2021 2022 B. Refurbishing of Subnational Laboratories (2 Facilities) 1. Lung Center of the October 4, February Jodans Engineering - Philippines 2021 2022 2. Baguio General Hospital and October 4, February Jodans Engineering 1.34 % Medical Center 2021 2022 C. Refurbishing of Bureau of Quarantine (BOQ) Stations (1 Facility) 1. Tabaco Quarantine Station October 4, February Jodans Engineering 8.40 % 2021 2022 Note: 1. As reported by HFEP-MO during October 28, 2021 Fortnightly Meeting Under CY 2021 Projects are 10 facilities for issuance of Notice to proceed; 4 facilities for issuance of Notice of Acceptance; and 21 facilities with bidding documents for clarification, evaluation, and for procurement. 1.5 Stakeholder Engagement Plan (SEP) of PCERP The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and it includes a mechanism by which they can raise concerns, provide feedback, or make complaints about the project and its related activities. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between the project staff and local communities and to minimize and mitigate the environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. For COVID-19 vaccination programs, stakeholder engagement is key to communicating the principles of prioritization of vaccine allocation and the schedule for vaccine rollout, reaching out to disadvantaged and vulnerable groups, especially in remote areas, overcoming demand-side barriers to access (such as mistrust of vaccines, stigma, cultural hesitancy), and creating accountability against misallocation, discrimination, and corruption. 11 | P a g e 2.0 Stakeholder Identification and Analysis Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e., the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project- related information and as a primary communication or liaison link between the Project and targeted communities and their established networks. Community representatives, cultural leaders and women leaders may also be helpful intermediaries for information dissemination in a culturally appropriate manner, building trust for government programs or vaccination efforts. The DOH, through the National Vaccine Operations Center (NVOC), has been coordinating with other government agencies and non- government organizations to know the concerns and challenges in reaching the marginalized and vulnerable sectors for the vaccination program. To date, its involvement with the Philippine Disaster Resilience Foundation (PDRF) has been instrumental in identifying the risks and barriers of these groups in accessing the COVID-19 vaccines. Moreover, NVOC is able to solicit sectoral recommendations for the prioritization and mitigation strategies providing the appropriate redress and remedy. Among the advocacies being supported by these activities are vaccine equity for the urban poor women, gender-based violence survivors, homeless people, and other vulnerable groups. For Indigenous People, stakeholder engagement should be conducted in partnership with Indigenous Peoples’ organizations and traditional authorities in coordination with the National Commission on Indigenous Peoples (NCIP). Among other things, they can provide help in understanding the perceptions of Indigenous Peoples on the causes of the virus, which will influence their opinions around the vaccination campaigns as a proposed solution. DOH also recognized the important role of religious institutions and faith-based organizations to further the information dissemination network. In this regard, the Department has requested an audience with representatives of this sector such as the Muslim imams and ulama in coordination with the National Commission on Muslim Filipinos (NCMF). The Commission has consulted the Muslim communities to promote and explain the COVID-19 vaccination program and the benefits to the people. Women can also be critical stakeholders and intermediaries in the deployment of vaccines as they are familiar with vaccination programs for their children and are the caretakers of their families. Verification of stakeholder representatives, i.e., the process of confirming that they are legitimate and genuine advocates of the community they represent, remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. With community gatherings limited or forbidden under COVID-19, it may mean 12 | P a g e that the stakeholder identification will be on a much more individual basis, requiring different media to reach affected individuals. 2.1 Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the Project will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns; • Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the Project is inclusive. All stakeholders are at all times encouraged to be involved in the consultation process. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, in particular women, youth, elderly, persons with disabilities, displaced persons, those with underlying health issues, and the cultural sensitivities of indigenous peoples and diverse ethnic groups. • Protection of safety and confidentiality: relevant measures to protect individual safety and confidentiality will be provided, particularly for grievance reporting and whistle blowing. Consent will be sought if there is a need to disclose personal identifying data. For the purposes of effective and tailored engagement, stakeholders of the proposed Project can be divided into the following core categories: • Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; • Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the Project and/or who could affect the Project and the process of its implementation in some way; and • Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the Project as compared with any other groups due to their vulnerable status4 and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. 2.2 Affected Parties Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category: 4 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. 13 | P a g e • COVID-19 patients and infected people • Communities with COVID-19 infected people • People under COVID-19 quarantine • Family members of COVID-19 infected people or people under COVID-19 quarantine • Frontline health workers particularly those dealing with COVID-19 patients • Population who are eligible for COVID-19 vaccination, including population groups aged 12 – 17 and their custodians (i.e., parents, teachers, etc.) • Population who has received their COVID-19 vaccination • Local government units where isolation/quarantine/screening facilities will be located and the vaccination activities will take place • Health facilities where vaccines will be administered • Security/uniformed personnel or local government unit-designated officers tasked to maintain peace and order during the vaccination activities • Security/uniformed personnel involved in ensuring the proper and safe logistics and distribution of the vaccines • Communities around proposed isolation/quarantine/screening facilities • Municipal waste collection and disposal workers • Waste transporters and transport, storage, and disposal (TSD) service providers handling hazardous healthcare wastes • Workers supporting the renovation/rehabilitation/construction of health care facilities, quarantine centers and screening posts. • Department of Health (DOH) and other public health agencies • Workers coming back to the Philippines from abroad; and • Business entities and individual entrepreneurs supporting and/or supplying key goods and services for prevention of and response to COVID-19 • Pharmaceutical companies particularly those involved in the COVID-19 vaccine development and supply • Private companies with cold storage facilities and transport and/or engaged in dry storage and cold chain services The affected parties of the COVID-19 vaccination activities are consisted mostly of the preliminary identified priority eligible population for vaccination, based on existing ethical principles and recommendations of the World Health Organization’s Strategic Advisory Group of Experts (WHO SAGE) Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply and the WHO SAGE Values Framework for the Allocation and Prioritization of COVID-19 Vaccination, and the recommendations of the recommendations of the National Immunization Technical Advisory Group (NITAG). The DOH Administrative Order No. 2021-0005 entitled “National Strategic Policy Framework for COVID-19 Vaccine Deployment and Immunization” provides the Decision Matrix in determining priority eligible population groups based on the principles of the abovementioned WHO SAGE Guidelines and NITAG recommendations. Table 5 below outlines the priority groups based on the said principles. Table 5. Decision Matrix in Determining Priority Eligible Population Groups Principles Objectives Population Groups Human well- • Reduce deaths and disease • Health workers being burden • Older adults (senior citizens with or • Protect those in the health without comorbidities) services and essential services • Persons with comorbidities • Personnel in government agencies providing essential services (DSWD, DeEd, DILG, BJMP & Bureau of 14 | P a g e Correction, PNP, AFP, PCG, BFP, CAFGU) • Government workers, teachers and students, essential workforce (agriculture, tourism, transportation, food industry, tourism, manufacturing, construction, among others) • All workforce Reciprocity • Protect those who bear significant • Health workers (all) additional risks and burdens of • Essential workers outside the health COVID-19 to safeguard the sector, those with high-risk of exposure, welfare of others such as contact tracers, social workers providing social services, among others Equal respect • Treat the interest of all individuals • All citizens based on the availability of and groups with equal vaccines consideration as allocation and priority setting • Vaccinate all citizens National equity • Ensure that vaccine prioritization • People living in poverty (indigent takes into account vulnerabilities, population) risks and needs groups because • Disadvantaged groups (PWD, PDLs, of underlying societal, geographic among others) or biomedical factors • Low-income workers • Hard-to-reach areas • Overseas Filipino Workers This was followed by the issuance of The Interim Omnibus Guidelines for the Implementation of Vaccine Deployment Plan for COVID -19 (DOH Memorandum No. 2021-0099) which provided the prioritization criteria to be used in the vaccination allocation in the country. A phased implementation is adopted in anticipation of a low vaccine starting supply, which is expected to increase gradually. The phased approach ultimately follows the objective of ensuring reduction of mortality from COVID-19 and preserving the health system capacity. The demand of priority populations to the expected vaccine supply is aligned in three phases: Phase 1: Potentially limited supply of COVID-19 vaccine doses available- Concentrating efforts on critical populations based on risk exposure and mortality Phase 2: Large number of vaccine doses available- Ensuring access for the general population, particularly to the working population; and Phase 3: Sufficient supply of vaccine doses for entire population (surplus of doses)- Ensuring equitable access to all populations, monitoring uptake and coverage, and re- strategizing to increase uptake in populations with low coverage. Ultimately, the prioritization of population groups is based on the following goals: Primary Goals ● Direct reduction of morbidity and mortality. ● Maintenance of most critical essential services. Secondary Goals ● Substantially control transmission ● Minimize disruption of social, economic and security functions. 15 | P a g e Tertiary Goal ● Resumption to near normal. The priority population groups for COVID-19 immunization are shown in Table 6. The original list from DM 2021-0099 has been expanded through DOH issuances and related advisories released by the National Vaccination Operations Center (NVOC). Table 6. Priority Eligible Groups for COVID-19 Vaccination Priorities Population Group Definition of Terms Priority Eligible Group A A1 Workers in Frontline Frontline workers in health facilities, both national and Health Services local, private and public, health professionals and non- professionals like students in health and allied professions courses with clinical responsibilities, nursing aides, janitors, barangay health workers, etc. Sub- prioritization are as follows: • A1.1- COVID-19 referral hospitals designated by the DOH; • A1.2- Public and private hospitals and infirmaries providing COVID-19 care, as prioritized based on service capability, starting from level 3 hospitals, to level 2 hospitals to level 1 hospitals, and then infirmaries; Among hospitals with a common service capability, the order of priority shall be from facilities owned by the DOH, then facilities owned by LGUs, then facilities owned by private entities; • A1.3- Isolation and quarantine facilities such as temporary treatment and monitoring facilities and converted facilities (e.g. hotels, schools, etc) that cater to COVID-19 suspect, probable, and confirmed cases, close contacts, travelers in quarantine; • A1.4- Remaining hospitals including facilities of uniformed services not catering to COVID-19 cases; • A1.5- Government owned primary care-based facilities such as Urban Health Centers, Rural Health Units and Barangay Health Stations, birthing homes, and Local Health Offices to include members of BHERTS, contact tracers, social workers; • A1.6- Stand-alone facilities, clinics and diagnostic centers, and other facilities otherwise not specified (e.g. clinics, dialysis centers, dental clinics, and COVID-19 laboratories), dealing with COVID-19 cases, contacts, and specimens for research purposes, screening and case management coordinated through their respective local government units; • A1.7- Closed institutions and settings such as, but not limited to, nursing homes, orphanages, 16 | P a g e jails, detention centers, correctional facilities, drug treatment and rehabilitation centers, and Bureau of Corrections. Expanded Priority • Overseas Foreign Workers leaving the country Group 1A within four (4) months • Adults living in the same household as the healthcare workers, including immediate family members, housemates, helpers, and drivers) • Additional Priority Group A1 (new hires, new rotating interns and residents, among others) A2 All Senior Citizens Senior citizens aged 60 years old and above • A2.1- Institutionalized senior citizens including those in registered nursing homes and other group homes with elderly working together (e.g. convents). • A2.2- All other senior citizens, including bed- ridden senior citizens at home A3 Persons with • Adults with any clinically controlled comorbidities Comorbidities that are among the top causes of COVID-19 and national morbidity and mortality (e.g., chronic respiratory disease, hypertension, cardiovascular disease, chronic kidney disease, cerebrovascular disease, malignancy, diabetes, obesity, chronic liver disease, neurologic disease, and immunodeficiency state), not otherwise included in the preceding categories. • Pregnant women (expanded A3) • Population between ages 12-17, with co- morbidities (Pediatric A3) A4 Frontline personnel in Frontline personnel in essential sectors both in public essential sectors, and private sectors, including uniformed personnel, and including uniformed those in working sectors identified by the IATF that are personnel directly client facing and cannot dutifully meet minimum public health standards. • A4.1- Private sector workers who work outside their homes. • A4.2- Employees in government agencies and instrumentalities, government-owned or controlled corporations (GOCC) and local government units • A4.3- Informal sector workers and self-employed who work outside their homes and those working in private households. A5 Indigent Population Poor population based on the National Household Targeting System for Poverty Reduction (NHTS-PR) not otherwise included in the preceding categories. Priority Eligible Group B (Now classified as part of the Rest of Adult Population, ROAP) B1 Teachers and social workers B2 Other government workers B3 Other essential workers 17 | P a g e B4 Socio-demographic groups at significant higher risk other than senior citizens and poor populations based on the NHTS-PR B5 Overseas Filipino Workers (OFWs) B6 Other Remaining Workforce: All remaining Filipino workforce as determined by the DOLE, DTI and CSC Priority Eligible Group C (Now classified as part of the Rest of Adult Population, ROAP) C Remaining Filipino Rest of the Filipino population not otherwise included in Citizens the above groups Rest of Pediatric Population (ROPP) Population groups aged between 12-17 (without comorbidities) References: 1. DOH Memorandum 2021-0099: The Interim Omnibus Guidelines for the Implementation of Vaccine Deployment Plan for COVID -19 2. DOH Memorandum 2021-0157: Implementing Guidelines for Priority Group A3 and Further Clarification of the National Deployment and Vaccination Plan for COVID-19 Vaccines 3. DOH Memorandum 2021-0406: Further Clarification on the Priority Population Groups 4. NVOC Advisory No. 20: Additional Guidance on the Prioritization Framework for Priority Group A1 5. NVOC Advisory No. 63: Guidance on the Estimation of Target Populations for each Priority Group 6. NVOC Advisory No. 96: COVID-19 Vaccination of the Adult Population Nationwide: 7. DOH Circular 2021-0464: Interim Operational Guidelines on the COVID-19 Vaccination of the Pediatric Population Ages 12-17 Years Old with Comorbidities 8. DOH Circular 2021-0483: Interim Operational Guidelines on the COVID-19 Vaccination of the Rest of the Pediatric Population Ages 12-17 Years Old All Filipinos, including OFWs, and foreign nationals (i.e., all nationals who are not Filipino citizens under the Philippine law, regardless of immigration status, including refugees, asylum seekers, and stateless person residing within the Philippine territory) shall be included in the priority group appropriate to their circumstance. Eligible adults meeting the eligibility criteria for priority group A2 (senior citizens) or A3 (adults with controlled comorbidities) may register with their respective LGUs subject to supply availability. Vaccination is generally provided to the identified population grouping above, following the prioritization schedule recommended by National Task Force (NTF) for COVID-19 and DOH. However, given the limited supply of vaccine, sub-prioritization is determined by the DOH upon the recommendation of NITAG. Geographical considerations are now factored in the supply allocation, based on the COVID-19 burden of disease (measured as active cases, attack rate per 1000,000 population in the past month and population density); and the supply chain capability of the LGU (e.g., availability of cold chain storage facility, vaccination sites, access road, etc.) to mount a vaccination campaign. The risk classification of LGUs is based on the data of the Regional Epidemiology and Surveillance Unit, while the availability of vaccination and storage facilities are monitored by DOH. The national strategy during June through September 2021 was to prioritize areas NCR+8 Areas (i.e., NCR, Metro Cebu, Metro Davao, Bulacan, Batangas, Cavite, Laguna, Pampanga, and Rizal) which are determined to have highest risk in transmission given their population density, with high burden of disease and loci or economic activities. Third and final sub-prioritization criteria, based on exposure and mortality risk, will be further employed if scarcity of supply is still present even after sub-prioritization on geographical location is considered. After the roll out of Priority Groups A1 through A5, the COVID-19 vaccination for the rest of adult population (Priority Eligible Groups B and C) has commenced on October 07, 2021, 18 | P a g e making all adult population nationwide now eligible for vaccination. Vaccination activities is further expanded on October 15, 2021, to include population ages 12-17 years old with vaccines granted Emergency Use Authorization by the Food and Drug Administration (FDA). Pilot implementation has commenced for population ages 12-17, with comorbidities, in selected hospital vaccination sites in Metro Manila. More recently, the DOH Health Technology Assessment Unit (HTAU) also released their recommendation regarding the administration of booster shots and additional doses for healthcare workers, elderly seniors, and immunocompromised starting fourth quarter of Year 2021. Another significant recommendation to be considered by DOH is from SAGE and the Emergency Use Authority from FDA. According to the recommendation, the boosters will start with the healthcare workers (A-1) and senior citizens (A-2). Afterwards, the booster implementation will follow the same prioritization among eligible groups. The complete guidelines on booster shot and additional doses administration is yet to be released by the DOH. Once finalized, DOH will be conducting information campaigns and consultation meetings to disseminate the guidelines to the public. 2.2.1 Vaccination of the Population Groups Aged between 12 - 17 Upon the recommendation of the Strategic Advisory Group of Experts (SAGE) on Immunization of the World Health Organization (WHO), DOH and IATF approved the commencement of the COVID-19 vaccination of the population ages 12 – 17 on September 22, 2021. For this purpose, Department Circular No. 2021-0464 on the Interim Operational Guidelines on the COVID-19 Vaccination of the Population Ages 12-17 with Comorbidities was issued for the pilot implementation. This particular policy directive does not cover the vaccination of the rest of the population ages 12 - 17. Simultaneously, interim guidelines were released for the utilization of other allied health practitioners as vaccinators. The DOH, through NVOC, has initiated several meetings with key stakeholders for the vaccination of the population ages 12 - 17 since October 2021. They have been coordinating with the parents and guardians, HCFs’ medical chiefs and spokespersons, data managers and encoders, vaccination teams, among others. Hospitals that conducted the pilot implementation were required to provide daily reports on the progress of the population ages 12 – 17 including AEFI cases, if any. The Health Promotion Bureau has developed related Information and Education Content to be used in the promotion of the said vaccination program. Eligible Population 1. Eligible vaccine recipients ages 12 – 17 with co-morbidities shall be categorized as part of Priority Group A3: Individuals with Comorbidities and shall be reported as “Pediatric A3”. 2. The defined comorbidities in the “Pediatric A3” shall be as follows: a. Medical complexity: long term dependence on technical support e.g. tracheostomy associated with developmental delay and/or genetic anomalies. b. Genetic conditions: Down’s Syndrome (Trisomy 21), Glucose-6-phosphate dehydrogenase deficiency (G6PD), genetic disorders affecting the immune 19 | P a g e systems such as primary immunodeficiency disorders, thalassemia, and other chromosomal abnormalities. c. Neurologic conditions: Seizure Disorder, Autism Spectrum Disorders (ASDs), Cerebral Palsy, Stroke in the Young, Chronic Meningitis e.g. Tuberculosis, chronic neuromuscular diseases, and chronic demyelinating diseases. d. Metabolic/endocrine diseases: Diabetes Mellitus (DM), Hypothyroidism, Diabetes Insipidus (DI), Adrenal insufficiency, Hypopituitarism, and other hereditary metabolic diseases. e. Cardiovascular diseases: Hypertension, Congenital Heart Diseases (CHDs), Cardiomyopathy, Rheumatic Heart Disease (RHD), Mitral Valve Disease, Pulmonary Hypertension with Right Heart Failure. f. Obesity: BMI > 95th percentile for age and height. g. HIV infection h. Tuberculosis: Pulmonary (collapse/consolidations, with empyema, and miliary), Extrapulmonary, (pleural effusion, pericarditis, abdominal, genitourinary, central nervous system, spinal column, bone, joint, cutaneous, ocular and breast), and Disseminated (involvement of two (2) or more organs). i. Chronic Respiratory Diseases: Chronic Lung Diseases (Bronchiectasis, Bronchopulmonary Dysplasia, Chronic Aspiration Pneumonia), Congenital respiratory malformation, Restrictive Lung Diseases, neuromuscular disorders, syndromic with hypotonia, skeletal disorders, chronic upper and lower airway obstruction (Severe Obstructive Sleep Apnea, Tracheomalacia, Stenosis, Bronchial Asthma). j. Renal Disorders: Chronic Kidney Diseases, Nephrotic Syndrome, End-Stage Renal Disease (ESRD), patients on dialysis and continuous ambulatory peritoneal dialysis (CAPD), Glomerulonephritis (e.g. lupusnephritis), Hydronephrosis. k. Hepatobiliary Diseases: Chronic Liver Disease, Cirrhosis, Malabsorption Syndrome. l. Immunocompromised state due to disease or treatment: Bone marrow or stem cell transplant patients, solid organ transplant recipients, haematological malignancies (leukemia, anemia, thalassemia), cancer patients on chemotherapy, severe aplastic anemia, autoimmune or autoinflammatory disorders requiring long-term immunosuppressive therapy (e.g. Systemic Lupus Erythematosus, Rheumatoid Arthritis), patients receiving immune-modulating biological therapy [e.g. Anti – Tumor Necrosis Factor (TNF), rituximab, among others], patients receiving long term systemic steroids [> one (1) month], functional asplenia, patients who underwent splenectomy. Photos: Roll-out of the vaccination program to the population ages 12 - 17 in the Philippine Heart Center and National Children’s Hospital 20 | P a g e Implementation of Vaccination Roll-out The COVID-19 vaccination rollout to the population ages 12-17 years old with comorbidities shall be implemented in a phased approach as determined by the regions while also prioritizing the vaccination of Priority Group A-2 and A-3. 1. There shall be four (4) phases in the COVID-19 vaccination rollout to the population ages 12-17 years old with comorbidities: a. First Phase: vaccination rollout in selected hospitals in the National Capital Region (NCR) as determined by DOH, where the hospitals shall vaccinate their patients/cohorts. b. Second Phase: vaccination rollout in hospitals as identified by the 17 LGUs of the NCR. Each LGU shall select at least one hospital for the rollout, either an LGU- managed or a private-owned hospital. c. Third Phase: vaccination rollout in hospital based and non-hospital-based vaccination sites identified by the Centers for Health Development (CHDs) in 15 regions and in the BARMM. d. Fourth Phase: as determined by NVOC, the vaccination rollout to regions may be expanded utilizing regular vaccination sites. 2. The commencement of the vaccination roll-out by region shall be determined by the Regional Director of the CHD, in coordination with the NVOC. 2.3 Other Interested Parties The projects’ stakeholders also include parties other than the directly affected communities, including: • General public who are interested in understanding the Government’s prevention and response to COVID-19; • Government officials, permitting and regulatory agencies at the national, regional, and community levels, including environmental, technical, social protection and labor authorities; • Government offices that oversee the policy directives on sectoral groups such as the National Commission for Indigenous Peoples (NCIP), National Council for Disability Affairs (NCDA), National Commission for Muslim Filipinos (NCMF), Philippine Commission on Women (PCW) among others; • Development partners and civil society organizations at the global, regional, and local levels that may become partners of the project, including those representing Indigenous Peoples, peoples with disabilities, gender-based advocacy organizations, marginalized sector, among others; • Business owners and providers of services, goods and materials that will be involved in the project’s wider supply chain or may be considered for the role of project suppliers in the future; • Mass media and associated interest groups, including local, regional, and global printed and broadcasting media, digital/web-based entities, and their associations; • Religious groups and other faith- based organizations which may disseminate information to their members regarding COVID-19 and vaccines; and • The academe and professional organizations with interest in COVID-19. 21 | P a g e 2.4 Disadvantaged / Vulnerable Individuals or Groups It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project. It is important to ensure that awareness raising (on infectious diseases and medical treatments in particular) and stakeholder engagement with disadvantaged or vulnerable individuals or groups be adapted to take into account such groups’ or individuals’ particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from the person ’s origin, gender, age, ethnicity, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g. minorities or fringe groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project- related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: • elderly; • children, particularly those who are malnourished and have high susceptibility to diseases; • those with underlying health conditions e.g., HIV/AIDS, diabetes, cancer, hypertension, coronary heart diseases, and respiratory diseases, among others; • persons with disabilities including physical and mental health disabilities; • poor, economically marginalized, and disadvantaged groups including women, children, LGBTQ+ and religious and ethnic minority groups; • population living in geographically challenged areas (e.g., conflict area, areas with poor accessibility, hazard prone areas) • Indigenous Peoples. Among the Project identified vulnerable and disadvantaged groups, the national vaccination program has identified the senior citizens and indigent population as priority groups under Priority Eligible Group A, sub-category A-2 and A-5, respectively. Other groups, unless they identify themselves as eligible under sub-categories of Group A, belong to the rest of adult population which is last in the priority list. In terms of data collection to deduce the vaccine coverage among the Project identified vulnerable and disadvantaged groups, there is also limited information available as the profiling of the vaccinees does not include all of the Project identified vulnerable group categories. Vulnerable group identifiers that may be deduced from the vaccinee profile include sex, age, indigent status, employment, and comorbidity. Senior Citizen ID and PWD ID may be presented as proof of identification. There is an indirect risk of social exclusion, in particular, the most vulnerable and marginalized groups such as the Indigenous Peoples in remote areas from access to the COVID-19 vaccines. Persons underlying medical conditions, though included in the priority populations to be vaccinated, may have limited access to the vaccines due to reduced mobility. For senior citizens, national efforts to ensure increase in their vaccination coverage is in place, through the Tutok A-2 Initiative launched by DOH. The program provided strategies to intensify vaccination demand generation, better communication, improved access to vaccination sites to the elderly, and simplify the vaccination process. The LGUs and Local Vaccination Operation Centers (LVOCs) are also encouraged to adopt other strategies that is suitable to the local needs such as house to house vaccination, among others. 22 | P a g e The information materials available on the COVID-19 vaccine could exclude the most vulnerable or if not developed in a way that is not sensitive to the needs and access of these different groups. In terms of distribution across regions, BARMM has the lowest Project vaccine allocated and delivered. This is consistent with the distribution pattern of the rest of the vaccines in the country. DOH cited its inherent low population, as well as the logistical challenges that affected the allocation of the vaccine in the region (e.g., limited flights to deliver the vaccines, the availability of cold chain facility to store the vaccines, peace and security concerns, and recurring power interruption). Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. Issues on accessibility of the vaccines can be addressed through the identification of strategic locations for vaccine administration or transport assistance for vulnerable groups for increased access to vaccination sites. In addition, risk communication materials to be developed will be made clear and concise and in a format or language that is understandable to all people, in particular the most vulnerable. This may require different types of media (print, broadcast, and digital or new media) as well as engaging existing formal and informal public health and community-based networks (schools, healthcare service providers at local level, etc.). On a national scale, efforts to expand the vaccination coverage in lagging region include the conduct of regular hand holding sessions to closely monitor the vaccination activity in the LGUs, allowing sharing of best practices and strategies among members of the Regional/Local Vaccination Operations Center in addressing vaccination operations concerns. Support on additional manpower and equipment is also being provided by DOH. Finally, the latest vaccine supply utilization scheme announced by DOH (through DOH Memorandum 2021-0449) in administering vaccines to the rest of the adult population is towards prioritization of the LGUs based on unvaccinated individuals. Description of the methods of engagement that will be undertaken by the Project is provided in the following sections. 3.0 Stakeholder Engagement Program 3.1. Summary of Stakeholder Engagements Conducted Given the urgency of this COVID-19 operation there were no stakeholder engagements conducted in the preparation of the first draft of the SEP. Discussions on project design and the SEP were only held between representatives from DOH and the World Bank. Stakeholder engagements were conducted after project approval to inform a revision of the SEP during implementation. The National Stakeholders Consultation on the Parent Project was conducted on August 18- 19, 2020 and the results and key feedback are provided in Annex A. Due to the physical distancing and large gathering restrictions, the engagement process was conducted virtually through a series of meetings. Local consultations with affected and interested stakeholders at recipient health facilities will be conducted during implementation, including for the civil works components. Further information on the approach for the said consultations is provided in Section 3.4. The DOH-DPCB has conducted the online Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment and Immunization on December 7, 2020 and 23 | P a g e January 8, 2021 which was participated by national government agencies, DOH CHDs, health care facilities, professional organizations, the academe, civil society organizations, private sector (health insurance corporation), and development partners. These had also been an avenue for orientation and policy advocacy to the Local Chief Executives and local leaders in line with the cascading of policies from the national to regional level to local levels. The proceedings of the open forum of these consultations are in Annexes B and C. The DOH HPB is also conducting Town Hall Meetings (https://bit.ly/TownHallVaccination). The proceedings of which will be requested. Listed below are other activities conducted with key stakeholders: • Consultations with PWD and gender- based groups on the PCERP were conducted on 5 and 30 October 2020, respectively. (Annexes D and E) • Consultation with the NCIP, NCIP Health Workers in Community Service Centers (nurses, midwives), IP Mandatory Representatives (IPMR), and IP leaders on the PCERP was held on 23 February 2021 which was attended by 300 participants nationwide. (Annex F) • Town hall consultations with the uniformed personnel for the security of the vaccines and vaccine implementation and with Indigenous Peoples and their representatives, the National Commission Indigenous Peoples (NCIP), and other relevant CSOs were conducted by the DOH-HPB on 23 and 26 February 2021 and 16 March 2021, respectively. • Townhall consultation with IPs/ICCs was held on16 March 2021 included NCIP- hired nurses and midwives in the community service centers (LGUs), doctors in the NCIP Regional Offices, IP regional representatives, IP Mandatory representatives (IPMR), IP leaders, and communities. • Community consultations on the construction activities for the RITM, 14 NCR hospitals, and Quirino Memorial Medical Center were participated by the DOH Central Office (BIHC, DPCB, HFEPMO); Metro Manila Center for Health Development - HFEP Counterpart; health facilities’ administrative and planning department, engineering department, and infrastructure committee; local government units (Building Official, Engineering Department, City Health Office, City Environmental and Natural Resources Office [CENRO], Barangay Officials); and the World Bank were held on 27 October 2020, 28 October 2020, and 23 February 2021, respectively. (Annexes G to J) • Community Consultation on the upgrading of Isolation Facilities in DOH and LGU Hospitals outside National Capital Region (NCR) held on July 29-30, 2021 (Annex K) • Community Consultation on the refurbishing of Reference Laboratories held on July 30, 2021 • The learning development interventions for uniformed personnel on the Code of Conduct and Environmental and Social Standards were held on 29 April 2021 for the Armed Forces of the Philippines and on 30 April 2021 for the Philippine National Police. A total of 892 participants attended both activities. (Annex L and M) • Consultations with stakeholders on the PCERP Grievance Redress Mechanism (GRM) were held from 24 and 25 June 2021 with a combined total of 139 participants. (Annex N and O) • Regular coordination meetings conducted on the Civil Works component on procurement and Environmental and Social Framework with health care facilities and contractors. (Annex P) • Regular ESF Training conducted for healthcare facilities and contractors of upcoming Civil Work Projects. Three trainings conducted this year, each on June 17, August 20, and October 11, 2021. (Annex Q) • Regular ESF Coordination Meeting for ongoing Civil Works projects which started on October 11, 2021(Annex R) • Regular Bi-weekly Fortnightly Meetings 24 | P a g e • Town hall meetings on vaccination of population Ages 12 – 17, with concerned groups such as parents and guardians, vaccination teams, data managers and encoders, spokespersons and medical chiefs started on October 12, 2021 • Town halls for other allied health practitioners such as midwives, dentists, and pharmacists to utilize them as vaccinators were also conducted on various dates. Since PCERP is embedded within the DOH structure, processes and programs, the Project would continue to coordinate with concerned offices and other government agencies that could support its components and activities. By doing so, this would help in expanding the reach to various stakeholders especially those from the vulnerable sectors. On such initiative is the improvement of accessibility for vulnerable groups in the Health Care Facilities services. The previous National Stakeholders Consultations resulted to a request of the CSOs representing persons with disabilities (PWDs) to improve their access to services and programs in Health Care Facilities (HCFs) such as virtual sign language interpretation services, active observance of gender and development (GAD), and accessibility of health services to Indigenous Cultural Communities/ Indigenous Peoples (ICCs/IPs). In order to gather baseline data on the capacity of HCFs to provide accessible health services to vulnerable groups and to determine areas of support and cooperation, the Project, with technical guidance from DOH offices, developed the Health Care Facility Capacity Self- Assessment Tool on the Accessibility of Services for Vulnerable Groups. Results of the HCF self-assessment resulted to the conception of the Action Plan to Improve Accessibility of Services to Vulnerable Groups in HCFs. The action plan identified the HCFs’ needed support to provide better services for the vulnerable group. These two outputs were coordinated with concerned DOH offices for their inputs to further improve the Self- Assessment Tool and Action Plan based on their respective functions and mandates to successfully endorse and implement these among HCFs. Another intervention is the study on the vaccination coverage among the IPs/ICCs in partnership with the World Bank, Disease Prevention and Control Bureau, Bureau of International Health Cooperation, and the National Commission on Indigenous Peoples. Entitled, Technical Assistance for Conducting a Mixed-methods Longitudinal Prospective Study (household surveys) on Indigenous Peoples Vaccination Coverage, the study aims to determine the extent of prioritization given to the IP groups in the government’s COVID-19 vaccination program through its accessibility, the challenges encountered in reaching them, and other interventions needed to enable them to have better access to vaccines against COVID-19. 3.2. Proposed Strategy for Information Disclosure The Environmental and Social Commitment Plan (ESCP) and the first draft of the SEP were disclosed on April 2, 2020 at the DOH website and at the World Bank’s external website on April 8, 2020. Subsequent revisions of SEP, ESCP, and the Environment and Social Management Framework (ESMF) were disclosed in the same websites on 4 August 2020, 09 October 2020, 25 November 2020, 8 January 2021, 4 February 2021, and 23 March 2021. The March 2021 version reflected the updates related to the PCERP Additional Financing. For the Second Additional Financing, updated versions of the SEP, ESCP, and ESMF will also be disclosed on the same websites starting this November 2021. The existing strategies for Project information disclosure that will be continuously be implemented throughout the Project life is shown in Table 7. 25 | P a g e Table 7. Strategies for Information Disclosure per Project Stage List of information to be Methods and timing Project stage Target stakeholders disclosed proposed Preparation, prior • Government • Project objectives and Disclosure on World Bank to effectiveness agencies including activities and DOH websites DENR, Office of the • Environmental and President, and Social Management NDRMMC Framework (ESMF). • Health agencies • Stakeholder • NCIP Engagement Plan (SEP) • General public and Grievance Redress • Civil society Mechanism (GRM). organizations • Environmental and • IP organizations Social Commitment • Development Plan (ESCP). partners • Mass media Project • Government • Updated ESF • Updated ESF Implementation agencies including instruments. documents were DENR, Office of the • Feedback of Project disclosed by DOH President, and consultations. and World Bank. Any NDRMMC • Information about project subsequent updated • Health agencies activities in line with the versions will also be • NCIP World Health disclosed • LGU, neighboring Organization (WHO) • Project updates, communities of the COVID19 guidance on issues, and status of civil work projects risk communication and compliance, • Health facilities and community engagement. • Regular Consultation civil works • Status of compliance to and Coordination contractors ESS and contract Meetings with • Professional agreements. Project beneficiaries Associations • Locality’s ways of • Municipal waste disseminating collection and information through disposal workers the LGUs’ system • Business owners and and community providers of services, network goods and materials • Information leaflets • General public, and brochures to be including distributed with representatives of sufficient physical custodians of distancing measures vaccination age • National Deployment groups between 12 - and Vaccination Plan 17 implementation • Civil society updates regularly organizations, released by NVOC including and the DOH organizations representing people vaccination with disabilities, awareness program • IP organizations / through online representatives platform. • Development partners • Mass media 26 | P a g e In line with WHO guidelines on prioritization, the initial target for vaccination under the World Bank COVID-19 Multi Phase Programmatic Approach financing of the Philippines COVID-19 Emergency Response Project is to reach 20% of the population in the first year in each country, prioritizing health care workers, other essential workers, and the most vulnerable, including the elderly and people with underlying co-morbidities. As all people will not receive vaccination all at the same time, inadequate or ineffective disclosure of information may result in distrust in the vaccine or the decision-making process to deliver the vaccine. Therefore, the government will ensure that information to be disclosed: • Is accurate, up-to-date and easily accessible; • Relies on best available scientific evidence; • Emphasizes shared social values; • Articulates the principle and rationale for prioritizing certain groups for vaccine allocation; • Includes an indicative timeline and phasing for the vaccination of all the population; • Includes explanation of measures that will be used to ensure voluntary consent, or if measures are mandatory that they are reasonable, follow due process, do not include punitive measures and have a means for grievances to be addressed; • Includes explanation of vaccine safety, quality, efficacy, potential side effects and adverse impacts, as well as what to do in case of adverse impacts; • Includes where people can go to get more information, ask questions and provide feedback; • Includes the expected direct and indirect economic costs of the vaccines and addresses measures should there be serious adverse impact on stakeholders due to the vaccine, such as serious side effects; and • Is communicated in formats taking into account language, literacy and cultural aspects. Over time, based on feedback received through the Grievance Mechanism and other channels, information disclosed should also answer frequently asked questions by the public and the different concerns raised by stakeholders. • Misinformation can spread quickly, especially on social media. During implementation, the government will assign dedicated staff to monitor social media regularly for any such misinformation about vaccine efficacy and side effects, and vaccine allocation and roll out. The monitoring should cover all languages used in the country. In response, the government will disseminate new communication packages and talking points to counter such misinformation through different platforms in a timely manner. These will also be in relevant local languages. • If the engagement of security or military personnel is being considered for deployment of vaccines, ensure that a communication strategy is in place to inform stakeholders of their involvement and the possibility of raising concerns and grievances on their conduct through the Grievance Mechanism. PCERP will continue to engage with the vulnerable groups such as persons with disabilities and indigenous peoples through mandated government agencies that provide policy guidance and technical assistance such as the National Council on Disability Affairs (NCDA) and National Commission on Indigenous Peoples (NCIP), respectively. The Project will coordinate with them for the concerns and feedback on the vaccination roll-out. Activities such as consultations / town halls on vaccination will be conducted for these identified stakeholder groups, through DOH. Further, as part of the vaccination campaign for the general population groups aged between 12 – 17, the DOH has been engaging associations of Pediatricians to share existing knowledge and prepare an information brief for policy makers at provincial and LGU levels. 27 | P a g e Going forward, information dissemination and consultations as well as virtual townhall sessions are expected to be organized to engage parents, relevant non-government organizations and civil society organizations (NGOs and CSOs) as well as general public about benefits of vaccinating adolescents and relevant AEFI management. The consultation / town hall meetings will target to solicit the concerns and feedback on the ongoing vaccination program. It will also identify recommendations to move forward the agenda of scaling-up the vaccinations to the rest of the population and in the remote areas. Based on the results from these activities with key stakeholders, recommendations can be made to address the concerns of the vulnerable groups. At the local level, LGUs can initiate partnerships with NGOs/CSOs/CBOs/private sector to assist in the implementation of their programs and projects such as deployment of additional vaccinators, community organizers / facilitators, as needed. PCERP can further validate the involvement of these groups in the vaccination roll-out. 3.2.1 Philippine National Deployment and Vaccination Plan for COVID-19 Vaccines (NDVP) The Philippine National Deployment and Vaccination Plan for COVID-19 Vaccines was drafted for the purpose of providing operational guidance in the implementation of the COVID-19 vaccine deployment and vaccination program. It is a living plan to be updated as more information becomes available or as recommendations are provided by international and national organizations. Its development has involved the participation of various government agencies to ensure alignment of policies and plans among agencies and integration of the said plans into national governance mechanisms. The development process for this Plan was participatory and involved various stakeholders led by the COVID-19 Vaccine Cluster and its Task Group (TG) and Sub-Task Group (STG) members. These TGs and STGs were composed of various Departments and Agencies as outlined in the section of Governance. The TGs and STGs under the COVID-19 Vaccine Cluster developed briefs to guide the implementation of the vaccine. Key Informant Interviews were also conducted to understand various perspectives in addition to various rapid assessments. A short-term technical assistance staff was hired to collate the briefs/guides developed by each of the TGs and STGs. A series of meetings were held to review and enrich the plan. The final draft of the NDVP was presented to the DOH Executive Committee, COVID-19 Vaccine Cluster of the National Task Force for endorsement. On 20 September 2021, DOH issued Department Circular 2021-0449 on the Interim Operational Guidelines on the Roll-out of the National COVID-19 Vaccine Deployment and Vaccination Program to the Rest of the Adult Population to set out additional directives for the implementation. The target audience includes policy makers, planners, program and project implementers, development partners, health service providers, partners in public and private sector, civil society organizations, health consumers, and the general public. The NDVP was approved and ratified by the IATF Resolution no. 95 and further reinforced by the NTF Against COVID- 19 Memorandum Circular no. 5 series of 2021. Disseminating the NDVP to the different audiences in a meaningful way that will engage the audience and enable action will require that there are different versions and formats of this plan. Table 8 below summarizes the proposed dissemination of the NDVP. 28 | P a g e Table 8. Proposed Dissemination Strategy for the NDVP Users Needs Dissemination Government at all levels Taking stock Contents (what) Development partners Any changes / updates in the Tables International agencies plan Graphs and maps Private Sector Follow-up Analysis Academic and Research Planning and Projections Policy briefs and briefers Institutions Sector analysis Powerpoint presentations General Public Buy-in Media (How) Hard copy of the plan Soft copy of the plan Media (TV, newspapers) Workshops and seminars Government’s knowledge management website. 3.3. Stakeholder Engagement Plan – Project Implementation The Government of the Philippines, with the lead of the DOH and guidance of the COVID-19 Vaccine Czar’s Office, will design and distribute a social mobilization and engagement strategy/demand plan and information awareness program, such as through advocacy, communications, social mobilization, risk and safety communications, community engagement, and training, to generate confidence, acceptance and demand for COVID-19 vaccines, including for engaging with national and local media, NGOs, social platforms, etc. and human resources for community outreach and risk communication management that also explains how complaints may be lodged and how they will be resolved, are available at all levels. This is being coordinated by the DOH- HPB with the Philippine Information Agency (PIA) and private sector partners. In response, community organizers will be hired and technical assistance on crisis communications and preparedness planning will be sought. For public communications, the assigned Task Group is the TG on Demand Generation and Communications that has the following functions: (a) design a demand and risk communication plan, (b) implement social mobilization and community engagement activities, and (c) ensure social preparation of target population groups and geographical areas prior to vaccination. The DOH through the Health Promotion Bureau (HPB), as member of the TG on Demand Generation and Communications headed by the Presidential Communications Operations Office (PCOO), together with the Philippine Information Agency (PIA), the National Telecommunications Commission (NTC), and the Department of the Interior and Local Government (DILG), will develop key messages and materials for public communications and advocacy aligned with the demand generation plan. The developed materials will be pre- tested in communities and will be subsequently rolled-out to the regional and local levels through learning development interventions of the Health Education and Promotion Officers (HEPOs). Moreover, the task group provided the LGUs a Demand Generation Playbook (https://tinyurl.com/DemGenPlaybook) which they can refer to when developing their respective micro-plan on demand generation. Working alongside with the HPB, the DOH-Communications Management Unit (CMU) is in charge of addressing vaccine hesitancy through surveys and various communication efforts through infographics and FAQs disseminated in various social media. The National Demand Generation and Communications Plan for COVID-19 Vaccines was developed and to be updated by the DOH-HPB for the COVID-19 immunization program and integrated in the NDVP. It is guided by a whole-of-government, whole-of-system, and whole- 29 | P a g e of-society approach which encompasses general information on (i) COVID-19 and the need for sanitation and hygiene practices, (ii) COVID-19 vaccine basic information, (iii) trials results and procurement, and (iv) vaccine program roll-out. The WHO risk communication and community engagement readiness and response to coronavirus disease (COVID-19) released on 19 March 2020 will also be used as reference in the development of messages and planning of risk communication and community engagement (RCCE) activities. A summary of the stakeholder strategy during the Project implementation is provided in Table 9. Table 9. Stakeholder Engagement Strategy Topics Methods Target stakeholders Responsible • The Project, its • Online meetings • Affected people, priority DOH activities and • Targeted consultations eligible population for locations, (virtual or with physical vaccination, and other potential impacts distancing in case of face interested parties as and mitigation to face) with relevant key appropriate. measures. stakeholder groups, in a • Relevant government • Vaccination culturally appropriate and agencies working in, or with Program and health-conscious manner an interest in health sector Status Updates, (e.g., consultations for and COVID-19. including relevant the civil works • DOH Units (CHDs, PHO, policies and components; community RHU, CHO) regulations consultations for the • IPOs, NGOs and CSOs may • COVID-19 vaccination activity; also be included. Infection consultations with • Local Government Units, Prevention and vulnerable groups Local Chief Executives Control • Awareness and (LCEs) • Introduction of the engagement through • Recipient health facilities; Project’s ESF unified messaging across Project beneficiaries instruments. multiple but streamlined • Host and neighboring • Updates in communication platforms communities where civil work Project’s ESF or spokespersons. (e.g., projects will be located instruments. correspondence by • Health facilities and their • Introduction of the phone/email, letters, workers SEP and the social media, online • Contractors engaged in Grievance messenger, online/virtual Project implementation Redress Mechanism discussion, etc. • Municipal waste collection • Site visits (with social and disposal workers • Validation of the GRM distancing and use of • Business owners and personal protective providers of services, goods steps/process equipment) and materials • Feedback from Project • Locality’s ways of • General public, including consultations engaging with representatives of custodians • Capacity Building constituents for vaccination age groups of health workers • Feedback listening from between 12 – 17 and other frontline social media/ any online • CSOs and NGOs workers on platform; rumor • IP organizations / communication management representatives and engagement • Feedbacks from survey • Development partners • Information on • Learning Development Project activities Interventions (LDI) in line with the • Information Management World Health • Existing or new Organization community communication systems 30 | P a g e (WHO) COVID19 guidance on risk communication and community engagement. The line-up of activities includes a series of consultations to be conducted with the implementers of the Grievance Redress Mechanism (GRM) and with the implementers and stakeholders of the COVID-19 vaccination activities, in consultation with and per directive of the COVID-19 Vaccine Cluster Organizational Structure. Targeted consultations directed at relevant key industry stakeholders such as private sector engaged in cold chain storage and transportation, health care waste management (e.g., waste transport, storage and disposal service) and others, will be also conducted to ensure understanding of the quality of service required consistent with government regulations and the environmental and social standards of the Banks’ ESF. These consultations should involve the Centers for Health Development, the Food and Drug Administration, local government units (LGUs), the recipient health facilities, and priority eligible population for vaccination, and the private sectors involved in cold chain management. Another strategy is to set-up data collection systems including (a) social media listening and rumor management and (b) assessment of behavioral and social data will be established. Currently, the frequently asked questions (FAQs) on COVID-19 and the vaccines are being reviewed and updated based on possible scenarios. Using the revised information, the KIRA ChatBot backend will be updated. To be able to effectively develop and implement the above data collection systems, the following human resource strengthening, and re-enforcement activities will be conducted: (i) contracting of third party for the conduct of surveys, (ii) hiring of regional staff, at least 1 per region, (iii) contracting of technical assistance provider on infodemic management, (iv) contracting of technical assistance provider on in-house social listening, and (v) learning development interventions of regional and local HEPOs. Included in the National Demand Generation and Communications Plan for COVID-19 Vaccines is the component on risk communication and community engagement for the effective delivery and deployment of the COVID-19 vaccines. It has the following objectives for the citizens: 31 | P a g e • Understand, feel confident in the government’s approach to roll-out COVID-19 vaccines, and believe that it is fair; • Maintain trust in, and demand for, COVID-19 vaccine and routine immunization; • Understand the importance of physical and mental resilience and continued practice of other preventive health behaviors (hand washing, mask wearing, and physical distancing); and • Rely on government-initiated platforms as the authoritative source of information on COVID-19 vaccines deployment. The specific objectives are as follows: • Adults, caregivers, and parents understand the threat of COVID-19 and the need for herd immunity to protect their families; • Eligible Filipinos are aware of the COVID-19 deployment plan (authorization for safety and efficacy, prioritization of recipients) and implementation plan (schedule, venue, and requirements for safe vaccination before the deployment start date); • All Filipinos understand the key difference of the COVID-19 vaccine clinical trials and the government-led roll out of the COVID-19 vaccines; • Health workers, community volunteers, and other frontline workers are able to communicate key messages of the campaign, respond to concerns regarding the campaign, and verify information appropriately; and • Private sector, civil society organizations, Local Chief Executives, and other key stakeholders are engaged to champion the immunization activities through provision of accurate and timely information and of resources for community mobilization. The approaches and strategies will include the following: • Raising awareness and engagement through unified messaging across multiple but streamlined communication platforms or spokespersons. • Ensuring feedback loops from monitoring of platforms to inform calibration of messages. • Strengthening capacities of health workers and other frontline workers on communication and engagement • Advocacy and engagement of partners and influencers, including Local Chief Executives (LCEs) • Media engagement and management Table 10. Overview of the Key Messages Per Phase Phases Pre Roll-Out Deployment Post Deployment Themes 1. Benefits of 1. Patient 5. Legitimate sources for Vaccine and responsibility and of vaccines and General Urgency of follow through reliable vaccination Public Deployment 2. posts 2. Prioritization and 3. Patient 6. Timing responsibility and 7. Sense of 3. Rigorous follow through community Development, 4. Continuous Approval and monitoring and Monitoring responsible 4. Global reporting Cooperation 32 | P a g e Social listening allows the COVID-19 vaccine communication team to prioritize and evaluate feedback from the different sources of information in order to create messages with relevant content for target audiences. Through this, communication can be adjusted based on trends and continuously shift strategies to fit the current needs of the target audiences. Social listening activities will generate insights and recommendations that will guide the development of policies, demand generation plans, creation, and dissemination of frequently asked questions (FAQs) and other communication materials regarding COVID-19 vaccines, and the overall COVID-19 vaccine deployment plan and strategies. The social listening framework is shown in Figure 3, and the strategy recommended per geographic area level is in Table 11. The critical topics that are recommended to be covered per target group of stakeholders is shown in Table 12. Figure 3. Social Listening Framework for the COVID-19 Vaccination The DOH Health Promotion Bureau (HPB) regularly convenes with the Office of the Vaccine Czar, with the following schedule: • Mondays at 8:00 AM, with the Boston Consulting Group, Vaccine Czar, and leads of the Task Group (TG) Demand Generation and Communications • Tuesdays at 6:00 PM, the Vaccine Cluster Meeting with other Task Groups (TGs) and Sub-task Groups (STGs) Together with the Office of the Vaccine Czar, the DOH HPB holds the ‘Laging Handa: COVID- 19 Vaccines Explained’ as information and demand generation campaign for the COVID-19 vaccines. The other platforms of interface include chat group with NTF, PIA, and DOH for issues management. The health promotion campaign of the HPB for the COVID-19 response (Figure 4) and the vaccination (Figure 5) may be summarized in the following figure: 33 | P a g e Table 11. Social Listening Strategy per Geographic Area Level Tool Level Task Output Community Events Regional Communications with local counterparts Weekly reporting to national Social Listening through established communication Sub-task Group (every Friday, starting channels/ social media groups; identify and February) consolidate relevant concerns Local Organize community assemblies, Town Hall Weekly feedback to the CHD/ Regional Meetings, or Community Engagement VOCs. Activities; gather relevant concerns and respond to queries and concerns COVID-19 Vaccine Online Survey Regional Disseminate the online survey to more than 345 healthcare workers in the region. Local Help in the regional in disseminating the online survey to healthcare workers in the localities. COVID-19 Vaccine Provincial face to Regional Oversee and coordinate survey Monitoring of data encoded and submitted Face Survey (General Adult dissemination and data gathering activities; online by local counterparts Population) Communicate regularly with local counterparts to update on survey status through established communication channels/ social media groups; Feedback regular updates on survey status to national Social Listening team. Conduct face to face data gathering for more Encode and submit data online on March and than 500 adult respondents per province and September. independent city; Feedback regular updates on survey status to CHD/ RVOC. Table 12. Topics for Targeted Stakeholders for Demand Generation of the COVID-19 Vaccines Vaccine Overview of Demand Feedback Demand Reportage the Vaccine Generation: Mechanisms Non HCW community Frontliners Generation: and Deployment Framework and Social Playbook Communicati Plan for Action Listening ons TARGET GROUPS at the NATIONAL LEVEL CHDs, HEPOs, Provincial/ Municipal Information Centres, LGU X X X X X HEPOs, Province/City Health Officer, PDRRMO LCE/LGUs through ULAP) X X X X X Key NGAs (e.g., DILG, DepEd, AFP, PNP, NDRRMC, etc.) X X X X X Medical Societies X X X X Media X X Faith based groups X PROVINCIAL/ REGIONAL/ LOCAL FOCAL POINTS (Capacity Building or cascading by Priority National Target Groups) Barangay LGU Officials X X X X BHWs/ BHERT X X X X Public and private primary and secondary school teachers X X Medical societies and network X X Faith based groups X Community leaders X Youth-based groups X 35 | P a g e Figure 4. Health Promotion Campaign Strategy of DOH for the COVID-19 Response Figure 5. Health Promotion Campaign Strategy of DOH for the COVID-19 Vaccination The Pulse Asia has conducted a survey last December 2018 on who can get an individual vaccinated and it is shown that health care providers, relatives, and local government units play a crucial role, considering the devolved nature of health care in the country (Figure 6). It is important to note, however, that this survey is not in the context of COVID-19. Figure 6. Pulse Asia Survey on Vaccination Positive Influencers (2018) The HPB also has been conducting a series of Town Halls wherein various stakeholder groups are invited to consult on the COVID-19 vaccination. Consultations with the Philippine Medical Association (PMA) last 14 January 2021, Philippine Nurses Association (PNA) last 16 January 2021, with pharmacists last 23 January 2021, and with midwives last 30 January 2021 show the vaccine acceptance of these groups (Figure 7) upon the poll on the question “How likely are you to get the COVID Vaccine if available, with safety and effectiveness comparable to other common vaccines, and with FDA approval for public use?”. Figure 7. Vaccination acceptance results during the Town Halls led by the HPB (2021) 37 | P a g e Various health trainings on COVID-19 and vaccination are also made available at the DOH Academy E-Learning Platform (https://learn.doh.gov.ph/). The module on health promotion for COVID-19 vaccines includes the following topics shown in Table 13. Table 13. Health Promotion Module for COVID-19 Vaccines in the DOH Academy E- Learning Platform Topic Target Audience 1: Overview of the Vaccine Deployment Plan: Communicators, General Public 10 Things You Need to Know 2: Demand Generation: Framework for Action Communicators 3: Demand Generation: Playbook Communicators 4: Feedback Mechanisms and Social Listening Communicators 5: Vaccine Reportage and Communications Communicators The Project would continue its active participation in the initiatives carried out the National Task Force Against COVID-19 and the DOH. The information would then serve as inputs to the interventions from the components such as assessment tools, studies and learning development initiatives for the various stakeholders PCERP works with. 3.4. Proposed Strategy to Incorporate the View of Vulnerable Groups The Project will carry out targeted stakeholder engagement with vulnerable groups to understand concerns/needs in terms of accessing information, medical facilities and services and other challenges they face at home, at workplaces and in their communities. Special attention will be paid to engage with indigenous peoples and women as intermediaries. The details of strategies that will be adopted to effectively engage and communicate to vulnerable group will be considered during project implementation. Examples may include the following approaches for each group: a. Women: ensure that community engagement teams are gender-balanced and promote women’s leadership within these, design online and in-person surveys and other engagement activities so that women in unpaid care work can participate; consider provisions for childcare, transport, and safety for any in-person community engagement activities; b. Pregnant women: develop education materials for pregnant women on basic hygiene practices, infection precautions, and how and where to seek care based on their questions and concerns; c. Elderly and people with existing medical conditions: develop information on specific needs and explain why they are at more risk & what measures to take to care for them; tailor messages and make them actionable for particular living conditions (including assisted living facilities), and health status; target family members, health care providers and caregivers; d. People with disabilities: provide information in accessible formats, like braille, large print; offer multiple forms of communication, such as text captioning or signed videos, text captioning for hearing impaired, online materials for people who use assistive technology; and e. Children: design information and communication materials in a child-friendly manner & provide parents with skills to handle their own anxieties and help manage those in their children. 38 | P a g e 3.5. Summary of Project Stakeholder Needs and Methods, Tools, and Techniques for Stakeholder Engagement Different engagement methods are proposed and cover different needs of the stakeholders: • Online formal meetings • Engagement through unified messaging across multiple but streamlined communication platforms or spokespersons. (e.g., correspondence by phone/email, letters, social media, online messenger, online/virtual discussion, etc.) • Community consultations where physical distancing measures are practiced in respective LGUs/areas • One-on-one interviews through phone or available local apps (i.e., Viber, Messenger) • Feedback listening from social media/ any online platform; rumor management • Site visits with personal protective equipment and physical distancing measures (when appropriate) • Learning Development Interventions (LDI) • Locality’s ways of engaging with constituents • Use of existing or new community communication mechanisms Targeted consultations with special interest groups will be regularly undertaken, as needed. These include the organizations representing and supporting people with disabilities (PWDs), such as the Alyansa ng may Kapansanang Pinoy, Inc. (AKAP-Pinoy), which is a 415-strong federation of local and national organizations and 900 individual members dedicated to advocate for the rights and promote the interests of persons with disabilities), the Life Haven Center for Independent Living, Regional Association of Women with Disabilities, the Philippine Federation of the Deaf, Inc. (PFD), and the Philippine Coalition on UNCRPD. Targeted consultations with indigenous peoples’ representatives and organizations including the National Commission on Indigenous Peoples (NCIP) will also be undertaken during project implementation. This will include, inter alia: • Identification of indigenous peoples’ organizations for stakeholder engagement; • Identification of potential affected groups and communities, their representative bodies and organizations; • Engagement approaches that are culturally appropriate that allow for sufficient time for feedback and decision-making processes; and • Measures to allow for their effective participation in the design of project activities or mitigation measures that could affect them either positively or negatively including relevant mechanisms and procedures of the Joint Memorandum Circular “Guidelines on the Delivery of Basic Health Services for Indigenous Peoples/Indigenous Cultural Communities (IPs/ICCs)” agreed to between DOH, NCIP, the Department of Interior and Local Government (DILG) on June 3, 2013. Where the SEP and the ESMF are used to address Indigenous Peoples, the SEP will be prepared in a manner consistent with the ESS7 to enable targeted meaningful consultation, including identification and involvement of Indigenous People communities and their representative bodies and organizations; culturally appropriate engagement processes; providing sufficient time for Indigenous Peoples decision making processes; and allowing their effective participation in the design of project activities or mitigation measures that could affect them either positively or negatively. For any vaccination program where Indigenous Peoples are beneficiaries, the SEP will include targeted, culturally- appropriate and meaningful consultations before any vaccination efforts begin. Consultations and vaccination campaigns will be conducted through partnership with relevant Indigenous Peoples organizations and traditional authorities. The GRM will be 39 | P a g e culturally appropriate and accessible for IPs taking into account their customary dispute settlement mechanism. Consultations will clearly communicate that there are policies ensuring that there is no forced vaccination.5 If the Borrower has mandatory vaccination regulations applicable to IP/SSAHUTLC, targeted, culturally appropriate and meaningful consultations should be conducted for applicability of these regulations to IP/SSAHUTLC communities. An adaptive approach may also be needed for engaging stakeholders in Bangsamoro Autonomous Region of Muslim Mindanao (BARMM) due to the fragile political situation and security context. Particularly if the project will finance site-specific investments in BARMM (in addition to awareness raising), the SEP will be revised to include specific provisions for stakeholder engagement. On the other hand, community consultations with the affected stakeholders in the civil works project sites and other project activities will still be conducted in coordination with the BARMM-Ministry of Health. A precautionary approach will be taken to the consultation process to prevent contagion, given the highly infectious nature of COVID-19. The risk from virus transmission is higher for Indigenous Peoples living in more remote areas. The following are some considerations for selecting channels of communication, in light of the current COVID-19 situation: • Avoid public gatherings (taking into account national restrictions or advisories), including public hearings, workshops and community meetings; • If smaller meetings are permitted/advised, conduct consultations in small-group sessions, such as focus group meetings. If not permitted or advised, make all reasonable efforts to conduct meetings through online channels; • Testing or vaccinating of the intermediaries conducting consultations who may travel in and out of communities. • Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, and mail), particularly to target stakeholders who do not have access to online channels or do not use them frequently. Traditional channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a context specific combination of email messages, mail, online platforms, dedicated phone lines with knowledgeable operators; • Each of the proposed channels of engagement should clearly specify how feedback and suggestions can be provided by stakeholders. • Identify trusted local civil society, ethnic organizations, community organizations and similar actors who can act as intermediaries for information dissemination and stakeholder engagement; engage with them on an ongoing basis. • For effective stakeholder engagement on COVID-19 vaccination, prepare different communication packages and use different engagement platforms for different stakeholders, based on the stakeholder identification above. The communication packages can take different forms for different mediums, such as basic timeline, visuals, charts and cartoons for newspapers, websites, and social media; dialogue and skits in plain language for radio and television; and more detailed information for civil 5 See the Project Appraisal Document for the COVID-19 Multi Phase Programmatic Approach Additional Financing, which can be found here and states that the Bank will provide assistance to Borrowers for the “establishment of policies related to ensuring that there is no forced vaccination.” Forced vaccination refers to a government mandate requiring vaccination of everyone or everyone in a defined group, without any exceptions or due process for refusing to be vaccinated. Refusal to be vaccinated may result in punitive measures such as criminal sanctions. 40 | P a g e society and media. These should be available in different local languages. Information disseminated should also include where people can go to get more information, ask questions, and provide feedback. Finally, during the implementation of the Project, the ESMF and the SEP will be regularly updated and the alternative tools for stakeholder engagement will be assessed, as needed. This may include: establishing community feedback mechanisms for healthcare providers to support two-way communications, for example to build vulnerability profiles in the community and to counter misinformation and misperceptions; use of community facilitators and leaders to provide two-way information channels to healthcare providers in identifying who is most vulnerable or at high risk, and who may require support; use of global and local tools developed to address COVID-19, such as the WHO COVID19 Alerts via WhatsApp, HealthBuddy, and Covid19Info App, including a tracking and educational platform with mobile phone alerts.. 4.0 Future of the Project Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the ESMF, Stakeholder Engagement Plan, and Grievance Redress Mechanism (GRM). 5.0 Resources and Responsibilities for Implementing Stakeholder Engagement Activities 5.1. Resources The original approved loan financing of US$ 100 Million (Loan no. 9105-PH) had been increased by US$ 500 Million (Loan no. 9220-PH) through the Additional Financing in March 2021, to cover the procurement of vaccines against COVID- 19 and to support the DOH National Deployment and Vaccination Plan (NDVP). The new total of the Project financing is US$ 600 Million. A breakdown of the Project financing is shown in Table 14. Table 14. PCERP Funding (Parent Project and Additional Financing (Loan Nos. 9105- PH and 9220-PH Parent Project + Government of the Component Additional Financing Philippines Component 1: Strengthening Emergency US$ 577,117,000 COVID-19 Healthcare Response Sub-component 1.1 Provision of medical and US$ 39,454,000 laboratory equipment and reagents; Sub-component 1.2 Provision of medical US$ 13,463,000 supplies, including Personal Protective Equipment (PPE), medical countermeasures, medicines, and ambulance Sub-component 1.2 Provision for COVID US$ 500,000,000 vaccines (Additional Financing 1) Sub-component 1.3 Regular and intensive care US$ 24,200,000 isolation rooms with negative pressure Sub-component 1.4 Deployment of COVID- US$ 155,500,000 19 vaccines** (new sub-component, financed by counterpart funding from the GOP) Component 2: Strengthening laboratory US$ 15,678,000 capacity at national and sub-national level to 41 | P a g e support Emerging Infectious Diseases (EIDs) Prevention, Preparedness, and Response Component 3: Implementation Management US$ 7,205,000 and Monitoring and Evaluation Component 4: Contingent Emergency - Response Component (CERC) Total US$ 600,000 US$ 155,500,000 Requested budget for the Second Additional Financing amounting to $300 million USD will be allocated for the procurement of additional COVID-19 vaccines for booster vaccines and/or additional doses to fully vaccinated individuals and for the expansion of the COVID-19 immunization program to include the population ages 12 - 17. The breakdown of the proposed expanded additional financing for PCERP is shown in Table 15. Table 15. Projected Breakdown of Expanded Additional Financing for PCERP (as of October 2021) Budget Item Quantity Total Cost A. COVID-19 Vaccine 25,6000 Php 13,926,400,000 US$ 274,000,000 B. Ancillary Supplies AD Syringe 28,160 Php 70,400,000 US$ 2,000,000 Safety Box 309,760 Php 19,824,640 US$ 1,000,000 C. End to end Logistics Php 1,280,000,000 US$ 26,000,000 Total Php 15,296,624,640 US$ 300,000,000 The budget for the SEP remains included in the Project Component 3 budget amounting to US$ 7,205,000 for Implementation Management and Monitoring and Evaluation of the Project, where the ESF Implementation is charged. The DOH will be responsible in the stakeholder engagement activities. 5.2. Management Functions and Responsibilities The DOH will be the implementing agency for the Project. The DOH has appointed a Project Director (Undersecretary level), and a Project Manager (Director level), with two Project Co- Directors for the implementation of the Project and the Additional Financing. The DOH will appoint a Project Manager. The Project Manager will be acting through DOH’s technical departments and national programs, as well as the regional health units, Local Government Units (LGUs), referral hospitals, and health centers. Within the DOH, the Project will be implemented through the following Departments, using mainstream DOH processes and will not involve a parallel project implementation unit or secretariat: Bureau of International Health Cooperation (BIHC), Health Facility Enhancement Program Management Office (HFEPMO), Disease Prevention and Control Bureau (DPCB), Health Emergency Management Bureau (HEMB), Procurement Service (PS), Finance Management Service (FMS), and relevant units, with BIHC as the main project focal point. However, the project will have a provision to strengthen these departments’ capacity and skills through additional consultants or advisors. The PCERP’s organizational structure is shown in Figure 8. 42 | P a g e Figure 8. Institutional Set Up for the Philippine COVID-19 Emergency Response Project (PCERP) DOH will be responsible for the implementation of the SEP, as well as the ESMF and the Environmental and Social Commitment Plan (ESCP). DOH will appoint an Environmental and Social Risk Management Specialist to manage environmental and social risks of the Project and the engagement with stakeholders. Consultants may be hired as necessary. The DOH Environmental and Social Safeguards Team will provide technical and administrative support to the DOH DPCB, HPB, and other offices as advised for the risk communication and community engagement activities, mainly for information, communication, and consultation of the COVID-19 vaccine deployment and delivery activities, as necessary. 43 | P a g e 5.2.1 The COVID-19 Vaccine Cluster Organizational Structure The COVID-19 Vaccine Cluster shall serve as a unified command, control, coordination, communication, and cooperation mechanism that ensures the procurement, deployment of COVID-19 vaccine and the vaccination of identified eligible populations. Figure 9. COVID-19 Vaccine Cluster Organizational Structure The organizational structure is shown on Figure 9, with the line of command for COVID-19 vaccines as follows: 1. The Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID, or merely the IATF) is a task force created through Executive Order No. 168 s. 2014 by the Philippine President to respond to affairs concerning emerging infectious diseases in the country. For COVID-19 vaccines, the IATF-EID shall serve as the National Coordinating Committee. 2. For the COVID-19 pandemic response, President Rodrigo Duterte established the National Task Force (NTF) Against COVID-19 to oversee the operations of the national response. Detailing the strategic framework of the pandemic response, the National Task Force drafted the National Action Plan Against COVID-19 (NAP) to guide the operations of the pandemic response anchoring on the principle that the response should be national-government- enabled, local government unit (LGU)-led, and people-centered. 3. Under the NTF Against COVID-19, there are three clusters namely, the Response Cluster, the Recovery Cluster and the COVID-19 Vaccine Cluster. As mentioned above, seeing the need for an organizational structure to support the strategic directions of the national government, the COVID-19 Vaccine Cluster was added based on the guidance stipulated in the NAP Phase III. In line with the directions of the VIRAT, the COVID-19 Vaccine Cluster shall serve as the National Technical Working Group. The COVID-19 Vaccine Cluster is led by Secretary Carlito G. Galvez, Jr., who was designated by President Rodrigo Roa Duterte as the COVID-19 Vaccine Czar. The President of the Philippines appointed a Vaccine Czar for the purchase of vaccines and negotiate with manufacturers. To support the Vaccine Czar, the Inter-agency Task Force on Emerging Infectious Diseases (IATF-EID) created a structure that 44 | P a g e would manage and distribute COVID-19 vaccines once they become available to the Philippines. The vaccine task group is led by the Department of Health. 4. Under the COVID-19 Cluster are six Task Groups, and based on the direction of the VIRAT, shall serve as the Sub-Technical Working Groups. Each TGs is represented by the designated lead in the COVID-19 Vaccine Cluster Executive Committee. The Committee, in turn, advises and updates the COVID-19 Vaccine Cluster Chair. The six Task Groups are: a. Scientific Evaluation and Selection b. Diplomatic Engagement and Negotiation c. Procurement and Finance d. Cold Chain and Logistics Management e. Immunization Program f. Demand Generation and Communications. The COVID-19 vaccination activities will be implemented in accordance with the directives of the COVID-19 Vaccine Cluster Organizational Structure. The Inter-Agency Task Force on the Management of Emerging Diseases is Chaired by Secretary Francisco Duque IIII of the Department of Health while the National Task Force Against COVID-19 is Chaired by Secretary Delfin Lorenzana of the Department of Defense. Secretary Carlito Galvez, Jr., Presidential Adviser on the Peace Process, is the Chairperson of the National Incident Command and COVID-19 Vaccine Cluster (Philippine National Vaccine Roadmap or PNVR). Undersecretary Leopoldo Vega of the Department of Health is the Chairperson of the Response Cluster while the National Economic and Development Authority (NEDA) is the Chair of the Recovery Cluster. Under the TG COVID-19 Immunization Program, are four Sub-Task Groups (STGs), namely: STG Planning, Policy & Technical Support, STG Program Implementation, STG Registry, Data Management and Monitoring & Evaluation, and STG Safety Surveillance & Response. The STGs are composed of the following: a. STG Planning, Policy & Technical Support i. Lead: DOH [Disease Prevention and Control Bureau (DPCB)] ii. Members: DOH [Epidemiology Bureau (EB), and Health Policy Development and Planning Bureau (HPDPB)], OCPLC, DepEd, DILG b. STG Program Implementation i. Lead: DOH (DPCB) ii. Members: DOH [Health Emergency Management Bureau (HEMB) and Health Human Resource Development Bureau (HHRDB)], DILG (BFP, PNP, BJMP), DSWD, DepEd, DND (AFP), DOJ (BuCor), DOTr (PCG) c. STG Registry, Data Management & M&E i. Lead: DOH (EB) ii. Members: DOH [Knowledge Management and Information Technology Service (KMITS) and DPCB], DICT, DWSD, DepEd d. STG Safety Surveillance & Response i. Lead: FDA ii. Members: DOH [EB, Field Implementation and Coordination Team (FICT), DPCB, HEMB] 45 | P a g e The Task Groups are composed of various government agencies and participated by diverse experts and professionals as shown in Table 16. Table 16. Summary of Task Groups (TGs) Task Group (TG) Lead Members Roles and Responsibilities Scientific Department of Department of Health (DOH), Food and Drug • Provide oversight on the evaluation of applications and Evaluation and Science and Administration (FDA), Research Institute for conduct of COVID-19 vaccine clinical trials in the Selection Technology Tropical Medicine (RITM), Department of country. (DOST) Trade and Industry (DTI), Department of • Evaluate results of COVID-19 vaccine clinical trials as Foreign Affairs (DFA), National Development part of the inputs on the criteria for COVID-19 vaccine Company (NDC), and the Vaccine Expert selection. Panel (VEP) • Develop criteria and provide recommendations of the evaluation and selection of COVID-19 vaccines that will be considered for procurement. • Continue engagement with bilateral partners for clinical trials interested in pursuing local manufacturing and technology transfer. Diplomatic Department of Department of Finance (DOF), DOH, National • Initiate diplomatic engagements with other Engagement and Foreign Affairs Task Force, DOST, Office of the President governments, international bodies, international non- Negotiation (DFA) (OP) government organizations, international financial institutions, and international cooperation agencies. • Provide feedback and updates to the other respective TGs pertaining to vaccines in the global market. • Coordinate and collaborate with TG Procurement and Finance in identifying viable global market vaccine manufacturers and entities. • Negotiate agreements for the provision of technical and financial assistance. Procurement and DOF Department of Budget and Management • Facilitate procurement through various mechanisms Finance (DBM), DOH allowed under existing laws, rules and regulations through bilateral, multilateral and other financial modalities (e.g. COVAX Facility and etc.). • Activate price negotiation board subject to HTA’s cost - effective price, if applicable. • Coordinate with legislators, as may be necessary on budget and co-payment ceilings. • Explore local vaccine production and supply, if applicable. Cold Chain and DOH, Co-Lead: DBM; Department of Interior and Local • Map the potential port(s) of entry, points of storage Logistics Task Group Government (DILG), specifically, the (stores), and fallback facilities in the country with their Management Resource Philippine National Police (PNP); Department respective cold chain and transportation/distribution Management and of National Defense (DND), specifically the capacity for vaccines and ancillary products and assess Logistics (TGRML) Armed Forces of the Philippines (AFP) and dry storage and cold chain capacity at all levels. under the the Office of Civil Defense (OCD), • Facilitate acceptance and inventory of vaccines and Response Cluster Department of Information and logistics. Communications Technology (DICT), • Facilitate and ensure storage, distribution and delivery Department of Transportation (DOTr), RITM, of vaccines and logistics to target areas. FDA, and DTI • Monitor cold chain practices and ensure that vaccines are handled and disposed correctly and properly. • Develop a distribution plan down to the local level; adapt needs of vaccines, syringes and safety boxes to planning of stages or phases according to vaccine availability. • Schedule transportation of vaccines and other supplies at all levels. • Implement monitoring systems for vaccine distribution and conduct inventories using logistics information software integrated into existing systems and technology development (barcodes, electronic tracking, etc.). • Define indicators to evaluate the supply chain from the international up to the service delivery points. COVID-19 DOH DILG, DND, Office of the Chief Presidential • Plan and craft policies, guidelines and standard Immunization Legal Counsel (OCPLC), Bureau of operating procedures related to the COVID-19 vaccine Program Corrections (BuCor), Philippine Coast Guard deployment and program implementation. (PCG), Department of Social Welfare and • Estimate potential numbers of target populations that Development (DSWD), Department of will be prioritized for access to vaccines stratified by Justice (DOJ), Department of Education target group and geographic location. (DepEd), AFP, PNP, BJMP, DICT, FDA, • Identify potential COVID-19 vaccine delivery strategies. Department of Labor and Employment • Create a data information system for all vaccine (DOLE) recipients • Provide capacity building and trainings to implementers • Develop or adapt existing and implement AEFI/Post- marketing surveillance and monitoring framework 47 | P a g e • Ensure or craft guidelines, procedures and tools for planning and conducting vaccine pharmacovigilance activities Demand Presidential DOH, National Telecommunications • Design a demand and risk communication plan. Generation and Communications Commission (NTC), Philippine Information • Implement social mobilization and community Communications Operations Office Agency (PIA), DILG engagement activities. (PCOO) • Ensure social preparation of target population groups and geographical areas prior to vaccination. 48 | P a g e The COVID-19 Vaccine Cluster is supported by several independent bodies. These are: a. The National Immunization Technical Advisory Group (NITAG) for COVID-19 Vaccines is a multidisciplinary group of national experts responsible for providing independent, evidence-informed advice to policymakers and program managers on immunization and vaccine policy issues. The Philippine NITAG was organized and created through a Department Personnel Order as issued by the Secretary of Health of the Republic of the Philippines . The NITAG shall serve as an independent body that provides recommendations to the DOH and COVID-19 Vaccine Cluster, ensuring transparency, credibility, and technical soundness to the decision-making process and contributes to building public confidence COVID-19 vaccination program. b. The National Adverse Event Following Immunization Committee (NAEFIC), comprises representatives from different medical societies and vaccine experts. It reviews, analyzes, and comes up with causality assessment as the basis for the Food and Drug Authority (FDA) action and appropriate DOH bureaus/offices on Adverse Events Following Immunization (AEFI) and Adverse Events of Special Interest (AESI). c. The Health Technology Assessment Council (HTAC), whose mandate is to undertake technology appraisals by determining their clinical and economic values in the Philippine healthcare system, with the aim to improve overall health outcomes and ensure fairness, equity and sustainability of coverage for all Filipino citizens. The National COVID-19 Vaccination Operations Center shall be headed by the COVID-19 Vaccine Cluster Chair, The Regional COVID-19 Vaccination Operations Center shall be led by the Centers for Health Development with the participation of other government agencies and the Regional Task Forces Against COVID-19. And lastly, the Local COVID-19 Vaccination Operations Center shall be led by the Local Government Units. The Provincial Vaccination Operations Center shall oversee the Municipal and City Vaccination Operations Center (component cities). To avoid overlapping of functions and oversight, the COVID-19 Vaccination Operations Centers shall be distinctly separated from the EOCs of the COVID-19 Response Clusters which are headed by the Regional/Local Task Forces Table 17. Functions of The Support Groups to the COVID-19 Vaccine Cluster Group Function National Immunization Technical ● Review the latest position papers, studies, international guidelines Advisory Group (NITAG) and recommendations from internationally acknowledged resources [i.e., World Health Organization (WHO), Strategic Advisory Group of Experts for Immunization (SAGE)] for possible adoption in the country policies and plans for the National Immunization Programme. ● Conduct existing policy analysis, review of the program data and evidence in order to provide evidence-based technical advice and recommendations for the development of appropriate and sustainable immunization policies, guidelines, strategies and approaches related to immunization program. ● Advise the DOH in the formulation of policies, plans and strategies for research and development of existing and new vaccines and the vaccine delivery technology. National Adverse Events • Review all reported serious and cluster of AEFI cases presented Following Immunization for expert opinion and provide a final causality assessment of the Committee AEFI cases as well as the cases that were not classified by the Regional AEFI Committee. • Ensure evidence-based causality assessment by recommending further investigation and data collection as needed. • Make final decisions on causality assessment of inconclusive investigations. • Ensure standard protocols for AEFI surveillance and investigation are correctly followed. • Engage with other national and international experts when requirements arise in establishing causality and vaccine quality issues. • Provide recommendations to the National Immunization Program, EB and National Cold Chain Manager on improving immunization service delivery, compliance with injection safety and effective vaccine management based on lessons from the AEFI cases. • Serve as technical advisory group on vaccine and immunization safety-related issues of highest consideration such as immediate recall of vaccine from the market or temporary/permanent withdrawal of a vaccine from the immunization program. • Serve as resource person in other AEFI related meetings, conferences or capacity building activities as requested. Health Technology Assessment ● Oversee and coordinate the health technology assessment Council process of candidate COVID-19 vaccine. ● Review and assess existing evidences of COVID-19 vaccines undergoing/undergone clinical trials. ● Coordinate and provide recommendations to the TG Vaccine Evaluation and Selection. The Focal Points will support implementing entities and partners, including LGUs and other government entities, in implementing the SEP. The stakeholder engagement activities will be documented through minutes of stakeholder engagements, minutes of monthly and quarterly meetings with implementing partners as well as in the Project’s semi-annual reports. Consultation reports will be prepared by DOH after project-related public engagement activities have been carried out. These reports will be widely shared with the stakeholders and reported to the World Bank as defined in the ESMF and ESCP. 6.0 Grievance Mechanism While the Project addresses the urgent needs and concerns of the pandemic, it also provides economic and social benefits to various stakeholders upon implementation. However, the roll- out can bring about possible problems that can affect the communities. Thus, PCERP adheres to the World Bank's Environment and Social Management Framework (ESMF) to anticipate and mitigate the risks and negative impacts during the implementation period. One of the strategies is the installation of a Grievance Redress Mechanism (GRM) to facilitate the handling of feedback, complaints and recommendations from stakeholders. The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective, and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: • Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of the Project; • Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and • Avoids the need to resort to judicial proceedings. 50 | P a g e Currently, PCERP has set up Kobo Toolbox online forms for GRM on civil works, contractor management and for the general public. Entries are monitored and summarized monthly to be included in the ESS Compliance Monitoring Report. Should there be any complaints, the Project will forward this to the concerned government agency / office for the appropriate action. The Project plans to conduct another round of consultations with key stakeholders to validate the revised FGRM process document to check if mechanisms are accessible and used at all and solicit other effective approaches being used. 6.1. Description of GRM The Grievance Redress Mechanism is open to all Project stakeholders, including the DOH personnel, health workers, communities nearby Project construction areas, vaccine candidates and vaccinated individuals, and civil society organizations to name a few. The Grievance Redress Mechanism is based on existing national policies such as the DOH’s Citizen Charter 2nd edition (2020), Civil Service Commission (CSC) Resolution no. 1701077 – 2017 Rules on Administrative Cases in the Civil Service (2017 RACCS), Department of the Interior and Local Government (DILG) Memorandum Circular no. 2017-109 – Designation of a Permanent Action Team for the Implementation of Citizen’s Complaint Hotline 8888, and the Labor Code of the Philippines (Presidential Decree no. 442 of 1974 as amended and renumbered), among others. 6.2 Grievance Reporting Channels 6.2.1 Reporting of Grievances to Authorities The grievances may occur in health facility or community settings and may be relayed through the following medium/channel: physical or walk-in, mail and e-mail, and phone call. Shown in Table 18 are the grievance reporting mechanisms per medium/channel: Table 18. Grievance Reporting Mechanisms Grievance Reporting Grievance Reporting Mechanism Grievance Receiver Medium or Channel Physical or Walk-In Complainant files grievance through the DOH CHU or similar unit in the DOH Complaints Handling Unit (CHU) or CO, CHDs, or health facilities similar unit in the DOH Central Office Civil Service Commission and its (CO), DOH Centers for Health Regional Offices Development (CHDs), DOH health DILG Central and Regional Offices facilities, Civil Service Commission and DOLE Central and Regional Offices its Regional Offices, DILG Central and LGU (Provincial/City/Municipal) Regional Offices, DOLE Central and Regional Offices, and the Local Government Unit (LGU) Mail, Online, and Complainant files grievance through snail DOH CO and CHD CHU, health E-mail mail, email, Complaint Centers (e.g., facilities, and Complaint Centers Contact Center ng Bayan Presidential Civil Service Commission and its Complaint Center, and Anti Red Tape Regional Offices Authority) DILG Central and Regional Offices DOLE Central and Regional Offices LGU (Provincial/City/Municipal) Phone Call Complainant files grievance through DOH CO and CHD CHU and health DOH Call Center/ Hotline (COVID-19 and facilities CSC Central and Regional Offices 51 | P a g e vaccines) or through hotline of DOH DILG Permanent Action Unit health facilities LGU Permanent Action Unit Citizens’ Complaint Hotline 8888 DOLE Complaints Unit DOLE Hotline 1349 Grievances may be raised by individuals or institutions who wish to be anonymous and the receiving authority should strictly observe and protect the confidentiality of the complainant. Per the 2017 RACCS of the CSC, no anonymous complaint shall be entertained unless the act complained of is of public knowledge or the allegations can be verified or supported by documentary or direct evidence. Depending on the nature of the grievances, concerns can be coursed through the following appropriate authorities listed in Table 19. The designated mail and email addresses for the identified offices is listed in Table 20. Table 19. Government Offices Handling Grievances of Specific Concerns Concern Authority Complaints against DOH Hospitals DOH Central Office, CHD, HCF Complaints against LGU Hospitals LGU, DILG Complaints against any public/government CSC official/institution Complaints against construction activity in health HCF, LGU facility Complaints of personnel against contractor Contractor, DOLE Complaints on COVID-19 vaccination and other DOH Central Office, CHD, HCF, DILG, LGU related services Table 20. Contact Information of Government Offices to Receive Grievances Office Physical Address E-mail Address Hotline DOH Complaints Handling Unit, Bldg. 1, dohpau.chu@gmail.com 1555, (02) Department of Health, San Lazaro 894COVID Compound, Rizal Avenue, Sta. Cruz, (26843) Manila DILG DILG-Napolcom Center, EDSA Cor. dilgmail@dilg.gov.ph 89251135, Quezon Avenue, Quezon City 1104 89250343 DOLE Department of Labor and laborcommunications@gmail.com 1349 Employment (DOLE) Building, , Muralla Wing cor. General Luna St., administrativeservice@gmail.com Intramuros, Manila, 1002 , dolecentralrecords@gmail.com CSC Civil Service Commission, email@contactcenterngbayan.gov 89318092, Constitution Hills, Batasang .ph 89317939, Pambansa Complex, Diliman, 89317935 Quezon City 1126 6.2.2 Reporting of Grievances to DOH on the COVID-19 Vaccination through the DOH Hotline For the COVID-19 National Immunization Program, the DOH will ensure a mechanism with multiple intake points has been designed and is in place and is operational for feedback and grievances in relation to the vaccine program. The National Emergency Operations Center with complete data management systems and tool will be established starting on January 2021. The EOC will also be established in the regional and local levels. The DOH COVID-19 hotline, which has been established last 17 March 2020, has also been an avenue for receiving 52 | P a g e grievances or complaints. The toll-free numbers accessible to the public are 1555 or (02) 894COVID (26843). The Complaints Handling Unit (CHU) of the DOH- AFMT is the central receiving body of complaints. The complaints received in the DOH hotline are also forwarded to the CHU. In view of the upcoming COVID-19 vaccination, there is a proposed hotline in support of the Vaccine Cluster. The DOH COVID-19 Hotline agents may be trained for basic protocols or provided with information guide or FAQs or basic troubleshooting steps to augment available support to vaccination teams. This will filter calls which require more advanced support and may eventually be forwarded to the appropriate team for immediate assistance. The call algorithm of the calls received through the DOH hotline is presented in Figure 10. Figure 10. Call Algorithm of the DOH COVID-19 Hotline PCERP would continue coordination with the DOH Knowledge Management and Information Technology Service (KMITS) and CART-Secretariat on the summary reports from the DOH hotlines regarding feedback and grievances related to vaccination. In view of the upcoming COVID-19 vaccination, there is a proposed hotline in support of the Vaccine Cluster. The objectives are as follows: ● Risk Communication - Provide a consistent, accurate information on COVID-19 vaccine to all COVID-19 Hotline callers ● Serve as a first level of technical support for vaccination teams for technical concerns concerning the registry ● Serve as a help desk to vaccination teams for any concerns regarding the deployment (supply request, program-specific questions, etc.) ● Serve as a source of real-time surveillance data to Epidemiology Bureau for COVID- 19 Hotline callers with AEFI The DOH COVID-19 Hotline agents may be trained for basic protocols or provided with information guide or FAQs or basic troubleshooting steps to augment available support to vaccination teams. This will filter calls which require more advanced support and may eventually be forwarded to the appropriate team for immediate assistance. The hotline may provide the following support listed in Table 21. 53 | P a g e Table 21. Possible Support Area of the COVID-19 Vaccine Hotline Area Activities Supported Information Technology QR Code generation Record inaccessibility Registration concern Implementation Vaccine handling guide Basic counseling Coordination LGU to LGU LGU to national government and other agencies The DOH COVID-19 Hotline may provide real-time information via email (or any provided platform) of collected epidemiologic information as it receives it from callers with AEFI ensuring immediate monitoring and follow-through of case as it is being investigated. The DOH COVID-19 Hotline will not replace, but simply augment existing communication channels. Shown in Figure 11 is the process flow of the COVID-19 vaccine hotline. Figure 11. Process Flow of the DOH COVID-19 Vaccine Hotline The Grievance Redress Mechanism for the COVID-19 vaccination will be further discussed and consulted by the DOH, not only involving concerns on AEFI but also on other vaccination-related complaints, such as but not limited to forced vaccination. 6.2.3 Receiving of Grievances by the Authorities The DOH Administration and Financial Management Team (AFMT) CHU personnel interviews the complainant to obtain all possible information. The CHU then evaluates if the grievance is within the jurisdiction of DOH. If complaint is within the jurisdiction of DOH, the CHU personnel will explain to the client which concerned office/agency has the jurisdiction of the complaint. Meanwhile, if complaint is within DOH jurisdiction, the CHU personnel will explain to the client that the complaint shall be properly endorsed to the concerned office and will be notified on. Grievances/complaints received by the DOH CHU are documented accordingly at the national level. The Department of Health will be in charge of keeping a database of grievances and monitoring of resolutions. This is also in line with the guidelines prescribed by the Memorandum from the Executive Secretary dated 28 January 2021 on the Updated Freedom of Information Manual of the Office of the President Proper. 54 | P a g e Similarly, the Civil Service Commission, DILG, DOLE and LGU, upon, receipt of a complaint which is sufficient in form and substance, will conduct preliminary investigation through the disciplining authority and may create an investigating committee or designate an investigator for such purpose, per Section 17- Action on the Complaint of the CSC 2017 RACCS. Further, the DILG cascades to the LGU the responsibility to create a Permanent Action Team through DILG Memorandum Circular no. 2017-109, to answer queries, concerns, and complaint received through Hotline 8888. 6.2.4 Satisfaction Survey A Satisfaction Survey is developed by the Project and was rolled-out to gauge the people’s perception on the COVID-19 vaccination services they have received. Initial analysis of the survey responses resulted to an overall satisfaction rating of 97.9% from the 6,784 respondents who were vaccinated and answered the survey. This rating is yet to be finalized as there are 19,000 forms left to be encoded. The availability of a third-party agency who can be engaged for the survey response encoding remains to be a challenge. Encoding and analysis is currently done by three members of the M&E team of PCERP. Result of the survey is summarized in Table 22 and Table 23 below: Table 22. Summary of Response to the Satisfaction Survey for Vaccination Activities Very Moderately Very Vaccination Activity/ Stage Unsatisfied Satisfied Unsatisfied Satisfied Satisfied Satisfaction with the pre- 1.87% 1.26% 8.94% 37.34% 47.84% registration process, registration, and services provided in the health education and final consent area. Satisfaction with the services 1.64% 0.52% 5.82% 36.33% 55.66% provided in the actual vaccination the services provided in the 1.69% 0.54% 7.64% 39.14% 50.35% health screening process the services provided in the 1.72% 0.61% 7.93% 37.70% 50.55% post-vaccination monitoring area. Overall Satisfaction 1.66% 0.49% 6.92% 33.95% 46.92% Almost half of the respondents indicated that they were “very satisfied” with every stage in the vaccination process. Highest satisfaction rating is on the actual administration of the vaccine. Disaggregating the results by LGU (Table 23), Manila has the highest satisfaction rating with 59% of the respondents being “very satisfied”. This is followed by Pasay with 56%, San Juan with 55%, Pateros with 46%, Quezon City with 44%, Muntinlupa with 43%, Makati with 41%, Mandaluyong, Taguig and Paranaque with 39%, Pasig with 37%, Las Pinas with 35%, Navotas with 34%, and Caloocan with 32%, of the respondents being very satisfied. All of the LGUs have less than 5% of the respondents who answered they were unsatisfied or very unsatisfied; exception is for Taguig City, where 16% were unsatisfied or very unsatisfied. 55 | P a g e Table 23. Overall Satisfaction Rating Aggregated per LGU Very Moderately Very Vaccination Activity/ Stage Unsatisfied Satisfied Unsatisfied Satisfied Satisfied Pasay City 1.02% 0.59% 6.62% 36.05% 55.73% Pasig City 1.76% 0.94% 12.82% 47.76% 36.71% Las Piñas City 1.10% 1.35% 14.20% 48.84% 34.52% Pateros 1.38% 0.59% 12.45% 39.53% 46.05% Mandaluyong City 1.42% 2.44% 15.65% 41.46% 39.02% Navotas 0.45% 1.34% 16.74% 47.54% 33.93% Muntinlupa City - 1.36% 10.88% 44.90% 42.86% Quezon City 2.89% 1.20% 10.60% 40.96% 44.34% Parañaque City 0.79% 0.79% 10.71% 48.81% 38.89% Caloocan City 2.15% 1.72% 15.89% 48.50% 31.76% Makati City 0.48% 0.48% 14.83% 43.06% 41.15% San Juan City - 0.77% 2.31% 41.54% 55.38% Manila City - 0.81% 11.38% 29.27% 58.54% Taguig City 13.93% 2.46% 7.38% 36.89% 39.34% Other LGUs 2.10% 1.75% 12.59% 33.92% 50.00% 6.3 Resolution/Investigation Process of the Grievance 6.3.1 For DOH, CHD, and Health Care Facilities (DOH- Owned/Managed) The grievance resolution mechanism for grievances within the jurisdiction of the DOH as described in DOH Administrative Order no. 2015-0048 – Revised Procedures on Handling Administrative Disciplinary Complaints in the Department of Health are in Annex S. These grievance resolution mechanism flowcharts provide the processes depending on the category of DOH services jurisdiction (i.e., Central Office, CHD, health facility), rank of personnel complained about, and the service capacity of the health facility concerned. Grievances will be handled at the local level by the respective health facility or LGU, by the Centers for Health Development (CHDs) at the regional level, and at the national level by the Department of Health which will also be in charge of keeping a database of grievances and monitoring of their resolution. The DOH Health Facilities and Services Regulatory Bureau (HFSRB), together with the Centers for Health Development, will conduct investigations, fact-finding on complaints against health facilities, and action complaints against hospitals and other health facilities through the HFSRB- Regulatory Compliance and Enforcement Division. The said unit will streamline the process of handling complaints and hasten its resolution, in coordination with the Regulation, Licensing and Enforcement Division (RLED) of the DOH Centers for Health Development (CHD), where the latter is in-charge of the renewal of licenses of operating health facilities. According to DOH Administrative Order 2012-0012 – Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines, the HFSRB or the Director of the CHD and/or the authorized representative/s shall investigate the complaint and verify if the hospital or other health facility concerned or any of its personnel is liable for an alleged violation and may suspend, cancel or revoke License to Operate (LTO) of the HCF after investigation if found that the provisions of the AO 2012-0012 and related issuances are violated, without prejudice to taking the case to judicial authority for criminal action. 56 | P a g e 6.3.2 For CSC, DILG, LGUs, and LGU-Owned Health Care Facilities The CSC RACCS of 2017 states that a preliminary investigation will be undertaken as a mandatory proceeding whether a prima facie case exists to warrant issuance of a formal charge or notice of charge. The preliminary investigation may be conducted in any of the following manner: ● Requiring submission of counter affidavit or comment and/or other documents from person complained of within 5 days from receipt of complaint which is sufficient in form and substance ● Ex- parte evaluation of records ● Clarificatory meeting with the parties to discuss merits of cases When complainant is initiated by disciplining authority, it or its authorized representative shall issue a show- cause order directing the person complained of to explain within the same period why no administrative case should be filed against the person. The failure to submit a comment, counter affidavit, or explanation shall be considered a waiver thereof and the preliminary investigation may be completed even without the comment, counter affidavit, or explanation. The right to counsel may be exercised even during the preliminary investigation. Preliminary investigation shall commence within non-extendible period of 5 days upon receipt of complaint by disciplining authority and shall be terminated within 20 days thereafter. Disciplining authority may extend such period in meritorious cases. Within 5 days from termination of the preliminary investigation, the investigating body shall submit the Investigation Report with recommendation and complete records of the case to disciplining authority, subject to treatment with confidentiality. If a prima facie case is established after preliminary investigation, the disciplining authority may issue either a formal charge or notice of charge in accordance with Rule 5 or the 2017 CSC RACCS. In absence of a prima facie case, the complaint/grievance shall be dismissed. 6.3.3 For Construction- Related Grievance of the Workers A Contractor’s Personnel Grievance Redress Mechanism will also be developed by the contractors for the civil works components, in compliance with the ESF requirements in the Contract. The monitoring and reporting of this GRM will also be the same as that of the main Project GRM. Resolution of the worker’s grievance will follow the Contractor’s Personnel Grievance Redress Mechanism. In case the worker’s complaint is not resolved, it may be elevated to the DOLE, with the resolution process in Annex T. 6.3.4 Closing of Grievance Once all possible redress has been proposed and if the complainant is still not satisfied, they should be advised of their right to legal recourse. 6.4 Operationalization of the GRM The operationalization of the GRM will similarly consider the multiple sources of GRM, such as those of relevant key agencies, as it links to the dedicated GRM in the DOH established as part of the Project. The GRM is monitored by all project recipient facilities with the report submitted online monthly to the DOH, through the PCERP Team. The monitoring forms and online dashboard is in Annex U. Following engagement and feedback, the GRM and its operationalization takes into account the needs of various affected groups including from indigenous peoples and ethnic minority representatives and organizations to ensure that methods are culturally appropriate and 57 | P a g e accessible and take account of their customary dispute settlement mechanisms, as appropriate. Consultations on the GRM were conducted with the implementers and stakeholders as participants, such as the project recipient facilities, DOH CHDs, LGUs, professional organizations, and civil society organizations. Below, in Table 24 is the list of participants to the online GRM consultation conducted. Table 24. List of Participants in the GRM Online Consultation Session 1 Session 2 24 June 2021 25 June 2021 1. Department of Health – Central Office 1. Department of Health – Central Office • Bureau of International Health Cooperation • Bureau of International Health (BIHC) Cooperation (BIHC) • Disease Prevention and Control Bureau • Disease Prevention and Control Bureau (DPCB) (DPCB) • Administration and Financial Management • Administration and Financial Team – Complaint Handling Unit (AFMT– Management Team – Complaint Handling CHU) Unit (AFMT–CHU) • Knowledge Management and Information • Knowledge Management and Information Technology Service (KMITS) Technology Service (KMITS) • eHealth Program Management Office • eHealth Program Management Office 2. DOH Centers for Health Development • BARMM Ministry of Health • Metro Manila CHD 2. DOH Centers for Health Development • Cordillera Administrative Region (CAR) • Western Visayas CHD CHD • Ilocos CHD • Central Visayas CHD • Cagayan Valley CHD • Eastern Visayas CHD • Central Luzon CHD • Zamboanga Peninsula CHD • CALABARZON CHD • Northern Mindanao CHD • MIMAROPA CHD • Davao CHD • Bicol CHD • Soccsksargen CHD 3. Other Government Agencies • Caraga CHD • Department of Labor and Employment 3. Other Government Agencies (DOLE) • Central Office – Bureau of Labor Relations • Department of Environment and Natural Resources (DENR) • Central Office – Bureau of Workers with • Strategic Communication and Initiatives Special Concerns Service – Stakeholder Management and Conflict • Regional Offices • Resolution Division (SCMS–SMCRD) • Department of Public Works and Highways • Public Assistance Unit Office (DPWH) • Central Office – Stakeholders Relation • Regional Offices Services • Central Office – Bureau of Quality and • Department of the Interior and Local Safety Government (DILG) • Regional Offices • Central Office – Legal and Legislative Liaison Service – Appellate Division (LLLS–AD) • Civil Service Commission (CSC) • Regional Offices • Central Office – Public Assistance and • Presidential Complaints Center (PCC) Information Office (PAIO) • Regional Offices – Public Assistance and • Contact Center ng Bayan (CCB) Complaints Desk (PACD) • Field Offices– Public Assistance and 4. Project Recipient Facilities Complaints Desk (PACD) • Anti- Red Tape Authority (ARTA) 5. Local Government Units 58 | P a g e • Investigation, Enforcement and Litigation • Provincial/City/Municipal Health Offices Office (IELO) • Legal and Public Assistance Office (LPAO) • Provincial/City Environment and Natural Resources Offices 4. Project Recipient Facilities • Western Visayas Region 5. Local Government Units • Central Visayas Region 6. Provincial/City/Municipal Health Offices • Eastern Visayas Region 7. Provincial/City Environment and Natural • Zamboanga Peninsula Resources Offices • NCR • Northern Mindanao Region • CAR • Davao Region • Ilocos Region • Soccsksargen • Cagayan Valley Region • Caraga Region • Central Luzon Region • BARMM • CALABARZON 8. Professional Organizations • MIMAROPA • Philippine Society for Microbiology and Infectious Diseases (PSMID) • Bicol Region • Philippine Association of Medical Technologists, Inc. (PAMET) 6. Professional Organizations • Philippine Society of Public Health Physicians (PSPHP) • Philippine Medical Association • Public Health Communications Advisory Network (PHCAN) • Association of Municipal Health Officers of • Civil Society Organizations the Philippines • Philippine College of Physicians • Philippine Task Force for Indigenous Peoples (TFIP) • Philippine Nurses Association • Indigenous Peoples Movement for Self- Determination and Liberation (IPMSDL) 7. Civil Society Organizations • Tebtebba Foundation • Hard of Hearing Group Philippines • Boses ng May Kapansanan sa Pilipinas (BKP), Inc. • Philippine Federation of the Deaf • Coalition of Services for the Elderly, Inc. (COSE) • Autism Society of the Philippines • Federation of Senior Citizens Association of the Philippines (FSCAP) • Psychosocial Disability Group • Norfil Foundation, Inc. • Down Syndrome Association of the • Philippine Business for Social Progress Philippines (PBSP) • Katipunan ng May Kapansanan sa Pilipinas • Caucus of Development NGO Networks (KAMPI) (CODE-NGO) • Alyansa ng may Kapansanang Pinoy, Inc. • Philippine NGO Council on Population, (AKAP- Pinoy) Health and Welfare (PNGOC) • Regional Association of Women with • Kythe Foundation Disabilities • Alay sa May mga Kapansanan Association, 9. World Bank Inc. • Philippine Mental Health Association (PMHA) 8. World Bank Further queries, concerns, or grievances on the project may be relayed to the Project Management Team through https://bit.ly/CERPFeedback. 59 | P a g e 7.0 Monitoring and Reporting 7.1. Involvement of Stakeholders in Monitoring Activities The DOH may consider involving particular stakeholders in the monitoring of project activities and the implementation of the SEP and ESMF during the project implementation. 7.2. Monitoring Indicators The Implementation Status and Results Report (ISR) indicator for the COVID-19 Investment Project Financing (IPF) will be observed to ensure that there is a feedback loop for citizens and stakeholders that will allow their grievances to be heard and resolved. The ISR will include the percentage of grievances resolved within the timeframe specified in the GRM for stakeholders. The ISR indicator will be monitored throughout the life of the project. Promotion and awareness on the GRM will be done continuously. Coordination with relevant LGUs/DOH offices will be conducted to record grievances and their resolutions, and to ensure that the GRM is part of the monitoring and evaluation database and system. The Key Performance Indicators (KPIs) will also be monitored by the Project monthly including the following parameters: ● Number of public hearings, consultation meetings and other public discussions/forums conducted annually (even if virtually); ● Number of grievances received monthly and number of those resolved within the prescribed timeline ● Number of press materials published/broadcast in the local, regional, and national media Figure 12. Template for the Monitoring of the SEP Month/Year: Monitoring of Public Discussions/Forums Date Activity Target Issues and Actions to be Status/ Stakeholder Feedback of Taken Remarks Stakeholders Total no. of public discussions/forum for the month: 60 | P a g e Figure 13. Template for Monitoring of Published/Broadcasted Materials in the Local, Regional, and National Media Type of Material Level of Issues Target Actions to be Status/Remarks on Date (News Article, Org Press Publication/Broadcast Raised and Stakeholder Taken Actions to be Taken Release, Annual Report, etc. ) (National/Regional/Local) Feedback 7.3 Monitoring of Adverse Events Following Immunization (AEFI) The WHO defines Adverse Event Following Immunization (AEFI) as any untoward medical occurrence which follows immunization, and which does not necessarily have a causal relationship with the usage of the vaccine. If not rapidly and effectively dealt with, AEFIs can undermine confidence in a vaccine and ultimately have dramatic consequences for immunization coverage and disease incidence. AEFIs The National Adverse Events Following Immunization Committee was created to monitor and assess the possible adverse effects of the COVID-19 vaccine on individuals. The roles and responsibilities of the Committee include the following: • Review all reported serious and cluster of AEFI cases presented for expert opinion and provide a final causality assessment of the AEFI cases as well as the cases that were not classified by the Regional AEFI Committee. • Ensure evidence-based causality assessment by recommending further investigation and data collection as needed. • Make final decisions on causality assessment of inconclusive investigations. • Ensure standard protocols for AEFI surveillance and investigation are correctly followed. • Engage with other national and international experts when requirements arise in establishing causality and vaccine quality issues. • Provide recommendations to the National Immunization Program, EB and National Cold Chain Manager on improving immunization service delivery, compliance with injection safety and effective vaccine management based on lessons from the AEFI cases. • Serve as technical advisory group on vaccine and immunization safety-related issues of highest consideration such as immediate recall of vaccine from the market or temporary/permanent withdrawal of a vaccine from the immunization program. • Serve as resource person in other AEFI related meetings, conferences or capacity building activities as requested. AEFIs are classified as a notifiable health event of public health concern in accordance with the 2020 Revised Implementing Rules and Regulations of RA 11332: Mandatory reporting of Notifiable Diseases and health Events of Public Concern Act. All health care providers and vaccination sites shall able to detect and notify AEFI resulting from COVID-19 vaccination until one year after the latest dose administered. This is in line with the Emergency Use Authorization grant from the Food and Drug Administration (FDA) for COVID-19. The AEFI reporting process is provided in the DOH Circular 2021-0101: Clarification on the Provisions of DM 2021-0099 entitled “Interim Omnibus Guidelines for the Implementation of the NDVP for COVID-19”. The reporting and monitoring process upon consultation with a potential AEFI case is guided by the following: 1. Health care provider shall ask for vaccination history of the patient seen and classification of AEFI seriousness based on the established definitions. 2. Prioritization of a “serious AEFI” condition in notification, reporting, and response efforts. By definition, serious AEFIs are cases that (a) result to either death; hospitalization or prolonged existing hospitalization; persistent or significant disability or incapacity; congenital anomaly or birth defect; (b) life threatening AEFI; (c) AEFI that requires intervention to prevent (a) and (b); and (d) AEFI classified by DOH, as recommended by the National AEFI Committee, as medically important event or reaction. 3. Upon detection, the health care provider shall accomplish the case investigation from (CIF) for AEFI (Downloadable at bit.ly/CIF-2021). 4. Reporting of non-serious AEFI cases requires filling out of certain fields on the first page of the CIF for AEFI. In case of a serious AEFI case, the CIF shall be filled out immediately. 5. In case of serious AEFI, immediate notification shall be done by the health care worker to their Respective LVOC and/or LESU; RVOC and/or Regional Epidemiology and Surveillance Units (ESU) based on locally set-up mechanism. 6. Immediate notification to DOH Epidemiology Bureau using the format below, sent through this number: 09278234328 (Globe) or 09392108316 Format for AEFI Notification Name, Age, Sex, Hospital, Date of Vaccination, Signs and Symptoms, date of Onset of Symptoms, Management Outcomes 7. The hospital ESU shall daily encode in the VigiFlow [vigiflow.who-umc.org], the page 1 of the CIF for all detected AEFIs, on a daily basis before 6PM. 8. In case of non-hospital health care setting such as local health offices, government and non-government non hospital vaccination site, the page 1 of the CIF shall be submitted for encoding by their LVOCs, through their local ESUs. Local ESUs then encode all received reports directly to Vigiflow, daily before 6PM. 9. For serious AEFIs, the local ESUs and hospital ESU shall report to their respective RESUs, by submitting updated CIFs and daily updating of the latest clinical status, investigation status, and other information. 10. The Vaccine Safety Surveillance and Response Teams of the LVOCs shall regularly coordinate with all government and non-government health care providers within their area of jurisdiction to capture the AEFI cases, monitor timelines of notification, render appropriate clinical management/ care coordination/referrals, and comprehensively investigate serious AEFIs. 11. The FDA Regional Offices, in line with their duty to monitor full product life cycle of authorized vaccines, shall regularly check the Vigiflow for the newly encoded AEFI reports, thrice daily. 12. FDA Regional Offices shall confer immediately with the RESU to validate and conduct investigation on the newly notified AEFI cases. 13. FDA Regional Offices shall be the lead investigating unit in specific sections of the CIF, pertaining to vaccine product, quality, and transport. 63 | P a g e Figure 14. Process Flowchart for AEFI Surveillance and Response in the Context Of COVID-19 Vaccine Administration Figure 15. Process Flowchart for Responding to Serious AEFIs of COVID-19 Vaccine 64 | P a g e Table 25. WHO-recommended safety surveillance activities for all countries introducing COVID-19 vaccine regardless of AEFI surveillance capacity Objective Recommended AEFI surveillance activities Strengthen routine passive ● Conduct learning development interventions on AEFI surveillance reporting identification and reporting of AEFI for systems for the health care professionals. management of increased ● Update, print and distribute AEFI surveillance tools. frequency or severity of ● Use both vaccine tracking information and passive AEFI AEFI reports (mild, reporting information to perform vaccine-specific safety moderate and severe) analyses. ● Review and adapt processes for timely reporting, review and data sharing nationally, regionally and globally (e.g. uploading data to global databases such as the WHO VigiBase) ● Develop clear standard operating procedures (SOPs) for the coordination process between the NRA, NIP/EIP, and other institutions with responsibilities for AEFI surveillance. ● Consider coordination of activities with Public Health Emergency Units. ● Consider setting up AEFI committees at subnational as well as national level, particularly in large countries Investigate potential AEFIs ● Prepare investigation teams and train them for AEFI causing concern, such as investigation activities that are relevant in the population clusters, serious events, being vaccinated. programmatic errors, ● Update, print and distribute AEFI investigation tools to community concerns obtain information on specific outcomes. ● Ensure the collection and storage of all relevant data to help make a causality assessment (AEFI reporting and investigation forms, clinical case record, laboratory reports, autopsy reports, etc.) Perform systematic ● Constitute an National AEFI committee to review and causality assessment of respond to AEFI safety signals and public concerns or AEFIs causing concern contact the WHO Country or Regional Office or send email to gvsi@who.int for assistance. ● Provide learning development interventionson causality assessment processes using WHO causality assessment guidelines for members of the National AEFI committee. ● Ensure regular updates to the Committee members on COVID-19 vaccine development and safety data, including safety reports from ongoing phase III clinical trials or any events reported in clinical trials. ● Foster and use the committee’s expertise to identify AEFI cases in need of further investigation, such as AESIs. 5. Anticipate an increased number of AEFI reports that will need to be reviewed and consider including AEFI committees at subnational as well as national level, particularly in large countries. Use AEFI and disease ● Regularly review and report AEFI surveillance data, surveillance data to detect particularly those relevant to AESIs or other conditions potential safety signals or identified during pre-licensure COVID-19 vaccine clinical clustering of events trials. ● Explore the use of disease surveillance data to complement AEFI surveillance systems for the detecting of AESIs, if indicated. 65 | P a g e ● Consider use of early signal detection methods, especially for certain AESIs. Prepare comprehensive ● Outline roles and responsibilities of key stakeholders plans to respond rapidly to (including the private sector) for the implementation of any COVID-19 vaccine- safety surveillance activities and responding to vaccine- related event related events. ● Keep stakeholders up to date with COVID-19 vaccine safety information. ● Communicate with WHO regions and globally and share data on outcomes of AEFIs and AESIs in a rapid, timely and regular manner. Address concerns of ● Create and share a COVID-19 vaccine safety healthcare professionals communication plan with relevant stakeholders. and maintain community ● Train and support personnel at all levels to address confidence. (Link to concerns that may arise before, during and after COVID-19 communication module to vaccine introduction. be added) ● Develop, print, and distribute messages concerning the safety COVID-19 vaccines Note: Objectives and Recommendations were adapted from the WHO COVID-19 Vaccines Safety Surveillance Manual: Module on Establishing surveillance systems in countries using COVID-19 vaccines, 2020. Figure 16. AEFI Surveillance Cycle The DOH has also been developing the ‘Standard Operating Procedure (SOP) in Handling Serious AEFI Cases in the Region’ with the aim of providing a standardized guideline to all epidemiology and surveillance units towards a robust implementation of safety surveillance and in order to maintain the public confidence in the national immunization program of the Department of Health. This SOP covers the general parameters in pursuance of AEFI surveillance and response across the private and government health facilities, with reference to the following guidelines: ● World Health Organization. (2014). Global manual on surveillance of adverse events following immunization. 66 | P a g e ● Department of Health – National Epidemiology Center. (2014). Adverse events following immunization (AEFI): A manual of procedure for surveillance and response to AEFI. ● DOH Administrative Order no. 2016-0006: Revised Guidelines on Surveillance and Response to Adverse Events Following Immunization Currently, the AEFI guidelines stated in the NDVP has been communicated to the implementers and the public through the series of consultations on the NDVP and the learning development interventions for vaccinators and DOH CHDs conducted by the DPCB. Once the said SOP had been finalized, consultations and trainings will be conducted by the DOH. 7.4. Reporting Back to Stakeholder Groups The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Monthly summaries and internal reports on public grievances, enquiries, and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. The monthly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways: ● Reporting on the status of KPIs and ISR indicators ● Publication of a stand-alone annual report on the Project’s interaction with the stakeholders ● The monthly and yearly monitoring forms will be used for the reporting to stakeholders. 67 | P a g e Annex A. Results and Summary of Key Feedback in the National Stakeholders Consultation on the Parent Project August 18-19, 2020 Topic Stakeholder Comment / Feedback Response Stakeholder Save the Query on the difference in the engagement The SEP is a guide for stakeholder engagement Engagement Children among groups or if the groupings were made to throughout the project implementation. It is a living Philippines facilitate consultation document which will be revised as appropriate, considering the feedback of the stakeholders. The In view of the prolonged pandemic and its wide SEP distinguishes between affected and interested impact, it may also be necessary to review who stakeholders and identifies vulnerable stakeholders are affected. that may require special attention. Philippine VAWC is an important issue. We should raise VAWC and GBV are highlighted in the ESMF and Coalition on the awareness, provide information on how to SEP and awareness will be integrated in the project UNCRPD access, and provide help desks. activities. Saint Anthony Risk of transmission is high for patient watchers The patient watchers are covered by the guidelines Mother and within hospitals. Guidelines for control and on the rational use of personal protective equipment Child Hospital mitigation measures of transmission and (PPE). There are no accommodations for them due to accommodation for them for social distancing is the high number of cases needed to be catered and recommended to be provided. the risk of infection. Strengthening MIMAROPA Health care manpower is the main challenge, The project activities include mostly provision of capacity in the Center for especially in geographically isolated and equipment to build COVID-19 response capacity and regions Health disadvantaged areas (GIDAs). Health care some repairs of health care facilities and laboratories, Development facilities are existing but there are no applicants. including the isolation rooms. (CHD) The locally stranded individuals or LSIs are major There will also be a capacity building component for CARAGA CHD sources of COVID-19 infection (56%) in the health care workers. MIMAROPA region. Ways in which the project can help address this problem are sought. Project consultations and trainings will be provided. Moreover, ways to strengthen capacity at the These will mostly be online due to challenges in the regional and facility levels are sought. implementation of the project due to the pandemic. Services for National The accessibility of services and infrastructure The DOH Health Facilities Development Bureau persons with Commission on (e.g. ramps) and hospitalization support for (HFDB) has reported that there are 10 provincial disabilities Disability Affairs PWDs who will contract COVID-19 should be hospitals which currently have Filipino sign language (PWDs) and (NCDA) provided. It was also pointed out that each type interpreters (FSL) who are mostly social workers children of disability has specific needs and support employed by the hospital. They are as follows: Filipino Sign services which may need capacity building of Language health care personnel. Region Hospital Access Team for NCR Jose Fabella Memorial Hospital, COVID-19 There is a need for virtual sign language Lung Center of the Philippines interpretation services in health care facilities, I Mariano Marcos Memorial Medical Center, Philippine testing centers, and quarantine/isolation areas. Ilocos Training and Regional Medical Alliance of There are networks who may be able to provide Center, Persons with sign language interpreters but they are mainly Region I Medical Center Chronic Illness based in Manila. TFSL interpretation in health IV Batangas Medical Center (PAPCI) facilities through video calls provided by service VI Corazon Locsin Montelibano Memorial providers is recommended. It was also pointed Regional Hospital, Philippine out that the DOH and DILG should comply with Don Jose Monfort Memorial Medical Center Federation of the RA 11106 or the Filipino Sign Language Law by Extension Hospital Deaf providing such services in health facilities, VII Vicente Sotto Memorial Medical Center workplaces, and the media. XII Cotabato Regional Medical Center Philippine Guidelines on FSL interpreter qualifications, National including skills and ethical considerations is According to the Degenerative Disease Office of the Association of needed. Disease Prevention and Control Bureau (DPCB- Sign Language DDO), the new education curriculum of social workers Interpreters Access to information for PWDs is also a main has integrated basic FSL. It should be noted that (PNASLI) concern as sign language interpretation is still hospitals have at least 1 social worker. It would be very limited. Unlike national TV news, regional TV ideal if the employed social worker has background Live Haven, Inc. news do not have sign language interpretation. on FSL. Grassroots organizations have turned to social The Metro Manila and CALABARZON Centers for Philippine media to disseminate information. They Health Development (CHDs) are conducting Coalition on the requested that the project stress the importance community- based trainings on FSL. It is planned to UNCRPD of access to information through DOH, even if the cascade the learning development interventionsto the COVID IEC funds come from a different donor other regions in 2021. source. 69 | P a g e Philippine Assistance to the deaf in finding hospitals which The Congress is also discussing the provision of FSL Pediatric Society are deaf- accessible and providing counseling interpreters in health facilities. However, the timeline (PPS) services should be given. for this is not yet known. Pediatric There is a need to accommodate and entertain The Project will be conducting a baseline assessment Infectious careers/personal assistants of PWDs and on the capacity of the recipient hospitals to provide Disease Society children in health care facilities, testing centers, accessible health services to vulnerable groups, of the and quarantine/isolation areas. including provision of virtual FSL services based on Philippines parameters such as availability of devices and (PIDSP) Vaccination for children and other vulnerable internet connection. The baseline assessment will sectors should be provided. also cover GBV, VAWC, and IPs. Based on the results of this assessment, the Project in coordination with The PWD groups have expressed their interest in HFDB and DPCB- DDO, will determine the feasibility being engaged and involved in the project of the virtual FSL services which would be in implementation. The need to recognize partnership with the FSL interpreters and PWD vulnerable groups, e.g., PWDs and IPs, were representatives to be financed by the Project. pointed out. The DOH Health Promotion and Communication Services (HPCS) has no COVID-19 health promotion materials for the PWDs. Currently, they only have the 30- second video with FSL interpretation for polio. The HPCS and the DPCB- DDO have included PWD- accessibility in their Communication Plan for 2021 which will include printer materials with Braille and videos with sign language. The DPCB- DDO in partnership with the Philippine Information Agency (PIA), have previously developed a Communication Plan for PWDs which was also presented to the PWD CSOs. The concerns of PWDs, particularly accessibility, will be considered in the activities under Component 3, Project Management and Monitoring and Evaluation, of the project by integrating into the prevention and preparedness activities. 70 | P a g e Project management and monitoring should ensure that the improved capacity of the health care facilities results in improved access for PWDs. The PWDs and other vulnerable sectors will be highly considered in the project. The ESMF will also be revised to include Republic Acts 11106 and 7277 and Batas Pambansa 344 to further strengthen the framework. The request for vaccination of children and other vulnerable groups as well as the guidelines for carers/personal assistants of PWDs and children will be relayed to the DOH DPCB, HFDB, and the DOH IATF Focal Team. The PWD CSOs will be requested to submit a formal request to the IATF (iatfsecretariat@gmail.com) and DOH regarding the grievances of the carers / personal assistants. The HFDB, with assistance from the Project, will develop a policy issuance to consider the carers of PWDs and children in health facilities. Indigenous Tebtebba It was recommended to include disaggregated The DOH Epidemiology Bureau (EB) which is in- Peoples Foundation data for Indigenous Peoples related to the charge of the data management on COVID-19 does COVID-19 response. not have disaggregated data for IPs. The group also relayed that they have conducted The request has been communicated to EB. The an assessment on IPs and COVID-19 which they Tebtebba Foundation has submitted their request for may share with the Project Team. data on Indigenous Peoples (identified as to their ethnicity) infected by COVID-19 and history of infection aside from the usual data provided to the EB. The Project will further assist Tebtebba Foundation on this request. 71 | P a g e To ensure that IPs will have access to the COVID-19 related health services, the DOH Bureau of Local Health Systems Development (BLHSD) has issued Department Circular 2020-0192 last April 2020 entitled ‘Ensuring that people in GIDAs, Indigenous Cultural Communities/Indigenous Peoples are well- informed on COVID-19 and have access to Temporary Treatment and Monitoring Facilities and Referral Hospitals.’ BARMM Community and Coordination with BARMM MOH and project BARMM is covered by the project. The Amai Pakpak Family Services coverage inclusion was asked. Medical Center is included in the tentative list of International recipient facilities. Coordination with BARMM MOH will be done through the Field Implementation and Coordination Team- Visayas and Mindanao Grievance Save the It was raised that if the grievance pertains to the It would be good if the issue will be resolved at the Redress Children service received from a local health facility or local level. Grievance may be elevated to regional and Mechanism Philippines LGU, submitting the grievance to them may national levels, following the GRM process. prevent the community to raise concern. ESMF Philippine The provision of pneumococcal, flu, and hepatitis This will be considered in the project activities. It has Medical B vaccines for health workers was recommended. also been relayed to DOH DPCB, as it is in-charge of Association vaccination initiatives (not financed by the Project). It should be noted that these vaccines are covered in the Expanded Program on Immunization (EPI) of DOH. The infectious waste- generating establishments as There is a need to address health hazards well as the waste service providers or treatment, brought about by the improper disposal of face storage and disposal facilities (TSDs) should comply masks. with the DENR EMB guidelines for waste generators. The ESMF includes measures to improve waste management and will be further enhanced through an ongoing audit of current infectious waste management at health facilities. The audit tool developed by the Project will provide the health facilities self- assessment tools to monitor waste 72 | P a g e disposal. Education campaigns and information materials on infectious wastes and proper disposal will be further promoted. The project will not develop additional guidelines as there is limited construction activities involved. Workers will be provided with face masks by the contractors and social distancing measures for Occupational safety and health risks during construction will be adhered to. The contractors will construction should be addressed. It was inquired also be asked to prepare the Environmental and whether specific guidelines will be issued due to Social Management Plan (ESMP), Environmental the COVID-19 pandemic, aside from the usual Codes of Practice (ECOP), Labor Management OHS and DOH issuances. Procedures (LMP), and Contractor’s Personnel Grievance Redress Mechanism to minimize occupational risks in the civil works components. The Republic Act 11058, Department Order 198, and the IATF issuances set liability on the contractor. To further highlight the contractor’s responsibility, the liability clause will be explicitly stated in the contract. The ESMF includes Labor Management Procedures. Cebu South Medical Center The coverage of medical bills and wages of workers who will contract COVID-19 was queried. Experience on symptomatic workers in which the hospitalization costs and compensation were covered by the hospital was relayed. Recipient Pangasinan The health facilities which will be covered by the The hospitals to be included as recipients of the World hospitals and Provincial Health project and the equipment to be given were Bank loan are the 70 retained DOH hospitals and the equipment Office asked. 30 hospitals part of the Universal Health Care implementation sites which were first approved by the NEDA. Luis Hora Other hospitals not part of the project may be covered Memorial by other projects such as that of ADB. 73 | P a g e Regional The hospitals invited in the National Stakeholders Hospital Consultation are included in the initial list of The recipient facilities were selected based on recipients recommended by the HFEPMO. The capacity to test, i.e., ongoing application for local government units through the provincial, accreditation. city, and municipal health offices were invited for their information and guidance on the project. The local government units through the provincial, Mariano Marcos city, and municipal health offices were invited for their Memorial It is envisioned to expand the testing in the rural information and guidance on the project. Hospital and areas also. However, the project recipients are Medical Center chosen based on the ongoing application for It was also clarified that the project is different from testing accreditation. the existing project of HFEPMO. The HFEPMO will finalize the list of hospitals and equipment to be distributed. Project Mariano Marcos The project requirements and expectations from There will be no project proposal required as the Implementatio Memorial recipients, e.g., proposal, timelines, funding health care facilities are chosen beneficiaries of the n Hospital and approval, project termination, and monitoring and project. It will follow the usual protocol on accepting Medical Center evaluation. donations from the DOH Central Office, such as accomplishing the Deed of Donation, i.e. formal transfer of ownership and acceptance from DOH to the recipient hospital. The recipient is expected to maintain the equipment for its sustainability. Post- evaluation and monitoring may also be conducted by the Project Team. The HFEPMO clarified that there will be mostly retrofitting/upgrading of the existing hospitals and that currently, only the National Center for Mental Health and Dr. Jose Rodriguez Memorial Hospital will have new constructions. The list of construction works will be sent by the HFEPMO. 74 | P a g e For the safety of the workers, PPEs will be worn and the hierarchy of controls will also be observed. Corazon Locsin It was queried if the civil works component of the Engineering controls and substitution will also be Montelibano project will cover only the existing facilities. observed. Memorial Regional Hospital Project Tebtebba The COVID-19 recovery will take a “heal as one” To extend the benefits of the project, the recipient Sustainability Foundation approach, aside from the direct results of the hospitals will have to and are expected to take good project, entailing community mobilization. care of the project donations, such as the equipment. Learning development interventionsof personnel will It was asked if there would be an exit strategy to also be part of the sustainability initiatives. guaranteed sustainability of project benefits. It was also inquired how the exit strategy ensure In areas with IP, the ESMF includes measures to that indigenous health care, knowledge and coordinate with traditional health care providers, management systems, as well as traditional consistent with DoH’s Guidelines on the Delivery of health care providers would be acknowledged Basic Health Services for Indigenous and recognized, given their significant roles in Peoples/Indigenous Cultural Communities. community health. 75 | P a g e Annex B. Key agreements in the Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment December 7, 2020 Topic Stakeholder Key Agreement/ Recommendation General Guidelines UP College of Medicine To include communication and health education in the specific objectives (UPCM) To include and to prioritize the widespread communication and understanding of COVID burden and its prevention To include and prioritize the widespread communication and understanding of COVID burden and its prevention DOH Reconsider statement that COVID-19 vaccine is a ‘public good’ as this term is different in economics UP College of Public To consider the reciprocity Principle under WHO SAGE framework Health (UP CPH) Financing and UPCM To specify the establishment of plans and strategies to make the country vaccine ‘resilient’ Funding able to address setbacks, disruptions, crises that could destroy the immunization Mechanisms programme with a view to ensure programme continuation Identification of UNICEF To identify the minimum list of the priority population Eligible Population DOH Epidemiology Inclusion of the term 'herd immunity' Bureau (EB) Coalition for People's Exclusion criteria must also be mentioned apart from eligibility Right to Health (CPRH) Supply Chain and UNICEF To have the supply chain management plan linked to the overall EPI cold chain management Management of plan and to use the evidences from the VRAT/VRAF assessment and EVMA Health Care Waste recommendations and Injection Safety Office of the Inclusion of the statement ‘Facilitate procurement through various mechanisms allowed Presidential Adviser on under existing laws, rules, and regulations through bilateral, multilateral and other financial the Peace Process modalities (e.g., COVAX Facility, etc.)’ (OPAPP)/ National Incident Command- Emergency Operations Center (NIC-EOC) 76 | P a g e Human Resource Philippine Pharmacists To include a provision for the active involvement of the barangay health workers at the level Management and Association (PPhA) of the community Training To include learning development interventionsof uniformed men to understand the proper handling and storage of these vaccines DOH EB To include 'health care waste' management plan DOH DPCB Consider to include in the definition of terms who are the members of the committees such Occupational Diseases as NITAG, etc. Division (ODD) Vaccine Acceptance UP CPH To identify and consult the end-users of the data management system with the other and Uptake stakeholders in the process of developing the information system (IS) to come up with a user-friendly digital system To train end-users in the functionality of the IS to minimize use of parallel (often paper- based) technologies which arise with non-familiarity with the new system Vaccine Safety UPCM To have an active surveillance system rather than just a passive surveillance system Monitoring, Management of There is a need for media management when it comes to AEFI reporting AEFI and Immunization Safety Immunization CPRH There should be communication of exclusion criteria to be specified apart from eligibility. Registration, DOH EB A phased-in profiling of eligible populations based on areas with high burden of disease and Monitoring and Data priority population groups shall be conducted. Management Systems Roles and OPAPP/NIC-EOC Task Group on Procurement and Finance be led by the Department of Finance with DBM Responsibilities and DOH as members One of the Task Groups to develop a strategic map with necessary indicators and targets for easy monitoring To include the number and general description of the NITAG’s composition DOH EB To include FDA in the agencies/ offices to be provided with recommendations by the NAEFIC PPhA Task Group on Cold Chain and Logistics to consider mobilizing pharmacies to be center for pharmacy-based immunization CPRH To review the implications on the implementation if Phase III clinical trials and the implementation of the vaccines with EUA will overlap 77 | P a g e Annex C. Key agreements in the Public Consultation on the National Strategic Policy Framework for COVID-19 Vaccine Deployment January 8, 2021 Topic Stakeholder Queries/Recommendations DOH Responses Presentation of Dr. Quizon Why are indigent populations among priority groups? DPCB answered that it will be discussed the National Their risk is no greater than a rich person. Is there during the next NITAG meeting to discuss the COVID-19 evidence that those who got infected so far, are order of priority Deployment and indigents? Vaccination Plan League of Will the National Government's purchase of vaccines be DPCB said yes and all vaccines will be Provinces of provided to the LGUs, as identified according to the coursed through the LGUs. the IATF's priority plan? Philippines Mr. Jose, Jr. Order of priority for non- medical government officials Dir. Sudiacal of DPCB responded that such as Mayors; local Gov’t officials and Government Government workers aside from those workers in Government offices? Also Congressmen and mentioned in Priority A area under Priority B. Senators? Far Eastern How will the vaccinees be notified of their vaccination The LGU and the implementing unit such as University - schedule? the health facility will determine your schedule. Nicanor On the other hand, a digital system will notify Reyes What is the implication of the vaccine pre-registration you of your vaccination schedule date. Medical already being done by various LGUs (i.e., online Foundation registration via Google Forms) with the proposed plan of As of now, DOH is working closely with the School of vaccine deployment? LGU to marry existing information systems Medicine and the COVID-19 Vaccine Electronic Immunization Registry (CEIR). Ideally, only those registered in the CEIR will be provided with a unique QR Code, and thus, eligible to be vaccinated. Ms. Ramos In the vaccination program and asked if the HCWs will The DOH is requiring each implementing unit be prioritized. However, this will impact the resources to do micro planning to ensure that needed for the vaccination program as well as contingency plans are available if a health continuous health services. In particular for the first worker is not able to report due to adverse round of 1.7M HCWs, they will need time off after reactions. And the vaccination activity is done 78 | P a g e vaccination due to the expected side effects. Will there through a determined schedule basis. Thus, be a number of people who will supplement the HCWs the health facility should be able to allocate while they are recuperating? How long will they be given adequate human resources for the conduct of time off? continuous health services. Ms. Kraft If remaining indigent population has been indicated as a The vaccines will be given to eligible priority population group, will this group include those population groups. As of now, data shows that who are below 17 years old? I ask because some of the COVID-19 vaccines can only be administered vaccines have not been tested on children. to >16 years old and above. Ms. Rabe Can the LDRRM Fund or Quick Release Fund be used Unfortunately, we do not have any jurisdiction for the purchase of vaccines? on this. We will forward your concern to DBM. As reiterated by Usec. Cabotaje, the vaccines will not be available commercially until late 2022. Procurement will be coursed through DOH. Ms. Nievera Will there be instances where vaccines will be used The vaccines will be given to eligible interchangeably - meaning another vaccine is used for population groups. As of now, data shows that the 2nd dose? How do we monitor/manage/avoid such COVID-19 vaccines can only be administered cases? to >16 years old and above. Mr. Songco Who is allowed to vaccinate? Doctors and nurses. Ms. Luzande What kind of distribution model will the government It will be a centralized hub. employ? Centralized, Hub and/or Decentralized? HTAC Evaluation Mr. Ybiernas What type and brand of vaccine to be given to the Filipino Dr. Guerrero mentioned that there is a need Framework for People? Do we have a list of brands to consider? for EUA before we can use and administer the COVID-19 vaccine. The FDA has yet to issue EUA to any Vaccines vaccine but they have received at least 2 applications as of the moment. Ms. Villa Regarding prioritization of vaccines to be given, will it be Yes, we are adhering to the principles of equity considered to prioritize giving to those LGUs who have and reciprocity. The national government will not manifested procurement of their own vaccines? provide vaccines to all LGUs/areas, following the priority eligible population. Cotabato If the individual has already been infected,what priority Dir. Arevalo mentioned that DOH through the Regional level will they belong to? Health Promo Bureau has done social 79 | P a g e Medical listening and surveys. Demand Generation is Center headed by the PCOO along with DOH, DICT Ms. If the EAU will be given to DOH only for purposes of and PIA. Maderazo intense side effect monitoring, does it mean that the LGUs with alleged budget allocation for their own Conduct of a series of townhall meetings have vaccine procurement is not necessary? started to increase awareness about the Laban The acceptability of vaccination among Filipinos is only vaccination. Consumer 50% as a result of the surveys. Therefore, what is the plan of the government to increase acceptance of the US experience: Vaccination sites were not vaccine? prepared so the DOH has started the capacity building and other strategies including communication before the vaccination. Ms. Kapunan Will the LGUs be able to independently procure vaccines The LGU can procure vaccine or will the EUA be granted only to DOH? Health How will the government certify that a person has been The DPCB will coordinate with HFSRB and Technology vaccinated? Will this certificate be recognized abroad? LGUs. Assessment Are there internationally accepted formats right now? Council (HTAC) Philippine What is the role of hospitals in this immunization Dir. Arevalo answered that Hospitals will be Hospital program? vaccination sites. Further, capacity building Association through e-learning will be done starting next week. Hence, both the Public and private hospitals are included in the training. Contact details of hospitals and LGUs where they are located were requested for succeeding trainings. Ms. Tiamzon In the news there are private companies who are saying The DPCB will still coordinate with the private that they will also be procuring COVID-19 vaccine. How sectors. is this in sync with the government's procurement of the vaccine? League of On the EUA/FDA Approval: FDA will provide information on the vaccines Provinces of Can LPP get the contact information of the FDA approved by January 15, only one applied is the approved supplier? currently being assessed. Philippines 80 | P a g e Usec. Myrna Cabotaje added that all vaccine trials are on Phase III, they have not finished Phase III and Phase IV yet. The DOH cannot introduce vaccines unless they are in Phase IV of the clinical trial. The EUA is an authorization not a marketing authorization so this will not make the vaccine commercially available for procurement of individuals, private entities and the government. Acquisition and access are done through Sec. Galvez. Consignee designation through Sec. Duque. Hence, we always have tripartite agreements. Ms. Delos Is the vaccination program on a voluntary basis? How do Vaccination will be based on vaccine Reyes we handle persons in the Priority Group who will not availability. If they miss their opportunity to be allow themselves to be vaccinated? vaccinated the first time they will have to wait for the second round based on the available vaccine. Dir. Arevalo said that it depends upon the LGUs, Hospitals and Priority group heads to encourage them to be vaccinated. If they refuse, it will be given to other priority groups. Dir. Arevalo encouraged them to be the champion among their organization to increase the uptake of COVID-19 vaccination. Mr. Salacut Under Eligible Population in the presentation, No. 5 is This has been duly noted. Uniformed Personnel. For its Definition of Term, recommend the following: All Officers and Enlisted Personnel 81 | P a g e Dr. Dy Which Priority Group would non-senior citizen patients If they are healthcare workers they will be with underlying medical conditions (such as DM, with prioritized but there will be intersectoral Congestive Heart Failure) belong to? prioritization for those with co-morbidities will be prioritized. The WHO SAGE recommendation does not include the co-morbidities. Ms. Ciriaco In this program, the vaccine will be given to the priority population for free, be it private or government? Philippine How to register personnel to attend the TOT? The secretariat will contact them. Coast Guard Medical Services Ms. Tinio What about the private clinics or physicians in private practice? Mr. Faraon Will there will be a geographic prioritization based on It will be determined based on the eligible local context and epidemiologic setting? how will population allocation be done? NCR will have more allocation compared to Batanes? Mr. Cruz What if, for example, a frontliner works in Quezon City The vaccinee will be vaccinated in his but resides in San Juan City, which LGU will vaccinate workplace as a frontliner this frontliner? Mr. Yudelmo What interventions are done to ensure that people will Dir. Arevalo said that there are communication get vaccinated? handles to have greater uptake on COVID19 immunization. Learning development interventions for navigators, community mobilizers will also be conducted especially those affected by previous vaccination initiatives. Dir. Arevalo enjoined all attending the forum to help promote the vaccination program of the government. 82 | P a g e Videos are being disseminated to Health Promotion Officers to be popularized. Dr. Anthony Will NCR be prioritized? Dir. Arevalo said that Eligible population is Faraon based on the burden (sectoral) and Family Considering the portfolio of medicines ( 5 to 6) how will geographical (based on prevalence). The Foundation this be allocated? What if an LGU has preference over a NITAG will discuss the priority population certain vaccine other than what is allocated to them? based on certain criteria (attack rate, case fatality, readiness of the LGU) tomorrow and give the recommendation to DOH and the vaccine czar. In terms of vaccine portfolio, the vaccines that will come based on the prioritization based on the specific guidelines that will not be based on preference . It will be administered as prioritized and not on preference. If they waive their opportunity to be vaccinated, there will be a second round still based on availability. Health Care After the use of EUA, will they still undergo HTAC Dr. Guerrero said that LGUs can not procure Professional review? Timeline after EAU to HTAC recommendation? without the clearance of HTAC. Alliance on COVID-19 Is there guidance for LGUs who already set aside their Even without the EAU, the HTAC budget for procurement of vaccines? are already reviewing the evidence for the vaccines for publication. It is easier to issue the recommendation. Per Bayanihan Law, only Phase IV was waived. The second question was already answered by Usec. Cabotaje earlier based on specific guidelines to be released thru Sec. Galvez and Sec. Duque. 83 | P a g e Mr. Dimagiba After all requirements have been complied, what is the The vaccine will not be available yet in the procedure for the vaccination? Will this be a prescriptive market and will not be available on vaccine or available in the market for consumers? prescription basis. We are still waiting for the EUA to vaccinate the priority population. The LGU preparation will follow the usual campaign of the National Immunization Program except that the vaccine is not yet available in the market but through EUA. Ms. Paredes It was suggested that the DOH and HTAC can be invited Noted. in their meeting for the Governors which they will schedule soon, to discuss the COVID-19 vaccines. Please communicate through sandy.paredes.lpp@gmail.com 09167528005 When will the vaccine be commercially available? The vaccine after clinical phase IV, will be given CPR and only then can it be commercially available. The Director General of FDA predicts that it might be commercially available by late 2022. Depending on the supply of the vaccine, all will be vaccinated on a phased implementation. Ms. Rabe What will be the guidelines/process for securing the The STG on registry and data management is consent of patients for the administration of the vaccine? in close coordination with the Legal service. what is the timeline for the release of the national roadmap on vaccine availment? LPP How does DOH/IATF intend to allocate the limited Distribution will be primarily based on sectoral vaccines to 82 provinces? prioritization. Followed by geographical prioritization,(based on disease burden - attack rate, incidence rate/active cases and readiness of LGU. 84 | P a g e UP Diliman Recently, there has been news that Taiwan has found 73 DPCB answered that the vaccines are side effects of China's Sinopharm, while Sinovac's evaluated regularly based on a set of vaccine appeared to have efficacy of less than 80% in guidelines. other countries, notwithstanding the more expensive price of these vaccines compared to other Western- made. Considering that the Duterte administration prefers vaccines from China and that the DOH prioritizes efficacy, how would the DOH (particularly the COVID-19 Task Force) compromise? Ms. Belen Makati LGU announced that they can include the vaccine The IATF will still have to determine the purchase of businesses around Makati if these process companies would like to buy the vaccine. Is this allowed? Also, Red Cross, as mentioned by Sen Gordon the other day, can procure vaccines for the country, and sell these to those who can pay. Is this allowed as well? PHPSP Will the vaccine procurement undergo HTAC review? HTAC recommendations can only be issued after an EUA is issued by the FDA to ensure Will the review happen before or after issuance of EUA? that basic safety and efficacy standards are met. 85 | P a g e Annex D. Results and summary of key feedback of the Consultation with Persons with Disabilities on the PCERP 5 October 2020 Topic Discussion Action Points/ Clarifications/ Key Agreements Competency and Ms. Agbay of the Philippine Federation of the Deaf raised that The level of knowledge/ competency of the guidelines on the FSL the FSL interpreters in the health facilities are knowledgeable interpreters on FSL will be added in the indicator. interpreters on the medical terms, especially for COVID-19, and not just the background on basic sign language such as hand signals The ethic and previous work experiences of FSL for letters. interpreters will be considered in the drafting of the said guidelines. Aside from the competencies of the FSL interpreters, Ms. Dagani of the Filipino Sign Language Access Team for COVID-19 pointed out that previous health- related experiences and ethic guidelines are necessary in the qualifications of the interpreters. It was noted that the civil society organizations (CSOs) are providing virtual FSL services during the COVID-19 pandemic. Moreover, it was noted that they will be charging fee from the government if their services will be contracted. Health promotion The PWD representatives concurred that the health Inclusivity and accessibility of PWDs in the health materials for PWDs promotion materials, especially for COVID-19, should be promotion materials was communicated to sensitive to the needs of all PWDs, covering all types of DPCB- DDO and HPCS. This will also be disabilities, as set forth in the Batas Pambansa 344. included in the indicators of the proposed HCF capacity assessment for services for vulnerable Ms. Rabino of the NCDA recommended to include accessible groups. website/s or ‘web accessibility’ for visual impairment in coordination with the Department of Information and Ms. Rabino of NCDA will share to DOH and the Communications Technology (DICT). PWD groups the information on web accessibility for better access for the blind. Infrastructure needs of Mr. Bernandino and Mr. Manlapaz of the UNCRPD stressed The structural requirements of the BP 344 and PWDs the importance of the compliance of health facilities to the Building Code for PWDs, such as the PWD- Building Code with regard to the needs of PWDs. accessible CRs. will also be included in the 86 | P a g e indicators of the proposed HCF capacity Ms. Agbay also added that the elevators of the health assessment for services for vulnerable groups. facilities should also be accessible to the PWDs and their assistants/carers. Ms. Rabino raised that the comfort rooms (CRs) of some health facilities do not fit wheelchairs. 87 | P a g e Annex E. Results and summary of key feedback of the Consultation with Gender- Based Groups on the PCERP 30 October 2020 Topic Discussion Action Points/ Clarifications/ Key Agreements Accessibility of Ms. Jennifer Garcia of the Regional Association for Engr. Joselito Riego de Dios responded that the DOH has services for Women with Disabilities raised that women with existing strategies and programs for the PWDs to provide women PWDs disabilities may have difficulty in accessing WCPU COVID-19 services as well as gender- related concerns. services due to decreased mobility during the These strategies were also discussed in the meeting with the pandemic. PWD representatives last October 5, 2020. To further improve the services for PWDs, GAD, and WCPU, the Project will conduct a health facility assessment to evaluate the services for vulnerable groups and identify areas for support and improvement. Coordination with Ms. Giceline Artuyo of DOH-HPDPB recommended Ms. Gaylan reiterated that the ESMF, ESCP, and SEP of the other DOH the Project to coordinate with the Office of Project are submitted to the Office of Usec. Bayugo for Bureaus Undersecretary Bayugo (FICT) to harmonize the clearance as the Chief Incident Commander for COVID-19. environmental and social risks identified in the Project with the National Action Plan of DOH for COVID-19. Further coordination with FICT and HEMB will done She also suggested to coordinate with DOH- HEMB succeedingly by the Project. for other gender- related initiatives with regard to emergency response. Importance of According to Atty. Rubin, the Commission on Human The suggestions of the CHR will be forwarded to the GAD gender- based Rights appreciates that gender is mainstreamed in the TWG for consideration and further discussion. initiatives and DOH programs and that GBV response is a gaps on the component. The CHR has emphasized the need for current gendered and intersectional response to the crisis, implementation particularly emphasizing that GBV should be a part of of services COVID response and special focus should be provided for marginalized groups, hence a Joint Memorandum Circular with DILG was developed to also address the risks posed, especially for marginalized groups. As we agree with the finding of WCPUs that there has been decrease in reporting of GBV, and that there are breakdown/gaps in referral 88 | P a g e mechanisms, we support programs that increase the number and enhance the functionality of WCPUs in the country. WCPUs are crucial to GBV response with their multi-sectoral teams, and it is distressing to hear the assessment that some were unable to provide the same services during the pandemic. Ensuring continued functionality, coupled with updated and community/LGU based functional and updated referral mechanisms is important. As part of the program's risk management, Atty. Rubin noted that it is good that gendered responses are included for health service providers. It was suggested to consider the need to protect and address as well the multiple burden of community health service providers (BHWs that are on allowance basis with LGUs), and contractual health workers engaged under the project. There is also a need to recognize unpaid care work at home of these workers, as well as adopting strategies that recognize flexible working hours, recognition of different vulnerabilities for workers who are solo parents, taking care of the ill or elderly, etc. Protocols and procedures should also remain in place for availment of maternal and paternal leaves, VAWC leaves for victims of violence and a clear reporting procedure not only among plantilla officers but also among contractuals, and communities engaged with. The CHR echoes the need to include in the GBV response the focus on strengthening community referral mechanisms, including sessions that connect WCPUs not only with women's desks, social welfare officers, prosecutors, but also with barangay VAW desks officers, civil society organizations, and 89 | P a g e regional offices of the CHR. This will fast track referral of cases and address issues of limited mobility and resources of women and girls reporting GBV. The program could also look into influencing DOH units to adopt protocols specific to marginalized groups including PWDs who often lack access to information and who face physical and social barriers; IDPs, IPs, LGBTQIs, and the incarcerated women. The vulnerable groups and their vulnerabilities were included in the JMC of CHR and DILG. 90 | P a g e Annex F Results and summary of key feedback of the Consultation with Indigenous Peoples on the PCERP February 2021 Topic Comment/Query Stakeholder Response Discriminatio In other provinces, Indigenous IP Mandatory DOH BLHSD has responded that the DOH has a joint Memorandum n against IPs Peoples are not accommodated Representativ Circular with DILG on the health service delivery for IPs. The IPs may in health properly or discriminate against in e (IPMR) of opt to visit a nearby hospital and file a complaint against the hospital facilities hospitals. This leads to the Olongapo where they were not catered as appropriate. The complaint should increased hesitation of IPs to seek be coursed through proper channels such as through DOH Centers medical care in health facilities. for Health Development or Provincial DOH Office. It was also reiterated that due to the devolved health system in the country, not all health facilities are owned by the DOH. Some facilities are run by the local government unit. To further prevent discrimination Municipal The BLHSD has an ongoing medical scholarship program to against IPs and considering the IPMR - capacitate IPs and absorb them in the government health facilities for ‘reserved’ nature of IPs, it was General professional practice. suggested to (1) designate a focal Nakar, In response to the query on the maintaining grades of IP scholars in person in hospitals who are also Quezon midwifery, the BLHSD reiterated the need to meet the grade cut-off members of the IP community, (2) to ensure the quality of future professionals and their capacity to provide a separate lane for IP IMPR North provide proprt medical services. services, and (3) designate an IP Cotabato helpdesk in all health facilities. Lack of financial Some COVID-19 positive IPs are IPMR Under the current assistance of the Philippine Health Insurance resources for staying at home for monitoring of Camarines Corporation (PhilHealth) and with the upcoming implementation of health care the NCIP nurses and barangay Sur the Universal Health Care (UHC), the IPs may avail free health health workers as they cannot services. The Medical Social Units and Malasakit Centers of health afford treatment in hospitals. It was facilities may also be approached for medical assistance to indigent asked if the DOH could provide IPs. free medical services for IPs who have COVID-19. 91 | P a g e Referral It was asked what the IP should do IPMR It was advised to seek treatment or isolation services from another pathway for if the health facility, including nearby facility in other municipalities. Referral of the health facility health services isolation area, closest to their may be sought, and there should be LGU to LGU coordination, as for IPs home cannot accommodate them prescribed in the DOH-DILG Joint Memorandum Circular for the as its full capacity has been health service delivery for IPs. reached. It should also be noted that most health facilities have no IP dedicated helpdesk and has no existing referral pathway, based on the health care facility assessment for services to vulnerable groups that the PCERP has conducted. Access to The access of IPs to health NCIP health The DOH through the Health Promotion Bureau and Communications information on information, especially on COVID- worker – Management Unit develops health information and campaign COVID-19 and 19 and vaccines, is limited. The San Jose materials for COVID-19. The dissemination is through the CHDs and other health need for further information Community also through LGU. It was recommended to further communicate with issues dissemination and communication Service the NCIP, IPMR, and IP Leaders to assure that information is with the IP communities was Center disseminate to all communities. expressed. They asked in which For the PCERP, it was reiterated that there is an online feedback form channels the DOH could further IPMR (http://bit.ly/CERPFeedback) and the GRM. communicate with them. Libungan The HCF assessment done by PCERP also shows that most information materials are not in the language understood by local and It was also suggested to designate IPMR IP communities. The assistance of the CHDs may be sought for an IP focal person per sitio or Olongapo translation in the development of appropriate materials. The HEPOs barangay for dissemination of in the CHDs may also assist to laymanize the medical terms. health information. According to the IPMRs, radio is the most effective way of providing health information to IP communities due to the absence of internet Some health information in the connection. mainstream media are not in the language used by the IP groups. Health care It was asked whether it is proper IMPR It was clarified that burning of wastes is not allowed based on the waste practice to burn health care waste Camarines Philippine Clean Air Act and other laws of the DENR. management in in health facilities and how to Sur Health care wastes are disinfected as appropriate based on the DOH health care ensure that these wastes will not and DENR guidelines, such as the use of chlorine solution. Proper facilities pose threat to communities PPEs should also be used by the waste handlers. Infectious wastes are segregated from general wastes using yellow plastic bags. It is 92 | P a g e especially during collection and delineated from the municipal wastes in black bags using the yellow transport. color for infectious. Some facilities also practice disposal of wastes by the use of a septic vault in the facility. COVID-19 Issues on the COVID-19 vaccines IPMR It was clarified that the COVID-19 vaccines is not part of the scope of vaccination were raised such as safety of the Occidental this consultation. However, issues on the vaccination had been vaccines and various brands, Mindoro, raised in relation to COVID-19. It was advised that a separate safety of vaccination for senior Libungan, consultation will be conducted by the DOH dedicated for the IP citizens and individuals with co- Filimon, and groups. morbidities, access to vaccines others considering the distance of health facilities, and the need for support on resources to access vaccines, e.g., organized transportation for IPs. 93 | P a g e Annex G. Results and summary of key feedback of the Community Consultation on the Retrofitting and Refurbishing of the Research Institute for Tropical Medicine (RITM) 27 October 2020 Action Points/ Clarifications/ Key Topic Discussion Agreements Risk of Coinciding with DOH COVID-19 Director Sudiacal of DOH– DPCB queried on the The RITM will accomplish an ESMP in vaccination activities in 2021 timeline of the construction activities in RITM as relation to the possible simultaneous it might coincide with the vaccination activities of construction and vaccination. DOH in the 2nd quarter of 2021. According to Arch. Magbanua, the construction activities might The RITM would possibly develop re-routing extend until the Q2 of 2021 as the bidding has not schemes and designate areas once its yet started. engagement in the vaccination activities has been finalized. According to Engr. Calma of the RITM Planning Office, the RITM is considered as a warehouse of the COVID-19 vaccines. Survey for Community Residents It was confirmed by the RITM Planning Office that DOH– DPCB to request the officials of a community survey is needed for the residents Barangay Alabang to facilitate the survey of Barangay Alabang, specifically the residents of which may be done accomplished online or Pleasant Village and Camella III which are printed questionnaires, in English (Annex F) nearby the RITM compound. and Filipino (Annex G) versions. 94 | P a g e Annex H. Results and summary of key feedback Retrofitting of the Isolation Rooms of Fourteen (14) Hospitals in the National Capital Region 28 October 2020 Topic Discussion Action Points/ Clarifications/ Key Agreements Burning of wastes It was clarified upon the query of Barangay Central, produced in the Quezon City that wastes will not be burned as a disposal construction site method in the construction sites. Permits required by Ms. Villaluz of the World Bank and Engr. Marayag of the The Implementation Arrangements of the Project will LGUs for the Dr. Jose N. Rodriguez Memorial Hospital reiterated that include the MOA with LGUs for the construction activities. construction activities there is a need for support from the LGUs as regards the The HFEPMO will be conducting a meeting with the project securing of permits and clearances for the construction recipients and other stakeholders regarding this matter. activities. Public hearing for Representatives of Barangay Bagong Ilog- Pasig City The Project will be requesting the barangay officials to communities asked if there should be a public hearing for nearby facilitate the survey to be answered by the barangay residents. residents, preferably those nearby, regarding the environmental and social risks of the minor construction activities. 95 | P a g e Annex I. Results and summary of key feedback Building Completion of the Quirino Memorial Medical Center (QMMC) 9 February 2021 Topic Comment/Query Stakeholder Response Number of For the completion of the 4th floor of the Phase 9 Quirino Memorial According to the HFEP Central Office, the workers and Building of the QMMC, the number of workers to Medical Center- number of workers cannot be determined at health be deployed in the construction area should be Engineering this point and it will depend on the number to protocols identified, considering the possible influx of Department be deployed by the contractor. workers and the need for observance of physical distancing, in compliance with minimum public health standards. Housing of the Based on the number of construction workers, it Quirino Memorial In the latest DPWH guidelines for the COVID- construction should be determined if the workers will be Medical Center- 10 pandemic, transient accommodation should workers housed inside the QMMC premises or not. Engineering be provided for the construction workers. The Department QMMC will find a suitable location in their facility to house the workers. This will be discussed with the contractor and the HFEP. 96 | P a g e Annex J. Results and summary of key feedback of the Townhall Consultation with Indigenous Peoples conducted by the DOH HPB 16 March 2021 Stakeholder Query/Comment Respondent Response Philippine Society Is it necessary that same brand of for Microbiology Yes, it is recommended that we take the same brand. Reason being, there is no vaccine that we are going to use for and Infectious study that involves intermixing different brands of the vaccine. the 1st and 2nd dose? Diseases Philippine Society How old is the target age (for for Microbiology Target population for the vaccines is 18 years old and above. That is the reason why vaccines)? and Infectious we give them to adults. Even 60, 70 or 80 years old will also be given the vaccine. Diseases Any comment on the numerous EU FDA clarified with Astrazeneca that the ones that were deployed to the EU countries countries that suspended the use of DOH have a different batch or lot number. It is not the same batch that we will be getting the Astrazeneca due to the blood from Astra right now. It is a different batch was deployed in those EU countries. clotting side effects and death? Philippine Society Even if you have a lot of allergies, you can still accept the vaccine. Unless you are I have allergies. Is there a specific for Microbiology proven to have an allergic reaction to the specific components of the vaccines. You brand that cannot trigger and Infectious can still get the vaccine, but what will happen is you would be closely monitored after anaphylactic shock? Diseases you receive the vaccine. Before leaving the vaccination site, you will be advised on the specific signs and What would the action be if you symptoms to watch out for. And if you start having those symptoms, you will be started to have symptoms after DOH informed of where to go and who to call. Even if they are minor, you are supposed receiving the vaccine? to report this. In case you need medical attention, you will be referred to a proper facility for proper management. Philippine Society There’s no specific study with the vaccine per se with pregnant women. But there are Is the vaccine safe for breastfeeding for Microbiology recommendations that pregnant women still get vaccinated with consent. Reason women and what are the side and Infectious being, there would still be more benefits to getting vaccinated. Antibodies could be effects? Diseases transferred to the babies. They are usually asked to sign a waiver. Philippine Society How long will the protection from the for Microbiology That is unknown to this point. We are still waiting for data that would specifically tell vaccine last for? and Infectious us on how long the antibodies would last. Diseases 97 | P a g e Philippine Society There is news that we would have There is a possibility. But as of now, we don’t know yet. We don’t know yet on how for Microbiology to be vaccinated for COVID every long the antibodies would last. There are data that suggests that it would be like a flu and Infectious year. Is this true? vaccine, that would be annually. Diseases Philippine Society Will you get the protection from the Average it would take 15 days before you start forming antibodies from the for Microbiology COVID-19 right after the vaccine? vaccination. Chances for your protection will increase as the days go by and you and Infectious Or after a few more days? receive your booster shot. Diseases Can a recipient choose on what The vaccination is not mandatory. But we are doing everything we can to convince brand of vaccine he/she want? Or people to get vaccinated to enable herd immunity. Target is 75% of the population. DOH will they just have to settle for Yes, you can turn down a specific vaccine, but you will now be included on the next whatever is available? round of vaccines. Philippine Society Is it safe to get the COVID vaccine for Microbiology with other vaccines like the flu There are no studies on whether it is safe, or not safe yet. and Infectious vaccines or pneumonia vaccines? Diseases Philippine Society It would be highly encouraged for those with co-morbidities to take the vaccine. On co-morbidities. What would be for Microbiology Reason being, studies show with those with diabetes or hypertension who got the side effects to those with co- and Infectious infected with the virus, their symptoms are more severe. You would benefit from it, morbidities? Diseases and there’s no documented side effects. If you tested positive for COVID, Philippine Society If you’re a patient who got infected by COVID, you could wait for up to 90 days to get when can you get vaccinated for it? for Microbiology vaccinated. But if you wish to get vaccinated to be earlier, you may do so. Provided, Will you have to wait after 14 days and Infectious that you are recovered from the COVID-19 virus. of quarantine? Diseases The IP is under the prioritization group B.4. Socio-demographic groups at significant Profiling & masterlisting. For the higher risks. When can they get vaccinated? Focus is on the 3rd quarter, where prioritization of the vaccines, what DOH millions of doses will come. It will be the local government unit who will initiate the category does the IP fall under? vaccination of our IP groups. Do all the suppliers of the COVID Philippine Society There are different platforms of vaccine. There are those who use vector like vaccine have the same elements? for Microbiology Astrazeneca so it uses a viral vector. There are also inactivated virus like Sinovac. What are the elements of the and Infectious There are different platforms, but they all have the same goal. COVID-19 vaccine? Diseases What about for those undergoing Philippine Society dialysis treatment? Can they still get You can still take the vaccine even if you are undergoing dialysis treatment. for Microbiology vaccinated? 98 | P a g e and Infectious Diseases Philippine Society DOH: Besides the NCIP advocating for our IPs to get vaccinated, aside from them Regarding the role of NCIP on for Microbiology helping us disseminate information, the team is composed of 6-8 members. They information dissemination. and Infectious can also volunteer as part of the vaccination team to take on several roles. Diseases Philippine Society Studies nowadays are on their behavior. The UK variant is more infectious. May we know the difference for Microbiology Regarding the effectiveness of the vaccines on them, there are still ongoing studies. between Philippine variant and UK and Infectious Some of the vaccines may still provide some amount of protection against these or Brazil or African variants? Diseases variants. Do we already have an initial report We already have data, but they are still incomplete. The immunization program we on the healthcare workers injected DOH have is government facilities. We cannot divulge that information yet, since they are with the vaccine? still incomplete. Philippine Society I think the campaign is not directly attacking the anti-vaxxers. This campaign is trying Is there an active anti-vaxxers for Microbiology to correct misinformation and set the facts straight as well as encouraging people to campaign in the Philippines? and Infectious take the vaccine. In the hopes of when the anti-vaxxers hear this, they would Diseases eventually become advocates for vaccines as well. 99 | P a g e Annex K Summary and Feedback from the Community Consultation for Civil Works Activities 29-30 July 2021 A. Community Consultation on the Upgrading of Isolation Facilities of DOH and LGU Hospitals NCR on July 29, 2021 Topic Issues/Comments/Queries Stakeholder Responses Isolation rooms as ICU Mr. Wilfredo Prilles, Jr. from the City City Planning & Engr. Padilla from DPCB responded that rooms Planning and Development Office of Naga Development Office according to HFEPMO, the 2 isolation rooms City asked if the upgraded isolation rooms of Naga City being upgraded can also function as ICU rooms can also be used as ICU in the hospital in as they are large enough to meet the standard view of the surge of COVID-19 patients. HFEPMO floor area of ICU rooms. Ar. Mennard Estavillo of HFEPMO remarked that the remaining three (3) isolation rooms which have smaller floor area can also function as an ICU as long as the ICU equipment can fit in the room. ICU equipment Mr. Prilles inquired if the project can support HFEPMO Ar. Altovar answered that currently, the focus of acquisition the acquisition of ICU equipment. the civil works is to upgrade the isolation rooms with negative pressure in selected hospitals nationwide. The PCERP has other components for the provision of medical equipment. These includes portable xray machines, infusion pumps, mechnical ventilator, RT PCR machines, and others which had been discussed earlier. Other equipment may not be supported as the allocation of majority of the budget has been determined. ESF Training Mr. Leonard Pasiderio from Guimaras ENRO LGUs, Health Engr. Padilla replied that the winning contractors, Participants inquired on who will be involved in the ESF Facilities, DOH health care facility project recipients, and training and if the LGU has the option to PCERP respective DOH offices and World Bank identify who will undertake the training. representatives will be invited in the training. 100 | P a g e Ms. Gaylan added that the LGUs are welcome to join the ESF training, provided that they send an email regarding their interest to participate. ESF Instruments Engr. Bim Punzalan from Bicol CHD clarified LGUs, Health Ar. Aira clarified that according to the RFQ, it is that the health care facilities in Masbate and Facilities, HFEPMO, indicated that the construction activities in Sorsogon will undergo a new construction DOH PCERP Masbate and Sorsogon is considered a new instead of upgrading of isolation facilities. construction instead of renovation or upgrading Also, he asked if the screening process, of isolation facilities. ESMP and ECOP are requirements before starting the project. Furthermore, he inquired Engr. Padilla replied that the screening process, if they could use the approved construction ESMP and ECOP will still be further discussed in safety and health program from DOLE the ESF training. It will be submitted monthly instead of ESMP. when the construction activities have commenced for the whole duration of the project. Moreover, the Labor Code of the Philippines, Occupational Safety and Health Standards Act, and other DOLE guidelines have been incorporated in the ESF instruments especially in ESMP, LMP and GRM. Engr. Punzalan suggested to schedule the ESF training soon to avoid delays in the start of the construction activities. Health Care Waste Mr. Hilarion Pasal asked if the Project can Health Facilities, According to Ms. Gaylan, the the Project cannot Management Training provide intervention on waste management, DOH PCERP cover the hiring of waste service provider, such especially on handling of used PPEs and as waste transporter and temporary storage and other infectious paraphernalia. disposal facility (TSD) for health care wastes. Meanwhile, the DOH Central Office provides Similarly, Ms. Sheila Mari Gilo Bayomof support to waste management by hiring a waste bong LGU inquired if the PCERP can provide transported and TSD facility to collect the wastes assistance in the management disposal and generated from the COVID-19 vaccination. It is treatment of infectious ways from health care also indicated in DOH Department Memorandum facilities. 2021-0031 that vaccine wastes shall be collected from vaccination sites and then transported to 101 | P a g e RHUs, PHOs or CHDs, prior to collection of the TSD. The Project only offers training on health care waste management for the health care facilities to be attended by health facilities, CHDs, Bakuna Centers, TSD facilities, and ENROs. B. Community Consultation Refurbishing of Reference Laboratories on July 30, 2021 Topic Issues/Comments/Queries Stakeholder Responses ESF Training Engr. Richie Dirige of the Baguio General Baguio GHMC, DOH Engr. Padilla responded that there is no definite Hospital and Medical Center wanted to PCERP schedule yet, but the ESF Training will be clarify on the schedule of the ESF Training. conducted before the commencement of construction activities. The target participants will be the Health Care Facility recipients, winning contractors, and an invitation will be extended to the LGUs or barangays where the HCF is located. Ms. Gaylan clarified that the training will be highly dependent on the status of the bidding. She then asked Engr. Dirige if they have acquired an NTP and NOA, to which Engr. Dirige replied not yet. Ms. Gaylan added that if the winning bidder has been selected, the ESF training can be planned so that the selected contractors will be able to attend. Supervision of project Ms. Anabel Cauilan-Binoya of DOH MMCHD DOH MMCHD Engr. Padilla stated that supervision of the ESF implementation asked who would be the one to oversee/ compliance will be the responsibility of the safety supervise the project to ensure that these officer of the winning contractors. The safety are implemented or conducted smoothly? officers shall be present on-site and shall coordinate with the sanitary engineers or sanitary officers of the HCF, to ensure that the operation activities adhere to the mitigating measures discussed. 102 | P a g e Ms. Gaylan added that while the contractor is mainly in charge of ensuring the practice and observance of the Environmental and Social Standards in the construction site, the recipient facilities also have a responsibility to guide the contractors. Enhancement of plans A question from the Lung Center of the Lung Center of the Ar. Mennard Estavillo of the PCERP-HFEPMO before bidding Philippines asked that if the bidding has not Philippines, team responded that since the LCP is yet commenced, would it be possible to HFEPMO recommended for award, it is not possible to retrieve their previous plan to further enhance them. However, during the improve/ enhance it? implementation phase, it may be possible to enhance the plan so long as the changes are not major. This needs confirmation with Ar. Ariel Magbanua. Construction permits Mr. Jack Guevara from QC EPWMD asked if QC EPWMD Ms. Gaylan shared that there was a meeting with the Project is covered by the ECC permit DENR EMB before the commencement of the from EM. project activities. As per discussion with DENR, if In addition, Mr. Guevara asked if there would the facility has a ECC beforehand, there will be be any amendments regarding the no need to apply for a new ECC for these construction activities, would there be any construction activities. additional permits under the ECC? On whether there will be any additional permit in case of amendments in the construction activities, Ms. Gaylan clarified that there will be no additional permits needed. To add, Ms. Gaylan shared that HFEPMO conducts pre- construction meetings wherein the permits and other licenses will be explained. 103 | P a g e C. Community Consultation on the Refurbishing of Bureau of Quarantine (BOQ) Stations on July 30, 2021 Topic Issues/Comments/Queries Stakeholder Responses Issuance of Permit to Ms. Dubhe Lynn Guarnes from DOH BOQ, HFEPMO Ar. Charm Topacio responded that those BOQ Construct (PTC) Western Visayas CHD asked if Bureau of Stations which are considered as new Quarantine (BOQ) Stations are required to construction and have a laboratory as one of its secure Permit to Construct (PTC). facilities are required to secure the PTC. These BOQ Stations are Tabaco and Zamboanga. On the other hand, the remaining BOQ Stations will only be subject for renovation and instead have to secure building permits. ESF Instruments Engr. Corinthia Aguilay from BOQ Central BOQ, DOH PCERP Engr. Padilla responded that after the ESF Office inquired who will be responsible for Training, the ESF instruments will be sent to the the preparation of ESF instruments. emails of both the contractors and the health care facilities, which in this case, the BOQ. Moreover, the ESF instruments shall be accomplished every 10th of the month. It is highly encouraged that the Sanitary Officer or Engineer of the health facility will coordinate with the Safety Officer in accomplishing these requirements. Ms, Gaylan added that only the GRM for Project Recipient Facilities is required for the BOQ to be accomplished monthly if they have any complaints about violations in the project site or lack of administrative requirements of the contractors. Sanitary Officer or Engr. Aguilay followed up a question on the BOQ, DOH PCERP Engr. Padilla clarified that it is acceptable if the Sanitary Engineer of absence of a Sanitary Officer or Engineer in existing engineer of the health facility or from the BOQ Stations the BOQ Stations. She asked if it is required BOQ main office will accomplish the ESF that the Sanitary Officers or Sanitary instruments for all the six (6) lots for construction Engineers will be the one accomplishing the under the Project. ESF instruments and if it is acceptable to consider one of the engineers from the BOQ main office. 104 | P a g e Issuance of Permit to Ms. Dubhe Lynn Guarnes from DOH BOQ, HFEPMO Ar. Charm Topacio responded that those BOQ Construct (PTC) Western Visayas CHD asked if Bureau of Stations which are considered as new Quarantine (BOQ) Stations are required to construction and have a laboratory as one of its secure Permit to Construct (PTC). facilities are required to secure the PTC. These BOQ Stations are Tabaco and Zamboanga. On the other hand, the remaining BOQ Stations will only be subject for renovation and instead have to secure building permits. 105 | P a g e Annex L Summary and Feedback from the Training on the Code of Conduct and Environmental and Social Safeguards for Uniformed Security Personnel – Armed Forces of the Philippines (AFP) 29 April 2021 Topic Comment/Query Stakeholder Responses Grievance Ms. Maya Villaluz of the World World Bank Cpt. Campos of the AFP shared that the AFP has a grievance redress Redress Bank had asked if the AFP has an mechanism that involves 3 investigative units in the AFP. Those are the Mechanism institutionalized Grievance Office of the Inspector General, the Office of Provost Marshall, and the (GRM) Redress Mechanism (GRM). Office of Ethical Standards and Public Accountability. Those 3 units have their own jurisdictions. The other Offices such as the NCIP, NCDA, etc. were also Ms. Dait-Cawed of the NCIP shared that it is effective if grievances will encouraged to share their be discussed and settled at the community level. If the grievances organization’s GRM. involved their staff not doing their work, or there are some complaints on the underperformance of staff, the NCIP has legal affairs that would If present, it was suggested to handle those cases. The NCIP has its Regional Offices, Provincial integrate this GRM with that of the Office, and Community Centers which could be utilized as grievance Project. channels. Ms. Sedenio of the NCDA shared that they have their own internal grievance redress mechanism which settles disputes internally prior to seeking external jurisdictions. For PWDs who would like to file complaints, they would have to pass the barangay level. Should a complainant opt to push through in filing cases, they have partner agencies such as PAU or DOJ that would process complaints. 106 | P a g e Annex M Summary and Feedback from the Training on the Code of Conduct and Environmental and Social Safeguards for Uniformed Security Personnel – Philippine National Police (PNP) 30 April 2021 Topic Comment/Query Stakeholder Response Grievance Ms. Maya Villaluz of the World Bank World Bank Dr. Jimlan of the PNP General Hospital shared that on her Redress had asked if the PNP has an knowledge of the grievance redress mechanism of the PNP, they Mechanism institutionalized Grievance Redress can forward their complaints to the 8888 Complaint Center which (GRM) Mechanism (GRM). is being brought to the respective units that would handle the case. It was also inquired whether there are helpdesks at the community level in which complaints or feedbacks cam be relayed. The other Offices such as were also encouraged to share their organization’s GRM. If present, it was suggested to integrate this GRM with that of the Project. Medico-legal Mr. Buboy Ampuan asked why medico- PNP, Dr. Cababa of the ITRMC replied that the cited situation is not the cases legal cases are ignored after 24 hours ITRMC proper practice. Cases that have passed 24 hours should still be in some Offices. catered to. COVID-19 Mr. Buboy Ampuan asked if there are PNP, DOH Ms. Gaylan answered that yes, before the vaccination is done, Vaccination any explanations done in the first there is an orientation or health education step done by the vaccination. medical team and they would ask for your written consent prior to vaccine administration. 107 | P a g e Annex N. Summary and Feedback from the Orientation and Consultation on the Grievance Redress Mechanism (GRM of the Philippines COVID-19 Emergency Response Project (PCERP) 24 June 2021 Actions to be Topic Issues/Comments/Queries Stakeholder Responses Taken/Remarks DOLE Ms. Honey Alipio of the DOLE Bureau DOLE Per Ms. Gaylan, the GRM processes Revision of GRM of PCERP Grievance of Labor Relations (BLR) clarified who were based on the Legal Framework based on DOLE Redress determined the GRM procedure and presented, including the Citizens’ recommendations Mechanism the resolution process for DOLE as the Charter of the various Offices, such that (GRM) feedback and complaints of workers of the DOLE. The recommendations of regarding labor working conditions Ms. Alipio had been noted and will be must be handled by the Bureau of integrated in the PCERP GRM. Working Conditions (BWC) and not the BLR. Moreover, the Public Assistance and Complaint Unit (PACU) is handled Ms. Gaylan explained that this meeting by the DOLE Legal Services (LS) and is done to consult, level- off, and validate not by the BLR. Further, it was clarified with the various national government that the mandate of the BLR is to agencies (NGAs), authorities, and other address inter- and intra- unit cases stakeholders the GRM of the Project, which is different from the jurisdiction of which was formulated based on the the BWC, where the latter is mandated abovementioned policies and Charters. to inspect and regulate the labor The Project GRM may be reviewed and standards and working conditions at updated based on the advise of the the project site. authorities on how they implement their own GRM. Ms. Gaylan requested for references from the DOLE which can be used to align and improve the PCERP’s GRM. 108 | P a g e Ms. Alipio confirmed that they will be sending reference materials. Handling of Dr. Nimfa M. Putong of San Lazaro San Lazaro Engr. Riego de Dios agreed that the Formulation of capacity Recurring, Hospital explained that PACU is an add Hospital filtering of unverified complaints in the building activities and other Biased, on in their Public Health Unit (PHU). process of handling grievance should be support for GRM implementers and She pointed out the need for capacity further strengthened. Written complaints Unverified and support in handling complaints with supplementary documents shall be Complaints since it is new in their unit. She also required. He also noted that as Strengthening of grievance from raised the need to address the government employees and public screening or initial evaluation Anonymou systemic problem in handling servants, these complaints and s complaints in the government offices feedback shall be welcomed. Grievance such as recurring forwarding of Strengthening of GRM Proponents unverified and biased complaints from Operationalization and anonymous sources. It was Ms. Gaylan concurred that there is a Endorseme emphasized that the screening of need for capacity building to further nt and grievances should be further strengthen GRM operationalization in Raising of grievance Closing of strengthened prior to endorsement to the ground. She added that the validity proponent accountability/ Grievance concerned Offices. The accountability of complaints must be immediately of the grievance proponent should also evaluated, which is a part of the current liability to the Civil Service be established in order to impose GRM of the Offices. The confidentiality Commission liability to individuals who pose of the nature of the grievance, the baseless and malicious complaints. proponent, and the grievance subject individual or organization shall also be guaranteed to prevent rumors and Atty. Jordan Falces of DOH CHD I preserve reputation during the shared the same sentiments and have investigation. However, this is poorly pointed out that these unverified implemented given that there is a non- complaints have been damaging the disclosure agreement. Anonymous reputation and safety of personnel and complainants are allowed according to the organization. the CSC RACCS 2017 as long as there are valid documents that support the complaints. DOH CHD I 109 | P a g e Per a representative from the Quirino Memorial Medical Center (QMMC), The Ombudsman does not admit According to Ms. Lily Grace Sayon of anonymous complaints anymore. CSC Region III, anonymous complaints are dismissible unless supported by verifiable documents, for example, in exams and surveys. It was also clarified that the role of CSC is to endorse the grievances to the concerned Offices as they are part of the latter’s jurisdictions. CSC Region The Contact Center ng Bayan (CCB), III Presidential Complaint Center (PCC), and CSC usually forward the complaints to the concerned Offices to improve the existing systems. In addition, CSC explained that the complainants can file the complaint directly to the concerned offices. Mr. Mark James Brozo of the DOH Committee on Anti-Red Tape (CART) Secretariat clarified that while grievances may have been submitted to other Offices, the resolution and the closing of the grievance shall be the responsibility of the Office where it was endorsed which has mandate or jurisdiction over the concern. Ms. Gaylan emphasized the need to harmonize the GRM of various Government Offices, as well as the 110 | P a g e DOH – CART policies, to resolve such issues of Secretariat unverified and anonymous complaints. The new normal brought about by the COVID-19 pandemic shall also be considered, such that most Offices limit face-to-face interactions and there is a need for improved online and hotline processes. The changing environment also now brings increased risk for online harassments, cybercrimes, and social media abuse. The recent developments in the ARTA should also be considered. Calls and Ms. April Molina of the KMITS and DOH DOH – Ms. Gaylan concurred that the concerns Strengthen referral pathways E-mails Call Center shared that they are KMITS must be endorsed to the concerned for grievance and feedbacks from receiving calls and e-mails from private Offices. Coordination must be Stakeholde organizations, general public, and established among the concerned rs to the other organizations with concerns not offices to fully address the reports, calls, DOH related to DOH, such as those or concerns from the stakeholders. Hotline and concerning DTI, FDA and BOQ. She the KMITS clarified if the calls and emails shall be not within directly endorsed to the concerned DOH Office, as per GRM of PCERP jursdiction Legal According to Mr. Brozo, the PACU and DOH – CART Ms. Gaylan explained that the GRM of Coordinate with DOH Legal Framework the Complaint Handling Unit (CHU had Secretariat PCERP is a working document which is Service and CART Secretariat of the been merged into one Office last April reviewed and updated. Revisions are for the issuances and GRM PCERP 2021. They are now called as the DOH possible based on the recommendations revision GRM Committee on Anti-Red Tape (CART) DOH CHD I of the Offices concerned and the recent Secretariat. In this regard, new policy developments. She signified that issuances will be released on the these inputs will be integrated in the handling of grievances. He also added PCERP revision. The updated PCERP GRM will that while the Republic Act (RA) no. be posted in the DOH website. 9485 and RA no. 11032 were both 111 | P a g e used in the PCERP GRM, the provisions of the RA no. 11032 shall prevail to prevent further confusion. Ms. Gaylan enjoined the cooperation of The DOH Administrative Order no. the DOH CART Secretariat and Legal 2015-0048 is also currently being Service for inputs in the PCERP GRM amended. He also suggested to invite updating. the DOH Legal Service in the next GRM Consultation. Per Atty. Falces, the Magna Carta prescribes the composition of the Atty. Jordan Falces clarified that some hearing committee in resolving parts of DOH AO 2015-0048, grievances. The composition of the specifically the hearing committees in hearing committee depends on the the resolution of complaints against location of the health care facilities. health care workers, are already Moreover, the purpose of revision of revised in Magna Carta for Public DOH AO 2015-0048 is to align it to the Health Workers. It states that the Magna Carta for Public Health Workers. Provincial Health Offices will be the Furthermore, this will include the hearing committee for hearing the changes in the hearing committees and cases of complained health care more defined jurisdictions. workers. Ms. Gaylan inquired if the Magna Carta will formulate a centralized body for grievance handling and resolution, integrating the current processes of the DOH Central Office, CHDs, health care facilities, including LGU- managed hospitals. She also clarified if the Magna Carta for Public Health Workers is different from the AO revision that will come from the DOH Legal Service. 112 | P a g e Scope of A representative from CSC Region V CSC Region The GRM of PCERP was designed to the PCERP inquired if the PCERP GRM was V cater grievances and feedbacks related GRM created to receive grievances or to the Project activities and components. feedbacks which exclusively pertain to However, the PCERP team has been the implementation of COVID-19 receiving feedbacks and complaints related rules, procedure, responses of which are not related to the Project and handling. are within the jurisdiction of other agencies. The PCERP endorses these grievances officially to the concerned offices. It was clarified that the PCERP is not a regular DOH unit and is only a project with bound timelines, thus has no mandate or jurisdiction to resolve grievances. The PCERP as a Project only endorses the feedbacks and grievances to the Concerned Offices, especially for concerns which are not project- related. The PCERP only resolves grievances which are under the Project scope, such as on implementation of project activities. 113 | P a g e Annex O. Summary and Feedback from the Orientation and Consultation on the Grievance Redress Mechanism (GRM of the Philippines COVID-19 Emergency Response Project (PCERP) 25 June 2021 Actions to be Topic Issues/Comments/Queries Stakeholder Responses Taken/Remarks Coordination Mr. Mark James Brozo DOH Committee DOH – Ms. Gaylan clarified that the PCERP between on Anti-Red Tape (CART) Secretariat CART team will not monitor and not require any PCERP and asked if the PCERP team will monitor Secretariat accomplishment reports from the DOH CART the CART Secretariat and how the CART Secretariat. It was clarified that Secretariat PCERP team will coordinate with them. the PCERP is not a regular DOH unit and is only a project with bound timelines, thus has no mandate or jurisdiction to resolve grievances. The PCERP as a Project only endorses the feedbacks and grievances to the Concerned Offices, especially for concerns which are not project- related. The PCERP only resolves grievances which are under the Project scope, such as on implementation of project activities. Ms. Gaylan added that if the CART Secretariat or the other DOH Offices receive concerns related to the scope of the Project, these should be relayed to the PCERP team to address accordingly. The Project scope only covers limited activities it has funded and the Project Operations Manual (POM) in the DOH website (https://doh.gov.ph/ COVID- 114 | P a g e 19/emergency-response-project) may be used as reference to determine if the grievance or feedback is PCERP related, excluding the majority of regular complaints on COVID-19 and vaccination which are not under the project. However, the PCERP team has been receiving feedbacks and complaints which are not related to the Project and are within the jurisdiction of other agencies. The PCERP endorses these grievances officially to the concerned offices. She noted that the DOH CART Secretariat shall be copied in all related communications as the main grievance body of the DOH. Ms. Gaylan signified that the PCERP will closely coordinate with the CART Secretariat. Mr. Brozo requested for contact details DOH – The PCERP will furnish the DOH CART To provide CART of the PCERP team and a list of World CART Secretariat the directory of the Project Secretariat with PCERP Bank-funded project activities for Secretariat focal persons and the Project Directory and POM incorporation in their tagging system. Operations Manual. Grievance Mr. Alex Legion from Eastern Visayas Eastern Ms. Gaylan explained that the PCERP Resolution Regional Medical Center inquired Visayas Team is project- based only not a Reporting and whether they will be receiving a report if Regional regular DOH unit. It does not have any Monitoring the case or grievance is closed, if there Medical jurisdictions for grievance resolution and Report will be certification if the grievance has Center is not a monitoring body. The PCERP been resolved, and if they will be Team will only coordinate with receiving grievance monitoring reports, concerned Offices and resolve issues i.e., percentage or number of grievances which are part of its Project scope when closed within the semester or quarter. possible. The PCERP will defer to the This is in line with their Office’s concerned Offices on how they will 115 | P a g e requirement to submit similar reports to resolve grievances, as prescribed by the national office. various national and local policies including the Office’s Citizens’ Charter. It will be the responsibility of the concerned Offices to prepare grievance resolution reports. Moreover, the PCERP will closely coordinate with these Offices for the monitoring of Project- related grievances and feedbacks for the independent monitoring and evaluation (M&E) of the PCERP. The PCERP team will extend its support and assistance to these Offices per request. PCERP Atty. Jo David Borces from DOH Central Central Ms. Gaylan explained that the GRM Revision of PCERP GRM Grievance Visayas Center for Health Development Visayas processes were based on the Legal Redress clarified if the discussed GRM is CHD Framework presented, such as the local Mechanism separate from the existing procedures and national policies on complaints and Process because there are steps that has been feedbacks, including the Citizens’ presented which are new compared to Charter of the concerned Offices or the existing procedures. She also authorities. The PCERP did not develop inquired if the GRM will be released a new protocol but has just consolidated through an official issuance and if the various existing protocols and policies, presentation deck will be the basis for for adoption of the Project. The PCERP the GRM. welcomes recommendations and corrections to further improve the Project GRM. The PCERP will revise the GRM based on the inputs of the Offices in today and yesterday’s Consultations, such as incorporating updated policies. The GRM and uptake forms are published in the DOH website at the above link of the PCERP- dedicated webpage. 116 | P a g e Additional Mr. Saturnino suggested to include CSC CSC This has been duly noted and will be Policies to Resolution No. 10113 and the Revised incorporated in the updated PCERP include in Policies on the Settlement of Grievance GRM. GRM of in the Public Sector. PCERP 117 | P a g e Annex P Minutes of Construction Coordination Meeting for 14 ongoing Civil Works Projects under CY 2020 conducted on August 04, 2021 Topic Comment/Query Stakeholder Response Cutting of trees Since there is a Dr. Jose N. The hospital applied for a cutting construction of a new Rodriguez permit which gave the 30 calendar building, details on Memorial Hospital days to cut down 39 trees. These affected trees were were also been tagged by DENR. asked such as the Recipient Per policy of the 1:50 ratio, the number of trees, advise hospitals hospital will buy 2,000 seedlings coming from DENR and for the repopulation. plans for repopulation. Due to heavy rains, the hospital It was also clarified issued a temporary suspension whether the delay of the order from July 12 to 31. Since the construction was due to trees are located in a sloping the postponement of terrain, it would be best for the the cutting of the trees. safety of the workers to stop the work until the weather improves. The rest of the facilities The representative from the are doing renovations hospital that the cutting of the in their current buildings trees will be completed by August so no trees will be 05, Thursday. affected by the projects. Samples of the trees will be sent to DENR but the hospital already have the permission to make them into furniture. Handling of Since most of the Recipient The contractors decide on how construction construction activities hospitals they manage the wastes – where wastes / debris are in its initial stage, the debris will go and what the hospitals were happens to them. The hospitals asked if how their will inquire about these details respective contractors and get back to the team. handle the debris from the demolition. One of the issues experienced by the Philippine Children’s Medical Engr. Padilla advised Center is the excessive dust going the hospitals that to the patients’ rooms. To address mitigation measures this, they put up additional board should be done based to prevent the dust from going to on the Environmental the area. Codes of Practice and the Environment and Social Management Plan which was submitted by the contractors. Temporary Engr. Padilla confirmed In Tondo Medical Center, the facility with the hospitals if temporary storage is located at temporary facilities the side of the building’s exit. were installed for the Engr. Padilla reminded them there workers and materials. should be no obstruction to the pathways and exit of the hospital. In the case of the Philippine Children’s Medical center, they have no available space for a new Topic Comment/Query Stakeholder Response temporary facility due to the ongoing development of PCMC. They only allowed 3 key personnel to stay-in at the work site. Scaffolding Since some hospitals Recipient In Jose R. Reyes Memorial access to the have limited access to Hospitals Medical Center, the contractor hospital the construction sites, was asked to submit a safety scaffoldings are put up access plan for the access of for the workers and workers and materials. They transfer of materials. provided assurance that the Engr. Padilla clarified scaffolding safe for use. But they safety details based on will still look for other pathways to the photos shown. deliver the materials. BIHC also agreed to In the Philippine Orthopedic this point and asked Center, they also installed whether the contractors scaffolding access where workers gave a demolition plan and materials need to walk on the which details access of roof. The hospital assured the patients and workers. structure is very safe for use. There might be a need They asked the contractor to to review where the ensure the safety of the area for materials will go the workers. through the hospitals. The project site of the Philippine Heart Center is at the 4th floor of the building so a scaffolding was also installed. The contractor set up a pulley system to haul materials to and from the area. Wearing of For the next meeting, Recipient Hospitals will provide photos or PPEs and BIHC would like to see Hospitals videos to show that workers wear practicing of photos that workers PPEs properly and observe the health protocols practice the wearing of necessary health protocols in the appropriate PPEs and construction sites. other health protocols. In the Philippine Orthopedic Engr. Alex followed this Center, they oriented the up with questions contractor and workers about the specific to workers health protocols to be observed. following health The hospital management also protocols in their regularly checks the project site barracks. which include the workers quarters. In the Philippine Hearth Center, the safety officer strictly ensures that PPEs and other health protocols are followed. Signages are also put up to remind everyone about the safety precautions. In the National Kidney and Transplant Institute, the construction area will have a blue sack / cover around it to prevent 119 | P a g e Topic Comment/Query Stakeholder Response dust and other materials from obstruction. Among all facilities, the National Center for Mental Health has the most number of workers at 27. They discussed with the contractor that they need to oversee the practice of health protocols. They also advised them to set up a mini-isolation room where anyone with symptoms can be brought in for observation. Transfer of In the buildings where In the Philippine Orthopedic patients to new patients needed Center, instead of transferring the location relocation to give way concerned patients, they waited to the construction, it for them to be discharged in the was verified whether hospital. They also did not accept biosafety guidelines patients for the affected pay observed. This is to wards. ensure that both patients and workers In the National Children’s would not be exposed Hospital, they needed to improved to possible infections. the rooms where the patients will be transferred. But in order to observe safe distance among patients, they have to be transferred partially to avoid overcrowding. Scheduling of It was mentioned that Quirino Memorial Quirino Memorial Medical Center manpower work continues on Medical Center responded that workers have Sunday in the project scheduled shifts depending on site. Engr. Padilla their assignments. So, not all 24 reminded that based on workers are working 7 days a the labor management week. procedures, workers should be given 24 hours of rest per week. Safety officer It was noticed that the Tondo Medical The hospital signified to revise the hospital has yet to give Center presentation to include the name the designated safety of the safety officer. officer for the project. 120 | P a g e Annex Q Minutes of the ESF Training conducted for healthcare facilities and contractors of upcoming Civil Work Projects August 20, 2021 Topic Discussion Environmental Engr. Padilla opened the training with the overview of the Project’s Environmental and and Social Social Framework. Safeguards The World Bank developed the Environmental and Social Framework or ESF which includes the ten (10) Environmental and Social Standards designed to help the borrowers manage the risks and impacts of their projection implementation. In addition, it improves the environmental and social performance through an outcomes-based approach. The set of Environmental and Social Standards that the Project has to comply with are the following: ESS 1 Assessment and Management of Environmental and Social Risks and Impacts ESS 2 Labor and Working Conditions ESS 3 Resource Efficiency and Pollution Prevention and Management ESS 4 Community Health and Safety ESS 5 Land Acquisition, Restrictions on the Land Use and Involuntary Resettlement ESS 6 Biodiversity Conservation and Sustainable Management of Living Natural Resources ESS 7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS 8 Cultural Heritage ESS 9 Financial Intermediaries ESS Stakeholder Engagement and Information Disclosure 10 Engr. Padilla gave a brief explanation of each standard while noting that ESS 5, 6, 8, and 9 are not relevant to the project due to the nature of the activities to be executed. Environmental The next topic discussed was on Environmental and Social Risks and Mitigation and Social Risks Measures. It contains the various risks that need to be anticipated in the project sites and Mitigation including the appropriate mitigation measures and corresponding impact as stated in the Measures ESF guidelines. Engr. Padilla stressed that all possible risks and mitigation measures should be planned and administered by the health care facilities and their respective contractors throughout the project duration. Risks are defined as an event or situation involving exposure to danger. There are different risks related to the project activities that can affect the communities, workers (occupational), and the environment. There are 3 levels of impact for these risks, which are as follows: • Low Risk ▪ Less exposure to safety and health hazards ▪ Low level of danger ▪ No or less probability to cause an accident, harm, injury, or illness • Medium Risk ▪ Moderate exposure to safety and health hazards ▪ Medium level of danger ▪ Moderate probability to cause an accident, harm, injury, or illness 121 | P a g e • High Risk ▪ Hazards that can affect not only workers but also persons outside the project site ▪ High level of exposure to safety and health hazards ▪ Probability of a major accident is likely to occur The levels of risks of the aforementioned potential Occupational, Community Health and Safety, and Environmental Risks are pre-determined based on other WB projects. They are characterized by the nature of construction activities in the project sites. The safety officer is the focal person to determine the different potential risks. A1. Occupational Engr. Padilla continued to discussed the potential occupational risks and impacts as well Risks and as corresponding mitigation measures and its level of impact. Mitigation Measures Potential Level of Occupational Proposed Risk Mitigation Measures Impact Risks and Impacts Minimum public Worker’s PPE complies with international good Low risk health and safety practice risks at the construction site No horseplaying Refer to Environmental Codes of Practice, DOH, and IATF Guidelines Transfer of Patient specimens must be categorized and Low risk potentially infected transported depending on its category (depends on specimens and the exposure exposure to Disinfection of area prior to construction of the patient contaminated to the working/ Adherence to Health Care Facility’s contingency workers) construction area plan to enable construction activity. Occupational Health Compliance to construction regulations Low risk and Safety (OHS) risks for project All employers must develop an OHS Program in workers associated accordance with DO 198-18 Section 12 with the upgrading activities All workers must undertake the Mandatory 8-hour Safety Health Seminar for Workers (Section 3) A qualified Safety Officer must be present in each workforce in accordance with DO 198 Section 14 Exposure to Encourage hand hygiene (washing then Low to infectious waste disinfection) moderate risk (chemical and (depends on physical hazards) Use gloves for handling waste the exposure) Dissemination of proper information regarding the chemical and physical hazards must be conducted by the Safety Officer Raise the awareness of staff about simple post exposure prophylaxis in the event of an occupation injury (e.g. needle-stick injury) Deployment of Ensure that all staff must be over 21 years and Low risk project workers below 60 years old (Per DPWH DO 39, series of 2020 – Revised Construction Safety Guidelines for the Implementation of Infrastructure Projects During the COVID-19 Public Health Crisis, repealing DO No. 35, series of 2020) 122 | P a g e Provide the necessary welfare facilities and amenities to workers for board and lodging ensuring compliance with social distancing and proper hygiene. Provide disinfection facilities at respective project sites in compliance with pertinent DOH and IATF guidelines. Provide continuous supply of vitamins, particularly vitamin C and other over-the-counter medicines, quarantine facilities and oxygen tanks for emergency purposes. Supply adequate food, safe/potable drinking water, disinfectants and hand soaps to in-house personnel Disseminate proper information regarding COVID-19 construction protocols, on top of existing construction safety practices must be conducted by Safety Officers Workers All workers must be reassured that they will Low to experiencing continue to get paid if they need to self-isolate moderate risk respiratory considering that they are showing COVID- (depends on symptoms may fear 19/respiratory symptoms. These provisions must the exposure not getting paid and be made including for contracted staff and are of the patient continue to show up included in the Labor Management Procedures to other at work (LMP). workers) Potential Law enforcement personnel must adhere to Code Low risk discrimination of of Conduct (CoC) including fair treatment and marginalized non-discrimination. groups, Gender- based Violence (GBV), Sexual Exploitation and Abuse (SEA) Civil servants and Training on community interaction and GBV Low risk outsourced staff/contractors may be involved in misconduct impacting women and children at local level. Below are some policies and regulations which are developed to mitigate occupational health risks: 1. Republic Act No. 11058 – The Occupational Safety and Health Standards (OSHS) Act This Act affirms that labor as a primary social and economic force and that a safe and healthy workforce is an integral aspect of nation building. It ensures a safe a healthful workplace for all working people by affording them full protection against all hazards in their work environment and ensures the provision of the Labor Code of the Philippines. 2. IATF Omnibus Guidelines: Inter-Agency Task Force (IATF) for the Management of Emerging Infectious Disease – Omnibus Guidelines for the Implementation of Community Quarantine in the Philippines 123 | P a g e All persons are mandated to wear face masks, ear loop masks, indigenous, reusable, do-it-yourself masks, or face shields, handkerchief, or such other protective equipment or any combination thereof, which can effectively lessen the transmission of COVID-19. 3. DTI-DOLE Joint Memorandum Circular No. 20-04-A s. of 2020 – Supplemental Guidelines on Workplace Prevention and Control of COVID-19 This applies to all private establishments regardless of economic activity, including those located inside special economic zones and other areas under the jurisdiction of Investment Promotion Agencies. It involves workplace safety and health, management of symptomatic and asymptomatic employees in the workplace, OSH committees, notification and reporting, disinfection and closure of workplaces, LOA and entitlements and compliance monitoring and enforcement. 4. DPWH Department Order No. 39 Series of 2020 – Revised Construction Safety Guidelines for the Implementation of Infrastructure Projects During the COVID-19 Public Health Crisis It grants authority to allow government and private construction projects under ECQ, MECQ, GCQ and MGCQ. It includes the types of construction projects, safety guidelines, monitoring, enforcement, and penalties for the implementation of infrastructure projects during COVID-19 public health crisis. Additional guidelines were also considered: 1. DOLE No. 198, series of 2018 – Implementing Rules and Regulation of 11058, “An Act Strengthening Compliance with Occupational Safety and Health Standards and Providing Penalties for Violations Thereof” 2. Presidential Decree No. 442 of 1974 – The Labor Code of the Philippines It is advised that compliance of both HCFs and contractors must be observed throughout the project life cycle. A2. Occupational Engr. Padilla also gave an overview of some Occupational Safety and Health (OSH) Safety and Health requirements for construction activities during the new normal: Requirements for Construction 1. Personal protective equipment (PPE) must be provided by the concessionaires, Activities in the contractors, subcontractors and suppliers such as face masks and face shields. New Normal 2. Proper respiratory hygiene must be performed before, during and after working in the construction area. For example, covering the mouth and nose by hands, elbow or own clothes before sneezing or coughing. 3. Perform proper hand hygiene frequently by washing hands with soap and running water or applying alcohol. 4. Workers experiencing COVID-19 or respiratory symptoms must seek immediate medical advice. 5. Maintain social distancing with a minimum of 1 meter from other persons. 6. Frequent disinfection of the construction area and employees’ quarters. B. Environmental The session proceeded with the discussion of potential environmental risks and impacts Risks and and mitigation measures. Mitigation Measures Potential Environmental Level of Proposed Risk Mitigation Measures Risks and Impact Impacts Increased Compliance to RA 9003 Low risk community solid waste due to No open burning of construction waste/material construction wastes at the site. 124 | P a g e Establish appropriate erosion and sediment control measures (hay bales, silt fences) to prevent sediment from moving off site and causing excessive turbidity in nearby streams and rivers. Construction wastes will be stored, collected and disposed properly by licensed collectors. Waste collection and disposal pathways and sites will be identified for all major waste types expected from demolition and construction activities. Mineral construction and demolition wastes will be separated from general refuse, organic, liquid and chemical wastes by on-site sorting and stored in appropriate containers Increased Compliance to RA 9275 and DENR DAO 35-90 Low risk wastewater or General Effluent Standards discharge The approach to handling sanitary wastes and wastewater from building sites (installation or reconstruction) must be approved by the local authorities. Before being discharged into receiving waters, effluents from individual wastewater systems must be treated in order to meet the minimal quality criteria set out by national guidelines on effluent quality and wastewater treatment. Monitoring of new wastewater systems (before/after) will be carried out. Construction vehicles and machinery will be washed only in designated areas where runoff will not pollute natural surface water bodies. Cutting, destroying, Preserve planted or growing trees, shrubs, or Low risk or injuring of plants by earth balling or repopulation to clear planted or growing area for construction activities trees, flowering plants and shrubs Compliance of contractors to the following: or plants to give way for construction DENR Department Administrative Order No. activities 2021-11 – Guidelines in the Processing and Issuance of Permits for Cutting, Removal, Relocation of Naturally Growing Trees Presidential Decree No. 705 – Revised Forestry Code of the Philippines Republic Act 3571 – An Act Prohibiting the Cutting, Destroying or Injuring of Planted or Growing Trees, Flowering Plants and Shrubs or Plants of Scenic Value Along Public Roads, in Plazas, Parks, School Premises or in Any Other Public Pleasure Ground The following additional guidelines have to be also observed during the project: 125 | P a g e Policy No. Title Republic Act No. 9003 Ecological Solid Waste Management Act of 2000 Republic Act No. 8749 Clean Air Act of 1999 Republic Act No. 9275 Clean Water Act of 2004 DENR AO No. 35 General Effluent Standards Series of 1990 Prohibit Cutting, Destroying or Injuring of Planted or Republic Act No. 3571 Growing Trees Act Presidential Decree Revised Forestry Code of the Philippines No. 705 DENR AO No. 11 Issuance of Tree Cutting Permit Series of 2021 C. Community Engr. Padilla then presented the potential community risks and impacts and mitigation Health and Safety measures. Risks and Mitigation Potential Measures Community Health Level of Proposed Risk Mitigation Measures and Safety Risks Impact and Impacts Legal issues of All legally required permits have been Low risk construction acquired for construction and/or rehabilitation. The public has been notified of the works through appropriate notification in the media and/or publicly accessible sites (including the site of the works). The local construction and environment inspectorates and communities have been notified of upcoming activities. Dust due to Demolition debris shall be kept in controlled Low risk construction activities area and sprayed with water mist to reduce debris dust. During pneumatic drilling/wall destruction, dust shall be suppressed by ongoing water spraying and/or installing dust screen enclosures at the site. The surrounding environment (sidewalks, roads) shall be kept free of debris to minimize dust. During interior demolition, debris-chutes shall be used above the first floor. 126 | P a g e Noise from Construction noise will be limited to Low risk construction activities restricted times agreed in the permit. During operations, the engine covers of generators, air compressors and other powered mechanical equipment shall be closed and placed as far away from residential areas as possible. Road blockage, There will be no excessive idling of Low risk heavier traffic due to construction vehicles at sites. construction activities Designated areas will be allocated for construction vehicles. Fear, mistrust and Conduct of community consultations and Low risk resistance among the open feedback loop for communities. local community Environmental The ESF Framework has six instruments, namely: and Social Framework (ESF) 1. Environmental and Social Screening Instruments 2. Environmental and Social Standards Implementation Review 3. Environmental and Social Management Plan (ESMP) 4. Environmental Codes of Practice (ECOP) 5. Labor Management Procedure (LMP) 6. Contractor’s Personnel Grievance Redress Mechanism (GRM) A. Environmental Engr. Padilla explained Environmental and Social Screening including the corresponding and Social form. He went through the different items under the screening process so that the Screening participants will be aware of the questions involved. The checklist and screening process involved here must be used by the DOH and Contractor to review the potential environmental and social safeguard impacts of the project. It is a tool to screen, classify, and evaluate the project activities during project preparation. Please refer to Annex B for the screening form. B. Environmental The newest instrument aims to validate whether the HCFs and contractors are complying and Social with the DOH and IATF guidelines. There are two parts to the review particularly the Standards guide questions and implementation documentation. Engr. Padilla ran through the Implementation questions and requirements needed for the review. Review Please refer to Annex C for the review forms for HCFs and Contractors. C. Environmental According to Engr. Padilla, the ESMP must be prepared by the contractor in coordination and Social with the health care facility during the project period, in accordance with the Management Plan Environmental and Social Management Framework (ESMF). It describes safeguard (ESMP) measures and guides the planning and implementation of the mitigation measures to be carried out by the contractor during the building construction works. It also includes safeguards performance monitoring, reporting, and disclosure. Engr. Padilla then went through the different items under the ESMP which covers Community and Environmental Health and Safety and Occupational Health and Safety. Please refer to Annex D for the ESMP. 127 | P a g e D. Environmental The team’s ESF Coordinator, Ms. Krystell Año, provided a presentation on the Codes of Practice Environmental Codes of Practice (ECOP). (ECOP) The ECOP is like a summary or a shorter version of the ESMP, with the specific details or activities for compliance. It is designed to be answered regularly to quickly assess the environmental and social compliance of the project activity. Unlike the ESMP, it does not require the budget required, timeline, and responsible persons. The ECOP refers to the document which provides general guidelines for the environmental and social management of activities not covered by the ESMP, ensuring compliance with national laws and the World Bank's ESS. It consists of basic standard operating procedures for activities that may generate temporary and reversible environmental and social impacts which are readily managed with good practices during the implementation. It has 3 components which are as follows: a. COVID-19 Exposure at Health Care Facility b. Community and Social Inclusion c. Small Scale Construction, Upgrades, Rehabilitation, and Expansion Ms. Año went through the entire three checklists for ECOP to familiarize the participants with it. Please refer to Annex E for the ECOP. D. Labor Ms. Maricel de Guzman, the team’s Social Specialist, discussed another ESF instrument Management which is the Labor Management Procedure (LMP). This contains the guidelines in the Procedure (LMP) ESMF which identifies the main labor requirements and risks associated with the project and helps the DOH to determine the resources necessary to address project labor issues. As initially mentioned, the checklist is anchored on the issuances, RA 11058 – An Act Strengthening Compliance with Occupational Safety and Health Standards and Providing Penalties for Violations Thereof, and PD 442 – The Labor Code of the Philippines. The LMP consists of six components: 1. Labor Working Conditions 2. Assessment of Potential Labor Risks 3. Labor Legislation 4. Contractor’s Personnel Grievance Redress Mechanism (GRM) 5. Contractor Management 6. Use of Security Personnel Ms. de Guzman showed the checklist and online form for the participants’ reference. Please refer to Annex F for the LMP. E. Contractor’s Ms. de Guzman also discussed the Contractor’s Personnel Grievance Redress Personnel Mechanism (GRM). The GRM is a feedbacking system which facilitates the uptake of Grievance complaints, comments, and recommendations of stakeholders on the Project and guides Redress the implementing agency to process feedbacks and resolve complaints and grievances Mechanism in a timely, effective, and efficient manner that satisfies all parties involved. It provides a (GRM) transparent and credible process for fair, effective, and lasting outcomes while building trust and cooperation as an integral component of broader community consultation that facilitates corrective actions, as well as provides the affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of the Project. It ensures that appropriate and mutually acceptable redress actions are identifies and implemented to the satisfaction of complainants. Lastly, it avoids the need to resort to judicial proceedings. The Legal Framework of the PCERP’s GRM or its policy/ regulation policy is based from the following issuances: 128 | P a g e • Republic Act 11032 – Ease of Doing Business and Efficient Government Service Delivery Act of 2018 • Republic Act No. 9485 – Anti-Red Tape Act (ARTA) of 2007 • Civil Service Commission (CSC) Resolution no. 1701077 – 2017 Rules on Administrative Cases in the Civil Service (2017 RACCS) • Department of the Interior and Local Government (DILG) Memorandum Circular no. 2017-109 – Designation of a Permanent Action Team for the Implementation of Citizen’s Complaint Hotline 8888 • Labor Code of the Philippines (Presidential Decree no. 442 of 1974 as amended and renumbered • Department of Health (DOH) Citizen Charter 2nd edition (2020) • DOH Centers for Health Development Citizen Charter • Department of Environment and Natural Resources (DENR) Citizen Charter 5th edition (2021) • Department of the Interior and Local Government (DILG) Citizen Charter 2nd edition (2020) • Department of Labor and Employment (DOLE) Citizen Charter 2020 edition • Department of Public Works and Highways (DPWH) Citizen Charter (2020) • Civil Service Commission (CSC) Citizen Charter 2020 (2nd edition) She also presented the types of feedback or complaint that are handles by appropriate government agencies. For project-related concerns, the following are the authorities that handles the specific concerns: Concern (Project-related) Authority Feedback on or complaint against DOH DOH Central Office, CHD, HCF hospitals Feedback on or complaint against LGU hospitals LGU, DILG Feedback on or complaint against any CSC public/government official/institution Feedback on or complaint against construction HCF, LGU, DOH, DOH CHD, DPWH activity in health facility (PCERP-funded) Feedback on or complaint of personnel against Contractor, DOH, DOLE, DPWH contractor (PCERP-funded construction) Feedback on or complaint against on COVID-19 DOH Central Office, DOH CHD, HCF, vaccination and other related services DILG, LGU Environmental-related feedback on or complaint DENR, LGU (P/CENRO) The participants were also oriented on the various reporting process / channels that are available to the public: Grievance Reporting Medium Grievance Reporting Mechanism Grievance Receiver or Channel Complainant files grievance DOH Central Office (CO) – Physical or Walk-In physically through the Office of the Complaints Handling Unit authorities (CHU) Complainant files grievance through DOH Centers for Health snail mail, email, Complaint Centers Development (CHDs) – Public Mail, Online, and E- Assistance Complaint Desk (e.g., Contact Center ng Bayan mail Public Assistance Desk of Presidential Complaint Center, and Anti Red Tape Authority) Health Care Facilities Complainant files grievance through DOH CHU or similar unit in the hotlines such as but not limited to: DOH CO, CHD PACD, or DOH Call Center/ Hotline (COVID-19 health facilities Phone Call and vaccines) or through hotline of CSC Central Office – Public DOH health facilities Assistance and Information Citizens’ Complaint Hotline 8888 Office (PAIO) DOLE Hotline 1349 129 | P a g e DPWH 165-02 CSC Regional Offices – Public ARTA Assistance and Complaints Presidential Complaint Center Desk (PACD) Contact Center ng Bayan CSC Field Offices– Public Assistance and Complaints Desk (PACD) DENR (Public Assistance Unit and Strategic Communication and Initiatives Service – Stakeholder Management and Conflict Resolution Division) DENR Regional Offices DILG Legal and Legislative Liaison Service – Appellate Division (LLLS–AD) DILG Regional Offices DOLE Bureau of Labor Relations (BLR) – Appeals and Review Unit DOLE Regional Offices DPWH Stakeholders Relation Services – Stakeholders Affairs Division DPWH Regional and Field Offices ARTA Presidential Complaint Center Contact Center ng Bayan LGU (Provincial/City/ Municipal Health Offices and Environment and Natural Resources Offices) Ms. de Guzman facilitated the run through of the different information being asked in the GRM form that covers environmental safety / pollution-related, occupational safety and health, temporary housing facilities, health facility-related, and administrative concerns. Please refer to Annex G for the Contractor’s Personnel GRM. Implementation As for the implementation arrangements, the DOH Department Circular no. 2020 – 0398 Arrangements or the Guidelines on Civil Works Implementation for the World Bank – PCERP sets forth the compliance requirements and implementation arrangements for the civil works component and ensures that all recipient facilities are following the DOH standards on the construction of facilities, quarantine and reference laboratories are aware of the World Bank regulations. Engr. Padilla explained this further by stating that the Contractors should submit a monthly monitoring report on the Environmental and Social Management Plan (ESMP) or the Environmental Codes of Practice (ECOP), the Labor Management Procedures (LMP), and the Contractor’s Personnel Grievance Redress Mechanism (GRM) to the Environmental and Social Risk Management Specialist of the Project Management Team in the DOH Disease Prevention and Control Bureau (DPCB) not later that the 10th day of each succeeding month, in signed electronic and hard copies. The Safety Officer of the Contractor shall accomplish the monthly M&E forms. Similarly, the health facilities may self- reporting of incidents or accidents through the GRM for Recipient Facilities form. The DOH DPCB will evaluate submissions while the health care facility to supervise contractor. The forms are accessible online at the following links: 130 | P a g e ESF Instruments to be Office Link Submitted DOH PCERP 1. Environmental and Social http://bit.ly/PCERPESS Screening Contractor 1. Environmental and Social To be emailed by DOH Standards Implementation Review DPCB monthly to Contractor (Parts A and B) 2. Environmental and Social https://bit.ly/PCERPESMP Management Plan (ESMP) or https://bit.ly/PCERPECOP Environmental Codes of Practice (ECOP) [choose 1 only] 3. Labor Management Procedure https://bit.ly/PCERPLMP (LMP) 4. Contractor’s Personnel https://bit.ly/GRMContractor Grievance Redress Mechanism Health Care 1. Environmental and Social To be emailed by DOH Facility Standards Implementation Review DPCB monthly to Health (Parts A and B) Facility 2. Grievance Redress Mechanism https://bit.ly/GRMRecipient (GRM) for Recipient Facilities The participants were asked to fill-up the Training Needs Assessment Form (http://bit.ly/TNAESFPCERP) prior to the ESF Training. Afterwards, they were asked to accomplish a Post-Training Assessment Form (http://bit.ly/ESFPostAssessment) to get their feedback on the activity. Engr. Padilla then presented the aforementioned online forms for the participant’s reference. Please refer to Annex H for the GRM for Recipient Facilities. Geotagging of Engr. Padilla gave a brief discussion on the Geotagging of Documentations. Geotagging Documentations is a process of adding geographical information to a digital content (e.g., images, videos). for Submission The geographical information includes latitude and longitude coordinates, place names, altitude, distance, bearing, accuracy data and even time stamps. The purpose of these is to find images and information based on location or create location-based updates, and to verify the actual construction site of the project. Basic steps of Geotagging: 1. Collect digital location data using Google Maps. 2. Edit the location data in the EXIF data or metadata of the photos. A video was also presented on the Geotagging process using Picasa and Google Earth: https://youtu.be/VwXTC0fzar4. Prevention of For this topic, Ms. Año facilitated the showing of videos curated from the DOH e-learning COVID-19 platform on the preventive measures against COVID-19. The main points from the videos are as follows: The equipment needed at home for basic hygiene at home include but are not limited to clean water, soap, alcohol hand rub (at least 70% solution), disposable tissue, no-touch trash can, household disinfectants, and medical masks, gloves, and plastic aprons for personal protective equipment. 131 | P a g e In all settings, there is a need to clean and disinfect frequently touched surfaces and objects daily. Use detergent or soap and water prior to disinfection. Spraying of cleaning or disinfectant solution on a surface is not recommended. Pump-action containers that dispense liquid to apply prepared cleaning or disinfection solutions should be used. For soft surfaces such as carpeted floor, rugs, and curtains, remove visible contamination, then launder or clean with appropriate products. Consider putting a wipeable cover on electronics. Follow manufacturer’s instruction for cleaning and disinfecting. If no guidance, use alcohol-based wipes containing at least 70% alcohol. In community spaces, mop the floors with regular household detergent and water at least daily. It is best done with separate buckets used for detergent, rinse water, and disinfectant. Disinfection can be done using household cleaners and disinfectants, diluted household bleach solutions or alcohol solutions with at least 70% alcohol. In case someone in the building is sick, close off all areas used by the sick person. Open outside doors and windows to increase air circulation in the area. Clean and disinfect after 24 hours if area can be vacated, or immediately if this is not possible. Remember to wear disposable or impermeable gloves and gowns for all tasks. Additional PPE might be required based on the cleaning/disinfectant products used and risk of splash. If there is a shortage of PPEs, wash your hands often. Always wash immediately after removing gloves and after contact with an ill person. Prevention of For the discussion of this segment, a video from Ms. Mary Joy Morin of the DOH National Sexually AIDS, STI Prevention and Control Program of the DOH was shown on the prevention of Transmitted sexually- transmitted diseases. Diseases Highlights from the session are noted below: Sexually Transmitted Infections (STI) are infections that are passed on through close body contact or through the exchange of body fluids. In STI, the 4 important body fluids are blood, semen, vaginal fluid, and breastmilk. Many people have no symptoms of STIs. If present, symptoms may include: • Unusual discharge from the penis, vagina, or anus • Itchiness around the genital area • Burning sensation when urinating • Rash, sores, or small lumps on or around the penis, vagina, or anus • Pain and swelling in the genital area STI needs to be diagnosed and treated/managed properly. These are common symptoms of Bacterial STIs: • Gonorrhea ➢ Burning during urination ➢ Vaginal or urethral discharge ➢ Pain in lower stomach • Chlamydia ➢ Whitish, cloudy or water discharge ➢ Pain/burning during urination ➢ Pain in lower stomach ➢ Pain during sex • Syphilis ➢ Painless sore on the genitals or anal area ➢ Rash on the soles of the feet, palms, or other parts of the body ➢ Enlarged lymph nodes, fever, fatigue, or hair loss Another type of STIs are Viral STIs. An example of these would be Herpes. • Herpes Simplex Virus Type 1 ➢ Cold sores or “fever blisters” on the lips ➢ Can spread through kissing or household contact • Herpes Simplex Virus Type 2 132 | P a g e ➢ Painful, fluid-filled blisters and crusted sores on the genital area, thighs, or anus, and lips through oral contact • Genital warts ➢ Can be raised, flat, or cauliflower-shaped ➢ No symptoms or visible warts • Hepatitis B ➢ Abdominal pain ➢ Dark urine ➢ Fever ➢ Joint pain ➢ Loss of appetite ➢ Weakness and fatigue ➢ Yellowing of skin and whites of eyes * Note that Hepatitis B has NO CURE Another type of STIs called Parasitic STI. An example of this is: • Trichomoniasis ➢ “Strawberry patch” – grainy/sandy ➢ Itching or irritation ➢ Burning during urination/ejaculation ➢ Discharge from penis ➢ Clear, white, yellowish, or greenish discharge with an unusual fishy smell * This is the most common curable STI An example of Fungal STI is: • Candidiasis ➢ A thick, white, cottage cheese-like vaginal discharge ➢ Itching or irritation of the vulva, penis, or testicles ➢ Has a yeasty odour Skin parasites may also exist. Pubic lice or “crabs” have severe itching, visible crawling lice, or eggs attached to the pubic hair. Basic hygiene can resolve this. Scabies has extreme itching that is worse at night. It is described as a pimple-like rash. If STI is left untreated, it can lead to long-term damage/complications such as infertility, blindness, brain damage, heart disease, cancer, adverse pregnancy, and can be passed on to the infant. Acquired Immunodeficiency Syndrome (AIDS) is a condition where signs and symptoms appear. HIV causes AIDs, but not all with HIV have AIDS. The sharing of HIV could also be transmitted through contaminated needles or syringes. This is common for people who engage with drugs. Another way of HIV transmission is through condom-less or unprotected sexual intercourse with an infected person. Sex between males is the most common way of HIV transmission. An HIV-infected mother could also pass on the disease through her pregnancy, labor and delivery, and even breastfeeding. HIV prevention can be prevented through: A – Abstinence B – Be mutually faithful C – Correct and consistent condom use D – Don’t use drugs/share needles E – Education, Early Diagnosis, & Early Treatment HIV is a lifetime infection. It has not specific signs and symptoms and has no cure. There is no vaccine to protect you against HIV. It does not spread through everyday contact with people who are infected with HIV. Do not to discriminate and stigmatize people living with HIV. 133 | P a g e Topic Comment/Query Stakeholder Response Vaccination for Engr. Salvador Jiao Contractors During the presentation on the workers from the World Bank LMP, Ms. de Guzman explained asked on how the that contractors should assist their contractors promote personnel in getting their vaccines vaccination among where it is available. construction workers, now that vaccines are more or less available for the public. Legal age of Engr. Jiao verified on PCERP Team Engr. Padilla initially clarified that workers in the mandated age as long as the worker is of legal construction requirement to employ age, they can be employed by the projects construction workers. In contractor considering that the the presentation, it was workers is not senior citizen and in stated that workers good health condition and can should be from 21 to 59 perform activities in the years old. But construction site. according to DOLE, persons of 18 years of After further research, DPWH age can be hired in issued DO 39, series of 2020, with construction work. guidelines stating that only ages 21 to 59 can be hired for construction activities in adherence to the Revised Omnibus Guidelines issued by the IATF while the quarantine restrictions are in place due to the pandemic. Copies of the Some the participants PCERP Engr. Padilla assured the group presentation including Ms. Agnes that the team will email the Balota from the World presentation. He reminded them Bank asked if copies of to input their email addresses in the presentation will be the chat box for reference. given. 134 | P a g e Annex R st Minutes for the 1 ESF Coordination Meeting for ongoing Civil Works projects conducted on October 11, 2021 Topic Discussion Findings from the Ms. Krystell Año of the DPCB presented the findings from the Environmental ESF Instrument and Social Framework (ESF) Instrument submissions as of September 10, Submissions 2021. Below are the top community health and safety impacts as well as the common mitigating measures that were noted in the forms filled up by the contractors. Community Health and Mitigating Measures Safety Impacts Noise from construction • Construction noise is limited to restricted activities times agreed in the permit. Road blockage/heavier traffic • No excessive idling of construction due to construction activities vehicles at sites. • Allocation of designated areas for construction vehicles. Increased generation of solid • Waste collection and disposal pathways wastes and sites will be identified for all major waste types expected from demolition and construction activities. • Construction waste will be collected and disposed properly by licensed collectors. • No open burning of construction/waste material at the site. Dust due to construction • Demolition debris are kept in controlled activities areas and sprayed with water mist to reduce debris dust. • Surrounding environment (sidewalks, roads) are kept free of debris to minimize dust. • Water spraying and/or installing dust screen enclosures at site. The following table shows the occupational health and safety for the workers as well as the common mitigating measures: Occupational Health and Mitigating Measures Safety Occupational, health, and • Compliance to construction regulations. safety (OHS) risks for project • Development of an Occupational Health workers associated with the and Safety Program. upgrading activities • Workers undertake the mandatory 8-hour safety and health seminar for workers. • Workforce has a qualified Safety Officer. • Rational use of PPE. • Adherence to basic hygiene procedures at all times to prevent the transmission of COVID-19. • Site-awareness-raising activities to remind personnel about occupational exposures and safe practices (i.e. Toolbox Meetings). • Practice of minimum public health standards. • Practices of occupational Safety and Health Standards. • Disinfection of area prior to construction. 135 | P a g e Workers may be asked to • Provision of OT pay. work overtime • Consultation with workers. Exposure to infectious waste • Encourage hand hygiene (washing, (chemical and physical preferably followed by disinfection). hazards) • Use gloves for handling waste. • Raise the awareness of staff about simple post exposure prophylaxis in case of injury. Workers experiencing • All workers must be reassured that they respiratory symptoms may will continue to get paid if they need to self- fear of not getting paid and isolate if they are showing with COVID- continue to show up at work 19/respiratory symptoms. As for the checklist on the Labor Management Plan, the following are the common compliance as reported by the contractors. Labor Requirements Mitigating Measures Labor Working Conditions • Legal age of workers • PPE provision • OHS Officer ** Compliance reported by all contractors Assessment of Potential • Controlled exit/entry at the work site Labor Risk • Availability of accommodation facility to reduce community contact • Availability of hygiene and sanitation facilities • Provision of PPE • Pre-employment health checks • Shifting or rotation of workers to allow social distancing • Alternatives to direct interaction (livestream, online instructions) Labor Legislation • Wages above minimum, paid twice a month or any agreed arrangement following Labor Code • Night shift differential / Overtime pay / Holiday pay • Compliance to OSH standards • Rest day [minimum of 24 hours] after 6 consecutive work days • Gender discrimination in employment and labor relations • Provide a hazardous free working environment (health and safety issues) • Sanitation and hygiene facilities is present and well-disinfected regularly • Employee training orientation (work/safety instructions, hazards, mitigating measures, drills) • Hazard reporting Contractor Personnel GRM • Implementation and monitoring of the GRM for civil works. This reporting period, there are two grievances of note: No available temporary facility since the temporary facility dismantled to give way to the construction of isolation rooms. The proposed new temporary housing facility is in immediate vicinity to the COVID-19 wards, and that the HCF could not issue IDs for the staff and workers of the contractor. Since this was reported, the PCERP ESF team will be monitoring the actions of the HCF or whoever is responsible for these concerns. 136 | P a g e ESS Ms. Año presented the common observations shown at the worksites. Below Implementation are the findings of the best practices implemented at the project sites from the Review documentations sent by the contractors: Observations 1. Social distancing is observed in the work area. 2. Temperature checking for workers - It is recommended that the temperature checking be done not just in the morning before work, but in the afternoon as well after work shifts. 3. Complete Personal Protective Equipment 4. Continuous supply of hand soap, alcohol, and other hygiene/sanitation supplies for workers. 5. Lavatory and hand washing stations available for workers 6. Access to worksite (scaffolding) 7. Continuous supply of vitamins to workers. 8. 9 out of the 14 project sites use an alternative access route to the construction area, that is different from the access route of hospital staff/patients/guests. 9. Dividers available to separate the worksite from the COVID facilities 10. Proper waste management for construction waste 11. Proper supplies storage for construction materials 12. Shuttle service provided for stay-out workers It is noted that 10 out of the 14 contractors provide Temporary Housing Facility for workers. The 4 facilities that are not included in these are PHC, PCMC, NKTI, and ARMMC. Some of the requirements for the temporary housing facility are listed below: • 4-5.5 sqm / worker • 1 meter between beds; 0.7-1.1 m for bunkbeds • 2.10 m ceiling height for proper air circulation Based on the photos provided by the contractors, Ms. Año noted that the housekeeping of the temporary housing facilities could be improved. This is one of the way to prevent any infection from spreading within the barracks. It is also noted that only 5 contractors reported of using the pantry area. There was a lack of social distancing reminders in the common area such as posters or signs that would help the workers keep in mind of the health protocol. Common Issues on Ms. Año presented the common issues on the ESF instrument submissions. ESF Instrument Some of the issues that were noticed in these submissions are the following: Submissions Issues In-Charge Actions to be Taken 1. Not following instructions HCFs and Reorientation on ESF - Not submitting the forms Contractors instruments online - Incomplete answers in the forms 2. Late submissions HCFs and Sending reminders on - Incomplete submissions Contractors the 1st week of the - No documentation in ESS IR month 3. No submissions HCFs Persistent followups and present submission trackers Incident Reporting Engr. Alexander Padilla Jr. of the DPCB presented the Incident Reporting System System of PCERP that was recently established. By definition, an incident refers to any event, condition, or situation which has: 137 | P a g e • Impact to Operation: causes disruption or interference to any activity/operation in the worksite; • Impact to Stakeholders: causes significant risks that could affect stakeholders • Impact to Perception: attracts negative media attention or a negative profile for the worksite An Incident Report shall be submitted to serve as a documentation of the incident, including the identification of the root cause and corresponding actions to resolve the incident. Submission to the PCERP ESF Team should be done within the next 24 to 48 hours after the incident occurred. The Incident Report shall be prepared by the Safety Officer and noted by his/her supervisor (General Manager/Project Manager/Project Engineer). This will be subject to validation and monitoring until close-out. The process of the Incident Report System is listed below: 1. Incident report preparation - An incident report form provided by the PCERP ESF Team will be given. 2. Infection Prevention and Control (IPC) Investigation Checklist Completion - IPC Checklist also given by the PCERP ESF Team to be filled out by the contractor 3. Virtual Site Audit - The PCERP ESF Team shall schedule a meeting for the virtual site audit after submission of the Incident Report and accomplished IPC Checklist. 4. Virtual Site Validation Tool Assessment - A virtual site validation tool shall be used by the PCERP ESF Team to inspect the compliance of the Project Site to the Environmental and Social Safeguards. 5. Action Plan and Work Resumption Plan Development - The work resumption plan will be generated containing the overall requirements before resuming the construction of activities. 6. Status Reporting (Weekly) - Weekly status reports shall be submitted by the Contractor to the PCERP ESF Team. These indicate the progress of the Contractor on the compliance to the Action Plan items. It is important to include documentation (e.g. photos, videos) as proof of compliance. 7. PCERP Validation - Validation reports shall be reverted to the contractor by the PCERP ESF Team to verify their compliance. It is expected to comply on all the Action Plan items immediately or in less than a month to meet the urgency nature of the project. 8. Incident Close Out - Recommendation for resumption 9. Incident Investigation Report Preparation - An Incident Investigation Report shall be made to record the whole incident in the project site. This will serve as a compilation of all the submissions by the Contractor. Incident Reporting Engr. Padilla presented the Incident Reporting Requirements to clarify on the Requirements specific incidents and documents to be submitted. Documents to be Office Incident Source Submitted Contractor COVID-19 1. Incident report To be and Health Infection 2. Infection Prevention and emailed by Care Facility Control Investigation Tool the DOH 3. Action Plan PCERP 4. Work Resumption Plan ESF Staff Any other 1. Incident Report incidents 2. Action Plan 3. Work Resumption Plan (if applicable) DOH PCERP All incidents 1. Virtual Site Validation ESF Team Tool 138 | P a g e 2. Validation Reports on Status Reports 3. Incident Investigation Report Incident Report Engr. Padilla briefly explained the contents of the Incident Report Form as well Form as the definitions for each of the choices listed. Incident Types: 1. Environmental - spills, leak, natural disaster (e.g. fire, landslides) 2. Health/Medical - disease outbreak 3. Safety Injury - slips, trips, falls 4. Mechanical - equipment or vehicular related injury/death 5. Administrative - sexual harassment, violence against women, discrimination Incident Categories: 1. Indicative - low probability, low impact 2. Serious - high probability, low impact or low probability, high impact 3. Severe - high probability, high impact. This must be reported to DOH and World Bank within 48 hours All incidents must be documented and reported to DOH as the implementing agency of the Project. Documentation: • Action taken to Prevent Recurrence - this involves the long-term corrective action applied to prevent recurrence • Attach Photo Cross Reference - simple pictures of the activities or scan of documents administered to employ the corrective action is needed for documentation • Corrective Action Carried Out By - the name and designation of the person responsible in administering the corrective action • Close Out By - person verifying the resolution of the incident • Close Out Date - date the incident was resolved Reported by - The Safety Officer, Project Engineer, and Contractor Supervisor must accomplish the Incident Report Validated by - The filed Incident Report must be validated by the Health Care Facility (HCF) Representative or the Resident Engineer of the HCF and by the staff of the PCERP team. Infection This is a self-assessment tool designed for baseline assessment of the IPC in Prevention and project sites under PCERP. It identifies the strengths and gaps with existing Control (IPC) IPC resources/activities for information on future plans. Investigation Tool From this, and Action Plan can be developed and executed to address the gaps and sustain the implementation of the project. Virtual Site Audit This activity refers to the remotely monitoring or a tour in the project site by any worker from the Contractor. The purpose of this activity is to inspect potential causes of the incident and other possible gaps while implementing the project. The recorded meeting video will only be used and kept by the PCERP ESF Team for documentation purposes. 139 | P a g e Virtual Site This is a tool intended to inspect the ESF compliance of the project site while Validation Tool being remotely monitored. The PCERP ESF Team will be the one responsible in answering this tool while the virtual site visit is undergoing. Identification of strength and gaps in the project implementation can be evaluated through this tool. It has 3 parts, namely: • Evaluation Profile • Validation Checklist • Proposed Corrective Measures Action Plan The Action Plan is a list of environmental and social compliance that must by met by the Contractor before resumption of construction activities. The gaps that were observed in the IPC Investigation Tool and Virtual Site Audit will be listed down in this document. The status reports of this Action Plan must be submitted to the PCERP ESF Team weekly for remote monitoring on the items committed to implement by the Contractor in the project site. Work Resumption This document summarizes all the scheduled activities and document Plan submissions that the Contractor in coordination with the HCF needs to accomplish before commencing construction activities. Documentation on the compliance and regarding addressing the incident in the project site is also included in this document. Status Report on This document refers to the progress of compliance of the Contractor on the the Action Plan Action Plan items committed among all the parties. It is submitted weekly by the contractor until all the items in the Action Plan is complied. It is noted that documentation must be attached as proof of evidence on the compliance. Validation Report This document indicates the verification of the submitted Status Reports on the Action Plan. Incompliance of the contractor can still be observed at this point. Validation Reports shall serve as a receipt of acknowledgement by the PCERP ESF Team on the compliance of Action Plan items. Incident This report refers to the compilation of all the submissions of the Contractor Investigation ever since the incident occurred in the project site. A Root-cause analysis shall Report be used to better represent the potential sources or gaps of the incident. Some of the content of this report are the following accomplished documents: • Incident Report • IPC Investigation Tool • Virtual Site Validation Tool • Action Plan • Work Resumption Plan • Status Reports on the Action Plan • Validation Reports • Documentation of ESF Compliance 140 | P a g e Annex S Grievance resolution process of grievances within the jurisdiction of the DOH as described in DOH Administrative Order no. 2015-0048 – Revised Procedures on Handling Administrative Disciplinary Complaints in the Department of Health Figure A. Grievance Resolution Process for Complaints Against the Personnel with Rank Lower than the Chief Departments under DOH CHDs 141 | P a g e Figure B. Grievance Resolution Process for Complaints Against the Chief of Departments under DOH CHDs Figure C. Grievance Resolution Process for Complaints Against the Chief of Health Facility under DOH CHDs Figure D. Grievance Resolution Process for Complaints Against Personnel with Rank Less than the Assistant Director under DOH CHDs 142 | P a g e Figure E. Grievance Resolution Process for Complaints Against the Personnel with Rank Lower than the Chief Departments under DOH Central Office Figure F. Grievance Resolution Process for Complaints Against the Chief Departments under DOH Central Office 143 | P a g e Figure G. Grievance Resolution Process for Complaints Against the Chief of Health Facility under DOH Central Office Figure H. Grievance Resolution Process for Complaints Against the Rank of Division Chief and Below under DOH Central Office and Attached Offices 144 | P a g e Figure I. Grievance Resolution Process for Complaints Against All Presidential Appointees in the DOH except Undersecretaries and Assistant Secretaries Figure J. Grievance Resolution Process for Complaints Against Undersecretaries and Assistant Secretaries 145 | P a g e Annex T . Grievance Resolution Process for DOLE- Related Cases 146 | P a g e Annex U Grievance Monitoring Forms and Online Dashboard Monitoring of Grievances Grievances received within the month will be recorded in this form. Each grievance received will be counted as one item in the monitoring. Grievance Grievance Date Level at Stakeholders Status Next Steps Level at Received Description Proponent which Involved (resolved/ Action In- Timeline which Grievance pending) Taken Charge Grievance was was Received Resolved (facility/ (facility/ LGU/regional/ LGU/region national) al/ national) Note: Grievance proponent may or may not provide personal details Monitoring of Grievance Resolution No. of No. of Grievances Percentage of Grievances Resolved Grievances Resolved (No. of Grievances Resolved / No. of Grievances Received Received) Health Care Facility (Project Recipient) GRM Monitoring Dashboard (https://ee.kobotoolbox.org/single/GairVkZg) 147 | P a g e The same monitoring mechanism will be observed for the Contractor’s Personnel Grievance Redress Mechanism for the civil works components monthly: Monitoring of Grievances Next Steps Date Grievance Grievance Stakeholder Action to In- Receive Status Description Proponent s Involved be Charg Timeline d Taken e Monitoring of Grievance Resolution No. of No. of Grievances Percentage of Grievances Resolved Grievances Resolved (No. of Grievances Resolved / No. of Grievances Received Received) 148 | P a g e