REPUBLIC of LIBERIA MINISTRY of HEALTH Updated STAKEHOLDER ENGAGEMENT PLAN (SEP) Liberia COVID-19 Emergency Response Project (P173812) Additional Financing (AF) (P176336) And Second Additional Financing (AF2) (P178479) April 11, 2022 2|Page Table of Contents ACRONYMNS AND ABBREVIATIONS .................................................................................................. 5 Executive Summary ...................................................................................................................................... 6 1.0 INTRODUCTION ............................................................................................................................ 8 1.1 Background of the project ................................................................................................................... 8 1.2 Objective of SEP ................................................................................................................................. 9 2.0 PROJECT DESCRIPTION ................................................................................................................... 10 2.1 Vaccine Plan and Distribution .......................................................................................................... 12 2.2 Vaccine Monitoring, AEFI Management, Safe InjectionPractice and Waste Disposal .................... 14 2.2.1 Composition of the National AEFI/AESI Causality Committee ............................................... 14 2.3 Safe Injection Practice and Waste Disposal ...................................................................................... 15 3.0 LEGISLATIVE FRAMEWORK FOR THE SEP................................................................................. 16 3.1 National Requirement for Stakeholder Engagement......................................................................... 16 3.2 World Bank’s Requirements for SEP ............................................................................................... 16 4.0 STAKEHOLDER IDENTIFICATION AND ANALYSIS .................................................................. 18 4.1 Overview ........................................................................................................................................... 18 4.1 Affected Parties................................................................................................................................. 19 4.2 Other Interested Parties ..................................................................................................................... 19 4.3 Vulnerable Groups ............................................................................................................................ 20 5.0 STAKEHOLDER ENGAGEMENT PROCESS................................................................................... 22 5.1 Summary of Stakeholder Engagement done during project preparation .......................................... 22 5.2 Governance and Accountability Framework .................................................................................... 23 5.3 Summary of Project Stakeholders need and methods, tools and techniques for stakeholder engagement ............................................................................................................................................. 25 5.4 Stakeholder Engagement Principles.................................................................................................. 25 6.0 STAKEHOLDER ENGAGEMENT PROGRAM ................................................................................ 27 6.1 Purpose of Stakeholder Engagement Plan ........................................................................................ 27 6.2 Strategy for information Disclosure .................................................................................................. 30 6.3 Proposed strategy to incorporate the views of vulnerable group .................................................... 35 7.0 RESOURCES AND RESPONSIBILITY FOR IMPLEMENTING SEP ACTIVITIES ...................... 36 7.1 Resources .......................................................................................................................................... 36 7.2 Management Function and Responsibility ...................................................................................... 36 7.3 Grievance Mechanism ...................................................................................................................... 36 7.4 Monitoring and Reporting................................................................................................................. 38 7.5 Involvement of Stakeholder in monitoring activities ........................................................................ 38 3|Page 7.6 Reporting Back to Stakeholder Group .............................................................................................. 39 7.7 Budget for SEP ................................................................................................................................. 39 ANNEXES .................................................................................................................................................. 40 Annex A: ................................................................................................................................................. 40 Summary of Stakeholder Consultation made with (CSOs and NGOs) on parent project November 16, 2020 ........................................................................................................................................................ 40 Annex B: ..................................................................................................................................................... 47 Summary of Stakeholder Consultation made in Montserrado County on parent project December 18, 2020 .................................................................................................................................................................... 47 Annex C: ................................................................................................................................................. 58 Summary of Stakeholder Consultation made in Lofa County on Parent Project February 8th to 9th 2021 ................................................................................................................................................................ 58 Annex D: Summary of Stakeholder Consultation made in Nimba County on parent project February 10th to 11th, 2021 ................................................................................................................................... 64 Annex E: ................................................................................................................................................ 70 Annex F: Photos of Stakeholder engagement at county level................................................................. 72 Annex G: Sample complaint filling form ............................................................................................... 73 Annex H: Indicative Time limits for processing complaints .................................................................. 75 Annex I: Complaint Respond Proposal Form ......................................................................................... 76 Annex J: Sample letter of acknowledgement of receipt of an ineligible complaint................................ 79 Annex K: Sample letter of acknowledgement of receipt of an eligible complaint ................................. 80 LIST OF TABLES Table 1: Eligible Target Population & Vaccination Strategies ................................................................ 171 Table 2: Relevent Environmental and Social Standard (ESS) .................... Error! Bookmark not defined. Table 3: Stakeholder Consultation Related to COVID-19 .......................................................................... 28 Table 4: Strategy for Information Disclosure for COVID-19 ..................................................................... 31 LIST OF FIGURES Figure 1 Trajectory of cases March 2020-January 2, 2022 (Truncated to show Dec. 2, 2021-Jan 25, 2022 8 Figure 2: Incidence Management System Chart ......................................................................................... 24 4|Page ACRONYMNS AND ABBREVIATIONS AF Additional Financing AFL Armed Forces of Liberia CDC Center for Disease Control CoD Code of Conduct COVID-19 Corona Virus Disease 2019 EIA Environmental Impact Assessment EOC Emergency Operation Center EPA Environmental Protection Agency EPI Expanded Program on Immunization ESMF Environmental and Social management Framework ESS Environmental and Social Standard GBV Gender based Violence GRM Grievance Redress mechanism HCF Health facility HCI Health Care Institution HCW Health Care Waste HCWMP Healthcare Waste management Plan ICU Intensive Care Unite IDSR Infection Disease reporting System IMS Incidence Management System IRCL Inter-Religious Council of Liberia LMDC Liberia Medical and Dental Council LMHRA Liberia Medicine and Regulatory Authority MCC Monrovia City Cooperation MOE Ministry of Education MOH Ministry of Health NCC National Coordinating Committee NDVP National Deployment and Vaccine Plan NERCC National Emergency Response Committee on Covid-19 NPHIL National public Health Institute of Liberia OHS Occupational Health and Safety PDO Project Development objective POE Port of Entry PPE Personal protective Equipment PWD Person with Disability SEA Sexual Exploitation and Abuse SEP Stakeholder Engagement Plan WB World bank WBG World Bank Group WDS Waste Disposal Site WHO World Health Organization 5|Page Executive Summary The Stakeholder Engagement Plan (SEP) presented herein is the updated version of the second additional financing AF2) (P178479) for the Liberia COVID-19 Emergency Response Project (ERP) (P173812).. No major changes have occurred to the Project Development Objective (PDO), project components and its implementation structure. The SEP focus mainly on the vaccine procurement, distribution logistics activities. The SEP is designed to establish an effective platform for productive interaction with potentially affected parties and persons with interest in the implementation and outcomes of the Liberia COVID-19 Emergency Response Project in the health sector, the community and throughout the country at large. Effective stakeholder engagement is a necessary aspect of any good project and the SEP will help solicit feedback to inform project design and implementation while simultaneously managing expectations of beneficiaries and project affected person (PAPs) especially from the pandemic of COVID -19. This will enhance interested parties about project design and expected outcomes. The AF2 project will support implementation of the COVID -19 Emergency Response throughout the health sectors and the community. It will also strengthen the government of Liberia’s immediate capacity to respond to the COVID 19 outbreak and in the longer time strengthen its capacity to respond to disease outbreak and emergencies. There are key specific objectives that the project will support which include the following: to mitigate and contain the transmission of COVID-19; to ensure adequate management of severe COVID- 19 diseases; strengthen the laboratory system for COVID-19 and other infectious disease; to provide humanitarian and social support to health workers and family affected by COVID-19 and finally to strengthen project management and coordination including partnership for COVID-19 respond. The project AF2 is a supplement of the parent project and additional financing which is national in coverage and scope. No major civil works are expected in this project, only minor renovation or rehabilitation of laboratories within the existing health facilities. This COVID-19 financing will support the rehabilitation of existing buildings within the state land only, no land acquisition or involuntary resettlement impacts are expected. As a result, there is no impact or risks to critical natural habitats, protected areas or cultural sites. However, the COVID-19 Preparedness and Response operations of laboratories (equipment, reagents /chemicals) as well as quarantine and isolation centers may have considerable environmental and social impacts, such as those related to medical and general waste disposal, and the potential for transmission of the COVID-19 virus if prevention protocols are not followed. The identification and analysis of stakeholder groups for the parent project, AF1 and AF2 include government agencies, development partners, Civil Society groups and leaders, Non-Governmental Organizations, community-based organizations, policuy makers, media and religious leaders of the quarantine community. This SEP details of the purpose, timing and methods of stakeholder engagement and strategy for information disclosure. It will incorporate the view of all persons directly and or indirectly affected by the project. 6|Page Resources and implementation arrangements for SEP activities will be included in Component 1.4 of the COVID-19 Emergency Response Project and will be included in mainstreamed activities of the Ministry of Health. A summary of key institutions and focal persons has been included in the SEP to allow for easy identification of roles and responsibilities. The Grievance Redress Mechanism (GRM) for this SEP is incorporated in an already existing GRM within the Ministry of Health. Also, Grievance Redress Committees (GRCs) have been created and operationalized at the level of the PIU. Follow up on grievances and actions taken will form part of the overall monitoring of the project implementation team. An estimated amount of US$150,000 (One Hundred and Fifty Thousand US Dollars) will be required for SEP implementation of the GRM operating costs. 7|Page 1.0 INTRODUCTION 1.1 Background of the project 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 thirteen fold 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 spread across the world. Liberia faces significant risks regarding the potential impact of the COVID-19 pandemic. Liberia reported its first COVID-19 case on March 20, 2020. To date, the country has experienced four waves of the pandemic and with the fourth wave showing signs of decline. The first wave was from May-August 2020, the second from October-December 2020 and the third from May to August 2021. The fourth wave is currently ongoing and includes the threats of variants of concern (VOC) of which the delta and omicron variants are the most the significant. These new variants have created an urgent need for accelerating vaccination efforts to ensure that most of the population is vaccinated. Despite an increase in the new number of infections globally, vaccinations have shown to reduce the severity of the COVID -19 disease reducing admissions and deaths. At its highest within the current fourth wave, 129 cases were recorded on December 29, 2021. Figure 1 highlights the trajectory of the cases during the period from Dec 2, 2021 to January 25, 2022. As of January 25, 2022, the country has had a total of 7270 cases confirmed. Liberia has also had several cases among healthcare workers (HCW). To date 358 health workers have been affected including 40 doctors and 126 nurses who suffered six deaths out of a total of 8 health Worker Deaths. Figure 1 Trajectory of cases March 2020-January 2, 2022 (Truncated to show Dec. 2, 2021-Jan 25, 2022 8|Page 1.2 Objective of SEP The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the project life 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. The SEP has also been designed, so that the project can demonstrate engagement that is effective, meaningful, consistent, comprehensive, coordinated and culturally appropriate in line with ESS10 objectives and requirements, and all the relevant Liberian legal and regulatory framework and good international industrial practice. For the 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, overcoming demand-side barriers to access (such as mistrust of vaccines, stigma, cultural uncertainty), and creating accountability against misallocation, discrimination, and corruption. The SEP provides a framework for stakeholder engagement throughout the project life cycle (identification, preparation, appraisal, negotiation, completion). 9|Page 2.0 PROJECT DESCRIPTION The proposed project intends to fill critical gaps in implementing the Liberia COVID 19 Master Plan, including strengthening the prevention activities, rapid detection, preparedness and response to COVID 19 outbreak. The Liberia COVID-19 Emergency Response project will complement the already existing REDISSE project to further sustain and widen the already One Health Platform being supported by the World Bank. Despite recent progress, Liberia remains one of the countries with a weak health system in the region affected by the COVID-19, thus rendering vaccine purchase and deployment a national priority. With the availability of vaccines, Liberia now has an opportunity to add a significant new layer to its COVID-19 emergency response. The Second Additional Financing (AF2) by the World Bank will form part of an expanded health sector response to the COVID-19 pandemic. The AF which is the amount of additional US $ 12.7 million will support the costs of expanding activities of the Liberia COVID-19 Emergency Response Project (P173812, the Parent Project) to enable affordable and equitable access to COVID-19 vaccines and to 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 (PDO) of the parent project and the proposed AF2 is “to prepare and respond to the COVID-19 pandemic in Liberia.� The parent project includes five components that support the 10 thematic pillars of the GoL’s COVID-19 Plan. These are: Component 1: Emergency Preparedness Response (US$1.0 million); Component 2: Supporting Preparedness through Laboratory System Strengthening (US$1.0 million); Component 3: Case Management and Clinical Care (US$3.0 million); Component 4: Community Engagement, Risk Communication and Advocacy (US$1.75 million); and Component 5: Project Management and Coordination, Monitoring and Evaluation (M&E) (US$0.75 million). Following approval for the AF1, the components of the Parent project were reduced to two, (Component 1: Emergency Preparedness Response (Total: US$14.25 million equivalent; including parent project and Component 2: Program Management and Coordination, Monitoring and Evaluation (Total: US$2.0 million equivalent; including parent project) to respond more efficiently to the COVID - 19 response and align more effectively to implementation on ground. The AF2 will be aligned to the revised components under implementation. The revised components of the parent project are discussed below: Component 1: Emergency Preparedness Response (Total: US$14.25 million equivalent; including parent project: US$6.75 million; AF1: US$6.5 million; TF: US$1.0 million) and AF2 US$12.7 million). The component includes five subcomponents. Through AF1, the project was restructured to merge the original activities outlined in Components 1, 2, 3 and 4 of the parent projects into Subcomponents 1.3, 1.4 and 1.5. All activities of the merged components were maintained to ensure that different levels of the health system are equipped to continue strengthening disease surveillance and preventing, detecting, and treating COVID-19 cases while the NDVP is being implemented. 10 | P a g e a) Subcomponent 1.1: Vaccine procurement. This subcomponent will support costs related to: (i) the acquisition, freight and transport of COVID-19 vaccines including increased access to vaccines procured via mechanisms selected by the country (for example, COVAX, AVATT, or through bilateral options) and (ii) procurement of vaccination supplies (syringes, waste management boxes, cold boxes, vaccine carriers, alcohol prep pads, IPC material, etc.). b) Subcomponent 1.2: Vaccine logistics and rollout. This subcomponent will be financed by the HEPR TF and will support: (i) coordination mechanisms at the national, regional and county levels for the preparation and deployment of vaccines; (ii) development of targeting strategies for each priority group; (iii) development of legal regulatory documents, including aspects related to personal data protection; (iv) development of operational micro-plans and budgets; (v) adoption of global tools and adaptation of the supply chain systems to best practices, including cold-chain strengthening; (vi) acquisition of ancillary supply kits (including waste management boxes, cold boxes, vaccine carriers, vaccination record cards, PPE for vaccinators, solar powered refrigerators/freezers, and related suppliers); (vii) distribution of COVID-19 vaccines to the last mile including transport, cold-chain, consumable and other operational costs to ensure equitable distribution of vaccines across all priority groups with a special focus on people with disabilities and those most vulnerable and (viii) support for staff deployment. c) Subcomponent 1.3: Surveillance, laboratory system strengthening, clinical care and vaccine pharmacovigilance. This subcomponent will support: (i) case detection, confirmation, contact tracing, recording, reporting, and surveillance; (ii) laboratory system strengthening for the diagnosis of COVID-19 and other infectious diseases of public health importance and procurement of tests and consumables; (iii) activities to strengthen the acute management of clinical cases of COVID-19 patients; (iv) pharmacovigilance and monitoring of cases of AEFIs, including to (a) to develop and adapt tools and guidelines for the M&E of the vaccination campaign and detection of AEFIs; (b) train all actors involved at all levels of vaccine deployment on AEFIs; and (c) procure and disseminate emergency kits for anaphylactic shock management and reinforce health structure with resuscitation equipment. d) Subcomponent 1.4: Strengthening community engagement, risk communication and surveillance. The original activities under Component 4 of the parent project will be reinforced to equip people with the necessary knowledge and motivation to adopt prevention-related behaviors and counter misinformation around the COVID-19 pandemic. Moreover, this subcomponent will also support community advocacy activities and risk management approaches to maintain enhanced demand for the COVID-19 vaccines. Specifically, the AF will support costs related to: (i) activities that strengthen community engagement and social mobilization and accountability for vaccine demand and use (e.g. develop systems for community based surveillance, multi-stakeholder engagement, training of community leaders, etc.); (ii) activities to promote behavior change and enhance risk communication; and (iii) developing messages and materials, and information dissemination and collection to ensure that information on COVID-19 and the vaccination campaign is consistent and channeled through a limited amount of recognized platforms. e) Subcomponent 1.5: ESS, WASH and Gender. This subcomponent will support, and address aspects related to vaccine equity and gender inclusion and operationalize 11 | P a g e mitigation measures against sexual exploitation and assault during vaccination rollout. Given the challenges noted in the implementation of the ESS instruments under the parent project, the AF will directly finance ESS activities to ensure compliance in the implementation of the ESS instruments. The AF will also finance WASH activities in fixed, semi-fixed, and mobile health facilities to mitigate against the spread of COVID-19. Component 2: Program Management and Coordination, Monitoring and Evaluation (Total: US$2.0 million equivalent; including parent project: US$0.75 million; AF1: US$0.5 million and AF2: US$0.75 million). This component will support the financing of project management, monitoring including digital information, management, operational research, and learning. Specific areas of support include program support, monitoring of implementation, development of tracking electronic dashboards, digital registration, production of weekly progress reports, and support for rolling out eIDSR. This component includes two subcomponents. a) Subcomponent 2.1: Program Management and Coordination. This component will continue supporting the coordination and management of activities under the parent project, as well as new activities introduced under the AF. Specific emphasis will be placed on building the capacity of the PIU to support the implementation of the new activities. This subcomponent will also finance the recruitment of personnel to support vaccine activities at both county and central levels, and the operational costs of the PIU. b) Subcomponent 2.2: Monitoring and Evaluation, Research, and Learning. This subcomponent will continue to support national and county level M&E of the prevention and preparedness interventions, and support capacity building in M&E. It will also support the introduction of viable IT technology for remote sensing as appropriate. The subcomponent will also support the implementation of research and learning activities related to the vaccination campaign. The Parent Project SEP has been updated to reflect the activities under the Additional Financing and the additional issues noted in line with the template provided by the Bank. The proposed second additional financing of US$12.7 million will support the scale-up of activities for vaccination. The PDO will remain unchanged as the proposed activities to be funded under the AF are aligned with the original PDO. The closing date of the AF will remain aligned with the closing date of the parent project. 2.1 Vaccine Plan and Distribution 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. 12 | P a g e According to Liberia National deployment and Vaccine Plan (NDVP) for COVID-19 Vaccine, the eligibility criteria for covid-19 vaccine prioritized eligible population, groups based on the principles of the abovementioned WHO SAGE Guidelines and National Coordinating Committee (NCC) / Incidence Management System (IMS) recommendations Table 1 below outlines eligible Target Population & Vaccination Strategies Table 1: Eligible Target Population Vaccination Strategies N0 Target population (in order of Number of Priority targeted Total priority) additional delivery strategy for cumulative individuals this population % of vaccines to be as a vaccinated percentage of population 1 Health Care Workers (i.e., 69,390 Permanent fixed 8% (231,300) clinicians whose primary intent is (Health Facility); to deliver health services) Outreach and mobile 2 Elderly people (i.e., people 60 + 298,809 Permanent fixed 33% years as defined by their age-based (Health Facility); (996,030) risk and mortality Outreach and mobile 3 People with co-morbidities 280,589 Permanent fixed 33% (people with pre-existing health (Health Facility); (935,297) conditions especially those Outreach and m5obile associated significantly with higher risk of death 4 Others (essential workers who 262,215 Permanent fixed 29% cannot social distant due to the (Health Facility); (874,050) work they performed or carried Outreach and mobile out daily. For instance, teachers, bartenders, waiters, and waitresses, etc. The Liberia National Deployment and Vaccination Plan (NDVP) 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 Ministry of Health and the National Public Health Institute of Liberia. The MOH and NPHIL in collaboration with PIU developed a briefs to guide the implementation of the vaccine. A series of meetings were held to review and enrich the plan. 13 | P a g e 2.2 Vaccine Monitoring, Adverse Event Following Immunization (AEFI) Management, Safe InjectionPractice and Waste Disposal All medicines, including vaccines, have known benefits and risk. Vaccines are a key intervention public health tool that have been proven to prevent serious diseases. However, no medicine is 100% safe so like any other medicines, vaccines can have side effects which must be immediately investigate and appropriate action taken. Therefore, effective passive surveillance monitoring fully functioning system will be established to implement active AESI during and after the use of the COVID-19 in Liberia. All safety data garnered will be reviewed and assessed by the National Adverse Effect After Immunization (AEFI) and Adverse Event of Special Interest (AESI)Causality Expert Committee and properly communicated with the public is no exception especially so when the vaccine is being use under Emergency Using Listing (EUL) Procedures. Therefore, post- deployment surveillance for use of covid-19 vaccine is cardinal and as such close monitoring of the safety data garnered from the administration of the of covid-19 vaccine will be reviewed by the National AEFI/AESI Causality Expert Committee in quickly identifying any new orchanging risk as possible and take the appropriate action(s). Additionally, to ensure high quality safety monitoring during and after the use of covid-19 vaccine in Liberia, a robust safety monitoring and risk management mechanism will be used to implement said task as shown in the below diagram: Review Monitor and assess Commun icate Collect, manage, and analyse Decide and act Figure 2: Monitoring and Risk Management Mechanism 2.2.1 Composition of the National AEFI/AESI Causality Committee The committee is composed of people with broad based expertise, to include but not limited to the following: - Public Health Physician - Pediatrician 14 | P a g e - Neurologist - Immunologist - Infectious Disease Specialist - Physician/Internist - Forensic physician - Pathologist - Epidemiologist - Laboratory Scientist - Pharmacy - Medical Specialist (invited for special clinical events) The committee should be independent to avoid conflict of interest, the following should support the functions of the committee but not limited to be included as members of the committee (i.e., they will attend meetings and contribute to or facilitate the discussion as needed but not deciding on the consensus opinion regarding the potential causal association to the vaccination). They will be supported by the AEFI Secretariat which consists of the EPI Manager, Direct Infectious Disease Epidemiology and the Pharmacovigilant Coordinator at the Liberia Medicines and Health Products Regulatory Authority (LMHRA). 2.3 Safe Injection Practice and Waste Disposal A safe injection does not harm the recipient, does not expose the health workers to any avoidable risk and does not result in waste that is dangerous for the community. This involves the safe collection and disposal of used sharps (needles, syringes with fixed needles) which is an integral part of the life cycle of injection devices. The collection of sharps waste in safety containers (safety boxes) at the point of use and their safe and environmentally responsible disposal protect health care workers and the general public from needle stick injuries that could lead to the spread of infection. Dumping sharp waste in open areas is a practice that can have major adverse effects on the population. It is estimated in 2005 that over 23 million infections of hepatitis B, C and HIV occur yearly due to unsafe injection practices (reuse of syringes and needles in the absence of been sterilized). In view of the supra-mentioned, prior to the destruction of all unusable vials on Covid-19 vaccine, deactivation procedure will be carried out at each health facilities level where the VAM will receive the usable vials from the vaccination teams and empty the contain of the zip lock bags in a chlorine solution (0,5%). The proper disposal of medical and sharp waste is cardinal and as such must be donethrough the standard means of incineration. All counties have at least one functioning incinerator or a method of incineration which is consistent with the waste management policy. For Covid-19 vaccine waste disposal, the unusable vials are all finally retrieved at the County Depot and incinerated. To validate the destruction of all unusable vials of Covid-19 vaccine, a destruction team will be constituted to include at least 2 representatives from the Community Health Committee of which theywill be entitled to witness the documentation with three members of the county health team. 15 | P a g e Destruction reports are crucial to collect so that at the end of the response the number of vials received equals the number of vials disposed plus number of vials in stock at central level. 3.0 LEGISLATIVE FRAMEWORK FOR THE SEP 3.1 National Requirement for Stakeholder Engagement Environmental Laws The Environmental Protection Agency (EPA) of Liberia is charged with implementing the Environment Protection and Management Law (EPML, 2002) of Liberia, a framework environmental law that envisions the development and harmonization of sector-specific laws, regulations and standards. EPA serves as the principal authority for managing and regulating environmental quality (including environmental and social impact assessments), and it is directed to coordinate all activities relating to environmental protection and the sustainable use of natural resources. It also promotes environmental awareness and oversees the implementation of international conventions related to the environment. The EPML as well as the Environmental Protection Agency Act (EPA Act) and the EPA Environmental and Social Impact Assessment Procedural Guidelines provide for the participation of stakeholders at all levels of project implementation to ensure that their concerns and inputs are considered as part of the design, planning, project implementation and decommissioning. The law provides provision for public hearing, provides the platforms for complaints by aggrieved persons, and the opportunity to make comments and provide suggestion on project matters. Several sections of the EPML underscore the need for public consultation, public hearing, and identification of affected persons. For instance, Section 11 of the EPML, amongst other things, requires project proponent or applicant to conduct public consultations to be termed as "scoping" with the objective to identify, inform and receive input from the effected stakeholders and interested parties. 3.2 World Bank’s Requirements for SEP The COVID-19 Emergency Response Project aims to engage stakeholders as early as possible to inform the design of the project and improve project outcomes. Wide range of issues will be discussed and analyzed in consultation with key stakeholders inside and outside of the health sector and other relevant and interested, beneficiaries, impacted. The SEP shall follow Environmental & Social Management Frameworks developed for the COVID-19 Emergency Respond project and that of the World Bank Environmental & Social Standards. More specifically, it will be considering the following key Environmental & Social Standards applicable to the World Bank as shown in Table 1. 16 | P a g e Table 2: Relevant Environmental & Social Standards (ESSs) Relevant Environmental & Actions taken Social Standard ESS1 Assessment and Ministry of Health (MOH) has established and shall maintain Management of Environmental assigned departments/institutes with qualified staff and and Social Risks and Impacts resources to support the management of ESHS risks and impacts of the Project including environmental and social risk management specialists. ESS2 Labor and Working Occupational Health and Safety (OHS) measures in line with Conditions the Environmental and Social Management Framework (ESMF), Labor Management Plan (LMP), World Health Organization (WHO) guidelines on COVID19 have been established and complied with in all facilities, including laboratories, quarantine and isolation centers, and screening posts. A Grievance Redress Mechanism has been developed with the establishment of focal points in county and health facilities to address grievances Provisions to prevent SEA, GBV and/or VAC, including CoC for PIU’s staff for contracted workers in line with relevant national laws and legislation is included at the project’s LMP, adopted and applied under the project. These shall be included in all relevant contracts ESS3 Resource Efficiency and IPC & Guideline for Safe Management of Health care Pollution Prevention and Waste acceptable to the Association were prepared for the Management parent project and shall be adopted for the AF2 and be implemented for relevant Project activities ESS4 Community Health and Precautions measures in line with the ESMF, IPC &WMP and Safety WHO guidelines on COVID19 shall continue to be put in place to prevent or minimize the spread of the infectious disease/COVID-19 from laboratories, quarantine and isolation centers to the community ESS10 Stakeholder The draft Stakeholder Engagement Plan (SEP) including a Engagement and Information Grievance Mechanism have been updated, consulted, and Disclosure disclosed for parent project and AF1. The same shall be updated for AF2 The Grievance Mechanism shall be made publicly available to receive and facilitate resolution of concerns and grievances in relation to the Project, consistent with ESS10, in a manner acceptable to the association. 17 | P a g e 4.0 STAKEHOLDER IDENTIFICATION AND ANALYSIS 4.1 Overview This section identifies key stakeholders who will be informed and consulted about the project, including individuals, groups, or communities. It will also identify and include disadvantaged or vulnerable individuals or groups, who may have limitations in participating and/or in understanding the project information or in participating in the consultation process. Collaboration with stakeholders throughout Project development often requires the identification of persons within groups who act as appropriate representatives of their respective stakeholder group. 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. For local People, stakeholder engagement should be conducted in partnership with local organizations and traditional authorities. Among other things, they can provide help in understanding the perceptions of local people on the causes of the virus, which will influence their opinions around the vaccination campaigns as a proposed solution. Women can also be critical stakeholders and mediators 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, confirming their 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 following 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 that the stakeholder identification will be on a much more individual basis, requiring different media to reach affected individuals. Based on the project scope and considering other aspects including stakeholder requirements/needs and interests, the stakeholder list below is categorized as (i) affected parties; (ii) other interested parties; and (iii) disadvantaged/ vulnerable individuals or groups. 18 | P a g e 4.1 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. 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: • COVID-19 infected people; • People under COVID-19 quarantine; • Relatives of COVID-19 infected people; • Relatives of people under COVID-19 quarantine; • Local government units where isolation/quarantine/screening centers will be located and the vaccination activities will take place • Neighboring communities to laboratories, quarantine centers, and screening posts; • Workers at construction sites of laboratories, quarantine centers and screening posts; • People at COVID-19 infection risk (travelers, inhabitants of areas where cases have been identified, etc.); • Healthcare workers; • Health facilities where vaccines will be administered • Municipal waste collection and disposal workers; • MoH and the National COVID-19 Taskforce and the National Emergency Response Committee (NERC) on COVID-19; • Other public authorities including police and security services who may be required to enforce directives; • Other public officers directly involved in COVID-19 response • Airline and border control staff; • Airlines and other international transport business; 4.2 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 The projects’ stakeholders also include parties other than the directly affected communities, including: i. Mainstream media; ii. Participants on social media; iii. Politicians; iv. Other national and international health organizations; v. Other national and international NGOs; vi. Businesses with international links; and 19 | P a g e vii. The public at large. viii. Development partners and civil society organizations, regional, including organizations representing local peoples and peoples with disabilities; ix. Other organizations involved in protection of human rights x. Health workers and clinicians 4.3 Vulnerable Groups These are persons who may be disproportionately impacted or further disadvantaged by the project as compared with any other groups due to their vulnerable status and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project is ensured. It is critical to ensure that awareness raising and stakeholder engagement with disadvantaged or vulnerable individuals or groups on infectious diseases and medical treatment in particular, is adapted to take into account such groups or individuals and to ensure a full understanding of project activities and benefits and protect them from the spread of COVID-19 through engagement. The vulnerability may stem from person’s origin, gender, age, health condition, economic deficiency and financial insecurity, disadvantaged status in the community For instance, the civil war affected group of youth which are commonly referred to as ZOGOs in Liberia. These youth are the most vulnerable to the COVID –19 pandemic. Their basic livelihood depends on street scavengers, theft, robbery and physical harassment of their victims. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at facilitating them to participate in the project-related decision making so that their awareness of and input into the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include but not limited to the following: • Older persons; • Child headed household • People living in informal settlement slum community • People living on the streets • People living in remote areas that are difficult to access • War affected persons or victims or youth commonly call (ZOGOs) • People with compromised immune systems or related pre-existing conditions; • Illiterate people; • Persons with disabilities (PWDs); There is an indirect risk of social exclusion, in particular, the most vulnerable and marginalized groups such as the local peoples in remote counties and hard to reach facilities from access to the COVID-19 vaccines. The elderly, those with underlying medical conditions, and people living with disability, though included in the priority populations to be vaccinated as identified in the National deployment and Vaccine Plan (NDVP) Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply, may have limited access to the vaccines due to reduced mobility. The information materials on the COVID-19 vaccine to be developed could exclude the 20 | P a g e most vulnerable or be developed in a way that is not sensitive to the needs and access of these different groups. Risk communication materials to be developed will also be clear and concise and in a format or language that is understandable to all people, especially 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, healthcare facilities at local level, etc.). Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. 21 | P a g e 5.0 STAKEHOLDER ENGAGEMENT PROCESS 5.1 Summary of Stakeholder Engagement done during project preparation Due to the emergency situation and the need to address issues related to COVID-19, consultations were held with public authorities and health experts, such as Ministry of Health, National Public Health Institute of Liberia, Monrovia City Cooperation, Ministry of Defence, and Ministry of Foreign Affairs among others. Other non-governmental agency such as CDC Africa, WHO, World Bank, USAID among others were part of the consultation process. A number of surveys and innovations for community engagement have recently been carried out through media, and the community radio talk show. Additionally, 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 the Ministry of Health (MOH), National Public Health Institute of Liberia and the World Bank. Stakeholder engagements were conducted after project approval to inform a revision of the SEP during implementation. The Environmental and Social Commitment Plan (ESCP) was disclosed on the World Bank website and the final draft of the SEP was disclosed on June 10, 2020 on the MOH/NPHIL websites and published in the daily newspapers. The Environmental and Social Management framework for the Additional Financing were adopted, consulted and disclosed in the daily newspaper on November 5, 2021, and at the National Public Health Institute of Liberia (NPHIL) website at www.nphil.gov.lr. The first National Stakeholders Consultation on the Parent Project was conducted on November 13, 2020, and the feedback from the consultation are provided in Annex A. Key participants for this first consultation were Civil Society Organization (CSOs) Non- governmental Organization (NGO) and other invitees from the MOH and NPHIL. Due to limitation in internet connectivity and other constraints related to the payment of internet data packages for all stakeholder, consultations were held face-to-face with adherence to COVID -19 health protocol that includes social distancing, washing of hands, wearing of nose mask among others. The second major consultation was held on December 18, 2020, with key participants in attendance. Some of the participants present included local authority (paramount chief, commissioners, City Majors, security apparatus, Superintendent, the marketer's association, women group, youth organization etc.). The feedback from the engagement meeting is attached as Annex B. The third consultation was held at the counties level from February 8 to 12, 2021. The counties selected for this consultation were Lofa, Nimba, Bong, Margibi and Rivercess. The main participants for this consultation were NGOs, CSOs, and Local government. The outcome of this consultation is also attached as Annex C and D respectively. 22 | P a g e The Project Implementation Unit (PIU) along with the Expanded Program on Immunization (EPI) unit of the Ministry of Health, and the National Public Health Public Institute of Liberia (NPHIL) conducted the online public consultation on the COVID-19 Vaccine deployment and immunization process with the provision of information on additional funding for the rollout of the vaccine. The meeting was held with CSOs, and NGOs on April 16, 2021. The summary of the consultation is attached as Annex E. Additionally, the EPI Unit in conjunction with the MoH has engaged various sector and government agencies across the country. Some of the consultations held include a virtual meeting with the Dental Council of Liberia on April 2, 2021, and a physical meeting with the Religious Council of Liberia and the Armed Forces of Liberia on April 8, 2021. Health protocols on the prevention of COVID-19 were observed during the physical meetings. 5.2 Governance and Accountability Framework The COVID-19 pandemic like the Ebola Virus Disease (EVD) has identified critical gaps in the health-care delivery systems of many economies including Liberia. These gaps have exposed the level of fragmentation in the global governance system as it relates to a more structural mechanism to coordinate the pooling and sharing of resources needed to combat the pandemic. Being cognizant of these evident but critical challenges, Liberia will leverage on the existing COVID-19 mechanism through the Incidence Management System (IMS) with an enhanced structure to coordinate, pool and share resources, vaccine administration, management and retrieval. Additionally, it will help increase vaccine confidence and demand generation for COVID-19 vaccine in Liberia, a National Coordinating Committee (NCC) / Incidence Management System (IMS) or its equivalent has been established to guide and oversee the introduction of COVID-19 vaccine in Liberia. Please see Figure 2 below: 23 | P a g e Figure 3: Incidence Management System Chart 24 | P a g e The COVID-19 vaccine accountability framework is a cyclical process of monitoring, review and remedy/action to assess progress, document success, identify problems that need to be rectified and take prompt action as and where needed. 5.3 Summary of Project Stakeholders Engagement Needs, Methods, Tools and Techniques The WHO “COVID-19 Strategic Preparedness and Response Plan: Operational Planning Guidelines to Support Country Preparedness and Response� (2020) outlines the following approach in Pillar 2 on Risk Communication and Community Engagement which will be the basis for the stakeholder engagement: It is critical to communicate to the public what is known about COVID‑19, what is unknown, what is being done, and actions to be taken on a regular basis. Preparedness and response activities should be conducted in a participatory, community-based approach that is informed and continually optimized according to community feedback to detect and respond to concerns, rumours and misinformation. Changes in preparedness and response interventions should be announced and explained ahead of time and be developed based on community perspectives. Responsive, empathic, transparent and consistent messaging in local languages through trusted channels of communication, using community-based networks and key influencers and building capacity of local entities, is essential to establish authority and trust. In addition to communication on COVID-19, it is also necessary to get feedback on the services provided under this project. Other major approaches that will be practiced for stakeholder engagement will include: having consultations in small groups if smaller meetings are permitted, else making reasonable efforts to conduct meetings through online channels (e.g., WebEx, Zoom, Skype, etc.); diversifying means of communication and relying more on social media, chat groups, dedicated online platforms and mobile social media applications (e.g., Facebook, Twitter, WhatsApp groups, project web links/websites, etc.); and employing traditional channels of communications such as TV, radio, dedicated phone-lines, SMS broadcasting, and public announcements when stakeholders do not have access to online channels or do not use them frequently. Continuous stakeholders’ consultations and engagement as well as review and adjustment of approach and methodologies will be important to avoid the risk of virus spread. 5.4 Stakeholder Engagement Principles 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(s) will be arranged during the whole life cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation. 25 | P a g e • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities will be provided for communicating stakeholders’ feedback to ensure two-way communication, for analyzing and addressing comments and concerns. • Inclusiveness and sensitivity: Stakeholder identification will be undertaken to support better communications and build effective relationships. The participation process for the projects should be inclusive. All stakeholders are encouraged to be involved in the consultation process. Equal access to information should be provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention must be given to vulnerable groups, in particular women, youth, elderly and the cultural sensitivities of diverse ethnic groups. 26 | P a g e 6.0 STAKEHOLDER ENGAGEMENT PROGRAM 6.1 Purpose of Stakeholder Engagement Plan This Stakeholder Engagement Plan (SEP) is designed to establish an effective platform for productive interaction with the potentially affected parties and others with interest in the implementation outcome of the project. Meaningful stakeholder engagement throughout the project cycle is an essential aspect of good project management and provides opportunities to: • Solicit feedback to inform project design, implementation, monitoring, and evaluation • Clarify project objectives, scope and manage expectations • Assess and mitigate project environmental and social risk • Enhance project outcome and benefits • Disseminate project information and materials • Address project grievances and coordinate To ensure adequate representation and participation of the different stakeholders, the project will rely on different methods and techniques. 27 | P a g e Table 2: Stakeholder Consultation Related to COVID-19 Project Topic of consultation / Method used Target Timeline/Date/L Responsibilities stage message stakeholders ocation Preparation • Need for the project • Phone, email, letters • Government At the beginning Environment and Social • Planned activities • One-on-one meetings officials from of the Project. In Specialist • E&S principles, • Outreach activities relevant line the entire country where there is Environment and social • Appropriate agencies at local NPHIL, MOH, PIU, level peak of COVID- Collaboration with all risk and impact adjustments to be made 19 outbreak management/ESMF to consider the need for • Health Government agencies in • Grievance Redress social distancing (use of institutions line with COVID-19 mechanisms (GRM) audio-visual materials, • Health workers response • Health and safety technologies such as and experts, impacts telephone calls, SMS, Communities & emails, etc.) Dedicated local authority hotline at the NPHIL • Need for the project • Outreach activities that • Affected At the beginning Environment and Social • Planned activities are culturally individuals and of the Project. In Specialist • Environment and social appropriate their families the entire country risk and impact • Appropriate • Local where there is MOH, NPHIL, & PIU peak of COVID- Collaboration with all management/ESMF adjustments to be made communities 19 outbreak • Grievance Redress to consider the need for • Vulnerable Government agency in mechanisms (GRM) social distancing (use of groups line with COVID-19 audio-visual materials, response technologies such as telephone calls, SMS, emails, etc.) Implementat • Project scope and • Training and workshops • Government During Environment and Social ion ongoing activities officials from implementation of Specialist the Project. In the 28 | P a g e • ESMF and other • Disclosure of relevant line entire country instruments information through agencies at local where there is MOH/PIU/NPHIL • SEP Brochures, flyers, level peak of COVID- Collaboration with all • Health 19 outbreak • GRM website, etc. Government agencies in • Health and safety • Appropriate institutions line with COVID-19 • Environmental concerns adjustments to be made • Health workers response to consider the need for and experts, social distancing (use of community, audio-visual materials, traditional technologies such as leaders & local telephone calls, SMS, groups emails, etc.) dedicated hotline at the NPHIL • Project scope and • Public meetings in • Affected During Environment and Social ongoing activities affected communities individuals and implementation of Specialist • ESMF and other • Rapid communication their families the Project. In the instruments assessment • Local entire country PIU/MOH/NPHIL where there is • SEP • Brochures, posters communities Collaboration with all peak of COVID- • GRM • Information desks in • Vulnerable 19 outbreak Government agencies in • Health and safety local government groups line with COVID-19 • Environmental concerns offices and health response facilities. • Appropriate adjustments to be made to consider the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, radio, TV etc.) 29 | P a g e 6.2 Strategy for information Disclosure In terms of approach, it will be important to ensure the inclusivity and cultural sensitivity of the different activities, thereby guaranteeing that the stakeholders outlined above have a chance to participate in the project benefits. Meetings can be face-to- face in the form of village consultations such as household outreach and focus group discussions. Consultations can be carried out in local language specific to the area and the use of verbal communication and pictures. Where face- to- face meetings is not possible due to the current COVID-19 restrictions, other channels of communication will be used to reach stakeholders such as social media. While country-wide awareness campaigns will be established, specific communication around Ports of Entry as well as quarantine/isolation centres and laboratories will have to be timed according to need and be adjusted to the specific local circumstances. The project ESMF and SEP will be disclosed prior to formal consultations and the SEP will be updated and re-disclosed during project implementation. 30 | P a g e Table 3: Strategy for Information Disclosure for COVID-19 Project stage Target List of Methods and timing proposed Timeline/ Date/ Responsibility stakeholders information to Location be disclosed Preparation of Government Project concept, Dissemination of information Before the start of PIU/MOH/NPHIL social entities; local E&S principles via dedicated project website, project preparation distancing communities; and obligations, Facebook site, SMS measures and vulnerable groups; documents, broadcasting (for those who do strengthening NGOs and Consultation not have smart phones) communication academics; health process/SEP, including hard copies at preparedness workers; media Project designated public locations; representatives; documents- Information leaflets and health agencies; ESMF, ESCP, brochures; and separate focus others GRM procedure, group meetings with vulnerable update on groups, while making project appropriate adjustments to development consultation formats to consider the need for social distancing (e.g., use of mobile technology such as telephone calls, SMS, etc.) The People under Project Public notices; Electronic During the entire Ministry of rehabilitation COVID-19 documents, publications and press releases lifecycle of the Health/NPHIL/PIU and equipping quarantine, technical on the MOH website & via project. Within the of selected including workers designs of the social media; Dissemination of entire country hospitals in the facilities; isolation units hard copies at designated public including the Relatives of and quarantine locations; Press releases in the Star Based & patients/affected facilities, SEP, local media; Consultation 14 Military people; relevant E&S meetings, separate focus group Hospital neighboring documents, meetings with vulnerable 31 | P a g e Project stage Target List of Methods and timing proposed Timeline/ Date/ Responsibility stakeholders information to Location be disclosed communities; GRM procedure, groups, while making public health regular updatesappropriate adjustments to workers; other on Project consultation formats to consider public authorities, development the need for social distancing civil society (e.g., use of mobile technology organizations, etc. such as telephone calls, SMS, etc.). During People under Project Public notices; Electronic During the entire MOH/NPHIL/PIU& preparation of COVID-19 documents, publications and press releases lifecycle of the in collaboration of ESMF & quarantine, technical on the Project website & via project. Within the governmental & HCMP including workers designs of the social media; Dissemination of entire country non-governmental in the facilities; isolation units hard copies at designated public agencies Relatives of and quarantine locations; Press releases in the patients/affected facilities, SEP, local media; Consultation people; relevant E&S meetings, separate focus group neighboring documents, meetings with vulnerable communities; GRM procedure, groups, while making public health regular updates appropriate adjustments to workers; other on Project consultation formats to consider public authorities; development the need for social distancing Municipal & (e.g., use of mobile technology District/ civil such as telephone calls, SMS, society etc.). organizations etc. During project COVID-affected SEP, relevant Public notices; Electronic During the entire MOH/NPHIL/PIU& implementation persons and their E&S documents; publications and press releases lifecycle of the in collaboration families, GRM procedure; on the Project website & via project. Within the with governmental 32 | P a g e Project stage Target List of Methods and timing proposed Timeline/ Date/ Responsibility stakeholders information to Location be disclosed neighboring regular updates social media; Dissemination of entire country per & Non- communities to on Project hard copies at designated public specific location of governmental laboratories, development locations; Press releases in the high hit COVID-19 agencies quarantine local media; Consultation outbreak centers, hotels and meetings, separate focus group workers, workers meetings with vulnerable at construction groups, while making sites of quarantine appropriate adjustments to centers, public consultation formats to consider health workers, the need for social distancing MoH, border (e.g., use of mobile technology control staff, such as telephone calls, SMS, police, etc.). government entities. 33 | 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 Liberia COVID-19 Emergency Response Project is to reach 52% of the population in the first year in the country, prioritizing health care workers, other essential workers, people above the age of 60 years, 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 through the Ministry of Health 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; • 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 through the Ministry of Health and NPHIL will correct misinformation about vaccine efficacy and side effects, and vaccine allocation and roll out. The monitoring should cover all languages used in the country. If the engagement of security or military personnel is being considered for deployment of vaccines, MOH should 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 Redress Mechanism. However, the government through the MOH will not engage in any use of security forces as per the project design. 34 | P a g e 6.3 Proposed Strategy to Incorporate the Views of Vulnerable Groups The project will carry out targeted consultations with vulnerable groups to understand concerns/needs in terms of accessing information that relates to COVID-19 emergency response. Some of the strategies that will be adopted to effectively engage and communicate to vulnerable groups are as follows. • Women: Consider provisions for childcare, transport, and safety for any in-person community engagement activities. • 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. • 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 living conditions (including assisted living facilities), and health status; target family members, health care providers and caregivers. • People with disabilities: Provide information in accessible formats and offer multiple forms of communication • 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. • Street Venders commonly known as ZOGOs, vulnerable youth and war- affected persons who rely on street mongers for survival are heavily affected by COVID-19 activities: 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 alternative livelihood empowerment and information on rehabilitation treatment centers and benefits • People living in remote place that are difficult to access: Design and develop information that can aired by radio For any vaccination program where local people 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 organizations and traditional and local authorities. Consultations will clearly communicate that there are policies ensuring that there is no forced vaccination. Lastly, stakeholder engagement and vaccinations will be conducted with extra precautions to minimize COVID-19 transmission risks, especially for Peoples living in more remote areas or in voluntary self-isolation. 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). 35 | P a g e 7.0 RESOURCES AND RESPONSIBILITY FOR IMPLEMENTING SEP ACTIVITIES 7.1 Resources Funding for the SEP implementation will be included as part of project cost under component 1.4, proposed project management which would fund all Technical Assistance (TA) and communication strategies conducted at Central level, regional counties and district levels. An estimated amount of US$150,000 (Hundred and Fifty Thousand US Dollars) will be required for SEP implementation and GRM operating costs for the period under review for this project. 7.2 Management Function and Responsibility The implementation of the COVID-19 Emergency Respond project and additional financing for the roll out of the vaccination will be mainstreamed in the Ministry of Health (MOH/NPHIL). A project implementation team is set up to drive project implementation including oversight of the SEP implementation since the activity is emergency driven. The Environmental specialist and Social Safeguard specialist of the PIU and the project coordinator will be responsible for shall directly implement, coordinate and monitor the SEP. These will also be responsible for timely updating and the successful implementation of the SEP, ESMF and ESCP. The National COVID-19 task force, chaired by the Ministry of Health and National Public Health of Liberia, will provide stewardship and oversight of the project. The National COVID-19 task force was established by the President through an executive order to address various aspects related to COVID-19 preparedness and response including: (i) coordinate Liberia’s preparedness and response to COVID-19; (ii) coordinate capacity building of medical personnel and other professionals; (iii) enhance surveillance at all points of entry; (iv) coordinate the preparation of national, county and private isolation and treatment facilities; (v) coordinate the supply of testing kits, critical medical supplies and equipment; (vi); conduct a risk capacity vulnerability assessment for the health sector and develop a system recovery strategy The National COVID-19 Taskforce will provide technical guidance throughout the project implementation. The Taskforce draws membership from the MoH/NPHIL, other relevant Government agencies, development partners, non-governmental and civil society organizations. The mandate of the Taskforce is to review the evolving threat from the COVID-19 outbreak and regularly offer technical advice to the MoH/NPHIL and other line ministries on appropriate measures. 7.3 Grievance Mechanism The main objective of a Grievance Redress Mechanism (GRM) is to assist in resolving complaints and grievances in a timely, efficient, and effective manner that satisfies all parties involved. Specifically, it provides a transparent and credible process resulting in outcomes that are fair, effective and lasting. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. 36 | P a g e The MOH through the Project Implementation Unit (PIU) has established a GRM which is currently being tested for the REDISSE project to ensure functionality. Even though the GRCs have not received any complaint from Project Affected Persons (PAPs) that could be addressed. However, channels of communication have been created with awareness of communities and PAPs on how to effectively express grievances from project activities. The project (COVID-19 Emergency Response) will support a GRM system that would have Two (2) toll free numbers which complainants or PAPs can directly call at the expense of the project. These toll-free numbers can also be used to text or WhatsApp complaints to the Center or the PIU directly. Complaints can also be received via written letters, emails and in person (See attached appendix 1, 4 & 5 for filling of complaint and letter of acknowledgement for eligible and ineligible complaint). The numbers and addresses will be disclosed or displayed based on the strategy for disclosure method as mentioned earlier in counties, health centers, communities, health facilities and at the center level of the Ministry of Health. The number will also be publicized through community information centers, advertisement and jingles on radio and television. The GRM may be used by all stakeholder groups. In addition, complaints may also be registered with County Health Officer (CHO) and District Health Officer (DHO) or at the local community level, who will document the complaints in a complaints Sheet and then register the call with the central (MOH) system. The GRM system will track the health center or community which the complainant is associated with to ensure that feedback can be directed to them if the grievance cannot be resolved immediately and requires further action. Once a complaint is received, it should be responded to within 24 hours and resolved within 30 working days. See appendix 2 for indicative time limit for processing of complaint The personnel employed to receive complaints will be given orientation on how to receive calls from PAPs, document relayed information and pass on to the Project Coordinator’s office. In addition, E&S officer of the PIU will also fill in a form (Grievance Register) as they interact on phone with the complainants for record purposes and further processing. Upon receipt, complaints will be directed to the appropriate units at the PIU for resolution. Complainants who cannot communicate in English would have the liberty to use their local language as the unit would find an interpreter for ease of communication. Complainants would also be assured of receiving feedback within thirty days. The CHOs and DHOs at the health facility in county are important stakeholders in addressing issues therefore complaints received from PAPs at the county would be relayed to them by the Project Coordinator (PC) through email or a WHATSAPP platform developed for this purpose. On a monthly basis, all complaints will be vetted and be reported at the project management team level. On a quarterly basis, the safeguards specialists at the MOH/PIU will randomly survey complainants to follow-up on satisfactory resolution. A summary of implementation of the grievance mechanism will be provided to the public on a regular basis, after removing identifying information on individuals to protect their identities. In handling GRM matters, confidentiality will be paramount. See appendix 3 for complaint response proposal form. If a complainant is not satisfied after exhausting all the grievance processes of the project, he/she may appeal to the Minister for Health as set out in the GRM document. In all cases, complainants 37 | P a g e will be reassured that they still have all their legal rights under their national judicial process to go to court. To enhance the system, SMS and coding of grievances have been incorporated into the system to widen its scope. The enhanced GRM would require categorization of grievances to be channeled to the appropriate location of the Ministry and PIU for redress. Below is a flow chart for grievance processing and reporting: Figure 4: Procedure to File Complaints. 7.4 Monitoring and Reporting The PIU maintained a Stakeholder Engagement Log that chronicles all stakeholder engagements undertaken or planned. The Engagement Log includes location and dates of meetings, workshops, and discussions, and a description of the project-affected parties and other stakeholders consulted. Monitoring reports presented to the Management Team include Stakeholder Engagement Logs as well as feedback from the GRM. There is currently quarterly reporting of the SEP as part of the project monitoring report. (Annex F presents photos of engagement and consultation of stakeholder at the county and national level) 7.5 Involvement of Stakeholder in monitoring activities As indicated earlier, the Project Implementation Team will have oversight over the SEP implementation. The Environmental and Social Safeguard specialist in the PIU will monitor the 38 | P a g e Stakeholder Engagement Plan (SEP) in accordance with the requirements of the legal agreement, including the Environmental and Social Commitment Plan (ESCP). The team will monitor and document any commitments or actions agreed during consultations, including changes resulting from changes in the design of the project or the SEP. 7.6 Reporting Back to Stakeholder Group The SEP will be periodically revised and updated as necessary during project implementation 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. Reporting back to stakeholder groups will be done through various means, key among which will be during the quarterly Project Technical Committee (PTC) meeting at the Ministry of Health, and various Technical Working Group (TWG) meetings. Other means will be through the Sector Working Group (SWG) meetings made up of Health sector stakeholders at the national and county level. For community level reporting back, it is important to utilize the several fora for training, orientation, and information sharing which will become available as the project is implemented. 7.7 Budget for SEP The implementation of the COVID-19 Emergency Respond project is estimated as 12 months from the day of project ratification. An estimated amount of US$150,000 (One hundred and Fifty Thousand US Dollars) will be required for SEP implementation and GRM operating costs, which is directly in line with COVID-19 implementation. 39 | P a g e ANNEXES Annex A: Summary of Stakeholder Consultation made with (CSOs and NGOs) on parent project November 16, 2020 Liberia COVID-19 Emergency Response Stakeholder Consultation and Engagement With Civil Society Project Organization (CSO) and Non-Governmental Organizations (NGOs) SEP Implementation Date November 13, 2020 Venue: Shark’s Entertainment Center, Air Field Montserrado County Monrovia-Liberia Attendees: Twenty Six (26) Participants Time (Start – Ends) 10:00Am to 45PM First Presenter: Mr. Sonpon Blamo Sieh, Snr. REDISSE/COVID project Coordinator Presentation Topic: Update on the Liberia COVID-19 Emergency Response Project Name Institution Issues Response Sue L. Lutheran This project is important as it Korgba Church In encourages pregnant women to go to Mr. Sonpon B. Sieh: Liberia waiting homes/facilities. I also The project collaborates with other partners to (LCL) believe we are losing sight of other help discourage home delivery. As we continue the response, it is also important that basic health services and only we document all the interventions. focusing on the outbreak. For example, the Lutheran Church continues to have challenges with the feeding program at the maternal waiting home. Patricia S. Executive How often will the project carry on Mr. Menitoyan J. Dolo: Kamara Director CSOs/NGOs engagement? There was an engagement done at a higher level Christian I am asking because there is a lot of with the Ministry of Health and partners. Due to Health information to be disseminated, had the nature of the pandemic, CSO’s network was Association not considered at the time, but going forward, CSOs been engaged earlier. of Liberia there will be regular engagements with CSOs. (CHAL) We are aware that CSOs have a pivotal role to play in the communities as we strive to break the chain of COVID-19 transmission. As an action point, the developed plan will be shared with you. 40 | P a g e In addition, the project has designed a stakeholder engagement plan for CSOs and NGOs in Liberia. Sondeh G. Executive The lack of trust in the healthcare Mr. Sieh: I agree with you. I think we can Wilson Director delivery system is one of the institute a more decentralized approach and SEARCH fundamental reasons for the many widen the scope for greater engagement and challenges experienced during the involvement. However, the CHA structure response. We defeated EVD because is greatly involved in the response. About CSOs were involved to regain trust. 10,000 Community Health Workers were The approach used in response to listed but there is less CSOs involvement. COVID-19; leaving already trained CHAs to recruit a new batch of people with no community strategies that has led to a high level of distrust from the communities. The government has created mistrust and not the residents. However, there is still hope that we can work with existing health structures and CSOs who have worked with those communities. We do not know how long this pandemic will last but it will be appreciated were we to change the approach. Joyce L. Executive It is important that the PIU share with Mr. Sieh: We can document and make it Kilikpo Director the facilities the support that has been available per county and facility as the Public directed to help us know the status of support is provided. This is geared towards Health the various supports. transparency and accountability. Initiative Liberia (PHIL) E.g.: A distribution schedule for ambulances and motorcycles should be shared with CSOs. It should include; the facilities and persons assigned to the ambulances and motorcycles' and also what are they intended for. If the above is done, it will allow us to inform the public adequately on this aspect of the Bank support. E.g. Support for laboratory strengthening. Keifala National In the presentation, Mr. Sieh talked Mr. Sieh: The laboratory is extremely Kromah Coordinator about asking partners to hold onto costly. There are clinical labs in these (ROCH) support to laboratories in areas where counties, but we are talking about research the Bank is already funding. Why lab that are extremely costly. So currently 41 | P a g e didn’t the PIU allow the partners to there are challenges with the running of use that support to expand the those Labs. Ones spreading across the laboratory system, considering Foya country will worsen the situation. and other hard-to-reach areas. Second Presenter: Mr. Abraham Nyenswah (Incident Management System (IMS) Coordinator, NPHIL Presentation Topic: Update of MOH/NPHIL involvement on Stakeholder Engagement on COVID-19 response Emmanuel Senior Did the project ever engage CSOs Mr. Abraham Nyenswah: This is the reason N. Kimen Program adequately? I am asking this why we are having issues and increase in Manager, questions because when CSOs are cases. The disease is ill-symptomatic, and EQUIP engaged they can further in interpret because of its ill-symptomatic nature, a LIBERIA and relate to the communities positive person can move around and thinks properly. At the beginning of the he/she has no sickness. Unlike EVD, a pandemic in Liberia, dead bodies positive person of COVID-19 can still be were tested and some results came strong and move about. However, that out positive for COVID-19, yet their person could infect others unknowingly, care providers didn’t come down making it even worse for persons with pre- positive nor show any sign or existing conditions. symptoms. What could be the technical explanation for this scenario? Jenneh Office What are the measures in place for Mr. Abraham Nyenswah: There are Nimely Assistant, the reopening of schools? guidelines in place for all public African institutions. There have been three (3) Network for separate meetings with the Ministry of the Education, leading to the opening of Prevention schools in phases, we intend to have the and Protection 12th Graders resumed first and feedbacks Against from this will be reviewed and corrective Child Abuse measures instituted for the remaining and Neglect classes. Currently, we are working closely (ANPPCAN) with the MoE and other institutions, including universities and colleges. To ensure this that this is possible, teams are in the field across the country to monitor. The issue of non-compliance is as a result of non-enforcement of the public health law. At the early stage of COVID-19, there were hand washing stations at various public places including security check posts mandating everyone to wash hands. Today, they are not available. It is because we are not enforcing the public health law. Do not relax the law. 42 | P a g e Richard K. Project Non-compliance to some extent is at Mr. Dolo: Younge Officer a result of the way messages are It is unbelievable that CSOs think that Lutheran being disseminated. Health health authority and healthcare workers are Church authorities think health messages the only people providing healthcare Liberia should be disseminated by health messages. Everyone has the responsibility practitioners only and ignoring the to disseminating health messages. role of CSOs in the dissemination of The project encourages all stakeholders messages at community level. especially (community based organizations, Community engagement should be a youth, woman, vulnerable groups, Counties major experience from the EVD authorities, chief, traditional and religious outbreak that should serve as a lesson leaders, for the fight against COVID-19. learned This is especially from lesson learned with the fight against EVD. Joyce Executive Until the fight is over, we need a Mr. Dolo: Kilikpo Director seat at the table of the IMS for Mr. Nyenswah will take key on that. (PHIL) CSOs. This will keep us informed about the response decisions making Third Presenter: Harry F. Neufville, Deputy project Manager (PIU/MOH) Presentation Topic: Identification of project beneficiaries Patricia Executive Please provide us with a full list of Mr. Neufville: The IPs for COVID-19 Kamara Director implementing partners on (COVID- project are the Ministry of Health and the CHAL 19) so that we can monitor their National Public Health Institute of Liberia. activities There are no outside implementer, except contractors. Sue L. Coordinator Is the project thinking about Mr. Neufville: Korgba (LCL) community preparedness for people The project addresses certain scope of the returning from the treatment unit? response, not every aspect. Preparedness In the context of psychosocial under the project is designed to look at how impact, is there a mechanism to train we are prepared to disseminate information, health workers and families affected availability of the information and how we by COVID-19? can keep the communities saved not to have How do you intend to implement more community transmissions. activity on sexual exploitation and abuse? The project does not have a component to address integration of persons leaving the treatment unit. However, this doesn’t mean that there are no institutions or other financing that are looking at that, but this project doesn’t address it. On the issue of sexual exploitation and abuse, it is considered under sub-project, which means there are no cases of sexual exploitation at any site of our project. Take for instance, if we are implementing a rehabilitation project in site A, we want to make sure that 43 | P a g e there is no case of sexual exploitation reporting from that site. There are mechanisms in place, like the grievance redress mechanism, to report and address if there is a case. The redress mechanism has a structure on how to report and how a case can be addressed and mitigated. David Dee County Field Most trainings are limited to Mr. Neufville: Projects are implemented as Kpangbala Officer governmental institutions. Is there developed. It is the government that decides (CHAL) any plan for faith-based institutions? the implementers of the project. If the government decides that Faith-Based organizations are to implement a certain component of the project, that’s how it works. This forms part of the project implementation framework and it is done at the development stage of the project. In this project, it is the Government of Liberia, through the MoH and NPHIL that implements. Most of our activities are ensuring availability of PPEs, ensuring laboratory systems functionality, facility capacity to refer and manage cases and supporting community engagement. This is an emergency project. Joyce L. Executive I think having the MoH and NPHIL Mr. Neufville: The issue at hand, COVID- Kilikpo Director as the only implementer is a miss of 19, is not like any normal project. It came at PHIL the mark. Before the project was the time when we were all learning about approved, there should be a the disease, which does not support stakeholder engagement to stakeholder engagement as we sit like this. incorporate inputs from stakeholders. Besides, technology is still an issue This are something that we must considering online engagement with work on moving forward. We think stakeholders. Also, time was a factor that the people are the direct beneficiaries limited the outreach. However, it is planned of these projects and should therefore that in this implementation stage, there will be involved as government will have be more stakeholder engagements. to pay back the loans. Like other projects in the making, e.g. IFISH. We hope that significant lessons learnt from stakeholder engagement will inform the implementation of the projects ahead. How is this project going to ensure that other vulnerable populations are cared for? 44 | P a g e Roland T. Executive Is there anything in the project for Mr. Sieh: Yes, there is an assumption in the Suemie Director persons at high risk, and or persons project that an average of 100 persons EQUIP who died while responding? (responders) will die during the response. Liberia Under this component of the project, US$5,000.00 is budgeted per person. However, to prevent deaths, PPEs and other basic logistic were supplied to responders. Mr. Sondeh Executive Information dissemination is key. Mr. Dolo: The essence of engagement is to Geepeh Director, Unless we provide the right have a listening ear; we are not defending Wilson SEARCH information at the right time, people the project. We are addressing what we will not know and will carry think will help us strengthen the process, whatever information they receive. It which will in turn support you at the is important that we do information community level. On the issue of masks, we dissemination prior to the problem, only have the healthcare waste management not when there is a problem. plan, but there is nothing to address the Secondly, the project talks about management of masks at home. This is environmental risk and disposable important, it is something to consider. masks that are used across the country. What is the project doing to address masks disposal at all levels? Forth Presenter: Mr. Menitoyan J. Dolo Environmental and Social Safeguard Specialist Presentation Topic: Grievance Redress Mechanism for project implementation Sondah SEARCH If a project staff is involved with Mr. Dolo: It depends on the involvement of Wilson abusing a beneficiary, how do you the staff with the beneficiary. In our handle it? engagement, it will be highlighted. Some complaints are evaluated and forwarded to central level. Complaints are addressed as either emergency or minor bases upon the nature of the complaints Mamayon Finance Will the GRM be established for the Mr. Dolo: The GRM was initially M. Officer, coming project? I understand from established for the EERP project to address Massaqui ROCH your presentation that there is a new the payment of PAPs at the reclamation of project to start under the portfolio the site for the Redemption Hospital construction. The new project (IFISH) has a structure for GRM and GBV action plan prepared. However, during the consultation and engagement of stakeholders, community dwellers for the IFISH project, PAPs were informed about the project GRM and channel of communication. 45 | P a g e Keifala National For some of us in the county, how do Mr. Dolo: As I stated in the presentation, we Kromah Coordinator we proceed with complaints if there are going to rollout these activities in the ROCH is any at the level of the project county. We will establish the committee at office? the county level and train focal person who will be responsible to channel sensitive and non-sensitive complaint to the central level. 46 | P a g e Annex B: Summary of Stakeholder Consultation made in Montserrado County on parent project December 18, 2020 Liberia COVID-19 Emergency Response Project Stakeholder Consultation and Engagement With SEP Implementation County Authority, Local Government, youth group, marketer, women group, the police, teachers etc. Date December 18, 2020 Venue: Bentol City Montserrado County Monrovia-Liberia Attendees: Fifty Eight (58) Participants Time (Start – Ends) 10:00Am to 4:5PM First Presenter: Mr. Menitoyan Johnson Dolo Environmental and Social Safeguard Specialist Presentation Topic: Brief Overview of Program-PIU Name Institution/Position Issues Response Hon. Morris City Mayor, With all the founding that have Mr. Dolo: The MOH have done exceedingly G. Richards Ministry of Internal been provided by the World Bank well in the past at various hospital and health Affairs (MIA) through the Ministry of Health, facilities. For example, the World Bank through yet still our people are dying in MOH make available funding to support What county from shortages of drugs we call performance Based Financing (PBF) at and lack of medical supplies etc. selective health facility mainly (Rivercess, what the MOH is doing through Sinoe county and Gbapolu County). this project? The exercise provide services to enable health workers obtain some bonus at the same time help them, adequately to reduce the rate of death of child birth and improve other essential activities in those hospital which are plus to the Government and people of Liberia. Intern of drugs supplies and logistic, the World Bank have been supportive to the MOH especially during this current fight against COVID-19. The Bank provided funding for Hospital beds, ventilators, IPC materials and supplies and other essential medical equipment in the facility with COVID-19 patients. Thomas V. Mayor Careysburg During your presentation you Mr. Menitoyan J. Dolo: That money did not Urey City, MIA mentioned that over 250 million come at once. It came in bits and pieces. Each dollars have been given by the project that I just spoke about, had its own World Bank to the Ministry of financing and with different objectives. Some Health. What has been done with supported infrastructure like the EERP project, these monies? the Construction of the Redemption hospital. Others like HSSP that supported the PBF I 47 | P a g e previously mentioned and the REDISSE which support disease surveillance for both humans and animals. Ruth L. Commissioner, I will start by saying thank you to This meeting is going to be a nationwide James Ministry of Internal the World Bank and partners for meeting, especially in places that have a high Affairs this meeting. This has never been infection rate of COVID-19. before, at least this process will inform us about happening and help to erase speculations about project implementation. What mechanism are you putting in place to continue more of these meetings as we see it very important to stakeholders and the public? Second Presenter: Mr. Sonpon B. Sieh Project Coordinator, REDISSE/COVID-19 Presentation Topic: Update on the Liberia COVID-19 Emergency Response project Implementation Daniel Pabie Commissioner, West Point Information is power! Thanks Mr. Dolo: Noted. This is something we have for the information provided. plan as a unit and budgeted for its Looking at your presentation, implementation throughout the country. We Pillar 4 remains the foundation hope to involve key stakeholder at the very of our involvement as local beginning of project development before government. The approach implementation start. Again, we have this as used by the sector in combating a challenge because of the manner and form COVID-19 has failed because in which COVID-19 started. of the manner in which it was done. Leaving out the local government was wrong. Now that you have identified the problem, we will not repeat them, but going forward, we can assure you of our fullest cooperation. We suggest that you work with us through the Office of the County Superintendent. Florence Superintendent, The reason why we are having Mr. Dolo: Thank you Madam Brandy Montserrado too many problems is because Superintendent for the deliberation. We can County we have not decentralized assure you from the level of the PIU that activities, in the context of the going forward we will do the needful Local Government Act. We especially when comes to the involvement made these same mistakes of stakeholder from the initial stage of any during the fight against EVD. outbreak or perfecting project The Ministry of Health initially implementation. operated from the National The recruitment process of COVID-19 level only. There was responder was actually done with people 48 | P a g e resistance in every community who fight against Ebola Virus Disease the teams visited. When the (EVD) at the time of that outbreak. So, the local government was Ministry of Health and National Public involved, all these came to an Health Institute of Liberia (NPHIL) decided end. We went down to districts, to recruit these people since they already townships, bringing on board have some level of training and experience every community leader. It was with EVD response. As you rightly said, anticipated that the lessons community entry and involvement is key to learnt from EVD situation the fight against any disease, therefore that would have tailored down this approach will be revisited and corrected in path, unfortunately, it is the the future. opposite. The COVID-19 protocol instituted by the MoH are not being adhered to because of the exclusion of the local government. Even the recruitment of mobilizers was done without the community’s involvement, it is wrong. However, it is still not late. We will work together in defeating the nightmare. We would like to thank the World Bank for the continuous support to our country. Even though this project is expected to end by 31st December 2021, please try to involve the local government structure in your subsequent recruitment efforts so that the actual results are achieved. Let’s build the sense of ownership by the local structure so that they are able to work within their local environment. 49 | P a g e Joe M. Journalist Dennis Thanks Mr. Sieh. I am not here Mr. Sieh’s respond: Thank you. I was only as a journalist, but as an making reference to responders, but we will eye of the young people of continue with the community engagement. Bentol. Your presentation In fact, this is the second stakeholder serves as an eye opener. The meeting. We will allow you along with the information provided has Community Engagement and Risk cleared more doubts and Communication team to sit and develop misinformation. Even though your work plan to rolling out this the recruitment, like other said, engagement. I am glad for the model used in did not involve the local selecting people in your district here, but in government, but in my area, it most areas it didn’t include the team that was done through the should have led the process, the districts. As community structure. I listened to the Superintendent say the Unfortunately, from your decentralization model is what we should presentation, I understand that use, I would like to highlight that the this project comes to an end operationalization of the developed plan this December. With that, I was different from what was developed, all have these comments: recruitments should have been driven by the communities, districts, etc. We are not 1. Globally, there is a drastic neglecting the community. As per your increase in cases, and recommendation, we have agreed to work considering that Liberians are with the community. However, in terms of not taking seriously the compensation for the work people do, there preventive measures, are there we have some hitches, the Bank will not do plans for you to redesign your that. But in terms of meetings transportation approach so that our country reimbursement, yes, I can assure you of that. doesn’t experience what is Thank you! being experienced in Europe, America and other places? I also would like to recommend that you continue your good support to Liberia as this has helped to contain the spread of the virus. Even though the behavior of some recruited young people did not go well and that the local government structure was not involved at some level, I would recommend that you get them involved to ensure a holistic approach. 50 | P a g e Philip O. Superintendent, Mr. Dolo: The provision of PPE especially Johnson Liberia National I control rural and urban for the security apparatus is extremely Police (LMP) Montserrado County. From the important. The security apparatus is one of fight against EVD to the the key stakeholders in the fight against current COVID-19 struggle. COVID-19. Law enforcement is extremely My officers have been in the paramount. But the challenge we had as a frontline providing support to project is that, the Bank through the PIU the health team. I remembered cannot directly get involve with the contact tracers meeting provision of PPE to your section. What can resistance in communities, my be done is negotiation with the relevant men were always there, though authority from your institution and that it has been a very difficult community be trigger down to the Ministry situation. I have been there of Health. MOH as end user can provide you myself, engaging the the necessary PPE where there is a need. communities to calm people down. We have been working along the local authority to ensure adherence to health protocols, but working without PPEs had been a challenge for the police. Please remember the police in your planning and community engagement efforts, thank you. McDaniel City Mayor Office Thanks for the efforts in Vampell Assistant, Bentol Mr. Sieh’s respond: Thank you, I think community engagement and City your question is basically about Case advocacy, the presentation is Management. There were several very clear. My attention is institutions requesting for IPC supplies, but drawn to Case Management this is how the World Bank project works: and the clinical aspect. Were there any items (IPC supplies) It is not in our purview to distribute that should have been whatever item that came. It is the distributed to townships, implementers’ responsibilities. The communities and cities by the Ministry of Health and the National Public World Bank? Health Institute of Liberia had already agreed where (health facilities and entry points) they wanted prevention to take place, including hotspot communities. They had the mandate, in terms of drawing up what they needed to supply, it is their responsibility. What we are doing now is to track where specifically those supplies were taken, because this has audit implications. Several items, some delivered to health facilities, hospitals, POEs, communities, etc. How did they do it, is what we are 51 | P a g e tracking now. What I can’t say right now is where these items were supplied, but in terms of facilities, every County Health Team received supplies. I am also not sure that every community received supplies, because the targets were hotspot communities. Thank you! Madam General Nancy Yallah Superintendent, In your presentation, you Mr. Sieh’s respond: Thanks Ma, though Liberia Marketing mentioned that some young you have provided some answer. That’s how Association (LMA) people who were agitated for people behave, they complained of not their salary broke chairs and having a job, but when they are given a piece some valuables at your office, of job, they misbehave and when it is taken, and that they were videotaped, they sit and complain. This is what we are what are you going to do to going to do: We have their photos, as they them? I think it is good that you come to collect their money on Wednesday, put their names on the radio so we are working with the police to ensure that that people get to know them. they pay for those damages. Thank you Musu K. National Tribal Tompson On behalf of the Tribal Mr. Dolo: Thanks, we will keep your Governor Council Governor Council, let me say Superintendent in the know especially for President for the thank you for the clarification. ongoing activities 15 Counties et 16 All the workshops we have tribes attended, this one has provided more information on how the process is being managed. Since the inception of the fight against COVID-19, our Superintendent has never been invited, as a result, we have not been a part of this process. We represent a very big constituent, please keep our superintendent in your activities, with that, we at the lower end will be inclusive. Thank you! 52 | P a g e Roosevelt Brewerville City Thank you for the presentation Mr. Dolo: Thank you: Our doors are to A. Morgan, Cooperation and thanks to the working with you from now on. Superintendent for gathering us here. Mr. Sieh, I am a bit disappointed in some Liberians, the way we behave, I just don’t know why. The misinformation and disbelieve in our communities is due to the way in which information is shared. In the midst of the rumors, our health officials didn’t step out to provide the rightful information, leaving the communities with doubts. In Brewerville, last week, Mr. Mulbah died, and the cause of death is unknown. Alphonso Browne also died and the cause of death is unknown. This is scaring. Lastly, a lady and her husband on Kpakor Road, died one after another, and the cause (s) of deaths is/are unknown. A girl died in Parker Corner, this has raised serious fear in the residents. None of those bodies were assessed and family members were seen. Brewerville City wants to work with you, we are going to write a project to your office, but please, may it not be like “who know you�. We want to work with you, we know our communities, and we know our people. We are not going to accept any recruitment from outside of the community. 53 | P a g e Mambu M. Now that COVID-19 vaccine Mr. Sieh’s respond: The laboratory is the Kromah has been developed, what nucleus of what we do. Our current mechanism has been put in laboratory evaluation is at level 3, and we place to ensure effective working to ensure upward strengthening. vaccination and the alleviation Right now, preliminary data is being of fear and denial to validate collected. This is important to prepare the the potency of the vaccine? country before joining the vaccine prevention program. It comes with huge financial implication; a vial is US$4.00, besides transportation. Considering our population and associated transportation, it is very costly. The data is being studied to determine the number of persons that can be vaccinated to stop the chain of transmission. The Bank has just paid over US$300,000.00 to WHO for the routine EPI vaccination campaigns. Raising money for COVID-19 vaccine is very expensive, but findings from the preliminary data will help us determine the next course of action, thank you! Hon. Tye S. Commissioner/T The Superintendent and others Mr. Sieh’s respond: Thank you, Mr. Weah. Weah ownship of have said it all. In 2014, we Precaution for COVID-19 is not different Virginia combated EVD, and in less from the message being disseminated by the than a decade, we are Ministry of Health. Precaution for other responding to COVID-19. I conditions, the unknown, is what is being would like to know your done now by the surveillance team, precautionary measures on the collecting samples. Samples are collected prevailing COVID-19 situation from livestock for test of any unknown and your preparedness for condition. At the port of entry in Nimba another possible pandemic in County, there’s a holding site to livestock to the near further. Secondly, be tested before entering the country. what mechanism do you have Because we don’t know what the next in place to properly test all the disease condition will be, there are over 200 livestock that are imported into surveillance officers deployed across the the country? country to keep watch. These people are paid and supported. It is only our surveillance system that can help us detect any possible outbreak/disease, thank you! 54 | P a g e Amos D. Special Assistant Currently, some of the Okay Noted Sackie to the responders recruited from our Superintendent, district cannot be seen and you Todee District, are paying them. Let me join Montserrado my voice to the many voices to County: appeal to you that please do not recruit anybody from Monrovia to work in our district. Please recruit people who are living in the district, thank you. Hon. Township Thanks for the meeting. Mr. Dolo: The Madagascar herbs were Joseph G. Commissioner, However, please know that never seen by the PIU. We only heard of it. Kollie Mount Coffee those who mislead the masses Therefore, it will be very difficult to provide are always louder than those any information regarding that. What we who spread the truth. Please can assure you is that, the WHO protocol join the race with them in must be follow at all time to prevent the providing accurate and factual spread of this virus. information to keep our people informed. Use the media outlets. Considering your role in the fight against COVID-19, can you please provide some information on the Madagascar herbs that was imported by the government Hon. Commissioner, Thank you for the meeting. My Mr. Sieh’s respond: Thank you for this. Comfort Dixville recommendation is for you to This is a whole new discussion, like I said, W. Taylor Township increase your awareness on this project also captures domestic animals. domestic animals’ care. Many Our surveillance systems are looking at times, when a stray dog is domestic animals. We have lost many killed by a vehicle, residents persons to rabies. This has been around for from the community collect the long, but not until in 2017 when we dog and eat it, not knowing thescientifically identify the first case. Right health status of that animal. now, we are conducting dog vaccination To further stop the spread of campaign each year, but that’s not enough. diseases, please increase your We are going to run census to know our dog awareness on domestic animal population. Rabies is one of the common killers, we are working to determine the care, thank you. strain of the virus as well. I agree with you that we have to expand the awareness. On the selection/recruitment process, we have agreed the way to go. On the issue of 55 | P a g e the Madagascar herb, I agreed with you that our information sharing process is weak. We will work with you and the media in the dissemination of information. On that note, let me say a very big thank you for your time. Third Presenter: Mr. Menitoyan J. Dolo Environmental and Social Safeguard Specialist Presentation Topic: Grievance Redress mechanism for the REDISSE & Liberia COVID-19 Response Hon. Tony Paramount Chief, Your presentation has actually Mr. Dolo: The issue of GBV is extremely Kamakor (MIA) enlighten us on so many things. sensitive. First of all, GBV could be What I want to understand is physical, sexual, psychological and so on. that if a project workers or Therefore, a GBV can take either of these contractors get involve with a form. If Sexual offense occur by a contractor community workers wife worker in the form and manner that is outside of the project and the unacceptable by definition of GBV such as husband gets to know and attempt to obtain a sexual act, or acts report to the project, can that be otherwise directed toward a person’s considered as a GBV issues? sexuality without a the person’s consent. So if a contractor gets involve with the wife of a community member, not in a forceful manner but rather in the form of consent as in a relationship, he the (Husband) has the right to directly take the contractor to court or the law for civil prosecution since it was not directly related to GBV or sexual harassment. David S. District Health Thank you for the good Mr. Dolo: We have a communication line George Officer (DHO) information. So what are some available for you to channel your complaint. of the means and ways in which We will have form available for reaching one can forward in a complaint out to us. Stakeholders can text, email, call without the persons involve directly through these channels. Remember, been traumatize at the end of your identity will be anonymous base on the the day? sensitivity of the complaints. It is our responsibility to protect the person’s information as a matter of security. Matina W. Superintendent, My recommendation is that, Mr. Dolo: Thank you, madam Wymah Liberia Marketing when you organized this Superintendent. Your recommendation will Association (LMA) committee in the various be considered. county as you said, please involve more women, so that situation of such cannot be compromised at the end of the 56 | P a g e day. Women’s participation is very much key to all of the issues being discussed here presently Rebecca Bassa I overheard you talking about Mr. Dolo: That’s a very good question� Kamara Governor, sexual harassment and sexual These are all act that are prohibited by any Ministry of exploitation and abuse. Are member of this project in any form and Internal they the same? What the manner. Sexual harassment is actually Affairs different? unwanted behavior of sexual nature towards (MIA) member of same team of work, same sex, opposite sex or any one either for job or some form of reward. At the same time sexual exploitation and Abused is more or less actual or threaten physical intrusion of sexual act on a person. But both of these acts are all Gender Based violence (GBV) per definition. The project take serious offence to either of these act especially during this period of COVID-19, there has been multiple GBV acts committed in other countries especially where people have to stay home. 57 | P a g e Annex C: Summary of Stakeholder Consultation made in Lofa County on Parent Project February 8th to 9th 2021 Stakeholder comments Was comment Explanation (Why? How?) taken into account (Yes/ No)? Patrick K. Manjor, Sr., Protocol Officer, and YES Dolo: There will be handout (pamphlets) for Superintendent’s Office: Will there be all the presentation along with the handouts (pamphlets) for participants to read establishment of the GRC. This will serve for a full understanding of the Bank’s support as a guide for their work. The document is to Liberia, and for better contribution in huge, printing it will be very difficult, but subsequent engagements? Uniqueness we can share it via email. I know it will be a disadvantage for those without emails, but it is the easiest way to get it to you. Jerry F. Momo, County Budget Officer: I YES Dolo: Like I said, every project has a understood from your presentation that developmental objective, this defines what stakeholder’s engagement was to be done the money is going to be used and how. before the initial disbursement of funds to E.g. IFISH project, Part of the US$54m you support the response, but with the remaining talked about will be used to build the US$54m, how are we going to get involved? Redemption Hospital in Caldwell. Portion of the money will support phase two including equipping the facility. Portion will also support Performance Based Financing and education. All objectives relating to the spending of this US54M have been defined and we are to stick to the project document. For your involvement, we will come back to you again to provide all the details you need to know on how the money will be expanded. Stakeholders’ awareness of this project is a part of the World Bank’s requirements. Hawa Kanneh, Village Development Fund: I YES Dolo: The objectives of this project were see this as just informing the stakeholders, not defined by the Government of Liberia getting them involved. All project decisions through MOH along with the World Bank. are made and information is brought to us at As officers of the Project Implementation county level, I don’t see this as involvement. Unit (PIU), we provide guidance to the What is the level of stakeholder’s Ministry of Health and other ministries and involvement, if it is not just information agencies involved. The involvement of sharing? stakeholders at all levels play a significant role in monitoring and tracking implementation. 58 | P a g e Mr. Sieh: Depending on the site of a project, there are different segments of stakeholder’s engagement. Stakeholders outside a project domain will not be involved in the engagement exercise. For example, the US$54M is impacting different areas; 60% of that money goes to Redemption Hospital, this was decided long since. As such, communities that are impacted are those in the area where the hospital is being built, and they must be involved. Like the PBF, all actors in the health sector that are involved in the implementation of the project, are part of the tiers of stakeholders who should therefore understand and even form pact of the process. Mohammed Kamara, Executive Director. The YES Mr. Dolo: The COVID-19 Emergency Progressive Youth for Community Safety response project which is the subject of the Initiative (PYCSI): Now that the project is at discussion came at the result of an its implementation stage, what is the emergency, just like EBOLA. Much and significance of coming to inform the little were known about the disease, beneficiaries who were never part of the therefore, we were busy with the design stage of the project? What is the state preparedness and response. We could not of the project’s implementation? Is our engage stakeholder as early as possible as involvement direct or indirect? per the Standard of the Bank. Now that we are in the implementation stage, as a requirement we have to consult stakeholder like you and continue to engage them until the end of the project for their involvement and participation Mr. Sonpon B. Sieh Presentation (Update on the Liberia COVID-19 ERP) Dr. John Doedeh, CHO, LCHT: I want to NO Comment Noted thank Mr. Sieh for the presentation. Looking at the details provided, you can see that Lofa County submitted names of 195 responders for April and June. This covered responders at all levels of the county. Of this number, ONLY 24 were paid, the remaining 171 persons pending. Lofa is as Maryland with more responders left to paid, I am glad that Mr. Sieh has provided the clarity. One of the challenges, as indicated, is wrong bank details (account numbers). It is NOW clear that the delay is not from the CHT. 59 | P a g e Alpha Tamba, CSO, LCHT: Many believe NO Comments Noted that outbreaks are for money making. This has attracted many to the COVID-19 response. Let me announce that this is wrong. Since the EVD outbreak, we have responded to several others, not a dime we have received. Thanks to the leadership of the Lofa County One Health Platform for the support, WHO and the communities who have been supportive. I am glad that Mr. Sieh has provided clarity to misinformation Lusenie B. Fofana, Civil Society: Thanks, Mr. Yes Mr. Sieh: Thanks! The approach used for Sieh. Like the EVD crisis, temporary the COVID-19 Project is much more structures were erected with huge budgets put sustainable. During the EVD crisis, into them, and right after the outbreak, they isolation units were built in some counties, are all down. With this COVID-19 Project, and those are the structures that are what are the sustainability plans? currently being used. For example, the 14 Military Hospital did have isolation unit focusing on respiratory infection. With this project, considerations were made to isolate patients with such condition. This is ongoing in Bong and it is expected that this continue in other counties. All the infrastructures you see are permanent. What comes along now is the needed resources to sustain these structures. Patrick K. Manjor, Sr., Protocol Officer, YES Mr. Sieh: What was presented are monies Superintendent’s Office: In your expenditure under the World Bank’s envelopes. drawdown, you talked about other institutions However, we avoided spending money on pledging to do what you already proposed. what other institutions were already Does this mean their activities fund came spending money on. For example, if we from the US$17M you received from the projected purchasing of cars under the World Bank, or did they use their own Bank’s envelop and another partner was money? If so, what happens to monies you did doing the same, we didn’t buy car, but save not spend because others were doing the same the money. Duplication of activities is activities? mismanagement of the Bank’s monies. Whatever was not spent is being kept and will be redirected to other activities. Eddie M. Fargalo Presentation Update on MOA involvement with COVID-19 Hawa Kanneh, Village Development Fund: YES Eddie: Thank you! What we have identified You mentioned that people are rejecting their is the lack of awareness. Many see animals dogs being vaccinated. Is there any plan put in as pets and food at the same time. In our 60 | P a g e place by the MoA to curtail this looking at the next steps, we are working with an NGO prevalence of rabies in the country? called Breakthrough Action for the development of messages and materials for more awareness on animal diseases. This is new, it will take some time, but we will get there. The messages, when developed, will be translated all dialects and aired on our community radios. Like the MoH, we are developing messages on various animal diseases. Eddie: We are also in the protection of Haja Talawally, Women Group: Is it that, YES animals, but when an animal is showing the only the brain of the animal is test for rabies? signs of rabies, it is first important to Are there other solutions besides killing the quarantine that dog. If the dog has bitten animal? We have animal welfare group in our someone and is behaving very aggressive, communities who don’t encourage killing of the only solution is to run a test for the lives animals. of those bitten by the dog. On many occasions, we paid for the dog’s head when it is killed and in preparation for eating. Lusenie: What policy does the MoA has in YES Eddie: Communities are strongly advised to place to test all imported animals before contact the MoA before slaughtering allowing them on our market. Please expand animal, and or, report persons slaughtering your engagement strategy. animals at their backyard. Alert our team. Together, we can fight animal diseases. Mohammed Kamara: Are there plan to Yes Eddie: We are gradually going to get there. working with other NGOs who are working in This is an old-age challenge, but we will get this area? How often do you engage there. There are FREE vaccines in country communities to disseminate information on for dogs and cats. these animal diseases? Glayds Zarby, Restore Hope Liberia: Eddie: Thank you. There were vaccines in Affected dogs are often killed and sometimes specified hospitals, but right now we are eaten before the MOA inspector reach the facing stock out. Besides, there is NO scene and this makes it more difficult to test FREE vaccine in country for humans. The for rabies. What are you doing to protect vaccine is sold for US$30.00 per dose, and victims of dog bites? Can you vaccinate them a victim of dog bite will require five doses though the status of the dog is unknown? (US$150.00). This is a huge expensive that we can avoid if our dogs are vaccinated. If a dog is seen behaving unusual, it is important to isolate and monitor the dog for 14 days, let’s avoid the rush to kill. Testing the dog prevents unnecessary spending. Testing is in 24 hours. Not all dog bites are rabies 61 | P a g e cases. Jerry Fallah Momo: The Committee that you YES Mr Dolo: ‘Score card’ sounds good, but it are going to set up, is it responsible to produce depends how you want to use it. The WB a project score card on the WB projects in the project has no secret. The GRC is directly county? going to work in the office of the Superintendent who chairs the OH Steering Committee. Stakeholder comments Was comment Explanation (Why? How?) taken into account (Yes/ No)? Hawa Kanneh, Village Development Fund: YES Eddie: Thank you! What we have identified You mentioned that people are rejecting their is the lack of awareness. Many see animals dogs being vaccinated. Is there any plan put in as pets and food at the same time. In our place by the MoA to curtail this looking at the next steps, we are working with an NGO prevalence of rabies in the country? called Breakthrough Action for the development of messages and materials for more awareness on animal diseases. This is new, it will take some time, but we will get there. The messages, when developed, will be translated all dialects and aired on our community radios. Like the MoH, we are developing messages on various animal diseases. Eddie: We are also in the protection of Haja Talawally, Women Group: Is it the only YES animals, but when an animal is showing the the brain of the animal that you use to test for signs of rabies, it is first important to rabies? Are there other solutions besides quarantine that dog. If the dog has bitten killing the animal? We have animal welfare someone and is behaving very aggressive, group in our communities who don’t the only solution is to run a test for the lives encourage killing of animals. of those bitten by the dog. On so many occasions, we paid for the dog’s head when it is killed and in preparation for eating. Lusenie: What policy does the MoA has in YES Eddie: Communities are strongly advised to place to test all imported animals before contact the MoA before slaughtering allowing them on our market. Please expand animal, and or, report persons slaughtering your engagement strategy. animals at their backyard. Alert our team. Together, we can fight animal diseases. 62 | P a g e Mohammed Kamara: What is your plan to Yes Eddie: We are gradually going to get there. work with NGOs who are working in this This is an old-age challenge, but we will get area? How often do you engage communities there. There are FREE vaccines in country to disseminate information on these animal for dogs and cats. diseases? Glayds Zarby, Restore Hope Liberia: Most Eddie: Thank you. There were vaccines in affected dogs are most often killed and specified hospitals, but right now we are sometimes eaten before you reach the scene facing stock out. Besides, there is NO which makes it more difficult to test for FREE vaccine in country for humans. The rabies. What are you doing to protect victims vaccine is sold for US$30.00 per dose, and of dog bites? Can you vaccinate them though a victim of dog bite will require five doses the status of the dog is unknown? (US$150.00). This is a huge expensive that we can avoid if our dogs are vaccinated. If a dog is seen behaving unusual, it is important to isolate and monitor the dog for 14 days, let’s avoid the rush to kill. Testing the dog prevents unnecessary spending. Testing is in 24 hours. Not all dog bites are rabies cases. Jerry Fallah Momo: The Committee that you YES Mr Dolo: ‘Score card’ sounds good, but it are going to set up, is it responsible to produce depends how you want to use it. The WB a project score card on the WB projects in the project has no secret. The GRC is directly county? going to work in the office of the Superintendent who chairs the OH Steering Committee. 63 | P a g e Annex D: Summary of Stakeholder Consultation made in Nimba County on parent project February 10th to 11th, 2021 Stakeholder comments Was comment Explanation (Why? How?) taken into account (Yes/ No)? Darius Dahn Waye, Civil Society Activist: YES Dolo: All of us are under obligation to Knowing that COVID-19 is still around, and reinforce the public health laws. I agree that that residents are not adhering to health the impact of the disease in Liberia is not as protocols; take for instance lack of high as other countries, but this does not handwashing stations at homes and some mean that we should relax or ignore healthy public places, even if you see them no one is practices. Relaxing or ignoring them puts us using them, the refusal to wear masks, what at a serious risk. The Ministry of Health are doing and how are you going to ensure continues to disseminate the information on that adherence is restored what we should and shouldn’t do. The lesson learned from EVD should guide every Liberian. Wear mask, avoid touching and shaking hands, public gathering, wash your hands with soap and water or sanitize as require. Proxy, Office of the Development YES Dolo: This is detailed in Mr. Sieh’s Superintendent: Is there any way that presentation. Again, every project has an traditional leaders can be captured in the objective that we cannot deviate from. REDISSE or COVID-19 budget to support meetings and other activities that buttress the efforts of local government? Ernest Yahnkpo, Youth Leader, District #1: YES Dolo: You are one hundred percent right. In the future, it will be prudent to conduct this Again as I have said in other consultation engagement meeting before the kick-up of the meetings, the nature of COVID-19 was project. Please consider this. Early basically not know. The PIU were in to engagement will minimize the preparedness and response for the project misinformation and possibly reduce the rate and not necessarily getting involve with of infection. stakeholder at the beginning. Even though, stakeholder consultation was made at the national and international lever but not with local and CSOs NGO etc. We will continue to engage you and provide you the needful information on environmental and social risk associated with the project and key information on project benefits. Mr. Sonpon B. Sieh Presentation (Update on the Liberia COVID-19 ERP) Unnamed Lady, Tapita: Are you aware of a YES Mr. Sieh: NO! That group is NOT a part of 64 | P a g e group in the community’s that is registering the World Bank’s support and we know people for cash benefits, if yes, are they part nothing about them. of the World Bank’s COVID-19 support? William S. Mandine, County Coordinator, YES Mr. Sieh: Liberia has joined the COVID-19 MYS: I didn’t hear anything concerning vaccine immunization program. There are COVID-19 vaccine. What is Liberia’s plan in still ongoing stakeholders’ engagements this regard? with the World Bank, GAVI and other partners on how to support Liberia in procuring vaccines. The WB is providing US$3.5M towards this while GAVI is planning the procurement processes. If all negotiations and arrangement processes are finalized, the vaccine will first be administered to specific category of people (elderly, frontline health workers, etc.). Children and pregnant women are excluded. Alfrecanos Dolo, Assistant to Ganta City YES Mr. Sieh: At the moment, there are still Mayor: What happens to survival of COVID- studies ongoing to understand the after 19; who are looking at possibility to still effects of the virus. There are reports of contract and transmit the virus, community some survival becoming impotent, some stigma, etc. What is the MoH and the WB hearing difficulty, etc. but there are still doing in this direction? ongoing studies to better understand these conditions and their associated factors. Liberia is now planning a research amongst survivals to understand their conditions, pre and post COVID-19. It is the study that will provide the basis for further attention. On stigma, there are ongoing radio programs, like we did for EVD, promoting self-esteem and community acceptance and reintegration. Imma Allieu Barrie, Saniquelle Central Yes Mr. Sieh: What is important is to encourage Mosque: From all the presentations, what is the people to continue to adhere to all public the plain message in a common tone for the health measures. What you can also do is to Religious Leaders to take back to the people? help dispel the misinformation about the GoL receiving more money from the WB and spending little. Lastly the environmental and social risk associated with the project that was presented to you must be address through the establish GRC here in Ninba. The issue with GBV,SEA, SH, VAC by project workers must be address by the project if it exist at any giving 65 | P a g e time. Serena Gehgeh, Liberia National Fire YES Mr. Sieh: YES! We are currently from Lofa Service: There has been misinformation and our next stop is Bong. There are other concerning the money sent to this country for colleagues providing this same message to this pandemic. Your presentation has given us people in other counties. This is important, a clear picture, will you now be able to spread you can also contact our offices to this message across the country? authenticate. Joseph Kerkula, Radio Kegayma: Yes Mr. Sieh: The media has a role in the fight Misinformation also comes from the against epidemic and pandemic. The way Government. Our first case was reported you, the media handle some of the when the person came in contact with several information has been bad and promoting the persons; today, that trace was never reported spread of rumours. When the first case was of those people. announced, contacts were listed, some For example, the test result of a lady who was showed up, others refused to. admitted at a hospital in Ganta didn’t come The health authority repeatedly announced out, until she expired and the body was turned the missing contacts and called on them to over to the family. A day later, the health team show up for the good of the country, the came back and said she was positive of media saw it another way. We can work to COVID-19. How do you think the family of damage or build our country, that choice is the deceased will believe the information? ours. James Beah, Radio Saclapea: What are the YES Mr. Sieh: In this presentation, I mentioned different roles play by the MoH and MoA the REDISSE project and the COVID-19 under the One Health Framework for which project. REDISSE is s disease surveillance they procured 100 motorbikes for the MoH project which strengthens the surveillance and 20 for MoA? systems of both sectors, animal and human. The COVID-19 is beyond one sector. Under the OH Framework, the MoA is a part of disease surveillance, animal disease, while the MoH who leads the surveillance structure looks at human disease surveillance. There are surveillance officers deployed across the country. Looking at COVID-19 many of you would only think on human infection, what about the animal linkages? So, it is the OHP that bring these sectors together to respond together to avoid duplication and overlapping. Leroy Dahn, Saclapea Market: Since you are YES Mr. Sieh: Currently, there are no human talking about disease prevention, for both vaccines for rabies. However, there are humans and animals, is there any facility that rabies vaccines for the animals. More will I can take my dog or other animals to for be said in Eddie’s presentation. 66 | P a g e treatment? Are there vaccines for animals? Darius Dahn Waye, Civil Society Activist: YES Mr. Sieh: You’re right! We have to more The Civil Society Organizations are here to community engagements, this is important. buttress the efforts of government. Not much What is challenging right now is resources has been done in your community to support your expansion. On the animal engagement and risk communication efforts. health side, my colleague will present. We believe that empowering CSOs will provide more education to the people, so that they know what to do as we battle this disease. We see more fliers and posters from you then physical engagement, please think about this. Secondly, the cows matching in from Guinea to Liberia without test and treatment before crossing. Diseases are now spreading from animal to human. What are you doing in this direction to arrest an animal disease so that it doesn’t spread to human? Kuku Yancy: Looking at the high rate of YES Mr. Sieh: COVID-19, like other conditions, denial as a result of either no sign and can be ill-symptomatic. There are some symptom or some perceived of not coming in people who are positive of the virus, but contact with sick people. Can one be positive show no sign. It is only the laboratory test of COVID-19 without showing sign and result that can prove it. Such a person will symptom? resist the result, but yes, you can be positive without a sign or symptom of the virus. Eddie Fargalo Presentation Darius Dahn Waye, Civil Society Activist: Yes Eddie: There is a standard lab to test these Growing up in the ‘80s we saw food being food, but again the MCI awaits you to take tested before entering the market. What is your goods to them to be tested. What is happening today? All kinds of frozen foods important for us is for every citizen to have are on our market and no one seems to care, some understanding of these animal are you guys checking them? diseases. If the awareness is done sufficiently, people will take action against these things. Amelia Saye, General Marketing Eddie: To vaccinate your animals, just Superintendent: Where do we go to treat our inform the County Agriculture team. animals? Currently, there is no specified facility to take them to for vaccination. Just inform the 67 | P a g e animal health workers in the county, they will vaccinate all your animals, including cattle. We are planning the construction of a permanent facility for the vaccination of dogs, until that is done, liaise with our animal health workers in the counties, for vaccination. The vaccines are free. Leroy Dahn, Saclapea Market: We have been YES Eddie: Man’s interaction with the wilds is asked to take our animals from the town to causing a serious problem. Your animals avoid diseases spreading from animals to roam the village, urinate and drink from humans. You also asked us to avoid hunting your drinking bucket is wrong. What you in the wilds. What is the MoA doing to can do for your safety is to keep your support farmers? animals in a fence and provide food for them. In that way, you minimize their interaction with your food, water and other activities. Marvel G. Belah: If one is bitten by a dog, is YES Eddie: NO! It is important to test the dog to it compulsory to see the dog before initiating know if you are exposed to the virus. If you treatment for the victim? are bitten by a dog, wash the place with soap and clean water and go to a nearby facility. If the vaccine for human is not available, you will have to pay for it. Don’t tie the spot of the bite. No one should say tetanus injection will solve your problem. Get treated since the dog cannot be found to run a test. Franklin Doloque, FPA: Why are you not YES Eddie: That place has been under confusion. utilizing the animal quarantine shelter Someone has been claiming the land on constructed by FAO at the Ganta – Guinea which the property was built. However, the Border? matter is gradually being resolved, the dedication of the facility will be done soon. Joseph L. Miller: Diseases affecting animals’ Eddie: If a disease is found in the liver of the liver should therefore be recommended by the animal, it is not save to eat the animal. MoA team to be assess before slaughtering. Whatever disease is found in the liver Minus the liver, if people consume the other covers the entire body. Right now, we are parts of the animal, are they going to get issuing certificates valid for one year. infected? Vaccination is done annually. The certificate covers the animal during this 68 | P a g e period. So, in the absence of a tag, the Secondly, is it possible that the MoA along certificate speaks. with MoJ work with communities to ensure that dogs and other animals living in the communities are tagged for identification to trace the vaccination status of the dog if there is an accident? 69 | P a g e Annex E: Summary of Stakeholder Consultation Made With CSOs and NGOs During Engagement on the Parent Project – November 16, 2020 Topic Stakeholder/Insti Comments/Feedback RESPONSES tution Overview on the Patricia Kromah When is the Ministry of Health going The MOH is learning by brain for vaccination to roll out the vaccine in others now. The rollout of the vaccination rollout process CHILD counties apart from Montserrado and process in the County has already Margibi? been scheduled and as such will begin as soon as the additional financing agreement is finalized by the Bank. The rollout plan has already been prepared by the EPI Unit and is awaiting full implementation Prioritization Kakafia Kromah What is the target for the vaccine and The vaccination process for now is and targets of when is the vaccine going to other going to target healthcare providers, the vaccine ROCH Counties? persons with co-mobility, elderly and people above the age of 60yrs, essential worker who cannot social distance themselves due to the level of task they perform and the total targeted persons is 1.4million depending on the availability of funding. Stakeholder What is the roll of CSOs in the The risk communication team have engagement and Emmanuel N. vaccination rollout process? started to meet with most of the key community Kimen stakeholders and CSOs networks participation already. CSOs are very important in Equip Liberia to this process because they will help government and its partners disseminate the right message out there. CSOs served as monitoring arm for vaccine roll out process PHIL If CSOs are ‘John the Baptist’ as the Mr. Chester said that those presenter said, then we should have comments was well noted and the been the one to start the engagement Minister was going to work on them Grace Yeaneh process. Emmanuel N. Where is the place of CSOs in the There is no information about CSOs Kimen budget that was just read by Mr. getting a specific budget. Providing Sieh? separate budget for CSOs Equip Liberia implementation requires the Banks, approval at the same time making it as part of the project PDO. Therefore, CSOs and NGOs should use their existing network for now 70 | P a g e in spreading the message on the vaccination process and should actively get involved with their respective institutions to disseminate vaccination information. Grievance and Sondah Geepea The GRM tool that was developed by CSOs were not part of said Redress the safeguard team of the PIU/MOH, development because the tool was Mechanism SEARCH was the CSOs part of any not the final tools for development of such document or implementation. However, the tools tools? will be shared with all of our stakeholders, especially CSOs and NGOs for their inputs if need arises. 71 | P a g e Annex F: Photos of Stakeholder engagement at county level 72 | P a g e Annex G: Sample complaint filling form N° Complaint Complainants Name and Sex Complaint label Place of Mode of Complaint Signatu date ID Number details of (M/F) complaint receipt(**) classification re of complainant (***) complai nant 73 | P a g e (*): Complainant identification number (to be used in case of anonymity of the complainant) (**): Mode of receipt of the complaint (**) Self-referral of the CMC on the basis of supervision reports and press articles. (2): Facts found during meetings, field visits. (3): Formal letter sent to the PIU. (4): Formal letter sent to the PIU. (5): Telephone call (***): Complaint classification (***) Sensitive Complaint (SC), Non-Sensitive Complaint (NSC) 74 | P a g e Annex H: Indicative Time limits for processing complaints N° Steps Timeframe 1 Receipt, Classification and filing of complaints Immediate (1 day) 2 Assessment of the eligibility of the complaint under 5 working days the mechanism 3 Acknowledgement of receipt 4 Review of complaints and identification of possible 30 days maximum (where no solutions investigation is required) 30 days maximum (where no investigation is required) 5 Implementation, follow-up of agreed measures and 30 days maximum closure of the complaint 75 | P a g e Annex I: Complaint Respond Proposal Form Details of the Date complaint Heading Proposal for the Date settlement of the Heading complaint 76 | P a g e Signature of PMB representative Complainant's Date response Heading Signature of complainant Solutions agreed with Heading the complainant Implementation Timeframe Signature of CMC representative Date and signature of the complainant 77 | P a g e Supporting documents (where applicable) 78 | P a g e Annex J: Sample letter of acknowledgement of receipt of an ineligible complaint (Contact details of the Complaint Management Committee) Date: __________________ (Name of the complainant (not required if anonymous) or the entity submitting the complaint) (Address of the complainant or entity submitting the complaint) Subject: Complaint regarding…………. (Provide a brief description) Dear Sir/Madam, (Name of complainant), We hereby acknowledge receipt of your complaint dated…………… Our Complaint Management Committee takes stakeholder concerns very seriously and we thank you for submitting your complaint to us. In keeping with our complaint handling procedure, and after evaluation of your case, your complaint has been deemed ineligible and cannot therefore be processed by our complaint handling mechanism for the reasons set out below. 79 | P a g e [Specification (s) of the reason(s)] We wish to inform you that the ineligibility of your complaint under our complaint management mechanism for the reasons mentioned above is without prejudice to your right to apply to the competent authorities for other remedies, if you are so minded and are not satisfied with our explanations and position. Yours faithfully, (Name of the Complaints Management Committee representative) Attachments (Where appropriate) Annex K: Sample letter of acknowledgement of receipt of an eligible complaint (Contact details of the Complaint Management Committee) Date: ____________________ (Name of the complainant (not required if anonymous) or the entity submitting the complaint) (Address of the complainant or entity submitting the complaint) Subject: Complaint regarding…………. (Provide a brief description) Dear Sir/Madam, (Name of complainant), 80 | P a g e We hereby acknowledge receipt of your complaint date…………… Our Complaint Management Committee takes stakeholder concerns very seriously and we thank you for submitting your complaint to us. Please rest assured that we will do our best to ensure that your complaint is examined expeditiously and fairly. In keeping with our complaint handling procedures, we will provide you with our proposed settlement in writing within ___ days (time limit) from the date of this letter. Please note also that we may need to contact you for further information on the matter. As a rough guide, please find attached the steps and timelines of our complaint management mechanism for more information on the process for handling your complaint. Yours faithfully, (Name of the Complaints Management Committee representative) Attachments (Where appropriate) 81 | P a g e