Kiribati Health Systems Strengthening Project (P176306) ANNEX X. Stakeholder Engagement Plan Kiribati Health Services Strengthening Project Stakeholder Engagement Plan 1. Introduction This report presents a Stakeholder Engagement Plan (SEP), which will be implemented by the Ministry of Health and Medical Services (MHMS) in preparation for the Kiribati Health Services Strengthening Project (KHSS) project (P176303). The MHMS will implement the project in all of Kiribati’s 22 inhabited islands. The KHSS project identifies four components, which will have a separate group of stakeholders: (a) Improving equitable access to health services in outer islands. (b) Strengthening quality and range of services provided through hospitals. (c) Project management enhancement, and (d) a contingent emergency response component (CERC). The project will be implemented by the Ministry of Health and Medical Services (MHMS). The responsible MHMS technical departments include (a) Hospital Services; (b) Public Health; (c) Laboratory; and (d) Pharmacy. The Project Management Unit (PMU) established for the Kiribati COVID-19 Emergency Project (P174219) will be responsible for the (a) the overall administration of the Project, including the preparation of the annual work plan and budgets and preparation of the Project Operations Manual; (b) the overall implementation of Project activities and achievement of Project results with support from the MHMS technical departments; (c) coordination with other Government ministries and stakeholders on all aspects of Project implementation as required; (d) the overall administration of financial management, procurement, environment and social (E&S) risks management, and communication of all Project activities; and (e) the overall monitoring, evaluation and reporting of Project activities. For Official Use Only The PMU, as with the COVID-19 ERP, will be supported Kiribati Fiduciary Services Unit (KFSU). The KFSU is based within the Ministry of Finance and Economic Development (MFED) who will provide Financial Management, Procurement, E&S, and Monitoring & Evaluation (M&E) oversight to the Project. The KFSU has engaged a social officer and is in the process of engaging an environmental officer and an environmental and social specialist. The KFSU is a new unit and will require capacity building with respect to the implementation of the World Bank Environmental and Social Framework (ESF). 2. Project Stakeholders To ensure effective and targeted engagement, the Project identifies three core stakeholder categories: affected parties; other interested parties; and vulnerable groups. 2.1 Affected Parties Affected Parties comprise persons, groups and other entities within the project area of influence 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. It should be of note Kiribati Health Systems Strengthening Project (P176306) that there are no other health care facilities or providers outside of hospitals or community clinics and all healthcare is public. There is one private pharmacy located in Bikenibeu, South Tarawa. The following are considered affected parties in the context of this project: Public Sector • Ministry of Health and Medical Services (MHMS) • Ministry of Finance and Economic Development / Fiduciary Services Unit (MFED/FSU) • Ministry of Information, Communication, Transport and Tourism Development/Kiribati Ports Authority (MICTTD/KPA) • Ministry of Environment, Lands and Agriculture Development – Lands Division (MELAD) • Ministry of the Interior | Island Councils | KILGA – Kiribati Local Government Association Hospital and clinic staff (nurses and doctors) • Hospital and community clinic personnel • MHMS personnel Civil Society • National and local health rganizations • Community Groups • Vulnerable groups • Communities serviced by the Tungaru Central, Betio and London Kiritimati Hospitals • Communities serviced by community clinics in their respective outer island • Construction workers working with physical improvement of healthcare structures/this project. • The public at large 2.2 Other Interested Parties Other interested parties include individuals, groups and other 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 its implementation in some way. Other interested parties may include: • Local and international health care NGOs o National: Kiribati Family Health Organization • International health organizations working in Kiribati • Local government: KILGA, Island Councils, Unimwane1 (traditional • Local businesses • Businesses with international links • Development partners working on health, such as WHO, UNICEF, New Zealand MFAT • Regional partners such as SPC, PIF. • Development partners working in water, infrastructure, and inter-island transportation such as ADB and EU It should also be of note that civil society and non-profit organizations are headquartered in the capital of South Tarawa and there is little presence in the outer islands unless there are a specific project they are working on. 1 A traditional council of elder males who oversee village and island affairs. They are still considered a relevant authority in some outer islands. Kiribati Health Systems Strengthening Project (P176306) 2.3 Vulnerable Groups The project identifies vulnerable groups as any persons or groups who may be disproportionately impacted or further disadvantaged by the project due to their vulnerable status, and who may require special engagement efforts to ensure their equal representation in project consultation and decision-making processes. The project will conduct targeted engagement with vulnerable groups to ensure they are fully informed of the project and to understand their concerns and needs in accessing basic healthcare in their communities and more specialized healthcare in hospitals. As all healthcare in Kiribati is public, the project will affect the entire population, however, during the consultation process, the following groups will need separate consultations to ensure their participation in the process. • Women (pregnant and recent mothers) • Youth and Children • People with disabilities • Illiterate individuals • People with pre-existing medical conditions such as heart or lung disease, diabetes, cancer, HIV/AIDS among others • Victims or potential victims of Gender Based Violence (GBV), Sexual Exploitation, Abuse and Harassment (SEA/SH) 2.4 Stakeholder Needs Community Stakeholder Group Key Characteristics Preferred means of Language and notification special needs Outer Islands Local Government - Low level of access to Local government and I-Kiribati Unimwane, / - Island technology (varies by Unimwane via KILGA Council island and proximity and via phone and e- to South Tarawa mail. and/or Kiritimati - General Public Island In-person (@ i-Kiribati maneaba- Secondary: Consultations divided radio by gender and age Kiritimati -Local government Available but Email, social media, English and I-Kiribati -Hospital and Public unreliable access to social media Health Staff technology, internet, messaging tools, radio, social media phone (landline and mobile) South Tarawa -Government High level of access to E-mail, social media, English -International -NGO technology, internet, social media -Development social media print and messaging tools, radio, Partners radio print media -Local NGOs Hospital and Public Health staff 3. Consultation During Project Conceptualization Currently, only government-chartered flights are allowed to enter Kiribati. These chartered flights transport urgent supplies to the country. It is expected that closures will remain until at least the end of the year- no announcements have been made by the GoK. While online consultations are a possibility with national governments, some NGOs and International Organizations, consultations with communities in the outer islands are not possible due to communications and technology issues. Kiribati Health Systems Strengthening Project (P176306) The ESMF, LMP and SEP have been presented to key institutional stakeholders during project preparation. Two consultations have been held, the first for MHMS staff and a second broader consultation was held on October 18, 2021, with representatives from MHMS, the Ministry of Infrastructure and Sustainable Energy and representatives from the Lands Division of the Ministry of Environment, Lands and Agricultural Development, (MELAD/LRD). Participants for the second consultation were provided with a copy of a presentation outlining i) project description; ii) E&S risk management requirements (including World Bank requirements); iii) the E&S assessment process; iv) institutional arrangements; v) potential E&S risks and impacts associated with project activities; and vi) proposed mitigation measures, ahead of the consultation meeting and offered the opportunity to review draft instruments prior to their disclosure. The SEP will be publicly disclosed on the MHMS website: https://mhms.gov.ki. The ESMF and LMP will also be disclosed on the MHMS website. Any significant changes to the ESMF, LMP and SEP will be consulted on, approved and disclosed during the project implementation period. The updated SEP, LMP and ESMF will be redisclosed on the MHMS website. 4. Stakeholder Engagement Program Engagement methods Kiribati faces significant challenges in communication and outreach given its lack of reliable communications, distance, and adequate transportation between islands. Communications in South Tarawa are more reliable and comprehensive. In the outer islands, there are less available communications outlets and less reliability of internet and mobile phone systems. Therefore, engagement methods may vary according to the location of stakeholders. - Direct communication and in-person meetings. given the high infection rate of COVID-19, it is not recommended that public gatherings take place, nor that staff located in South Tarawa travel to the outer islands for consultations and/or trainings until the corresponding authority approves such travel and gatherings. However, small meetings can take place between WB staff and consultants located in South Tarawa per MHMS guidelines. E-mails are the preferred method of direct communication given time variations and convenience. - Mass Media. Through the Kiribati Broadcasting and Publication Authority, an SOE, Kiribati has one newspaper and one radio station that reaches all of Kiribati and operates out of Kiritimati and South Tarawa. Other newspapers are available only online. - Social Media. MHMS and in-country WB consultant will deliver social media updates throughout the design and implementation of the project. Anecdotal evidence suggests that WhatsApp and in particular Facebook are the preferred methods of social media - Written communication materials such as brochures or flyers will be developed in i-Kiribati and English and disclosed to the public before the project activities begin and upon project completion to inform the public of new facilities and services - Online surveys will be used to assess project scope and rationale remotely given Kiribati’s communication challenges. These will be used to target stakeholders in South Tarawa as internet connections in the outer islands is unreliable. - Outer Islands Local Government. Due to COVID-19, travel to the outer islands is possible but discouraged. The Kiribati Local Government Association, housed under the Ministry of the Interior can supply information from South Tarawa to the respective Island Councils to disseminate print materials or other information. The main purpose of engagement with stakeholders with this project will be as follows: Kiribati Health Systems Strengthening Project (P176306) Project Information to disclose Location Target Stakeholder Topic of engagement Engagement Methods Stage -Environmental and Social Small gatherings and focus Management Framework South Tarawa groups (ESMF) Internet based meeting -Consultations on project scope -Stakeholder Engagement platforms Project affected and rationale Plan (SEP) Outer Islands Online newspapers parties and -Project E&S principles -Draft Grievance Mechanism Surveys vulnerable groups -Grievance mechanism process Environmental and Social Mass and social media Commitment Plan Via MHMS and Kiribati Preparation -Draft project scope and Island Local Government rationale. Association - Regular updates on project South Tarawa development -Environmental and Social Internet based meeting -Consultations on project scope Management Framework platforms Project interested and rationale (ESMF) Surveys Parties -Project E&S principles -Stakeholder Engagement Mass and social media -Grievance mechanism process Plan (SEP) Outer Islands Via MHMS and Island -Draft grievance Mechanism Councils Environmental and Social Commitment Plan -Project scope -Updated Project's ESF -How to participate (depending instruments on component – training, -Feedback of project Small gatherings construction employment, consultations Email procurement) - Information about the South Tarawa Affected parties Mass and social media -Project E&S principles project's activities and vulnerable Written material -Grievance mechanism process Outer Islands groups Indirect communications Implementation -Health and safety impacts through Island Councils and -Environmental concerns MHMS -Satisfaction with engagement activities and grievance mechanism process -Project information- scope and -Updated Project's ESF Email rationale and E&S principles instruments Mass and social media -Coordination activities Feedback of project South Tarawa Project interested Written material -Grievance mechanism process consultations Parties Indirect communications -Health and safety impacts Information about the Outer Islands through Island Councils and -Employment opportunities project's activities MHMS -Environmental concerns Stakeholder engagement in South Tarawa will rely on a variety of methods. it is recommended to hold small- group sessions, focus groups and interviews. Other methods will include but are not limited to the publication of project information through social media: including MHMS’ website and Facebook page, social media, and mass media via public service announcements through radio, and printed materials that can be distributed at the local level. Public information materials aimed at the general population will be translated to i-Kiribati. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders Traditionally, consultations outside of South Tarawa take place in maneaba, a public house, where the local population discusses community issues. However, given the high transmission rate of COVID-19, it is not recommended that public gatherings take place, nor that staff located in South Tarawa travel to the outer islands for consultations and/or trainings until the corresponding authority approves such travel and gatherings. The MHMS has the potential to distribute print materials to the general public as there is one clinic in each island. Additionally, Kiribati Local Government Association has direct access to Island Kiribati Health Systems Strengthening Project (P176306) Councils in each of the outer islands which can potentially support the project team in the distribution of materials. 5. Stakeholder Engagement During Project Implementation Consultation will take place throughout the life of the project, to disclose information to project stakeholders and seek their feedback. Dedicated channels for information dissemination will be established to ensure consistent communication at national and local levels throughout the project. Stakeholder engagement will comprise consultations with stakeholders throughout the entire project cycle to inform them of the project and to solicit their concerns, feedback and complaints about any activities related to the project and consultations to improve project design and implementation. Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the SEP and the GM. 5.1. Project launch The launch of the project is, potentially, a good opportunity to engage stakeholders. However, COVID- 19 restrictions will provide further guidance as to the scope of the project launch. 6. Grievance Redress Mechanism The project GM2 will seek to resolve complaints and grievances in a timely, effective, and efficient manner that satisfies all parties involved. It will provide a transparent and credible process for fair, effective, and lasting outcomes. It will also build trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. MHMS will establish and implement the GM within 30 days and update the GM as necessary throughout project implementation. The GM will be coordinated by the Social Specialist working under the supervision of the Project Manager. The GM will: • Provide affected people with avenues for making a complaint or resolving any dispute that may arise during the implementation of the projects and all its components. • Ensure that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants. • Avoid the need to resort to judicial proceedings. 6.2 World Bank Grievance Redress Communities and individuals who believe that they are adversely affected by a World Bank-supported project may submit complaints to existing project-level GM or to the World Bank’s Grievance Redress Service (GRS). Once the concerns have been brought directly to the World Bank’s attention, and Bank management has been given an opportunity to respond, complaints may be submitted to the World Bank’s independent Inspection Panel which determines whether harm occurred, or could occur, because of World Bank non-compliance with its policies and procedures. Information on the World Bank’s corporate Grievance Redress Service is provided at: www.worldbank.org/en/Projects-operations/products-and- services/grievance-redress-service. Information on how to submit complaints to the World Bank’s Inspection Panel is provided at: www.inspectionpanel.org. 2 The project GM officer (s) Address Title Contact Details Aree Redfern MHMS, Nawerewere Project Manager, K-HSSP E: areeredfern@gmail.com; M: 73049011 Ema Nauan MHMS, Nawerewere Acting Deputy Secretary E: ds@mhms.gov.ki; M:73007496 Kiribati Health Systems Strengthening Project (P176306) 7. PROCESS DOCUMENTATION The SEP will be periodically revised and updated as necessary during project implementation to ensure that the information presented is consistent and reflects the evolving nature of information required at different stages of the project, 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 project related activities or schedule will be reflected in the SEP. Quarterly summaries and internal reports on public grievances, enquiries, and related incidents, together with the status of implementation of associated corrective/preventative actions, will be collated by the designated GM officer, and referred to the Project Director and Project Steering Committee. Quarterly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the project’s ability to address those in a timely and effective manner.