The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 02/24/2021 | Report No: ESRSAFA102 Feb 27, 2021 Page 1 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Cote d'Ivoire AFRICA WEST Government of Côte Ministere de la Sante et de d'Ivoire l'Hygiene Publique (MSHP) Project ID Project Name P176257 Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines Parent Project ID (if any) Parent Project Name P173813 Cote d'Ivoire COVID-19 Strategic Preparedness and Response Project (SPRP) Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 2/17/2021 3/1/2021 Population Financing Public Disclosure Proposed Development Objective To prevent, detect, and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Cote d'Ivoire. Financing (in USD Million) Amount Current Financing 0.00 Proposed Additional Financing 0.00 Total Proposed Financing 0.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? Yes C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] Feb 27, 2021 Page 2 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) The proposed project will support the implementation of Cote D'Ivoire's COVID-19 Emergency Preparedness and Response Plan endorsed by the National Institute of Public Hygiene and the Minister of Health (on March 20, 2020). This plan aims to reinforce the country's capacity to: (i) limit the transmission of COVID 19 in the population including health workers; (ii) strengthen early detection notification and confirmation of cases of COVID-19; (iii) effectively manage isolation and case management for all suspected and confirmed cases of COVID-19; (iv) support health promotion and community mobilization for the protection and prevention to COVID-19; (v) support Implementation Management and Monitoring and Evaluation; and (vi) strengthen multi-sector coordination of national institutions using a one-health approach, to improve preparedness and response and to minimize the socio-economic impact of a potential outbreak of COVID-19. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] The parent project (CIV-SPRP - P173813) was prepared under the COVID-19 Strategic Preparedness and Response Plan (SPRP) using the Multiphase Programmatic Approach (MPA), and approved by the Board on May 2, 2020, became effective on May 21, 2020, and has a closing date of May 31, 2021. The parent project is being implemented throughout Côte d’Ivoire through the COVID-19 dedicated treatment facilities, with the aim of contributing to COVID-19 surveillance and response. Likewise, the Additional Financing (AF) will cover the 33 health regions and 113 health districts, which include 2,403 vaccination centers, as well as the regional branches of the National Institute of Public Health (l’Institut National de l’Hygiène Publique; INHP)and for Public Disclosure dealing with COVID-19 surveillance and treatment. Some departments will be targeted by supported activities, such as the rehabilitation of the regional cold rooms in Yamoussoukro (Centre region) and San Pedro (Southwest), the Expanded Program on Immunization (EPI) dry storage space in Abidjan, and upgrading of cold chain equipment to meet global standards, including those of Odienné (Northwest region) and Bondoukou (Est region); storage capacity in the 113 districts will be strengthened with the acquisition of refrigerators; and, at central and regional levels, the acquisition of ultra-cold freezers equipped with remote temperature monitoring devices for vaccine to be stored between -70°C and -90°C, which will be done only in the city of Abidjan at 10 selected sites. The AF is also expected to finance small civil works to rehabilitate screening rooms/posts at designated Points of Entry (POEs) and isolation sites. These works will be undertaken within existing facilities. The project is not expected to have an impact on natural habitats or cultural heritage sites. No proposed activities have the potential to lead to involuntary resettlement issues. Based on the initial screening of the proposed AF activities and a preliminary assessment of the baseline characteristics for potential project sites, the deployment of operational plans for the COVID-19 vaccination campaign requires a particular attention to waste management (medical wastes including sharps) from the vaccination campaign, as well as to the risk of accidents related to the distribution and transport of vaccines, to sharp needles),and the possible water pollution associated with waste management. An intense focus on expanding immunization capacity is necessary to ensure that the country’s health systems can effectively implement a comprehensive, and unprecedented, COVID-19 vaccine deployment strategy. This includes a Feb 27, 2021 Page 3 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) critical assessment of and actions to ensure functional, end-to-end supply chain and logistics management systems for effective vaccine storage, handling and stock management; rigorous cold chain expansion and control; robust service and coverage tracking systems; well-trained, motivated and supervised vaccinators; large-scale communication and outreach campaigns tailored to at household, community and national levels; people-centered service delivery models that can reach different target populations effectively; and effective political leadership. Côte d’Ivoire may also need to consider and enhance relevant additional institutional frameworks for the safe and effective deployment of vaccines, including voluntary vaccination practices; regulatory standards for vaccine quality; guidelines for acceptable minimum standards for vaccine management, including cold chain infrastructure; the safe management and disposal of sharp waste; and policies to ensure robust governance, accountability and citizen engagement mechanisms. D. 2. Borrower’s Institutional Capacity Côte d’Ivoire has comprehensive environmental and social legislation, including national environmental laws that provide that all public and private activities/projects that may cause significant environmental impact should be subject to proper environmental licensing, including environmental assessment studies, to identify potential risks and impacts, as well management plans aiming to minimize and mitigate foreseen impacts. Legislation also provides legal procedures for managing resettlement and for public consultations, including public hearings with the participation of the affected population to validate environmental and social impact studies. At the institutional level, the Ministry of Environment and Sustainable Development (MINEDD) is responsible for Public Disclosure setting policy guidelines on environmental issues and ensuring compliance with national environmental standards. It has different departments, including the National Agency of Environment (ANDE, Agence Nationale de l’Environnement), which oversees all projects nationwide to ensure compliance with various safeguard requirements. The agency is well-staffed, but its capacities are considered moderate by the Environmental and Social Systems Assessment (ESSA) in Côte d'Ivoire that was carried out as part of the preparation for the Improvement of Basic Services for the Ivorian Population Project (P164302) in January 2018. The Minister of Health and Public Hygiene (MHPH) is the implementing agency for the CIV-SPRP project, through its Project Implementing Unit (PIU) for World Bank-financed projects. The MSHP has an established and well-functioning PIU, which has managed all the Bank-financed health projects since its creation in 2015, including the ongoing CIV- SPRP project (P167959) and the SPARK-Health project (P167959). The PIU is responsible for the overall project planning, oversight, coordination and management. The coordination and roles of key staffs responsible for the implementation have been defined and are being implemented in a satisfactory manner. The PIU’s environmental and social specialists, hired respectively in May 2020 and in July 2020, are experts in their fields with experience in implementing environmental and social risk management strategies, including mass media campaigns and aspects of social inclusion for public health projects. Together with a biomedical specialist, who has been in the PIU since February 2018, they are dedicated to ensuring compliance with the environmental and social commitment plan (ESCP) and supervising the implementation of the recommended environmental and social risk mitigation measures through the screening of proposed activities and preparation of site-specific ESMPs and Infection Control and Waste Management Plans (ICWMPs) and any other requirements that may arise from the present AF. As such, the capacities of the PIU to manage ongoing and emerging E&S risks are deemed to be adequate. Feb 27, 2021 Page 4 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The project will have long-term, positive environmental impacts as it will strengthen COVID-19 surveillance, monitoring, treatment, containment and response in accordance with World Health Organization (ESF and WHO) guidelines and prepare the country for future pandemics. The increased scope financed by the Additional Facility is expected to further enhance these positive impacts through additional investment in the procurement of handwashing and sanitation facilities, in rehabilitation facilities, and in vaccine administration. The environmental risk is rated Substantial because of inherent occupational and community health and safety risks and the challenges associated with medical waste management. In addition, there are several short-term risks which are expected to be mostly temporary, predictable and reversible. The main environmental risks of the project include: (i) environmental and community health related risks from the inadequate storage, transportation and disposal of medical waste. This includes waste resulting from vaccine delivery, such as sharps, and the disposal of used and expired vaccine vials as a result of AF activities. Waste materials generated from labs, quarantine facilities, screening, treatment and vaccination facilities to be supported by the parent project and AF, all require special handling and awareness as they may pose a risk of infection for healthcare workers handling; (ii) occupational health and safety (OHS) issues related to the availability and supply of personal protective equipment (PPE) for healthcare workers and the logistical Public Disclosure challenges in transporting PPE across the Côte d’Ivoire in a timely manner; (iii) community health and safety risks, given close social contact and limited sanitary and hygiene services (clean water, soap and disinfectants) and isolation capabilities at healthcare facilities across the country; and (iv) OHS risks related to the rehabilitation of existing facilities. Social Risk Rating Substantial The social risk rating of the project is Substantial, possible risks and impacts are reversible but, given the highly infectious nature of the COVID-19 virus, some risks could persist. The main social risks are related to: (i) difficulties in access to health services and facilities by vulnerable social groups (that is people with chronic conditions/disabled, poor people, migrants, the elderly and disadvantaged sub-groups of women); (ii) lack of access to vaccine supplies, facilities and services designed to control the disease by marginalized and vulnerable social groups; (iii) the accelerated pace of vaccine development and the information conveyed by media on associated risks that could increase public anxiety and compromise public acceptance. This risk could be exacerbated by a lack of transparency in the dissemination of information by the government, which may create public mistrust of vaccines; (iv) social conflicts and risks to human safety resulting from diagnostic testing; (v) the limited availability of vaccines and social tensions related to the challenges of a pandemic situation; (vi) the risks of sexual exploitation and abuse/sexual harassment (SEA/SH) among patients and health care providers, particularly with regard to vaccine distribution; (vii) labor influx and the issue of migrant workers; (viii) SEA/SH risks among patients and health care providers, especially in relation to distribution of lifesaving vaccines; (ix) inadequate data protection measures and insufficient or ineffective communication by stakeholders on vaccine deployment strategy; (x) risks related to adverse Feb 27, 2021 Page 5 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) events following immunizations (AEFIs), which may lead to the stigmatization of vaccine-friendly populations in certain communities and contribute to refusal of vaccines or second dose. These risks will be mitigated through effective risk communication and community engagement to raise awareness among the general population. Continuous awareness raising and education campaigns that will help rebuild community and citizen trust will be done through engagement with religious leaders, political and local traditional leaders, and women's and young people's associative movements, which are generally very dynamic and representative. Potential risks and impacts are mostly temporary or reversible but could become widespread given the highly infectious nature of the COVID-19 virus. This Additional Financing will invest in small civil works to rehabilitate existing health facilities, but no new land will be acquired or accessed. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: The AF will provide funding for the development and deployment of vaccination delivery and the associated medical waste management program, including the development of guidelines and protocols, information systems, distribution, training and additional cold chain equipment, as needed. Investments in vaccines will prevent new infections and produce economic benefits through saving lives, averting morbidity and avoiding the costs of treatment. Public Disclosure The measures taken to address environmental and social risks in the original project remain relevant, including infection prevention and control improvements in health facilities, such as assessment and mitigation measures for (i) medical waste risk management that will be expanded, as the inoculation sites themselves expand, in order to include waste resulting from vaccine delivery, such as sharps, and the disposal of used and expired vaccine vials; (ii) Occupational health and safety (OHS) issues related to the availability and supply of personal protective equipment (PPE) for healthcare workers and the logistical challenges in transporting PPE across the Côte d’Ivoire in a timely manner; (iii) community health and safety risks, given close social contact and limited sanitary and hygiene services (clean water, soap and disinfectants) and isolation capabilities at healthcare facilities across the country; and (iv) OHS risks related to the rehabilitation of existing facilities; (v) difficulties in access to health services and facilities by vulnerable social groups; (vi) lack of access to vaccine supplies, facilities and services; (vii) public anxiety and acceptance; (viii) social conflicts and risks to human safety; (ix) the risks of sexual exploitation and abuse/sexual harassment (SEA/SH); (x) SEA/SH risks among patients and health care providers; (xi) risks related to adverse events following immunizations (AEFIs). To manage these risks, the MSHP has prepared two major instruments for the project: 1. The ESMF of the parent project has been updated and will be redisclosed by the time the AF goes into effect. The updated ESMF will include guidelines on the vaccine’s safe transportation and storage, vaccine delivery and medical waste management, the allocation and prioritization of COVID-19 vaccination, and prioritizing population groups for vaccines and vaccine fair allocation. These updates will be based on WHO guidance, including: the Values Framework for the allocation and prioritization of COVID-19 vaccination; the Roadmap for Prioritizing Population Groups for Feb 27, 2021 Page 6 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) Vaccines against COVID-19; the Fair Allocation Framework; monitoring vaccine wastage at country level; guidelines for program managers; the management of waste from immunization campaign activities: Practical guidelines for planners and managers; Health-Care Waste Management in COVID-19COVID19 context; and : Best and Sustainable Practices. A Vaccine Delivery and Distribution Manual (VDDM) for effective vaccine delivery, vaccination implementation and medical waste management will be included as an Annex to the updated ESMF. Measures to ensure the vaccine’s quality is maintained throughout the supply chain, and in accordance with WHO guidance for storage and transportation of vaccines, will also be incorporated. Where necessary, existing measures and tools in the ESMF (such as ESMPs & ICWMPs) will be revised to ensure they fully cover additional risks associated with the AF-funded activities. 2. Stakeholder Engagement Plan (SEP) for effective outreach and citizen participation, prepared under the parent project, will be updated to cover both. and be disclosed before appraisal. Additional communication measures, financed by the proposed AF, will cover information on COVID-19 vaccines and help address potential risks of fair vaccine access and hesitancy. To achieve the above mentioned positive environmental and social impacts, the aforementioned areas of risks must be addressed and mitigated as discussed below: Medical Waste Management and Disposal. The ESMF adequately covers environmental and social infection control measures and procedures for safe handling, storage, and processing of COVID-19 materials, including the techniques for preventing, minimizing, and controlling environmental and social impacts during the operation of project- supported laboratories and medical facilities. It also clearly outlines the implementation arrangement put in place by the MSHP for environmental and social risk management; and compliance monitoring and reporting requirements, including those on medical waste management based on the existing ICWMP Template prepared as part of the ESMF. Public Disclosure Each targeted healthcare facility will continue to apply infection control and waste management planning following the requirements of the updated ESMF and relevant Environmental Health and Safety (EHS) Guidelines (EHSG), plus those laid out by the Good International Industry Practice (GIIP) and, WHO Worker Health and Safety. Workers in healthcare facilities are particularly vulnerable to contagions like COVID-19. Healthcare-associated infections due to inadequate adherence to OHS standards can lead to illness and death among health and civil workers, as well as the wider spreading of the disease within communities. Community Health and Safety. The SEP will continue to serve as a key instrument for outreach to the community at large on issues related to social distancing, higher risk demographics, self-quarantine and quarantine measures. It is critical that these messages be widely disseminated, repeated often and clearly understood. Vaccine Safety and Efficacy. To mitigate the potentially adverse health effects of administering unsafe vaccines, the funds can only be used for the procurement of thoroughly tested and approved vaccines. The project will develop a Monitoring and Evaluation (M&E) system to record the details of the recipients of vaccine, as well as vaccine adverse effects. Vaccine Safe Transportation and Storage. The vaccines are prone to rapid decay and ineffectiveness when not stored at the proper temperature, which could lead to high wastage. Wasted vaccines may be dangerous or, at the very minimum ineffective when administered. Storage and transportation are a challenge in global supply chains, particularly in places that lack the enough quantity and quality of storage and the appropriate transport infrastructure. The MSPH has assessed the country’s readiness for deployment of the COVID-19 vaccine and is developing the Vaccine Deployment Plan, which is expected to be completed before starting the vaccine operations. The AF will fund necessary investment in storage equipment and logistics to enable the safe delivery of vaccines throughout the country. Feb 27, 2021 Page 7 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) Vaccine Equitable Distribution and Access. Risks of elite capture or the inability to distribute the vaccine safely to more remote areas could lead to the exclusion of people vulnerable to vaccination. The AF will support the implementation of the national COVID-19 vaccine deployment plan, which has already been developed following the WHO Framework for Allocation and prioritization of COVID-19 vaccination that ensures that multiple disadvantaged or vulnerable groups are prioritized in the plan and will benefit under the vaccination campaign and the project. These include the elderly and those with immune systems compromised by pre-existing conditions. Moreover, the project will be implemented nationwide using both fixed and outreach service delivery approaches to ensure equitable access to the most vulnerable, including those residing in remote areas. The updated SEP and ESMF will address the relevant project risks and impacts, including the: (i) risk that project-related impacts fall disproportionately on individuals or groups who, because of their particular circumstances, may be disadvantaged or vulnerable; and (ii) a risk of prejudice or discrimination toward individuals or groups in providing access to development resources and project benefits, particularly in the case of those who may be disadvantaged or vulnerable. Examples of target priority groups include frontline health and care workers at high risk of infection, older adults, patients with comorbidities, pregnant women and other priority groups with increased risk of COVID-19- related mortality. The national plan also includes the national dissemination of social mobilization, community engagement and communication activities under Component 2 to foster a positive and consistent dialogue with communities, including those who are traditionally neglected, as well as to disseminate information and key messages in local languages and through community platforms and networks to build trust and promote community ownership of the vaccine process and prevent and combat stigma and discrimination. The AF will support the development of operational plans through a consultative process in each district and support the Ivorian Government to put in place Public Disclosure an institutional framework to ensure the safe and effective deployment of the vaccine, which will include mechanisms to ensure voluntary vaccination practices including the development of guidelines and training of vaccinators in pre-vaccination counselling and other elements required to ensure informed consent. The framework will be complemented by community engagement activities under subcomponent 2.2 that aim to ensure the population has a clear understanding of the risks and benefits of the vaccination campaign and feels motivated to make a voluntary, informed decision to protect itself, their families and communities. However, the AF-funded procurement, distribution and administration of vaccines can equally lead to occupational and community health and safety risks, as well as risks associated with vaccine allocation coverage. ESS10 Stakeholder Engagement and Information Disclosure This standard is relevant. The Borrower prepared a Stakeholder Engagement Plan (SEP) for the parent project consistent with ESS10 requirements in order to ensure a participatory and inclusive approach during the project’s life cycle. The project will establish a coordinated approach to reach out to stakeholders with key partners, including WHO/United Nations Childrens’ Fund (UNICEF). The participation of local populations is essential to the success of the AF in order to ensure harmonious collaboration between project personnel and local communities and minimize and mitigate environmental and social risks associated with the proposed AF activities. The SEP has been updated and will be disclosed before appraisal. Some consultations/meetings have been undertaken with UNICEF, WHO and two civil society groups, and with new stakeholders (Unite de coordination des Programmes Elargis de Vaccination UC-PEV, Direction des Laboratoires). During implementation, the PIU will further identify other stakeholders and maintain a constructive relationship with them to inform the rationale for vaccinating selected target populations and the process for vaccine deployment. Effective communication and outreach will be imperative to build trust and Feb 27, 2021 Page 8 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) reduce stigma around any COVID-19 vaccine for a larger target population and increase awareness and “vaccine literacy” and the vaccine rollout strategy. The SEP primarily focuses on the development of a structured communications plan, including public information disclosure and consultation throughout the entire project cycle to ensure consistent messaging around key issues, (prevention, mitigation, social distancing, awareness raising, how to access the services available and equitable and inclusive vaccines access and allocation), considering the specific challenges associated with COVID-19 vaccine. The GRM will be updated to receive any concerns or grievances raised in relation to the implementation of Additional Financing activities. Stakeholder mapping has allowed the project to better organize information and communication strategies depending on the level of interest and the capacity of influence of each actor. The SEP has thus identified in more detail the roles and responsibilities of religious leaders, traditional chiefs, local elected officials and NGOs, including the organization of traditional healers as important stakeholders with specific roles to play in project implementation and the implementation of the SEP. Existing community platforms will be able to integrate the activities of local Covid Vaccine Committees (CCVC). These committees will be based on voluntary work and citizen engagement to ensure a high level of adherence to the vaccination plan and serve as community relays to disseminate the right information and facilitate behavior change messaging, community mobilization, and undertake additional laboratory and vaccine logistic functions, and also carry out beneficiary feedback. The SEP provides guidance regarding how to: effectively engage citizens; develop culturally appropriate adaptations regarding behavior change; seek stakeholder inputs regarding project activities; and communicate effectively to people about the project Public Disclosure B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions Like the parent project, the AF will be implemented in accordance with the applicable requirements of ESS2 in a manner acceptable to the Bank, including through, inter alia, implementing adequate occupational health and safety measures (including emergency preparedness and response measures), setting out grievance arrangements for project workers, and incorporating labor requirements into the OHS specifications of the procurement documents and contracts with contractors and supervising firms. The Project Operational Manual (POM) for the original project includes the labor management provisions, which will be followed by the AF. The POM will be updated as necessary during implementation when issues are identified by either the MSPH, the project or the Bank that require such a change. Healthcare workers play a critical role in outbreak response and are the backbone of a country's defenses to limit or contain the spread of disease. They face higher risks of potential COVID-19 infection in their efforts to protect the greater community and are exposed to other health hazards, such as psychological distress, fatigue and stigma. They will be prioritized for early vaccination. Worker safety: Healthcare associated infections, due to inadequate adherence to OHS standards, can lead to illness and death among health and laboratory workers. The laboratories to be supported by the project will process COVID- 19 and will therefore have the potential to cause serious illness, or potentially lethal harm, to the laboratory staff and Feb 27, 2021 Page 9 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) to the community, so effective administrative and containment controls will be put in place to minimize these risks. Environmentally and socially sound health facilities’ management will require adequate provisions for the minimization of occupational health and safety risks including the proper management of hazardous waste and sharps, use of appropriate disinfectants, proper quarantine procedures for COVID-19, appropriate chemical and infectious substance handling, and transportation procedures. These measures are covered in the ICWMP Template contained in the ESMF and are based on the national healthcare delivery standards and norms set out by the MSHP, in addition to WHO guidance. Under the ongoing project, the MSPH has been implementing the mitigation measures defined in the ESMF, which includes specific instruments on OHS, prepared either by the client and/or the contractor prior to the commencement of works (such as OHS checklists, codes of conduct, and safety training ). The project team will ensure that the civil works’ contracts incorporate social and environmental mitigation measures based on the Bank’s EHS Guidelines and the updated ESMF and the SEP. All contracts, including civil works and vaccine transportation contracts, will comprise industry-standard codes of conduct that incorporate measures to prevent Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH). A locally based Grievance Mechanism (GM) designed specifically for direct and contracted workers has been in place in each facility/site, and the GM data is collected and analyzed by PIU staff on regular basis. ESS3 Resource Efficiency and Pollution Prevention and Management Public Disclosure Waste management in general is a big challenge in most West African countries. Cote d’Ivoire is not an exception. This is due to limited authorized disposal sites; contaminated medical waste is a special concern. Medical waste (including water, reagents, infected materials, sharps and so on) from healthcare facilities and vaccination centers can have a significant impact on the environment and human health. Waste that may be generated from medical facilities/labs could include liquid contaminated waste, chemicals and other hazardous materials, and other waste used in diagnosis and treatment, as well as waste from the vaccination campaign (needles, syringes, glass shards from ampoules or vials). Each target healthcare facility—following the requirements of the ESMF to be updated for the AF Projects, WHO COVID-19 guidance documents and other best international practices—will finalize and follow an Infection Control and Medical Waste Management Plan (ICMWP) to prevent or minimize such adverse impacts. A health care waste management plan has been developed as part of the parent project's ICWMP to ensure that the waste management practices at the various hospitals receiving assistance from the project comply with WHO guidance and international best practice for infectious and hazardous waste management. The ICWMP will be updated to include: (i) the emerging waste types, including sharps and used and expired vaccine vials; (ii) and measures to mitigate them. The ICWMP template contains detailed procedures, based on WHO guidance, with protocols necessary for handling medical waste and environmental health and safety guidelines for staff and laborers, including the necessary PPE and working conditions. ESS4 Community Health and Safety Feb 27, 2021 Page 10 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) As noted above, medical waste and general waste from the healthcare facilities has a high potential of carrying micro- organisms that can infect the community at large if they are not properly disposed of. There is a possibility for the infectious microorganism to be introduced into the environment if not well contained within the health facility or due to accidents/emergencies, for example a fire or natural event. The site-specific ICWMPs will be updated to describe: 1. On-site waste management related to AF activities, and any specific improvements necessary,; 2. how project activities will be carried out in a safe manner with (low) incidence of accidents and incidents in line with GIIP (WHO guidelines); 3. measures in place to prevent or minimize the spread of infectious diseases; and 4. emergency preparedness measures; 5. and the monitoring of adverse impacts and side effects of vaccines on recipients of the vaccinations. The AF will invest in safe vaccine transportation and logistics and ancillary supplies (syringes, safety boxes, PPE) for the initial batch of the vaccine covering 4 percent of the population of Côte d’Ivoire, and strengthening of vaccine delivery systems and management capacity. Procurement and delivery of the vaccine will be provided by UNICEF’s Supply Division. UNICEF or its subdivisions will not be engaged in distribution within Côte d’Ivoire; the MSPH will manage this process based on the National Deployment and Vaccination Plan. It is envisioned that the proposed Additional Financing will cover the cost of transportation and logistics under the agreement with UNICEF’s Supply Division, which will delivery only to the country via airways and in some cases by ground transport. The potential SEA/SH risks associated with international Public Disclosure transportation company workers are limited as all the contractors have to accept and comply with the UN Supplier Code of Conduct, which includes the prohibition of SEA/SH. The transportation of vaccines to remote areas will be managed in-house by the MSPH, which owns the appropriate trucks. Only internal MSPH’s truck drivers with signed labor agreements and code of conducts will be engaged in the transportation of vaccines to remote areas. Further vaccines will be distributed by district and transport arrangements made by the MSPH. Thus, the SEA/SH risks are very low. To date, there are no plans to use security personnel in any part of the vaccination program. While the use of security forces is not anticipated, in the event that they do need to be deployed, the MSHP/PIU will take relevant mitigation measures to ensure that the engagement of security personnel in the implementation of project activities for the provision of security to project workers, sites and/or assets, be consistent with ESS4 and associated Bank guidance. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement This standard is not relevant. The project will not require any land acquisition leading to physical or economic displacement. All rehabilitation/renovation and construction will take place within existing health facilities, including laboratories and warehouses within health centers and hospitals. Feb 27, 2021 Page 11 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources This standard is not relevant. No adverse impacts on natural resources or biodiversity are anticipated as a result of project activities. No adverse impacts on natural resources or biodiversity are anticipated as a result of project activities. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities This standard is not relevant. There are no Indigenous Peoples/Sub-Saharan African Historically Undeserved Traditional Local Communities in Côte d’Ivoire. ESS8 Cultural Heritage This standard is not currently relevant. It is not anticipated that the project will impact cultural heritage, and any physical works planned in the context of the project will be limited to rehabilitation or the upgrading of existing facilities and some new constructions in existing sites. ESS9 Financial Intermediaries This standard is not relevant. Public Disclosure B.3 Other Relevant Project Risks N/A C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No OP 7.60 Projects in Disputed Areas No B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Is this project being prepared for use of Borrower Framework? In Part Areas where “Use of Borrower Framework” is being considered: ESS1, ESS2, (local regulations and laws), ESS3 (waste Management PLan) IV. CONTACT POINTS Feb 27, 2021 Page 12 of 13 The World Bank Côte d’Ivoire COVID-19 Strategic Preparedness and Response Project Additional Financing on Vaccines (P176257) World Bank Contact: Opope Oyaka Tshivuila Matala Title: Senior Health Specialist Telephone No: 5331+3483 Email: otshivuilamatala@worldbank.org Borrower/Client/Recipient Borrower: Government of Côte d'Ivoire Implementing Agency(ies) Implementing Agency: Ministere de la Sante et de l'Hygiene Publique (MSHP) V. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Public Disclosure Task Team Leader(s): Opope Oyaka Tshivuila Matala Practice Manager (ENR/Social) Maria Sarraf Cleared on 24-Feb-2021 at 07:59:14 GMT-05:00 Feb 27, 2021 Page 13 of 13