The World Bank Mongolia PEF support for COVID-19 (P174571) Concept Environmental and Social Review Summary Concept Stage (ESRS Concept Stage) Public Disclosure Date Prepared/Updated: 07/29/2020 | Report No: ESRSC01521 Jul 31, 2020 Page 1 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) BASIC INFORMATION A. Basic Project Data Country Region Project ID Parent Project ID (if any) Mongolia EAST ASIA AND PACIFIC P174571 Project Name Mongolia PEF support for COVID-19 Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 7/31/2020 Population Financing Borrower(s) Implementing Agency(ies) Mongolia Mongolia Ministry of Health Proposed Development Objective The proposed project development objective is to strengthen Mongolia’s capacity to prevent and to respond to the COVID-19 outbreak. Public Disclosure Financing (in USD Million) Amount Total Project Cost 1.00 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] The aim of this project is to strengthen Government of Mongolia’s to prevent and to respond to the COVID-19 outbreak. Assistance will be provided to the health care system for preparedness planning to provide optimal medical care, maintain essential lifesaving services, ensuring hospital infection control interventions and minimize risks for patients and health personnel. In doing this it will support the health system with supplies including Personal Protective Equipment like N95 respirators, medical masks, goggles, gloves, gowns; laboratory equipment and supplies for improved diagnostic capabilities etc. Through these measures the project will enhance preparedness and strengthen essential health care service delivery to be able to provide the best care possible in the event of a surge in demand. Jul 31, 2020 Page 2 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] This emergency operation is proposed as a new stand-alone project which will be implemented alongside the Mongolia COVID-19 Emergency Response and Health System Preparedness project (P173799) and will be implemented throughout Mongolia. In supporting the health system with supplies of personal protection equipment (PPE), laboratory equipment and medical supplies for case management and infection prevention, as well as procurement of drugs such as antivirals, antibiotics and essential medicines for patients with co-morbidity and complications such as CVDs and diabetes, the project activities will mirror a subset of those being undertaken under the $26.9 million for the Mongolia COVID-19 Emergency Response and Health System Preparedness Project approved in April 2020. The new project will support the availability of equipment and drugs through the Ministry of Health and selected tertiary hospitals. The primary beneficiaries include patients visiting hospitals, health care providers in Aimags, Districts and selected hospitals and Taxation and / Customs General Administration personnel who will receive protective equipment to ensure safe interactions with local communities. The decision to use the stand-alone Recipient Executed Trust Fund RETF was made by the Government of Mongolia. The Pandemic Emergency Financing Facility (PEF) had offered the GPM 3 modalities including directly through a WB operation (co-financing from a Trust Fund); through a new stand-alone Trust-Fund operation; by nominating a PEF- accredited Responding Agency to receive the funds. Considering the relative smaller volume of funding, the clear definition of its use and the limitations set with a short implementation time frame, GOM decided to sue the RETF option. Further, an Additional Financing would have also required special waiver from the RVP given that there is than 12 months of implementation of the parent project and eventually RVP level clearance. The final decision was Public Disclosure made by the China/Mongolia Country Management Unit. The first ISR for the Emergency Response Project has just been completed. The ESMF is under preparation and is expected to be completed by end of September 2020. Similarly, recruitment of E&S specialists in the PIU is in progress and these people are expected to be onboard by end of September 2020. Although the goods to be procured under the PEF can be purchased, the client will commit (via the ESCP) to not dispensing/using the goods until the ESMF and requisite staff are in place. D. 2. Borrower’s Institutional Capacity The Project Implementation Unit (PIU) for the Mongolia COVID-19 Emergency Response and Health System Preparedness Project (Emergency Response Project) approved in April 2020 will provide all support required for implementation of this project. The existing Project Implementation Unit will include a bio-medical engineer, environment and occupational health specialist, risk communication and community engagement officer, and procurement officer with good English language skills who are expected to be engaged/appointed by end of September 2020. This strengthened and amalgamated PIU will liaise with the World Bank on day to day activities. Since these operations have been prepared under emergency procedures during a period of extreme constraint on in- country support the successful resourcing and implementation of the proposed ES instruments is still to be demonstrated. However, the institutional capacity is considered to be more than adequate to manage the level of E&S risks associated with the RETF activities. II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS Jul 31, 2020 Page 3 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial This emergency operation has been prepared as a new stand-alone project which will be implemented alongside the Mongolia COVID-19 Emergency Response and Health System Preparedness project (P173799), which has an ESRC of Substantial. The environmental risks relate primarily to waste management and occupational health and safety. Specifically, the risks would include (i) purchasing sub-standard PPE; (ii) inadequate training on the use of the PPE leading to it not providing the intended level of protection; (iii) effective management of used PPE in a manner which ensures pathogens and diseases are not transferred between people and/or places and that it is disposed of in a manner meeting GIIP for medical waste. The Mongolia COVID-19 Emergency Response and Health System Preparedness project (P173799) (Emergency Response Project) presents these (and other) risks. The E&S instruments being prepared for the Emergency Response Project will manage and mitigate risks relevant to this RETF also. Accordingly, standalone E&S instruments for this RETF are not proposed; instead, the risks will be managed in an integrated manner with the Emergency Response Project. Although procurement of the supplies can proceed upon project effectiveness, the client commits via the ESCP to not dispensing/using the goods until these instruments and requisite staff are in place. While the grant funds will be used for the purchase and distribution of medicines and medical supplies, the entire implementation arrangement as well as the risk assessment and management are directly linked to P172799 which Public Disclosure has an ESRC of Substantial. At a practical level supplies will be provided to medical/health care facilities and the E&S risk management cannot be ring-fenced from the other COVID project. Accordingly, it is proposed that this project also have an Environmental risk categorization of Substantial. The RETF will be legally linked to the Emergency Response Project via the Environmental and Social Commitment Plan (ESCP) which forms part of the loan agreement. Social Risk Rating Substantial The social risks relate primarily to occupational and community health and safety in addition to ensuring inclusion of vulnerable people (including ethnic minorities) and those personnel who work with them as project beneficiaries. COVID-19 impacts tend to reinforce existing inequity in access to quality medical care and supplies. Vulnerable communities risk experiencing disproportionate impacts from the virus and typically have poorer access to services. By increasing the supply of protective equipment and medicines for hospitals and administrative officials in preparation for the event of an outbreak, the operation will benefit vulnerable groups such as the elderly, the urban poor, ethnic minorities and others at increased risk of infection and hospitalization who may otherwise experience barriers to prevention and treatment. As outlined under "Environment Risk Rating" above: 1. The RETF will be legally linked to the Mongolia COVID-19 Emergency Response and Health System Preparedness project (P173799) (Emergency Response Project) via the Environmental and Social Commitment Plan (ESCP) which Jul 31, 2020 Page 4 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) forms part of the loan agreement, and E&S instruments being prepared for the Emergency Response Project will manage and mitigate risks relevant to this RETF; 2. the implementation arrangement as well as the risk assessment and management are directly linked to P172799 which has an ESRC of Substantial. Accordingly, it is proposed that this project also have a social risk categorization of Substantial. 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: ESS 1 is relevant. The project will have positive environmental and social impacts as it should improve supply of quality protective equipment as well as medication to address the COVID-19 emergency. Multiple disadvantaged or other vulnerable groups stand to benefit, starting with the elderly and those with compromised immune systems due to pre-existing conditions. The community engagement activities proposed under component 1.1 of the MONGOLIA COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEM PREPAREDNESS PROJECT (P173799) (Emergency Response Project), which will be implemented in parallel with this project, will seek to ensure inclusion of these groups. This is addressed under ESS 10 below and the ESCP. Public Disclosure Environmentally and socially sound health facilities management will require adequate provisions for minimization of occupational health and safety risks, proper management of hazardous waste and sharps, use of appropriate disinfectants, proper quarantine procedure for COVID-19, appropriate chemical and infectious substance handling and transportation procedures, etc. A Project ESMF for the Emergency Response Project (P173799) has been drafted and is expected to be completed by the end of September 2020 (based largely on adopting WHO guidance, World Bank EHS Guidelines and other GIIP). This will provide for the application of international best practices in COVID-19 diagnostic testing and handling the medical supplies, disposing of the generated waste, and treating confirmed cases. The ESMF under preparation includes both environmental and social assessments to ensure all project E&S risks and opportunities are adequately managed/optimized. The RETF project is being prepared under the emergency provisions of Paragraph 12 of the World Bank’s IPF policy, and deferral of E&S instrument preparation is proposed so that these can be prepared during project implementation. The E&S risks associated with this RETF project will all be addressed through the ESMF for the Emergency Response Project and this will be documented in the Environmental and Social Commitment Plan (ESCP) and therefore in the loan agreement. The E&S risks associated with this RETF project will all be addressed through the ESMF for the EMERGENCY RESPONSE AND HEALTH SYSTEM PREPAREDNESS PROJECT and this will be documented in the Environmental and Social Commitment Plan (ESCP) and therefore in the loan agreement. Jul 31, 2020 Page 5 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) Whereas procurement of the supplies can proceed upon project effectiveness, the client commits via the ESCP to not dispensing/using the goods until these instruments and requisite staff are in place. Areas where “Use of Borrower Framework” is being considered: Use of borrower framework is not proposed. ESS10 Stakeholder Engagement and Information Disclosure Component 1.1 of the Emergency Response Project is the Risk Communication and Community Engagement activity, which will be undertaken in accordance with WHO Guidance. The WHO guidance is a tool designed to support risk communication, community engagement staff and responders working with national health authorities, and other partners to develop, implement and monitor an effective action plan for communicating effectively with the public, engaging with communities, local partners and other stakeholders to help prepare and protect individuals, families and the public’s health during early response to COVID-19. This RETF funded project will be integrated into this outreach and communication campaign and likely affected and interested stakeholders are the same for this new operation. Engagement will be required with vulnerable groups and those personel who work with them who are at greater risk of infection and hospitalization and who are typically less able to access medical services and supplies (these may be poor communities in urban areas of Aimags, ethnic minorities and remote indigenous herders). The Stakeholder Engagement Plan (SEP) prepared for the Emergency Response Project covers activities under the RETF. The SEP was prepared by the client and cleared by the Bank in March 2020. The SEP has subsequently been Public Disclosure updated by the client to include measures to address the activities under the RETF and is currently under review by the Bank Task Team. It is not considered that a separate SEP is needed for this RETF funded project because all of the activities proposed are also being carried out as part of the Emergency Response Project. The existing E-health project unit will run day- to-day management of an existing Grievance Redress Mechanism for receipt of environmental and social concerns about the RETF as well as for the existing emergency operation. 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 The procurement of international standard personal protective equipment under this project aims to reduce occupational health and safety risks in medical facilities. Primary caregivers and other hospital staff, Taxation and / Customs General Administration personnel who will receive protective equipment to ensure safe interactions with local communities, are considered beneficiaries of the project activities (in receipt of protective equipment and medical supplies). Risks associated with transport, storage and distribution of personal protective equipment and medical supplies are minor, site specific and relatively easily managed. Risk of improper/ineffective use of PPE is to be addressed through training. Jul 31, 2020 Page 6 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) An ESMF and a Labor Management Procedure is being prepared under the Emergency Response Project. It is proposed that the Labor and Working Conditions risks associated with this RETF project (including training for personal protective equipment) be addressed via the ESMF and LMP for Emergency Response Project and this will be documented in the Environmental and Social Commitment Plan (ESCP) and therefore in the loan agreement. .. ESS3 Resource Efficiency and Pollution Prevention and Management Medical and chemical wastes (including water, reagents, infected materials, etc.) from the labs, quarantine, and screening posts to be supported through provision of drugs, supplies and PPE can have significant impact on environment and human health. Wastes that may be generated from medical facilities/ labs could include liquid contaminated waste, chemicals and other hazardous materials, and other waste from labs and quarantine and isolation centers including sharps, used in diagnosis and treatment. A health care waste management plan (HCWMP) will be developed as part of the Emergency Response Project to ensure 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 Resource Efficiency and Pollution Prevention and Management risks associated with the current RETF project will all be addressed via the HCWMP and ESMF for the Emergency Response Project and this will be documented in Public Disclosure the Environmental and Social Commitment Plan (ESCP) and therefore in the loan agreement. ESS4 Community Health and Safety Protecting the safety of communities from infection with COVID-19 is a central part of the Emergency Response Project and the current RETF project.. Community exposure to health issues therefore is relevant and the project activities are designed to mitigate these risks, primarily by increasing supply of protective equipment and medicines for distribution to key medical centres to assist in swift prevention and treatment in event of an outbreak. Measures will be required to target distribution on a needs basis in the event of an outbreak to ensure that vulnerable communities and staff who work with them who are more at risk of infection are able to access relevant supplies. Exposure of health care workers and broader community members to the virus and other pathogens will be reduced with the proper use of high quality PPE and its safe disposal in a manner which meets GIIP for healthcare waste disposal. The Community Health and Safety risks associated with the project will all be addressed via the ESMF for the Emergency Response Project and this will be documented in the Environmental and Social Commitment Plan (ESCP) and therefore in the loan agreement. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement No land acquisition will be required. Jul 31, 2020 Page 7 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources No construction or other physical activities are proposed by this project. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS7 is considered relevant as the personal protective equipment and other supplies proposed to be purchased with RETF funds will be distributed/used in accordance with the procedures governing the Emergency Response Project and, accordingly, will consider the specifc needs of ethnic minority people. The project is nationwide and therefore supply of equipment and medicine may apply to areas where ethnic Kazakh reside in the western part of Mongolia and speak and read in Kazakh language. Similarly, it may apply to indigenous herder communities in some remote rural areas. Measures to ensure awareness, enhance participation, and minimize risk for these groups are included in the SEP and the ESMF for the emergency Response Project. ESS8 Cultural Heritage This standard is currently considered Not Relevant as the project is not expected to support any construction or rehabilitation activities that would involve the movement of earth or other activities that could have an impact on intangible cultural heritage. Public Disclosure ESS9 Financial Intermediaries No FI proposed. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No The Project will not affect international waterways OP 7.60 Projects in Disputed Areas No The project will not be in or near disputed areas. III. WORLD BANK ENVIRONMENTAL AND SOCIAL DUE DILIGENCE A. Is a common approach being considered? No Financing Partners Nil B. Proposed Measures, Actions and Timing (Borrower’s commitments) Actions to be completed prior to Bank Board Approval: Jul 31, 2020 Page 8 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) Confirmation via ESCP that the E&S instruments for the Emergency Covid Response Project will apply in full to this project and that the matters identified in the ESCP are committed to. Possible issues to be addressed in the Borrower Environmental and Social Commitment Plan (ESCP): The main commitment is that the E&S instruments for the Emergency Covid Response Project will apply in full to this project (the ESMF is under preparation and is expected to be completed by end of September 2020) and that the client commits (via the ESCP) to not dispensing/using the goods until the ESMF and requisite staff are in place. Other commitments effectively mirror those of commitments made for the Emergency Covid Response project. C. Timing Tentative target date for preparing the Appraisal Stage ESRS 23-Jul-2020 IV. CONTACT POINTS World Bank Contact: Dinesh M. Nair Title: Senior Health Specialist Telephone No: 5788+7786 / 86-10-58617786 Email: dnair@worldbank.org Contact: Anna L Wielogorska Title: Lead Procurement Specialist Public Disclosure Telephone No: 5777+7320 / 84-243-9367320 Email: awielogorska@worldbank.org Contact: Pagma Genden Title: Operations Officer Telephone No: 5725+8243 / 976-70-078243 Email: pgenden@worldbank.org Borrower/Client/Recipient Borrower: Mongolia Implementing Agency(ies) Implementing Agency: Mongolia Ministry of Health V. FOR MORE INFORMATION CONTACT Jul 31, 2020 Page 9 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects Public Disclosure Jul 31, 2020 Page 10 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) VI. APPROVAL Public Disclosure Jul 31, 2020 Page 11 of 12 The World Bank Mongolia PEF support for COVID-19 (P174571) Task Team Leader(s): Anna L Wielogorska, Dinesh M. Nair, Pagma Genden Practice Manager (ENR/Social) Susan S. Shen Recommended on 29-Jul-2020 at 23:23:43 EDT Public Disclosure Jul 31, 2020 Page 12 of 12