The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 10/27/2020 | Report No: ESRSAFA050 Oct 28, 2020 Page 1 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Gambia, The AFRICA WEST The Gambia Ministry of Health Project ID Project Name P175740 AF to The Gambia COVID-19 Preparedness and Response Project Parent Project ID (if any) Parent Project Name P173798 The Gambia COVID-19 Preparedness and Response Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 11/12/2020 11/13/2020 Population Financing Public Disclosure Proposed Development Objective To prevent, detect and respond to the threat posed by COVID-19 and strengthen national system for public health preparedness 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] The proposed project will support the implementation of The Gambia COVID-19 Plan endorsed by the Minister of Health (on March 6, 2020): Emergency COVID-19 Response; Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach; Oct 28, 2020 Page 2 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) Supporting National and Sub-national, Prevention and Preparedness; and Implementation Management and Monitoring and Evaluation 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 AF proposal is fully consistent with The Gambia COVID-19 Preparedness and Response Project (P173798) and does not require a change of the PDO or project components. The AF is expected to finance the following activities: (i) Procurement of additional laboratory equipment and supplies and (ii) Procurement of medical waste disposal and cargo trucks. The activities of this AF will be implemented throughout The Gambia and will contribute to improved COVID-19 prevention, detection and response through 4 components: Emergency Response; Strengthening national disease surveillance and diagnostic capacities; Support for National and Subnational, Prevention and Preparedness; and Project Implementation. The project has national coverage, with some specific existing facilities identified as treatment and isolation centers (Sanatorium treatment center, Soma treatment center, Essau isolation rooms, Brikama isolation center, and Basse isolation center) for the care of patients which will be renovated and equipped. Thus, the proposed project will not endanger natural habitats or cultural sites. Further, one of the components of the proposed project will improve healthcare waste management in the region where most of the confirmed cases will be treated (ie Sanatorium treatment center in the Western region). Additionally, biohazard bags and plastic pedal bins will be procured for all health facilities. Public Disclosure D. 2. Borrower’s Institutional Capacity The implementation of the project is ensured by the Project Coordination Unit (PCU) of the Ministry of Health (MoH). The project is the first in the Gambia to employ the new Environmental and Social Framework. The MOH has assigned focal points for environmental safeguards and social safeguards. Additionally, an Operations Officer manager was recruited at the PCU to assist the focal points in the management and monitoring of the risks and social and environmental impacts of the project. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The risks linked to the management of healthcare waste (especially handling highly infectious medical wastes associated with COVID-19) are substantial. The capacity of the MOH to manage the environmental and social risks ie bing enhanced through ongoing support and training during project implementation as well as dedicated MOH focal points for environmental and social safeguards and an Senior Operations Officer at the PCU who oversees environmental and social due diligence. Social Risk Rating Moderate Misinformation and rumors regarding COVID-19, and stigma for those who will be quarantined or admitted to isolation and treatment centers is a project risk. However, one of the components of the proposed project entails risk Oct 28, 2020 Page 3 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) communication, social mobilization and community engagement to raise public awareness and knowledge on prevention and control of COVID-19 among the general population and vulnerable groups. Beyond conflicts resulting from false rumors, vulnerable groups are at risk being excluded from vital services, and quarantine interventions could entail sexual exploitation and abuse; as well as culturally inappropriate accommodation and services. In The World Bank The Gambia COVID-19 Preparedness and Response Project (P173798) Mar 25, 2020 Page 4 of 9 For Official Use Only Public Disclosure addition, there might be some labor management and OHS risks in relation to the building/renovation of facilities. The project’s ESMF will outline how these risks will be managed, through both project design that focuses on communications and behavior change around the pandemic, and specific application of WHO protocols for managing quarantine and isolation facilities. 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 project will have positive impacts as it should improve COVID-19 surveillance, monitoring and containment. However, the project could also cause significant environment, health and safety risks due to the dangerous nature of the pathogen (COVID-19) and reagents and other materials to be used in the project-supported laboratories and quarantine facilities. Healthcare associated infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among health and laboratory workers. The laboratories and relevant health facilities which will be used for diagnostic testing and isolation of patients can generate biological waste, chemical Public Disclosure waste, and other hazardous bioproducts. To mitigate against the risk of project staff contracting the virus, the project has already developed an Environmental and Social Management Framework (ESMF) based on WHO protocols for managing risks associated with COVID-19. The ESMF has adequately covered environmental and social infections control measures and procedures for the 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. The relevant parts of WHO’s COVID-19 Quarantine Guideline and COVID-19 biosafety guidelines have been incorporated into the ESMF. These guidelines include provisions to address the needs of patients, including the most vulnerable. They also include provisions for the establishment of quarantine and isolation centers and their operation considering the dignity and needs of patients. The proposed AF project will also provide equipment/supplies for laboratory and cargo trucks for the management of medical waste. It should be noted that within the framework of the parent project, the following documents were developed and approved: • Environmental and Social Management Plan (ESMP) For Medical Equipment and Supplies (P173798 • Environmental and Social Management Framework (ESMF) The Gambia COVID-19 Preparedness and Response Project (P173798) • Stakeholder Engagement Plan (SEP) - The Gambia COVID-19 Preparedness and Response Project - P173798 • Environmental and Social Commitment Plan (ESCP) - The Gambia COVID-19 Preparedness and Response Project - P173798 These instruments do not need to be updated for the proposed additional financing since no new activities are proposed. Oct 28, 2020 Page 4 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) The PCU has submitted for the Bank's review the environment and social due diligence report for the period April to September 2020. ESS10 Stakeholder Engagement and Information Disclosure Stakeholder engagement is a critical tool for social and environmental risk management, project sustainability and success. The proposed project will support a communication, mobilization, and community engagement campaign to raise public awareness and knowledge on prevention and control of COVID-19 among the general population and contribute to strengthening the capacities of community structures in promoting coronavirus prevention messages. The Project’s draft Stakeholder Engagment Plan (SEP) has been updated in the early part of implementation, following a set of consultations in the districts. A project-wide grievance redress mechanism (GRM), proportionate to the potential risks and impacts of the project has been established in the final SEP, and is operational. 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 Project activities will be performed by mostly healthcare and laboratory personnel and firms that will be recruited for Public Disclosure the renovation of isolation and treatment centers. During implementation the client will includeLabor Management Procedures (LMPs) in contracts that will set out the way in which project workers will be managed in accordance with the requirements of national law and the ESS2. Key issues to be addressed in the LMPs for the construction companies include terms and conditions of employment, nondiscrimination and equal opportunity, and establishing/managing worker’s organizations. Due diligence is also needed to ensure the client meets requirements on child labor, forced labor and occupational health and safety. The LMP will include measures to ensure that labor is provided on a voluntary basis and will further ensure that the health and safety of workers, especially women, are given adequate attention. It will also have the details of the grievance redress mechanism for workers and the roles and responsibilities for monitoring such workers. For healthcare and laboratory personnel, a key issue to be addressed in the LMPs will be contamination with COVID-19. The project will ensure the application of occupational health and safety measures according to WHO guidelines. ESS3 Resource Efficiency and Pollution Prevention and Management Air emissions: During the rehabilitation of infrastructures, air emissions may include fugitive dust. Those most likely to be affected are people living within the proximity of these infrastructure sites but also the workers. The implementation of mitigation measures such as dust suppression and vehicle maintenance will be applied to minimize the impact of air emissions during construction, wearing suitable masks, and residual impacts are expected to be limited in scope and duration. Oct 28, 2020 Page 5 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) Waste management: Highly infectious medical waste is expected from the handling of COVID-19. The ESMF already approved takes into account a plan for health care waste management plan for health facilities. Waste from rehabilitation works will be covered by the site waste management plan, which will be developed by the contractors as part of their ESMPs. ESS4 Community Health and Safety Inappropriate handling of COVID-19 can expose the community to further spread of the disease. The ESMF describes the measures in place to prevent or minimize the spread of COVID-19 for laboratories, quarantine and isolation centers, and screening posts. It will cover procedures for waste management of contaminated materials, protocols on the transport of samples, and workers cleaning before leaving the work place back into their communities, among others. The quarantine and isolation centers will also ensure that communities, COVID-19 patients and their families are treated with respect and dignity, in reference to infrastructure, accommodation and supplies, and communication. The project has put in measures to avoid any form of Sexual Exploitation and Abuse/Harassment (SEA/H) by following the WHO Code of Ethics and Professional conduct for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructure such as segregated toilets and adequate light in quarantine and isolation centers. Also, special attention will be given to remote and border areas to avoid conflict between host communities and refugees/IDPs. Public Disclosure ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Almost all construction is expected to be undertaken within existing facilities; therefore, ESS5 is not considered relevant at this point. In case a need for land acquisition leading to economic or physical displacement emerges during project implementation, Resettlement Action Plans (RAPs) would be developed to the satisfaction of the Bank prior to commencement of any civil works/construction. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources This standard is currently not relevant as the project's small-scale construction activities are not expected to impact the integrity of biodiversity or living natural resources. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities This standard is not relevant as there are no Indigenous Peoples/Sub-Saharan Historically Underserved Traditional Local Communities in the project area of influence. ESS8 Cultural Heritage Oct 28, 2020 Page 6 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) This standard is not relevant at this time as the limited civil works are unlikely to affect cultural assets. Out of an abundance of caution, the ESMF will include measures for “Chance Finds” of archaeological or other cultural heritage. ESS9 Financial Intermediaries This standard is not relevant for the suggested project interventions. 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? No Public Disclosure Areas where “Use of Borrower Framework” is being considered: n/a IV. CONTACT POINTS World Bank Contact: Samuel Lantei Mills Title: Senior Health Specialist Telephone No: 5381+39100 / 1-202-473-9100 Email: smills@worldbank.org Borrower/Client/Recipient Borrower: The Gambia Implementing Agency(ies) Implementing Agency: Ministry of Health V. FOR MORE INFORMATION CONTACT Oct 28, 2020 Page 7 of 8 The World Bank AF to The Gambia COVID-19 Preparedness and Response Project (P175740) The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Samuel Lantei Mills Practice Manager (ENR/Social) Aly Zulficar Rahim Cleared on 27-Oct-2020 at 09:43:21 GMT-04:00 Public Disclosure Oct 28, 2020 Page 8 of 8