The World Bank Gabon COVID-19 Additional Financing (P176464) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 08/31/2021 | Report No: ESRSAFA237 Aug 31, 2021 Page 1 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Gabon AFRICA WEST Republic of Gabon Commission nationale des travaux d'intérêt public pour la promotion de l'entrepreneuriat et de l'emp Project ID Project Name P176464 Gabon COVID-19 Additional Financing Parent Project ID (if any) Parent Project Name P173927 GABON COVID-19 Strategic Preparedness and Response Project (SPRP) Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Public Disclosure Health, Nutrition & Investment Project 8/26/2021 9/13/2021 Population Financing Proposed Development Objective The Project Development Objective (PDO) is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Gabon. 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? No Aug 31, 2021 Page 2 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] The Project is organized in three components responding directly to the response Plan: 1) component 1- Emergency COVID-19 Response focuses on case detection, confirmation, contact Tracing, recording, reporting as well as health system strengthening. It also will support Gabon’s response by financing the procurement of medical ambulances with the necessary equipment to provide safe care for COVID19 patients; 2) Supporting National and Sub-national, Prevention and Preparedness, finances the required laboratory equipment to set up three new COVID19 diagnostic facilities in Gabon and strengthening the currently existing two. It also allows to procure for COVID19 diagnostic tests, reagents and other related commodities to ensure adequate laboratory case confirmation for COVID19 throughout the five designated laboratories in the country; 3) Project Implementation and Monitoring. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] Located along the Atlantic coast in Central Africa, the Gabonese Republic is bordered by the Republic of Congo, Cameroon and Equatorial Guinea. The country is relatively small with a total area of 270,000 k2 and an estimated population of 2.1 million. At 8 inhabitants per km2, the country is one of the least dense in the world. In general, the majority of the population is urban (86%) and resources are concentrated in urban areas and wealthier regions, but the inequalities observed in Gabon go beyond the constraints of geography and demographics. The distribution of health resources reflect existing hospital locations rather than the health needs and this will also be the case for the COVID project sub-components; they will cover both urban as well as remote areas in existing health facilities. There Public Disclosure are no civil works envisioned and all activities will take place in existing health facilities. An ESMF was prepared, and it includes recommendations of the environmental and social audit of the parent project. As part of this AF, the following additional instruments were prepared: the LMP, the SEP, and the Infection Control and Waste Management Plan (ICMWP). The Project is not expected to impact natural habitats or cultural sites. D. 2. Borrower’s Institutional Capacity In close coordination with the National COVID-19 Response Steering Committee, the National Commission of Work of Public Interest for the Promotion of Entrepreneurship and Employment (Commission Nationale des Travaux d’Interet Public pour la Promotion de l’Entrepreneuriat et de l’Emploi or CNTIPPEE in French) will be the PIU for this Project. As the main implementing agency for other World Bank financed projects in Gabon, the CNTIPPEE will be responsible for procurement, financial management, monitoring and evaluation, and Environmental and Social (E&S) risk management. They have demonstrated their capacity to screen, implement, monitor and report on environmental and social commitments. While CNTIPPEE has two qualified E&S specialists who successfully completed the Borrower training on the World Bank’s Environmental and Social Framework (ESF) in 2018, they have limited health or medical waste management experience and are already supporting four other projects. In addition to these specialists, an additional environment specialist and one more social specialist will be hired. Other capacity building and training needs for CNTIPPEE will be identified and reflected in the ESCP currently being updated as part of the AF. Capacity building interventions will also target hazardous waste management firms, owners of isolation sites to be identified and contracted for quarantine interventions, GBV / SEA / SH in the context of vaccination, taken in consideration of vulnerable/disadvantage people in project activities, etc. Given the need for a comprehensive stakeholder Aug 31, 2021 Page 3 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) engagement and communications strategy, specialists in the field of public health awareness and communication will need to be assigned from other projects to provide guidance for the implementation of the community engagement and Stakeholder Engagement Plan (SEP) activities. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial Although the main long-term impacts are likely to be positive, there are several short-term risks that need to be considered. The key environmental risks and impacts include: (i) environmental and community health related risks from inadequate storage, transportation and disposal of infected medical waste; (ii) occupational health and safety (OHS) issues related to the availability and supply of personal protective equipment (PPE) for surveillance teams, Rapid Response Team, laboratory personnel and healthcare workers; (iii) community health and safety risks given close social contact; and (iv) occupational risks from inadequate transfer of cases from the various country's entry points (land, rail and airport) and from the communities. Social Risk Rating Substantial The proposed AF is anticipated to have positive social impacts both at the individual and community levels as it addresses the health sector responses to the COVID-19 emergency. The social risk rating is Substantial. Key social Public Disclosure risks and impacts are related to: : i) difficulties in accessing health facilities and services for the overall population; ii) marginalized and vulnerable social groups being unable to access vaccines, facilities, and services designed to combat the disease; iii) complaints related to vaccine administration process, and security risks resulting from diagnostics testing, limited availability of vaccines and social tensions related to the difficulties of a pandemic situation; iv) SEA/SH risks among patients and health care providers, especially in relation to distribution of vaccines; v); inappropriate data protection measures and insufficient / ineffective stakeholder communication on the vaccine roll-out strategy; iv) social conflicts resulting from false rumors on the vaccine and misinformation; (vi) discrimination toward individuals or groups in providing access to project activities, particularly in the case of those who may be disadvantaged or vulnerable The SEA/SH is rated substantial at this stage. The client will develop and implement a risk assessment and management measures and actions for gender-based violence, sexual exploitation and abuse, including for the 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, including risks related to SEA and SH. These measures and actions will be maintained throughout Project implementation. 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: Aug 31, 2021 Page 4 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) This operation is being processed as an emergency response using condensed procedures under the Fast Track COVID-19 Facility. The Project will have overall positive environmental and social impacts and will contribute to prevent, detect and respond to the threat posed by COVID-19 as well as strengthen national systems for public health preparedness. Nonetheless there are wide-ranging environmental and social risks and impacts that will need to be assessed and managed through a risk-based approach. The primary risks identified include: (i) environmental and community health related risks from inadequate storage, transportation and disposal of infected medical waste; (ii) OHS issues related to the availability and supply of PPE for surveillance teams, rapid response teams, laboratory personnel and healthcare workers; (iii) community health and safety risks given close social contact; (iv) marginalized and vulnerable social groups (including poor, disabled, elderly, isolated communities) being unable to access facilities and services; (v) social conflicts resulting from false rumors and misinformation; (vi) issues resulting from people being kept in quarantine, including stigma faced by those admitted to treatment or isolation facilities; and (vii) risks of Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) to project workers and beneficiaries. With the AF for vaccination, the new risks are: (v) risk that project-related impacts fall disproportionately on individuals or groups who, because of their particular circumstances, may be disadvantaged or vulnerable; and (vi) the 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. 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 overall Project activities will seek to ensure inclusion of these groups. The identification of target groups (phase 1) that will receive vaccination based on the WHO recommendations has been achieved. COVID-19 vaccine social Public Disclosure mobilization, risk and crisis communication strategy and routine surveys to track knowledge and attitudes has been initiated. To mitigate these risks, the PIU will hire one more environment specialist and one more social specialist to implement the Environmental and Social Management Framework (ESMF) and other ESHS instruments. The updated ESMF includes: (i) provisions for storing, transporting, and disposing of contaminated medical waste and outline guidance in line with international good practice and WHO standards on COVID-19 response on limiting viral contagion in healthcare facilities; and (ii) measures for an Infection Control and Medical Waste Management Plan (ICWMP) for implementation by facilities supported under the project, including primary health care facilities, hospitals, and laboratories. The relevant sections of the WHO COVID-19 quarantine guidelines, COVID-19 biosafety guidelines and OHS protocols are incorporated in the ESMF so that all relevant occupational and community health and safety risks and mitigation measures will be covered. The relevant part of COVID-19 Quarantine Guideline and WHO COVID-19 biosafety guidelines are included in an ICWMP annexed in the ESMF. The E&S audit indicated a certain number of measures to be implemented within the framework of the parent project and AF. Some of these measures are listed below: o Complete updating/developing all environmental and social instruments of the SPRP (ESMF, SEP, LMP, o ICMWMP...) and improve their ownership and deployment to all stakeholders (parent project remedial measures); o Regularly supply health center with the appropriate PPE and biomedical waste management consumables in sufficient quantities (parent project remedial measures); o Put in place at the entrance of each medical center concerned by the SPRP, all the health security system related to COVID-19 and systematic disinfection of hands and temperature measurement parent project remedial measures); o Develop and validate the regulatory framework for the management of Medical Waste in Gabon; Aug 31, 2021 Page 5 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) o Organize information campaigns on COVID-19 specific to Indigenous Peoples (IP) (parent project remedial measures); o Popularize the SPRP GRM to ensure its ownership by project stakeholders and its deployment in the project Intervention areas (parent project remedial measures); o Formalize the biomedical waste management procedure specific to the SPRP and ensure its ownership and deployment to project stakeholders (parent project remedial measures). o Ensure that the receipt vouchers for SPRP acquisitions sent to the CN-TIPPEE by the WHO are correctly filled in in term of date and stamp of receipt (parent project remedial measures); o Systematically validate the SPRP training programs by the Ministry in charge of Health (parent project remedial measures); o Bring up to standards the fire-fighting system (smoke detectors, fire alarms, fire blankets and fire extinguisher monitoring, etc.) of the OPN's warehouses (parent project remedial measures); o Formalize a maintenance schedule for each SPRP medical analysis equipment supplied to medical facilities (parent project remedial measures). To mitigate impacts related to OHS, the Ministry of Health -CNTIPPEE will work with relevant partners to identify and leverage all existing supply chain options and open new ones where possible to ensure that PPE and other relevant equipment, kits and material can be procured and dispatched nationwide in a timely manner, subject to the existing health PPE constraints in the global supply chain. Vaccine hesitancy risk can be also mitigated through the following measures: The Government has developed explicit, Public Disclosure contextually appropriate, and well communicated criteria for access to vaccines. There is consensus to first target health workers, other essential workers, and the most vulnerable populations, which will include a mix of the elderly and people with co-morbidities. Second, the Government will actively use the National COVID Risk Communication and Community Engagement Strategy to address misinformation and distrust as a main barrier to vaccination. The mitigation measures are largely based on the WHO technical guidelines on COVID-19 response, the EHS guidelines of the WB Group, with the responsibilities within the Ministry of Health, the required trainings, implementation schedule and budget. In addition, following the first results of the E&S audit of the current parent project, an Infection Control and Waste Management Plan (ICWMP) to safeguard health care workers, patients and the larger community from transmission and infection by the COVID-19 virus as the result of their daily routines that include testing, quarantining, and treating patients and managing the safe disposal of the resulting medical waste was prepared as part of the AF activities. The Environmental and Social Commitment Plan (ESCP) includes commitments and timelines to undertake the required assessments and prepare the necessary instruments as required. Mitigation measures for site-specific impacts will be managed through the implementation of required environmental and social instruments to be prepared as per the ESMF. Relevant capacity building measures are included in the ESCP. ESS10 Stakeholder Engagement and Information Disclosure To ensure a participatory, inclusive, and culturally appropriate approach during the project’s life cycle, the Borrower prepared a Stakeholder Engagement Plan (SEP) for the parent project in compliance with ESS10 requirements. The AF project has reviewed the PP SEP to introduce the vaccines requirements and including potential new stakeholders, other interested stakeholders, and vulnerable groups and/or persons. During the consultations for the updated SEP, Aug 31, 2021 Page 6 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) specific attention was given to the vaccine roll-out strategy. The SEP was updated and will be disclosed for AF Package. For the parent project, a GRM was prepared and was operational. An update of the current GRM were done as part of the SEP updating to ensure the current GRM includes the requirements in relation to the potential risks and impacts of the AF and includes measures that are accessible to potential new stakeholders. The current GRM which has already recommendations regarding the SEA/SH will be strengthened to include SEA/SH-sensitive measures related to the vaccine aspects, including multiple channels to initiate a complaint and specific procedures for SEA/SH, such as confidential and/or anonymous reporting with safe and ethical documenting of SEA/SH. The communication campaign will be implemented in all stages of the national vaccination rollout, and will leverage mass media, social media, and healthcare workers. 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 Many activities supported by the project will be conducted by health care and laboratory workers and will include the treatment of patients, vaccination as well as the assessment of patient samples and therefore COVID-19 infection is a Public Disclosure key risk for these workers. The PIU will ensure the application of OHS measures as outlined in WHO guidelines which are reflected in an Infection Control Medical Waste Management Plan (ICMWMP) and a Labor Management Procedure (LMP) annexed to the ESMF. These measures include: procedures for monitored entry into health care facilities, including minimizing visitors and undergoing strict checks before entering; procedures for protection of workers in relation to infection control precautions; provision of immediate and ongoing training on the procedures to all categories of workers, and post signage in all public spaces mandating hand hygiene and PPE; ensuring adequate supplies of PPE (particularly face masks, gowns, gloves, handwashing soap and sanitizer); and generally ensuring adequate OHS protections in accordance with the general and industry specific EHSGs and The World Bank GABON COVID-19 Strategic Preparedness and Response Project (SPRP) (P173927) consistent with the evolving international best practice in relation to COVID-19 protection. Also, the PIU will be constantly integrating the latest COVID-19 guidance by WHO. The LMP provides guidance regarding the policies and procedures that will govern health care workers, project staff and other direct workers hired under the project. The LMP provides details regarding the establishment of a labor GRM to allow workers to quickly inform management of labor issues, such as a lack of PPE and unreasonable overtime via the PIU. In line with ESS2, the use of forced labor or the use of child labor for any person under the age of 18 in hazardous work situation (e.g. in health care facilities) will be prohibited. A workers Grievance Redress Mechanism, sensitive to GBV/SEA/SH issues, will be established and operated through a grievance hotline and assignment of focal points to address these grievances within MoH. A GBV Code of Conduct (Code of conduct) will be developed and signed by all workers. The Code of Conduct will be associated with the GBV/SEA/SH Prevention and Response Action Plan, which includes an Accountability and Response Framework. Aug 31, 2021 Page 7 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) Finally, the LMP takes into account the recommendations of the E&S audit commissioned in terms of (i) measures to be taken in order to avoid any infection of workers, (ii) working conditions of medical staff (working hours per week, etc...) ESS3 Resource Efficiency and Pollution Prevention and Management Pollution prevention and management - specifically medical waste management - will be a particularly important activity under the Project. Medical waste, including chemicals, contaminated PPE, vaccines and equipment, and lab testing kits from healthcare facilities will need to be safely stored, transported and disposed. Hazardous waste management in general is a binding constraint in Gabon due to a limited number of authorized disposal sites and contaminated medical waste is of special concern. A number of healthcare facilities operate their own incinerators to ensure safe disposal, although these are unevenly dispersed across Gabon. The ESMF includes an ICMWMP that reflects WHO COVID-19 guidance and other international good practice to prevent or minimize contamination from inadequate waste management and disposal. ICMWMP will also take into account the waste likely to be generated within the framework of the activities of the incinerators which will be installed. AF activities include financing and installation of incinerators. The energy-efficient incinerators and cold-storage equipment will be procured through the AF project and coolants that will be used in cold storage should not contain any ozone-depleting substances. ESS4 Community Health and Safety Public Disclosure Protecting communities from COVID-19 infection is the intention of the project but without adequate controls and procedures, project activities have the potential to contribute to the spread of the virus and may also generate social conflict. Medical waste and other waste from the labs, health centers, and quarantine and isolation centers have a high potential of being contaminated with coronavirus and this can infect the community at large if not properly managed. Army or police will not be used for vaccine deployment or protection. The military hospital is no longer involved in the Covid-19 response in Gabon for this AF. Measures for industry standard waste management are outlined in the ICMWMP which includes: (i) how Project activities involving the COVID-19 pathogen or waste generated will be managed in a safe manner with (low) incidences of accidents and incidents in line with Good International Industry Practice (such as WHO guidelines); (ii) measures in place to prevent or minimize the spread of infectious diseases; and (iii) emergency preparedness measures. Information on preventive health measures to protect the communities surrounding health facilities will be provided through continuous stakeholder engagement and reflected in the SEP. Sexual Exploitation and Abuse (SEA)/ Sexual Harassment (SH) risks will be assessed and addressed during implementation, including screening and implementing measures to prevent and mitigate these risks. In addition, risk mitigation measures will be outlined in a SEA/SH Prevention and Response. Action Plan, which will incorporate an accountability and response framework will prepared 30 after project effectiveness, including codes of conduct to be signed by all individuals engaged in the project activities (including if possible MOPH relevant partners, health staff, and all suppliers linked to the execution of project activities) outlining prohibited conduct and applicable sanctions, procedural adaptations to the project grievance mechanism to ensure safe and confidential management of SEA/SH claims with timely referrals to Aug 31, 2021 Page 8 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) appropriate survivor care, as well as training and sensitization activities. In addition, SEA/SH risk will be addressed through robust stakeholder identification and consultation processes, which will take into specific account consultation with women and other vulnerable groups in safe and enabling, sex-segregated environments (including with same-sex facilitators). ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement There will be no land acquisition in the framework of this project. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources The Project is not expected to support any activities that might jeopardize the integrity of biodiversity or living natural resources. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities The Government has put in place a national covid-19 response program. The Strategic Preparedness and Response Project (SPRP) which is a contribution to this program, is being implemented throughout the national territory. For the AF, the consideration of IPs will be done according to the mapping of their location where the project activities will be effectively carried out. Standard 7 is considered relevant. The Government plans to broaden its communication strategy within the framework of the national vaccination Public Disclosure program, particularly through outreach communication. For the information and awareness campaigns, it will use existing communication channels and will also be supported by a UN agency within the framework of the PPRS project and will address all segments of the population, including IPs. The PIU will support the Ministry in this activity. The updated ESMF which takes into account the activities of the additional financing, presents the procedure for the preparation of specific instruments in favor of IPs. In fact, the PPRS will take specific measures (in accordance with the provisions defined in the ESCP and the SEP of the AF ) to integrate indigenous groups into the national covid-19 response program and into the national vaccination program. The project will ensure that such communities are appropriately informed and can share in the benefits of the project in an inclusive and culturally appropriate manner (i.e. communication, sensitization, prevention and treatment) with provisions included in the SEP. IPPs will be prepared before deployment of vaccines in areas where IPs are located to ensure adequate consideration of their specific cultural needs, to the satisfaction of the Bank. The project will exclude any activities which would require Free, Prior and Informed Consent (FPIC) and will follow WHO guidelines for consultations during vaccinations. ESS8 Cultural Heritage This Standard is not currently relevant. A Chance Find procedure is included in the ESMF as a precaution. ESS9 Financial Intermediaries Not relevant. No financial intermediaries will be involved in this project. Aug 31, 2021 Page 9 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) 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 Areas where “Use of Borrower Framework” is being considered: N/A IV. CONTACT POINTS World Bank Contact: Agnes Couffinhal Title: Senior Economist, Health Public Disclosure Telephone No: +1-202-458-4230 Email: acouffinhal@worldbank.org Borrower/Client/Recipient Borrower: Republic of Gabon Implementing Agency(ies) Commission nationale des travaux d'intérêt public pour la promotion de l'entrepreneuriat et de Implementing Agency: l'emp 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 Task Team Leader(s): Agnes Couffinhal Aug 31, 2021 Page 10 of 11 The World Bank Gabon COVID-19 Additional Financing (P176464) Practice Manager (ENR/Social) Sanjay Srivastava Cleared on 24-Aug-2021 at 10:53:22 GMT-04:00 Safeguards Advisor ESSA Nathalie S. Munzberg (SAESSA) Concurred on 31-Aug-2021 at 14:27:39 GMT-04:00 Public Disclosure Aug 31, 2021 Page 11 of 11