KINGDOM OF LESOTHO COVID-19 Emergency Preparedness and Response Project (P173939) Additional Financing (P176307) ENVIRONMENTAL AND SOCIAL MANAGEMENT FRAMEWORK (ESMF) Updated Draft JUNE 29, 2021 For comments or inquiries please contact the below-mentioned: Mrs. Boopane Ntai Project Coordinator Lesotho COVID-19 Emergency Preparedness and Response Project Ministry of Health P.O. Box 514 Maseru 100 Lesotho Email: mathabo.ntai@gov.ls OR Mr. Lepekola Lepekola Environmental and Social Specialist Lesotho COVID-19 Emergency Preparedness and Response Project Ministry of Health P.O. Box 514 Maseru 100 Lesotho Email: lepekola.lepekola@gov.ls This report is also available from Physical Address Project Coordinator Ministry of Health Head-Quarters 3rd Floor Maseru Abbreviations and Acronyms ..................................................................................................................... i Executive Summary ................................................................................................................................... iii Project Description and Overview of Project Components ............................................................... iv Applicable World Bank Environmental and Social Standards ........................................................ vii Applicable GoL Environmental and Social Legislations ................................................................... vii Environmental and Social Screening .................................................................................................. vii Environmental and Social Risks and Impacts .................................................................................... vii Consultation and Stakeholder Engagement ......................................................................................... x Grievance Redress Mechanism .............................................................................................................. x Implementation Arrangements, Responsibilities and Capacity Building ......................................... xi Budget ..................................................................................................................................................... xi 1. Background ............................................................................................................................................ 1 1.1 General ............................................................................................................................................. 1 1.2. Objective, Rationale and Application of the ESMF ..................................................................... 4 1.3. Key Contents of the Environmental and Social Management Framework ............................... 5 1.4. Revision/Modification of the ESMF .............................................................................................. 6 2. Project Description ................................................................................................................................ 7 2.1. Background ..................................................................................................................................... 7 2.2. Project Development Objective ..................................................................................................... 9 2.3. Project Components........................................................................................................................ 9 2.4. Eligibility Criteria for Exclusion of Subprojects........................................................................ 21 2.5. Project Area and Beneficiaries .................................................................................................... 21 Policy, Legal and Regulatory Framework ......................................................................................... 23 3.1. Key Applicable National Laws, Policies and Regulations ......................................................... 23 3.2. Review of International Conventions and Treaties.................................................................... 28 3.3. World Bank Environmental and Social Standards.................................................................... 30 3.4. World Bank Environment, Health and Safety (EHS) Guidelines ............................................ 45 3.5. WHO and Other Technical Guidelines on COVID-19 .............................................................. 45 3.6 International and Regional Regulations and Guidance ............................................................ 46 3.7 Government of Lesotho Project E&S classification System compared to the World Bank System .................................................................................................................................................... 47 4 Environmental and Social Baselines .................................................................................................. 52 4.1. Biophysical Environmental Baseline ........................................................................................... 52 4.2. Socio-Economic Baseline .............................................................................................................. 54 4.3. COVID-19 Testing and Treatment in Lesotho ........................................................................... 60 4.4. National New Vaccine Introduction Program in Lesotho ......................................................... 61 4.4.1. Vaccine Program Status ....................................................................................................... 61 4.4.2. Disadvantaged / Vulnerable Individuals or Groups .......................................................... 63 5 Potential Environmental and Social Risks and Mitigation .............................................................. 66 5.1. Methodology for Assessing Risks and Impacts .......................................................................... 67 5.2. Risk Summary ............................................................................................................................... 68 5.3. Environmental and Social Risks and Impacts and Mitigation Measures ................................ 70 6 Procedures to Address Environmental and Social Issues .............................................................. 116 6.1. Subproject Environmental and Social Screening..................................................................... 117 6.2. Preparation of Environment and Social Management Plans and Instruments .................... 117 6.3. Review and Approval of Environment and Social Management Plans and Instruments .... 118 6.4. Inclusion of E&S Requirements in Procurement Documents ................................................. 118 6.5. Implementation of Environment and Social Management Plans and Instruments .............. 118 6.6. Monitoring, Supervision and Reporting on E&S Implementation ........................................ 118 7 Consultation and Disclosure ............................................................................................................. 119 7.1. Stakeholder Consultation ........................................................................................................... 119 7.2. Stakeholder Consultations done during ESMF preparation .................................................. 126 7.3. Document Disclosure .................................................................................................................. 127 8 Stakeholder Engagement .................................................................................................................. 128 8.1 General ......................................................................................................................................... 128 8.2 Reporting back to stakeholders ................................................................................................. 129 8.3 Grievance Redress Mechanism (GRM) .................................................................................... 129 9 Project Implementation Arrangements, Responsibilities and Capacity Building ....................... 132 9.1 Institutional Arrangements and Responsibilities ..................................................................... 132 9.2 Capacity Building........................................................................................................................ 135 9.3 Budget .......................................................................................................................................... 136 10 . Annexes ............................................................................................................................................. 137 Annex 1: Screening Form for Potential Environmental and Social Issues ........................................ 137 Annex 2: Infection Control Considerations and Tools for E&S Screening & Risk Rating ......... 141 Annex 3: Site-Specific Environmental and Social Management Plan (ESMP) Template ............ 144 Annex 4: Code of Conduct Guidance ................................................................................................ 156 Annex 5: Checklists............................................................................................................................. 157 Annex 6: Resource List on COVID-19 Guidance ............................................................................ 176 Annex 7: GBV/SEA/SH Risk Mitigation Plan ................................................................................. 178 Annex 8: Consultations....................................................................................................................... 226 Annex 9: Sample E&S Impact Assessment Questionnaires (ESMF Preparation)........................ 238 Annex 10: Infection Control and Waste Management Plan (ICWMP) ......................................... 239 Annex 11: Labor Management Procedures ...................................................................................... 240 Annex 12: Clauses for Inclusion in Contracts .................................................................................. 280 Annex 13: National New Vaccine Introduction Governance Structure ......................................... 283 Annex 14-A: Grievance Logbook Template ..................................................................................... 284 Annex 14-B: Grievance Reporting Template ................................................................................... 285 Annex 15: Security Management Plan .............................................................................................. 286 Abbreviations and Acronyms ACM Asbestos Containing Materials AIDS Acquired Immunodeficiency Syndrome BAT Best Available Techniques BSL Biosafety Level BMWM Biomedical Waste Management CAT-DDO Catastrophe Deferred Drawdown Option CDC Centre for Disease Control and Prevention CEDAW Convention on the Elimination of All Forms of Discrimination Against Women CHAI Clinton Health Access Initiative CoC Condition of Contract COVID-19 Coronavirus Disease 2019 DDPR Directorate of Dispute Prevention and Resolutions DHIS District Health Information System DPO Disabled People’s Organization ESF Environmental and Social Framework EHS Environmental, Health and Safety ERP Emergency Response Plan ESC Environmental and Social Committee ESHS Environmental, Social, Health and Safety ESIA Environmental and Social Impact Assessment ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan ESS Environment and Social Standard GBV Gender Based Violence GDP Gross Domestic Product GESI Gender Equality/Equity and Social Inclusion GHG Greenhouse Gas GRC Grievance Redress Committee GRM Grievance Redress Mechanism GRS Grievance Redress Service (World Bank) HCF Healthcare Facility HCW Healthcare Waste HDI Human Development Index HIV Human Immunodeficiency Virus HVAC Heating, Ventilation and Air Conditioning ICWMP Infection Control and Waste Management Plan IFC International Finance Corporation (World Bank Group) ILO International Labor Organization IPC Infection Prevention and Control LMP Labor Management Procedures L&FS Life and Fire Safety MOH Ministry of Health NDVP National Deployment and Vaccination Plan i NIP National Implementation Plan NNVI National New Vaccination Introduction NRL National Reference Laboratory NRRT National Rapid Response Team OHS Occupational Health and Safety PCR Polymerase Chain Reaction PDO Project Development Objectives PEPFAR President’s Emergency Plan for AIDS Relief PHC Population and Housing Census PHEIC Public Health Emergency of International Concern PIM Project Implementation Manual POE Point of Entry PPE Personal Protective Equipment QMMH Queen Mamohato Memorial Hospital RAP Resettlement Action Plan RCCE Risk Communication and Community Engagement RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health SATBHSSP Southern Africa Tuberculosis and Health Systems Support Project SEA Sexual Exploitation and Abuse SEP Stakeholder Engagement Plan SMP Security Management Plan SH Sexual Harassment SO Social Officer SOP Standard Operating Procedures SRA Security Risk Assessment TA Technical Assistance TB Tuberculosis TWG Technical Working Group UN United Nations UNDP United Nations Development Program UNICEF United Nations International Children’s Emergency Fund VAC Violence Against Children VIRAF Vaccine Introduction Readiness Assessment Form VIRAT Vaccine Introduction Readiness Assessment Tool WASCO Water and Sewerage Company of Lesotho WASH Water, Sanitation and Health WB World Bank WBG World Bank Group WHO World Health Organization WWTP Wastewater Treatment Plant ii Executive Summary This Environmental and Social Management Framework (EMSF) is developed to support the environmental and social due diligence provisions for activities financed by the World Bank (WB) Group for the Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) – including the Parent Project (PP) (P173939) and the Additional Financing (AF) Project (P176307) implemented by the Ministry of Health (MOH) under the Government of Lesotho (GoL). The Project Development Objective (PDO) of the Lesotho COVID-19 EPRP (PP and AF) is to strengthen the capacity of the GoL to prevent, detect, and respond to the threat posed by COVID- 19 and to strengthen national systems for public health preparedness. The primary objectives of the Project are (a) to enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in the Kingdom of Lesotho through vaccination system strengthening and (b) to further strengthen preparedness and response activities under the parent project. This ESMF is envisaged to assist the Ministry of Health (MoH) in identifying the type of environmental and social assessment that should be carried out for the Project activities that involve the construction, expansion, rehabilitation and/or operation of healthcare facilities, and the deployment of a safe and effective vaccination program in response to COVID-19, and in developing the environmental and social (E&S) management plans in accordance with the World Bank’s Environmental and Social Framework (ESF). The ESMF is applicable to all investments/Subprojects under the EPRP. The rationale of the ESMF is that specific locations and detailed information about the Subprojects can only be known during implementation to guide the Project Implementation Unit (PIU) and the Subproject Proponents on the E&S screening and subsequent subproject assessment during implementation, including preparation of Subproject-specific plans and their implementation in accordance with the ESMF. The objective of the ESMF is to assess and mitigate potential negative environment and social (E&S) risks and impacts, and enhance the beneficial impacts of the Project consistent with the relevant legislative provisions of the GoL, and the WB (including Environmental and Social Standards (ESSs) of the World Bank Environmental and Social Framework (ESF)). Specific objectives of the ESMF are to: (a) assess the potential E&S risks and impacts of the proposed Project and propose their mitigation measures; (b) establish procedures for the E&S screening, review, approval, and implementation of activities; (c) specify appropriate roles and responsibilities, and outline the necessary reporting procedures, for managing and monitoring E&S issues/ concerns related to the activities; (d) identify the training and capacity building needed to successfully implement the provisions of the ESMF; (e) address mechanisms for public consultation and disclosure of the Project documents as well as redress of possible grievances; and iii (f) establish the budget requirements for implementation of the ESMF. The ESMF also provides principles and specific processes to ensure that disadvantaged, vulnerable individuals or groups have access to the Project’s benefits. Project Description and Overview of Project Components The Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) supports Lesotho to prevent, detect and respond to the threat posed by COVID-19. In order to respond to this global pandemic, the Government of Lesotho (GoL) has been implementing (since May 2020) the Lesotho COVID-19 EPRP Parent Project - with World Bank (WB) financial support. The EPRP PP, with US$ 7.5 million total budget, comprises of two main components, Emergency COVID-19 Response (US$6.675 million), and Project Implementation and Monitoring & Evaluation (US$0.825 million). Under Component 1 of the PP, the three focus areas are: (i) COVID-19 case detection, confirmation, contact tracing, recording and reporting; (ii) containment, isolation and treatment through enhanced clinical care capacity; and (iii) community engagement, preventions and risk communication. Likewise, Component 2 of the PP includes: (i) Project Implementation and Monitoring & Evaluation activities; and (ii) operational reviews as well as logistical support. The Parent Project ESMF was prepared and disclosed in August 2020, and is being implemented smoothly in compliance with the EPRP requirements. The recent Parent Project Implementation progress review was conducted in November 2020. Each of the current ‘Progress Towards Achievement of the PDO’, and ‘Overall Implementation Progress’ has been rated as “satisfactory� for the Parent Project. In January 2021, the GoL requested the WB for additional resources to expand the COVID-19 response with the objective to provide additional financing as well as technical assistance to the Ministry of Health (MOH)/GoL to adequately plan and rollout the vaccines for COVID-19, once available. The proposed additional financing (AF) Project will be a total envelope of US$25.5 million, financed by the World Bank - International Development Association (IDA) (US$22 million) and the Health Emergency Preparedness and Response Trust Fund (HEPRTF) (US$3.5 million). The additional financing will provide essential resources to enable an expansion of a sustained and comprehensive pandemic response that will also include vaccination program in Lesotho. The changes proposed for the AF entail expanding the scope of activities in the Parent Project, and adjusting its overall design. An increase in scope and cost will be required to support: (i) vaccination program; (ii) upgrading the cold chain for the vaccines; (iii) strengthening service delivery to ensure effective vaccine deployment; (iv) rehabilitation of the Intensive Care Units and establishing mini oxygen plants at two of the existing hospitals; (v) construction of the Maseru district vaccine store; (vi) expansion of the polymerase chain reaction (PCR) laboratory within the National Reference Laboratory (NRL); and (vii) monitoring, tracking of vaccine use and recording iv of any adverse reactions to vaccination. Additional financing is also required to extend the testing, PPE, and sustained communications and promotions around National Plans for Immunization (NPI)s which are essential to sustain throughout the vaccine roll-out. The EPRP-AF comprises the following components: Component 1: Emergency COVID-19 Response (Total of US$29.675 million) including US$6.675 million IDA under the parent project, US$19.5 million IDA AF and US$3.5 million HEPR TF). Sub-component 1.1: Vaccine procurement (US$14 million IDA AF). Support for vaccines will be added as part of the containment and mitigation measures to prevent the spread of SARS-CoV- 2 and COVID-19 deaths under Component 1. This sub-component will also cover associated costs (freight and insurance, clearing and transportation, handling charges) as well as medical supplies needed for administration (e.g. needles, syringes, alcohol prep pads). Sub-component 1.2: Strengthen systems for vaccine deployment (US$5.5 million IDA AF). The AF will support investments to bring the immunization system capacity to the level required to successfully deliver COVID-19 vaccines at scale. The AF is geared to assist the GoL, working closely with the WHO, the UNICEF and other Development Partners (DPs), to overcome bottlenecks as identified in the country’s COVID-19 vaccine readiness assessment. Envisioned support includes distribution and administration of vaccines and strengthening the immunization supply chain system, including: (a) procurement and distribution of ancillary supply kits that may include COVID-19 vaccination record cards for each vaccine recipient and PPE for vaccinators; (b) supporting the administration of vaccines including training health workers in vaccine distribution, administration, and climate disaster response, micro-planning activities for rollout, development of contingency plans to maintain vaccination campaigns during climate shocks, and outreach sessions to reach specific target groups as well as people living in remote areas (e.g., operating costs, vehicles); (c) strengthening the supply chain and logistics systems including financing climate friendly cold-chain equipment to comply with the cold-chain requirements of different vaccines and the construction of the Maseru district vaccine store; (d) undertaking relevant traceability activities to ensure capabilities for the system to track and trace from production to the target population; (e) strengthening post-vaccination vigilance and monitoring system(s) to identify any adverse reactions on people and undertake corrective measures immediately; (f) conducting focused group discussions at community level targeting different stakeholders to gather information and adapt immunization rollout; (g) developing and distributing risk communication products for COVID-19 vaccination, including communication on the risks and response to climate shocks; and (h) ensuring adequate medical waste management. Sub-component 1.3: Strengthen systems for the COVID-19 response (Total of US$10.175 million IDA including US$6.675 million IDA under the parent project and US$3.5 million HEPR TF AF). In line with the National COVID-19 Preparedness and Response Plan and the original activities under Component 1 in the parent project, sub-component 1.3 will also continue v supporting the overall government response to COVID-19. This includes: (a) enhancing disease surveillance, improving sample collection and ensuring rapid diagnoses to promptly detect all potential COVID-19 cases and carry out contact tracing to quickly contain COVID-19; (b) strengthening critical clinical care capacity, including enhancing isolation and treatment capacity for infected patients in the country; and (c) reinforcing public health measures such as social distancing, personal hygiene promotion, risk communication and community engagement (RCCE) using local language and traditional channels to communicate the risks associated with COVID- 19. The AF will cover new activities to: (a) increase capacity for case management such as through refurbishment of two intensive care units (ICUs) with minor civil works, supervision and mentoring visits, training of ICU staff, increased availability of oxygen through procurement of equipment and supplies and establishment of two mini-plants, and procurement of medical supplies including PPE; (b) increase testing capacity such as through expansion of the polymerase chain reaction (PCR) laboratory within the National Reference Laboratory (NRL); enhanced and decentralized testing capacity using multiple modalities (such as using the existing PCR instrument used for human immunodeficiency virus (HIV)/tuberculosis testing (GeneXpert) as well as procuring WHO-approved antigen test kits that can be scaled up rapidly in the community through mobile testing centers at low cost); (c) strengthen surveillance capacity; and (d) strengthen COVID-19 data reporting and management across the board, including support for COVID-19 vaccination specific M&E and surveillance strengthening, which will apply to COVID-19 as well as other climate-induced, vaccine preventable diseases. Component 2: Project Implementation and Monitoring and Evaluation (Total US$3.325 million including US$0.825 million IDA under the parent project and US$2.5 million IDA AF). As under the parent project, Component 2 will continue supporting the coordination and management of project activities, including procurement of goods and their distribution across health facilities, technical assistance, rapid surveys as part of the project M&E, and operating costs. This will include a client feedback survey through digital health solutions to gather iterative feedback on project implementation, especially of immunization activities. The capacity of the PIU will also further be enhanced. Eligibility Criteria for Exclusion of Subprojects under the EPRP (both PP and AF) have been determined, and documented in the project’s Environmental and Social Commitment Plan (ESCP). The excluded main activities under the project include: (a) activities that may cause long term, permanent and/or irreversible adverse impacts; (b) activities that have high probability of causing serious adverse effects to human health and/or the environment not related to treatment of COVID19 cases; (c) activities that may have significant adverse social impacts and may give rise to significant social conflict; (d) activities that may affect lands or rights of vulnerable minorities/communities; and (e) activities that may involve permanent involuntary resettlement, among others as detailed under section 2 of the ESMF. vi Applicable World Bank Environmental and Social Standards The environmental and social risk associated with the Project is classified as ‘Substantial’. Five of the ten Environmental and Social Standards (ESSs) of the WB’s Environmental and Social Framework (ESF) have been assessed as relevant: ESS1 Assessment and Management of Environmental and Social Risks and Impacts, ESS2 Labor and Working Conditions, ESS3 Resource Efficiency and Pollution Prevention and Management, ESS4 Community Health and Safety, and ESS10 Stakeholder Engagement and Information Disclosure. The ESMF also takes into account the national requirements as well as the application of relevant international protocols for infectious disease control and medical waste management. WBG Environment, Health and Safety (EHS) Guidelines will apply to the extent relevant as well as appropriate current Africa CDC guidelines and WHO Guidance on COVID-19 including those on “healthcare facilities�, “waste management�, “hazardous materials management�, and “construction and decommissioning�. Applicable GoL Environmental and Social Legislations In addition to World Bank ESSs, the Project shall comply with Lesotho’s Environmental and Social Regulatory Framework. Applicable Laws and regulations include The Constitution of Lesotho of 1993; National Environmental Policy of 1998; National Health Policy of 2011; Lesotho Poverty Reduction Strategy (PRS) Paper; Environmental Act of 2008; Local Government Act of 1997; Labor Code Order No. 24 of 1992 with its amendments; Labor Code Amendment Act 2000; Labor Code Amendment Act 2006; Public Health Order No. 12 (1970); Declaration of COVID- 19 Statement of Emergency Notice (2020) and Public Health (COVID-19) Regulations (2020); Hazardous and Non-Hazardous Waste Management Act (2008); Hazardous (Health Care) Waste Management Regulations (2012) and the Water Act No. 15 (2008), Criminal Procedure and Evidence Act of 1981, Penal Code Act of 2010, etc. Environmental and Social Screening The purpose of screening is to: (i) determine whether activities are likely to have potential negative environmental and social risks and impacts; and (ii) identify appropriate mitigation measures. For activities with adverse risks or impacts, the mitigation measures are then incorporated into the activity implementation, e.g., through appropriate environmental and social management plans the implementation of which is monitored and reported. Environmental and Social Risks and Impacts The Project will be national in coverage and scope. Overall, the environmental and social risks and impacts are expected to be ‘Substantial’ due to the nature of associated activities and works under the EPRP – AF. The major environmental risks and impacts are: (i) occupational health & and safety (OHS) risks related to testing and handling of supplies, during treatment and vaccination. Other OHS risks are related to the suboptimal percentage of health workers using appropriate PPE as a result of both vii insufficient PPE and individual behavior; (ii) production and management of medical healthcare waste resulting from vaccine delivery (such as sharps and the disposal of used and expired vaccine vials) as a result of AF activities; (iii) community health and safety issues related to the handling, transportation and disposal of hazardous and infectious healthcare waste; (iv) construction environmental impacts associated with the proposed minor civil works under the AF; and (v) risks to produce greenhouse gas (GHG) and cause potential negative impacts to capacity to respond to future climate-related crises. The major social risks and impacts are Substantial, and include: (a) the risk of inequity in access to vaccines and deviation from the rollout strategy due to limited accessibility of remote rural areas and political pressures to provide vaccines to groups that are not prioritized, or target groups are misaligned with available vaccines as well as fraud, corruption and elite capture in vaccine procurement and distribution; (b) barriers faced by marginalized and vulnerable social groups including women, disabled, illiterate, migrants, refugees and people living in remote rural areas in accessing essential services (including COVID-19 services) and critical information. There is a risk that vaccine deployment plans could leave behind these groups due to their limited participation in formal economic activities; (c) inadequate or conflictual public engagement and lack of trusted and adequate consultation, social conflicts resulting from false rumors and misinformation could negatively influence demand generation activities for the vaccine, especially among communities that are generally distrustful of the public health system and/or have traditionally been marginalized, and resulting in interferences with disease prevention and control measures; (d) discrimination and stigma faced by those admitted to treatment or isolation facilities; (e) risks of gender-based violence (GBV)/sexual exploitation and abuse (SEA)/sexual harassment (SH) to project workers and beneficiaries; (f) labor management and OHS related risks; (g) risks linked to the engagement of security personnel (especially to ensure transport, distribution and/or safeguarding of vaccines and accessories to remote rural areas). The risks have been reassessed and updated as part of the updated Environmental Safeguard and Management Framework (ESMF). The updated ESMF also includes a security management plan (SMP) guided by the principles of proportionality and Good International Industrial Practice. The Labour Management Procedures (LMP) and GBV/SEA /SH Action Plan have been also prepared and incorporated in the updated ESMF. Adequate preparedness actions have been ongoing as part of the parent project, and shall be further enhanced to ensure disadvantaged and vulnerable groups have awareness and are able to receive appropriate preventive support/services. Full social inclusion is fundamental to achieve development outcomes, thus, effective implementation of the Project’s stakeholder engagement plan prepared/updated for the EPRP AF will be critical to mitigate the risks. Communication materials to be developed will also be clear and concise and in a format and language that is understandable to all people (Sesotho), in particular the most vulnerable (including the illiterate, elderly, those in remote inaccessible areas). viii Procedures to Address Environmental and Social Issues The ESMF provides a screening tool for potential project activities to allow determination of potential environmental and social issues. The screening process identifies possible instruments, e.g., Environmental and Social Management Plan (ESMP), Environmental Codes of Practice (ECOP), to be applied during Project implementation, based on subproject typology. These issues will also be addressed through relevant capacity building activities, observance of the labour management procedures and environmental and social management plans for project sites, conduct of community consultations, and active observance of the Grievance Redress Mechanism. The Stakeholder Engagement Plan includes provisions for engaging affected and interested stakeholders throughout the project cycle. Measures to address concerns of vulnerable groups, including persons with disabilities and women, are included in the ESMF and SEP. Likewise, risks and impacts (both beneficial and adverse) on the workers shall be managed adhering to the Labour Management Procedures (LMP) prepared for the EPRP AF. The Infection Control and Waste Management Plan considers the HCF staff and waste management service providers and the community health and safety issues related to the handling, transport, and disposal of healthcare wastes, which are addressed through the ESMF. To ensure the safety of the vaccines to be procured, the vaccine regulatory approval of the Stringent Regulatory Authorities (SRAs)1 identified by the World Health Organization will be required. Appropriate messages shall be delivered to address the vaccine safety while identification of priority population have been documented in ‘Lesotho’s National Deployment and Vaccination Plan for COVID-19 Vaccines’ prepared for the purpose. The Environmental Health Department (EHD) working together with the PIU under the MoH has developed key messages on COVID-19 information, prevention, and treatment. The communications approach will be adapted to the EPRP-AF focused activities encompassing general information on: (i) COVID-19 and the need for sanitation and hygiene practices, (ii) COVID19 vaccine basic information, (iii) trials results and procurement, and (iv) vaccine program roll-out. The WHO Risk communication and community engagement readiness and response to coronavirus disease (COVID-19) released on 19 March 2020 will also be used as reference in the development of messages and planning of risk communication and community engagement (RCCE) activities. Serial obtaining of informed consent from the identified vaccines and counselling shall be conducted prior to the administration of the COVID-19 vaccine. The profiling and screening of candidate individuals to be vaccinated should be performed aimed at avoidance of the risk of vaccine contraindications. A comprehensive data management system is also needed to support 1 World Health Organization. (June 2020). Essential medicines and health products: List of stringent regulatory authorities (SRAs). https://www.who.int/medicines/regulation/sras/en/. ix the profiling, screening, and scheduling to address the risk of individuals not completing the required shots/doses of the vaccine. Coordination with the local government units as well as the uniformed personnel (if any engaged) will be done to assist in crowd management and for the successful implementation of the National Deployment and Vaccination Plan. The social risks associated with the Project will be addressed through the Project’s ESMF, Stakeholder Engagement Plan (SEP) including a Grievance Redress Mechanism (GRM), Environmental and social management plans (ESMPs), GBV/SEA/SH Management Plan, Labor Management Procedures (LMP) (Annex 11), and Security Management Plan (SMP) (Annex 15) - amongst others - in line with the applicable legislations of the GoL, Environmental and Social Standards (ESSs) of the WB’s ESF and the WHO COVID-19 WHO guidance tools for COVID- 19 preparedness and response. Consultation and Stakeholder Engagement The Project has prepared and updated the PP Stakeholder Engagement Plan (SEP), to include the Additional Financing (AF) components (including vaccination), which defines a program for stakeholder engagement, including public information disclosure and consultation, throughout the Project cycle. It also outlines a communication strategy with the Project stakeholders, and offers mechanisms for them to raise concerns, provide feedback, or make complaints about the Project activities. The SEP is a living document with objectives to: a) Identify all Project stakeholders including their priorities and concerns, and ensure the Project has ways to incorporate these; b) Identify strategies for information sharing and communication to stakeholders in ways that are meaningful and accessible; c) Specify procedures and methodologies for stakeholder consultations, documentation of the proceedings and strategies for feedback; d) Establish an accessible, culturally appropriate and responsive grievance mechanism, and e) Develop a strategy for stakeholder participation in the monitoring of Project activities and impacts Grievance Redress Mechanism A grievance redress mechanism (GRM) is part of the Project ESMF and SEP, and has been established under the PP to receive stakeholder feedback and to resolve any complaints or grievances in a timely, effective and efficient manner. Gender equity/equality and social inclusion (GESI) principles shall be followed wherever applicable during the formation/renewal of the grievance redress committee (GRC) to manage the GRM. Project related grievances can be submitted for avoiding or preventing detrimental impact on the community, the environment, or on their quality of life. Stakeholders may also submit feedback/comments and suggestions. The GRM also provides complaint resolving measures for any dispute, appropriate redress actions and aims at avoiding the need to resort to judicial proceedings. The World Bank grievance redress x service (GRS) may also be accessed if so required to help resolve any grievances as may be triggered due to the project activities. Implementation Arrangements, Responsibilities and Capacity Building Overall, responsibility and arrangements for implementation of this ESMF, and its supporting Environmental and Social Safeguards documents, such as site-specific ESMP, Infection Control and Waste Management Plan, Labor Management Procedures, Security Management Plan, etc., lies with various institutions, mainly, the Ministry of Health, and Department of Environment. The responsibility of the World Bank, and Department of Environment is also to review and approve project E&S documents, and ensure compliance with the World Bank, and national E&S requirements. Ministry of Health is the project implementing body, and has the responsibility to ensure preparation and proper implementation of the project E&S documents, including the ESMF. The Project Implementation and Monitoring & Evaluation Component (Component 2) will continue supporting with program coordination, management and monitoring activities. This will include support also for the COVID-19 Incident Management System Coordination Structure; the recently established multisectoral National COVID-19 Secretariat (NACOSEC) for COVID-19; operational reviews to assess implementation progress and adjust operational plans; and logistical support. The Project Implementation Unit (PIU) will continue to prepare and submit to the GoL/MoH and World Bank regular monitoring reports on the environmental, social, health and safety (ESHS) performance of the Project, including but not limited to, stakeholder engagement activities, accidents and grievances log. The health facility management will be responsible for day-to-day supervision on implementation of mitigation measures. As some of the activities under the Project involve minor civil works, the civil work contractor/supervision team will incorporate the status of the implementation of Environment and Social Management Plans (ESMP) and/or Environmental Codes of Conduct/Practice (ECOP), as relevant, into the periodic (at least Quarterly) progress reports. The Project will provide funding, training and capacity building to manage risks and impacts associated with COVID-19 EPRP AF activities - including diagnostic testing, vaccination, quarantine and isolation centers for COVID-19 treatment, storage and deployment of vaccines and accessories, applicable management of logistics and vaccination facilities, and surveillance, amongst others. Specific measures for public communication and handling social concerns around COVID-19 are included. These critical initiatives will build upon international best practices in line with the WB and WHO guidelines. Budget ESMF implementation costs are allocated to include training, development of E&S due diligence measures, implementation of the stakeholder engagement plan (SEP) and gender based violence (GBV) prevention, sexual exploitation and abuse (SEA)/sexual harassment (SH) plan, preparation and implementation of the ESMPs and other to be determined tools and instruments, etc. adhering xi to the ESMF requirements. The approx. cost for all these initiatives is estimated at US$183,196. This, however, is the best estimate made by the project preparatory team, may vary during the implementation of the project/ESMF, and shall be taken care of by the Implementing Agency (MoH) as per the actual expenses incurred. The ESMF budget is part of the overall operational costs of the project. xii 1. Background 1.1 General An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARSCoV-2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased dramatically. On March 11, 2020, the World Health Organization (WHO) declared it as a global pandemic as the coronavirus rapidly spread across the world. As of May 25, 2021, the outbreak has resulted in an estimated 167,454,138 cases and 3,476,320 deaths in more than 197 countries and territories 2 . COVID-19 is one of several emerging infectious disease (EID) outbreaks in recent decades that have emerged from animals in contact with humans, resulting in major outbreaks with significant public health and economic impacts. Following the declaration of COVID-19 as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization in January 2020, there has been a continuous increase in the number of confirmed cases globally. Lesotho confirmed its first case of COVID-19 on May 13, 2020. The infection rate has increased since then, with 10,822 confirmed cases, of whom 326 have unfortunately passed away as of May 25, 20213. In order to respond to this global pandemic, the Government of Lesotho (GoL) has been implementing (since May 2020) the Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) – the Parent Project (PP) - with World Bank (WB) financial support. The EPRP PP, with US$ 7.5 million total budget, comprises of two main components, Emergency COVID-19 Response (US$6.675 million), and Project Implementation and Monitoring & Evaluation (US$0.825 million). Under Component 1 of the PP, the three focus areas are: (i) COVID-19 case detection, confirmation, contact tracing, recording and reporting; (ii) containment, isolation and treatment through enhanced clinical care capacity; and (iii) community engagement, preventions and risk communication. Likewise, Component 2 of the PP include: (i) Project Implementation and Monitoring & Evaluation activities; and (ii) operational reviews as well as logistical support. In January 2021, the GoL requested the WB for additional resources to expand the COVID- 19 response with the objective to provide additional financing as well as technical assistance to the Ministry of Health (MOH)/GoL to adequately plan and rollout the vaccines for COVID- 19, once available. The proposed additional financing (AF) Project will be a total envelope of US$25.5 million, financed by the World Bank - International Development Association 2 Home - Johns Hopkins Coronavirus Resource Center (jhu.edu) 3 Lesotho - COVID-19 Overview - Johns Hopkins (jhu.edu) 1 (IDA) (US$22 million) and the Health Emergency Preparedness and Response Trust Fund (HEPRTF) (US$3.5 million). The Additional Financing will provide essential resources to enable an expansion of a sustained and comprehensive pandemic response that will appropriately include vaccination in Lesotho. The changes proposed for the AF entail expanding the scope of activities in the Parent Project, and adjusting its overall design. An increase in scope and cost will be required to support: (i) deployment of vaccines and accessories; (ii) upgrading the cold chain for the vaccines; (iii) strengthening service delivery to ensure effective vaccine deployment; (iv) rehabilitation of health facilities to establish two ICUs and establishing mini oxygen plants; and (v) monitoring, tracking of vaccine use and recording of any adverse reactions to vaccination. Additional Financing is also required to extend the testing, PPE, and sustained communications and promotions around NPIs which are essential to sustain throughout the vaccine roll-out. This Environmental and Social Management Framework (ESMF) has been prepared to assess and manage the environmental and social risks and impacts of the Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) and Additional Financing Project. A framework approach is chosen as the specific locations and details of the subprojects will not be known until implementation. The ESMF assists the MoH in identifying the type of environmental and social assessment that should be carried out for projects that involve the construction, expansion, rehabilitation and/or operation of healthcare facilities, and the deployment of a safe and effective vaccine in response to COVID-19, to the extent possible and based on existing information, the environmental and social management approach that should be taken at the subproject level and the E&S management plans to be developed, in accordance with the Government of Lesotho (GoL) and the World Bank (WB) Environmental and Social Framework (ESF), inter alia. The purpose of the ESMF is to guide MoH and other proponents on the environmental and social screening, assessment, and management of specific project activities during implementation. The document also provides guidance on the preparation and implementation of location specific Environmental and Social Management Plans (ESMPs), when needed, in accordance with the ESMF. Additional Financing will support the costs for expanding activities of the Lesotho COVID- 19 EPRP (P173939, the Parent Project) to enable affordable and equitable access to COVID- 19 vaccines and help ensure effective vaccine deployment in the country through enhanced vaccination system and to further strengthen preparedness and response activities under the parent project for additional US$25.5 million. The various components under the EPRP AF are summarized below. 2 Component 1: Emergency COVID-19 Response (Total of US$29.675 million including US$6.675 million IDA under the parent project, US$19.5 million IDA AF and US$3.5 million HEPR TF). Sub-component 1.1: Vaccine procurement (US$14 million IDA AF). Support for vaccines will be added as part of the containment and mitigation measures to prevent the spread of SARS-CoV- 2 and COVID-19 deaths under Component 1. This sub-component will also cover associated costs (freight and insurance, clearing and transportation, handling charges) as well as medical supplies needed for administration (e.g. needles, syringes, alcohol prep pads). Sub-component 1.2: Strengthen systems for vaccine deployment (US$5.5 million IDA AF). The AF will support investments to bring the immunization system capacity to the level required to successfully deliver COVID-19 vaccines at scale. Sub-component 1.3: Strengthen systems for the COVID-19 response (Total of US$10.175 million IDA including US$6.675 million IDA under the parent project and US$3.5 million HEPR TF AF). In line with the National COVID-19 Preparedness and Response Plan and the original activities under Component 1 in the parent project, sub-component 1.3 will also continue supporting the overall government response to COVID-19. This includes: (a) enhancing disease surveillance, improving sample collection and ensuring rapid diagnoses and carry out contact tracing to quickly contain COVID-19; (b) strengthening critical clinical care capacity; and (c) reinforcing public health measures such as social distancing, personal hygiene promotion, RCCE using local language and traditional channels to communicate the risks associated with COVID- 19. The AF will cover new activities to: (a) increase capacity for case management; (b) increase testing capacity; (c) strengthening surveillance capacity; and (d) strengthening COVID-19 data reporting and management. Component 2: Project Implementation and Monitoring and Evaluation (Total US$3.325 million including US$0.825 million IDA under the parent project and US$2.5 million IDA AF). As under the parent project, Component 2 will continue supporting the coordination and management of project activities, including procurement of goods and their distribution across health facilities, technical assistance, rapid surveys as part of the project M&E, and operating costs, among others. The Parent Project ESMF and relevant other documents - e.g., Stakeholder Engagement Plan (SEP), Environmental and Social Commitment Plan (ESCP), Labour Management Procedures (LMP), Infection Control and Waste Management Plan (ICWMP), etc. - have been updated to reflect the activities under the Additional Financing and the identified issues related to COVID-19 response based on guidance provided by the Bank. This Environmental and Social Management Framework (EMSF), and the related Infection Control and Waste Management Plan (ICWMP) (see Annex 10), have been developed to support the environment and social due diligence provisions for activities financed by the World Bank 3 Group to the Government of Lesotho (GoL)’s COVID-19 Emergency Preparedness and Response Project (P173939), and its Additional Financing (P176307). The Labor Management Procedures (LMP), also updated for the AF purposes, and the Security Management Plan (SMP) prepared during the AF design process form part of the key Environmental and Social documents. The Ministry of Health (MOH) supported by the Project Implementation Unit (PMU) which is also supporting the World Bank-financed Southern Africa Tuberculosis and Health Systems Support Project and managing the preparation of the Nutrition and Health System Strengthening Project is implementing both the Parent Project (PP), and its Additional Financing (AF). The ICWMP sets out appropriate measures for infection control and waste management during the implementation of the PP and AF activities including the deployment of a safe and effective vaccination program in response to COVID-19. The COVID-19 ESMF follows GoL and WB Environmental and Social Framework (ESF), which also mandates preparation and update of the other three documents previously issued under the PP: Environmental and Social Review Summary (ESRS), Environmental and Social Commitment Plan (ESCP), and the Stakeholder Engagement Plan (SEP). They all have been updated and disclosed during the AF preparation (updated SEP disclosed on April 6, 2021; updated ESCP disclosed on May 27, 2021). Also, as part of the GoL and WB requirements, the Ministry of Health has updated this EMSF during the AF processing stage, which shall be disclosed before the project Effectiveness date adhering to the GoL and WB legislations. 1.2. Objective, Rationale and Application of the ESMF The objective of the ESMF is to assess and mitigate potential negative environment and social (E&S) risks and impacts of the Project consistently with the relevant legislative provisions of the GoL and the WB - primarily the Environmental and Social Standards (ESSs) of the World Bank Environmental and Social Framework (ESF). Specific major objectives of the ESMF are to: a) Assess the potential E&S risks and impacts of the proposed Project and propose their mitigation measures; b) Establish procedures for the E&S screening, review, approval, and implementation of activities; c) Specify appropriate roles and responsibilities, and outline the necessary reporting procedures, for managing and monitoring E&S issues/ concerns related to the EPRP activities; d) Identify the training and capacity building needed to successfully implement the provisions of the ESMF; e) Address mechanisms for public consultation and disclosure of Project documents as well as redress of possible grievances; and f) Establish the budget requirements for implementation of the ESMF. The ESMF sets out principles, rules and guidelines and procedures to the MOH and external consultants and contractors (if any of them is engaged in the Project activities) to assess and 4 manage expected environmental and social risks and impacts throughout all stages of the Project. This ESMF is connected to the Stakeholder Engagement Plan (SEP & GRM) and other specific plans (such as ESCP, LMP, ICWMP etc.) that have been prepared for the Parent Project and updated during the AF Project preparations. This ESMF will be applied to all activities (works, procurement of goods/services, vaccination campaign, technical assistance, etc.) to be financed by the Project and/or its subprojects. The ESMF includes guidance for the preparation of site specific Environmental and Social Management Plans (ESMPs) (see Annex 3) for the civil works and rehabilitation to be supported under the Project. The ESMF also includes extracts from World Bank Group Environment Health and Safety (EHS) Guidelines, including EHS checklists (Annex 5), resource list on COVID-19 (Annex 6), and Codes of Conduct including measures to prevent gender-based violence, sexual exploitation or abuse/harassment (SEA/SH action plan), and security. These will be prepared prior to commencement of civil works wherever applicable. The ESMF will be guided by the GoL legislations, World Bank ESF, WB Group EHS Guidelines (EHSGs), relevant WHO Guidelines and other international/regional guidelines on healthcare facilities and additional resources on good international industry practice (GIIP) found in these Guidelines. The ESMF is applicable to all investments/activities under the EPRP, including the AF components. The ESMF will be integrated into the preparation and implementation stages of the various Project components. It is an essential ingredient aligned with the Project/subproject activities and it will be followed through the entire Project cycle from planning, including site identification; design; implementation and operation/maintenance to attain the above outlined purposes and objectives. This ESMF will be applied to all Project activities (such as rehabilitation works, procurement of good/services, technical assistance, etc.) to be financed by the project and/or its subprojects. 1.3. Key Contents of the Environmental and Social Management Framework The framework describes the principles, objectives and approach to be followed for selecting, avoiding, minimizing and/or mitigating the adverse environmental and social impacts that are likely to arise due to the Project. The framework details out the various policies, standards, guidelines and procedures that need to be integrated during the planning, design and implementation cycle of the Bank-funded Project. It also outlines the indicative management measures required to effectively address or deal with the key issues that have been identified. The required institutional arrangements for effective environment management have also been outlined as a part of this framework. Specifically, the Environmental and Social Management Framework includes the following: 5 a. Information on the Government of Lesotho’s environmental legislations, standards and policies, the World Bank Environmental and Social Standards, WB Group EHS Guidelines (EHSGs), and WHO guidelines that are applicable to the overall Project context; b. Environmental and social baseline information; c. Description of the stakeholder consultation and engagement process; d. Process to be followed for environmental screening to guide decision-making about proposed sub-projects; e. Steps and process to be followed for conducting environmental and social assessment and preparation of Environmental and Social Management Plans for selected sub-projects; f. Preliminary assessment of anticipated environmental and social impacts in the context of broad/known Project interventions; g. Generic environment and social management measures to avoid, minimize and mitigate anticipated impacts; and h. Institutional arrangements for environment and social management, including monitoring and reporting. 1.4. Revision/Modification of the ESMF An ESMF was prepared and disclosed in August 2020 for the parent project (P173939), which has been updated in June 2021 to accommodate the components and activities under the proposed Additional Financing project (P176307). The ESMF will be an “up-to-date‟ or a “living document‟ enabling revision, when and where necessary. Unexpected situations and/or changes in the project or subproject design would therefore be assessed and appropriate management measures incorporated by further updating the ESMF as may be required. Such revisions will also cover and update any changes/modifications introduced in the legal/regulatory regime of the country/state. Also, based on the experience of application and implementation of this framework, the provisions and procedures would be updated, as appropriate, in consultation with the World Bank and the implementing agencies/departments. 6 2. Project Description 2.1. Background The Lesotho COVID-19 Emergency Preparedness and Response Project is aligned with “Component 1 Emergency COVID-19 Response� of the global MPA (P173789) and includes two components: (a) Emergency COVID-19 Response; and (b) Project Implementation and Monitoring & Evaluation. The Project design also considers good practices from other projects in the region responding to the COVID-19 pandemic. The Parent Project has been providing immediate support to prevent and limit the local transmission of the SARS-CoV-2 virus through detection, containment and treatment strategies, community engagement, and relevant and cost-effective WASH measures not already covered by other sectors. It has enabled mobilization of personal protective equipment (PPE), sterilization capacity and surge response capacity, and trained and well- equipped frontline health workers for surveillance and treatment. As noted in the project paper for the AF, the parent project is progressing satisfactorily. With funds and technical support, the MoH has enhanced case investigation and contact tracing at the national and district levels; strengthened health facilities with isolation capacity; and supported new/rehabilitated ICU beds and facilities in selected public hospitals for managing public health emergences. Risk communication messages are delivered to the public through multiple channels including media briefings, radio, televisions, and online applications. The project’s progress towards achievement of the PDO and overall implementation progress were both rated Satisfactory in the last Implementation Status and Results Report (ISR) of April 13, 2021, and the project continues to make good progress. The parent project has supported the procurement of critical equipment and medical supplies, additional human resources (HR), training for both specialized and community health workers, and refurbishment of the Mafeteng COVID-19 treatment center, which provides critical medical care for COVID-19 patients. All PDO level indicators have either been achieved or surpassed: 93 percent of diagnosed cases have been treated as per protocol, 52,593 suspected cases of COVID- 19 have been reported and investigated, and the proportion of COVID-19 cases among facility- based health care workers has been kept below 20 percent. Six of seven intermediate result indicators (IRIs) have reached or surpassed their targets. However, both the lack of PPE and individual behavior have limited the percentage of health workers using appropriate PPE to date. The PPE procured under the project were delivered in February 2021 and the GoL has recently conducted hands on training at health facilities to improve infection prevention and control (IPC). Critical gaps remain in the COVID-19 response 7 particularly with the evolving epidemic context, which the AF will help address in addition to financing vaccine procurement and deployment. These gaps include limited diagnostic capacity to scale up testing and improve turn-around times for results, inadequate supply of PPE, a fragmented information system that does not adequately capture and track COVID-19 cases, and limited capacity to decentralize critical medical care to the regions. On community perception issues including stigmatization, the AF SEP expresses the need for key messages to address ill-informed perceptions, address hesitancy, and generate community support for the AF activities. The PDO of the parent project and of this AF is to prevent, detect and respond to the threat posed by COVID-19 in the Kingdom of Lesotho. The parent project includes two components: (1) Emergency COVID-19 Response (US$6.675 million); and (2) Project Implementation and Monitoring and Evaluation (US$0.825 million). Component 1 of the parent project comprises three focus areas: (a) COVID-19 case detection, confirmation, contact tracing, recording and reporting; (b) Containment, isolation and treatment through enhanced clinical care capacity; and (c) Community engagement, prevention and risk communication. Component 2 of the parent project supports program coordination, management and monitoring, operational support and logistics, and project management. The AF will expand Lesotho’s COVID-19 response through adding to Component 1: (a) co- financing vaccine procurement to reach at least 50 percent of the country’s population, prioritizing the most vulnerable, (b) strengthening the systems required to support effective and efficient vaccine deployment under four core areas: planning and management, supply and distribution, program delivery, supporting systems and infrastructure; and (c) filling critical gaps in the existing overall COVID-19 response; and to Component 2: Project Implementation and Monitoring and Evaluation. To support the GoL’s vaccination planning, the AF will finance technical and operational assistance to support Lesotho to establish institutional frameworks for the safe and effective deployment of vaccines. While the WHO is taking the lead in providing technical assistance in this area, the AF will contribute to operationalize the policies and guidelines. In particular, the AF will support strengthening of institutional frameworks for effective pharmacovigilance (e.g., reviving of the adverse events following immunization (AEFI) committee, training on AEFI at the district and community level) as well as the creation of accountability, grievances, and citizen and community engagement mechanisms. The changes proposed for the AF entail the inclusion of vaccine financing and expansion of the scope of activities in the parent project, Lesotho COVID-19 EPRP, adjusting its overall design. The AF will support the GoL’s efforts to further strengthen its response to the COVID-19 pandemic by purchasing vaccines, preparing the health system for the deployment of the COVID-19 vaccines, and supporting their distribution and administration. Moreover, the AF will increase development effectiveness of the parent project by addressing emerging gaps in the COVID-19 response. 8 2.2. Project Development Objective The overall objective of the EPRP parent project is to prevent, detect and respond to the threat posed by COVID-19 to the Kingdom of Lesotho. This remains unchanged for the AF project. 2.3. Project Components To strengthen Lesotho's national systems for public health preparedness and support the achievement of the PDOs, the Parent Project consists of two interlinked components. Component 1: Emergency COVID-19 Response (US$6.675 million) Strengthen COVID-19 Case Detection, Confirmation, Contact Tracing, Recording and Reporting. This component has been supporting the GoL to enhance disease surveillance, improve sample collection and transportation, and ensure rapid laboratory confirmed diagnoses to promptly detect all potential COVID-19 cases and to carry out contact tracing to quickly contain COVID-19. The focus is on: (a) screening travellers at all nine ports of entry (Maseru airport and cross-border areas) as well as priority communities and targeted health facilities; (b) diagnosing cases by setting up designated testing and laboratory sites, including inter alia through development of ‘minilabs’ using available GeneXpert machines, other Polymerase Chain Reaction (PCR) technologies and SARS-CoV-2 testing cartridges; (c) carrying out contact tracing to minimize risk of transmission; (d) conducting risk assessments to identify hotspot areas of transmission, including digital maps that can help visualize transmission; (e) providing on-time data and information for guiding decision-making and response and mitigation activities; and (f) referring cases for quarantining and/or treatment as needed. Additional support is being provided to strengthen health management information system (specifically the COVID-19 module of district health information system (DHIS2) that has been developed for this purpose) to facilitate recording and sharing of information on COVID-19 patients. To this end, the PP has been supporting with: (a) medical supplies and equipment (e.g. thermometers and thermo scanners in places where people gather); PCR test kits for diagnoses; serology test kits for serological surveillance; drugs; laboratory equipment and supplies; health workers’ personal protective equipment, and the ability to sterilize such equipment, as applicable; (b) training and capacity building for frontline health workers; and (c) operating costs for Rapid Response Teams and (d) recruitment of additional personnel. The PP has been supporting efforts to align responses with South Africa and seek appropriate cross border collaboration by leveraging existing bilateral arrangements for case detection, confirmation, contact tracing, recording and reporting. This support is aligned with Pillar 3 Surveillance, rapid response and case investigation, Pillar 4 Points of entry and Pillar 5 9 Laboratory services of the Lesotho National Integrated Response Plan and the WHO COVID- 19 Strategic Preparedness and Response Plan. Containment, Isolation and Treatment through enhanced Clinical Care Capacity have been also ongoing under the PP. With respect to clinical care, the project has been supporting the government to establish and enhance isolation and clinical care capacity for infected patients. The support is enhancing triaging and treating COVID-19 cases. The goal is to refurbish and adapt existing structures with necessary equipment, and leverage isolation units established for other infectious diseases to make efficient use of existing structures. To support providers to triage and provide urgently needed care to sick patients, the project has been supporting in ensuring enhanced capacity so that health personnel are well protected and work in a safe and secure environment. To this end, the project has been funding: a) medical and laboratory equipment and supplies, waste management equipment and supplies, and video conferencing equipment for telemedicine; b) contracted telemedicine services for either consulting on COVID-19 cases or to provide alternative ways for the population to access routine health services; and c) operating costs, including temporary recruitment of additional clinical personnel. Under the PP, support is being provided also to ensure the operations of effective case containment and treatment though IPC measures which must always be enforced with necessary equipment, commodities and basic infrastructure. Psychosocial and essential social support is being provided to those who are in designated isolation/treatment centres with consideration of gender sensitivity and special care for people with disabilities and/or chronic conditions, including through services of additional trained health workers. This support is aligned with Pillar 5 (Laboratory services), Pillar 6 (Infection prevention and control) and Pillar 7 (Case management) of the Lesotho National Integrated Response Plan and the WHO COVID-19 Strategic Preparedness and Response Plan. Community Engagement, Prevention and Risk Communication. An effective intervention to prevent contracting a respiratory virus such as SARS-CoV-2 is to strictly limit physical contact through social distancing measures, and especially to cocoon the vulnerable, including individuals over 60 years and those with co-morbidities and/or those who are immunocompromised. This is particularly important in Lesotho with very high prevalence of HIV and TB. This component has been supporting the reinforcement of policies and measures including: social distancing (e.g. border closings; work-at- home policies; restricting public gatherings); personal hygiene promotion, including promotion of proper handwashing behaviour (frequency and improved practice) and use of hand sanitizers, food hygiene and safe water practices and safe cooking practices; and risk communication and community engagement using local channels (e.g. national radio and other IT related tools) to disseminate messages about the risks associated with COVID-19, providing reminders for treatment adherence and applying innovative digital solutions such as use of mobile applications for 10 sending out advisories. Accordingly, the Parent Project has been supporting in: a) production and dissemination of communication materials (including in digital form) and organization of national and local campaigns to raise awareness; b) establishment of data analytics capability to improve targeting and measure effectiveness; and c) large-scale production and distribution of face masks and sanitation materials, including locally produced alcohol- based hand rubs, especially for high-density and high-risk areas. Financing is being made available to develop guidelines on social distancing measures (e.g., in phases) to operationalize existing or new laws and regulations, support coordination among sectoral ministries and agencies, and support the MOH on the care of health and other frontline personnel involved in pandemic control activities with IPC measures and psychosocial support when distressed. This is aligned with Pillar 2 (Advocacy, Risk Communication and Community Engagement) and Pillar 6 (Infection prevention and control) of the Lesotho National Integrated Response Plan and the WHO COVID-19 Strategic Preparedness and Response Plan. To support the GoL’s vaccination planning, the AF will finance technical and operational assistance to support Lesotho to establish institutional frameworks for the safe and effective deployment of vaccines. While the WHO is taking the lead in providing technical assistance in this area, the AF will contribute to operationalize the policies and guidelines. In particular, the AF will support strengthening of institutional frameworks for effective pharmacovigilance (e.g., reviving of the AEFI committee, training on AEFI at the district and community level) as well as the creation of accountability, grievances, and citizen and community engagement mechanisms. The changes proposed for the AF entail the inclusion of vaccine financing and expansion of the scope of activities in the parent project, Lesotho COVID-19 EPRP, adjusting its overall design. The AF will support the GoL’s efforts to further strengthen its response to the COVID-19 pandemic by purchasing vaccines, preparing the health system for the deployment of the COVID-19 vaccines, and supporting their distribution and administration. Moreover, the AF will increase development effectiveness of the parent project by addressing emerging gaps in the COVID-19 response. The AF involves adding three sub-components under Component 1: Emergency COVID-19 Response: (a) COVID-19 vaccines procurement, (b) strengthen systems for vaccine deployment, and (c) strengthen systems for the COVID-19 response, i.e., scale up activities under the parent project. Component 2: Project Implementation and Monitoring and Evaluation will continue to support the activities defined under the parent project but will be expanded as per the description of implementation arrangements. As the proposed activities to be funded under the AF for Lesotho are aligned with the original PDO, the PDO will remain unchanged. The content of the components and the Results Framework of the parent project are adjusted to reflect the new activities proposed under the AF and the expanded scope. The implementation arrangements will be adjusted to implement the AF, including through 11 strengthening the PIU and introducing a steering committee. New requirements to be tracked for all COVID-19 operations approved in FY21 will apply to this AF, namely: gender tag, citizen engagement framework, and climate and disaster screening requirements and climate co-benefit commitments. Given uncertainties related to the availability of vaccines globally and their efficacy against new variants of the virus, the closing date will be extended by two years from June 30, 2022 to June 30, 2024. The EPRP AF involves adding three sub-components under Component 1: Emergency COVID-19 Response: (a) COVID-19 vaccines procurement, (b) strengthen systems for vaccine deployment, and (c) strengthen systems for the COVID-19 response, i.e., scale up activities under the parent project. Likewise, Component 2 (Project Implementation and Monitoring and Evaluation) will continue to support the activities defined under the parent project but will be expanded as per the description of implementation arrangements. The EPRP Additional Financing project components and activities are further detailed below. Component 1: Emergency COVID-19 Response (Total of US$29.675 million including US$6.675 million IDA under the parent project, US$19.5 million IDA AF and US$3.5 million HEPR TF). Sub-component 1.1: Vaccine procurement (US$14 million IDA AF). Support for vaccines will be added as part of the containment and mitigation measures to prevent the spread of SARS-CoV- 2 and COVID-19 deaths under Component 1. This sub-component will also cover associated costs (freight and insurance, clearing and transportation, handling charges) as well as medical supplies needed for administration (e.g. needles, syringes, alcohol prep pads). Given the recent emergence of COVID-19, there is no conclusive data available on the duration of immunity that vaccines will provide. While some evidence suggests that an enduring response will occur, this will not be known with certainty until clinical trials follow participants for several years. As such, this AF will allow for re-vaccination efforts if they are warranted by peer-reviewed scientific evidence at the time. In the case that re-vaccination is required, limited priority populations (such as health workers and the elderly) will need to be targeted for re-vaccination given constraints on vaccine production capacity and equity considerations (i.e., tradeoffs between broader population coverage and re-vaccination). Sub-component 1.2: Strengthen systems for vaccine deployment (US$5.5 million IDA AF). The AF will support investments to bring the immunization system capacity to the level required to successfully deliver COVID-19 vaccines at scale. The AF is geared to assist the GoL, working closely with the WHO, the UNICEF and other Development Partners (DPs), to overcome bottlenecks as identified in the country’s COVID-19 vaccine readiness assessment. Envisioned support includes distribution and administration of vaccines and strengthening the immunization supply chain system, including: 12 a) procurement and distribution of ancillary supply kits that may include COVID-19 vaccination record cards for each vaccine recipient and PPE for vaccinators; b) supporting the administration of vaccines including training health workers in vaccine distribution, administration, and climate disaster response, micro-planning activities for rollout, development of contingency plans to maintain vaccination campaigns during climate shocks, and outreach sessions to reach specific target groups as well as people living in remote areas (e.g., operating costs, vehicles); c) strengthening the supply chain and logistics systems including financing climate friendly cold-chain equipment to comply with the cold-chain requirements of different vaccines and the construction of the Maseru district vaccine store; d) undertaking relevant traceability activities to ensure capabilities for the system to track and trace from production to the target population; e) strengthening post-vaccination vigilance and monitoring system(s) to identify any adverse reactions on people and undertake corrective measures immediately; f) conducting focused group discussions at community level targeting different stakeholders to gather information and adapt immunization rollout; g) developing and distributing risk communication products for COVID-19 vaccination, including communication on the risks and response to climate shocks; and h) ensuring adequate medical waste management. Sub-component 1.3: Strengthen systems for the COVID-19 response (Total of US$10.175 million IDA including US$6.675 million IDA under the parent project and US$3.5 million HEPR TF AF). In line with the National COVID-19 Preparedness and Response Plan and the original activities under Component 1 in the parent project, sub-component 1.3 will also continue supporting the overall government response to COVID-19. This includes: a) enhancing disease surveillance, improving sample collection and ensuring rapid diagnoses to promptly detect all potential COVID-19 cases and carry out contact tracing to quickly contain COVID-19; b) strengthening critical clinical care capacity, including enhancing isolation and treatment capacity for infected patients in the country; and c) reinforcing public health measures such as social distancing, personal hygiene promotion, RCCE using local language and traditional channels to communicate the risks associated with COVID-19. The AF will cover new activities to: (a) increase capacity for case management such as through refurbishment of two intensive care units (ICUs) with minor civil works, supervision and mentoring visits, training of ICU staff, increased availability of oxygen through procurement of equipment and supplies and establishment of two mini-plants, and procurement of medical supplies including PPE; 13 (b) increase testing capacity such as through expansion of the polymerase chain reaction (PCR) laboratory within the National Reference Laboratory (NRL); enhanced and decentralized testing capacity using multiple modalities (such as using the existing PCR instrument used for human immunodeficiency virus (HIV)/tuberculosis testing (GeneXpert) as well as procuring WHO-approved antigen test kits that can be scaled up rapidly in the community through mobile testing centers at low cost); (c) strengthen surveillance capacity; and (d) strengthen COVID-19 data reporting and management across the board, including support for COVID-19 vaccination specific M&E and surveillance strengthening, which will apply to COVID-19 as well as other climate-induced, vaccine preventable diseases. Component 2: Project Implementation and Monitoring and Evaluation (Total US$3.325 million including US$0.825 million IDA under the parent project and US$2.5 million IDA AF). As under the parent project, the current Component 2 will continue supporting the coordination and management of project activities, including procurement of goods and their distribution across health facilities, technical assistance, rapid surveys as part of the project M&E, and operating costs. This will include a client feedback survey through digital health solutions to gather iterative feedback on project implementation, especially of immunization activities. The capacity of the PIU will also further be enhanced. The implementation arrangements will be adjusted to implement the AF, including through strengthening the PIU and introducing a steering committee. New requirements to be tracked for all COVID-19 operations approved in FY21 will apply to this AF, namely: gender tag, citizen engagement framework, and climate and disaster screening requirements and climate co-benefit commitments. Given uncertainties related to the availability of vaccines globally and their efficacy against new variants of the virus, the closing date will be extended by two years from June 30, 2022 to June 30, 2024. Citizen Engagement: The project will build upon the existing citizen engagement and grievance redress mechanisms (GRMs) already in use by the MoH for the three World Bank- financed health projects. However, the existing GRM needs to include both provider- triggered and beneficiary-triggered GRM to enable stakeholders to register complaints on any health issue affecting them and their communities through a short message system (SMS) at no cost to them. This will be the beneficiary-triggered GRM system, which will allow to collect beneficiary feedback from all who get immunized (asking them to rate the care they received on both clinical and non-clinical aspects) and to register any grievance they might have on the health care received for that visit. In order to ensure proper recording of citizen feedback and closing the feedback loop, the project will also implement an iterative beneficiary monitoring as well as social media surveys to inform the public about COVID-19 vaccine roll out approach. For example, lessons from the current national vaccination 14 program, community outreach, advocacy and information sharing activities have allowed the government to collect information on community values, beliefs and attitudes toward vaccination which will be critical to implement the COVID-19 national deployment and vaccination plan (NDVP) for all target populations. The iterative beneficiary monitoring as well as social media surveys and engagement with community and religious leaders, especially in remote areas, will ensure the inclusion of ongoing feedback in the roll-out and implementation of the COVID-19 vaccination campaign to strengthen targeting accuracy and increased uptake. Moreover, the COVID-19 vaccination campaign will go beyond using traditional outreach and citizen engagement strategies to reach those living in remote areas as well as the priority groups such as people with co-morbidities and older populations who may face mobility barriers as well as barriers accessing information. These target populations are less likely to use social media or live close to a health center. In addition, most of the remote rural communities comprise the elderly, illiterate, poor and those that do not have access to television, radio or internet. This requires a more customized approach to reaching, mobilizing and engaging with these priority groups. The updated SEP acknowledges the particular challenges with engaging marginalized and vulnerable social groups and propose possible solutions such as using simple graphics, translating communication materials into Sesotho and engaging grassroots level community-based organizations and local governance structures. Acquiring feedback from initial efforts to deploy the COVID-19 vaccine will also be essential to compile lessons learned on an ongoing basis, and to inform subsequent efforts for outreach and vaccine deployment for other population groups. Local and international non-governmental organizations which are already stakeholders in this project will be mobilized to support engagement with these target populations and collect feedback during project implementation. The project will conduct citizens engagement through the following activities, in alignment with the SEP: (a) inform stakeholders about the project, its objectives, and importance. The MoH will provide relevant information about the project using free text alerts, and community gatherings (where safe to do so), and engaging various community platforms such as local councilors, community councilors, religious leaders, chieftains and village health committee meetings; (b) consult the community to establish their needs and perceptions about the COVID-19 vaccines. This will include conducting focus group discussions with the community to understand their perceptions, socio-cultural norms and values, beliefs and attitudes towards vaccination which will provide critical inputs to implement the national vaccination deployment plan for all target populations. The PIU will then work closely with the EPI to address these barriers and monitor uptake of vaccines; and (c) gather feedback, grievance, and inputs from the stakeholders from the project GRM through community consultations, village health worker outreach sessions, and from client satisfaction surveys. This will facilitate continuous learning and improve project monitoring and outcomes. This 15 information will be consolidated by the PIU who will work with the MoH to analyze the information and close the feedback loop. Communication materials to be developed will also be clear and concise and in a format and language that is understandable to all people (Sesotho), in particular the most vulnerable. This will require different types of media (e.g., radio, print, broadcast, digital or new media), public gatherings (following COVID-19 regulations) as well as engaging existing formal and informal public health and community- based networks (e.g., schools, churches, healthcare service providers at local level). Vulnerable groups will further be reached through their respective representatives such as community-based organizations, interest groups and local and traditional authorities. The measures to address environmental and social risks in the parent project remain relevant, including infection prevention and control (IPC) improvements in health facilities and assessment and mitigation measures for medical waste risk management that will be expanded as inoculation sites expand. Experience indicates that moderate environmental risks can be expected if medical waste and OHS risks are well-managed. These risks will be mitigated through several measures to ensure vaccine delivery targets the most vulnerable and remote populations in accordance with criteria specified in the NDVP and other pertinent documents. Environmental and social instruments prepared under the parent project have been updated to incorporate activities to be financed under the AF. These instruments include ESCP, ESMF including LMP, SEP, SMP, GBV/SEA/SH plan, and ICWMP. The updated ESMF also incorporates international protocols for community health and safety during a pandemic and measures to address GBV/SEA. As part of the Environmental and Social Framework requirements, the project will continue to implement measures to mitigate the risks of SEA/SH. The ESMF has been consulted with stakeholders using the modified approach currently being promoted by the WHO and shall be publicly disclosed per the requirements of the ESMF before project Effectiveness date. The project implementation will ensure appropriate stakeholder engagement, proper awareness raising and timely information dissemination. This will help: (a) avoid conflicts resulting from false rumors; (b) ensure equitable access to services for all who need it (refugees, migrants and South African nationals residing in Lesotho will be eligible for the vaccine); and (c) address issues resulting from people being kept in quarantine. These will be guided by standards set out by the WHO as well as other international good practices including social inclusion and prevention of SEA and SH. The World Bank will support the GoL to develop and adapt explicit, contextually appropriate, and well-communicated criteria for accessing vaccines. All targeting criteria and implementation plans will be reflected in the country’s national vaccination program and communication plan. The Borrower will ensure that this plan be subject to timely and meaningful consultations in accordance with Environmental and Social Standard (ESS) 10 of the World Bank ESF. Moreover, the RCCE will be further strengthened to prevent stigma and discrimination against the suspected and COVID-19 survivors as well as socio-economically marginalized groups with substantial consideration of gender. 16 The risks from the use of government security personnel for transportation of vaccination to remote rural areas using helicopters and to keep medical workers and storage facilities safe has been reassessed and updated as part of the updated ESMF to ensure that the use of the military personnel in project activities does not result in adverse consequences to community health and safety, including in matters relating to SEA/SH. The military has already established rules of engagement with civilian authorities, which the project will further review and strengthen where necessary. The updated ESMF includes a security management plan (Annex 15 to the ESMF) guided by the principles of proportionality and Good International Industry Practice. The security management plan will be effectively implemented to ensure that military/security personnel follow a strict code of conduct in line with the pertinent legislations of the GoL, ESS4 of the World Bank ESF, and the SMP, inter alia. The project will further mitigate ESS risks by: (a) strengthening capacity of the implementing agencies; (b) developing a procurement plan with appropriate cost estimates, quantities, and selection methods; (c) fielding a qualified community liaison officer and a social specialist with experience in public works and closely monitoring implementation of the ESCP, ESMF, SEP and other applicable E&S tools and instruments; (d) implementing OHS standards and specific IPC strategies, guidelines and requirements as recommended by WHO; and (e) ensuring effective administrative and infection-controlling and engineering controls to minimize environmental and social risks. Climate Vulnerability and Resilience. This project has been screened for climate and disaster risks. Lesotho’s exposure to current climate and disaster risk is rated Moderate, and to future climate and disaster risk is rated High. Lesotho experiences extreme temperature, extreme precipitation, drought, localized fording and wildfire. An increase in the number of hot days and nights (and hottest days) and a decrease in the number of cold days and nights has been observed in the country in recent decades. The mean annual temperature in Lesotho has increased by 0.76° C between 1970 and 2001. Droughts are becoming more frequent in recent years, resulting in a steep reduction in the production of cereals and other staple crops. With agriculture as one of the major economic activities and over 70 percent of the population living in rural areas, climate and disaster risks result in food insecurity and consequently malnutrition. Additionally, research in Lesotho has documented that loss of agriculture production, caused by severe drought, was associated with increased risk for HIV-related behaviors, especially among women and adolescent girls 4 . Furthermore, climate and geophysical hazards may slightly affect project activities. For example, heat stress on health workers may slightly curb their capacity to distribute vaccines. Finally, while both COVID- 19 and the climate crisis impact everyone, it is the poor and marginalized who suffer the most. Both crises exacerbate and create an additional burden for many who lack adequate access to 4Andrea et al. 2019. Association between severe drought and HIV prevention and care behaviors in Lesotho: A population- based survey 2016–2017. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1002727 17 clean water, clean air, adequate shelter, nutritious food, a dependable supply of energy and decent healthcare. Measures to address these twin crises must be implemented through the lens of assuring greater equity in access to basic needs and services. Lesotho has demonstrated its commitment to addressing climate change. The country ratified the Paris Agreement and submitted a National Determined Contribution in June 2018. The National Determined Contribution puts forth several adaptation and mitigation activities to tackle the country’s vulnerabilities to climate change. Adaptation initiatives include capacity building and policy reform to integrate climate change in sectoral development plans, and improvement of an early warning system against climate induced disasters and hazards. Mitigation targets plan to reduce greenhouse gas emissions across five key sectors: energy, industrial processes, agriculture, land-use, and waste. The Ministry of Energy and Meteorology also instituted a Climate Change Policy in 2017, which translates the National Vision 2020 and the National Strategic Development Plan into concrete actions to address climate change. The proposed climate-related activities in this project will support Lesotho’s national climate agenda. The AF plans to enhance climate resiliency and intends to address climate vulnerabilities through the climate adaptation measures outlined below. Although the country is currently moderately vulnerable to the impacts of climate change, the risk to impact on project activities is rated Low, based on climate adaptation measures to be financed by the project. Sub-component 1.2: Strengthen systems for vaccine deployment (US$5.5 million IDA AF) Strengthening the disease surveillance system. The AF will support the implementation of the COVID-19 NDVP and most importantly strengthen surveillance systems enabling Lesotho to better respond to future climate related outbreaks such as rotavirus, cholera, and meningitis (under sub-component 1.2). Community outreach and sensitization. Outreach activities and communications materials will be developed in Sesotho and simple graphics will include training modules and communication materials to help increase the population’s awareness of climate-related risks and how to respond to extreme weather events (heat, flooding). The AF will finance inclusive community outreach activities, aiming to raise knowledge of and demand for COVID-19 vaccinations as well as vaccines for climate-induced, vaccine preventable diseases (ex: cholera, typhoid, and meningitis). This will include training modules and communication materials sensitizing the population on the risks related to heat waves and flooding. Training of health workers on modules responding to climate risk and climate related health consequences. The AF will support COVID-19 related training (demand generation, vaccination, cold chain management, disease surveillance) of health workers to carry out vaccination, especially those that are equipped to respond to highly stressful emergency 18 situations. These trainings will include specific modules educating health workers on climate related risks and how to respond to climate risks such as extreme weather events (ex: flooding and heatwaves). Climate related risks and response will also be integrated in training materials. Digital health vaccine management system. The project will support the operationalization of a digital vaccine registration and monitoring system which will be based on the open source district health information software (DHIS2) tracker. This system investments will lay the foundation for both COVID-19 and other vaccine preventable diseases including climate- induced, vaccine preventable diseases. Contingency plans for extreme climactic shocks. The AF will strengthen Lesotho’s preparedness and response to health emergencies. Specifically, to reduce the impact of climactic events on project activities, the AF will finance development of contingency plans for vaccination during climactic shocks, including extreme heat and floods. Plans will include actions to mitigate against the consequences of climactic events (e.g., protecting vaccination supplies from flooding and extreme heat) and to adjust vaccination activities during climactic events (e.g., community outreach during floods). Component 2: Project Implementation and Monitoring and Evaluation (Total US$2.5 million IDA AF). Beneficiaries feedback mechanism. The AF will finance a phone based digital health system to track beneficiaries’ feedback from all who seek/receive immunization/health services, asking them to rate the care they received on both clinical and non-clinical aspects and to register any grievance they might have on the health care received for that visit. This system investments will apply to COVID-19 vaccine first but will lay the foundation for other vaccine-preventable diseases including climate-induced, vaccine preventable diseases. The AF intends to mitigate against greenhouse gas emissions through the following strategies: Sub-component 1.2: Strengthen systems for vaccine deployment (US$5.5 million IDA AF) Cold storage technology. The AF will help the GoL strengthen its supply-chain systems to not only ensure continuous provision of healthcare during the current pandemic, but also enhance health sector capacity to respond to future climate-related crises. The AF will finance the procurement of ultra-cold chain freezers and vaccines carriers and the selection of such technologies for vaccine delivery and storage will prioritize available, affordable, WHO pre- qualified equipment or other validated technologies that are energy efficient. In addition, the project will install temperature controls and monitoring systems on the refrigerators and 19 freezers, which will help cut down on excessive use of energy and reducing the project’s impact on greenhouse gas emissions. Gender considerations are critical when designing policies and interventions in emergency situations and pandemics, especially for the COVID-19 response. The pandemic has aggravated gender inequalities which, in turn, have amplified the negative impacts of the pandemic in the country. For instance, the pandemic is deepening already existing gender inequalities across every sphere, with women bearing the highest impacts as they are the main care givers and comprise the majority of the frontline workers. This AF will therefore support mitigation measures to promote a gender-sensitive COVID-19 response including gender- disaggregated monitoring systems, where possible. To mitigate the disproportionate impact of the pandemic on women, the AF will apply a gender lens to the project interventions. These include: (a) continuing supporting communication campaigns that include messages to minimize psychological impact such as appropriate care for sick family members, resources available to women, and coping strategies; (b) providing targeted community messages on SEA/SH as well as other vaccines related misinformation (e.g., misconceptions about vaccines causing fertility problems, stigmatization of workers administering vaccines, immunization information for pregnant women, messaging to prevent adolescent fertility); (c) ensuring that MoH guidelines for pandemic preparedness, response and vaccine plans consider the unique needs of vulnerable and marginalized populations as well as gendered roles and responsibilities, and social norms; (d) recognizing the status of community volunteers to enhance support of family and communities; and (e) collecting and reporting gender disaggregated data on core COVID-19 indicators wherever possible including on the share of females vaccinated, share of female health care workers trained on COVID-19 vaccination deployment, and the number of communication sessions targeting gender-specific concerns. Deployment of a safe and effective vaccine has potential to reduce these additional burdens placed on women due to the COVID-19 pandemic. The GoL has confirmed that vaccine services will be provided free of charge, hence service fees are not expected to represent a financial barrier for women to be immunized. Moreover, the service delivery strategy envisions outreach services for hard-to-reach areas and health care workers are among the 20 prioritized group, thus further contributing to ensuring that women will access vaccination services. 2.4. Eligibility Criteria for Exclusion of Subprojects To avoid and/or minimize the adverse impacts of the project, some activities are predetermined as ineligible for project financing and support due to their potential for causing high social and environmental risks and impacts that are diverse, irreversible, or unprecedented. These activities have been noted in the project’s Environmental and Social Commitment Plan (ESCP) and include the following: a) Activities that may cause long term, permanent and/or irreversible (e.g., loss of major natural habitat) adverse impacts; b) Activities that have high probability of causing serious adverse effects to human health and/or the environment not related to treatment of COVID19 cases; c) Activities that may have significant adverse social impacts and may give rise to significant social conflict; d) Activities that may affect lands or rights of vulnerable minorities/communities; e) Activities that may involve permanent involuntary resettlement, including physical and/or economical displacement, and/or land acquisition, and/or adverse impacts on cultural heritage; f) Activities that involve actions by the police or the military that requires use of forceful measures resulting in violation of human rights. g) Activities that block the access to or use of land, water points, etc. used by others. h) Activities that may intentionally cause or give rise to Gender Based Violence (GBV), Sexual Exploitation and Abuse (SEA), and Deny Human rights, Discrimination and Racism. i) Activities that are likely to increase rise to COVID-19 infections or loss of life. 2.5. Project Area and Beneficiaries The Project will be implemented countrywide. The expected Project beneficiaries will be health workers, the population-at-large, infected individuals, at-risk populations, particularly the elderly, people with chronic conditions, medical and emergency personnel, medical and testing facilities, and public health agencies engaged in the response in Lesotho. The proposed Project will make specific efforts to reach the most vulnerable communities, including poor households, remote communities, female-headed households, people with a disability and other populations that are at high risk of epidemic disease. 21 In the case of vaccine deployment, the country will roll out the vaccine in three phases. About 430 115 people will be targeted in the first phase. This constitutes about 20% of the country’s population. The priority beneficiaries to this first batch of vaccine will be the health care workers, Border Control Officials, and Port Health Officials, people with co-morbidities and all the elderly population 5 . In phase two, the country is targeting 394 000 people (around 18% of the population). The targeted priority groups in this regard are; people with co-morbidities, clothing and textile factory workers, people working in the mining sector, law enforcement officers (police and military), correctional services officers and prisoner, and students and teachers. In phase three, 591 000 people (around 27% of the population) will be targeted. This will constitute of people 16 years and above who were not eligible in phase one and two. Priority will be given to the Figure 1: Project Location Map upper age brackets, starting with those aged 59 years. 5 Defined as those that are 60 years and above 22 Policy, Legal and Regulatory Framework Activities under the project will be operationalized in a way that they are consistent with the relevant laws, regulations, policies of the Government of Lesotho, the World Bank’s Environmental and Social Standards (ESSs), the World Bank Group’s Environmental, Health and Safety Guidelines, and relevant World Health Organization (WHO) protocols on COVID-19. In particular, the relevant aspects of these laws, regulations, standards, and protocols will serve as the framework and guidance for the assessment and management of the environmental and social risks and impacts of the project activities. The following is an overview of the select national and international laws which are relevant to the environmental and social impacts and risks of the activities supported under the Lesotho COVID-19 Emergency Preparedness and Response Project Additional Financing components and activities. 3.1. Key Applicable National Laws, Policies and Regulations The Constitution of Lesotho, which is the basic law governing the Kingdom of Lesotho, was adopted in 1993 and has been revised five times. One of the aims of the Constitution is promoting and consolidating sustainable socio-economic development in the country through the mainstreaming of environmental and social considerations in Project planning and implementation. Amongst others, the following sections of the constitution and national laws will support the implementation of this ESMF. 3.1.1. Section 36 of the Constitution of Lesotho (1993) Section 36 of the Constitution of Lesotho lays the foundation for environmental legislation and stipulates that Lesotho will adopt policies designed to protect and enhance the natural and cultural environment of Lesotho for the benefit of both present and future generations and shall endeavour to ensure for all citizens, a sound and safe environment adequate for their health and well-being (GoL, 2002). The Lesotho COVID-19 Emergency Preparedness and Response Project will adopt approaches that will conform to the requirements of the Constitution. 3.1.2. Lesotho Labor Legislation (1992) There is one main legislation in the Kingdom of Lesotho dedicated to Labor issues namely Labor Code Order No. 24 of 1992 with its amendments: a) Labor Code Amendment Act 2000 – Established the Directorate of Dispute Prevention and Resolutions (DDPR) and a Labor Appeal Court; b) Labor Code Amendment Act 2006 – made a provision for HIV and AIDS in the workplace and transferred the review powers from the Labor Appeal Court to the Labor Court; 23 The Act defines the legal minimum age for employment as 15, or 18 for hazardous employment and prohibits worst forms of child Labor. The Labor Code as the primary law protecting the employment rights of individual workers covers protection of wages; contracts; employment terms and conditions; recruitment; classifies workers; prohibits child Labor and all forms of forces or compulsory Labor. The Lesotho constitution also encourages the formation of independent trade unions to protect workers' rights and interests and to promote sound labour relations and fair employment practices. This Project will comply with the World Bank code of conduct for all its labour related matters in conjunction with the Lesotho labour Code. 3.1.3. Occupational Health and Safety The Labor Code Order of 1992 has legal provision pertaining to occupational health and safety in the Kingdom of Lesotho in Part VII: Health and Safety and Welfare at Work. 92: Application; 93: Duties of employers; 94: Duties of employees; 95: Duties of Designers, manufactures, importers etc.; 96: Keeping of documents; 97: Safety and Health Officers; 98: Safety and Health committees; 99: Prohibition orders; 100: Regulations; 101: Notification of industrial accidents and dangerous occurrences; 102: Notification of Industrial deceases; 103: Training and supervision of persons working at dangerous machines; 104: Fire prevention, Fire-fighting; 105: Prohibited and toxic substances; 106: Removal of dust or fumes; 107: Reduction of noise and vibrations; 108: Lifting of weights; 109: Personal protective equipment and clothing; 110: Water Supply; 111: Registration of factories; 112: Cancellation of registration; 113: Appeal form decision; 114: Removal of nuisance in or near a factory; 115: Employer provided housing and 116: Penalties. Lesotho COVID-19 Emergency Preparedness and Response Project will adhere to the requirements of this Labor Code. 3.1.4. Environment Act No. 10 (2008a) Environment Act makes provision for the protection and management of the environment and conservation and sustainable utilization of natural resources of Lesotho. The Act emphasizes on the use and conservation of the environment and natural resources of the Basotho nation for the benefit of both present and future generations, taking into account the rate of population growth and the productivity of available resources and to require prior environmental impact assessment of proposed projects or activities which are likely to have adverse effects on the environment or natural resources (GoL, 2008a). The proposed COVID-19 Project activities will have various effects on the environment and the relevant clauses that cover the protection and management of the environment include the following: a) Part V: Environmental Impact Assessment, Audits and Monitoring: This clause provides for undertaking environmental impact assessment of the Project developments; 24 b) Part VI: Environmental Quality Standards: Makes provision for soil, water, air, waste, noise, ionization, and other radiation, control of noxious smells, guidelines for environmental disasters and other standards; c) Part VII: Pollution control: Makes provision for prohibition of discharge of hazardous substances, chemicals and materials or oil into the environment and spiller's liability; d) Part VIII: Environmental Management: Makes provision for the notifications of any spill, including the measures to be taken, like clean-ups, recovery of expenses and spill liabilities; e) Part XIII: Information, Education and Public Awareness: Makes provision for freedom of access to information, education and awareness on environmental management or natural resources; and f) Part IX: Environmental restoration notice and order: Identification and protection of areas which are at risk of degradation. The implantation of the ESMF under the Lesotho COVID-19 Emergency Preparedness and Response Project will have to be in line with the requirements of the Environment Act No. 10 of 2008 by providing for environmental planning and management in all its sub-projects so that they can be implemented in an environmentally friendly manner. The activities at each sub-Project site have the potential of impacting on the environment and each sub-Project must be screened for potential environmental and social impacts and then a site specific Environmental and Social Management Plan (ESMP) (see Annex 3) has to be prepared and implemented for mitigating the potential risks that would have been identified in the screening. 3.1.5. Public Health Order No. 12 (1970) The Order sets out the functions of the Ministry of Health as the promotion of the personal health and environmental health within Lesotho; to prevent and guard against the introduction of disease from outside; to prevent or control communicable disease; to advise and assist district administrations and local authorities in regard to matters affecting public health; to promote or carry out researches and investigations in connection with the prevention and treatment of human diseases; to prepare and publish reports and statistics or other information relative to the public health; to report on the work of the Ministry to the Minister who may submit such report to the Council of Ministers each year; to provide for the appointment of advisers, advisory bodies or councils to assist the Minister in all matters concerning public health; and generally to administer the provisions of this Order (GoL, 1970). Generally, the Order makes provisions for all matters concerning public health in Lesotho and thus the objectives of the current Project will be adequately covered by its provisions. 25 3.1.6. Declaration of COVID-19 Statement of Emergency Notice (2020), and Public Health (COVID-19) Regulations (2020) Government of Lesotho has declared that state of emergency exists throughout the Kingdom of Lesotho, in respect of the pandemic caused by COVID-19; and as a result, Declaration of COVID- 19 Statement of Emergency Notice, 2020, and Public Health (COVID-19) Regulations, 2020 were issued for the general purposes of containment of the virus and protection of nation against COVID-19. During the period for which this declaration and the regulations are in force, there will be restrictions of movement and provision of certain services, which will definitely have some impacts on the Lesotho COVID-19 Emergency Response and Preparedness activities. As a result, compliance with these declaration and regulations, will be necessary. 3.1.7. The Hazardous and Non-Hazardous Waste Management Act (2008) This Act covers all aspects of waste management, i.e., both general or non-hazardous waste and hazardous waste. It addresses health care waste, both general and risk waste (GoL, 2008b). The objectives of this Act are to make provision for the generation, transportation, storage, importation, exportation, recycling and disposal for both hazardous and non-hazardous waste. It also makes provision for institutional measures for the control and management of hazardous and non-hazardous waste. Participating Health facilities or institutions must comply with the requirements of this Act and handle all waste accordingly. 3.1.8. Hazardous (Health Care) Waste management Regulations (2012) This Act covers all aspects of waste management, i.e., both general or non-hazardous waste and hazardous waste. It addresses health care waste, both general and risk waste (GoL, 2008b). The objectives of this Act are to make provision for the generation, transportation, storage, importation, exportation, recycling and disposal for both hazardous and non-hazardous waste. It also makes provision for institutional measures for the control and management of hazardous and non-hazardous waste. Participating Health facilities or institutions must comply with the requirements of this Act and handle all waste accordingly. 3.1.9. Water Act No. 15 (2008) The Water Act provides for the ownership of all water resources to be vested in the Basotho nation and held in trust by the King. It also makes provision for the management, protection, conservation, development, and sustainable use of the Lesotho’s water resources (GoL, 2008c). The Water Act also provides for the prevention of pollution of water resources through measures such as the control of processes causing pollution, the control or prevention of movement of 26 pollutants, compliance with prescribed standards or management of waste, and the elimination of any sources or potential sources of pollution. These provisions have direct relevance to the activities of the COVID-19 Project roll out as the main activities of the COVID-19 Project will require provision of clean and safe potable water for sanitation and consumption. Absence or pollution of water may promote wide spread of COVID- 19. 3.1.10. National Disability and Rehabilitation Policy (2011) The Social Development Policy which aims at ensuring the social inclusion of persons with disability. The implementation of this ESMF, under the Lesotho COVID-19 Emergency Preparedness and Response Project will adhere to the requirements of this policy and will note how persons with disabilities are uniquely impacted by the pandemic. 3.1.11. Children’s Protection and Welfare Act (2011) The Children’s Protection and Welfare Act prohibits child labour. The implementation of this ESMF, under the Lesotho COVID-19 Emergency Preparedness and Response Project will comply to the requirements of this act and ensure prohibition of engagement of children under 18 for illicit activities hazardous occupations. 3.1.12. Sexual Offences Act (2003) and Gender and Development Policy (2018) The Act and policy consolidate and repeal the laws relating to sexual offences, to combat sexual violence and to prescribe appropriate sentences for sexual offences and to provide for other incidental matters. The overall goal of the Gender policy is to take gender concerns into account in all national and sectoral policies, programmes, budgets and plans in order to achieve gender equality in the development process. The Policy indicates that the above can be achieved through: ensuring equal opportunities for males and females in the development process to promote better standards of living and to achieve economic efficiency for all; ensuring equal access to education, training, and health services and control over resources like land and credit; ensuring that gender sensitive laws exist and are enforced to provide direction for development of effective awareness creation programmes on causes and gender-based violence and of mechanisms geared at eradicating such problems. The implementation of this ESMF, under the Lesotho COVID-19 Emergency Preparedness and Response Project will adhere to these legal requirements. 3.1.13. Local Government Act (1997) This Act provides for establishment of local authorities and lists several public/community considerations and consultations from Project design up to operation. During the implementation of this ESMF, the PIU will align with the provision of the need for community consultations and awareness with regard to the resources under the local Government Authority. 27 3.1.14. Criminal Procedure and Evidence Act (1981) Section 228 rejects the use of evidence obtained through the use of torture. It provides that if a confession has been made to a police officer under duress, it shall not be admissible in judicial proceedings. Any misbehavior of laborers of the project will be subjected to this Act. 3.1.15. Penal Code Act (2010) Sections 30, 31, 40-42, 38, 51 and 52 prohibit aggravated assault, murder, culpable homicide, indecent assault and unlawful sexual acts respectively. Any misbehavior of laborers of the project will be subjected to this Act. 3.1.16. Police Service Act (1998) Section 22 provides for the establishment of the Police Complaints Authority, a statutory body where the public can lodge their complaints against police officers. The Act also provides for code of conduct of the police officers. Any misbehavior of laborers of the project will be subjected to this Act. 3.1.17. Disaster Management Act (1997) The Government authorities can make a statutory decision to deploy public security personnel during the emergencies, such as COVID-19 outbreak. Activities of the project may be exposed to emergencies and disasters. 3.2. Review of International Conventions and Treaties Lesotho is a signatory and party to more than twenty-one international, conventions, treaties and protocols. Of the many treaties, the following will be relevant to the implantation of this ESMF requirements: 3.2.1. The Basel Convention for hazardous wastes and disposal The Basel Convention Technical Guidelines is focused on reducing the impacts on health and the environment of biomedical and healthcare wastes that is based on the major classification in Annexes I, II, VII of the Basel Convention, but specified for practical use in the healthcare sector. This guideline focuses on: (i) a strict definition and classification of the relevant waste streams, (ii) the segregation at source of the waste, and (iii) access to the best available information for the identification of waste. The activities of the COVID-19 Project may induce an increase in the use of medical facilities and hence an increase in the generation of health care waste. Therefore, the implementation of this 28 ESMF requirements for management of health care waste will be line with this convention in order to handles these anticipated increases properly. 3.2.2. Stockholm Convention on Persistent Organic Pollutants This is an important convention for the proper management of HCW as it recognizes that persistent organic pollutants possess toxic properties that are transported through air, water and migratory species across international boundaries and are deposited far from their place of release, where they accumulate in the ecosystems. The dioxins and furans from the thermal treatment process of incineration is an important contributor. The Lesotho National Implementation Plan (NIP) under Stockholm Convention, produced in May 2005, outlines enabling activities to facilitate early action on the implementation of this convention. In the NIP, under Intervention Area 3.3.1 Institutional and regulatory strengthening measures, the GoL undertook to develop an Integrated Waste Management and Pollution Control policy framework and to amend relevant legislation to ensure significant reduction in the release of dioxins and furans. As part of this plan, the Environment Act 2008 was promulgated. The provisions of this convention have to be adhered to in handling any health care waste in the Lesotho COVID-19 Emergency Preparedness and Response Project. 3.2.3. International Convention on the Elimination of All Forms of Racial Discrimination This convention encourages universal and effective respect for human rights and fundamental freedoms for all, without distinction as to race, sex, language or religion. Risk of discrimination is possible during implementation of some of the activities of the COVID-19 Project, (e.g. During provision of COVID-19 Personal Protective Equipment (PPE) to communities or any form of aid), therefore, it will be important for implementing bodies to adhere to this convention with consideration of article 1.2 of this convention which state that “This Convention does not apply to distinctions, exclusions, restrictions or preferences established by a State party to the Convention according to whether they are its nationals or non-nationals�, where necessary. 3.2.4. Ratification of International Conventions on Labor Lesotho ratified both the ILO Minimum Age Convention (C138) and the ILO Worst Forms of Child Labour Convention (C182) in 2001. In addition, the country has also ratified the UN Convention on the Rights of the Child in 1992 and the African Charter on the Rights and Welfare of the Child (in 1990). The Government of Lesotho has established institutional mechanisms for the enforcement of laws and regulations on child Labor. The updated Labor Code includes 18 years or above as the minimum age for workers in the hazardous sectors, including Construction/rehabilitation works, and waste management and strengthens provisions to combat the worst forms of child Labor. However, the risk is minimum for the Project. Lesotho has ratified all core Labor-Standard-Conventions of the International Labor Organization. 29 3.2.5. International Convention on Gender and Vulnerability Promoting and protecting the rights of vulnerable groups have been among the most important policy agenda for the Government of Lesotho in recent years. The Lesotho Constitution bans discrimination on grounds of sex and the Country is also signatory to several international instruments addressing gender equality including the Convention on the Elimination of All Forms of Discrimination (CEDAW), 1993, CEDAW Optional Protocol in 2006 (with reservations on Articles 7 (a) and 16), Commonwealth Action Plans on Gender Equality. Gender equality and protection of the rights of vulnerable groups will be practiced throughout project implementation. 3.3. World Bank Environmental and Social Standards The World Bank’s Environmental and Social Framework consists mainly of the environmental and social policy with ten Environmental and Social Standards that it uses to examine potential environmental and social risks and benefits associated with Bank lending operations. The environmental and social standards are designed to avoid, mitigate or minimize adverse environmental and social impacts of projects supported by the Bank. The World Bank GBV action plan (“Working Together to Prevent Sexual Exploitation and Abuse: Recommendations for World Bank investment projects�), Group EHS Guidelines, World Bank guidelines on “Effective targeting for the Poor and Vulnerable� are some of the other key guidance documents of the World Bank applicable to the Project. Gap analysis between the World Bank ESF and Lesotho National Laws: ESSs National Legislations Gaps ESS 1: Assessment Constitution of Lesotho The legislation comprehensively and Management (1993); Environment Act provides for assessment and monitoring of Environmental (2008); Lesotho Labor environmental and social impacts of and Social Risks Legislation (1992); Labor projects and Impacts Code Amendment Act 2000; The penalties for failing to observe the Labor Code Order of 1992 provisions of the Environment Act 2008 (with legal provision which is the main statute are very low pertaining to occupational health and safety); Public Some institutions mentioned in the Health Order No. 12 (1970); legislation not in place, e.g., Lesotho Declaration of COVID-19 Environment Authority – mandates of Statement of Emergency such scattered Notice (2020), and Public The law makes limited provisions for Health (COVID-19) repair of the environment in case of Regulations (2020); damage Hazardous and Non- Hazardous Waste The are no clear sanction for violation of Management Act (2008); the stakeholder engagement processes. 30 Hazardous (Health Care) Wherever there are gaps in the national Waste management legislations and the World Bank Regulations (2012); Water Standards, the provisions of the World Act No. 15 (2008); National Bank Standards shall be applicable to Disability and Rehabilitation fulfil the gap as may be required for Policy (2011); Children’s successful implementation of the Project Protection and Welfare Act ensuring E&S compliance. (2011); Sexual Offences Act (2003); Gender and Development Policy (2018); Local Government Act (1997); Criminal Procedure and Evidence Act (1981); Penal Code Act (2010); Police Service Act (1998); Disaster Management Act (1997) ESS 2: Labor and Constitution of Lesotho The legislation comprehensively Working (1993); Lesotho Labor provides for assessment and monitoring Conditions Legislation (1992); Labor environmental and social impacts of Code Amendment Act 2000; projects Labor Code Order of 1992 The penalties for failing to observe the (with legal provision provisions of the Environment Act 2008 pertaining to occupational which is the main statute are very low health and safety); Public Health Order No. 12 (1970); Some institutions mentioned in the Declaration of COVID-19 legislation not in place, e.g., Lesotho Statement of Emergency Environment Authority – mandates of Notice (2020), and Public such scattered Health (COVID-19) Guidelines for workplace grievance Regulations (2020); mechanism not clearly defined Hazardous and Non- Hazardous Waste Majority of the occupational health and Management Act (2008); safety requirements are covered by the Labour Code Order 1992 and other Hazardous (Health Care) pieces of supporting legislation Waste management Regulations (2012); Water Limited labour inspections in high-risk Act No. 15 (2008); sectors such as the informal sector. Children’s Protection and Wherever there are gaps in the national Welfare Act (2011); Sexual legislations and the World Bank Offences Act (2003); Gender Standards, the provisions of the World and Development Policy Bank Standards shall be applicable to (2018); Criminal Procedure fulfil the gap as may be required for and Evidence Act (1981); successful implementation of the Project Penal Code Act (2010); ensuring E&S compliance. 31 Disaster Management Act (1997) ESS 3: Resource Constitution of Lesotho The Water Act 2008 requires that a Efficiency and (1993); Environment Act water balance be developed for projects Pollution (2008); Public Health Order with high water demand and impacts on Prevention and No. 12 (1970); Public Health water quality Management (COVID-19) Regulations Lesotho does not have benchmarks to (2020); Hazardous and Non- guide performance with regards to Hazardous Waste efficient use of resources Management Act (2008); Hazardous (Health Care) There’s minimal standards for Waste management monitoring impacts on water quality, air Regulations (2012); Water quality etc Act No. 15 (2008); Local The law makes no clear specific Government Act (1997); requirements for remediation in case of Disaster Management Act pollution (1997) No clear provisions of requirements for climate change considerations in the design of buildings. Wherever there are gaps in the national legislations and the World Bank Standards, the provisions of the World Bank Standards shall be applicable to fulfil the gap as may be required for successful implementation of the Project ensuring E&S compliance. ESS 4: Constitution of Lesotho There are no sanctions imposed on Community Health (1993); Environment Act developers who fail to comply with and Safety (2008); Public Health Order requirements for community health and No. 12 (1970); Declaration of safety COVID-19 Statement of No standards and limits of exposure for Emergency Notice (2020), substances and materials that pose a risk and Public Health (COVID- to community health and safety 19) Regulations (2020); Hazardous and Non- No specific guidelines for regular Hazardous Waste reporting on dam safety Management Act (2008); Provisions of risks to the community Hazardous (Health Care) posed by security personnel not clear. Waste management Wherever there are gaps in the national Regulations (2012); Water legislations and the World Bank Act No. 15 (2008); National Standards, the provisions of the World 32 Disability and Rehabilitation Bank Standards shall be applicable to Policy (2011); Children’s fulfil the gap as may be required for Protection and Welfare Act successful implementation of the Project (2011); Sexual Offences Act ensuring E&S compliance. (2003); Gender and Development Policy (2018); Local Government Act (1997); Criminal Procedure and Evidence Act (1981); Penal Code Act (2010); Police Service Act (1998); Disaster Management Act (1997) ESS 5: Land Constitution of Lesotho Laws governing land acquisition are Acquisition, (1993); (Land Act 2010); The administered by different institutions Restrictions on Building Control Act (No. There are standard compensation rates, Land Use and 68) of 1995; Environment numerous compensation systems used Involuntary Act (2008); Local by different developers Resettlement Government Act 1997 (amended as Act No. 53 of The are no specific requirements for 2004), and the Local development of RAPs in the law Government Regulations There are no provisions for (No.48) 2005). compensation of intangible assets in land acquisition such as social capital The law provides for compensation at market value No clear provisions for managing land- based livelihoods in case of physical displacement Compensation usually occurs outside the mainstream of institutions responsible for land administration. Wherever there are gaps in the national legislations and the World Bank Standards, the provisions of the World Bank Standards shall be applicable to fulfil the gap as may be required for successful implementation of the Project ensuring E&S compliance. ESS 6: Constitution of Lesotho There is limited control over Biodiversity (1993); Environment Act commercialization of natural resources Conservation and (2008); Hazardous and Non- and their derivatives Sustainable Hazardous Waste 33 Management of Management Act (2008); A license is required for fish farming, Living Natural Water Act No. 15 (2008); however, there are no guidelines and Resources Local Government Act control overfishing from riverbanks (1997); Criminal Procedure Lack of penalties for non-compliance, and Evidence Act (1981); e.g., there are no penalties for Penal Code Act (2010); overharvesting Disaster Management Act (1997) Legally protected areas of high biodiversity have their own management plans developed. Wherever there are gaps in the national legislations and the World Bank Standards, the provisions of the World Bank Standards shall be applicable to fulfil the gap as may be required for successful implementation of the Project ensuring E&S compliance. ESS 7: Indigenous - (Not applicable as all No specific laws pertinent to Indigenous Peoples/Sub- communities in Peoples in Lesotho. However, the Saharan African Lesotho are part of Constitution of Lesotho enshrines Historically the mainstream provisions, including non- Underserved societies). discrimination, right to information, etc. Traditional Local Wherever there are gaps in the national Communities legislations and the World Bank Standards, the provisions of the World Bank Standards shall be applicable to fulfil the gap as may be required for successful implementation of the Project ensuring E&S compliance. ESS 8: Cultural Constitution of Lesotho Legislation limited in terms of Heritage (1993); Environment Act provisions for protection of intangible (2008); Local Government value of heritage features Act (1997); Criminal Lack of penalties for destruction of Procedure and Evidence Act natural and cultural heritage (1981); Penal Code Act (2010); Police Service Act Lack of clear standards for sharing of (1998); Disaster Management benefits with local communities in case Act (1997) of commercial use of cultural heritage There is limited documentation of data on natural and cultural heritage. Wherever there are gaps in the national legislations and the World Bank Standards, the provisions of the World 34 Bank Standards shall be applicable to fulfil the gap as may be required for successful implementation of the Project ensuring E&S compliance. ESS 9: Financial - (Not applicable) - Intermediaries ESS 10: Constitution of Lesotho No specific guidelines for the Stakeholder (1993); Environment Act stakeholder engagement processes Engagement and (2008); Public Health Order Weak feedback mechanisms throughout Information No. 12 (1970); Declaration of the life of a project generally weak Disclosure COVID-19 Statement of Emergency Notice (2020), No targeted approach to the GBVs and Public Health (COVID- Weak functional GRM system. 19) Regulations (2020); Local Government Act Wherever there are gaps in the national (1997); Criminal Procedure legislations and the World Bank and Evidence Act (1981); Standards, the provisions of the World Penal Code Act (2010); Bank Standards shall be applicable to Police Service Act (1998); fulfil the gap as may be required for Disaster Management Act successful implementation of the Project (1997) ensuring E&S compliance. The following ESSs are anticipated to be relevant to the Lesotho COVID-19 Emergency Preparedness and Response Project: 3.3.1. ESS 1 – Assessment and Management of Environmental and Social Risks and Impacts: This Standard is relevant. The measures to address social and environmental risks in the parent project remain relevant, including infection prevention and control improvements in health facilities as well as mitigation measures for medical waste risk management that will be expanded as inoculation sites expand. Both parent project and AF activities still present substantial environmental, social, health and safety risks for the project workforce and communities. Substantial environmental risks can be expected if medical waste and occupational health and safety risks are not well-managed. No major construction works will be financed under the Project, but will finance some minor renovation and rehabilitation of existing health facilities. Civil works envisaged in the project refer to repair and rehabilitation of existing buildings only, no land acquisition or involuntary resettlement impacts are expected. Substantial social risks include exclusion of vulnerable and marginalised groups; use of military personnel for transportation of vaccines to remote inaccessible areas; contextual SEA/SH risk; OHS risks for project workers associated with the upgrading activities; OHS risks related to the spread of the virus among health care workers; risks 35 related to the spread of COVID-19 among the population at large, and especially for the most disadvantaged and vulnerable populations (such as elderly, children, poor households, etc.) due to poor training, communication and public awareness related to the readiness and response to the new COVID-19; and risk of panic/conflicts resulting from false rumors and social unrest, the social stigma associated with COVID-19 or potential unrest with respect to access to testing, vaccination and other services related to public health services. These risks will be mitigated through several measures to ensure vaccine delivery targets the most vulnerable and remote populations in accordance with criteria specified in this AF. To manage these risks, the Environmental and Social Management Framework (ESMF) including the related LMP, Infection Control and Waste Management Plan (ICWMP), Stakeholder Engagement Plan (SEP) prepared for the parent project will be updated and disclosed before AF effectiveness to include mitigation of risks caused by the activities planned under the AF. The updated ESMF will identify additional potential environemntal and social risks and outline appropriate mitigation measures based largely on adopting WHO guidance, World Bank Group Health, and Safety (EHS) Guidelines, and other good international industry practices (GIIP). The updated LMP will reflect the new categories of workers associated with the activities under the AF as well as any new training requirements and procedures for occupational health and safety. Furthermore, the updated LMP will address issues of job conditions, OHS issues, worker interactions with the communities, prohibition of child labor and the workers’ Grievance Redress Mechanisms (GRM). The updated ICWMP will include infection control measures to limit the spread of COVID-19 during AF activities. To support the GoL’s vaccination planning, this AF will finance technical and operational assistance to support Lesotho to establish institutional frameworks for the safe and effective deployment of vaccines. While the WHO is taking the lead in providing technical assistance, the AF will contribute to operationalize the policies and guidelines. In particular, the AF will support strengthening of institutional frameworks for effective pharmacovigilance (e.g., reviving of the Adverse Event Following Immunization (AEFI) committee, training on AEFI at the district and community level) as well as the creation of accountability, grievances, and citizen and community engagement mechanisms. Other technical assistance to support in-country implementation include assessments of effective vaccine management capacity and training of front-line delivery workers; and vaccine logistics and information management systems and information systems to monitor adverse effects from immunization. The World Bank will support the GoL to develop and adapt explicit, contextually appropriate, and well-communicated criteria for accessing vaccines. All targeting criteria and implementation plans will be reflected in country’s national vaccination program and communication plan. Refugees, migrants and South African nationals residing in Lesotho will be eligible for the vaccine. Furthermore, the policies for prioritizing intra-country vaccine allocations will follow principles established in the WHO Allocation Framework, including targeting an initial coverage of 20 percent of the country’s population. The potential risk of increased incidence of retaliations against 36 healthcare workers will be mitigated through explicit inclusion in robust stakeholder identification and consultation processes. The Borrower will ensure that this plan be subject to timely and meaningful consultations in accordance with ESS 10. Moreover, the RCCE will be further strengthened to prevent stigma and discrimination against the suspected and COVID-19 survivors as well as socio-economically marginalized groups with substantial consideration of gender. In addition, the grievance mechanisms required under the ESS 10 will be in place and equipped to address community and individual grievances including GBV/SEA/SH related issues and a survivor referral pathway. SEA/SH risks will be assessed and addressed during implementation through the ESMF, including screening and putting in the corresponding measures to prevent and mitigate the SEA/SH risks. A GBV/SEA/SH Action Plan will be prepared and incorporated in the updated ESMF. The risk from use of government security personnel for logistics and distribution of vaccines to remote rural health facilities will be reassessed using the Security Risk Assessment adopted for the parent project and will be updated as part of the updated ESMF. The updated ESMF for the AF will propose adequate mitigation measures and strengthen existing measures from the parent project, where necessary, consistent with the requirements of ESS4 for government security personnel. This will ensure that the use of the military in project activities will not result in adverse consequences to community health and safety, including in matters relating to SEA/SH. Another potential risk is the social acceptability of the vaccine, this risk will be mitigated through the establishment of a robust effective risk communication strategy informing society and beneficiary communities of safety issues and treatment if negative side effects are shown. The AF will support the development and implementation of vaccine demand generation and communication through the deployment of the vaccine and an M&E system. The MoH will introduce revised protocols regarding consent to vaccinations, a process for agreeing to or refusing to be vaccinated. The updated SEP prepared for the parent project will identify specific beneficiaries (vaccine receivers) and ways and platforms to engage them, motivate them for adopting the service and provision of a Grievance Redress Mechanism (GRM) to raise issues, complaints and concerns. The SEP is based on the draft National Deployment and Vaccination Plan and responds to the requirements of the ESS10. The PIU will also develop codes of conduct and training materials and develop communication strategies as part of the SEP to raise awareness around SEA/SH. The project will further mitigate the risks by: (i) strengthening capacity of the implementation agencies; (ii) developing a procurement plan with appropriate cost estimates, quantities, and selection methods; and (iii) fielding of additional community liaison officer and a qualified social specialist with experience in public works and closely monitoring implementation of the Environmental and Social commitment Plan (ESCP). The ESCP will include timelines for updating, preparing or finalizing required instruments such as the ESMF, SEP, site-specific ESMPs (if necessary), LMP, GRM, etc. In addition, the AF ESCP will include material actions including timelines as well as roles and responsibilities to ensure compliance with the ESF. 37 The parent project ESMF will be updated prior to effectiveness of the AF project to include the risks and impacts associated with the AF activities and subsequent mitigation measures. The updated ESMF will take into account international protocols for infectious disease control and medical waste management, transportation, storage and delivery of vaccines, issues of inclusion/non-discrimination, use of military personnel for logistics of vaccines and other E&S risks. The updated ESMF and its Annexes will be finalized and disclosed before Project Effectiveness. This will be before the deployment of the vaccine and related medical equipment supported under the AF. In addition, any activities that have been screened for environmental and social risks will not be carried out without the completed, consulted, and disclosed ESMF. Environmental and social instruments developed under the parent project to address and mitigate environmental and social risks of the parent project were updated to mitigate impacts associated with activities to be financed under the AF. In line with WHO Interim Guidance (February 12, 2020) on “Laboratory Biosafety Guidance related to the novel coronavirus (2019-nCoV)�, and other guidelines, the parent project developed an Infection Control and Waste Management Plan (ICWMP) and prepared an ESMF for the Project by adding to it WHO standards on COVID-19 response. The plan includes training of staff to be aware of all hazards they might encounter. This provides for the application of international best practices in COVID-19 diagnostic testing and handling the medical supplies, disposing of the generated waste, and road safety. The parent project also developed a Labor Management Procedures (LMP), conducted a Security Risk Assessment as part of the ESMF and a Stakeholder Engagement Plan (SEP). The updated ESMF covers mitigation measures including Surveillance of Adverse Events Following Immunization plan and cold chain temperature monitoring plan as elements of the ESMF update. Mitigation measures, where relevant, are in line with relevant GIIP, relevant Africa CDC and WHO guidelines; World Bank GBV action plan, World Bank Security Management Guidelines, Group EHS Guidelines, WHO code of ethics, targeting of vulnerable groups, WHO guidelines on “Key considerations for repatriation and quarantine of travelers in relation to the outbreak of novel coronavirus 2019-nCoV� as well as the Africa CDC guideline on “Africa CDC Guidance for Assessment, Monitoring, and Movement Restrictions of People at Risk for COVID-19 in Africa�, inter alia, ensuring access to and allocation of Project benefits in a fair, equitable and inclusive manner. In addition, the GoL finalized and adopted the ESCP outlining the environmental and social measures and timelines for completion. 3.3.2. ESS 2 – Labor and Working Conditions ESS2 is considered relevant to the AF activities of the Project. The project is expected to use direct workers, contracted workers as well as volunteers and support staff. The exact number of workers engaged under the activities of the AF will be known during project implementation. Most activities supported by the project will be conducted by direct workers of the project, such as health 38 and laboratory technicians and civil servants employed by the MOH. The project may outsource minor civil works to contractors for activities such as constructing minor civil works and rehabilitation/repairs of facilities. While the number of workers cannot be estimated at the current stage, no large-scale labor influx is expected. Activities encompass treatment of patients, deployment of COVID-19 vaccines, and small-scale civil works for medical facilities refurbishment or completion of ongoing construction. The key risk for the project workers (primarily direct and contracted healthcare workers) is exposure to the COVID-19 virus or other contagious illnesses which can lead to illness and death of workers. High-risk environments include laboratories, hospitals, and health care centers, isolation and vaccination centers, and the broader community where project workers may be exposed to the virus. Project workers are also at higher risk of psychological distress, fatigue, and stigma due to the nature of their work. In line with ESS2 and Lesotho Laws, the use of forced labor or the use of child labor for any person under the age of 18 in hazardous work situations (e.g., in health care facilities) is prohibited. There could be some SEA/SH risk associated with labor and this will be addressed through the workers’ GRM. Mitigation measures relating to occupational health and safety are documented in the updated LMP and are included in the ESMF. Project workers are susceptible to risks associated with exposure to hazards encountered in the workplace; this will require infection control precautions and adequate supplies of PPE. The mitigation measures incorporates the World Bank Group's General EHSGs, the EHSGs for Health Care Facilities, and other Good International Industry Practices. The LMP also includes a Code of Conduct, including measures to prevent SEA/SH, and safety training materials, measures to protect workers’ rights as set out in ESS2, procedures for entry into healthcare facilities, and use of PPE where relevant. These have been updated as part of the AF ESMF by the Borrower. The PIU will implement adequate occupational health and safety measures, including emergency preparedness and response measures, in line with the ESMF, WHO guidelines on COVID-19 and the World Bank Group's General EHSGs, the EHSGs for Health Care Facilities in all facilities, including laboratories, isolation and vaccination centers, and screening posts. The PIU will also ensure a non-discriminatory, decent work environment including ensuring that all health workers adhere to the WHO Code of Ethics and Professional conduct. Relevant PPE will be provided to workers engaged under the activities of the project. A worker Grievance Redress Mechanism will be established and operated through a grievance hotline and assignment of focal points to submit and address these grievances within the MOH which will be outlined in the LMP. Also, the project will regularly integrate the latest guidance by WHO as it develops over time and experience addressing COVID-19 globally. The PIU will ensure that all procurement documents, supervising firms and civil works contracts comply with the Environmental, Social, Health, and Safety (ESHS) mitigation measures based on the WBG EHS Guidelines, ESMF, SEP, and other relevant instruments. PIU will also ensure that ESS2 related trainings are delivered as needed to the workers engaged under the activities of the project 39 3.3.3. ESS 3 – Resource Efficiency and Pollution Prevention and Management This Standard is relevant. Pollution prevention and management, specifically medical waste management, will be a particularly important activity under the AF. Medical waste—including chemicals, contaminated PPE and equipment, and lab testing kits from healthcare facilities—will need to be safely stored, transported and disposed. Wastes generated from labs, screening posts and treatment facilities to be supported by AF could include contaminated waste (e.g., blood, other body fluids and contaminated fluid) and infected materials (water used, lab solutions and reagents, syringes, bed sheets, majority of waste from labs and isolation centers, etc.) require special handling and awareness, as they may pose an infectious risk to healthcare workers in contact with the waste. Informal disposal may lead to contamination of soil and groundwater, but more importantly, to further spreading of the virus to nearby communities. Additionally, attention should also be paid to management of health and safety risks associated with the cold chain for vaccine transport, storage and distribution. The Environmental and Social Management Framework (ESMF) and other relevant management plans that were prepared for the parent project will be updated before AF effectiveness to include mitigation of risks caused by the activities planned under the AF. The parent project ICWMP will be updated to take into account activities supported under the AF. The updated ICWMP will follow WHO guidelines for COVID-19 response, including Guidelines for Quarantine, Biosafety, and Code of Ethics and Professional Conduct and other Good Industry International Practice (GIIP). The ESMF will include guidance related to transportation and management of samples and medical goods or expired chemical products as well as sustainable ways to use environmental resources (water, air, other relevant solutions/reagents) as recommended in healthcare infection control practices in line with Africa CDC Best Practices for COVID-19 in Primary Health Care Facilities and WHO environmental infection control guidelines for medical facilities. In addition, should there be a need for rehabilitation of selected health facilities and laboratories, site-specific ESMPs will be prepared based on the provisions of the ESMF to manage general pollution impacts related to these small-scale works. The Project activities also include the provision of technical assistance to support Lesotho to establish institutional frameworks for the safe and effective deployment of vaccines. Such technical assistance includes assisting the GoL in supporting medical waste management, which will result in a positive downstream effect on the MoH capacity to manage ESS3 related aspects such as waste management. To mitigate risks to production of GHG and cause potential negative impacts to capacity to respond to future climate related crises, the AF will address climate change vulnerabilities and enhance climate resilience and adaptation through the following prevention and mitigation activities. The 40 AF will support the COVID-19 NDVP and most importantly the delivery structures to strengthen Lesotho’s ability to respond to future outbreaks as follows: - Strengthening the disease surveillance system. The AF will support the implementation of the COVID-19 NDVP and most importantly strengthen surveillance systems enabling Lesotho to better respond to future climate-related outbreaks such as rotavirus, cholera, and meningitis (under sub-component 1.2). - Community outreach and sensitization. Outreach activities and communications materials will be developed in Sesotho and simple graphics will include training modules and communication materials to help increase the population’s awareness of climate-related risks matters and how to respond to extreme weather events (heat, flooding). The AF will finance inclusive community outreach activities, aiming to raise knowledge of and demand for COVID-19 vaccinations as well as vaccines for climate-induced, vaccine-preventable diseases (ex: cholera, typhoid, and meningitis). This will include training modules and communication materials sensitizing the population on the risks related to heatwaves and flooding. - Training of health workers on modules responding to climate risk and climate-related health consequences. The AF will support COVID-19 related training (demand generation, vaccination, cold chain management, disease surveillance) of health workers to carry out vaccine distribution, especially those that are equipped to respond to highly stressful emergency situations. These trainings will include specific modules educating health workers on climate-related risks and how to respond to climate risks such as extreme weather events (e.g. flooding and heatwaves). Climate-related risks and responses will also be integrated with training materials. - Digital health vaccine management system. The project will support the operationalization of a digital vaccine registration and monitoring system which will be based on the open- source DHIS-2 tracker. This system investment will lay the foundation for both COVID-19 and other vaccine-preventable diseases including climate-induced, vaccine preventable diseases. - Contingency plans for extreme climatic shocks. The AF will strengthen Lesotho’s preparedness and response to health emergencies. Specifically, to reduce the impact of climatic events on project activities, the AF will finance the development of contingency plans for vaccination during climactic shocks, including extreme heat and floods. Plans will include actions to mitigate against the consequences of climatic events (ex: protecting vaccination supplies from flooding and extreme heat) and to adjust vaccination activities during climactic events (ex: community outreach during floods). - Beneficiaries feedback mechanism. The AF will finance a phone-based digital health system to track beneficiaries ‘feedback from all who seek/receive immunization/health services, asking them to rate the care they received on both clinical and non-clinical aspects and to register any grievance they might have on the health care received for that visit. This system 41 investments will apply to COVID-19 vaccine first but will lay the foundation for other vaccine preventable diseases including climate-induced, vaccine-preventable diseases. The Project also intends to mitigate against greenhouse gas emissions through the following strategies: - Cold storage technology. The AF will help the GoL strengthen its supply-chain systems to not only ensure continuous provision of healthcare during the current pandemic but also enhance health sector capacity to respond to future climate-related crises. The AF will finance the procurement of ultra-cold chain freezers and vaccine carriers – the selection of such technologies for vaccine delivery and storage will prioritize available, affordable, WHO pre-qualified equipment or other validated technologies that are energy efficient. In addition, the project will install temperature controls and monitoring systems on the refrigerators and freezers, which will help cut down on excessive use of energy and reducing the project’s impact on greenhouse gas emissions. 3.3.4. ESS 4 – Community Health and Safety ESS4 is considered relevant to the AF activities of the Project. Inappropriate handling of COVID- 19 samples, vaccines and patients can expose local communities to infections, and could lead to further spread of the disease. Therefore, relevant aspects of this standard shall be considered, as needed, including, inter alia, measures to: minimize the potential for community exposure to communicable diseases; ensure that individuals or groups who, because of their particular circumstances, may be disadvantaged or vulnerable have access to the development benefits resulting from the subproject. Exclusion from vaccines and lack of provision of medical services to disadvantaged or vulnerable people is also a potential risk. Accidents and/or emergencies in hospitals such as fire incidents or natural phenomena events are also associated risks. Some project activities such as minor civil works may heighten the risk of SEA/SH at health and vaccination facilities, exposing female health workers, communities and patients to risk of SEA/SH from construction workers. As mitigation measures, the PIU will address the risk of any form of SEA/SH by or against workers in the quarantine, isolation and vaccination facilities by relying on the WHO Code of Ethics and Professional conduct as well as through the provision of gender- sensitive infrastructure such as secure and sufficiently private sex-segregated toilets in quarantine, isolation and vaccination centers. The project will also prepare a SEA/SH Action Plan to address other SEA/SH risks that may arise from project activities. The PIU will further put measures in place to prevent or minimize the spread of the infectious disease/COVID-19 to the community. The risk of use of government security personnel for transportation/delivery of vaccination to remote rural areas using helicopters and maintenance of the safety of medical workers and storage facilities will be reassessed using the Security Risk Assessment adopted for the parent project and a Security Management Plan has been updated as part of this ESMF. To support the GoL’s vaccination planning, this AF will finance technical and operational assistance to support Lesotho to establish institutional frameworks for the safe and effective 42 deployment of vaccines. While the WHO is taking the lead in providing technical assistance, the AF will contribute to operationalizing the policies and guidelines. In particular, the AF will support the strengthening of institutional frameworks for effective pharmacovigilance (e.g., reviving of the Adverse Event Following Immunization (AEFI) committee, training on AEFI at the district and community level) as well as the creation of accountability, grievances, and citizen and community engagement mechanisms. Other technical assistance to support in-country implementation includes assessments of effective vaccine management capacity and training of front-line delivery workers; and vaccine logistics and information management systems and information systems to monitor adverse effects from immunization. The MoH is also working closely with other DPs located in-country, especially UNICEF and WHO, who are providing technical assistance on aspects that include vaccine registration and risk communication. Though there are no regulatory measures in place for approval of COVID-19 vaccines in Lesotho, the Bank will accept as the threshold for eligibility of the World Bank’s resources in COVID-19 vaccine acquisition or deployment either (i) the vaccine has received regular or emergency licensure or authorization from at least one of the SRAs identified by WHO for vaccines procured and/or supplied under the COVAX Facility, as may be amended from time to time by WHO; or (ii) the vaccine has received WHO Prequalification (PQ) or WHO Emergency Use Listing (EUL). The AF will also support the strengthening of the cold chain supply and logistic systems to comply with the cold-chain requirements of different vaccines. COVID-19 vaccination will be voluntary. The MoH has committed, through the ESCP, to adopting procedures to ensure vaccination under the project does not include forced vaccination. The AF will support the strengthening of frameworks for voluntary vaccination practices. 3.3.5. ESS 5 – Land Acquisition, Restrictions on Land Use and Involuntary Resettlement No Project activities involving resettlement may proceed without prior written approval of the Association and the adoption of E&S instruments required by ESS5. Any such instruments shall be adopted and implemented throughout Project implementation and reflected in this ESCP through an amendment 3.3.6. ESS 6 – Biodiversity Conservation and Sustainable Management of Living Natural Resources In the event that any Project activities involve impacts to biodiversity or living natural resources, appropriate instruments shall be prepared by the Recipient in accordance with ESS6 subject to the written agreement of the Association. Any such instruments shall be adopted and implemented throughout Project implementation and reflected in this ESCP through an amendment. 3.3.7. ESS 7 – Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS7 is not relevant as there are no groups in Lesotho meeting the criteria as set out in ESS7 43 3.3.8. ESS 8 – Cultural Heritage In the event of construction or the movement of the earth in connection with any Project activities, these Project activities shall be conducted in accordance with ESS8, including an “Chance Finds� procedure for archaeological or other cultural heritage, which shall be integrated in the ESMF. 3.3.9. ESS 9 – Financial Intermediaries ESS9 is not relevant to the Project activities. 3.3.10.ESS 10 – Stakeholder Engagement and Information Disclosure ESS 10 is relevant. The COVID-19 vaccination program requires support and engagement from all the stakeholders (particularly recipients of the vaccine, workers/staff involved in administering the vaccines, media, traditional authorities, community representatives, local communities including vulnerable and marginalized groups and other interested parties). During project preparation the MoH has identified and engaged, through meaningful consultations, with key stakeholders, paying special attention to the inclusion of women, and vulnerable and disadvantaged groups (especially the elderly, people with disabilities, the illiterate and the poor). The updated SEP acknowledges the particular challenges with engaging marginalized and vulnerable social groups such as those living in remote or inaccessible areas and proposes possible solutions such as engaging grassroots level CBOs. Lessons learned from the parent project and in similar emergency epidemic operations indicates that the risks of misinformation are apparent. A significant risk in the proposed AF relates to the potential for vaccine skepticism and misconceptions about the benefits and risks of the COVID- 19 vaccine. The parent project developed a SEP in line with ESS 10 and WHO’s Standards Guidelines for RCCE taking into account procedures and strategies for public disclosure of relevant project-related information, public consultations, and risks communication. The updated SEP incorporates awareness about COVID-19 vaccines helping to generate vaccine acceptablity by addressing rumors and fears. The draft COVID-19 National Deployment and Vaccination Plan recognizes that transparency, information disclosure and stakeholder engagement are key factors in the success of the vaccination program. This is also reflected in the strategy’s operationalization plan and stand-alone documents on communication and stakeholder engagement. A communication campaign tailored to the context of Lesotho is being implemented through various communication channels including traditional channels. As part of the updated SEP, consultation and engagement activities are deploying key messages on priority groups, vaccination centers and procedures, and other COVID-related information. Communications materials developed are being translated into Sesotho. The updated ESMF, including the LMP and SEP, will be consulted and disclosed in-country and on the World Bank external website before the Project Effectiveness Date. 44 Given the considerable stakeholder risks associated with the vaccination program, the SEP for the parent project has been updated and will be adopted and disclosed prior to commencement of the AF activities. The SEP identified key project stakeholders (at national, district and community levels), stated key objectives, messages on vaccine prioritization, deployment and phasing, health and safety, and public health measures, as well as requirements for grievance management, including SEA/SH reporting. The SEP also includes a grievance redress mechanism to address project-related concerns. A project-wide GRM, which includes measures for handling SEA/SH complaints, is being established, as outlined in the SEP. The details of contact and process of different GRM have been included in the updated SEP. 3.4. World Bank Environment, Health and Safety (EHS) Guidelines The EHS Guidelines are technical reference documents with general and industry-specific examples of Good International Industry Practice (GIIP). They contain the performance levels and measures that are normally acceptable to the World Bank Group, and that are generally considered to be achievable in new facilities at reasonable costs by existing technology. The general EHSG contain information on cross – cutting environmental, health, and safety issues potentially applicable to all industry sectors and covers the performance levels and measures that are generally considered to be achievable in new facilities by existing technology at reasonable costs. Application of the EHSG to existing facilities may involve the establishment of site-specific targets, with an appropriate timetable for achieving them. The applicability of the EHSG. The general EHSG cover the following issues: • Environmental Safety, • Occupational Health and Safety, • Community Health and Safety, and • Construction and Demolishing. In the case of the present Project, the MOH will pay particular attention to EHS 1.5 Hazardous Materials Management; EHS General Facility Design and Operation; EHS 2.5 Biological Hazards; EHS 2.7 Personal Protective Equipment (PPE); EHS 2.8 Special Hazard Environments; EHS 3.5 Transportation of Hazardous Materials; EHS 3.6 Disease Prevention; EHS 4.2 Occupational Health and Safety; and EHS 4.3 Community Health and Safety. 3.5. WHO and Other Technical Guidelines on COVID-19 To help countries navigate through these challenges, the World Health Organization (WHO) has updated operational planning guidelines in balancing the demands of responding directly to COVID-19 while maintaining essential health service delivery and mitigating the risk of system collapse. This includes a set of targeted immediate actions that countries should consider at 45 national, regional, and local level to reorganize and maintain access to high-quality essential health services for all. The WHO is maintaining a website specific to the COVID-19 pandemic with up- to-date country and technical guidance. As the situation remains fluid it is critical that those managing both the national response as well as specific health care facilities and programs keep abreast of guidance provided by the WHO and other international best practice. WHO technical guidelines, together with other resources, related to Covid-19 have been presented as Annex 6 to the ESMF. 3.6 International and Regional Regulations and Guidance A variety of Regulations and Guidance Notes have been prepared by the relevant national and international entities which are specifically applicable and supportive to COVID-19 management - including the Vaccination program. Vaccine Introduction Readiness Assessment Tool (VIRAT)/Vaccine Readiness Assessment Framework (VRAF) Integrated Tool: The Vaccine Introduction Readiness Assessment Tool (VIRAT)/Vaccine Readiness Assessment Framework (VRAF) Integrated Tool was developed by WHO, UNICEF and the World Bank. The introduction of the integrated tool or Readiness Assessment Tool is a national level instrument which aims to assist countries assess readiness to deliver COVID-19 vaccines when they become available; identify gaps and prioritize opportunities for enhanced readiness; and identify opportunities for financial support. The VIRAT/VRAF tool measures countries’ readiness to administer the COVID-19 vaccine across ten categories namely: a) Planning and Coordination, b) Budgeting, c) Regulatory, d) Prioritization, Targeting and COVID19 Surveillance, e) Service Delivery, f) Training and Supervision, g) Monitoring and Evaluation, h) Vaccine, Cold Chain, Logistics, and Infrastructure, i) Safety Surveillance, j) Demand Generation and Communication. Within these categories are assessment/activity areas. The tool is designed to provide information necessary for identifying gaps in readiness across the various activities, listing actions necessary to meet the gaps and generating financial implications of those actions. WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply The Strategic Advisory Group of Experts (SAGE) on Immunization of the World Health Organization (WHO) has released guidelines on 13 November 2020 on the implementation of national vaccination programs against COVID-19 which include the values framework, prioritization roadmap, and vaccine- specific recommendations. It outlines vaccine allocation, prioritization, and administration recommendations. 46 WHO SAGE Values Framework for the Allocation and Prioritization of COVID-19 Vaccination The WHO SAGE published the Values Framework for the Allocation and Prioritization of COVID-19 Vaccination on 14 September 2020 to provide guidance for countries on national prioritization and allocation of COVID-19 vaccines considering the limited supply. The main goal is for the COVID-19 vaccines to contribute significantly to the equitable protection and promotion of human well-being among all people of the world. The guiding principles include the (a) human well-being, (b) equal respect, (c) global equity, (d) national equity, (e) reciprocity, and (f) legitimacy. Under the national equity, the goals include (i) ensuring that vaccine prioritization within countries takes into account the vulnerabilities, risks and needs of groups who, because of underlying societal, geographic or biomedical factors, are at risk of experiencing greater burdens from the COVID-19 pandemic; and (ii) developing the immunization delivery systems and infrastructure required to ensure COVID-19 vaccines’ access to priority populations and taking proactive action to ensure equal access to everyone who qualifies under a priority group, particularly socially disadvantaged populations. Hence, priority groups and others which need to be consider include the following: • People living in poverty, especially extreme poverty • Homeless people and those living in informal settlements or urban slums • Disadvantaged or persecuted ethnic, racial, gender, and religious groups, and sexual minorities and people living with disabilities • Low-income migrant workers, refugees, internally displaced persons, asylum seekers, populations in conflict setting or those affected by humanitarian emergencies, vulnerable migrants in irregular situations, nomadic populations • Hard to reach population groups Further, the EPRP AF implementation shall make reference to the WHO guidelines on “Key considerations for repatriation and quarantine of travelers in relation to the outbreak of novel coronavirus 2019-nCoV� as well as the Africa CDC guideline on “Africa CDC Guidance for Assessment, Monitoring, and Movement Restrictions of People at Risk for COVID-19 in Africa. A summary of key relevant guidance and access links are presented in Annex 4. Likewise, Annex 6 to the ESMF provides relevant Resource Lists for further details. 3.7 Government of Lesotho Project E&S classification System compared to the World Bank System The Lesotho legislation classifies projects and activities into three categories as follows: 47 a) Category 1: Projects under this category are not listed in the Schedule and are unlikely to cause any significant environmental impact and thus do not require any additional environmental assessment. b) Category 2: Projects under this category are listed in the Schedule and are likely to cause environmental impacts, some of which may be significant unless mitigation actions are taken. Such projects cause impacts which are relatively well known and easy to predict. Also, the mitigation actions to prevent or reduce the impacts are well known. From the assessment of the Project Brief the projects are classified as not requiring a full environmental impact study (EIS). c) Category 3: Projects under this category are listed in the Schedule and are likely to have significant adverse environmental impacts whose scale, extent and significance cannot be determined without in-depth study. Appropriate mitigation measures can only be identified after such study. From the assessment of the Project Brief the projects are classified as requiring a full EIS. Sub-projects will be classified to the Lesotho legislation classification during screening procedures of the relevant activities. The World Bank requires that all projects financed by the Bank are screened for their potential environmental and social impacts to determine the appropriate extent and type of environmental and social work. The Bank - through the Environmental and Social Framework (ESF) - classifies the proposed projects into one of four categories as follows. The EPRP is classified to have ‘Substantial’ Environmental and Social Risks. Table 3-7 outlines the Project Environmental and Social Risk Classification (ESRC) according to levels and nature of impacts. In addition to the level and nature of impacts, other issues are also taken into account in determining the appropriate risk classification/ ESRC and they include: type, location, sensitivity, scale of project, capacity and commitment of the Borrower(s). Table 3-1 Project Environmental and Social Risk Classification (ESRC) of the World Bank ESF CLASSIFICATION DEFINITION High Risks Projects encompassing sub-project or activities with potential significant adverse environmental or social risks/ impacts that are diverse, irreversible, or unprecedented. Examples of these activities includes project affecting sensitive ecosystems services, project with large resettlements components, projects with serious occupational and health risks, projects with poses serious socio- economic concerns. These impacts may affect an area broader than the sites or facilities subject to physical works. 48 Substantial Risks Projects whose activities have some potentially adverse environmental and social impacts on human populations or environmentally important areas – including wetlands, forests, grasslands, and other natural habitats – though less adverse than those of “High Risk� projects. These impacts are site – specific, few if any of them are irreversible; and in most cases mitigatory measures can be designed more readily than for “High Risk� projects. Medium Risks Projects with activities with potential limited adverse environmental or social environments and social risks and or impacts that are few in numbers, generally site specific, largely reversible, and readily addressed through mitigation measures. Examples of these projects include small scale agricultural initiative, schools and hospital construction, forest management activities, low emission energy project. Low Risks Projects with activities with minimal or no adverse environmental and social risks and or/ impacts. Example of these projects or activities include education and training, public broad casting, health, and family planning, monitoring programmes, plans and studies and advisory services. The Bank requires that all projects be screened, and the requisite environmental and social assessment work be carried out based on these screening results. To ensure that future small scale sub-projects are implemented in an environmentally and socially sustainable manner the bank has developed an environmental and social screening process for small scale sub-projects consistent with ESS1. While Lesotho’s EA procedures are generally consistent with the Bank’s Standards, there are some gaps regarding the screening of sub-projects where the sites and potential adverse localized impacts cannot be identified prior to the appraisal of the project. Therefore, under the Lesotho COVID-19 EPRP the environmental and social screening processes as described in this report adhering to the ESF and other guiding documents of the World Bank shall be followed, including for classification of the Project. Table 3-3 describes the gap analysis and comparison of World Bank and Lesotho environmental and social assessment procedures. Table 3-2 Comparison between Bank and Lesotho ESA procedures Subject/Issue World Bank Policy Lesotho Policy Solution/mitigation EIA process Environmental Assessment Only projects EIA should be initiated (EA) work is initiated as classified as as early as possible in early as possible in project category 3 require project processing to processing and is EIS inform design of all 49 integrated closely with the projects. economic, financial, Wherever there are gaps institutional, social, & in the national technical analyses of all legislations and the proposed projects. World Bank Standards, the provisions of the World Bank Standards shall prevail. Screening The Bank’s project Only projects Lesotho CoVID-19 Criteria screening criteria group classified as EPRP is classified as projects into three category 3 require Substantial Risk Project categories depending on full EIS adhering to the World the severity of impacts: Bank’s screening • High Risk – Detailed criteria; and is required Environmental to prepare an overall Assessment, ESMF during the project • Substantial Risk – Initial design stage and site Environmental specific ESMPs for sub- Examination, projects once they are • Moderate Risk - identified. • Low Risk – The provisions of the Environmentally World Bank Standards friendly. shall prevail. ESMF used for screening No Provision for of sub-projects where the screening of sub- sites and potential adverse projects where the localized impacts cannot be sites and potential identified prior to the adverse localized appraisal of the project. impacts cannot be identified prior to the appraisal of the project. Environmental ESMPs are required for In addition to EIS ESMPs will be prepared and Social each set of activities (e.g., for category 3 for each sub-project to be Management sub-projects) that may projects, no other financed under Lesotho Plans (ESMPs) require specific mitigation, plans are prepared COVID-19 EPRP and monitoring and will include specific institutional measures to be mitigation, monitoring taken during and institutional implementation. measures to be taken during implementation adhering to national legislations and the ESF 50 Standards of the Bank. Wherever there are gaps in the national legislations and the World Bank Standards, the provisions of the World Bank Standards shall prevail. Disclosure World Bank requires ESIA EIS reports are Upon completion of reports to be: available for public ESIA reports, these must a) disclosed for written consumption and be: comments from the disclosed in- a) circulated for written various agencies and country at website comments from the government agencies. upon completion various agencies and b) notify the public of the but are not government agencies, place and time for its circulated for b) notify the public of review and written comments the place and time for c) solicit oral or written from the various its review, and comments from those agencies and public c) solicit oral or written affected. comments from those affected. d) Reports will be disclosed in-country and on the World Bank’s external website. e) Wherever there are gaps in the national legislations and the World Bank Standards, the provisions of the World Bank Standards shall prevail. 51 4 Environmental and Social Baselines 4.1. Biophysical Environmental Baseline The Lesotho COVID-19 Emergency Preparedness and Response Project and Additional Financing Project are being implemented in all ten districts of the country. The following subsections provide further details on some of the key background information specific to the bio-physical environment and COVID-19 risk prevalence in Lesotho. 4.1.1. Topographical and Geographical Features The rugged and broken terrain makes it difficult to deliver health care services to the majority of the population especially in the rural areas. The people of Lesotho are at high risk and vulnerable to the COVID-19 pandemic.6 Lesotho’s geographical proximity and porous borders, and its close economic ties with South Africa, places it at a particular risk of importation of COVID-19 cases, and subsequent community transmission. As of May 25, 2021, South Africa has reported 1,637,848 confirmed cases of COVID-19 and 55,874 deaths. 7 Many Basotho reside in South Africa as migrant workers, both in the mines as well as in the domestic and industrial sectors, and frequently travel between the two countries (over 60% of Basotho households receive a remittance from South Africa every month). Travel restrictions in and out of Lesotho from South Africa or other countries was declared to begin on March 30, 2020. Despite the restrictions of the South Africa-Lesotho borders and national lockdowns, the illegal migration of Basotho back into Lesotho are continuing, posing significant risks of COVID-19 transmission. As of May 25, 2021, Lesotho has reported 10,822 confirmed cases, and 326 deaths8. As of May 25, 2021, there have been 10,822 confirmed cases and 326 deaths due to COVID-19. A quarter of the population is HIV-positive, with women being disproportionately affected. Among those living with HIV, 39% are not on treatment, indicating a large proportion of the population may be immunocompromised and potentially at a higher risk of infection and its associated morbidity/ mortality. Limited access to essential public services, such as water and sanitation in certain areas, poses an extra risk for transmission of SARS-CoV-2. 4.1.2. Waste Management for the Health Care System The Lesotho Government developed a number of instruments to address Health Care Waste Management (HCWM) problems. These include: the adoption of the Primary Health Care strategy for service provision in 1979; development of the National Health Policy (2012 – 2020); and the developed a Health Sector Strategic Plan (HSSP) with various facets for addressing the country’s 6 Due to the weakness of its health system, World Health Organization (WHO) categorizes Lesotho as high risk and high vulnerability setting. 7 Johns Hopkins University and Medicine, Coronavirus Resource Centre, South Africa - COVID-19 Overview - Johns Hopkins (jhu.edu)https://coronavirus.jhu.edu/map.html, Retrieved: 25/05/2021 8 Lesotho - COVID-19 Overview - Johns Hopkins (jhu.edu), Retrieved: 25/05/2021 52 health sector challenges of which HCWM is a part. The National Health Policy acknowledged that the health sector is under pressure due to several factors including: increasing morbidity and mortality, insufficient financial and logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment as well as a shortage of adequately and appropriately trained health personnel. Subsequently, there is a high prevalence of communicable and non- communicable diseases. However, the National Health Policy points out that most of these diseases can easily be prevented if appropriate environmental and lifestyle measures are taken. With more attention being paid to the development of health promotion and prevention actions as opposed to merely and solely focusing on curative care. In 2016, GoL developed the Infection Control and Waste Management Plan (ICWMP) for Lesotho and associated Standard Operating Procedures (SOP) (2016) which focus on preventive measures. Mainly, the initiatives to be taken in order to prevent and mitigate the environmental and health impacts of Health Care Waste on Health Care staff and the general public. The ICWMP provides a holistic approach to HCWM that embraces the legal and institutional aspects and involved all interested and affected parties. The 3-bin system was subsequently introduced into all the Health Care Facilities country-wide to facilitate the segregation of medical waste. The bins are placed at all generation points and comprise of the following: a) one container with a red liner for the infectious waste, b) one yellow container or “sharps container� for the sharps and c) one container with a black liner for the general waste. An assessment of the Health Care Waste Management (HCWM) systems in Lesotho carried out under the ongoing Southern Africa Tuberculosis and Health Systems Support Project (SATBHSSP) (P155658) identified the following constraints: a) Non formalization of HCWM in the health care facilities; b) Absence of specific operational policy about HCW; c) Weak HCWM legislative regime; d) Absence of standard HCWM operational procedures; e) Inadequate budgetary resource allocations; f) Limited qualified human resources; g) Technological challenges in handling, treatment and disposal facilities; h) Subdued and insufficient knowledge about HCW (staff and public); and i) Absence of private sector participation. The Lesotho Health Care Waste handling model is based on having pyrolytic incinerators at tertiary hospitals and clinics, while hospitals and clinics without an incinerator transport their waste to nearest incinerator facility. The Lesotho Millennium Development Authority (LMDA) assists the Ministry of Health to collect, transport and treat HCW at these incinerator facilities. If 53 waste segregation is performed well, the quantities to be incinerated will be reduced and negative impacts on the environment will be insignificant. To ensure that inappropriate materials are not incinerated, the waste incineration system is based on a strategy of segregation at source, to reduce as much as possible the infectious waste stream and to prevent the contamination of other wastes (papers, plastic objects, etc.). All types of wastes must not be incinerated, mainly the non-incinerable ones mentioned above. Waste segregation is used to allow the non-contaminated, non-infectious and non-incinerable wastes to be disposed at municipal disposal sites. Only the contaminated wastes (needles, sharp objects, blood stained cottons, etc.) are reserved for incineration. The latter don’t produce (or produce very little) toxic elements. In addition, this system of treatment allows a complete melting of needles. Although incineration has its critics, it is difficult to choose another system for developing countries such as Lesotho, given the economic and technical conditions. The purpose is not to incinerate all solid waste (including general waste), but only selected contaminated health care wastes. This incinerator technology is supported by the WHO elsewhere in Africa and are in consistent with Good International Industrial Practice (GIIP). For example, during vaccination campaigns against tuberculosis in Togo and Benin, the WHO has supported, since 2001, a program to produce craft incinerators (made of local materials, cement with clay), in order to destroy the syringe needles used in the vaccination program. WHO organized a workshop in Bamako in 2001 to train some African technicians in the building of these types of incinerators. These models can reach very high temperatures (800° C) able to get the needles and sharp objects melted. Presently, there are no environmentally sound options at low-cost for safe disposal of infectious wastes. Incineration of wastes has been widely practiced, but alternatives, which may be preferable under certain circumstances, are becoming available, such as autoclaving, chemical treatment and microwaving. Land filling, when safely practiced, may also be a viable solution for part of the already segregated wastes. Although Lesotho has some experience in infection prevention and control, healthcare waste management, communication and public-awareness on emergency situations, its capacity to manage risks associated with COVID-19 is a major concern. Healthcare professionals may not have the detailed know-how on infectious risk management in the labs and treatment/isolation centers. Handling of wastes and adequate use of PPE equipment may also be challenging, though this should improve with the Project intervention. Key hospital staff, such as cleaners, are likely to have low levels of education in infection prevention and could contract COVID-19 if protection measures are not taken. 4.2. Socio-Economic Baseline Lesotho is a small, landlocked mountainous country, surrounded by the Republic of South Africa with a population of 2.1 million in 2017 and a per capita gross national income of US$1,280 (in current US$). Approximately 75% of its population live or are at risk of living below the poverty 54 line, and a quarter of the population has HIV/ AIDS. Lesotho’s economy is integrated with that of the Republic of South Africa from which it not only imports more than 90 percent of its goods and services, but many Basotho reside in South Africa as migrant workers (including illegal and undocumented) both in the mines as well as in the formal, domestic and industrial sectors. There are also cultural relations between the people of South Africa and Lesotho. Lesotho is regarded as more vulnerable due to the possible knock-on effects from South Africa, due to its geographic location and socio-economic interdependencies between the two countries, and its fragile health system. The Gender Development Index indicates that that there is equality between men and women in terms of Lesotho’s Human Development Index (HDI) achievements. The Gender Inequality Index suggests inequality between men and women in terms of reproductive health, education, political presentation and the labour market. The 2018 Multidimensional Poverty Index indicates that approximately 57.1% of households live below the National Poverty Line in terms of income. Approximately 33.64% of the population can be defined as multi-dimensionally poor. Lesotho’s declining economic growth and significant fiscal challenges may be worsened because of the COVID-19 pandemic. Real gross domestic product (GDP) growth declined from 1.7 percent in 2018 to 1.4 percent in 2019. Economic risks are related to the sharp declines in Southern African Customs Union (SACU) revenues, uncertainty of the Africa Growth and Opportunity Act renewal of the United States, inflation due to drought-induced higher food prices, and South Africa’s declining growth. Lesotho relies on South Africa for 75% of its imports and 30% of exports. Furthermore, worker remittances from South Africa represent 23% of GDP. The COVID-19 pandemic has already had a significant negative impact on economic growth globally due to its negative impact on trade, supply chains, consumption and demand. South Africa’s growth forecast for 2020 foresees a significant contraction. This has resulted in a downward revision of Lesotho’s forecasts, given its close ties with the South African economy. COVID-19 has larger ramifications on Lesotho’s supply chains, remittance flows, and key industries (e.g., tourism, transport, textiles). Due the COIVD-19 pandemic, Lesotho’s overall fiscal deficit is revised upwards to 5.5 percent of GDP from the budget projection of 4.7 percent of GDP. In addition, between April and December 2018, the Government accumulated LSL 1.1 billion (equivalent to US$78 million) in public expenditure arrears. 4.2.1. Socio-economic Conditions In Lesotho, the gross domestic product (GDP) growth at 4.6% in 2017, is being driven primarily by mining production, construction and government services. Unemployment in Lesotho stood at 24% in 2008 and is unlikely to have changed much, even as underemployment and low productivity employment is widespread, especially in rural areas. Recent unemployment data is not yet available. Preliminary government estimates based on the 2010/11 Household Budget Survey show that the national poverty head count rate stood at 57.1% 55 and the Gini Coefficient based on consumption stood at about 0.53. Poverty has decreased in urban areas, while it has increased in rural areas. In the past, many social welfare programs were organized on the local level or by missions. But the need for concerted action to alleviate hardships brought about by the severe droughts led to the creation in 1965 of a Social Welfare Department under the Ministry of Health (later the Ministry of Health and Social Welfare). Community development teams stimulate local initiative by conducting courses and forming voluntary community development committees. 4.2.2. Demography The total population of Lesotho is 2,007,201 with 982,133 being males and 1,025,068 as females and this suggests an increase of 130,568 persons from the Census of 2006 (Population and Housing Census (PHC) report, 2016) as illustrated by figure 6 below. In return, the increase indicates the annual growth rate from 2006 to 2016 of 0.68 which reflects a substantial increase from 0.08 which was experienced in 2006 census. Nationwide, 35 percent of households are headed by women. Female-headed households are slightly more likely than male-headed households to live in urban areas: of all male-headed households’ 29.5 percent are in urban areas, and the rest are in rural areas. For female-headed households, 30.1 percent are in urban areas and the rest are in rural areas. 4.2.3. Water Supply and Sanitation Lesotho is known to have abundant water, but its distribution in the country is disproportionate owing to rainfall and other physical factors. The highlands receive more rainfall than the lowlands where most of the people reside. In general, the provision of clean water rose from 52% to 63% in the 1990s (GoL, 2006) on a national scale, but the situation has been steadily deteriorating in the peri-urban areas, especially with the number of people per collection point. So, there is a critical shortage of water supply to potential development sites like industries and factories and health care delivery centers, as well as to the general communities, especially in rural areas, and many are still deprived of safe sanitation systems. This has ripple effects to the prevention of COVID-19 infections and the health care delivery system in general. 4.2.4. Education Officially, almost all children enroll in school but only half complete their final primary year. Only 41 percent of children of relevant age complete lower secondary school, and enrollment in secondary school is 33.4 percent. There are no government secondary schools, so many families cannot afford secondary education, even for successful students. In contrast to some other countries, some girls in Lesotho are able to continue their education further than boys because they are not forced to leave home early to find employment. Other 56 parents prefer to see their daughters married young. Estimates of adult literacy vary widely, but there are significant numbers of adults who cannot read and write. 4.2.5. Health Care Diseases such as TB and HIV/AIDS are wreaking havoc in Lesotho (24% of the population). The scourge was exacerbated by the system of labor migration, which generally exposed people to high-risk behavior and made migrants more vulnerable to infection. The migrants imported the diseases back to their families, infecting a large number of people who never migrated. Then the additional consequence is that rural people’s scarce resources are used in caring for the sick ones, covering funeral expenses and supporting orphans. With an HIV prevalence of 24%, Lesotho ranks as the second country most impacted by HIV/AIDS in the world. Lesotho is facing an acute human resource for health (HRH) crisis. The available workforce constitutes a large number of women, many whose husbands are former mineworkers or who no longer work due to disease (especially tuberculosis and HIV/AIDS) or disability (18 percent). The COVID-19 pandemic, if not contained, will distress socioeconomic development that is already heavily impacted by natural disasters. If no action is taken, it is estimated that up to 92% of Basotho could be infected with the virus that causes COVID-19 and that almost 8000 deaths could result from it9. The impact of this on all sectors of society will be immense. Frequent climate shocks, including recurrent droughts, dry spells and floods challenge the livelihoods of 80% of the population who are reliant on natural-resource based industries such as agriculture. There are almost no buffers enabling a prolonged management of a massive health outbreak for the population of Lesotho. Limited access to essential public services such as water and sanitation in certain areas poses an extra risk for transmission of the SARS-CoV2. Access to healthcare in Lesotho varies greatly by gender, socio-economic status and geography (remoteness and inaccessibility). Factors affecting access to healthcare include insufficient funds to travel to health centers, inaccessibility and remoteness of the rural areas situated in a rugged mountainous terrain. 4.2.6. Health Care Facilities The government of Lesotho is working to rehabilitate some hospitals and is making an overall effort to strengthen health care services. However, it is facing an acute human resource for health (HRH) crisis. A third of MoH labour force consists of support staff. Nurses constitute 73.3% of the workforce in MoH followed by physicians at 6% with other health cadres constituting a low percentage of the workforce. While there is a general shortage of staff, it should be emphasized 9 Walker, P. G., Whittaker, C., Watson, O., Baguelin, M., Ainslie, K. E. C., Bhatia, S., ... & Cucunuba, Z. (2020). The global impact of covid-19 and strategies for mitigation and suppression. On behalf of the Imperial College COVID-19 response team, Imperial College of London. 57 that Lesotho generally experiences an acute shortage of specialized health cadres. (Lesotho National Health Strategic Plan) Laboratory services in the health sector remain understaffed and laboratory personnel who are specialized are very few in the system. As a result of this shortage, at health centers level health center staff collect specimen for processing at the district hospital. In addition to lack of personnel, there are interrupted supplies of medicines and some gaps are being filled by development partners who purchase laboratory reagents among other things. (Lesotho National Health Strategic Plan). The formal system of Lesotho health facilities is divided into the national (tertiary), district (secondary), and community (primary) levels. The community level includes both health posts and health centers. The district level comprises hospitals that receive patients referred from the community level and filter clinics. The national level consists of one referral and two specialized hospitals. Any patients with conditions that cannot be addressed at the national level are referred to South Africa for care, through the national referral hospital. In Lesotho, 42 percent of the health centers and 58 percent of the hospitals are government owned, 38 percent of the hospitals and 38 percent of the health centers fall under the control of the Christian Health Association of Lesotho (CHAL), and the remaining facilities are either privately owned or operated by the Lesotho Red Cross. In addition to the hospitals, filter clinics, health centers, and health posts recognized within the Government of Lesotho (GOL) system of health facilities, there is also an extensive network of private surgeries, nurse clinics and pharmacies providing care and/or medicines. In terms of HCWM the Ministry of Health is assisted by Lesotho Millennium Development Authority (LMDA) for collection and treatment of HCW in its facilities. LMDA has sub- contracted other companies for this function. The contracted companies are expected to supplier the health facility with waste management equipment (container, liners). It collects HCW from the Health facilities for treatment at the incinerator at the hospitals. It is also mandated to maintain day to day running of the incinerator. They are again expected to collected and transport general waste from the hospital for disposal at a designated disposal site. National level: At the national level, Lesotho has three tertiary-level hospitals: Queen Momahato Hospital, Mohlomi Mental Hospital, and Bots`abelo Leprosy Hospital. Queen Momahato Hospital is the national referral hospital. It is a large tertiary public-private partnership hospital. Any cases that cannot be treated at Queen Momahato are referred to South Africa. It is linked to a network of filter clinics. District level: Districts have filter clinics and district hospitals. Filter clinics are a first point of care intended to lighten the load of district hospitals and function as “mini-hospitals,� offering curative and preventive services and limited inpatient care. Unlike health centers, filter clinics are staffed by doctors and some have pharmacy technicians. They also offer selected laboratory and radiology services (administered through the hospitals). 58 Although district hospitals provide both in-patient and outpatient care, their services vary widely depending on the availability of financial resources, equipment, and human resources. Treatment and diagnostic services are more complex at this level. These facilities provide minor and major operative services, ophthalmic care, counselling and care of rape victims, radiology, dental services, mental health services, and blood transfusions as well as preventive care. Some specialized care is also available for TB, HIV, and non-communicable diseases. Community level: Communities offer health posts and health centers. Health centers are the first point of care within the formal health system. Staffed by nurse clinicians with comprehensive skills in preventive and curative care and in the dispensing of medication, health centers offer curative and preventative services, including immunizations, family planning, and postnatal and antenatal care on an outpatient basis (with the exception of services to expectant mothers). Their mandate also extends to supervising the community public health efforts and training volunteer community health workers (CHWs). Health posts provide community outreach services and are typically managed by volunteers. Generally, health posts are opened at regular intervals (not daily) and provide promotive, preventive, and rehabilitative care in addition to organizing health education gatherings and immunization efforts. Volunteer CHWs include traditional birth attendants and community-based condom distributors, among others The major hospitals/health care facilities supported under the Project are presented below: No. Name of Hospital Location/Address Management Capacity (Approx. no. of Beds) 1. Berea Hospital Berea District Government 128 2. Butha- Buthe Butha-Buthe District Government 129 Hospital 3. Machabeng Hospital Qacha’s Nek District Government 100 4. Mafeteng Hospital Mafeteng District Government 151 5. Mokhotlong Hospital Mokhotlong District Government 120 6. Motebang Hospital Leribe District Government 287 7. Queen II Hospital Maseru District Government 450 8. Quthing Hospital Quthing District Government 132 9. Tebellong Hospital Qacha’s Nek District Government 38 10. Nts’ekhe Hospital Mohale’s Hoek Government 133 11. Makoanyane Maseru District Military hospital 40 Hospital 12. Maluti Hospital Berea District CHAL 159 13. Mamohau Hospital Leribe Distrcit CHAL 28 14. Paray Hospital Thaba-Tseka District CHAL 100 15. Seboche Hospital Butha-Buthe District CHAL 90 16. St James Hospital Thaba-Tseka District CHAL 59 59 17. St Joseph’s Hospital Maseru District CHAL 120 18. Scott hospital Maseru District CHAL 165 4.2.7. Broader social issues: Gender, Sexual Exploitation and Abuse SEA)/Gender Based Violence (GBV) The past 10 years have seen the passing of several key legal reforms advancing gender equality, including recognizing women’s equal standing before the law, and rights to land ownership, inheritance and decisions about household assets, as well as reforms to increase political representation and protections against Gender-based Violence (GBV). Women could be adversely affected through several channels. Because of their overrepresentation in essential and service occupations (domestic workers, nurses, and service workers such as cashiers), women face greater risk of contagion. Women will also be affected through their segregation in vulnerable employment. Women also face an increased care burden with school closures, and if family members fall sick. With economic stress, women are more likely to forego meals or medical care in order to meet their caregiving responsibilities and stretch household resources further. An increase in caregiving responsibilities could also mean women exit the labor market. In this context, the COVID-19 crisis will affect women acutely. Though Lesotho has made efforts to attain gender equity and equality legislation, customary law and practice still contain considerable gaps and SEA/GBV incidents are common. In the past, GBV has increased with economic shocks including the recent droughts10, and there is a reason to think such violence is increasing with the COVID-19 crisis. The GBV risk for the Project have been assessed thoroughly in the social assessment, and a dedicated GBV/SEA/SH plan has been prepared (see Annex 7 to the ESMF). Interventions will be tailored to Project realities and in- country context and may include e.g., institutionalizing GBV prevention and response mechanism, establishing women’s professional networks and access to upskilling and training opportunities on COVID-19 awareness, prevention and management. 4.3. COVID-19 Testing and Treatment in Lesotho Since the outbreak of the COVID-19 virus, Lesotho has been sending samples of suspected COVID-19 cases to National Institute of Communicable Disease (NICD) in South Africa, for testing, due to unavailability of COVID-19 testing facilities in the country. However, the country continued to carry out contact tracing on all the confirmed cases and screening for COVID-19 symptoms across the country in various public locations, such as at boarder gates, schools, health facilities, workplaces, etc., as well as monitoring of those in home quarantine and isolation facilities. Due to the burden imposed by rapid increase of COVID-19 cases in South Africa, resulting in high volume of tests run by NICD, Lesotho has established a COVID-19 testing facility 10 A 2016 study of GBV induced by the El Niño drought the previous year, reported that the majority of respondents (54 percent) felt there had been an increase as a result of El Niño in the previous 12 months. Another 16.5 percent perceived an increase but did not see it as linked to the drought, while 29 percent said they did not think El Niño had led to an increase (UNFPA and Kingdom of Lesotho 2016). 60 at the National Reference Laboratory (NRL), using GeneXpert machines, starting from June 24, 2020. The current testing capacity is estimated at 48 tests per day, which is expected to increase to at least 68 tests per day starting from August, 2020 after completion of newly established additional testing laboratory using Polymerases Chain Reactions (PCR) testing. Quarantine and isolation facilities have been established in various locations across the country, which among others include quarantine facility at Thaba-Bosiu, Mafeteng Hospital, private acquired facilities in various hotels and guests house in Mohale’s Hoek district, etc. Confirmed COVID-19 patients are currently being treated at Berea district Hospital, and an additional new quarantine and treatment facility has been established in Mafeteng Hospital, under the Lesotho COVID-19 Emergency Preparedness and Response Project. During the consultations, it has been reported that that some hospitals (including Mafeteng Hospital) have faced shortages of Personal Protective Equipment, oxygen supplies and ventilators. The issue was promptly resolved in most of the hospitals/health care facilities enabling them to provide the services as required. 4.4. National New Vaccine Introduction Program in Lesotho 4.4.1. Vaccine Program Status Prior to existence of the COVID-19 pandemic, the MOH had just established a Working Group in May 2019, officially known as HPV Vaccine Introduction Working Group for introduction of Human Papilloma Virus (HPV) vaccine. This working group comprised of multi-sectoral representation that include stakeholders in health and other government ministries; Ministry of Education and Training, and Ministry of Local Government and Chieftainship, religious bodies and community-based stakeholders and more. This working group was well-functioning, robust, and it had a transparent decision-making structure. Due to the successful functioning of this working group, the Expanded Program on Immunization (EPI) Technical Working Group (TWG) relaunched this working group as the National New Vaccine Introduction (NNVI) TWG. For purposes of the COVID-19 vaccine introduction, the NNVI TWG has been further expanded to also include all stakeholders who are supporting the country in responding to the COVID-19 pandemic as guided by the WHO 8 Pillar Country Operational Preparedness and Response Guidance. The NNVI has a multi-sectoral representation that includes stakeholders in health and other government ministries such as the Ministry of Education and Training, the Ministry of Local Government and Chieftainship, religious bodies and community-based stakeholders, among others. The governance structure of the COVID-19 NNVI TWG has been included in Annex 13 to the ESMF. As a body that provides the Ministry of Health with ongoing and timely public health advice in response to questions relating to immunization, the NNVI-TWG also communicates with key stakeholders, partners, and the media in the context of COVID-19 vaccine deployment and vaccination. The Planning and Coordination, & Service Delivery working consolidates updates from all the other working groups on a weekly basis, and these updates are presented to the Honorable Minister of Health, and Director General of Health Services on a weekly basis. 61 Furthermore, these updates are also presented during the weekly COVID-19 Partners’ Meeting. COVID-19 vaccine introduction forms a standing agenda item for the meeting. As with other new vaccines introductions, the National Immunization Technical Advisory Group (NITAG) has been equipped to provide evidence-based recommendations and policy guidance. To that end, NITAG continues to review the relevant epidemiology data, and advise on priority target groups and vaccinations strategies, issues vaccine-specific recommendations, and review behavioral and social data to help advise on public communication plan. Moreover, WHO, UNICEF, Gavi and the World Bank have provided technical assistance to the MoH through participation in weekly planning, coordination and service delivery working groups and providing extensive review of relevant documents. To strengthen planning and coordination for new vaccine introductions at the district level, MoH is working on co-opting members in existing district committees in being part of the District Immunization Steering Committees in all ten districts. Membership of these steering committees will be sought from already existing structures under the District COVID-19 Secretariat. Composition of these steering committees is as follows: EPI Child Health Officer (CHO), Public Health Nurse, one representative from the District Administrator’s Office, one representative from the District Councilor’s office, one representative from the Ministry of Education and Training, and one representative from the Ministry of Local Government and Chieftainship. Eight districts have thus far been sensitized on the COVID-19 vaccine introduction, and useful feedback was provided by the districts to further inform the establishment of the steering committees. The steering committees will be oriented on new vaccines introduction and immunization outreach planning and coordination. Work for establishment of these steering committees for preparation of the Human Papilloma Virus (HPV) vaccine in 2022 were underway when the world was hit by this pandemic. Responding to the pandemic thus provided MoH with an opportunity to expedite the establishment, orientation, and capacity building of these steering committees to lead the planning and coordination for every new vaccine introduction and immunization campaigns at the district level. MoH will ensure annual orientation and regular capacity building for sustainability of these established committees. As per the EPI governance structure, final approval of all work plans and applications for vaccines and cold chain equipment is undertaken by the Inter-Agency Coordinating Committee (ICC). For purpose of the COVID-19 vaccine introduction, membership was also expanded to include leadership from institutions and organizations that are not traditional immunization partners. This expanded ICC has been oriented on the introduction of the COVID-19 vaccine, and has also approved the Vaccine Request Form (VRF) that was submitted to Gavi on 7th December 2020. 62 4.4.2. Disadvantaged / Vulnerable Individuals or Groups It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups11, who often do not have a voice to express their concerns or understand the impacts of a project and to ensure that awareness raising and stakeholder engagement with disadvantaged or vulnerable individuals or groups (on infectious diseases and medical treatments in particular) be adapted to take into account such groups or individuals particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from a person’s origin, literacy level, gender, age, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g., minorities or fringe groups), dependence on other individuals or natural resources, etc. Additionally, communities in remote and isolated highlands communities are vulnerable due to their lower rate of access to health care facilities and awareness campaigns, and general poverty and lack of information. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project-related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. The main Vulnerable Groups – those who may be disproportionately impacted or further disadvantaged by the Project as compared with any other groups due to their vulnerable status – in Lesotho include: (i) the differently-abled/disabled persons; (ii) children; (iii) elderly people (those above 60 years of age); (iv) people under the poverty line (US$ 1.90 PPP); (v) marginalized/deprived groups/individuals; (vi) Nomadic herders; (vii) people living in remote/isolated areas; (viii) the refugees/illegal immigrants, amongst others. The NDVP is guided by the WHO Framework for Allocation and Prioritization of COVID-19 Vaccination for vulnerable or disadvantaged groups. There is a likelihood of social exclusion, especially in the most vulnerable and marginalized groups such as communities in remote inaccessible areas from access to the COVID-19 vaccines. The elderly, those with underlying medical conditions, and people living with disability, though included in the priority populations to be vaccinated as identified in the country prioritization framework, may have limited access to the vaccines due to reduced mobility. The information 11 Further details are provided at: World Bank Directive: Addressing Risks and Impacts on Disadvantaged or Vulnerable Individuals or Groups and the WHO Framework for Allocation and Prioritization of COVID-19 Vaccination. Of the numerous disadvantaged and vulnerable groups listed in the Framework, following main groups or individuals are applicable in case of COVID-19 in Lesotho: • People living in poverty, especially extreme poverty • Homeless people and those living in informal settlements or urban slums • Disadvantaged or persecuted ethnic, racial, gender, and religious groups, and sexual minorities and people living with disabilities • Low-income migrant workers, refugees, internally displaced persons, asylum seekers, vulnerable migrants in irregular situations, nomadic populations • Hard to reach population groups. • Older adults defined by age -based risk • Older adults in high risk living situations (examples: long term care facility, those unable to physically distance) • Groups with comorbidities or health states (e.g. pregnancy/lactation) determined to be at significantly higher risk of severe disease or death • Sociodemographic groups at disproportionately higher risk of severe disease or death • Social groups unable to physically dis tance (examples: geographically remote clustered populations, detention facilities, military personnel living in tight quarters, refugee camps) • Groups living in dense urban neighborhoods • Groups living in multigenerational households. 63 materials on the COVID-19 vaccine to be developed could exclude the most vulnerable or be developed in a way that is not sensitive to the needs and access of these different groups. These concerns will be addressed through the identification of strategic locations for vaccine administration for vulnerable groups for increased access to Vaccination sites. Communication materials to be developed will also be clear and concise and in a format or language (Sesotho) that is understandable to all people, in particular the most vulnerable. This may require different types of media (radio, print, broadcast, and digital or new media) public gatherings (following COVID 19 regulations) as well as engaging existing formal and informal public health and community- based networks (schools, churches, healthcare service providers at local level, etc.). Vulnerable groups will be reach out through their respective representatives such as Community Based Organizations (CBOs), local and traditional authorities, interest groups, local authorities, etc. Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. For any vaccination strategy, the SEP will include targeted, culturally appropriate and meaningful consultations for disadvantaged and vulnerable groups before any vaccination efforts supported by the project begin. Description of the methods of engagement that will be undertaken by the project is provided in the following sections. Prior to existence of the COVID-19 pandemic, the MOH had just established a Working Group in May 2019, officially known as HPV Vaccine Introduction Working Group for introduction of Human Papilloma Virus (HPV) vaccine. This working group comprised of multi-sectoral representation that include stakeholders in health and other government ministries; Ministry of Education and Training, and Ministry of Local Government and Chieftainship, religious bodies and community-based stakeholders and more. The Expanded Program on Immunization (EPI) Technical Working Group (TWG) relaunched this working group as the National New Vaccine Introduction (NNVI) TWG. The vaccines will be stored at the national level in Maseru and distributed to the districts once vaccines become available for the identified priority groups. The target population is calculated as those 16 years and above based on vaccine product profiles of already approved COVID-19 vaccines for emergency use, and recommendations of the WHO Strategic Advisory Group of Experts (SAGE). The vaccine will be deployed in three phases. About 430,115 people will be targeted in the first phase. This constitutes ~20% of the country’s population. The priority beneficiaries for this first batch of vaccines will be health care workers, Border Control Officials, and Port Health Officials, people with co-morbidities and all the elderly population. In phase two, the country is targeting 394,000 people. The targeted priority groups in this regard are; people with co-morbidities, clothing and textile factory workers, people working in the mining sector, law enforcement officers (police and military), correctional services officers and prisoner, and students and teachers. In phase three, 591,000 people will be targeted. This will constitute of people 16 64 years and above were not eligible in phase one and two. Priority will be given to the upper age brackets, starting with those aged 59 years. The communication and community mobilization on immunization is useful in the context of the current pandemic, and the acceptance and uptake of COVID-19 vaccines may present an unprecedented challenge considering the magnitude of the coming Vaccination efforts. This will require targeted and tailored communication strategies to increase public awareness and create demand for COVID-19 vaccine acceptance and uptake. As a general objective, the country is pursuing the goal of high acceptance and demand for the COVID-19 vaccine through employing transparency in communication while also managing miscommunication and misinformation. Deployment of vaccines from the national to the district level is not envisaged to be challenging, and from the district level to easily accessible health facilities. However, challenges are envisaged for the deployment of the vaccine to a hard to reach areas should the current rain fall persist as it results in flooded rivers, and hard to navigate gravel roads. These areas may need deployment of vaccines through the use of helicopters. Security risk for the in country deployment and storage of the COVID-19 vaccine has been noted due to constrained supply, and measures to prevent percutaneous injuries associated with the use and disposal of needles and other sharp instruments must be taken care of. This also includes the protective equipment that will be used by vaccinators during each COVID-19 immunization session. Conducting post-introduction evaluations (PIE) is warranted to assess the overall impact of the introduction of the new vaccine to the country’s national immunization programme. The targeted Vaccination sites in all three phases will allow patients to be monitored for at least 15 minutes following administration of the vaccine, taking into consideration of the WHO SAGE interim recommendation. 65 5 Potential Environmental and Social Risks and Mitigation Implementation of the project activities will be positive and urgently needed. As this project will finance procurement of vaccines and drugs, medical supplies, medical equipment, and vaccine storage or vaccine distribution equipment, ICU rehabilitation works, expansion of the national laboratory & construction of the storage facility in Maseru, and installation of mini oxygen plants within the existing HCF premises – which have limited, if any, adverse impacts. The environmental risks result from the operation of the labs, the quarantine and isolation centers, and screening posts at land crossings, deployment of vaccine, as well as with the appropriateness of the medical waste management system to be put in place by the Ministry of Health. Given that Lesotho has limited experience in managing highly infectious medical wastes such as those associated with COVID-19, the project can be judged to have a substantial environmental risk and will require that appropriate precautionary measures are planned and implemented. Environmental and social risk assessments have been conducted by the Ministry of Health with support from the PIU during the project preparation process. Specially designed screening forms (Annex 1, and Annex 2) were implemented for the purposes. As for the Parent Project, the anticipated overall environmental and social risks for the AF remain Substantial. The changes proposed for the AF entail the inclusion of vaccine financing and expansion of the scope of activities in the parent project. The measures to address social and environmental risks in the Parent Project remain relevant, including infection prevention and control improvements in health facilities, such as assessment and mitigation measures for medical waste risk management that will be expanded as inoculation activities expand. While experience indicates that substantial risk ratings can be expected for the environment, more attention should be given to address the medical waste and occupational health and safety risks, especially because of the required appropriateness and safety of refrigerants, and the potential huge demand for cold storage and transportation requirements needed to cover the entire country. The social risk is anticipated to be at least substantial - primarily in view of the fact that there is a broader social risk of inequity in access to vaccines and elite capture, such as due to political pressures to provide vaccines to groups that are not prioritized. These risks will be mitigated through several measures to ensure that vaccine delivery targets the most vulnerable populations, particularly health care workers, poor and elderly populations, and other vulnerable persons as specified in the ESMF, Lesotho NDVP, security management plan (SMP) and other pertinent documents. First, the Bank will support the GoL to develop and adopt an explicit, contextually appropriate, and well-communicated targeting criteria and implementation plan (e.g., the national vaccination program and any subsidiary programs), including criteria for access to vaccines. As part of the SEP, the Borrower has ensured that this plan is subject to meaningful consultations per ESS 10. 66 5.1. Methodology for Assessing Risks and Impacts The ESMF is prepared based on an assessment of direct and indirect risks and impacts of the specific project activities. A direct impact is defined under the ESF as “…an impact which is caused by the project, and occurs contemporaneously in the location of the project.� An indirect impact is one “…which is caused by the project and is later in time or farther removed in distance than a direct impact, but is still reasonably foreseeable, and will not include induced impacts�. Induced impacts are those that are unknown, speculative, uncertain, or remote. Induced impacts are not considered further in this document as they cannot be reasonably assessed or mitigated at this time. Induced impacts emerging during project implementation will be managed responsively and the ESMF amended accordingly. The project will apply the World Bank’s Environment and Social Framework (ESF), procedures for IPF operations designed to respond to COVID-19 and processed as an emergency operation under paragraph 12 of the IPF Policy. The Project will have positive social and environmental impacts as it should improve COVID-19 immunization, surveillance, monitoring, and containment. However, the project could also cause substantial environment and social risks. There are both beneficial and adverse impacts of the Project. The major beneficial impacts include the following: a) Social and Behaviour Change: The implementation of the COVID-19 Project is geared for positive social and behaviour change as people become aware of the need for safe sanitation practices, including regular hands washing, covering of mouth when coughing or sneezing, etc. b) Employment opportunities: Once the facilities are up and running, temporary or permanent jobs may be created to run the expanded facilities ranging from the technical staff to train and run the testing equipment to non-technical job opportunities for cleaners, security guards, etc. c) Improved services at the health facilities, including enhanced access to oxygen supplies, and vaccination facilities: The Project will positively impact on the health delivery programs through improved quality and diversity of services offered. Renovation of the facilities and installation of equipment will enable currently inefficient facilities to provide improved health care services leading to improved health conditions. d) Improvement in livelihoods and local economies: Improved health care delivery will improve the health of the labor force, resulting in increased productivity and household incomes and ultimately to long-term benefit of improved local economies. e) Improved aesthetics of the Health Facilities: Renovation will improve aesthetics of the Health Facilities which, in their present state, some look dilapidated. Some buildings currently under use are unfit for occupation. Renovation will also give these buildings and equipment an extended life. 67 f) Reduction of covid-19 spread due to vaccination. Beneficial impact enhancement measures shall be integrated into all Project/subproject activities and implemented to the best possible extent. 5.2. Risk Summary 5.2.1. Environmental Risks The main environmental risks of the AF are the same as those of the parent project. Activities under both the parent project and the AF will potentially cause environment, health and safety risks due to the dangerous nature of the pathogen (COVID-19), reagents and equipment used in the project-supported activities. Health facilities treating patients, inoculation centres, laboratories, and quarantine/isolation centers may also generate health care waste and chemical wastes (including water, reagents, infected materials, sharps used in diagnosis and treatment and other hazardous by-products) that could have substantial impact on the environment and human health. The main environmental risks identified as may be triggered due to the project activities are: i. occupational health & and safety (OHS) risks related to testing and handling of supplies, during treatment and vaccination. Other OHS risks are related to the suboptimal percentage of health workers using appropriate PPE as a result of both insufficient PPE and individual behavior ii. production and management of medical healthcare waste resulting from vaccine delivery (such as sharps and the disposal of used and expired vaccine vials) as a result of AF activities. Additionally, waste materials generated from labs, quarantine facilities, screening, treatment and vaccination facilities to be supported by the parent project and AF require special handling and awareness, as they may pose an infectious risk to healthcare workers who come in contact or handle the waste iii. community health and safety issues related to the handling, transportation and disposal of hazardous and infectious healthcare waste iv. construction environmental impacts associated with the proposed minor civil works under the AF, including refurbishment of up to two existing functional buildings into ICUs, construction of the PCR laboratory, and the construction of a district storage for vaccine in Maseru and two mini-oxygen plants in the highlands districts - as no major civil works other than small construction works, refurbishing facilities on existing hospital grounds or other government owned sites are to be undertaken, environmental risks associated with these works are expected to be minor and readily mitigated v. risks to produce greenhouse gas (GHG) and cause potential negative impacts to capacity to respond to future climate-related crises. 5.2.2 Social Risks 68 The anticipated social risks are Substantial. The main inherent social risks include the following: i. the risk of contracting COVID-19 to health workers and the general population; ii. the risk of inequity in access to vaccines and deviation from the rollout strategy due to limited accessibility of remote rural areas and political pressures to provide vaccines to groups that are not prioritized, or target groups are misaligned with available vaccines as well as fraud, corruption and elite capture in vaccine procurement and distribution; iii. barriers faced by marginalized and vulnerable social groups including women, disabled, illiterate, migrants refugees and people living in remote rural areas in accessing essential services (including COVID-19 services and other social services) and critical information - there is a risk that vaccine deployment plans could leave behind these groups due to their limited participation in formal economic activities; iv. risks of gender-based violence (GBV)/sexual exploitation and abuse (SEA)/sexual harassment (SH) to project workers and beneficiaries (including the local communities); v. inadequate or conflictual public engagement and lack of trusted and adequate consultation, social conflicts resulting from false rumors and misinformation could negatively influence demand generation activities for the vaccine, especially among communities that are generally distrustful of the public health system and/or have traditionally been marginalized, and resulting in interferences with disease prevention and control measures; vi. discrimination and stigma faced by those admitted to treatment or isolation facilities; vii. labor management and OHS related risks; and viii. risks linked to the engagement of security personnel in project activities – mainly to ensure transport, distribution and/or safeguarding of vaccines, especially to remote rural areas using helicopters. The Project will not involve any resettlement or land acquisition as all proposed minor civil works are limited to the existing hospital/health care facilities – considered as the State lands. Likewise, impacts to Indigenous communities are not applicable to the project as all communities in Lesotho are part of the mainstream societies. The social risks have been re-assessed and updated as part of the updated Environmental Safeguard and Management Framework (ESMF). The updated ESMF also includes security management plan (SMP) – Annex 15 to the ESMF – prepared for the Project guided by the principles of proportionality and Good International Industrial Practice. The Labour Management Procedures (LMP) and GBV/SEA/SA Action Plan, Stakeholder Engagement Plan (SEP) including Grievance Mechanism, have been also prepared and incorporated into the updated ESMF based on an assessment of environmental and social risks and impacts in line with the applicable WB ESSs (ESF), relevant WBG EHSGs, the WHO COVID-19 guidance on risk communication and community engagement, and national laws and regulations. Each of the instruments shall be implemented effectively as applicable to ensure that the potential risks and impacts are appropriately addressed. 69 The Environmental and social risks and impacts and mitigation measures are further detailed below. 5.3. Environmental and Social Risks and Impacts and Mitigation Measures 5.3.1. Planning and Design Stage Environmental and Social impacts and risks are expected during the planning and design stage. Table 5.1 below summarizes the potential E&S risks and impacts, mitigation measures and responsible entities to address them for the Lesotho COVID-19 EPRP during the planning and design stage. 70 Table 5-1: E&S Risks and Mitigation Measures During Planning and Design Stage Key Activities Potential Risks and Impacts Proposed Mitigation Measures Responsibilities Planning of minor The choice of location of facilities • Ensure that the process for selection of the Ministry of Health, civil works to be rehabilitated could also locations of health care facilities to be repaired / district referral hospitals including exclude vulnerable and high-risk upgraded / rehabilitated under the Project takes and other Health Facilities development of groups. into account enhanced access of the vulnerable and minilabs and high-risk groups to the services to be provided by refurbishment and such facilities. adaptation of Design of healthcare facilities • When designing and planning rehabilitation and/or Ministry of Health, existing structures (e.g., minilabs and screening posts) construction of healthcare facilities, the design district referral hospitals and does not meet layout and should: and other Health Facilities isolation/treatment/ engineering requirements for a) meet National guidelines ICUs or nosocomial infection control, b) take into account guidance from WHO and/or vaccination units increasing risk of spreading CDC on COVID-19 management and with necessary COVID-19 in health facilities. infection control such as: equipment, mini- - WHO guidance for Severe Acute Respiratory oxygen plants, Infections Treatment Center; vaccine storage - WHO interim guidance on Infection prevention facility, etc. and control during health care when novel coronavirus (nCoV) infection is suspected; - WHO technical brief water, sanitation, hygiene and waste management for COVID-19; - WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); - CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; and - CDC guidelines for environmental infection control in healthcare facilities. • Prepare an operation manual prior to the opening of relevant healthcare facilities to describe the working procedures to be taken by healthcare 71 Key Activities Potential Risks and Impacts Proposed Mitigation Measures Responsibilities workers to protect themselves and prevent infection while providing treatment. • Provide hand washing/sanitizing facilities entrances to and in health care facilities in line with WHO Recommendations to Member States to Improve Hygiene Practices. Design of laboratory does not meet Consider and ensure guidance from WHO Laboratory Ministry of Health, requirements for biosafety biosafety guidance related to coronavirus disease 2019 district referral hospitals (COVID-19). and other Health Facilities Social Exclusions: Design of Consider and ensure universal access (i.e., access for Ministry of Health, rehabilitation of the facilities does people with disabilities where ramps for wheelchairs district referral hospitals not take into account universal should be included, braille IEC materials, etc.) where and other Health Facilities access. Design and planning of applicable. facilities pose potential exclusion of vulnerable and high-risk social groups (ultra-poor, HIV/AIDS infected, disabled, pregnant women, elderly, women and children, and remote and isolated highlands communities). Development of Incorrect standard or quality of • Provide the healthcare workers with proper Ministry of Health, technical PPE leads to spread of infection to medical personal protective equipment (PPE) district referral hospitals specifications for healthcare workers and cleaners. including: Medical mask, Gown, Apron, Eye and other Health Facilities PPEs protection (goggles or face shield), Respirator (N95 or FFP2 standard), Boots/closed work shoes. • Refer to WHO interim guidance on rational use of PPE for coronavirus disease 2019 for further details on the types of PPE that are required for different functions. Procurement of Inappropriate standard or quality of • WHO specifications and guidelines as applicable Ministry of Health, other goods and the goods and supplies and/or their to the procurement of goods and supplies shall be district referral hospitals supplies, including: non-delivery on time may turn all followed. and other Health Facilities (a) COVID-19 efforts futile in combatting the vaccines; (b) PPE pandemic impacts, enhancing 72 Key Activities Potential Risks and Impacts Proposed Mitigation Measures Responsibilities and other medical challenges in saving lives of the • Reference should be made to the relevant WHO supplies for people guidelines and GIIP – as have been published also vaccinators and at: other healthcare https://www.who.int/publications/m/item/list-of- workers; (c) priority-medical-devices-for-covid-19-case- antigen test kits; management (d) ice lined refrigerators and https://apps.who.int/iris/bitstream/handle/10665/331792 /WHO-2019-nCoV-Clinical-Ventilator_Specs-2020.1- vaccine carriers; eng.pdf (e) vehicles including https://www.who.int/publications-detail- refrigerator redirect/oxygen-sources-and-distribution-for-covid-19- vehicles and treatment-centres vaccinator personnel https://www.who.int/publications-detail- transport; (f) redirect/covid-19-v4-operational-support-and- oxygen cylinders logistics-disease-commodity-packages and concentrators as needed, etc. • Procurement under the Project shall be carried out in accordance with the World Bank’s Procurement Regulations for Investment Project Financing Borrowers for Goods, Works, Non-Consulting and Consulting Services, dated November 2020 - using the Systematic Tracking of Exchanges in Procurement (STEP) to plan, record and track procurement transactions – and the PIU capacity in terms of procurement will be enhanced through engaging a procurement officer. Planning for - the risk of inequity in access to • preparation and dissemination of information, Ministry of Health, vaccination vaccines and deviation from the communication and education materials/ messages district referral hospitals rollout strategy ensuring inclusiveness and accessibility to all and other Health - barriers faced by marginalized service recipients Facilities, Contractors and vulnerable social groups including women, disabled, 73 Key Activities Potential Risks and Impacts Proposed Mitigation Measures Responsibilities illiterate, migrants refugees and • effective implementation of the planning/design people living in remote rural stage provisions of the stakeholder engagement areas plan prepared for the project - risks of gender-based violence • effective implementation of the relevant provisions (GBV)/sexual exploitation and of the GBV/SEA/SH plan prepared for the project abuse (SEA)/sexual harassment • effective implementation of the relevant provisions (SH) of the LMP prepared for the project (also ensuring - inadequate or conflictual public planning for inclusive engagement of the workers engagement and lack of trusted providing employment opportunities also to the and adequate consultation, social local communities, female members, conflicts poor/vulnerable groups, etc.), OHS and CHS - discrimination and stigma compliance requirements at planning and design - labor management and OHS, and stage community health and safety • Integration of applicable E&S (CHS) related risks provisions/compliance requirements into the Procurement/Bidding and Contract documents Planning for Inadequate assessment of risks and • Effective implementation of the relevant Ministry of Health, engagement of impacts from engagement of the provisions of security management plan (SMP) district referral hospitals security personnel security agencies in project prepared for the project – attached as Annex 15 to and other Health Facilities in project activities activities the ESMF. 74 5.3.2. Construction/Rehabilitation Stage Environmental and Social Risks and Mitigations Environmental risks during the construction stage are not expected to be significant. Construction works will mainly involve fit-out type activities in existing premises. Minor quantities of construction waste will be generated; however, none is expected to be hazardous and all will be disposed in accordance with applicable regulations and best practices. Construction activities within health facilities will need to comply with relevant regulations for the specific circumstances to ensure that the integrity of the facility is not compromised. The environmental guidelines that will be complied with include air and water quality, vibration and noise standards, COVID-19 protocol and healthcare wastes management guidelines relevant to the small construction works, management of healthcare equipment and operational activities of the healthcare facilities financed by the project. There are also social risks associated with social exclusions, and or discrimination in relation to employment opportunities, GBV risks at and around the construction sites, and child labour. The contractors shall observe the relevant health protocols and guidelines and observe the Labor Management Procedures (LMP). Conduct of training and awareness raising activities will be done to ensure these procedures are followed, as needed. Construction works required under the project are low hazard activities; hence standard construction OH&S principles should be followed as described in Department of Labor and Employment (DOLE) (2020) Occupational Safety and Health Standards. The Environmental and Social Management Plan (ESMP), Environmental Codes of Practice (ECOP), and the Labor Management Procedures (LMP), Contractor’s Personnel Grievance Redress Mechanism will be developed by the Contractors based on the templates as part of the bidding document. The ESMP, ECOP, LMP and GRM will be implemented, updated, and monitored by the Contractors and project recipient facilities throughout the project duration. Monthly monitoring reports will be prepared accordingly using the templates. To further specify the liability of the contractors to the workers if they contract COVID-19, it will be explicitly stated in the contract that the MoH and the recipient hospitals will not be in-charge of the medical bills and wages of the workers and that it will be covered by the contractor. The environmental and social risks and mitigation measures during the construction/rehabilitation stage have been detailed in Table 5-2 below. 75 Table 5-2: E&S Risks and Mitigation Measures During Construction/Rehabilitation Stage Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts Upgrading Soil and Land - The contractor(s) is responsible for Contractor(s) and Degradation: Although compliance with relevant national refurbishment construction work will be legislation with respect to soil and of healthcare limited to the footprint of land degradation. facilities and existing infrastructure, - The contractor(s) should implement isolation or mitigation measures are Good International Industrial vaccination needed for unlikely Practices (GIIP) and other units, circumstance that may international guidelines such as the development involve works that will WBG EHS Guidelines. of minilabs, expose the soils to erosion - Plant cover grasses to prevent rehabilitation and also compact it and erosion of the ICUs, break down the soil installation of structure which will mini oxygen potentially decrease the plants drainage of the areas. This construction will generally result in soil of the prefab erosion, defacing of the structures, countryside and generation etc. of dust. Ambient air quality: Air - The contractor(s) is responsible for Contractor(s) quality will be temporarily compliance with relevant national impacted by emissions legislation with respect to indoor and from vehicles, building ambient air quality. equipment and particulate - The contractor(s) undertaking matters released from works shall ensure that the rehabilitation activities. generation of dust is minimized and Interior demolition to implement a dust control plan for upgrade and refurbish necessary subprojects involving healthcare facilities and interior works to maintain a safe isolation units will lead to working environment and minimize considerable levels of disturbances for patients, staff and cement dust which can surrounding community. affect workers, patients and - The contractor(s) undertaking staff. Deteriorated indoor exterior works shall implement dust air quality may pose risks suppression measures (e.g., water to workers and patients, paths, covering of material with either minor or severe stockpiles, etc.) as required. health impact depending on Materials used shall be covered and level and duration of secured properly during exposure. transportation to prevent scattering of soil, sand, materials, or generating dust. Exposed soil and material stockpiles shall be protected against wind erosion. - Ensure that vehicles are serviced regularly. 76 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts Construction Waste - The contractor(s) shall develop and Contractor(s) Management: Activities at follow a brief site-specific solid construction sites will waste control procedure (storage, produce construction provision of bins, site clean-up, bin wastes such as demolition clean-out schedule, etc.) before debris, excavated soils, commencement of any financed cement bags, paint drums, rehabilitation works; brick and concrete rubble, - The contractor(s) shall use litter scrap metal, broken glass, bins, containers and waste collection timber waste and other facilities at all places during works. debris. This debris could - The contractor(s) may store solid obstruct the general public, waste temporarily on site in a the movement of the designated place prior to off-site workers and vehicles as transportation and disposal through a well as affect the aesthetics licensed waste collector. Transport of the environment. management plan in line with WBG good practice should be developed. - The contractor(s) shall dispose of waste at designated place identified and approved by local authority. Open burning or burial of solid waste at the hospital premises shall not be allowed. It is prohibited for the contractor(s) to dispose of any debris or construction material/paint in environmentally sensitive areas (including watercourse). - Recyclable materials such as wooden plates for trench works, steel, scaffolding material, site holding, packaging material, etc. shall be segregated and collected on- site from other waste sources for reuse or recycle (sale). Asbestos Containing - The asbestos/hazardous products Contractor(s) Materials (ACM): The audit will be undertaken as required risk of accidental discharge prior to/at the beginning of of asbestos containing refurbishment. materials (ACM) generated - Safe removal of any asbestos- from construction, containing materials or other rehabilitation, or minor hazardous substances shall be civil works. performed and disposed of by specially trained workers in line with the WBG guidelines on asbestos management. - If ACM at a given hospital is to be removed or repaired, the MOH will stipulate required removal and repair 77 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts procedures in the contractor's contract. - Contractors will remove or repair ACM strictly in accordance with their contract. Removal personnel will have proper training prior to removal or repair of ACM. - All asbestos waste and products containing asbestos is to be buried at an appropriate landfill and not to be tampered or broken down to ensure no fibers are airborne. - Disposal of waste containing asbestos and/or hazardous materials should be agreed with MOH. - No ACM will be used for renovation works. Hazardous Waste: The - Contractor(s) will ensure proper Contractor(s) risk of accidental discharge storage and labelling of hazardous of hazardous products like materials. paint, leakage of - Maintain an inventory of hazardous hydrocarbons, oils or materials when used in work sites. grease from machinery - Use proper protective equipment constitutes potential and procedures for managing spill, sources of soils and land exposures and other incidents. pollution. - Hazardous materials should be handled in accordance with the accepted practices. Only trained personnel should handle the materials with precautions by using required protection equipment. Occupational Health and - The contractor(s) shall comply with Contractor(s) Safety: The movement of all national and good practice trucks to and from the site, regulations regarding workers’ the operation of various safety. equipment and machinery - The contractor(s) shall have or and the actual receive minimum required training refurbishment activities on occupational safety regulations will expose the workers to and use of personal protective work-related accidents and equipment. injuries. Pollutants such as - The contractor(s) shall provide dust and noise could also safety measures as appropriate have negative implications during works such as installation of for the health of workers. fences, fire extinguishers, first aid kits, restricted access zones, warning signs, overhead protection against falling debris, lighting system to protect hospital staff and patients against construction risks. 78 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts - To manage potential COVID-19 infection risk as an OHS issue among construction workers, wash stations should be provided regularly throughout site, with a supply of clean water, liquid soap and paper towels (for hand drying), with a waste bin (for used paper towels) that is regularly emptied. Wash stations should be provided wherever there is a toilet, canteen/food and drinking water, or sleeping accommodation, at waste stations, at stores and at communal facilities. Where wash stations cannot be provided (for example at remote locations), alcohol-based hand rub should be provided. Relevant GIIP including WBG ESH Guidelines will be complied with. - Communication materials on COVID-19 prevention and control should be put in workplaces. Occupational and The contractor(s) shall prepare and Contractors(s) Community Health and implement an Emergency Response Safety: Risks exist in Plan to cope with risk and emergency relation to unforeseen (e.g., fire, earthquake, floods, circumstances. COVID-19 outbreak). Temporary Visual - The contractor(s) shall display Contractor(s) Intrusion: Construction signage around the work area to activities will require inform the bypasses of the civil work material, equipment and in progress. cordons at the health - Minimize visual intrusion by facilities or any other barricading work sites and by rehabilitation facilities. maintaining order in work sites. Since facilities under renovation would not be closed from access by the public, these activities and materials thereof will cause temporary visual intrusion at all sites. This may be exacerbated by the contractor setting up camp on site. Temporary disruption of - The contractor(s) will use utility Contractor(s) Utilities Service: The services, such as electricity and water demolitions and as agreed with the Hospital 79 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts refurbishment activities Management where the available may cause temporary generator at hospital will be used and disruptions of utility temporary water tanks will be services such as electricity, availed in case there is disruption of communication and water. services. No community utilities Such disruptions may services will be used, however, if inconvenience the there is a need to use community communities in the vicinity utilities, communities will be of the centers. consulted for approval, prior to use of the utilities. Temporary disruption of - Renovations will be carried out as Contractor(s) Health Care and other agreed with the Hospital services: Since facilities Management, to ensure prior under renovation will not arrangement is made to provide be closed, they will alternative work space for the areas experience shortages of to be refurbished. working space. Thus, modifications of rooms in which health care services is provided may entail moving patients or equipment from one area or room to another. This may cause temporary disruption of the health care delivery programs. Water Quality: Water - The contractor(s) is responsible for Contractor(s) quality will be impacted by compliance with relevant national wastewater discharges from legislation with respect to water the refurbishment activities. quality. These will include - The contractor(s) shall ensure discharges from onsite onsite latrine be properly operated sewage system and and maintained to collect and dispose rainwater run-off from sites wastewater from those who do the of exterior works at health works. facilities. Given the - The contractor(s) shall dispose of possibility of generation of waste at designated place identified waste/spoil that will be and approved by local authority. generated, it is likely that Open burning or burial of solid waste the waste will be stockpiled at the hospital premises shall not be on road sides and in the allowed. It is prohibited for the health facilities premises. If contractor(s) to dispose of any debris it is not properly contained, or construction material/paint in rains could carry it along environmentally sensitive areas with runoff into surface (including watercourse). waters, leading to increased turbidity and siltation. 80 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts Noise: Noise and vibration - The contractor(s) is responsible for Contractor(s) caused by machines, site compliance with relevant national vehicles, pneumatic drills legislation with respect to ambient etc. will be common place air quality, noise and vibration. during the refurbishment - The contractor(s) should not carry activities. These impacts out construction activities generating can affect the quietness of high level of noise during healthcare the communities and can activities, especially when services also impact patients and the are being delivered to the clients. healthcare workers. - When performing interior works during healthcare activities, the contractor(s) should communicate the work schedule with the relevant health facilities. Working conditions: Close - The contractor(s) shall follow Good Contractor(s) working and poor working International Industrial Practices conditions may create (GIIP) and other guidelines such as conditions for the easy the World Bank Group EHS transmission of COVID-19 Guidelines. and the infection of large - The contractor(s) shall also numbers of people, implement COVID-19 prevention especially vulnerable measures as follows: groups. ‣ Consider ways to minimize/control movement in and out of construction areas/site. ‣ If workers are accommodated on site require them to minimize contact with people outside the construction area/site or prohibit them from leaving the area/site for the duration of their contract ‣ Implement procedures to confirm workers are fit for work before they start work, paying special to workers with underlying health issues or who may be otherwise at risk ‣ Check and record temperatures of workers and other people entering the construction area/site or require self-reporting prior to or on entering ‣ Provide daily briefings to workers prior to commencing work, focusing on COVID-19 specific considerations including cough etiquette, hand hygiene and distancing measures. ‣ Require workers to self-monitor for possible symptoms (fever, cough) 81 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts and to report to their supervisor if they have symptoms or are feeling unwell. ‣ Prevent a worker from an affected area or who has been in contact with an infected person from entering the construction area/site for 14 days (with insurance in place to ensure they can continue to access salary, as per the LMP). ‣ Preventing a sick worker from entering the construction area/site, referring them to local health facilities if necessary or requiring them to isolate at home for 14 days (with insurance in place to ensure they can continue to access salary, as per the LMP). - The contractor(s) shall develop contingency plans with arrangements for accommodation, care and treatment for: Workers self-isolating; Workers displaying symptoms; Getting adequate supplies of water, food and supplies. - The contractor(s) shall provide workers with PPEs; - The contractor(s) ensure that worker accommodation that meets or exceeds IFC/EBRD worker accommodation requirements (e.g. in terms of floor type, proximity/no of workers, no ‘hot bedding’, drinking water, washing, bathroom facilities etc.) will be in good state for keeping clean and hygienic, and for cleaning to minimize spread of infection. - The contractor(s) shall develop and implement LMP. Risks of Gender-Based The contractor shall ensure that Contractor(s) Violence (GBV) or Sexual workers are well briefed on the LMP Abuse and Exploitation (see Annex 11), including aspects (SEA). relating to preventing GBV and SEA and no tolerance for these behaviors, and sign the Code of Conduct (see Annex 4). GBV/SEA/SH action plan 82 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts has been also prepared (Annex 7 to the ESMF). Workers may be under- Child labor or indentured labor is Contractor(s) aged. absolutely prohibited in the Project. Labor law prohibits anyone under 18 years to be involved in hazardous work. LMP will be developed to include measures for pre-employment checks to ensure that no under aged workers will be hired. Procurement Material/equipment Maximize and prioritize local Contractor(s) of Materials suppliers and contractors: sourcing of materials, manpower and and hiring of The proposed equipment in order to empower local workers refurbishments of the communities and businesses and to health facilities and other avoid conflicts. facilities will necessitate the procurement of equipment, construction materials and services, providing income to suppliers and contractors, as well as to local communities in case of local sourcing. There are risks that such local resources may not be utilized or opportunities may not be equitably provided to the local communities or relevant service providers. Employment Maximize opportunities for the local Contractor(s), opportunities: During the community to work as construction MoH, PIU refurbishment/rehabilitation workers or for any other suitable job process, vaccination opportunities to minimize social program implementation conflicts while enhancing the and other activities under beneficial impacts of the Project. the Project, jobs may become available for both local and non-local for construction works. There are risks that the opportunities may not be offered inclusively 83 Key Potential Risks and Proposed Mitigation Measures Responsibilities Activities Impacts (including also to the vulnerable groups). Employment Bidding and Contract documents Contractor (s), opportunities to shall include clauses making it MoH, PIU women/female segments mandatory on part of each of the societies: During the construction/rehabilitation construction/rehabilitation Contractor to employ female workers works, there may be from the communities (at least 20 discrimination against percent of the total workforce women in accessing engaged), keep gender-disaggregated employment opportunities record of workers, pay equal wages for equal works without any gender- based discrimination. Engagement Risks and impacts due to Effective implementation of the Ministry of of security engagement of the security relevant provisions of security Health, district personnel in agencies in project management plan (SMP) prepared referral project activities for the project. hospitals and activities other Health Facilities 5.3.3 Operational Stage The Operational Stage risks and impacts and mitigation measures have been detailed below. 5.3.3.1 Occupational Health and Safety Occupational health and safety (OHS) risks in the operational stage are predominantly associated with COVID-19 transmission risk. There is a risk that health care workers are exposed to COVID- 19 during the initial screening and vaccine administration in the health facility or community setting if the proper infection and prevention control measures are not observed. It should be noted that it may be difficult to draw a clear line between existing, manifested risks managing which is the Project objective, and the risks and impacts that could additionally be created by the Project. For example, spread of COVID-19 among the population at large is a pre- existing condition the Project is tackling, but could also be a risk from potentially poorly implemented Project activities. There is also some risk due to underage workers working as cleaners in medical facilities or transporting medical supplies or equipment, though the Labor law prohibits anyone under 18 years being involved in hazardous work. 84 Mitigation Measures The following mitigation measures shall be implemented to mitigate the OHS risks and impacts: • Covid-19 protocols and guidelines shall be properly followed; • Awareness-building activities shall be implemented regularly for the workers/staff engaged in Project activities; • All workers shall be provided with security of medical care, in particular ensuring they can access free medical care if they contract COVID-19; • It shall be ensured that staff with lower qualification or less experienced working in the health sector (e.g., cleaners, part-time workers, etc.) - often female workers - also have access to the required Personnel Protection Equipment (PPE) – including gloves, gowns, masks and eye protection if exposed to patients with COVID-19, their waste, clothes or linen – and training to make sure they work in a safe environment; • Vulnerable workers shall be identified, such as female single heads of household, who may need additional support in order for them to do their job (for instance, female nurses who are single heads of household may need additional support if they have to work overtime). Additional support to consider may include cash grants, access to food support or provision of childcare services; • Health care workers shall be actively supported by their employers and commended for their work, as well as offered psychological, emotional or mental support if possible; • All workers shall be reassured that they will continue to get paid if they need to self-isolate if they are showing with COVID-19/respiratory symptoms. These provisions must be made including for contracted staff and are included in the Labor Management Procedures (LMP); • Child labor or indentured labor is absolutely prohibited in the Project. All medical staff, cleaners, and all others handling equipment, tests, wastes, etc. or involved in the transportation of medical equipment and supplies related to the project shall be 18 years of age or higher. 5.3.3.2 Waste Management Risks The vaccination activities will produce wastes such as sharps and infectious non-sharp wastes that can cause direct negative health impacts on the community and healthcare workers. There are also indirect health effects to the community and environment resulting from inadequate treatment and disposal of these wastes. Mitigation Measures 85 The management of wastes from the vaccination program will be in accordance with the MOH Infection Control and Waste Management Plan (ICWMP), 2016 with July 2020 update. Measures to be implemented include the following: • Waste segregation and packaging: o Segregation of sharps from non-sharps o Discard entire syringe with needle into a safety box immediately after use o Placement of the safety boxes (when full) into plastic bags closed hermetically and with clear marking to avoid leakage during transportation o Placement of empty vials into waste containers with plastic lining to avoid leakage. o Waste treatment and final disposal o Placement of sharp boxes and containers of empty vials into secure septic vaults for on- site burial. o If septic vaults are not available, employ the services of a licensed hazardous waste treatment facility for the off-site transportation and treatment of the vaccination wastes. 5.3.3.3 Community Health and Safety Risks Potential community health and safety risks associated with the project activities include: • Transport of wastes, transport of lab tests, transport of people who have tested positive with COVID-19 and movement of health workers and other staff in contact with patients with COVID-19, has the potential to spread the virus in the community (note transport of medical supplies and equipment is not expected to result in virus transmission); • Communities may have fear and apprehension on COVID-19 vaccine efficacy and safety due to the novelty and relative timeframe of development; • The proper storage conditions and transport of the vaccines are also major risks as they are needed to ensure the efficacy and safety of the vaccine. • Misinformation and disinformation on the adverse health effects of vaccines and hearsays on the conspiracy theories and underlying political agenda on the vaccines are widespread. • There is a risk of adverse health effects if the profiling and screening of candidate individuals to be vaccinated and proper data management were not observed to consider vaccine contraindications. • Crowding or influx of people in the vaccination sites as well as the violation of physical distancing are also risks. 86 • Use of Security and Military personnel in the delivery and distribution of the vaccines may also exist. • Health workers may face discrimination and harassment when going back to their communities due to people’s fear in contracting the virus, frustrations over medical care or misinformation; • Screening of people entering the country, in particular land borders with migrants coming back into Lesotho, as well as checks and/or enforcement of any community movement restrictions or quarantine/lockdown or social restriction measures, could lead to abuse of power by law enforcement, fear from community members (especially the elderly), a potential for discrimination of marginalized groups, GBV, Sexual Exploitation and Abuse (SEA) and/or VAC; Mitigation Measures The Stakeholder Engagement Plan (SEP) provides measures for stakeholder engagement at participating health facilities to inform local communities of project activities, seek their feedback on potential risks and mitigation measures. The following community health and safety measures will be applied: • Transport of all COVID-19 wastes and lab tests, blood samples, etc., should be collected safely in designated containers and bags, treated and then safely disposed; • Collection of samples, transport of samples and testing of the clinical specimens from patients meeting the suspect case definition should be performed in accordance with biosafety measures and WHO guidelines on Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases; • Transport of medical equipment/supplies is not expected to be a vector in transmitting the virus, however, workers transporting materials should be reminded to wash hands appropriately and to avoid touching their face; • To ensure the safety of the vaccines to be procured, the vaccine regulatory approval of the Stringent Regulatory Authorities (SRAs)12 identified by the World Health Organization will be required; • Appropriate messages will be developed under the risk communication plan to address the vaccine safety concerns of communities; • A Communications Campaign Plan will also be developed by the MoH/EHD/DOH/PIU for the COVID-19 vaccination program. It will have a whole-of government, whole-of-system, and whole-of-society approach which will encompass general information on (i) COVID-19 and the need for sanitation and hygiene practices, (ii) COVID-19 vaccine basic information, 12 World Health Organization. (June 2020). Essential medicines and health products: List of stringent regulatory authorities (SRAs). https://www.who.int/medicines/regulation/sras/en/. 87 (iii) trials results and procurement, and (iv) vaccine program roll-out, amongst others. The WHO Risk communication and community engagement readiness and response to coronavirus disease (COVID-19) released on 19 March 2020 will also be used as reference in the development of messages and planning of risk communication and community engagement (RCCE) activities. • A series of counselling and obtaining of informed consent will be conducted prior to the administration of the COVID-19 vaccine; • The profiling and screening of candidate individuals to be vaccinated should be performed so as to avoid the risk of vaccine contraindications; • A comprehensive data management system is also needed to support the profiling, screening, and scheduling to address the risk of individuals not completing the required shots/doses of the vaccine; • Coordination with the local government units as well as the uniformed personnel will be done to assist in crowd management; • Training must be provided to medical and other staff (doctors, nurses, cleaners, lab technicians, etc.) in contact with patients with COVID-19 and/or their wastes, clothes, linen or tests, on disinfection procedures when going back to their homes/communities. In extreme cases, this may involve isolating medical and other personnel involved with COVID-19 patients; • Any medical or other hospital staff (including cleaners) experiencing symptoms of COVID19 or a respiratory illness (fever + cold or cough) must remain at home/isolated and report symptoms immediately to supervisors; • Communication materials must reinforce the positive contribution of health care workers and other essential workers and their need to be supported by community members; • Communication materials should make clear the steps health workers and other staff are taking to protect themselves against the virus and their use of PPE; • Ensure widespread engagement with communities in order to disseminate information related to community health and safety, particularly around social distancing, hand washing, high-risk demographics, self-quarantine, and mandatory quarantine; Workers and law enforcement personnel must adhere to Code of Conduct (CoC), including fair treatment and non-discrimination when carrying out their duties. Key points in CoC must be publicly available as part of disclosure and law enforcement personnel must be made aware and trained in key items (especially non-discrimination, OHS and issues relating to GBV). 5.3.3.4 Engagement of Security Personnel 88 Security and military personnel may be engaged mainly for vaccine deployment. It will be, however, ensured that the security personnel follow a strict code of conduct and avoid any escalation consistent with the ESF and WB/IFC guidance on the use of security personnel (IFC Good Practice Handbook on the Use of Security Forces: Assessing and Managing Risks and Impacts). Risks There are internal and external risks identified during the Security Risk Assessment. Internal risks include illegal behaviors such as theft of vaccine stocks. Furthermore, there is a challenge of misuse of vaccines by teams that may engage in providing vaccination to prioritized groups, including friends and families. There is also a risk of physical assault or GBV/Sexual Abuse and Exploitation (SEA) by the public security personnel to the project personnel or communities living around the project sites. Lastly, there may be abuse of power by public security personnel to the private security personnel, project personnel or communities who live around the project sites. As a result, survivors of the abuse may retaliate and there may be vicious cycle of violence that may negatively affect the implementation of the project. Mitigation Measures Whenever the public security personnel are engaged in protecting health care facilities, vaccine stocks, isolation, or quarantine facilities; the health facility Management and district administrations (District Administrators, District Councils Secretaries and Principal Chiefs) will be informed. In addition, the public around the facilities will be informed by their chiefs, headmen or community councilors. They will be informed about the presence and duties of the security personnel in their area. Furthermore, the public will be sensitized about the Grievance Redress Mechanism (GRM) that shall be followed if there are any grievances related to the security personnel engaged in the project activities. Members of the security force will also be sensitized about the code of conduct and application of the human rights-based approach in line with the provision of security services and practices. In case if any gender-based violence or sexual exploitation and abuse issues arise or are alleged during project implementation or supervision, the Bank Management shall be alerted immediately. Grievances and incidents involving security personnel shall be reviewed, and incident reports submitted to the Bank, together with the grievance mechanism logs regarding grievances or allegations that involve project-related security personnel. Security-related allegations or incidents can include issues such as abuse of power and retaliation, sexual harassment and exploitation, and gender-based violence. Allegations or incidents related to security personnel shall be documented 89 and assessed with the objective of determining compliance or noncompliance with policies and procedures and whether any corrective or preventive actions are required. Unlawful or abusive acts shall be reported to appropriate authorities, including Bank Management. Project staff responsible for the project SEP and Grievance Mechanism shall communicate outcomes to complainants and other relevant parties, keeping in mind confidentiality provisions and the need to protect victims from further incidents or retaliation. Where appropriate, relevant lessons learned shall be shared with the community and any changes made to prevent future incidents. Procurement documents shall include relevant provisions to ensure avoidance of adverse impacts due to the engagement of any security personnel. A binding memorandum of understanding (MoU) or other formal agreement shall be documented, committing the public security force to the Code of Conduct, proportional use of force, and other requirements similar to those that would be included in a contract with private security providers, including disciplinary measures, training, incident follow-up and the need for regularly updating of the documentation. The binding agreement shall make provisions with responsibility for monitoring security engagement conditions and a communication protocol with the Implementing Agency/Borrower, the security personnel and the Bank. The security management plan documents in details the risks and mitigation measures along with the applicable standards, protocols and good international practices that shall be adopted to ensure that the engagement of security or military personnel in the implementation of project activities or for provision of security to project assets and personnel is carried out in accordance with the ESSs and other provisions applicable to the EPRP. MoH/PIU will ensure that the workers and local community are informed about the security arrangements and the project’s GRM. MoH/PIU will review any allegations of unlawful or abusive acts of security personnel, take action (or urge appropriate parties to take action) to prevent recurrence and, where necessary, report unlawful abusive acts to the relevant authorities. Any incidents, concerns or grievances regarding the conduct of security personnel will be received, monitored, documented (taking into account the need to protect confidentiality), and resolved through the Project’s grievance mechanism. Any severe incidents with such personnel need to be reported to the Bank no later than 48 hours with basic information and a detailed incident report within 10 working days. Details about incident reporting are included under the Labour Management Procedures (LMP). Regular community consultations will be conducted continuously to identify any additional risks and mitigation measures. The Grievance Redress Mechanism is already in place (established under the parent project), and shall be applicable to the AF as well. The security management plan prepared for the project shall be effectively implemented. 5.3.3.5 Social Exclusion 90 Risks The following potential risks of social exclusion have been identified: • Planning and design of measures to screen people for COVID-19 and information materials developed could exclude the most vulnerable, including the poor, elderly, people living with a disability and households headed by single women, who are also less likely to have access or be active on social media. • Limited access to COVID-19 testing and other public health services, especially in rural areas. • Restrictions on travel, general movement, etc. have the potential to enhance negative impacts to the vulnerable groups, who may have lower incomes, lack social support, lose jobs, have childcare duties, and may also be the most vulnerable to contracting COVID-19. • The information materials on the COVID-19 vaccine to be developed could exclude the most vulnerable or be developed in a way that is not sensitive to the needs and access of these different groups. • Communication materials may not reach the most vulnerable, in particularly the elderly, and workers from the informal sector, who tend to have lower levels of education, lower incomes and may have lower literacy. • There is an indirect risk of social exclusion, in particular, the most vulnerable and marginalized groups such as the refugees and peoples in remote areas from access to the COVID-19 vaccines. • The elderly, those with underlying medical conditions, and people living with disability, though included in the priority populations to be vaccinated as identified in the WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply13, may have limited access to the vaccines due to reduced mobility. Mitigation Measures The following mitigation measures are considered for social exclusion risks and impacts: • Planning of quarantine measures and social distancing restrictions need to take into account the livelihood impact it will have for the population, in particular the most vulnerable (the poor, elderly, women single heads of household, those with disabilities, etc.); • Communication materials must be clear and concise and in a format/language that is understandable to all people, in particular the most vulnerable. Messages should be clear and concise, focusing on hygiene measures (hand washing, coughing), what to do if suspect have COVID-19, as well as restrictions if applicable (for instance specific guidelines on social- 13 World Health Organization. (November 2020). WHO SAGE Roadmap for Prioritizing Uses Of COVID-19 Vaccines in The Context of Limited Supply. https://www.who.int/publications/m/item/who-sage-roadmap-for-prioritizing-uses-ofcovid-19-vaccines-in-the-context-of- limited-supply. 91 distancing). This may require different media (social media, radio, TV) plus engaging existing formal and informal public health and community-based networks (schools, healthcare service providers at local level, etc.), including information on the vaccine and its administration. • Communication materials must also be clear about (i) how to avoid contracting COVID-19 (good hygiene measures); (ii) symptoms of COVID-19; (iii) what to do if suspect have COVID-19. • Workplaces should be encouraged to post and provide communication materials, in particular workplaces which may face a higher risk of COVID-19 spread, such as construction sites and factories. • Transport assistance for vulnerable groups for increased access to vaccination sites or identification of strategic locations for vaccine administration. • Information on how to protect oneself from COVID-19, the symptoms of COVID-19, where and how to get tested should be made available to everyone and ensure they are accessible to the marginalized groups, those with disabilities, other vulnerable groups and the elderly. • Identify trusted community groups (local influencers such as community leaders, religious leaders, health workers, community volunteers, celebrities) and local networks (such as women’s groups, youth groups, business groups, and traditional healers) that can help to disseminate messages. • Stakeholder Engagement Plan (SEP) includes consultations with the Project stakeholders that can also provide recommendations on how to communicate information for serving the purposes at its best. 5.3.3.6 Gender Based Violence and/or Violence Against Children Risks Gender based violence (GBV) and violence against children (VAC) risks may include the following: • Quarantine measures, together with fears over COVID-19, livelihood impacts as a result of any restrictions in movement, social isolation and increased economic pressures and loss of jobs (informal or formal sector) may exacerbate household tensions and lead to an increase in GBV and VAC. • School closures mean children are at home and this could increase risk of VAC and GBV, in particular if family members are stressed, drinking or violent. Young females may be in particular risk. 92 • Project staff (civil servants and outsourced staff/contractors) may be involved in misconduct behaviours impacting women and children at local level. Mitigation Measures The following measures should be considered in mitigating GBV and VAC risks: • Communication materials should include advice to cope with psychological aspects of the COVID-19 pandemic, including loss of jobs and quarantine measures. For instance, there should be information on how to cope with stress and anxiety, recommendations on how to talk to children, etc. Information materials should provide links to resources/organizations that can provide support. • Ensure that GBV-resolution mechanisms and GBV and other mental health services continue to be well resourced as there may be increased demand for their services. NGOs or other organizations working on GBV or mental health may need to be supported to increase their services (or, for instance, enhancing support to a hotline to report cases or to women’s shelters). • Apply the WHO Code of Ethics and Professional Conduct - Code of Conduct (CoC) for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructure, such as segregated toilets and enough light in quarantine and isolation centers. • The CoC should be included in the letter of staff appointment and contracts (for contracted workers) in line with relevant national laws and legislations and the EPRP Labor Management Procedures (LMP). • Awareness/Training on community interaction and GBV/VAC to be provided for all teams (including the security personnel), staff (civil servants and outsources staff/contractors) to ensure the teams respect local communities and their cultures, and not engage in any misconduct. 5.3.3.7 Social Stigma Another potential risk is the social acceptability of the Covid-infected persons, and the vaccine (given the biosafety characteristics of the vaccine and possible negative side effects). Other risk that has been identified is data-related, and this is rated as Substantial. Large volumes of personal data, personally identifiable information and sensitive data are likely to be collected and used in connection with the management of the COVID-19 vaccination and deployment efforts under circumstances where measures to ensure the legitimate, appropriate and proportionate use and processing of that data may not feature in national law or data governance regulations, or be routinely collected and managed in health information systems. Indirect risks include social stigma that could be precipitated by COVID-19 both to and from sufferers as follows: 93 • Risk of fear and/or stigma towards the virus, which may make people hide symptoms, avoid getting tested and even reject hygiene measures or wearing PPE equipment (or masks if recommended). • Health workers may suffer stigma, in particular when coming back to their communities, as they may be seen as potential “carriers�. • Misinformation on the adverse health effects of vaccines and hearsays on the conspiracy theories and underlying political agenda on the vaccines are widespread. • The fear and apprehension of individuals and communities on the scientific integrity, efficacy, and safety of the COVID-19 vaccines may lead to people refusing vaccination activities. • The vaccine acceptance may also be affected by the country’s previous experience with the other vaccination programs in the past. Mitigation Measures Mitigation of social stigma shall include the following measures: • When developing communication messages about COVID-19, it is important to have social stigma issues in mind and choose language that does not exacerbate stigma. It is best to not refer to people with the disease as “COVID-19 cases�, “victims� “COVID-19 families� or “the diseased�. It is better to refer as “people who have COVID-19�, “people who are being treated for COVID-19�, or “people who are recovering from COVID-19�. • Ensure accurate information about the virus is widely disseminated, and that there is also a focus on people who have recovered. • Engage social influencers, such as religious leaders, who can help communicate accurate messages and help to reduce social stigma as well as support those who may be stigmatized. • Communication materials must reinforce the positive contribution of health care workers and other essential workers and their need to be supported by community members. • Communication materials should make clear the steps health workers and others are taking to protect themselves against the virus and their use of PPE. • Engage community leaders or other prominent persons when it comes to vaccination activities. 5.3.3.8 Cold Chain Operation Risks 94 Refrigeration 14 in the cold chain system for vaccine storage and distribution is necessary to maintain efficacy of the vaccines. The refrigeration facilities (cold storage and refrigerated road transport), require huge amount of energy to operate and use different kinds of cooling agents/refrigerants in their cooling systems. The use of refrigerants in the cold chain system can cause depletion of the ozone layer and can contribute to greenhouse gas emissions that cause global warming. The lack of proper maintenance and knowledge very often translates into an inadequate management of the life cycle of refrigerant gases. More refrigerant leakage results to less efficient equipment and higher emission of high global warming potential (GWP) gases into the atmosphere. Refrigerants are toxic and some are flammable and could form explosive mixture with air if leakage occurs, posing risk to people’s health and safety. Some cold storage warehouses use ammonia as a refrigerant which has negligible GWP but is toxic and mildly flammable, with the potential to cause health hazards. Moreover, some cold storage may not be energy- efficient. Mitigation Measures • Use of alternative refrigerants with zero or low climate impact in the refrigeration system • Use of more energy-efficient technology for the refrigeration system • To include relevant technical specifications as part of procuring cold storage/chain equipment and transport and/or stipulating performance standards for the cold chain service providers • Improve energy efficiency of refrigeration systems through maintenance of the refrigeration systems, implementation of procedures and best practices that reduces energy consumptions of chillers and refrigeration systems, e.g. closing the doors of cold rooms during operation, switching-off mobile refrigeration units while opening doors of refrigerated trucks, parking refrigerated trucks in the shade, regular controls and monitoring of all equipment parameters, such as energy performance, pressure, and temperature. • Observe proper handling of refrigerants and during servicing and ensure that workers involved in servicing are trained to avoid leakage of refrigerant in the atmosphere and use PEEs to avoid exposure to refrigerants. 5.3.3.9 Climate Change Related Risks Lesotho has been found to be extremely vulnerable to the effects of climate change. There are particular vulnerabilities to extreme temperature, extreme precipitation and flooding, drought, and 14 In the 2017 UNEP Report of the Technology and Economic Assessment Panel (Montreal Protocol on Substances that deplete the ozone layer), industrial refrigeration accounts for approximately 2% of HFC consumption in terms of CO2-eq and is projected to grow by approximately 6.7% annually between 2015 and 2050. 95 landslides. Increasing temperatures bring uncertainty for the prediction of precipitation patterns. The Lesotho has a mountainous terrain prone to landslides, which climate change-related precipitation is predicted to make more frequent. The climate-related threats highlighted above are expected to affect the most vulnerable project beneficiaries. Older people and those with pre-existing health condition are at particular risk from higher climate-induced temperatures, including extreme heat events as well as increasing average temperatures. This is particularly the case for those suffering from chronic respiratory or cardiovascular conditions and diabetes. Extreme weather events, in particular those leading to heavy precipitation, flooding, storm surges, and high winds, inflict a heavy toll on human life— with acute impacts including physical injuries and drowning, followed by increases in risks of vector and waterborne disease. In the longer term, more profound adverse health impacts are mediated through damage to health infrastructure, as well as the mental health effects of traumatic experiences and the economic hardships these events precipitate. Each of these climate related health threats are expected to hit poorest households and communities hardest, with income and health shocks driving them deeper into poverty. Conversely, severe food shortages from drought lead to numerous adverse nutrition impacts, with women and children the most vulnerable. Reduced social interaction and population movements implemented by the GoL to reduce the spread of COVID-19 can exacerbate social isolation and increase vulnerability to certain climate related exposures, in particular extreme heat. Climate-related disruption to health facilities, healthcare delivery, and access to services also impact the most vulnerable populations, such as older people, women, babies, and young children. Moreover, the natural disasters such as earthquake, landslide, flooding, heat and other climate change- related risks as well as unstable power supply resulting to power outages exist in some areas in the country which may affect the security of the delivery and distribution of the vaccines – including effects on the efficacy of low temperature- requiring vaccines. Mitigation Measures/Adaptation Activities The Project will work to minimize the aforementioned vulnerabilities and enhance resilience and adaptation through the following activities: Provision of medical supplies, including Personal Protective Equipment (PPE), COVID-19 vaccines, medicines, and accessories focused in the priority on coverage of climate vulnerable groups, including senior citizens, thereby allowing these groups to return to normal life and reduce their climate vulnerability - in particular to extreme heat events and other climate-sensitive diseases. Pollution prevention and management, specifically medical waste management, will be a 96 particularly important activity under the Project. Medical waste—including chemicals, contaminated PPE and equipment, and lab testing kits from healthcare facilities—will need to be safely stored, transported and disposed. Wastes generated from labs, screening posts and treatment facilities to be supported by AF could include contaminated waste (e.g., blood, other body fluids and contaminated fluid) and infected materials (water used, lab solutions and reagents, syringes, bed sheets, majority of waste from labs and isolation centers, etc.) require special handling and awareness, as they may pose an infectious risk to healthcare workers in contact with the waste. Informal disposal may lead to contamination of soil and groundwater, but more importantly, to further spreading of the virus to nearby communities. Additionally, attention should also be paid to management of health and safety risks associated with the cold chain for vaccine transport, storage and distribution. The Environmental and Social Management Framework (ESMF) and other relevant management plans that were prepared for the parent project will be updated before AF Effectiveness to include mitigation of risks caused by the Project activities. The parent project ICWMP will be updated to take into account activities supported under the AF. The updated ICWMP will follow WHO guidelines for COVID-19 response, including Guidelines for Quarantine, Biosafety, and Code of Ethics and Professional Conduct and other Good Industry International Practice (GIIP). The ESMF will include guidance related to transportation and management of samples and medical goods or expired chemical products as well as sustainable ways to use environmental resources (water, air, other relevant solutions/reagents) as recommended in healthcare infection control practices in line with Africa CDC Best Practices for COVID-19 in Primary Health Care Facilities and WHO environmental infection control guidelines for medical facilities. The Project activities also include the provision of technical assistance to support Lesotho to establish institutional frameworks for the safe and effective deployment of vaccines. Such technical assistance includes assisting the GoL in supporting medical waste management, which will result in a positive downstream effect on the MoH capacity to manage ESS3 related aspects such as waste management. To mitigate risks due to production of GHG the Project will address climate change vulnerabilities and enhance climate resilience and adaptation through the following prevention and mitigation activities. - Strengthening the disease surveillance system. The AF will support the implementation of the COVID-19 NDVP and most importantly strengthen surveillance systems enabling Lesotho to better respond to future climate related outbreaks such as rotavirus, cholera, and meningitis (under sub-component 1.2). - Community outreach and sensitization. Outreach activities and communications materials will be developed in Sesotho and simple graphics will include training modules and communication 97 materials to help increase the population’s awareness of climate-related risks matters and how to respond to extreme weather events (heat, flooding). The AF will finance inclusive community outreach activities, aiming to raise knowledge of and demand for COVID-19 vaccinations as well as vaccines for climate-induced, vaccine preventable diseases (ex: cholera, typhoid, and meningitis). This will include training modules and communication materials sensitizing the population on the risks related to heat waves and flooding. - Training of health workers on modules responding to climate risk and climate related health consequences. The AF will support COVID-19 related training (demand generation, vaccination, cold chain management, disease surveillance) of health workers to carryout vaccine distribution, especially those that are equipped to respond to highly stressful emergency situations. These trainings will include specific modules educating health workers on climate related risks and how to respond to climate risks such as extreme weather events (e.g., flooding and heatwaves). Climate related risks and response will also be integrated in training materials. - Digital health vaccine management system. The project will support the operationalization of a digital vaccine registration and monitoring system which will be based on the open source DHIS- 2 tracker. This system investments will lay the foundation for both COVID-19 and other vaccine preventable diseases including climate-induced, vaccine preventable diseases. - Contingency plans for extreme climactic shocks. The AF will strengthen Lesotho’s preparedness and response to health emergencies. Specifically, to reduce the impact of climactic events on project activities, the AF will finance development of contingency plans for vaccination during climactic shocks, including extreme heat and floods. Plans will include actions to mitigate against the consequences of climactic events (ex: protecting vaccination supplies from flooding and extreme heat) and to adjust vaccination activities during climactic events (ex: community outreach during floods). - Beneficiaries feedback mechanism. The AF will finance a phone based digital health system to track beneficiaries’ feedback from all who seek/receive immunization/health services, asking them to rate the care they received on both clinical and non-clinical aspects and to register any grievance they might have on the health care received for that visit. This system investments will apply to COVID-19 vaccine first but will lay the foundation for other vaccine-preventable diseases including climate-induced, vaccine preventable diseases The Project also intends to mitigate against greenhouse gas emissions through the following strategies: - Cold storage technology. The AF will help the GoL strengthen its supply-chain systems to not only ensure continuous provision of healthcare during the current pandemic, but to also enhance health sector capacity to respond to future climate-related crises. The AF will finance the procurement of ultra-cold chain freezers and vaccines carriers – the selection of such technologies for vaccine delivery and storage will prioritize available, affordable, WHO pre-qualified 98 equipment or other validated technologies that are energy efficient. In addition, the project will install temperature controls and monitoring systems on the refrigerators and freezers, which will help cut down on excessive use of energy and reducing the project’s impact on greenhouse gas emissions. Supporting the establishment, construction, retrofitting/refurbishment of quarantine facilities in major points of entry as well as increases in numbers of regular isolation rooms – ensuring that these facilities withstand the impacts of extreme climate related events, such as flooding and heat events, thereby enhancing the climate resilience of the populations and adapting these healthcare facilities to climate-related risks. Strengthening laboratory capacity at national and sub-national level to support Emerging Infectious Diseases (EIDs) Prevention, Preparedness, and Response. In addition, the works themselves will be designed to withstand the impacts of extreme climate related events, in particular heat events, thereby enhancing the climate resilience of the populations and adapting these healthcare facilities to predicted climate related risks. Enhancing isolation/quarantine facilities with attention to enhancing the energy efficiency of these facilities through improved insulation, door closures, and where possible renewable energy sources to reduce greenhouse gas emissions from these facilities. In terms of health infrastructure, extreme temperatures can reduce comfort in health clinics and increase the need for heating and cooling devices, while extreme precipitation and flooding, or strong winds can damage hospitals and health care equipment and cause power outages in clinics and cold chain storages of vaccines. Building climate smart health infrastructure should be highly considered when enhancing resilience in these contexts. Strengthening health systems componets under the Project shall take into account the impacts of climate change and geophysical hazards to enhance resilience. Climate and disaster risk management plans of hospitals and health care facilities will be reviewed and updated consistent with the GoL requirements. To ensure operation of vaccine cold storage during power outages, alternative power supply sources shall be available. Table 5-3 below provides further details on some of the expected major risks and impacts and potential mitigation measures to address them throughout Operational Stage of the Project. 99 Table 5-3: E&S Risks and Mitigation Measures During Operational Stage Key Activities Potential Risks and Proposed Mitigation Measures Responsibilities Impacts COVID-19 testing and Collection of samples and - Collection of samples, transport of samples and testing of the Healthcare diagnosis laboratory testing for clinical specimens from patients meeting the suspect case definition facilities, MoH, COVID19 could result in should be performed in accordance with WHO interim guidance PIU spread of disease to Laboratory testing for coronavirus disease 2019 (COVID-19) in medical workers or suspected human cases. Tests should be performed in appropriately laboratory workers, or equipped laboratories (specimen handling for molecular testing population during the requires BSL-2 or equivalent facilities) by staff trained in the transport of potentially relevant technical and safety procedures. affected samples. - National guidelines on laboratory biosafety should be followed. There is still limited information on the risk posed by COVID-19, but all procedures should be undertaken based on a risk assessment. For more information related to COVID-19 risk assessment, see specific interim guidance document: WHO interim guidance for laboratory biosafety related to 2019-nCoV. - Samples that are potentially infectious materials (PIM) need to be handled and stored as described in WHO document Guidance to minimize risks for facilities collecting, handling or storing materials potentially infectious for polioviruses (PIM Guidance), while COVID-19 guidance documents are in preparation. - For general laboratory biosafety guidelines, see the WHO Laboratory Biosafety Manual, 3rd edition. Procurement, delivery Surfaces of imported Technical specifications for procuring equipment should require MOH, PIU and set up of equipment materials may be good hygiene practices in line with WHO technical guidance to be for the storage and contaminated and observed when preparing the procured goods. handling of vaccines and handling and processing associated medical may result in spread of Check national and WHO technical guidance for latest information equipment COVID-19 regarding transmission of COVID on packaging prior to finalization of working protocols at facilities receiving procured goods, https://www.who.int/westernpacific/internal-publications- detail/infection-prevention-and-control-considerations-for-handling- 100 cargo-in-the-context-of-covid-19, and update working methods as necessary. Transport of goods or COVID-19 is spread by Good hygiene and cleaning protocols should be applied. During the MOH, PIU supplies, including the drivers during the transport, truck drivers should be required to wash hands frequently delivery, storage and transport and distribution and /or be provided with hand sanitizer, and taught how to use it. handling of vaccine, of goods or supplies. specimen, samples, reagents, Measures to minimize impacts during transportation, including pharmaceuticals and Traffic accidents occur hazardous materials can be found in the EHSGs. medical supplies during transportation of goods Isolation, care and Infections: There may be - Health facilities should establish and apply Standard Precautions Healthcare treatment of COVID-19 possible risk of COVID- including: facilities, patients in healthcare 19 virus infections at the ‣ Hand Hygiene (HH); PIU/MoH facilities treatment facilities to ‣ Respiratory hygiene/cough etiquette. Health Care workers and general workers involved ‣ Use of personal protective equipment (PPE); in activities such as ‣ Handling of patient care equipment, and soiled linen; testing for COVID-19, ‣ Environmental cleaning; transportation of samples ‣ Prevention of needle-stick/sharp injuries; to testing facilities, ‣ Appropriate Health Care Waste Management; delivery and storage of - In addition, health facilities should establish and apply goods, including samples, Transmission based precautions (contact, droplet, and airborne pharmaceuticals, precautions) as well as specific procedures for managing patients in cleaning, waste isolation room/unit. collection, etc. - Establishment of Standard precautions and Transmission based precautions should be in line with National guidelines for IPC in healthcare facilities and take into account guidance from WHO and/or CDC on COVID-19 infection control: ‣ WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; ‣ WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); ‣ CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; and 101 ‣ CDC guidelines for environmental infection control in healthcare facilities. Increased generation of - All hospitals and laboratories should prepare waste management Healthcare infectious waste: The procedures in accordance with the national requirements that outline facilities, Health facilities and waste segregation procedures, on site handling, collection, transport, PIU/MoH laboratories will generate treatment and disposal, and training of staff. Wastes should be increased amount of segregated at the point of generation by risk, including segregation waste, such as infectious of organic, recyclables, biological infectious and hazardous health sharps, infectious care wastes which are temporary stored for pickup of contracted wastewater (including waste management company on site. Transport routes including excreta (feces and urine)) elevators should also be defined and marked for infected wastes and and also increased other types of wastes. Instructions related how to handle medical incinerator usage waste safely should be made to relevant people handling medical resulting in toxic waste including health and waste workers. emissions and ash. These - The treatment of healthcare waste produced during the care of will need to be managed COVID-19 patients should be collected safely in designated carefully to prevent containers and bags, treated and then safely disposed. public health risk and - Open burning and incineration of medical wastes can result in environmental impacts. emission of dioxins, furans and particulate matter, and result in Medical waste is unacceptable cancer risks under medium (two hours per week) or contaminated with higher usage. COVID-19 virus. - If small-scale incinerators are the only option available, the best Improper collection, practices possible should be used, to minimize operational impacts transport, treatment and on the environment. Single-chamber, drum and brick incinerators do disposal of infectious not meet the Best Available Techniques (BAT) requirements under waste becomes a vector Stockholm Convention. Small-scale incineration should be viewed for the spread of the as a transitional means of disposal for health-care waste. If existing virus. on-site incinerators are used, mitigation measures will be taken to control emissions to air in line with WBG EHS for healthcare facilities and WHO’s guidelines for safe management of waste generated from healthcare activities. - The good practices as follow: ‣ Waste reduction and segregation to minimize quantities of waste to be incinerated; ‣ Siting incinerators away from patient wards, residential areas or where food is grown; 102 ‣ A clearly described method of operation to achieve the desired combustion conditions and emissions; for example, appropriate start-up and cool-down procedures, achievement and maintenance of a minimum temperature before waste is burned, use of appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures, proper disposal of ash and equipment to safeguard workers; ‣ Periodic maintenance to replace or repair defective components; ‣ Improved training for operators and improved management including the availability of an operating and maintenance manual, visible management oversight, and regular maintenance schedules. ‣ Alternative treatments should be designed into longer term projects; such as steam treatment methods. Steam treatment should preferably be on site, although once treated, sterile/non-infectious waste may be shredded and disposed of in suitable waste facilities. ‣ The Project health facilities should establish and apply procedures for healthcare waste management. ‣ HCWM procedures should be in line with National guidelines for Infection Prevention and Control in healthcare facilities and take into account WHO guidelines for Safe management of wastes from health-care activities and WHO technical brief water, sanitation, hygiene and waste management for COVID-19; ‣ Implement and ensure compliance with the ICWMP prepared for this Project. Poor sanitation and - Health facilities shall ensure the provision of safe water, sanitation, Healthcare improper management of and hygienic conditions, which is essential to protecting human facilities, wastewater related to health during all infectious disease outbreaks, including the COVID- PIU/MoH COVID-19 diagnosis and 19 outbreak. Health facilities shall establish and apply good treatment services practices line with WHO guidance on water, sanitation and waste transmit diseases to management for COVID-19 and National guidelines for Infection communities and pollute Prevention and Control healthcare facilities. environment. - Enhanced cleaning arrangements should be put in place, to include regular and deep cleaning using disinfectant of food and drink facilities, toilets/showers, communal areas, including door handles, floors and all surfaces that are touched regularly (ensure cleaning 103 staff have adequate PPE when cleaning consultation rooms and facilities used to treat infected patients). Hazardous materials used The hospitals and laboratories should develop a hazardous material Healthcare and generated during the management procedure that defines: inventory of hazardous facilities, provision of COVID-19 materials in the health care facilities, proper labeling of hazardous PIU/MoH diagnosis, care and materials, safe handling, storage and use of hazardous materials, use treatment services of protective equipment procedure for managing spill, exposures and Hazardous chemicals in other incidents, procedure for reporting of incidents. Hazardous the hospitals and health materials should be handled in accordance with the accepted care centers are limited to practices. Only trained personnel should handle the materials and small volumes of precautions taken when handling materials by using required laboratory reagents, protection equipment such as ventilation hoods and personal chemicals, solvents, protective equipment. medicinal gases etc. Mass vaccination Mass vaccination Develop infection control and waste management plan for MOH, PIU, program involving provides a vector for the vaccination program to consider the use of non-HCF for deployment Hospital/ HCF deployment of vaccines spread of disease from many facilities (not just HCF), vehicles and locations Labor management Health workers - All workers must be paid for overtime as per Labor Law. MoH, (especially nurses), - All workers must be provided with security of medical care, in Healthcare cleaners, ambulance particular ensuring they can access free medical care if they contract facilities, PIU, drivers and caterers may COVID-19. regional/district be asked to work - Ensure that the staff with lower qualification or less experienced referral hospitals overtime to respond to working in the health sector (e.g., cleaners, caterers, part-time the COVID-19 pandemic. workers, etc.), often female workers, also have access to the required It is important that these Personnel Protection Equipment (PPE) – including gloves, gowns, personnel are able to masks and eye protection if exposed to patients with COVID-19, access overtime pay as their waste, clothes or linen – and training to make sure they work in needed. Health care and a safe environment. other staff, including - Most vulnerable workers should be identified, such as female cleaners, or workers in single heads of household, who may need additional support in order upgrade/rehabilitation for them to do their job (for instance, female nurses who are single may need medical care if heads of household may need additional support if they have to work they contract COVID-19. 104 Health workers, a big overtime). Additional support to consider may include cash grants, proportion who are access to food support or provision of childcare services. female (and who may - Health care workers must be actively supported by their employers also bear additional and commended for their work, as well as offered psychological, responsibilities in terms emotional or mental support if possible. This may mean bringing in of child and eldercare), monks to a hospital for a ceremony or ensuring health workers have may face mental health regular breaks and proper food throughout the day. issues or burnout as result - All workers involved in upgrading facilities, health workers, of an outbreak. cleaners, etc., must be reassured that they will continue to get paid if Health workers, cleaners they need to self-isolate if they are showing with COVID- or workers involved in 19/respiratory symptoms. These provisions must be made including upgrades experiencing for contracted staff and are included in the Labor Management Plan respiratory symptoms (LMP). may fear not getting paid and continue to show up at work. Labor Issues: Even - Enforce and ensure proper orientation on acceptable behaviors for Contractor(s), though child labor, forced construction personnel on/off-site. MoH/PIU labor or labor influx are - Train all workers on special occupational health and safety not expected during the guidelines and practices to follow during the COVID-19 crisis in implementation of the line with WB & WHO guidelines. COVID-19 Project, the - Implement relevant measures to mitigate potential impacts between risks are not negligible, as the workers and community members i.e. operating two GRMs, one their existence may for Project workers and other for Project beneficiaries to report on increase importation of issues that concerns them. COVID-19 infections, - Ensure that community workers including communities and gender-based violence, vulnerable groups would also be made aware on protocols to adhere and community conflicts to during community interactions such as practicing proper hygiene, due to continuous masking, other safety precautions and social distancing measures. interaction with local communities. Gender Based Violence, - The Project will train all Project workers on GBV, SEA and SH Contractor(s), Sexual Exploitation and prevention measures and protocols (see Annex 7). MoH/PIU, Abuse (SEA)/ Sexual - Raise awareness will be made on risk of GBV, SEA, SH and Hospital/ HCF Harassment (SH): Risks domestic violence and on prevention measures. of SEA and SH may also 105 increase as a result of - Ensure frontline medical personnel are gender balanced and health increased interactions facilities are culturally and gender sensitive. between the workers of - Provision of separate sanitation facilities for men and women in health workers and health/isolation facilities. community groups during - Ensure that all staff will be made aware of the GRM available for home visits, especially the staff and will also be able to lodge complaints to the GRM. for homes without any - Effective implementation of the GBV/SEA/SH Plan (incorporated male presence. as Annex 7 to the ESMF) Service Delivery Access to COVID-19 - Planning of containment measures and social restrictions need to MoH, healthcare services, take into account the livelihood impact it will have for the Healthcare including access to population, in particular the most vulnerable (the poor, elderly, facilities, vaccines: Planning and women single heads of household, IPs, those with disabilities). hospitals, PIU design of measures to MOH and RGC may need to develop specific mitigation measures screen people for for this, outside the scope of this ESMF. This may include social COVID-19 and safety nets with cash transfers to specific population groups, information materials ensuring that it does not exclude informal workers, the poor, home- developed could exclude based workers, etc. May also include food grants, essential basket of the most vulnerable, goods, childcare support for women, etc. including the poor, - RGC/MOH should consider having a dedicated hotline for people elderly, indigenous to call for questions and recommendations on what to do if they peoples, people living suspect they may have COVID-19. with a disability and - Communication materials must also be clear about (i) how to avoid households headed by contracting COVID-19 (good hygiene measures); (ii) symptoms of single women, who are COVID-19; (iii) what to do if suspect have COVID-19. also less likely to have - Information on how to protect oneself from COVID-19, the access or be active on symptoms of COVID-19, where and how to get tested should be social media. made available to everyone and ensure they are accessible to IPs, Vulnerable groups and marginalized groups, those with disabilities, other vulnerable groups people in the rural areas and the elderly by using different languages (including sign are at heightened risk if language, graphics and illustrations or other forms of visual they contract COVID-19 communication), and in a manner that is culturally appropriate to the due to their remoteness in respective groups and specific needs. accessing treatment - Ensure that testing and treatment centres are disability inclusive. (though their remoteness - Provide specific advice for people - usually women - who care for may protect them from children, the elderly and other vulnerable groups in quarantine, and contracting the virus). who may not be able to avoid close contact. 106 Their location may also - Communication materials and outreach to people, including RCCE make the diagnosing and materials, must make clear that all treatment for COVID-19 at treatment of the virus regional/referral hospitals and public hospitals is free and accessible more difficult. for all population. People must also be told about the GRM process to denounce any instance where they are asked to pay to access needed medical services (unless it is a private hospital). - Ensure that community engagement teams are gender balanced and promote women’s leadership within these. - Develop education materials for pregnant women on basic hygiene practices, infection precautions, and how and where to seek care based on their questions and concerns. - Provide information that uses clear and simple language and disseminate information in accessible formats, like braille, and large print. The SEP prepared for the project addresses in detail principles on fair, equitable and inclusive access and allocation of vaccines, reaching out to disadvantaged and vulnerable groups, overcoming demand-side barriers to access (such as mistrust of vaccines, stigma, cultural hesitancy), and creating accountability against misallocation, discrimination and corruption. People are asked to pay at - All regional/referrals hospitals must treat any patient accessing public hospitals in order services for COVID-19 in a manner appropriate to ensure their to access medical care. wellbeing. There is a risk that the - Communication materials and outreach to people, including RCCE poor, those with materials, must make clear that all treatment for COVID-19 at disabilities and IP groups, provincial/referral and PP public hospitals, is free. People must also who could be be told about the GRM process to denounce any instance where they disproportionately are asked to pay to access needed medical services (unless it is a affected by COVID-19, private hospital). may face discrimination when accessing health services, particularly if they do not have money to pay for services. 107 Vaccine is going to be Stakeholder engagement is key to communicating the principles on MoH, deployed in phases, with fair, equitable and inclusive access and allocation of vaccines, Healthcare the first phase targeting reaching out to disadvantaged and vulnerable groups, overcoming facilities, only 20% of the demand-side barriers to access (such as mistrust of vaccines, stigma, hospitals, PIU population. As a result, cultural hesitancy), and creating accountability against disadvantaged and misallocation, discrimination and corruption. These issues should be vulnerable maybe at the addressed in detail in a Stakeholder Engagement Plan (SEP), and risk of being excluded referenced in the ESMF. due no barriers to access to vaccination facilities in Communication, and vaccination introduction plan and strategies time. should be well communicated to different type of people, appropriately regardless of their status. Adherence shall be ensured to the National Deployment and Vaccination Plan (NDVP) for COVID-19 Vaccine, SEP, GRM, etc. developed for the EPRP. Access to other - Hospitals and other health facilities must ensure they still have MoH, healthcare services: adequate staff to deal with ongoing medical needs. While non-urgent Healthcare Focus on COVID-19 may cases may be deferred, it is important that childhood vaccinations facilities, PIU redirect staff and continue, that women have prenatal and antenatal visits, that sexual resources at health and reproductive health services are available and that those with facilities and negatively chronic conditions and/or disabilities continue to receive necessary impact other areas, such treatments (with adequate measures to separate from patients with as maternal health check- COVID-19, as detailed in other sections in this Table). ups, vaccinations for - Communication materials must stress that these normal services children and treatment of are still being provided, and explain measures taken in health centers chronic diseases. This to avoid COVID-19 risks (for instance, that COVID-19 patients are may particularly impact treated in a different area from where mothers deliver babies) as women, young children there may be apprehension from community members to go to and the elderly. health facilities. This may include radio messages, Facebook, People, in particular loudspeaker announcements, signage in hospitals, etc. women with young children, pregnant women, the elderly, those with disabilities, chronic illness and other 108 vulnerable populations, may be fearful of going to the hospital/health center for fear of contracting the virus. This may cause children to miss out on needed vaccinations, women not seeking support during pregnancy, etc. It may also be that people - All provincial/referrals hospitals must treat any patient accessing MoH, are asked to pay services in a manner appropriate to ensure their wellbeing. Healthcare increased fees for non- - Communication materials and outreach to people, including RCCE facilities, PIU COVID-19 related materials, must make clear that all treatment for COVID-19 at illnesses, in order to provincial/referral and PP public hospitals, is free. People must also cover other hospital costs. be told about the GRM process to denounce any instance where they For instance, fees for are asked to pay to access needed medical services (unless it is a maternal services, private hospital). surgeries, etc. may increase as a result on hospital pressures dealing with COVID-19, which may also disproportionally impact the poor and vulnerable, in particular if they face livelihood losses as a result of the COVID-19 pandemic. Information, Inappropriate information - When developing communication messages about COVID-19, it is MoH, communication, and communication important to have social stigma issues in mind and choose language Healthcare capacity building and increase social stigma that does not exacerbate stigma. facilities, PIU stakeholder engagement, with those who expose or - It is best to not refer to people with the disease as “COVID-19 for all Project activities are infected by virus. cases�, “victims� “COVID-19 families� or “the diseased�. It is better including COVID-19 Risk of fear and/or stigma to refer as “people who have COVID-19�, “people who are being vaccination towards the virus, which treated for COVID-19�, or “people who are recovering from 109 may make people hide COVID-19�. It is important to separate a person from having an symptoms, avoid getting identity defined by COVID-19, in order to reduce stigma. This tested and even reject language should be used throughout all communication materials. hygiene measures or - Ensure accurate information about the virus is widely wearing PPE equipment disseminated, and that there is also a focus on people recovered. (or masks if - When developing communication materials, refer to WHO recommended) information on social stigma: https://www.who.int/docs/default- Health workers may source/coronaviruse/covid19-stigma-guide.pdf. suffer stigma, in - Engage social influencers, such as religious leaders, who can help particular when coming communicate accurate messages and help to reduce social stigma as back to their well as support those who may be stigmatized. communities, as they may - Correct misconceptions and provide accurate information. One be seen as potential way to do this could be through District health officials and/or “carriers� commune leaders/officials. They could be trained on the basics of Some groups may be COVID-19 prevention (good hygiene, frequent hand washing, avoid particularly vulnerable to touching face, social isolation measures), including a need for stigma, such as Cham vaccination and be provided with simple materials in Sesotho or minorities who are English language. These officials can use this information to inform already being prejudiced others in their communities, including correcting false rumors. again due to high number Focus should be on prevention as well as on identifying symptoms of cases in their and how to seek treatment. communities. - The SEP should include outreach to NGOs and other stakeholders There may be lot of to ensure it captures their views and suggestions on best methods to misinformation regarding develop RCCE materials. vaccine side effects - Communication materials must reinforce the positive contribution following immunization. of health care workers and other essential workers and their need to be supported by community members. - Communication materials should make clear the steps health workers and others are taking to protect themselves against the virus and their use of PPE. Communication materials - When developing communication materials, it is important to MoH, may not reach the most ensure that they are clear and concise, and that they are in a Healthcare vulnerable, including the format/language that is understandable to all people, in particular the facilities, PIU elderly, vulnerable groups most vulnerable. Messages should be clear and concise, focusing on and workers from the hygiene measures (hand washing, coughing), what to do if suspect informal sector, a lot of have COVID-19, as well as restrictions if applicable (for instance 110 whom are women, who specific guidelines on social-distancing), and requirements for tend to have lower levels vaccination introduction. of education, lower - Potential communication breakdown shall be mitigated through the incomes and may lack Project's "Risks Communication and Community Engagement access to reliable Strategy� (RCCES). information materials. - When developing communication materials, refer to WHO information on social stigma: https://www.who.int/docs/default- source/coronaviruse/covid19-stigma-guide.pdf - This may mean that different media needs to be used (social media, radio, tv) plus engaging existing formal and informal public health and community-based networks (schools, healthcare service providers at local level, etc.). Ensure that information is accessible in sign language, braille, illustrations/pictorial and in Sesotho. - Ensure messages relating to COVID-19 reach all groups of people, in particular the most vulnerable (the poor, elderly, women single heads of household, those with a disability, vulnerable groups, any marginalized group). This may include having a multi-faceted approach to consultations and disclosure of information and information sharing, such as by loudspeaker (by community authorities or district health authorities), radio, TV, newspapers, WhatsApp broadcast messages, Facebook, SMS, You Tube videos, community announcement, social influencers/religious leaders, etc. - A focus of information materials should be on women, as they tend to be the best venue of communication for children, disabled and the elderly in the household. Social conflicts: May - Stakeholder Engagement Plan (SEP) uses different communication MoH, result from false rumors methods. Stakeholder Engagement Plan (SEP) ensures consultations Healthcare and misinformation, with NGOs and other stakeholders that can provide facilities, PIU especially for Project recommendations on how to communicate information and develop supported facilities, Risk Communication and Community Engagement Plan (RCCE). Project beneficiaries, and - Ensure consultations on SEP and this ESMF include relevant other services, including government agencies, NGOs and other organizations working on selection criteria for health and gender, including GBV, as well as vulnerable groups. vaccination. If Ensure women, and women’s groups, are targeted during stakeholders are not consultations on the SEP and ESMF, as well as information properly consulted, campaigns and RCCE materials as described above. 111 information is not - Identify trusted community groups (local influencers such as disclosed and people are community leaders, religious leaders, health workers, community not informed about their volunteers, celebrities) and local networks (such as women’s groups, rights, options for youth groups, business groups, and traditional healers) that can help grievance redress or to disseminate messages. Define clear and easy mechanisms to Project timelines, there disseminate messages and materials based on community questions could be and concerns. misunderstandings, - Ensure communication materials not only focus on COVID-19 conflict, stigma, gender- symptoms and hygiene, but also on coping strategies if there is based violence, false social isolation, vaccination program, avenues (materials, rumors or loss of organizations, hotline) available for mental health, GBV, etc. that confidence in the may be available. community regarding the Project. Targeting of Outreach/communication tools to make potential beneficiaries aware MOH, HCF, beneficiaries may not be of the eligibility criteria, principles and methods used for targeting PIU done in a fair, equitable and inclusive manner: Ensure Project includes a functional Grievance Mechanism • Lack of transparency about the vaccination program • Poorest / most needy See above. Clear, transparent and unambiguous eligibility criteria households are left out Use good quality Government data combined with geographical targeting Use local community structures to identify and select beneficiaries, based on inclusive consultations • Lack of diversity and Ensure women participate in the program and, where possible, give inclusion in preference to women within households as transferees vaccination program, resulting in Work with community representatives/NGOs so that vulnerable inadequate benefits groups such as unaccompanied children, youth, Sexual Exploitation for other vulnerable and Abuse/Sexual Harassment (SEA/SH) survivors, Indigenous groups Peoples, LGBTI communities, refugees, internally displaced peoples, etc. are included in Project activities and benefits 112 • SEA/SH increase in Consultations to discuss process for identifying vaccination Project area (e.g., prioritization requests for sexual favors to receive Grievance Mechanism (GM) to be established as soon as possible to vaccinations) handle complaints Provide information to potential beneficiaries on eligibility criteria and GM process via various media (radio, SMS, television, online, posters) Work with local NGOs to provide social services for affected beneficiaries, as well as assistance to register Undertaking relevant • Risks associated with Tracking/tracing activities shall be effectively conducted in MoH, traceability activities exclusions due to compliance with the applicable Project provisions Healthcare remoteness, facilities, PIU, unavailability of The database system shall be appropriately managed regional/district resources, etc. referral hospitals Periodic progress reports shall include relevant data/findings, issues and challenges, etc. Strengthening post- • Risks associated with Vigilance and monitoring activities shall be effectively conducted in MoH, vaccination vigilance exclusions due to compliance with the applicable Project provisions Healthcare and monitoring remoteness, facilities, PIU, system(s) unavailability of The database system shall be appropriately managed regional/district resources, etc. referral hospitals Enhancing disease • Risks associated with Disease surveillance activities shall be effectively conducted in MoH, surveillance exclusions due to compliance with the applicable Project provisions Healthcare remoteness, facilities, PIU, unavailability of The database system shall be appropriately managed regional/district resources, etc. referral hospitals Periodic progress reports shall include relevant data/findings, issues and challenges, etc. Cold-chain operation • Risks associated with Procurement of standard equipment adhering to WHO and other MoH, adverse impacts on guidelines shall be ensured Healthcare climate facilities, PIU, Provision of alternative power-supply system shall be in place 113 • Risks linked to regional/district unavailability of Appropriate storage and monitoring mechanism shall be in place; referral hospitals reliable power-supply only properly maintained vaccines shall be utilized. • Risks due to inappropriate storage, temperature- maintenance issues, etc. Engagement of security Community health and Effective implementation of the security management plan that has MOH, HCF, personnel safety risks, including been prepared for the EPRP activities with envisaged engagement of PIU transmission of diseases, the security agencies/personnel. SEA/SH, etc. 114 5.3.4 Decommissioning Stage In response to the surge of COVID-19 testing, and treatment, and vaccination, temporary facilities may be established, which could shortly thereafter be decommissioned. Wherever applicable to any sub-Project or activities under the EPRP, environmental and social risks associated with the decommissioning of these temporary facilities should be considered and site specific decommissioning plan be developed. Details of the decommissioning stage will emerge throughout Project implementation, and the ESMF will be updated to include further details according to the details. Generally, the Environment and Social impacts during decommissioning may be similar to the impacts that may be encountered during constructions phases. These include, Increased Construction Waste materials, Soil and Land Degradation, Environmental Pollutions, Occupational Safety and Health, Noise, Temporary/permanent disruption of Health Care and other services, Employment opportunities, etc. Appropriate mitigations measures, as described under relevant sections above, shall be implemented ensuring compliance with the GoL, WB and WHO provisions. 115 6 Procedures to Address Environmental and Social Issues This section sets out in detail the procedures to be followed in identifying, preparing and implementing the environmental and social management plans and related instruments in order to address environmental and social issues of the Project and the subproject activities throughout the Project life cycle. The classification of the sub- project will follow both the Government of Lesotho, and the World Bank Project E&S classification discussed in Chapter 3, sub-section 3.5. The procedure is diagrammatically represented in figure 6-1 below. Figure 6-1 Flow for sub-project E&S screening, clearance, implementation and monitoring. SUB-PROJECT IDENTIFICATION AND SELECTION PROJECT E&S SCREENING Screening of Project activities and sites by PIU:(To be based on screening form: Annex 1) • Identify relevant Environmental and Social Standards (ESS) • Establish an appropriate E&S risk rating for the subprojects • Specify the type of environmental and social assessment required, including specific instruments/plans If Category is High Risk (as per If Category is Substantial, Moderate or WB) and Category 3 (as per GoL) Low (as per WB) and Category 1 to 2 (as per GoL) Sub-project is excluded for financing under Prepare sub-project ESMP (Template Annex 3) this Project as per project ESCP and ESMF and related instruments such as the ESIA as per requirements. recommendation of the screening Submit E&S documents to the World Bank for review and approval Submit ESMP and relevant instruments to Department of Environment for clearance and certification. Consult and Disclose site-specific ESMPs and related instruments Include ESMP and related instrument requirements into procurement documents Monitor and supervise the implementation of the requirements of the ESMPs and related instruments and report to the World Bank. 116 6.1. Subproject Environmental and Social Screening Each of the sub-projects to be financed under the Lesotho COVID-19 EPR Project, including the Additional Financing, will be subject to an environmental and social screening process before it is selected for inclusion in the Project. The screening process establishes the level of environmental and social assessment required and intends to identify relevant possible environmental and social concerns as well as suggest any further investigation and assessment as necessary using screening form in Annex 1. Copies of each of these screening forms will be kept at the PIU and individual health care facilities. The PIU’s periodic report to the Bank will include copies of each screening undertaken during the subject quarter. The major environmental and social issues to be identified will be determined by the type, location, sensitivity and scale of the sub-project. The results/findings from this exercise will be used to determine: a) Potential environmental and social impacts, either direct or indirect of proposed sub-projects from the site selection stage onwards; b) Appropriate environmental and social category for the sub-project (High, Substantial, Moderate or Low risk); c) What World Bank ESSs will be applicable to the sub-project and any related activities; d) Level of environmental work and the type of project specific management plans/instruments required to assure compliance with the ESF any follow-up instruments instrument required, such as an Environmental and Social Management Plan (ESMP), Labor Management Plan (LMP), Security Management Plan (SMP), Resettlement Action Plan (RAP), etc., or whether no additional environmental work is required); subproject eligibility or the possibility of exclusion, where necessary. Based on the screening, the MOH PIU will (a) ensure that the activities on the “ineligible list� (detailed in section 1) will not be financed by the Project; (b) sign the E&S screening form; and (c) prepare and implement the specific E&S instrument/plan as needed. 6.2. Preparation of Environment and Social Management Plans and Instruments Upon completion of the screening process, the PIU E&S team will prepare site-specific ESMPs and other related instruments such as ICWMP, GBV Action Plan and GRM, LMP, SMP, etc. for the subproject as per the outcome of the screening process. The ESMP provides principles and specific process and technical guidance to the Project implementing unit (PIU) and external consultants/contractors to assess the E&S risks and impacts of the Project activities, and their mitigation measures. The ESMP is implemented in line with the Project ESMF and other relevant documents such as ESCP, SEP, etc. that have been prepared for the Project. The ESMP will be applied to all activities (works, goods/services activities) to be carried out under the Project or subproject. The specific objectives of the ESMP will be to: a) Document the potential E&S risks and impacts of the sub-project and their proposed mitigation measures; b) State the procedures for the E&S screening, review, approval, and implementation of sub-project activities; c) Specify appropriate roles and responsibilities, and outline the necessary reporting procedures, for managing and monitoring E&S issues/ concerns related to the sub-project activities; d) Identify the training and capacity building needed to successfully implement the provisions of the ESMP; 117 e) Address mechanisms for public consultation and disclosure of project documents as well as redress of possible grievances; and f) Establish the budget requirements for implementation of the ESMP. 6.3. Review and Approval of Environment and Social Management Plans and Instruments Once all the E&S safeguards documentation regarding a sub-project have been compiled, they are then submitted to the World Bank for review and approval to ensure compliance with the developed project E&S safeguards documents, such as ESMF, ESCP, SEP, etc. Upon review and clearance by the World Bank, the site-specific ESMPs are then submitted to Department of Environment for clearance and certification prior to commencement of the sub-project activities, as per Lesotho Environment Act No. 10 (2008a) and related instruments. 6.4. Inclusion of E&S Requirements in Procurement Documents The requirements of the developed ESMPs and related instruments, such as labor management plans, security management plans, gender-based violence prevention plans, etc., for the sub-project will be included in the procurement documents, such as bid or contract documents. Annex 12 to the ESMF provides further details on the key inclusions in the contract documents. These measures are to ensure that external contractors or consultants procured for implementation of the sub-project activities are made aware of the environment and social management requirements before they commit to the sub-project work, in order to avoid and minimize issues of non-compliance. 6.5. Implementation of Environment and Social Management Plans and Instruments Once the sub-project has been given the certificate to proceed by the Department of Environment, then implementation can start in earnest. The implementation will involve the application of all the relevant environmental and social standards and instruments that would have been developed for the particular sub-project. 6.6. Monitoring, Supervision and Reporting on E&S Implementation The Environment and Social Specialist, with the assistance of Social Officer, will continue to monitor, and supervise the implementation of the requirements of the E&S plans and instruments, throughout the Project implementation in order to ensure that all the implementing institutions i.e., PIU, contractors/consultants, Health facilities, etc., comply with the requirements ESMPs and related instruments. Environment and Social Specialist, under the oversight of the Project Coordinator will document and report the World Bank the results of the implementation of the ESMPs and related instruments. The arrangements for monitoring the ESMF and site specific ESMPs will fall under the overall responsibility of the Ministry of Health’s Project Implementation Unit (PIU). The PIU will prepare and submit regular environmental and social monitoring reports presenting the state of compliance with the actions set out in the Project’s Environmental and Social Commitment Plan (ESCP) and, particularly, in relation to the preparation and implementation of the environmental and social management tools and actions prepared for the project. 118 7 Consultation and Disclosure 7.1. Stakeholder Consultation Consultations during Project Preparation and Implementation The World Bank team through representation in Maseru maintained regular contact with the MOH and other key stakeholders during Project preparation to formulate Project activities and subprojects. Meaningful consultations have been conducted by the MoH supported by the PIU focused on the EPRP AF components and activities, including the vaccination program. The major key stakeholders of the Project have been consulted, mostly virtually, owing to COVID-19 protocols and to minimize risk of exposure to COVID-19, documenting their concerns and issues about the virus as well as their needs and expectations in relation to the EPRP. The stakeholders engaged during the PP and the AF design and the SEP preparation processes included the direct beneficiaries/directly affected individuals and groups, including the vulnerable ones, and the other interested parties, amongst others. Numerous multimedia platforms were utilized for sensitization and awareness raising on the Project and as part of the national COVID-19 emergency program. Consultations and information disclosure activities will continue throughout Project cycle. The SEP further illustrates procedures and methodologies for stakeholder consultations including the dissemination of this ESMF and other key E&S instruments with proper documentation of the process and strategies for feedback. The SEP outlines various communication channels to be employed consistent with ongoing restrictions. Consultations with stakeholders have been and will continue to be key mechanism to inform them of the Project and to get their feedback. The views of the Project interested and affected persons that were taken into account during Environmental and Social Management Framework (ESMF) preparation shall continue to form a basis for further design and implementation of the subprojects throughout the Project implementation. The current process aims to improve and facilitate decision making and create an atmosphere of understanding that actively involves Project-affected people and other stakeholders in a timely manner, and that these groups are provided sufficient opportunity to voice their opinions and concerns that may influence Project decisions. In general, there are three kinds of stakeholders - affected and interested stakeholders, and vulnerable groups - that will continue be engaged throughout the Project lifecycle: Affected stakeholders - Those who will be likely impacted by the Project (positively or negatively). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. A guiding principle is that engagement with these stakeholders will be commensurate with the level of impacts they suffer. In line with the SEP, the affected parties include: a) COVID-19 infected people in the Project-impacted facilities; b) People under COVID-19 quarantine, including workers in the quarantine facilities; c) Patients at health care facilities; d) Staff at selected hospitals, including janitorial staff, workers in quarantine/isolation facilities, diagnostic laboratories, etc.; 119 e) Workers involved in storage and transportation of samples, PPE, sanitation materials, vaccine, etc.; f) Neighboring communities to laboratories, quarantine centers, and screening posts, and the selected hospitals; g) Public Health Workers, including vaccinators in the vaccination facilities; h) Medical and testing facilities staff; i) Public health agencies engaged in the response; j) People affected by or otherwise involved in Project-supported activities; k) Female-headed households or single mothers with underage children15; l) Migrants returning from South Africa and other neighboring countries. Other interested parties - Those who are not impacted by the Project but who may be interested in the Project outcomes and who may have an influence in the Project. Interested stakeholders identified are as follows: a) Traditional and opinion leaders in the Kingdom of Lesotho b) Media and other interest groups, including social media and the Government Information Department c) Other national and international health organizations, CSOs and UN agencies Vulnerable Groups – Those who may be disproportionately impacted or further disadvantaged by the Project as compared with any other groups due to their vulnerable status (e.g., the disabled, children, elderly, poor, marginalized, etc.), and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the Project. The current engagement process is in line with the Stakeholders Engagement Plan that has been developed for the Lesotho COVID-19 Emergency Preparedness and Response Project, and updated to include the Additional Financing. The SEP outlines detailed requirements on stakeholder engagement and GRM. The consultation process will be a continuous process throughout the life of the Project and will be used as a means of checks and balances for the proper implementation of the Project. The process will employ a technically and culturally appropriate approach, which involves identifying the concerned/affected stakeholders, soliciting their views and continuously checking if their views are being taken care of as the Project implementation progresses. The engagement strategy defined in table 7-1 below will be used. 15 This vulnerable group may also be organized along the following lines: households with presence of children or elderly, single parents, elderly-only households, child headed households. 120 Table 7-1: Strategy for stakeholder engagement and information disclosure Project Target stakeholders List of Methods of engagements activity information to be disclosed During All three groups of stakeholders Introduce the Public notices (see Annex 8); preparation (Affected stakeholders, other Project’s ESF Press releases in the local media; of ESMF interested parties, and Vulnerable instruments; Consultation meetings; and site- Technical designs of Use of mobile technology such as Groups) as have been detailed above specific the isolation units and telephone calls, SMS, emails, ESMPs (section 7.1). treatment facilities; etc.). SEP and GRM procedure; During the All three groups of stakeholders ESMF requirements Consultations (face to face and/or rehabilitatio (Affected stakeholders, other including GBV, virtual consultations); n works and interested parties, and Vulnerable SEA/SH and other Use of mobile technology such as procuremen risks and impacts telephone calls, SMS, emails, Groups) as have been detailed above t of mitigation measures etc.). equipment (section 7.1). (see Annex 7); for the SEP, and GRM selected procedure; health care, Regular updates on and vaccine Project development. facilities. During All three groups of stakeholders Applicable specifics Public notices (see Annex 8); Operations (Affected stakeholders, other as required for the Press releases in the local media; stage and interested parties, and Vulnerable implementation of Consultation meetings; vaccine the ESF instruments Induction trainings; Groups) as have been detailed above introduction including the ESMP, Use of mobile technology such as (section 7.1). SEP, GRM, LMP, telephone calls, SMS, emails, ICWMP, OHS plan, etc.). inter alia. The stakeholder engagement plan guides stakeholders and Project implementers as to when, how and with whom consultations and exchanges should be undertaken throughout the life of the Project. Development of the stakeholder engagement plan is informed by further detailed categorization of the Project’s stakeholder mentioned above, conducting further analysis as detailed below (see Table 7-2, and Figure 7-1). The stakeholder analysis facilitates development of tailored engagement approaches for specified stakeholder groups. Group 1: Stakeholders are very important to the success of the activity but may have little influence on the process. For example, (see Table 7-2), the success of the Lesotho COVID-19 EPR Project may depend on how well participating health facility staff, village health care workers, and vaccinators are able to participate in the Project, but these groups may not have much influence on the design and development objectives of the Project. In this case, they are highly important but not very influential. They may require special emphasis to ensure that their interests are protected and that their voices are heard. 121 Group 2: Stakeholders are central to the planning process as they are both important and influential. These should be key stakeholders for partnership building. For example, Principal Secretary at Ministry of Health may be both very important (as chief accounting officer for the Project finances) and influential (without his support, the Project may not be possible). Group 3: Stakeholders are not the central stakeholders for an initiative and have little influence on its success or failure. They are unlikely to play a major role in the overall process. One example could be Religious, and Traditional Leaders groups that has little influence on implementation activities of the Project. Similarly, they are not the intended beneficiaries of, and will not be directly impacted by, the Project activities. Group 4: Stakeholders are not very important to the activity but may exercise significant influence. For example, general public may not be important stakeholders for the Lesotho COVID-19 EPR Project, but this group could have major influence on the process due to access to media platforms, such as social media platforms, radios, etc., and the ability to mobilize people or influence public opinion. These stakeholders can sometimes create constraints to Project implementation or may be able to stop all activities. Even if they are not involved in the planning process, there may need to be a strategy for communicating with these stakeholders and gaining their support. Table 7-2: Lesotho COVID-19 EPR Project Stakeholder Analysis Stakeholders Interests at stake in relation to Project16 Effect of Project on interest17 Group 1 National Emergency Coordination, monitoring, oversight and dissemination Positive Command Centre of information related to COVID-19 (ECC) District Health Public Health care service provision in response to Positive Management Team COVID-19 in line with 9 pillars provided by World (DHMT) Health Organization. Participating Health Public Health care service provision in response to Positive Facility Staff, and COVID-19 in line with 9 pillars provided by World vaccinators Health Organization. Village Healthcare Primary Health Care: Community level COVID-19 Positive Workers surveillance; presumptive case monitoring; targeted timely counseling (TTC) on COVID-19, Infection Prevention and Control (IPC), nutrition and other related lung diseases awareness creation; access to information COVID-19 Patients Psychosocial support (stigma, anxiety, etc.), access to Positive health care services Group 2 Office of the King Public protection against COVID-19 disease outbreak Positive 16 Interest at stake in relation to the project refers to the expectations of stakeholders with regard to the project activities. 17 Effect on project on interest refers to whether the project will affect stakeholders’ interest positively or neutrally or neg atively. 122 Stakeholders Interests at stake in relation to Project16 Effect of Project on interest17 Office of the Prime National development: improvement of health service Positive Minister delivery, and ensure safety of the people against the COVID-19 pandemic. Ministry of Health Public Health service provision, and oversee the overall Positive senior management implementation of the Project, including successful (e.g., Minister of deployment of the COVID-19 vaccine. Health, Principal secretary, Director of Planning, Rapid response team, etc.) Principal Chiefs Access to Information Positive Members of Political participation, information, and National Positive Parliament development District Information, advocacy, availability of resources Positive Administrator District Council Information, advocacy, availability of resources Positive Secretary Community Information dissemination and community health service Positive Councils delivery Group 3 Other government Information dissemination, participation. Positive ministries Lesotho COVID-19 Delivery of Project Development Objectives and Positive EPR PIU, including Activities, facilitate implementation of the Project the Additional Financing Project Civil society Information and advocacy Positive organization Christian Council of Information, psychosocial support Positive Lesotho (CCL) Traditional leaders Information, referrals Positive Media Information dissemination Positive Participating Accessibility of health care services: Infection Positive Communities e.g., Prevention and Control (IPC), information education and Mafeteng Hospital communication Area Group 4 General Public Accessibility of health care, and vaccination services: Positive IPC, information education and communication The stakeholder importance and influence matrix is a tool that helps to prioritize stakeholder engagement management. 123 Low ------------------------------------------------- High Keep NECC, Ministry of Manage Health, DHMT, satisfied participating health closely General public facility, village health workers, Vaccinators, COVID-19 patients Importance Office of the King, Other government Office of the Prime ministries, PIU, Minister, Principal traditional leaders, Chiefs, members of Monitor CCL, media, parliament, District participating Administrator, District Keep informed communities, civil Council Secretary, society community councils Influence Low ------------------------------------- High Figure 7-1: Stakeholder Importance and Influence Matrix Manage Closely: Stakeholders who have high importance and influence in the Project will be engaged at every stage of the Project. They will take part in decision making processes related to the Project, and they will be requested to produce progress reports quarterly. Their activities will be managed by looking into availability of resources and technical support that might be needed. Keep informed: Stakeholders who have high influence on the Project but low importance need to stay informed in order to avoid misinformation. Therefore, stakeholders of high influence but low importance will be provided with regular updates of the Project. Project reports will also be shared with them. Monitor: Other stakeholders who have low importance and low influence on the Project will be monitored by ensuring that they are always well informed about the Project and its activities. The information will be provided quarterly by using local media platforms, such as radios and newspapers, etc. Keep satisfied: Stakeholders of high importance but low influence will be kept satisfied by providing them with precise information. For instance, the general public will be provided with information regarding availability of health care services for COVID-19; the information will be provided regularly by using pamphlets or media. The stakeholder management plan was developed with the stakeholders themselves. As a starting point for any stakeholder engagement plan, it is important to consider the key factors in ensuring meaningful, effective and informed consultation processes, as articulated in the Project SEP. These criteria and considerations for stakeholder engagement plans are elaborated in Table 7-3 below. 124 Table 7-3: Meaningful, effective and informed consultation processes Characteristic Considerations during stakeholder engagements Free of external • No acts of intimidation or violence or provision of bribes, gifts, and manipulation, unregulated and questionable patronage; interference, • Timelines for stakeholder engagement need to be realistic and respectful of coercion, and intimidation stakeholder decision-making processes; • Carefully consider security arrangements to ensure safety but also to avoid perceptions of intimidation. Where possible, security arrangements should be discussed with all parties. Gender and age-inclusive • Ensure stakeholder analysis accounts for differentiated roles and interests of and men and women, and that women stakeholders are appropriately identified; responsive • Include culturally appropriate mechanisms/processes to facilitate the increased participation of women, youth and the elderly and ensure feedback is reflected in Project design. Culturally appropriate and • Cultural understanding and awareness are central to meaningful stakeholder tailored to the language engagement. Design consultations/workshops to specificities of each preferences and decision- stakeholder group, including respect for local decision-making processes making processes of each (including appropriate time frames); identified stakeholder • Ensure materials and outreach methods are understandable and accessible to group, including the range of stakeholders involved. Tailor materials for different disadvantaged or stakeholders to ensure equity in information access; marginalized groups • Apply principles of accessibility and make reasonable accommodation for persons with disabilities; • Consider diverse forms of communication: fact sheets, flyers, community postings, press releases, newsletters, hotlines, graphics, oral representation, posters, community bulletin board postings, local press announcements, public hearings, community meetings, informal meetings, videos, electronic media (websites, SMS messages, WhatsApp messages), community radio, local plays and dramas, use of liaisons (community elders, religious leaders, NGO supporters); Based on prior and timely • Ensure information on Project’s purpose, nature, scale, duration, and disclosure of accessible, potential risks and impacts is available in timely, accessible manner; understandable, relevant • Ensure that draft social and environmental assessments and management and plans are disclosed, and stakeholder feedback is considered; adequate information, • Disclose final environmental and social assessments, management plans, and including draft documents screening reports (appended to Project E&S document); and plans • Provide summaries of technical information in accessible and understandable manner. Initiated early in the • Engage stakeholders early in Project planning process; Project design process, • Identify in stakeholder engagement plan key junctures where stakeholder continued iteratively engagement is required before further Project activities can advance throughout the Project life • Update stakeholders about upcoming activities and issues that may require cycle, and adjusted as their input; risks and impacts arise • Provide adequate lead time to accommodate stakeholder decision-making processes. Addresses environmental • Involve stakeholders in screening of Project for environmental and social and social risks and risks/impacts; 125 Characteristic Considerations during stakeholder engagements adverse impacts, and the • Consult with stakeholders on assessment of environmental and social risks proposed measures and and development of mitigation and management measures. Ensure those actions to address these who may experience potential adverse impacts are fully consulted; • Consider participatory assessment techniques. Seeks to empower • Provide iterative opportunities to stakeholders to express concerns, ideas and stakeholders, particularly knowledge and reflect stakeholder input in Project goals, objectives and marginalized groups, and design; enable the incorporation • Seek to transfer as much decision-making as possible to stakeholder groups; of all relevant views of • Provide for stakeholder representation on Project boards, monitoring affected people and other committees and other key Project structures; stakeholders into decision- • Allocate budget for capacity building where needed (and available), as well making processes, such as as payment for accessibility and reasonable accommodation, and expenses Project development incurred by stakeholders. objectives and design, mitigation measures, the sharing of development benefits and opportunities, and implementation issues Documented and reported • Ensure that stakeholders are regularly informed of relevant information and in accessible form to new developments, including setbacks and delays, throughout the life of the participants, in particular Project; the measures taken to • Include reporting intervals in stakeholder engagement/communications plan avoid or minimize risks to • Include feedback mechanism for stakeholder input on Project progress, and and adverse impacts on how feedback is addressed; the Project stakeholders • Disclose monitoring reports in a culturally appropriate format. Consistent with the • Ensure stakeholder engagement plan consistent with national laws and national laws and regulations regarding public engagement (e.g., public gatherings during obligations under COVID-19 pandemic) international law • Support international obligations of governments to ensure public participation and, where relevant, consent processes, transparency, redress for grievances, and accountability. 7.2. Stakeholder Consultations done during ESMF preparation The stakeholder engagement process was divided into two phases, with the first phase being a technical discussion with the key stakeholders, notably Prime Minister’s office, Ministry of Health, WHO, other relevant development partners and NGOs, Ministry of Finance, Ministry of Local Government, and sensitization exercise that entailed informing district officials (e.g., District Administration Offices), chiefs and local councils of the Project. The second phase was to publish the notices (in Sesotho and English) in the local newspapers. Key findings of the ESMF consultations – including the process, sample public notices, etc. - have been documented in Annex 8 to the ESMF. The public were informed of the Project and given the opportunity to share their views in writing and telephonically to the Project team. In addition, as a component of the Environmental and Social Assessments questionnaires were issued to various stakeholder groups to assess the impact of the subprojects on the existing communities and settlements located within the respective subproject’s neighborhood (see Annex 9 for sample 126 questionnaire used). Information gathered from these stakeholder engagements for instance prioritizing recruitment of unskilled labor and taking into consideration the traditional reporting channels for beneficiary feedback have been incorporated into this ESMF and the LMP. 7.3. Document Disclosure The Environmental and Social Safeguard team has prepared and disclosed (on Ministry of Health website and the Bank’s website) the Project Environment and Social Commitment Plan (ESCP). The updated Environment and Social Management Framework (ESMF) (including a SEA/SH/GBV risk assessment (see Annex 7); Labor Management Procedures (see Annex 11), Stakeholder Engagement Plan (SEP), and Grievance Redress Mechanism (GRM) have been also prepared. The SEP and ESMF have been disclosed in-country at the MoH website on April 6, 2021 (re-disclosed), and August 2020, respectively – they will be disclosed again once the required Approvals are received. The team has also updated the Infection Control and Waste Management Plan (ICWMP) for Lesotho (2016) to reflect the inclusion of COVID-19 disease outbreak and response, including the COVID-19 vaccine deployment, based on updated WHO COVID-19 guidelines. The other Environment and Social Safeguards instruments are being developed/updated as required and will be disclosed in-country and at the Bank’s website adhering to the applicable provisions of the GoL and the Bank. 127 8 Stakeholder Engagement 8.1 General The project implementing agency (MoH) supported by the PIU is committed to stakeholder engagement ensuring that meaningful consultations with various stakeholders (including health workers, Project affected communities, women and youth groups, NGOs, patients, line ministries, community-based groups and Disabled People’s Organizations (DPOs) and other vulnerable and disadvantaged members of the communities) are conducted ensuring the GESI principles throughout the Project life cycle. Due to the nature of COVID-19 outbreak and its infection and transmission mechanism, initial consultation have been limited to public authorities and national health experts, as well as international health organization representatives and NGOs. With regard to the vaccination introduction, consultations have also been done by the MOH NVI-TWG. These consultations were conducted in line with WHO requirements as well as the current restrictions for meetings and social gatherings in the COVID-19 context in country. Furthermore, the PIU will continue to ensure accessible public information disclosure in format and location. The Project’s SEP presents a detailed road map and a communication strategy for stakeholders and avenues to provide their feedback. The MOH will ensure that all stakeholder consultations are inclusive and appropriate for the local context. Relevant stakeholders will continue to be provided with timely, relevant and understandable information in a culturally appropriate format. The Parent Project SEP was prepared in April 2020, and disclosed for public purposes on April 29, 2020. The SEP is being implemented smoothly and is in compliance with the EPRP requirements. The recent PP Implementation progress review was conducted in November 2020. Each of the current ‘Progress Towards Achievement of the PDO’, and ‘Overall Implementation Progress’ have been rated as “satisfactory� for the PP. The major objectives of SEP as informed by ESS-10 are to: • identify the roles and responsibility of all stakeholders and ensure their participation in the complete project cycle; • establish a systematic approach to stakeholder engagements that will help the project identify stakeholders and build and maintain a constructive relationship with them, in particular project-affected parties; • assess the level of stakeholder interest and support for the project and to enable stakeholders’ views to be taken into account in project design and environmental and social performance; • promote and provide means for effective and inclusive engagement with project affected parties throughout the project life-cycle on issues that could potentially affect them; • ensure that appropriate project information on environmental and social risks and impacts is disclosed to stakeholders in a timely, understandable, accessible and appropriate manner and format taking special consideration for the disadvantaged or vulnerable groups; • provide project-affected parties with accessible and inclusive means to raise issues and grievances and allow the project to respond to and manage such grievances; • devise a plan of action that clearly identifies the means and frequency of engagement with each stakeholder; • allocate budgetary and other resources in the project design, project implementation, and Monitoring and Evaluation (M&E) for stakeholder engagement and participation. The SEP outlines the ways in which the 128 project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make grievances about project and any activities related to the project. Moreover, the involvement of the local population is essential to the success of the Project in order to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. Also, for COVID-19 vaccination programs, stakeholder engagement is key to communicating the principles of prioritization of vaccine allocation and the schedule for vaccine rollout, reaching out to disadvantaged and vulnerable groups, overcoming demand-side barriers to access (such as mistrust of vaccines, social stigma, cultural hesitancy), amongst others. In preparation of this ESMF, consultations have been conducted focusing also on vaccination component and activities under the Project. 8.2 Reporting back to stakeholders Consultations with stakeholders are the main mechanism to inform them of the Project and to get their feedback. The PIU has and will ensure the documentation of Project meetings and incorporation of comments into Project documents when applicable. Stakeholders who provide specific suggestions will be followed up with after consultations with feedback on how their comments were considered. For instance, an email, message and/or official letter will be sent (in person or virtually) on how comments/suggestions were considered. Support of the grassroots level community-based organizations (CBOs), volunteers engaged in the project activities, community health workers, community leaders, etc. shall be taken to reach to the communities in hard to reach remote rural areas. 8.3 Grievance Redress Mechanism (GRM) An accessible (format & location) GRM (taking into consideration traditional communication channels too) has been established to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved as outlined in the SEP that has been prepared for the Parent Project, and shall be updated/adapted for the Additional Financing Project. The main objective of the GRM is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. The GRM allows the PIU to receive, respond to, facilitate resolution of concerns and manage grievances. Specifically, the GRM: a. Provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions; b. Provides affected parties with avenues for making a complaint or resolving any dispute that may arise during the implementation of projects; c. Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; 129 d. Avoids the need to resort to judicial proceedings; e. Ensures inclusive and active participation of the communities and other key stakeholders. Any Project grievances arising, will be addressed using the developed GRM, with necessary steps and institutional arrangement for addressing Project relevant grievances. Grievances or suggestions related to the Project are handled at the Project level by E&S team, in consultation with relevant stakeholders. With the proposed vaccination program, the existing GRM will be strengthened through working in collaboration with the newly formed MOH Environmental and Social Committee – Grievance Redress sub-committee (ESC - GRC), which has been established to manage all grievances or suggestions received for the Projects under the ministry. The PIU Social Specialist will form part of the ESC - GRC, and will track and report on all grievances received by the ESC – GRC that are relevant to the Project and provide technical support to the group. The Project/PIU, working in collaboration with the ESC - GRC, will publicise GRM on a regular basis through existing channels such as press briefing, TV, radio and other social media. The Project will consider cultural characteristics and accessibility factors when disseminating information about the GRM. The GRM will include the following steps: Step 1: Submission of grievances either orally or in writing to MOH ESC - GRC, or other entities/personnel engaged in the Project activities. A toll-free phone line and email will also be established. In order to ensure the GRM is accessible to all stakeholders, particularly in rural areas and those that are vulnerable, specific measures will be explored during consultations. The GRM will also allow anonymous grievances to be raised and addressed. The following grievance uptake channels will be used: telephone, text message, email, grievance boxes, suggestion boxes in local authority offices, social media, WhatsApp, Facebook, fax, mail, walk-in, face to face, logbook etc.). Once a complaint/grievance has been received, by any and all channels, it should be recorded in the complaints logbook or grievance excel-sheet/grievance database and reported as part of the quarterly report using the logbook templates attached as Annexes 14-A and 14-B, respectively, to the ESMF. Step 2: Recording of grievance, classifying the grievances based on the typology of complaints and the complainants in order to provide more efficient response, and providing the initial response within 24 hours by the ESC - GRC The typology will be based on the characteristics of the complainant (e.g., vulnerable groups, persons with disabilities, people with language barriers, etc.) and also the nature of the complaint (e.g., site effects due to vaccination, inability to access the information provided on COVID-19 vaccination guidelines, etc.). Step 3: Investigating the grievance and communication of the response within 7 days. Step 4: Complainant Response: Either grievance closure or taking further steps if the grievance remains open. If grievance remains open, the grievance will be forwarded to the relevant department and management level within the ministry to the Principal Secretory in the Ministry of Health. In the case of a complainant not being satisfied with a resolution or recommended remedy, the MOH through the ESC – GRC shall forward the copy of the grievance and its resolution to the Ombudsman. The Ombudsman will review the case and determine if further reasonable action is possible. If no reasonable action is possible, the 130 Ombudsman will authorise the close out of the complaint. A close out letter will be sent to the Complainant explaining the Ombudsman’s position within 30 working days. If the Complainant does not agree with the resolution provided by the Ombudsman, he/she may take legal action through Courts of Laws. If resolution is approved case will be closed. The aggrieved person/entity may also access the Grievance Redress Service (GRS) at the World Bank. Annex 14-A to the ESMF provides sample template for the grievance logbook while GRM status reporting template has been included as Annex 14-B to the ESMF. 131 9 Project Implementation Arrangements, Responsibilities and Capacity Building This section describes the institutional arrangement, responsibilities, capacity building and the budget needed for implementation of the ESMF activities, such as the screening of subprojects for environmental and social risks and impacts, preparation and consultation in relation to the assessment and identification of mitigation measures for subprojects, review, clearance and disclosure of documentation and instruments, and monitoring the implementation of the ESMP. 9.1 Institutional Arrangements and Responsibilities Overall responsibly, and arrangements for implementation of this ESMF, and its supporting Environmental and Social Safeguards documents, such as site-specific ESMP, Infection Control and Waste Management Plan, Labor Management Plan, and Security Management Plan, lies with various institutions, mainly, the World Bank, Ministry of Health, and Department of Environment. The responsibility of the World Bank, and Department of Environment is to review and approve project E&S documents, and ensure compliance with the World Bank, and national E&S requirements. Ministry of Health is the project implementing body, and does has the responsibility to ensure proper implementation of the prepared project E&S documents. The Ministry of Health has a newly established Environmental and Social Committee (ESC), that is responsible for management of all environmental and social issues for the ministry’s activities and projects. The ESC is made up of an executive committee, formally referred to as Executive Environmental and Social Committee (EESC), which is chaired by the Principal Secretary of the Ministry of Health. Under the executive committee are three subcommittees: Environmental and Social sub-committee, which its objective is to identify and assess environmental and social risks and impacts associated with activities within the MoH, including projects not directly funded by MOH; Stakeholder Engagement and Information Dissemination sub-committee, which its objective is to develop stakeholder engagement plans, and communication strategies for MOH activities, and ensure their successful implementation; and Grievance Redress sub-committee, which its objective is ensure that stakeholders are able to raise their concerns regarding MoH related activities, including the application of relevant environmental and social safeguards and mitigation measures. In order to ensure fair grievance redress process, the committee also have a Health Ombudsman. This is a neutral person, that is, one that favors neither the MoH nor the complainant and an autonomous person that functions apolitically. The overall objective of the Health Ombudsman, is to receive and investigate grievances/complaints that will compromise a fair judgment if handled by the ESC. The ESC is the national governance body for overseeing and ensuring that the MoH is proactively addressing the environmental and social issues when fulfilling its mandate. Its areas of responsibility include: • Overseeing the development of environmental and social impacts/risk assessment of all MOH works and services, including from projects funded by external bodies, and develop appropriate mitigation measures • Overseeing the development environmental and social management plans, for submission of department of environment for approval • Overseeing the implementation and adherence to the environmental and social standards when undertaking any activity within the MoH 132 • Engage stakeholders/citizens in inclusive country dialogue regarding MOH projects and service delivery thereby building resilient and sustainable systems of health • Address grievances or complaints directed to MOH • Monitor that all the grievances and complaints addressed to the MOH are properly dealt with, and implement proactive measures to ensure no further grievances in relation to MOH works and service. Other already existing departments within the MOH that are responsible for the ministry’s environmental and social issues, such as Environmental Health Department, Public Relations Office, etc., are represented in these committees. The PIU is will, work directly with these committees to ensure proper implementation of this ESMF and other project Environmental and Social Safeguards documents, as the responsible body for implementation of the World Bank funded projects within the Ministry of Health. Environment and Social Management Framework implementation arrangement will be as outlined in Table 9-1 below. Table 9-1: Institutional Arrangement and responsibilities for implementation of ESMF No Activity Responsibility Institutions 1 Development of the ESMF, and the PIU Environmental and Social Ministry of Health, Project related E&S safeguards documents Safeguard Team Implementation Unit as per ESMF requirements, such as site-specific ESMP, LMP, SEP, GRM, and ICWMP 2 Review of the ESMF, and related Environmental Safeguards World Bank E&S safeguards documents. Specialist, Social Safeguards Specialist, etc. 3 Approval of the ESMF, and related World Bank, Department of World Bank, Department of E&S safeguards documents. Environment Environment 4 Consultation and Disclosure of PIU Environmental and Social Ministry of Health, Project ESMF, and related E&S safeguards Safeguard Team Implementation Unit documents. 5 Clearance and approval of site- Department of Environment Department of Environment specific ESMPs 6 Inclusion of ESMP requirements into PIU Environmental and Social Ministry of Health, Project procurement/contract documents Safeguard Team, and Implementation Unit Procurement Specialist 7 Training on requirements of the PIU Environmental and Social Ministry of Health, Project ESMF, and related E&S safeguards Safeguard Team Implementation Unit documents 133 No Activity Responsibility Institutions 8 Implementation of the requirements PIU Environmental and Social Ministry of Health, Project of the ESMF, and the related E&S Safeguard Team, MOH Implementation Unit, safeguards documents Environmental and Social Health facilities, NGOs, Committee, Health care professionals, Consultants & Contractors, Undertaking track and tracing Department of Health, Ministry of Health, activities Ministry of Health Project Implementation Project Implementation Unit Unit, Health facilities Health care professionals, Consultants & Contractors Strengthening post-vaccination Department of Health, Ministry of Health, vigilance and monitoring system(s) Ministry of Health Project Implementation Project Implementation Unit Unit, Health facilities Health care professionals, Consultants & Contractors Construction/rehabilitation activities Ministry of Health Ministry of Health, Project Implementation Unit Project Implementation Consultants & Contractors Unit, Health facilities, Contractors Cold-chain operations Ministry of Health Ministry of Health, Project Implementation Unit Project Implementation Health care professionals, Unit, Health facilities Consultants & Contractors Monitoring and surveillance of AEFI Ministry of Health Ministry of Health, Project Implementation Unit Project Implementation Health care professionals/ Unit, Health facilities Consultants 9 Safe transportation of medical Compliance with ESMF and Ministry of Health, Project equipment, vaccines and potentially other E&S plans; Compliance Implementation Unit, infected samples to testing facilities; with applicable project provisions project-supported health recording and tracking waste streams care facilities/hospital in the healthcare facilities Management 134 No Activity Responsibility Institutions 10 Deployment of vaccines Compliance with ESMF Ministry of Health, Project requirements during Implementation Unit, Implementation of the Health facilities, Military vaccination program including for transportation to remote vaccine deployment and areas and safety/security vaccination activities aspects, and other entities of the GoL 11 Reporting of ESMF implementation PIU Environmental and Social Ministry of Health, Project Safeguard Team, under oversight Implementation Unit, of the Project Coordinator. project-supported health care facilities/hospital Management (including for tracking and recording waste streams) 9.2 Capacity Building Effective implementation of the Environmental and Social Management Framework will require technical capacity of implementing institutions. Project implementing bodies need to understand inherent social and environmental issues and values and be able to clearly identify indicators of these. This section sets out the training and capacity building that is required to support the implementation of this ESMF. The health sector in Lesotho has experience in infection prevention and control, healthcare waste management, communication and public awareness for emergency situations. However, as found across most countries, the capacity to manage risks associated with COVID-19 is a huge challenge as the healthcare professionals may not have the detailed know-how on the infectious risks associated with the management of waste and control of infections in COVID-19 laboratories, treatment facilities, diagnostic testing stations, quarantine and isolation centers, and vaccination facilities. Additionally, the communication process with the public and in handling social concerns around COVID-19 issues is a catch-up process globally. The Project will provide considerable funding, training and capacity building to support these critical initiatives and build upon international expertise to achieve international best practices on these matters in line with WHO guidelines. To strengthen the capacity, the PIU will also hire a Public Health Specialist with expertise in vaccine logistics/deployment as well as an additional Community Liaison Officer and a Social Specialist. Awareness creation, training and sensitization, on E&S management procedures and COVID-19 infection control and waste management issues will be required for personnel of the following implementing bodies: a) Health care professionals; b) Project Contractors; c) PIU E&S team; d) other MOH teams engaged with the Project, such as the MOH ESC and its sub-committees. Depending on needs identified for each of the implementing bodies, the training will cover the following areas: a) Environment and Social Management tools and their implementation, including: 135 i. Stakeholder engagement plan; ii. Grievance redress mechanism; iii. Labour management procedures; iv. Understanding concerns with sexual exploitation and abuse/sexual harassment, gender-based violence, violence against children, social stigma with COVID 19 b) COVID-19 emergency preparedness and response issues: i. COVID-19 Infection Prevention and Control Recommendations; ii. Standard precautions for COVID-19 patients; iii. Risk communication and community engagement; iv. COVID-19 Infection Control and Waste Management. 9.3 Budget ESMF implementation costs allocated here cover the cost for implementation of the environmental and social risk and impact mitigation measures detailed in chapter 5 (Table 5-1 to 5-3) of this ESMF. Such costs include contractor(s) trainings if engaged, development of E&S due diligence measures and other to be determined tools, such as COVID-19 emergency and preparedness plans. The anticipated cost for all these initiatives is estimated at US$12,000.00. Likewise, the total budget for implementation of the SEP and GBV/SEA/SH plan has been estimated at US$171,196, which also is the best estimate done by the Project preparatory team and may vary during the implementation. The total budget for the ESMF implementation, thus, has been estimated at US$183,196. Being an estimate by the Project preparatory team, it may, however, vary, and shall be allocated/disbursed by the MoH/Implementing Agency as per the actual expenses as may be incurred during implementation of the ESMF activities. It is also worth noting that the required costs for ESMF implementation - including those relevant to the vaccination program and other activities under the EPRP and monitoring and reporting activities - are part of the Project operational costs. 136 10 . Annexes Annex 1: Screening Form for Potential Environmental and Social Issues This form is to be used by the Project Implementation Unit (PIU) to screen for the potential environmental and social risks and impacts of a proposed subproject. It will help the PIU in identifying the relevant Environmental and Social Standards (ESS), establishing an appropriate E&S risk rating for these subprojects and specifying the type of environmental and social assessment required, including specific instruments/plans. Use of this form will allow the PIU to form an initial view of the potential risks and impacts of a subproject. The use of this form will also help identify activities that are not eligible to be financed by the Project. Based on the screening, MOH will (a) ensure that the activities in the “ineligible list� will not be financed by the Project; (b) sign the E&S screening form; and (c) prepare and implement the specific E&S instrument/plan as needed. Consultation with WB specialists on screening is strongly encouraged. It is not a substitute for Project-specific E&S assessments or specific mitigation plans. The environmental and social risk rating of the sub-projects can be assessed by the criteria in the below table. E&S Risk Project Type, Location, Nature and Magnitude of E&S Risks & Impacts, Available Risk Classification Sensitivity, Scale Criteria Risk Criteria • physical considerations; • impacts on greenfield sites; • type of infrastructure; • impacts on brownfield sites; • volume of hazardous waste • nature of potential risks and impacts (e.g. irreversible, and disposal unprecedented, or complex); • resettlement activities; • Indigenous Peoples presence; • possible mitigation measures considering the mitigation hierarchy High Risk • complex; • wide range of significant adverse risks and impacts; • large to very large scale; • long term, permanent and/or irreversible, impossible to avoid • in sensitive location(s) entirely; • some cannot be mitigated or require complex, unproven mitigation, sophisticated social analysis; • high in magnitude and/or in spatial extent (large to very large area or population); • significant adverse cumulative or transboundary impacts; • high probability of serious adverse effects to human health and/or the environment; • high value and sensitivity (e.g. protected and internationally recognized areas); • high value, sensitive lands or rights of Indigenous Peoples and other vulnerable minorities; • Intensive or complex involuntary resettlement or land acquisition; • Impacts on cultural heritage or densely populated urban areas; • may give rise to significant social conflict, harm or human security risks; 137 E&S Risk Project Type, Location, Nature and Magnitude of E&S Risks & Impacts, Available Risk Classification Sensitivity, Scale Criteria • a history of unrest in area or sector, concerns about use of security forces Substantial Risk • not as complex; • some significant risks and impacts; • Large to medium scale; • mostly temporary, predictable and/or reversible; • not such sensitive location • possibility of avoiding or reversing but with substantial investment and time; • may give rise to limited degree of social conflict, harm, human security risk; • medium in magnitude and/or in spatial extent (medium to large area and population); • less severe, more readily avoided/mitigated cumulative and/or transboundary impacts; • medium to low probability of serious adverse effects to human health and/or the environment (with known and reliable mechanisms to prevent or minimize); • lower effects on areas of high value or sensitivity; • more readily available and reliable mitigatory and/or compensatory measures Moderate Risk • no activities with high • risks and impacts not likely to be significant; potential for harming people • not complex and/or large; or environment; • predictable and expected to be temporary and/or reversible; • located away from sensitive • low in magnitude; areas • site-specific, without likelihood of impacts beyond the Project footprint; • low probability of serious adverse effects to human health and/or the environment; • Routine safety precautions are expected to be sufficient to prevent accidents; • easily mitigated in a predictable manner Low Risk • Minimal or negligible risks to and impacts on human populations and/or the environment; • few or no adverse risks and impacts and issues (no further assessment after screening) A note on Considerations and Tools for E&S Screening and Risk Rating specific to infection control is included as Annex 2 to assist the process. Subproject Name Subproject Description Subproject Location Subproject Proponent Estimated Investment 138 Start/Completion Date Questions Answer ESS Instruments to be Yes No prepared and reviewed Does the subproject involve civil works including new construction, ESS1 ESMF/ESMP, ICWMP, expansion, upgrading or rehabilitation of healthcare facilities and/or SEP waste management facilities? Does the subproject involve acquisition of assets for quarantine, ESS5 ESMF/ESMP, ICWMP isolation or medical treatment purposes? Is the subproject associated with any external waste management ESS3 ESMF/ESMP, ICWMP facilities such as a sanitary landfill, incinerator, or wastewater treatment plant for healthcare waste disposal? Is there a sound regulatory framework and institutional capacity in ESS1 ICWMP, place for healthcare facility infection control and healthcare waste management? Does the subproject have an adequate system in place (capacity, ESS3 ESMP, ICWMP processes and management) to address waste? Does the subproject involve recruitment of workers including direct, ESS2 LMP, SEP contracted, primary supply, and/or community workers? Does the subproject involve activities requiring appropriate OHS ESS2 ESMP, ICWMP, SEP procedures and an adequate supply of PPE? Does the subproject have a GRM in place, to which all workers have ESS2/ ESMF, SEP access, designed to respond quickly and effectively? ESS10 Does the subproject involve transboundary transportation (including ESS3 ESMP/ICWMP Potentially infected specimens may be transported from healthcare facilities to testing laboratories, and transboundary) of specimen, samples, infectious and hazardous materials? Does the subproject involve use of security or military personnel ESS4 ESMP, LMP, SEP during construction and/or operation of healthcare facilities and related activities? Is the subproject located within or in the vicinity of any ecologically ESS6 ESIA/ESMP, SEP sensitive areas? Are there any indigenous groups (meeting specified ESS7 criteria) ESS7 Indigenous Peoples present in the subproject area and are they likely to be affected by Plan/other plan reflecting the proposed subproject negatively or positively? agreed terminology Is the subproject located within or in the vicinity of any known ESS8 ESIA/ESMP, SEP cultural heritage sites? Does the Project area present considerable Gender-Based Violence ESS1 ESMP, SEP (GBV) and Sexual Exploitation and Abuse (SEA) risk? Does the subproject carry risk that disadvantaged and vulnerable ESS1 ESIA/ESMP, SEP groups may have unequitable access to Project benefits? Does the subproject carry risk that disadvantaged and vulnerable ESS1 ESIA/ESMP, SEP groups may have unequitable access to project benefits? Is there any territorial dispute between two or more countries in the OP7.60 Governments concerned subproject and its ancillary aspects and related activities? Projects in agree Disputed Areas Will the subproject and related activities involve the use or potential OP7.50 Notification pollution of, or be located in international waterways18? Projects on (or exceptions) International Waterways 18 International waterways include any river, canal, lake or similar body of water that forms a boundary between, or any river or surface water that flows through two or more states. 139 Yes No ESMF Guidance Remarks A Type of activity – Will the sub-projects: 1 Involve the construction or rehabilitation of any small dams, weirs or reservoirs? 2 Support irrigation schemes? 3 Build or rehabilitate any rural roads? 4 Build or rehabilitate any electricity power generating system? 5 Build or rehabilitate any structures or buildings? 6 Support agricultural activities? 7 Be located in or near an area where there is an important historical, archaeological or cultural heritage site? 8 Be located within or adjacent to any areas that are or may be protected by government (e.g. national park, national reserve, world heritage site) or local tradition, or that might be a natural habitat? 9 Depend on water supply from an existing dam, weir, or other water diversion structure? If the answer to any of questions 1-9 is “Yes�, please use the indicated Resource Sheets or sections(s) of the ESMF for guidance on how to avoid or minimize typical impacts and risks B Environment – Will the sub-projects: 10 Risk causing the contamination of drinking water? 11 Affect the quantity or quality of surface waters (e.g. rivers, streams, wetlands), or groundwater (e.g. wells)? 12 Cause poor water drainage and increase the risk of water-related diseases such as malaria or bilharzia? 13 Harvest or exploit a significant amount of natural resources such as trees, soil or water? 14 Be located within or nearby environmentally sensitive areas (e.g. intact natural forests, mangroves, wetlands) or threatened species? 15 Create a risk of increased soil degradation or erosion? 16 Create a risk of increasing soil salinity? 17 Produce, or increase the production of, solid or liquid wastes (e.g. water, medical, domestic or construction wastes)? 18 Result in labor influx If the answer to any of questions 10-18 is “Yes�, please include an Environmental and social Management Plan (ESMP) with the sub-projects application. C Social: Gender, Land acquisition and access to resources – Will the sub-projects : 19 Require that land (public or private) be acquired (temporarily or permanently) for its development? 20 Use land that is currently occupied or regularly used for productive purposes (e.g. gardening, farming, pasture, fishing locations, forests) 21 Displace individuals, families or businesses? 22 Result in the temporary or permanent loss of crops, fruit trees or household infrastructure such as granaries, outside toilets and kitchens? 23 Result in the involuntary restriction of access by people to legally designated parks and protected areas? 24 Result in and maintain adverse gender balances? 25 Exacerbate existing gender imbalances? 26 positively address gender imbalances in the agriculture sector? 140 Yes No ESMF Guidance Remarks 27 Include less privileged potential beneficiaries? (i.e. youths, disabled persons, child headed households, farmers with less than 1ha, the poorest). D Pesticides and agricultural chemicals – Will the sub-projects: 28 Involve the use of pesticides or other agricultural chemicals, or increase existing use? If the answer to question 28 is “Yes�, please consult the ESMF and, if needed, prepare a Pest Management Plan (PMP). Exclusion List: Does the activity have the potential to cause long term, permanent and/or irreversible (e.g., loss of major natural habitat) adverse impacts? Does the activity have the potential to increase COVID-19 infections or loss of life? Does the activity have high probability of causing serious adverse effects to human health and/or the environment not related to treatment of COVID19 cases? Does the activity have the potential to cause significant adverse social impacts and may give rise to significant social conflict? Does the activity have the potential to affect lands or rights of vulnerable minorities? Does the activity have the potential to involve permanent resettlement or land acquisition or adverse impacts on cultural heritage? Does the activity involve actions by the police or the military that requires use of forceful measures resulting in violation of human rights? Does the activity block the access to or use of land, water points, etc. used by others? Does the activity have the potential to intentionally cause or give rise to Gender Based Violence (GBV), Sexual Exploitation and Abuse (SEA), and Deny Human rights, Discrimination and Racism If the sub-project answers ‘yes’ to any of the above questions, this is ineligible activity for Project financing. Conclusions: 1. Proposed Environmental and Social Risk Ratings (High, Substantial, Moderate or Low). Provide Justifications. 2. Proposed E&S Management Plans/Instruments. Sign by Subproject/activities owner: …………………………… Position: …………………………………………………………Date ……………………….. Signed by: ……………………………………………… Position: …………………………………………………………Date:………………………… Annex 2: Infection Control Considerations and Tools for E&S Screening & Risk Rating In the context of global COVID-19 outbreak, many countries have adopted a containment strategy that includes extensive testing, quarantine, isolation and treatment either in a medical facility or at home. A COVID-19 response Project may include the following activities: • construction of and/or operational support to medical laboratories, quarantine and isolation centers at multiple locations and in different forms, and infection treatment centers in existing healthcare facilities 141 • procurement and delivery of medical supplies, equipment and materials, such as reagents, chemicals, and Personal Protective Equipment (PPEs) • transportation of potentially infected specimens from healthcare facilities to testing laboratories • construction, expansion or enhancing healthcare waste and wastewater facilities • training of medical workers and volunteers • community engagement and communication 1. Screening E&S Risks of Medical laboratories Many COVID-19 projects include capacity building and operational support to existing medical laboratories. It is important that such laboratories have in place procedures relevant to appropriate biosafety practices. WHO advises that non- propagative diagnostic work can be conducted in a Biosafety Level 2 (BSL-2) laboratory, while propagative work should be conducted at a BSL-3 laboratory. Patient specimens should be transported as Category B infectious substance (UN3373), while viral cultures or isolates should be transported as Category A “Infectious substance, affecting humans� (UN2814 ). The process for assessing the biosafety level of a medical laboratory (including management of the laboratory operations and the transportation of specimens) should consider both biosafety and general safety risks. OHS of workers in the laboratory and potential community exposure to the virus should be considered. The following documents provide further guidance on screening of the E&S risks associated with a medical laboratory. They also provide information for assessing and managing the risks. • WHO; Prioritized Laboratory Testing Strategy According to 4Cs Transmission Scenarios • WHO COVID-19 Technical Guidance: Laboratory testing for 2019-nCoV in humans: • WHO Laboratory Biosafety Manual, 3rd edition • USCDC, EPA, DOT, et al; Managing Solid Waste Contaminated with a Category A Infectious Substance (August 2019) 2. Screening E&S Risks of Quarantine and Isolation Centers According to WHO: • Quarantine is the restriction of activities of or the separation of persons who are not ill but who may have been exposed to an infectious agent or disease, with the objective of monitoring their symptoms and ensuring the early detection of cases • Isolation is the separation of ill or infected persons from others to prevent the spread of infection or contamination. Many COVID-19 projects include construction, renovation and equipping of quarantine and isolation centers at Point of Entry (POE), in urban and in remote areas. There may also be circumstances where tents are used for quarantine or isolation. Public or private facilities such as a stadium or hotel may also be acquired for this purpose. In screening for E&S risks associated with quarantine and isolation, the following may be considered: • contextual risks such as conflicts and presence or influx of refugees • construction and decommissioning related risks • land or asset acquisition • use of security personnel or military forces • availability of minimum requirements of food, fuel, water, hygiene • whether infection prevention and control, and monitoring of quarantined persons can be carried out effectively 142 • whether adequate systems are in place for waste and wastewater management The following documents provide further guidance regarding quarantine of persons. • WHO; Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19) • WHO; Key considerations for repatriation and quarantine of travelers in relation to the outbreak of novel coronavirus 2019-nCoV • WHO; Preparedness, prevention and control of coronavirus disease (COVID-19) for refugees and migrants in non-camp settings 3. SCREENING E&S RISKS OF TREATMENT CENTERS WHO has published a manual that provides recommendations, technical guidance, standards and minimum requirements for setting up and operating severe acute respiratory infection (SARI) treatment centers in low- and middle-income countries and limited-resource settings, including the standards needed to repurpose an existing building into a SARI treatment center, and specifically for acute respiratory infections that have the potential for rapid spread and may cause epidemics or pandemics. • WHO Severe Acute Respiratory Infections Treatment Centre • WHO COVID-19 Technical Guidance: Infection prevention and control / WASH • WBG EHS Guidelines for Healthcare Facilities 4. SCREENING E&S RISKS RELATING TO LABOR AND WORKING CONDITIONS A COVID-19 Project may include different types of workers. In addition to regular medical workers, workers engaged in vaccination activities and laboratory workers who would normally be classified as direct workers, the Project may include contracted workers to carry out construction and community workers (such as community health volunteers) to provide clinical support, contact tracing, and data collection, etc. The size of the workforce engaged could be considerable. Risks for such a workforce will range from occupational health and safety to types of contracts and terms and conditions of employment. Further details relevant to labor and working conditions for COVID-19 projects are discussed in the LMP template for COVID-19. 143 Annex 3: Site-Specific Environmental and Social Management Plan (ESMP) Template Introduction The Borrower will need to develop a site-specific Environmental and Social Management Plan (ESMP) for projects sites with civil works, setting out how the environmental and social risks and impacts will be managed through the Project lifecycle. This site-specific ESMP template includes several matrices identifying key risks and setting out suggested E&S mitigation measures. The Borrower can use the matrices to assist in identifying risks and possible mitigations. The ESMP should also include other key elements relevant to delivery of the Project, such as institutional arrangements, plans for capacity building and training plan, and background information. The Borrower may incorporate relevant sections of the ESMF into the ESMP, with necessary updates. The matrices illustrate the importance of considering lifecycle management of E&S risks, including during the different phases of the Project identified in the ESMF: planning and design, construction, operations and decommissioning. The issues and risks identified in the matrix are based on current COVID-19 responses and experience of other Bank financed healthcare sector projects. The Borrower should review and add to them during the environmental and social assessment of a subproject. The WBG EHS Guidelines, WHO technical guidance documents and other GIIPs set out in detail many mitigation measures and good practices, and can be used by the Borrower to develop the ESMP. Proper stakeholder engagement should be conducted in determining the mitigation measures, including close involvement of medical and healthcare waste management professionals. The Infection Control and Waste Management Plan forms part of the ESMP. The ESMP should identify other specific E&S management tools/instruments, such as the Stakeholder Engagement Plan (SEP), labor management procedures (LMP), Medical Waste Management Plan, and GBV/SEA/HS Risk Mitigation Plan. 144 Table 1 - Environmental and Social Risks and Mitigation Measures during Planning and Designing Stage Key Activities Potential E&S Proposed Mitigation Measures Responsibilities Timeline Budget Risks and Impacts Identify the type, location and scale of healthcare facilities (HCF) or facilities to be used for deployment of vaccines Identify the need for new construction, expansion, upgrading and/or rehabilitation Identify the needs for ancillary works and associated facilities, such as access roads, construction materials, supplies of water and power, sewage system Identify the needs for acquisition of land and assets (e.g. acquiring existing assets such as hostel, stadium to hold potential patients) Identify onsite and Inadequate ➢ - Estimate potential waste offsite waste facilities and streams, including sharps and management facilities, processes for vaccine program wastes - Consider the capacity of existing and waste treatment of waste facilities, and plan to increase transportation routes capacity, if necessary, through and service providers construction, expansion etc. - Specify that the design of the facility considers the collection, segregation, transport and treatment of the anticipated volumes and types of healthcare wastes - Require that receptacles for waste should be sized appropriately for the waste volumes generated, and color coded and labeled according to the types of waste to be deposited. - Develop appropriate protocols for the collection of waste and transportation to storage/disposal areas in accordance with WHO 145 Key Activities Potential E&S Proposed Mitigation Measures Responsibilities Timeline Budget Risks and Impacts guidance. Design training for staff in the segregation of wastes at the time of use Identify needs for transboundary movement of samples, vaccines, specimen, reagent, and other hazardous materials Identify needs for - Identify numbers and types of workforce and type of workers Project workers - Consider accommodation and measures to minimize cross infection - Use the COVID-19 LMP template to identify possible mitigation measures Identify needs for using security personnel during construction and/or operation of HCF HCF design – general - Structural safety risk; - Functional layout and engineering control for nosocomial infection HCF design - Some groups may considerations for have difficulty differentiated accessing health treatment for groups facilities of higher sensitivity or vulnerable (the elderly, those with preexisting conditions, or the very young) and those with disabilities Design of facility - The design, set up and should reflect specific management of will take into treatment account the advice provided by WHO guidance for Severe Acute requirements, Respiratory Infections Treatment including triage, Center. isolation or quarantine - Hand washing facilities should be provided at the entrances to health care facilities in line with WHO Recommendations to 146 Key Activities Potential E&S Proposed Mitigation Measures Responsibilities Timeline Budget Risks and Impacts Member States to Improve Hygiene Practices. - Isolation rooms should be provided and used at medical facilities for patients with possible or confirmed COVID-19. - Isolation rooms should: i. be single rooms with attached bathrooms (or with a dedicated commode); ii. ideally be under negative pressure (neutral pressure may be used, but positive pressure rooms should be avoided) iii. be sited away from busy areas or close to vulnerable or high-risk patients, to minimize chances of infection spread; iii. have dedicated equipment (for example blood pressure machine, peak flow meter and stethoscope iv. have signs on doors to control entry to the room, with the door kept closed; - have an ante-room for staff to put on and take off PPE and to wash/decontaminate before and after providing treatment. Design to consider Insufficient - Include adequate mortuary mortuary capacity arrangements in the design arrangements Spread of infection - See WHO Infection Prevention and Control for the safe management of a dead body in the context of COVID-19) Identify the needs for an effective communication campaign on vaccination, including tailored outreach to different groups (including disadvantaged or vulnerable groups), with different partners Assess the capacity of Failure to store ➢ Support the Borrower to the Borrower to and handle design and establish or establish effective vaccines properly improve vaccine cold chain vaccine cold chain can reduce vaccine temperature monitoring plan. temperature potency, resulting See WHO guidance on temperature monitoring in inadequate monitoring 19 and CDC immune responses 19 https://apps.who.int/iris/bitstream/handle/10665/183583/WHO_IVB_15.04_eng.pdf;jsessionid=9F079AFFA760DBD35C08B13930268B01?sequence=1 147 Key Activities Potential E&S Proposed Mitigation Measures Responsibilities Timeline Budget Risks and Impacts in patients and Vaccine storage and Handling poor protection toolkit20 against disease Assess the capacity of Insufficient ➢ Support the Borrower to the Borrower to capacity for design and establish or monitor adverse ensuring improve surveillance system events following immunization of AEFI. immunization (AEFI) safety through See WHO Global manual of in line with WHO detecting, surveillance of adverse events guidelines reporting, following immunization21. investigating and responding to AEFI. 20 https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html 21 https://www.who.int/vaccine_safety/publications/Global_Manual_revised_12102015.pdf?ua=1 148 Table 2 - Environmental and Social Risks and Mitigation Measures during construction/implementation Stage Activities Potential E&S Proposed Mitigation Measures Responsibilities Timeline Budget Risks and Impacts Clearing of vegetation - Impacts on natural and trees; Construction habitats, ecological activities near resources and ecologically sensitive biodiversity areas/spots General construction - Impacts on soils activities Foundation and groundwater; excavation; borehole - Geological risks digging General construction - Resource efficiency activities issues, including raw materials, water and energy use; - Materials supply General construction - Construction solid activities – general waste; pollution management - Construction wastewater; - Nosie; - Vibration; - Dust; - Air emissions from construction equipment General construction - Fuel, oils, lubricant activities – hazardous waste management General construction - Workers coming - Refer to COVID-19 LMP activities – Labor issues from infected areas - Consider ways to minimize/ control - Co-workers movement in and out of construction becoming infected areas/site. - Workers - If workers are accommodated on site introducing infection require them to minimize contact with into people outside the construction community/general area/site or prohibit them from leaving public the area/site for the duration of their contract - Implement procedures to confirm workers are fit for work before they start work, paying special to workers with underlying health issues or who may be otherwise at risk - Check and record temperatures of workers and other people entering the construction area/site or require self- reporting prior to or on entering - Provide daily briefings to workers prior to commencing work, focusing on COVID-19 specific considerations including cough etiquette, hand hygiene and distancing measures. - Require workers to self-monitor for possible symptoms (fever, cough) and 149 Activities Potential E&S Proposed Mitigation Measures Responsibilities Timeline Budget Risks and Impacts to report to their supervisor if they have symptoms or are feeling unwell - Prevent a worker from an affected area or who has been in contact with an infected person from entering the construction area/site for 14 days - Preventing a sick worker from entering the construction area/site, referring them to local health facilities if necessary or requiring them to isolate at home for 14 days General construction activities – Occupational Health and Safety (OHS) General construction activities – traffic and road safety General construction activities – security personnel General construction Acquisition of land activities – land and and assets asset General construction GBV/SEA issues activities General construction Cultural heritage Chance-finds procedure activities – cultural heritage General construction activities – emergency preparedness and response Construction activities related to onsite waste management facilities, including temporary storage, incinerator, sewerage system and wastewater treatment works Construction activities related to demolition of existing structures or facilities (if needed) Capacity building and Exclusion of hard to Engagement of Lesotho Defense PIU training of Village reach communities, Force for provision of helicopters. Coordinator Healthcare Workers due to available MOH has existing MOU with LDF mode of transport 150 Table 3 - Environmental and Social Risks and Mitigation Measures during Operational Stage Activities Potential E&S Risks Proposed Mitigation Measures Responsibilities Timeline Budget and Impacts General HCF General wastes, operation – wastewater and air Environment emissions General HCF - Physical hazards; operation – OHS - Electrical and issues explosive hazards; - Fire; - Chemical use; - Ergonomic hazard; - Radioactive hazard HCF operation – Labor issue HCF operation - considerations for differentiated treatment for groups with different needs (e.g. the elderly, those with preexisting conditions, the very young, people with disabilities) HCF operation – - Provide cleaning staff with adequate cleaning cleaning equipment, materials and disinfectant. - Review general cleaning systems, training cleaning staff on appropriate cleaning procedures and appropriate frequency in high use or high-risk areas. - Where cleaners will be required to clean areas that have been or are suspected to have been contaminated with COVID-19, provide appropriate PPE: gowns or aprons, gloves, eye protection (masks, goggles or face screens) and boots or closed work shoes. If appropriate PPE is not available, provide best available alternatives. - Train cleaners in proper hygiene (including handwashing) prior to, during and after conducting cleaning activities; how to safely use PPE (where required); in waste control (including for used PPE and cleaning materials). HCF operation - Infection control and waste management plan 151 Activities Potential E&S Risks Proposed Mitigation Measures Responsibilities Timeline Budget and Impacts Mass vaccination Mass vaccination Develop infection control and waste program involving provides a vector for the management plan for vaccination deployment of spread of disease program to consider the use of non- vaccines from HCF for deployment many facilities (not just HCF), vehicles and locations Waste Use of incinerators - Where possible avoid the use of minimization, results in emission of incinerators reuse and recycling dioxins, furans and - If small-scale incineration is the only option, this should be done using best particulate matter practices, and plans should be in place to transition to alternative treatment as soon as practicable (such as steam treatment prior to disposal with sterile/non-infectious shredded waste and disposed of in suitable waste facilities) - Do not use single-chamber, drum and brick incinerators - If small-scale incinerators are used, adopt best practices to minimize operational impacts. Procurement, Surfaces of imported Technical specifications for procuring delivery and set up materials may be equipment should require good hygiene of equipment for contaminated and practices in line with WHO technical the storage and handling and processing guidance to be observed when handling of may result in spread of preparing the procured goods. vaccines and COVID-19 associated medical Check national and WHO technical equipment guidance for latest information regarding transmission of COVID on packaging prior to finalization of working protocols at facilities receiving procured goods and update working methods as necessary. Transport of goods COVID-19 is spread by Good hygiene and cleaning protocols or supplies, drivers during the should be applied. During the including the transport and transport, truck drivers should be delivery, storage distribution of goods or required to wash hands frequently and and handling of supplies. /or be provided with hand sanitizer, and vaccine, specimen, taught how to use it. samples, reagents, Measures to minimize impacts during pharmaceuticals Traffic accidents occur transportation, including hazardous and medical during transportation of materials can be found in the EHSGs. supplies goods Delivery and storage of specimen, samples, reagents, pharmaceuticals and medical supplies Storage and handling of specimen, samples, 152 Activities Potential E&S Risks Proposed Mitigation Measures Responsibilities Timeline Budget and Impacts reagents, and infectious materials Waste segregation, packaging, color coding and labeling Onsite collection and transport Waste storage Onsite waste treatment and disposal Waste transportation to and disposal in offsite treatment and disposal facilities Transportation and disposal at offsite waste management facilities HCF operation – transboundary movement of vaccines, specimen, samples, reagents, medical equipment, and infectious or hazardous materials Operation of acquired assets for holding potential COVID-19 patients Emergency events - Spillage; - Emergency Response Plan - Occupational exposure to infectious disease; - Exposure to radiation; - Accidental releases of infectious or hazardous substances to the environment; - Medical equipment failure; - Failure of solid waste and wastewater treatment facilities - Fire; - Other emergent events Mortuary - Arrangements are - Implement good infection control arrangements insufficient practices (see WHO Infection Prevention and Control for the safe 153 Activities Potential E&S Risks Proposed Mitigation Measures Responsibilities Timeline Budget and Impacts - Processes are management of a dead body in the insufficient context of COVID-19) - Use mortuaries and body bags, together with appropriate safeguards during funerals (see WHO Practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID- 19) Vaccination campaign - considerations for communication and outreach for disadvantaged or vulnerable groups Stakeholder engagement – considerations for simple, accurate, accessible and culturally appropriate information dissemination; combating misinformation; responding to grievances Targeting of Lack of transparency Outreach/communication tools to make beneficiaries is not about the vaccination potential beneficiaries aware of the done in a fair, program eligibility criteria, principles and equitable and methods used for targeting inclusive manner Ensure project includes a functional Grievance Mechanism Poorest / most needy See above. Clear, transparent and households are left out unambiguous eligibility criteria Use good quality Government data combined with geographical targeting Use local community structures to identify and select beneficiaries, based on inclusive consultations Lack of diversity and Ensure women participate in the inclusion in vaccination program and, where possible, give program, resulting in preference to women within households inadequate benefits for as transferees other vulnerable groups Work with community representatives/NGOs so that vulnerable groups such as unaccompanied children, youth, Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) survivors, 154 Activities Potential E&S Risks Proposed Mitigation Measures Responsibilities Timeline Budget and Impacts Indigenous Peoples, LGBTI communities, refugees, internally displaced peoples, etc. are included in project activities and benefits SEA/SH increase in Consultations to discuss process for project area (e.g. identifying vaccination prioritization requests for sexual favors to receive Grievance Mechanism (GM) to be vaccinations) established as soon as possible to handle complaints Provide information to potential beneficiaries on eligibility criteria and GM process via various media (radio, SMS, television, online, posters) Work with local NGOs to provide social services for affected beneficiaries, as well as assistance to register Table 4 - Environmental and Social Risks and Mitigation Measures during Decommissioning Key Activities Potential Proposed Mitigation Responsibilities Timeline Budget E&S Risks Measures and Impacts Decommissioning of interim HCF Decommissioning of medical equipment Regular decommissioning To be expanded 155 Annex 4: Code of Conduct Guidance 1. A satisfactory Code of Conduct will contain obligations on all Project workers (including the security personnel/agencies and sub-contractors) that are suitable to address the following issues, as a minimum. Additional obligations may be added to respond to particular concerns of the municipality, the location and the Project sector or to specific Project requirements. 2. The Code of Conduct should be written in plain language and signed by each worker to indicate that they have: • received a copy of the code; • had the code explained to them; • acknowledged that adherence to this Code of Conduct is a condition of employment; • understood that violations of the Code can result in serious consequences, up to and including dismissal, or referral to legal authorities. 3. The Contractor should conduct continuous awareness-raising and training activities (such as toolbox talks) to ensure that workers abide by the Code of Conduct. The Contractor should also ensure that local communities are aware of the Code of Conduct and enable them to report any concerns or non-compliance. 4. The issues to be addressed include: i. Compliance with applicable laws, rules, and regulations of the jurisdiction ii. Compliance with applicable health and safety requirements, including wearing prescribed personal protective equipment (PPE), preventing avoidable accidents and a duty to report conditions or practices that pose a safety hazard or threaten the environment iii. The use of illegal substances iv. Non-Discrimination, including on the basis of family status, ethnicity, race, gender, religion, language, marital status, birth, age, disability, or political conviction v. Interactions with community members, including conveying an attitude of respect and non- discrimination vi. Sexual harassment, including the prohibition of use of language or behavior, in particular towards women or children, that is inappropriate, harassing, abusive, sexually provocative, demeaning or culturally inappropriate vii. Violence or exploitation, including the prohibition of the exchange of money, employment, goods, or services for sex, including sexual favors or other forms of humiliating, degrading or exploitative behavior viii. Protection of children, including prohibitions against abuse, defilement, or otherwise unacceptable behavior with children, limiting interactions with children, and ensuring their safety in Project areas ix. Sanitation requirements including ensuring workers use specified sanitary facilities provided by their employer and not open areas x. Avoidance of conflicts of interest, so that benefits, contracts, or employment, or any sort of preferential treatment or favors, are not provided to any person with whom there is a financial, family, or personal connection xi. Respecting reasonable work instructions, including regarding environmental and social norms xii. Protection and proper use of property, including the prohibition of theft, carelessness or waste xiii. Duty to report violations of this Code xiv. No retaliation against workers who report violations of the Code, if that report is made in good faith. 156 Annex 5: Checklists Checklist 1 Environmental and Social Codes of Practice – COVID-19 Exposure at Health Care Facility Target: Health Care Workers/Health Care Facility Visitors/Construction Workers General Infection Prevention and Control ✓ Procedures for entry into health care facilities, such as minimizing visitors and visitor hours, taking temperature checks and having separate area (including entry area) for patients presenting with COVID-19 symptoms/respiratory illness, who should be taken to a different area and given a face mask. All persons visiting hospitals should wash hands before entering and before leaving. ✓ Simple poster/signage (can be A4 paper) in Khmer language explaining entry procedures. ✓ Signage available in hospitals to remind visitors to wear masks if necessary and wash hands before entering/leaving. ✓ Minimize contact between patients and other persons in the facility: health care professionals should be the only persons having contact with patients suspected of having COVID-19 and this should be restricted to essential personnel only (except in cases of young children or other persons requiring assistance, then a family member may be present but they must also be wearing PPE – at least gloves and mask – and adhering to protocols). ✓ Adequate facilities for hand washing available – this may mean setting up additional facilities throughout health centers. ✓ Provide alcohol-based hand sanitizer (60-95% alcohol), tissues and facemasks in waiting rooms and patient rooms. Isolation and Treatment ✓ Isolate patients as much as possible, separate from people presenting with COVID-19. People with COVID-19 should be separate from each other by curtains or in different rooms if possible. Only place together in the same room patients who are have all contracted COVID-19. People with COVID-19 must be separated at all times from other hospital patients and health and other staff. This means there must be dedicated toilet facilities (or bedpans), hand washing facilities, and medical equipment (stethoscope, blood pressure machine, etc.) for patients with COVID-19 only. ✓ Use of Personnel Protection Equipment (PPE) at all times for medical staff and cleaners as needed (particularly facemask, gowns, gloves, eye protection and potentially face shield) when in contact with someone who may have COVID-19/ who is presenting with a respiratory illness, including for those caring directly for patients, cleaners entering patient’s room, or where patient has been treated, and lab technicians handling blood samples. Train staff on how to use the PPE. Put reminders in hospitals (paper/signage) in Khmer language. Staff Occupational Health and Safety ✓ Immediate and ongoing training on the procedures to all categories of workers (lab technicians, doctors, nurses, cleaning staff, etc.) on use of PPE, personal hygiene and thorough disinfecting of surfaces on a regular basis (multiple times per day using a high-alcohol based cleaner to wipe down all surfaces and when COVID-19 patients are discharged; wash instruments with soap and water and then wipe down with high-alcohol based cleaner; dispose of rubbish by burning etc.) Put signage in hospital as a reminder. ✓ Make particular efforts to ensure that all staff (such as cleaners and those doing the washing) are able to understand these procedures and have access to the necessary PPE. ✓ Laboratories undertaking testing for COVID-19 virus should adhere strictly to appropriate biosafety practices and WHO guidelines on Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. ✓ Labor personnel needs to be trained and acquainted with key provisions in Labor Management Plan (LMP), in particular Occupational Health and Safety (OHS) aspects. ✓ All staff to be trained and reminded of hand washing procedures, and signage included in bathrooms and other key health center areas. Hand washing should involve use of soap / detergent, rubbing to cause friction, and placing hands under running water. Washings of hands should be undertaken before and after direct patient contacts and contact with patient blood, body fluids, secretions, excretions, or contact with equipment or articles contaminated by patients (including wastes, clothes and linen). Washing of hands should also be undertaken before and after work shifts; eating; smoking; use of personal protective equipment (PPE); and use of bathrooms. If hand washing is not possible, appropriate antiseptic hand cleanser and clean cloths / antiseptic towelettes should be provided. Hands should then be washed with soap and running water as soon as practical. Reminders should be placed throughout the health care facility, including pictorial on how to properly hand wash Sanitation and Waste Management ✓ Ensure that the designs for medical facilities consider the collection, segregation and treatment of medical waste ✓ The treatment of healthcare wastes produced during the care of COVID-19 patients should be collected safely in designated 157 containers and bags, treated and then safely dispose ✓ General cleaning strategies: (i) proceed from cleaner to dirtier areas to avoid spreading dirt and microorganisms; (ii) proceed from top areas to bottom areas to prevent dirt and microorganisms from dripping or falling down and contaminating already cleaned areas (for example clean mattress first, then clean bed legs); (iii) proceed in a methodical, systematic manner to avoid missing areas (for example, proceed from left to right or clockwise). Provide training to cleaning staff on these procedures, as well as on the use of PPE equipment, and put signage of reminders throughout health centers. ✓ Hospitals/health centers will also need to develop procedures and facilities for handling dirty linen and contaminated clothing, and preparing and handling food. For instance, social distancing measures (people 2m apart) should be implemented for those preparing and serving food in hospitals, ensuring thorough handwashing as per above guidelines, with reminders in kitchen and eating areas, and cooks/servers should wear masks. REFERENCES ➢ WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; ➢ WHO technical brief water, sanitation, hygiene and waste management for COVID-19; ➢ WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); ➢ WHO interim practical manual for improving infection prevention and control at the health facility; ➢ CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; ➢ CDC guidelines for environmental infection control in healthcare facilities 158 Checklist 2 Environmental and Social Codes of Practice – COVID-19 Waste Management Procedures Target: Health Care Workers/Health Care Facilities/Laboratories General Instructions ✓ All health care waste produced during the care of COVID-19 patients must be considered as infectious waste and should be collected safely in designated containers and bags, treated and then safely disposed (WHO). ✓ Train the staffs who are assigned in handling and disposal of waste management ✓ Train staffs on how to put and remove PPE. ✓ Ensure necessary PPE (Gown, gloves, face mask, goggles or face shield, gumboots) is provided to all staffs. ✓ Ensure staff wear PPE when handling and disposing waste according to HCW guideline. General Waste - Food waste, paper, disposable cups, plates, spoons etc. ✓ Collect in black bag ✓ Close and tie when 2/3rd full ✓ Transfer the waste to a temporary storage point for general waste along a specified route at a fixed time point and store the waste separately at a fixed location ✓ Transport to landfill away from facility Infectious Waste - Gown, gloves, apron, shoe cover, disposable items, mask etc. ✓ Collect in small biohazard red bags ✓ Close, seal the bag with cable ties and tie close when 2/3 full ✓ Transfer the waste to a temporary storage point for medical waste along a specified route at a fixed time point and store the waste separately at a fixed location ✓ Securely transfer out for incinerating ✓ Transport outcome as general waste Sharpe Waste ✓ Put in puncture proof plastic container ✓ Close the lid and seal the container when 2/3 full ✓ Put in the red bag and tie lose ✓ Transfer the waste to a temporary storage point for medical waste along a specified route at a fixed time point and store the waste separately at a fixed location ✓ Securely transfer out for incinerating or appropriate disposal REFERENCES ➢ WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; ➢ WHO technical brief water, sanitation, hygiene and waste management for COVID-19; ➢ WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); ➢ WHO interim practical manual for improving infection prevention and control at the health facility; ➢ CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; ➢ CDC guidelines for environmental infection control in healthcare facilities 159 Checklist 3 Environmental and Social Codes of Practice – COVID-19 Community And Social Inclusion Target: General Population/Vulnerable Groups General Communication ✓ When developing communication materials, it is important to ensure that they are clear and concise, and that they are in a format/language that is understandable to all people, in particular the most vulnerable. Messages should be clear and concise, focusing on hygiene measures (hand washing, coughing), what to do if suspect have COVID-19, as well as restrictions if applicable (for instance specific guidelines on social-distancing). ✓ Utilize appropriate media needs to be used (social media, radio, tv) plus engaging existing formal and informal public health and community-based networks (schools, healthcare service providers at local level, etc.). Ensure that information is accessible in sign language and Sesotho. ✓ Communication materials must also be clear about (i) how to avoid contracting COVID-19 (good hygiene measures); (ii) symptoms of COVID-19; (iii) what to do if suspect have COVID-19. ✓ Communication materials and outreach to people, including RCCE materials, must make clear that all treatment for COVID-19 at provincial/referral hospitals and public hospitals is free and accessible for all population. People must also be told about the GRM process to denounce any instance where they are asked to pay to access needed medical services (unless it is a private hospital). ✓ Identify trusted community groups (local influencers such as community leaders, religious leaders, health workers, community volunteers, celebrities) and local networks (such as women’s groups, youth groups, business groups, and traditional healers) that can help to disseminate messages. Define clear and easy mechanisms to disseminate messages and materials based on community questions and concerns ✓ A focus of information materials should be on women, as they tend to be the best venue of communication for children and the elderly in the household. ✓ RGC/MOH should consider having a dedicated hotline for people to call for questions and recommendations on what to do if they suspect they may have COVID-19. Infection Prevention ✓ Information on how to protect oneself from COVID-19, the symptoms of COVID-19, where and how to get tested should be made available to everyone and ensure they are accessible to IPs, marginalized groups, those with disabilities, other vulnerable groups and the elderly by using different languages (including sign language), and in a manner that is culturally appropriate to the respective groups and specific needs. ✓ Promote large scale social and behaviour change. Introduce preventive community and individual health and hygiene practices with a focus on handwashing. Could include gifting of soap bars, distributed by commune authorities or District health officials. ✓ Workplaces should be encouraged to post and provide communication materials, in particular workplaces which may face a higher risk of COVID-19 spread, such as construction sites and factories. This may include social isolation measures in workplaces, separating people from each other (2m), opening spaces to allow for natural ventilation, providing hand sanitation facilities (soap/water or hand sanitizer), etc. Economic and Livelihood Impacts ✓ Planning of containment measures and social restrictions need to take into account the livelihood impact it will have for the population, in particular the most vulnerable (the poor, elderly, women single heads of household, IPs, those with disabilities). MOH and RGC may need to develop specific mitigation measures for this, outside the scope of this ESMF. This may include social safety nets with cash transfers to specific population groups, ensuring that it does not exclude informal workers, the poor, home-based workers, etc. May also include food grants, essential basket of goods, child care support for women, etc. Stakeholder Engagement ✓ Stakeholder Engagement Plan (SEP) must use different communication methods. ✓ Stakeholder Engagement Plan (SEP) should ensure consultations with NGOs and other stakeholders that can provide recommendations on how to communicate information and develop Risk Communication and Community Engagement Plan (RCCE). REFERENCES ➢ WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; ➢ WHO Risk Communication and Community Engagement (RCCE) Guidance, https://www.who.int/publications-detail/risk- communication-and-community-engagement-(rcce)-action-plan-guidance ➢ IFRC, UNICEF, WHO Social Stigma associated with COVID-19: A guide to preventing and addressing social stigma, https://www.unicef.org/documents/social-stigma-associated-coronavirus-disease-covid-19 ➢ Human Rights Watch COVID-19 A Human Rights Checklist: https://www.hrw.org/sites/default/files/supporting_resources/202004_northamerica_us_covid19_checklist2.pdf 160 Checklist 4 Environmental and Social Codes of Practice – COVID-19 small scale construction, upgrades, rehab, expansion Target: Construction Workers OHS/Project Supervisor/Facility Manager Worker Safety ✓ The local construction and environment inspectorates and communities have been notified of upcoming activities ✓ The public has been notified of the works through appropriate notification in the media and/or at publicly accessible sites (including the site of the works) ✓ All legally required permits have been acquired for construction and/or rehabilitation ✓ The Contractor formally agrees that all work will be carried out in a safe and disciplined manner designed to minimize impacts on neighboring residents and environment. ✓ Workers’ PPE will comply with international good practice (always hardhats, as needed masks and safety glasses, harnesses and safety boots) ✓ Appropriate signposting of the sites will inform workers of key rules and regulations to follow. General Rehabilitation and/or Construction ✓ During interior demolition debris-chutes shall be used above the first floor ✓ Demolition debris shall be kept in controlled area and sprayed with water mist to reduce debris dust ✓ During pneumatic drilling/wall destruction dust shall be suppressed by ongoing water spraying and/or installing dust screen enclosures at site ✓ The surrounding environment (sidewalks, roads) shall be kept free of debris to minimize dust ✓ There will be no open burning of construction / waste material at the site ✓ There will be no excessive idling of construction vehicles at sites ✓ Construction noise will be limited to restricted times agreed to in the permit ✓ During operations the engine covers of generators, air compressors and other powered mechanical equipment shall be closed, and equipment placed as far away from residential areas as possible ✓ The site will establish appropriate erosion and sediment control measures such as e.g. hay bales and / or silt fences to prevent sediment from moving off site and causing excessive turbidity in nearby streams and rivers. Waste Management ✓ Waste collection and disposal pathways and sites will be identified for all major waste types expected from demolition and construction activities. ✓ Mineral construction and demolition wastes will be separated from general refuse, organic, liquid and chemical wastes by on- site sorting and stored in appropriate containers. ✓ Construction waste will be collected and disposed properly by licensed collectors ✓ The records of waste disposal will be maintained as proof for proper management as designed. ✓ Whenever feasible the contractor will reuse and recycle appropriate and viable materials (except asbestos) Wastewater Treatment ✓ The approach to handling sanitary wastes and wastewater from building sites (installation or reconstruction) must be approved by the local authorities ✓ Before being discharged into receiving waters, effluents from individual wastewater systems must be treated in order to meet the minimal quality criteria set out by national guidelines on effluent quality and wastewater treatment ✓ Monitoring of new wastewater systems (before/after) will be carried out ✓ Construction vehicles and machinery will be washed only in designated areas where runoff will not pollute natural surface water bodies. REFERENCES ➢ WHO technical brief water, sanitation, hygiene and waste management for COVID-19; ➢ WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); 161 Checklist 5: Institutional Capacity Assessment Tool for Biomedical Waste Management and Infection Control at Healthcare Facility Checklist 5-A: Assessment of healthcare facility capacity to manage biomedical waste No. Questions/Description Yes No 1 Does the facility (occupier) have the authority to set up its own treatment facility or having any other Yes No alternative option 2 Is the segregation of waste being done at the point of generation Yes No 3 Is Biomedical waste mixed with other waste Yes No 4 Are waste collection containers available Yes No 5 Are containers color coded as per the rule Yes 6 Does the waste marked for incineration have plastic waste mixed in it Yes No 7 Does the institution have system for waste classification Yes No 8 Are the containers in good condition Yes No 9 Is institution taking steps for Biomedical waste management as per the recommended method of treatment Yes No and disposal for the particular category 10 Is the used COVID 19 test Kit or biomedical waste of COVID 19 patients managed and buried/ Yes No incineration properly and separately 11 Is spill treatment kit available Yes No 12 Does the institution have standard operating procedure for mercury spill management Yes No 13 Is liquid waste being treated with 1% sodium hypochlorite solution before discharge into sewers Yes No 14 Are needle destroyers available in sufficient number Yes No 15 Are needle destroyers in Good working condition Yes No 16 Is there proper storage and internal and external transport facility available Yes No 17 Are these facilities as per BMWM rules Yes No 18 Do employees wear protective barrier (PPE) while on the job Yes No 19 Is there any incidence of occupational injury Yes No 20 Is the record of such injury with sufficient details available Yes No 21 Is daily record of generation of waste available as per the category Yes No 22 Is there any accessibility of unauthorized person to waste storage Yes No 23 Is separate facility for treated and untreated waste storage available Yes No 24 Is there any separate route for waste transport Yes No 25 Does the institution have recorded policy on the waste type, collection time and weighing of waste Yes No 26 Is medical record of waste handlers available Yes No 27 Is the vehicle which is carrying waste from institution to offsite authorized for such specialized work Yes No 28 Is the training manual for staff available Yes No 29 Is record of employees training available Yes No 30 Are colored plastic bags in good condition Yes No 31 Is waste generation aware of difference between soiled and unsoiled waste Yes No 32 Are Doctors, Nurses, Housekeeping staff and BMW handler and ambulance driver test/screen for COVID- Yes No 19, if suspect any infection 33 Is any record of accidental transmission infection in Doctors & other staff during treatment of corona Yes No patients 34 Is record available of treatment for Doctor & other staff infected during the treatment of corona patients Yes No 162 Checklist 5-B: Assessment of Healthcare facility capacity to manage infection prevention No. Questions/ Description Yes No 1. Decontamination of instruments a. Is sterilizer available Yes No b. Is it in good working condition Yes No c. Are clean instruments stored in cupboards under lock Yes No d. Are instruments rust free Yes No 2. Handling of sharps a. Is puncture proof container available Yes No b. Are sharps pepping out of containers Yes No c. Are sharps lying outside containers Yes No d. Is there any recapping of needles/ syringes Yes No e. Is needle cutter available Yes No f. Is it in good working condition Yes No 3. Close of protective barrier a. Are protective barriers available Yes No b. Are they in good condition Yes No c. Are they of good quality Yes No d. Are they being used by staff having the risk of exposure Yes No 4 Availability of Personal Protective Equipment (PPE) a. availability of appropriate personal protective equipment (PPE) for all personnel at the point-of-care to Yes No apply standard, contact and droplet precautions b. Is surgical Mask available for the patients Yes No c. Is the patients wearing mask in the hospital Yes No d. Is surgical cap available for covering the head of staff Yes No e. Is surgical gloves available as per the standard quality Yes No f. Is the FFP2/FFP3 Respirators (N95/N99 mask) available for Doctors, Paramedical staff and Nursing Yes No staffs involve in treatment of Corona patients g. Is the COVID -19 protective suit/gown available for Doctors and Nursing staff involve in treatment of Yes No Corona patients h. Is the COVID -19 protective suit /gown available for Housekeeping staff and ambulance driver involve in Yes No Corona patients treatment and transportation i. Is COVID-19 protective suit/ gown, as per the standard quality to protect from infection /transmission of Yes No disease j. Are the Doctor, Nurse, Housekeeping staff and ambulance drivers wearing mask Yes No k. Is the goggles adapted for clinical assessment of suspected COVID-19 case by Doctor and Nurses Yes No l. Is the use of heavy-duty gloves and boots considered for the BMW handler Yes No 5. Hand washing practices a. Is liquid soap and clean water available Yes No b. Is paper towel/ clean towel available Yes No c. Is staff aware of hand washing practices Yes No d. Are staff members washing their hands properly (more than 20 second) Yes No e. Are list of universal precautions available Yes No f. Is the poster of hand washing instruction pasted near facility Yes No 6. Hand Sanitizing practices Yes No a. Is Hand sanitizers available Yes No b. Is the hand sanitizer with 60% Isopropyl alcohol based Yes No c. Are the Doctor, staff, Nurses and Patients using hand sanitizer regularly Yes No d. Are staff and patient taking care as the sanitizer highly flammable Yes No e. Is BMW handler using sanitizer regularly before and after the work Yes No f. Is the Housekeeping staff using sanitizer regularly before and after the work Yes No g. Is the ambulance driver using sanitizer regularly Yes No 7. Social distancing a. Is dedicated separate ward and isolation centre for COVID 19 patients Yes no 163 b. Is the healthcare workers performing the first assessment without direct contact Yes No c. Is the patients following social distance while consult Doctor Yes No d. Is the social distance following during the treatment Yes No e. Is the distance between the patients and staff (3 - 6 ft) Yes No f. Is the social distance marked with some sign/ color/shape/symbol Yes No g. Are suspected cases of COVID-19 isolated, or at least separated from other patients Yes No h. Is dedicated toilet facilities available for COVID-19 patient Yes No I Non-essential contacts between suspected cases and other persons minimized Yes No 8. Waste management a. Is waste being managed as per rule Yes No b. Is there any contaminated waste littered around Yes No c. Are the container in good condition Yes No d. Does staff handle the waste with bare hands Yes No e. Are containers color coded as per rules Yes No f. Is the COVID 19 patient waste managed separately as the infection spreads through any objects also Yes No g. Are the isolation ward, separate hospital ward of COVID 19 patients being sanitized regularly Yes No h. Are the waste storage area, containers and vehicles being sanitized regularly Yes No 164 Checklist 6: WHO - Key considerations for repatriation and quarantine of travellers in relation to the outbreak of novel coronavirus 2019-nCoV 11 February 2020 On 30th January 2020, the WHO Director General has declared the outbreak of novel coronavirus 2019nCoV as a Public Health Emergency of International Concern (PHEIC), based on the advice of the Emergency Committee under the International Health Regulations (2005)22. Following that determination, WHO did not recommend any travel or trade restrictions, based on the current information available. Evidence on travel measures that significantly interfere with international traffic for more than 24 hours shows that such measures may have a public health rationale at the beginning of the containment phase of an outbreak, as they may allow affected countries to implement sustained response measures, and non- affected countries to gain time to initiate and implement effective preparedness measures. Such restrictions, however, need to be short in duration, proportionate to the public health risks, and be reconsidered regularly as the situation evolves. Countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO. In accordance with their obligations under the Article 43 of the International Health Regulations (2005), States Parties must inform WHO about additional health measures that significantly interfere with international traffic. For countries that have decided to repatriate their nationals from Wuhan City, Hubei province, the following key considerations need to be made, in order to ensure the health and wellbeing of those involved in the repatriation. In addition, measures aimed at bolstering national preparedness capacities to prevent the further spread or importation of 2019-nCoV before, during, and after repatriation need to be considered. Measures to be adopted before embarkation • Advanced bilateral communication, coordination, and planning with the responsible authorities before departure. • The aircraft should be properly staffed with sufficient medical personnel to accommodate the number of nationals anticipated, and that they are outfitted with appropriate PPE and equipment/supplies to respond to illness en route. • The non-medical crew of the aircraft should be properly briefed and outfitted, as well as aware of the signs and symptoms to detect symptomatic passengers for nCoV. • Exit screening, for example temperature measurement and a questionnaire, should be conducted before departure for the early detection of symptoms. Screening results should be shared with the receiving country. • It is advised to delay the travel of the suspected ill travellers detected through exit screening to be referred for further evaluation and treatment. 22 Statement on the second meeting of the IHR emergency committee regarding the outbreak of the 2019- nCoV: https://www.who.int/news- room/detail/30-01-2020-statement-on-the-second-meeting-of-the-internationalhealthregulations-(2005)-emergency-committee-regarding-the-outbreak- of-novel-coronavirus-(2019-ncov). 165 On-board the Aircraft • The seating location of passengers inside the aircraft should be duly noted/mapped in case a passenger begins to display symptoms, so they can be isolated, and to furthermore take note of those in the in the immediate vicinity (ex: those within same row, and two rows in front and two rows behind) for the needed follow up upon arrival. • In case suspected cases are detected on the aircraft, the cabin crew should inform and seek advice from a ground-based medical service provider at the point of entry of arrival through the control tower. In cases of severe illness, the pilot in command may consider diversion for the unwell passenger to the nearest point of entry receive the required treatment. In the event of a respiratory illness en route, the following immediate steps may be taken to reduce exposure and limit transmission to other passengers or aircraft crew • Designate one dedicated cabin crew member to look after the ill traveller, preferably one who has previously interacted with the passenger; • Use appropriate personal protective equipment (PPE) when dealing with symptomatic patients (medical or surgical mask, hand hygiene, gloves); • In all cases, the adjacent seat(s) of the patient should be left unoccupied, if feasible; • Passengers seated in the close vicinity should have their information on itinerary and contact details recorded for further follow up, as potential contacts, using a Passenger Locator Forms3. This information may be collected on a voluntary basis for the remaining passengers; • The patient on the aircraft should adhere to respiratory/cough etiquette either by wearing a medical or surgical mask (if available and tolerated) or the patient could contain his cough or sneeze by using disposable tissue. If the patient cannot tolerate a mask, healthy travellers adjacent to the ill traveller may be offered masks; • Practice hand hygiene (hand washing or hand rub); • Handle any blankets, trays or other personal products used by the patient with respiratory symptoms carefully; • In case of presence of spills (vomits, blood spills, secretions or others), practice environmental cleaning and spills-management; • Handle all waste in accordance with regulatory requirements or guidelines; • Notify the health authority at the point of arrival. The health part of the aircraft general declaration (Annex 9 of IHR) can be used to register the health information on board and submit to point of entry health authorities, when requested by the country; • Ensure the flight crew maintain continuous operation of the aircraft’s air recirculation system (HEPA filters are fitted to largest aircraft and will remove some airborne pathogens, depending on the size of the particulate or microorganism). Upon arrival at the Point of Entry • Entry screening: temperature screening alone may not be very effective as it may miss travellers incubating the disease or travellers concealing fever during travel, or it may yield false positive (fever of a different cause). If temperature screening is implemented, it should be accompanied with: 166 WHO Handbook for the management of public health events in air transport: https://www.who.int/ihr/publications/9789241510165_eng/en/ Public health PLF http://www.icao.int/safety/aviationmedicine/Pages/guidelines.aspx Public health PLF http://www.icao.int/safety/aviation-medicine/Pages/guidelines.aspx • Health messages: Dissemination of health messages and travel notices informing persons on signs, symptoms and where to seek medical support if needed. • Primary questionnaire: Development and use of forms to collect information on symptoms, history of exposure and contact information. • Data collection and analysis: Establishment of proper mechanisms for collection and analysis of data generated from the entry screening for the rapid evaluation and response. Suspected cases detected at arrival • Personnel and supplies: Trained personnel should be available for the early detection and initial evaluation of cases and equipped with the needed supplies. • Interview and initial management: A separate space should be designated for the initial assessment of suspected cases and the interview of contacts. • Fast track pathway and transport: A separate pathway should be delineated to rapidly refer suspected cases to the designated hospital/facility for further evaluation to avoid contact with the other passengers. Arrangement for safe transportation of suspected cases to the designated hospital/facility should also be in place. • Contingency plan: A functional public health emergency contingency plan at point of entry should be in place to respond to public health events. • Disinfection of the Aircraft: In accordance with the aircraft make and model, usage of preferred cleaning chemicals and methods should be consulted to properly disinfect the aircraft. A segregated space at the PoE and trained personnel should be available to clean the aircraft after disembarking passengers. Non-suspected passengers’ arrival into the country • Risk communication: Prepare countries to communicate rapidly and transparently with the population and ensure the involvement of media to support the spread of the right messages and avoid rumours23. Countries should communicate with their public early and effectively to mitigate stigma or discrimination and avoid panic, in line with the principles of Article 3 of the IHR. • Health measures: If there is evidence of an imminent public health risk from the arriving passengers, the country may, in accordance with Article 31 of the IHR and in alignment with its national law, deeming the extent necessary to control such a risk, compel the traveller to undergo additional health measures that prevent or control the spread of disease, including isolation, quarantine or placing the traveller under public health observation. In the absence of an established quarantine law, countries should ensure emergency contingency protocols to support quarantine. 23 WHO Guidance on risk communication and community engagement for 2019-nCoV: https://www.who.int/publicationsdetail/ risk-communication- and-community-engagement-readiness-and-initial-response-for-novel-coronaviruses-(-ncov). 167 Quarantine If the country decides to put arriving passengers, those not displaying symptoms, in a quarantine facility, the following needs to be considered, in accordance with Article 32 of the IHR: • Infrastructure: there is no universal guidance regarding the infrastructure for a quarantine facility, but space should be respected not to further enhance potential transmission and the living placement of those quarantined should be recorded for potential follow up in case of illness Accommodation and supplies: travellers should be provided with adequate food and water, appropriate accommodation including sleeping arrangements and clothing, protection for baggage and other possessions, appropriate medical treatment, means of necessary communication if possible, in a language that they can understand and other appropriate assistance. A medical mask is not required for those who are quarantined. If masks are used, best practices should be followed24. • Communication: establish appropriate communication channels to avoid panic and to provide appropriate health messaging so those quarantined can timely seek appropriate care when developing symptoms. • Respect and Dignity: travellers should be treated, with respect for their dignity, human rights and fundamental freedoms and minimize any discomfort or distress associated with such measures, including by treating all travellers with courtesy and respect; taking into consideration the gender, sociocultural, ethnic or religious concerns of travellers. • Duration: up to 14 days (corresponding with the known incubation period of the virus, according to existing information), may be extended due to a delayed exposure. Personnel Health Care Workers: trained personnel should be assigned for the observation and follow up of these passengers in the quarantine facility. These health care workers should be equipped with the basic PPEs and commodities needed to deal with the suspected cases (medical/surgical masks, gowns, gloves, face shields or goggles, hand sanitizers and disinfectants). Additional commodities are needed for surveillance, lab and clinical management of the 2019-nCoV25. Additionally, they should be trained on case definitions, infection prevention and control measures, and the initial management of suspected cases to perform the following interventions26: • Active surveillance: to identify suspected cases; • Isolate suspected cases and ensure safe transport: strictly adhere to infection prevention and control 24 WHO Interim Guidance. Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak, 28 January, 2020. https://www.who.int/publications-detail/advice-on-theuse-of-masks-the-community-during- home-care-and-inhealth-care-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak?fbclid=IwAR1m0- 3pzqy3vfY11WrHcn_WKEpzg0bZpe0eWTbBkxkwqgoLKtTdd4kV_8o 25 WHO disease commodity package for the 2019- nCoV: https://www.who.int/publications-detail/diseasecommoditypackage---novel-coronavirus- (ncov) . 26 Technical advice on surveillance, laboratory, management and infection control are available on the WHO website:https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance. 168 (IPC) measures and social distancing procedure to prevent potential spread of the infection to others; Collect laboratory samples: to test for the 2019-nCoV in the national reference laboratory or international laboratories in the absence of the lab testing capacity; • Manage cases clinically: Identify ambulances and designated health facilities to refer cases to for the necessary isolation, treatment and follow up. Adhere to strict IPC measures to prevent the spread of the infection among health care workers or other patients; • Trace contacts: to identify other potential cases within the quarantine facility, test, isolate and treat as necessary. Extend and adapt quarantine period to correspond to the incubation period of the delayed exposure; • Share data: on the number and description of cases with WHO using the WHO reporting forms and in accordance to Article 6 of the IHR. Other Support Staff: personnel responsible for administrative work and cleaning service should also be trained and properly briefed on signs and symptoms of the disease and provided with appropriate PPEs, as needed. 169 Checklist 7: Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19) Interim guidance 19 March 2020 On 30 January 2020, the WHO Director-General determined that the outbreak of coronavirus disease (COVID-19) constitutes a Public Health Emergency of International Concern.1 As the outbreak continues to evolve, Member States are considering options to prevent introduction of the disease to new areas or to reduce human-to-human transmission in areas where the virus that causes COVID-19 is already circulating. Public health measures to achieve these goals may include quarantine, which involves the restriction of movement, or separation from the rest of the population, of healthy persons who may have been exposed to the virus, with the objective of monitoring their symptoms and ensuring early detection of cases. Many countries have the legal authority to impose quarantine. Quarantine should be implemented only as part of a comprehensive package of public health response and containment measures and, in accordance with Article 3 of the International Health Regulations (2005), be fully respectful of the dignity, human rights and fundamental freedoms of persons.2 The purpose of this document is to offer guidance to Member States on implementing quarantine measures for individuals in the context of the current COVID-19 outbreak. It is intended for those who are responsible for establishing local or national policy for the quarantine of individuals and for ensuring adherence to infection prevention and control (IPC) measures. This document is informed by current knowledge of the COVID-19 outbreak and by considerations undertaken in response to other respiratory pathogens, including the severe acute respiratory syndrome coronavirus (SARS-CoV), the Middle East respiratory syndrome (MERS)-CoV and influenza viruses. WHO will continue to update these recommendations as new information becomes available. 1. Quarantine of persons The quarantine of persons is the restriction of activities of or the separation of persons who are not ill but who may have been exposed to an infectious agent or disease, with the objective of monitoring their symptoms and ensuring the early detection of cases. Quarantine is different from isolation, which is the separation of ill or infected persons from others to prevent the spread of infection or contamination. Quarantine is included within the legal framework of the International Health Regulations (2005), specifically: • Article 30 − Travellers under public health observation; • Article 31 − Health measures relating to entry of travellers; • Article 32 − Treatment of travellers.2 Member States have, in accordance with the Charter of the United Nations and the principles of international law, the sovereign right to legislate and to implement legislation, in pursuit of their health policies, even if this involves the restriction of movement of individuals. 170 Before implementing quarantine, countries should properly communicate such measures to reduce panic and improve compliance.1 • Authorities must provide people with clear, up-to-date, transparent and consistent guidelines, and with reliable information about quarantine measures. • Constructive engagement with communities is essential if quarantine measures are to be accepted. • Persons who are quarantined need to be provided with health care; financial, social and psychosocial support; and basic needs, including food, water, and other essentials. The needs of vulnerable populations should be prioritized. • Cultural, geographic and economic factors affect the effectiveness of quarantine. Rapid assessment of the local context should evaluate both the drivers of success and the potential barriers to quarantine, and they should be used to inform plans for the most appropriate and culturally accepted measures. 2. When to use quarantine Introducing quarantine measures early in an outbreak may delay the introduction of the disease to a country or area or may delay the peak of an epidemic in an area where local transmission is ongoing, or both. However, if not implemented properly, quarantine may also create additional sources of contamination and dissemination of the disease. In the context of the current COVID-19 outbreak, the global containment strategy includes the rapid identification of laboratory-confirmed cases and their isolation and management either in a medical facility3 or at home.4 WHO recommends that contacts of patients with laboratory-confirmed COVID-19 be quarantined for 14 days from the last time they were exposed to the patient. For the purpose of implementing quarantine, a contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient: • Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes; • Providing direct care for patients with COVID-19 disease without using proper personal protective equipment; • Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time; • Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any kind of conveyance; • and other situations, as indicated by local risk assessments.5 3. Recommendations for implementing quarantine If a decision to implement quarantine is taken, the authorities should ensure that: 171 • the quarantine setting is appropriate and that adequate food, water, and hygiene provisions can be made for the quarantine period; • minimum IPC measures can be implemented; • minimum requirements for monitoring the health of quarantined persons can be met during the quarantine period. Ensuring an appropriate setting and adequate provisions. The implementation of quarantine implies the use or creation of appropriate facilities in which a person or persons are physically separated from the community while being cared for. Appropriate quarantine arrangements include the following measures. • Those who are in quarantine must be placed in adequately ventilated, spacious single rooms with en suite facilities (that is, hand hygiene and toilet facilities). If single rooms are not available, beds should be placed at least 1 metre apart. • Suitable environmental infection controls must be used, such as ensuring are adequate air ventilation, air filtration systems, and waste-management protocols. • Social distance must be maintained (that is, distance of at least 1 metre) between all persons who are quarantined. • Accommodation must provide an appropriate level of comfort, including: – provision of food, water, and hygiene facilities; – protection for baggage and other possessions; – appropriate medical treatment for existing conditions; – communication in a language that those who are quarantined can understand, with an explanation of their rights, services that will be made available, how long they will need to stay and what will happen if they get sick; additionally, contact information for their local embassy or consular support should be provided. • Medical assistance must be provided for quarantined travellers who are isolated or subject to medical examinations or other procedures for public health purposes. • Those who are in quarantine must be able to communicate with family members who are outside the quarantine facility. • If possible, access to the internet, news, and entertainment should be provided. • Psychosocial support must be available. • Older persons and those with comorbid conditions require special attention because of their increased risk for severe COVID-19. 172 Possible settings for quarantine include hotels, dormitories, other facilities catering to groups, or the contact’s home. Regardless of the setting, an assessment must ensure that the appropriate conditions for safe and effective quarantine are being met. When home quarantine is chosen, the person should occupy a well-ventilated single room, or if a single room is not available, maintain a distance of at least 1 metre from other household members, minimize the use of shared spaces and cutlery, and ensure that shared spaces (such as the kitchen and bathroom) are well ventilated. Minimum infection prevention and control measures. The following IPC measures should be used to ensure a safe environment for quarantined persons. 1. Early recognition and control • Any person in quarantine who develops febrile illness or respiratory symptoms at any point during the quarantine period should be treated and managed as a suspected case of COVID-19. • Standard precautions apply to all persons who are quarantined and to quarantine personnel: – Perform hand hygiene frequently, particularly after contact with respiratory secretions, before eating, and after using the toilet. Hand hygiene includes either cleaning hands with soap and water or with an alcohol-based hand rub. Alcohol-based hand rubs are preferred if hands are not visibly dirty; hands should be washed with soap and water when they are visibly dirty. – Ensure that all persons in quarantine are practicing respiratory hygiene and are aware of the importance of covering their nose and mouth with a bent elbow or paper tissue when coughing or sneezing and then immediately disposing of the tissue in a wastebasket with a lid and then performing hand hygiene. – Refrain from touching the eyes, nose and mouth. • A medical mask is not required for persons with no symptoms. There is no evidence that wearing a mask of any type protects people who are not sick. 2. Administrative controls Administrative controls and policies for IPC within quarantine facilities include but may not be limited to: • establishing sustainable IPC infrastructure (for example, by designing appropriate facilities) and activities; • educating persons who are quarantined and quarantine personnel about IPC measures. All personnel working in the quarantine facility need to have training on standard precautions before the quarantine measures are implemented. The same advice on standard precautions should be given to all quarantined 173 persons on arrival. Both personnel and quarantined persons should understand the importance of promptly seeking medical care if they develop symptoms; • developing policies to ensure the early recognition and referral of a suspected COVID-19 case. 3. Environmental controls Environmental cleaning and disinfection procedures must be followed consistently and correctly. Cleaning personnel need to be educated about and protected from COVID-19 and ensure that environmental surfaces are regularly and thoroughly cleaned throughout the quarantine period. • Clean and disinfect frequently touched surfaces − such as bedside tables, bed frames and other bedroom furniture − daily with regular household disinfectant containing a diluted bleach solution (that is, 1-part bleach to 99 parts water). For surfaces that cannot be cleaned with bleach, 70% ethanol can be used. • Clean and disinfect bathroom and toilet surfaces at least once daily with regular household disinfectant containing a diluted bleach solution (that is, 1-part bleach to 99 parts water). • Clean clothes, bed linens, and bath and hand towels using regular laundry soap and water or machine wash at 60-90 °C (140–194 °F) with common laundry detergent, and dry thoroughly. • Countries should consider implementing measures to ensure that waste is disposed of in a sanitary landfill and not in an unmonitored open area. • Cleaning personnel should wear disposable gloves when cleaning surfaces or handling clothing or linen soiled with body fluids, and they should perform hand hygiene before putting on and after removing their gloves. Minimum requirements for monitoring the health of quarantined persons. Daily follow up of persons who are quarantined should be conducted within the facility for the duration of the quarantine period and should include screening for body temperature and symptoms. Groups of persons at higher risk of infection and severe disease may require additional surveillance owing to chronic conditions or they may require specific medical treatments. Consideration should be given to the resources and personnel needed and rest periods for staff at quarantine facilities. This is particularly important in the context of an ongoing outbreak, during which limited public health resources may be better prioritized for health care facilities and case-detection activities. Respiratory samples from quarantined persons, irrespective of whether they have symptoms, should be sent for laboratory testing at the end of the quarantine period. 4. References 1. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). In: World Health Organization/Newsroom 174 [website]. Geneva: World Health Organization; 2020 (https://www.who.int/newsroom/detail/30-01-2020-statement- on-the-second-meetingof-the-international-health-regulations-(2005)-emergencycommittee-regarding-the-outbreak- of-novel-coronavirus(2019-ncov), accessed 29 February 2020). 2. Key considerations: quarantine in the context of COVID-19. In: Social Science in Humanitarian Action: A Communication for Development Platform [website]. New York: UNICEF, Institute of Development Studies; 2020 (https://www.socialscienceinaction.org/resources/february2020-social-science-humanitarian-action-platform/, accessed 29 February 2020). 3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID- 19 disease is suspected. (accessed 16 March 2020). 4. World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: interim guidance, 17 March 2020. Geneva: World Health Organization; 2020 (accessed 17 March 2020). 5. World Health Organization. Global Surveillance for human infection with coronavirus disease (COVID-19): interim guidance, 6. World Health Organization. Advice on the use of masks in the community, during home care and in health care settings in the context of COVID-19: interim guidance, WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/2019-nCoV/IHR_Quarantine/2020.2 175 Annex 6: Resource List on COVID-19 Guidance Given the COVID-19 situation is rapidly evolving, a version of this resource list will be regularly updated and made available on the World Bank COVID-19 operations intranet page (http://covidoperations/). WHO Guidance Advice for the public • WHO advice for the public, including on social distancing, respiratory hygiene, self-quarantine, and seeking medical advice, can be consulted on this WHO website: https://www.who.int/emergencies/diseases/novel- coronavirus-2019/advice-for-public Technical guidance • Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected, issued on March 19, 2020 • Recommendations to Member States to Improve Hygiene Practices, issued on April 1, 2020 • Severe Acute Respiratory Infections Treatment Center, issued on March 28, 2020 • Infection prevention and control at health care facilities (with a focus on settings with limited resources), issued in 2018 • Laboratory biosafety guidance related to coronavirus disease 2019 (COVID-19), issued on March 18, 2020 • Laboratory Biosafety Manual, 3rd edition, issued in 2014 • Laboratory testing for COVID-19, including specimen collection and shipment, issued on March 19, 2020 • Prioritized Laboratory Testing Strategy According to 4Cs Transmission Scenarios, issued on March 21, 2020 • Infection Prevention and Control for the safe management of a dead body in the context of COVID-19, issued on March 24, 2020 • Key considerations for repatriation and quarantine of travelers in relation to the outbreak COVID-19, issued on February 11, 2020 • Preparedness, prevention and control of COVID-19 for refugees and migrants in non-camp settings, issued on April 17, 2020 • Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health, issued on March 18, 2020 • Oxygen sources and distribution for COVID-19 treatment centers, issued on April 4, 2020 • Risk Communication and Community Engagement (RCCE) Action Plan Guidance COVID-19 Preparedness and Response, issued on March 16, 2020 • Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19), issued on March 19, 2020 • Operational considerations for case management of COVID-19 in health facility and community, issued on March 19, 2020 • Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19), issued on February 27, 2020 • Getting your workplace ready for COVID-19, issued on March 19, 2020 • Water, sanitation, hygiene and waste management for COVID-19, issued on March 19, 2020 • Safe management of wastes from health-care activities, issued in 2014 • Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak, issued on March 19, 2020 • Disability Considerations during the COVID-19 outbreak, issued on March 26, 2020 • Vaccine readiness assessment, issued on 20 November 2020 176 • surveillance of adverse events following immunization27 , issued in September 2014 • UN Code of Conduct for Law Enforcement Officials: www.ohchr.org/EN/ProfessionalInterest/Pages/LawEnforcementOfficials.aspx WORLD BANK GROUP GUIDANCE • Technical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, issued on March 20, 2020 • Technical Note: Use of Military Forces to Assist in COVID-19 Operations, issued on March 25, 2020 • ESF/Safeguards Interim Note: COVID-19 Considerations in Construction/Civil Works Projects, issued on April 7, 2020 • Technical Note on SEA/H for HNP COVID Response Operations, issued in March 2020 • Interim Advice for IFC Clients on Preventing and Managing Health Risks of COVID-19 in the Workplace, issued on April 6, 2020 • Interim Advice for IFC Clients on Supporting Workers in the Context of COVID-19, issued on April 6, 2020 • IFC Tip Sheet for Company Leadership on Crisis Response: Facing the COVID-19 Pandemic, issued on April 6, 2020 • WBG EHS Guidelines for Healthcare Facilities, issued on April 30, 2007 • Technical Note Citizen Engagement on Health Emergency IPF Operations Under the COVID-19 SPRP MPA, issued in December 2020 • World Bank Corporate Security Courses http://workgroup.worldbank.org/org/units/GSD/GSDCS/Pages/Course-Offerings.aspx • International Finance Corporation (IFC) Handbook on the Use of Security Forces: Assessing and Managing Risks and Impacts, 2017 (available in English, French, Spanish) https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainabilityat- ifc/publications/publications_handbook_securityforces ILO GUIDANCE • ILO Standards and COVID-19 FAQ, issued on March 23, 2020 (provides a compilation of answers to most frequently asked questions related to international labor standards and COVID-19) MFI GUIDANCE • ADB Managing Infectious Medical Waste during the COVID-19 Pandemic • http://www.africacdc.org/press-centre/news/116-outbreak-coronavirus-2019 -ncov-resources-and-information • IDB Invest Guidance for Infrastructure Projects on COVID-19: A Rapid Risk Profile and Decision Framework • KfW DEG COVID-19 Guidance for employers, issued on March 31, 2020 • CDC Group COVID-19 Guidance for Employers, issued on March 23, 2020 27 https://www.who.int/vaccine_safety/publications/aefi_surveillance/en/ 177 Annex 7: GBV/SEA/SH Risk Mitigation Plan Acronyms AF Additional Financing GBV Gender Based Violence IA Project Implementing Agencies GRM Grievance Redress Mechanism PP Parent Project PDO Project Development Objective SEA Sexual Exploitation and Abuse SH Sexual Harassment Introduction Gender-based violence (GBV)/Sexual Exploitation and Abuse (SEA), and Sexual Harassment (SH) exist in every society worldwide and is exacerbated in emergencies. There is already un unsettling amount of information on GBV/SEA/SH occurring against the backdrop of the COVID-19 outbreak. It is also becoming increasingly clear that many of the measures deemed necessary to control the spread of the disease (e.g. restriction of movement, reduction in community interaction, closure of businesses and services, etc.) are not only increasing GBV/SEA/SH related risks and violence against women and girls, but also limiting survivors’ ability to distance themselves from their abusers as well as reducing their ability to access external support. In addition, it is clear from previous epidemics that during health crises, women typically take on additional physical, psychological and time burdens as caregivers. As such, it is critical that all actors involved in efforts to respond to COVID-19 – across all sectors – take GBV/SEA/SH into account within their programme planning and implementation. Promoting gender equality is a major focus of global development donors including the World Bank Group and other bi-lateral and multi-lateral donors. Most, if not all, international donors, international non- governmental organizations and NGOs have taken steps to address gender mainstreaming, although to varying degrees, within their programming. The Lesotho COVID-19 EPRP is cognizant of the impact that gender inequality and GBV/SEA are likely to have on achievement of project objectives. Therefore, addressing gender equality in development programs is a critical success factor. Similarly, the World Bank Group believes that addressing gender equality in programming is a SMART development policy and business practice (World Bank, 2016). Through the Lesotho COVID-19 EPRP, the Government of Lesotho is committed to advancing gender equality and addressing GBV/SEA by strengthening the stakeholders’ capacity to implement gender and GBV/SEA/SH responsive project services and strengthening the monitoring systems. This GBV/SEA/SA action plan describes the way Lesotho COVID-19 EPRP will meet its GBV/SEA/SH mainstreaming objectives through detailed action steps that describe how and when these activities will be implemented. It is designed to help the project stakeholders to be clear on GBV/SEA/SH mainstreaming goals, objectives, targets, outputs, timeframe and measures of success. 178 Contextual GBV/SEA/SH Risks Globally, GBV/SEA/SH has increased during the COVID-19 pandemic. COVID-19 and past pandemics have led to increases in inmate partner violence (physical, verbal, economic and psychological); digital harm, including online and offline sexual harassment and gender based bullying and abuse, sexual exploitation and abuse, attacks against female health workers. Perpetrators of abuse may use restrictions due to COVID-19 to exercise power of control over their partners to further reduce access to services, help and psychological support from both formal and informal networks. Perpetrators may exert control by spreading misinformation about the disease and stigmatize partners. Several factors have triggered the increase during the current pandemic, curtailed movement from home because of stay-at-home measures and/or social isolation increased use of the internet, reduced access to support networks and financial stress. Some GBV incidence data indicate decreases in GBV/SEA/SH, which are likely due to underreporting. The Lesotho COVID-19 EPRP and its additional financing project involves a large number of labor force, especially the health professionals who engage with a large number of COVID-19 patients and their family members, and other stakeholders, which put all parties at the risk of experiencing GBV/SEA/SH. Lesotho has recorded high levels of GBV with 86% women reporting having experienced GBV in their lifetime and 41% of men affirming they have committed GBV. While much of the violence occurs at home with 69% women reporting that they have been violated by their partners, women continue to experience violence from the public where 8% women were raped by a non-partner in their lifetime and 63% women who had ever worked, had been sexually harassed in the workplace. There is low access to post GBV care services. Only 4% of GBV survivors sought medical attention while only 6% reported abuse to the policei. The project also perceives GBV/SEA/SH by project staff and stakeholders as a tragic failure of protection of the very people the project is expected to protect. Allegations of GBV/SEA/SH can lead to serious repercussions such as damaging of the project’s image among donors and beneficiaries, disruption or cessation of funding which would result in loss of jobs by staff and limited funding opportunities, sabotaging of project interventions by the communities leading to failure to achieve intended objectives, poor ability to monitor progress, nonreceptive and unsupportive communities and many more. It’s therefore essential for the project to take into consideration the high levels of poverty, harmful cultural practices and norms, violence against women and girls. If not well managed, these factors can lead to further marginalization and abuse of women, girls and children who are already vulnerable. This GBV/SEA/SH action plan is developed to support the environmental and social due diligence provisions for activities financed by the World Bank (WB) Group for the Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) - P173939 Parent Project (PP) - including the Additional Financing (AF) Project (P176307) implemented by the Ministry of Health (MOH) under the Government of Lesotho (GoL). The Project Development Objective (PDO) of the Lesotho COVID-19 EPRP (Parent Project) and of the AF is to strengthen the capacity of the GoL to prevent, detect, and respond to the threat posed by COVID-19 and to strengthen national systems for public health preparedness. The primary objectives of the AF are (a) to enable affordable and equitable access to COVID-19 vaccines and help ensure effective vaccine deployment in the Kingdom of Lesotho through vaccination system strengthening and (b) to further strengthen preparedness and response activities under the parent project. 179 This document contains initial summary of potential GBV/SEA/SH risks and mitigation measures under the Lesotho COVID-19 EPRP. Definition of GBV/SEA/SH The Inter-Agency Standing Committee (IASC) defines gender-based violence as “an umbrella term for any harmful act that is perpetrated against a person’s will, and that is based on socially ascribed (gender) differences between males and females. GBV broadly encompasses physical, sexual, economic, psychological/emotional abuse/violence including threats and coercion, and harmful practices occurring between individuals, within families and in the community at large. These include sexual violence, domestic or intimate partner violence, trafficking, forced and/or early marriage, and other traditional practices that cause harm28. The United Nations defines “sexual exploitation� as any actual or attempted abuse of a position of vulnerability, differential power, or trust, for sexual purposes, including, but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another. Sexual abuse on the other hand is “the actual or threatened physical intrusion of a sexual nature, whether by force or under unequal o r coercive conditions.� SEA is therefore a form of gender-based violence and generally refers to acts perpetrated against beneficiaries of a project by staff, contractors, consultants, workers and Partners. Sexual harassment occurs between personnel/staff and involves any unwelcome sexual advance or unwanted verbal or physical conduct of a sexual nature. Key Risk Factors Individual level: • For perpetration - Excessive alcohol use; experience of violence in childhood; • For victimization - Experience of violence in childhood; young women have greater risks of experiencing physical & sexual intimate partner violence; pregnancy does not protect women from violence; Household level: • Economic pressures on the household; • Poor couple communication and cooperation. Community level: • Harmful social norms around women’s inferior status, masculinity and acceptability of violence, victim-blaming; • Conflict, post conflict and displacement may exacerbate existing violence, such as by intimate partners, and present additional forms of violence against women. An Integrated Approach to Ending GBV Support Services for Access to Justice Violence Prevention Survivors 28 Strengthening the enabling environment for addressing GBV Inter-Agency Standing Committee- the primary mechanism for inter-agency coordination of humanitarian assistance among UN and non-UN humanitarian partners 180 Guiding Principles in Working with Survivors and Witnesses of GBV/SEA/SH • Ensure access to service – health, psychosocial, legal/security, safe house/shelter, livelihood; • Ensure a survivor centered approach – give the power back to the survivor – listen, present options of support, ensure informed decision making; • Ensure Safety – facilitate the survivor feeling safe at all times; • Ensure Confidentiality – (for the survivor and her family) Not disclosing any information at any time to any party without the informed consent of the person concerned; • Actions are to be guided by respect; • Non-discrimination - Survivors of violence should receive equal and fair treatment regardless of their age, race, religion, nationality, ethnicity, sexual orientation or any other characteristics GBV/SEA/SH Risk Assessment and Response Capacity During Project Preparation Throughout Project Implementation Access Address Respond Existing risk management systems, Laws and Standards The Sexual Offences Act (SOA) of 2003: Considers as offence any use of coercion or inducement to engage another person in sexual act. Part II section 3. (1) says a sexual act is prima facie unlawful if it takes place in any coercive circumstances. In part IV section 12 says that a person who offers or engages a child for purpose of committing a sexual act for financial or other rewards, favor or compensation commits an offence (The Kingdom of Lesotho, 2003). The Children’s Protection and Welfare Act of 2011 Defines a child as a person under the age of 18. Part II sets out a commitment to ensure all actions are done in the best interest of the child; and ensures children’s rights to education and health. Section 11. (1) protects children’s rights to access adequate diet, medical attention and reproductive health information (The Kingdom of Lesotho, 2011). The Lesotho Gender and Development Policy of 2018 – 2030 visualizes a nation of women, men, girls, boys and other marginalized groups who are equal contributors to, and beneficiaries of national development. Objective 8 aims at preventing and reducing all forms of gender-based violence in the public and private spheres and to provide integrated services to GBV survivors and perpetrators. While objective 9 aims at providing and making accessible to all women, men, adolescents and other marginalized groups good quality healthcare services, including sexual and reproductive health care, information and related services (The Kingdom of Lesotho, 2018). 181 The African Charter on Human and People’s Rights: Article 16 declares that every individual shall have the right to enjoy the best attainable state of physical and mental health. The charter also compels State Parties to take the necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick. Article 18 guides States to ensure the elimination of every discrimination against women and also ensure the protection of the rights of women and the child as stipulated in international declarations and conventions. The Charter also provides for protection of the aged and disabled to have the right to special measures of protection in keeping with their physical or moral needs (Organization of African Unity, 1986). The Convention on the Rights of the Child (CRC): Article 1 of part I defines a child as every human being below the age of eighteen years. Encourages States Parties to recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilitate for the treatment of illness and rehabilitation of health. Article 24 of the Convention further provides for States Parties to strive to ensure that no child is deprived of his or her right of access to such health care services (United Nations, 1990). Article 24 of the Convention further encourages State Parties to take appropriate measures to diminish infant and child mortality; to ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care; to combat disease and malnutrition, including within the framework of primary health care, through provision of adequate nutritious foods and clean drinking-water. To ensure appropriate pre-natal and post-natal health care for mothers; family planning education and services; to abolish traditional practices prejudicial to the health of children (United Nations, 1990). The convention also encourages States Parties to protect the child from all forms of sexual exploitation and sexual abuse by taking all appropriate measures to prevent the inducement or coercion of a child to engage in any unlawful sexual activity; the exploitative use of children in prostitution or other unlawful sexual practices; the exploitative use of children in pornographic performances and materials and to prevent the abduction of, the sale of or traffic in children for any purpose or in any form (United Nations, 1990). Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW): Lesotho has also ratified CEDAW which obligates states to ensure free and full consent to marriage. Article 2 of the CEDAW encourages States Parties condemn discrimination against women in all its forms. Article 5 (a) encourages States Parties to take all appropriate measures to modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes or on stereotyped roles for men and women. Article 12 of the CEDAW encourages States Parties to take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning. The Convention also indicates that State Parties ensure women access appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation (United Nations, 1981). Referral pathways Annex section delineates GBV/SEA/SH service providers mapping with organization name, district, physical location, type of GBV/SEA/SH services provided, target group or beneficiaries and contact details, that were 182 identified under. This service providers mapping entails GBV/SEA/SH service providers from different ministries and civil organizations. They vary in the type of services they provide for GBV/SEA/SH survivors. There are gaps with regard to the services that are provided by different institutions, at different districts. However, to ensure full coverage of the GBV services, survivors are always referred to neighboring service providers when there is a need to. Grievance Redress Mechanism The Lesotho COVID-19 EPRP has established a Grievance Redress Mechanism (GRM), specific to the project and has been designed to ensure a prompt resolution of the project specific grievances. These GRM is expected to promote reporting which will ultimately require linkage of reported GBV/SEA/SH cases to relevant GBV/SEA/SH service providers. The GRM seeks to give the Project Affected Parties (PAPs), or Aggrieved Parties (Aps) within the project scope access to seek redress to their perceived or actual grievances or any feedback that needs clarity. 183 GBV/SEA/SH Risks Mitigation Action Plan Project Phase Sequence Activities Indicators Responsibilities Frequency Estimated Budget ($) Project 1 Support identification of local level Number of key actors/potential PIU (Project During project 3,000 Planning and actors/potential partners; partners supported Coordinator) planning and Design design phase 2 Conduct mapping of GBV prevention and GBV service providers mapping done PIU (Social response actors in the Project area of Specialist, influence and potential high risk areas Community Liaison Officer) Project 1 Highlight GBV risks and identify GBV risks identified and mitigation PIU (Social During project 2,000 Preparation and preliminary mitigation measures in ESIA measures proposed Specialist) preparation, Appraisal (social assessment); to include GBV and prior to mapping; appraisal 2 Inform communities in Project areas of Communities informed of GBV risks PIU (Social GBV risks and options for and proposed mitigation measures Specialist, remediate/response during stakeholder Community Liaison consultations (with appropriate capacity); Officer) 3 Integrate community engagement on GBV GBV measures integrated into SEP PIU (Social into Stakeholder Engagement Plan Specialist) (Substantial) 4 Develop a site specific GBV Action plan GBV action plan developed Contractor including an accountability and response framework Project 1 Clearly define the GBV requirements and GBV prevention requirements PIU (Social At the 2,000 Implementation: expectations in a note to bidders; included in procurement documents Specialist, beginning of Procurement procurement, 184 Project Phase Sequence Activities Indicators Responsibilities Frequency Estimated Budget ($) Procurement prior to Specialist) contract signing. 2 Include and clearly explain the Codes of Code of conduct defined in PIU (Social Conduct requirements in the note to procurement documents. Specialist, bidders, provide a sample Codes of Procurement Conduct (SPD Requirement); Specialist) Include GBV activities (e.g. trainings) as part of the contract (e.g. under Occupational Health and Safety); 3 Include provisions on how GBV activities Provisions made on GBV activities and PIU (Social and costs will be paid for in the contract; costs Specialist, o Include line items in the Bill of Procurement Quantities for clearly defined GBV Specialist) activities (ex. preparation of relevant plans, GBV trainings, etc.); o Specify provisional sums for activities that cannot be defined in advance (e.g. implementation of plans, engaging GBV service providers, etc.); 185 Project Phase Sequence Activities Indicators Responsibilities Frequency Estimated Budget ($) 4 Include all the GBV responsibilities in the GBV activities responsibilities defined PIU (Social particular conditions of contract; Specialist, o Workers must sign a Codes of Procurement Conduct; Specialist) o Workers must attend and be made available for trainings; o Stipulate the number of training days and frequency Evaluate Contractor’s GBV Response Proposal as part of bid evaluation Project 1 Review Contract and ESMP to ensure all GBV measures included in site specific PIU (Social Throughout 25,000 Implementation GBV provisions are included - make any ESMPs Specialist) project revisions as necessary; implementation Ensure GRM outlines protocols and processes for safe, ethical and confidential response to GBV complaints (may include identification of separate reporting channels for GBV cases); 2 Ensure all those that have physical Codes of conduct signed by project PIU (Social presence on the Project site have signed workers Specialist), and understood the Codes of Conduct; Contractor 3 Train Project-related staff on SEA and SH Project staff trained on GBV, including PIU (Social and the Codes of Conduct; SEA and SH, and Code of Conduct Specialist) 4 Conduct community awareness raising Community awareness activities done PIU (Social about GBV mitigation measures e.g. on GBV mitigations Specialist, Codes of Conduct, GRM, how to report Community Liaison and provide multiple entry-points Officer) 186 Project Phase Sequence Activities Indicators Responsibilities Frequency Estimated Budget ($) 5 Train Health facility staff in Number of health facility staff trained PIU (Social mainstreaming gender in COVID-19 and in mainstreaming gender in nutrition Specialist) health services. and health services. 6 Develop GBV screening tools for health GBV screening tools distributed to PIU (Social facilities participating in the project health facilities. Specialist) activities 7 Orient Health facility staff in screening for Number of health facility staff oriented PIU (Social GBV during vaccine deployment in screening for GBV during vaccine Specialist) deployment. 8 Conduct gender mainstreaming and GBV DFNCO and Community Liaison PIU (Social TOT for DFNCO and Community Liaison Officers trained as trainers (TOT) in Specialist) Officers. gender mainstreaming and GBV/SEA. 9 Develop IEC materials for stakeholders Number of materials developed. PIU (Social (Training manuals, Dialogue guides, GBV Specialist) Screening tools, Posters). 10 Print and distribute IEC materials for Number and type of IEC materials PIU (Social stakeholders (Training manuals, Dialogue printed. Specialist, guides, GBV Screening tools, Posters). Community Liaison Officer) 11 Disseminate and operationalize the Number of dissemination meetings PIU (Social GBV/SEA policies to all contractors held. Specialist, Community Liaison Officer) 187 Project Phase Sequence Activities Indicators Responsibilities Frequency Estimated Budget ($) 12 Review GRM for specific GBV/SEA GRM tools to integrate GBV/SEA PIU (Social procedures Specialist) 13 Print and distribute the GBV mapping tool Number of Stakeholders provided with PIU (Social for each district to facilitate referral by all copies of the mapping of GBV Service Specialist, community structures (traditional leaders, providers. Community Liaison FBO, schools, VHWs etc). Officer) 14 Train stakeholders in the identification, Number stakeholders trained in the PIU (Social prevention and reporting GBV. identification, prevention and Specialist, reporting GBV. Community Liaison Officer) Monitoring 1 Ongoing training of workers and Number of training contacted PIU (Social Throughout 10,000 community awareness raising; Specialist, project Community Liaison implementation Officer) 2 Provide support and referrals to any GBV No of GBV grievances addressed PIU (Social complaints that may arise; Specialist, Community Liaison Officer) 3 Undertake regular M&E of progress on No of GBV activities contacted PIU (Social GBV activities Specialist, Community Liaison Officer, M&E specialist) 188 Project Phase Sequence Activities Indicators Responsibilities Frequency Estimated Budget ($) 4 Ongoing training of workers and Number of GBV trainings contacted Contractor community awareness raising; 5 Provide support and referrals to any GBV Number of GBV support given Contractor complaints that may arise; Undertake regular M&E of progress on GBV activities. 42,000 Monitoring and Reporting Indicators • Successful implementation of agreed GBV Action Plan (Y/N); • Number of key actors/partners supported on GBV mitigation activities; • GBV mitigation measures included in procurement documents [Y/N]; • Number of training courses related to GBV delivered; • Percentage of workers that have signed a CoC; and/or • Percentage of workers that have attended the CoC training. • Number of GBV grievances that have been referred to GBV Services Providers 189 Appendix 7-1: Mapping of GBV service Providers in Lesotho per districtii BEREA No. Organization District Physical Type of GBV services provided Target Contact details (name, Name Location group/beneficiaries position, phone number) 1 Good Shepherd Berea Provide Berea Plateau, structured classes: Teenage Mothers and Sister Jacintha Rantso, Centre for Mathematics, English, Sesotho, about 20km their babies. Director Teenage Mothers vocational training, sewing, catering North of the +266 630 25846 capital and decoration, farming jntsoaki@hotmail.com Maseru. (horticulture, animal husbandry) life Fax +266 2231 0197 skills and psycho-social support, counselling, child-care and parenting skills. 2 Women and Law Operates WLSA house, Legal services, mediation and Women, Girls, Key Ms. Mohau Maapesa, in Southern in all the Katlehong, arbitration services, GBV Populations, men and Programmes Manager Africa 10 Maseru prevention, care and support for boys, factory workers Gender and Human Rights, Districts GBV survivors and Legal and the general 58888403 representation. population. 3 Child and Gender Operates Refer for Psycho-socio counseling, Vulnerable Malebohang Nepo, Protection Unit in all the GBV prevention and perpetrator populations. malnepo@yahoo.com (CGPU) 10 accountability, mediation, Districts investigation of criminal cases. 4 St Cecilia Berea Ha Bua sono Provide structured classes: vulnerable Catholic Church district Mathematics, English, Sesotho, populations. vocational training, sewing, catering and decoration, farming (horticulture, animal husbandry) life skills and psycho-social support, counselling, child-care and parenting skills. 190 BEREA No. Organization District Physical Type of GBV services provided Target Contact details (name, Name Location group/beneficiaries position, phone number) 5 Lesotho Red Around the Disseminate information to the Boys and girls from 18 Neko Hababa 63018087 Cross Society town community on GBV, child years up. district protection policy, make referrals when appropriate., capacitate the youths with different skill as part of empowerment. provision of arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of agriculture and Food Security during a crisis. 6 Social Berea Placement of abandoned children in Vulnerable coordinator, Matumelo development district care facilities, supporting with social populations. Letlatsa 58068892 (district grants for disabled children and Manage) vulnerable households, provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 191 BEREA No. Organization District Physical Type of GBV services provided Target Contact details (name, Name Location group/beneficiaries position, phone number) 7 Ministry of Berea GBV sensitization and training, care Youths Rosina Lesema, District Gender and district and support for GBV survivors, Youth Coordinator, Youth, Sports and micro financing, business training, 57044890 Recreation grants and material hand- out, agriculture inputs. Paralegal- sensitize and disseminate information to communities, chiefs, councilors, traditional leaders and other social structures about user friendly laws. BUTHA BUTHE No. Organization Name District Physical Type of GBV services Target Contact details (name, Location provided group/beneficiaries position, phone number) 1 Ministry of Police (CGPU Butha BB police Refer for Psycho-socio Vulnerable Malebohang Nepo, Buthe station counseling, GBV prevention populations. malnepo@yahoo.com and perpetrator ac-countability, mediation, investigation of criminal cases. 2 Ministry of Health Butha DHMT Psycho –social counselling, post All Matsebo Chele Buthe Botha exposure prophylaxes, District Senior HIV and TB Bothe emergency contraceptive, counselor trauma management and 58008424 recovery support for GBV survivors. Provide HIV tests, STI treatment, referrals and help with medical history form if the 192 BUTHA BUTHE No. Organization Name District Physical Type of GBV services Target Contact details (name, Location provided group/beneficiaries position, phone number) GBV survivor wants to seek legal redress. 3 Ministry of social development Butha Dahmbah Placement of abandoned all Mareitumetse Khali Buthe building children in care facilities, Senior Child welfare supporting with social grants for officer disabled children and vulnerable 67284947 households, provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 4 Law office (prosecution) Butha TEBA Arbitration services and all victims of crime Makhotso Letsoisa Senior Buthe premises prosecution services. Crown counsel 59122322 5 LENASO Butha Urban GBV sensitization, training and People living with Thabang Molahloe Buthe council referral of GBV survivors. HIV. Retention Officer premises 63002545 193 BUTHA BUTHE No. Organization Name District Physical Type of GBV services Target Contact details (name, Location provided group/beneficiaries position, phone number) 6 Lesotho parenthood Planned Butha TEBA Provides PEP for rape cases and all Retselisitsoe Makabateng Association (LPPA) Buthe premises emergency contraceptives and Clinic Manager integrated sexual and 50049939 reproductive health services. 7 Ministry of Small business Butha Tayob Legal education, provide Youth at community Tebejane Ntsiki Development, Cooperatives and Buthe building formation of Byelaws, import level, Schools Cooperative Officer Marketing permits and provide market (primary and high 63257377 advice, facilitate registration of school). cooperatives, corporative law and management; arbitration services, trauma management, business trainings, business proposals, bookkeeping and accounting and corporative management. 8 Ministry of Agriculture and Food Butha Agric Provide savings and micro All DAPO Security Buthe financing for women empowerment. Establishment of savings and internal lending communities’ groups (SILC) of savings and micro loans. Agricultural inputs: empowerment of women production, short, cycled livestock, agronomy and horticulture, fodder production and irrigation system. provide grants and material inputs by providing cash for work to activities, communal garden tools and energy saving stoves, extension services. 194 BUTHA BUTHE No. Organization Name District Physical Type of GBV services Target Contact details (name, Location provided group/beneficiaries position, phone number) 9 Women and Law in Southern Africa Operates WLSA Legal services, mediation and Women, Girls, Key Ms. Mohau Maapesa, in all the house, arbitration services, GBV Populations, men Programs Manager Gender 10 Katlehong, prevention, care and support for and boys, factory and Human Rights, Districts Maseru GBV survivors and Legal workers. 58888403 representation. 195 LERIBE # Organisation Name District Physical Location Type of GBV Target Contact details name services provided group/benefici aries 1 Women and Law in Operates in all the msr Legal services, Women, Girls, Ms. Mohau Maapesa, Southern Africa 10 Districts mediation and Key Programmes Manager Gender arbitration services, Populations, and Human Rights, 58888403 GBV prevention, care men and boys, and support for GBV factory workers. survivors and Legal representation. 2 Child and Gender Operates in all the Refer for Psycho- Vulnerable Malebohang Nepo, Protection Unit (CGPU) 10 Districts socio counselling, populations. malnepo@yahoo.com GBV prevention and perpetrator ac- countability, mediation, investigation of criminal cases. 3 Ministry of social Leribe hlotse Placement of All Molisana Mokhoabo development abandoned children in 58787181 care facilities, supporting with social grants for disabled children and vulnerable households, provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable 196 Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 4 Sentebale Leribe Hlotse (DHMT) Legal education, Youths Malephallo Majoro, 62315553 provide formation of Byelaws, registration. corporative law and management; arbitration services, trauma management, business trainings, business proposals, bookkeeping and accounting and corporative management. 5 Ministry of Small business Leribe hlotse, Agric Legal education, All Nkahle Ramorero, 57893957 Development, premises provide formation of Cooperatives and Byelaws, import Marketing permits and provide market advice, facilitate registration of cooperatives, corporative law and management; arbitration services, trauma management, business trainings, business proposals, bookkeeping and accounting and corporative management. 197 6 Ministry of Education and Leribe hlotse - education Sensitisation, cooks and matsepo Moloisane, Extension Training (SSRFU) office training, and Micro caterers officer, 56239607 financing. 7 Help Lesotho Leribe hlotse GBV Sensitisation All makhauta shasha, and training, care and 28400809/59575243 support for GBV survivors and recovery support for survivor – Follow-up. 8 JHPIEGO Leribe hlotse -motebang Post exposure All Tumo Lelimo, District hospital prophylaxes (PEP), Coordinator, 5888337 Pre-Exposure prophylaxes, She- Hive Associations. 9 Red Cross Lesotho Leribe hlotse-red cross Disseminate All Masonta Malapo, Divisional offices information to the Secretary, 59389729 community on GBV, child protection policy, make referrals when appropriate, capacitate the youths with different skill as part of empowerment. Provision of arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of agriculture and Food Security during a crisis. 10 Ministry of Health Leribe hlotse-DHMT Psycho–social All Leponesa Mpholo counselling, post Public Health, 58570206 exposure prophylaxes, emergency 198 contraceptive, trauma management and recovery support for GBV survivors. Provide HIV tests, STI treatment, referrals and help with medical history form if the GBV survivor wants to seek legal redress. 11 Lesotho correctional Leribe hlotse-prisons Treatment and Inmates principal rehabilitation services recovery support for Officer, 59159876 survivors. 12 Ministry of Agriculture Leribe hlotse, Agric Provide savings and All Nyakallo, District Agricultural and Food Security (SADP, premises micro financing for Officer, 63810269 FAO) women empowerment. Establishment of savings and internal lending communities’ groups (SILC) of savings and micro loans. Agricultural inputs: empowerment of women production, short, cycled livestock, agronomy and horticulture, fodder production and irrigation system. provide grants and material inputs by providing cash for work to activities, communal garden tools and saving energy stoves, extension services. 199 13 Ministry of Gender and Leribe hlotse -near taxi rank GBV sensitisation All Lekhabunyane Khoeli, Youth, Sports and and training, care and 62463069/58920803 Recreation support for GBV survivors, micro financing, business training, grants and material hand- out, agriculture inputs. Paralegal- sensitize and disseminate information to communities, chiefs, councillors, traditional leaders and other social structures about user friendly laws. MAFETENG No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries name 1 Women and Law in Operates in all WLSA house, Legal services, mediation and Women, Girls, Key Ms. Mohau Southern Africa the 10 Districts Katlehong, Maseru arbitration services, GBV Populations, men and Maapesa, prevention, care and support boys, factory workers Programmes for GBV survivors and Legal Manager Gender representation. and Human Rights, 58888403 2 Ministry of Social Operates in all Placement of abandoned Vulnerable populations Development the 10 Districts children in care facilities, supporting with social grants for disabled children and vulnerable households, provide devices to people with 200 MAFETENG No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries name disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 3 Child and Gender Operates in all Refer for Psycho-socio Vulnerable populations. Malebohang Nepo, Protection Unit the 10 Districts counselling, GBV prevention malnepo@yahoo.c (CGPU) and perpetrator ac- om countability, mediation, investigation of criminal cases. 4 Karabo ea bophelo Mafeteng Motse-mocha Determined Resilient, OVC -17 years, Girls and Ms Mamokoli (Baylor) Empowered AIDS free young women 15-24 Sekantsi 58083694 Mentored Safe (DREAMS), years, boys and men 20-49 msekantsi@bayloe parenting skills, growth years. lesotho.org monitoring, child simulation sessions, savings groups, messaging on medication use, WASH and tippy taps, keyhole gardening, messaging on violence against children, assessments for referral, homework clubs, school bursaries, PREP through mobile clinic. 5 Lesotho Red Cross Mafeteng Mathebe, Thabana- Disseminate information to the ALL Mr Lebamang Society Morena, Kolo, Tsupane, community on GBV, child Sehloho. Kopanong, Ha protection policy, make referrals when appropriate., 201 MAFETENG No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries name Ramohapi, Tsoeneng, capacitate the youths with Tlai-tlai, Vanroyen different skill as part of empowerment. Provision of arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of agriculture and Food Security during a crisis. 6 Ministry of Health Mafeteng Mafeteng Urban, Psycho –social counselling, children, men and women Mrs Mampho Litsoeneng, Kolo, Thaba- post exposure prophylaxes, Mafereka Tsoeu, Motsekuoa, emergency contraceptive, 58719919 Thabana Morena, trauma management and Sebelekoane, Ha recovery support for GBV Makhakhe, Matelile, survivors. Provide HIV tests, Ribaneng, Sekameng, STI treatment, referrals and Tsakholo help with medical history form if the GBV survivor wants to seek legal redress. MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 1 Federation of Women MASERU HOOHLO EXT.HOUSE Legal Services: Women and Children Mabela Lehloenya Lawyers provide legal education, 63591837 arbitration, legal aid clinics, 202 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) subsidized legal services including pro bono services. 2 Women and Law in Operates in all WLSA house, Legal services, mediation and Women, Girls, Key Ms. Mohau Southern Africa the 10 Districts Katlehong, Maseru arbitration services, GBV Populations, men and Maapesa, prevention, care and support boys, factory workers. Programmes for GBV survivors and Legal Manager Gender representation. and Human Rights, 58888403 3 Ministry of Social Operates in all Placement of abandoned Vulnerable populations Development the 10 Districts children in care facilities, supporting with social grants for disabled children and vulnerable households, provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 203 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 4 Karabo ea Bophelo Maseru 2nd Floor Old Agric GBV prevention, care and Orphans and Vulnerable Mamello Molapo - Bank Building Kingsway support for GBV survivors, Children and adolescents. mmolapo@encom Street (968.28 mi) business training, psychosocial passworld.com Maseru, Lesotho 100 counselling, PEP, emergency contraceptive, Pre-EP, Legal services, legal representation in court. 5 Child and Gender Operates in all Refer for Psycho-socio Vulnerable populations. Malebohang Nepo, Protection Unit the 10 Districts counselling, GBV prevention malnepo@yahoo.c (CGPU) and perpetrator ac- om countability, mediation, investigation of criminal cases. 6 Women Intimate Maseru Sensitization on issues Women and children. Expressions regarding Gender based violence, HIV and AIDS and Socio- economic development. 7 She-Hive Association Maseru Address: Old labour and Psychosocial counselling and Women and children GBV Phone:266 employment building referral, PrEP sensitisation, use Survivors. 57075354 OR Box 2556, Pitso Ground, Nakaneng App for GBV/SEA +266 5193 8270; education. Maseru 102 Lesotho Email: info@shehive.org. ls 204 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 8 Lesotho Council of Maseru House No.544, Hoohlo Strengthening Civil Society, Lesotho NGOs +266 5727 3244 Non-Governmental Extension, Maseru 100, environment protection and Organisations Lesotho Stewardship, Maseru, Lesotho House economic Justice and Social No.544 development, governance and accountability, empowering the vulnerable and marginalised, responding to HIV and AIDS, harnessing information and technology. 9 Lesotho National Maseru Physical Address: Advocate, promote, and defend People living with Mr. Nkhasi Sefuthi Federation of 22 Mabile Rd the rights of people with disabilities. (Executive Organisations of the Old Europa disabilities and their families Director) Disabled Maseru through provision of training, Tel: +266 223 203 (LNFOD)/Southern material and emotional 45 E-mail: Africa Federation of support, and by representing nkhasi@lnfod.org. the Disabled their needs to government, ls Mobile: +266 development partners and the 632 017 8 wider community. Postal Address: PO Box 9988 Maseru 0100 Lesotho Tel: +266 223 203 45 Tel / Fax: +266 223 261 96 Fax: +266 22268960. 205 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 10 Catholic Commission Maseru Justice and Peace House, Promotes and safeguards People affected by 266 2232 4263 for Justice and Peace Main North 1 (962.78 mi) human dignity through structural injustice. Maseru, Lesotho activities that enhance social, economic and political justices in Lesotho. 11 BAM Group Maseru Suite 5, Metcash Women empowerment, Women, youths and 266 2232 7228 Foundation Complex, Kingsway youth empowerment, communities. Road, Maseru-Lesotho community building, entrepreneurship, development. 12 Sesotho Media and All ten Sesotho Media and Disseminating information in Communities 266 22321446 or Development districts Development support of human rights 22326086 Lancers Road, House through locally produced films info@sesothomedi 232, Maseru West, and facilitated discussions. a.org or Lesotho director@sesotho media.org 13 Girls Not Brides Maseru Ending child marriage and Policy makers and general info@GirlsNotBri enabling girls to fulfil their public. des.org potential. 206 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 14 Help Lesotho Maseru Lesotho – Maseru Office Advocates for social justice, Women, children and Phone: +266 Help Lesotho particularly the rights of girls Youths. 28330581 Post Office 15105 and women in pursuit of Maseru 100 gender equity; promotes the LESOTHO prevention of HIV transmission; and champions and challenges all involved to make healthy decisions and be socially responsible. 15 Touch Roots Africa Maseru 22, Mabille Road, Child Protection, CBOs and NGOs Telephone: P. O Box 4568 psychosocial support, +26657107704 Maseru organisational, business and Fax: 100 financial development +26622311115 Lesotho advocacy. Email: tra@touchrootsafri ca.com Address: 22, Mabille Road, Maseru, Lesotho 100 16 Khotla Lesotho A male forum that helps to Men restore man in male and empower male person to become a productive person from family through society. 207 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 17 Lapeng Care Centre Maseru Six Months maximum shelter nursing mothers, women, Rannyaliseng for women, girls and boys girls, boys under 12 years, Maanela, Senior younger than 17 years, and women with children. Gender Officer Treatment of minor ailments Boys ages 13 to 17 years Phone: 22327105 and injuries; referral of serious must be accompanied by Department of cases to hospitals or clinics; their mother. Boys older Gender, 6th floor, mental health and social needs than 17 years cannot stay Post Office screening, (e.g., food, at the shelter. building, Maseru transportation, shelter); Office hours: psychosocial support and Monday–Friday, 8 counselling to walk through a a.m.–4:30 p.m. care plan and address Teboho Ntlhakana, additional needs; assistance in Chief Gender finding permanent housing and Officer employment; plan for Phone: 63285685 community reintegration and Email: referrals to legal and health tebohontlhakana@ services. yahoo.com Available 24 hours a day, 7 days a week (call for emergencies only) 18 Beautiful Dream Maseru Khato House 24-hour, crisis care shelter for Child survivors of human Beautiful Dream Society’s Hope victims of human trafficking, trafficking and orphans Society of Lesotho House. food, and clothing, medical and and vulnerable children. PO Box 10165 mental health care, ART Maseru 100 therapy, skills training and job Lesotho placement, education and financial aid assistance. +266 5733 2854 208 MASERU No. Organisation Name District Physical Location Type of GBV services Target Contact details provided group/beneficiaries (name, position, phone Number) 19 Lesotho Child Mazenod Ha Paki provide resources, Vulnerable boys and girls. Contact Lesotho Counselling Unit for information, outreach, Child Counselling psychosocial services counselling and in some Unit (LCCU) on instances shelter to vulnerable Messenger, +266 children who have been 5878 7555 victims of rape, sexual offence, trafficking, physical or psychological abuse. MOHALE’S HOEK No. Organisation Name District Physical Location Type of GBV services Target group/beneficiaries Contact details provided name 1 Women and Law in Operates in WLSA house, Legal services, mediation and Women, Girls, Key Ms. Mohau Southern Africa all the 10 Katlehong, Maseru arbitration services, GBV Populations, men and boys, Maapesa, Districts prevention, care and support factory workers. Programmes for GBV survivors and Legal Manager Gender representation. and Human Rights, 58888403 2 Ministry of Social Operates in Likhutlong Placement of abandoned Vulnerable populations. Mrs. Bernice Development all the 10 Mohales'hoek near children in care facilities, 63247160 Districts PISSA Offices supporting with social grants for disabled children and vulnerable households, provide devices to people with disabilities, take people with 209 MOHALE’S HOEK No. Organisation Name District Physical Location Type of GBV services Target group/beneficiaries Contact details provided name disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 3 Child and Gender Operates in Mohales'hoek Police Refer for psycho-socio Vulnerable populations. Malebohang Protection Unit all the 10 Station near World counselling, GBV prevention Nepo, (CGPU) Districts Vision and perpetrator accountability, malnepo@yahoo. mediation, investigation of com criminal cases. 4 World Vision Operates in Near Mohale's Hoek new Raise awareness on child Vulnerable children and the Mrs Hopolang Lesotho Butha Buthe, Police station protection. Mobilize the community at large. Lentsa 58910307 Mokhotlong, community on how to report Leribe, crimes. Link the community Berea, with responsible personnel on Maseru, any crime committed to Mafeteng, children. Mohale's Hoek and Quthing 5 Lesotho Red Cross Operates in Near Nts'ekhe Disseminate information to the All vulnerable groups. Mr Thabo Society all the 10 Government Hospital community on GBV, child Leketanyane Districts protection policy, make Division secretary referrals when appropriate, 58606377 capacitate the youths with Benzo.leketanyan different skill as part of e@gmail.co m empowerment. Provision of 210 MOHALE’S HOEK No. Organisation Name District Physical Location Type of GBV services Target group/beneficiaries Contact details provided name arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of agriculture and Food Security during a crisis. 6 Lesotho parenthood Operates in Opposite Hotel mount Provides PEP for rape cases All vulnerable groups. Planned Association all the 10 malu and emergency contraceptives (LPPA) Districts and integrated Sexual and Reproductive. 7 Ministry of Health Operates in opposite old Ministry of Psycho –social counselling, All vulnerable groups. Mrs. Thato all the 10 Trade Offices post District TB and Districts exposure prophylaxes, HIV coordinator emergency contraceptive, trauma management and recovery support for GBV survivors. Provide HIV tests, STI treatment, referrals and help with medical history form if the GBV survivor wants to seek legal redress. 8 Msizi Africa Lesotho Mohales'hoek Opposite WASCO Feeding orphans and All vulnerable Children aged Mr. Mochesane vulnerable children. 3 to 18 years. Mosoloane Managing Director 50792046 9 USAID Lesotho Operates in Ha Tanka Opposite Integrates chid protection into OVCs (Orphans and Mrs Nkomane Karabo ea Bophelo all the 10 Imperial Flirt services the case management process, Vulnerable children). Seele Distrct (Solution to Good Districts by ensuring that case manager. Email health) management workers (CMW) address: are trained to recognise signs ngomaneseele@g 211 MOHALE’S HOEK No. Organisation Name District Physical Location Type of GBV services Target group/beneficiaries Contact details provided name of violence against children mail.com (VAC) and gender-based 58910508/588872 violence (GBV) and make 18 appropriate referrals. It also concentrates on raising awareness and trainings on communities’ cadres and other service providers to ensure that they understand the key issues on prevention, mandatory reporting, responding and existing referral networks for supporting survivors of violence against children and gender-based violence. Survivors of violence get legal care services through Paralegals. 212 MOKHOTLONG No. Organisation District Physical Type of GBV services Target Contact details name Name Location provided group/beneficiaries 1 Women and Law in Operates in all WLSA house, Legal services, mediation and Women, Girls, Key Ms. Mohau Maapesa, Southern Africa the 10 Districts Katlehong, arbitration services, GBV Populations, men and Programmes Manager Maseru prevention, care and support for boys, factory workers. Gender and Human GBV survivors and Legal Rights, 58888403 representation. 2 Child and Gender Operates in all Refer for psycho-socio Vulnerable populations. Malebohang Nepo, Protection Unit the 10 Districts counselling, GBV prevention malnepo@yahoo.com (CGPU) and perpetrator ac-countability, mediation, investigation of criminal cases. 3 Ministry of Social Operates in all Matamong next Placement of abandoned Vulnerable populations. Pontso Tsoeunyane Development the 10 Districts to calvin building children in care facilities, +26658526904 supporting with social grants for disabled children and vulnerable households, provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 4 Lesotho Red Cross Mokhotlong A12 opposite Disseminate information to the All Limpho Ntai Society, Education community on GBV, child +26653788023 building protection policy, make referrals when appropriate., capacitate the youths with different skill as 213 MOKHOTLONG No. Organisation District Physical Type of GBV services Target Contact details name Name Location provided group/beneficiaries part of empowerment. Provision of arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of agriculture and Food Security during a crisis. 5 Touching tiny lives Mokhotlong Next to shelter for GBV survivors. Abused under five Nthabeleng Lephoto, Mokhotlong children. +266 62115648 hospital 6 Ministry of Health Mokhotlong Mokhotlong Psycho –social counselling, post All Dr Mbuliso, hospital exposure prophylaxes, 26627001150 emergency contraceptive, trauma management and recovery support for GBV survivors. Provide HIV tests, STI treatment, referrals and help with medical history form if the GBV survivor wants to seek legal redress. 7 Karabo ea bophelo Mokhotlong GROW premises GBV sensitisation and training, Orphans and vulnerable Tumelo Sehlabi, agricultural inputs, savings. children. 26658887214 8 Baylor Mokhotlong Mokhotlong Pre-exposure prophylaxes (pre- People living with Dr David +26622920701 hospital premises EP), post exposure prophylaxes. HIV/AIDS. 9 Ministry of Small Mokhotlong Old-egg circle Legal education, provide Cooperatives, Mahlalele Mokhothu business building formation of Byelaws, import associations and +26662694455 Development, permits and provide market individuals. Cooperatives and advice, facilitate registration of Marketing cooperatives, corporative law 214 MOKHOTLONG No. Organisation District Physical Type of GBV services Target Contact details name Name Location provided group/beneficiaries and management; arbitration services, trauma management, business trainings, business proposals, bookkeeping and accounting and corporative management. 10 Ministry of Mokhotlong Next to Provide savings and micro All farmers Melato Machaea, Agriculture and Mokhotlong financing for women 26658049690 Food Security hotel empowerment. Establishment of savings and internal lending communities’ groups (SILC) of savings and micro loans. Agricultural inputs: empowerment of women production, short, cycled livestock, agronomy and horticulture, fodder production and irrigation system. provide grants and material inputs by proving cash for work to activities, communal garden tools and energy saving stoves and extension services. 11 Food and Nutrition Mokhotlong FMU building Agricultural inputs. Caregivers of children Malimpho Malefane coordinating office under five years. +26658745999 12 Law Office Mokhotlong Next to District Arbitration services, care and All victims of crime, Manyefolo Ramakhula (Prosecution office) Administrator’s support for GBV survivors, people living with offices perpetrator accountability, legal HIV/AIDS. education only on invitation. 215 MOKHOTLONG No. Organisation District Physical Type of GBV services Target Contact details name Name Location provided group/beneficiaries 13 LENASO Mokhotlong Hospital GBV sensitization, training and People living with HIV. Lora Mohase, premises referral of GBV survivors. 26662204034 QACHA’S NEK No. Organisation Name District Physical Type of GBV services Target Contact details name Location provided group/beneficiaries 1 Child and Gender Operates in Refer for Psycho-socio Vulnerable populations. Malebohang Nepo, Protection Unit (CGPU) all the 10 counselling, GBV prevention malnepo@yahoo.co Districts and perpetrator accountability, mediation, investigation of criminal cases. 2 Women and Law in Operates in WLSA house, Legal services, arbitration Women, Girls, Key Ms. Mohau Maapesa, Southern Africa all the 10 Katlehong, services, GBV prevention, care Populations, men and boys, Programmes Manager Districts Maseru and support for GBV survivors factory workers. Gender and Human and Legal representation. Rights, 58888403 3 Ministry of Social Qacha’s Seilatsatsi Placement of abandoned Vulnerable populations Nts’ebo Mopeli, Development Nek Building. Next children in care facilities, 26663610125 to District Taxi supporting with social grants Rank for disabled children and vulnerable households, provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) 216 QACHA’S NEK No. Organisation Name District Physical Type of GBV services Target Contact details name Location provided group/beneficiaries and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 4 Lesotho Red Cross Qacha’s Red Cross Disseminate information to the All Motautona Thabo, Society, Nek Building at community on GBV, child 26658452211 Motse Mocha protection policy, make referrals when appropriate, capacitate the youths with different skill as part of empowerment. Provision of arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of Agriculture and Food Security during a crisis. 5 Ministry of health Qacha’s Machabeng Psycho –social counselling, All Dr Jean Claude Nek Hospital post Balengesila, 26657497744 exposure prophylaxes, emergency contraceptive, trauma management and recovery support for GBV survivors. Provide HIV tests, STI treatment, referrals and help with medical history form if the GBV survivor wants to seek legal redress. 217 QACHA’S NEK No. Organisation Name District Physical Type of GBV services Target Contact details name Location provided group/beneficiaries 6 Karabo ea bophelo Qacha’s Seilatsatsi GBV sensitisation and orphans and vulnerable Lineo Oliphant, Nek Building next training, agricultural inputs, children. 26663390942 to District Taxi savings. Rank 7 Ministry of Small business Qacha’s Bedco Legal education, provide Cooperatives, associations M. Moshoeshoe, Development, Nek Buildings formation of Byelaws, import and individuals. 26658690050 Cooperatives and permits and provide market Marketing advice, facilitate registration of cooperatives, corporative law and management; arbitration services, trauma management, business trainings, business proposals, bookkeeping and accounting and corporative management. 8 Ministry of Agriculture and Qacha’s Next to Provide savings and micro All farmers Ts’iu Mphanya, Food Security Nek Lesotho financing for women 26659029629 Electricity empowerment. Establishment Cooperation of savings and internal lending communities’ groups (SILC) of savings and micro loans. Agricultural inputs: empowerment of women production, short, cycled livestock, agronomy and horticulture, fodder production and irrigation system. provide grants and material inputs by proving cash for work to activities, communal garden tools and saving energy stoves. 218 QACHA’S NEK No. Organisation Name District Physical Type of GBV services Target Contact details name Location provided group/beneficiaries 9 Food and Nutrition Qacha’s District Agricultural inputs. Caregivers of children Mathabang Kalaka coordinating office Nek Administrators under five years. +26663575977 Offices 10 Law Office, (Prosecution, Qacha’s Next to District Arbitration services, care and All victims of crime. Monyake Mahlehle, Master of high court and Nek Administrator’ support for GBV survivors, 26662708199 Magistrate) s offices perpetrator accountability, legal education only on invitation. 11 LENASO Qacha’s Machabeng GBV sensitization and People living with Rethabile Mohasi, Nek Hospital training. HIV/AIDS. 26662710089 premises QUTHING No. Organisation District Physical Type of GBV services provided Target Contact details Name Location group/beneficiaries (name, position, phone number) 1 Women and Law Operates in all WLSA house, Legal services, mediation and Women, Girls, Key Ms. Mohau in Southern the 10 Districts Katlehong, arbitration services, GBV Populations, men and boys, Maapesa, Africa Maseru prevention, care and support for factory workers. Programmes GBV survivors and Legal Manager Gender and representation. Human Rights, 58888403 2 Ministry of Social Operates in all Placement of abandoned children in Vulnerable populations. Development the 10 Districts care facilities, supporting with social grants for disabled children and vulnerable households, provide 219 QUTHING No. Organisation District Physical Type of GBV services provided Target Contact details Name Location group/beneficiaries (name, position, phone number) devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 3 Child and Gender Operates in all Refer for Psycho-socio counselling, Vulnerable populations. Malebohang Nepo, Protection Unit the 10 Districts GBV prevention and perpetrator ac- malnepo@yahoo.co (CGPU) countability, mediation, m investigation of criminal cases. 4 Lesotho Red Quthing Upper Moyeni Disseminate information to the All communities Lieketseng Cross Hospital Area community on GBV, child Masunyane, District protection policy, make referrals Secretary, 56113716 when appropriate., capacitate the youths with different skill as part of empowerment. Provision of arbitration services during crisis such as COVID 19 and offer sensitization and training on nutrition in collaboration with the Ministry of agriculture and Food Security during a crisis. 220 QUTHING No. Organisation District Physical Type of GBV services provided Target Contact details Name Location group/beneficiaries (name, position, phone number) 5 Skill Share Quthing Upper Moyeni Education on life skills and GBV. Youth 10 to 24 years. Include contact DA’s Office person opposite to Magistrate office 6 Master of The Quthing Upper Moyeni Protection of children against Children from 0-17 years. Monyaluoe Buzi, High Court next to property grabbing. Child protection 58005080 Magistrate exclusively for GBV survivors and court administration of insolvent estates. 7 LENASO Quthing Upper Moyeni GBV sensitization, training and Childbearing groups. Mamolise Khati referral od GBV survivors. District coordinator, 58597303 221 THABA TSEKA No. Organisation District Physical Location Type of GBV services Target Contact details (name, Name provided group/beneficiaries position, phone Number) 1 GEM Institute Thaba Tseka TTT 550 Gender, entrepreneurship Men, boys and 26663317449 Thaba Putsoa, Empowerment and Media communities. gemisntitute@gmail.com Lesotho (GEM). Institute aims to be a partner with marginalised communities to promote healthy and innovative lifestyles. 2 Child and Gender Operates in all Refer for Psycho-socio Vulnerable populations. Malebohang Nepo, Protection Unit the 10 Districts counselling, GBV prevention malnepo@yahoo.com (CGPU) and perpetrator ac- countability, mediation, investigation of criminal cases. 3 Law Office/ Thabatseka Project Legal education, provide All vulnerable People. MR Molaoli, Prosecution Lephuruhloana's counselling, give legal advice SINIORNPUBLIC building and support, legal PROSECUTOR, representation in court by 59198916/68780240 representing cases in court. Arbitration services. 4 Ministry of Small Thabatseka Tim and sons building Legal education, provide Financial Cooperatives, Makananelo Kotope, business formation of Byelaws, import youth cooperatives and District Cooperative Development, permits and provide market agricultural cooperatives. Officer Cooperatives and advice, facilitate registration Marketing of cooperatives, corporative law and management; arbitration services, trauma management, business trainings, business proposals, bookkeeping and accounting and corporative management. 222 THABA TSEKA No. Organisation District Physical Location Type of GBV services Target Contact details (name, Name provided group/beneficiaries position, phone Number) 5 Ministry of Social Thabatseka PROJECT Placement of abandoned ALL ages MRS Makori Ratlali, Development Lephuruhloana's children in care facilities, District Cooperative building supporting with social grants Officer, 58035021, for disabled children and (Rehabilitation Officer), vulnerable households, 57819633/62991111 provide devices to people with disabilities, take people with disabilities to special schools, offer public assistance (PA), Child Grant Program, (CGP) and Orphans and Vulnerable Children’s (OVC) grant, support the small farmers with seeds and shed nets and livelihood promotion, GBV mobilization in collaboration with Ministry of Gender. 223 THABA TSEKA No. Organisation District Physical Location Type of GBV services Target Contact details (name, Name provided group/beneficiaries position, phone Number) 6 Ministry of Food Thabatseka PROJECT Provide savings and micro Youth, Men and Women. MRS Pulane Thulo, and Agricultural financing for women (District Technical Organisation empowerment. Establishment Coordinator), (FAO) of savings and internal 50176965/58920002 lending communities’ groups (SILC) of savings and micro loans. Agricultural inputs: empowerment of women production, short, cycled livestock, agronomy and horticulture, fodder production and irrigation system. provide grants and material inputs by proving cash for work to activities, communal garden tools and saving energy stoves. 7 Ministry of Thabatseka DA'S BUILDING Provide savings and micro All vulnerable people MRS PHALATSI, DAO Agriculture and financing for women District Agricultural Food Security empowerment. Establishment Officer, 63127802 of savings and internal lending communities’ groups (SILC) of savings and micro loans. Agricultural inputs: empowerment of women production, short, cycled livestock, agronomy and horticulture, fodder production and irrigation system. provide grants and material inputs by proving cash for work to activities, 224 THABA TSEKA No. Organisation District Physical Location Type of GBV services Target Contact details (name, Name provided group/beneficiaries position, phone Number) communal garden tools and energy saving stoves. 8 LENASO Thabatseka DHMT GBV sensitization, training people living with HIV. Mr Sekake, Project and referral. Officer, 63336453 9 EGPAF Thabatseka Health division Psychosocial counselling, People living with HIV MRS MATLOSA, PEP, Prep, treatment and AND AIDS. Nurse, 58094381 recovery, care and support for GBV Survivors. 225 Annex 8: Consultations Consultative Process Multiple rounds of consultations with relevant stakeholders have been conducted during preparation of the Parent Project as well as the Additional Financing to the EPRP. For the Consultation and information dissemination purposes, public notices have been published also in the newspapers. The consultations aimed to provide relevant stakeholders with overall generic information about the Project, and to seek their feedback and suggestions regarding Project risks, impacts and mitigation measures. As a summary, their feedback received include both positive and negative impacts of the Project. On a positive side, the stakeholders see the Project as part of the government initiative to significantly improve the health care service delivery, and mores specifically prevent the threat caused by COVID-19 diseases, while on the negative side, they still have a fear that establishment of COVID-19 facilities within their local reach may increase their exposure to COVID-19. The Vaccination program under the AF has been also much appreciated by all stakeholders consulted, affirming their full support and willingness to participate in it. Further details on the consultation process are presented below. I. Consultations During the EPRP-AF Preparations A. Summary of participants’ views Consultations have been conducted for the EPRP Parent Project as well as the Additional Financing Project. From the discussions and consolidation of the participants’ answers and views on the questionnaire issued to the participants, including those at the Scott Hospital as part of the EPRP AF Consultations, it is evident that all participants have indicated acceptance of the COVID-19 EPRP including the Vaccination program. They were ready to be vaccinated, even if they were to be the first ones to get vaccinated. However, of all the 15 participants, only one participant did not support the government’s decision to procure COVID-19 vaccine, as he/she believes that it will not help to prevent the spread of COVID-19 as the people will not adhere to COVID-19 guidelines, hence there is a high chance of the increase in COVID- 19 infections. He/she was also not ready to be the first to get vaccinated, as he/she believes that elderly people should be prioritized. The participants also acknowledged that the ministry has appropriately trained and disseminated information to them prior to engaging them in the vaccine campaign. However, there was a concern that enhanced arrangements were to be made regarding follow-ups with His Majesty King Letsie III and his family regarding any effects after they received the Vaccination. Also, appropriate arrangements with the Prime minister, Minister of Health and other officials for their feedback were suggested by some of the participants. Most of the vaccinated staff, consulted here had some minor effects after getting vaccinated, ranging from dizziness, tiredness, mild headache, and swelling on injected area to rise in body temperature. However, most of these effects were communicated to them prior to Vaccination, hence they were not much worried. The participants do not believe that the Vaccination campaign may result in major environmental impacts, especially since they are carried out at the health facilities where the waste management systems are already in place. However, with regard to social impacts, they indicated that there are community members 226 who have been visiting their hospital because they also wanted to be vaccinated, which could result in some conflicts, or attempts to vaccine theft - mainly if the government delays to rollout the Vaccination program to the general population. The other concern is that they got vaccinated using AstraZeneca (while South Africa has rejected it) which might result in their being restricted to travel to South Africa even when they have been vaccinated. The participants also have a positive view and support on the Vaccination program in general. However, they believe that the government should improve more on communication and dissemination of information to the general population regarding the vaccine program. 227 B. Sample list of participants (at the Scott Hospital) Consulted on Lesotho COVID-19 EPRP-AF 228 229 C. Sample Consultation tool (Questionnaire) used for the EPRP-AF Consultations 230 231 232 Public Notice - EPRP AF Consultation 233 II. Consultations Conducted During the EPRP PP Preparations A. Sample list of stakeholders engaged during preparation of the Project ESMF 234 B. Stakeholder Engagements Public Notices a. Project ESMF and ICWMP public notice 235 b. Subproject (Mafeteng Hospital Renovations) public notice (Public notice in English) 236 (Public notice in Sesotho) 237 Annex 9: Sample E&S Impact Assessment Questionnaires (ESMF Preparation) A. Sample Consultation tool (Questionnaire ) used for the EPRP PP Consultations 238 Annex 10: Infection Control and Waste Management Plan (ICWMP) (Note: Attached as separate document) 239 Annex 11: Labor Management Procedures Labour Management Procedures (LMP) For the Lesotho COVID-19 Emergency Preparedness and Response Project Kingdom of Lesotho Ministry of Health Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Additional Financing (P176307) LABOUR MANAGEMENT PROCEDURES April 2020 Updated: April 2021 240 Table of Contents 1.0 Introduction.................................................................................................................................................. 230 2.0 Overview of Labour on the Lesotho COVID-19 EPR Project ..................................................................... 232 3.0 Assessment of Potential Labour Risks ........................................................................................................... 237 4.0 Overview of Labour Legislation: Terms and Conditions ............................................................................... 244 5.0 Responsible Staff ............................................................................................................................................ 245 6.0 Policies and Procedures .................................................................................................................................. 247 7.0 Disciplinary Procedures and Grievance Mechanism ...................................................................................... 251 8.0 Consultant/ Contractor Management .............................................................................................................. 253 Appendix 1: Consultant/contractor Safety, Health and Environment (SHE) file monitoring form ...................... 254 Appendix 2: Particulars of employment record .................................................................................................... 255 Appendix 3: Individual Code of Conduct ............................................................................................................. 256 Appendix 4: Contractors’ general guideline Covid-19 considerations in construction/civil works projects ................259 241 Abbreviations and acronyms ACRWC African Charter on the Rights and Welfare of the Children AIDS Acquired Immunodeficiency Syndrome DDRP Directorate of Dispute Prevention and Resolutions EBRD European Bank for Reconstruction and Development EHS Environment Health and Safety EHSG Environmental Health and Safety Guidelines EPRP Emergency Preparedness and Response Project ESMF Environmental and Social Management Framework ESS Environmental and Social Standards GBV Gender Based Violence GIIP Good International Industry Practice GRM Grievance Redress Mechanism HCW Health Care Waste HCWM Health Care Waste Management HIRA Hazard Identification and Risk Assessment HIV Human Immunodeficiency Virus IA Implementing Agencies IDA International Development Association IFC International Finance Corporation ILO International Labor Organization LMP Labour Management Procedures MPA Multiphase Programmatic Approach NEP National Environment Policy OHS Occupational Health and Safety PIU Project Implementing Unit PPE Person Protective Equipment RfP Request for Quotations SADC Southern Africa Development Community (SADC) SBCC Social and Behavior Change Communication SEA Sexual Exploitation and Abuse SEAH Sexual Exploitation, Abuse and Harassment SP Social Protection VHW Village Health Worker WASH Water, Sanitation and Hygiene WB World Bank WHO World Health Organization 242 1.0 Introduction 1.1 Background The outbreak of the coronavirus disease (COVID-19) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, China. On March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. Lesotho has been also severely affected due to the pandemic – with 10,686 positive cases recorded, and 315 deaths as of March 30, 2021.29 In order to respond to this global pandemic, the Government of Lesotho (GoL) has been implementing the Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) – the Parent Project (PP) - with World Bank (WB) financial support. The PP (P173939) was prepared and approved in May 2020 and became effective on May 27, 2020 with an amount of US$ 7.5 million. The recent PP Implementation progress review conducted in November 2020 has found the current ‘Progress Towards Achievement of the PDO’, and ‘Overall Implementation Progress’ as “satisfactory� for the PP. The Lesotho COVID-19 PP comprises of two main components: Component 1: This component has been supporting the government to enhance disease surveillance, improve sample collection and transportation, and ensure rapid laboratory confirmed diagnoses to promptly detect all potential COVID-19 cases and to carry out contact tracing to quickly contain COVID-19. The focus has been on: (i) screening travelers at all nine ports of entry (Maseru airport and cross-border areas, including when the current restrictions are lifted) as well as priority communities and targeted health facilities; (ii) diagnosing cases by setting up designated testing and laboratory sites, including inter alia through development of ‘minilabs’ using available GeneXpert machines, other PCR tech nologies and SARS-CoV-2 testing cartridges; (iii) carrying out contact tracing to minimize risk of transmission; (iv) conducting risk assessments to identify hot spot areas of transmission, including maps that can help visualize transmission; (v) providing on-time data and information for guiding decision-making and response and mitigation activities; (vi) referring cases for quarantining and/or treatment as needed, community and village health workers to strengthen surveillance efforts; and (viii) strengthening health management information system, DHIS2, specifically the COVID-19 module of DHIS2 that has been developed for this purpose to facilitate recording and on-time virtual sharing of information on COVID-19 patients. Component 2: This component has been supporting program coordination, management and monitoring, operational support and logistics, and project management. This includes support for the COVID-19 Incident Management System Coordination Structure; operational reviews to assess implementation progress and adjust operational plans; and provide logistical support. The project has been supporting in technical assistance, conducting representative rapid phone surveys targeting health workers and the general population as part of monitoring and evaluation, and operating costs. Further to GoL request to the WB in January 2021 for additional resources to expand the COVID-19 response with the objective to provide additional financing as well as technical assistance to the Ministry of Health (MOH)/GoL to adequately plan and roll out the vaccines for COVID-19, the proposed Additional Financing (AF) Project (P176307) will be a total envelope of US$25.5 million. It will be financed by the World Bank International Development Association (IDA) (US$22 million) and the Health Emergency Preparedness and Response Trust Fund (HEPRTF) (US$3.5 million). The AF is envisaged to provide essential resources to enable an expansion of a sustained and comprehensive pandemic response that will appropriately include also the vaccination program in Lesotho. 29 Lesotho - COVID-19 Overview - Johns Hopkins (jhu.edu) 243 The changes proposed for the AF entail expanding the scope of activities in the PP, and adjusting its overall design. An increase in scope and cost will be required to support: (i) vaccine and drug purchase; (ii) upgrading the cold chain for the vaccines; (iii) strengthening service delivery to ensure effective vaccine deployment; and (iv) monitoring, tracking of vaccine use and recording of any adverse reactions to vaccination. The AF is also required to extend the testing, PPE, and sustained communications and promotions around the national vaccine introduction (NVI) plan, inter alia. For the AF, the number of components, content of the components and the Results Framework of the PP are adjusted to reflect the expanded scope and activities proposed under the AF. Accordingly, Indicators on Gender (gender disaggregated data on the number of people receiving the vaccine) and Citizen Engagement (documentation of the participation including in the GRM/feedback mechanism) have been integrated for the AF. The implementation arrangements would remain the same while the closing date would be extended by two years (from June 30, 2022 to June 30, 2024). 1.2 Purpose of the Labour Management Plan The Labour Management Plan (LMP) was developed to manage risks that may rise during the implementation of the Lesotho COVID-19 Emergency Preparedness and Response Project funded by the World Bank (WB). The LMP is a living document to be reviewed and updated throughout development and implementation of the Project. The LMP stipulates the Project ‘s approach to meeting the requirements of the Labour Code of the Kingdom of Lesotho as well as the objectives of the World Bank’s Environmental and Social Framework regarding labour management. Accordingly, the purpose of this LMP for AF is a fore in an endeavour to facilitate the planning and implementation of the Project by setting out general guidance relevant to different forms of labour but also to issues and concerns that relate to COVID-19 considerations. The LMP directly addresses the objectives of the following environmental and Social Standards: • ESS 2 – Labor and Working Conditions • ESS 4 – Community Health and Safety The focus of the LMP is on workers (full-time, part-time, temporary or migrant workers) that are going to be employed by consultants or contractors during the implementation of the Lesotho COVID-19 EPR Project and also under the AF, therefore adhering to this procedure the consultants or contractors will be required to adapt this LMP and specific procedures will be inserted in the contracts as part of consultants’ legal obligations. The approach will be assessed as part of the initial screening of environmental and social risk and impact carried out by Lesotho COVID-19 EPR Project Implementation Unit. Included in this LMP is also summary of the stakeholders consulted (see Annex 9). 244 2.0 Overview of Labour on the Lesotho COVID-19 EPRP and the AF The Lesotho COVID-19 EPR Project activities will include different categories of workers, some of whom will be engaged in activities that raise COVID-19 exposure concerns. This LMP therefore, applies to all Project workers whether full-time, part-time, temporary, seasonal or migrant workers. The LMP is applicable, as per ESS 2 to all the Lesotho COVID-19 EPR Project workers as per the following condition: • People employed or engaged directly by Lesotho COVID-19 EPR Project to work specifically in relation to the Project; • The Government public servants, who provide support to the Project, will remain subject to the terms and conditions of their existing public sector employment agreement or arrangement; • People employed or engaged by consultants or contractors to perform work related to core function of the Project, regardless of location; • People employed or engaged by Lesotho COVID-19 EPR Project’s primary suppliers In general, projects supporting COVID-19 response activities will include different workers some of which will be more susceptible to the pandemic than others. As opposed to the Parent Project, significant community labour is envisaged due to the scope of this Project. However, the same conditions that apply to the Lesotho COVID-19 EPR Project as per ESS2 will also be adopted for AF. 2.1 Labour Requirements 2.1.1 Project Implementation Unit The Lesotho COVID-19 EPR Project has engaged the existing Project Implementation Unit (PIU) that is currently supporting the World Bank-financed Southern African Tuberculosis Health System Support Project and preparation of the Lesotho Nutrition and Health System Strengthening Project to oversee the implementation of the Lesotho COVID-19 EPR Project, including the Additional Financing Project. The Unit will engage throughout the Project the following personnel: • Project Coordinator • Administrator • Procurement Specialist • Project Accountant • Internal Auditor • Monitoring and Evaluation Specialist • Environmental and Social Specialist • Social Specialist • Community Liaison Officer • Driver The PIU will be strengthened to handle additional technical areas that will be required for working with additional sectors of the pandemic response, through staff support including engaging: • Epidemiologist, and • Program officer. Project Coordinator will be responsible for the overall implementation of this LMP, the focal person for labor related issues will be the Environmental and Social Specialist for the Project. Together, the Social Specialist and the Environmental and 245 Social Specialist will provide overall policy and technical direction for Environmental and Social management under the Project. They will coordinate with technical teams and stakeholders assigned to implement the subcomponents. Specifically, the PIU will have the overall responsibility of: • Implementing these labor management procedures; • Ensuring that the provisions in the LMP as they apply for the direct workers, contracted workers, community workers, are adhered to; • Monitoring compliance with occupational health and safety standards at all workplaces, including the additional measures put in place to prevent COVID-19 spread; • Ensuring that the grievance redress mechanism for Project workers is established and implemented and that workers are informed of its purpose and how to use it; • Have a system for regular monitoring and reporting on labor and occupational safety and health performance; and • Monitoring implementation of the Labour Code Order No. 24 of 1992 with its amendments. Medical Staffs at Health Care, and Vaccination Facilities The Project interventions in health, and vaccination facilities will require the services of following types of workers in health facilities. The exact number of workers at this moment is yet to be known, thus an estimated figure is given. Doctors. Doctors will include Specialists (Medicine Specialists, Anaesthesiologists, ICU Specialists, and any other relevant discipline), however, the exact number is yet to be determined. Nurses. There will both be Nursing Supervisors and Staff Nurses; the exact number is yet to be determined. Medical Technologists (Laboratory) and Other Discipline. A number of laboratory technicians will be employed for pathological testing, exact number not yet known. Waste Management workers. The waste management crew in various health centres where the Project interventions are planned is not yet known. COVID-19 Vaccinators. There will be health workers, who will be responsible for the rollout of the vaccine. An exact number of these workers in yet to be determined. Security Personnel (Military) for Logistics/Security Purposes. The security personnel will be engaged for transporting and enhancing security of the vaccines, medical supplies and accessories, especially to the remote areas. The precise number shall be decided at the time of actual engagement by the implementing agency (MoH) in consultation with the relevant stakeholders. 2.1.2 External Consultants or Contractors The PIU will engage external consultants or contractors to carry out some of the Project activities. Employees of the consultants or contractors will be managed in accordance with this LMP. It is expected that unskilled labour will be sourced from respective Project communities, and the overall labour requirements will form part of the Request for Proposal (RfP). The RfP will specify among other, a preference for local labour from the communities that fall within the Project area. 246 The exact number of Project workers which will be engaged through external consultants or contractors is currently, unknown. The bidding documents for the construction of sub-projects (renovation of health facilities) are yet to be prepared. The number of construction phase worker’s estimation for the sub-projects, based on experience gained from the similar projects undertaken in Lesotho and Worldwide would be roughly 16 persons. (not including direct workers). It is not expected that any single construction site would ever have more than 20 persons at the time. The main construction personnel would include the following: • Earth works – 4 workers • Construction crew – 4 workers • Maintenance and repair crew 8 workers It is expected that, most or all workers are likely to be from local and in-country labor force. Likewise, mobilization of the security personnel is envisaged mainly for the vaccination program under the EPRP-AF for the purposes of safety and security of the vaccines and other assets, and project personnel engaged in the vaccination activities. The number of such security personnel at a site expected to be up to five persons at a time. Security personnel are envisaged to be disengaged from the EPRP activities once the vaccination component is over. 2.1.3 Timing of labor requirements It is expected that the construction phase of the sub-projects (rehabilitation and renovation of health facilities) would last approximately 6 months, while other project activities, such as vaccinations, will run to the end of the project duration. Therefore, other workers except contraction workers are expected to be engaged throughout the project duration, and as per their terms of contracts. It is estimated that there will be 10 main workers responsible for the construction of each sub- Project. About 40% percent of the workers will be skilled laborers; with semi-qualified and qualified positions such as managers, engineers, foreman, technicians, etc. Majority of workers (unskilled labor) is likely to come from local communities, while other workers (skilled, technical) are expected to come from other parts of Lesotho. It is expected that Project will engage the following categories of Project workers as defined by ESS2: 2.1.4 Direct workers Direct workers would likely include the health workers who are the MoH’s technical staff. The MoH staff are civil servants. Project implementation will be led by a Project implementation unit (PIU), comprising of professional staff and consultants. The PIU will be responsible for all day-to-day management and coordination needs of the Project, including E&S aspects, and M&E. The estimated total number of direct workers would not likely exceed 20 staff from the PIU, Ministry of Health and relevant departments and individual specialists. It is estimated that the direct workers would include current PIU and other employees from different departments who will be assigned to work on this Project. It is expected that direct workers would also include independent consultants, who are specialized in certain disciplines (such as social safeguards and environmental subjects, etc.). The Labor Code shall apply to all consultants. Civil servants involved in Project operations, regardless of whether they work full time or part time, will continue to work under terms and conditions of their existing contracts or appointments in the public sector. The Project complies with the ESS2 provisions on occupational health and safety, and prohibition of child and forced labor applies to all Project workers. 2.1.5 Contracted Workers 247 Contracted workers would be hired under construction contractor(s). As the Bidding documents include sub-constructors for sub-projects and contracts will be awarded separately. Each contractor might need engagement of multiple subcontractors. The subcontractors’ workforce will be considered as contracted workers. It is estimated that the Project would engage between 16 and 20 contracted workers, in about five (5) subprojects, totaling to a maximum of 100 workers. While, health facilities are supported by Lesotho Millennium Development Agency (LMDA), the estimated contracted workers exclude these LMDA workers. The working environment and workplaces will comply with all requirements of the Environmental and Social Standard 2, Labor and Working Conditions, Section D: Occupational Health and Safety (OHS) requirements of The World Bank Environmental and Social Framework. 2.1.6 Community workers Community surveillance, mobilization and sensitization will be undertaken by the existing village healthcare workers within the Ministry of Health. These are full time government workers, and will be engaged throughout the entire implementation of the project. The following safety measures will be put in place to prevent or minimize exposure to COVID-19, as well as for addressing situations where there are cases of symptomatic workers: a) Set up a system at the community level that links up with health facilities and sub-county system for the management of COVID-19 related matters (this could be an e-system); b) Set up an online system (use WhatsApp for instance) to provide the VHWs with updates on COVID-19; c) Establish a referral system that will allow the VHWs to refer people with various COVID-19 related symptoms and questions. d) Develop training materials that will also give the VHC accurate information on COVID-19 including prevention and control measures; e) Equip the VHWs with basic protective equipment such as masks and sanitizers; f) Provide information on the GRM to be used in case of a community complaint (abuse, stigma, etc.) (GRM procedures have been outlined in the project GRM document); and g) Establish a monitoring system on the performance of the VHWs. 2.1.7 Migrant workers The Project is not expected to engage any migrant workers. 2.1.8 Primary Supply Workers A primary supply workers are workers employed or engaged by a primary supplier, providing goods and material to the project, over whom a primary supplier exercises control for the work, working conditions, and treatment of the person. However, the primary supply workers for this project are also expected to abide by the requirements of this management plan. The Project is thus anticipated to employ a range of workers portrayed below: Project activity Estimated Characteristics of Project Workers Timing of Contracted Workers Number of Labor Project Requirements Workers 248 Strengthen COVID-19 Currently National or international contractor, Construction Direct construction Case Detection, unknown and subcontractors may be engaged phase workers from firm Confirmation, Contact for upgrading/renovating labs or responsible of minor Tracing, Vaccination, isolation/treatment centers civil work for the Recording and Reporting establishing and Recruitment of local labor upgrading of health Establishing and upgrading recommended to (i) avoid labor facilities, vaccine laboratory, isolation and influx from other provinces, (ii) facilities, labs/centers. treatment centers, and reduce the need to set up labor camps vaccination facilities and equipping them Enhance disease Unknown National workers who drive trucks Construction, Direct and/or Contracted surveillance, improve at this stage and deliver medical supplies, and and Operation worker – those sample collection and vaccines, and equipment may be phase supplying or transporting transportation, and hired directly or contracted by medical and vaccine vaccine supplies. company/person selling the medical supplies and equipment equipment. Preparedness, Capacity Unknown Workers contracted for preparation, Operations Direct and/or Contracted Building and Training: at this stage and/or implementation of activities or worker -- NGO, CSO or communications and outreach consultant materials on COVID-19, including vaccination procedures, GBV, or conduct additional assessments Project Implementation 20 PIU staff Civil servants at MOH implementing Throughout the Direct worker and Monitoring: including the Project. whole Project Consultancy contracts procurement, safeguards, cycle are likely to be monitoring, costs for Consultants hired to support tendered to individual consultants, etc. implementation and monitoring consultants. activities such as online surveys 249 3.0 Assessment of Potential Labour Risks Project activities: The Project will provide COVID-19 related interventions (including testing, treatment, communication, laboratory, equipping ICU quarantine facilities, security, renovations and expansion civil works, waste management, vaccination, and program coordination, management and monitoring) in different health facilities. Key Labor Risks The major labor risks will emanate from hazardous work environment due to COVID-19 pandemic (Occupational Health and Safety, OHS) and sexual exploitation and abuse/sexual harassment (SEA/SH). Project workers may come into contact with hazardous wastes and with people diagnosed with COVID-19. It is therefore critical that all Project workers that are in direct contact with patients and/or medical or any other hazardous waste, follow strict protocols as recommended by the World Health Organization (WHO) and Occupational Health and Safety (OHS) measures highlighted in the ESMF. There are also some general construction-related risks linked to the upgrading or establishing of isolation/treatment centers and upgrading of laboratories. Guideline for Contractors to address COVID-19 issues will be appended in Appendix 4 following World Bank Interim Notes on Construction of Civil Work. The rest of the labour risks will be managed as follows: 3.1 Labour Influx It is not expected that there will be any labour influx in any Project community. The Lesotho COVID-19 EPR Project will mandate and localize the economic benefits and only allow for outside, including expatriate labour, where there is a requirement for special skills. There will not be any labour camps established for worker accommodation in the Project. Risks associated with interaction of Project workers and local communities, (such as communicable diseases and sexual exploitation and abuse/sexual harassment), will be managed through contractual requirements, Code of Conduct and training set out in this document. These procedures are guided by the national legislation. 3.2 Occupational Health and Safety The occupational health and safety measures and actions will be developed and implemented to assess and manage risks and impacts to the workers arising from project activities, from planning and design, construction, to operation of the project. Risks There will be OHS risks associated with planning and design phase, as well as construction stage of the project and its subprojects, such as risks associated with Working at Height, Slips, Trips, & Falls, Material & Manual Handling, Fires, Hazardous Chemicals, etc. However, there are also higher occupational health and safety risk that are anticipated during operation stages of the Project, directly associated with COVID-19, which include risk of infections to health care workers, including vaccinators. The healthcare workers (e.g., doctors, nurses, paramedics, emergency medical technicians) are at the front line of any outbreak response and as such are exposed to hazards that put them at risk of infection with an outbreak pathogen (in this case COVID-19). Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. The occupational health and safety of those involved in the Project is a significant issue as COVID-19 appears to be a highly contagious virus that spreads easily from person to person when in close proximity. In addition, some infected people may not know that they have become infected and may contribute to the spread unknowingly. Risk factors for worker exposure to COVID-19 include job duties that involve close (within 2 metres) contact with other workers, the community, and patients and healthcare workers in the health facilities. 250 However, during construction stage, exposure risks can increase for civil workers interacting with individuals with higher risks of contracting COVID-19 and for workers who have exposure to other sources of the virus in the course of their job duties. Mitigation measures A guideline for Contractors to address COVID-19 issues has been outlined in Appendix 4: contractors’ general guideline covid-19 considerations in construction/civil works projects. In addition, the consultants or contractors to be engaged will ensure that their employees/staff will be trained on occupational health and safety during daily or weekly tool box talks, and records of which are to be inspected weekly or monthly (depending of the duration of the subproject) and audited at the end of the Project. Moreover, COVID-19 control and prevention protocols will be put in place by all health facilities engaged in the project, which include among others the following: Public Education: Government and stakeholders must work together to distribute accurate information quickly. Information must be as clear, simple and consistent as possible across the entire passenger travel experience. General hygiene: Hand hygiene (washing hands with soap and water or, where this is not available, using alcohol-based hand-sanitising solution), respiratory etiquette (covering the mouth and nose when sneezing or coughing) and limiting direct contact with any surfaces at the airport and in the aircraft to only when absolutely necessary should be observed at all times unless otherwise advised by airport staff or aircrew members. Physical Distancing: To the extent feasible, people should be able to maintain social distancing consistent with World Health Organization (WHO) or applicable National health guidelines. Face Coverings and Medical Masks: Face coverings and medical masks should be worn consistent with the applicable public health guidelines, including whom to exempt (e.g. young children or passengers that cannot tolerate a face covering or medical mask such as individuals with physical disabilities, respiratory or other conditions). Always follow best practice about when and how to wear, remove, replace, and dispose of face coverings and medical masks in addition to proper hand hygiene following removal. Face coverings should be two or more layers and fully cover the nose and mouth. The face covering or medical mask should be worn during all phases of flight except while eating. It should be replaced when it is no longer functional (e.g. becomes wet). Medical masks should be prioritized for use as personal protective equipment by healthcare workers, passengers at high risk of developing complications due to COVID-19, and symptomatic persons suspected of being infected with COVID-19. Face coverings and medical masks with exhalation valves can transmit the virus and should not be used. Routine Sanitation: High touch surfaces should be cleaned and disinfected as prescribed by public health authorities with frequency based on operational risk assessment. Health Screening: Government should ensure that health screening, at exit or entry, is conducted in accordance with the protocols of the ministry of health. Screening could consist of pre-work and post-work health declarations, non-invasive temperature measurement and/or visual observation conducted by employees trained to recognise signs suggestive of COVID-19 and in the use of these measures. Such screenings could identify ill persons that may require additional examination prior to 251 working. This screening may be conducted upon entry and/or exit at any project area. Temperature and other symptom- based screening could be a part of a multi-layered approach but should not be relied on as a stand-alone mitigation measure as it has limited effectiveness, in detecting COVID-19 cases. The virus can be associated with mild symptoms or asymptomatic infections and is transmitted from both pre-symptomatic or asymptomatic individuals. If a person shows signs and symptoms suggestive of COVID-19, or their declaration form shows a history of respiratory infection or/and exposure to high-risk contacts, appropriate follow up would be necessary, including a focused health assessment performed by healthcare personnel either in a dedicated interview space at project area, or in an offsite pre- identified health care facility. Health Monitoring and Contact Tracing: Methods for the collection of employee contact information should be in place, including through web applications, or physical files. Such information is critical to support public health authorities in contact tracing should this be warranted following the identification of a COVID-19 case. Updated contact information should be requested as part of the above mentioned declaration. 3.3 Gender-Based Violence (GBV) and Violence Against Children (VAC) Construction workers are often younger males. Those who are away from their families and communities and may act outside their normal sphere of social control. This may result in inappropriate behaviour, such as sexual harassment of women and girls, exploitative sexual relations, and illicit sexual relations with minors from the local community as well as health care workers. However, due to the nature and scope of the Project, only a few specialised personnel will be engaged and majority of unskilled labor will be recruited from neighbouring communities and all construction works will be confined to the boundaries of existing health care facilities. Thus, the SEA/SH risk is expected to be moderate and manageable. Additionally, contraction workers will be provided with the necessary GBV/SEAH training and sign code of conducts prior to commencement of works. Appropriate measures will also be put in place to mitigate GVB/SEAH risks in quarantine/isolation facilities. Gender is a critical consideration when designing policies and interventions in emergency situations and pandemics. Gender plays an important role in who gets access, and how fast, to critical health services. Gender also determines the social roles ascribed to people that can influence their risk of exposure to disease, as well as of spreading it. At the same time, the biological sex can influence how susceptible a person is to disease and how well they respond to treatment and/or vaccines. In a pandemic, this has multiple implications. On the one hand, pandemic response has to be cognizant of the gender-based differences in access to and use of services due to limited mobility and financial capacity; and on the other, support needs to be provided to at-risk groups such as caregivers (the majority of whom are women taking care of children and the elderly) to reduce their risk of getting ill and/or passing it on to others. Moreover, pandemics can create or exacerbate economic and social vulnerabilities that especially put women and girls at risk of sexual exploitation. Health care workers involved in the deployment of vaccines are comprised mostly of women, which in turn enhances outreach to women. Women generally bear heavier care responsibilities at home, such as child and elder care. These female health workers (as well as males with care responsibilities) may therefore need alternative care arrangements as they perform their duties in the deployment effort. 252 The frontline health workers are also among the top three priority population groups to be given the COVID-19 vaccination, along with indigent senior citizens, and the remaining senior citizens. If the vaccination will cause any significant side-effects to vaccine recipients, this will compound the need for alternative care arrangements for female vaccine recipients who have care responsibilities at home. Risks GBV and VAC risks may include the following: • Quarantine measures, together with fears over COVID-19, livelihood impacts as a result of any restrictions in movement, social isolation and increased economic pressures and loss of jobs (informal or formal sector) may exacerbate household tensions and lead to an increase in GBV and VAC. • School closures mean children are at home and this could increase risk of VAC and GBV, in particular if family members are stressed, drinking or violent. Young females may be in particular risk. • Project staff (civil servants and outsourced staff/contractors) may be involved in misconduct behaviours impacting women and children at local level. Mitigation Measures The following measures should be considered in mitigating GBV and VAC risks: • Communication materials should include advice to cope with psychological aspects of the COVID-19 pandemic, including loss of jobs and quarantine measures. For instance, there should be information on how to cope with stress and anxiety, recommendations on how to talk to children, etc. Information materials should provide links to resources/organizations that can provide support. • Ensure that GBV-resolution mechanisms and GBV and other mental health services continue to be well resourced as there may be increased demand for their services. NGOs or other organizations working on GBV or mental health may need to be supported to increase their services (or, for instance, enhancing support to a hotline to report cases or to women’s shelters). • Apply the WHO Code of Ethics and Professional Conduct - Code of Conduct (CoC) for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructure, such as segregated toilets and enough light in quarantine and isolation centers. • The CoC should be included in the letter of staff appointment and contracts (for contracted workers) in line with relevant national laws and legislations and the EPRP Labor Management Procedures (LMP). • Awareness/Training on community interaction and GBV/VAC to be provided for all teams, staff (civil servants and outsources staff/contractors) to ensure the teams respect local communities and their cultures, and not engage in any misconduct. • When sourcing for primary suppliers, the Project will require such suppliers to identify the risk of child labor/force labor and serious safety risks. The PIU will review and approve the purchase of primary supplies from the suppliers following such risk identification/assessment. Where appropriate, the Project will be required to include specific requirements on child labor, forced labor and work safety issues in all purchase orders and contracts with primary suppliers. The PIU will, as part of its monitoring, include indicators for assessing the functions of primary supply workers. 253 Labor Rights and Gender Risks The following potential risks at health facility may occur: • Workers, in particular health personnel (especially nurses) and cleaners, may be asked to work overtime to respond to the COVID-19 pandemic. It is important that these personnel are able to access overtime pay as needed and required by law; • Women in particular, if they are single heads of household and have child-care duties may have difficulties responding to requests for overtime; • Health care and other staff, including cleaners, or workers in upgrade/rehabilitation may need medical care if they contract COVID-19; • Health workers, a big proportion who are female, may face mental issues or burnout as result of an outbreak; and • Health workers, cleaners or workers involved in upgrades experiencing respiratory symptoms may fear not getting paid and continue to show up at work. • There is a risk that health care workers are exposed to COVID-19 during the initial screening and vaccine administration in the health facility or community setting. • There is also a risk that the cleaners and waste collectors of the health care facilities and waste service providers are exposed. There are some risks of underage workers working as cleaners in medical facilities or transporting medical supplies or equipment. Labor law prohibits anyone under 18 years being involved in hazardous work. Mitigation Measures The following mitigation measures are applicable to labor rights and gender as per the Lesotho labor law and consistent with ESS2: • All workers must be paid for overtime in accordance with Government labor laws; • All workers must be provided with security of medical care, in particular ensuring they can access free medical care if they contract COVID-19. • Ensure that staff with lower qualification or less experienced working in the health sector (e.g., cleaners, part-time workers, etc.) - often female workers - also have access to the required Personnel Protection Equipment (PPE) – including gloves, gowns, masks and eye protection if exposed to patients with COVID-19, their waste, clothes or linen – and training to make sure they work in a safe environment; • Vulnerable workers should be identified, such as female single heads of household, who may need additional support in order for them to do their job (for instance, female nurses who are single heads of household may need additional support if they have to work overtime). Additional support to consider may include cash grants, access to food support or provision of childcare services; • Health care workers must be actively supported by their employers and commended for their work, as well as offered psychological, emotional or mental support if possible; 254 • All workers must be reassured that they will continue to get paid if they need to self-isolate if they are showing with COVID-19/respiratory symptoms. These provisions must be made including for contracted staff and are included in the Labor Management Procedures (LMP); • Child labor or indentured labor is absolutely prohibited in the Project. All medical staff, cleaners, and all others handling equipment, tests, wastes, etc. or involved in the transportation of medical equipment and supplies related to the project must be over 18 years. Community Health and Safety Risks Potential community health and safety risks associated with the project activities include: • Transport of wastes, transport of lab tests, transport of people who have tested positive with COVID-19 and movement of health workers and other staff in contact with patients with COVID-19, has the potential to spread the virus in the community (note transport of medical supplies and equipment is not expected to result in virus transmission); • Communities may have fear and apprehension on COVID-19 vaccine efficacy and safety due to the novelty and relative timeframe of development; • The proper storage conditions and transport of the vaccines are also major risks as they are needed to ensure the efficacy and safety of the vaccine. • Misinformation and disinformation on the adverse health effects of vaccines and hearsays on the conspiracy theories and underlying political agenda on the vaccines are widespread. • There is a risk of adverse health effects if the profiling and screening of candidate individuals to be vaccinated and proper data management were not observed to consider vaccine contraindications. • Crowding or influx of people in the vaccination sites as well as the violation of physical distancing are also risks. • Use of Security and Military personnel in the delivery and distribution of the vaccines may also exist. • Health workers may face discrimination and harassment when going back to their communities due to people’s fear in contracting the virus, frustrations over medical care or misinformation; • Screening of people entering the country, in particular land borders with migrants coming back into Lesotho, as well as checks and/or enforcement of any community movement restrictions or quarantine/lockdown or social restriction measures, could lead to abuse of power by law enforcement, fear from community members (especially the elderly), a potential for discrimination of marginalized groups, GBV, Sexual Exploitation and Abuse (SEA) and/or VAC; Mitigation Measures The Stakeholder Engagement Plan (SEP) provides measures for stakeholder engagement at participating health facilities to inform local communities of project activities, seek their feedback on potential risks and mitigation measures. The following community health and safety measures will be applied: • Transport of all COVID-19 wastes and lab tests, blood samples, etc., should be collected safely in designated containers and bags, treated and then safely disposed; • Collection of samples, transport of samples and testing of the clinical specimens from patients meeting the suspect case definition should be performed in accordance with biosafety measures and WHO guidelines on Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases; 255 • Transport of medical equipment/supplies is not expected to be a vector in transmitting the virus, however, workers transporting materials should be reminded to wash hands appropriately and to avoid touching their face; • To ensure the safety of the vaccines to be procured, the vaccine regulatory approval of the Stringent Regulatory Authorities (SRAs)30 identified by the World Health Organization will be required; • Appropriate messages will be developed under the risk communication plan to address the vaccine safety concerns of communities; • A Communications Campaign Plan will also be developed by the MoH/EHD/DOH/PIU for the COVID-19 vaccination program. It will have a whole-of government, whole-of-system, and whole-of-society approach which will encompass general information on (i) COVID-19 and the need for sanitation and hygiene practices, (ii) COVID- 19 vaccine basic information, (iii) trials results and procurement, and (iv) vaccine program roll-out, amongst others. The WHO Risk communication and community engagement readiness and response to coronavirus disease (COVID- 19) released on 19 March 2020 will also be used as reference in the development of messages and planning of risk communication and community engagement (RCCE) activities. • A series of counselling and obtaining of informed consent will be conducted prior to the administration of the COVID- 19 vaccine; • The profiling and screening of candidate individuals to be vaccinated should be performed so as to avoid the risk of vaccine contraindications; • A comprehensive data management system is also needed to support the profiling, screening, and scheduling to address the risk of individuals not completing the required shots/doses of the vaccine; • Coordination with the local government units as well as the uniformed personnel will be done to assist in crowd management; • Training must be provided to medical and other staff (doctors, nurses, cleaners, lab technicians, etc.) in contact with patients with COVID-19 and/or their wastes, clothes, linen or tests, on disinfection procedures when going back to their homes/communities. In extreme cases, this may involve isolating medical and other personnel involved with COVID-19 patients; • Any medical or other hospital staff (including cleaners) experiencing symptoms of COVID19 or a respiratory illness (fever + cold or cough) must remain at home/isolated and report symptoms immediately to supervisors; • Communication materials must reinforce the positive contribution of health care workers and other essential workers and their need to be supported by community members; • Communication materials should make clear the steps health workers and other staff are taking to protect themselves against the virus and their use of PPE; • Ensure widespread engagement with communities in order to disseminate information related to community health and safety, particularly around social distancing, hand washing, high-risk demographics, self-quarantine, and mandatory quarantine; Workers and law enforcement personnel must adhere to Code of Conduct (CoC), including fair treatment and non-discrimination when carrying out their duties. Key points in CoC must be publicly available as part of disclosure and law enforcement personnel must be made aware and trained in key items (especially non- discrimination, OHS and issues relating to GBV). 30 World Health Organization. (June 2020). Essential medicines and health products: List of stringent regulatory authorities (SRAs). https://www.who.int/medicines/regulation/sras/en/. 256 • Security and military personnel may be utilized for vaccine deployment. It will be ensured that the security personnel follow a strict code of conduct and avoid any escalation consistent with the ESF and WB/IFC guidance on the use of security personnel (IFC Good Practice Handbook on the Use of Security Forces: Assessing and Managing Risks and Impacts). The MoH/PIU has assessed potential risks and impacts likely to be posed by these security arrangements to project workers and the local community. A dedicated Security Management Plan (SMP) has been prepared accordingly which is consistent with the relevant requirement of the World Bank’s ESS4, and the legislations of the GoL. Security personnel will provide security services in a manner consistent with the applicable laws and code of practices as have been documented in the SMP, and applicable other legislations. • MoH/PIU will ensure that the workers and local community are informed about the security arrangements and the project’s GRM. MoH/PIU will review any allegations of unlawful or abusive acts of security personnel, take action (or urge appropriate parties to take action) to prevent recurrence and, where necessary, report unlawful abusive acts to the relevant authorities. Any incidents, concerns or grievances regarding the conduct of security personnel will be received, monitored, documented (taking into account the need to protect confidentiality), and resolved through the Project’s grievance mechanism. Any severe incidents with such personnel need to be reported to the Bank no later than 48 hours with basic information and a detailed incident report within 10 working days. Details about incident reporting are included under the Labour Management Procedures (LMP). Regular community consultations will be conducted continuously to identify the additional risks and mitigation measures in the health care facilities as well as their additional needs. The Grievance Redress Mechanism is already in place. COVID-19 CONSIDERATIONS COVID-19 specific risks will relate to the activities undertake by the workers, in the context within which the Project operates, and appropriate mitigation measures should be implemented that adhere to the Lesotho Public Health Act, 1970 : Public Health (COVID-19) Regulations, 2020 (2), which amongst others, clearly defines the requirements with regard to the following: Prevention of introduction and spread of COVID-19, Restrictions on transport, Operating hours and mode of operation for entities, enterprises and businesses , Fumigation and disinfection of public places and places of business , Medical screening and testing , Quarantine , etc. Where there is a gap with the national Public Health Act, specifically with the Public Health (COVID-19) Regulations, and other relevant regulations, the WHO guidelines and other good international industry practice (GIIP) should be applied. Reference may also be made to applicable international conventions, and directives for addressing health and safety issues relevant to COVID-19, such as: ▪ ILO Occupational Safety and Health Convention, 1981 (No. 155) ▪ ILO Occupational Health Services Convention, 1985 (No. 161) ▪ ILO Safety and Health in Construction Convention, 1988 (No. 167) ▪ WHO International Health Regulations, 2005 ▪ WHO Emergency Response Framework, 2017 ▪ EU OSH Framework Directive (Directive 89/391) The project level risks identification measures, will assist designing appropriate mitigation measures to address COVID- 19 risks, including: • conducting pre-employment health checks • controlling entry and exit from site/workplace 257 • reviewing contract durations, to reduce the frequency of workers entering/exiting the site • rearranging work tasks or reducing numbers on the worksite to allow social/physical distancing, or rotating workers through a 24-hour schedule • providing appropriate forms of personal protective equipment (PPE) • putting in place alternatives to direct contact, like tele-medicine appointments and live stream of instructions. 258 4.0 Overview of Labour Legislation: Terms and Conditions Lesotho has national legislation that outlines worker’s rights. The Labor Act (1997) remains the key document governing the regulatory framework for labor in Lesotho. Thus, the Labor Code is the primary law protecting the employment rights of individual workers covers protection of wages; contracts; employment terms and conditions; recruitment; classifies workers; prohibits child labor and all forms of forces or compulsory labor. The Act defines the legal minimum age for employment as 15, or 18 for hazardous employment and prohibits worst forms of child labor. The Lesotho constitution also encourages the formation of independent trade unions to protect workers' rights and interests and to promote sound labour relations and fair employment practices. This Project will comply with the World Bank code of conduct for all its labour related matters in conjunction with the Lesotho labour Code. The Labour Code Order of 1992 provides for the amendment, consolidation and codification of laws relating to employment. Part I: Preliminary Part II: Interpretation and fundamental provisions; Part III: Administration and Adjudication; Part IV: Wage fixing machinery; Part V: Contacts of Employment, Termination, Dismissal, Severance pay; Part VI: Protection of Wages; Part VII: Health, Safety and Welfare at work; Part VIII: Weekly rests, Hours of Work, holidays with pay, educational leave, sick leave; Part IX: Employment of young persons, women and children; Part X: Labour Agents; Part XI: Contracts of Foreign Service, Part XII: Employment of Non-Nationals; Part XIII: Trade Union Organisations and employer’s organisations. Establishment and Registration; Part XIV: Trade Unions and Employer’s Organisations. Membership, Officers, rules; Part XV: Unfair labour practices; Part XVI: Property, funds and Accounts of Trade unions and employer’s organisations; Part XVII: Rights and liabilities of trade unions and employer’s organisations; Part XVIII: Settlement of Trade disputes; Part XIX: Strikes, lock outs and Essential Services; Part XX: Picketing, intimidation and other matters related to trade disputes; Part XXI: Miscellaneous, repeals and amendments. It is therefore, very important that all consultancies or contractors engaged in the Lesotho COVID-19 EPR Project, and its additional financing, comply with the Labour Legislations of the Kingdom of Lesotho and with serious consideration of the following sections: 4.1 The Labour Code Wages (Minimum Wages) Notice of 2019 This labour code deals specifically with the minimum wages and basic terms and conditions of employment in all sectors of economic activity in the Kingdom of Lesotho. 4.2 The Labour Code (Codes of Good Practice) Notice 2003 Published by the Minster of Labour after consultation with the Industrial Relations Council through the provision made in Section 240 of the Labour Code, a code of good practice is what is called “soft law�. Therefore, do not impose any obligation to any person. They constitute policy or best practice – in other words what is expected of a person. The code of a fair procedure describes the kind of practices that are expected of an employer before dismissing an employee. It gives content to the meaning of a ‘fair procedure’. An employer may depart from the provisions of the code but if it does so it will have justified why it did so. The Codes of Good Practice also cover arbitration and conciliation. The arbitrator and conciliation codes are generally directed to an arbitrator or conciliator. They are directed to a decision-maker and constitute official executive policy. But no decision maker under administrative law may fetter his or her discretion. Accordingly, a conciliator or arbitrator must take all relevant facts and law into account, including the codes, before making a decision and may depart from the official policy if the circumstances justify a departure. In other words, like codes, the policy must be flexibly applied. The 259 publication of policies is permissible under administration law. The publication of these policies after tripartite consultation is a step to improving transparency and consistency in decision making. 4.3 Occupational Health and Safety Hazardous (Health Care) Waste management Regulations (2012) This covers all aspects of waste management, i.e., both general or non-hazardous waste and hazardous waste. It addresses health care waste, both general and risk waste (GoL, 2008b). The objectives of these regulations are to make provision for the generation, transportation, storage, importation, exportation, recycling and disposal for both hazardous and non-hazardous waste. It also makes provision for institutional measures for the control and management of hazardous and non-hazardous waste. The Labor Code further includes provisions on Occupational Health and Safety (OHS) mostly consistent with ESS2 and ESS 4 of the World Bank’s Environmental and Social Framework (ESF). Additional measures must also be taken compliant with WHO guidelines on COVID-19, as outlined in this ESMF. Participating Health facilities or institutions must comply with the requirements of these regulations and handle all waste accordingly. 4.4 Age of Employment Lesotho has ratified all relevant ILO conventions, such as those on forced labor, freedom of association, right to organize and collective bargaining, equal remuneration, minimum age, discrimination and child labor. The country also adopted the African Charter on the Rights and welfare of the Children (also known as ACRWC or Children’s Charter). The minimum age of employment for this Project shall be 18 years and to ensure compliance, all employees will be required to produce National Identification Cards as proof of their identity and age which is the national identification required for employment, at any point in time as may be required by the PIU. If any consultant or other entities employ a person under the age of 18 years, that consultant or entity will not only be terminated but also reported to the authorities. 5.0 Responsible Staff This section identifies the function and/or individuals/agencies within the Project responsible for oversight mechanisms. 5.1 Engagement and Management of Direct Workers The Ministry of Health (MOH) through the PIU is responsible for engagement of direct workers/contractors and compliance with contract conditions (payment of invoices). The MOH will address all LMP aspects as part of procurement for works (such as transport of medical supplies, minor civil works to renovate labs or medical facilities, consultancy/technical assistance, etc.). The PIU established in MOH will be responsible for overseeing all aspects of implementation of the Project, including compliance of direct workers and contractors, and monitoring and evaluation. 5.2 Engagement and Management of Sub-Contracted Workers 260 The Contractor is responsible for management of their workers or subcontracted workers in accordance with this LMP, which will be supervised by MOH. This includes ensuring compliance with key aspects, in particular those relating to COVID-19 prevention and general OHS. 5.3 Labor and Working Conditions Contractors will keep records in accordance with specifications set out in this LMP. MOH may at any time require records to ensure that labor conditions are met and that prevention mechanisms and other safety issues, general to OHS and specific to COVID-19, are being followed. MoH will review records against actuals at a minimum on a monthly basis and can require immediate remedial actions if warranted. A summary of issues and remedial actions will be included in quarterly reports to the World Bank. 5.4 Training of Workers The COVID-19 AF implementation entities are required to have a designated safety officer. The contractor, wherever engaged, must train staff on OHS measures, hygiene practices, precautions against COVID-19, and other aspects of this LMP as appropriate. Contractors, must make staff available for any mandatory trainings required by MOH, as specified by the contract. Meanwhile MOH must ensure adequate training and materials are provided to direct workers, such as those working on communication materials, screening, etc. 5.5 Addressing Worker Grievances MOH and Contractors will be required to implement a Grievance Redress Mechanism (GRM) for workers which responds to the minimum requirements in this LMP. The PIU will review records regularly. PIU will keep abreast of GRM complaints, resolutions and reflect in quarterly reports to the World Bank. The environment and social officer will oversee the implementation of the workers’ GRM. 5.6 Occupational, Health and Safety Contractors on civil works must designate a minimum of one safety representative to ensure day-to-day compliance with specified safety measures and OHS, including on precautions against COVID-19, and record any incidents to MOH on a monthly basis; serious incidents should be reported immediately. Cases of COVID-19, and actions taken, should also be reported immediately. Minor incidents should be reflected in the quarterly reports to the World Bank, and major issues should be flagged to the World Bank immediately. Further to enforcing the compliance of environmental and social management, contractors will be responsible and liable for the safety of site equipment, laborers and daily workers attending to the construction site and safety of citizens for each subproject site, as mandatory measures. Worker Grievances. All contractors will be required to establish a worker grievance redress mechanism (GRM, described in detail below) which responds to the minimum requirements of ESS2. The PIU’s Environment and Social Officer as well as Social Officer will review records on a monthly basis. Where worker concerns are not resolved, the national system will be used, however, the PIU will keep abreast of resolutions and reflect in quarterly reports to the World Bank. 261 6.0 Policies and Procedures Most environmental and social impacts of the Project resulting from activities directly under the control of contractors will be mitigated directly by the same contractors. As such, the approach is to ensure that contractors effectively mitigate Project related impacts. PIU will incorporate standardized environmental and social clauses in the tender documentation and contract documents in order for potential bidders to be aware of environmental and social performance requirements that shall expected from them, are able to reflect that in their bids, and required to implement the clauses for the duration of the contract. As a core contractual requirement, the contractor is required to ensure all documentation related to environmental and social management, including the LMP, is available for inspection at any time by MOH. The contractual arrangements with each Project worker must be clearly defined. All environmental and social requirements will be included in the bidding documents and contracts. In addition, MOH will be responsible to ensure that safe messaging around COVID-19 prevention and OHS measures are distributed and available to all Project staff directly hired/working for MOH, as per provisions in this LMP. All Project workers must be aware and sign the Manager’s Code of Conduct and/or the Individual Code of Conduct (see Appendix 3), as applicable. 6.1 Occupational Health and Safety (OHS) All Project workers should receive training on OHS as well as COVID-19 prevention, social distancing measures, hand hygiene, cough etiquette and relations with local community. Training programs should also focus, as needed, on COVID- 19 laboratory bio-safety, operation of quarantine and isolation centers and screening posts, communication and public- awareness strategies for health workers and the general public on emergency situations, reporting and actions on COVID- 19 cases in the workforce, as well as compliance monitoring and reporting requirements, including on waste management based on the existing instruments prepared as part of the ESMF, OHS and Project’s labor-management procedures, stakeholder engagement and grievance mechanism. The Health and Safety specifications will include the following provisions: • Ensuring workplace health and safety standards in full compliance with Lesotho laws, at a minimum, and including o basic safety awareness training to be provided to all persons as well as on COVID-19 prevention and related measures; o all vehicle drivers to have appropriate licenses; o safe management of the area around operating equipment inside or outside hospitals/laboratories/treatment facilities/isolation centers; o workers to be equipped with safety equipment/PPE equipment as needed (particularly facemask, gowns, gloves, handwashing soap, and sanitizer) to protect from COVID-19; o secure scaffolding and fixed ladders to be provided for work above ground level; o First aid equipment and facilities to be provided in accordance with the Labour Code; o at least one supervisory staff trained in safety procedures to be present at all times when construction work is in progress; o adequate provision of hygiene facilities (toilets, hand-washing basins), resting areas etc. separated by gender as needed and with distancing guidelines in place; • Comply with Lesotho’s legislation, WB’s ESS2 requirements and other applicable requirements which relate to OHS hazards, including WHO specific COVID-19 guidelines, 262 • All workplace health and safety incidents to be properly recorded in a register detailing the type of incident, injury, people affected, time/place and actions taken including COVID-19 cases in the workforce, which should be reported to the PIU and the World Bank immediately; • All workers (irrespective of contracts being full-time, part-time, temporary or casual) to be covered by insurance against occupational hazards and COVID-19, including ability to access medical care and take paid leave if they need to self-isolate as a result of contracting COVID-19; • Procedures confirming workers are fit to work, which may include temperature testing and refusing entry to sick workers (with insurance in place to cover payment, as described above); • All work sites to identify potential hazards and actions to be taken in case of emergency; • Any on-site accommodation to be safe and hygienic, and with distancing guidelines in place, including provision of an adequate supply of potable water, washing facilities, sanitation, accommodation and cooking facilities; • Workers residing at site accommodation to receive training in preventing prevention of infection through contaminated food and / or water, COVID-19 prevention and avoidance of sexually transmitted diseases; • Provide laminated signs of relevant safe working procedures in a visible area on work sites, in English and Sesotho as required, including on hand hygiene and cough etiquette, as well as on symptoms of COVID-19 and steps to take if suspect have contracted the virus; • Fair and non-discriminatory employment practices; • Provide PPE as suitable to the task and hazards of each worker, without cost to the worker; • Under no circumstances will contractors, suppliers or sub-contractors engage forced labour; • All employees to be aware of their rights under the Labour Code, including the right to organize; • All employees to be informed of their rights to submit a grievance through the Project Worker Grievance Mechanism; • All employees to be provided training on appropriate behaviour with communities, gender-based violence and violence against children (also see Codes of Conduct). 6.2 Terms and Conditions of Employment The terms and conditions of employment for the Project workers are governed by the provisions of the Lesotho Labor Code and ESS2 requirements. Upon receiving the Project contract, the Contractor shall certify in writing that the wages, hour and conditions of work or persons to be employed by him on the contract are not less favourable than those contained in the most current wages regulation issued by the government. The Contractor shall maintain worker’s register which will be available for inspection during working hours. 6.3 COVID-19 Considerations The Project will employ workers/ laborers for both civil works and health service delivery. While Annexes 1, 2, 4, 11, 12 and others provide relevant further details, specific provisions for the minor construction/rehabilitation/civil works are indicated below: Construction/Civil Works. The contractors will ensure adequate precautions are in place to prevent or minimize an outbreak of COVID-19, and provisions when a worker gets sick. This will include: • Confirming workers are fit for work, to include temperature testing and refusing entry to sick workers; 263 • Considering ways to minimize entry/exit to site or the workplace, and limiting contact between workers and the community/general public; • Training workers on hygiene and other preventative measures, and implementing a communication strategy for regular updates on COVID-19 related issues and the status of affected workers; • Treatment of workers who are or should be self-isolating and/or are displaying symptoms; • Assessing risks to continuity of supplies of medicine, water, fuel, food and PPE, taking into account international, national and local supply chains; • Reduction, storage and disposal of medical waste; • Adjustments to work practices, to reduce the number of workers and increase social distancing; • Expanding health facilities on-site compared to usual levels, developing relationships with local health care facilities and organize for the treatment of sick workers; • Establishing a procedure to follow if a worker becomes sick (following MOH and WHO guidelines); • Implementing a communication strategy in relation to COVID-19 issues on the site. 6.4 Health Service Delivery including Vaccine storage, transportation and deployment Contractors of employers should have plans or procedures are in place to address the following issues: • Obtaining adequate supplies of medical PPE, hand washing soap and sanitizer; and effective cleaning equipment; • Training medical staff on the latest MOH advice and recommendations on the specifics of COVID-19; • Conducting enhanced cleaning arrangements, including thorough cleaning (using adequate disinfectant) of catering facilities/canteens/food/drink facilities, latrines/toilets/showers, common areas, including door handles, floors and all surfaces that are touched regularly; • Training and providing cleaning staff with adequate PPE when cleaning consultation rooms and facilities used to treat infected patients; • Implementing a communication strategy/plan to support regular communication, accessible updates and clear messaging to health workers, regarding the spread of COVID-19 in nearby locations, the latest facts and statistics, and applicable procedures; • Prioritizing different groups for allocation of vaccines, based on WHO guidance for the fair and equitable allocation of COVID-19 vaccination or national regulations (as appropriate); • Training medical staff on the latest WHO advice and recommendations on the specifics of COVID-19, and principles on fair, equitable and inclusive access and allocation of Project benefits, including vaccines • Training medical staff on the priority groups for allocation of vaccines and the timetable for these groups, as well as why they are required to only vaccinate persons from the particular priority group at the particular time (for example, because that group is at higher risk, for reasons of inclusion and equity etc. where there is limited supply of vaccines); • Improving community perception of vaccination programs, particularly where they are taking place in fragile, conflict or vulnerable settings such as IDP camps or affecting vulnerable sectors (e.g. children under 5, pregnant women, elderly, hard-to-reach), by sensitizing community members on the safety and efficacy of the vaccine, and building public trust in the ability of the vaccination campaign to avoid increased risk of COVID-19 infection; • For vaccination sites, ensuring that the space is organized in a safe and socially distant manner, and necessary logistical controls and waste management are planned for in advance; • For the deployment and use of vaccines, safe cold-chain practices, checking that vaccines are approved for use by WHO or another regulatory authority agreed by the Bank, selecting safe injection equipment, immunization practices for vulnerable people such as pregnant women or children under 5, immunization waste-disposal plan, supervision and reporting on implementation of immunization practices as required under national legislation; 264 • Conducting enhanced cleaning arrangements, including thorough cleaning (using adequate disinfectant) of catering facilities/canteens/food/drink facilities, latrines/toilets/showers, common areas, including door handles, floors and all surfaces that are touched regularly; • Training and providing cleaning staff with adequate PPE when cleaning consultation rooms and facilities used to treat infected patients; • Implementing a communication strategy/plan to support regular communication, accessible updates and clear messaging, regarding the spread of COVID-19 in nearby locations, the latest facts and statistics, and applicable procedures. 265 7.0 Disciplinary Procedures and Grievance Mechanism In any working environment it is essential for both employers and employees to be fully conversant with all aspects of disciplinary processes, the grievance handling procedures and the legal requirements and rights involved. In implementing an effective dispute management system consideration must be given to the disputes resulting from the following: • Disciplinary Action • Grievance Redress Mechanism (GRM) 7.1 Disciplinary Procedure The starting point for all disciplinary action is rules. These rules may be implied or explicit and of course will vary from workplace to workplace. Some rules are implied in the contract of employment (e.g., ruling against use of alcohol and drugs at workplace), however it is advisable that even implied rules be included in the disciplinary code or schedule of offences. Therefore, the workplace rules must be: • Valid and reasonable • Clear and unambiguous • The employee must understand the procedure to be applied in the event that he/she contravenes nay of the rules. A comprehensive Grievance Redress Mechanism has been developed for the Project, however the following dispute resolution procedures at work place will be followed: • Conducting of a comprehensive investigation to determine whether there are grounds for a hearing to be held; • If a hearing is to be held, the employer is to notify the employee of the allegations using a language that the employee can understand; • The employee is to be given reasonable time to prepare for the hearing and to be represented by a fellow employee or lawyer; • The employee must be given an opportunity to respond to the allegations, question the witnesses of the employer and to lead witnesses; • If an employee fails to attend the hearing the employer may proceed with the hearing in the absence of the employee; • The hearing must be held and concluded within a reasonable time and is to be chaired by an impartial representative; • If an employee is dismissed, it must be given the reasons for dismissal and the right to refer the dispute concerning the fairness of the dismissal to the Directorate of Dispute Prevention and Resolutions (DDPR). Therefore, it is incumbent upon the consultants or contractors to ensure that they have a disciplinary procedure and Code and Standards which the employees are aware of. Each consultant or contractor will be required to produce this procedure to ensure that employees are not treated unfairly. 7.2 Grievance Redress Mechanism The PIU will require contractors to develop and implement a workers’ GRM pr ior to commencement of construction activities. This will be communicated to the workers and circulated in an accessible format (in Sesotho and in graphics). The workers GRM will therefore include: 266 • A channel to receive grievances such as comment/complaint form, logbook, suggestion boxes, email, a telephone hotline that might also be anonymous; • Stipulated timeframes to respond to grievances; • A register to record and track the timely resolution of grievances; • A responsible person/unit/department to receive, record and track resolution of grievances. The GRM will be described in workers induction and toolbox trainings, which will be provided to all Project workers, including the security personnel engaged in project activities. The mechanism will be based on the following principles: • The process will be transparent and allow workers to express their concerns and file grievances. • There will be no discrimination against those who express grievances and any grievances will be treated confidentially. • Anonymous grievances will be treated equally as other grievances, whose origin is known. • Management will treat grievances seriously and take timely and appropriate action in response. Information about the existence of the grievance mechanism will be readily available to all Project workers (direct and contracted) through notice boards, the presence of “suggestion/complaint boxes�, and other means as needed. • The Project workers’ grievance mechanism will not prevent workers to use conciliation procedure provided in the Labor Code. A PIU representative (Social Officer) will monitor the Contractors’ recording and resolution of grievances, and r eport these to Project Coordinator in their monthly progress reports. The process will be monitored by the GRM Focal Point of PIU (preferably the Environment & Social Officer). COVID-19 CONSIDERATIONS In addition to the above provisions of GRM, specific COVID-19 provisions will also be developed where the nature of complaints may be particularly time-sensitive and sensitive in terms of confidentiality. The provisions will include addressing the: • Lack of Personal Protective Equipment (PPE) of the right quality and enough quantity • Absence of Protocols and non-adherence of the same • Unreasonable overtime causing fatigue • Forced to work under unhygienic and potentially contaminated situations without proper remedial measures The Workers’ GRM should allow for the GBV/SEA/SH case reporting and provide for immediate referral of survivors to GBV service providers (e.g., allow for immediate reporting of rape case to Police Office). Generally, the grievance mechanism should provide linkages to the legal system of the country. 267 8.0 Consultant/ Contractor Management The Lesotho COVID-19 EPR Project requires that consultants or contractors monitor, keep records and report on terms and conditions related to labour management, using SHE monitoring tool and particulars of employment record in Appendix 1 and Appendix 2, respectively. The consultant or contractors must provide workers with evidence of salary payments regardless of the worker being engaged on fixed term contract, full time, part time or temporary. The application of this requirement will be proportionate to the activities and to the size of the contract, in a manner acceptable to Lesotho COVID- 19 EPR Project and the World Bank. In addition, the following indicators will be monitored: • Labour Conditions: Records of workers engaged under the Lesotho COVID-19 EPR Project, including contracts, registry of induction of workers, hours worked, remuneration and deductions (including overtime), collective bargaining agreements; • Safety: Recordable incidents and corresponding Root Cause Analysis (lost time incidents, medical treatment cases), first aid cases, high potential near misses, and remedial and preventive activities required (e.g., revised job safety analysis, new/different equipment, skills training); • Workers: Number of workers, indication of origin (expatriate, local, non-local nationals, gender, age with evidence that no child labour is involved, and skill level (unskilled, skilled, supervisory, professional, management); • Training/induction: dates, number of trainings and topics covered; • Details of any Security Risks: Details of risks the Consultant may be exposed to while performing its work, the threats may come from third parties external to the Lesotho COVID-19 EPR Project; • Worker Grievances: Details including occurrence date, grievance, date submitted; actions taken and dates; resolution (if any) and date. And follow-up yet to be taken. The following procedures are going to be used for consultants or contractor management: • Ensure that consultants or contractors have valid contracts with clearly defined Service Level Agreement and all Environmental and Social clauses as applicable; • Consultant or contractor’s induction to Lesotho COVID-19 EPR Project standards and LMP requirements are carried out; • Weekly or monthly submission of records (as agreed with the PIU): Consultant or contractor submission to the PIU includes: o Managing incidents and accidents, the incident reporting and investigation procedures followed and the incident/accident monitoring register; o Consultant or contractor employees recorded using employee list. • Concerns and issues tracking using the Lesotho COVID-19 EPR Project GRM; • Training needs identification recorded in consultants or contractor training schedule; • Health & Safety (HS) monitoring and evaluation of consultant or contractor requirements using HS files. 268 Appendix 1: Consultant/contractor Safety, Health and Environment (SHE) file monitoring form Name of Consultant/Contractor: Name of Subproject: Instructions: Tick (√) if available, put a cross (×) if unavailable. Tick (√) if there was activity, put a cross (×) if there was no activity. Tick (√) if there’s evidence, put a cross (×) if there’s no evidence. Make a comment according to the changes that have taken place as reflected by availability, activity and evidence on each SHE item. NO. Monthly SHE Items Checklist Available Activity Evidence Comment 1 Valid Working Contract 2 Current Employee List 3 Appointment Letter Included & Copy of ID per employee 4 Inductions – all Consultant Staff: Reports available 5 HIRA & Reporting: Incidents, Accidents & Near Misses 6 Vehicles: Daily Inspection Sheet, Drivers Licences 7 Register for complaints: GRM being Implemented 8 Consultants Field Workers PPE: Branded and Properly worn at all times while on duty 9 Training Needs Assessment 10 Fire Extinguishers: Valid 11. Any Other Lesotho COVID-19 EPR Project E&S Specialist Name: Signature: Date: Consultant/Contractor: Signature: Date: 269 Appendix 2: Particulars of employment record 1. Name of Employer________________________________________________ 2. Name of Employee________________________________________________ 3. Date of Employment_______________________________________________ 4. Employee origin (local or non-local) ___________________________________ 5. Employee skill level (unskilled, skilled) _______________________________ 6. Wage___________________________________________________________ 7. Interval at which wages are paid______________________________________ 8. Normal Working Hours____________________________________________ 9. Position of Employee______________________________________________ 10. Probation Period__________________________________________________ 11. Annual Leave Entitlement__________________________________________ 12. Paid Public Holiday_______________________________________________ 13. Payment during Sick Leave_________________________________________ 14. Maternity Leave (If Employee Female) _______________________________ 15. Notice Employee entitled to receive__________________________________ 16. Notice Employer entitled to give____________________________________ 17. Any other matter either party wishes to include_________________________ 18. Summary of grievance procedures and disciplinary procedures in place that need to be followed when a grievance arise or disciplinary action that need to be undertaken. ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________ Employer’s Signature___________________________ Date ____________________ Witness________________________ Date___________________________ Employee’s Signature _______________________Date _________________________ Witness________________________ Date___________________________ 270 Appendix 3: Individual Code of Conduct Instructions: This Code of Conduct should be included in bidding documents for the civil works contractor(s) and in their contracts once hired. I, ______________________________, acknowledge that adhering to environmental, social, health and safety (ESHS) standards, following the Project’s occupational health and safety (OHS) requirements, and preventing Violence Against Children (VAC) and Gender Based Violence (GBV) is important. The Contractor considers that failure to follow ESHS and OHS standards, or to partake in activities constituting VAC or GBV—be it on the work site, the work site surroundings, at workers’ camps, or the surrounding communities—constitute acts of gross misconduct and are therefore grounds for sanctions, penalties or potential termination of employment. Prosecution by the Police of those who commit GBV or VAC may be pursued if appropriate. I agree that while working on the Project I will: a. Consent to a background check in any place I have worked for more than six months. b. Attend and actively partake in training courses related to ESHS, OHS, COVID-19 prevention, VAC and GBV as requested by my employer. c. Will wear my personal protective equipment (PPE) at all times when at the work site or engaged in Project related activities, in particular if related to exposure to COVID-19. d. Will follow all prevention measures relating to COVID-19, including (i) washing hands with water and soap before and after eating, when entering my work area, after sneezing/coughing, etc.; (ii) sneeze or cough on elbow and/or wash hands after sneezing/coughing; (iii) if feeling unwell or have symptoms of a cold, flu or any respiratory illness, inform manager immediately, stay at home and do not come to work. e. Take all practical steps to implement the environmental and social management framework (ESMF). f. Implement OHS measures. g. Adhere to a zero-alcohol policy during work activities, and refrain from the use of narcotics or other substances which can impair faculties at all times. h. Treat women, children (persons under the age of 18), and men with respect regardless of ethnicity, color, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. i. Not use language or behavior towards women, children or men that is inappropriate, harassing, abusive, sexually provocative, demeaning or culturally inappropriate. j. Not sexually exploit or abuse Project beneficiaries and members of the surrounding communities. k. Not engage in sexual harassment of work personnel and staff —for instance, making unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature is prohibited: i.e. looking somebody up and down; kissing, howling or smacking sounds; hanging around somebody; whistling and catcalls; in some instances, giving personal gifts. l. Not engage in sexual favors —for instance, making promises of favorable treatment (i.e. promotion), threats of unfavorable treatment (i.e. loss of job) or payments in kind or in cash, dependent on sexual acts—or other forms of humiliating, degrading or exploitative behavior. m. Not use prostitution in any form at any time. 271 n. Not participate in sexual contact or activity with children under the age of 18—including grooming or contact through digital media. Mistaken belief regarding the age of a child is not a defense. Consent from the child is also not a defense or excuse. o. Unless there is the full consent31 by all parties involved, I will not have sexual interactions with members of the surrounding communities. This includes relationships involving the withholding or promise of actual provision of benefit (monetary or non-monetary) to community members in exchange for sex (including prostitution). Such sexual activity is considered “non-consensual� within the scope of this Code. p. Consider reporting through the GRM or to my manager any suspected or actual GBV by a fellow worker, whether employed by my company or not, or any breaches of this Code of Conduct. With respect to children under the age of 18: q. Bring to the attention of my manager the presence of any children on the construction site or engaged in hazardous activities. r. Wherever possible, ensure that another adult is present when working in the proximity of children. s. Not invite unaccompanied children unrelated to my family into my home, unless they are at immediate risk of injury or in physical danger. t. Not use any computers, mobile phones, video and digital cameras or any other medium to exploit or harass children or to access child pornography u. Refrain from physical punishment or discipline of children. v. No hiring of children for any Project activity (no persons under the age of 18). Sanctions I understand that if I breach this Individual Code of Conduct, my employer will take disciplinary action which could include: w. Informal warning; x. Formal warning; y. Additional Training; z. Loss of up to one week’s salary; aa. Suspension of employment (without payment of salary), for a minimum period of 1 month up to a maximum of 6 months; bb. Termination of employment; cc. Report to the Police if warranted. 31 Consent is defined as the informed choice underlying an individual’s free and voluntary intention, acceptance or agreement to do some thing. No consent can be found when such acceptance or agreement is obtained using threats, force or other forms of coercion, abduction, fraud, deception, or misrepresentation. In accordance with the United Nations Convention on the Rights of the Child, the World Bank considers that consent cannot be given by children under the age of 18, even if national legislation of the country into which the Code of Conduct is introduced has a lower age. Mistaken belief regarding the age of the child and consent from the child is not a defence. 272 I understand that it is my responsibility to ensure that the environmental, social, health and safety standards are met. That I will adhere to the occupational health and safety management plan. That I will avoid actions or behaviors that could be construed as VAC or GBV. Any such actions will be a breach this Individual Code of Conduct. I do hereby acknowledge that I have read the foregoing Individual Code of Conduct, do agree to comply with the standards contained therein and understand my roles and responsibilities to prevent and respond to ESHS, OHS, VAC and GBV issues. I understand that any action inconsistent with this Individual Code of Conduct or failure to act mandated by this Individual Code of Conduct may result in disciplinary action and may affect my ongoing employment. Signature: _________________________ Printed Name: _________________________ Title: _________________________ Date: _________________________ 273 Appendix 4: Contractors’ general guideline Covid-19 considerations in construction/civil works projects Introduction. The Contractor should identify measures to address the COVID-19 situation. What will be possible will depend on the context of the Project: the location, existing Project resources, availability of supplies, capacity of local emergency/health services, the extent to which the virus already exist in the area. A systematic approach to planning, recognizing the challenges associated with rapidly changing circumstances, will help the Project put in place the best measures possible to address the situation. As discussed above, measures to address COVID-19 may be presented in different ways (as a contingency plan, as an extension of the existing Project emergency and preparedness plan or as standalone procedures). Implementing Agencies (IA) and contractors should refer to guidance issued by relevant authorities, both national and international (e.g. WHO), which is regularly updated (WHO advice for the public, including on social distancing, respiratory hygiene, self-quarantine, and seeking medical advice, can be consulted on this WHO website: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-forpublic). Addressing COVID-19 at a Project site goes beyond occupational health and safety, and is a broader Project issue which will require the involvement of different members of a Project management team. In many cases, the most effective approach will be to establish procedures to address the issues, and then to ensure that these procedures are implemented systematically. Where appropriate given the Project context, a designated team should be established to address COVID-19 issues, including PIU representatives, the Supervising Engineer, management (e.g., the Project manager) of the contractor and sub- contractors, security, and medical and OHS professionals. Procedures should be clear and straightforward, improved as necessary, and supervised and monitored by the COVID-19 focal point(s). Procedures should be documented, distributed to all contractors, and discussed at regular meetings to facilitate adaptive management. The issues set out below include a number that represent expected good workplace management but are especially pertinent in preparing the Project response to COVID19. (a) Assessing workforce characteristics Many construction sites will have a mix of workers e.g., workers from the local communities; workers from a different part of the country; workers from another country. Workers will be employed under different terms and conditions and be accommodated in different ways. Assessing these different aspects of the workforce will help in identifying appropriate mitigation measures: • The Contractor should prepare a detailed profile of the Project work force, key work activities, schedule for carrying out such activities, different durations of contract and rotations (e.g., 4 weeks on, 4 weeks off). • This should include a breakdown of workers who reside at home (i.e., workers from the community), workers who lodge within the local community and workers in on-site accommodation. Where possible, it should also identify workers that may be more at risk from COVID-19, those with underlying health issues or who may be otherwise at risk. • Consideration should be given to ways in which to minimize movement in and out of site. This could include lengthening the term of existing contracts, to avoid workers returning home to affected areas, or returning to site from affected areas. • Workers accommodated on site should be required to minimize contact with people near the site, and in certain cases be prohibited from leaving the site for the duration of their contract, so that contact with local communities is avoided. • Consideration should be given to requiring workers lodging in the local community to move to site accommodation (subject to availability) where they would be subject to the same restrictions. • Workers from local communities, who return home daily, weekly or monthly, will be more difficult to manage. They should be subject to health checks at entry to the site (as set out above) and at some point, circumstances may make it necessary to require them to either use accommodation on site or not to come to work. 274 (b) Entry/exit to the work site and checks on commencement of work Entry/exit to the work site should be controlled and documented for both workers and other parties, including support staff and suppliers. Possible measures may include: • Establishing a system for controlling entry/exit to the site, securing the boundaries of the site, and establishing designating entry/exit points (if they do not already exist). Entry/exit to the site should be documented. • Training security staff on the (enhanced) system that has been put in place for securing the site and controlling entry and exit, the behaviours required of them in enforcing such system and any COVID - 19 specific considerations. • Training staff who will be monitoring entry to the site, providing them with the resources they need to document entry of workers, conducting temperature checks and recording details of any worker that is denied entry. • Confirming that workers are fit for work before they enter the site or start work. While procedures should already be in place for this, special attention should be paid to workers with underlying health issues or who may be otherwise at risk. Consideration should be given to demobilization of staff with underlying health issues. • Checking and recording temperatures of workers and other people entering the site or requiring self-reporting prior to or on entering the site. • Providing daily briefings to workers prior to commencing work, focusing on COVID-19 specific considerations including cough etiquette, hand hygiene and distancing measures, using demonstrations and participatory methods. • During the daily briefings, reminding workers to self-monitor for possible symptoms (fever, cough) and to report to their supervisor or the COVID-19 focal point if they have symptoms or are feeling unwell. • Preventing a worker from an affected area or who has been in contact with an infected person from returning to the site for 14 days or (if that is not possible) isolating such worker for 14 days. • Preventing a sick worker from entering the site, referring them to local health facilities if necessary or requiring them to isolate at home for 14 days. (c) General hygiene Requirements on general hygiene should be communicated and monitored, to include: • Training workers and staff on site on the signs and symptoms of COVID-19, how it is spread, how to protect themselves (including regular hand washing and social distancing) and what to do if they or other people have symptoms (for further information see WHO COVID-19 advice for the public). • Placing posters and signs around the site, with images and text in local languages. • Ensuring hand washing facilities supplied with soap, disposable paper towels and closed waste bins exist at key places throughout site, including at entrances/exits to work areas; where there is a toilet, canteen or food distribution, or provision of drinking water; in worker accommodation; at waste stations; at stores; and in common spaces. Where hand washing facilities do not exist or are not adequate, arrangements should be made to set them up. Alcohol based sanitizer (if available, 60- 95% alcohol) can also be used. • Review worker accommodations, and assess them in light of the requirements set out in IFC/EBRD guidance on Workers’ Accommodation: processes and standards, which provides valuable guidance as to good practice for accommodation. • Setting aside part of worker accommodation for precautionary self-quarantine as well as more formal isolation of staff who may be infected. (d) Cleaning and waste disposal Conduct regular and thorough cleaning of all site facilities, including offices, accommodation, canteens, common spaces. Review cleaning protocols for key construction equipment (particularly if it is being operated by different workers). This should include: • Providing cleaning staff with adequate cleaning equipment, materials and disinfectant. 275 • Review general cleaning systems, training cleaning staff on appropriate cleaning procedures and appropriate frequency in high use or high-risk areas. • Where it is anticipated that cleaners will be required to clean areas that have been or are suspected to have been contaminated with COVID-19, providing them with appropriate PPE: gowns or aprons, gloves, eye protection (masks, goggles or face screens) and boots or closed work shoes. If appropriate PPE is not available, cleaners should be provided with best available alternatives. • Training cleaners in proper hygiene (including handwashing) prior to, during and after conducting cleaning activities; how to safely use PPE (where required); in waste control (including for used PPE and cleaning materials). • Any medical waste produced during the care of ill workers should be collected safely in designated containers or bags and treated and disposed of following relevant requirements (e.g., national, WHO). If open burning and incineration of medical wastes is necessary, this should be for as limited a duration as possible. Waste should be reduced and segregated, so that only the smallest amount of waste is incinerated (for further information see WHO interim guidance on water, sanitation and waste management for COVID-19). (e) Adjusting work practices Consider changes to work processes and timings to reduce or minimize contact between workers, recognizing that this is likely to impact the Project schedule. Such measures could include: • Decreasing the size of work teams. • Limiting the number of workers on site at any one time. • Changing to a 24-hour work rotation. • Adapting or redesigning work processes for specific work activities and tasks to enable social distancing, and training workers on these processes. • Continuing with the usual safety trainings, adding COVID-19 specific considerations. Training should include proper use of normal PPE. While as of the date of this note, general advice is that construction workers do not require COVID- 19 specific PPE, this should be kept under review (for further information see WHO interim guidance on rational use of personal protective equipment (PPE) for COVID-19). • Reviewing work methods to reduce use of construction PPE, in case supplies become scarce or the PPE is needed for medical workers or cleaners. This could include, e.g., trying to reduce the need for dust masks by checking that water sprinkling systems are in good working order and are maintained or reducing the speed limit for haul trucks. • Arranging (where possible) for work breaks to be taken in outdoor areas within the site. • Consider changing canteen layouts and phasing meal times to allow for social distancing and phasing access to and/or temporarily restricting access to leisure facilities that may exist on site, including gyms. • At some point, it may be necessary to review the overall Project schedule, to assess the extent to which it needs to be adjusted (or work stopped completely) to reflect prudent work practices, potential exposure of both workers and the community and availability of supplies, taking into account Government advice and instructions. (f) Project medical services Consider whether existing Project medical services are adequate, taking into account existing infrastructure (size of clinic/medical post, number of beds, isolation facilities), medical staff, equipment and supplies, procedures and training. Where these are not adequate, consider upgrading services where possible, including: • Expanding medical infrastructure and preparing areas where patients can be isolated. Guidance on setting up isolation facilities is set out in WHO interim guidance on considerations for quarantine of individuals in the context of containment for COVID-19). Isolation facilities should be located away from worker accommodation and ongoing work activities. Where possible, workers should be provided with a single well-ventilated room (open windows and door). Where this is not possible, isolation facilities should allow at least 1 meter between workers in the same room, separating 276 workers with curtains, if possible. Sick workers should limit their movements, avoiding common areas and facilities and not be allowed visitors until they have been clear of symptoms for 14 days. If they need to use common areas and facilities (e.g., kitchens or canteens), they should only do so when unaffected workers are not present and the area/facilities should be cleaned prior to and after such use. • Training medical staff, which should include current WHO advice on COVID-19 and recommendations on the specifics of COVID-19. Where COVID-19 infection is suspected, medical providers on site should follow WHO interim guidance on infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. • Training medical staff in testing, if testing is available. • Assessing the current stock of equipment, supplies and medicines on site, and obtaining additional stock, where required and possible. This could include medical PPE, such as gowns, aprons, medical masks, gloves, and eye protection. Refer to WHO guidance as to what is advised (for further information see WHO interim guidance on rational use of personal protective equipment (PPE) for COVID-19). • If PPE items are unavailable due to world-wide shortages, medical staff on the Project should agree on alternatives and try to procure them. Alternatives that may commonly be found on constructions sites include dust masks, construction gloves and eye goggles. While these items are not recommended, they should be used as a last resort if no medical PPE is available. • Ventilators will not normally be available on work sites, and in any event, intubation should only be conducted by experienced medical staff. If a worker is extremely ill and unable to breathe properly on his or her own, they should be referred immediately to the local hospital (see (g) below). • Review existing methods for dealing with medical waste, including systems for storage and disposal (for further information see WHO interim guidance on water, sanitation and waste management for COVID-19, and WHO guidance on safe management of wastes from health-care activities). (g) Local medical and other services Given the limited scope of Project medical services, the Project may need to refer sick workers to local medical services. Preparation for this includes: • Obtaining information as to the resources and capacity of local medical services (e.g., number of beds, availability of trained staff and essential supplies). • Conducting preliminary discussions with specific medical facilities, to agree what should be done in the event of ill workers needing to be referred. • Considering ways in which the Project may be able to support local medical services in preparing for members of the community becoming ill, recognizing that the elderly or those with pre-existing medical conditions require additional support to access appropriate treatment if they become ill. • Clarifying the way in which an ill worker will be transported to the medical facility, and checking availability of such transportation. • Establishing an agreed protocol for communications with local emergency/medical services. • Agreeing with the local medical services/specific medical facilities the scope of services to be provided, the procedure for in-take of patients and (where relevant) any costs or payments that may be involved. • A procedure should also be prepared so that Project management knows what to do in the unfortunate event that a worker ill with COVID-19 dies. While normal Project procedures will continue to apply, COVID-19 may raise other issues because of the infectious nature of the disease. The Project should liaise with the relevant local authorities to coordinate what should be done, including any reporting or other requirements under national law. (h) Instances or spread of the virus who provides detailed advice on what should be done to treat a person who becomes sick or displays symptoms that could be associated with the COVID-19 virus (for further information see WHO interim guidance on infection 277 prevention and control during health care when novel coronavirus (nCoV) infection is suspected). The Project should set out risk-based procedures to be followed, with differentiated approaches based on case severity (mild, moderate, severe, critical) and risk factors (such as age, hypertension, diabetes). These may include the following: • If a worker has symptoms of COVID-19 (e.g., fever, dry cough, fatigue) the worker should be removed immediately from work activities and isolated on site. • If testing is available on site, the worker should be tested on site. If a test is not available at site, the worker should be transported to the local health facilities to be tested (if testing is available). • If the test is positive for COVID-19 or no testing is available, the worker should continue to be isolated. This will either be at the work site or at home. If at home, the worker should be transported to their home in transportation provided by the Project. • Extensive cleaning procedures with high-alcohol content disinfectant should be undertaken in the area where the worker was present, prior to any further work being undertaken in that area. Tools used by the worker should be cleaned using disinfectant and PPE disposed of. • Co-workers (i.e., workers with whom the sick worker was in close contact) should be required to stop work, and be required to quarantine themselves for 14 days, even if they have no symptoms. • Family and other close contacts of the worker should be required to quarantine themselves for 14 days, even if they have no symptoms. • If a case of COVID-19 is confirmed in a worker on the site, visitors should be restricted from entering the site and worker groups should be isolated from each other as much as possible. • If workers live at home and has a family member who has a confirmed or suspected case of COVID19, the worker should quarantine themselves and not be allowed on the Project site for 14 days, even if they have no symptoms. • Workers should continue to be paid throughout periods of illness, isolation or quarantine, or if they are required to stop work, in accordance with national law. • Medical care (whether on site or in a local hospital or clinic) required by a worker should be paid for by the employer. (i) Continuity of supplies and Project activities Where COVID-19 occurs, either in the Project site or the community, access to the Project site may be restricted, and movement of supplies may be affected. • Identify back-up individuals, in case key people within the Project management team (PIU, Supervising Engineer, Contractor, sub-contractors) become ill, and communicate who these are so that people are aware of the arrangements that have been put in place. • Document procedures, so that people know what they are, and are not reliant on one person’s knowledge. • Understand the supply chain for necessary supplies of energy, water, food, medical supplies and cleaning equipment, consider how it could be impacted, and what alternatives are available. Early pro-active review of international, regional and national supply chains, especially for those supplies that are critical for the Project, is important (e.g., fuel, food, medical, cleaning and other essential supplies). Planning for a 1-2-month interruption of critical goods may be appropriate for projects in more remote areas. • Place orders for/procure critical supplies. If not available, consider alternatives (where feasible). • Consider existing security arrangements, and whether these will be adequate in the event of interruption to normal Project operations. • Consider at what point it may become necessary for the Project to significantly reduce activities or to stop work completely, and what should be done to prepare for this, and to re-start work when it becomes possible or feasible. 278 (j) Training and communication with workers Workers need to be provided with regular opportunities to understand their situation, and how they can best protect themselves, their families and the community. They should be made aware of the procedures that have been put in place by the Project, and their own responsibilities in implementing them. • It is important to be aware that in communities close to the site and amongst workers without access to Project management, social media is likely to be a major source of information. This raises the importance of regular information and engagement with workers that emphasizes what management is doing to deal with the risks of COVID- 19. Allaying fear is an important aspect of work force peace of mind and business continuity. Workers should be given an opportunity to ask questions, express their concerns, and make suggestions. • Training of workers should be conducted regularly, as discussed in the sections above, providing workers with a clear understanding of how they are expected to behave and carry out their work duties. • Training should address issues of discrimination or prejudice if a worker becomes ill and provide an understanding of the trajectory of the virus, where workers return to work. • Training should cover all issues that would normally be required on the work site, including use of safety procedures, use of construction PPE, occupational health and safety issues, and code of conduct, taking into account that work practices may have been adjusted. • Communications should be clear, based on fact and designed to be easily understood by workers, for example by displaying posters on handwashing and social distancing, and what to do if a worker displays symptoms. (k) Communication and contact with the community Relations with the community should be carefully managed, with a focus on measures that are being implemented to safeguard both workers and the community. The community may be concerned about the presence of non-local workers, or the risks posed to the community by local worker’s presence on the Project site. The following good practice should be considered: • Communications should be clear, regular, based on fact and designed to be easily understood by community members. • Communications should utilize available means. In most cases, face-to-face meetings with the community or community representatives will not be possible. Other forms of communication should be used; posters, pamphlets, radio, text message, electronic meetings. The means used should take into account the ability of different members of the community to access them, to make sure that communication reaches these groups. • The community should be made aware of procedures put in place at site to address issues related to COVID-19. This should include all measures being implemented to limit or prohibit contact between workers and the community. These need to be communicated clearly, as some measures will have financial implications for the community (e.g., if workers are paying for lodging or using local facilities). The community should be made aware of the procedure for entry/exit to the site, the training being given to workers and the procedure that will be followed by the Project if a worker becomes sick. • If Project representatives, contractors or workers are interacting with the community, they should practice social distancing and follow other COVID-19 guidance issued by relevant authorities, both national and international (e.g., WHO). 279 Annex 12: Clauses for Inclusion in Contracts ▪ Clauses already part of contract/bidding documents being used need not be duplicated. ▪ The primary/main contractor will be responsible for ensuring these, even if one or more subcontractors are used for completing the civil works. ▪ The contractor to put in place measures to avoid or minimize the spread of the transmission of COVID-19 and/or any communicable diseases that may be associated with the influx of temporary or permanent contract-related labor. ▪ Any suspect case of COVID-19 should be tested as per the national guidelines issued by the Ministry of Health or the Department of Health, and precautions/protocols should be followed for the infected worker and his/her co- workers. General Obligations of the Contractor • To take all necessary precautions to maintain the health and safety of the Contractor’s Personnel. • To depute a health and safety officer at site, who will have the authority to issue directives for the purpose of maintaining the health and safety of all personnel authorized to enter and or work on the site and to take protective measures to prevent accidents, including spread of COVID19. • To ensure, in collaboration with local health authorities, access to medical help, first aid and ambulance services are available for workers/labors, as and when needed. Labor • No child labor and/or forced labor at construction site for all works. • Equal pay/wage for men and women labors. • Provide health and safety training/orientation on COVID19 to all workers and staff and other employees of the sub-contractor (tips on cough etiquette, hand hygiene and social distancing). • Prepare a detailed profile of the Project work force, key work activities, schedule for carrying out such activities, different durations of contract and rotations, confirmed addresses of the labor and any underlying health conditions that increases the risk of severe infection, to facilitate tracking of workers in case of COVID-19 exposure. • All laborers to be provided with photo ID cards. • All laborers engaged to be provided with the required Personal Protection Equipment (PPE) – safety helmet and shoes, secured harness when working at heights, electrical gloves, eye protection for welding etc., without which entry to the construction site shall not be allowed. • In relation to COVID19, masks, adequate hand washing/ sanitization, clean drinking water and sanitation facilities to be provided at construction site. • All workers/labor to be regularly checked for symptoms before allowing entry to the work site. • Steps necessary to prevent labor harassment, including sexual harassment, gender-based violence and any discrimination based on religious, political and/or sexual orientation. 280 Labor Camps (only when labor camps are established) • Contractor to provide hygienic living conditions and safe drinking water. • Separate toilets for male and females and adequate hand washing/sanitization facilities. • Small creche and/or play areas for children with helper, when labor is away at work. • Fireproof wiring and good quality electricals to be used inside the camp. • Cooking gas and/or electric/induction plate to be provided for each labor household. • Monthly/weekly health check up to be organized at the camp for all labors/family. • Organize awareness campaign for social distancing and general health and hygiene. Involuntary Resettlement Related Provisions (Only When Relevant) • No forced eviction of any squatter and/or encroacher at the construction site. • Such matter to be informed in writing to the concerned authorities and the World Bank for appropriate action as per the environment and social standard (ESS5). Greenfield/New Constructions – Permits / Environment and Social Management Plan (ESMP) • No use of Asbestos or components/fixtures having asbestos. • Comply with all applicable national permits. • For greenfield projects involving construction of new buildings and/or adding new floors and/or constructing a new section/wing in an existing building (hospitals, laboratories, isolation wards and quarantine facilities), an ESMP should be prepared by the PIU Construction Management in Upgrading of Existing Buildings • For all contracts involving upgrading of existing buildings (adding rooms, wards, halls, treatment and isolation areas, medication rooms, operation theaters, intensive care units, laboratories etc.), follow the relevant provisions of the ESMF, ESMP, and the construction ESMP prepared by the contractor, along with following various guidelines issued by the Government of Lesotho, WHO best practices, etc. • Maintain a roster of workers/staff at work site indicating their health condition and symptoms and ensure screening procedures (non-physical temperature measurement) at work sites. • Depute and assign monitoring and reporting responsibilities on environmental management, health and personnel safety. • Prevent a worker from an affected area or who has been in contact with an infected person from returning to the site for 14 days or (if that is not possible) isolating such worker for 14 days. • Place posters and signages at/around the site, with images and text in Sesotho/local languages relating to personal safety, hygiene and on COVID-19 symptoms and guidelines. • Ensuring handwashing facilities supplied with soap, disposable paper towels and closed waste bins exist at key places throughout site, including at entrances/exits to work areas; where there is a toilet, canteen or food distribution, or provision of drinking water; in worker accommodation; at waste stations; at stores; and in common spaces. 281 • Segregate lunch hours at worksite of workers to maintain social distancing. • Designated separate space for storing construction material. • Securing the construction site with entry only for authorized personnel and disinfecting of the worksite to be undertaken at close of work every day or as may be required. • Any medical waste produced during the care of ill workers should be collected safely in designated containers or bags and treated and disposed of following relevant requirements (e.g., Biomedical Waste Rules-2018, WHO). Grievance Redress Mechanism (GRM) • Contractor to establish and widely advertise (within labor camps and at construction site) a GRM. Workers to be informed of their rights for reporting a workplace condition that is not safe or healthy for them and poses imminent risk of contracting COVID-19 without any reprisal/penalty. • GRM to have provisions for receiving, registering, following up and resolution system for any complaint/grievance received during the construction period. • A Logbook will always be maintained at the site office and responsibilities allotted to a sufficiently senior official for complaint redress. • Monthly and Quarterly report on the grievances received at each of the Subproject is submitted to the PIU. 282 Annex 13: National New Vaccine Introduction Governance Structure 283 Annex 14-A: Grievance Logbook Template LESOTHO COVID-19 EMERGENCY PREPAREDNESS AND RESPONSE PROJECT - AF (P176307) Address: …………….…… (Office/Site) Date: …………………………..………… Signature Grievance Lead Grievance of Lead Grievance Raiser Type/ Key Dates Resolution Remarks (Focal) Specifics (Focal) Nature Officer Officer SN Number First First meeting Address Name (Male/ Final Final Contact Date Response Gender Female) Second Received Meeting Meeting Resolution 1. 2. 3. 4. 5. 284 Annex 14-B: Grievance Reporting Template LESOTHO COVID-19 EMERGENCY PREPAREDNESS AND RESPONSE PROJECT - AF (P176307) Reporting Period: ……………………….. No. Type/ Number Resolution Status Grievance Max. Time Resolution/ Source/Form of Grievance Nature (Total) Raiser (Days) Taken Referral Level for Resolution Process on-going Others (specify) Hospital/health or Referral management Community Female (no.) care facility Male (no.) Referred Hospital Resolved Written Spoken Phone GRC PIU 1. Dust 2. Noise 3. Health and Safety 4. Land 5. Other assets 6. Traffic Mobility 7. Works 8. Others Total 285 Annex 15: Security Management Plan Kingdom of Lesotho Ministry of Health Lesotho COVID-19 Emergency Preparedness and Response Project (P173939) Additional Financing (P176307) SECURITY MANAGEMENT PLAN April 18, 2021 286 Abbreviations and acronyms AIDS Acquired Immunodeficiency Syndrome COVID Corona Virus Disease EHS Environment Health and Safety EHSG Environmental Health and Safety Guidelines EPRP Emergency Preparedness and Response Project ESCP Environmental and Social Commitment Plan ESIA Environmental and Social Impact Assessment ESMF Environmental and Social Management Framework ESS Environmental and Social Standards GBV Gender Based Violence GIIP Good International Industry Practice GoL Government of Lesotho GRM Grievance Redress Mechanism HCF Health Care Facility HIV Human Immunodeficiency Virus IA Implementing Agency IFC International Finance Corporation LMP Labour Management Procedures PIU Project Implementing Unit PPE Person Protective Equipment SMP Security Management Plan SEA Sexual Exploitation and Abuse SEAH Sexual Exploitation, Abuse or Harassment WB World Bank WHO World Health Organization Contents 1. INTRODUCTION........................................................................................................................................... 1 2. SMP OBJECTIVES........................................................................................................................................ 1 3. OVERVIEW OF SECURITY SITUATION.................................................................................................. 2 4. SECURITY RISK ASSESSMENT................................................................................................................. 2 5. SECURITY RISKS......................................................................................................................................... 3 6. SUMMARY OF SECURITY APPROACH AND RISK MITIGATION MEASURES................................ 4 7. STANDARDS AND GOOD INTERNATIONAL PRACTICES................................................................... 8 8. SECURITY MANAGEMENT ROLES AND RESPONSIBILITIES........................................................... 13 9. SMP IMPLEMENTATION MONITORING AND REPORTING ARRANGEMENTS.............................. 14 10. REFERENCES............................................................................................................................................... 15 1. INTRODUCTION The Lesotho COVID-19 Emergency Preparedness and Response Project (EPRP) has been in implementation since the year 2020. The Government of Lesotho (GoL) mad a request to the World Bank (WB) in January 2021 for an Additional Financing (AF) to expand the activities under the Parent Project(P173939). The EPRP-AF (P176307) includes additional support for purchase and deployment of the COVID-19 vaccines, PPEs, and other accessories. The legislations of the GoL and those of the WB require that environmental and social risks and impacts are assessed and effectively managed. Such risks and adverse impacts include, among others, threats to communities, and project personnel and other assets. For the Bank supported project (s), potential threats to project workers, sites, assets and activities as well as to project-affected communities are assessed and mitigated by the Borrower throughout the project life cycle. As security personnel are envisaged to be engaged, the potential risks and impacts stemming from such engagement in turn should be assessed and management measures identified adhering to the principles of avoidance or minimization and mitigation as applicable. Security personnel can be private (employees of a private security company) or public (such as police or military personnel). They can be engaged by the project contractor, or by the Borrower. Their presence may pose risks to, and unintended impacts on, both project personnel and local communities. For example, the way in which security personnel interact with communities and project workers may appear threatening to them or may lead to conflict. A clear Code of Conduct for the security personnel, can help to mitigate this risk by specifying what constitutes unacceptable behavior. Separately, a binding agreement with security personnel will require, among other matters, that use of force always be proportional to the scope, nature and level of envisaged risks and adverse impacts. The Security Management Plan (SMP) is intended to support project teams and environmental and social specialists in assessing and managing the risks and impacts as may be triggered due to the use or presence of security personnel envisaged to be engaged to protect the project personnel, assets or related aspects. The SMP will be used for the design, implementation, monitoring and evaluation of Lesotho COVID-19 Vaccine Emergency Preparedness and Response Project to describe how and by whom security will be managed and delivered in the project. In the context of high demand but limited vaccine stocks, it is necessary to safeguard the security of the vaccines and medical supplies along with that of all concerned staff in all vaccine storage facilities, including during transit. To that end, security measures will be in place to protect staff, assets and storage facilities. The SMP will be referenced in other project documents such as Environmental and Social Management Framework (ESMF) that has been prepared for the Lesotho COVID-19 EPRP. 2. SMP OBJECTIVES In general, the security management plan is aimed at streamlining the engagement of the security personnel for the protection of the project personnel, vaccines and accessories, and other project assets while enhancing community health and safety aspects. The key specific objectives are: • to outline the project’s general approach to security; • to assess and manage the risks and impacts of the use of Security Personnel in the project activities; • to anticipate and avoid the adverse impacts (wherever applicable) on the health and safety of project-affected communities; • to have in place effective and efficient measures to address any emergency events linked to project activities; and 1 • to ensure that the safeguarding of the project-personnel and properties is carried out in a manner that avoids, minimizes or mitigates risks to the project-communities/service recipients under the project. 3. OVERVIEW OF SECURITY SITUATION The total population of Lesotho is 2,007,201 with 982,133 being males and 1,025,068 as females and this suggests an increase of 130,568 persons from the Census of 2006 (Population and Housing Census (PHC) report, 2016). Moreover, nationwide, 35 percent of households are headed by women. Female-headed households are slightly more likely than male- headed households to live in urban areas: of all male-headed households’ 29.5 percent are in urban areas, and the rest are in rural areas. For female-headed households, 30.1 percent are in urban areas and the rest are in rural areas. The limited amount of police data available shows an increase in violent crimes such as armed robbery, sexual assault, homicide and residential break-ins.32 Moreover, criminals are resorting to violence to subdue their victims, obtain items of value, commit a sexual offence and or elicit information regarding valuables.33 In addition, Gender Based Violence has been exacerbated by the outbreak of COVID-19. The Lesotho Mounted Police Service reported that there has been an increase in sexual assaults, including rape since the existence of lockdowns; two weeks into the April 2020, lockdown, 18 cases of sexual assaults had been reported in Lesotho, which was unusually high. 4. SECURITY RISK ASSESSMENT Security risk assessment (SRA) has been undertaken as part of the ESMF preparation by MoH with support from PIU to document the risks and impacts as may be triggered due to the engagement of security personnel in the EPRP activities. It has been found that the GoL envisages to make such engagement mainly for the safety of the vaccines, PPEs and accessories. Security agencies are also envisaged to support the authorities in enforcing the COVID-19 protocols. During the assessment of security risks and impacts, consultations with the key stakeholders have been conducted. Accordingly, the project proposes adequate measures for strengthening the existing security system, where necessary, consistent with the requirements of the WB ESS4 for engaging security personnel, to ensure that the use of the security agencies in project activities will not result in adverse consequences to project personnel, assets and communities. There is a security management system (mostly engaging the private security agencies) in place at the MoH and its line agencies (including the District Hospitals). The security staff also includes female staff members. For the management of the challenges posed by the COVID-19, GoL has engaged the public security agencies (police and military) as well. The SRA findings indicate that the key risks and impacts from the engagement of security agencies in the project activities are principally those linked to health and safety of the project personnel, assets and communities, including on matters relating to Sexual Exploitation or Abuse/Sexual Harassment (SEA/SH). Security personnel are envisaged to be engaged in site-specific health care facilities, mostly in transporting the vaccines and accessories, and taking care of the safety and security aspects. The potential adverse impacts and risks are mainly due to the interaction of the security personnel with the communities which may enhance the disease transmission, communities may inadvertently perceive presence of the security personnel as a threat, incidences of SEA/SH, inter/intra-security team conflicts, and any mishandling of the arms/weapons, amongst others. 32 US Department of State (2019) Lesotho 2019 Crime & Safety Report 33 US Department of State (2020) Lesotho 2020 Crime & Safety Report 2 The potential risks and adverse impacts due to the engagement of the security personnel in the Project activities are envisaged to be moderate, site-specific, localized, temporary (limited to the short-term/vaccination period engagement), and mitigable. If security issues escalate or deescalate, the SRA and any management plans shall be adjusted, following discussion with the Bank. A summary of material changes should also be communicated to local stakeholders consistent with stakeholder engagement and information disclosure requirements in ESS10. The beneficial impacts of security personnel engagement are found to outweigh the adverse ones in the implementation of the EPRP activities aimed at saving lives from the pandemic. 5. SECURITY RISKS There are internal and external risks identified during the Security Risk Assessment. Internal risks include illegal behaviors such as theft of vaccine stocks. Furthermore, there is a challenge of misuse of vaccines by teams that may engage in providing vaccination to prioritized groups, including friends and families. These risks will be mitigated by engaging security personnel, and the management of health facilities will be urged to ensure that the engaged security agencies protect the project sites by having clear boundary security, access-point operations and incident response. There is also a risk of physical assault or GBV/Sexual Abuse and Exploitation (SEA) by the public security personnel to the project personnel or communities living around the project sites. These risks will be mitigated by sensitizing the public security personnel working on project sites about GBV/SEA. Moreover, the project personnel and the communities affected by the project will be sensitized about GBV/SEA. They will also be introduced to the project’s GRM for lodging their grievances as well as being introduced to GBV Referral Pathway for GBV case management. Community Liaison Officers will disseminate the GRM and GBV Referral Pathways as well as facilitating sensitization activities. Lastly, there may be abuse of power by public security personnel to the private security personnel, project personnel or communities who live around the project sites. As a result, survivors of the abuse may retaliate and there may be vicious cycle of violence that may negatively affect the implementation of the project. The Project Implementation Unit will lead activities of mitigating this risk. To mitigate this risk, the public security personnel shall be reminded and given copies of their Code of Good Practices, and the project personnel, private security personnel and communities around the project sites will be introduced to the GRM and procedures for lodging any complaints/grievances. Following sections provide further details on the risks and mitigation measures. 3 6. SUMMARY OF SECURITY APPROACH AND RISK MITIGATION MEASURES Engagement of the public security agencies (police and military) is envisaged to be further supportive, primarily, in enforcing the COVID-19 protocols, and transporting the vaccines, PPEs and medical supplies to the various health facilities across the nation. Whenever the public security personnel are engaged in protecting health care facilities, vaccine stocks, isolation, or quarantine facilities; the health facility Management and district administrations (District Administrators, District Councils Secretaries and Principal Chiefs) will be informed. In addition, the public around the facilities will be informed by their chiefs, headmen or community councilors. They will be informed about the presence and duties of the security personnel in their area. Furthermore, the public will be sensitized about the Grievance Redress Mechanism (GRM) that shall be followed if there are any grievances related to the security personnel engaged in the project activities. Members of the security force will also be sensitized about the code of conduct and application of the human rights-based approach in line with the provision of security services and practices. In case if any gender-based violence or sexual exploitation and abuse issues arise or are alleged during project implementation or supervision, the Bank Management shall be alerted immediately. Grievances and incidents involving security personnel shall be reviewed, and incident reports submitted to the Bank, together with the grievance mechanism logs regarding grievances or allegations that involve project-related security personnel. Security-related allegations or incidents can include issues such as abuse of power and retaliation, sexual harassment and exploitation, and gender-based violence. Allegations or incidents related to security personnel shall be documented and assessed with the objective of determining compliance or noncompliance with policies and procedures and whether any corrective or preventive actions are required. Unlawful or abusive acts shall be reported to appropriate authorities, including Bank Management. Project staff responsible for the project SEP and Grievance Mechanism shall communicate outcomes to complainants and other relevant parties, keeping in mind confidentiality provisions and the need to protect victims from further incidents or retaliation. Where appropriate, relevant lessons learned shall be shared with the community and any changes made to prevent future incidents. Procurement documents shall include relevant provisions to ensure avoidance of adverse impacts due to the engagement of any security personnel. A binding memorandum of understanding (MoU) or other formal agreement shall be documented, committing the public security force to the Code of Conduct, proportional use of force, and other requirements similar to those that would be included in a contract with private security providers, including disciplinary measures, training, incident follow-up and the need for regularly updating of the documentation. The binding agreement shall make provisions with responsibility for monitoring security engagement conditions and a communication protocol with the Implementing Agency/Borrower, the security personnel and the Bank. Table 1 below summarizes the risks and mitigation measures that shall be adopted to ensure that the engagement of security or military personnel in the implementation of project activities or for provision of security to project assets and personnel is carried out in accordance with the ESSs and other provisions applicable to the EPRP. Table 1: Security Engagement Risks and Mitigation Measures No. Risks or Impacts Mitigation Measures Timelines Key Responsibility 1. Lack of risk (i) Assess the risks and impacts of (i) Assessment Ministry of assessment, engagement of the security or military carried out in the same Health personnel, and implement measures to timeframe than action manage such risks and impacts, including a 1.2 i) above and any 4 documentation, and Security Management Plan prepared as part required measures management system of the ESMF, guided by the principles of shall be adopted proportionality and GIIP, and by applicable before deploying law, in relation to hiring, rules of conduct, security or military training, equipping, and monitoring of such personnel under the security or military personnel. Project and thereafter implemented throughout Project implementation and thereafter implemented throughout Project implementation. (ii) Adopt and enforce standards, (ii) Before protocols and codes of conduct for the deploying security or selection and use of security or military military personnel personnel, and screen such personnel to under the Project and verify that they have not engaged in past thereafter throughout unlawful or abusive behavior, including Project sexual exploitation and abuse (SEA), sexual implementation. harassment (SH) or excessive use of force. (iii) Ensure that the Ministry of Health enters into a memorandum of understanding (iii) Before (MoU), with the Ministry of Defense, setting deploying security or out the arrangements for the engagement of military personnel the military or security personnel under the under the Project and Project, including compliance with the thereafter throughout relevant requirements of this ESCP; Project implementation. (iv) Ensure that such personnel is adequately instructed and trained, prior to (iv) Before deployment and on a regular basis, on the deploying security or use of force and appropriate conduct military personnel (including in relation to civilian-military under the Project and engagement, SEA and SH, and other thereafter throughout relevant areas), as set out in the Project Project Operational Manual, ESMF, GBV action implementation. plan, as well as the MoU and Security management plan which shall be developed 5 by the Borrower for the involvement of the military for distribution of medical supplies as set out under or vaccines, distribution of other supplies actions 10.1 and 10.2, under the Project; respectively (v) Ensure that the stakeholder (v) as set out engagement activities under the Stakeholder under actions 10.1 and Engagement Plan (SEP) include a 10.2 respectively. communication strategy on the involvement of security or military personnel under the Project; (vi) Ensure that any concerns or grievances regarding the conduct of security (vi) within the or military personnel are received, timeframes requested monitored, documented (taking into account by the Association. the need to protect confidentiality), resolved through the Project’s grievance mechanism and reported to the Association no later than 2 days after being received; (vii) At the Association’s written request after consultation with the Borrower: (i) Within the timeframes promptly appoint a third- party monitor requested by the consultant, with terms of reference, Association. qualifications and experience satisfactory to the Association, to visit and monitor the Project area where military or security personnel are deployed, collect relevant data and communicate with Project stakeholders and beneficiaries; (ii) require the third-party monitor consultant to prepare and submit monitoring reports, which shall be promptly made available to and discussed with the Association; and (iii) promptly take any actions, as may be requested by the Association upon its review of the third- party monitor consultant reports. 2. Incidents/accidents Appropriate documentation and reporting Throughout project Ministry of shall be done cycle Health 6 3. Transmission of Implementation of the ICWMP, SMP and Throughout project Ministry of COVID-19 or other other provisions as applicable to the EPRP cycle Health diseases 4. GBV, SEA/SH risks Conduct GBV, SEA/SH risk assessment, During the project Ministry of and impacts and plan and implement risk preparation/design Health avoidance/prevention actions as required phase as part of environmental and social impact assessment (ESIA) - as part of the ESMF preparation process Prepare and implement the security SMP preparation Ministry of management plan (SMP) during the project Health preparation/design phase as part of ESMF, and implementation 5. Grievances • The project-level grievance Throughout project Ministry of mechanism that is required by ESS10 should cycle Health explicitly note its acceptance of grievances related to security and the use of security forces. • Project-affected communities should be made aware of the grievance mechanism and the types of issues that can be brought to its attention. • Complaints related to security personnel should be logged/registered as is required for any other complaint, and worker and community concerns related to security personnel should be addressed promptly. • The Bank should review the grievance logs as part of project supervision and engage with the Borrower as necessary to address issues related to security and the use of security personnel. • In project planning, implementation and supervision, close attention should be paid to stakeholder engagement particularly as it relates to security personnel. Community engagement is a central aspect of a good security program, and good 7 relations with workers and local communities can substantially contribute to overall security in the project area. • Having women employed as part of the security team may help reduce tension or incidents involving local communities and should be encouraged. • Dialogue with communities about security issues can help to identify potential risks and local concerns, and can serve as an early warning system. Community members should be aware of their ability to make complaints without fear of intimidation or retaliation. Because guards often are the first point of contact Personnel with community members at the project gates, they should also be informed about their role in community relations and about the grievance mechanism and key issues of concern to local communities. 6. Monitoring and Monitoring and reporting on Throughout project Ministry of reporting implementation of the SMP cycle specific to Health engagement of the security personnel engagements in project components The budget required for implementation of the SMP is part of the EPRP Operational costs, and shall be taken care of as required. 7. STANDARDS AND GOOD INTERNATIONAL PRACTICES The use of security personnel during the emergency may involve violation of human rights, illegal acts and failure to provide redress to victims of such violations. Therefore, there are applicable international human rights standards, national laws, World Bank Environmental and Social Standards, and other relevant international good practice to guide the Government of Lesotho to comply with and prioritize public health safety throughout the project cycle. The table below shows standards and good international practice. TYPE OF NAME DESCRIPTION APPLICATION LAW/STANDARD 8 International human International Lesotho is a state party to ICCPR. State parties If the public security rights law Covenant on thereto recognize that human beings can only personnel is used in the Civil and enjoy civil and political freedom, as well as Covid-19 project sites, the Political freedom from fear and want if all human rights authority in charge of such Rights are protected. personnel will be (ICCPR) sensitized about ICCPR and urged to comply with by the PIU. Convention on CEDAW obligates state parties to prevent and This treaty is significant in the prohibit gender-based torture (GBT), punish its protecting women’s rights Elimination of perpetrators and provide redress to its victims. during the Covid-19, All Forms of Lesotho has also ratified CEDAW. especially women who Discrimination will be affected by the against project. Women (CEDAW) Convention Lesotho is a state party to CAT, which is a legally CAT is more applicable against Torture binding instrument that focuses entirely on than other human rights and Other torture. CAT obligates state parties to take treaties in the security Cruel, legislative, administrative or judicial measures to sector. Its provisions guide Inhuman or prevent and absolutely prohibit torture. on the prevention and Degrading prohibition of torture. Treatment or Punishment (CAT) National law Constitution of Section 8(1) thereof provides that ‘no one shall The Constitution is the Lesotho of be subjected to torture or inhuman or degrading supreme law which is used 1993 treatment. In addition, Section 24(3) provides in the protection of that any person who is a member of security constitutional rights of all force is not immune to the provisions of the citizens. Therefore, it is Constitution in relation to torture and inhuman legal instrument that can treatment. be used against the security personnel who torture or inhumanly treat project’s stakeholders. 9 Criminal Section 228 rejects the use of evidence obtained This act is applicable in Procedure and through the use of torture. It provides that if a instances where projects Evidence Act confession has been made to a police officer beneficiaries or of 1981 under duress, it shall not be admissible in judicial stakeholders are forced to proceedings. provide evidence by the security forces. Penal Code Sections 30, 31, 40-42, 38, 51 and 52 prohibit Penal Code will be used Act of 2010 aggravated assault, murder, culpable homicide, for protecting project indecent assault and unlawful sexual acts health care facilities, and respectively. quarantine/isolation facilities personnel and community members who may be assaulted by the security personnel. Internal It regulates public security and use of armed This act protects the Security Act of forces in the public sphere. project’s stakeholders 1984 against threats posed by security forces. Institutional Police Service Section 22 provides for the establishment of the Police Service Act will framework Act of 1998 Police Complaints Authority, a statutory body prohibit members of the where the public can lodge their complaints Lesotho Mounted Police against police officers. The Act also provides for Service who will be code of conduct of the police officers. deployed in the project sites from perpetrating illegal acts. Disaster The Government authorities can make a statutory Security agencies shall be Management decision to deploy public security personnel mobilized wherever Act of 1997 during the emergencies, such as COVID-19 required in managing the outbreak. risks and impacts imposed by the COVID-19. World Bank Environmental ESS1 addresses the need to assess environmental Security risk assessment Environmental and and Social and social assessment risks and impacts, will be carried out, and in Social Standards Standard including those related to human security. ESS1: cases where government (ESS1): Annex 1 5(e) Social and conflict analysis is an security personnel is Assessment instrument that assesses the degree to which the deployed in the COVID- and project may (a) exacerbate existing tensions and 19 project, Ministry of Management inequality within society (both within the Defense and National of communities affected by the project and between Security, and Ministry of Environmental these communities and others); (b) have a Police will be encouraged and Social negative effect on stability and human security; to disclose the security 10 Risks and (c) be negatively affected by existing tensions, arrangements for health Impacts; and conflict and instability, particularly in care facility, vaccine ESS4: circumstances of war, insurrection and civil storage facilities, and Community unrest. quarantine/isolation Health and facilities to the public, Safety subject to overriding ESS4 addresses the health, safety, and security security concerns. risks to and impacts on project-affected Furthermore, they will be communities and the corresponding sensitized about responsibility of Borrowers to avoid or minimize appropriate conduct such risks and impacts, with particular attention towards workers and to people who, because of their particular affected communities. circumstances, may be vulnerable. The following paragraphs of the ESS4 are specifically pertinent in this regard: Paragraph 24: “When the Borrower retains direct or contracted workers to provide security to safeguard its personnel and property, it will assess risks posed by these security arrangements to those within and outside the project site. In making such arrangements, the Borrower will be guided by the principles of proportionality and GIIP, and by applicable law, in relation to hiring, rules of conduct, training, equipping, and monitoring of such security workers. The Borrower will not sanction any use of force by direct or contracted workers in providing security except when used for preventive and defensive purposes in proportion to the nature and extent of the threat�. Paragraph 25: “The Borrower will seek to ensure that government security personnel deployed to provide security services act in a manner consistent with paragraph 24 above, and encourage the relevant authorities to disclose the security arrangements for the Borrower’s facilities to the public, subject to overriding security concerns�. Paragraph 26: “The Borrower will (i) make reasonable inquiries to verify that the direct or 11 contracted workers retained by the Borrower to provide security are not implicated in past abuses; (ii) train them adequately (or determine that they are properly trained) in the use of force (and where applicable, firearms), and appropriate conduct toward workers and affected communities; and (iii) require them to act within the applicable law and any requirements set out in the ESCP�. Paragraph 27: “The Borrower will review all allegations of unlawful or abusive acts of security personnel, take action (or urge appropriate parties to take action) to prevent recurrence and, where necessary, report unlawful and abusive acts to the relevant authorities�. According to this standards, the Borrower should ensure that the safeguarding of personnel and property is carried out in a manner that avoids or minimizes risks to the project-affected communities. There should be an assessment of risks posed by security arrangements to those within and outside the project site. Other international UN Basic The principles state that law enforcement This practice encompasses good practices Principles on officials must take non-violent measures when the enforcement of the the Use of providing security services. legislation described in Force and this table. Firearms by Law Enforcement Officials. 12 8. SECURITY MANAGEMENT ROLES AND RESPONSIBILITIES The security sector of Lesotho is guided by the legal and institutional frameworks. The key actors in the security sector include Lesotho Defense Force, Lesotho Mounted Police Service, National Security Service, Lesotho Correctional Service and private security companies. In respect of the Disaster Management Act of 1997, Section 4(f), the Minister in charge has access to and utilization (mobilization) of the Lesotho Defense Force and Lesotho Mounted Police Service personnel during the emergency; their role is to maintain law and order. During the COVID-19 pandemic, the public security personnel ensures public safety and security by making sure that the public observes COVID-19 protocols, and the military force in particular may be deployed to assist in delivering commodities and equipment to rural health facilities, especially in remote and hard to reach areas. Public health facilities, including vaccine storage facilities in the project area have already existing private security companies in place to protect property, vaccine stocks, staff and visitors as well as controlling movement within the facilities. The Expanded Program on Immunization (EPI) under the Ministry of Health (MoH) will engage in security planning with Ministry of Defense and National Security to mitigate any security risks and adverse impacts. For the engagement of the security agencies in the project activities, the MoH shall perform the overall liaison with the relevant ministries and line agencies of the GoL. The Ministry of Defense and other authorities engaged in the selection of the security personnel for engaging in the project activities will ensure that essential due diligence elements are in place for vetting the security personnel to ensure that they are of good character and not associated with a history of abuse. Such abuse includes actions that violate the safety and security of a person or persons (such as deprivation of life/liberty/security, torture, extra-judicial killing, rape or other gender-based violence, including sexual exploitation or abuse). The engagement process should also ensure the following: • Code of conduct, behaviour commitments, clear and accessible disciplinary process, and grievance process; • Induction/Training requirements specific to the engagements, including on the management systems for security/asset protection, and for interactions with the stakeholders; • Provisions for situations that might escalate to a point that private project security cannot manage without the support of public security personnel, coordination of security management between authorized public security personnel; • Induction/training on engagement with communities about the project's impacts on community safety and security, awareness raising concerning the Code of Conduct commitment and project grievance mechanism, as outlined in the Stakeholder Engagement Plan (SEP) and SMP; • References to “good international industry practice�; • Policy on "use of force" and clarity on proportionality to risk. The use of force by direct or contracted workers in providing security should not be sanctioned except when used for preventive and defensive purposes in proportion to the nature and extent of the threat; • Weapons: if used by security, why, who, what, and how they are controlled (this includes firearms, as well as nonlethal weapons and guard dogs); • References to the grievance mechanism (s) with clear and transparent process for allegations of abuse or gender-based violence are to be managed, and clear prohibitions against any form of retaliation for raising grievances; 13 • Incident reporting: means of receiving and reporting incidents and allegations, and guidelines for receiving and following up on them, including procedures for reporting to the Implementing Agency (MoH) and the Bank, as required; • HCF site access control: guidelines for security personnel on how to interact with community members seeking access to HCF site in view of the COVID-19 transmission prevention or raising a concern; • Compliances to the provisions/requirements of the security management plan, amongst others. The MoH (Implementing Agency) shall implement the SMP - also adhering to the environmental and social commitment plan (ESCP) that has been prepared for the EPRP. The PIU, health care facilities and other relevant entities shall support the MoH as may be required in the process. 9. SMP IMPLEMENTATION MONITORING AND REPORTING ARRANGEMENTS The security management plan implementation monitoring should be carried out regularly to ensure compliance with the required principles, policies, standards and processes; to document improvements in any areas; and to ensure that good practices are performed as applicable. Measures should be adopted to ensure that any issues encountered are identified and mitigated in compliance with the SMP and other project provisions. The MoH will be supported by the Ministry of Defense and other relevant entities including the PIU in monitoring the implementation of the SMP. The PIU-based Environmental and social safeguards team, including the Community Liaison Officers will plan and conduct site visits to monitor the SMP implementation, and document any changes to security risks and arrangements. They will meet with key personnel in the health facilities, vaccine storage facilities, quarantine/isolation facilities, security staff, and the affected communities as may be required in the process. The site visits and monitoring shall focus also on any incidents involving security during project implementation, and any records of grievances involving security agencies. These should also be noted in supervision reports on environment and social performance along with a summary of incidents or credible allegations of abuse by public or private security personnel in or around the project site, as well as updates on actions/follow-up related to previous incidents or allegations. The quarterly and other key reports (including the implementation status and results reports (ISR) should also include an update on the SMP implementation. The SMP should be reviewed during supervision missions by the Bank. Depending on the level of risk, and where appropriate, this review may take place through an independent security audit. Significant changes in the project’s security situation should be reported immediately also to the Bank, which will allow for necessary changes to the SMP or ESCP. Equally, allegations of security personnel non-compliance with the Code of Conduct should be investigated. If allegations include gender-based violence, an expert in dealing with this issue should be included in the investigation and be responsible for any discussion with survivors. If required, at the Association’s written request after consultation with the Borrower, a third-party monitor consultant shall be appointed, with terms of reference, qualifications and experience satisfactory to the Association, to visit and monitor the project area where military or security personnel are deployed, collect relevant data and communicate with project stakeholders and beneficiaries. The third-party monitor consultant thus appointed shall prepare and submit monitoring reports, which shall be promptly made available to and discussed with the Association; and prompt actions shall be taken as may be requested by the Association upon its review of the third-party monitor consultant reports as applicable. 14 10. REFERENCES UN Basic Principles on the Use of Force and Firearms by Law Enforcement Officials: www.ohchr.org/EN/ProfessionalInterest/Pages/UseOfForceAndFirearms.aspx UN Code of Conduct for Law Enforcement Officials: www.ohchr.org/EN/ProfessionalInterest/Pages/LawEnforcementOfficials.aspx Voluntary Principles (VPs) on Security and Human Rights: http://www.voluntaryprinciples.org/what-arethe-voluntary- principles/ ANSI’s Management System for Quality of Private Security Company Operations: http://www.acq.osd.mil/log/ps/.psc.html/7_Management_System_for_Quality.pdf Voluntary Principles Implementation Guidance Tool: http://www.voluntaryprinciples.org/wpcontent/uploads/2013/03/VPs_IGT_Final_13-09-11.pdf (English); http://www.voluntaryprinciples.org/wp-content/uploads/2013/03/IGT-SPANISH1.pdf (Spanish) ICRC and DCAF’s Security and Human Rights Toolkit: http://www.securityhumanrightshub.org/content/toolkit University of Denver’s Private Security Monitor: http://psm.du.edu/ USAID OFDA safety and security update: https://reliefweb.int/sites/reliefweb.int/files/resources/USAID- OFDA%20Safety%20and%20Security%20Sector%20Update%20-%20FY%202017.pdf Voluntary Principles on Security and Human Rights: http://www.voluntaryprinciples.org/resources/ US State Department: https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html WORLD BANK RESOURCES World Bank Corporate Security Department http://workgroup.worldbank.org/org/units/GSD/GSDCS/Pages/Travel-Security.aspx World Bank Corporate Security Courses http://workgroup.worldbank.org/org/units/GSD/GSDCS/Pages/Course-Offerings.aspx International Finance Corporation (IFC) Handbook on the Use of Security Forces: Assessing and Managing Risks and Impacts, 2017 (available in English, French, Spanish) https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainabilityat- ifc/publications/publications_handbook_securityforces MIGA’s Implementation Toolkit for Major Project Sites: https://www.miga.org/documents/vpshr_toolkit_v3.pdf 15