The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 05/29/2021 | Report No: ESRSAFA176 May 29, 2021 Page 1 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Congo, Democratic AFRICA EAST Democratic Republic of Ministry of Health, PDSS Republic of Congo PIU COVID 19- MinSante Project ID Project Name P176215 Additional Financing DRC COVID-19 Strategic Preparedness and Response Project Parent Project ID (if any) Parent Project Name P173825 DRC COVID-19 Strategic Preparedness and Response Project (SPRP) Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 6/14/2021 6/24/2021 Population Financing Public Disclosure Proposed Development Objective To Strengthen the DRC Government capacity to prepare for and respond to COVID-19 pandemic. Financing (in USD Million) Amount Current Financing 0.00 Proposed Additional Financing 0.00 Total Proposed Financing 0.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] The proposed project will support the implementation of The Democratic Republic of Congo COVID-19 Preparedness and Response Plan endorsed by the Minister of Health (on March 16, 2020). It aims to: (i) strengthen technical and operational coordination of activities to prepare for and respond to COVID-19 through existing mechanisms and May 29, 2021 Page 2 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) partnerships; (ii) develop and implement early detection of suspected cases of COVID-19 with or without epidemiological links (including monitoring of travelers with or without epidemiological links) at entry points (airports, ports and other border posts), health facilities and the community; (iii) respond quickly and effectively to any suspected or confirmed case of COVID-19 thorough epidemiological investigation, evacuation, isolation and biological diagnosis, optimized psychosocial and medical care, preventive measures and infection control and tracking of pre- listed contacts; and (iv) develop and implement an aggressive communication campaign, awareness programs, and social distancing measures for behavioral change in the community, including communication at entry points and to airline companies. The AF will use the Multiphase Programmatic Approach. The AF and restructuring will include the following changes to the parent project: a. Revision of the total project costs to account for an additional IDA commitment of US$200 million; b. Expansion of activities across the country and thus revision of the PDO of the project where the phrase “with a focus on selected provinces” will be dropped from the PDO statement; c. Revision of components 1, 2, and 3 to add new activities that will increase development effectiveness and the impact of the COVID-19 response; d. Revision of the results framework to add new indicators and revise some of the existing indicators given project implementation experience so far and evolution of the pandemic in the country; and Public Disclosure e. Extension of the Closing Date of the project by two years to June 30, 2024, to provide sufficient time for implementation of vaccine supply and deployment. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] The AF project will be implemented at national level, including urban, rural and peri-urban areas. Interventions will involve health access from national down to community level. Initial AF interventions will be focused initially on six priority provinces with high rates of infection: Kinshasa, North Kivu, South Kivu, Kongo Central, Lualaba, and Haut Katanga. Availability/quality of health facilities in the provinces varies widely from large hospitals in cities to small health posts in rural areas. Security conditions also vary widely by province, with significant security risks due to armed groups in some rural areas of North and South Kivu. Eastern Congo has a high number of refugees and internally displaced persons from decades of conflict, while gender based violence, sexual exploitation and abuse and sexual harassment (GBV/SEA/SH) against women exists nationwide. DRC has high numbers of poor people in both urban and rural settings, and limited access to basic health care outside the major cities, especially in remote communities. The AF and restructuring will include changes to the parent project: (a) revision of total project costs to include an additional IDA commitment of US$200 million; (b) revision of components 1, 2, and 3 to add new activities to increase May 29, 2021 Page 3 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) development effectiveness and impact of the COVID-19 response; (c) revision of results framework to add new indicators and revise some indicators given project implementation experience so far and evolution of the pandemic in the country; and (d) extension of project closing date by two years to June 30, 2024. The following activities and interventions will be supported by the AF within existing project components. New activities to be funded by the AF include: Component 1. Emergency COVID-19 Response, National and Sub-national Prevention and Preparedness (proposed AF allocation US$190 million) In line with government’s strategy of using a health systems approach to tackle major public health challenges, the roll-out of COVID-19 vaccines will leverage DRC’s routine child immunization system, building capacity of health care systems to immunize adults and vulnerable groups and address underlying risk factors. The AF will support vaccine deployment, including: (i) purchase of COVID-19 vaccines to complement financing under the COVAX facility; (ii) strengthening supply chain and logistic systems to comply with the cold-chain requirements of different vaccines and promote energy efficiency; (iii) supporting training of health providers, community health workers and other personnel responsible for delivery, storage, handling, transportation, tracking and safety of vaccines; (iv) conducting assessments to inform deployment of vaccines (seroprevalence studies in at - risk geographic areas and among People Living with HIV (PLHIV), TB and prisoners, screening for non-communicable diseases (NCD). People with NCDs will be referred for outpatient or inpatient treatment; and (v) strengthening policy environment through production of guidelines, standard operating procedures and protocols. This includes reinforcing DRC’s regulatory capacity to expedite registration and approval processes, in line with WHO prequalification procedures and World Bank requirements for financing of vaccines; supporting planning and coordination of vaccine deployment, leveraging existing coordinating mechanisms under the national immunization Public Disclosure program; and strengthening health care waste management and occupational health. The AF will support procurement of vaccines; energy efficient cold chain equipment; vehicles; medical supplies and consumables (e.g. personal protective equipment, syringes and safety boxes, vaccine sharp disposal containers); TA; and operating costs. Female community health workers will be recruited and trained to respond to inquiries about vaccines (adverse effects, information around vaccines causing fertility problems - sterilization, miscarriages/abortions for women) which can lead to hesitancy among women. Component 1 aims to provide effective vaccine deployment,. Its activities will entail workplace safety, community health and safety, pollution and public health risks from inappropriate management of liquid, hazardous and solid waste materials rom clinical care operations, and social risks associated with exclusion of vulnerable and disadvantaged people . Under phase 1 of the National Deployment and Vaccination Plan (NDVP), the COVAX mechanism will finance purchase of COVID-19 vaccine for 20% of the population. The AF will fund purchase of vaccine for an additional 5% of the population, to help vaccinate up to 25 percent of the population. The COVAX AMC facility plans to provide vaccine to cover 20 percent of the population by end of CY2021. The first shipment of COVAX AMC doses arrived in DRC on March 2, 2021. This AF plans to finance purchase of vaccines to cover an additional 5 percent of the population, to be procured through the COVAX mechanism. Government aims to ultimately reach 60 percent coverage. The government has defined the following priority groups to receive COVID-19 vaccination during Phase 1 of its plan: (a) Priority group 1: Health professionals and social workers ( (b) Priority group 2: People with comorbidities (chronic renal disease, hypertension, diabetes), (c) Priority group 3: People aged over 55 years May 29, 2021 Page 4 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) (d) Contingency group: People aged 45-55 who request to be vaccinated. Where allocated vaccines are under-utilized, vaccination will be opened up to this group. Internally displaced and refugee populations will be prioritized during phase 1. Vaccines will be made available to refugees and internally displaced populations in camps; high-density settings with high transmission risks. Other vulnerable groups including indigenous peoples will be considered for vaccination in subsequent phasing. Vaccine deployment will entail hazardous management waste risks, OHS and biosafety risks of labs (needlesticks and blood exposures). Vaccine transportation and distribution from storage entails road safety risks. Risks from operation of incinerators are also expected. Component 2 includes a Communication campaign, Community Engagement and Behavior Change (proposed AF allocation US$3 million). Potential social risks under Component 2 are similar to those under 1: lack of social inclusion in project communications and access to services, and risk of SEA/SH. Under this component, proposed AF will support: (i) development of explicit, contextually appropriate and transparent criteria for identification of priority populations for vaccination and supporting implementation plans; (ii) communication to address vaccine hesitancy to improve demand generation through mass and interpersonal communication; (iii) outreach interventions; (iv) citizen engagement for feedback and grievance redress mechanisms sensitive to SEA/SH complaints; (v) development of targeted training programs for managers, service providers and evaluators of vaccine deployment; and (vi) knowledge management and learning. Women leaders / traditional female authorities or village elders will be invited to participate to counter misinformation. In order to ensure increased access of the vaccine to women, strategies such Public Disclosure as sensitization of society on the importance of vaccinating women will be used to sensitize males of the family, society, religious leaders, and community members including messages oriented to prevent/mitigate GBV/SEA/SH risks. Component 3: Implementation Management and Monitoring and Evaluation (proposed AF allocation US$7 million,) Under this component, AF will support COVID-19 vaccination-specific monitoring and evaluation, including: (i) impact of vaccination program through disease surveillance; (ii) monitoring of coverage, effectiveness and safety of vaccination; (iii) sero-surveillance studies; (iv) operational and management costs of implementing vaccination program; and (v) provision of vaccination certificates to all people vaccinated. The AF also will support a technical audit of implementation of phase 1 of the government plan, including verification at a sample of vaccination sites of vaccine supply, cold chain systems, vaccine administration systems, reporting, and beneficiary targeting. All vaccination staff will be rquired to sign a code of conduct and will receive training on Prevention of Sexual Exploitation and Abuse (PSEA). Components 1 and 3 propose TA activities (establishment of policies to ensure there is no forced vaccination; acceptable policy for prioritized intra-country vaccine allocation; national level regulatory standards, including pharmacovigilance; appropriate minimum standards for vaccine management including cold chain infrastructure, strengthening the policy environment through production of guidelines, standard operating procedures and protocols, etc.), which will involve potential downstream environmental and social risks and impacts (risk of inequitable access; safety of services risk related to cold chain facilities, safety monitoring of vaccine, etc.). No major civil works are expected in this AF project, nor greenfield works. Any works involving refurbishments will be carried out within existing healthcare facilities and laboratories. May 29, 2021 Page 5 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) The social context for the project varies widely across the 26 provinces. Initial vaccinations will occur in major urban areas where risk of social conflict, displaced populations, access to health services, and high rates of SEA/SH are expected to be relatively low. These risks will be higher in rural and remote areas, particularly in non-urban areas of Eastern Congo or the Kasais where there is ongoing armed conflict. As of April 22, 2021, there have been 29084 confirmed or probable cases of COVID-19 reported in 23 provinces.The epicenter of the pandemic remains Kinshasa, which has recorded 74.5 % of cases, followed by North Kivu with 6.2% and Haut-Katanga with 6.1%. D. 2. Borrower’s Institutional Capacity The project will be implemented by the Ministry of Public Health (MoPH), with day-to-day management delegated to the Health System Strengthening for Better Maternal and Child Health Results (PDSS/P147555) Project Implementation Unit (PDSS-PIU). It has experience working with World Bank Safeguards as well as with the environmental and social framework (ESF). The PDSS-PIU has a consistently satisfactory record implementing WB environmental and social safeguard policies and has practiced an oversight mechanisms consistent with the current Environmental and Social Standards of the Bank. This includes most recently satisfactory implementation of COVID-19 related health measures. The parent project has a “Satisfactory” overall environmental and social performance and compliance. E&S commitments made by the Borrower in its Environmental and Social Commitment Plan (ESCP), which were negotiated and agreed under the parent project were met. However, the PIU is staffed with two E&S specialists and is currently implementing four health and nutrition projects financed by the Bank including P145777 - the Health System Strengthening for Better Maternal and Child Health Results Project, P168756 – DRC Multisectoral Nutrition and Health Project, P167817 - Public Disclosure Regional Disease Surveillance Systems Enhancement IV Project and P173825 - DRC COVID-19 Strategic Preparedness and Response Project (SPRP). Additional E&S specialists need to be hired by the PIU, including an occupational health and safety specialist, to adequately cover the expanded E&S responsibilities under the activities of the AF. Similarly, the PDSS-PIU has committed to the recruitment of two GBV specialists to support SEA risk mitigation for the entire health portfolio of five projects, one of whom will be tasked to cover the parent COVID-19 project and this AF. With technical support from key development partners, DRC used the Vaccine Introduction Readiness Assessment- Vaccine Readiness Assessment Framework (VIRAT-VRAF) 2.0 tool to assess country readiness for vaccine deployment, including prioritization, targeting and surveillance of target groups, service delivery, and training and supervision. The VIRAT-VRAF 2.0 findings on country readiness for vaccine deployment noted that a national logistics working group is in place with a mandate to coordinate deployment of COVID-19 vaccines. Detailed mapping of health facilities that will serve as vaccine distribution points at the health zone level is being conducted. A distribution strategy has been developed, including the mapping of port(s) of entry, storage points (stores) and fallback facilities in the country with their respective cold chain (2-8C , -20C, -60 / 70C), as well as transport capacity and human resources. UNICEF has completed an assessment of cold chain and logistic needs. The AF will provide support to fill these gaps. PDSS-PIU has been effectively coordinating project planning and procurement under the parent project. Administrative delays initially constrained project implementation, but was addressed proactively by PDSS-PIU in improving coordination with the National Technical Secretariat. Key lessons learned during Ebola outbreaks and rollout of COVID-19 parent project provide guidance for distribution of COVID-19 vaccines. They highlight importance of building trust, working with health care workers and communities to understand how vaccine works, where to get it and what tareside effects, rather than simply communicating vaccine’s existence. Targeted risk communications and community engagement will be key for a successful COVID-19 vaccination campaign, and addressing vaccine May 29, 2021 Page 6 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) hesitancy. Social media platforms will be used to ensure accountability and promote equal distribution. The parent project is already financing communication activities, including community engagement provided by Oxfam. This effort will be expanded to also include vaccination as an important element of COVID-19 prevention. In addition, the AF will finance specialized technical communication agencies (including possibly UNICEF) to help with conducting communication campaigns to boost community engagement and address the challenges of vaccine hesitancy. Oxfam has been doing communications outreach under the parent project, As with the parent project, the AF will be coordinated with the REDISSE IV project and others in the HNP portfolio, including the PDSS project, which will contribute to help with coordinated rollout of the vaccine operation across the country. During preparation, E&S capacity building efforts will draw on results of the assessment where appropriate in tailoring the project’s E&S training activities. Vaccination activities will require services such as electricity and water and will generate medical waste. Incinerators and facilities should be in place to ensure appropriate conditions for distributing and storing vaccinations, and managing medical waste generated. Borrower’s technical and organizational capacities to properly manage hazardous waste, infectious waste, non-hazardous and non-infectious medical waste will be further assessed during preparation. The national technical agency in charge of environmental and social monitoring and management is National Agency for the Environment (Agence Congolaise de l’Environnement or ACE). ACE is responsible for monitoring and management of E&S impacts for all projects in accordance with national regulations: it approves and monitors implementation of E&S instruments (e.g. Environmental and Social Impact Framework (ESMF)). Agency is understaffed, has limited capacity, and largely relies on donor and project funds to carry out field supervision duties. Its capacity and powers are constrained due limited staff and funding. At provincial level, government agencies (including those attached to the MoE) often do not have necessary equipment to monitor social Public Disclosure and environmental impacts, staff lack training, and management capacity is limited. Considering additional E&S specialists to be recruited to the PDSS-PIU and capacity of ACE, there is a need to build capacity on E&S risk and impact management to meet requirements of the ESF. An MoU to clarify roles of the various agencies (WHO, UNICEF, GAVI, etc.) involved should also be considered. Agencies supporting project activities must follow the Project ESMF and comply with all relevant ESSs. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) High Environmental Risk Rating Substantial The environmental risk rating of the AF activities remains Substantial. Each of the various stages of the vaccine deployment and vaccination processes are likely to entail OHS, environmental and social issues, and mass vaccination clinics may pose risks for vaccinators, especially when performed in non-traditional settings and in high volumes. Key risks are those related to (i) OHS and biosafety risks of labs (needlesticks and blood exposures), (ii) use and disposal of medical supplies, (iii) use of cleaning and disinfection chemicals, and waste-related issues including community exposure to medical waste, and (iv) use of ozone depleting refrigerants associated with cold chain logistics. In addition, vaccine transportation and distribution from storage will entail road safety risks, and risks related to the operation of incinerators are also expected. TA products (regulatory standards at the national level including pharmacovigilance, standards for vaccine management including cold chain infrastructure, standard operating procedures and protocols, etc.) will be consistent with the ESS requirements, and their key direct and downstream risks are those related to safety of services (risks related to the administration procedure/risks of May 29, 2021 Page 7 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) vaccination errors; dosage and dosing regimen; the safety profile of vaccine; etc.) and pharmacovigilance activities (monitoring of existing and detection of new safety concerns). Standards for vaccine management including cold chain infrastructure are required because COVID-19 vaccine products are temperature-sensitive, and the cold chain capacity management due to frequent interruptions of electricity supply poses a safety of services risk which could negatively affect the quality and effectiveness of vaccines. The Borrower E&S capacity to manage E&S risks and impacts is another factor in consideration of environmental risks and the capacity will be further assessed during the due diligence mission and appropriate capacity enhancement measures included in project design. The measures to address environmental risk 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 sites expand. In most cases, it will be necessary to acquire generators in areas not served by electricity to maintain the cold chain; which will require appropriate fuel and waste oil management. Social Risk Rating High Social risk rating for the AF is High. Key social risks and impacts are related to (i) marginalized and vulnerable social groups (including indigenous peoples, the poor, and displaced persons or refugees) who may not be vaccinated until phase 2 of the government plan, after the first prioritized 25 percent of the population has been vaccinated; (ii) social conflicts resulting from false rumors and misinformation about prevention and treatment activities, including vaccination initiatives, (iii) issues resulting from people being kept in quarantine, including stigma faced by those admitted to treatment or isolation facilities, and (iv) risks of SEA/SH to Project workers and beneficiaries; as well as (v) labor management risks. There is broader social risk of inequity in access to vaccines, such as political pressures to provide vaccines to groups that are not prioritized for need or vulnerability, elite capture, or if target groups are misaligned with available vaccines. The government’s stategy of focusing initially on vaccinating priority populations Public Disclosure in large urban centers in six provinces where the virus is most present inevitably means people living in outside cities, including vulnerable persons and the general population will not access vaccines until later stages of the campaign. These risks will be mitigated through several measures to ensure vaccine delivery targets the most vulnerable populations, particularly women, elderly, poor, refugees, and minorities. The Bank will support DRC to develop and adapt explicit, contextually appropriate, and well-communicated targeting criteria and implementation plan (e.g., national vaccination program and any subsidiary programs) including criteria for access to vaccines, starting with the four priority groups. While the plan is still under development, it will first target health workers, those over the age of 55, and people with co-morbidities, and refugees or IDPs in high-population density locations that may include slums and refugee camps. Another potential risk is increased incidence of reprisals and retaliation against healthcare workers and researchers, due to vaccine hesitancy, resistance or misinformation. This risk will be mitigated through explicit inclusion in robust stakeholder identification and consultation processes. The project will ensure that the national vaccination plan will be subject to timely and meaningful consultations in accordance with ESS 10. In addition, grievance mechanisms required under ESF should be in place and equipped to address community, worker, and/or individual grievances related to such issues. MoPH developed procedures and health communications strategies during the Ebola response that could be leveraged to manage and mitigate some of these risks. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts May 29, 2021 Page 8 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) Overview of the relevance of the Standard for the Project: The AF project could cause environment, health and safety risks due to the dangerous nature of the pathogen (COVID-19) and reagents and equipment used in the project-supported activities. Key environmental risks include: (i) Occupational Health and Safety issues as workers in healthcare facilities and laboratories are particularly vulnerable to COVID-19 and other disease contagion; facilities treating patients may also generate biological, chemical waste, and other hazardous by-products that could be injurious to human health; (ii) vaccine transportation and distribution from storage will entail road safety risks; (iii) oxygen enrichment as the result of faulty or leaky equipment, the operation of incinerators and generators will entail fire and life safety risks; (iv) the future infection spread risk is significantly associated to the management of medical waste generated in laboratories and other facilities alike. If not adequately handled and treated, waste can turn into a vector in spread of COVID-19 or new infections; (v) community health and safety related risks includind safety of services risk; (iv) downstream E&S impacts of TA activities. Climate change can affect the trajectory of the COVID-19 pandemic and impact groups that are most susceptible to the virus including healthcare workers. Key social risks are those related to (i) marginalized and vulnerable social groups (including Indigenous Peoples, the poor, and displaced persons and/or refugees) will not be vaccinated until phase 2 of the government plan, after the first prioritized 20 percent of the population has been vaccinated, (ii) social conflicts resulting from false rumors and misinformation, (iii) issues resulting from people being kept in quarantine, including stigma faced by those admitted to treatment or isolation facilities, and (iv) risks of Sexual Exploitation and Abuse, or Sexual Harassment (SEA/SH) to Project workers and beneficiaries. Public Disclosure The WHO Framework for Allocation and Prioritization of COVID-19 Vaccination lists the following potential disadvantaged or vulnerable groups in the case of COVID-19: • 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 settings or those affected by humanitarian emergencies, 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 distance (examples: geographically remote clustered populations, detention facilities, dormitories, military personnel living in tight quarters, refugee camps) • Groups living in dense urban neighborhoods • Groups living in multigenerational households. The ESMF for the parent project was prepared, adopted and disclosed on February 9, 2021 and it covers infection control, quarantining and treating patients and managing the safe disposal of the resulting medical waste, risk of transmission of COVID-19, safe transport, distribution and handling of COVID-19 tests, medical equipment and PPEs. An interim ESMP for the distribution of medical equipment and vehicles was prepared, adopted and disclosed on June 2, 2020. The Stakeholder Engagement Plan (SEP) for the parent project was prepared and disclosed on March 26, 2020. In order to take into account new activities under the AF, particularly those related to deployment of May 29, 2021 Page 9 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) vaccines and related cold chain, the SEP has been revised to incorporate what is currently known about the vaccination campaign, and will be disclosed prior to appraisal for the AF. The ESMF does not cover occupational health and safety (OHS) and biosafety risks associated with vaccine deployment. Nor does it cover the (i) safe transport and cold chain capacity, cold chain storage capacity. Frequent interruptions of electricity supply and lack of electricity in remote locations remain key constraints in DRC; (ii) procurement, voluntary consent to vaccination, equitable access and prioritized distribution system with a well- established operating procedure to guide vaccine and logistical management and the management of waste generation from vaccines within selected districts. The project is updating the ESMF to address the AF activities, and will cover any additional risks that arise as a result of the project and it will include an exclusion list for project activities that may not be undertaken unless the appropriate OHS capacity and facilities are in place (e.g., Bio Safety), and mitigation measures of risks associated with the fitting out of vaccination sites within existing health facilities; transportation and distribution of vaccines, and risks related to the operation of incinerators and generators. The updated ESMF willinclude information about vaccine cold chain management and surveillance system to monitor, investigate and respond to adverse events following immunization. The updated ESMF will be cleared, adopted and disclosed not later than the Effective Date. An integrated SEA/SH Action Plan that covers the entire HNP portfolio of four projects supervised by PIU-PDSS, including the COVID-19 parent project is in place and will adequately cover currently anticipated early stage activities under this AF, including the initial activities of the vaccination campaign. The HNP portfolio SEA/SH Action plan will be updated to include additional measures for the vaccination campaign, if needed, by the Effective Date, and included Public Disclosure as an annex in the revised ESMF..SEA/SH The parent project Labor Management Procedures will be updated to include information on the AF as more details become available about the vaccination campaign rollout and other AF activities, and disclosed no later than the Effective Date. The AF Project will establish institutional frameworks for the safe and effective deployment of vaccines including developing policies related to ensuring that there is no forced vaccination. This will include a guiding document to be developed for the vaccine operation, the COVID-19 Vaccine Operation Manual (CVOM). This document will provide a framework not only for the safe and effective vaccine deployment based on voluntary consent, but also details of technical, fiduciary and E&S safeguards arrangements for the operation. A well-communicated implementation plan will be prepared to ensure a fair, equitable and inclusive process for voluntary in-country vaccine access and allocation,. A Third Party Monitoring (TPM) Agent financed by the AF will independently verify Government’s adherence with the CVOM. Given the potential for violent conflict in some rural and remote areas in provinces to be covered by the project, a preliminary Security Due Diligence Assessment (SDA) was carried out by the Bank and was completed prior to Appriasal. It will be updated periodically and as evolving security conditions in priority provinces warrant it. Prior to beginning operations on the ground in high risk areas (e.g. outside major cities targeted in the first phase), the project will develop a Security Risk assessment and Management Plan, to be developed within 60 days of the Effective Date and updated periodically and as circumstances warrant. Activities during first phase/first year of AF anticipated to take place in four large urban centers, not deemed to be high risk security areas. No project activities will occur in areas of substantial or high risk until an SMP is completed. May 29, 2021 Page 10 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) A Third Party Monitoring (TPM) Agent will be hired to carry out independent robust and systematic monitoring and verification of the project activities including availability of key inputs, compliance with ESHS and ESS requirements, Fiduciary requirements, etc. A TPM acceptable for the Bank and the Borrower will monitor, through both field and desk work, the project compliance with the Environmental Social Health and Safety (ESHS) requirements set out in the Legal Agreement, ESCP, ESMF, and SEP. The TPM will also monitor performance of, but not replace, the project’s own GRM. Documentation and information available and reviewed as part of due diligence activities included project documents prepared by client as well as UN and donor partner materials and guidance on vaccine campaigns, including the WHO Framework for Allocation and Prioritization of COVID-19 Vaccination, and information on the COVAX AMC Program. ESS10 Stakeholder Engagement and Information Disclosure Stakeholder engagement is a critical tool for social and environmental risk management, project sustainability and success. A Stakeholder Engagement Plan (SEP) was prepared for implementation and disclosed prior to Appraisal for the parent project. It was updated in February 2021 to include some vaccine-related stakeholder considerations and will be disclosed prior to the AF project Appraisal. It will continue to be periodically updated and redisclosed throughout implementation as needed, as more information about the vaccination plan become available. The SEP includes guidance on the Risk communication and community engagement (RCCE) strategy, to be used under the Public Disclosure project in line with WHO provisions “Risk communication and community engagement (RCCE) readiness and response to the 2019 novel coronavirus (2019-nCoV)” (January 26, 2020). The proposed project will support a communication, mobilization, and community engagement campaign to raise public awareness and knowledge on prevention and control of COVID-19 among the general population and contribute to strengthening the capacities of community structures in promoting coronavirus prevention messages, as well as promoting vaccine education and acceptance. Given the potential for vaccine hesitancy, proper and early communication will be pivotal for a successful COVID-19 vaccine operation in DRC. The parent project is already financing communication activities, which will be expanded to also include vaccination as an important element of COVID-19 prevention. In addition, the AF is going to finance specialized technical communication agencies (including possibly UNICEF) to help with conducting communication campaigns to boost community engagement and address the challenges of vaccine hesitancy. The client will engage in meaningful consultations on policies, procedures, processes and practices (including grievances) with all stakeholders throughout the project life cycle, and provide them with timely, relevant, understandable and accessible information. The consultations will provide information on project-related risks, including SEA/SH, and the proposed reporting and response measures, with a particular focus on women, children and other vulnerable groups. SEA/SH consultations will be focused on understanding women and girls’ experience, their wellbeing, health and safety concerns, as they relate to COVID-19 project activities, including the vaccination activities. Consultations methods will need to be adjusted to accommodate the social distancing and public assembly May 29, 2021 Page 11 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) requirements of the government. The Bank will advise the client on various approaches to engaging stakeholders without raising medical risks. A project-wide grievance redress mechanism (GRM), sensitive to GBV/SEA/SH issues, and proportionate to the potential risks and impacts of the project has been established under the parent project. Once approved, the AF project will establish a structured approach to stakeholder engagement and public outreach concerning vaccination activities that is based on meaningful consultation and disclosure of appropriate information, considering the specific challenges associated with combating COVID-19. Relevant stakeholders will be consulted in all stages following the SEP prepared for the project to mitigate risks of reprisals against healthcare workers or community members who voice concerns over COVID-19 related operations or policies. The grievance redress mechanism (GRM) sensitive to SEA/SH implemented by the parent project will cover the AF and will handle SEA/SH complaints in an ethical and confidential manner, following a survivor-centered approach. The response mechanism will include a referral pathway for survivors. The consultations will provide information about specific AF risks, including SEA/SH, and the effectiveness and relevance of mitigation measures included in the portfolio SEA/SH AP in order to modify and adapt them to the new activities and risks as needed. All Technical Assistance activities will be required to address pertinent E&S aspects to ensure that TA products are consistent with the ESF including in their approach to downstream impacts (e.g. strengthening the policy environment through production of guidelines, standard operating procedures and protocols, etc.). The project implementation will ensure appropriate stakeholder engagement, proper awareness raising and timely Public Disclosure information dissemination. These will be guided by standards set out by WHO, WBG EHS Guidelines to the project as well as other international good practices including social inclusion and prevention of sexual exploitation and abuse and sexual harassment. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions ESS2 is considered relevant to this Project. The project is expected to encompass the following categories of workers: direct workers and contracted workers. Most activities supported by the project will be conducted by direct workers of the Project such as health and laboratory workers, i.e. civil servants employed by MoPH. The project may outsource minor civil works to contractors. Community health workers (relais communautaires) are involved in the parent project activities, and will be involved in the AF as well. Considering the small civil works that will be carried out under the project, no large-scale influx of labor is expected. The key risk is in relation to the contamination with COVID-19 (or other contagious illnesses as patients taken seriously ill with COVID-19 are likely to suffer from illnesses which compromise the immune system, which can lead to illness and death of workers). In line with ESS2, the use of forced labor or the use of child labor for any person under the age of 18 in hazardous work situations (e.g. in health care facilities) is prohibited. Mitigation measures relating to OHS are included in labor management procedures (LMP) to protect workers from risks associated with exposure to hazards encountered in the workplace; This will require infection control precautions and adequate May 29, 2021 Page 12 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) supplies of PPE. The mitigation measures will incorporate the World Bank Group's General Environment, Health, and Safety Guidelines (EHSGs), the EHSGs for Health Care Facilities, and other Good International Industry Practices. The LMP includes a Code of Conduct, that will be signed by all workers (if they have not already done so under previous health projects), including measures to address Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) behaviors and prohibitions against sexual activity with anyone under the age of 18, and safety training materials. A worker Grievance Redress Mechanism sensitive to SEA complaints within MoPH will be established and operated through a grievance hotline and assignment of focal points to address these grievances, which will be outlined in the LMP. The LMP prepared for the parent project will be updated to include vaccination related labor risks and mitigation measures and will be disclosed within two months of effectiveness. Healthcare workers (HCWs) play a critical role in outbreak response and are the backbone of a country's defense to limit or contain the spread of disease. They face higher risks of potential COVID-19 infection in their efforts to protect the greater community and are exposed to hazards such as psychological distress, fatigue and stigma. They will be prioritized for early vaccination. Worker safety: Healthcare associated infections due to inadequate adherence to occupational health and safety (OHS) standards can lead to illness and death among health and laboratory workers. The laboratories to be supported by the project will process COVID-19 and will therefore have the potential to cause serious illness or potentially lethal harm to the laboratory staff and to the community, so effective administrative and containment controls will be put in place to minimize these risks. Environmentally and socially sound health facilities management will require adequate provisions for minimization of occupational health and safety risks, proper management of hazardous waste and sharps, use of appropriate disinfectants, proper quarantine procedure for COVID-19, appropriate chemical Public Disclosure and infectious substance handling and transportation procedures, etc. These measures are covered in the ICWMP contained in the draft ESMF and are based on the national healthcare delivery standards and norms set by the MoPH in addition to WHO guidance. ESS3 Resource Efficiency and Pollution Prevention and Management ESS3 is considered relevant to the AF activities of the Project. Medical and hazardous chemical wastes are expected to be generated from health facilities and laboratories. The improper handling, transporting, and disposal of these hazardous and medical waste streams may result in adverse impacts to human health and the environment. The management of medical waste remains a challenge in the DRC. The inventory of incinerators in the DRC shows that number is not sufficient to cover the needs at the level of health facilities. Only 54% of incinerators are functional in health structures that vaccinate but do not meet the required standards (temperature does not reach 800°C, crack in the seal, etc.). Indeed, during the vaccination of targeted people against COVID-19, there will be an increase in medical and hazardous waste. Given the increase in the quantity of waste, the project will support the health facilities concerned by the project by purchasing appropriate incinerators to ensure rational waste disposal. The Infection Control and Waste Management Plan (ICWMP) for health facilities developed as an Annex to the ESMF under the parent project will be updated and implemented. This updated ICWMP will follow WHO guidance documents on COVID-19 and other Good Industry International Practice (GIIP).Technical capacity of the Borrower to manage hazardous and medical waste in line with GIIP i.e. infrastructure, facilities and specialized companies for collection and treatment of hazardous and medical waste which operate in the country, will be assessed and May 29, 2021 Page 13 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) addressed as part of the updated ICWMP. The project will support the Borrower to address identified gaps and minimize potential impacts on environment and community health and safety. Any beneficiary medical facility/lab will follow the requirements of the ESMF and the ICWMP that is being updated to cover risks associated with the Project, WHO COVID-19 guidance documents, and other best international practices including WBG Guidelines on Environmental Health and Safety Guidelines, to prevent or minimize such adverse impacts. Any activities that have been screened for environmental and social risks will not be carried out until a completed, consulted and disclosed ESMP is prepared. In addition, when required, site-specific ESMPs will be prepared on the basis of the provisions of the ESMF for rehabilitation works. Waste materials associated with the setting up of vaccination sites and/or incinerators in existing health facilities will be managed in accordance with good practice waste management procedures, which will be covered in the ESMF for minor civil work. The ESMF and in particular the waste management procedures will also be relevant to the management of waste materials derived from activities funded by the Project. There is no procurement of pesticides foreseen in the project, and the project is not considered to be significant user of water. The project is also not expected to generate significant Greenhouse Gas emissions. Resources (water, electricity, fuel, etc.) used in labs and health facilities will follow standards and measures in line with US-Center for Disease Control (CDC) and WHO environmental infection control guidelines for medical facilities. Further support for local health centers will include further capacity building and training in waste management and disposal. Raw resources are not estimated to pose a risk as rehabilitation will be relatively small in scale. Climate Co-Benefits: To maximize climate co-benefits, the project where possible, will finance purchases of climate friendly cold chain equipment. Procurement standards will be used to ensure that cold chain equipment purchased Public Disclosure through the project is climate friendly and energy efficient. In the case of cold chain equipment, this means procuring and installing Solar Direct Drive Refrigerators and WHO PQS certified climate friendly refrigerators/freezers to reduce greenhouse gas emissions from fossil fuels. In any activities to install cold-chain equipment in healthcare facilities, emphasis will be place in using clean energy solutions (such as solar and battery systems) to provide continuous power to health facilities and cold-chain equipment, and to reduce operating costs. ESS4 Community Health and Safety ESS4 is considered relevant to the AF activities of the Project. Inappropriate handling of COVID-19 vaccine and patients can expose communities and could lead to further spread of the disease. Exclusion from vaccines and lack of provision of medical services to disadvantaged or vulnerable people is also a potential risk under the project interventions. As the project is investing to strengthen the oxygen production capacity for the public hospitals, fire safety is a considerable risk and the ESMF to be updated will contain procedures for mitigating the risk of fire and explosion from oxygen enrichment as the result of faulty or leaky equipment, as well as the use of incompatible products and spare parts. Public hospitals that receive funding will be expected to update their emergency response procedures to ensure they cover the associated fire and explosion risks. Accidents and/or emergencies in hospitals such as fire incident or natural phenomena events are also associated risks. Protecting the safety of communities from infection with COVID-19 is a central part of the project. The PDSS-PIU will put measures in place to prevent or minimize the spread of the infectious disease/COVID-19 to the community. Medical and general waste from the labs, health centers, and quarantine and isolation centers have a high potential of carrying micro-organisms that can infect the community at large if they are is not properly disposed of. May 29, 2021 Page 14 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) Standards for vaccine management including cold chain infrastructure are required to be in place because COVID-19 vaccine products are temperature-sensitive, and the cold chain capacity management due to frequent interruptions of electricity supply poses a safety of services risk which could negatively affect the quality and effectiveness of vaccines. The project ESMF will include elements on: (i) how project activities will be carried out in a safe manner with (low) incidences of accidents and incidents in line with Good International Industry Practice (WHO guidelines); (ii) measures in place to prevent or minimize the spread of infectious diseases; (iii) emergency preparedness measures will also be developed and implemented to manage unlikely cases of laboratory accidents/ emergencies, e.g., a fire response or natural phenomena event; iv) available infrastructure and capacity of the Borrower to established and implement vaccine cold chain temperature monitoring in line with GIIP which should cover the whole vaccine chain transport, storage and handling, and v) monitoring of adverse impacts and side effects of vaccines on recipients of the vaccinations. The safety systems, protocols and emergency preparedness measures for the storage, transport, use and disposal of medical waste and vaccines will be put in place to ensure community health and safety. Traffic safety risks during transportation and disbritution of vaccines is a major concern in DRC, the ESMF will develop minimal technical standards including the general requirements for the vehicles and mtorcycles, minimal standards for safe journey, road safety awareness with defensive driving elements, requirements for drivers (age and experience; training requirement, medical fitness; roles and responsibilities, etc.). The project’s mitigation strategy for addressing SEA/SH risk will follow the standalone SEA/SH Action Plan (“Plan Directeur”) developed by the PIU with Bank support that covers for the entire HNP portfolio of four projects Public Disclosure supervised by PIU-PDSS, including the COVID-19 parent project. The parent project has developed an integrated SEA/SH prevention, mitigation and response Action Plan (SEA/SH AP) for the entire HPN portfolio, currently at an early stage of implementation. The parent project SEA/SH AP will adequately cover currently anticipated early stage activities under this AF, and it will be updated to include measures pertaining to the vaccination campaign, if needed, by the Effective Date, and included as an annex in the revised ESMF Community consultations will be undertaken in order to identify to identify if there are any particular unforeseen SEA/SH risks expressed by women, girls or other stakeholders regarding the vaccination campaign. If necessary, detailed mitigation measures will be designed and the SEA/SH AP updated accordingly before the Effective Date. Measures will be put in place to ensure that vulnerable individuals or groups have access to the development benefits resulting from the Project, including vaccination campaigns. These measures will be reflected in the updated ESMF and SEP. The COVID-19 Vaccine Operation will be spearheaded by the directorate of Expanded Program of Immunization (EPI) of the MOPH, which is well-established and has proven track-record for years. The AF will strengthen EPI’s capacity to strengthen the routine data collection (including adverse events) through digitizing the data collection and reporting tools. In addition, the TPM is going to systematically and independently audit the validity of the data reported through the routine system. Given the potential for violent conflict in some provinces to be covered by the project, a preliminary Security Due Diligence Assessment (SDA) was carried out by the bank prior to Appraisal. In the event that the quarantine and isolation centers or vaccination sites need to be protected by security personnel, or security personnel are otherwise May 29, 2021 Page 15 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) involved in project activities, the project will take steps to ensure that, prior to deployment, such personnel are: (i) screened to confirm that they are not has not engaged in any illegal or abusive behavior in the past, including SEA/SH or excessive use of force; (ii) properly educated and trained, on a regular basis, in the use of force and in appropriate behavior and conduct (including with regards to SEA/SH), as provided for in the ESMF; and (iii) deployed in a manner consistent with applicable national legislation. The project is unlikely to employ military personnel to deploy the vaccine across the country; however, if the situation changes, the project will carry out a review of the army's rules of engagement with civilian authorities and will identify and identify specific risks associated with providing security at the various sites of the project. The project should then propose adequate mitigation measures and would strengthen existing measures, if necessary, to ensure that the use of the military in project activities will not result in consequences for the health and safety of the community, including with regard to issues related to SEA/SH. Issues related to use of security forces and mitigation measures will be included in the Security Risk Assessment and Security Management Plan to be developed by the Recipient. The project will encourage the avoidance of SEA/SH based on the WHO code of ethics and Professional Conduct for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructures such as segregated toilets and enough light in quarantine and isolation centers, and vaccination sites. Regarding adverse events following immunization (MAFI), the DRC has developed and validated since 2018 with the help of the WHO a guide describing the process of surveillance and management of MAFI. There is a national committee with MAFI experts and MAFI surveillance focal points in the provinces and health zones of the country. This national committee is made up of clinicians, pharmacists, biologists, epidemiologists and health logisticians. As part of post-introduction surveillance, tools and definitions of MAFI cases related to the administration of the Public Disclosure COVID-19 vaccine will be developed and integrated into the pharmacovigilance guide and disseminated. The MAFI surveillance system in force in the DRC will be used for the COVID-19 vaccine. The Expanded Program of Immunization (EPI or French acronym PEV), of the MOPH, which is well-established and has a proven track-record for years on immunization campaigns, is responsible for managing COVID-19 Vaccine Operation and deployment plan, and will monitor the operational implementation of MAFI surveillance in accordance with the national guide. The AF will strengthen EPI’s capacity to strengthen the routine data collection (including adverse events) through digitizing the data collection and reporting tools. In addition, the TPM is going to systematically and independently audit the validity of the data reported through the routine system. Regarding the cold chain, an assessment was conducted in May 2019 by PEV and UNICEF in order to evaluate needs to provide routine immunizations for the entire country. The following gaps were identified: 15 central warehouses, 14 walk-in cold rooms, 12 solar energy systems for cold-rooms, 134 large solar-powered refrigerators, 3900 solar- powered refrigerators for health centers, freezers, and various other requirements. The project will finance the strengthening of the cold chain throughout the country. To deal with cases of climate-related emergencies and climate-induced disease epidemics, modules on emergency preparedness and response will be included in the project to train health workers. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement ESS5 is considered not relevant to the project as almost all construction is expected to be undertaken within existing facilities. In an unlikely case where land acquisition leading to physical or economic displacement is needed during May 29, 2021 Page 16 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) project implementation, Resettlement Action Plans (RAPs) would be prepared, consulted upon, cleared by the Bank and disclosed prior to commencement of any construction and/or land acquisition. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources ESS6 is not currently relevant to the AF activities of the Project. No greenfield works are envisaged for this project ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS7 is considered relevant for this Additional Financing as there is a presence of Indigenous Peoples/Sub-Saharan Historically Underserved Traditional Local Communities in a number of the provinces targeted by the project, and vaccination campaigns are expected to include IP/SSAHUTLC populations. Project activities, including vaccination campaigns, will not (a) have adverse impacts on land and natural resources subject to traditional ownership or under customary use or occupation; (b) cause relocation of IP/SSAHUTLC nor (c) significant impacts to cultural heritage that is material to the identity and/or cultural, ceremonial or spiritual aspects of the affected people. The Project does not anticipate given the types of activities that FPIC will be applicable. An Indigenous Peoples Planning Framework (IPPF) will be prepared no later than 90 days after the Effective Date, and before any vaccination operations take place in Indigenous Peoples communities. The project will ensure that such Indigenous communities are appropriately informed and can share in the benefits of the project in an inclusive and culturally appropriate manner (i.e. prevention and treatment measures, as well as vaccinations) with provisions included in the revised SEP. The project will respect the human rights, dignity, Public Disclosure aspirations, identity, culture and livelihoods of IP/SSAHUTLC and avoid adverse impacts on them or, when avoidance is not possible, minimize, mitigate or compensate for such impacts. In case whole African Historically Underserved Traditional Local Communities/ SSAHUTLC would be addressed by quarantine provisions, or on-site vaccination campaigns, site-specific plans would be prepared to ensure adequate consideration of their specific cultural needs, to the satisfaction of the Bank. The project will exclude any activities which would require FPIC. When the vaccination program has been more fully developed, and if needed, the SEP will be further revised to contain guidance on the following to ensure: • No forced eviction of IP/SSAHUTLC has or will take place • Barriers to access specific to IP/SSAHUTLC, such as living in remote areas, lack of access to the formal healthcare system or local languages, will be considered and costed for when vaccination campaigns are planned • Cultural reasons for hesitancy towards vaccination and distrust of government healthcare systems should be considered • Targeted, culturally appropriate and meaningful consultations will be conducted for any vaccination campaigns where IP/SSAHUTLC are beneficiaries. Consultations and vaccination campaigns will be conducted through partnership with relevant IP/SSAHUTLC organizations and traditional authorities. • Consultations will clearly communicate that there are policies ensuring that there is no forced vaccination. • Stakeholder engagement and vaccinations will be conducted with extra precautions to minimize COVID-19 transmission risks, especially for IP/SSAHUTLC living in more remote areas or in voluntary self-isolation. ESS8 Cultural Heritage May 29, 2021 Page 17 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) ESS8 is not currently relevant to the Project. Civil works are unlikely to affect cultural assets. In the unlikely event of construction or the movement of earth in connection with any project activities that have not yet been identified. The updated ESMF will include measures for “Chance Finds” of archaeological or other cultural heritage. ESS9 Financial Intermediaries This standard is not Relevant to the proposed project interventions, as no financial intermediaries will be used. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No OP 7.60 Projects in Disputed Areas No B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Is this project being prepared for use of Borrower Framework? No Public Disclosure Areas where “Use of Borrower Framework” is being considered: Not applicable IV. CONTACT POINTS World Bank Contact: Ghulam Dastagir Sayed Title: Senior Health Specialist Telephone No: 5377+3342 / 93-70-113-3342 Email: gsayed@worldbank.org Borrower/Client/Recipient Borrower: Democratic Republic of Congo Implementing Agency(ies) Implementing Agency: Ministry of Health Implementing Agency: PDSS PIU COVID 19- MinSante V. FOR MORE INFORMATION CONTACT May 29, 2021 Page 18 of 19 The World Bank Additional Financing DRC COVID-19 Strategic Preparedness and Response Project (P176215) The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Ghulam Dastagir Sayed Practice Manager (ENR/Social) Africa Eshogba Olojoba Cleared on 28-May-2021 at 18:49:27 GMT-04:00 Safeguards Advisor ESSA Peter Leonard (SAESSA) Concurred on 29-May-2021 at 11:20:45 GMT-04:00 Public Disclosure May 29, 2021 Page 19 of 19