The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) Appraisal Environmental and Social Review Summary Appraisal Stage (ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 04/29/2021 | Report No: ESRSA01450 Apr 29, 2021 Page 1 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) BASIC INFORMATION A. Basic Project Data Country Region Project ID Parent Project ID (if any) Ukraine EUROPE AND CENTRAL ASIA P175895 Project Name Ukraine Emergency COVID-19 Response and Vaccination Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 3/10/2021 5/11/2021 Population Financing Borrower(s) Implementing Agency(ies) Ministry of Finance of Ministry of Health, Ministry Ukraine of Health of Ukraine Proposed Development Objective The Program Development Objective is to prevent, detect, and respond to the threat posed by COVID-19 and Public Disclosure strengthen national systems for public health preparedness in Ukraine. Financing (in USD Million) Amount Total Project Cost 90.00 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 US$90 million project will support preparation and implementation of the COVID-19 vaccination campaign, vaccine procurement costs, deployment of COVID-19 vaccines to eligible groups of the population, and support concurrent activities to strengthen the COVID-19 response. To effectively prepare and support the country in the first phase of vaccine roll-out, the project will invest in procurement of COVID-19 vaccines and logistics, will help set up the cold chain, information and waste management system at national, regional, and facility levels, and support service delivery by reimbursing costs associated with the delivery of COVID-19 vaccination through the deployment of additional staff hours or additional staff, and covering related recurrent costs. Concurrently, the project will support activities to further expand COVID-19 testing capacity. Strong testing is essential as vaccine Apr 29, 2021 Page 2 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) coverage will be incomplete and focused on priority populations, hence prevention will continue to be critical in the interim. Together, these investments will increase the capacity of the Ukrainian government to prevent new COVID- 19 cases and reduce COVID-19 related complications, respond to the pandemic (as well as prepare for future pandemics), and, ultimately, decrease COVID19-related morbidity and mortality in the country. Activities supported by the project will be organized into 2 components: Component 1 Strengthen public health system for COVID-19 response (US$60 million). This component will support procurements necessary to achieve the PDO and PDO indicators. Specifically, it will cover COVID-19 vaccine procurement for at least 2 million people and any associated costs not covered by COVAX (storage, in-country logistics), procurement of goods to prepare health system for COVID-19 vaccination deployment (cold chain, storage, logistics, waste management), support elements of vaccination campaign, development and essential vaccine management information systems. It will also support activities to further expand COVID-19 testing capacity. Strong testing is essential for vaccine surveillance, given that vaccine coverage will be incomplete and focused on priority populations, hence prevention will continue to be critical in the interim. Component 2 COVID-19 vaccination deployment (US$30 million). This component will finance payments to providers for completion of COVID-19 vaccination for individuals of priority populations and will be organized as reimbursement for agreed performance-based conditions (PBCs). It is expected that the Government of Ukraine will finance the delivery of COVID-19 vaccines to the eligible population by introducing a separate package into the Program of Medical Guarantees (PMG) administered by the National Health Service of Ukraine (NHSU). This package will provide resources to cover the additional costs (beyond the actual vaccines) associated with the rollout of the COVID-19 vaccination program, including “surge staffing” (i.e. additional staff time or additional staff needed to provide COVID- Public Disclosure 19 vaccination), hazard pay, additional PPEs, fuel, small consumables, etc. Based on compliance with agreed requirements endorsed by the MoH and set up in NHSU contracts, public providers will be contracted by NHSU for the provision of COVID-19 vaccination to target groups and will be paid agreed fees. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] Ukraine is a country in Eastern Europe bordered by Russia, Belarus, Poland, Slovakia, Hungary, Romania, Moldova, and the Black Sea to the south. Ukraine has an area of 603,628 km2 and a population of about 42 million people. With 765,117 registered COVID-19 cases as of December 1, 2020 and daily new cases exceeding 16,000, Ukraine is among the countries in Europe most affected by COVID-19. Testing capacity is limited, with less than 50,000 PCR tests performed daily (appr. 25% of which are done by private labs), which constraints testing mainly to patients with symptoms. The contact tracing and tracking system is weak. The capacity of the hospital sector, in terms of beds properly equipped and connected to oxygen supply, is limited. Unless a full lockdown is introduced soon (planned by the Government in April 2021), there is a high risk that hospital capacity will be not enough. Medical waste management in Ukraine is regulated by the State Sanitary and Anti-Epidemic Rules and Norms on Medical Waste Management, approved by the order of the Ministry of Health of June 8, 2015 № 325 (hereinafter - Order 325). According to Order 325, medical wastes generated during vaccination are category B wastes or infectious Apr 29, 2021 Page 3 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) hazards. This category also includes any waste that has been in contact with biological fluids, i.e. the largest group of medical waste. As per Order 325, Category B wastes are subject to chemical or physical disinfection (thermal, radiation, electromagnetic) followed by landfilling in specially dedicated landfills. There are only few medical waste incinerators in the country. Licenses to handle medical and hazardous waste are issued by the Ministry of Environmental Protection, environmental inspection is responsible for monitoring of their activity. As of January 2021, there are up to 30 companies in Ukraine who have the license to utilize medical waste and 50 more who can transport and store medical waste. However, their geographical spread is not equal across Ukraine. According to the preliminary 2020 data, about 4 thousand tons of category B medical waste is generated in Ukraine monthly. COVID-19 Response and Vaccination Project deals with acquisition of goods (medical equipment, testing supplies, vaccines) and payment for results through performance-based conditions. The Project is not expected to fund any civil works. If minor improvement works will be necessary to install different equipment and upgrading of cold-chain and storage facilities, these works will be funded by healthcare facilities/state budget. The Project will support initial rollout of COVID-19 vaccines and associated supplies. It will also provide emergency financial support for the procurement of laboratory equipment and tests as well as other necessary materials that will be necessary for effective COVID-19 response. During the project preparation, the World Bank worked with the Government to asses readiness to deliver COVID-19 vaccine when they become available using Covid-19 Vaccine Readiness Assessment Framework (VRAF). The VRAF measures countries’ readiness to administer the COVID-19 vaccine across four core areas: Planning and Management, Supply and Distribution, Program Delivery, Support Systems and Infrastructure. The VRAF tool helped identify gaps Public Disclosure and prioritize opportunities for enhanced readiness, and uncovered needs for financial support. Based on the results of the assessment, World Bank funding is required for immediate vaccine requirements and strengthening of immunization systems, including expanding cold-chain refrigeration and logistic systems, procurement of vaccines and associated supplies, improvement of waste management procedures and required equipment, training and supporting vaccinators, ensuring communication and awareness, and the like. According to the draft National Plan of COVID-19 Vaccination Deployment, the country had set the interim target of vaccinating 50% of the total population (20,866,390 people). Based on the WHO SAGE recommendations, the National Immunization Technical Advisory Group (NITAG) recommendations, taking into account availability of vaccines against COVID-19, and logistical, operational and infrastructural constraints, Ukraine plans to prepare and deploy a multi-staged vaccination campaign against COVID-19 in 2021-2022 to cover at least 50% of the country population. The campaign will be deployed in stages, starting from the priority groups such as medical professionals directly engaged in the COVID-19 response. Ukraine will consider age as one of the key priorities, meaning that within the priority groups, people of older age (60 years of age and older) will be prioritized to receive vaccines first. However, this age-related may change to reflect final information on safety, efficacy and tolerability of the vaccines in older population. It should be noted that the exact timeline, as well as more precise proportion of population to be vaccinated can only be determined after the full information on vaccines safety, tolerability, efficacy and effectiveness, dosage, and storage (cold chain) requirements is released. Thus, the proportion of target population for vaccination may change in the future, in line with the release of new information about the vaccine candidates, and immunization modalities. Apr 29, 2021 Page 4 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) The Project activities such as COVID-19 testing, operation of laboratories (equipment, reagents /chemicals), vaccination and medical staff training can have considerable environmental and social impacts. All project activities will be implemented countrywide on government controlled territories. Specific locations where the materials, equipment and vaccines will be received, stored, and used are not yet identified - all activities will be implemented in urban as well as rural areas; above all in the latter quality control will be essential. Also, the likelihood of occurrence of risks of infection through medical and laboratory waste will be high should there be poor management of the COVID-19 medical and infectious wastes and / or if there is poor adherence to standard bio-safety practices. All environment and social risks such as medical waste, worker and community safety will be addressed through the development of an Environmental and Social Management Framework (ESMF), which will set out environmental and social (E&S) risk assessment requirements of each sub-component/activity. It will provide guidance on the environmental and social management of ES risks and impacts and the preparation of Infection Control and Waste Management Plan (ICWMP). The ESMF will include a section on Occupational Health and Safety (OHS) of workers and relevant aspects of Labor Management Procedures (LMP) focusing on the COVID specific risks. It will consider national and international protocols for infectious disease control and will include updated provisions on medical waste management. The Project is not expected to impact natural habitats or cultural sites. There is no land acquisition or involuntary resettlement envisaged under the Project. However, other social dimensions including risks of exclusion, unequal access to vaccination programs for most vulnerable and Public Disclosure disadvantaged groups, and gender aspects will need to be further analyzed and incorporated into project design and implementation. The initial stakeholder activities conducted under the project preparation with both government and non-government stakeholders and other interested parties have identified primary stakeholders and formed comprehensive baseline for the Stakeholder Engagement Plan that will guide all outreach and communication for both the health and social protection activities to target beneficiary groups. D. 2. Borrower’s Institutional Capacity The Project will be implemented over a period of 24 month after approval (until March 31, 2023). The Ministry of Health (MoH) will be the implementing agency for the Project and will have overall responsibility for project implementation including fiduciary, monitoring and evaluation, environmental and social risk management. The MoH is formally accountable for the health of the population, oversight of the health system, the quality of health services, as well as for strategic planning and management of the health protection programs of the Government of Ukraine. The MoH will be accountable for the execution of project activities. The Project will be delivered through the Project implementation unit (PIU) that currently implements the Serving People, Improving Health Project (P144893) and Additional Financing to Serving People, Improving Health Project (P170740) (closing date of the Project is March 31, 2023). The PIU has a designated environment and social focal point, who will be responsible for the preparation of environmental and social instruments during the project preparation and will ensure coordination with MoH staff on environmental and social risk management during the project implementation, including supervision of waste management practices and OHS issues related to COVID-19 risks. Given the scale of the current project, the requirement for specialized risk management expertise around OHS and medical waste management, and the need for extensive community outreach (in addition to the PIU’s current duties), the Borrower will supplement the PIU's capacity to support the national vaccination implementation Apr 29, 2021 Page 5 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) campaign by hiring additional consultants to work alongside the environmental and social specialist. This commitment is reflect in the ESCP. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The Project will have long term positive environmental and social impacts, as it should strengthen the public health system overall and specifically improve COVID-19 surveillance, monitoring, prevention and containment. In the short-term, the environmental risks are considered to be Substantial. Uncertainty remains around specific activities and locations. The COVID-19 vaccination rollout poses a lot of uncertainties, that may need ad hoc decisions and adjustments. The main environmental risks identified at this stage are: (i) the Occupational Health and Safety issues related to testing and handling of supplies during vaccination; (ii) the logistical challenges in transporting vaccines across the country in a timely manner, adhering to the recommended temperature and transportation requirements; (iii) production and management of medical healthcare waste; (iv) community health and safety issues related to unforeseen effects of vaccination, traffic/road safety risks associated with transporting vaccines as well as with handling, transportation and disposal of hazardous and infectious healthcare waste. These risks are covered by ESS 1, ESS 2, ESS 3, ESS 4, and ESS 10. Health care waste and chemical wastes (including wastewater, disposed of vaccines, reagents, infected materials, etc.) can have a substantial impact on the environment and human health. Wastes that may be generated from health facilities/ labs could include liquid contaminated waste, Public Disclosure chemicals and other hazardous materials, and other waste including sharps used in diagnosis and treatment. All of this requires special handling and disposal as it may pose a risk to health care workers from occupational infections and to the communities if not disposed off properly. The “cold chain” storage, handling, and transportation of the vaccines also require adhering to stringent health and safety standards and practices to minimize associated risks. Old and outdated refrigerators containing ozone depleted substances must also be safely disposed in accordance with pertinent national and international practices. The implementing agency has committed to prepare, during project implementation and before project effectiveness, an ESMF that will cover the procedures for the screening and the identification of the environmental and social risks as well as the mitigation measures to be implemented for the various proposed activities, including the establishment of effective on-site medical waste management, storage, transportation and disposal schemes. Mitigation measures will be based on WHO technical guidance on COVID-19 response on limiting viral contagion in healthcare facilities, World Bank Group EHS Guidelines and other good international industry practice (GIIP). The ESMF will include an Infection Control and Waste Management Plan (ICWMP) which will describe in detail appropriate waste management practices to be utilized under the Project. The ESMF will also include an elaboration of roles and responsibilities within the PIU and the Ministry of Health, training requirements, timing of implementation and budgets. Procurement of goods (purchase of testing kits, medical equipment, vaccines etc.) and consultancy activities for COVID-19 communication can be initiated as soon as the Project is approved. The ESMF, including relevant management plans should be finalized before deployment of medical equipment, establishing the laboratory facilities, distribution and administering vaccines. Social Risk Rating Substantial The project social risks are rated as substantial given there may be substantial gaps in coverage of the program for the most vulnerable and disadvantaged groups. Other social risks are related to community health and safety- Apr 29, 2021 Page 6 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) related outcomes, especially associated with labor management, ensuring proper conditions of work for workforce, management of worker relationships, potential Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) and provision of adequate support. Given that limited information is available on detailed vaccines distribution protocol to be followed by the country at this stage, measures will need to be taken to address key drivers of their exclusion by modifying COVID-19 assistance programs. To ensure elite capture does not result from higher vaccine hesitancy in vulnerable groups (than elites who accept vaccines), the project has designed a comprehensive social engagement strategy including robust communication outreach measures, GRM and stakeholder engagement plan. The Government with the assistance of donor partners, including the Bank, has prepared a draft vaccine readiness assessment framework and elaborated a National Plan of COVID-19 Vaccination Deployment that outlines detailed procedures and protocols for implementation of COVID-19 vaccination and proposes measures for effective vaccination procedures for the population. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: This standard is relevant. The Project is expected to result in positive environmental and social impacts as it seeks to improve planning, processes and on-the-ground service delivery for COVID-19 containment and response through support of COVID-19 Public Disclosure vaccination and testing, and including strengthened surveillance, and monitoring. However, project activities also present significant environmental, social, health and safety risks for the project workforce and communities. Given the nature of how the disease spreads, the medical requirements and resources needed to address the issue, health-care workers, community members, beneficiaries of the Project, and the environment are likely to be exposed to risks from medical, solid and liquid wastes generated from the health facilities (if not properly treated and managed) and the interaction among the potential COVID-19 cases and general public. To manage these risks, MoH will prepare the following instruments: The Environmental and Social Management Framework which will include procedures relevant to the development of the subprojects including the screening and assessment of associated environmental risks and impacts and identification of pertinent mitigation measures and plans. Mitigation measures will be mainly based on relevant WHO guidance, World Bank Group EHS Guidelines and other good international industry practices (GIIP). The Bank’s Environmental and Social Management Framework for COVID-19 Response template will be used as the basis for the ESMF. The ESMF will include measures for screening for infection prevention and healthcare waste management; Labor Management Procedures (LMP) for PIU and the engaged workforce to ensure proper working conditions and management of worker relationships; occupational health and safety and COVID-19 specific risks; measures to prevent potential Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) risks; guidelines for establishing and managing an accessible multichannel grievance mechanism establishment; and capacity strengthening for social, environment, health and safety management. Medical, solid and liquid wastes need to be treated as per accepted standards for which an Infection Control and Waste Management Plan (ICWMP) will be prepared for the project interventions, as a part of the ESMF. Apr 29, 2021 Page 7 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) The Project is not expected to fund any civil works. If minor improvement works to install different equipment and to upgrade cold-chain and storage facilities is deemed necessary, these works will be funded by the healthcare facility and/or state budget. Relevant ESMP Checklist will be prepared for such works and will be included in the contract document. The Environmental and Social Specialist will monitor these activities. The ESMF will be prepared to a standard acceptable to the World Bank and disclosed on the MoH website and on the World Bank website before the Effectiveness Date. According to ESS1, the Borrower will engage with stakeholders as an integral part of the Project’s environmental and social assessment and project design and stakeholder engagement will continue through implementation. Preliminary design stage stakeholder activities conducted by the Client have involved participation from both government and non government players and are set out in the Stakeholder Engagement Plan (and Grievance Redress Mechanism). The SEP focuses on establishing a structured approach for community outreach and two-way engagement with stakeholders with emphasis on most vulnerable and disadvantaged groups. The SEP is prepared in both English and Ukrainian and is based upon meaningful consultation and disclosure of appropriate information, considering the specific challenges associated with public meetings as a result of COVID-19. It will be updated by the PIU and re-disclosed before the Effectiveness Date. The MoH has prepared the Environmental and Social Commitment Plan (ESCP) as a requirement of the legal agreement that will ensure project compliance with the Environmental and Social Standards and the World Bank Public Disclosure Group (WBG) Environmental, Health and Safety (EHS) Guidelines. To achieve the above mentioned positive environmental and social impacts, the aforementioned areas of risks must be addressed and mitigated as discussed below: Medical Waste Management and Disposal. Wastes that may be generated from labs, screening posts and treatment facilities could include liquid contaminated waste (e.g. blood, other body fluids) and infected materials (water used; lab solutions and reagents, syringes, facemasks, gloves, gowns etc.) require special handling and awareness, as they may pose an infectious risk to healthcare workers in contact with the waste. Informal disposal of such waste may lead to the contamination of soil and groundwater, and, more importantly, to the further spreading of the virus in nearby communities. In order to mitigate the risks associated with medical waste management and disposal, the Project will invest in the procurement of appropriate waste management infrastructure, including containers, PPE, disinfection equipment, as well as training of medical, laboratory and waste management personnel to ensure compliance with the ICWMP, WHO guidance and GIIP. This will be documented in the ESMF in the ICWMP. Worker Health and Safety. Workers in healthcare facilities are particularly vulnerable to contagions like COVID-19. Healthcare-associated infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among health and laboratory workers. The ICWMP will contain detailed procedures, based on WHO guidance, for protocols necessary for testing, administering vaccines and handling medical waste as well as environmental health and safety guidelines for staff, including the necessary personal protective equipment (PPE). Proper disposal of sharps (see medical waste above), disinfectant protocols, and regular testing of healthcare workers will be included. Apr 29, 2021 Page 8 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) Community Health and Safety. All project activities ranging from the operation of laboratories to community engagement activities present a risk of transmission in the community. The operation of laboratories and health facilities have a high potential of carrying micro-organisms that can infect the community at large if they are not properly managed and controlled. The Project’s ESMF will outline procedures for each project activity commensurate to the risk. The ICWMP being developed will contain detailed procedures, based on WHO guidance, for the operation of health facilities. ESS10 Stakeholder Engagement and Information Disclosure The Stakeholder Engagement Plan (SEP) has been developed and will be implemented by the Borrower with the participation of potentially affected parties to ensure the adequacy of the project design, and inform stakeholders about the Project and its potential environmental and social risks and impacts including how the Project would address potential exclusion risks. The Project will ensure that stakeholder engagements is conducted on the basis of timely, relevant, understandable and accessible information. The SEP also includes other interested parties (OIPs), various beneficiaries and directly impacted Project affected persons (PAPs), including disadvantaged and vulnerable groups. The SEP will be updated, as necessary, throughout the project cycle (preparation and/or implementation). If major changes are made to the SEP during Project preparation or implementation, a revised SEP will be publicly disclosed. Project preparation included a detailed mapping of the stakeholders. Individuals and groups likely to be affected Public Disclosure (direct beneficiaries) have been identified. Mapping of other interested parties such as government agencies/authorities, NGOs and CSOs, and other international agencies have also been completed. The Project will continue financial support and further expansion of the national COVID-19 hotlines established by the MoH. It will support capacity training of services providers on delivering messages pre-approved by the Ministry of Health and National Health Service explaining how to follow national protocol on COVID-19 (symptoms, testing options and timelines, referrals, access to other essential health services during the pandemic, etc) to the general public. It will also include COVID-19 vaccine-specific counselling of priority groups of populations and other interested individuals. The SEP implementation will contribute to the National Communications and Outreach Strategy as part of the National COVID-19 Vaccination Deployment Plan. Implementation of the National Communications and Outreach Strategy will be supported by USAID and implemented by UNICEF. Accessible grievance mechanism shall be established, publicized, maintained and operated in a transparent manner that is culturally appropriate and readily accessible to all Project-affected parties, at no cost and without retribution, including concerns and grievances filed anonymously, in a manner consistent with ESS10. The grievance mechanism shall also receive, register and address concerns and grievances related to the sexual exploitation and abuse, sexual harassment in a safe and confidential manner, including through the referral of survivors to gender-based violence service providers. B.2. Specific Risks and Impacts Apr 29, 2021 Page 9 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions Given the planned project activities, environmental and social risks/impacts related to OHS are expected to be substantial. Project workers will include civil servants, direct workers (MoH staff (that are not civil servants) and consultants), and contracted workers (employees of medical health facilities, laboratories, workers of the waste disposal companies, and providers for transportation and storage of vaccines). The Borrower as part of the Environmental and Social Management Framework will prepare by no later than 30 days after Effectiveness the Labor Management Procedures (LMPs) applicable to the Project. The LMPs will describe (i) procedures relevant to each category of workers involved, including the process for hiring experienced consultants if necessary to provide “hands-on” technical assistance and capacity-building programs; (ii) overview of key potential labor risks (if any); (iii) overview of Ukraine’s labor legislation; (iv) description of grievance redress mechanism or mechanisms available for all direct workers and contracted workers; (v) procedure for incorporating labor requirements into the ESHS specifications of the procurement documents; and (vi) implementation of adequate occupational health and safety measures (including emergency preparedness and response measures); (v) definition and procedures for “surge staffing”. The LMP will be applicable to all workers engaged directly by the project or provided from other sources to support project activities. These measures will be included in the ESMF and ICMWP noted under ESS1 and will include: procedures for entry into health care facilities (strict checks before entering); procedures/ precautions for the protection of workers against infection; provision of immediate and periodical training on the procedures to all categories of workers; posting signage in all public spaces mandating hand hygiene and PPE; and ensuring adequate supplies of PPE Public Disclosure (particularly facemask, gowns, gloves, googles, handwashing soap and sanitizer). The Project will also regularly integrate the latest COVID-19 guidance and best practices by WHO as it evolves. Key gaps between national legislation and ESS2 will be assessed and described along with gap-filling measures in the document. The Project Operational Manual will include the labor management provisions and the requirement for contractors to have industry standard Codes of Conduct, including measures to prevent SEA/SH. ESS3 Resource Efficiency and Pollution Prevention and Management This standard is relevant. Pollution prevention and management – specifically medical waste management – will be of particular importance under the Project. Medical waste generated from labs, screening posts, vaccination centers and treatment facilities to be supported by the Project will likely include contaminated wastes and infected materials (e.g. blood and other body fluids, wastewater, lab solutions and reagents, vaccines, syringes, sharps, PPE equipment, etc.) that would require special handling and disposal , as they may pose risk to healthcare workers in contact with these wastes including those of the specialized waste disposal companies. Informal disposal may lead to contamination of soil and groundwater, and more importantly, to further spreading of the virus to nearby communities. Furthermore, if the Project procures new refrigerators for the transportation and storage of vaccines, then the old refrigerators containing ozone-depleting substances must be disposed of safely in accordance with pertinent national regulations and international requirements. Apr 29, 2021 Page 10 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) Ukraine generally lacks adequate solid waste disposal infrastructure and has few facilities for permanent disposal of medical waste. While on-site separation and collection of medical waste is mostly well-organized, its final disposal is a challenge, especially in rural areas. In order to mitigate the risks associated with on-site management of medical waste, its transportation and disposal, the Project will invest in the purchase of medical equipment to neutralize COVID-19 associated waste (autoclaves, shredders and needle incinerators). The distribution of these equipment will be done based on the results of the in-depth country-wide waste management system needs assessment covering country waste management capacity including information on health/medical waste management facilities in Ukraine (existing service providers, waste transportation and disposal facilities, licensing, operational practices, and performance) and waste management needs of the vaccination/testing campaign. The study will be conducted by the Borrower at the beginning of project implementation. Also, the study will propose optimal waste management schemes (to define which waste streams should be disinfected at the healthcare facility level and which should be transported to specialized facility outside) for all beneficiary healthcare facilities and outline staff training requirements. This commitment is reflect in the ESCP. Furthermore, the ESMF will include an Infection Control and Waste Management Plan (ICWMP), which will include specific requirements for waste management practices employed under the Project for the supported health facilities. At a minimum, the ICWMP will cover: (a) anticipated waste composition and quantity; (b) existing medical, solid and liquid waste management system, including deviation and gaps from the relevant EHSGs, GIIP, WHO guidelines and other protocols; (c) existing regulatory framework and supervision / monitoring arrangements; (d) plan for using the existing medical, solid and liquid waste management system, including any measures to upgrade or remedy identified gaps and deviations; and (e) additional arrangements for supervision and monitoring of waste Public Disclosure management. The PIU will ensure the execution of the ICWMP throughout the project implementation period. ESS4 Community Health and Safety This standard is relevant. The early phase of COVID-19 vaccination will cover up to 20% of population (or about 8,346,556 million people).The Project will contribute to ensure sufficient supply of vaccines, transportation and utilization logistics, as well as training for medical staff. The National COVID-19 Vaccination Deployment Plan has been drafted and is being reviewed by WHO. The expectation is that the National COVID-19 Vaccination Deployment Plan will be approved in January 2021. It is planned that first wave of vaccination will cover most vulnerable groups - medical staff, social workers, elderly, teachers and education staff, and other population categories and professional groups who are at high risk of contracting COVID-19. The vaccination will be done on the voluntary basis. Protocols for adapting surveillance systems for surveillance of events attributable to vaccination are bein developed and will be duly disseminated. Reporting on adverse effects that will track immunization status of a person on an individual level will be done through IT solutions (an app). The Government is working on establishing the compensation schemes in the event that there are unintended health consequences as result of vaccines. Protecting the health of communities from infection with COVID-19 is a central part of the Project. Without adequate controls and procedures, project activities have the potential to contribute to the spread of the virus and may also contribute to social conflict. Medical wastes and general waste from the labs, testing facilities and health centers Apr 29, 2021 Page 11 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) have a high potential of being contaminated with the coronavirus or other micro-organisms that can infect the community at large if they are not properly disposed of. There is a possibility for these infectious microorganisms to be transmitted to members of the public if not well contained within laboratories or appropriately isolated areas of hospitals and medical centers, or due to accidents or emergencies (i.e. a fire or natural phenomenal events). The improper storage, transport, use and disposal of vaccines could also pose health and safety risks if not adequately managed. The ESMF will describe emergency preparedness and response (EPR) measures for safe cold chain management during power outages and natural disasters. The Project’s ESMF and the Infection Control and Waste Management Plan (ICWPM) will outline procedures for project activities commensurate to the risk including (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. The engagement of security or military personnel in the implementation of project activities is not anticipated. There are no project-related assets for which the engagement of security or military personnel is envisaged. The Project will ensure the avoidance of any form of Sexual Exploitation and Abuse by relying on the WHO Code of Ethics and Professional conduct for all workers in the healthcare facilities and laboratories. The Project’s risk communication and community engagement activities coupled with broader stakeholder engagement activities will ensure that clear information is provided to the public. The PMU will oversee the implementation of the GRM with Public Disclosure the aim of addressing concerns or grievances early. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement The Standard is not currently relevant to the Project. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources The Standard is not currently relevant to the Project. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities The Standard is not currently relevant to the Project. ESS8 Cultural Heritage The Standard is not currently relevant to the Project. ESS9 Financial Intermediaries The Standard is not currently relevant to the Project. Apr 29, 2021 Page 12 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No OP 7.60 Projects in Disputed Areas No B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Is this project being prepared for use of Borrower Framework? No Areas where “Use of Borrower Framework” is being considered: Use of Borrower Framework is not envisaged for this Project IV. CONTACT POINTS World Bank Contact: Olena Doroshenko Title: Economist, Health Public Disclosure Telephone No: 5262+3907 Email: odoroshenko@worldbank.org Borrower/Client/Recipient Borrower: Ministry of Finance of Ukraine Implementing Agency(ies) Implementing Agency: Ministry of Health Implementing Agency: Ministry of Health of Ukraine V. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Olena Doroshenko Apr 29, 2021 Page 13 of 14 The World Bank Ukraine Emergency COVID-19 Response and Vaccination Project (P175895) Practice Manager (ENR/Social) Anne Olufunke Asaolu Cleared on 27-Apr-2021 at 11:38:10 GMT-04:00 Safeguards Advisor ESSA Agnes I. Kiss (SAESSA) Concurred on 05-Mar-2021 at 15:55:50 GMT-05:00 Public Disclosure Apr 29, 2021 Page 14 of 14