COVID-19 Response SEP Template Updated Stakeholder Engagement Plan (SEP) The Federal Government of Nigeria Federal Ministry of Health Nigeria Centre for Disease Control UPDATED STAKEHOLDERS’ ENGAGEMENT PLAN (SEP) NIGERIA COVID-19 PREPAREDNESS AND RESPONSE PROJECT (P173980) AND NIGERIA COVID-19 PREPAREDNESS AND RESPONSE PROJECT ADDITIONAL FINANCING WITH RESTRUCTURING (P177076) August 2021 1 Contents 1. Introduction.......................................................................................................................................... 3 1.2 Project Description ..................................................................................................................... 3 1.3 Nigeria CoPREP ......................................................................................................................... 4 1.4 Proposed New Activities............................................................................................................ 7 2. Stakeholders Engagement Plan .................................................................................................... 10 2.1 Stakeholder Identification and Analysis ..................................................................................... 11 2.1.1 Methodology ........................................................................................................................... 11 3. Stakeholder Engagement Plan ...................................................................................................... 16 3.1. Summary of Stakeholder Engagement done during Project Preparation ............................ 16 3.2. Summary of Project Stakeholder Needs and Methods, Tools and Techniques for Stakeholder Engagement ................................................................................................................... 17 3.3. Proposed Strategy for Information Disclosure ......................................................................... 18 3.4. Stakeholder Engagement Plan .............................................................................................. 20 3.5. Proposed Strategy to Incorporate the View of Vulnerable Groups ....................................... 21 3.6. Reporting Back to Stakeholders ................................................................................................. 21 4. Resources and Responsibilities for Implementing Stakeholder Engagement Activities ....... 22 4.1. Resources ...................................................................................................................................... 22 4.2. Management functions and responsibilities.............................................................................. 22 5. Grievance Mechanism ..................................................................................................................... 22 5.1. Description of GM ......................................................................................................................... 23 6. Monitoring and Reporting ................................................................................................................ 27 6.1. Involvement of Stakeholders in Monitoring Activities .............................................................. 27 6.2. Reporting back to Stakeholder Groups ..................................................................................... 27 Annex 1 GRM Tools ............................................................................................................................. 28 Revised SEP 2 1. Introduction The parent project, the Nigeria COVID-19 Preparedness and Response Project (Nigeria CoPREP), prepared a Stakeholder Engagement Plan (SEP) which was disclosed in May 2020. The SEP is now updated due to the request by the Government of Nigeria for an Additional Financing (AF) and Parent Project restructuring to include vaccine acquisition and deployment activities. The updated SEP will be disclosed in-country and on the World Bank website prior effectiveness. This updated SEP now covers procedure for stakeholder engagement for the Parent project, the AF, and the restructured project. 1.2 Project Description Over the years, the world has witnessed several recurrent epidemics, a few pandemics and other public health issues accompanied by negative impacts on both human health and the ecosystem. The major threats are the diseases that interface at the human-animal ecosystem thereby significantly increasing morbidity and mortality. It is estimated globally that 75% of emerging infectious diseases are of zoonotic origin (OHSP, 2019). A recent pandemic is the outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. As of July 22, 2021, the outbreak has resulted in an estimated 191,773,590 of confirmed cases including 4,127,963 deaths with a total of 3,568,861,733 vaccine doses administered globally (WHO, COVID 19 Dashboard). In Nigeria, the total number of COVID 19 confirmed cases as of July 23, 2021 is 170,122 including 164,752 discharged cases, 3,240 active cases and 2,130 deaths, leading to a tremendous burden on the fragile heath system of the country. The Nigeria Center for Disease Control (NCDC) is the country’s public health institute with the mandate to lead the preparedness, direction and response to infectious disease and public health emergency. The NCDC has been investing in epidemic preparedness for the past three years and has helped to set up Public Health Emergency Operation Centers (PHEOCs) in 23 out of the 36 states in Nigeria. These PHEOCs help States to coordinate, prevent, monitor, and respond to infectious disease emergencies. Furthermore, Nigeria’s experience in managing the Ebola outbreak also helped it to be better prepared for COVID-19. Across the country, there are efforts to increase the response capacity through the expansion of facilities to handle isolation and treatment of suspected and confirmed cases of COVID-19. In curbing the spread of the virus, the Nigerian Government has initiated and implemented various activities, programs and subprojects. One of such initiation by the government resulted in the World Bank approval of Nigeria COVID-19 Preparedness and Response Project (Nigeria CoPREP) on August 6, 2020, effectiveness on March 15, 2021 with a credit of about US$100 million and a grant in the amount of US$14.28 million as part of the Multiphase Programmatic Approach (MPA), supported under the Fast- Track COVID-19 Facility (FTCF). Recently, the Nigerian Government formally requested the need for an AF and to restructure and expand the Nigeria CoPREP to support COVID-19 vaccination at the federal and state level which can be attributed to the immediate financial need and the inability of the state to carry out all the needed activities to ensure acquisition and rapid deployment of vaccines in their administrative wards. Other reasons for restructuring are: o revision of disbursement estimates to accommodate the delayed effectiveness of the project; and o revision of the results framework to reflect the newly introduced activities. Revised SEP 3 The amount proposed for the AF and the Parent project restructuring is US$ 400 million. 1.3 Nigeria CoPREP The Nigeria CoPREP Project Development Objective aims to prevent, detect, and respond to the threat posed by COVID-19 at state level in Nigeria. The Parent Project comprises the following components: Component 1: Emergency COVID-19 Response This component would provide immediate support to break the chain of COVID-19 local transmission and limit the spread of COVID-19 in Nigeria through containment and mitigation strategies. It will support COVID-19 emergency operations nationally, with a focus on states. It will support enhancement of institutional and operational capacity for disease detection capacities through provision of technical expertise, and supporting coordination, detection, and case management efforts of Nigeria’s COVID-19 response, consistent with the WHO guidelines in the Strategic Response Plan. The Nigeria CoPREP will have a strong complement of surge federal support needed for coordination and management. In addition, the federal-level subcomponent will finance high-value procurements that will go to states, to leverage on economies of scale and take advantage of the different procurement opportunities being provided through UN agencies, the World Bank-facilitated procurement (BFP) and through use of emergency procurement procedures. The states may undertake low level procurements in line with unique state needs. Subcomponent 1.1) on Federal Support and Procurement for COVID-19 Emergency Preparedness and Response This subcomponent will provide immediate support to Nigeria at the federal level for the COVID-19 preparedness and response. This subcomponent will finance federal procurements of COVID-19-related commodities including medical equipment, laboratory tests, and medicines for COVID-19 emergency response to be distributed to the states based on the need to ensure there is no wastage, keeping in mind the emergent global supply chain challenges.1 Additionally, this subcomponent will complement REDISSE II’s strengthening of disease surveillance and response systems, and short-term emergency support to national IAP to fill surge financing gaps for POE surveillance, case detection, confirmation, contact tracing, recording, and case management, including handwashing and sanitation activities. This subcomponent will also support national level activities aimed at COVID-19 vaccine deployment, such as development of micro-plans for vaccination, training and retraining of health workers on microplanning and vaccine implementation, advocacy communication and social mobilization, monitoring and supervision of vaccination, payment to personnel involved in deployment of vaccines, procurement of devices such as syringes, cold boxes and carriers and transport and logistics costs. Subcomponent 1.2: Direct Support to States for COVID-19 Emergency Preparedness and Response This subcomponent will support establishment, activation, and operationalization of EOCs in states, state vaccination deployment and provide financing support to all states and the FCT through the NCDC for the implementation of State COVID-19 IAPs. This subcomponent, through the approved IAPs, will finance implementation of state activities within the plan, including, among others, (a) the development 3 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. Revised SEP 4 and dissemination of plans and standard operating procedures for case management, IPC, and so on; (b) establishment and operationalization of state EOCs as needed; (c) epidemiological investigations and contact tracing; (d) strengthening of risk assessment; (e) strengthening of public health emergency management and community and event-based surveillance; (f) provision of on-time data and information for guiding decision-making and response and mitigation activities; (g) RDT testing at Points of Entry (POE); (h) provision of additional support to laboratories for early detection and confirmation; (i) identification of training needs; (j) equipping, furnishing, and renovation of isolation and treatment centers including community support centers and equipping and setting up of holding area at Points of Entry (POE);(k) improvement in patient transfer systems through financing of ambulances and training as needed; and subnational level activities in support of COVID-19 vaccine deployment. Subcomponent 1.3: Health System Strengthening. This subcomponent will support activities geared toward: Sub-component 1.3.1: Strengthening Laboratory detection, Surveillance, Coordination for COVID-19: this activity will be support by (i) strengthening disease surveillance systems, public health laboratories, and epidemiological capacity for early detection and confirmation of COVID-19 cases and other epidemic threats; (ii) strengthening of the sample transfer system at a national and county level; (iii) EOC operations and monitoring of pandemic; (iv) establishment of two satellite laboratories in prioritized counties to support the National Reference Laboratory (NRL), and ensure that the links between NRL and satellite laboratories are strengthened; (v) training of laboratory staff and support laboratory surge capacity; (vi) procurement of laboratory equipment, consumables and laboratory tests (including COVID-19 testing kits and reagents); (vii) active contact tracing; (viii) epidemiological investigations; (ix) monitoring of outbreak trends; (x) training on case investigations; (xi) calling cards and communication needs for contact tracing and epidemiological investigations; (xii) operational cost of EOC; and (xii) on-time data and information for guiding decision-making and response and mitigation activities. Additional support could be provided to strengthen health management information systems to facilitate recording and on-time virtual sharing of information. This will also cover Point of Entry (PoE) activities, including but not limited to: (i) commodities and infection prevention and control (IPC) materials needed at PoE; (ii) surge staff and personnel for surveillance at PoEs; (iii) training; (iv) temporary holding areas (portacabins) at Domestic airports and ground crossings for screening; (v) logistics and operational support such as fueling of ambulances, etc. Sub-component 1.3.2: Case Management and clinical care. The Project would also finance (i) procurement of COVID-19 specific medical supplies and commodities, medical equipment, infection prevention and control (IPC) materials, PPEs for healthcare personnel; (ii) assessments and development of guidelines and protocols; (iii) training and capacity building of health care workers and support personnel on case management, and personal protection, WASH, and infection control; (iv) scaling up of triage capacity triage at all points of access to the health system, including primary health centers, clinics, hospital emergency units, and ad hoc community settings; (v) deployment and equipping of satellite and mobile clinics; (vi) repurposing of structures for provision of surge response; (vii) rehabilitation, renovation, and equipping of select health care facilities for scaling up ICU capacity; (viii) support to operational expenses such as those related to mobilization of health teams and salaries, hazard/indemnity pay consistent with the Government’s applicable policies; (ix) strengthening of cold chain capacities; (x) coordination and training activities with private sector, including private sector consortium, private health sector and laboratories; (xi) provision of GBV training, including psychosocial first aid, for frontline workers; (xii) provision of psychosocial services to family members and patients among others. The project will work in synergy with the Nigeria Electrification Project (NEP) to ensure provision of energy for critical treatment centers, laboratories for COVID-19 response. Revised SEP 5 Sub-component 1.3.3: Water Sanitation and Hygiene (WASH). The Project will work with the Water global practice of the World Bank to support safe water and basic sanitation in health facilities to ensure safe water supply and sanitation and hygiene services in health care facilities and temporary isolation centers. Rapid assessments will be conducted by local officials as these facilities are identified or established to document existing service gaps and promptly escalate any WASH needs such that they can be addressed through the project. It will finance such activities as: (1) emergency support to water supply and sanitation utilities to ensure continuity of water supplies; (2) emergency provision of safe water and hygiene materials to poor and vulnerable populations; and (3) the pursuit of strategies and partnerships with the private sector to incentivize increased production and provision of hygiene materials. Emergency support will be provided to water and sanitation utilities who are the mandated service providers to develop and implement Pandemic Emergency Response Plans that ensure continuity of water supplies. Given that the majority of Nigerians lack access to water on premises, most poor and vulnerable communities will require additional assistance in accessing water supply for use and handwashing given increasing financial constraints and social distancing and mobility restrictions, either through improvement and strengthening of existing water supply systems or provision of new water services and storage. Subcomponent 1.4. Communication Preparedness: Community Mobilization and Risk Communication and advocacy. This sub-component will support a comprehensive behavior change and risk communication intervention to support the reduction of the spread of COVID-19 by working with private, public and civil society actors to support the development of messaging and materials including support to development and implementation of a strategy to prevent gender based violence during epidemics and information dissemination on GBV at community level and in multiple ways in order to reach those who are most vulnerable or without access to technology. This subcomponent will be linked to and implemented with coordination with Stakeholder Engagement Plan (SEP) of the project. The subcomponent will also support social distancing measures to prevent contracting a respiratory virus such as COVID-19. These measures would be to limit, as possible, contact with the public such as: school closings, escalating and de-escalating rationale, backed up by a well-designed communication strategy.2 Component 2: Project Management, Coordination, Monitoring and Evaluation This component will support program coordination, management and monitoring, operational support and logistics, and project management. This will include support for the COVID-19 Incident Management System Coordination Structure; operational reviews to assess implementation progress and adjust operational plans; and provide logistical support. To this end, the project will also support technical assistance, rapid surveys as needed, and operating costs. Subcomponent 2.1: Project Management and Coordination. This subcomponent will support the strengthening of public structures for the coordination and management of the individual COVID-19 project which will be provided, including central and local (decentralized) arrangements for coordination of activities, financial management and procurement. The relevant structures will be strengthened by the recruitment of additional staff/consultants responsible for overall administration, procurement, and 3 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. Revised SEP 6 financial management under country specific projects. To this end, project will support costs associated with project coordination. Subcomponent 2.2: Monitoring and Evaluation. This component would support monitoring and evaluation of emergency preparedness and response, building capacity for clinical and public health research, including veterinary, and joint learning across and within countries. This sub-component would support training in participatory monitoring and evaluation at all administrative levels, evaluation workshops, and development of an action plan for M&E and replication of successful models. The sub- component could also finance among other things: (i) support to COVID-related research; (ii) Simulation exercises and After-Action review and post-epidemic learning phase of the national plan to adapt approaches for future epidemics. The project components introduced under the restructuring include: Component 1: Emergency COVID-19 Response - US$ 104.28 million Component 2: Project Management, Coordination, Monitoring and Evaluation - US$ 10 million 1.4 Proposed New Activities Vaccine purchasing will be done through Component 1 of the Global COVID-19 MPA (SPRP). The support for vaccines when available, which was anticipated in the initial Global COVID-19 MPA, will be added as part of the containment and mitigation measures to prevent the spread of COVID-19 and deaths under Component 1: Emergency COVID-19 Response. See details of changes to components below. As at July 18, 2021, Nigeria has two options to acquire vaccines: (i) donations received from COVAX and other Governments; and (ii) direct purchases by the country from vaccine manufacturers, either individually or jointly with other countries as facilitated under the African Union-AVATT arrangement through UNICEF. The vaccines from COVAX will be donated while those from AVATT will be IDA-financed. Given the recent emergence of COVID-19, there is no conclusive data available on the duration of immunity that vaccines will provide. While some evidence suggests that an enduring response will occur, this will not be known with certainty until clinical trials follow participants for several years. As such, this additional financing will allow for re-vaccination efforts if they are warranted by peer-reviewed scientific knowledge at the time. In the case that re-vaccination is required, limited priority populations (such as health workers and the elderly) will need to be targeted for re-vaccination given constraints on vaccine production capacity and equity considerations (i.e., tradeoffs between broader population coverage and re-vaccination). As a prudent and contingent measure, budget for funding has been retained for re-vaccination, if needed, of such a subset of the population. 1. Component 1: Emergency COVID-19 Response (US$504.28 million). This component would provide immediate support to break the chain of COVID-19 local transmission and limit the spread of COVID-19 in Nigeria through containment and mitigation strategies. The allocation for this component will be increased from US$ 104.28 to US$ 504.28 to accommodate the newly introduced subcomponents on vaccine acquisition and deployment. Subcomponent 1.1: Federal Support and Procurement for COVID-19 Emergency Preparedness and Response (US$14.28 million) will be retained as originally designed. Activities under this subcomponent will be primarily funded from the parent project but it is possible to also fund these activities from the AF since both subcomponents 1.1 and 1.3 are proposed under the same disbursement category to allow some flexibility in the reallocation of funds in the procurement of vaccines Revised SEP 7 (subcomponents 1.3) and more traditional COVID-19-related commodities (subcomponent 1.1) such as medical equipment, laboratory tests and medicines during implementation without restructuring Subcomponent 1.2: Direct Support to States for COVID-19 Emergency Preparedness and Response. Activities under this subcomponent will be primarily funded from the parent project but it is also possible to fund these activities from the AF since both subcomponents 1.2 and 1.4 are proposed under the same disbursement category to allow some flexibility in the states’ reallocation of funds for the newly introduced vaccine deployment activities (subcomponent 1.4) and the more traditional response activities (subcomponent 1.2) such as surveillance, testing, case management etc during implementation without restructuring The scale of activities and allocation will be reduced from US$ 90 million to US$ 56.5 million with the deducted US$ 33.5 million going to subcomponent 1.4. The scale down in activities under this subcomponent is in recognition of the fact that some of the initially conceived activities have been implemented using domestic resources and funds from other sources since the parent project is yet to start disbursing IDA resources, as well as a recalibration of the scale of some activities given implementation experience and newly available information. For instance, given that the spread of COVID-19 is now at a period of sustained community transmission, contact tracing is less so an effective containment measure that the project will not focus on anylonger. Moreso, earlier contact tracing done have been funded from other sources. Additionally, the initial support for all 36 states and the FCT to each have at least three functional isolation / treatment centres for the management of COVID-19 cases has been scaled down to each state and FCT having at list one functional isolation / treatment centre. Thus subcomponent 1.2, like the parent project, will through the approved Incident Action Plans finance implementation of state activities within the plan, including, among others, (a) the development and dissemination of plans and standard operating procedures for case management, infection prevention and control and so on; (b) establishment and operationalization of state EOCs as needed; (c) epidemiological investigations; (d) strengthening of risk assessment; (e) strengthening of public health emergency management and community and event-based surveillance; (f) provision of on-time data and information for guiding decision-making and response and mitigation activities; (g) provision of additional support to laboratories for early detection and confirmation; (h) training; (i) equipping, furnishing, and renovation of isolation and treatment centers including community support centers; and (j) improvement in patient transfer systems through financing of ambulances. Finally, this subcomponent will also finance emergency Water, Sanitation and Hygiene (WASH) measures, community mobilization, risk communication, and advocacy measures, and social distancing measures. A new Subcomponent 1.3 (COVID-19 Vaccine acquisition - US$ 357.5 million) will be added and will fund the purchase of COVID-19 vaccines and related costs from AVAT to cover 18.4 percent of the population as well as contain some uncommitted funds that could be used in a relatively flexible manner depending on how the pandemic unfolds. Specifically, of the US$357.5 under this subcomponent: US$ 300 million has been estimated for procurement of vaccines from AVAT; US$ 38.5 million for the related cost associated with procurement and freight of the vaccines; and an uncommitted US$19 million that could be used for procurement of additional vaccines (for up to 1 percent of the population) or implement Federal level procurements in support of the overall COVID-19 response, if so needed, without requiring a restructuring during implementation. The related cost includes UNICEF handling charges as procurement agency, legal fees, provision for No Fault Compensation Scheme, Commission charged on guarantee provided by Afrexim Bank to Johnson & Johnson, Afreximbank Down Payment Advance and Freight to point of Entry. This subcomponent will be funded purely from new resources from the AF. Though this subcomponent will be managed by NPHCDA, it is proposed under the same disbursement Revised SEP 8 category as subcomponent 1.1 to allow some flexibility in the reallocation of funds by Federal Agencies (NCDC and NPHCDA) in the procurement of more traditional COVID-19-related commodities (subcomponent 1.1) such as medical equipment, laboratory tests and medicines and the newly introduced purchase of vaccines (subcomponent 1.3) during implementation without restructuring. A new Subcomponent 1.4 (COVID-19 Vaccine deployment - US$ 76 million) will be added and will fund deployment of vaccines from all sources (COVAX, donations from Governments of India and United States, World Bank-financed purchases through AVAT and other sources of vaccines) to meet the 51.4 percent national vaccination target. The funding will support needed activities geared towards the deployment of COVID-19 vaccines at the subnational levels to ensure that the COVID-19 vaccines are available in the country and are deployed safely, timely, effectively and without wastages in all administrative wards in Nigeria. The activities include development of microplans for vaccination, training and retraining of health workers on microplanning and vaccine implementation, advocacy communication and social mobilization, monitoring and supervision of vaccination, pharmacovigilance, AEFI kits and data tools, payment of feeding and transport allowances to personnel involved in deployment of vaccines, procurement of cold boxes, carriers and PPE for vaccination teams and transport and logistics costs for vaccines within the states. Where possible, climate sensitive/ energy efficient waste management supplies will be procured and fuel-efficient vehicles used. Though members of the Nigeria Police Force and Nigeria Civil Defence Corps will be part of the vaccination team to maintain law and order at vaccination sites and provide escort services for movement of vaccines, they nor any other security forces will not be paid feeding and transportation allowances, any other allowances or stipends from the proceeds of this project. The Government will be responsible for any payments to security forces. This subcomponent will be partly funded from a reallocation of US$ 33.5 million of existing funds from Component 1.2 (Direct Support to States for COVID-19 Emergency Preparedness and Response) of the parent project and from an addition of US$ 42.5 million from new resources from the AF. Though this subcomponent will be managed by NPHCDA, it is proposed under the same disbursement category as subcomponent 1.2 to allow some flexibility in the states’ reallocation of funds for more traditional response activities (subcomponent 1.2) such as surveillance, testing, case management etc and the newly introduced vaccine deployment activities (subcomponent 1.4) during implementation without restructuring. 2. Component 2: Project Management, Coordination, Monitoring and Evaluation (US$10.00 million) is retained as originally designed. It will continue to support coordination, monitoring, operational support and logistics, and project management. This will include operational support to the national EOC; support to the COVID-19 Incident Management System (IMS) Coordination Structure; operational reviews, routine monitoring, and rapid surveys to assess implementation progress and inform adjustments to operational plans; and project management. Its Subcomponent 2.1: Project Management and Coordination (US$5.00 million) and Subcomponent 2.2: Monitoring and Evaluation (US$5.00 million) will also be retained. It is worth noting that the Government of Nigeria has prepared a National COVID-19 Deployment and Vaccination Plan (NDVP) that is being revised as new information becomes available. The Plan specifically provides information on the risk communication and demand generation for COVID-19 vaccine introduction, providing a two-prong approach in evidence generation and rumour management. The objective of the NDVP is to provide safe and effective COVID-19 vaccines to an eligible population of 111,776,503 (18 years and above including pregnant women) Nigerians over two years. This translates to 51.4% of the total population by the fourth quarter of 2022. Revised SEP 9 The Presidential Task Force on COVID-19 coordinates and oversees the multi-sectoral inter-governmental efforts in containing the spread and mitigating the impact of the COVID-19 pandemic in the country. The National Primary Health Care Development Agency (NPHCDA) is the lead agency for Primary Health Care and is thus responsible for the immunization program in Nigeria. Relying on the existing structure of NPHCDA to ensure effective governance and coordination framework, NPHCDA leads the technical coordination for the COVID-19 vaccine introduction in the country. To this end, the agency has established the COVID-19 Technical Working Group; an inter-sectoral group to oversee the technical preparations for the introduction of COVID-19 vaccine in the country. In addition, the Agency has established functional Command Centers for COVID-19 at National and the 36 states and FCT to monitor, and directly drive the Primary Health Care (PHC) response to the COVID-19 pandemic. This will also leverage the relevant structures of the National Immunization Program within the NPHCDA, and corresponding structures at the State, Local Government Authority, ward and community levels. There is a robust regulatory process for the COVID-19 vaccines under the direct supervision of the National Agency for Food and Drug Administration and Control (NAFDAC). This includes the provision of marketing authorization and lot release of COVID-19 vaccines in response to the pandemic. NAFDAC has and will use its authority to grant import permits in the instances of emergencies such as the COVID-19 pandemic. 2. Stakeholders Engagement Plan The Nigeria COVID-19 Preparedness and Response project is being prepared under the World Bank’s Environment and Social Framework (ESF). As per the Environmental and Social Standard ESS 10, Stakeholders Engagement and Information Disclosure, the implementing agencies should provide stakeholders with timely, relevant, understandable and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination and intimidation. SEP Objective The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make complaints about project and any activities related to the project. The involvement of the local population is essential to the success of the project to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. For COVID-19 vaccination programs, stakeholder engagement is key to communicating the principles of prioritization of vaccine allocation and the schedule for vaccine rollout, reaching out to disadvantaged and vulnerable groups, overcoming demand-side barriers to access (such as mistrust of vaccines, stigma, and cultural hesitancy), and creating accountability against misallocation, discrimination and corruption. This SEP is a living document that will be updated during project implementation as more details on the stakeholder’s groups and measures are identified. Revised SEP 10 2.1 Stakeholder Identification and Analysis Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e., the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. Community representatives, cultural leaders and women leaders may also be helpful intermediaries for information dissemination in a culturally appropriate manner, building trust for government programs or vaccination efforts. Women can also be critical stakeholders and intermediaries in the deployment of vaccines as they are familiar with vaccination programs for their children and are the caretakers of their families. Verification of stakeholder representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. With community gatherings limited or forbidden under COVID-19, it may mean that the stakeholder identification will be on a much more individual basis, requiring different media to reach affected individuals. 2.1.1 Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns; • Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the projects is inclusive. All stakeholders at all times are encouraged to be involved in the consultation process. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, in particular women, youth, elderly, persons with disabilities, displaced persons, those with underlying health issues, and the cultural sensitivities of diverse ethnic groups. Revised SEP 11 • Flexibility: if social distancing inhibits traditional forms of engagement, the methodology should adapt to other forms of engagement, including various forms of internet communication. (See Section 3.2 below). For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) can be divided into the following core categories: • Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; • Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way and • Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status3, and that may require special engagement efforts to ensure their equal representation in the consultation and decision- making process associated with the project. 1. Affected Parties Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category: • Regional Disease Surveillance Systems Enhancement (REDISSE) Project Staff • National Primary Health Care Development Agency (NPHCDA) • State Primary Health Care Development Agency (SHPCDA) • National Agency for Food and Drug Administration and Control (NAFDAC) • Local Government Area and Ward health care workers and representatives • Nigeria COVID-19 Vaccine Introduction Technical Working Group • Nigeria Center for Disease Control (NCDC) • Federal and State Ministry of Health • National Reference Laboratory (NRL) • Emergency Operations Centers (EOC) personnel • WHO, UNICEF, World Bank, CDC and other development partners who directly support COVID-19 response • Infected and quarantine people including staff • Frontline healthcare workers in the 12 states • Volunteer community mobilisers to support in vaccination activities (similar structure implemented under Polio immunization) • Waste collection and disposal workers in affected States • Nigeria Police Force • Nigeria Security & Civil Defense Corps (NSCDC) 3 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. Revised SEP 12 • Airline and border control staff, law enforcement authorities and their staff (e.g., Police, Army, Navy, Air Force etc.) • Logistics company and other supply chain workers. 2. Other Interested Parties The projects’ stakeholders also include parties other than the directly affected communities, including: • Other national health organizations, CSOs, CBO, FBOs and UN agencies • Media and other interest groups, including social media and the Government Information Department; • NGOs for vulnerable groups • The public at large • Goods and service providers involved in the project’s’ wider supply chain • Regulatory agencies (e.g., Aviation, Health Ministry, Ministry of Interior, Ministry of Environment, Ministry of Information, The Presidential Task Force, Emergency and, Economy): • Health: o National Institute for Pharmaceutical Research and Development o National Institute of Medical Research o National Drug Law Enforcement Agency o National Medical Stores o National Animal Disease Information Service • Aviation o Nigeria Civil Aviation Authority • Defense o Office of the National Security Adviser • Ministry of Interior o Security Agencies ( Nigerian Army, Nigerian Air force, Nigerian Navy, Nigerian Police, NSCDC ) • Nigeria Immigration Services • Emergency response o National Emergency Management Agency o State Emergency Management Agency • Ministry of Environment o State Waste Management Agency • Ministry of Information o National Orientation Agency o News Agency of Nigeria o Federal Radio Corporation of Nigeria – FRCN o National Broadcasting Commission o Nigeria Television Authority • Economy o Central Bank of Nigeria o Nigeria Customs Services o Standards Organization of Nigeria o Nigeria Shippers Council • Ministry of Human Affairs, Disaster Management and Social Development o Nigeria Social Investment Programme • The Presidential Task Force (PTF) on COVID-19 now Presidential Steering Committee Revised SEP 13 o Media and other interest groups, including social media & the Government Information Department o National and international health organizations/associations (e.g. -NCDC and PHEOCs) o Interested international NGOs, Diplomatic mission and UN agencies (especially UNICEF, WHO, etc.) o Interested businesses o Schools, universities and other education institutions closed due to the COVID-19 pandemic o Churches, Mosques, Shrines, temples and other religious institutions o Transport workers (e.g., cab/taxi drivers, truck drivers, bus drivers, motorcyclists) 3. Disadvantaged / vulnerable individuals or groups It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project and to ensure that awareness raising and stakeholder engagement with disadvantaged or vulnerable individuals or groups on infectious diseases and medical treatments in particular, be adapted to take into account such groups or individuals particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from person’s origin, gender, age, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g., minorities or marginal groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project-related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: - Elderly - Individuals with chronic diseases and pre-existing medical conditions - People with disabilities - Pregnant women - Forest dwellers - Women, girls and female headed households - Children - Daily wage earners - Those living below poverty line - Unemployed and the homeless - Communities in remote and inaccessible areas - Refugees and internally displaced people - Migrant workers and immigrant workers - Prisoners - Persons in IDP Camps Some of the barriers in accessing information are: absence of alternative communication methods for vulnerable groups, absence of android phones, lack of mobility, poverty, absence of ramps in public infrastructures, cultural and religious beliefs, insufficient information, indifference and the notion that government only cares for the rich within the society, disability, poor understanding due to dialectical and Revised SEP 14 language differences, stigmatization, inaccessibility to remote areas, insecurity, etc. Empirical data will be provided in subsequent stakeholders’ consultation and will be updated appropriately. Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. Description of the methods of engagement that will be undertaken by the project is provided in the following sections. For the vaccination program, the SEP will include targeted, culturally appropriate and meaningful consultations for disadvantaged and vulnerable groups before any vaccination efforts begin. The Government of Nigeria will deploy COVID-19 vaccine using three strategies: fixed post, temporary fixed post, and special teams (mobile), over 4 phases. o Phase 1 targets all health workers, frontline workers and strategic leaders; o Phase 2 will vaccinate older adults aged 50 years and above; o Phase 3 is to vaccinate those aged 18-49 years with co-morbidities; and o Phase 4 will target adults 18-49 years of age without co-morbidities. To ensure an effective governance and coordination framework, the COVID-19 vaccine introduction in Nigeria will rely on existing structures supporting the COVID-19 response. The NDVP highlights the following phases for the vaccination plan. Table 1: Categorization of target groups and population to be reached Category Population Remarks Source Health workers (+ 2,116,394 (1%) • Estimates 0.44% of the total • Nigeria Health contingency) population are health workers Workforce Country and other support staff Profile FMOH 2018 • 0.56% for contingency (strategic • PHC Ward Health leaders, POE workers, RRTs, System contact training teams, COVID 19 vaccination teams, etc.) Older adults (50+) 21,163,394 (10%) • Case fatality rates are high in • National Population selected age group Commission • Case fatality rates: 50-59 = 19%; • NCDC situation report 60-69 = 21% Significant co- 16,466,786