Tanzania Covid 19 Pandemic Emergency Financing Facility Project (PEFFP) Stakeholder Engagement Plan (SEP) 1. Introduction/Project Description New Corona Virus- 2019 is a respiratory pathogen of public health importance because of its ability to spread rapidly. Currently all countries are at high risk of COVID- 19 and almost all have reported cases (WHO 2020 SitReps). In Tanzania, out of 26 regions 24 have reported sporadic cases of COVID-19. The country has implemented robust interventions including community awareness, suspension of air travel and restrictions to cross border movement of persons, restriction of public gathering and closure of institutions, promoting use of traditional medicine, faith healing, social distancing, public masking, hand washing, contact tracing, quarantine measures and case isolation. These measures resulted into the decrease of admitted cases. Despite these measures the country has not fully achieved outbreak control and remains at high risk of COVID-19 transmission due to high transmission rate in neighboring countries, reopening of commercial flights, ongoing cross-border trade, reopening of tourism, sports and learning institutions and commercial activities. The Government of Tanzania has demonstrated a high level of leadership and activated the response to be led by the Prime Minister and have implemented various measures including closure of schools and travel advisory. The country has also developed the COVID-19 Response Plan, following an assessment done in collaboration with WHO in March 2020. Tanzania COVID 19 Pandemic Emergency Financing Facility Project (PEFFP) aims to prevent, detect and respond to the threat posed by COVID-19 in the United Republic of Tanzania. The PEFP comprises the following components: Component 1: Strengthening Laboratory Diagnosis Capacity This component would mobilize immediate support to limit further spread of COVID-19 and support enhancement of disease detection capacities by ensuring prompt case finding and contact tracing. The project would support improving operational capacity of the National Public Health Laboratory (NPHL) to ensure it is fully functional and is able to test at least 500 samples per day by the end of the project period. It will finance procurement of equipment, medical supplies and reagents for testing COVID-19 specimens. Component 2: Improving Management of COVID-19 Cases This component would help improve case management of COVID-19 through: (i) procurement and installation of liquid oxygen generating plants and oxygen supply system at 7 regional referral hospitals1 as well as supply of oxygen cylinders to 126 neighboring health facilities; (ii) procurement of essential medicines and supplies; and (iii) training biomedical technicians on production and management of oxygen plants, nurses on proper provision of oxygen gas to patients and laboratory staff on diagnosis of SARS-CoV-2. Component 3. Implementation Management and Monitoring and Evaluation (M&E) 1 In Dar es Salaam, Geita, Mbeya, Kilimanjaro, Ruvuma, Lindi and Mtwara 1 This component would support strengthening of existing government structures for coordination of project activities and as well as project management, including financial management and procurement arrangements. Specifically, it will support: (i) project coordination/operational costs; (ii) environmental and safeguards related activities including stakeholder engagement and waste management; and (iii) monitoring of implementation progress to track achievements against targets and address implementation challenges as well as evaluation workshops. 2. 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. 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 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 lifecycle, 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 2 is given to vulnerable groups, in particular women, youth, elderly and the cultural sensitivities of diverse ethnic groups. • 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 status, and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. 2.2. 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: 1. Facility Healthcare Workers 2. Community Leaders around the facility 3. Non- Governmental Organizations (NGOs) 4. Patients within the Regional Referral Health (RRH) Facilities; 5. Neighboring communities to beneficiary laboratories and medical facilities where installation of oxygen plants will be undertaken; 6. Workers at construction sites of laboratories, quarantine centers and screening posts; 7. Public Health Workers; 8. Waste collection and disposal workers; 9. Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDEC); 10. Other Public authorities at the Regions and Districts where the project will be implemented. 2.3. Other interested parties The projects’ stakeholders also include parties other than the directly affected communities, including: 1. Vice president Office – Department of Environment 3 2. National Environmental Management Council (NEMC); 3. Tanzania Atomic Energy Commission 4. Occupational Safety and Health Authority (OSHA) 5. Ministry of Finance (MoF) 2.4. 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 fringe 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 persons with disabilities and their caretakers accessing the medical facilities during project implementation. 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. 3. Stakeholder Engagement Program 3.1. Summary of stakeholder engagement done during project preparation During preparation consultation meetings were conducted in various levels (Involvement of National Environmental Management Council for review and approval of the project, Facility Management Teams who accepted the project to be implemented in the facility site. Participants were oriented on the purpose of the project and the related benefits. The speed and urgency with which this project has been developed to meet the growing threat of COVID-19 in the country, combined with recently-announced government restrictions on gatherings of people has limited the project’s ability to develop a complete SEP before this project is approved by the World Bank. This initial SEP was developed and disclosed prior to project appraisal, as the starting point of an iterative process to develop a more comprehensive stakeholder engagement strategy and plan. It will be updated periodically as necessary, with more detail provided in the first update planned after project approval. 4 3.2. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement A precautionary approach will be taken to the consultation process to prevent infection and/or contagion, given the highly infectious nature of COVID-19. The following are some considerations for selecting channels of communication, in light of the current COVID-19 situation: • Avoid public gatherings (taking into account national restrictions or advisories), including public hearings, workshops and community meetings; • If smaller meetings are permitted/advised, conduct consultations in small-group sessions, such as focus group meetings. If not permitted or advised, make all reasonable efforts to conduct meetings through online channels; • Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone- lines, and mail) when stakeholders to do not have access to online channels or do not use them frequently. Traditional channels such as phone calls, text messages, in-person conversation at the medical facilities or suggestions in the available suggestion boxes in medical facilities can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a context specific combination of email messages, mail, online platforms, dedicated phone lines with knowledgeable operators; • Each of the proposed channels of engagement should clearly specify how feedback and suggestions can be provided by stakeholders. In line with the above precautionary approach, different engagement methods will be used to cover different needs of the stakeholders as below: i) Structured Agenda; (ii) Focus Group Meetings/ Discussions; (iii) Community consultations; (iv) Formal meetings; . The minimum standards for face to face consultations in the project will include but not limited to: Face-to-Face Convene only when virtual options (Webex, Zoom, and audio- Meetings conferences) are not available. Carry out only under certain conditions such as: Physical distancing Minimum of 1 meter between participants (preference 2 meters) - This may require a large conference room with good ventilation - Outside space can reduce transmission 5 - May mean multiple small meetings over a few days or multiple small groups in different locations connected by webex. This should be organized in a way that allows for a distance of between 1 to 2 meters between each participant in a location. Timing Schedule meeting for a maximum of 2 hours (indoors) and 4 hours (outdoors). It is recommended that there are staggered breaks during each meeting. PPE & other The Ministry will: protection • Provide masks and require that they are used (PIU should provide masks). • Provide hand sanitizers in the meeting room. • Ensure paper tissues are available for those with a cold and closed bin for disposal. The bins should be emptied regularly throughout and at the end of each day. • Encourage participants to cover their face with the bend of their elbow or a tissue if they cough or sneeze. • Open windows and doors whenever possible to make sure the venue is well ventilated. • Participants should avoid sharing items such as writing materials, etc. • If possible, the temperature of participants should be check prior to and after leaving the meeting room. • Washrooms should be made available and clean regularly including toilet flush and seats. • Ensure all extremely clinically vulnerable persons do not attend the meeting. • Log all useful information of the participants who attend meetings. • Remove or disable entry systems that require skin contact, e.g., fingerprint scanners. • If someone becomes ill during the meeting, the person should return home immediately and report to the nearest health facility. • Meeting rooms should be clean before and after each meeting. • Where touchpoints like door handles and water coolers remain, paper towels are provided to allow users to avoid skin contact. • Encourage participants to cover their face with the bend of their elbow or a tissue if they cough or sneeze • Open windows and doors whenever possible to make sure the venue is well ventilated. Food and drinks Will not be served during this consultation Cleaning Wipe surfaces (e.g. desks and tables) and objects (e.g. telephones, keyboards) with disinfectant prior to and after the meeting 3.3. Proposed strategy for information disclosure 6 Information disclosure under the project will include: Project stage Target List of Methods and timing stakeholders information to be proposed disclosed Project • MoHCDEC; • Project Paper; • Virtual consultation Inception • GRM procedure; meetings and • SEP; roundtable • ESMF with the discussions. ICWMP. Project • Project affected • Various Awareness Information leaflets, Implementation person; and messages project posters and brochures; • Other interested implementation audio-visual materials, Parties. progress and social media and other information on how direct communication to access project channels such as mobile/ benefits; telephone calls, SMS, • Infection Prevention etc; Public notices; and Control (IPC) Electronic publications measures within and press releases on and surrounding the MoHCDEC websites; communities to the Press releases in the targeted beneficiary local media (both print facilities; and electronic); • GRM Procedures; Consultation with • Update on project vulnerable groups using implementation and mobile/ telephone calls, progress; SMS, etc.; virtual • Relevant E&S training and meetings; documents. Help desk mechanism; virtual meetings and roundtable discussions Supervision & • Project affected Project’s outcomes, Virtual roundtable Monitoring person; and overall progress and discussions; Press • Other interested major achievements releases; Press Parties conferences; media channels including radio and TV; Reports; MoHCDEC websites; Project Close • MoHCDEC and • Project exit strategy; Virtual consultation Out Phase MDAs; and meetings; information • Project affected • Dissemination of leaflets, posters and persons; and final project reports. brochures; audio-visual 7 • Other interested materials, social media; Parties Electronic publications and press releases on the MoHCDEC websites; Press releases in the local media (both print and electronic); media; virtual roundtable discussions 3.4. Stakeholder engagement plan Project stage Topic of consultation / Method used Target Responsibilities message stakeholders Project Introduction of the Emails, official Health MoHCDEC Inception project and letters, virtual Personnel information about time consultation and venue of training, meetings, phone Other Health & safety and calls. government sub-management personnel plans GRM tools for such as filing complaints and Immigration, providing feedback police, local council officers Contractors, service providers, suppliers and their workers General information of Emails, official Government MoHCDEC the project as letters and officials; stipulated in the virtual meetings media, project documents; and round table private fiduciary issues; discussions with sector; Civil announcements of relevant society planned activities, organizations groups and associated risks and NGOs; mitigation measures. National and international 8 Project stage Topic of consultation / Method used Target Responsibilities message stakeholders health organizations Project • Project status Information General MoHCDEC Implementation • Project progress in leaflets, posters population, containing and and brochures; including treating the audio-visual Vulnerable infection materials, social households • Risks and media and other Government mitigation direct agencies, measures communication media, • Communication channels such private sector campaign: Press as mobile/ etc. releases in the local media (both print telephone calls, and electronic), SMS, etc; Public written information notices; will be disclosed Electronic including publications and brochures, flyers, press releases posters, etc. on the MoHCDEC Website, MoHCDEC to be updated websites; Press regularly releases in the local media (both print and electronic). Face to face meetings following guidelines prescribed in the SEP and WHO IPC guidelines. Information about Official letters, All MoHCDEC Project development emails, phone stakeholders updates, health and calls and virtual safety, employment meetings (if and procurement, needed) environmental and social aspects, Project- related materials. 9 Project stage Topic of consultation / Method used Target Responsibilities message stakeholders Supervision & Project’s outcomes, Press releases in Government MoHCDEC Monitoring overall progress and the local media; officials; Civil major achievements Virtual society consultation groups and meetings and NGOs; round table National and discussions international health organizations This Stakeholder Engagement Plan as well as the Environmental and Social Management Framework (ESMF) and Environment Social Management Plans (ESMPs) that will be prepared under the project will also be consulted upon and disclosed. The details of this will be prepared during the update of this SEP after project approval and continuously updated throughout the project implementation period when required. 3.5. Proposed strategy to incorporate the view of vulnerable groups The project will carry out targeted stakeholder engagement with vulnerable groups to understand concerns/needs in terms of accessing information, medical facilities and services and other challenges they face at home, at workplaces and in their communities. The details of strategies that will be adopted to effectively engage and communicate to vulnerable group will be considered during project implementation. 3.6. Reporting back to stakeholders Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the stakeholder engagement plan and grievance mechanism. 4. Resources and Responsibilities for implementing stakeholder engagement activities 4.1. Resources The Ministry of Health, Community Development, Gender, Elderly and Children will be in charge of stakeholder engagement activities. The budget for the SEP is US$ 40,000 included in component EIA of the project. 4.2. Management functions and responsibilities The MoHCDEC will be the implementing agency and will be in charge of the will be responsible for implementing the SEP while working closely with other departments and institutions as 10 required. The stakeholder engagement activities will be documented through progress reports, to be shared with the World Bank. The linkages between these departments and institutions with the PIU will be elaborated in the revised SEP to be prepared after project approval. 5. Grievance Mechanism The main objective of a Grievance Mechanism (GM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects; ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. 5.1. Description of GM Grievances will be handled at the project’s level by MoHCDEC working through the Environmental and Social Focal point person to institute multiple grievances and concerns receipt points including a dedicated hotline and a WhatsApp with stipulated service standards for response times. The GM will be accessible to all project’s stakeholders, including affected people, community members, health workers, civil society, media, and other interested parties. Stakeholders can use the GM to submit complaints related to the overall management and implementation of the project. The structure of the GM will also ensure that SEA/SH related issues and complaints can be addressed by instituting within it dedicated SEA/SH champions. The PIU will inform the stakeholders about the existence of a grievance procedure and will keep a log of the complaints and their status of resolution at hand. This will be through maintenance of a grievance log at each participating RRH and Mabibo National Laboratory. A project level grievance log will also be maintained at the national level by the Ministry’s Environmental and Social Focal point person. A Grievance Management Committee (GCs) will be formed comprised of a Environmental and Social Focal point person, community member and a representative of the hospital management. The composition takes account of gender considerations such as the GCs not more than seventy-five (75%) representation of coming from one gender. These GC composition will be guided by the Health Facility Governing Committees (HFGCs) which has already existing structures within the medical facilities and has community members representation. Grievance uptake will also take advantage of suggestion boxes already in place in each medical facility. The hospital management in the project’s monthly reports will include information on grievance management to be shared with the MoHCDEC PIU. Types of grievances that are likely to arise may be related to challenges emanating from construction related interactions among the community, health workers, patients and project workers; health and safety risks surrounding project implementation; lack of dissemination of project information; and SEA/SH at the construction sites within the medical facilities. 11 Grievance feedback shall be communicated with complainants by telephone, email, or in writing. The GM will include the following steps: The GM will include the following steps and indicative timelines: Step 1: Submission of grievances: Anyone from the affected communities or anyone believing they are affected by the Project can submit a grievance: • By completing a written grievance registration form that will be available at the at Regional Referral Hospitals (RRH) and Mabibo National Laboratory; • Submitting the complaint through emails; • Through suggestion boxes already existing in each of the beneficiary RRH and Mabibo National Laboratory; • Telephone and mobile numbers assigned for complaints at the MoHCDEC. Where possible it is desirable that complaints are submitted in writing by the complainant. Should the complainant not wish to comply with this request and submit the complaint verbally, then the complainant information and the details of the complaint should be entered in the GM log. All contact names, addresses, numbers and websites/emails will be made available in the updated SEP that will be completed within two (2) weeks of Project Effectiveness. Step 2: Recording of grievance and providing the initial response: The complainant fills in the designated form in writing and signs it, or fills it electronically including all personal information and details of the complaint. Confidentiality will be maintained for SH/SEA related grievances and protocols to guide receipt and management of the same will be adopted. The complainant encloses all copies of documents that may support the complaint. The staff at MoHCDEC and beneficiary facilities will ensure that the form is filled in accurately. The complainant receives a receipt or a confirmation email of acknowledgment with a reference number to track the complaint. The following information will be registered in the Log: • Complaint Reference Number; • Date of receipt of complaint; • Name of complainant (Depending on sensitivity of the complaint details will be kept anonymous); • Confirmation that a complaint is acknowledged; • Brief description of Complaint; • Details of internal and external communication; 12 • Action taken: (Including remedies / determinations / result); • Date of finalization of complaint. The MoHCDEC staff will inform the complainant that an investigation is underway within seven business days. The complainant shall be informed of the estimated duration for resolving the complaint, which is no later than fourteen business days from the date of receipt of the complaint. Where the complaint is unlikely to be resolved within the estimated duration, the MoHCDEC staff must promptly contact the complainant to request additional time and explain the delay. In any event, the complaint must be resolved no later than twenty-one days from the date of receipt of the complaint. Step 3: Investigating the grievance: The Grievance Committee and/or MoHCDEC staff will investigate the grievance by following the steps below: • Verify the validity of the information and documents enclosed; • Ask the complainant to provide further information if necessary; • Refer the complaint to the relevant department; • The relevant department shall investigate the complaint and prepare recommendation to the MoHCDEC of actions to be taken and of any corrective measures to avoid possible reoccurrence; • The MoHCDEC staff shall register the decision and actions taken in the GM log. Step 4: Communication of the Response: The MoHCDEC staff hall notify the complainant of the decision/solution/action immediately either in person, writing, or by calling or sending the complainant a text message. When providing a response to the complainant, the MoHCDEC staff must include the following information: • A summary of issues raised in the initial complaint; • Reason for the decision. Step 5: Grievance closure or taking further steps if the grievance remains open: A complaint is closed in the following cases: • Where the decision/solution of complaint is accepted by the complainant. • A Complaint that is not related to the project or any of its components. • A Complaint that is being heard by the judiciary. • A malicious complaint. Step 6: Appeals process: 13 Where the complainant is not satisfied with the outcome of his/her complaint after the issue is addressed by GCs at different levels, staff in charge for complaints at the MoHCDEC advise the complainants that if they are not satisfied with the outcome of their complaint, they may re- address the issue to the MoHCDEC through the Environmental and Social Focal point person. Once all possible redress has been proposed and if the complainant is still not satisfied then they will be advised by the PIU of their right to legal recourse. Flow of grievance management Receipt of Recording of Investigation of Communication Grievance grivance grievance of response closure complain t 6. Monitoring and Reporting 6.1. Involvement of stakeholders in monitoring activities The Project provides the opportunity to stakeholders, especially Project Affected Parties to monitor certain aspects of project performance and provide feedback. This will be done through the suggestion boxes and existing engagement channeled such as regular meetings organized by the HFGCs. GRM will allow PAPs to submit grievances and other types of feedback. Due to the high risk of contamination, frequent and regular meetings and interactions with the local stakeholders will be suspended until decided otherwise by the health authorities. 6.2. Reporting back to stakeholder groups The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Monthly summaries and internal reports on public grievances, enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. The monthly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways: • Through public engagements and sharing of reports prepared by participating RRHs. • A number of Key Performance Indicators (KPIs) will also be monitored by the project on a regular basis, including the following parameters: o Number of sensitization meetings with hospital staff on the project and related grievance redress mechanism; 14 o Number of sensitization Information Education and Communication (IEC) with information on the project presented at strategic places in hospitals and the Mabibo National Laboratory for users and patients; o number of public grievances received and number of those resolved within the prescribed timeline; o Number of meetings held with the project beneficiary RRH with the local neighboring communities. 15