The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 02/08/2021 | Report No: ESRSAFA065 Feb 23, 2021 Page 1 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Congo, Republic of AFRICA WEST Republic of Congo Ministry of Health, Population, Promotion of Women and Integration of Women in Development Project ID Project Name P175805 Republic of Congo COVID-19 Emergency Response Project - Additional Financing Parent Project ID (if any) Parent Project Name P173851 Republic of Congo COVID-19 Emergency Response Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 2/24/2021 3/29/2021 Public Disclosure Population Financing Proposed Development Objective To prevent, detect, and respond to the threat posed by COVID-19 and strengthen the national system for public health preparedness in the Republic of Congo. Financing (in USD Million) Amount Current Financing 0.00 Proposed Additional Financing 0.00 Total Proposed Financing 0.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? Yes C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] Feb 23, 2021 Page 2 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) This COVID-19 Emergency Response Project will support the implementation of the Government of Congo's Integrated COVID-19 Preparedness and Response Plan which was developed under the leadership of the Ministry of Health with support from the donor community. The Plan puts in place measures to control the spread of COVID-19 and mitigate its impact. These measures are around key strategic response areas as guided by International Health Regulations, as well as the Africa CDC and CEMAC regional responses. They include: Epidemiological surveillance and point of entry restrictions; Enhancing laboratory capacity; Infection prevention and control; Preparedness for acute case management; Communication and community mobilization; and Coordination. The Project is organized in three components responding directly to the response Plan: Component 1: Emergency COVID-19 Response which focuses on case detection, case investigation, contact tracing, recording and reporting as well as surveillance and health systems strengthening; Component 2: Communication campaign, Community Engagement, and Behavior change which supports the establishment of community surveillance networks and mass media and social media campaigns; Component 3: Implementation Management and M&E. Geographically, in addition to national level activities, the Project has initially focused on Brazzaville and Pointe Noire where the majority of the population lives and where the first four COVID-19 cases were identified. This is also where the major health facilities and laboratories involved in the response are located. Sites with care facilities and laboratories also include Oyo and Ouesso. Given the high degree of uncertainty on the pandemic’s trajectory, additional locations will be selected at a later time, based on data. Public Disclosure D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] The Republic of CongoCOVID-19 Emergency Response Project - Additional Financing will be a standalone operation for the Republic of Congo to prevent, detect, and respond to the threat posed by COVID-19 and strengthen the national system for public health preparedness. The project will be implemented at a national scale but, the specific locations where project subcomponents will be implemented have not yet been identified. No major civil works are expected in this project, and no greenfield works will be supported under this project. Also, any works involving refurbishments will be carried out in the existing health care facilities and laboratories. The project will have three components of which two have implications for environmental and social risks management: Component 1: Emergency COVID-19 Response and Health System Strengthening. Sub-component 1.1. Scale-up early case detection, diagnostic capacity, contact tracing, recording and case reporting. This subcomponent will include a) expanded testing which is essential for vaccine surveillance. Testing is a critical tool to be used alongside vaccines, given that: (i) vaccine induced immunity must be monitored with testing on a population level; (ii) the real-world effectiveness of COVID-19 vaccines will be largely uncertain and possibly variable across settings and populations; and (iii) vaccine coverage will be incomplete and focused on priority populations (Campbell, Evans, Mohpal, and Veillard 2020); b) The government will be supported to conduct a baseline sero- surveillance study, with technical support from WHO. Representative samples of target populations to receive the COVID-19 vaccine in order be able to distinguish between infection and vaccine acquired immunity. This sub- component will additionally continue to advance the strengthening of disease surveillance systems, and Feb 23, 2021 Page 3 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) epidemiological capacity for early detection and confirmation of cases using test methods. However, no construction work/upgrading of Biosafety level 2 (BSL-2) or higher-level laboratories for expanded COVID-19 testing is planned in this sub-component. Project activities will be limited to procurement of COVID-19 PCR test kids, rapid test, and antibody test kits; and Personal Protective Equipment and tablets for the Rapid Response Teams who go into the communities to test. Sub-Component 1.2: Scale-up Health System Strengthening. RoC will continue to seize this opportunity to strengthen its health system for future resilience, while focusing on the immediate response – aided by a COVID-19 vaccine. a. Human Resources: Activities under the AF will support identification and training of health facility staff and frontline ancillary staff on vaccine preparedness. Models for efficient two-way mass communication as well as training platforms for frontline workers that allow for more frequent touchpoints for capacity building “on the job” as well as facilitating sharing of information, verification of vaccine delivery, and monitoring the performance of the vaccines will also be explored. b. Regulatory Systems Strengthening: There will be support to: i) strengthen and adapt the Pharmacovigilance System to be sensitive to detect adverse effects following immunization (AEFI) for the COVID-19 vaccines; ii) undertake relevant traceability activities to ensure capabilities for the system to track and trace from “production to people.” The project will support country level policy and operational actions to implement lean traceability in coordination with global and regional efforts taking place in this area around COVID_19 vaccinations. These “lean traceability” tools will form basic building blocks for ROC enhance visibility related to COVID vaccines and will also support sustainable approaches for traceability post-pandemic. c. Health information system and data infrastructure. Comprehensive and effective immunization programs Public Disclosure require robust data infrastructure at different levels of the health system to be able to effectively track and monitor vaccination. Patient tracking is particularly important in the case of COVID-19 vaccinations which will likely require a two-dose regimen. Activities will include: i) developing context-appropriate models for innovative tracking schemes such as digitized health records, electronic immunization records, and individual and community coverage mapping methods; ii) developing long-term visioning, roadmaps and support for integrating unique client health identifiers into digital health infrastructure such as immunization records, case referral, and larger shared health record systems especially for newly diagnosed NCD patients; iii) supply chain digitization which will improve the efficiency of COVID- 19 vaccination as well as broader immunization strengthening efforts; (iv) building a human resources health information system (HRHIS) that can produce an accurate, current and dynamic snapshot of health workers while building planning capacity that informs HRH strategies for quantifying health workforce needs, demands and supply under various forward-looking scenarios. Sub-component 1.3: Immunization System Enhancements and COVID-19 Vaccination. This sub-component will support the Government to develop its national COVID19 vaccine purchase strategy and allocation and deployment plan. Key activities to be supported under the AF will include: a. COVID-19 Vaccination Program Planning and Management: This will include support the to the development of a robust COVID-19 vaccine procurement plan that assesses current available financing modalities against overall context and vaccines needs, including the COVAX Facility and direct purchasing options. The subcomponent will also include procurement of ancillary supply kits that may include needles, syringes, alcohol prep pads, COVID-19 vaccination record cards for each vaccine recipient, and PPEs for vaccinators. b. Purchase of Vaccines: Financing will support: (i) procurement, importation, storage, transportation and distribution of COVID-19 vaccines, including increased/equitable access to vaccines procured via mechanism selected by the country (e.g., COVAX facility and/or direct procurement options) and in accordance with criteria adopted under Feb 23, 2021 Page 4 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) AF). Given the unprecedented pace of vaccine development, the WBG will accept as the threshold for eligibility of IBRD/IDA resources for vaccine purchase either (i.e., approval by three Stringent Regulatory Authorities (SRAs) in three regions or WHO prequalification and approval by 1 SRA). See paragraph 42 of PID for financing arrangements. c. Effective Vaccine Deployment: Actions related to strengthening the immunization program to be able to effectively deliver vaccines, including the COVID-19 vaccine will build on existing systems and service delivery modalities. Support will overhaul existing cold chain facilities, provide logistics infrastructure; and build the capacity of front-line delivery workers. Emphasis will be placed on dual use interventions that allow for effective COVID-19 deployment while strengthening health systems for the longer term. In this regard, the AF will enhance the following areas envisioned under the parent project to ensure effective vaccine deployment d. Policies and Normative Guidance. The AF will finance up-front technical assistance to assess and enhance policies and institutional frameworks around the safe and effective deployment of vaccines. These will include: (i) reviewing or establishing policies related to ensuring that there is no forced vaccination; (ii) acceptable approved guiding policy for ensuring prioritized intra-country vaccine allocation; (iii) regulatory standards at the national level; (iv) appropriate minimum standards for vaccine management including cold chain infrastructure. Component 2: Communication campaign, Community Engagement and Behavior Change. To foster confidence in a new vaccine for COVID-19, effective communication and outreach will be imperative. to increase awareness and “vaccine literacy,” build trust, and reduce stigma around any COVID-19 vaccine for a larger target population. Building confidence in a new vaccine will boost overall confidence in vaccinations thereby leading to greater utilization of other vaccines and medicines known to be linked to climate induced diseases. Activities will include: a. Expanding risk communication campaigns. Financing will include activities such as reviewing existing and undertaking in-depth beneficiary research on perceptions, and obstacles to vaccine uptake to inform developing mass Public Disclosure media and BCC campaigns that are tailored to Congo’s context, generating information in local languages and adapted to varied contexts within ROC, development and implementation of mass media and BCC campaigns that distribute information across high-penetration platforms, and efforts to garner support and endorsement through trusted community and national leaders. b. Community and multi-stakeholder engagement. Community engagement to increase awareness on prevention of COVID-19 and generate demand and uptake of new technologies, upcoming vaccines and other essential public health services essential. D. 2. Borrower’s Institutional Capacity The Ministry of Health, Population, Promotion of Women and Integration of Women in Development (MoHP) of the Republic of Congo will have overall responsibility for the implementation and coordination of the project. The MoHP has the experience to manage the project under safeguards policies, drawing especially from the implementation of the closed Health Sector project (P143849) and the parent project (P173851). The Ministry of Health will rely, among others, on the national technical coordination for the response to COVID-19 in the Republic of Congo, Technical Committee, Vaccination Commission and advisory bodies (Committee of Experts, Technical Advisory Group on Vaccination of the Covid-19 response for the implementation of the vaccine response). The Project Implementation Unit (PIU) of the Integrated Public Sector Reform Project (PRISP) P160801 has been effectively coordinating project planning and procurement under the guidance of the MoHP. The PIU team has been strengthened with the recruitment of a Focal Point focusing on the COVID-19 response, and the creation of a steering committee. The PIU has also worked on recruiting three safeguards specialists (social safeguards, environmental safeguards, and gender- based violence specialist) who support the project with the implementation and monitoring of environmental and social risk management. The parent project is in the process of transitioning to the recently established PIU under the Feb 23, 2021 Page 5 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) Regional Disease Surveillance Systems Strengthening – Phase IV (REDISSE IV – P167817) Project which became effective on September 1, 2020. As the proposed project is being conducted under the new Environmental and Social Framework (ESF), the recent recruited safeguards specialists do not have experience and adequate knowledge of the new requirements. The capacity to manage environmental and social risks is therefore limited. At the national level, the implementing agency, the Directorate General for Environment (DGE) is the main institution responsible for conducting and coordinating the environmental and social assessment process in the country. However, the DGE is facing challenges in terms of institutional capacity associated with staffing, finances and regulatory requirements. DGE has some experience with the implementation of World Bank projects under the environmental and social safeguards instruments but has no experience with the ESF since no project is being implemented under the ESF in the country. As with the PIU, the DGE also has limited capacities to monitor the implementation of this project. Considering the above, there is a need for capacity building targeting the PIU, DGE, and experts in key sectoral ministries and agencies on E&S risks and impacts management to meet the ESF requirements. This will include training and technical support on mitigating and responding to GBV/SEA/SH risks for the project. It is in this order that the World Bank has already registered all the E&S specialists of the project in the ESF online course and support them technically daily in order to acquire the adequate knowledge of the new requirements. This online registration in the ESF course will be extended to other experts of the project, the DGE and other key sectorial ministries and agencies. In addition to an E&S capacity building program, other training will be provided to the PIU to increase their capacity, Public Disclosure and training topics will include: (i) communications strategy on COVID-19 Infection Prevention and Control; (ii) COVID- 19 Infection Prevention and Control Recommendations; (iii) laboratory biosafety guidance related to the COVID-19; (iv) Specimen collection and shipment; (v) standard precautions for COVID-19 patients; (vi) risk communication and community engagement; and (vii) WHO and Africa CDC guidelines on quarantine including case management. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The Environmental Risk Rating is Substantial. The three major areas of risks for the project are: (i) risks related to hazardous and medical waste management and disposal; (ii) risks related to occupational health and safety including the risk of spread of the virus among health care workers; and (iii) risks related to community health and safety including the risk of the spread of COVID-19 among the population at large. The project interventions will lead to the handling of COVID19 related high-risk medical samples and large quantities of vaccine doses. Improper handling of hazardous and medical wastes can cause infection and health problems for workers, the community and the environment. Wastes that may be generated from health care facilities and hospitals to be supported by the project interventions may include transmissible, infected, hazardous materials and wastes. Proper and safe handling, managing, transporting, and disposing of the waste needs to be ensured. Also, the storage, transport and distribution of COVID-19 vaccines present potential risks and impacts in terms of E&S, in particular contamination, health intolerance and waste production. Risks associated with labor and working conditions are also Feb 23, 2021 Page 6 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) predicted under a working environment with medical wastes. Ensuring the delivery of appropriate personal protective equipment (PPE) for all health care workers is critical. The substantial risk classification takes also into account the limited capacity of the designated PIU, as well as all stakeholders involved in the preparation and implementation of the RoC COVID-19, to manage potential E&S risks in compliance with the ESF, as well as the current health system to respond to COVID-19 at the national and provincial level. Social Risk Rating Substantial The social risk is also classification for the project is Substantial. The Project will not involve resettlement or land acquisition. The Key social risks and impacts are related to: (i) marginalized and vulnerable and high-risk social groups (including Indigenous Peoples, the poor, and displaced persons and/or refugees) are unable to access facilities, services and access to vaccination, due to their income, and distance from health centers, in a way that could undermine the central objectives of the project; (ii) social conflicts resulting from false rumors and misinformation; (iii) issues resulting from people being kept in quarantine, including stigma faced by those admitted to treatment or isolation facilities; (iv) risks of SEA/SH to Project workers and beneficiaries; and (v) labor management and OHS risks. There is need to develop adequate preparedness actions to ensure disadvantaged and vulnerable groups have awareness and able to receive appropriate preventive support. Full social inclusion is not only fundamental to improved social development outcomes, but given the nature of COVID, if parts of society (by geography, income, gender or any other measure) are excluded, the overall efficacy of the engagement will be compromised. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered Public Disclosure 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: The Project will have overall positive environmental and social impacts in that it will contribute to epidemic preparedness, monitoring, surveillance, and response, specifically with regard to combatting COVID-19. Nonetheless, there are wide-ranging environmental and social risks and impacts that will need to be assessed and managed through a risk-based approach. Key environmental risks for the project are: (i) management of biomedical waste (especially handling highly infectious medical wastes such as COVID-19 and a large quantity of vaccine doses); (ii) environmental and community health- related risks from inadequate storage, transportation and disposal of infected medical waste; and (iii) occupational health and safety issues related to the availability and supply of personal protective equipment (PPE) for healthcare workers and the logistical challenges in transporting PPE across the country in a timely manner. Risks related to occupational and community health and safety are anticipated due to the dangerous nature of the pathogen (COVID- 19) and reagents and other materials to be used in primary health care facilities and hospitals. Diagnosis, testing, treatment, providing isolation of patients and the administration of vaccines can generate biological, chemical, hazardous medical wastes and may eventually lead to health risks in case of poor packaging. The project could also present risks related to the rehabilitation and equipping of selected primary health care facilities and hospitals; however, they are expected to be site-specific, mainly limited to existing facilities. The specific facilities and hospitals have not yet been identified, however, should there be a need for major rehabilitation. Feb 23, 2021 Page 7 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) Key social risks for the project are those related to: (i) marginalized and vulnerable and high-risk social groups (including the poor, Indigenous Peoples, minorities, and displaced persons and/or refugees) are unable to access facilities, services and access to vaccination, due to their income, and distance from health centers, in a way that undermines the central objectives of the project; (ii) the low participation of the population due to the non- acceptance by the population of the existence of COVID-19 on the national territory and the non-acceptance of vaccination by the population. (iii) social conflicts resulting from false rumors and misinformation; (iv) issues resulting from people being kept in quarantine, including stigma faced by those being admitted to treatment or isolation facilities and the risk of stigma between the refugees or displaced people and the host communities; (iv) issues resulting from social distancing and confinement measures, including the risk of intimate partner domestic violence during the quarantine as a result of household stress over economic and health shocks combined with forced coexistence in small living spaces and the risk of social unrest owing to prolonged confinement measures, especially for the economically vulnerable (e.g. the poor and informal workers); (iv) The risk of security particularly in the departments of Pool and the border area with the Central African Republic; and (vi) risks of SEA/SH for project workers and beneficiaries, including attacks on female healthcare workers. Risk of security: Congo’s history is marked by a pattern of conflict and violence. The Republic of Congo’s post-conflict context is characterized by a gradual consolidation of peace as well as an increase in economic reconstruction and rebuilding activities. The risk of security and conflict remains present, particularly in the departments of Pool and the border area with the Central African Republic. The Department of Pool was at the epicenter of violence in the Republic of Congo’s conflicts. It continues to host people who participated in or were affected by the conflict and were not supported through prior community development and reintegration programs. At the national level, the unsatisfied social demands and low levels of inclusion have heightened insecurity. Persistent security concerns since Public Disclosure the 2016 presidential election have disrupted the movement of goods, increasing the costs of doing business and leading to a reallocation of public funds to address security issues. This risk remains even though the country is planning to hold elections in 2021. In this context, the project prepared an environmental and social plan in preparation for the vaccine procurement activity that includes security risks. SEA/SH Risks: The project has been given a preliminary rating of moderate risk for SEA/SH, based upon the country context and project-specific indicators. This risk rating is subject to validation following project approval, and SEA/SH risks will be further assessed and addressed during the implementation phase. This will include a review of the preliminary screening exercise and establishment of the corresponding measures to prevent and mitigate identified risks. Although DHS data is not available, the MoHP estimates that sexual violence has been increasing and accounted for 2.6% of gynecology consultations between January 2014 and December 2015. Young women (98%) aged 14 on average and students (77.3%) were the main victims. Experience from past outbreaks (e.g., Ebola) and other COVID- 19-affected countries suggest that the COVID-19 emergency might further increase the likelihood of SEA/SH in RoC, including domestic violence, workplace violence in the health sector, racial and sexual harassment, abuse and exploitation of vulnerable women workers, and violence against women and girls (VAWG) in emergency settings. To mitigate these risks and impacts, the project will develop and implement an Environmental and Social Management Framework (ESMF), including an Infection Control and Medical Waste Management Plan (ICWMP) for implementation by facilities supported under the project, including primary health care facilities, hospitals, and laboratories, as well as a template for preparing Environmental and Social Management Plans (ESMPs), as necessary for managing risks and impacts related to any civil works. The ESMF will also outline the implementation arrangement to be put in place for environmental and social risk management, as well as training programs focused on COVID-19 operations. The Infection Control and Medical Waste Management Plan (ICWMP) will include measures Feb 23, 2021 Page 8 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) and procedures for the safe handling, storage, and processing of COVID-19 materials including the techniques for preventing, minimizing, and controlling environmental and social impacts. It will also clearly outline the implementation arrangement to be put in place for environmental and social risk management; training programs focused on COVID-19 laboratory biosafety, operation of isolation centers and screening posts; and compliance monitoring and reporting requirements. The ESMF will also define the institutional arrangements for the implementation of all measures which must be taken to avoid, reduce and/or mitigate to acceptable levels adverse environmental and social impacts during project implementation. The relevant part of COVID-19 Quarantine Guideline and WHO COVID-19 biosafety guidelines will be included in an ICWMP to be annexed in the ESMF so that all relevant risks and mitigation measures are adequately identified and addressed. An IPPF will be prepared to outline basic key principles to be applied to ensure a full participation and consultation of Indigenous Peoples/Sub- Saharan Historically Underserved Traditional Local Communities (IP/SSAHUTLCs). Should the presence of indigenous communities be confirmed through further screening, the project will address any risks posed to them and measures will be put in place to ensure that they receive culturally appropriate benefits. This will be done by ensuring that their views are sought as specified in the SEP and that a Social Assessment (SA) is carried out prior to carrying any activities that would impact indigenous communities. Following the SA, and as appropriate, a stand-alone Indigenous Peoples Plan will be developed. The project Environmental and Social Commitment Plan (ESCP) includes commitments to undertake the required assessments and preparation of the necessary instruments for the Project. Mitigation measures for site-specific impacts will be managed through the implementation of required environmental and social instruments to be prepared as per the ESMF. Relevant capacity building measures will be included in the ESMF and ESCP. Any rehabilitation of primary health care facilities and hospitals will develop and implement an ESMP that will be Public Disclosure approved before the start of work. To prevent, mitigate SEA/SH risks, response and monitoring measures will be put in place in during the project implementation. ESS10 Stakeholder Engagement and Information Disclosure COVID-19 presents unique and considerable challenges for stakeholder engagement and information disclosure, as the stakeholder engagement and consultation processes cannot be conducted following established methods and procedures due to the timelines of an emergency operation and in the light of limitations on social gatherings and other forms of personal contact put in place to address the pandemic. Nevertheless, the approach to stakeholder engagement should be based on the principles of meaningful consultation and disclosure of appropriate information with consultation and communication methods adapted in the light of the pandemic. The Bank team will provide advice to the client on managing stakeholders’ engagement in these constrained circumstances. Identification of project stakeholders and analysis of their needs and levels of influence should be as complete and thorough as possible, with the identification of vulnerable people affected by the project requiring special attention as early as possible. The SEP will include the use of different, culturally appropriate communication approaches to ensure communication also with the most vulnerable, including illiterate and people with disabilities. Feb 23, 2021 Page 9 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) The SEP prepared for the parent project was updated to consider consultation needs in the face of stakeholders' skepticism about the vaccine, and on the country global vaccination process. Also, stakeholders will be consulted about the vaccination plan (strategy, who gets priority, access of vulnerable groups to vaccines, etc.). The proposed project will support a Risk Communication and Community Engagement campaign to raise public awareness and knowledge on prevention and control of COVID-19 among the general population, raising awareness on the merits of the vaccine and contribute to strengthening the capacities of community structures in promoting coronavirus prevention messages. This activity will be expanded with activities to inform the public of the rationale for vaccinating selected target populations; vaccine safety; the process for vaccine deployment; and possible side- effects to foster confidence in a new vaccine. Effective communication and outreach will be imperative to increase awareness and “vaccine literacy”, build trust, and reduce stigma around any COVID-19 vaccine for a larger target population. The Recipient will engage in meaningful consultations on policies, procedures, processes, and practices (including grievances) with all stakeholders throughout the project life cycle, and provide them with timely, relevant, understandable and accessible information. The consultations will provide information on project-related risks, including SEA/SH, and the proposed reporting and response measures, with a particular focus on women, children and other vulnerable groups. Community consultations with women and girls that are related to SEA/SH risk mitigation will be conducted in safe and enabling environments, such as in sex-segregated groups and with female facilitators (virtually, and if and when it becomes possible, in-person), and will be focused on understanding women’s and girls’ risks and vulnerabilities. A project-wide grievance redress mechanism (GRM), which includes measures for Public Disclosure handling SEA/SH complaints, will be established, as outlined in the SEP. The parent project is in the process of developing the grievance mechanism. The details of contact and process of different GRM will be include in the update SEP. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions ESS2 is considered relevant to this Project. The project is expected to encompass the following categories of workers: direct workers and contracted workers. Most activities supported by the project will be conducted by direct workers of the Project such as health and laboratory workers, i.e. civil servants employed by MoHP. The project may outsource minor civil works to contractors. While the number of workers may not be estimated at the current stage, no large-scale labor influx is expected. The key risk is in relation to the contamination with COVID-19 (or other contagious illnesses as patients taken seriously ill with COVID-19 are likely to suffer from illnesses which compromise the immune system, which can lead to illness and death of workers). In line with ESS2, the use of forced labor or the use of child labor for any person under the age of 18 in hazardous work situations (e.g. in health care facilities) is prohibited. Measures related to occupational health and safety will be documented in labor management procedures (LMP) that Feb 23, 2021 Page 10 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) will be included in the ESMF. They are aimed at protecting project workers from injury, illness, or impacts associated with exposure to hazards encountered in the workplace or while working, such as the provision of infection control precautions and adequate supplies of PPE. The mitigation measures will incorporate the World Bank Group's General Environment, Health, and Safety Guidelines (EHSGs), the EHSGs for Health Care Facilities and other Good International Industry Practices (GIIP). The ESMF will also include sections on Environment Health and Safety (EHS) including specific instruments, such as EHS checklists, Codes of Conduct, including measures to prevent SEA/SH, and safety training materials. Healthcare workers (HCWs) play a critical role in outbreak response and are the backbone of a country's defense to limit or contain the spread of disease. They face higher risks of potential COVID-19 infection in their efforts to protect the greater community and are exposed to hazards such as psychological distress, fatigue and stigma. They will be prioritized for early vaccination. Worker safety: Healthcare associated infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among health and laboratory workers. The laboratories to be supported by the project will process COVID-19 and will therefore have the potential to cause serious illness or potentially lethal harm to the laboratory staff and to the community, so effective administrative and containment controls will be put in place to minimize these risks. Environmentally and socially sound health facilities management will require adequate provisions for minimization of occupational health and safety risks, proper management of hazardous waste and sharps, use of appropriate disinfectants, proper quarantine procedure for COVID-19, appropriate chemical and infectious substance handling and transportation procedures, etc. These measures are covered in the ICWMP Public Disclosure contained in the draft ESMF and are based on the national healthcare delivery standards and norms set by the MoH in addition to WHO guidance. The PIU will implement adequate occupational health and safety measures, including emergency preparedness and response measures, in line with the ESMF and WHO guidelines on COVID-19 in all facilities, including laboratories, quarantine and isolation centers, and screening posts. The PIU will also ensure a non-discriminatory, decent work environment, including ensuring that all health workers adhere to the WHO Code of Ethics and Professional conduct. A worker Grievance Redress Mechanism within MoHP will be established and operated through a grievance hotline and assignment of focal points to address these grievances, which will be outlined in the LMP. The PIU will also include any environmental and social management plans or other instruments, ESS2 requirements, and any other required ESHS measures, into the ESHS specifications of the procurement documents and contracts with contractors. The PIU will ensure that in case of civil works, every contract comply with the environment, social, health, and safety (ESHS) mitigation measures based on the WBG EHS Guidelines, ESMF, SEP, and other relevant instruments. ESS3 Resource Efficiency and Pollution Prevention and Management ESS3 is considered relevant to the Project. Highly infectious medical waste is expected from the handling of COVID-19 patients. Hazardous chemical wastes are expected to be generated from medical facilities, laboratories, and related facilities. The improper handling, transporting, and disposal of these hazardous and medical waste streams may result in adverse impacts to human health and the environment. An Infection Control and Waste Management Plan (ICWMP) for health facilities will be developed as Annex to the ESMF and will be implemented. The ICWMP will follow Feb 23, 2021 Page 11 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) WHO guidance documents on COVID-19 and other GIIP (Good Industry International Practices). In addition, should there be a need for major rehabilitation, site-specific ESMPs will be prepared based on the provisions of the ESMF. ESS4 Community Health and Safety ESS4 is considered relevant to the Project. Inappropriate handling of COVID-19 can expose the community to health risks that could lead to further spread of the disease. Lack of provision of medical services to disadvantaged or vulnerable people is a potential risk under the project interventions. Laboratory accidents and/or emergencies such as fire incidents or a natural phenomena event is also an associated risk. Some project activities may give rise to the risk of SEA/SH, such as health facilities rehabilitation work which may place female health workers and patients at risk of SEA/SH from construction workers; establishment of isolation or quarantine centers where female health workers and patients may be at risk of SEA/SH from male staff, supervisors or security personnel; and distribution of critical medical supplies and protective equipment, which could see cases of provision of materials to female health workers or patient made conditional on granting of sexual favors. As mitigation measures, the PIU will put measures in place to prevent or minimize the spread of the infectious disease/COVID-19 to the community. The project will prepare emergency preparedness measures including with respect to vaccine storage, transport, use and disposal, as well as laboratory accidents/emergencies (e.g. a fire response or natural phenomena event). Public Disclosure Measures to ensure that vulnerable groups and individuals, among others the elderly, individuals living alone or in remote areas and Indigenous Peoples, will be made aware of and have equitable access to project benefits and services. These measures will be captured in the ESMF and other instruments to be prepared within two months of Project Effectiveness. The PIU will address the risk of any form of SEA/SH by or against workers in the quarantine facilities by relying on the WHO Code of Ethics and Professional conduct s as well as through the provision of gender- sensitive infrastructures such as secure and sufficiently private sex-segregated toilets and adequate light in quarantine and isolation centers. The project will also prepare a SEA/SH Action Plan to address other SEA/SH risks that may arise from project activities. In case quarantine and isolation centers are to be protected by security personnel, the project will take measures to ensure that, prior to deployment such personnel are: (i) screened to confirm that they have not engaged in past unlawful or abusive behavior, including SEA/SH or excessive use of force; (ii) adequately instructed and trained, on a regular basis, on the use of force and appropriate behavior and conduct (including in relation to SEA and SH), as set out in ESMF; and (iii) deployed in a manner consistent with applicable national law. The project is not likely to employ military personnel for deployment of vaccine, but if the situation changes, the project will undertake a Security Risk Assessment (SRA) to review the military’s rules of engagement with civilian authorities and identify the specific risks related to providing increased security at the various project sites. The project would then propose adequate mitigation measures and strengthen existing measures, where necessary, to ensure that the use of the military in project activities will not result in adverse consequences to community health and safety, including in matters relating to SEA/SH. The project will promote the avoidance of SEA/SH by relying on the WHO Code of Ethics Feb 23, 2021 Page 12 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) and Professional Conduct for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructures such as segregated toilets and enough light in quarantine and isolation centers. The ESMF project is currently being updated will also take into account the following aspects : (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; and iv) monitoring of adverse impacts and side effects of vaccines on recipients of the vaccinations. The safety systems, protocols and emergency preparedness measures for the storage, transport, use and disposal of vaccines to ensure community health and safety (including if community centers are used for administration of the vaccination) . In case of necessity PIU will follow all relevant requirements of WHO guidelines to help manage this risk will be applied. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement ESS5 is not currently relevant to the Project. All eventual construction will be undertaken within existing facilities. No adverse impacts relating to land acquisition, restrictions on land use or involuntary resettlement are anticipated as a result of proposed project activities. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources Public Disclosure ESS6 is not currently relevant to the Project. No greenfield works are envisaged for this project. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS7 is relevant to the project. According to the National Agency of Statistics, Indigenous Peoples in the areas of intervention of the project represent 18.17% for the Sangha, 0.72% for the Kouilou and Pointe Noire, and 5.89% for Brazzaville and Pool. It is then necessary to fully involve them in project’s activities to ensure that they have access to project’s actions and that project’s activities are conducted in manner that respect their culture and their needs. An IPPF will be prepared, consulted upon and disclosed before project’s negotiation stage. The IPPF will outline basic key principles to be applied to ensure a full participation and consultation of Indigenous Peoples/Sub- Saharan Historically Underserved Traditional Local Communities (IP/SSAHUTLCs) are present or in areas to which they have a collective attachment. Should the presence of indigenous communities be confirmed through further screening, the project will address any risks posed to them and measures will be put in place to ensure that they receive culturally appropriate benefits. This will be done by ensuring that their views are sought as specified in the SEP and that a Social Assessment (SA) is carried out prior to carrying any activities that would impact indigenous communities. Following the SA, and as appropriate: a stand-alone Indigenous Peoples Plan (IPP) will be developed; Public consultations with representatives of indigenous communities and their organizations are provided for in the SEP, considering their circumstances. These organizations and representatives will be consulted during the revision of the SEP. There is a need to design and implement adequate preparedness actions targeted to disadvantaged and vulnerable groups (elders, women/children, people with disability and ethnic minorities who speak and read other than IP, Feb 23, 2021 Page 13 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) patients with lung, cardiovascular, renal disease, cancer, type I and II diabetes, adults above 60 years old, pregnant woman and family members of heath care service providers (on average 2-3 members) through adopting WHO guidance which are designed to support risk communication, community engagement staff and responders working with national health authorities. The MoH through its PIU will update the SEP to ensure culturally appropriate communication strategies are developed. ESS8 Cultural Heritage ESS8 is not relevant to the Project as the potential civil works are unlikely to affect cultural assets. In the unlikely event of construction or the movement of the earth in connection with any project activities that have not yet been identified, for example, the ESMF will include measures for “Chance Finds” of archaeological or other cultural heritage. ESS9 Financial Intermediaries ESS9 is not relevant to the Project for the suggested project interventions. B.3 Other Relevant Project Risks None Public Disclosure 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: none IV. CONTACT POINTS World Bank Feb 23, 2021 Page 14 of 15 The World Bank Republic of Congo COVID-19 Emergency Response Project - Additional Financing (P175805) Contact: Lombe Kasonde Title: Senior Health Specialist Telephone No: 458-8861 Email: lkasonde@worldbank.org Borrower/Client/Recipient Borrower: Republic of Congo Implementing Agency(ies) Ministry of Health, Population, Promotion of Women and Integration of Women in Implementing Agency: Development 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 Public Disclosure Task Team Leader(s): Lombe Kasonde Practice Manager (ENR/Social) Sanjay Srivastava Cleared on 08-Feb-2021 at 14:42:32 GMT-05:00 Feb 23, 2021 Page 15 of 15