Ministry of Health and Social Development of the Kyrgyz Republic Kyrgyz Republic Emergency COVID-19 Project (P173766) Including Additional Financing (P176054) STAKEHOLDER ENGAGEMENT PLAN (SEP) (UPDATED) April 16, 2021 Contents List of Abbreviations........................................................................................................................ 3 1. Introduction................................................................................................................................. 4 2. Project Description ...................................................................................................................... 5 3. Stakeholder Identification and Analysis ...................................................................................... 7 3.1. Affected Parties........................................................................................................................ 8 3.2. Other Interested Parties .......................................................................................................... 8 3.3 Disadvantaged / vulnerable individuals or groups ................................................................... 9 4. Stakeholder Engagement Program ............................................................................................. 9 4.1 Summary of stakeholder engagement done during Parent Project implementation.............. 9 4.2 Summary of project stakeholder needs and methods, tools, and techniques for stakeholder engagement .............................................................................................................................. 13 4.3 Proposed strategy for information disclosure ........................................................................ 16 4.4 Proposed strategy for consultations ....................................................................................... 18 5. Resources and Responsibilities for implementing stakeholder engagement activities ........... 19 5.1. Resources ............................................................................................................................... 19 5.2. Management functions and responsibilities ......................................................................... 19 6. Grievance Mechanism ............................................................................................................... 20 6.1. Description of the GM............................................................................................................ 21 6.2 GM Structure for Contracted Workers ................................................................................... 22 6.3 GM for medical workers and communities ............................................................................ 23 6.4 GM for Direct Workers............................................................................................................ 23 6.5 Receiving Grievances .............................................................................................................. 24 7. World Bank Grievance Redress System .................................................................................... 26 8. Monitoring and Reporting......................................................................................................... 26 Annex 1. Existing Grievance Mechanisms of the Ministry of Health and Social Development and Mandatory Health Insurance Fund of Kyrgyz Republic ................................................................ 28 Annex 2. Stakeholder Engagement Activities Held During Parent Project Implementation ........ 31 2 List of Abbreviations ADB Asian Development Bank AF Additional Financing ARIS Community Development and Investment Agency of the Kyrgyz Republic COVID-19 Coronavirus Disease 2019 ESF Environment and Social Framework ESMF Environment and Social Management Framework ESMO Environmental and Social Management Plan GIZ German Agency for International Cooperation GRC Grievance Review Committee GM Grievance Mechanism GRS Bank’s Grievance Redress Service HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome HO Health Organization ICMWMP Infection Control and Medical Waste Management Plan ICU Intensive Care Unit KPIs Key Performance Indicators MHIF Mandatory Health Insurance Fund of the Kyrgyz Republic MoES Ministry of Emergency Situations of the Kyrgyz Republic MoHSD Ministry of Health and Social Development of the Kyrgyz Republic NGO Non-governmental organization OHS Occupational health and safety PIU Project Implementation Unit PoE Point of Entry PPE Personal Protective Equipment PR Public Relations RCHPMC Republican Center for Health Promotion and Mass Communication SEP Stakeholder Engagement Plan SEA/SH Sexual Exploitation and Abuse/Sexual Harassment UNDP United National Development Programme UNICEF United National Children’s Fund USAID United States Agency for International Development VC Video conference WBG World Bank Group WHO World Health Organization 3 1. Introduction The Kyrgyz Republic, like all other countries in the world, remains vulnerable to the Coronavirus 2019 (COVID-19) pandemic. The World Health Organization has rated the Kyrgyz Republic's operational readiness to prevent, detect and respond to a public health emergency as one of the lowest in the region. The Kyrgyz health care system is not sufficiently equipped to contain the spread of COVID-19 and provide the necessary treatment. As COVID-19 will put a significant burden on inpatient and outpatient health care, healthcare organizations will not be able to provide critical health care services and the increased demand for services caused by the outbreak, and there are no in-hospital infection control measures on the ground, including the lack of blood transfusion services for ensuring the availability and safety of blood products to prevent transmission of viruses. The system of infectious, epidemiological and environmental control in the country is multifaceted and consistently evolving, but it cannot respond to the COVID-19 outbreak in a timely and effective manner. Sanitary and Epidemiological Councils have been established in all districts to coordinate and resolve issues of development, management and improvement of the sanitary and epidemiological service, however, there is an acute shortage of specialists, as well as skills in public health organizations (HOs) to ensure reliable infection control, along with health care waste management and infection control. In many ways, the risks of infectious and parasitic diseases in public health institutions are associated with inadequate provision of clean drinking water and disinfectants - especially in rural areas. The Kyrgyz Republic has been heavily hit by the COVID-19 pandemic. As of February 12, 2021, there were 85,398 confirmed cases of COVID-19, as well as 1439 deaths. The country already experienced two spikes in the epidemic, one in July/August 2020, and a second one in October/November 2020. The real number of cases is likely to far exceed the reported number of cases due to a lack of universal testing and the prevalence of asymptomatic infections. The mortality impacts of the COVID-19 pandemic are much more severe than what is suggested by official COVID-19 death tolls. To help the Government respond to the pandemic, the World Bank approved the Kyrgyzstan COVID-19 Emergency Project (P173766). The Project, with funding of US$12.15 million, was prepared as part of the emergency response under the COVID-19 Strategic Preparedness and Response Program using the Multiphase Programmatic Approach. It was approved in April 2, 2020 and has a closing date of March 31, 2022. The Project aims to support the Government of the Kyrgyz Republic in strengthening its capacity to prepare for and respond to the COVID-19 pandemic in the Kyrgyz Republic. The need for additional resources to expand the COVID-19 response was formally conveyed by the Government of the Kyrgyz Republic on December 1, 2020. The request included financing for purchase of additional volumes of vaccines against COVID-19 and additional expenses, in excess of those provided by GAVI under the COVAX Mechanism (20% of the population); logistic assistance for the supply, distribution of vaccines in the country; the provision of cold storage equipment for vaccines; MoHSD activities related to planning and deployment of COVID-19 vaccination. 4 A process is currently ongoing to supplement the Emergency COVID-19 Project with additional financing (AF) to fill critical gaps in the scope and the scale of the initial Project. The AF will form part of an expanded health response to the pandemic, which is being supported by development partners under the coordination of the Government of the Kyrgyz Republic. Additional World Bank financing will provide essential resources to enable the expansion of a sustained and comprehensive pandemic response that will appropriately include vaccination in the Kyrgyz Republic. 2. Project Description The Project Development Objective (PDO) of the parent project and the AF is to prepare and respond to the COVID-19 pandemic in the Kyrgyz Republic. The AF with total funding of US$ 20.00 million will finance new activities that will support the deployment of COVID-19 vaccines, including vaccine acquisition, systems for vaccine delivery, and follow-up. There are no substantial changes in the activities under subcomponents 1.1 and 1.2 and the only substantial change is the addition of vaccination activities under subcomponent 1.3. (US$ 19.50 million). The AF will also increase the amount of funding available under Component 2 (US$ 0.50 million) to ensure proper implementation management and M&E of AF activities. COMPONENT 1: EMERGENCY COVID-19 RESPONSE (US$ 31.48 million): This component supports the capacity of the Kyrgyz health system to detect, contain, manage, and treat COVID- 19 disease. This component will also finance the deployment of COVID-19 vaccines, including vaccine acquisition, systems for vaccine delivery, and follow-up. Supported activities include: Sub-component 1.1 Case Detection, Containment, Confirmation, Recording and Contact Tracing. The Project supports public health functions related to COVID-19: disease surveillance systems, public health laboratories, and epidemiological capacity for detection and confirmation of cases; active contact tracing; epidemiological investigation; risk assessment; and collection of on-time data and information for guiding decision-making and response and mitigation activities. The Project supports Rapid Response Teams (RRTs) in Bishkek and seven regions by procuring vehicles, equipment, and supplies. The Project also contributes to strengthening testing capacities in designated laboratories through centralized procurement of equipment and supplies. The Project also supports the strengthening of medical points in border Points of Entry (PoE) with training, Personal Protective Equipment (PPE), and updates to handwashing facilities, restrooms to a basic level. Sub-component 1.2. Health System Strengthening. The Project aims to contribute to strengthening of health system preparedness, improving the quality of medical care provided to COVID-19 patients, and minimizing the risks for health personnel and patients. These objectives will be achieved through procurement of essential medical goods such as PPE, Intensive Care Unit (ICU) and non-ICU equipment and supplies for hospitals, medicines, and waste management equipment. The Project will also finance repairs and minor modifications in eleven designated hospitals. Eleven designated hospitals will undergo repairs and minor modifications, including the provision and/or repair of handwashing and hygiene facilities, upgrading electrical and plumbing work to safely connect and operate medical equipment, carrying out other emergency 5 repairs to ensure patient and staff safety and infection prevention and control, and installation of additional doors and partitions to ensure proper isolation of COVID-19 patients. These funds will be advanced to hospitals through the Mandatory Health Insurance Fund (MHIF). Sub-component 1.3. Vaccine purchasing and deployment. The AF will finance upfront technical assistance to support the Kyrgyz Republic to establish institutional frameworks for the safe and effective vaccine deployment. The AF will also support investments to bring immunization systems and service delivery capacity to the level required to successfully deploy COVID-19 vaccines at scale. The investments are geared towards overcoming bottlenecks identified in the COVID-19 vaccine readiness assessment. The AF will finance goods, consulting services, and non- consulting services needed for: (a) vaccine importing, such as customs fees and customs and customs handling services; (b) cold storage of vaccines; (c) transportation of vaccines and vaccination teams; (d) vaccination supplies; (e)training of health workers; (f) vaccine administration services; (g) security of the vaccine deployment chain; (h) infection control in vaccination sites; (i) safe disposal of medical waste generated by vaccination; (j) information systems needed to deploy and monitor vaccines; (k) call center operation; (l) communication services; (m) third-party monitoring of the vaccination effort. COMPONENT 2: IMPLEMENTATION MANAGEMENT AND M&E (US$ 0.67 million) . This Component supports the capacity of the Project Implementation Unit (PIU), located at the Ministry of Emergency Situations (MoES), to coordinate activities with MoHSD, RCHPMC, MHIF, and other entities and manage the financial management and procurement functions of the Project. The PIU was strengthened by the recruitment of additional staff/consultants responsible for the overall administration, procurement, environmental and social safeguards, and financial management. This component also supports the M&E of Project implementation. The AF finances activities under sub-component 1.3 (vaccination) for US$ 19.5 million as well as under component 2 (US$ 0.5 million). The AF will not finance new activities under sub- component 1.1 or subcomponent 1.2. The Kyrgyz Republic - Emergency COVID-19 Project and the AF have been prepared under the World Bank’s Environment and Social Framework (ESF). The following Environmental and Social Standards (ESSs) – 1, 2, 3, 4 and 10—are relevant for the parent project and the AF. Environmental and Social Standard (ESS)_ 10 and Stakeholder Engagement Plan (SEP). As per the 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. 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 6 essential to the success of the project in order 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 and vaccination. 3. 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 (‘other 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. Rural health facilities and community leaders 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. For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) can be divided into the following core categories: (i) Affected Parties – persons, groups and other entities within the Project Area of Influence 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; (ii) 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; (iii) 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 status1, and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. 1 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. 7 3.1. Affected Parties Affected Parties include individuals, 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. COVID-19-infected people; 2. Covid -19 Vaccine aspirants; 3. Public health workers including Doctors, Nurses, Other medical attendants as well as suppliers working in the target health facilities; 4. Patients/visitors of the target health facilities; 5. Medical waste collection and disposal workers; 6. Returning labor migrants and civil works laborers; 7. Airport and border control staff; 8. Neighboring communities to health facilities, laboratories, and screening posts; 9. People with chronic disease; 10. People over 60 years of age – senior citizens; and 11. Workers of social and education sector. 3.2. Other Interested Parties The projects’ stakeholders also include parties other than the directly affected communities, including: 1. MoES/PIU; 2. Ministry of Health and Social Development (MoHSD), its regional & local departments, and adjunct healthcare and epidemiological surveillance institutions and health organization; 3. MHIF under the Government of the Kyrgyz Republic; 4. Ministry of Finance; 5. Republican COVID-19 Response Headquarters; 6. Republican Center for Health Promotion and Mass Communication (RCHPMC) 7. Traditional media and journalists; 8. Civil society groups and non-governmental organizations (NGOs) on regional, national and local levels that pursue environmental and socio-economic interests; 9. Non-governmental organizations/individuals who may function as partners of the project; 10. Social media platforms; 11. Implementing agencies for the World Bank-funded projects working in the border regions and health improvement sector (Regional Economic Development Project- ARIS2, Primary Healthcare Quality Improvement Project-MoHSD/PIU); 12. Other national and international health organizations (Red Crescent Society, WHO, Global Fund, Aga Khan Health Services); 2 Community Development and Investment Agency of the Kyrgyz Republic 8 13. Other donor organizations: COVAX, Asian Development Bank (ADB), United Nations Children’s Fund (UNICEF), United Nations Development Program (UNDP), German Agency for International Cooperation (GIZ), and United States Agency for International Development (USAID); and 14. The public at large. 3.3 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 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 include and are not limited to the following: • Retired and elderly persons; • Persons with disabilities; • Pregnant women, infants, and children; • Women-headed households and single mothers with underage children; • Extended low-income families; • Unemployed; • Homeless people and street persons; and • Rural population living in remote and isolated areas. Description of the methods of engagement that has been undertaken by the project is provided in the following sections. 4. Stakeholder Engagement Program 4.1 Summary of stakeholder engagement done during Parent Project implementation The project has done a reasonably good job in implementing the SEP prepared under the Parent Project. The progress needs to be viewed in the background of two deterring factors- one, Covid Pandemic situation; and other, country’s political atmosphere. While the former was well known, 9 and accordingly, the project geared itself, political turmoil which erupted in/ around October 2020 (as a result of the National Elections) crippled the government functioning severely. The political situation in Kyrgyzstan remained uncertain and the Kyrgyz Republic witnessed power shifts, provisionally and definitively, among three presidents and five prime ministers in the recent times. This has paralyzed the administration and several decisions are still in limbo. Despite these compelling constraints, the project has been quite effective in reaching out the stakeholders. The COVID-19 pandemic situation meant conduction of large-scale face-to-face consultations extremely difficult. So, innovative virtual methods had to be deployed to reach out and be engaged with the stakeholders. Table 1 below summaries the methods used to inform and consult with key stakeholders during the Parent Project. Details are in Annex --2. Major themes of these engagement are centered around creating knowledge, awareness creation and capacity building. Table 1. Summary of Public Consultations and Information Disclosure During Parent Project Implementation Name and Activity Timetable: Target Responsible purpose of Methods used Outputs Location and dates stakeholders parties the activity The first round of Virtual September 2, Representatives of 7 MOHSP/ PIU Leadership of the consultations on workshop 2020 target hospitals target HOs the draft ESMF introduced to potential the E&S impacts Disclosure of draft Online Website of the General public MOHSP/MoES PIU 2278 internet ESMF consultations Ministry of users reviewed the Emergency draft ESMF Situations, August 15, 2020 The first round of Face-to face October 2020 61 health workers from MOHSP/MoES PIU Feedback received consultations on meetings Zhayil, Tokmok, territorial hospitals (14 from medical the draft ESMF Kochkor, Osh and females) workers on the 2 online Uzgen regions ICMWM meetings via Leilek and Tash- ZOOM Komur hospitals The second round 2 face-to-face November 18 – Health workers of the MOHSP/MoES PIU New format of of consultations meetings December 16, 2020 National hospital and ICMWMP template on the draft ESMF 7 virtual Bishkek National Maternal and was proposed and meetings with Child Healthcare Center training on Health workers from ICMWMP for HOs Virtual meetings is recommended hospitals in Osh, Uzgen, Leilek, Tash Komur, to be included Kochkor, Tokmok, Zhaiyl district Raise awareness online Website posting General public MOHSP Grievance on project specific Mechanism leaflet GM is accessible online 10 Name and Activity Timetable: Target Responsible purpose of Methods used Outputs Location and dates stakeholders parties the activity Raise community Printed GM Civil works sites at 8 Local communities MOES PIU GM poster was awareness on the posters hospitals developed and project-specific installed in 8 civil GM work sites (HO) Raise awareness WhatsApp 8 project sites Local communities Community GM focal point on the project- groups leaders contacts are specific Grievance available to Mechanism citizens Disclose draft Municipal November 20, 2020 Wider public of Tokmok Tokmok Mayor’s Public access to ESMF website of town office E&S measures Tokmok town Brief community WhatsApp November 18 – Community members Community 4980 community members on groups and December 16, 2020 of Uzgen, Kara- Balta, leaders/ MoES PIU members were upcoming civil Telegram Tokmok, Tash Komur informed about works and project channels towns and Kochkor the project activities in their villiage activities areas Raise awareness Website December 17, 2020 Wider public MOHSD, MoES SEP is nationally on the updated disclosure disclosed SEP Disclose the Face-to-face December 28-29, Employees of hospitals MoES PIU Eight ESMPs and ESMPs and meetings 2020 in Bishkek; (including those for ICMWMPs are ICMWMPs October 6, 2020 in infection control), disclosed Online Zhayil District; heads of contractors consultations October 8, 2020 in and technical for 5 hospitals Tokmok town supervision consultants Disclose the Website December, 2020 Project workers MOHSD LMP is disclosed project specific posting LMP Introductory virtual Nov 18, 2020 – Leilek Employees of MOES PIU ESMP provisions, training on LMP, meetings hospitals (including ICMWMPs, Labor ESMP, ICMWMP Dec 15, 2020-Uzgen those for infection Management control), heads of Procedures were Jan 13, 2021-Bishkek contractors and explained, in technical supervision Face-to-face particular the Code Jan 18, 2021-Tokmok consultants meetings of Conduct, GRM, Jan 19, 2021 - Zhayil District labor protection Jan 20, 2021-Osh Jan 21, 2021- Tash- Kumyr Jan 25, 2021 – Bishkek Feb 2, 2021-Bishkek March 25, 2021-Tash- Kumyr Information on Websites, Websites of Kara- Community members Local governments Informed ongoing civil facebook Balta and Tokmok and local activists community about works pages, cities, Facebook the upcoming WhatsApp page of the Kara- project works groups Balta city; Newspaper “My city-Tokmok�; Newspaper Facebook page of the Osh mayor's 11 Name and Activity Timetable: Target Responsible purpose of Methods used Outputs Location and dates stakeholders parties the activity articles office; local WhatsApp groups, ZOOM group, mayors’ office communication channels Identify effective Communication December, 2020 MOHSD, PCHPMC MOES PIU Communication communication working group action plan is approaches to developed raise public awareness about project results Raise public Postings at Jan-March, 2021 Wider public MOHSD and MOES 3 press releases awareness news agencies PIU and video materials about the are accessible at 9 project activities news agency websites Public disclosure Website March 19, 2021: Wider public MoHSD and MoES Final ESMF for the of the final ESMF uploads www.med.kg and parent project is www.mes.kg. disclosed The detailed information on the stakeholder engagement activities held and public consultations findings are enclosed in Annex 2. Stakeholder Consultations during AF Preparation: Virtual consultations have been held with key stakeholder groups with the theme centered around the new component- Vaccination Program. Details are presented below. Table 2. Summary of Stakeholder Consultations During AF Preparation Name and Timetable: Location and purpose of the Methods used Target stakeholders Responsible parties dates activity AF Project Virtual discussion, On need basis, donor MOHSP and Republic WB team, MOHSD design one-on-one organizations’ offices, MOHSD Center for Immuno- Leadership meetings, e-mail office, online connections Prophylaxis, international exchanges health organizations COVID-19 Virtual meetings, September 2020 Republic Center for Immuno- MOHSD vaccination discussions Prophylaxis practices Establishment of Meetings, virtual November 2020-March 2021 RHCPMC staff, PIU, WB RCHPMC, PIU community discussions team engagement platform 12 Vaccine Readiness Virtual meetings, November 2020 Gavi, UNICEF, the World MOHSP and the Assessment discussions, desk Health Organization Republican Center Framework review of existing for Immuno- regulations and Prophylaxis (RCIP) practices Public consultations Virtual meetings, December 2020-January, Gavi, UNICEF, the WHO, Technical working on National discussions 2021 ministerial officials, and group within the Deployment and heads of the HOs MOHSD Vaccination Plan 4. 2. Summary of project stakeholder needs and methods, tools, and techniques for stakeholder engagement The SEP prepared under the Parent Project has been updated to provide for the new intervention – Vaccination. It may however be noted that SEP will remain as one comprehensive program encompassing both PP and AF elements. Given the deteriorating situation in the country, project will try developing and adopting a digital community engagement platform to be administered by the Republic Center for Health Promotion and Mass Communication under the MOHSD for reaching out to the stakeholders (detailed in Table 4.4). Approach and methods depend upon the needs of each sub-group and their current / likely status and the overall project context. Project recognizes that face-to-face interactions (planned under normal circumstances) are not possible given the nature and spread of COVID-19. So, methods have been unique to ensure that stakeholder engagement itself is not be a cause for the spread of virus. Stakeholder engagement approaches are defined based on the needs of each group. Taking into account the stakeholder groups and the current status of the project, as well as the general expectations, the project has worked out various approaches - using both print and electronic media. Table 3. Summary of Stakeholder Needs and Preferred Notification Means Stakeholder Key characteristics Expectations Specific Engagement method group communication needs Language (e-mail, needs phone, radio, letter) Affected Parties (risks are substantial) COVID-19 People receiving Conditions for sustained Warnings, advance Kyrgyz, Oral and written infected people treatment in treatment in hospitals notices Russian, announcements with in hospitals hospitals where participation of where civil renovation and medical staff works are rehabilitation works carried out are carried out Workers Workers engaged in Waste management Guidance Kyrgyz Written instructions engaged in renovation and precautions, hand hygiene Russian on occupational renovation and rehabilitation of and PPEs, safety measures health and safety rehabilitation health organizations works in HOs Public health Medical staff Occupational health and On-job safety guidance, Kyrgyz, Print out materials, workers of Hos biosafety measures, PPEs, PPEs provisions, Russian Placement of posters and PoEs where hands-on training about upcoming 13 Stakeholder Key characteristics Expectations Specific Engagement method group communication needs Language (e-mail, needs phone, radio, letter) renovation programs, infection control effective grievance repairing works at works are and risk management redress channels information stands carried out planning Medical waste Medical staff Occupational health and Guidance Kyrgyz Written instructions collection and involved in waste safety (OHS) measures, Russian On-job instructions/ disposal management and training, PPEs, waste trainings workers; waste removal and management plans, safe transfer waste transfer vehicles for rural health facilities Returning labor Frustrated and Initial epidemiological Regular updates on the Kyrgyz, Social media migrants forced to travel screening at aircrafts and Covid situation, dos and Russian, platforms, e-mails , laborers with airports, medical check- don’ts during travelling English mass media relatively mid income ups, placement in and economic updates quarantine facilities and and in-country continuous monitoring. economic opportunities Points of entry At risk employees Improved working Oral and written Kyrgyz, Emails, text messages, staff at airports working at the front conditions, hand hygiene messages (posters, Russian, WhatsApp groups, and border lines with large and PPEs signposts) printouts control staff amount of people MoHSD and its Selected hospitals Assistance in response to Implementation of the Kyrgyz, Letters, e-mails, regional & local where renovation COVID-19; Medical Communication Russian videoconferences branches works will be carried supplies, equipment, staff Strategy and Action (VCs), training out preparedness capacity Plan building, improved ESMP3 and ICMWMP4 quarantine centers and implementation and screening posts, enough monitoring support PPEs; Health workers Workers at the Information about Labor and occupational Kyrgyz, Training, information healthcare facilities immunization points, safety measures, Russian materials schedule, and vaccination practical training, and risk management programs Social and Teachers of Information about Labor and occupational Kyrgyz, Press releases, education sector preschool immunization points, safety measures, Russian informational printing workers institutions, schedule, and vaccination practical training, and materials secondary schools, risk management specialized programs educational and higher educational institutions Special groups Employees of the Information about Labor and occupational Kyrgyz, Training, information (Ministry of Border Service, immunization points, safety measures, Russian materials, brochures, Emergencies, Ministry of schedule, and vaccination; practical training, and posters airport, Ministry Emergencies, airport, Regular update on risk management of Internal Ministry of Internal vaccination related news programs Affairs, Customs, Affairs, Customs and arrangements with Border Service,) Service tailored information 3 Environmental and Social Management Plan 4 Infection Control and Medical Waste Management Plan 14 Stakeholder Key characteristics Expectations Specific Engagement method group communication needs Language (e-mail, needs phone, radio, letter) Population over Population over 60 informing the about the hand hygiene and PPEs, Kyrgyz, Press releases, age of 60 years of age purpose of vaccination, safety measures, Russian posters identified as a risk ability of vaccines to physical distancing, Advertisement on group since age protect and stop the mobile immunization targeted vaccination threshold was pandemic, algorithm, points groups, phases and determined based on contraindications, possible coverage number of country-specific risk post vaccination effects these groups criterion Population with Persons registered Informing the about the Hand hygiene and PPEs, Kyrgyz, Press releases, chronic diseases for chronic diseases purpose of vaccination, safety measures Russian Information posters in registered for and co-morbidity, ability of vaccines to physical distancing dispensary facilities continuous subject to a higher protect and stop the medical follow- risk of severe disease pandemic, algorithm, up (with or death, incl. contraindications, possible dispensary) oncological and post vaccination effects cardiovascular diseases, diabetes mellitus, chronic lung diseases, kidney diseases and obese people. Other interested parties (Risks are moderate) MoES Emergency response Contributes funds from the Coordination of efforts Kyrgyz, Letters, meetings, e- functions WB-funded project on between line ministries Russian mails, VCs Enhancing Resilience in Kyrgyzstan Project (P162635) and serves as a PIU for the COVID-19 Project Ministry of Monitoring and Effective financial Reporting Kyrgyz, Letters, meetings, e- Finance Evaluation management Russian mails, Republican Tracking COVID-19 Leadership on taking Communication on Kyrgyz, Letters, meetings, e- Headquarters on situation national measures against ongoing activities Russian mails, COVID-19 COVID-19 Data exchange Mass media National, regional Press conferences, press Press conferences, Kyrgyz, e-mails, social media and local releases press releases Russian platforms, websites, newspapers, local posting press releases and national TVs on websites channels Social media Users of Facebook, Reliable information 24/7 communications, Kyrgyz, social media platforms users; Instagram etc., active sources, timely updates on timely and reliable Russian, platforms and groups, internet users real current situation with information source COVID.kg webpage, COVID-19 in the country, website and Facebook of MoHSD Implementing ARIS, MoHSD, MoES Timely awareness and Timely awareness and Kyrgyz, Letters, meetings, e- agencies for the PIU, ERIK PIU invitation for participation, invitation for Russian, mails, VCs, World Bank- joint action plan with their participation, joint participation in funded projects emergency response action plan with their multisectoral task working in the contributions emergency response force or coordination border regions contributions meetings 15 Stakeholder Key characteristics Expectations Specific Engagement method group communication needs Language (e-mail, needs phone, radio, letter) and health promotion Other national, Red Crescent Society, Frequent donor Frequent donor English Letters, e-mails, VCs, international WHO, GIZ, Global coordination meetings to coordination meetings list serves health Fund, Aga Khan avoid duplication, mapping to avoid duplication, organizations, Health Services, of donor activities, mapping of donor development UNICEF, UNDP, synergies between donor- activities, synergies donors & USAID, ADB funded investments between donor-funded partners investments Civil society Wide range of civil Transparency of the Covid- Access to internet and Kyrgyz, e-mail, website organizations society organizations 19 funding and invitations to press Russian postings, social and community- investments conferences media, media outlets based organizations Local Representatives of Awareness on ongoing Communication Kyrgyz, VCs/ WhatsApp Community Local administrations renovation works in through WhatsApp and Russian groups and zoom hospitals Zoom as necessary meetings Vulnerable and disadvantage groups (Risks are Substantial) Retired elderly Aged people of 65+, Economic and social Daytime Kyrgyz, Target family and people with unable to work, support from social communications, Russian medicine centers, disabilities physically and workers and ad-hoc accessibility target HOs mentally disables payments, home-based problems, social people staying family doctor consultations worker assistance Pregnant Reproductive age Frequent medical check- Daytime Kyrgyz, Target family women, parents women, babies of 0- ups by family doctors, communications, Russian medicine centers, of infants 18-month age, access to Target HOs and children; children with weak free hospital services immune system Women-headed Single mothers, Economic support to afford Daytime Kyrgyz, Target family households divorced, widows, the prevention and communications, child Russian medicine centers, and/or single abandoned wives treatment costs, access to care support Target HOs mothers with free hospital services underage children; Extended low The families have 6 Economic support to afford Daytime Kyrgyz, Target family income or more members, the prevention and communications Russian medicine centers, families; many of them are treatment costs, access to Target HOs underaged to work free hospital services Unemployed Laborers with Looking for jobs Large printouts about Kyrgyz, Ads of contracting professional skills or job announcements at Russian organizations unskilled workers civil works sites, 4.3 Proposed strategy for information disclosure The project will build synergies with other development donors and will use the information and educational materials produced by them during the outreach campaigns. Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the stakeholder engagement plan 16 and grievance mechanism. This will be important for the wider public, but equally and even more so for suspected and/or identified COVID-19 cases as well as their relatives. The following Communication Action Plan has been developed for the period of project implementation and will be periodically updated as necessary. Table 4. Communication Action Plan No. Activity Participants Activity description Terms 1. Posting press releases on news sites 1 Development and placement of PIU / Public Placement on news sites Once a month / quarter press releases on purchased Relations (PR) akipress.kg, kabar.kg, as needed medical equipment, medicines Service of the 24.kg, kaktus.media, and disinfectants MoHSD facebook, med.kg 2 Development and placement of a PIU / PR Service Placement on news sites Once a month / quarter press releases on the repair work of the MoHSD akipress.kg, kabar.kg, as needed in regional hospitals 24.kg, kaktus.media, facebook, med.kg 3 Development and placement of a PIU / PR Service Placement on news sites Once a month / quarter press releases about the of the MoHSD akipress.kg, kabar.kg, as needed rehabilitation of medical points at 24.kg, kaktus.media, the PoEs and temporary PoEs facebook, med.kg 2. Information materials 4 Preparation of video materials on PIU Placement on news sites Once a month / quarter equipping healthcare akipress.kg, kabar.kg, as needed organizations with medical 24.kg, kaktus.media, equipment facebook, med.kg 5 Preparation of informational PIU Placement on news sites Once a month / quarter video material about ongoing akipress.kg, kabar.kg, as needed repair work in hospitals 24.kg, kaktus.media, facebook, med.kg 6 Updating Grievance mechanism PIU / PR Service Placement at stands HO, Once during the repair (GM) poster for hospitals and of the MoHSD distribution via work local communities WhatsApp 7 Production of the GM poster for PIU Placement at the site of As needed the PoEs installation of the PoEs 8 Development of press releases on MoHSD Press Postings at the news Regularly: during the vaccination: goals of vaccination, service, PIU agencies’ websites preparation phase of the points of vaccinations, adverse campaign and until the events following vaccinations end of the vaccination 9 Development of poster on RCHPMC/PIU Dissemination in Before vaccination vaccination benefits and phases vaccination points, launch for vaccination sites (A2) public places, airports, shopping markets Electronic version- web sites, social media, facebook, telegram ect. 17 10 Development and printing flyers RCHPMC/PIU Dissemination in Before vaccination on post vaccination vaccination points, program launch recommendations public places, airports, shopping markets Electronic version- web sites, social media, facebook, telegram ect. 3. Meetings, Roundtables 11 Conducting meetings with the PIU, HOs, Discussion of Labor Once a month with each HOs and Contractors, where Contractors, local Management hospital and contractor repairs are planned community Procedures, Code of involved Conduct, GM, reporting on the scope of renovation work in hospitals 12 Press conference for journalists MoHSD / HOs Communicating the As needed progress of the COVID- 19 response in news agencies with the participation of journalists and stakeholders 4. Web-based COVID-19 Community Engagement Platform5 14 Establishment and launch of the RCHPMC Disseminating online Starting from May 2021 web-based community information and engagement platform receiving feedback from communities on project Regular postings and online activities, particularly discussions via web based COVID- vaccination 19 community engagement platform for interaction with civil society and citizens 4.4 Proposed strategy for consultations Due to the spread of COVID-19 and emergency, face-to-face interactions (required under regular situation) are not possible. So, methods will have to be unique and such as to ensure that stakeholder engagement itself should not be a cause for the spread of virus. The following methods will be used during the project implementation to consult with key stakeholder groups, considering the needs of the final beneficiaries, and in particular vulnerable groups. Proposed methods vary according to target audience. Table 5. Stakeholder consultation methods proposed during implementation stage Consultatio Topic of consultation Method Timeframes Target stakeholders Responsibili n level ties Regional ICMWMPs and ESMPs Phones/emails, Before, during HO leadership and PIU implementation WhatsApp and after civil health workers, meetings, zoom, works Contractors site visits implementation 5 This will be new, a digital platform, for reaching out to the stakeholders. 18 Regional GM operations status Phone calls, quarterly Regional focal points PIU level reporting and hospital managers, MoHSD, MHIF Nationwide Media coverage of Distribution of regularly Public at large, MoHSD, PIU project activities press releases traditional journalists, social media platforms Regional Rehabilitation Information During Communities Target HOs level works at board near the renovation nearby the civil medical sites, WhatsApp works works site facilities messages Regional/ho Implementation of Online meetings Before starting Contracting PIU spital level LMP renovation organizations works Regional, Information about Web based Before and Communities covered RCHPMC/ national vaccination points, COVID-19 online during and post by vaccination as per PIU benefits, schedule platform vaccination vaccination schedule Local Information about Advertisement Before and Communities covered Republican vaccination points, at the during and post by vaccination as per Center for benefits, schedule vaccination vaccination vaccination schedule Immuno- points prophylaxis Nationwide Raising public Informational Before and HO workers, social and PIU, Press awareness on priority materials: during education sector service of target groups to be posters, flyers, vaccination workers, people with MoHSD vaccinated at the first and press chronic disease, batch releases people over 60+, special group (Ministry of Emergencies, airport, Ministry of Internal Affairs, Customs, Border Service, etc.) 5. Resources and Responsibilities for implementing stakeholder engagement activities 5.1. Resources The MoHSD will be the implementing agency for the Project. An existing Project Implementation Unit (PIU) in the MoES will provide implementation and project management support, including environmental and social risk management, procurement and financial management to the MoHSD. Accordingly, SEP updating, and implementation are partly funded from the Project Management budget with additional funds on communication purposes under Sub-Component 1.3 – Vaccine Purchasing and Deployment of the project which has a total budget of US$19.50 million from AF funding. 5.2. Management functions and responsibilities The Republican Headquarters for the Prevention of the Spread of COVID-19, led by the Prime Minister of the Kyrgyz Republic, play a steering role in the national response overall and for the 19 project interventions specifically. The Headquarters include representatives from all ministries and state agencies, such as the MoHSD, MoES, Ministry of Finance, and Ministry of Foreign Affairs. The MoHSD has also established its own COVID-19 Headquarters and a 24/7 Secretariat. The MoHSD taskforce is represented by the Public Health Department of MoHSD, Department of Health Care Delivery and Drug Policy, Department of Disease Prevention and State Sanitary Epidemiological Surveillance, Republican Center for Quarantine and Especially Dangerous Infections, Department of Drug Supplies and Medical Equipment, and the RCHPMC. The MoHSD is responsible for the coordination and implementation of COVID-19 activities. The MoHSD Department of Disease Prevention and State Sanitary Epidemiological Surveillance will be responsible for the day-to-day management and coordination of activities supported under the Project. In addition, other technical divisions at the MoHSD, research institutes, national medical services, regional and local health authorities, village health communities, and other key agencies will be involved in project activities based on their functional capacities and institutional mandates. An existing Project Implementation Unit (PIU) in the MoES provides implementation and project management support, including procurement and financial management, to the MoHSD. It has extensive experience with World Bank procedures and is currently implementing Enhancing Resilience in Kyrgyz Republic (P162635) and Central Asia Hydromet Modernization Project (P120788), including additional financing projects financed by the Bank. The PIU will directly implement certain technical activities, including procurement of medical supplies, equipment, and renovation works. The PIU also oversees preparing a consolidated annual workplan and a consolidated activity and financial report for the project components. The PIU will work closely with the MoHSD, which will provide the necessary documentation, including technical specifications for procurement. The PIU will also be supported by the MHIF in channeling funds and preparing respective financial reporting on the use of the funds under Component 1 for health care system preparedness activities at health care facility level As the PIU had limited capacity to administer proper implementation of the environmental and social framework elements, it has also deployed the staff needed for the meet the new ESF standards requirements, including Environmental Specialist, Social Development and Communications Specialist, and Infection Control and Medical Waste Management Consultant. The PIU jointly with MoHSD and RCHPMC will be responsible for carrying out stakeholder engagement activities, while working closely together with other entities, such as local government units, media outlets, health workers, etc. The stakeholder engagement activities will be documented through quarterly progress reports, to be shared with the World Bank. 6. 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 20 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 project activities; • 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. The GM is accessible to a broad range of project stakeholders who are likely to be affected directly or indirectly by the project. These include beneficiaries, community members, project implementers/contractors, civil society, media. Each of them can refer their grievances and feedback to the GM. What types of grievance/feedback will this GM address? The GM can be used to submit complaints, feedback, queries, suggestions, or compliments related to the overall management and implementation of the project activities, including: • Violation of project policies, guidelines, or procedures, including those related to procurement, labor procedures, child labor, health and safety of community/ contract workers and gender violence; • Disputes relating to resource use restrictions that may arise between or among targeted districts and communities; • Grievances that may arise from members of communities who are dissatisfied with the project planning measures, or actual implementation of project investments; • Concerns and grievances related to the sexual exploitation and abuse, sexual harassment as a result of the project activities; and • Concerns arising from unintended health consequences after vaccination especially those resulting in serious adverse effects. 6.1. Description of the GM The MoHSD, MHIF and RCHPMC continue to use the existing institutional GM to address all citizen complaints and requests. 6 This has proved to be quite good under the Parent Project (details are in Annex 2). The system and requirements (including staffing) for the grievance redress chain of action – from registration, sorting and processing, and acknowledgement and follow�up, to verification and action, and finally feedback – are incorporated embodied in this GM. In emergency situations, to encourage proactive beneficiary engagement, the outreach messages and information are communicated through mass media, social media and city/district 6 The MoHSD has a wide range of health institutions at the national, regional, district and rural levels. Each health institution manager is responsible to receive and handle at his respective level and if not resolved, the complaint can be escalated to the upper level or directly to the MoHSD or MHIF. Considering that the public health service are state insured, MHIF being the single payer in the state-run health system, MHIF monitors quality of medical services and manages the grievances. The existing complaint mechanisms will be utilized by the project to accept and solicit feedback to promote the citizen right on access to information and feedback. More details could be found in Annex 1. 21 information boards and websites to reach people at large. As a part of the outreach campaigns, MoHSD and its affiliated RCHPMC will make sure that the relevant staff are fully trained and has relevant information and expertise to provide phone consultations and receive feedback at the COVID-19 Information Center established recently. The project utilizes this system (hotline, online, written and phone complaints channels) to ensure all project�related information is disseminated and complaints and responses are disaggregated and reported. According to the Law “On Guarantees and Free Access to Information� (amended 28 December 2006), each state agency is obliged to provide relevant information to citizens and NGOs within a period of two weeks. This is now widely used by citizens and NGOs, and they regularly channel their voices to the MoHSD, the MHIF, and the RCHPMC through their websites www.med.kg andhttp://www.ds.kg/ http://www.ds.kg/. Any citizen can get information regarding COVID-19 prevention measures, testing possibilities and treatment referrals, as well as freely file a complaint through below described channels. All grievances and appeals received from citizens are delivered to the corporate system for further processing and follow-up. Channels for submitting grievances with the MHIF 1. National hotline: 113 (free of charge call); 2. Web-site address: www.forms.kg. 3. Verbal or written grievance received during working meetings/personal appointments; 4. Incoming correspondence via courier to MHIF; 5. Incoming correspondence by e-mail: mail@foms.kg 6. Contact # of MHIF public reception: +996 (312) 663551 7. MHIF address: 122 Chui Street, Bishkek, Kyrgyz Republic Regional branches of MHIF: 1. Bishkek City: 42 Mederova Street, Bishkek, tel (0312) 548737, 543231 2. Chiy Oblast: 43 Razzakova Street, Bishkek, tel. (0312) 665362, 666273 3. Osh Oblast: 53 Shkolnaya Street, Osh, tel. (03222) 56732, 56696 4. Jalalabad Oblast: 15 Lenin St., Jalalabad city, tel. (03722) 20244, 21774 5. Talas Oblast: 166 Berdike B St., Talas city, tel. (03422) 56026, 56875 6. Batken Oblast: 14 Khojaeva St., Batken city, tel. (03622) 50640, 50178 7. Issyk-kul Oblast: 21 1 Maya St., Karakol city, tel. (03922) 52055, 56727 8. Naryn Oblast: 49 Sheralieva St., Naryn city, tel. (03522) 50387, 55686 6.2 GM Structure for Contracted Workers All contracted workers will be offered a Worker GM whereby they can report issues of concern. At the time of recruitment, all employees will be made aware of this mechanism, as well as the protective measures against any retaliation that may be applied against persons applying to the mechanism. To make the grievance mechanism available to all project workers, the necessary 22 measures will be taken to meet the requirements of the EES2 standard. The project -based GM includes channels for the contracted workers to voice their concerns and to protect the workers against their employers. There are several options for the workers to file their complaints allowing anonymous grievances: 1) Contractor's grievance resolution representative at the civil works site; 2) Grievance Focal Point at the Technical Supervision Consultant Office located in the region; 3) Workers can also contact the /PIU GM Focal Point under the MoES; 4) At any time, the workers can contact the MHIF Coordinator (serving as manager of civil works under Component 1) directly. 6.3 GM for medical workers and communities The participating health care facilities to be supported under Component 1 will use the existing local GM at the facility level. The Head of the HO will be responsible to arrange registration and to resolve complaints within 14 days upon the receipt of OHS related complaints from patients and health workers, and report on regular basis to the PIU on GM implementation. The GM Focal point will be assigned to file complaints and communicate the status of complaint resolution. Workers of the health organizations engaged in the project activities and surrounding communities should contact the management of their health organization. Ministry level. If the issue cannot be resolved at the management level of the local target health facility within 14 business days, contractors should refer the issue to the MoHSD. Channels for accessing COVID-19 information and submitting grievances with the MoHSD 1. Central hotlines: 0312660663 (MoHSD), 0312323202, 0312323055, 0550033607 (State Sanitary and Epidemiological Surveillance); 2. Helpline: 0312 621023 3. Regional hotlines: 0322270755 (Osh Health Dept), 03123318767 (Bishkek Health Dept.) 4. WhatsApp: 0770895556; 5. Web-site address: www.med.kg. 6. Verbal or written grievance received during working meetings/personal appointments; 7. Incoming correspondence via courier to MoHSD general department; 8. Incoming correspondence by e-mail: mz@med.kg 9. Contact # of MoHSD public reception: +996 (312) 621023 10.MoHSD address: 148 Moskovskay St., Bishkek, Kyrgyz Republic 6.4 GM for Direct Workers Direct workers can file their complaints with the PIU. The Communications and Social Development Specialist will act as a Grievance Coordinator (GC) and keep a record of complaints and appeals. A Grievance Redress Group is established to deal with complaints on an ongoing basis. The commission is approved by the order of the PIU director. If the problem cannot be 23 resolved at the PIU level within 14 working days, the problem will be referred to the ministerial level (MoES). Contact person at PIU level/MoES Contact details Yuldasheva Maksatai Tel.00996555482003 Email: maksatai.yuldasheva@gmail.com 6.5 Receiving Grievances The grievance mechanism shall also receive, register and address concerns arising from unintended health consequences after vaccination especially those resulting in serious adverse effects. When receiving a grievance, the following points are determined: • Type of grievance; • Category of the grievance; • Persons responsible for review and execution of the grievance; • Deadline for grievance resolving; • Agreed actions. After the type of action is determined, the hotline operator registers details regarding the actions in the incoming correspondence journal. The complainant will receive a notification by phone on the following: • Full name of the executor (head of the department) to whom the grievance was forwarded; • Redressal will be made within a maximum of 7 working days; • The deadline and actions are determined in accordance with the MoHSD instructions for handling the grievances. Hotline of the Ministry of Emergency Situations Citizens from all over the country can dial the national hotline of the MoES requesting for an emergency assistance. Hotline number: 112 (free of charge call). All complaints received will be passed on to the MoHSD for redressal. Complaints can be also submitted to the MoES PIU by phone 0312 431110, and email: covid.mes.kg@gmail.com Grievance Filing Complaints are registered by the PIU Communications and Social Development Specialist or respective GM focal point in the GM registration log, and are accepted for consideration provided that the following data are indicated: • Full Name; 24 • registration and residence address or phone number; • content of the appeal; • other reference information. If necessary, documents are attached to them confirming the arguments of the citizen. If appeals / complaints are received in the absence of any of the above data (anonymously), they are also recorded in the GM registration log and measures are taken to eliminate the complaint, if they are related to the project. In such cases, no responses to complaints are provided. In accordance with World Bank ESS’s, the GM channels accept anonymous complaints. The PIU registers the complaint in the GM registration log, assigns an incoming number. The PIU Grievance Redress Group represented by the Environmental Specialist, Social Development Specialist and other relevant staff is responsible for reviewing the complaint and resolving it. A complaint is considered resolved if it has been examined in response to the questions raised in it, the necessary measures are taken and the applicant is given answers through the channel through which the complaint was submitted and within the time frame stated below. The response to the collective appeal is sent to the address of the citizen indicated in the appeal first, unless otherwise specified in the text. In cases of electronic appeal, citizens in their appeal indicate the name of the PIU, their last name, first name, patronymic, contact phone number (home, mobile or work), address of residence, and state the essence of the appeal. In cases where, in order to resolve a citizen's complaint, it is necessary to conduct a study, verification, request additional materials, or take other measures, the deadlines for resolving complaints, as an exception, may be extended, but not more than 30 calendar days. The decision on this is taken by the director of the PIU and communicated to the applicant in writing (electronic). Based on the results of consideration of the appeal, the PIU makes a decision to take measures to resolve the issues raised and eliminate the identified violations. The GM focal point will assist the complainant at all stages of the proceedings and ensure that the complaint is dealt with properly. The project will have to put additional measures in place to handle sensitive and confidential complaints, including those related to Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) in line with the World Bank ESF Good Practice Note on SEA/SH. At this end, the GM will integrate SEA/SH-sensitive measures, such as confidential reporting with safe and ethical documenting of SEA/SH cases. The SEA/SH-specific measures include a green line for confidential calls, indication of specific cases for differential treatment and confidentiality and referral of survivors to gender-based violence service providers. The grievance mechanism shall also receive, register, and address concerns arising from unintended health consequences after vaccination especially those resulting in serious adverse effects. 25 7. World Bank Grievance Redress System Communities and individuals who believe that they are adversely affected by a project supported by the World Bank may also complaints directly to the Bank through the Bank’s Grievance Redress Service (GRS) (http://projects-beta.worldbank.org/en/projects-operations/products- and-services/grievance-redress-service). A complaint may be submitted in English, Kyrgyz or Russian, although additional processing time will be needed for complaints that are not in English. A complaint can be submitted to the Bank GRS through the following channels: • By email: grievances@worldbank.org • By fax: +1.202.614.7313 • By mail: The World Bank, Grievance Redress Service, MSN MC10-1018, 1818 H Street Northwest, Washington, DC 20433, USA • Through the World Bank Country Office in Bishkek: 210 Moskovskaya Street, Bishkek, Kyrgyz Republic, bishkek@worldbank.org , Tel. +996 312 625262 The complaint must clearly state the adverse impact(s) allegedly caused or likely to be caused by the Bank-supported project. This should be supported by available documentation and correspondence to the extent possible. The complainant may also indicate the desired outcome of the complaint. Finally, the complaint should identify the complainant(s) or assigned representative/s and provide contact details. Complaints submitted via the GRS are promptly reviewed to allow quick attention to project-related concerns. In addition, project-affected communities and individuals may submit complaints to the World Bank’s independent Inspection Panel, which will then determine whether harm occurred, or could occur, as a result of the World Bank’s non-compliance with its policies and procedures. Complaints may be submitted to the Inspection Panel at any time after concerns have been brought directly to the World Bank’s attention, and after Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org. 8. Monitoring and Reporting The SEP will be periodically revised and updated when needed 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. Quarterly 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 quarterly 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 26 engagement activities undertaken by the Project during the year may be conveyed to the stakeholders through publication of annual report on project’s interaction with the stakeholders. 27 Annex 1. Existing Grievance Mechanisms of the Ministry of Health and Social Development and Mandatory Health Insurance Fund of Kyrgyz Republic According to the Law “On Guarantees and Free Access to Information� (amended 28 December 2006), each state agency is obliged to provide relevant information to citizens and NGOs within a period of two weeks. This right is now widely used by NGOs and they regularly submit enquiries to the MoHSD, the MHIF, the Department of State Sanitary-Epidemiological Surveillance and the Department of Drug Provision and Medical Equipment. Information about patient rights in the health sector is accessible on the web sites of the MoHSD, www.med.kg and the MHIF, www.foms.kg . Moreover, the MHIF has carried out public awareness campaigns, including the dissemination of information leaflets, the publication of articles in newspapers and broadcasts on national television and radio. Telephone hotlines are available at the central MHIF agency and all its regional departments. Any citizen can get information regarding health services and patient rights through these hotlines. Complaint procedures. Although a wide range of patient rights are included in the Health Protection Law, some of them are not implemented. Many of the problems with implementation stem from the underfinancing of the health sector, resulting in patients failing to receive the full range of services to which they are entitled by law. There are several mechanisms for patients or the population in general to provide feedback in the health sector, including: • writing letters of complaint to the MoHSD and subordinated agencies; • attending regularly available personal appointments with the Minister of Health or his/her deputies, the heads of departments of the MoHSD and the heads of subordinated agencies; • airing complaints in the mass media in special sections or at particular times (such as “questions and answers�, hotlines, or “you ask – we answer�); and • using “trust� phones. In situations where patient rights are violated, patients can address their complaints to the manager or other senior staff of the health facility where they received health services, to the appropriate professional association or to a civil court. All complaints are registered and, in some cases, further investigated by a specially established commission. Following the work of the commission, the manager of the respective health facility is informed about the outcome of the investigation. Where infringements of patient rights have been established, the manager of the health facility imposes a legally defined penalty on the member of staff who has violated patient rights. If the commission concludes that the treatment was of poor quality, the regional department of the MHIF imposes penalties on the respective health facility, according to the Law “On Health Insurance of the Citizens of the Kyrgyz Republic� (1999), which regulates the management and quality assurance of medical services. Where irregularities in the use of earmarked health care funds are found in the regular check-ups of health facilities by the regional departments of the MHIF, the case is handed over to the MoHSD. 28 The response will be provided within 14 working days, during which meetings and discussions will be held with the aggrieved person. If the problem cannot be resolved within 14 working days, the complaint is to be considered at the next level. The complainant is to notified of the fact that their complaint is transferred to the next instance and that redress will take 30 working days. If the complainant is not satisfied or if response to the complaint was not provided within 30 working days, the complainant has the right to send the case for a trial to the local court. The MHIF bears the primary responsibility for protecting patient rights to health care. It has a central unit as well as regional (oblast) units whose main function is to work directly with patients for the protection of their rights. Specifically, each regional unit has the following tasks: • to operate a hotline; • to investigate complaints and ensure corrective measures are taken; • to conduct information and awareness campaigns on patient rights; • to work with civil society organizations on issues related to patient rights, particularly in the area of HIV/AIDS7; • to liaise with the broader quality assurance system; and • to carry out regular patient satisfaction surveys. A telephone hotline number is prominently displayed in all health facilities. In addition, it is regularly advertised in local newspapers and sometimes distributed directly to the population as part of a calendar or other promotional items. The purpose of the hotline is to receive calls from patients concerning under-the-table payments, negligence, low quality of services and refusal of service on discriminatory grounds, such as having certain diseases or inability to pay. When a call is received, a unit specialist registers the call in a database for further action, such as a visit to the facility in question by the unit’s staff. If the enquiry by the unit shows that the complaint is justified, the MHIF formally requests the facility to take specific corrective actions within a certain time period. The case is open until the MHIF confirms that the required actions have been taken. Failure to follow MHIF’s initial recommendations leads to further interventions by the MHIF. The hotline number is free, but lack of telephone lines in some rural areas still limits access to it. The central unit receives approximately 8–10 calls per day and has eight full-time staff to provide follow-up. At the oblast level, approximately three or four calls are received each day and each unit has three or four members of staff. Majority of calls to the hotlines are queries, for complaints the PAPs mostly use written channels and/or social media. In addition to responding to specific complaints, experts from each regional unit visit randomly selected facilities to check the quality of health services, review the volume and use of formal co- payments and observe the patient–health worker interaction to ensure that patients are treated with respect. Violations of approved clinical protocols and patient rights are recorded and followed by a formal letter to the facility manager, who is required to respond in a given time frame providing evidence of corrective measures that have been taken. These random checks are carried out on a quarterly basis. 7 Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome 29 30 Annex 2. Stakeholder Engagement Activities Held During Parent Project Implementation The Stakeholder Engagement Plan was updated and approved by the World Bank on December 17, 2020. The SEP is disclosed at the websites of the Ministry of Health and Social Development, and the Ministry of Emergency Situations. Below are the disclosure links: http://med.kg/ru/dokumenty/obshchestvennoe-obsuzhdenie-npa/3640-plan-vzaimodejstviya-s- zaintresovannymi-storonami-v-sootvetstvii-ekologicheskimi-i-sotsialnymi-standartami-ess10- vsemirnogo-banka-2.html http://ru.mes.kg/2020/12/21/plan-vzaimodejstviya-s-zainteresovannymi-storonami/ As part of the Stakeholder Engagement Plan, the following methods were used to disclose information, as well as consult and implement the E&S instruments and GM: - meetings (online and offline) with healthcare organizations, contractors, as well as a technical supervision consultant; - printed materials developed (GM poster); - distribution of press releases on rehabilitated and equipped hospitals; - daily communication via telephone and e-mails with public health facilities and contractors on the implementation of the E&S instruments, GM. A Communication Action Plan has been developed and being implemented. Three press releases and videos on the projects "ERIK CERC" and "COVID -19" about the project's assistance to healthcare organizations have been developed and widely disseminated through news agency sites. Some links are below: − https://www.vb.kg/doc/396376_regiony_kyrgyzstana_polychili_pomosh_dlia_borby_s_covid_1 9.html − https://vesti.kg/obshchestvo/item/81074-regiony-kyrgyzstana-poluchili-pomoshch-dlya-borby- s-koronavirusom.html − https://vesti.kg/obshchestvo/item/81079-bolnitsy-kyrgyzstana-osnashcheny-apparatami- iskusstvennoj-ventilyatsii-ljogkikh.html − https://for.kg/news-685763-ru.html − https://www.vb.kg/doc/396387_bolnicy_kr_osnasheny_apparatami_iskysstvennoy_ventiliacii_l egkih_ivl.html − http://kabar.kg/news/regiony-kyrgyzstana-poluchili-pomoshch-dlia-bor-by-s-covid-19/ − https://24.kg/obschestvo/181023_vkarabalte_prodoljaetsya_remont_infektsionnogo_otdeleniy a_jayyilskoy_bolnitsyi/ − https://www.vb.kg/doc/397544_infekcionnye_otdeleniia_9_ti_bolnic_kr_remontiryut_v_ekstre nnom_poriadke.html − https://manas.news/obschestvo/78-mln-somov-vydeleno-na-remont-infekcionnyh-otdelenij/ Consultations on the ESMF 31 Wide public consultations were held in target sites and through online platforms to consult on the potential environmental and social risks/impacts and mitigation measures to address them: − The first round of the virtual public consultations on ESMF was held on September 2, 2020 with participation of representatives from 7 hospitals. The draft ESMF was also posted on the website of the Ministry of Emergency Situations for online public inputs and recommendations. During October 2020, the Project conducted face-to-face meetings with the territorial hospitals of Zhayil, Tokmok, Kochkor, Osh and Uzgen and conducted 2 online ZOOM meetings with the territorial hospitals of Leilek and Tash-Komur. Based on inputs and recommendations received, in November 2020 the ESMF was amended and adapted by including a new format of ICMWMP and requirement to conduct training on ICMWMP for HOs. − The second round of public consultations on the updapted version of ESMF was held with the target hospitals during the period of November 18 – December 16, 2020. The Project conducted two face-to-face meetings at the National Hospital and National Maternal and Child Healthcare in Bishkek and 7 virtual meetings with Osh interregional clinical hospital, Uzgen, Leilek, Tash Komur, Kochkor, Tokmok territorial hospitals and Joint territorial hospital of Zhaiyl district. The draft ESMF was forwarded to the management of the target hospitals a week prior the anticipated consultations for review and comments. − The main topics discussed were: Project objectives, planning of activities, expected environmental and social impacts and proposed mitigation measures, and a grievance mechanism for community members; description of the project and its components; potential project planning activities, national environmental and social legislation and relevant WB ESS requirements, identified social and environmental impacts and mitigation measures, safeguards documents to be developed under the Emergency COVID-19 project for each project site under the project; GRM. The discussions were attended by the management of hospitals, persons responsible for working with the PIU, infectious disease specialists of hospitals, financial officers or accountants. During the discussion, representatives of the hospitals underlined to the necessity to repair of the ACM roofing and repairing the street sewer system, which is beyond the scope of the project activities. They also expressed concern about the repairs during winter season. The heads of the Uzgen and Tokmok hospitals noted that some of the facilities could not be included in the list for repairs, as they are considered in emergency conditions. The PIU advised heads of hospitals to take the necessary safety measures (dismantling or temporary fixing of such structures, arrangement of fences of hazardous areas, etc.). According to the BUILDING STANDARDS “ASSESSMENT OF SEISMIC RESISTANCE OF EXISTING BUILDINGS� OF THE KYRGYZ REPUBLIC dated 01.03.2019, it is recommended not to conduct repair works in emergency facilities. − The ESMF was supported by the stakeholders in general. It was decided that the issues raised during the meeting would be considered by the project. Stakeholders emphasized the importance of this document for the implementation of repair works in the target hospitals. Participants raised issues regarding timely delivery of medical equipment, availability of PPEs and etc. Also the participants raised questions related to the high standard requirements stated in the ESMF. It was noted that ESMF provides for the implementation of practical measures that do not contradict the legislation of Kyrgyzstan on the environment. − Besides, the ESMF was published on the website of the Tokmok City and the links were disseminated through local WhatsApp groups and Telegram channels in Uzgen, Kara- Balta, 32 Tokmok, Tash Komur towns and Kochkor villiage. The total number of participants in the virtual groups is 4 980. ESMF received 2278 reviews from the websites of the Ministry of Health (1970) and Ministry of Emergency (308). − Total number of participants of face to face meetings during second round of public consultations was 61, including 14 females. PIU face a problem related to determining gender of the website reviewers and virtual groups members (WhatsApp and Telegram). However, according the names and photo of virtual group participants, we determined 609 females among 4980. − The final Environmental and Social Framework (ESMF) was published on the MoHSD and MoES websites on March 19, 2021: www.med.kg and www.mes.kg. To consult on the site-specific ESMPs and ICMWMPs, meetings were organized in the following hospitals: National Hospital under the Ministry of Health of the Kyrgyz Republic, National Center for Maternal and Child Health (NCMCH) on December 28-29, 2020; Joint Territorial Hospital of Zhayil District on October 6, 2020; Tokmok Territorial Hospital on October 8, 2020. For the remaining 5 hospitals, consultations were carried out online. The participants were the heads and employees of hospitals (including those for infection control), heads of contractors and technical supervision consultants. The summary of the ESMPs were also circulated through local Whats App groups: Kochkor reclama, Leilegime zhardam, Mikrashka yntymagy, Ozgon jaryya. The site-specific ESMPs and ICMWMPs are disclosed at the local and national levels. Draft ESMPs developed for 9 target hospitals have been discussed with target health facilities and approved by the World Bank. The approved ESMPs were posted on the website of the Ministry of Health on November 6, 2020: http://med.kg/ru/dokumenty/obshchestvennoe-obsuzhdenie-npa/3370-v-ramkakh-proekta- ekstrennoe-reagirovanie-na-covid-19-finansiruemogo-vsemirnym-bankom-planiruetsya-provedenie- tekushchikh-remontnykh-rabot-v-infektsionnykh-otdeleniyakh-sleduyushchikh-bolnits.html Stakeholder engagement approaches are defined based Consultations on LMP, ESMPs Public discussions with contractors were held at the following project sites in order to disclose information, as well as on the implementation of ESMP, LMP, including GM and the Code of Conduct for the Contractor's personnel. During the meeting, the provisions of the ESMPs and the LMP (Labor Management Procedures) were presented, in particular the Code of Conduct to be signed, GM for workers in place, health and safety conditions to be secured, etc. 1) Leilek territorial hospital, KUBA LLC and technical supervision consultant on Nov 18, 2020 (virtual meeting). 2) Uzgen Territorial Hospital, Investkurulush LLC, Technical Supervision Consultant on Dec 15, 2020 (virtual meeting). 3) National Centre for Maternal and Child Health (NCMCH), “Construction Firm Sirius� LLC, Technical Supervision Consultant on Jan 13, 2021 (face-to-face meeting). 4) Tokmok Territorial Hospital, "Beine-Stroy" LLC, Technical Supervision Consultant, on Jan 18, 2021 (face-to-face meeting). 5) Joint Territorial Hospital of Zhayil District, "Amal NT" LLC, “Stream group� LLC Technical Supervision Consultant, on Jan 19, (face-to-face meeting) 6) Osh Interregional United Clinical Hospital, "Baya-Zhan" LLC, on Jan 20, 2021 (in real time, in the office of the PIU). 33 7) Tash-Kumyr Territorial Hospital, "Imaratkurulush" LLC, Technical Supervision Consultant, on Jan 21, 2021 (virtual meeting). 8) National Hospital under the Ministry of Health of the Kyrgyz Republic, Alym Stroy LLC, Yug-Stroy LLC, Dastan Stroy LLC, GTS Corp LLC, Technical Supervision Consultant on Jan 25, 2021. 9) National center for mother and child protection, Azhy Stroy LLC, Technical Supervision Consultant, on Feb 2, 2021. 10) “Story master plus�, contracting organization foe Tash Komur territorial hospital LLC on March 25, 2021 (face-to-face meeting) The Grievance Mechanism has been developed as a part of the SEP. The mechanism description is posted at the website of the Ministry of Health: http://med.kg/images/MyFiles/spravka/MRJ_2020_COVID- 19.pdf. A GM poster was developed and handed over to eight project sites (HO) for placement at the repair site. In addition, information on ongoing repairs, including GM, has been posted for disclosure purposes: − website of the Mayor's office of the city of Kara-Balta, Facebook page of the Mayor's office of the city of Kara-Balta; − Tokmok Mayor's office website, the newspaper “My city-Tokmok�; − official Facebook page of the Osh Mayor's office; − Distribution list of the local WhatsApp groups "Leilegime jardam", "ZOOM group of the Mayor's office", "Mikrashka yntymagy". The grievance mechanism was presented during consultations (online meeting). The GM focal points at the hospitals have been approved by order of the Hospital Directors. A grievance redress mechanism at the contractor level has been developed by each contracting organization. A person in charge was appointed to deal with complaints from the contractor workers, as well as from the public by the internal Order of the contracting organization. The Contractor's Personnel also signed Code of Conduct. Due to the COVID-19 pandemic, field visits are limited. Therefore, the WhatsApp channel is widely used to inform the local community. Thus, the local community was informed about the ongoing repair works and GM through messages posted in What’s App groups, websites of the Mayors offices, facebook pages. In addition, the GM database is being maintained by the PIU. As of Dec 31, 2020, 6 complaints have been received mainly related to the procurement process. The first letter was received from “Kloop Media" requesting to provide information on the allocated funds, purchase of medical equipment, PPEs and other goods through the World Bank project. The other two complaints were related to procurement process from “ABM auto� LLC and 3 appeals were about suspension of the contract from “DT technic� LLC. A letter of request from “Kloop Media� dated 10.23.2021 and 2 appeals from “DT Technic� LLC dated 09.29.2021 and 10.23.2021 are registered in the General Department of the Ministry of Health and Social Development. The remaining letters were received directly by the PIU under MoES. All the complaints have been resolved. Based on the received complaints/requests, the GM database is regularly shared with the World Bank. 34