Contingency Emergency Response Component (CERC) ENVIRONMENTAL AND SOCIAL MANAGEMENT FRAMEWORK Yemen Emergency Health and Nutrition Project P 161809, IDA Grant Number D 164 P 163741, IDA Grant Number D 195 P 164466, IDA Grant Number D 232 P 167195, IDA Grant Number D 465 1 Contents ABBREVIATIONS AND ACRONYMS ................................................................................................................ 3 1. Introduction .......................................................................................................................................... 4 2. Support to the COVID-19 Crisis under the CERC ................................................................................. 5 3. Rationale for the CERC-ESMF ............................................................................................................... 6 4. Policy, Legal and Institutional Framework .......................................................................................... 6 a. National Legal Framework ................................................................................................................ 6 b. World Bank Safeguards Requirements ............................................................................................. 9 5. Environmental and Social Risks and Impacts of CERC and potential mitigation measures............... 9 6. Environmental and Social (E&S) Screening and Management Plan ................................................. 13 6.1 Screening Process for the Proposed Activities............................................................................ 13 6.1.1. Screening E&S Risks of Quarantine and Isolation Centers ..................................................... 13 6.1.2. Screening E&S Risks of Treatment Centers/Health Facilities ................................................. 14 6.1.3. Screening E&S Risks Relating to the Workplace ..................................................................... 14 6.2 COVID-19 Infection Control Risks Mitigation Measures ................................................................... 14 6.3 Mitigating and Responding to Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH) . 15 6.4 Other Contingency Risks and Emergency Response ......................................................................... 16 6.5 Preparation of Site Specific Environmental and Social Management Plan (ESMP) .......................... 16 7. Reporting and Monitoring Plan ......................................................................................................... 16 8. Third Party Monitoring (TPM)............................................................................................................ 18 9. Infection Control Risk Management Guidelines ............................................................................... 19 10. Institutional arrangement .............................................................................................................. 19 11. Public Consultation and Disclosure ............................................................................................... 19 12. Grievance Redressal Mechanism (GRM) ....................................................................................... 22 Annexes ....................................................................................................................................................... 24 Annex A: CERIP Workplan and Budget.................................................................................................... 26 Annex B: PPE NEEDS FOR DIFFERENT CADRES OF WORKERS ................................................................. 29 Annex C: CURRENT GAPS IN PPE ............................................................................................................. 31 Annex D: TRIAGE SOPS ............................................................................................................................ 33 Annex E: SOPs on IPC in PHCs ................................................................................................................. 42 Annex F: Comments received during consultation on the CERC-ESMF .................................................. 48 2 ABBREVIATIONS AND ACRONYMS ACU : Agricultural Cooperative Union CC : Call Centre CERC : Contingency Emergency Response Component CoC : Code of Conduct E&S : Environmental and Social EIAs : Environment Impact Assessments EHS : Environmental Health and Safety EPL : Environment Protection Law EPA : Environment Protection Authority ESMF : Environmental and Social Management Framework ESMP : Environment and Social Management Plan GBV : Gender based Violence GM : Grievance Mechanism GRM : Grievance Redress Mechanism HFs : Health Facilities IDA : International Development Association IPC : Infection Prevention and Control MWE : Ministry of Water and Environment NGOs : Non-governmental Organizations NWRA : National Water Resources Authority NWSSIP : National Water Sector Strategy and Investment Program OHS : Occupational Health and Safety OP/BP : Operation Policy/Best Practice PPE : Personal Protective Equipment SARI : Severe Acute Respiratory Infection SEA/SH : Sexual Exploitation and Abuse/Sexual Harassment TPM : Third Party Monitoring UNICEF : United Nations Children's Fund WASH : Water, Sanitation and Hygiene WB : World Bank WBG : World Bank Group WHO : World Health Organization WUAs : Water Unions and Associations WWTP : Waste Water Treatment Plant YEHNP : Yemen Emergency Health and Nutrition Project 3 1. Introduction In Yemen, the number of confirmed COVID-19 cases has grown since the first case was reported on April 10, 2020 in the governorate of Hadhramaut; as of July 14, 2020, 1,502 confirmed cases, including 425 deaths, have been reported. Data are hardly reported from the authorities in the Houthi-controlled North. There is a high reported case fatality partly because of the limited number of tests conducted – 7,399 as of July 11, 2020 for the population of 28 million. At the same time, donor funding for Water, Hygiene and Sanitation (WASH) activities are running dangerously low. Yemen’s WASH systems and services are almost completely reliant on humanitarian assistance; 20.1 million Yemenis will be directly impacted by reduced WASH services which are critical for survival and in preventing the spread of COVID-19. Although there are very significant gaps in knowledge of the scope and features of the COVID-19 pandemic, it is apparent that one main set of economic effects will derive from increased sickness and death among humans and the impact this will have on the potential output of the global economy. The already vulnerable health care system in Yemen is under great strain. Evidence of a decreasing trend in the use of health care services is emerging, with an estimated 25% reduction in general consultations between January to April 2020. The health seeking behaviors are negatively affected by fear because of the perceived poor safety in the health facilities, ill prepared workforce and stigma. There are reports of health facilities closing and turning away symptomatic patients. The health workforce lacks the required personal protective equipment (PPE) and the appropriate knowledge for action. The Yemeni health system is feared to be on a downward spiral and collapse from the multifaceted COVID-19 crisis. WASH services are essential for preventing diseases, but prevention is not only from the disease itself, but from secondary impacts such as loss of income, malnutrition, as well as compounding risks. Without adequate access to clean water and soap, COVID-19 transmission will be widespread, and the Yemenis’ vulnerability will be exacerbated. The conditions for the activation of the International Development Association (IDA) Contingency Emergency Response Component (CERC) and how they have been met are described below: ▪ Eligible Emergency. The Bank’s CERC guidance note, dated October 16, 2017 on how to establish, activate, and provide implementation support for Project-specific CERCs in IPF operations, states that CERC is eligible when there is an “official declaration of emergency or equivalent as agreed with the Bank (for example, a statement of facts from a designated authority of the Borrower or action by a third party).� On January 30, 2020, WHO declared that the outbreak of the novel coronavirus of 2019 (SARS-CoV-2) constituted a Public Health Emergency of International Concern . Then on March 11, 2020, the WHO declared a global pandemic as the coronavirus diseases (COVID-19) rapidly spread across the world. ▪ Approval of the CERC Operations Manual. The World Bank approved the CERC Operations Manual on July 15, 2020. ▪ CERC Activation Request by the Government. UNICEF sent a request for Bank’s assistance for COVID- 19 response on June 20 and July 15, 2020. 4 2. Support to the COVID-19 Crisis under the CERC The CERC activities for COVID-19 will complement the new COVID-19 Response Project approved on April 2, 2020 and implemented by the World Health Organization (WHO). Specifically, the CERC will: (a) support infection prevention and control (IPC) through the provision of WASH services and supplies to communities and isolation units; (b) provide case management supplies to save lives (e.g. PPE in isolation units, PCR test kits, oxygen supply); and (c) ensure the continuity of primary health and nutrition services by sensitizing and providing PPE for facility and community health workers and establishing triage at primary health facilities. Activities financed under the contingent component will be limited to the provision of critical goods and services, as well as repair or reconstruction of damaged infrastructure outlined in a positive list in the Emergency Operations Manual (Table 1). Land acquisition leading to involuntary resettlement and/or restrictions of access to resources and livelihoods is not anticipated. It is also unlikely that changes to the existing safeguards instruments of the project will be required. Table 1: Positive list of goods, services and works Item Goods • Medical equipment and supplies • Protective Personal equipment • Non-perishable foods, bottled water and containers • Tents for advanced medical posts, temporary housing, and classroom/daycare substitution • Equipment and supplies for temporary housing/living (gas stoves, utensils, tents, beds, sleeping bags, mattresses, blankets, hammocks, mosquito nets, kit of personal and family hygiene, etc.) and school • Gasoline and diesel (for air, land and sea transport) and engine lubricants • Spare parts, equipment and supplies for engines, transport, construction vehicles. • Vehicles (Vans, trucks and SUVs) – (only eligible for import reimbursement) • Equipment, tools, materials and supplies for search and rescue (including light motorboats and engines for transport and rescue) • Tools and construction supplies (roofing, cement, iron, stone, blocks, etc.) • Equipment and supplies for communications and broadcasting (radios, antennas, batteries) • Water pumps and tanks for water storage • Equipment, materials and supplies for disinfection of drinking water and repair/rehabilitate of black water collection systems. • Equipment, tools and supplies for agricultural, forestry, and fisheries. • Feed and veterinary inputs (vaccines, vitamin tablets, etc.) Services • Consulting services related to emergency response including, but not limited to urgent studies necessary to determine the impact of the disaster and to serve as a baseline for the recovery and reconstruction process, case management in public health emergencies, and support to the implementation of emergency response activities. • Non-consultant services including, but not limited to: aerial photographs, satellite images, maps and other similar operations, information and awareness campaigns. 5 • Services related to community mobilization, provision of training and distribution of non-food items to be undertaken as per the relevant global public health guidance. Works • Repair of damaged public buildings, including schools, hospitals and administrative buildings Emergency Operating Costs • Incremental expenses by UNICEF for a defined period related to early recovery efforts arising as a result of the impact of an emergency. This includes, but is not limited to: costs of staff/consultants attending emergency response, operational costs and rental of equipment 3. Rationale for the CERC-ESMF Based on the specific activities to be financed under the CERC, the CERC-Environmental and Social Management Framework (ESMF) will rely as much as possible on the Original Project’s social and environmental assessments and safeguard instruments. The sequence of environmental and social instruments produced, disclosed, and consulted on, and how these inform the technical design process, follow the general principle that all key technical decisions should be supported by an appropriate level of environmental and social information and due diligence. Consultations need to be organized at a time when results from relevant social and environmental analyses are available, to allow mainstreaming them into the final designs and tender documents. The Project does have an ESMF; however, it does not contain specific provisions on COVID-19 since it is a new health emergency and the disease was previously unknown and neither does it include specific requirements the screening process and mitigation measures of environmental and social risks and impacts related to CERC. Therefore, this brief CERC-ESMF is prepared to describe the type of emergencies and activities to be financed and evaluates the risks and mitigation measures associated with them. It also identifies vulnerable locations and/or groups and includes, where needed, some social assessment to guide emergency responses. The CERC-ESMF will outline a screening process built around the positive list for key environmental and social issues and risks. This will be linked to identifying institutional arrangements for oversight of any required additional Environmental and Social (E&S) due diligence and monitoring. In addition, the CERC- ESMF will include generic emergency small-scale civil works “sector� guidance identifying key E&S issues with practical Environmental and Social Management Plan (ESMP) type checklists. Other relevant Occupational Health and Safety (OHS) guidelines will be also applied as needed. However, if necessary, the safeguards instruments will be updated if the emergency activities do not fall within the scope of the existing instruments. It is unlikely that emergency works will trigger new safeguards policies; however, if required, new instruments will be prepared, consulted upon and disclosed per the requirements of the World Bank’s Investment Project Financing Policy. 4. Policy, Legal and Institutional Framework a. National Legal Framework The CERC is subject to the following Yemeni laws and regulations: Related to water: 6 • National Water Sector Strategy and Investment Program (NWSSIP) • Water Law No. 33 issued in 2002 and modified in 2006 after the creation of Ministry of Water and Environment (MWE). Its by-law was issued in 2011 by Cabinet decree. • Environment Protection Law (EPL) nr. 26 of 1995 and its amendments The Water Law No. 33 defines water resources as any water available in the republic's territory and its share of common waters jointly owned with neighboring countries. This is comprised of ground water, surface water, wastewater after purification, and saline water after desalination. The law's main objective is to regulate, develop, sustain and increase efficiencies in water utilization, protect from pollution, transport, and engage the beneficiaries of water installations in participatory management, investment, development, operation, maintenance and preservation at the various stages of development. Water is considered as a common property accessible to all. Management of water resources is entrusted to the National Water Resources Authority (NWRA), which assesses the resources, classifies water basins and zones, and prepares the national water plan, considered one of the components of national economic and social planning. Drinking and domestic water use shall have absolute priority. Then in declining priority, watering livestock, public utilities, irrigation, industrial purposes, minimal level of environmental needs. For these uses, water distribution and transport should be undertaken according to hygiene means. Existing and acquired water rights prior to the issuance of the law will be maintained, except in special cases when fair compensation will be ensured. Traditional water rights of rainwater harvesting and natural runoff flow in relation to irrigation shall be maintained. The same applies for the traditional rights on natural springs, streams, and creeks. The Water Law and its by-law are a notable achievement in Yemeni legislation and provide important legislation for environmental management of UNICEF activities. Related to the environment: The environmental related polices and laws in Yemen include inter alia: The Environment Protection Law (EPL) number 26 of 1995, which forms the basis for the protection of the environment, issuance of permits, and Environmental Impact Assessments (EIAs). The provisions of this law are implemented through Executive Regulations (By-Law 148-2000), issued by a decree of the Council of Ministers to protect the environment, natural resources, society, and health. In addition, the law is designed to protect the national environment from activities practiced beyond national boundaries and to implement international commitments ratified by the Republic of Yemen in relation to environmental protection, control of pollution, conservation of natural resources, and the protection of such globally important environmental issues such as the ozone layer depletion and climate change. The law equally stipulates the incorporation of environmental considerations in economic development plans at all levels and stages of planning for all sectors. It also requires the preparation of EIAs for projects proposed by the public and private sectors. However, to date there is still no regulatory framework to support the implementation of the EPL and the provision of undertaking EIAs for projects is not strictly enforced. EIAs studies should be undertaken by an independent authority. Equally important, environmental standards and specifications have been prepared by the former Environment Protection Council as annexes to the Executive Regulations, covering potable water quality, wastewater quality for agriculture, and ambient air quality, emissions, noise, biodiversity and protected areas. These include standard application forms intended for use by all relevant government bodies. Also, 7 there are other policies, strategies and programs in Yemen to safeguard the environment. The list of these policies, strategies and programs include: • National Environmental Action Plan • Environment & Sustainable Investment Program • Biodiversity Strategy • Environmental Impact Assessment Policy for the Republic of Yemen • Reports on the State of Environment (by Environmental Protection Agency (EPA)) • Evaluation of Future Development of the EIA System in Yemen Related to cooperatives: Cooperatives Societies and Unions Law (Law No. 39 of 1998), concerning Cooperative Societies and Unions, is the organizational and legal reference for all cooperatives and cooperative unions in the Republic of Yemen. This law is seen of relevance since it addresses community mobilization in terms of collective actions that would lead to better community involvement in the design, implementation and operation and maintenance of coping measures and income generation activities. The law grants a relevant Ministry and its departments and branches in the governorates the right to supervise and assure compliance with relevant laws and provide advice and technical assistance to the cooperatives to plan their activities as well as to attend their General Assembly meetings. It defines five specific types of cooperatives. Any other type of cooperative, such as Agricultural Cooperative Union (ACU) and its branches in the country can be created according to the provision of Article 142, which states that it is lawful to establish other cooperative societies, according to provision of this Law, in other services. More specifically, Article 142 stipulates that a decree of establishment under appropriate line Ministry shall be developed and forwarded to the Ministry of Social Affairs and Labor for approval and issuance. Water Unions and Associations (WUAs) which were supported by the water law are eligible under the law 39 of 1998. These associations have the privileges granted to them by law, as well as the support of the water law, International and regional environmental legislation. Related to public health: Public Health Law, Law No 04 / 2009, Chapter 5 Article 10,11 states that the Ministry of Health shall implement the programs and activities to track infection and diseases and make the necessary arrangement to provide the related information to the public. Implementation of the required measures are to be done with other related authorities to prevent any disease transmission. The law also allows for the isolation of any person with infectious disease and provide the required medical treatment in the treatment facilities. In Chapter 36 Article 36, 37, the law allows for the Identification of any aspect that could cause adverse impact on the public health. It also calls for the protection of all environmental health components and prevention of any cause of adverse Impacts. This includes the requirement that all Health Facilities (HF) shall perform adequate treatment of medical waste following international regulations. Chapter 36 Article 39, states that adequate measures shall be made to transport the hazardous material or waste and perform adequate treatment. Other relevant multilateral agreements: The Yemeni Government has ratified multilateral environmental agreements on agro-biodiversity and natural resources, oceans and seas, hazardous materials and chemicals, atmosphere and air pollution, and 8 health and workers’ safety. The following list provides the multilateral agreements relevant to the project activities: • The Convention on Biodiversity, signed on 1/12/2005 • The Convention on the Conservation of Migratory Species; starting on the 1st of December 2006; Yemen is party No.100 • The Convention on International Trade in Endangered Species of Wild Fauna and Flora. Signed at Washington, D.C., on 3 March 1973 and amended at Bonn, on 22 June 1979 • The United Nations Framework Convention on Climate Change • Kyoto Protocol • The United Nations Convention on Combating Desertification • Environmental Modification Convention • World Cultural & Natural Heritage, Paris 1982 • Civil Responsibility for Damage from Oil Pollution, Paris 1979 • Convention on Wetlands of International Importance Especially as Waterfowl Habitat 1971 • Law of the Sea • Ozone Layer Protection • Yemen has signed Stockholm Convention on Persistent Organic Pollutants (Signed: 12/05/2001; Ratified: 01/09/2004), which is a global treaty to protect human health and the environment from chemicals that remain intact in the environment for long periods, become widely distributed geographically and accumulate in the fatty tissue of humans and wildlife. • Yemen is also party to Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal, since 21/02/1986. The Basel Convention is a global treaty to protect human health and the environment from the adverse effects of hazardous wastes. Its scope of application covers a wide range of wastes defined as “hazardous wastes� based on their origin and/or composition and their characteristics. b. World Bank Safeguards Requirements In addition to the Yemeni laws and regulations, the ESMF and subsequent ESMPs should comply with the safeguards policies and procedures of the World Bank–specifically OP/BP 4.01 on Environmental Assessment which is the only triggered safeguards policy. 5. Environmental and Social Risks and Impacts of CERC and potential mitigation measures CERC will have positive environmental and social impacts as it will improve COVID-19 surveillance, monitoring, and containment. However, the CERC might involve environmental, health and safety risks due to the hazardous nature of the pathogen and reagents and other materials to be used in the project-supported laboratories, quarantine facilities and health centers. Healthcare-associated infections due to inadequate adherence to OHS measures and IPC standards can lead to illness and death among health and nutrition workers and further spread the virus among communities benefitting from health and nutrition services. Due to the increased use of PPE by both the health workers and general public visiting health and nutrition service areas, inevitably, there will be increased volume of all types of wastes. The disposable waste will increase environmental risks, hence the need to increase the capacity of the health facilities to handle the situation. The increased need will require prompt operations costs support and increased incineration capacity. Improper disposal of medical waste including the used PPEs might 9 increase conflicts between the health facilities and the communities with anticipated community complaints about haphazard disposal of medical waste in communities and potential of infection risks to the general public. COVID-19 related wastes will be disposed of following the existing Medical Waste Management Plan as well as the measures that will be included in the CERC-ESMF. Social risks are mainly related to the risk of elite capture of project benefits and exclusion of the poor and vulnerable groups such as elderly people, children under the age of five who are acutely malnourished and unable to access facilities and services, women, as well as the internally displaced persons because of the ongoing conflict in the country. Thus, there is a need to make sure procured items needed to prevent, detect and clinically manage COVID-19 are distributed in a transparent and equitable manner. Further, rumors and misinformation must be addressed promptly and transparently. To mitigate these risks UNICEF will use its best practice in stakeholder engagement, as far as possible, to avoid conflicts resulting from false rumors, vulnerable groups not accessing services, as well as ensuring the appropriate amounts of PPE and materials are provided to facilities. The risks to different vulnerable groups will be taken into account and suitable mitigation measures will be identified and implemented, as appropriate. This CERC- ESMF includes provisions to prevent and respond to Sexual Exploitation and Abuse (SEA)/ Sexual Harassment (SH), notably exchange of sexual favors for access to health care and other project benefits. In addition, there might be potential impacts due to (lack of) access to drinking water including: • improper level of dose of chlorine, • unbalanced preparation of chlorine solution, • absence of measurement of the free chlorine, • measurement before reaching the retention time, • dirty/polluted water truck, • polluted water source, • truck movement noise, • dust and gasses emission from exhaust inside the health facility, • unsafe climbing the truck to dose the chlorine, • polluting the source while sampling, • methods of sampling and analysis might give wrong results. Potential mitigation measures In addition to the Yemen Emergency Health and Nutrition Project (YEHNP)-ESMF and the measures contained in the YEHNP-Medical Waste Management Plan, the CERC-ESMF contains additional provisions to reduce the risk that could occur during implementation of the CER, as required. Moreover, the COVID- 19 guidelines and best practice from WHO and the World Bank Group (WBG) will be applied during activities’ implementation and special infection control will be applied during COVID-19 spread. The table below lists the potential impacts and potential mitigation measures for the CERC. Table 2: Potential impact and mitigation measures # Potential impact Mitigation measures Civil works (repair damaged building/WASH facilities - HFs) 1 Dust generation during • Use well-maintained equipment construction equipment and • Spray water for dust control materials loading and unloading, and working material mixing 10 # Potential impact Mitigation measures 2 Increased levels of noise and • Use quiet/well-maintained equipment vibration due to vehicles • Use operational noise muffler; movement and construction • Limit noisy activities to normal daylight hours machineries • Limit vehicle speed at critical locations 3 Air pollution due to emissions • Properly maintain construction machinery to minimize exhaust from construction vehicles and emissions of CO, suspended particulates and fumes machinery 4 Work-related accidents and • Construction site must have protection measures (barriers, fence) injuries are likely to increase • Removable barriers erected in high risk areas during civil work • Warning signs, and authorized persons are only allowed to access working area • Provide proper support for trench, to protect against collapse • Provide workers with personal protective equipment • Allocate an alternative route far from the site for pedestrians • Provide light and fence and warning signs 5 Disruption of proper work in the • Isolate the work site from workers, patients and visitors HF due to civil work • Limit the work in one area in series implementation • Spray the site with water to dampen dust . • Work during the day when noise is an issue • Get rid of oils and grease • Take care and caution while disposing liquid waste • Apply OHS measures • Use PPE as appropriate 6 Risk to workers from hazardous • Train workers regarding the handling of hazardous materials material used for rehabilitation, • Store hazardous materials as per the national and international laws such as acetylene cylinders, and guidelines including the World Bank Environmental, Health, and petroleum, spirits, lubricating Safety (EHS) Guidelines1 oils, paints and chemicals 7 Poor management of liquid • Remove and recycle liquid waste wastes, leading to soil or groundwater pollution 8 Poor disposal of construction • Properly dispose of solid waste at designated permitted sites debris and waste materials 9 Health problem due to stagnant • Ensure proper utilization of water water pools formation (vector • Take necessary actions for fighting vectors, such as spraying with borne disease spread) insecticides • Eliminate and reclaiming stagnant pools. 10 Ground water pollution from pit • Ground water quality testing at source development and regular latrines intervals 11 Poor onsite sanitation or water • Provide employees with access to toilets and potable drinking water supply, leading to illness and disease WASH provisions 12 Water contamination due to • Train and make sure of applying standard concentration during chlorination process and mixing of chlorine polluted equipment • Correct measurement of residual chlorine and retention time 1 World Bank General EHS Guidelines are available under the following website: http://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainability-at-ifc/policies-standards/ehs-guidelines 11 # Potential impact Mitigation measures • Keep chlorine away from others • Allocating safe and closed area for storing chlorine • Use special PPE (overall, mask, glass, gloves, and safety shoes, etc..) during mixing and operating dosing pumps • Make shower ready for any accident from chlorine splashing on the operator • Ensuring used water trucks are clean and not polluted; and the water is clean 13 Incompetent hygiene practices • Ensure proper and safe management of equipment and materials and behavior used by health workers including waste management staff and site workers • Ensure medical waste safe final disposal • Awareness of employees, patients and the community on the importance of personal hygiene and cleanliness of the surrounding environment • Training on the sorting, collection and safe disposal of hazardous medical waste, liquid and solid • Training cleaning crew and providing (appropriate PPEs) tools for safety and hygiene 14 Health risk due to pandemic • Applying of safety standards to avoid infection infection • Isolating patients with infectious diseases • Providing the necessary medicines • Continuous cleaning using proper detergents • Providing the necessary equipment, chemicals and specialized medical staff • Providing alternative energy continuously as well as safe drinking chlorinated water • Properly disposing and managing medical waste • Providing proper PPE to health workers and to patients; and ensuring safe disposal of used PPEs • Use related guidelines and procedures mainly those prepared by WHO, and the WBG EHS 15 Exclusion of vulnerable groups • Ensure that vulnerable groups have equal or better access to the project benefits and services • Identify the vulnerable groups at the project area • Carry out environmental regular assessment to determine the concern of vulnerable groups • Conduct regular consultation, explain the benefit of the project and disclose the Grievance Redressal Mechanism (GRM) communication channels and how to use • Provide orientation on the project benefits and activities impact 16 Labor influx related social • Offer employment opportunities to locals risks • Ensure Labor management plans, and code of conducts for workers are in place • Sensitization of communities on employment opportunities 17 Risk of child labor • Refuse to hire children under the legal age of employment for any activity 12 6. Environmental and Social (E&S) Screening and Management Plan The CERC project is a part of the YEHNP project; thus, the YEHNP ESMF remains in place for WASH and Health and Nutrition activities. The CERC-ESMF complements the EHNP-ESMF and it will use the existing E&S instruments with an addition of use of COVID-19 prevention guidelines prepared by the WHO, and WBG and special infection control will be applied during the COVID-19 spread. Every intervention will undergo a screening process, and the screening will determine the level of the anticipated risk associated with activity implementation, and accordingly. UNICEF will prepare specific environmental and social mitigation measures as described in the sections below. 6.1 Screening Process for the Proposed Activities A screening form is to be used by UNICEF to screen for the potential environmental and social risks and impacts of a proposed subproject. It will help UNICEF in identifying the relevant instruments/plans. Use of this form will allow UNICEF to form an initial view of the potential risks and impacts of a subproject. 6.1.1. Screening E&S Risks of Quarantine and Isolation Centers According to WHO: • Quarantine is the restriction of activities of or the separation of persons who are not ill but who may have been exposed to an infectious agent or disease, with the objective of monitoring their symptoms and ensuring the early detection of cases • Isolation is the separation of ill or infected persons from others to prevent the spread of infection or contamination. UNICEF will not be engaged in any construction of quarantine or isolation centers under the CERC. The activities are limited to small civil works in HFs. There may also be circumstances where tents are used for triage, quarantine or isolation within HFs. The project is not expected to involve any land acquisition or repurposing of land. In screening for E&S risks associated with quarantine and isolation, the following may be considered: • contextual risks such as conflicts and presence or influx of internally displaced persons • construction and decommissioning related risks • availability of minimum requirements of food, fuel, water, hygiene • whether infection prevention and control, and monitoring of quarantined persons can be carried out effectively • whether adequate systems are in place for waste and wastewater management The following documents provide further guidance regarding quarantine of persons: • WHO; Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19) • WHO; Key considerations for repatriation and quarantine of travelers in relation to the outbreak of novel coronavirus 2019-nCoV • WHO; Preparedness, prevention and control of coronavirus disease (COVID-19) for refugees and migrants in non-camp settings 13 6.1.2. Screening E&S Risks of Treatment Centers/Health Facilities WHO has published a manual that provides recommendations, technical guidance, standards and minimum requirements for setting up and operating severe acute respiratory infection (SARI) treatment centers in low- and middle-income countries and limited-resource settings, including the standards needed to repurpose an existing building into a SARI treatment center, and specifically for acute respiratory infections that have the potential for rapid spread and may cause epidemics or pandemics. The following documents provide guidance: • WHO Severe Acute Respiratory Infections Treatment Centre • WHO Covid-19 Technical Guidance: Infection prevention and control / WASH • WBG EHS Guidelines for Healthcare Facilities, issued on April 30, 2007 • WBG General EHS Guidelines. 6.1.3. Screening E&S Risks Relating to the Workplace Implementation of the CERC may include different types of workers. In addition to regular medical workers and laboratory workers who would normally be classified as direct workers, the project may include contracted workers to carry out construction and community workers (such as community health volunteers) to provide clinical support, contact tracing, and data collection. These workers may face various levels of risk for contracting and spreading COVID-19, and these risks should be minimized as far as possible, following the existing guidelines and best practice from WHO and WBG. 6.2 COVID-19 Infection Control Risks Mitigation Measures The YEHNP engineers/environmental health consultant should advise the staff of the HFs of the appropriate practices for the safe disposal of medical waste using the existing Medical Waste Management Plan. The YEHNP engineers/environmental health consultant should provide the staff of the HF with supportive training, documents, leaflets or posters on the safe handling and disposal of medical and hazardous liquid waste. Environmentally and socially sound HF management will require adequate provisions for minimization of OHS 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. In addition, the project will support activities for strengthening selected HFs and establishment and equipping of triage, isolation and health care centers, so that they can manage COVID-19 cases. This may also include minor civil works and retrofitting of isolation rooms in such facilities and treatment centers which might cause impacts such as dust, noise, solid waste generation and management as well as workers' safety including occupational health and safety, and other standard risks and impacts of rehabilitation. However, the environmental risks and impacts are expected to be site-specific, reversible and of low magnitude that can be mitigated following appropriate measures. Furthermore, the application of adequate occupational and community health and safety precautions is expected to be enough to prevent any associated impacts. The project is not expected to involve any land acquisition or repurposing of land. UNICEF will conduct a training, on a national and regio nal levels, for the staff of HFs and Training-of- Trainers for local communities on WASH implementation activities. 14 Social risks emanating from disease identification, prevention and control efforts related to the possibility of ineffective and inappropriate communication surrounding the disease and control efforts, inadvertently harming or excluding marginalized people and communities, or mistreatment of affected communities to enforce the quarantine. UNICEF will be engaging in ongoing communication for development activities to address the social risks. As noted above, UNICEF will ensure proper stakeholder engagement to identify potential impacts on vulnerable groups and address these impacts as far as possible. Project implemented activities will meet the WHO standards on COVID-19 response; the international best practice is outlined in the WHO “Operational Planning Guidelines to Support Country Preparedness and Response�, annexed to the Yemeni “COVID-19 Strategic Preparedness and Response Plan� (February 12, 2020). As the evidence base for COVID continues to grow, guidelines and documents are subject to change; thus, these documents are to be considered ‘living documents’ that will be revisited and updated in an evidence-informed way. 6.3 Mitigating and Responding to Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH) The Project will address SEA/SH, during the project cycle and will follow procedures and recommendations, as outlined in Good Practice Note: Addressing Sexual Exploitation and Abuse and Sexual Harassment in IPF involving Major Civil Works. SEA/SH risks are deemed Substantial due to the emergency nature of the operations, the level of vulnerability of the population and weak protection. Most of the laborers hired for rehabilitation are expected to be local, potentially reducing labor influx- related SEA risks; bidding documents will include specific requirements to minimize the use of expatriate workers and encourage local hiring. Mitigating SEA/SH risks stemming from project activities will include the following: • Multi-sectoral coordination and monitoring mechanism; capacity building of direct, contracted and community workers; and community awareness-raising activities to implement these SEA/SH mitigation measures in an effective manner. • Contractual obligations to prevent SEA/SH risks, through the signing of Codes of Conduct (CoC) and disciplinary actions for offenders; • Strengthening response mechanisms through survivor-centered mitigation measures and Grievance Mechanisms to effectively handle SEA/SH complaints in collaboration with non- governmental organizations (NGOs) having expertise on Gender Based Violence (GBV); If the CERC implementation introduces contractual obligations in rehabilitation contracts, the risk of SEA will be reduced by: • Briefing prospective contractors on Environmental, Social and OHS Standards and on SEA-related requirements during pre-bid meetings; • Incorporating requirements in the bidding documents for contractors to develop a GBV Action Plan, including an Accountability and Response Framework; • Incorporating requirements in bidding documents to minimize the use of expatriate workers; • Requiring that contractors and consulting firms submit CoC with their bids; • Based on the project’s needs, the World Bank’s Standard Procurement Documents and the implementing agency’s policies and goals, defining the requirements to be included in the bidding documents for CoC that address GBV; and 15 • Clearly establishing how adequate GBV costs will be paid for in the contract, as well as worker training on SEA, HIV/AIDS mitigation, and CoC obligations. The Project will handle SEA/SH grievances as outlined in the UN processes for addressing SEA/SH, complemented by the Grievances Mechanisms for SEA/SH in World Bank-financed Projects. The mandate of a SEA/SH Grievance Mechanism (GM) is limited to: • referring, any survivor who has filed a complaint to relevant services, • determining whether the allegation falls within the World Bank definition of SEA/SH, and • noting whether the complainant alleges the grievance was perpetrated by an individual associated with a World Bank project. A SEA/SH GM does not have any investigative function. It has neither a mandate to establish criminal responsibility of any individual (the prerogative of the national justice system), nor any role in recommending or imposing disciplinary measures under an employment contract (the latter being the purview of the employer). Samples of CoC can be found in Good Practice Note: Addressing Sexual Exploitation and Abuse and Sexual Harassment in IPF involving Major Civil Works. 6.4 Other Contingency Risks and Emergency Response The CERC allows UNICEF to receive support by reallocating funds from other project components to mitigate, respond and recover from the potentially harmful consequences arising from the emergency. Disbursements under this component will be subject to the declaration of emergency and the “Emergency Operational Manual� by UNICEF and WHO, agreed upon by the World Bank. 6.5 Preparation of Site Specific Environmental and Social Management Plan (ESMP) Prior to the implementation of project activities, based to the screening results and the level E&S impact and risk anticipated to occur, the project will develop site specific and relevant Environmental and Social Management Plans (ESMPs) that will screen all sub-activities in conformity with the present and disclosed ESMF for the YEHNP. This will cover the various ESMPs for areas such as WASH interventions in HF, Households, Rainwater Harvesting, amongst others. The site specific ESMPs will incorporate all the preventive COVID-19 guidelines, procedures and measures prepared by the World Bank, WHO and the Republic of Yemen. Adequate level of supervision of the activities implemented under this project shall be performed in addition to the organization of regular training on Hygienic Practices, Environmental and Social Safeguards and Waste Handling, Transport and disposal methodologies, amongst others. 7. Reporting and Monitoring Plan UNICEF, as part of YEHNP with collaboration of local concerned Ministry staff, is required to supervise the provisions of the ESMP during the rehabilitation and maintenance and operational phases of the intervention. The safeguards consultant hired by UNICEF will be responsible for monitoring and evaluating safeguard compliance of the entirety of the subprojects, as guided by the ESMF. The individual intervention ESMP monitoring reports will provide information about key environmental and social impacts of the project, effectiveness of mitigation measures, and any outstanding issues to be remedied. UNICEF will include a section on safeguards compliance in each progress report which will be submitted to the World Bank, with input from relevant stakeholders, as needed. Monitoring will be undertaken by 16 UNICEF staff or consultants either in person or remotely, or through third party organizations. UNICEF has recently developed and implemented remote monitoring guidelines through its Program Monitoring and Evaluation Section, and these will be used as required. Key objectives of the monitoring plan include: • Tracking environmental and social performance of the project activities. • Verifying that all requirements of ESMF and ESMP are addressed and implemented. • Ensuring the capacity building of personnel and providing any required support. • Ensuring adequate stakeholders’ engagement, proper feedback and communication. • Undertaking site visits to review documents and meet with workers, management, and stakeholders. • Ensuring proper implementation of the Project's Medical Waste Management Plan. The monitoring plan contains the objectives, and specific targets, as well as main elements of the monitoring, e.g. parameters to be monitored, full description of methods and equipment to be used for monitoring, sampling locations, frequency of measurements, threshold limits (per national and international standards), corrective action procedures, personnel responsible for monitoring, reporting and communication procedures. Monitoring and procedures are set out in a way that allows for: • Early detection of conditions that necessitate particular mitigation measures • Information on the progress and results of mitigation is furnished prior to applying the monitoring plan The following table outlines the key components of the monitoring plan; these will be elaborated further after screening is undertaken for each intervention: Table 3: Key components of the monitoring plan # Parameters Monitoring requirement Responsible party Frequency Review of sub- project Environmental During • Mitigating measures included in component and bills of and Social preparatio the set of interventions. quantities. Specialist; ns of bill of • Mitigating measures cost Review of awareness YEHNP engineers; quantities included in the bill of quantities of program materials before for the the intervention. the start of the activities and project • Awareness activities are carried reviewing the reports and component out indicators after conducting s the program. Health and safety measures: Site inspection checklists Environmental Monthly/ • Protective clothes photos and Social Quarterly • Site protection Specialist; Local • Disposal of hazardous materials Authorities; • Readiness of health facilities for YEHNP engineers; emergencies environmental health consultant 17 • Normal working hours (not more than 8 hours /day) Noise and dust level: Site inspection checklists Environmental Monthly • Ear protection and dust masks and photos and Social for workers Specialist; • No work at night YEHNP engineers; • Spray water General Hygiene Condition: Visual inspection Environmental Monthly • Water truck and tanks quality Laboratory test and Social • Quantity of mixing chlorine in Interview with staff and Specialist; Local water community members Authorities; • Safe disposal of all toxic WHO standards of drinking YEHNP engineers; materials including medical water environmental waste health consultant • Health and safety of worker; • Capacity building program • Training of local staff and awareness 8. Third Party Monitoring (TPM) The general description of the monitoring agent services is as follows: “To verify that the physical implementation of projects is in accordance with signed contracts and in accordance to the agreed social and environmental guidelines; (b) verification that the completed project is serving the community as envisioned (i.e. water, safe sanitation, disinfection, hygiene kits, rehabilitation and maintenance of water and wastewater networks, Waste Water Treatment Plants (WWTP), water and wastewater quality analysis (WASH) is being delivered to project beneficiaries and is of reasonable quality.� To carry out the above services, a Third Party Monitoring (TPM) Agent will visit the projects and submit the reports: (1) during the implementation report, final stage of implementation report and after completion of implementation reports: and (2) carry out physical verification with digital photographs of ongoing works and goods supplied, alerting UNICEF and the Bank to deficiencies in implementation and following up on the correction of these deficiencies. This will be done for a selected subset of each of the World Bank projects, i.e. a selected number of YEHNP subprojects. Specific to CERC, the TPM will report on (1) quality and progress of works vis-à-vis the plan and contract document (2) abidance by the contractor regarding disposal of unwanted materials, if any, to the designated dump sites (3) strict adherence of the contractor with regard to workers and safety procedures on the construction sites and, (4) any other specific issues that the TPM team wants to highlight. Based on each specific contract, TPM should provide comments on any safeguard issues included in that particular contract. In case there are issues not mentioned in each of the specific contract and the TPM team finds that there are important and relevant issues not mentioned in the contract, the TPM team may provide its comments and/ or recommendations, if any, in the report for that particular site. 18 TPM will also assess the status and performance of COVID-19 response project implementation phases, compliance status, or emerging issues through a specialized party and to provide an unbiased perspective on the issue and status, and to make recommendations for improvement, where relevant. 9. Infection Control Risk Management Guidelines The safe and sustainable management of medical waste is a public health imperative and a responsibility of partners working in the health sector. Improper management of medical waste poses a significant risk to patients, health-care workers, the community and the environment but this can be addressed. The right investment of resources and commitment will result in a substantive reduction of disease burden and corresponding savings in health expenditures The effective management of medical waste is an integral part of a national health-care system, and as such needs to be integrated in this project. A holistic approach to medical waste management should include a clear delineation of responsibilities, occupational health and safety programs, waste minimization and segregation, the development and adoption of safe and environmentally-sound technologies, and capacity building. For this purpose and to ensure safe and adequate handling of medical waste from the project intervention facilities, a dedicated and separate procedure has been prepared as reference and guideline to implementation partners. The procedure outlines the required measures need to be applied by the HFs in addition to the contingency procedure. UNICEF plans on recruiting a consultant to focus on environmental health at HFs and will follow-up on a regular basis the implementation of mentioned procedure as part of the regular monitoring of this project. 10. Institutional arrangement UNICEF’s WASH section is staffed with an Environmental and Social Safeguards Consultant. This Consultant will be supported for ten months by an Environmental Health Consultant. As part of the regular reporting (every six months), they will prepare and submit updates on the environmental, social, health and safety performance of the CERC. UNICEF will provide implementation partners in the country with the material resources, technical guidance, and actions so that the CERC is implemented in compliance with the World Bank Operational Policies, WHO policies and guidance on COVID-19, and best practices. UNICEF will have overall responsibility for project implementation and oversight of the project activities. UNICEF will be responsible for all procurement, trainings and capacity building activities supported by the project. For all environmental and social assessments required, UNICEF may outsource detailed studies or activities (e.g., public awareness, risk communication, etc.) to consultants and manage them where needed. 11. Public Consultation and Disclosure The need for public consultation for the ESMF is paramount. In the current COVID-19 context, face-to- face consultation has not been possible. However, UNICEF has, following guidance from the WB team, engaged in consultation through remote means, as described in this section. The purpose of this consultation was to allow the relevant stakeholders to be aware of the CERC-ESMF contents, and to provide them an opportunity to comments on issues of relevance to them. The stakeholders targeted 19 included, but was not limited to, governorate and district health offices, governorate and district water and environment offices, national ministries (health and water in both north and south), UNICEF implementing partners, amongst others. The approaches used included the following: • The draft CERC-ESMF was disclosed on the UNICEF website in both Arabic and English, providing an email address for any comments, for a week. This was complemented by posts about the document on Facebook and Twitter. • The CERC-ESMF was shared with the Ministry of Health and Population (MOPHP) and MWE in both Sana’a and Aden. • The CERC-ESMF was sent to the cluster leads in nutrition, WASH, and health and a request made for the cluster leads and sub-cluster coordinators to share the draft with the NGOs and others in the respective clusters. • The WASH section sent out the CERC-ESMF to all of their implementing partners. • The CERC-ESMF was shared with relevant UN agencies via email with a request for comments within a week. • A three page summary in both English and Arabic was developed and shared via WhatsApp groups to health worker networks. • Through the Community for Development section in UNICEF, the Arabic summary was shared with implementing partners. Selected comments and actions are summarized in the Table below. The full list of comments received is in Annex F in this document: Table 4: Selected comments received, and actions taken Comment from Comment How addressed PMU General Some suggested changes to the indicators proposed: Director – Urban Water • Number of people with access to improved and Not changed as these have Supply and safe drinking water in targeted areas (to be already been agreed with Sanitation deleted, duplicated indicator) the WB after extensive Project • Number of people with access to improved discussion sanitation in targeted areas (to be deleted, duplicated indicator) • Additional number of people added to the sanitation system through the rehabilitation activities • Number of people and isolation units provided improved access to drinking water supply • Number of people and isolation units provided basic sanitation services through UNICEF supported interventions PMU General • To focus more on the associated impact of the socio- Addressed, through Director – economic aspects, pollution, health and safety inclusion of updated table 20 Urban Water including occupational health resulting from the related to risks and Supply and proposed water and sanitation interventions and mitigation (see Table 2) Sanitation suggest best practice to mitigate them. Project PMU General • Managing COVID 19 risks on construction sites to Noted. The site specific ES Director – keep workers and engineers safe all the time. instrument will contain site Urban Water specific COVID—19 infection Supply and measures and clauses. Sanitation Project Yemen WHO Noted, Civil works is now Safeguards The Environmental and Social risk / impacts and included in Table 2 Team mitigations of the activity (Repair of damaged public buildings, including schools, hospitals and administrative buildings) neither mentioned nor included in the identification and mitigation of risks within the document. Yemen WHO This is noted. The CERC Safeguards The identification of beneficiaries and selection criteria targets all functional HFs in Team of the supported facilities is not mentioned within the Yemen, approximately 4000. ESMF. Suggest adding the selection criteria and mitigations for the associated risks. Yemen WHO This has been reviewed and Safeguards Monitoring frequency, quarterly, is not efficient for civil the table (table 2) has been Team works as well as the other supported activities. Suggest revised to monthly, as that daily monitoring frequency for civil work and includes is more appropriate. increased monitoring frequency for other supported activities. Yemen WHO Other social risks need further details and mitigations: Noted. Have addressed the Safeguards • Social tensions due to concerns about infection relevant risks and mitigation Team spread to the communities in the vicinity of the HCFs, measures in Table 2. quarantine centers, etc. • Risks of pathogen exposure, infection and associated illness, death, for workers engaged in carrying out the testing, transporting samples, delivering training, etc • Discrimination in relation to recruitment, hiring, compensation, working conditions, terms of employment, etc .. • Stigma and passing on infections to family and community • Discrimination in relation to recruitment, hiring, compensation, working conditions, terms of employment, etc. • Absence of a mechanism to express grievances and protect rights regarding working conditions and terms of employment 21 12. Grievance Redressal Mechanism (GRM) UNICEF has established a Grievance Redress Mechanism (GRM) for YEHNP, where complaints, queries or feedback on the project is received and addressed. This GRM will be used for the CERC as well. This GRM is used to ensure the engagement of community members and beneficiaries in all aspects of project implementation. Complaints are received from beneficiaries, stakeholders and community members and addressed properly and accurately in order to improve project management and implementation and enhance the quality of the project intervention and maximize the benefit to the communities. The timelines and responsibility for management of the complaints is found in Table 5 below. Complaints through the GRM can be made through a toll-free call center (CC) (8004090) or via email (info@ehnp.org). All communications received through the GRM are treated confidentially. Names and details of complainants or complaints are not disclosed to authorities or others; all complaints are kept confidential and only those who have to know to be able to deal with the complaint – those within UNICEF – are informed of the details. This is to safeguard the complainant from any reprisals or retaliation. Communication through the GRM is free of charge. The GRM communication plan and tools were distributed to all YEHNP sites and tools will also be available to all CERC sites. Complaints are reviewed and addressed by the UNICEF Field Office Focal Points (limited number of people per UNICEF Field Office) and they are only closed after the Country Office Focal Point reviews and agrees that the complaint is appropriately dealt with. If she does not believe it is so, she sends it back to the relevant focal points and/or their supervisors with comments and a request that these be addressed. In addition, when the call center agent contacts the complainant to provide the response, they ask the complainant if he/she is satisfied. If the complainant says no, the call center reopens the grievance and it comes back to the program team again. While this is not a formal appeals process, it does add some further safety and ensures that complaints are addressed appropriately before they are closed. Through the GRM, community members and service providers may make complaints on issues such as the following: • Adverse social or environmental situations caused by the project; • Access to project services (for example if an intended project beneficiary has not been reached by the project); • Deviation in implementation or use of project inputs (if implementing partners deliver services or pay to beneficiaries an amount less than the standard set by UNICEF for the project); • Complaints GBV/SEA related issues with ensuring complete confidentiality to protect impacted survivors due to culture norms in the country; and • Any other concerns. The YEHNP GRM: • Is responsive to beneficiaries, addresses and resolves their grievances; • Serves as a channel to receive suggestions, and to increase community participation; • Collects information to enhance management and improve implementation performance; 22 • Promotes transparency and accountability on the modality and performance of the project; • Deters fraud and corruption; • Includes referral pathways to refer GBV survivors to appropriate support services; • Mitigates environmental and social risks; and • Builds trust between citizens and YEHNP management. GRM principles under the EHNP include: • Protection of beneficiaries’ and stakeholders’ rights: beneficiaries and stakeholders have the right to make their voices heard. No retribution will be exacted for participation/use of the GRM system. • Transparency and Accountability: All complainants will be heard, taken seriously, and treated fairly. • Timeliness: All complaints will be addressed – ideally - within two to three weeks. Complainants will be informed if their issue requires more time than this. • Neutrality, Equity, and Non-Discrimination: All complaints will be treated with respect and equally regardless of the community groups and individuals, types, ages and gender. • Accessibility: The GRM will be clear and accessible to all segments of affected communities. • Confidentiality: Information communicated through the GRM is restricted to a limited number of people and is not disseminated more widely, offering protection and security to the complainant. Every complaint related to CERC will be received via the same channels of EHNP GRM. All GRM contact information will be available at all sub-project sites. UNICEF will ensure that the partners and beneficiaries are made aware of the channels available. The EHNP GRM is well known by partners working in implementation of the EHNP activities. However, more consultation and orientation will be conducted at the start of CERC activities’ implementation. A summary of the grievances received and time required to solve them is provided in the progress reports and during the implementation support missions. We typically do not have grievances that go unresolved or unaddressed (for example, SEA is not resolved by us but is sent through the necessary channels for investigation and resolution, as noted above). The process of managing complaints is found in Table 5 below. Table 5: GRM Complaints Management Process No Action Responsibility Time frame 1. Complaint is submitted to the Call Center Complainant Any time (CC) 2. Complaint logged into the CC registration CC Agent Day 1 system with index number 23 No Action Responsibility Time frame 3. Confirm receipt of complaint and notify CC Agent Day 1 complainant whether complaint is related to the YEHNP project or not 4. Gather evidence on the complaint and YEHNP appointed staff /team Day 2 to 7 conduct interviews as necessary, analyze (at central level and local focal the information and develop resolutions points) on grievance (correction actions). In case of SEA allegations, UNICEF do not conduct any interviews, but use the information received and send it to the Office of Internal Audit and Investigations who are responsible for conducting investigations and recommend further (disciplinary) actions, as per the SEA guidance from UNICEF and for the UN system. Investigations take longer than 7 days. 5. Inform the complainant on the CC Agent Day 7-8 resolutions (correction actions) 6. Review and close the complaint YEHNP -GRM central Focal Point Day 8 to 11 7. Produce grievance summary report EHNP -GRM central FP Quarterly The GRM Call Center (CC) agents have been trained to receive SEA complaints using the right protocol. The other branches (for example, Health care centers and other points of interaction with beneficiaries) are yet to be trained on receiving SEA complaints but this is planned. For all cases received, the national GBV referral pathway is used to refer the survivor to the services available including medical care and psychosocial support. Annexes Annex A: CERIP Workplan and Budget Annex B: PPE NEEDS FOR DIFFERENT CADRES OF WORKERS Annex C: CURRENT GAPS IN PPE Annex D: TRIAGE SOPS Annex E: SOPS ON IPC IN PHCs Annex F: Comments received during consultation on the CERC-ESMF 24 25 Annex A: CERIP Workplan and Budget According to the expanded WASH proposal, annexed to the 15 July 2020 proposal submitted to the WB, the WASH Infection Prevention and Control (IPC) intervention will contribute to the suppression of COVID- 19 transmission in communities and households, through the following output / activities: - IDPs and crises affected vulnerable populations are provided access to gender responsive and life-saving emergency WASH services Activities: - Activity 1: Provision of WASH supplies and WASH Non-Food Items (NFIs). The budget for this is 10,817,358 USD. o Supply - Procurement and distribution of WASH NFI’s (Aqua tabs, HTH, PUR, filters, tanks, Jerry cans, consumable, basic and dignity kits etc.). - Activity 2: Provision of safe water and sanitation services to affected areas including isolation units for COVID-19 response. The budget for this is 9,087,253 USD. o Provide gender responsive emergency life-saving safe drinking water supply, such as water trucking to IDPs and others affected by disaster . o Emergency sanitation services such as latrine construction, rehabilitation, repairs, desludging, septic tanks, solid wastes and alike considering protection and gender aspects. o Provision of safe water and sanitation services to affected areas including isolation units for COVID-19 response o Hygiene promotion and IEC materials/C4D - Activity 3: Operational support to local water and sanitation corporations in affected area. The budget for this is 12,141,119 USD o Operational support to local water and sanitation corporations in affected areas which will include support in term of repair and rehabilitation, including fuel, disinfectants of urban and rural water supply and sanitation systems (WWTP/sewage stations The indicators are as follows: • Number of people benefitted from WASH supplies and WASH NFIs • Number of people (of which % are females) attended hygiene promotion and awareness campaign • Number of emergency responses to IDPs, and other affected people of cholera • Number of direct IDPs benefited from safe drinking water supplied through WASH activities and tanker trucks • Number of people with access to improved and safe drinking water in targeted areas • Number of people with access to improved sanitation in targeted areas • Additional number of people added to the system through the rehabilitation activities • Number of people provided improved access to drinking water supply • Number of people accessing to basic sanitation services through support to UNICEF supported interventions 26 SAVE LIVES Pillar 7: Complimentary support with Supply related to case management Objectives: • To complement WHO and other partners’ interventions with provision of equipment and COVID-19 testing capacity in isolation units Anticipated partners: UNICEF Supply Division, WHO Performance Indicators • Number of persons protected by PPE and period of protection • Number of oxygen concentrators provided • Number of tests provided # Activity Budget Timeline 1 Provision of PPEs in Isolation Units 1,000,000 July - Dec 2 Provision of PCR test kits for COVID-19 500,000 May - Dec 4 Providing oxygen supply 1,000,000 July - Sept Total 2,500,000 SAVE THE SYSTEM Pillar 9: Continuity of services Objectives: • To ensure continuity of existing health and nutrition services at all levels, including mental health, psychosocial support, management of GBV, and strengthening of PSEA. • To monitor the provision of critical/priority health and nutrition services, including services for GBV and PSEA within the context of COVID-19. Anticipated partners: Decentralized authorities (GHOs/DHOs), community health workers and volunteers, facility based health workers, UNICEF, WHO Performance indicators 27 Pillar 9: Continuity of services • Number of healthcare facilities staff and community health workers provided with Personal Protective Equipment (PPE) # Activity Budget Timeline 1 Sensitization of facility and community health workers on COVID- 7,470,000 April - Oct 19 (approximately $166 per HW or $2662 per session of 16 HWs, to train a total of 45,000 HWs (15,000 facility based and 30,000 community based) 2 Provision of Personal protective equipment (PPE) 24,500,0002 April - Dec 3 Establishment of Triage 6,000,000 April - Oct 4 Provision of general use masks for people presenting with 800,000 April - Oct suspected COVID -19 cases at facilities and in child focused public institutions- schools 5 Provision of technical assistance to 4000 health facilities to ensure 3,280,0003 August - ongoing quality services Dec Total 42,050,000 2 This figure includes $21 million for the cost of PPE to be procured, plus $3.5m for freight. The freight charges will also cover procurement of oxygen and isolation unit supplies. However, it is not possible to split these charges at the budgeting stage so all freight for the CERC is included here. Note also that the PPE is to cover 18 months, but procurement will be done during the course of the year by December 2020. 3 The contract for the third party firm and the technical assistance provided will last for one year. 28 Annex B: PPE NEEDS FOR DIFFERENT CADRES OF WORKERS ISOLAT CHWs Hospital staff Campaign PHC Item description (medical Hygienists Triage and CMWs providing staff staff staff) CHVs MNCH services Apron protection, plastic, disposable, thick. 20 um, pack- 100 X X x Apron protection, polyester, reusable, 300g/m2, white, pack-10 x x x Boots, rubber, pair X x Face shield, clear plastic, disp., box-200 x Gloves protection, heavy duty, nitrile, green, cat iii X x x Gloves, examination, nitrile x x x x X x x Gloves, surgical, latex, s.u., sterile, pair x X x x Goggles protective, wraparound, soft frame, indirect vent., box-100 x X x x 29 ISOLAT CHWs Hospital staff Campaign PHC Item description (medical Hygienists Triage and CMWs providing staff staff staff) CHVs MNCH services Gown, aami level 3, non sterile, disp. x X x x x x Mask surgical, non sterile, x (for x (for pz) disp., 3 ply, pack-50 susp) x x X x x Mask surgical, type iir, level 2, s.u, non sterile, earloop, size x X x m, box-120 Respirator, mask, n95 (safetyware 3280), s.u., x X duckbill, box-100 x Set, tunic + trousers surgical, woven, reusable, green X x Protective Outwear (disposable, splash resistant for Non-hazardous Aerosols (sprays), Non-hazardous Liquids, General Industrial Clean-up and Processing) Hand sanitizer x x X x x 30 Annex C: CURRENT GAPS IN PPE 31 32 Annex D: TRIAGE SOPS Overview of Triage in Non-COVID-19 Health Facilities Triage is the process of sorting patients when they arrive at a health facility, initially for the purpose of assessing if they have coronavirus disease 2019 (COVID-19). If patients are not suspected to have COVID-19, triage will further determine the patient flow within the health facility so they may have access to essential health services, such as nutrition, vaccination, and antenatal care. However, if they are suspected to have COVID-19, they should not enter the facility. Instead, suspected COVID- 19 patients must be referred to a COVID-19-designated health facility, such as isolation center or isolation unit, depending on severity of their symptoms. Triage and appropriate referral of patients is intended to prevent COVID-19 transmission in non-COVID-19 health facilities. This brief provides the minimum standards and SOP for triage. Terminology Asymptomatic cases: Patients who do not display any clinical signs or symptoms Mild cases: Uncomplicated upper respiratory tract viral infection; people may have non-specific symptoms such as fever, fatigue, anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache. Elderly people and people with immunosuppression may present with atypical symptoms. Moderate cases: Adult: Pneumonia but no signs of severe pneumonia. Child: cough or difficulty breathing and fast breathing (age < 2 months, ≥ 60 breaths/min; age 2–11 months, ≥ 50 breaths/min; age 1–5 years, ≥ 40 breaths/min) and no signs of severe pneumonia Severe cases: Adult: Fever or suspected respiratory infection, plus one of: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air. Child: cough or difficulty breathing, plus at least one of the following: central cyanosis or SpO2 < 90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions. Also fast breathing (in breaths/min): see under moderate cases above. Critical cases: Patients with acute respiratory distress syndrome, sepsis and/or septic shock Minimum Standards Structure and location: The first preference is a well-ventilated tent structure outside of a health facility as close as possible to the main entrance of the health facility in order to centralize all entrances. Choose an area that has good access for patients, visitors, and staff where security can be guaranteed while at the same time, a set up of a unidirectional flow for all patients and visitors accessing the health facility is possible. Ideally, there should be a divider to create individual booth. If this is not possible, place chairs 2 meters apart (Annex 1) Avoid all flood areas and stay at least >30 33 meters away from rivers or other bodies of water. The floor should be flat and level and be made with concrete or reinforced concrete. Referral mechanism: A referral mechanism must be in place to transport the patient to a COVID-19 isolation center or unit depending on severity of patient’s condition. Asymptomatic, mild and moderate patients should be referred to isolation center. Severe and critical cases should be referred to isolation units. (Annex 2) Equipment and supplies: See Annex 3 Personal protective equipment: Activity Hand Medical Gown Goggle Gloves hygiene mask Suspected case of COVID-19 ≥ 2-meter x X X assessment Suspected case of COVID-19 <2-meter x X x x X assessment Cleaning x X x x X Screening and Triage: Step-by-step procedures (Figure 1) 1. At the first point of contact of a health facility, take temperature of all individuals using a handheld thermometer gun and screen all individuals for possible COVID-19 using the established case definition. If the individual meets the case definition, he/she becomes a suspected case. If the individual does not meet the case definition, he/she is not a suspected case and should receive routine care. If the individuals arriving must wait to be screened, at least 2-meter distance should be kept between individuals arriving at the health facility. Case definition (as of 20 March 2020): A. A patient with acute respiratory illness (fever of ≥38⸰C and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset; OR B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset; OR C. A patient with severe acute respiratory illness (fever of ≥38⸰C and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation. 2. Suspected case should immediately be given a mask and isolated in a separate area, ideally in an isolation room if available. At least 2-meter distance should be kept between suspected 34 patients and other patients. (Annex 1). Suspected patients will wait in a separate area/room until they are transferred to a COVID-19 health facility (i.e., isolation center or isolation unit). Apply appropriate infection prevention and control precautions to prevent spread of illness to health care workers and other patients. 3. Call the rapid response team for the investigation of the suspected cases and arrange transportation so they can be transferred to a COVID-19 isolation center or isolation unit. (Annex 2) 4. Triage the patients who are not suspected of being infected with COVID-19, using a standardized triage tool to ensure reliability and valid sorting of patients, such as the Interagency Integrated Triage Tool. 5. The patients will proceed to care according to the instructions from the triage nurse. Instruction to Patients • Wear a mask if patient has fever or respiratory symptoms upon arrival or is a contact of a confirmed COVID-19 case • Cover nose and mouth during coughing or sneezing with tissue or flexed elbow and perform hand hygiene after contact with respiratory secretions • Stay at least 2 meters away from other patients • Restrict the number of family members accompanying patients at the health facility. 35 Figure 1. Flow Chart of Screening and Triage Process Infection Prevention and Control Considerations Standard precautions should always be applied in all areas of health facility, including triage. Standard precautions include hand hygiene and the use of personal protective equipment (PPE). Safe waste management, cleaning and disinfection of equipment, and cleaning of the environment are also important practices to keep the health facilities safe for health workers and patients. Hand hygiene Regularly perform hand hygiene. Hand hygiene includes either the use of an alcohol-based hand rub product or washing with soap and water. Alcohol-based hand rubs are the preferred option if hands are not visibly soiled. Hands should be washed with soap and water whenever they are visibly soiled. It is important to ensure environmental cleaning and disinfection procedures are followed consistently and correctly. Thoroughly cleaning environmental surfaces with water and detergent and applying commonly used hospital-level disinfectants such as (0.5%) solution of sodium hypochlorite and keep area wet for 10 minutes. Consider emphasizing regular cleaning of high- contact areas such as door handles, benches and gate. 36 WASH Provision of safe water and sanitation services in PHC to maintaining the operational services of health facilities. It is also important to ensure availability of latrines for patient male and female and for staff male and female. PPEs Healthcare workers should wear a medical mask, gloves, goggles/face shield, and gown when entering a room where suspected patients isolated. PPE should be removed when leaving the room. Health workers must immediately practice hand hygiene after PPE removal. Direct and indirect contact Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially contaminated gloved or ungloved hands. Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handles and light switches). Perform hand hygiene. Routinely clean and disinfect patient-contact surfaces. Environmental surface cleaning and disinfection The environment must be thoroughly cleaned by applying the following general principles. The list of disinfectants effective against SARS-CoV-2 in required concentrations is given in Annex 4. • Cleaning consists of the removal of dust, soil, and contaminants on surfaces and ensures a dry, hygienic and healthy environment for patients, staff, and visitors. • Cleaning is an essential step prior to any disinfection process as it removes dirt, debris and other materials, which decrease the effectiveness of chemical disinfectants. • The use of neutral detergent solutions is essential for effective cleaning. • Special attention should be given to sanitation or toilet facilities as these are often areas that are heavily contaminated and reservoirs for healthcare-associated infections. 37 Examples triage layout Example of waiting room and triage within a tent with a surface >100m2 38 Example of waiting room and triage within a tent with a surface ~45m2 Small tents allow more flexibility in term of capacity, as installing more tents to increase the waiting room capacity or to install a second triage tent could be easily done. Internal separations and screens may be put in place with wooden frames folded with washable plastic sheeting. The transparent surface for triage could be replaced with a two-meter distance properly marked such as a double 1,1-meter-high fence. Small tent can be used as well for waiting room as shows below where a standard 45 m 2 tent is divided into 10 individual booths for patients waiting to access the triage. 39 Patient Referral Pathway 40 Minimum required resources Equipment and supplies Plain soap, hand sanitizer Medical masks Displayed protocols for hygiene Gowns and aprons Single use gloves for health workers Clinical waste bags Infrared (no contact) thermometer Reusable gloves for environmental cleaning Sprayer machine for disinfection of General waste collection bins with two wheels, 110 floors litre Autoclave (100 litre capacity) Multipurpose trolleys (for brooms, mops, etc.) Sodium Hypochlorite Ethanol/isopropyl alcohol Human Resources Nurse (1 per shift) Cleaning staff (1 per shift) 2 staff for maintaining the patient flow Disinfectants Antimicrobial agent Concentration Ethanol 70% Sodium Hypochlorite 0.1-0.5% 0.05-0.1% Povidone-iodine 10% (1% iodine) Glutaraldehyde 2% Isopropanol 50% Bezalkonium Chloride 0.05% Sodium Chlorite 0.23% Formaldehyde 0.7% 41 Annex E: SOPs on IPC in PHCs Standards Procedures for Referral Pathway and Triage in Primary Health Care Setting for Infection prevention and control during health care in the context of COVID-19 The goal is to minimize the transmission of COVID_19 among patients in Primary health care settings by establishing or reinforcing screening and triage at all points of access in primary health care centers, clinics, and ad hoc community settings and also to establish a referral for suspected cases with identification of the nearby treatment center. Screening and triage are critical at health facilities to prevent transmission so that patients continue to safely require access to essential health services, including nutrition, vaccinations, antenatal care, medication refills and management of other communicable and non-communicable diseases. IPC protocol will be adhered to prevent or limit infection transmission in health-care settings I. Risk Communication for restriction of patient inflow If possible, inform the population that screening procedure will take in place at the health facility; this requires sending messages out to the community using traditional and social media. Hotlines has been established by the MOPHP (hotlines: Aden 02358259/02358260 and Sana’a 01255942/01255952) inform the populations and patients should call or text the hotlines if they are seeking care for respiratory symptoms. Inform patients of preventive measures to take as they seek care (e.g. wearing a mask, having tissues to cover cough/sneeze) if they have respiratory symptoms. II. In the reception Area Prevent overcrowding in waiting areas keeping at least 1-meter distance between everyone IF possible, the reception should be covered by a glass screen to protect the health worker from contamination. He will direct the patient to screen and triage area Screening and Triage area: Trained staff should conduct screening. Ensuring triage, early recognition and source control Post well cultural understood signs in waiting areas to instruct symptomatic patients to alert health care workers. This should be easily understood by persons with low literacy levels Screen all patients and visitors presenting to the primary health center (PHC), including those presenting for antenatal, vaccine, TB, HIV, and other routine services allowing early recognition of possible 2019- nCoV infection and immediately isolate patients suspected with COVID-19 in an separate area from other patients (source control). Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow and perform hand hygiene after contact with respiratory secretions. Limit patient movement within the institution 42 Instruction for patients suspected to have COVID-19. Give suspect case patient mask and direct him to the appropriate area. Keep at least 1 m distance between suspected patients. They should wait in an isolation room to referred accordingly. Restrict the number of family members in the waiting area for suspected COVID-19 cases. Avoid the movement and transport of patients out of the room or area unless medically necessary. Ensure health- care workers who are transporting patients wear appropriate PPE and perform hand hygiene Contact quickly the referral system (hotlines) for the Rapid response team (RRT) for suspected cases Continue performing hand hygiene. Hand hygiene includes either the use of an alcohol-based hand rub product or washing with soap and water. Alcohol-based hand rubs are the preferred option if hands are not visibly soiled. Hands should be washed with soap and water whenever they are visibly soiled. It is important to ensure environmental cleaning and disinfection procedures are followed consistently and correctly. Thoroughly cleaning environmental surfaces with water and detergent and applying commonly used hospital-level disinfectants such as 100% solution of sodium hypochlorite and keep area wet for 10 minutes. Consider emphasizing regular cleaning of high-contact areas such as door handles, benches and gate. Screening area specifications: Ensure the screening areas have adequate ventilation. Establish if possible, posts with a roof. A space of at least 1 meter should be maintained between all patients and/or visitors and between patients and health care workers. If possible, individual seating should be used and Keep at least 1 m distance each. Or respect this distance if using benches HWs in the screening area should respect patient dignity and avoid stigmatization Equipment needed for screening staff as well as any other staff working in the screening areas or inside the PHC: Alcohol-based hand rub. Medical masks. Tissues for patients to cover their mouth/nose when coughing or sneezing. Bins/waste receptacles with lids for disposable tissues. GUN thermometers. Patient mask for suspected cases III. Health facility units and OTP and TSFP Areas Because of the asymptomatic cases, standard precautions should always be applied in all areas of health centers unit. standard precautions include hand hygiene and the use of personal protective equipment (PPE) when in indirect and direct contact with patients’ blood, body fluids, secretions (including respiratory secretions) and non-intact skin. Standard precautions also include prevention of needle-stick or sharps injury; safe waste management; cleaning and disinfection of equipment; and cleaning of the environment. 43 Provision of safe water and sanitation services in PHC to maintaining the operational services of PHC units. Also ensure availability of latrines for patient male and female and for staff male and female. In addition to standard precautions, health care workers should do a point-of-care risk assessment at every patient contact to determine whether additional precautions (e.g. droplet, contact) are required. Droplet precautions prevent large droplet transmission of respiratory viruses. When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection (face mask or goggles), because sprays of secretions may occur. Use medical masks. Use eye and facial protection if possible (goggles, face shield). Wear clean, nonsterile, long-sleeved gowns. Wear single-use gloves. If possible, place patients in separate post, or group together those with the same etiological diagnosis. If an etiological diagnosis is not possible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation. Contact precautions prevent direct or indirect transmission from contact with contaminated surfaces or equipment. Use PPE: medical mask, gloves eye protection, and gown if possible when entering room where suspected patients are and remove PPE when leaving and practice hand hygiene after PPE removal. Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially contaminated gloved or ungloved hands. Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handles and light switches). Perform hand hygiene. Routinely clean and disinfect patient-contact surfaces. 44 SCREENING and TRIAGE AREA DIAGRAM Health worker with mask and gloves screen all patients and visitors for COVID_19 based on WHO case definition using the screening form and their reasons of visiting the health center and direct them COVID 19 Suspected/Probable Area A: NOT COVID_19 Suspect Cases case Provide mask to patient if available coming for routine care ✓ Provide instructions to patient for respiratory and hand hygiene precautions ✓ Send the patient to the isolation room in Area B ✓ Send for routine care in the relevant unit ✓ Or send home if not seeking care ✓ Isolate patient in Area B respecting at least 1meter distancing ✓ Call quickly the Hotline or Notify the hospital infection control program and other appropriate staff or the referral team to take care of the patient Health care unit ✓ Because of asymptomatic case, HW COVID_19 Positive should apply all precautions ✓ Waiting areas in all health center COVID_19 Refer positive cases to units should have individual seat Negative isolation center with at least 1-meter distance or benches following the same rules Provide RUTF to based on MOPHP guidelines children coming for nutritional status follow up Isolation Units or Centers 45 TRIAGE AND SCREENING QUESTIONNAIRE IN PRIMARY HEALTH CARE SETTING Hotlines: Aden 02358259/02358260 and Sana’a 01255942/01255952 Governorate.…………………………. District………………………………. PHC name ………………… I. Patient information Age (years)…………….. If less than one year in month ……………. If less than one month in day………… Sex Male /……/ Female /……/ Reason of visiting the hospital …………………………………………………………………………………. Respect at least 1-meter distance between all patients and between health workers and the patient and Take the temperature with Gun thermometer II. Does the patient respond to one of the case definitions below? ➢ Suspect case A. YES NO 1.A patient with acute respiratory illness (fever (>38°C) and at least one sign/symptom of respiratory disease, e.g., cough, sore throat, shortness of breath dyspnea, nasal congestion, or headache ..), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset; OR 2. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of contact4) in the last 14 days prior to symptom onset; OR 3. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath…; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation. ➢ Probable case 1.A suspect case for whom testing for the COVID-19 virus is inconclusive5. OR 2. A suspect case for whom testing could not be performed for any reason ✓ If yes in one of the suspected or probable definition, immediately provide a mask to the patient, instruct him on hand and respiratory hygiene and isolate him. ✓ Quickly notify the hospital infection control program and other appropriate staff or call the hotline for procedures to be taken. If a suspected child is 6 to 59 months, assess his nutritional status with a MUAC Tape before referring. MAM = 115< MUAC < 125 mm Yes /…./ No /…./ SAM, MUAC < 115mm Yes /…../ No /…./ 4 A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case: 1. Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes; 2. Direct physical contact with a probable or confirmed case; 3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment; 2OR 4. Other situations as indicated by local risk assessments. Note: for confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was taken which led to confirmation. 5 Inconclusive being the result of the test reported by the laboratory. 46 Reference Reference World Health Organization: Operational considerations for case management of COVID_19 in Health facilities and Community: Interim Guidance 19 March 2020. World Health Organization: Severe Acute Respiratory Infection Treatment Center: Practical manual to set up and manage a SARI treatment center and a SARI screening facility in health care facilities. March 2020 World Health Organization: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance13 March 2020 V 1.2 Resolve to Save lives, Vital Strategies: Tools for Primary Health Care Centers COVID-19 — APRIL 2020. World Health Organization: Global surveillance for COVID-19 caused by human infection with COVID-19 virus Interim guidance 20 March 2020 World Health Organization. Patient Safety. The world alliance for safer care. WHO Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge Clean Care is Safer Care. World Health Organization 2009. ECDC TECHNICAL REPORT Infection prevention and control for COVID-19 in healthcare settings - first update. 12 March 2020 47 Annex F: Comments received during consultation on the CERC-ESMF All comments received are summarized in the table below: Comment from Comment How addressed PMU General Some suggested changes to the indicators proposed: Director – Urban Water • Number of people with access to improved and Not changed as these have Supply and safe drinking water in targeted areas (to be already been agreed with Sanitation deleted, duplicated indicator) the WB after extensive Project • Number of people with access to improved discussion sanitation in targeted areas (to be deleted, duplicated indicator) • Additional number of people added to the sanitation system through the rehabilitation activities • Number of people and isolation units provided improved access to drinking water supply • Number of people and isolation units provided basic sanitation services through UNICEF supported interventions PMU General • To focus more on the associated impact of the socio- Addressed, through Director – economic aspects, pollution, health and safety inclusion of updated table Urban Water including occupational health resulting from the related to risks and Supply and proposed water and sanitation interventions and mitigation (see Table 2) Sanitation suggest best practice to mitigate them. Project PMU General • Managing COVID 19 risks on construction sites to Noted. The site specific ES Director – keep workers and engineers safe all the time. instrument will contain site Urban Water specific COVID—19 infection Supply and measures and clauses. Sanitation Project Yemen WHO • The abbreviation table is not matching the content of Noted and updated Safeguards Team ESMF, several abbreviations in the table are not included in the content and vice versa such as: INGOs, M&E, HFs, …etc Yemen WHO Added in the relevant Safeguards Team Suggest adding the below under the World Bank Requirements: guidelines and will also keep these in mind when engaging in Other World Bank Group Environmental, Health and Safety the screening and the Guidelines (EHS Guidelines) relevant to the project are: implementation • Technical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, issued on March 20, 2020 48 • ESF/Safeguards Interim Note: COVID-19 Considerations in Construction/Civil Works Projects, issued on April 7, 2020 • Technical Note on SEA/H for HNP COVID Response Operations, issued in March 2020 • Interim Advice for IFC Clients on Preventing and Managing Health Risks of COVID-19 in the Workplace, issued on April 6, 2020 • Interim Advice for IFC Clients on Supporting Workers in the Context of COVID-19, issued on April 6, 2020 • IFC Tip Sheet for Company Leadership on Crisis Response: Facing the COVID-19 Pandemic, issued on April 6, 2020 • WBG EHS Guidelines for Healthcare Facilities, issued on April 30, 2007 • Good International Industry Practice (GIIP) such as WHO technical guidance developed for addressing COVID-19 also apply to the Project. WHO resources include technical guidance on: (i) laboratory biosafety, (ii) infection prevention and control, (iii) rights, roles and responsibilities of health workers, including key considerations for occupational safety and health, (iv) water, sanitation, hygiene and waste management, (v) quarantine of individuals, (vi) rational use of PPE, (vii) oxygen sources and distribution for COVID-19 treatment centers Yemen WHO Noted, Civil works is now Safeguards The Environmental and Social risk / impacts and included in Table 2 Team mitigations of the activity (Repair of damaged public buildings, including schools, hospitals and administrative buildings) neither mentioned nor included in the identification and mitigation of risks within the document. Yemen WHO This is noted. The CERC Safeguards The identification of beneficiaries and selection criteria targets all functional HFs in Team of the supported facilities is not mentioned within the Yemen, approximately 4000. ESMF. Suggest adding the selection criteria and mitigations for the associated risks. Yemen WHO We will be using the existing Safeguards Team Screening form for potential E&S risks is not included. Suggest screening form from the YEHNP adding the screening form as annex so determination of the with the necessary revisions for required instruments could be feasible. the CERC Yemen WHO This has been reviewed and Safeguards Monitoring frequency, quarterly, is not efficient for civil the table (table 2) has been Team works as well as the other supported activities. Suggest revised to monthly, as that daily monitoring frequency for civil work and includes is more appropriate. 49 increased monitoring frequency for other supported activities. Yemen WHO Noted. As these were included Safeguards Team None of the annexes is referenced in the ESMF content. by the WB, we have left these Suggest adding them in the relevant contents or parts of the as is ESMF. Yemen WHO Now added Annex E: SOPS ON IPC IN PHCs Safeguards Team This annex is not available within the ESMF although mentioned in page 19 Yemen WHO Noted and we have tried to Annex C: CURRENT GAPS IN PPE Safeguards Team make the content easier to read The content is not clear Yemen WHO The WB in their comments did ESMF implementation budget is not included. World Bank team Safeguards Team not request this specifically so it might request provision of such and include it in the ESMF. has not been added Yemen WHO We do not anticipate any Risks and impacts of the storage and transportation of good Safeguards Team significant risks are associated and supplies is not mentioned in the ESMF. Mitigations for such with this -the original YEHNP needs to be addressed. ESMF still applies and will cover this Yemen WHO This was not requested by the Stakeholders engagement activities and procedure not Safeguards Team WB included in the proposed ESMF. Yemen WHO Other social risks need further details and mitigations: Noted. Have addressed the Safeguards • Social tensions due to concerns about infection relevant risks and mitigation Team spread to the communities in the vicinity of the HCFs, measures in Table 2. quarantine centers, etc. • Risks of pathogen exposure, infection and associated illness, death, for workers engaged in carrying out the testing, transporting samples, delivering training, etc • Discrimination in relation to recruitment, hiring, compensation, working conditions, terms of employment, etc .. • Stigma and passing on infections to family and community • Discrimination in relation to recruitment, hiring, compensation, working conditions, terms of employment, etc. • Absence of a mechanism to express grievances and protect rights regarding working conditions and terms of employment Project Manager, After schools are closed due to the Corona epidemic, Noted, this is a programmatic National schools now need, after opening them, to provide health- intervention Organization for enhancing resources to encourage students to return Health safely after the interruption and for education, as most Development schools in Taiz Governorate lack a school clinic that (NGO) 50 contains the minimum requirements in addition to the sanitation facilities in schools, as they are dilapidated and not There are points in schools for providing safe water, as well as health-promoting programs in schools that include behavioral change and information materials Project Manager, Allocating support for infection control programs, Noted. IPC is a key component National especially in hospitals and health centers, including the of the CERC Organization for establishment of integrated infection control units from Health training, rehabilitation, awareness, and information to Development the provision of all vital safety equipment and supplies (NGO) and the safe disposal of medical waste. Cholera or Corona epidemic and others. Project Manager, I hope that our observations will be successful in Noted. IPC in HFs is a key National identifying priority proposals. Supporting programs that component of the CERC Organization for integrate education and health-promoting programs are Health the greatest means of combating poverty in any society. Development In addition to fighting the enemy in health institutions, (NGO) which has become a great danger threatening our society due to the scarcity of resources allocated to these programs and the lack of knowledge and awareness among health sector workers and members of society. Executive The plan focused on the two most important aspects, Noted Director, namely health and nutrition, as well as water and Generation environmental sanitation, which are the two most without Qat important areas we need in light of the response to any (NGO) emergency. Executive But as I mentioned the risks that have an environmental The need for quick action is Director, and social impact, and these risks will continue in the noted Generation event of a delay in the speed of the emergency without Qat response, which will be important for the displaced and (NGO) displaced from their homes due to natural disasters such as floods and others, or due to displacement from war. Executive Focusing on speeding up the rehabilitation of the water This is noted and some Director, network in general and the supplies, which will solve the activities in CERC are related to Generation biggest problem that threatens the displaced and WASH rehabilitation without Qat residents if the use of wards to deliver water is (NGO) dispensed with. Executive Focusing on awareness-raising and community The CERC will use a variety of Director, mobilization through different media to enhance communication channels and Generation awareness among people and use awareness-raising means to communicate GRM, without Qat methods such as flashes and short videos. project activities etc. (NGO) 51 Executive - Ensure that the supplies, such as bags and other items, Noted Director, are provided before the start of the project and not Generation after the end of the project. without Qat (NGO) Executive - Intensifying the training process for community SEA/SH will be an important Director, committees, which have a primary role in educating part of this project (as well as Generation society, especially the committees run by women, to YEHNP). Capacity building and without Qat ensure the safety of the beneficiaries from harassment consultation will be part of the (NGO) CERC. We will focus on various and sexual exploitation. vulnerable groups, including women Executive Pre-preparation and awareness of the community about Noted and this is planned Director, the use of the complaints mechanism. Generation without Qat (NGO) Senior Program Can women be engaged in making the masks, sanitisers, This is a programmatic issue Advisor, Atanweer soaps, etc? This way, it will be possible to generate Development employment and women will benefit Foundation Senior Program Rehabilitation of infrastructure too can be done through As above Advisor, Atanweer the CFW modality Development Foundation Senior Program So far the lockdown in Yemen is not a total lockdown. This is not part of the CERC Advisor, Atanweer But if such a case arises, there should be some amount Development allocated for providing ambulance services to people Foundation who are in critical need. Because people around the world have died because they just could not get to the hospitals Senior Program Another point is about additional beds. Some amount This is not part of the CERC. We Advisor, Atanweer should be kept for opening additional isolation units. believe that the WHO managed Development COVID 19 project has addressed Foundation this issue MWE Advisor While discussing the protocol for Yemen and whether Noted and hand washing is a Engineer such a protocol had been developed in accordance with key component of the CERC the specificity of Yemen for the purposes of combating Availability of water is a key COVID 19. Of course, with my knowledge that a general component of the CERC protocol was drawn up by the WHO, but in fact I followed how the actions were done to combat COVID 19 in different countries, for example in the Arab countries, the experience of Jordan and Tunisia was effective, and in Spain different from Italy, Britain and America and each had its own experience, and Yemen has its own experience as well. However, the issue of hygiene and hand washing was at the top of all protocols 52 Here, as long as cleanliness is in the foreground, I only preferred to share my experience during the past period during the pandemic, and I list it as follows I had a demand cycle for water supply at home every three days before the pandemic, and the quantity met the need for this period without any shortage. During the pandemic, this quantity became sufficient for a day and a half or two only, and there was a shortage in the quantity as a result of the use of adherence to the part of the protocol related to hand washing and hygiene in the sense that the water by 30% decreased and no longer met the need according to the schedule of use, and also I asked some colleagues and they had the same problem. Long enough MWE Advisor This is a lesson learned on a personal level. But is it Availability of water is a key Engineer possible to benefit from this lesson in the future at the component of the CERC general level, so that in the upcoming plans, focus is on increasing the quantities of water as a priority, and thus benefiting from the available funding, so that it is devoted to water sources by raising the efficiency of operation through allocating more funding for this purpose in particular. MWE Advisor I suggest that the institutions be asked to conceptualize Engaging authorities is a key Engineer their need to raise the operating efficiency of water part of the CERC resources and discussed this matter with the authorities that will finance the operations so that water resources will be an operational focus of top priority in the upcoming implementation programs to confront COVID 19 and agree on this in particular and here the impact will be greater in terms of beneficiaries and combating. 53