Tajikistan Emergency COVID-19 Project Stakeholder Engagement Plan (SEP) 1. Introduction 1. Tajikistan is a low-income country and despite notable accomplishments in poverty reduction, a large proportion of the population remains vulnerable to poverty and shocks. Tajikistan has a population of 8.92 million. 1 From 2000-2015 the country had an average economic growth rate of 7.7 percent annually and saw dramatic reductions in the poverty rate, from 80 to 31 percent. Yet Tajikistan also had the lowest Gross National Income (GNI) per capita (US$990 in 2017) in the Europe and Central Asia (ECA) region. The main drivers of Tajikistan’s economy are remittance inflows (one-third of the country’s gross domestic product (GDP), cotton and aluminum exports, official development assistance inflows, and in recent years, substantial levels of public investment. Seventy-three percent of the population is rural and heavily reliant on agriculture: these areas are typically significantly poorer than urban settings, with higher income insecurity during winter and spring months. 2. The country is socially vulnerable and fragile, and issues such as food insecurity are compounded by the country’s geography. Fragility risks include the legacy of the 1992-97 civil war, persistent poverty pockets in lagging regions, income insecurity, unemployment and security risks from the border with Afghanistan, where there is currently an outbreak of Covid-19. In addition, service delivery to most Tajiks is challenged by a mountainous terrain, which accounts for 93 percent of the landlocked country. Many households in Tajikistan live precariously close to food insecurity. In 2019 more than 10 percent of households reported an inability to buy enough food, and more than 20 percent having skipped at least one meal over the preceding month due to a lack of money or other resources according the recent Listening to Tajikistan survey. The poverty rate among children is structurally higher than among adults, and the country struggles with elevated rates of stunting. 3. Tajikistan is land locked country, and it borders with Uzbekistan, Kyrgyzstan, China and Afghanistan. It borders with China in Murghob District, Gorno-Badakhshan Autonomous Region (GBAO). It is 477 km in length and runs across various mountain ridges and peaks of the Pamir range down to the tripoint with Afghanistan. The Kulma pass is the only border crossing between China and Tajikistan. It opened in June 2014 as a standard international border crossing; however, it is temporarily closed due to the COVID-19 outbreak. Airline connections to China are also closed. Khatlon and GBAO Regions of the country share a 1,400-kilometer border with Afghanistan. The border runs from the tripoint with Uzbekistan in the west to the tripoint with China in the east, almost entirely along the Amu Darya, Pyanj and Pamir rivers, except for the eastern-most section along the Wakhan Corridor. There are seven border crossings with Afghanistan, which currently remain open. 4. Food insecurity and the remittance base of the Tajik economy increase the risk of COVID-19 having a significant, negative economic impact, and informal estimates from the IMF point towards a 1.6% reduction in economic growth in 2020. The Tajik economy has been impacted by this shock given its close relations with China and additional negative impacts on growth projections, fiscal and debt sustainability are anticipated. In addition, an upward inflationary pressure is expected from a planned electricity increase of 15 percent this year and the supply shock from a shortfall in Chinese imports. These short- term pressures will compound structural weaknesses. Tajik migrants living in Russia are the source of more than 90 percent of remittance income in Tajikistan, and the rapidly deteriorating economic prospects in Russia linked to falling oil prices, fears of the Covid-19 outbreak spreading, and exchange rate volatility are severe risks to economic stability. Remittances are highly targeted to the poorest regions and districts of the country, and declining income from remittances and in the absence of a quick recovery 1 Official data of the Agency on Statistics under the Government of Tajikistan (GoT), 2018. 1 will lead to rising incidence and depth of poverty. These challenges are compounded by a high prevalence of food insecurity. In 2019 more than 10 percent of households reported an inability to buy enough food, and more than 20 percent having skipped at least one meal over the preceding month due to a lack of money or other resources according the ongoing Listening to Tajikistan survey. 5. The WHO assessment of Tajikistan’s operational readiness for preventing, detecting and responding to a public health emergency was amongst the lowest in the region (scoring 2 out of 5), indicating the country’s vulnerability to COVID-19. The WHO has assessed National Outbreak Preparedness Plans and compliance with International Health Regulation activities of preventing, detecting, and responding to a public health emergency. Recognizing these challenges, the GoT has begun to mobilize a pandemic preparedness response. A standing headquarters on outbreak prevention and containment has been established. The National Public Health Laboratory has been designated as a reference laboratory for COVID-19 testing, and the laboratory is equipped with some analysis kits and is staffed by WHO-trained specialists. Fourteen facilities (healthcare facilities and a sanatorium) have been prepared and assigned to host quarantined and suspected cases. MoHSP, in collaboration with other national and international agencies, has established a working group for the development of the coronavirus emergency response plan (ERP). The World Bank is currently engaged in financing an Emergency Project in Tajikistan. 2. Project Description 6. The Tajikistan Emergency COVID-19 Project aims to strengthen the Government of Tajikistan’s capacity to be prepared to respond to the COVID-19 outbreak. 7. The Tajikistan Emergency COVID-19 Project comprises the following components: Component 1. Medical Supplies, Equipment and Minor Infrastructure Works for Facility Repurposing [US$5.5 million]: This component will finance the procurement of medical supplies and equipment needed for activities for emergency response such as: case detection, management and reporting; infection prevention and control; and, facility repurposing and surge capacity for treatment. Items procured will include: (i) drugs and medical supplies for case management and infection prevention; (ii) equipment, reagents, testing kits, and consumable supplies for laboratories; and (iii) equipment and refurbishment for establishment of up to 10-bed intensive care units (ICU) across Tajikistan (locations to be determined). Component 2: Multisectoral response planning and community preparedness [US$1 million]: This component will finance the coordination, planning and community engagement aspects of emergency response. These activities include: (i) the development of a multisectoral task force and support to national, regional and district bodies in mobilizing effective response activities; (ii) communication activities, across multiple channels, including a hotline coordinated by the MoHSP, and working with religious leaders for end of life practices; (iii) the development and dissemination of communication materials; (iv) training of media outlets on emergency response procedures; and (v) training of community workers training at the Center for Health Lifestyles in Dushanbe.. Component 3 – Temporary social assistance for food insecure households [US$3.75 million]: This component will finance a targeted social transfer mechanism to support vulnerable groups, across 68 districts, from economic shocks and food insecurity for six months. This will be provided as an extension of the existing Targeted Social Assistance (TSA) program, through the National Agency for Social Protection (NASP) under the MoHSP. The current infrastructure for the TSA includes an additional module 2 to allow for ad-hoc payments in emergency situations and the eligibility criteria can be flexed to target vulnerable communities that are expected to be most affected by the coronavirus. This includes female- headed households and those reliant on remittance payments. In addition to the transfer, this component will also support an awareness and enrolment program through district social protection offices and jamoats, following the current TSA model. Component 4. Project Implementation and Monitoring [US$1.0 million]: Implementing the proposed Project will require administrative and human resources that exceed the current capacity of the implementing institutions. For this reason, bbuilding on the existing strong project management capacity is critical for rapid implementation and scale-up of project activities.2 The MOHSP will receive professional implementation and project management support, including for procurement and financial management (FM), from a designated new Project Implementation Unit (PIU). The core of the new PIU will be formed from the team of the well-functioning Project Implementation Unit of the Tajikistan Social Safety Nets Strengthening Project (SSNSP), which is closing on June 30, 2020. This component will also support the evaluation of project activities. Activities include: (i) support for procurement, financial management, environmental and social safeguards, monitoring and evaluation, and reporting; and (ii) operating costs. 8. The Tajikistan Emergency COVID-19 Project is being prepared under the World Bank’s Environment and Social Framework (ESF). As per the Environmental and Social Standard ESS 10 Stakeholders Engagement and Information Disclosure, the implementing agency should provide stakeholders with timely, relevant, understandable and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination and intimidation. 9. The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make complaints about project and any activities related to the project. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. 3. Stakeholder Identification and Analysis 10. Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and 2 The rationale for using the SSNSP PIU over the Technical Support Group (TSG) of the Health Services Improvement Project (HSIP), both under the same MOHSP, is as follows: (i) strong performance and sustainable team dynamic over the whole 5-year implementation period of the SSNSP under MOHSP; (ii availability of freed up staff time given approaching closing date of the SSNSP; (c) forthcoming implementation of innovative activities under second additional financing for the HSIP, which by itself would be a challenging task and put additional strains on the TSG of HSIP; and (iv) substantially weakened capacity of the HSIP TSG team owing to the recent departure of two experienced key staff: Project Officer (head of TSG) and Procurement Specialist. 3 (ii) may have an interest in the Project (‘other interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. 11. Cooperation and negotiation with the stakeholders throughout the project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e. the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the project. Rural health facilities and mahalla leaders may provide helpful insight into the local settings and act as main conduits for dissemination of the Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. Verification of stakeholder representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. 12. For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) can be divided into the following core categories: (i) Affected Parties – persons, groups and other entities within the Project Area of Influence that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; (ii) Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way; and (iii) Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status,3 and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. 3.1. Affected Parties 13. Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category: • COVID-19 infected people; • People under COVID-19 quarantine; • Relatives of COVID-19 infected people; • Relatives of people under COVID-19 quarantine; • Neighboring communities to laboratories, quarantine centers, and screening posts; • Workers at construction sites of laboratories, quarantine centers and screening posts; 3 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resourcesю 4 • People at COVID-19 risks (elderly 75+, people leaving with AIDS/HIV, people with chronic medical conditions, such as diabetes and heart disease, travelers, inhabitants of border communities, etc.) • Public health workers; • Medical waste collection and disposal workers; • Workers of large public places, including public markets, supermarkets etc.; • Returning labour migrants and laborer’s working on roads construction sites; • Airport and border control staff; and • Airlines and other international transport businesses. 3.2. Other Interested Parties 14. The projects’ stakeholders also include parties other than the directly affected communities, including: • MoHSP and its regional & local branches; • MoES and educational facilities; • MOLME and occupational safety control institutions; • Traditional media and journalists; • Civil society groups and NGOs on regional, national and local levels that pursue environmental and socio-economic interests and may become partners of the project; • Social media platforms; • Implementing agencies for the WB-funded projects working in the border regions and health improvement sector (SERSP- NSIFT, HISP -MoHSP PIU, CARs-2 -MOT/PIG, TREP- Barqi Tojik, Pamir Energy Company, REDP-MOF PIU/Tourism Committee PIG); • Other national and international health organizations (Red Crescent Society, WHO, Global Fund, Aga Khan Health Services); • Other donor organizations (UNICEF, JICA, USAID, ADB, MSF); • Businesses with international links; and • Public at large. 3.3. Disadvantaged / vulnerable individuals or groups 15. It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project and to ensure that awareness raising and stakeholder engagement with disadvantaged or vulnerable individuals or groups on infectious diseases and medical treatments in particular, be adapted to take into account such groups or individuals, particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from person’s origin, gender, age, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g. minorities or fringe groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project-related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. 16. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: 5 • Retired elderly; • People with disabilities; • Pregnant women, infants and children; • Women-headed households and/or single mothers with underage children; • Extended low-income families; • Unemployed; • School and colleges; and • Residents of public orphanages and elderly houses. 17. Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. Description of the methods of engagement that will be undertaken by the project is provided in the following sections. 4. Stakeholder Engagement Program 4.1. Summary of stakeholder engagement done during project preparation 18. Due to the emergency situation and the need to address issues related to COVID-19, no dedicated consultations beyond public authorities and national health experts, as well as international health organizations representatives, have been conducted so far. The Table below summaries the methods used to consult with key informants. Table 1. Summary of Stakeholder Consultations During Project Preparation Project stage Topic of Methods used Timetable: Target Responsibilities consultation Location and dates stakeholders Preparation Project design DCC meetings, On need basis, Development WB team, MoHSP one-on-one donor donor, Leadership meetings organizations’ international offices health organizations Sectoral and Interviews MoHSP and other Health WB Health team Institutional line agencies institutions Context management Project Discussions MoHSP Health PIU, Implementing MoHSP implementation and Social agency International arrangements Protection PIU department Community Discussions with Office of HLSC Medical Project design outreach Republican educators team approaches Healthy lifestyle center staff Hospital readiness Site visit report 3-6.03.2020 Management and WHO Consultant assessment staff of 4 hospitals Behavior Rapid Summary findings March, 2020 78 children and UNICEF Behavior Assessment adolescents Change Specialist 6 4.2. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement 19. In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns; • Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the projects is inclusive. All stakeholders at all times encouraged to be involved in the consultation process. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, including women, youth, elderly, people with HIV/AIDS and other disadvantage groups. Table 2. Summary of Stakeholder Needs and Preferred Notification Means Stakeholder group Key characteristics Preferred Specific needs Language needs notification (accessibility, large print, child means (e-mail, care, daytime meetings phone, radio, letter) Affected Parties COVID-19 infected Wide range of people Tajik, Russian, SMS messaging, Medical examination and treatment in people; that affected by COVID- English radio, phone hospitals, ad-hoc financial support to 19 low-income households with infected family member(s) People under Diverse range of people Tajik, Russian, Personal Favorable conditions to stay in COVID-19 isolated from the English instructions on quarantine facilities quarantine; community, different virus nationalities transmission methods Relatives of COVID- Frustrated family Tajik, Russian Leaflets, phone Large print outs and disseminations, 19 infected people; members and unaware special instructions from health care-givers workers, hand hygiene and PPEs Relatives of people Frightened family Tajik, Russian, Print-outs, social Information and educational materials under COVID-19 members and concerned English media group quarantine surrounding people postings, phone calls, e-mails Neighboring Concerned residents of Tajik Print outs, Awareness raising, waste management communities to local communities and information precautions, hand hygiene and PPEs; laboratories, employees of local boards; Special sessions for parents with young quarantine enterprises/ line Info sessions by children to avoid outbreaks centers, and organizations community screening posts leaders 7 Workers at Workers engaged in Tajik Print-outs, Waste management precautions, hand construction sites renovation and occupational hygiene and PPEs, safety measures of laboratories, rehabilitation of health health and safety quarantine centers facilities training and screening posts People at COVID- Discouraged elderly 75+; Tajik, Russian Info sessions by Behavior instructions for people with 19 risks suspecting people leaving community chronic diseases, ad-hoc supportive with AIDS/HIV; people leaders, health treatment for HIV/AIDS positive with chronic medical worker people, instructions on extra personal conditions, such as consultations health safety, awareness raising diabetes and heart and emergency campaigns, hand hygiene and PPEs disease; travelers, contacts inhabitants of border available, communities phones, print outs, ads, radio Public health Unprepared managers, Tajik, Russian Trainings, print Occupational health and biosafety workers; doctors, nurses, lab outs, measures, PPEs, hands-on training assistants, cleaners programs, infection control and risk management planning Medical waste Medical nurses, cleaners, Tajik Written Occupational health and safety (OHS) collection and hospital incinerators’ instructions, measures, training, PPEs, waste disposal workers; workers, waste removal trainings management plans, safe waste & transfer workers in transfer vehicles for rural health rural health houses facilities Workers of large Managers, salesmen, Tajik, Russian Written OHS measures, hand hygiene and PPEs, public places, like marketing specialists, instructions from extra safety measures, like social public markets, workers, cashiers, SES, OHS distancing supermarkets security officers trainings, social media platforms Returning labor Frustrated and forced to Tajik, Russian, Social media Initial epidemiological screening at migrants and travel laborers with English platforms, e- aircrafts and airports, medical check- laborers working relatively mid income mails, letters to ups, placement in quarantine facilities on roads Chinese and continuous monitoring. construction sites contractors working in the country Airline and border At risk employees Tajik, Russian, Extra OHS Emergency risk management skills, control staff working at the front lines English trainings, letters improved working conditions, hand with large amount of hygiene and PPEs people Airlines and other Large and diverse staff Tajik, English Letters, e-mails, Timely notices on travel bans and international alert notices at relevant timely safety actions to be transport the MOT taken from their side; increased safety businesses websites measures, extra OHS and first medical aid trainings for their staff Other interested parties MoHSP and its Implementing agency and Tajik, Russian, Letters, Requires financing for immediate regional & local coordinating unit for English meetings, e- emergency response needs (medical branches COVID-19 emergency mails, VCs supplies, equipment, staff rapid response preparedness capacity building, quality laboratories, improved quarantine centers and screening posts, enough 8 PPEs; effective community engagement and outreach); needs assistance with improvement and roll- out of the TSA and incorporation of the ad-hoc financial payments to needy households during emergencies MoES and The policy maker and Tajik, Russian Letters, Needs information and educational educational supervisor of a wide meetings, e- materials on prevention measures, facilities; network of educational mails, VCs capacity building of educators on service providers prevention measures MOLME and Employment, labor and Tajik, Russian Letters, Needs resources to contribute to occupational safety migration policy maker, meetings, e- emergency rapid response control supervisor of labor mails, VCs institutions; inspection agency Traditional media National, regional and Tajik, Russian e-mails, social Training to improve knowledge and and journalists; local newspapers, local media platforms, techniques to arrange for media and national TVs channels websites coverage of COVID-19 related emergency response procedures Civil society Non-for-profit Tajik, Russian e-mails, social Donor funding to contribute to organizations organizations on regional, media platforms, emergency response procedures national and local levels websites that pursue environment- tal and socio-economic interests and may become partners of the project Social media Users of Facebook, Tajik, Russian, social media Reliable information sources, timely platforms users; Instagram etc., active English platforms and updates on real current situation with internet users groups, special COVID-19 in the country, online COVID-19 information on how to filter false webpage to be information and fake news created Implementing SERSP- NSIFT, HISP - Tajik, Russian, Letters, Timely awareness and invitation for agencies for the MoHSP PIU, CARs-2 - English meetings, e- participation, joint action plan with WB-funded MOT/PIG, TREP- Barqi mails, VCs, their emergency response projects working in Tojik, Pamir Energy, participation in contributions the border regions REDP-MOF PIU/Tourism multisectoral and health sector Committee PIG, ECDP- task force or MoF/PIU; coordination meetings Other national, Red Crescent Society, English Letters, Frequent donor coordination meetings international health WHO, MSF Global Fund, meetings, e- to avoid duplication, mapping of donor organizations, Aga Khan Health Services, mails, VCs, list activities, synergies between donor- development UNICEF, JICA, USAID, ADB serves funded investments donors & partners Public at large Urban, rural, peri-urban Tajik, Russian, Traditional Updated and reliable information on residents, expats and English media, SMS the current situation to reduce their family members messaging, dissemination of false rumors residing in the country information boards, social media, MoHSP website Vulnerable and disadvantage groups 9 Retired elderly and Aged people of 62+, Tajik, Russian Frequent social Economic and social support from people with unable to work, physically works home social workers and ad-hoc payments, disabilities and mentally disables visits home-based family doctor people staying consultations Pregnant women, Reproductive age Tajik, Russian Community Frequent medical check-ups by family infants and women, babies of 0-18- leaders, family doctors, access to free hospital children; month age, children with doctors services and free testing at labs weak immune system Women-headed Single mothers, divorced, Tajik, Russian Community Economic support to afford the households and/or widows, abandoned leaders, family prevention and treatment costs, access single mothers wives doctors to free hospital services and free with underage testing at labs children; Extended low- The families have 6 or Tajik, Russian Community Economic support to afford the income families; more members, many of leaders, family prevention and treatment costs, access them are underaged to doctors to free hospital services and no cost lab work testing services Unemployed Labours with professional Tajik Employment Economic support to afford the skills or unskillful workers agency leaflets, prevention and treatment costs www.kor.tj Tuition waivers to obtain vocational website skills certificates Residents and Lonely and abandoned Tajik Letters to the Need funding to improve living workers of public people residing in Managers of conditions, in-house medical services orphanages and boarding schools or Houses, site visit and nutrition elderly houses houses, underpaid to assess their workers poor situation 4.3. Proposed strategy for information disclosure and consultation process4 20. It is critical to communicate to the public what is known about COVID‑19, what is unknown, what is being done, and actions to be taken on a regular basis. Preparedness and response activities should be conducted in a participatory, community-based way that are informed and continually optimized according to community feedback to detect and respond to concerns, rumours and misinformation. Changes in preparedness and response interventions should be announced and explained ahead of time and be developed based on community perspectives. Responsive, empathic, transparent and consistent messaging in local languages through trusted channels of communication, using community-based networks and key influencers and building capacity of local entities, is essential to establish authority and trust. 21. In terms of methodology, it will be important that the different activities are inclusive and culturally sensitive, thereby ensuring that the vulnerable groups outlined above will have the chance to participate in the Project benefits. This can include household-outreach and information boards at the village level, the usage of different languages, the use of verbal communication (audio and video clips, pictures, booklets etc.) instead of direct verbal contacts. 22. The project will thereby have to adapt to different requirements. While country-wide awareness campaigns will be established, specific communication around borders and international airports, as well as quarantine centres and laboratories will have to be timed according to need and be adjusted to the specific local circumstance. 4 This will draw from the note prepared on Infection and Prevention Control Protocol – details in Annex. 10 23. The ESMF and SEP prepared during the project preparation will be disclosed and updated regularly including following virtual consultations. 24. The Implementing Agency will follow the below steps to arrange for nation-wide risk communication and community engagement activities: Figure 1. Strategic Steps on Nation-wide Risk Communication and Community Engagement Activities 25. The project includes considerable resources to implement the above actions under Component 2. The table below briefly describes what kind of information will be disclosed, in what formats, and the types of methods that will be used to communicate this information at four levels to target the wide range of stakeholder groups and the timetables. Table 3. Information Disclosure Proposed Methods during Implementation Stage Project stage Information Methods Timelines/ Target Percentage Responsibilities to be proposed Locations stakeholders reached disclosed National level Prevention tips Audio reels National radio Adults, 65% of PIU Community Video clips and TV twice adolescents, population Outreach Officer daily children Dos and Don’ts Printed National wide Schools 15% MoES school booklets departments 11 Dos and Don’ts Information & Social media Internet users, 20% of PIU Community educational platforms youth population Outreach Officer materials Hotline Phone 24/7 MoHSP Public at large TBD Health consultations Information professionals Center Quarantine Leaflets, e- List serves, Travelers N/A Airport and measures, news internet news, border staff travel bans website news, info boards Regional level Prevention tips Audio reels regional radio Adults, 40% of each PIU Community Video clips and TV twice adolescents, region Outreach Officer daily children through regional TV and Radio companies Helplines Phone 24/7 regional People at risk, 15% in each Medical focal consultations focal points at infected, region points at regional health facilities relatives of level infected people Quarantine Leaflets Info boards Travelers N/A Regional airport measures, and border staff travel bans WHO COVID-19 Print-outs and Regional Medical staff 25% Regional health guidance e-materials, centers, institutions documents and trainings quarterly managers protocols District level Treatment Print-outs and District centers, Medical staff 75% District health protocols and e-materials, quarterly institutions practices trainings managers Prevention tips Posters on District centers, District center 80% District Emergency info board at constantly population authorities, contact khukumats, hospitals numbers health facilities managers, Healthy entrances Lifestyle Centers Community level Treatment Print-outs and District centers, Medical staff of 60% of jamoat District health protocols and e-materials, quarterly rural health institutions practices trainings houses and PCH managers Prevention tips Posters on Rural health Jamoat 80% Jamoat Emergency info board at houses, population authorities, health contact jamoats and constantly house managers numbers rural health facilities entrances Prevention tips In-house Vulnerable People at risk 80% Family doctors, Emergency outreach households nurses, social contact workers numbers 4.4. Proposed strategy for consultation 26. The following methods will be used during the project implementation to consult with key stakeholder groups, considering the needs of the final beneficiaries, and in particular vulnerable groups. 12 Proposed methods vary according to target audience. Table 4. Stakeholder Consultation Methods Proposed during Implementation Stage Consultation Level Topic of Method Timeframes Target stakeholders Responsibilities consultation Nation wide Communication Interviews / 1st month journalists, CSOs PIU Plan Development phones/ sms/ leaders, educators Communication emails and health workers Specialist GRM Phone interviews 1st month Regional focal PIU Community establishment points and hospital Outreach managers Specialist National Hotline Discussions with 1st month Hotline PIU establishment at line ministries, administrators and Communication MoHSP administrators users Specialist and users Nation-wide Communication Multiple channels Starting from 2nd Public at large PIU activities month and ongoing Communication Specialist National Establishment of a Discussions 1st month Relevant national, PIU Management multisectoral task regional and district force bodies National Level Information and Discussions 2nd month Republican Healthy PIU education Lifestyle Center, Communication materials content UNICEF, WHO Specialist and printing National and Media coverage of trainings 2nd month Traditional and PIU regional levels COVID-19 risk social media Communication management journalists Specialist procedures National level Medical supply Discussions 2nd month Other donors and PIU Management and equipment MoHSP officials installation mapping Regional level WHO COVID-19 Hands-on 2nd month and Doctors, nurses PIU experts protocols and trainings further as needed treatment advices National and TSA roll-out and Discussions with 3rd month Social Protection PIU experts district levels improvement local experts Agency, district administrations Regional and Rehabilitation Information 3rd month Communities PIU Community District level works at medical boards near the nearby the civil Outreach facilities, sites works site Specialist quarantines, isolation and screening centers District Level Implementation of Meetings, site 3rd month, further Waste producers PIU Environmental Medical and visits on monthly basis and collectors and Specialist Construction removers/burners Waste Management Plan 13 Community level Current safety In-house outreach 1st month and Vulnerable and Family doctors measures taken at ongoing on disadvantage the household monthly basis groups level 27. The details will be prepared as part of the respective Communication Plan within one month of effectiveness and consequently this SEP will be updated to outline how the above points will be implemented for the different areas to be funded by the Project. 28. Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the stakeholder engagement plan and grievance mechanism. This will be important for the wider public, but equally and even more so for suspected and/or identified COVID-19 cases as well as their relatives. 5. Resources and Responsibilities for implementing stakeholder engagement activities 5.1. Resources 29. The existing Social Protection PIU under the Ministry of Health and Social Protection will be responsible for stakeholder engagement activities. The SEP activities will be funded under the Component 2 of the project. 5.2. Management functions and responsibilities 30. Ministry of Health and Social Protection (MOHSP) will be the implementing agency for the project. It is the designated as the central operational body within the Government and standing headquarters for COVID-19 prevention and response. The Project Implementation Unit (PIU) of the WB- funded Social Safety Network Project (SSNP) functioning under the MOHSP will be responsible for the day- to-day management of project activities. The SSNP will be closing on June 30, 2020 and the PIU staff will graduate transfer to implement the project components, including those related to stakeholder engagement plan update and implementation. The PIU will also deploy the staff needed for proper implementation of the environmental and social framework elements of the project, as this project will be implemented under the new ESF standards. 31. The PIU will serve as the key implementation entity for all components. The PIU will also be responsible for preparing a consolidated annual workplan and a consolidated activity and financial report for the project components. For Components 1 and 2 directly related to COVID-19, the PIU will report to the Deputy Minister of Health and Social Protection/National Coordinator for COVID-19 Counteraction; while for Component 3, the PIU will report to the Deputy Minister of Health and Social Protection in charge of social protection area through SASP similar to the current arrangements for SSNSP. Both Deputy Ministers will be accountable to the Minister of Health, who, in turn, will be reporting on project performance to the higher-level authorities. 32. Supported by the PIU the MOHSP’s Division of Sanitary and Epidemiological Safety, Emergencies and Emergency Medical Care (DSESEEMC) will be responsible for carrying out stakeholder engagement activities, while working closely together with other entities, such as local government units, media outlets, health workers, etc. supported under Component 2 of the Project. The stakeholder engagement activities will be documented through quarterly progress reports, to be shared with the World Bank. 14 33. The nature of the project requires a partnership and coordination mechanisms between national, regional and local stakeholders. 6. Grievance Mechanism 34. The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects; ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. 6.1. Description of GRM 35. Having an effective GRM in place will also serve the objectives of reducing conflicts and risks such as external interference, corruption, social exclusion or mismanagement; improving the quality of project activities and results; and serving as an important feedback and learning mechanism for project management regarding the strengths and weaknesses of project procedures and implementation processes. 36. Who can communicate grievances and provide feedback? The GRM will be accessible to a broad range of project stakeholders who are likely to be affected directly or indirectly by the project. These will include beneficiaries, community members, project implementers/contractors, civil society, media—all of who will be encouraged to refer their grievances and feedback to the GRM. 37. What types of grievance/feedback will this GRM address? The GRM can be used to submit complaints, feedback, queries, suggestions or compliments related to the overall management and implementation of the project activities, including: • Violation of project policies, guidelines, or procedures, including those related to procurement, labor procedures, child labor, health and safety of community/contract workers and gender violence; • Disputes relating to resource use restrictions that may arise between or among targeted districts and communities; • Grievances that may arise from members of communities who are dissatisfied with the project planning measures, or actual implementation of project investments; • Any issues with land donations, asset acquisition or resettlement specifically for project supported activities. 38. The project specific GRM will be based on the Laws of the Republic of Tajikistan “Appeals of Individuals and Legal Entities” (2016) and “On Civil Service”, as well as the Instructions of the Government of the Republic of Tajikistan “On the Procedures of Records Management on the Appeals of Citizens”. 39. The GRM’s functions will be based on the principles of transparency, accessibility, inclusiveness, fairness and impartiality and responsiveness. 15 6.2. GRM Structure 40. Grievances will be handled at the district, regional and national levels, including via dedicated hotline to be established. Project stakeholders and citizens can also submit complaints regarding the violation of project policies, guidelines, or procedures, including those related to procurement, labor procedures, child labor, health and safety of community/contract workers and gender violence to the World Bank Grievance Redress Service (GRS). 41. The project-specific GRM will include the following steps: Step 0: Grievance raised with the COVID-19 hotline and the website of the MoHSP Step 1: Grievance raised with the district coordination committee Step 2: Grievance raised with the regional coordination committee Step 3: Grievance raised with the MoHSP/PIU 24/7 Hotline and website level. Project stakeholders and citizens can submit complaints on any issues by addressing the hotline to be established before the project commences by the MoHSP at the national level. The hotline operator will accept and register all complaints and grievances received through phone calls, letters, SMS and e-mail messages. The hotline centre will forward all grievances for further consideration to the Grievance Management Group at the MoHSP PIU described below. Citizens can also file their complaints through the website of the MoHSP at www.moh.tj. District Level. District Coordination Committee to be established in each district administration (khukumat) will address and resolve complaints within 30 days of receiving complaints. The DCC will be headed by a Deputy Chair of Khukumat on social sectors and comprise key relevant departments: social protection, health, education, sanitary and epidemiological service, environment protection, public relations, CSOs and water utility. The DCC will select the Grievance Focal Point (GFP), who will be responsible for maintaining feedback logs. If the issue cannot be resolved at the district level, then it will be escalated by the DCC to the regional coordination committee. Regional Level. Regional Coordination Committee to be established in each province administration (oblast khukumat) will also address and resolve complaints within 30 days of receiving complaints. The DCC will be headed by a Deputy Chair of Khukumat and comprise key relevant departments: social protection, health, education, sanitary and epidemiological service, environment protection, public relations, CSOs and water utility. The DCC will select the Grievance Focal Point (GFP), who will be responsible for maintaining feedback logs. If the issue cannot be resolved at the regional level, then it will be escalated by the RCC to the MoHSP PIU. National Level. If there is a situation in which there is no response from the regional level GFP, or if the response is not satisfactory then complainants and feedback providers have an option to contact the MoHSP PIU directly to follow up on the issue. The MoHSP PIU will establish a Grievance Management Group (comprising medical professionals, M&E, E&S specialists) and will assign a GFP to be responsible for complaints and issues related to all districts and components. The MoHSP PIU Head will make a final decision after a thorough review of the investigation and verification findings. The timeline for complaint resolution at the central level will be 30 days upon receipt of the complaint. The complainant will be informed of the outcome immediately and at the latest within 5 days of the decision. The GRM will establish clearly defined timelines for acknowledgment, update and final feedback to the complainant. To enhance accountability, these timelines will be disseminated widely to the project stakeholders. The timeframe for resolving the complaint shall not exceed 30 days from the time that it 16 was originally received; if an issue is still pending by the end of 30 days the complainant will be provided with an update regarding the status of the grievance and the estimated time by which it will be resolved; and all grievances will be resolved within 45 days of receipt. Appeal Mechanism. If the complaint is still not resolved to the satisfaction of the complainant, then s/he can submit his/her complaint to the appropriate court of law. 42. In the instance of the COVID 19 emergency, existing grievance procedures should be used to encourage reporting of co-workers if they show outward symptoms, such as ongoing and severe coughing with fever, and do not voluntarily submit to testing. Can we do this? Can the PIU then force a worker to submit to testing or be fired? 43. In case of emergency, there are many other windows in rural areas through which the rural and remote residents can have access to updated information and forward emergency notices. They include but not limited to the World Bank-funded projects being implemented by national agencies and local companies in diverse geographic locations. They include the National Social Investment Fund of Tajikistan working in GBAO, Khatlon and Sughd; PamirEnergy in GBAO; Project Implementation Groups at the Ministry of Finance, SUE KMK, Dushanbe Vodocanal, Barki Tojik, Tourism Committee, Ministry of Transport and Ministry of Education operating throughout the country. Other donor-funded projects, like UNICEF-funded Youth Friendly Health Clinics, SDC-funded Project on Domestic Violence, CSO Fidokor implemented project on HIV/AIDS people support, and other CSO networks and projects could be contacted and engaged to spread the word and support effective risk management and mitigation measures. Mahalla leaders, jamoat representatives at the village level, as well as the IRCS and Youth Committee volunteers could be a vital human resource to arrange for voluntary community outreach, if needed. 6.3 Grievance Logs 44. The Grievance Focal Points (GPFs) will maintain local grievance logs to ensure that each complaint has an individual reference number and is appropriately tracked, and recorded actions are completed. When receiving feedback, including grievances, the following is defined: - Type of appeal; - Category of appeal; - People responsible for the study and execution of the appeal; - Deadline of resolving the appeal; and - Agreed action plan 45. The GFPs will ensure that each complaint has an individual reference number and is appropriately tracked, and recorded actions are completed. The log should contain the following information: • Name of the PAP, his/her location and details of his / her complaint; • Date of reporting by the complaint; • Date when the Grievance Log was uploaded onto the project database; • Details of corrective action proposed, name of the approval authority; • Date when the proposed corrective action was sent to the complainant (if appropriate); • Details of the Grievance Committee meeting (if appropriate); • Date when the complaint was closed out; and • Date when the response was sent to the complainant. 17 6.4 Monitoring and Reporting on Grievances 46. The MoHSP PIU M&E Specialist will be responsible for: • Collecting and analyzing the qualitative data from GFPs on the number, substance and status of complaints and uploading them into the single project database; • Monitoring outstanding issues and proposing measures to resolve them; • Preparing quarterly reports on GRM mechanisms to be shared with the WB. 47. Quarterly reports to be submitted by WB shall include Section related to GRM which provides updated information on the following: • Status of GRM implementation (procedures, training, public awareness campaigns, budgeting etc.); • Qualitative data on number of received grievances \ (applications, suggestions, complaints, requests, positive feedback), highlighting those grievances related to the involuntary resettlement and number of resolved grievances, if any; • Quantitative data on the type of grievances and responses, issues provided and grievances that remain unresolved; • Level of satisfaction by the measures (response) taken; • Any correction measures taken. 6.5 World Bank Grievance Redress System 48. Communities and individuals who believe that they are adversely affected by a World Bank (WB) supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address project-related concerns. Project affected communities and individuals may submit their complaint to the WB’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of WB non-compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank’s attention, and Bank Management has been given an opportunity to respond. 49. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS), please visit http://www.worldbank.org/en/projects-operations/products-and- services/grievance-redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org. 7. Monitoring and Reporting 50. The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Quarterly summaries and internal reports on public grievances, enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. The quarterly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s 18 ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways: • Publication of a standalone annual report on project’s interaction with the stakeholders; • A number of Key Performance Indicators (KPIs) will also be monitored by the project on a regular basis. 51. Further details will be outlined in the updated SEP, to be prepared within 1 month of effectiveness, based on the details of the Communication Plan. Annex 1 INFECTION AND PREVENTION CONTROL PROTOCOL (adapted from the CDC Interim Infection Prevention and Control Recommendations for patients with confirmed COVID-19 or persons under investigation for COVID-19 in Healthcare Settings) HEALTH CARE SETTINGS 1. Minimize Chance of Exposure (to staff, other patients and visitors) • Upon arrival, make sure patients with symptoms of any respiratory infection to a separate, isolated and well-ventilated section of the health care facility to wait, and issue a facemask • During the visit, make sure all patients adhere to respiratory hygiene, cough etiquette, hand hygiene and isolation procedures. Provide oral instructions on registration and ongoing reminders with the use of simple signs with images in local languages • Provide alcohol-based hand sanitizer (60-95% alcohol), tissues and facemasks in waiting rooms and patient rooms • Isolate patients as much as possible. If separate rooms are not available, separate all patients by curtains. Only place together in the same room patients who are all definitively infected with COVID-19. No other patients can be placed in the same room. 2. Adhere to Standard Precautions • Train all staff and volunteers to undertake standard precautions - assume everyone is potentially infected and behave accordingly • Minimize contact between patients and other persons in the facility: health care professionals should be the only persons having contact with patients and this should be restricted to essential personnel only • A decision to stop isolation precautions should be made on a case-by-case basis, in conjunction with local health authorities 3. Training of Personnel • Train all staff and volunteers in the symptoms of COVID-19, how it is spread and how to protect themselves. Train on correct use and disposal of personal protective equipment (PPE), including gloves, gowns, facemasks, eye protection and respirators (if available) and check that they understand • Train cleaning staff on most effective process for cleaning the facility: use a high-alcohol based cleaner to wipe down all surfaces; wash instruments with soap and water and then wipe down with high-alcohol based cleaner; dispose of rubbish by burning etc. 4. Manage Visitor Access and Movement 19 • Establish procedures for managing, monitoring, and training visitors • All visitors must follow respiratory hygiene precautions while in the common areas of the facility, otherwise they should be removed • Restrict visitors from entering rooms of known or suspected cases of COVID-19 patients Alternative communications should be encouraged, for example by use of mobile phones. Exceptions only for end-of-life situation and children requiring emotional care. At these times, PPE should be used by visitors. • All visitors should be scheduled and controlled, and once inside the facility, instructed to limit their movement. • Visitors should be asked to watch out for symptoms and report signs of acute illness for at least 14 days. CONSTRUCTION SETTINGS IN AREAS OF CONFIRMED CASES OF COVID-19 1. Minimize Chance of Exposure • Any worker showing symptoms of respiratory illness (fever + cold or cough) and has potentially been exposed to COVID-19 should be immediately removed from the site and tested for the virus at the nearest local hospital • Close co-workers and those sharing accommodations with such a worker should also be removed from the site and tested • Project management must identify the closest hospital that has testing facilities in place, refer workers, and pay for the test if it is not free • Persons under investigation for COVID-19 should not return to work at the project site until cleared by test results. During this time, they should continue to be paid daily wages • If a worker is found to have COVID-19, wages should continue to be paid during the worker’s convalescence (whether at home or in a hospital) • If project workers live at home, any worker with a family member who has a confirmed or suspected case of COVID-19 should be quarantined from the project site for 14 days, and continued to be paid daily wages, even if they have no symptoms. 2. Training of Staff and Precautions • Train all staff in the signs and symptoms of COVID-19, how it is spread, how to protect themselves and the need to be tested if they have symptoms. Allow Q&A and dispel any myths. • Use existing grievance procedures to encourage reporting of co-workers if they show outward symptoms, such as ongoing and severe coughing with fever, and do not voluntarily submit to testing • Supply face masks and other relevant PPE to all project workers at the entrance to the project site. Any persons with signs of respiratory illness that is not accompanied by fever should be mandated to wear a face mask • Provide handwash facilities, hand soap, alcohol-based hand sanitizer and mandate their use on entry and exit of the project site and during breaks, via the use of simple signs with images in local languages • Train all workers in respiratory hygiene, cough etiquette and hand hygiene using demonstrations and participatory methods • Train cleaning staff in effective cleaning procedures and disposal of rubbish 3. Managing Access and Spread 20 • Should a case of COVID-19 be confirmed in a worker on the project site, visitors should be restricted from the site and worker groups should be isolated from each other as much as possible; • Extensive cleaning procedures with high-alcohol content cleaners should be undertaken in the area of the site where the worker was present, prior to any further work being undertaken in that area. 21