New St. Maarten General Hospital Environmental & Safety Management Plan (ESMP) Date: October 2019 Version: Rev_02 October 2019 St. Maarten General Hospital ESMP Page 1 of 135 Contents ABBREVIATIONS AND ACRONYMS ................................................................................................................ 4 EXECUTIVE SUMMARY .................................................................................................................................... 6 1. INTRODUCTION ....................................................................................................................................... 12 1.1. Overview and scope ........................................................................................................................... 12 1.2. Objectives ........................................................................................................................................... 12 2. PROJECT DESCRIPTION ........................................................................................................................ 13 2.1. Project Owner ..................................................................................................................................... 13 2.2. Project background............................................................................................................................. 13 2.3. Project location ................................................................................................................................... 14 2.4. Project components ............................................................................................................................ 15 2.5. Project activities .................................................................................................................................. 16 2.6. Project planning .................................................................................................................................. 23 2.7. Project workforce ................................................................................................................................ 23 3. ENVIRONMENTAL AND SOCIAL IMPACTS AND RISKS ....................................................................... 24 3.1. Applicable World Bank Safeguard Policies ........................................................................................ 24 3.2. Assessment of Environmental and Social Impacts and Risks........................................................... 25 4. ORGANIZATION ........................................................................................................................................ 31 4.1. Roles and responsibilities................................................................................................................... 31 4.2. Institutional arrangements (permitting) .............................................................................................. 33 4.3. Training, awareness and competency ............................................................................................... 34 4.4. Communication and stakeholder engagement .................................................................................. 34 4.5. Documentation.................................................................................................................................... 35 4.6. Management of change ...................................................................................................................... 35 4.7. Operational controls ........................................................................................................................... 35 4.8. Emergency preparedness and response ........................................................................................... 36 4.9. Checking and corrective actions ........................................................................................................ 36 4.10. Monitoring of Contractors Performance ............................................................................................... 36 4.11 Reporting ............................................................................................................................................ 37 5 ENVIRONMENTAL AND SOCIAL MANAGEMENT ................................................................................. 38 5.1 ESMP .................................................................................................................................................. 38 5.2 Specific Management Plans ............................................................................................................... 38 REFERENCES .................................................................................................................................................. 41 APPENDIX 1: SMMC NEW GENERAL HOSPITAL DESIGN DOCUMENTS ................................................. 42 APPENDIX 2: ESMP TABLES .......................................................................................................................... 49 APPENDIX 3: SMMC Management Plans ....................................................................................................... 66 3.1 Complaints Handling ............................................................................................................................... 66 October 2019 St. Maarten General Hospital ESMP Page 2 of 135 3.2 SMMC Evacuation Plan .......................................................................................................................... 74 3.3 SMMC Stake holder Engagement and Communication Plan .............................................................. 122 APPENDIX 4: Stakeholder Meeting November 2018 .................................................................................... 131 APPENDIX 5: INSO Health, Safety & Environment (HSE) Plan .......................................... Separate Document LIST OF TABLES Table 3.1 E&S Safeguards Triggered 19 Table 3.2 New General Hospital Components and Activities Environmental and Social Impact and Risk 21 Assessment Matrix* Table 4.1 Roles, responsibilities and Contact Details 24 Table 4.2 Principal Agencies Providing Support under the ESMP 25 LIST OF FIGURES Figure 2-1 SMMC Location Including Adjacent Areas and Main areas 9 Figure 2-2 SMMC Site Configuration at the End of Phase 1 11 Figure 2-3 SMMC Site Configuration at the End of Phase 2 12 Figure 2-4 SMMC Site Configuration at the End of Phase 3 13 Figure 2-5 Planning of the LEED Certification Process 15 Figure 2-6 Project Planning 18 October 2019 St. Maarten General Hospital ESMP Page 3 of 135 ABBREVIATIONS AND ACRONYMS AQCMP Air Quality Control and Monitoring Plan AW Additional Wing BOD Board of Directors CC Complaint Committee CHSSMP Community Health, Safety and Security Management Plan CLA Collective Labour Agreement CLO Community Liaison Officer CTMP Construction Traffic Management Plan DBM Design Build and Maintenance E&S Environmental and Social EDP Emergency Disaster Preparedness Plan EHS Environmental Health and Safety EOC Emergency Operations Center EPRP Emergency Preparedness and Response Plan ER Employee Representative ER Employees Representative ESIA Environmental and Social Impact Assessment ESMP Environmental and Social Management Plan ESMS Environmental and Social Management System FTE Full Time Equivalent Gemeenschappelijk Electriciteitsbedrijf Bovenwindse Eilanden – GEBE Electricity and Water Company GFA Gross Floor Area GoS Government Services HMMP Hazardous Material Management Plan HP Hurricane Plan HSE PLAN Health Safety and Environmental Plan IGRM INSO Grievance Redress Mechanism INSO INSO Sistemi per le Infrastrutture Sociali S.p.A Italy JCI Joint Commission International LEED Leadership in Energy and Environmental Design MB Main Building October 2019 St. Maarten General Hospital ESMP Page 4 of 135 MECYS Ministry of Education, Culture, Youth and Sports MSDS Material Safety Data Sheets NCMP Noise Control and Monitoring Plan ODM Office of Disaster Management OHSP Occupational Health and Safety Plan PMP Project Management Plan PPE Personal Protective Equipment Project The New General Hospital PRT Permitted Recovery Time QMS Quality Management System SMGH St Maarten General Hospital SMMC St Maarten Medical Center Sociale Ziekte Verzekering – SZV Social and Health Insurances TB Technical Building TMP Traffic Management Plan Tripartite Protocol est. 2015 consisting of VSA, SZV and SMMC Volkshuisvesting, Ruimtelijke Ordening, Milieu en Infrastructuur – VROMI Ministry of Public Housing, Spatial Development, Environment and Infrastructure Volksgezondheid, Sociale en Arbeidszaken – VSA Ministry of Public Health, Social Development and Labour WMP Waste Management Plan WWTP Waste Water Treatment Plan October 2019 St. Maarten General Hospital ESMP Page 5 of 135 EXECUTIVE SUMMARY Background This document provides the Environmental and Social Management Plan for construction and operation of the new general hospital. The ESMP has been developed to meet international standards on environmental and social management performance, specifically those set out by the World Bank in its Environmental and Social Safeguard Policies. In addition, the safeguard provisions defined in this ESMP also incorporate appropriate national building, environmental and planning requirements. The ESMP is essential for successfully implementing the Project’s social and environmental performance throughout the life of the Project. Having this framework in place ensures a systematic approach to bringing environmental and social considerations into decision making and day-to-day operations. It establishes a framework for tracking, evaluating and communicating environmental and social performance and helps ensure that environmental and social risks and liabilities are identified, minimised and managed. The ESMP will be a living document and will continue to develop during the design and construction phase to enable continuous improvement of the Project’s social and environmental performance. In particular, the objectives of the ESMP are to: • Promote environmental and social management and communicate the aims and goals of the ESMP; • Ensure that all workers, contractors and others involved in the Project meet legal and other requirements with regard to environmental and social management; • Incorporate environmental and social management into Project design and operating procedures; • Address concerns and issues raised in the ESMP stakeholder consultation process and those that will likely continue to arise during the Project’s lifetime; • Serve as an action plan for environmental and social management for the Project; • Provide a framework for implementing Project environmental and social commitments; and • Prepare and maintain records of Project environmental and social performance (i.e. monitoring, audits and non- compliance tracking). Project Description The St Maarten Medical Center (SMMC) is a private non-profit foundation and is the owner and operator of the only hospital facility on St Maarten. Government signed a bilateral agreement with SMMC in which it delegated the new general hospital implementation responsibility to SMMC. As such, SMMC will have the overall responsibility for technical supervision and fiduciary activities for the execution of the Project. To strengthen the healthcare sector on St Maarten, a Tripartite protocol (Tripartite) was established in 2015 consisting of: (i) the VSA, (ii) the SZV and (iii) the SMMC. With its focus on achieving affordable and sustainable quality healthcare, the Tripartite declared that the existing hospital building was unsuitable for a complete re-design over the long-term. Given the Tripartite is focused on achieving affordable and sustainable quality healthcare based on the concept of „care close to home, ‟ it decided on the need to build a new general hospital (hereinafter „The Project‟). A turn-key Design, Build and Maintain contract will build the new general hospital in St Maarten which includes all medical equipment, furniture and ICT infrastructure. The Project will be financed by (i) a consortium of private financiers (local pension funds and banks), (ii) a contribution from the St. Maarten Hurricane IRMA Reconstruction, Recovery and Resilience Trust Fund managed by the World Bank (registered as Project P167532) and (iii) own funds of the SMMC. The new general hospital will be constructed on the same location as the existing hospital, Welgelegen Road 30 (known as Cay Hill). This location (hereinafter the SMMC location) has been zoned by Government as a Hospital. The land is owned by Government and SMMC has been given a long-term lease for the use of this land. The area adjacent to the current and new general hospital consists of mixed use of businesses, residencies, schools, sports complex, and several smaller public buildings. The new general hospital Project, upon completion, will be a modern multiple service operational facility consisting of 110 beds and after completion will include: • A Main Building (MB) with 5 stories of each between 3.300 and 4.000 square meters, • An Additional Wing (AW) with 3 stories of each approximately 1,000 square meters, • A Technical Building (TB), October 2019 St. Maarten General Hospital ESMP Page 6 of 135 • General parking area, • A Parking garage of 4 to 5 floors, • A Heliport, and • Supply and installation of medical equipment, furniture, backup power plant and all IT related equipment/network (medical). The construction of the new Main Building will be undertaken while the existing Hospital is fully operational. This Main Building with be completed upon approval and certification of all medical services and equipment at the same time the existing hospital is in operation. After transfer of all medical services to the new general hospital facility, the existing building will be demolished. After demolition the construction of the “additional wing”, main entrance, parking lots, parking garage and heliport and landscaping will follow. The Project will be constructed in four main phases: Phase 1: Includes all the steps and processes to complete design, permitting and site preparation including the following: • Preliminary design • LEED submission • Permit applications • Soil investigation • Site preparation and staging • Demolition and construction of the new waste water treatment plant • Final technical design Phase 2: Construction of the new general hospital, which includes the Main Building and Technical Building, erected adjacent to the existing hospital. This Phase includes also retaining walls, drainages, services and access roads and can be divided into the following sub phases: • Construction of the Main Building and Technical Building • New Building Commissioning certificate. Phase 3: Demolition of the existing hospital. This phase can be divided into the following sub phases: • Moving into the Main Building • Demolition of Existing Hospital Phase 4: Construction of the main entrance and other facilities. This phase can be divided into the following sub phases: • Construction Main Entrance Main building • Construction Additional Wing • Construction new parking lot • Construction Parking Garage • Construction Heliport The construction for the new general hospital will require a relatively small work force (100-130 workers) across skilled and unskilled workers. As far as possible, unskilled workers who consist of the largest work force contingent will be locally contracted. Special skilled labourers and professionals are expected to be temporarily on the island for various stretches of time during construction. Consequently, there will be no worker camp or special worker housing compounds, since these workers will live in accommodations around Phillipsburg and its outskirts. SMMC, contractors and the Project supervisor have been made aware of the provisions of the World Bank Guidance on Managing the Risks of Adverse Impacts on Communities from Temporary Project Induced Labour Influx. In collaboration with the World Bank safeguards specialists assigned to the Project there is agreement that the worker living and working arrangements are not per se conditions required to be applied for this Project. Nonetheless, INSO and the Project supervisor will apply relevant provisions of the HSE Plan covering worker conduct, behaviour and social interaction rules. Applicable World Bank Safeguard Policies This Project has been classified as a Category B Project, as documented in the World Bank Project Information Documents / Integrated Safeguards Datasheet (PID/ISDS) issued in June 2018. Based on early scoping of the Project by World Bank environmental and social specialists, there are only two World Bank safeguards policies triggered explained in detail in the ESMP, Environmental Assessment OP/BP 4.01 and Pest Management OP/BP 4.09. The Project’s overall potential social impacts are positive for the entire Dutch side of the island and adjacent islands. As October 2019 St. Maarten General Hospital ESMP Page 7 of 135 explained in the early sections of this document, in addition to the expansion in the scope of services, the new general hospital will: (i) increase capacity from 66 to 110 beds; (ii) have 4 operating theatres and larger areas for ambulatory care, including a new flow of patients for ambulatory surgery; (iii) include critical characteristics to increase the resiliency of the hospital (external protection to withstand category 5 plus hurricanes, installation of modern and safe medical gas, greater storage capacity for having supplies for longer periods, underground communication through fiber optic capability, and a landing platform for helicopters for the transport of trauma patients, etc.). Environmental impacts are limited to the life of the construction process and result directly from construction activities. Such impacts may include noise (to patients and surrounding businesses and residences), dust, oil leakages from heavy equipment, traffic issues, worker safety, community health and safety, and construction waste management. During the operational phase, hospital waste management will be the main operational level concern. Compliance with OP 4.01, Environmental Assessment, will be accomplished, in part, by the application of relevant clauses in construction contracts designed to mitigate the potential impacts identified as well as the application of mitigation measures outlined in the pre- identified mitigation measures. The details of these measures are found in the subsequent descriptions of the INSO HSE Plan and the specific Project Management Plans. The Project activities do not trigger OP 4.12 Involuntary Resettlement. The construction of the new general hospital, financed by the Project, will take place on public land free of occupants and not in use for any type of activities, and does not involve any involuntary resettlement. It is part of the land of the existing hospital and its public ownership is not contested. Potential adverse social impacts include: worker safety in the construction activities; safety of patients and staff using the current hospital facility while the current hospital is being used; the management of labour coming from outside St Maarten; community health and safety. ESMP Process, Consultation, and Review Process Several steps have been followed in the ESMP development, submissions and review. These are summarized below. • Specialists across environment and social safeguards teamed with the SMMC staff to contribute to the ESMP • A 1st consultation was held at SMMC on November 26, 2018. See appendix. • A World Bank environmental safeguards specialist reviewed the ESMP • The Preliminary ESMP was posted on the SMMC websites for public review and comment • The ESMP was disclosed also on the World Bank website • The ESMP was updated prior to the start of construction works in October 2019 • The Final ESMP will be posted on the SMMC website for public review • A 2nd stakeholder meeting will be held at SMMC prior start construction Potential environmental and social impacts and risks were evaluated during a scoping process. There is a defined Area of Influence that is considered the “direct impact” zone. In this area the Project activities are assessed to determine any direct and indirect impacts between the Project and its environment resources and people, communities and businesses. An Environmental and Social Impact and Risk Assessment matrix is presented in the report. It is important to clarify that this assessment is considered “preliminary” and will need to be updated once the final design with all detailed construction details is completed in 2019. SMMC is committed to provide resources essential to the implementation and control of the ESMP. Resources include the appropriate human resources and specialised skills. SMMC will have dedicated personnel competent on the basis of appropriate education, training, and experience that will manage and oversee the E&S aspects of the Project. SMMC selected INSO as the Design Build and Maintain (DBM) Contractor („the Contractor‟) for the Project, according to commercial, technical, quality assurance and its past performance on EHS standards so as to satisfy SMMC‟s requirements and policies. Scope of the Contractor is to Design, Build and Maintain for 20 years (10 years plus an option for another 5+5 years) the Project components mentioned in 2.4. SMMC selected DZFAS and Royal HaskoningDHV to act as Employer’s Representative and support SMMC during the design, construction and first year of operation of the Project. The Employer’s Representative will provide the ESMP implementation support across the life of the Project which is detailed in the ESMP. Several GoS agencies have direct responsibility for this Project. They include VROMI, (public Works), and VSA (Department of Health and Social Services). These agencies will work closely with SMMC to ensure compliance with all building and operational requirements. The World Bank will provide the necessary implementation support to ensure adherence to all World Bank Project requirements across safeguards as well as financial and procurement requirements. This implementation support will be provided through regular interactions, implementation support missions, and thematic review missions if required. October 2019 St. Maarten General Hospital ESMP Page 8 of 135 Stakeholders Meeting November 2018 In addition to a public notification, personal invitations to surrounding businesses, schools, church and resident associations where sent prior to our 1st Stakeholders Meeting, which was held November 26, 2018. Representatives from the Fire Department, Antek, Baker Tilly, and Contract of Jehovah’s Witnesses were present together with members of the SMMC staff. Besides general questions about design points, the main concerns from the persons present were: - Parking hindrance around SMMC during construction, as the current parking will be construction site; - Traffic congestion at Welgelegen road due to construction traffic; - Working hours; - Dust hindrance for surrounding facilities; - Traffic congestion at Welgelegen road during operational phase (helipad). SMMC is arranging temporary parking close to the SMMC for staff and visitors as the current parking area will become the construction site resulting in insufficient parking spots available within the SMMC perimeter. It is expected to have this temporary parking area arranged prior to the start construction Main Building. Further to this, SMMC will instruct the contractor to arrange sufficient parking for their workers, to prevent hindrance in the surrounding hospital area. The contractor has to follow the local regulations for Heavy Equipment on the public roads. Prior to starting construction works, the contractor is obligated to submit a construction plan. In this plan they have to provide a site phasing, which includes how construction traffic will enter and leave the site in a safe way and indicate how they will reduce hindrance to the public traffic as less as possible. During the weekly construction meetings with the contractor, SMMC will discuss the mitigation measures for the upcoming works to prevent hindrance as much as possible. As the construction of the new hospital building is very close to the current building, which remains operational, working hours are restricted in the contract for exterior works and the contractor has to request the approval of SMMC if they would like to perform certain works outside of the contracted hours. SMMC will inform Stakeholders regularly on the progress of the works and indicate which works can be expected during the next phase. The contractor has to work according to their HSE plan and follow the mitigations as indicated in this plan, which include dust management. If the mitigations are not sufficient, additional measures are to be taken by the contractor. During our daily inspections it will be monitored if the contractor follows the plans and if the mitigation measures are sufficient. SMMC will develop for the Helicopter Operations an operational plan whereby Aviation’s and the Traffic Police will be consulted. This plan will be realized in a later stage and our Stakeholders will kept informed on this new service. Prior to the start of construction works a 2nd Stakeholder meeting will be organized. During this meeting we will present more detailed information on the topics which were discussed during the previous meeting. The contractor will also be present to answer specific questions from the Stakeholders. October 2019 St. Maarten General Hospital ESMP Page 9 of 135 Training, awareness and competency Both SMMC and INSO will identify, plan, monitor, and record training needs for personnel whose work may have a significant adverse impact upon the environment or social conditions. The Project recognises that it is important that employees are aware of the Project’s environmental and social management plans including potential impacts of their activities and specific roles and responsibilities to comply with these plans and procedures. Employee training will include awareness and competency with respect all aspects of environmental and social impacts and conforming to the requirements of the ESMP (including its specific Management Plans and Procedures). An EHS Manager is responsible for coordinating training, maintaining employee-training records, and ensuring that these are monitored and reviewed on a regular basis. The EHS Manager will also periodically verify that staff is performing competently through discussion and observation. Communication and stakeholder engagement As part of the existing hospital operations, SMMC maintains a formal procedure for communications with the regulatory authorities. A client panel is also in place as well as a Complaints Policy and Procedure. SMMC will develop a Stakeholder Consultation and Engagement Plan for the Project, first for the Construction Phase and then for the Operation Phase. The EHS Manager will be responsible for communication of E&S issues to and from regulatory authorities whenever required. The CLO will be responsible for communication with communities. The Stakeholder Engagement and Communications Plan (SECP) for the construction phase sets out the approach that the SMMC will follow in order to engage and communicate with stakeholders over the life of the New General Hospital. Consultation is undertaken in order to interact and incorporate the viewpoints of Affected Parties. Special consideration will be given to vulnerable groups, including with relation to engagement and consultative activities. This plan is organized as follows (see appendix 3 section 3): • Section 2 outlines the objectives of stakeholder engagement; • Section 3 introduces the SECP and related methods, in addition to previous and future activities; • Section 4 introduces the Communication Plan and outlines its goals and objectives; • Section 5 describes roles and responsibilities for grievance redress; Environmental and Social Management Plan – ESMP Matrix Mitigation and enhancement measures, responsibility for implementation, and monitoring and verification indicators are provided in the ESMP Table in Appendix 2. These measures and the Management Plans discussed in the document have been adopted by SMMC and are considered INSO contract requirements. SMMC and INSO will determine what additional risks and proposed management controls are required based on the final design and work method statements. October 2019 St. Maarten General Hospital ESMP Page 10 of 135 Specific Management Plans Several Management Plans are still to be finalized to support the implementation of this ESMP. The timing of the development of the plans may be staged, ensuring that the appropriate focus and level of detail is provided for construction and operational activities. They will be finalised by INSO with SMMC and Employees Representative coordination. When appropriate, the Project owner and their representatives may meet with GoS agencies and other key stakeholders. The contents of the Management Plans are outlined in Appendices, including the Management Plans available at this stage. Construction Phase As per contractual requirements, INSO submitted its HSE Plan (“the Contractors HSE Plan‟) which requires the approval of SMMC before the start of new general hospital Construction activities. The INSO HSE Plan will include the following Sections or Management Plans: • Air Quality Control and Monitoring Plan • Noise Control and Monitoring Plan • Waste Management Plan • Hazardous Materials Management Plan • Emergency Preparedness and Response Plan • Construction Traffic Management Plan • Occupational Health and Safety Management Plan • Community Health, Safety and Security Management Plan • Hurricane Plan for the Construction Phase • INSO Grievance Redress Mechanism An updated HSE Plan was submitted to SMMC in October 2019. The HSE Plan is a living document, prior to each construction phase this report will be updated accordingly. The Contractor will also develop and implement its own internal Grievance Redress Mechanism in either the Contractors HSE Plan or Quality Management System (QMS) developed for the Project. Operational Phase The Contractor will adopt and amend specific Management Plans to address all the E&S risks associated with the operational phase of the new general hospital. There will also be a Quality Management System developed for this operational service period. October 2019 St. Maarten General Hospital ESMP Page 11 of 135 1. INTRODUCTION This document provides the Environmental and Social Management Plan (“ESMP”) for construction and operation of the new general hospital (“the Project”). 1.1. Overview and scope The ESMP has been developed to meet international standards on environmental and social management performance, specifically those set out by the World Bank in its Environmental and Social Safeguard Policies. In addition, the safeguard provisions defined in this ESMP also incorporate appropriate national building, environmental and planning requirements. The ESMP is intended to cover those activities described in Chapter 2 of this document. It covers Project activities during pre-construction, construction and operation and will be subject to thorough reviews prior to the commencement of activities to ensure completeness. The ESMP does not include measures for activities related to equipment and facility fabrication being done offsite. It should be noted that this provides the outline requirements for environmental and social management. Provisions will be made for updating the outline ESMP once the detailed Project design is complete and for adapting the ESMP to relevant Project stages as part of the overall ESMS. 1.2. Objectives The ESMP is essential for successfully implementing the Project’s social and environmental performance throughout the life of the Project. Having this framework in place ensures a systematic approach to bringing environmental and social considerations into decision making and day-to-day operations. It establishes a framework for tracking, evaluating and communicating environmental and social performance and helps ensure that environmental and social risks and liabilities are identified, minimised and managed. The ESMP will be a living document and will continue to develop during the design and construction phase to enable continuous improvement of the Project’s social and environmental performance. In particular, the objectives of the ESMP are to: • Promote environmental and social management and communicate the aims and goals of the ESMP; • Ensure that all workers, contractors and others involved in the Project meet legal and other requirements with regard to environmental and social management; • Incorporate environmental and social management into Project design and operating procedures; • Address concerns and issues raised in the ESMP stakeholder consultation process and those that will likely continue to arise during the Project’s lifetime; • Serve as an action plan for environmental and social management for the Project; • Provide a framework for implementing Project environmental and social commitments; and • Prepare and maintain records of Project environmental and social performance (i.e. monitoring, audits and non- compliance tracking). October 2019 St. Maarten General Hospital ESMP Page 12 of 135 2. PROJECT DESCRIPTION 2.1. Project Owner The St Maarten Medical Center (SMMC) is a private non-profit foundation and is the owner and operator of the existing hospital. In 2007, SMMC was appointed by Government through a National Decree as the only hospital facility on St Maarten. On June 19, 2018, Government signed a bilateral agreement with SMMC in which it delegated the Project implementing responsibility to SMMC. As such, SMMC will have the overall responsibility for technical supervision and fiduciary activities for the execution of the Project. SMMC is governed by a Supervisory Board responsible for the supervision of the Board of Directors. The Supervisory Board formally approves key decisions made by the Board of Directors, such as budget setting, foundation reorganization, investments outside the original budget and annual financial statements submitted by the Board of Directors. Supervisory Board members have specific profiles approved by the Minister of VSA to ensure that the Board has diverse expertise (e.g. medical, legal, financial, organizational management/human resources). Comprised of a minimum of three and a maximum of five members, Supervisory Board members are appointed by the Minister of VSA, upon a binding nomination by the Supervisory Board. The Board of Directors is tasked with the daily management and decision making related to operating the hospital, according to the strategic plan and the budget. The Board of Directors is comprised of a maximum of two members: one with a background in financial management and the other with medical expertise. The Directors are appointed by the Supervisory Council in consultation with the Minister of VSA. While the objectives, functions, capacities and legal status of the foundation will not be affected, it is expected that by the end of 2018, the name of the foundation will be changed and the current governance structure will be adjusted. These changes will not have an impact on the foundation as a legal entity and all existing rights and obligations of the foundation will continue to exist unaltered following the name change of the foundation to the St Maarten General Hospital (SMGH). The changes to the governance structure will include: (i) the Supervisory Board will include an appointment of one representative of the VSA and one member appointed by the SZV; and (ii) the Board of Directors will expand from a current maximum of two members to three members. 2.2. Project background In terms of health service delivery, only primary and secondary care is provided in St Maarten by a mix of non-profit and private providers, as follows: the St Maarten Medical Center (SMMC), 23 general practitioners (private), dental care providers, the White and Yellow Cross Foundation (primary care, nursing home and specialized ambulatory care), the Turning Point Foundation (drugs and rehabilitation), the AIDS Foundation, the Diabetes Foundation and 15 pharmacies, of which one is situated within SMMC (Cay Hill Pharmacy). SMMC is the only hospital and the only source of secondary health services on the Dutch side of the island and is the primary source of care for the nearby islands of Saba and St. Eustatius. SMMC provides outpatient (emergency, radiology, dialysis and other special clinics) and inpatient care (medical paediatric and surgical wards, intensive care, labour and delivery, and an operating theatre). No tertiary services are provided on the island and patients needing such services are referred to neighbouring countries (Colombia, Dominican Republic, Puerto Rico, etc.). In addition to the permanent population, SMMC provides services to approximately 2.6 million tourists per year (2 million cruise ship tourists and 0.6 million stay-over tourists). Built in 1991 for a population of 23,000, the existing hospital has surpassed its lifetime capacity and has weathered several hurricanes. The hospital design has an open structure with five internal open-air patios that leave the hospital vulnerable to severe weather and hurricane damage. After Hurricane Irma in September 2017, the SMMC suffered substantial damage and services were disrupted for several units, for example, intensive care and dialysis. Although the SMMC October 2019 St. Maarten General Hospital ESMP Page 13 of 135 resumed operations immediately after the hurricane, due in part to provisional repairs carried out by the Dutch Marine engineering support unit, it is not expected to withstand another hurricane higher than Category 4. In addition, the hospital capacity and design (including 4 to 6 persons per room) does not provide options to rehabilitate or redesign the hospital to improve quality, reduce risk of the admitted patients and increase efficiency of health services. To strengthen the healthcare sector on St Maarten, a Tripartite protocol (Tripartite) was established in March 2015 consisting of: (i) the VSA, (ii) the SZV and (iii) the SMMC. With its focus on achieving affordable and sustainable quality healthcare, the Tripartite declared that the existing hospital building was unsuitable for a complete re-design over the long-term. At that time, SMMC was in a poor financial situation because the hospital service fees (tariffs) were not increased between 2004 and 2016, which resulted in underinvestment. This has had negative impacts on maintenance, technology, quality care and expansion of services in line with the increased demand for care. Given the Tripartite is focused on achieving affordable and sustainable quality healthcare based on the concept of “care close to home”, it decided on the need to build a New General Hospital (hereinafter “The Project”). A turn-key Design, Build and Maintain contract will build the new general hospital in St Maarten which includes all medical equipment, furniture and ICT infrastructure. The Project will be financed by (i) a consortium of private financiers (local pension funds and banks), (ii) a contribution from the St. Maarten Hurricane IRMA Reconstruction, Recovery and Resilience Trust Fund managed by the World Bank (registered as Project P167532) and (iii) own funds of the SMMC. 2.3. Project location The new general hospital will be constructed on the same location as the existing hospital, Welgelegen Road 30 (known as Cay Hill). This location (hereinafter the SMMC location) has been zoned by Government as a Hospital. The land is owned by Government and SMMC has been given a long-term lease for the use of this land. Reference is made to figure 2.1 for the SMMC location. The area adjacent to the current and new general hospital consists of mixed use of businesses, residencies and the following facilities: • The Learning Unlimited School (LUS) located at Welgelegen Road #32, Cay Hill Dutch Caribbean, which is at the opposite of the new general hospital. The LUS is an US accredited school that provides the following classes (i) Kindergarten, (ii) Elementary school, (iii) Middle school and (iv) Upper School. • The Asha Stevens Elementary School (ASES), located at Jackal Road #4 (Cay Hill) / Grapefruit Road #25 (St. Peters) which is also used as a public shelter and houses the Office of Disaster Management for post disaster management and administration. • The island main Fire Brigade station that houses all essential equipment and communication facilities and fire trucks. • The ambulance service which is the central station for the Island. • The Raoul Illidge Sport Complex, and • Several smaller public buildings like churches, community centre, sport schools etc. The SMMC complex is very central and is accessible via three main roads: • From Simpson Bay area via the G.A. Arnell Boulevard • From Philipsburg area via Little Bay Road • From Philipsburg area via the A.J.C. Brouwer Road. October 2019 St. Maarten General Hospital ESMP Page 14 of 135 Figure 2-1: SMMC location including adjacent areas and main areas 2.4. Project components The new general hospital Project, upon completion, will be a modern multiple service operational facility consisting of 110 beds. The new general hospital Project includes the construction of the following components: • The Main Building (MB) with 5 stories of each between 3.300 and 4.000 square meters, • The Additional Wing (AW) with 3 stories of each approximately 1,000 square meters, • A Technical Building (TB), • General parking area, • A Parking garage of 4 floors, • A Heliport, and • Supply and installation of medical equipment, furniture, backup power plant and all IT related equipment/network (medical). The design is to incorporate the following departments and facilities: October 2019 St. Maarten General Hospital ESMP Page 15 of 135 • Surgery department • Central equipment sterilization • Treatment department (endoscopy) • Emergency department • Imaging • Special care • Inpatient • Mother and child department • Day care ward • Dialysis • Outpatient • Administration, General Facilities, Laboratory, Pharmacy, Factory non-medical • Option for medical tourism • Technical area • parking area for staff, patients and visitors • Heliport • Self-supporting back up power • Waste Water Treatment Plant (WWTP) • Grinder-Microwave system for medical waste treatment • Retaining walls and drainage. Appendix 1 contains several illustrations of the new general hospital. 2.5. Project activities 2.5.1. Construction Phase The construction of the new Main Building will be undertaken while the existing Hospital is fully operational. This Main Building with be completed upon approval and certification of all medical services and equipment at the same time the existing hospital is in operation. After transfer of all medical services to the new general hospital facility, the existing building will be demolished. After demolition the construction of the “additional wing”, main entrance, parking lots, parking garage and heliport and landscaping will follow. The Project will be constructed in four main phases: Phase 1: Includes all the steps and processes to complete design, permitting and site preparation including the following: • Preliminary design • LEED submission • Permit applications • Soil investigation • Site preparation and staging • Demolition and construction of the new waste water treatment plant • Final technical design Phase 2: Construction of the new general hospital, which includes the Main Building and Technical Building, erected adjacent to the existing hospital. This phase includes also retaining walls, drainages, services and access roads and can be divided into the following sub phases: • Construction of the Main Building and Technical Building October 2019 St. Maarten General Hospital ESMP Page 16 of 135 • New Building Commissioning certificate. Figure 2-2: SMMC site configuration at the end of Phase 1 Phase 3: Demolition of the existing hospital. This phase can be divided into the following sub phases: • Moving into the Main Building • Demolition of Existing Hospital Figure 2-3: SMMC site configuration at the end of Phase 2 Phase 4: Construction of the main entrance and other facilities. This phase can be divided into the following sub phases: • Construction Main Entrance Main building • Construction Additional Wing • Construction new parking lot October 2019 St. Maarten General Hospital ESMP Page 17 of 135 • Construction Parking Garage • Construction Heliport Figure 2-4: SMMC site configuration at the end of Phase 3 Phase 1: Pre-construction design, permitting, and site preparation Preliminary design The pre-design of the new hospital considered not only additional capacity in terms of beds and ambulatory services, but also the need to incorporate new services, adding new diagnostic and treatment procedures, and new medical specialties. In September 2016, the selection process to hire a firm to design, construct and implement the new hospital was completed. This turn-key contract included full design of the new hospital, construction and equipment (medical and non- medical equipment), training (for equipment) and maintenance services for a 10-year period (with an option to extend the maintenance period for two additional periods of 5 years). By the time the complete design of the hospital was ready, damages caused by Hurricane Irma underlined the critical need for the new hospital to be designed with a structure and features that will increase the hospital’s ability to withstand category 5 plus hurricane level winds (200mph+). These changes required an amendment to the existing turn-key contract (variation order) with the increased cost of the contract to allow for the required additional works, features and protections. The final detailed designs are still under preparation, but the preliminary designs were submitted for all building permit applications. October 2019 St. Maarten General Hospital ESMP Page 18 of 135 Building permits A Building and Hindrance Permit have been submitted to the appropriate local authority (VROMI). The Building Permit is an authorization for construction based on the Building Ordinance or Zoning Ordinance and is issued by the Government of St Maarten before the construction of the new building can legally occur. This authorization also includes approval from several designated authorities (fire department, traffic police, aviation department etc.). The Hindrance Permit is required for specific types of activities that can cause danger, damage and/or nuisance to the environment or the surroundings. It is tied to regulations designated to protect the environment and ensure safe and clean practices on St Maarten. These regulations prevent, and/or limit pollutions (soil, water, noise, air, and odour) and energy use. The Hindrance Permit is required for the Waste Water Treatment plant and the Generators, Transformers. Chillers, Air Compressors, Oxygen Generator, Steam Generators, Autoclave/Grinder, etc. Soil investigation The soil investigation consisted of Geotechnical and Hydrological investigations to provide sufficient data concerning the ground and the ground-water conditions at and around the construction site for a proper description of the essential ground properties and a reliable assessment of the characteristic values of the ground parameters to be used in design calculations. January 14, 2019 INSO / EXOFOR Report of Subsurface Exploration and Geotechnical Engineering Study. Site preparation Site preparation will include a limited number of preparation activities undertaken during a three-month period in the beginning of 2019. The activities include: • Site fence & Access Construction • Acoustic soundproof panel installation • Construct new Waste Water Treatment Plant and connect to the existing Hospital • Embankment excavation • Clean existing drainage including slope to runoff rainwater • Connect existing drainage to the main system alone Welgelegen Road • Construct concrete retaining wall and drain box • Set-up a storage, security and deposit area • Demolish existing Waste Water Treatment Plant • Temporary installation of electrical, water and internet connections • Install small temporary office • Install truck wheel wash station with a silt trap reusable water system This starts with SMMC relocating the current parking area which is now located on the new hospital construction area- relocating to where. Subsequently, INSO will install fencing to secure the construction site. Sound proofing panels will then be assembled along strategic locations on the fencing. Within the construction site, a small office will be installed for the contractor and labour facilities including adequate washroom, toilet facilities and a shaded rest area. This site will also be used to store equipment and materials for the first construction activities. Clear visible warning and security signs will be displayed in strategic locations to inform the public, hospital patients, visitors and staff about construction warnings and detours and fencing will be put up to ensure separation of the public from the on-going works. The site layout and activities for this preparation stage are presented in Appendix 1-1. The activities shown include the location of the construction fence, storage area, acoustic sound panels, embankment excavation, and the new concrete retaining wall and box drain. Also, the new temporary access road and security gate for worker and construction equipment access is designated. The new flow of hospital traffic, patient access, and emergency traffic is also designated. October 2019 St. Maarten General Hospital ESMP Page 19 of 135 Demolition and construction of waste water treatment plant In the Cay Hill area there is no sewerage distribution network. Therefore, the existing hospital has its own waste water treatment plant (WWTP) on the SMMC location which is discharged to the pond at the other side of the Arnell Boulevard. The current WWTP is too small and will not meet the capacity requirements for the new hospital. Therefore, a new WWTP needs to be completed in the early stage of construction. Appendix 1 contains the location of the current WWTP and the new WWTP. The new WWTP must be operational before demolishing the old one. The new and existing hospital need to be connected to the new waste water system. The design and specifications of this new system ensure that there will be no noxious odours around the hospital area. Grinder-Microwave medical waste treatment Installation SMMC recently installed a Grinder-Microwave system for the treatment of medical waste. This system allows to treat up to 500 litres of biomedical waste per hour in complete safety. Biohazardous waste is ground down by rotating blades and sterilized using microwaves and converted into municipal waste, reducing its volume by 80% and its weight by 25%. This environmentally friendly system will be relocated to one of the technical buildings behind the new hospital once the Main Building goes operational. Final technical design In the final design INSO will provide detailed floor plans and room layout for all departments, and complete mechanical, electrical and plumbing drawings. All drawings will include layout calculations and specifications needed for construction and designate the sequence of construction. LEED design submission As part of the requirements for the New General Hospital a LEED (Leadership in Energy and Environmental Design) certificate has to be obtained. LEED requires certain building standards and is ranked by points: Certified 40-49 points, Silver 50-59 points, Gold 60-79, and Platinum 80+ points. The Project was required to meet at least the certified level. The current design has been indicated by a LEED specialists’ firm at 49 points. However, additional efforts are being made to reach the silver level. An independent party with both experience in the Caribbean and with hospital projects will be contracted to complete the LEED submission and ensure the desired certification is acquired. The steps to acquire LEED certification is detailed in Figure 2-5. Figure 2.5 Planning of the LEED Certification Process Phase 2: Construction of the Main Building and Technical Building The construction of the Main Building will commence in early 2020 and will be ready for use in the second part of 2022. October 2019 St. Maarten General Hospital ESMP Page 20 of 135 The Main Building will be constructed at the existing parking lot at the west side of the SMMC location. Parking for employees, patients and visitors will be diverted to alternative location controlled by SMMC. The Main Building will be 5 stories high consisting of 4 functional floors of average 3.600 square meters per floor plus one floor for technical equipment. The equipment on the roof (chillers, solar panels) will be protected against hurricane winds and debris by a metal cage. All windows will be constructed of hurricane proof glass and all glass and doors are covered by hurricane shutters. This phase includes the procurement and installing of all medical equipment, beds, furniture and ICT network/terminals. The Main Building has two large patios to ensure that all rooms with a public function have daylight access. These patios will also be used as a recreational area for patients, visitors and employees. In order to maximize the functionality of the new general hospital, the Main Building will be built as close as possible to the existing hospital that will remain in operation during construction. Adequate measures will be taken by the contractor to avoid dust and noise nuisance as much as possible. The new general hospital is designed for wind forces of 200 miles per hour and is protected against earth quakes, (up to an earthquake with a magnitude 6 on the Richter scale), by using base Isolators. As protection against flooding, the SMMC location is connected to the existing large storm drains. In order to protect the SMMC location for erosion, retaining walls will be constructed at the west side of the SMMC location. The Main Building will have separate entrances for public (patients, visitors, employees), logistic and emergency traffic. When the Main Building will become operational in 2022 there will be temporary main entrance at the West side of the Main building. After demolishing of the existing hospital, the temporary entrance will be reallocated to the east side. The final entrance will be built at the east side of the Main Building together with the Additional Wing. A separate Technical Building will be constructed for: • The connection to the electricity grid based on two individual power lines; • To house the hospital dedicated set of backup generators including storing capacity for fuel for at least 7 days. The tanks for the water storages (at least 7 days’ supply) will be located in the basement of the Main Building. The contractor (and its subcontractors, suppliers) are responsible for providing adequate training to SMMC personnel for the use of new equipment (medical and technical). The contractor will be responsible for the maintenance (including replacement) of the new general hospital and all technical and medical equipment. New Building Commissioning certificate Before SMMC can use the new general hospital, the following inspections need to be executed: • Technical inspection of the Buildings and testing of all (medical) equipment by SMMC‟s engineer and specialized advisors (medical, security etc.) • Inspection by the various departments of the Government amongst others the fire department, traffic department, VROMI etc. • Inspections by the (independent) Medical Inspectorate (Ministry of Health) • SMMC acceptance October 2019 St. Maarten General Hospital ESMP Page 21 of 135 Phase 3: Moving into the Main Building and Demolition of Existing Hospital Commissioning patients to a new general hospital is a complicated logistical process which will be prepared well in advance by SMMC supported by a specialized company. The new general hospital is turnkey Project with all new equipment which reduces the operational issues to a large extent. Demolition of the existing hospital After the Main Building is fully operational the existing hospital will be demolished whereby the construction debris will be transported to the Island dump. The demolition and the transportation of debris will be executed under the stipulations of this ESMP. Phase 4: Construction of the Main Entrance and Other Facilities The Main entrance (north side) can only be constructed after the demolition of the existing hospital as the entrance will be built on the location of the existing hospital. Construction of the Additional Wing The Additional Wing will have 3 stories of approximately 1,000 square meters each. On top of the top floor there will be some technical equipment which will be protected for hurricane winds and debris by a cage. There will be one central patio for daylight access. The technical construction and the use of the materials of the Additional Wing are similar to the Main Building. In this phase only the ground floor will be fully furnished. The other two floors will be constructed based on a core and shell principle. SMMC will develop a business case for the use of these floors in the second half of 2019. Construction of the new parking area Parking is important as many employees, patients and visitors will come by car as public transportation is very limited to Cay Hill. Based on the stipulations of VROMI, there is a minimum ratio of 2.5 parking spots per 100 square meters GFA. Based on the projected seize of the Main Building and the Additional Wing, this results in a minimum of 439 parking spots of which 343 will be created at the new parking area. The remaining 96 parking spots will be located in the multilevel parking garage. SMMC has developed a parking plan to secure safe walking and parking which includes a separation between parking for employees and patient/visitors. Construction of the Parking Garage As there is no sufficient parking space at the parking area, a Parking Garage of 4 floors will be constructed on the North West side of the SMMC location. In addition to the 96 mandatory parking spots, SMMC will construct approximately another 100 parking spots for possible future developments in the Additional Wing. Although there are currently only a limited number of electric cars on St. Maarten, the Parking Garage will be equipped with 4 chargers for electric cars with the possibility to expand on a demand base. Construction of the Heliport SMMC also supports the secondary care on the two sister islands; Saba and St. Eustatius. For emergency transportation, the new general hospital will be equipped with a Heliport. The helicopter is stationed in Saba and the Heliport will only be used for emergency transportation to drop off and or pick up patients. Patients will be transported by ambulance from the Heliport to the emergency entrance of the Hospital. For safety reasons there will be no refuel facilities at the Heliport at the SMMC location. For refuelling the helicopter will fly to the Princess Juliana International Airport in St. Maarten. 2.5.2. Operation phase The new general hospital will be able to provide approximately 84% of the basic specialties, increase the number of beds from 66 to 110 and expand specific areas to provide more outpatient surgeries and other ambulatory services. In addition, there will be new diagnostic and treatment procedures including new medical specialties like Urology, Ophthalmology, October 2019 St. Maarten General Hospital ESMP Page 22 of 135 Pulmonology, Orthopaedics and Neurology. Approximately 300 FTE (full time equivalent) are currently employed by the SMMC which will be increased to 400 FTE when the new general hospital is operational. In addition to these attributes, the new general hospital will: • Meet international healthcare quality standards of the Joint Commission International (JCI) 1 through a rigorous certification program • Operate in an energy efficient and environmentally friendly and sustainable manner through compliance with LEED (Certified or Silver) • Be earthquake and hurricane resistant (category 5 plus hurricane level winds (200mph+) • Be expandable in the future, within the limits of the current location. The turnkey Design Build and Maintenance contract also ensures the Contractor will perform according to the requirements within the DBM contract. The Contractor will provide preventive maintenance, corrective maintenance and replacement maintenance. In addition, the current SMMC maintenance program (inclusive of administration and staffing) will be integrated in the new DBM maintenance contract. This operational service contract will be valid for a ten (10) year period with two optional periods of five (5) years each. 2.6. Project planning The planning for this new general hospital Project started in 2015. INSO, the selected contractor, started working on the preliminary design in 2017 and submitted the Building Permit on August 7, 2018. The Phase 1 site preparation is scheduled to start in November 2019 and the construction phase of the Project is expected to be completed in July 2023. A more detailed time schedule is provided in Figure 2-6. Time Schedule Design and Construction Process 2018 2019 2020 2021 2022 2023 New General Hospital St. Maarten Oct. Nov. Dec. Qtr 1 Qtr 2 Qtr 3 Qtr 4 Jan - Jun Jul - Dec Jan - Jun Jul - Dec Jan - Jun Jul - Dec Jan - Jun Jul - Dec Phase 1 Construction of the New Hospital Soil Investigation Site Preparation Demolition / Construction Waste Water Treatment Plan Final Design LEED Design Submission Registration Nov 2018 | Submittal Design April 2019 | Submittal Construction Jan 2023 Construction Main Building New Building Operation Certificate Phase 2 Demolition Existing Hospital Moving into New Hospital Feb - Mar Demolition of New Hospital April Phase 3 Construction Main Entrance Main Building July - Construction Additional Wing April 2022 - July 2023 Construction New Parking Area/Green Works Apr - July Construction Helicopter Platform Apr - July Figure 2-6: Project planning 2.7. Project workforce The construction for the new general hospital will require a relatively small work force (100-130 workers) across skilled and unskilled workers. As far as possible, unskilled workers who consist of the largest work force contingent will be locally contracted. Special skilled labourers and professionals are expected to be temporarily on the island for various stretches of time during construction. Consequently, there will be no worker camp or special worker housing compounds, since these workers will live in accommodations around Phillipsburg and its outskirts. SMMC, contractors and the Project supervisor have been made aware of the provisions of the World Bank Guidance on Managing the Risks of Adverse Impacts on Communities from Temporary Project Induced Labour Influx. In collaboration with the World Bank safeguards specialists assigned to the Project there is agreement that the worker living and working arrangements are not per se conditions required to be applied for this Project. Nonetheless, INSO and the Project supervisor will apply relevant provisions of the HSE Plan covering worker conduct, behaviour and social interaction rules. 1The Joint Commission International identifies, measures, and shares best practices in quality and patient safety. JCI provides leadership and innovative solutions to help health care organizations across all settings improve performance and outcomes. JCI is the oldest and largest standards-setting and accrediting body in health care in the United States. October 2019 St. Maarten General Hospital ESMP Page 23 of 135 3. ENVIRONMENTAL AND SOCIAL IMPACTS AND RISKS The environmental and social management issues per se are not substantial in this Project. One of the risk factors identified in the early stages of the overall Hurricane Irma Recovery Program, is that the Government of St Maarten is a new client to the World Bank and is being introduced to the World Bank Environmental and Social Safeguards for the first time. In addition, the Project has been prepared under condensed procedures in a post-hurricane environment. 3.1. Applicable World Bank Safeguard Policies This Project has been classified as a Category B Project, as documented in the World Bank Project Information Documents / Integrated Safeguards Datasheet (PID/ISDS) issued in June 2018. Based on early scoping of the Project by World Bank environmental and social specialists, there are only two World Bank safeguards policies triggered as explained below. Safeguard Policies Explanation This policy is triggered and the proposed Category B classification is based on the proposed investments that will finance construction of the new general hospital and rehabilitation of the existing damaged hospital. These works are expected to be of moderate impact generating localized environmental impacts due to the Project- financed activities. These impacts will include debris management, soil stabilization and erosion control, noise and traffic management and worker’s health and safety, and the management of hospital/hazardous waste that can be identified, mitigated, and managed by following the Government Requirements and the General Environmental Assessment OP/BP 4.01 World Bank Group Environmental, Health, and Safety (WB EHS) Guidelines and the Specific Industry WB EHS Guidelines for Health Care Facilities. The Project will prepare an Environmental and Social Management Plan (ESMP) to be consulted and disclosed before the start of works as considered by the Safeguards Action Plan of the PAD. Given the lack of client experience with WB safeguards, the ESMP will include provisions for training and capacity- building early-on to avoid delays related to screening and environmental and social management planning as necessary. While the Project does not expect to utilize or purchase pesticides, this policy is triggered on Pest Management OP/BP 4.09 a precautionary basis since existing or new structures may need rodent/pest control. Table 3-1: E&S Safeguards Triggered The Project’s overall potential socio-environmental impacts are positive for the entire Dutch side of the island and adjacent islands. In addition to the expansion in the scope of services, the new general hospital will: (i) increase capacity from 66 to 110 beds; (ii) have 4 operating theatres and larger areas for ambulatory care, including a new flow of patients for ambulatory surgery; (iii) include critical characteristics to increase the resiliency of the hospital (external protection to withstand category 5 plus hurricanes, installation of modern and safe medical gas, greater storage capacity for having supplies for longer periods, underground communication through fiber optic capability, and a landing platform for helicopters for the transport of trauma patients, etc.). Environmental impacts are limited to the life of the construction process and result directly from construction activities. Compliance with OP 4.01, Environmental Assessment OP/BP, will be accomplished by the application of relevant clauses in construction contracts designed to mitigate the potential impacts identified. The details of these measures are found in the subsequent descriptions of the INSO HSE Plan and the specific Project Management Plans. The Project activities do not trigger OP 4.12 Involuntary Resettlement. The construction of the new general hospital, financed by the Project, will take place on public land free of occupants and not in use for any type of activities, and does not involve any involuntary resettlement. It is part of the land of the existing hospital and its public ownership is not contested. Potential adverse social impacts include: worker safety in the construction activities; safety of patients and staff using the current hospital facility while the current hospital is being used; the management of labour coming from outside St Maarten; community health and safety. October 2019 St. Maarten General Hospital ESMP Page 24 of 135 3.1.1. ESMP Process, Consultation, and Review Process Several steps have been followed in the ESMP development, submissions and review. These are summarized below. • Specialists across environment and social safeguards teamed with the SMMC staff to contribute to the ESMP • A first consultation was held at SMMC on November 26, 2018 • A World Bank environmental safeguards specialist reviewed the ESMP • The Preliminary ESMP was posted on the SMMC websites for public review and comment • The ESMP was disclosed also on the World Bank website 3.2. Assessment of Environmental and Social Impacts and Risks 3.2.1. Approach for impact and risk assessment In this section each of the Project components and associated activities are assessed for potential environmental and social impacts and risks. There is a defined Area of Influence that is considered the “direct impact” zone. In this area the Project activities are assessed to determine any direct and indirect impacts between the Project and its environment resources and people, communities and businesses. The ESIA also predicts and quantifies to the extent possible the magnitude of impacts and risks for each of the Project activities. For this ESIA magnitude of impacts and risks are based on the following considerations: • Type of impact (i.e., direct, indirect) • Nature of the change (what is affected and how) • Size, scale, or intensity • Duration and/or frequency (e.g., temporary, short term, long term, permanent) The magnitude describes the actual change that is predicted to occur and in the case of adverse impacts is ranked from low, medium to high. It is also imperative to identify positive impacts. The Environmental and Social Impact and Risk Assessment matrix is presented in Table 3.2. It is important to clarify that this assessment is considered “preliminary” and will need to be updated once the final design with all detailed construction details is completed. October 2019 St. Maarten General Hospital ESMP Page 25 of 135 Table 3.2 New General Hospital Components and Activities Environmental and Social Impact and Risk Assessment Matrix* * + represents positive impacts or risks and – is negative impacts or risks Phase 1. Preconstruction design, permitting and site preparation New General Hospital Activities Environmental and social impacts/risks Mitigation Measures 1.1 Soil Investigation Environmental • Geotechnical & hydrological + Provides better understanding of baseline investigations conditions • Identify specific soil substrate and groundwater conditions for detailed Social construction planning No significant impacts, as working hours will be coordinated with nearby offices and it is for a limited time 1.2 Site Preparation Environmental • Relocation of current parking area - air emissions from machinery and vehicles - Equipment to be turned off when not in use. • Build new access road and security - noise from construction and equipment - Equipment regularly maintained gates - demolition debris - Low sulphur diesel fuels to be sourced. • Install fencing - oil and lubricant discharge from equipment - Waste will be removed regular from site • Install sound barriers + Sound barriers reduce noise - Site sanitary facilities to be cleaned and sanitized regular • Install office facility and worker facility + Fencing creates secure area • Establish storage area for equipment and materials Social - Ensure that approved traffic control measures are • Embankment excavation - traffic interruption along adjacent roads established, implemented and executed according to • Build new retaining wall and box drain - disruption to local schools, businesses and households plan. in the AoI - Continuously monitor to ensure acceptable performance Apply Site Preparation Environmental + SMMC & INSO advertise and conduct community and apply additional measurements if noise levels Construction Management Plan outreach exceeded. + Establish GRMs October 2019 St. Maarten General Hospital ESMP Page 26 of 135 1.3 Demolition and Construction of the Environmental WWTP - air emissions from machinery and vehicles - Equipment to be turned off when not in use. • Remove current WWTP - noise from construction equipment - Equipment regularly maintained • Build new WWTP - demolition debris - Low sulphur diesel fuels to be sourced. • Hook up and operate new WWTP - oil and lubricant discharge into canal waters from repair - Waste will be removed regular from site equipment - Perform repairs at proper location not close to drains and Apply Site Preparation Environmental + Allows uninterrupted operation of WWTP open water Construction Management Plan + Apply Site Preparation Environmental Construction Management Plan Social + WWTP design reduces noxious odours 1.4 Permit Applications and Final Designs Environmental No significant impacts, as this administration will be done in timely manner. Social No significant impacts, as this administration will be done in timely manner October 2019 St. Maarten General Hospital ESMP Page 27 of 135 Phase 2. Construction of the Main Building and Technical Building New General Hospital Activities Environmental and Social impacts/risks Mitigation Measures 2.1 Main building construction Environmental 2.2 Technical building construction - air emissions from machinery and vehicles - Equipment to be turned off when not in use. - noise from construction equipment - Equipment regularly maintained Apply all INSO Management Plans - construction waste - Low sulphur diesel fuels to be sourced. - oil and lubricant discharge from equipment - Waste will be removed regular from site - Perform repairs at proper location not close to drains and Social open water -worker activities around current hospital operations - traffic interruption along adjacent roads - Ensure that approved traffic control measures are - disruption to local schools, businesses and households in the AoI established, implemented and executed according to plan. - Ensure stakeholder engagement plan is followed 2.3 New General Hospital Environmental commissioning No significant impacts, as systems will be tested before utilizing Social - challenges in coordinating all changeover to NGH + Modern new and improved facility providing better services - Ensure transition plan is in place and followed October 2019 St. Maarten General Hospital ESMP Page 28 of 135 Phase 3. Moving into the Main Building and Demolition of Existing Hospital 3.1 Transfer of all operations Environmental into new building No significant impacts, as it is related to moving current operations. Social - Ensure transition plan is in place and followed - challenges in coordinating all changeover to NGH + Modern new and improved facility providing better services 3.2 Demolition of existing hospital Environmental - air emissions from machinery and vehicles - Equipment to be turned off when not in use. Apply all INSO Management Plans - noise from construction equipment - Equipment regularly maintained - demolition debris - Low sulphur diesel fuels to be sourced. - oil and lubricant discharge from equipment - Waste will be removed regular from site - Perform repairs at proper location not close to drains and open water Social - worker activities around current hospital operations - traffic interruption along adjacent roads - Ensure that approved traffic control measures are established, - disruption to local schools, businesses and implemented and executed according to plan. households in the AoI - Ensure stakeholder engagement plan is followed October 2019 St. Maarten General Hospital ESMP Page 29 of 135 Phase 4. Construction of the Main Entrance and Other Facilities New General Hospital Activities Environmental and Social impacts/risks Mitigation Measures 4.1 Build main entrance Environmental 4.2 Build additional wing - air emissions from machinery and vehicles - Equipment to be turned off when not in use. 4.3 construct new parking area - noise from construction equipment - Equipment regularly maintained 4.4 construct new parking garage - demolition debris - Low sulphur diesel fuels to be sourced. 4.5 build heliport - oil and lubricant discharge from equipment - Waste will be removed regular from site - Perform repairs at proper location not close to drains and open Apply all INSO Management Plans Social water -worker activities around current hospital operations - traffic interruption along adjacent roads - disruption to local schools, businesses and households in - Ensure that approved traffic control measures are established, the AoI implemented and executed according to plan. - Ensure stakeholder engagement plan is followed October 2019 St. Maarten General Hospital ESMP Page 30 of 135 4. ORGANIZATION 4.1. Roles and responsibilities 4.1.1. SMMC SMMC is committed to provide resources essential to the implementation and control of the ESMP. Resources include the appropriate human resources and specialised skills. SMMC will have dedicated personnel competent on the basis of appropriate education, training, and experience that will manage and oversee the E&S aspects of the Project. Table 4-1: Roles, responsibilities and contact details Position Responsibilities Name Oversee and coordinate all activities pertaining to the Project; ultimately responsible for Director EHS. Ensure delivery by the Project of its EHS and operational targets. Ensure effective Kees Klarenbeek communication with all stakeholders. Operations Technical aspects of the Project including Contractor supervision during operations. Erika van der Horst Manager Responsible for the execution of Emergency Response Plan. Construction Technical aspects of the Project including Contractor supervision during Erika van der Horst Manager construction. Ensuring that the Project and Contractor operate in accordance with the applicable EHS Manager regulatory environment, health and safety requirements and plans. Erika van der Horst Monitor implementation of environmental and social protection measures. Community Liaise with local communities and government regulators on the Project’s behalf. Implement Liaison Officer Janneke Lok EHS awareness and education programmes with communities. (CLO) October 2019 St. Maarten General Hospital ESMP Page 31 of 135 4.1.2. Contractor SMMC selected INSO as the Design Build and Maintain (DBM) Contractor („the Contractor‟) for the Project, according to commercial, technical, quality assurance and its past performance on EHS standards so as to satisfy SMMC‟s requirements and policies. Scope of the Contractor is to Design, Build and Maintain for 20 years (10 years plus an option for another 5+5 years) the Project components mentioned in 0. Contractor is made responsible for: • To Design Build and Maintain the Project according to SMMC‟s requirements, • Inventory of all required Permits (see section 4.2.1 for details) etc., • Making the Project compliant to all Permit Requirements, • Reporting to the SMMC on the progress regarding Permits etc. Obligations of the Contractor regarding health and safety management as included in the Process Requirements of SMMC include: • Applying an HSE management system. • All activities required under the National Safety Ordinance and the Safety decrees I, II and III. • Appointing HSE coordinators and attending the HSE coordination meetings / events. • The preparation and implementation of an HSE plan, HSE file and emergency plan. • Organising the relevant HSE instruction (training) and induction for employees, assistants, staff and visitors to the construction site. • Implementing risk management to benefit health and safety. • Recording and handling of incidents and (near) misses and accidents. During the Operation Service Period, the Contractor’s role is to ensure and prove that the Permanent Works (e.g., building, fixed furniture, medical equipment, inventory and terrain) keep performing according to SMMC‟s requirements at all times ensuring continuous health care services. INSO will assign an HSE Manager whose responsibility is to ensure that environment, health and safety regulatory requirements are met and that ESMP requirements are properly implemented. 4.1.3. Regulatory agencies Several GoS agencies have direct responsibility for this Project. They include VROMI, (public Works), and VSA (Department of Health and Social Services). These agencies will work closely with SMMC to ensure compliance with all building and operational requirements. Principal Agencies Providing Support under the ESMP Table 4-2: Principal Agencies Providing Support under the ESMP Agency Agency Role VROMI National public works agency. Responsible for preparation of technical specifications for construction related contracts. Provides inspection and supervision services for all works. Includes the national solid waste management department. GEBE National company for the provision of water and electricity for St. Maarten. Responsible for preparation of technical specifications for construction related water and power infrastructure. Also provides supervision services for construction activities in the utility sectors October 2019 St. Maarten General Hospital ESMP Page 32 of 135 VSA- Department of Health Statutory authority in charge of occupational and public health. Also in charge of the screening of social eligibility criteria of the roof repairs program. MECYS – Ministry of Education, Counterpart agency for historic preservation and archaeological concerns Culture, Youth and Sports 4.1.4. Employer’s Representative (ER) SMMC selected DZFAS and Royal HaskoningDHV to act as Employer’s Representative and support SMMC during the design, construction and first year of operation of the Project. The Employer’s Representative will provide the following support to SMMC regarding the ESMP implementation: • Review of the design, working methods, materials, risk registers and specific management plans developed by the Contractor for the pre-construction and construction and maintenance activities. This review includes several predefined documents to be provided by the Contractor as listed in SMMC‟s process requirements (including e.g., Project Management Plan, Final Design, Construction Plan, Contractor HSE plan, Verification Plan, Construction Work Inspection Plan, detailed time schedules for all Project phases). Approval of these documents by SMMC is required before the Contractor is allowed to carry out the related activities. • Site supervision during construction activities. SMMC‟s contract manager and two dedicated site supervisors will monitor if the contractor carries out all works according to the approved documents and management plans. This includes HSE supervision. Contractor is required to proof compliancy to all requirements following the approved Verification Plan and Construction Work Inspection Plan. Verification, audit plan and weekly site meeting between SMMC, Employer’s Representative and Contractor will also cover HSE performance. • Review of the specific management plans developed or updated by SMMC for the operation and maintenance of the new general hospital. 4.1.5. The World Bank The World Bank will provide the necessary implementation support, including by bringing in international expertise where relevant, providing hands on guidance and training to ensure: (i) SMMC‟s knowledge and understanding of Bank safeguards instruments; (ii) that counterparts have the capacity to undertake environmental and social analyses and develop mitigation approaches; and (iii) regular and close implementation support during the terms of the Grant. This implementation support will be provided through regular interactions, implementation support missions, and thematic review missions if required. 4.2. Institutional arrangements (permitting) This section presents the permits and clearance required before the start of construction, during construction and operation. 4.2.1. Construction Permits A Building Permit (BP 200-18), Demolition Permit and Hindrance Permit (HP 2018-06) were obtained from the appropriate local authority (VROMI) in November 2018. The Building Permit is an authorization for construction or development, based on the Building Ordinance or Zoning Ordinance and is issued by the Government of St Maarten before the construction of the new building can legally occur. This authorization includes the approval from Local Authorities (fire department, traffic police, aviation department etc.). The Hindrance Permit is required for specific types of activities that can cause danger, damage and/or nuisance to the environment or the surroundings. It is tied to regulations which are meant to protect the environment and ensure safe and clean practices on St Maarten. The regulations generally pertain to regulate, prevent, and/or limit pollutions (soil, water, October 2019 St. Maarten General Hospital ESMP Page 33 of 135 noise, air, and odour) and energy. A Hindrance Permit is required for the Waste Water Treatment plant and the Generators, Transformers, Chillers, Air Compressors, Oxygen Generator, Steam Generator, Autoclave/Grinder, etc. The Demolition Permit is required for both the existing Waste Water Treatment Plant (WWTP) and the demolition of the existing Hospital. Goal of the permit is to limit impact of the activities on the living- and working environment for the public and ensure that demolished materials are disposed of according to regulations. 4.2.2. Operation The Department of Public Health has issued a Permit (Nr 11777) to procure medical equipment and construct new general hospital. 4.3. Training, awareness and competency Both SMMC and Contractor will identify, plan, monitor, and record training needs for personnel whose work may have a significant adverse impact upon the environment or social conditions. The Project recognises that it is important that employees are aware of the Project’s environmental and social management plans including potential impacts of their activities and specific roles and responsibilities to comply with these plans and procedures. Employee training will include awareness and competency with respect to: • Environmental and social impacts that could potentially arise from their activities; • Necessity of conforming to the requirements of the ESMP (including its specific Management Plans and Procedures), in order to avoid or reduce those impacts; and • Employee roles and responsibilities across all these plans and procedures. The EHS Manager is responsible for coordinating training, maintaining employee-training records, and ensuring that these are monitored and reviewed on a regular basis. The EHS Manager will also periodically verify that staff is performing competently through discussion and observation. Employees responsible for performing site inspections will receive training by drawing on external resources as necessary. Training will be coordinated by the EHS Manager prior to commissioning of the facilities. Upon completion of training and once deemed competent by management, staff will be ready to train other people. The Contractor HSE Training Program will be subject to consent by SMMC and it will be audited to ensure that: • Training programs are adequate; • All personnel requiring training have been trained; and • Competency is being verified. 4.4. Communication and stakeholder engagement As part of the existing hospital operations, SMMC maintains a formal procedure for communications with the regulatory authorities. A client panel is also in place as well as a Complaints Policy and Procedure. SMMC will develop a Stakeholder Consultation and Engagement Plan for the Project, first for the Construction Phase and then for the Operation Phase. The EHS Manager will be responsible for communication of E&S issues to and from regulatory authorities whenever required. The CLO will be responsible for communication with communities. Meetings will be held, as required, between SMMC, INSO, the employee’s representative, subcontractors and the appropriate regulatory agency and community representatives to review EHS performance, areas of concern and emerging issues. All such meetings shall be properly documented with the proceedings made available to the public. October 2019 St. Maarten General Hospital ESMP Page 34 of 135 4.5. Documentation SMMC will manage the EHS reports, management plans, associated procedures, and checklists. All records will be kept on site and will be backed up and stored in a secure cloud site. Records will be kept in both hard copy and soft copy formats and all records will be archived for the life of the Project. Furthermore, the document control procedure will describe the processes that the Project will employ for official communication of both hardcopy and electronic (through the internet) document deliverables. In addition, it will describe the requirement for electronic filing and posting and for assignment of document tracking and control numbers (including revision codes). The EHS Manager is responsible for maintaining a master list of applicable EHS documents and making sure that this list is communicated to the appropriate parties. The EHS Manager is responsible for providing notice to the affected parties of changes or revisions to documents, for issuing revised copies and for checking that the information is communicated within that party’s organisation appropriately. The subcontractors will be required to develop a system for maintaining and controlling its own EHS documentation and describe these systems in their respective EHS plans. 4.6. Management of change Changes in the Project may occur during final design, commissioning or even operations. The Project will implement a formal Variation Procedure that applies to all Project activities. The objective of the procedure is to ensure that the impacts of changes on the environment and health and safety of workers and communities are identified and assessed prior to changes being implemented. The management of change procedure will ensure that: • Proposed changes have a sound technical, safety, environmental, and commercial justification; • Changes are reviewed by competent personnel and the impact of changes is reflected in documentation, including operating procedures and drawings; • Hazards resulting from changes that alter the conditions assessed in the present ESMP have been identified and assessed and the impact(s) of changes do not adversely affect the management of health, safety or the environment; • Changes are communicated to personnel who are provided with the necessary skills, via training, to effectively implement changes; and • The SMMC EHS Manager accepts the responsibility for the change. Significant design and procedural changes will also be updated in each appropriate Management Plans. The environmental, social and engineering feasibility and cost considerations will be taken into account when choosing between possible alternatives. 4.7. Operational controls As indicated in the table 3-2, and in Appendix 2, all potential impacts identified in the present ESMP have mitigation measures that specifies appropriate procedures, work instructions, best management practices, roles, responsibilities, authorities, monitoring, measurement and record keeping provisions. These Operational Controls will be monitored for compliance and effectiveness on a regular basis through the designated monitoring and auditing processes described in Section Error! Reference source not found. October 2019 St. Maarten General Hospital ESMP Page 35 of 135 4.8. Emergency preparedness and response 4.8.1. SMMC SMMC has an Emergency Disaster Preparedness Plan (EDP) (SMMC document reference no. 116) in place to identify the potential for, and response to, environmental accidents and health and safety emergency situations and for preventing and mitigating potentially adverse environmental and social impacts that may be associated with them. The EDP is covering the following disaster scenarios: hurricane, tornadoes, earthquakes, tsunamis, mass casualties accident (air crashes, maritime accidents and road traffic accidents), structure fire (code red), gas rupture/exploration (code grey), hazardous material incidents – biological and chemical (code brown), civil disorders, barricaded suspect/hostage situation, bomb incidents (code black). Emergency preparedness and response is being reviewed by SMMC on at least every two years and after the occurrence of any accidents or emergency situations to ensure that lessons learnt inform continuous improvement. The EDP will be updated for the new general hospital upon completion of final design and before the new general hospital is commissioned. Emergency exercises are and will be undertaken on a regular basis to confirm adequacy of response strategies. Investigations of accidents or incidents will follow formal documented procedures. 4.8.2. Contractor INSO has developed a Hurricane Plan for the Construction Phase, which is included in the HSE plan (Appendix 5). This will be aligned with the SMMC EDP plan. INSO will also prepare as part of its HSE Plan a Section on Emergency Preparedness and Response covering other emergency scenarios identified in its risk assessment for the Construction Phase. 4.9. Checking and corrective actions These actions discussed below include inspections, monitoring as well as audit activities to confirm proper implementation of mitigations and enhance measures proposed in the ESMP. Corrective actions include response to improper activities, non-compliances, and non-conformance. These actions also include measures to improve performance. 4.9.1. Monitoring and verification Monitoring will be conducted to ensure compliance with the ESMP. Monitoring and verification indicators are detailed in the ESMP table provided in Appendix 2. 4.10. Monitoring of Contractors Performance During the Construction phase and the first year of Operations, the Employer’s Representative will monitor the Performance of the Contractor as described in section 4.1.4. During the rest of the Operational Service Period, SMMC will take over that role and monitor the performance of INSO‟s maintenance activities as follows: • SMMC Supervisor will review the performance of the works of the Contractor, and • SMMC Contract Manager will monitor the performance of the Contractor in relation to the management plans (requirements, impact to the healthcare processes, and the level of cooperation). The proposed frequency of monitoring by SMMC is as follows: • At Strategic level: yearly contract meetings • Monthly Progress meetings and discussion of monthly progress reports • Tactical performance meeting (quarterly), and • Weekly work meetings. October 2019 St. Maarten General Hospital ESMP Page 36 of 135 4.10.1 Auditing Beyond the routine inspection and monitoring activities conducted, audits will be carried out internally by SMMC (or the Employer’s Representative) to ensure compliance with regulatory requirements as well as their own EHS standards and policies. Audits to be conducted will also cover the Contractor self-reported monitoring and inspection activities. The audit shall be performed by qualified staff and the results shall be reported to SMMC to be addressed. The audit will include a review of compliance with the requirements of the ESMP and include, at a minimum, the following: • Completeness of EHS documentation, including planning documents and inspection records; • Conformance with monitoring requirements; • Efficacy of activities to address any non-conformance with monitoring requirements; and • Training activities and record keeping. There will be a cycle of audits into specific areas of the Project. The frequency of audits will be risk based and will vary with the stage of the Project and will depend on the results of previous audits. 4.10.2 Corrective action Investigating a „near-miss‟ or actual incident after it occurs can be used to obtain valuable lessons and information that can be used to prevent similar or more serious occurrences in the future. SMMC and Contractor will implement a formal Non-compliance and corrective action tracking procedure for investigating the causes of, and identifying corrective actions to, accidents or environmental or social non- compliances. This will require coordinated action between SMMC and Contractor. The EHS Manager will be responsible for keeping records of corrective actions and for overseeing the modification of environmental or social protection procedures and/or training programs to avoid repetition of non- conformances and non- compliances. 4.11 Reporting Throughout the Project, SMMC will keep the regulatory agencies informed of the Project performance with respect to EHS matters by way of written status reports and face-to-face meetings. SMMC will prepare a report on environmental and social performance and submit it to the regulatory agencies. The frequency of this reporting will be agreed upon between SMMC and the regulatory agencies. If required, SMMC will provide appropriate documentation of EHS related activities, including internal inspection records, training records, and reports to the relevant regulatory agencies. Contractor is also required to provide EHS performance reporting to SMMC on a regular basis through monthly progress reports. These will be used as inputs to the above. October 2019 St. Maarten General Hospital ESMP Page 37 of 135 5 ENVIRONMENTAL AND SOCIAL MANAGEMENT 5.1 ESMP Mitigation and enhancement measures, responsibility for implementation, and monitoring and verification indicators are provided in the ESMP Table in Appendix 2. These measures and the Management Plans discussed below have been adopted by SMMC and are considered INSO contract requirements. SMMC and INSO will determine what additional risks and proposed management controls are required based on the final design and work method statements. The table contains reference to the specific INSO Health, Safety and Environment Plan (HSE) Plan sections that describe each of the required provisions. 5.2 Specific Management Plans As highlighted in the ESMP Table, specific Management Plans are to be finalized to support the implementation of this ESMP. The timing of the development of the plans may be staged, ensuring that the appropriate focus and level of detail is provided for construction and operational activities. They will be finalised by INSO with SMMC and ER coordination. When appropriate, the Project owner and their representatives may meet with GoS agencies and other key stakeholders. The contents of the Management Plans are outlined in Appendix 4, while Appendix 3 includes the Management Plans available at this stage. 5.2.1 Construction Phase Contractor As per contract requirements, INSO submitted its HSE Plan (“the Contractors HSE Plan‟) which requires SMMC approval before the start of new general hospital construction activities. The INSO HSE Plan will include the following Sections or Management Plans: • Air Quality Control and Monitoring Plan • Noise Control and Monitoring Plan • Waste Management Plan • Hazardous Materials Management Plan • Emergency Preparedness and Response Plan • Construction Traffic Management Plan • Occupational Health and Safety Management Plan • Community Health, Safety and Security Management Plan • Hurricane Plan for the Construction Phase • INSO Grievance Redress Mechanism The HSE Plan was submitted to SMMC in September 2019. Based on comments by the Employer’s Representative, INSO is finalising this HSE Plan. The Contractor will also develop and implement its own internal Grievance Redress Mechanism in either the Contractors HSE Plan or Quality Management System (QMS) developed for the Project. SMMC SMMC has developed a Complaints Policy and Procedure. They will also develop a Stakeholder Consultation and Engagement Plan. See appendix 3. October 2019 St. Maarten General Hospital ESMP Page 38 of 135 5.2.2 Operational Phase Contractor The Contractor will adopt and amend specific Management Plans to address all the E&S risks associated with the operational phase of the new general hospital. There will also be a Quality Management System developed for this operational service period. The Contractor will provide the following documents for Consent or Approval not later than 90 days before the start of the Operational Service Period: • Operation & Maintenance Management Plan • HSE Plan Operation Service Period • Procedures for periodical tests (monitoring): o Audit of the Quality management system o Evaluation report energy & water consumption o Audit monitoring system o Test on Compliance to law and regulations o Maintenance condition assessment o Yearly maintenance plan o Yearly safety scan Medical Equipment o Fire safety scan o Legionella inspection o Air Quality inspection o Emergency power system inspections o Medical Gasses inspection o Waste water treatment system inspection Many of the above plans and actions require various types of reports, monitoring or both. These results shall be reported to SMMC in a standardized computer format. All defects, shortcomings, and problems are required to be rectified within the applicable permitted recovery time (PRT). SMMC SMMC has the following Operational and Management Plans for the current hospital operations: • Medical waste protocol, including hazardous waste chart, September 2019 • Emergency Disaster and Preparedness Plan (Ref 116) • Security tasks plan (Ref FM 103-2) • Fire safety and evacuation plan (Ref FM 101-1) • Complaint Policy and Procedure • FONA (Fault or Near Accidents) procedure • Rodent and Pest Control Plan (complies with the triggered World Bank Pest Management Policy) Further, related to Human Resource Development, SMMC has the following documents: • Collective Labour Agreement (CLA), • Staff Handbook, • Introduction form new staff / specialists, including new in-service program with coaching, • Evaluation procedures all staff, • Several policies, a lot due for revising (health care), and • Training program for critical procedures (nursing staff). Additional plans identified to be required to be developed or updated based on the existing above-mentioned documentation include: October 2019 St. Maarten General Hospital ESMP Page 39 of 135 • Stakeholder Consultation and Engagement Plan • Complaint Policy and Procedure • Exposure Control Plan for blood-borne pathogens • Radiation Exposure Control Plan • Radioactive Substance Management Plan • Occupational Health and Safety Management Plan • Air Quality Control and Monitoring Plan • Emergency Preparedness and Response Plan • Community Health and Safety Management Plan • Security Plan • Human Resources Policy October 2019 St. Maarten General Hospital ESMP Page 40 of 135 REFERENCES INSO, 2018, Health, safety & Environment plan Rev. 00, Design and Construction Phases https: Hyperlink SMMC, 2018, Preliminary LEDD Report https: Hyperlink World Bank Group, Environmental, Health, and Safety (EHS) Guidelines; MAIN WEB PAGE https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainability-at- ifc/policies- standards/ehs-guidelines World Bank Group, Environmental, Health, and Safety (EHS) Guidelines; GENERAL EHS GUIDELINES: INTRODUCTION https://www.ifc.org/wps/wcm/connect/554e8d80488658e4b76af76a6515bb18/Final%2B- %2BGeneral%2BEHS%2BGuidelines.pdf?MOD=AJPERES World Bank Group, Environmental, Health, and Safety (EHS) Guidelines; HEALTH CARE FACILITIES https://www.ifc.org/wps/wcm/connect/bc554d80488658b6b6e6f66a6515bb18/Final%2B- %2BHealth%2BCare%2BFacilities.pdf?MOD=AJPERES&id=1323161961169 World Bank, 2016 - Managing the Risks of Adverse Impacts on Communities from Temporary Project Induced Labour Influx http://pubdocs.worldbank.org/en/497851495202591233/Managing-Risk-of-Adverse-impact-from-project- labor- influx.pdf World Bank, 2018, Project Information Document-Integrated Safeguards Data Sheet - Sint Maarten Hospital Resiliency Preparedness Project - P167532 http://documents.worldbank.org/curated/en/214261530290733277/Project- Information-Document-Integrated- Safeguards-Data-Sheet-Sint-Maarten-Hospital-Resiliency-Preparedness-Project- P167532 October 2019 St. Maarten General Hospital ESMP Page 41 of 135 APPENDIX 1: SMMC NEW GENERAL HOSPITAL DESIGN DOCUMENTS Figure 1.1 Site layout during site preparation October 2019 St. Maarten General Hospital ESMP Page 42 of 135 Figure 1.2 New general hospital impressions Figure 1.2A General Perspective October 2019 St. Maarten General Hospital ESMP Page 43 of 135 Figure 1.2B Façade detail October 2019 St. Maarten General Hospital ESMP Page 44 of 135 Figure 1.2C Entrance exterior October 2019 St. Maarten General Hospital ESMP Page 45 of 135 Figure 1.2D Interior Entrance Hall October 2019 St. Maarten General Hospital ESMP Page 46 of 135 Figure 1.2E Interior Patient Room October 2019 St. Maarten General Hospital ESMP Page 47 of 135 Figure 1.2F Corridor and Patio October 2019 St. Maarten General Hospital ESMP Page 48 of 135 APPENDIX 2: ESMP TABLES Table 2.1 ESMP Matrix for Construction Phase (*contains reference to specific sections in the INSO HSE Plan found in Appendix 3) Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures 1. Environmental and Social Management System (ESMS) Implement the ESMS (INSO HSE Plan - Quality, Environmental and System to manage, Safety), as certified by Lloyd’s Register in compliance with UNI EN Monthly progress reports and control and monitor Contractor ISO 9001:2015 - UNI EN ISO 14001:2015 - OHSAS 18001:2007; as meetings E&S risk well as the EMS 14001. Audits 2. Noise and Air Pollution Noise generated by construction Maintain all construction equipment in accordance with Training of workers and Contractor equipment and manufacturer’s specifications. drivers to raise awareness activities Schedule construction and rehabilitation work during daylight hours Check vehicles’ maintenance and to minimize activity during peak periods of tourism and recreation results (weekends, holidays, etc.). Check results of noise Develop and implement a Construction Communications Plan to monitoring and vibration-if inform businesses and residents of construction activities. needed- monitoring Limit construction noise levels to applicable standards such as EHS Site inspections to check Guidelines construction site practices The plants and equipment used in construction (including the Grievance register (both aggregates crushing plant) shall strictly conform to the EHS noise INSO & SMMC) standards. All vehicles & equipment used in construction shall be fitted with exhaust silencers. During routine servicing operations, the effectiveness of exhaust silencers shall be checked and if found to be defective shall be replaced. Limits for construction equipment used in this Project (measured at one meter from the edge of equipment in the free field) such as compactors, rollers, front loaders, concrete mixers, cranes (moveable), vibrators and saws as specified in the EHS Guidelines. Maintenance of vehicles, equipment and machinery shall be regular and to the satisfaction of the Project Supervisor to keep noise from these at a minimum. October 2019 St. Maarten General Hospital ESMP Page 49 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures Workers shall wear earplugs in vicinity of loud noise, and working with or in crushing, compaction, or concrete mixing operation. Chapter 12.9 Contractor HSE Plan for the Air Quality Control and Monitoring Plan. Chapter 12.7 of Contractor HSE Plan for the Noise Control and Monitoring Plan. Chapter 10.1 of the Contractor HSE Plan for the Construction Traffic Management Plan SMMC Complaints Policy and Procedure. Inso Grievance Redress Mechanism Exhaust emissions The construction equipment and trucks will be maintained regularly to from construction Check results of air quality keep them in good working condition to minimize exhaust emissions Contractor vehicles and monitoring caused by poor performance. equipment Training of workers and Low sulphur fuel will be preferred as far as possible. drivers to raise awareness Engines of the equipment/trucks will be prevented from idling and Site inspections to check running unnecessarily. construction site practices Suppress dust as needed in unpaved areas. Grievance register Avoid burning non-vegetative wastes (refuse, etc.) at construction sites. Chapter12.9 of the Contractors HSE Plan for the Air Quality Control and Monitoring Plan. Chapter 10.1 of the Contractors HSE Plan for the Construction Traffic Management Plan. 3) Materials Supply Aggregates and materials will be sourced from quarries, borrow pits, crushing plants and asphalt plants operating with valid environmental Check records of construction and other permits and licenses and where the sites are managed in Contractor material supply sources full compliance with all applicable environmental standards and specifications. Identification of opportunities Recycled materials and materials certified as “green” and low carbon for use of recycled or low will be used to the extent possible. carbon sources Materials used are part of the LEED sustainability certification and will LEED sustainability be sourced from locations as required. certification October 2019 St. Maarten General Hospital ESMP Page 50 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures Contractor will be required to adopt good construction site practices for the protection of soils and to follow the EHS Guidelines. Provisions will be taken for the protection of newly exposed soil surfaces from rainfall and wind erosion, use of silt fences mandatory. 4) Materials and Waste Management Soils, surface water Contaminated soils (if generated any) will be disposed of in an Periodic (e.g. weekly) site Contractor and ground water appropriately licensed disposal site. inspections The use of cement and wet concrete in or close to any exposed areas will be carefully controlled. Good construction site practices (i.e. Check that hazardous and measures such as using designated areas for storing materials, non-hazardous waste regular inspections at construction sites, training of construction disposal records are kept workers, placement of sediment traps and/or oil/water, etc.) will be properly adopted to minimize risks of water pollution. Check the installation of the Construction workers and relevant staff will be trained on spill conduit system and response and prevention measures. communication records with DSI The location, storage and handling of hazardous material (including Regular inspection of refuelling activities) will be as per the Hazardous Material construction activities and Management Plan training of relevant staff The storage, transport and disposal of waste materials generated will Check inspection and training be as per the Waste Management Plan records Check necessary measures Hazardous materials will be handled according to the Hazardous (i.e. bunds) are in place at Material Management Plan areas where hazardous materials are handled Check the records of regular Hazardous and non-hazardous waste will be handled according to the integrity testing of Waste Management Plan underground storage tanks and lines Chapters 6 and 12.5 of the Contractors HSE Plan for the Hazardous Check subcontractors’ Material Management Plan. contract in line with Chapter 12.4 of the Contractors HSE Plan for the Waste Subcontractor Management Management Plan. and Monitoring Plan Fuels, oils and chemicals will be stored on an impervious base Check the records of Spills/accidents and protected by bunds to 110% of capacity. Drip trays will be used for Contractor contaminated soil (if any contaminated land fuelling mobile equipment. occurred) disposal October 2019 St. Maarten General Hospital ESMP Page 51 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures Any spillages from handling fuel and liquids will be immediately Check records of surplus contained on site and the contaminated soil removed from the site for material reuse suitable treatment and disposal. Spoil and other surplus material arising from the works which is classed as “acceptable fill” shall, wherever practicable, be recovered Review accidents and spills and used in the construction works. Relevant authorities shall be records consulted regarding this on a site by site basis to ensure the re-use of waste materials is acceptable. All contractors and subcontractors will be required to report any incidents and these will be subject to investigation and remedial and preventive actions will be taken as needed. Appropriate spill response kits including absorbent materials will be present on site. These will be kept at designated areas with specific instructions for their use. Site staff will be trained on the use of spill kits. An Emergency Preparedness and Response Plan will provide for mitigation of spills from hazardous materials during construction. Response to the spill will be made as fast as possible. Contaminated materials will be collected and sent to appropriate disposal facilities. Operation of a closed drainage system and implementation of Emergency Preparedness and Response Plan in the event of spills, fire etc. will prevent significant impacts on soils during construction and operation. Chapter 5 of the Contractors HSE Plan for the Emergency Preparedness and Response Plan. Chapter 12.8 of the Contractors HSE Plan for Soils and Contamination actions. 5) Material Resources and Waste Management Ensure that the WMP is Water generation and All wastes during construction will be managed in line with the Waste Contractor implemented during management Management Plan (WMP). construction phase Check consents/permits from Necessary permits related to disposal of excavated soil to be local authorities for the obtained from the local environmental authorities. disposal of excavated soils October 2019 St. Maarten General Hospital ESMP Page 52 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures Should risk management actions be warranted, the assessment approach (as outlined in the IFC EHG Guidelines) are to be applied Check disposal records of (establish whether the three risk factors of ‘Contaminants’, contaminated soils ‘Receptors’, and ‘Exposure Pathways’ co-exist, or are likely to co- exist) and put in place permanent risk reduction measures. Ensure that central temporary waste storage area is Chapters 12.4 of the Contractors HSE Plan for the Waste designed and constructed to Management Plan. ensure that hazardous wastes are properly stored at the construction site Periodic site inspections to ensure that all wastes are separately collected, segregated, labelled and stored in designated areas Check disposal records of all types of wastes (including against SMMC MW Protocol) Check waste disposal contracts Check copies of haulers’ and disposal facilities’ licenses Check declaration records made to the Ministry Ensure that all waste manifests are in order and ready for review during Authorities’ audits Check training records of staff and awareness during site audits October 2019 St. Maarten General Hospital ESMP Page 53 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures A new Wastewater Treatment Plant will be erected at a different location on the Project site to enable the construction of the new hospital. The current Wastewater Treatment Plant will only be Check effluent analysis demolished after new Plant has been commissioned and tested. The results to ensure they meet Wastewater WWTP will require a permit which will be obtained prior to build. After Contractor with discharge criteria defined WWTP is approved, demolition permit is obtained (as part of the in the connection certificate Building permit). The new Wastewater Treatment Plant will be designed and built according to both Employers Requirements and Authorities requirements. · Check permit obtained from the relevant authority 6) Occupational Health and Safety and Human Resource Development Management of Monitor INSO HSE Plan The revised INSO HSE plan must be approved by the SMMC before Contractor / health and safety of particularly in terms of start of any construction works SMMC workers - general progress and updates. INSO Worker Grievance Mechanism (including SMMC All applicable national health and safety legislation and international responsibility for Contractor regulations will be followed. actions) to be assessed in terms of workers feedback. All the health and safety risks of each activity during construction will Monitor updated Contractors be identified followed by identification of the appropriate mitigation risk register. measures/personal protective equipment. All relevant training requirements will be dealt with in the HSE Plan. On-site verification Chapter 9 of the Contractors HSE Plan for Occupational Health and Safety Plan. Worker occupational All employees will be trained on health and safety, and the Contractor / Check implementation of health and safety - Emergency Preparedness and Response Procedures to respond SMMC worker training programmes fire and emergencies timely to the incidents. All medical emergency procedures will be included in the Emergency Preparedness and Response Plan (in Contractors HSE Plan) and SMMC’s Monitoring of Emergency Disaster and Preparedness Plan. Chapter 5 of Contractors HSE Plan for the Emergency Preparedness and Response Plan SMMC Monitoring of Emergency Disaster and Preparedness Plan (Ref 116) SMMC Fire Safety and Evacuation Plan (Ref 101-1) October 2019 St. Maarten General Hospital ESMP Page 54 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures Worker Occupational All hazardous materials will be stored in designated areas having Monitoring of monthly update health and safety - secondary containment and handled with care by authorized staff to Contractor of INSO HSE Plan and equipment use and prevent potential spills. SMMC’s Plan 085. hazardous materials ü chapters 6 and 12.5 of INSO HSE Plan Monitor compliance of Worker Human Contractor is required to comply with the Country Worker safety Contractor with Country Contractor / Resource ordinance (February 3, 1958) and ILO conventions to which it is (via Worker safety ordinance SMMC Development the Kingdom of the Netherlands) a signatory. (February 3, 1958), and ILO conventions. Monitor updated Contractors risk register. All records of accidents or any mishap either at construction camp, Monitor updated Contractors Record of accidents construction workers‟ camp or at construction sites shall be risk register maintained and documented regularly by the contractor. 7) Labour Engagement and Disclosure Potential worker Implement Worker Grievance Mechanism to ensure transparent and strikes and Union Monitor updated Contractors informed information sharing channel. Labour grievance channel is Contractor action on work risk register. applicable to all workers and should be monitored. stoppage Monitor SCEP and worker INSO HSE Plan, QMS or Project Management Plan (PMP) for the grievance records and Worker Grievance Mechanism (to be developed since the SMMC resolutions, particularly in Complaints Policy and Procedure doesn’t cover INSO and terms of progress and subcontractors workers). updates. 8A) Community Engagement and Disclosure Transparency around Monitor SCEP and grievance Regular transfer of Project information to all stakeholders and the Project status and records and resolutions, general public through a Stakeholder Consultation and Engagement SMMC sharing of alerts and particularly in terms of Plan (external). Also include full disclosure and regular engagement. updates progress and updates. Disclosure method, tools, program to be documented in updated Monitor updated Contractors versions of the SCEP. risk log. Ensure update of Complaints SMMC Stakeholder Consultation and Engagement Plan (to be Policy to include SMMC developed) responsibility for Contractor actions. SMMC Complaints Policy and Procedure. October 2019 St. Maarten General Hospital ESMP Page 55 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures 8B) Staff, Patient, and Visitor Engagement and Disclosure Staff, Pati Transparency around Monitor SCEP and grievance Regular transfer of Project information to all staff, patients, and Project status and records and resolutions, visitors through a Stakeholder Consultation and Engagement Plan SMMC sharing of alerts and particularly in terms of (external). Also include full disclosure and regular engagement. updates progress and updates. Disclosure method, tools, program to be documented in updated Monitor updated Contractors versions of the SCEP. risk log. Ensure update of Complaints SMMC Stakeholder Consultation and Engagement Plan (to be Policy to include SMMC developed) responsibility for Contractor actions. SMMC Complaints Policy and Procedure. 9A) Community Health, Safety, and Security Exposure to Implement risk management strategies to protect the community from Early stages daily monitoring hazardous situations physical, chemical, or other hazards associated with sites under Contractor required, thereafter weekly. at construction site construction. Update INSO HSE Plan (Chapter 7) to include risks to community. Visual site inspection Update and monitoring of the Update Chapter 10 to include construction traffic risks to community. HSE Plan (including Site Preparation EMP) Chapter 7 of the Contractors HSE Plan for the community risk Contractor risk register management actions (to be updated) Chapter 10 of the Contractors HSE Plan for construction traffic risks to community via a Traffic Management Plan (to be updated) INSO HSE Plan to be updated to encompass community health, safety and security in order to manage general risks and impacts to the community Update SMMC grievance management system to include general public not just the hospital community. Increased workers / All employees trained on health and safety, and Emergency SMMC and Monitor Complaints procedure movement of people Preparedness and Response Plan to respond timely incidents. Contractor feedback and vehicles SMMC’s Complaints Policy and Procedure. INSO HSE Plan, specifically Chapter 10 for the Construction Traffic Management Plan and Chapter 5 for the Emergency Preparedness and Response Plan October 2019 St. Maarten General Hospital ESMP Page 56 of 135 SMMC Monitoring of Emergency Disaster and Preparedness Plan (Ref 116) Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures The Contractor intends to recruit construction workforce locally to the Inappropriate worker extent possible. The full labour complement during construction is Contractor / Health reports from nearby behaviour likely to not exceed 130 people since workers will be absorbed into SMMC health facilities. accommodation facilities in the nearby Philipsburg area. Contractors Code of Conduct covers workforce behaviour on and off the jobsite, prohibits unauthorised and illegal substance use, and Grievance register addresses the prevention of communicable diseases. Monitor updated Contractors risk register Record of monthly progress meetings 9B) Staff, Patient, and Visitor Health, Safety, and Security Exposure to Implement risk management strategies to protect the community from Early stages daily monitoring hazardous situations physical, chemical, or other hazards associated with sites under Contractor required, thereafter weekly. at construction site construction. Update INSO HSE Plan (Chapter 7) to include risks to community. Visual site inspection Update and monitoring of the Update Chapter 10 to include construction traffic risks to community. HSE Plan (including Site Preparation EMP) Chapter 7 of the Contractors HSE Plan for the community risk Contractor risk register management actions (to be updated) Chapter 10 of the Contractors HSE Plan for construction traffic risks to community via a Traffic Management Plan (to be updated) INSO HSE Plan to be updated to encompass community health, safety and security in order to manage general risks and impacts to the community Update SMMC grievance management system to include general public not just the hospital community. Increased workers / All employees trained on health and safety, and Emergency SMMC and · Monitor Complaints movement of people Preparedness and Response Plan to respond timely incidents. Contractor procedure feedback and vehicles SMMC’s Complaints Policy and Procedure. INSO HSE Plan, specifically Chapter 10 for the Construction Traffic Management Plan and Chapter 5 for the Emergency Preparedness and Response Plan October 2019 St. Maarten General Hospital ESMP Page 57 of 135 SMMC Monitoring of Emergency Disaster and Preparedness Plan (Ref 116) Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures The Contractor intends to recruit construction workforce locally to the Inappropriate worker extent possible. The full labour complement during construction is Contractor / Health reports from nearby behaviour likely to not exceed 130 people since workers will be absorbed into SMMC health facilities. accommodation facilities in the nearby Philipsburg area. Contractors Code of Conduct covers workforce behaviour on and off the jobsite, prohibits unauthorised and illegal substance use, and Grievance register addresses the prevention of communicable diseases. Monitor updated Contractors risk register Record of monthly progress meetings Nuisance / disturbance of current hospital healthcare The contractor is required to avoid disturbance of the healthcare Contractor / RHDHV Process requirement, services due to processes due to construction activities. SMMC IB008, Item 6.2.2 energy disturbances / vibrations / air quality / noise Process requirement 6.2.2 (IB008) to be followed for the procedure Monthly progress meetings related to “Work that causes and Nuisance”. Corrective measures will be applied with agreement from both Contactors risk register Contractor and SMMC. SMMC’s Complaints Policy and Procedure. Grievance register Reduced parking (access) of current Schedule parking and transport alternatives allowing patients, visitors SMMC Monthly progress meetings hospital for visitors and staff to reach the facility. and staff Provide alternative parking and transport for patients, visitors and Contactors risk register staff Possible planning for a temporary parking area within a 500-meter Grievance register distance from the current hospital. Construction related traffic inconveniences anticipated and measures available to reduce inconveniences Chapter 10.1 for the Contractors HSE Plan for the Construction Traffic Management Plan. SMMC’s Complaints Policy and Procedure. October 2019 St. Maarten General Hospital ESMP Page 58 of 135 Responsible E&S Impact / Issue Mitigation or Enhancement Measures for Monitoring and Verification Measures Access to fire brigade Emergency response of Fire brigade and ambulance (which are / department during adjacent to the construction site and use the same access route) may Monthly progress meetings construction works not be hindered Chapter 10.1 for the Contractors HSE Plan for the Construction Contactors risk register Traffic Management Plan. SMMC’s Complaints Policy and Procedure. Grievance register 10) Socio-economy Procurement policy Formal local implementation and progress procurement There will be added opportunity for local tradesmen to secure Contractor to be reported on as per Inso (tradesmen, other contracts for service provision. Document 2.4 Local specialty work) Involvement Contractor is contractually required to recruit a significant amount of Complaints Policy (applicable the labour force out of the available local labour workforce. to community and labour) See Contractor’s document 2.4 Local Involvement. Grievance register RHDHV Process requirements IB008, Item 7, May 2016 Surge in demand for basic services Local authorities to advise of availability of facilities for non-local provision (housing, workforce, bearing in mind that the majority will be from the local water, electricity, areas. The expected number of workers in the construction phase is schooling, religious 100 - 130. As mitigation, on-going monitoring will have to occur to sites and health) from ensure that demand does not outweigh supply. construction labour force 11) Cultural Heritage Potential finds of This WB Safeguards Policy was not triggered however a chance-find Monitor updated Contractors cultural / heritage Contractor procedure will be updated to the HSE plan. risk register. value October 2019 St. Maarten General Hospital ESMP Page 59 of 135 Table 2.2 ESMP Matrix for Operation Phase Potential impact / Responsible Mitigation or enhancement measures Monitoring issue for Measures 1. Environmental and Social Management System (ESMS) An NGH Operation phase ESMS will be developed in line with System to manage, international good practice and guidelines (i.e. ISO 9001: 2008 – control and monitor Quality Management System, ISO 14001: 2004 – Environmental SMMC Monitoring records E&S risk Management System, OHSAS 18001: 2007 – Occupational Health and Safety Management System). Build on current hospital administration, management and Training / inspection records operation polices and norms 2. Noise and Air Pollution Air emissions of trigeneration and boiler systems comply with General SMMC Air quality monitoring national regulatory requirements Greenhouse gas emission Autoclave grinder adheres to WB EHS Guidelines. quantification Operations Phase Air Quality Control and Monitoring Plan. Noise generating Proper operation of noise machinery and ‘Low-noise’ equipment to be installed SMMC silencers equipment Plans to enclose noise generating equipment and machinery in buildings with isolated and sound proofed walls, Technical Building and silencers comply with regulatory standards. 3. Material Resources Contractor / Add LEED Accredited Professional to Facility Management SMMC / LEED Energy Consumption Monitor LEED progress reports Department Commissioning Authority Recycled materials and materials certified as eco-friendly and low Supply of Materials carbon used. The NGH will operate as detailed in the LEED sustainability certificate 4. Waste Management Update WMP every three years Waste generation and All wastes during operation will be managed in line with the SMMC in accordance with the relevant management SMMC WMP regulations October 2019 St. Maarten General Hospital ESMP Page 60 of 135 Potential impact / Responsible Mitigation or enhancement measures Monitoring issue for Measures An updated HWM plan will be developed to ensure Disposal records and contracts implementation with the new auto-clave and grinder equipment of all types of wastes Copies of haulers’ and disposal SMMC's Bio-hazardous and general waste disposal (085) facilities’ licenses Training records of staff and SMMC's Medical Waste Protocol awareness during site audits SMMC's Waste Management Plan (to be developed) New wastewater treatment plant will already be fully functional Permit obtained from the Wastewater SMMC prior to the operation phase relevant authority Effluent analysis results to Necessary measures will be taken for liquid wastes contaminated ensure they meet with with radioactive substances and its treatment. There are no discharge criteria defined in the expected radioactive effluents. connection certificate All hazardous materials will be stored in designated areas having Ensure that Hazardous Material Hazardous Material secondary containment and handled with care by authorized staff SMMC Management Plan is in place in order to prevent potential spills. and implemented All detail relative to an inventory, PPE (equipment and training), and handling and storage will be reflected in a Hazardous Material Management Plan. SMMC's Bio-hazardous and general waste disposal (085) 5. Occupational Health and Safety and Human Resource Development Occupational Health All applicable national health and safety legislation and Checks records of internal and SMMC and Safety - General international regulations will be followed. external audits All employees (including sub-contractors) will be trained on Training records of workers health and safety, and EPRP to respond timely to the incidents. All the health and safety risks of each activity during operations will be identified followed by identification of the appropriate mitigation measures/personal protective equipment. These issues will be detailed in an Occupational Health and Safety Immunization records Management Plan that is to be developed. The Plan must address control of radiation exposure, blood-borne pathogens, infections, the importance of the Hazardous Material Management Plan, and Waste Management Plan. The efficiency of health and safety practices will be monitored through internal and external audits, and corrective actions will be Records of accidents taken if required. October 2019 St. Maarten General Hospital ESMP Page 61 of 135 Potential impact / Responsible Mitigation or enhancement measures Monitoring issue for Measures Fire safety measures to also be included. SMMC's Occupational Health and Safety Management Plan (to be revised on the current system). Occupational Health and Safety - Adherence to all Safe operation of helipad to be maintained through the safety emergency response SMMC SMMC safety protocol register. measures (fire/floods/political crisis, etc.) Emergency responses related to natural or man-made disasters Conduct regular emergency fully functional. drills Regular training for staff, drills and evacuation tests, etc. SMMCS’s Emergency Disaster and Preparedness Plan (Ref 116). SMMC’s Occupational Health and Safety Management Plan (to be revised). Verify contracts and conditions Human Resource Apply national labour requirements to all contracts SMMC of work for staff Cross-check internal labour policies to National Labour Recruitment procedures will be in line with SMMC Human regulation alignment (including Resources Policy recruitment, retrenchment, downscaling procedures) SMMC’s Human Resource Policy. 6. Community Engagement and Disclosure Public awareness and Maintain internal and external communications process SMMC Complaint Registry outreach Revise current program and amend as necessary SMMC Stakeholder Consultation and Engagement Plan (to be updated for the Operation phase) SMMC Complaints Policy and Procedure 7. Socio-economic Records regarding local Local economy and Continue to promote local employment SMMC employment and local employment purchasing policies Purchasing local goods and services to the extent possible. October 2019 St. Maarten General Hospital ESMP Page 62 of 135 Potential impact / Responsible Mitigation or enhancement measures Monitoring issue for Measures 8. Community Health, Safety and Security Community health, A Community Health and Safety Management Plan will be Records of health and safety safety and security - developed and implemented to manage risks and impacts to the SMMC training of employees General community. Community Health, Safety and Security Management Plan Training on emergency (updated based on current policies) response measures SMMC’s Complaints Policy and Procedure. Ensure Air Quality Control and Air quality impacts on An Air Quality Control and Monitoring Plan will be prepared and SMMC Monitoring Plan is in place and the nearby community implemented during the operation phase of the Project. implemented See Operations Phase Air Quality Control and Monitoring Plan (to be developed) Proper communication Exposure to disease Potential disease risks to the community minimized measures See Community Health, Safety and Security Management Plan (CHSSMP) (to be developed) Value added health Hospital expansion provides value-added services to a wider Hospital records service range of citizens. Clinical guidelines and quality control protocols updated. NGH advances access and provision of health services across genders. Review applicability of Emergency Response Heliport operates in accordance with all local and international Helicopter traffic Contractor Procedure for the activity in the transport standards Emergency Response Management Plan An Emergency response procedure to be developed and Monitor updated Contractors SMMC implemented to enable safe helicopter operation. risk log See SMMC’s Emergency Disaster and Preparedness Plan (Ref 116) (to be updated). NGH designed, constructed, and operated in full compliance with Life and Fire Safety local building codes, local fire department regulations, and local Contractor Register official inspections legal/insurance requirements. Fire safety is part of the Building Permit approval. SMMC Audit reports Maintenance of all fire safety systems in proper working order, including self- closing doors in escape routes and ventilation ducts with fire safety flaps. Life and Fire Safety Audits will be undertaken by qualified professionals. October 2019 St. Maarten General Hospital ESMP Page 63 of 135 Potential impact / Responsible Mitigation or enhancement measures Monitoring issue for Measures SMMC’s Fire and Evacuation Plan (Ref FM 101-1) Security provided in a manner that does not jeopardize the Credentials of security staff Security SMMC community’s, staff’s and patron’s safety. training records of security staff SMMC’s Service Provider(s) will ensure that security personnel have not been involved in past abuses and are adequately trained Security will operate within the law. SMMC’s Security Plan (Ref FM 103 -2) All actions to avoid security risks to the local communities, to be highlighted in the Code. Chapter 10.2 in the HSE Plan for the Contractors Code of Conduct. Nuisance / The contractor is required to avoid disturbance of the healthcare Contractor / RHDHV Process requirement, disturbance of current processes due to construction activities. SMMC IB008, Item 6.2.2 hospital healthcare Process requirement 6.2.2 (IB008) to be followed for the services due to energy Monthly progress meetings procedure related to “Work that causes and Nuisance”. disturbances / vibrations / air quality / Corrective measures will be applied with agreement from both Contactors risk register noise Contractor and SMMC. SMMC’s Complaints Policy and Procedure. Grievance register Reduced parking (access) of current Schedule parking and transport alternatives allowing patients, SMMC Monthly progress meetings hospital for visitors visitors and staff to reach the facility. and staff Provide alternative parking and transport for patients, visitors and Contactors risk register staff Possible planning for a temporary parking area within a 500- Grievance register meter distance from the current hospital. Construction related traffic inconveniences anticipated and measures available to reduce inconveniences Chapter 10.1 for the Contractors HSE Plan for the Construction Traffic Management Plan. SMMC’s Complaints Policy and Procedure. October 2019 St. Maarten General Hospital ESMP Page 64 of 135 Potential impact / Responsible Mitigation or enhancement measures Monitoring issue for Measures Access to fire brigade Emergency response of Fire brigade and ambulance (which are / department during adjacent to the construction site and use the same access route) Monthly progress meetings construction works may not be hindered Chapter 10.1 for the Contractors HSE Plan for the Construction Contactors risk register Traffic Management Plan. SMMC’s Complaints Policy and Procedure. Grievance register October 2019 St. Maarten General Hospital ESMP Page 65 of 135 APPENDIX 3: SMMC Management Plans 3.1 Complaints Handling SUBJECT: COMPLAINT HANDLING WB REFERENCE: PROJECT DEPARTMENT: MANAGEMENT EFFECTIVE: August __ 2018 APPROVED Board of REVISED: BY: Directors INTENDED USERS: GRMC & other involved in complaint handling INTERNAL COMPLAINT HANDLING POLICY - HOSPITAL RESILIENCY AND PREPAREDNESS PROJECT Purpose of this policy To advise and inform all relevant SMMC staff of the process for handling complaints and concerns relating to the work to be executed with the funding under the Grant Agreement between SMMC and the World Bank (hereafter referred to as the “ Work”). Definitions − Complaint: an expression of dissatisfaction from a person, requiring a response. A complaint can be expressed verbally or in writing. This policy applies to complaints in relation to the Work as executed under the responsibility of SMMC. − Complainant: a person raising a complaint (this can be staff, a patient, any affected person, or a person acting on behalf of a company). This can be a person who is affected by or likely to be affected by the action, decision or omission of SMMC. Policy Statement SMMC is committed to provide an effective method by which affected persons can express their concerns or raise a complaint regarding the execution of the Work. Complaints are a valuable October 2019 St. Maarten General Hospital ESMP Page 66 of 135 tool for SMMC to monitor its performance and review areas that require improvement. They therefore contribute an important mechanism as part of SMMC’s overall approach to environmental and social safety. This policy gives guidance on how complaints will be managed to ensure a consistent, fair and just approach to those involved in a complaint. SMMC is committed to promoting an environment that values diversity. Any person who makes a complaint, or any other person involved in the investigation and resolution of a complaint, will be treated equally and fairly and not discriminated against because a complaint has been made, or on the grounds of race, sex, disability, religion, age, sexual orientation or any other unjustifiable reason. Key Principles ▪ Easy access for people raising complaints: we will provide information, advice and support enabling people to understand the procedure for making a complaint ▪ Complaints will be dealt with efficiently and will be properly investigated, with a honest and thorough approach and with the aim of resolving complaints to the satisfaction of the complainant ▪ People raising a complaint and staff will be treated fairly, without apportioning blame ▪ Complainants will be treated with respect and courtesy and should be reassured that they will not be treated differently as a result of raising a complaint ▪ We will provide a timely and appropriate response that will (if applicable) include the outcome of an investigation into the complaint ▪ Action will be taken if necessary in the light of the outcome of a complaint PERSONS INVOLVED IN COMPLAINT HANDLING – DUTIES AND RESPONSIBILITIES Board of Directors − The Board of Directors (‘BOD’), has overall responsibility for the correct handling of complaints and signs off all complaint responses. Complaint Committee (‘CC’) The CC exists of the Manager Facilities, the Manager New Hospital Project and the Legal Counsel. The CC has the responsibility to treat complaints according to this policy. The CC will effectively and timely communicate with the complainant, will investigate a complaint and propose a measure and/or response, to be approved by the BOD, and follow up on finalization and closing of the complaint. October 2019 St. Maarten General Hospital ESMP Page 67 of 135 The CC will ensure through a meeting with all supervisors and internal communication (e-mail, intranet) that all SMMC staff is aware of this complaint handling policy before the start of the Work. Staff − If a complaint is expressed verbally to an SMMC employee or consultant (hereafter all referred to as ‘Employee’) directly, that person should if possible, looking at the nature of the complaint, deal with the complaint directly and always in a professional and sensitive manner. − If a complainant is not satisfied after the conversation with the Employee, the Employee will provide the complainant with the complaint brochure and refer the complainant to the CC. CC tasks − The CC is overall responsible for managing the complaints process within the SMMC. − The CC will ensure that all complaints are triaged and allocated to the relevant persons and ensure that complaints are being handled according to this policy. − The CC monitors the progress of investigations into complaints and provides advice and support to all (investigating) staff to ensure resolution of the issues. Support Secretariat The secretariat support will be provided to the CC in managing and monitoring complaint procedures administratively. The Secretariat / Legal Assistant will collect and archive received complaints and will send a confirmation of receipt to the complainant. NECESSITIES − Complaint Handling Policy (this document) − Complaint Brochure (hard copies by the service desk and soft copies on the website) − Complaint Tracking Sheet CONTACT INFORMATION: PROJECT COORDINATOR October 2019 St. Maarten General Hospital ESMP Page 68 of 135 OFFICE ___ EXT. ___ CELL: ___ COMPLAINT HANDLING PROCEDURE 1. In the first instance when someone expresses dissatisfaction about the Work taking place at SMMC, we advise the person to speak directly to the individual causing dissatisfaction (if applicable), or for example the supervisor of the particular work causing dissatisfaction. 2. If the complainant is not satisfied after the conversation, or it is not adequate to have a conversation with the individual or the supervisor, we advise the complainant to express its dissatisfaction to the CC, preferably through e-mail, letter or phone call. 3. The complaints brochure is available at the service desks and on the website. The phone number and e-mail address to reach the CC is provided in the complaint brochure and on the website. The contact information will also be published in the newspaper before the start of the Work. 4. Confirmation of receipt of the complaint is sent within 4 – 7 days (time and date entered in complaint tracking sheet) by Legal Assistant. 5. The CC will perform a ‘triage’ and will ask assistance of the relevant persons the ‘Project Implementation Unit’ for the Work (hereafter referred to as ‘ PIU’), the relevant external contracted parties (e.g. construction or supervision company) and where necessary SMMC Management or BOD. 6. The CC will assess whether a conversation between the complainant and the relevant (internal or external) parties may resolve the complaint and will try to mediate. 7. The CC will make sure that the complaint will be addressed within the time frame as included in the Table below. October 2019 St. Maarten General Hospital ESMP Page 69 of 135 Process Description Time frame Responsibility & remarks Identification of Complaints can be filed face Day of receipt complaints@smmc.sx; grievance to face, via phone, via letter, complaint 543 1111 ext: 2500 or via e-mail, or recorded during public/community Postal address: Welgelegen road interaction 30, Cay Hill, Sint Maarten. Attn. Complaint Committee Grievance Significance assessed and 4 - 7 Days Significance criteria assessed and grievance recorded or logged upon receipt Level 1 - one off event; logged (i.e. in a log book) complaint Level 2 - complaint is widespread or repeated; Level 3- any complaint (one off or repeated) that indicates breach of Grievance is Acknowledgement of 4 - 7 Days or Assistant Legal law applicableconfirms receipt of policy/regulation acknowledged grievance to complainant upon receipt the complaint to the complainant complaint via e-mail or letter Development of -Grievance assigned to 4 - 7 Days CC response appropriate party for upon receipt resolution complaint -Proposal response with 10 - 14 Days input from management and upon receipt Response signed BOD SMMC Redress action approved at complaint 14 - 18 Days CC and Board of Directors (BOD) off appropriate levels upon receipt SMMC Implementation Redress action implemented complaint 18 - 24 Days PIU to implement redress action and and update of progress on upon receipt communication of resolution communicated to complaint response complainant Legal Counsel to communicate resolution to complainant Redress action recorded in grievance log book Complaints Obtain confirmation 24 - 30 Days CC Response complainant that grievance upon receipt can be closed or determine what follow up is necessary complaint Close grievance Record final sign off 30 - 34 Days Final sign off by Chairman BOD grievance upon receipt SMMC If grievance cannot be complaint closed, return to step 2 or refer to mediation, Minister VSA, World Bank or ultimately court of law October 2019 St. Maarten General Hospital ESMP Page 70 of 135 8. A complaint is considered resolved if the complainant indicates such and wishes no further review of the complaint. 9. If a complaint cannot be resolved to the satisfaction of the complainant, the CC can suggest discussing the complaint under the guidance of an independent mediator, having the complaint assessed by a third party with specific expertise [ or: to be discussed: forwarding the complaint to the IRC / National recovery bureau / the Ombudsman / in ultimate scenario the court of law ]. 10. After a complaint being resolved internally, or after reaching a solution/assessment/ judgment by the relevant instances after escalation, the CC will ensure that all relevant persons within SMMC and World Bank receive information on the outcome. October 2019 St. Maarten General Hospital ESMP Page 71 of 135 Process Description Time frame Responsibility & remarks Establish composition of Set up of Complaint 2 weeks before Committee exists of Complaint Committee Committee (CC); start of civil work Manager facilities, New members & procedures Hospital Project Manager, Legal Counsel Publish article in newspaper and on SMMC website: start date of works and contact information for complainants Identification of grievance Complaints can be filed Day of receipt complaints@smmc.sx; face to face, via phone, via complaint phone: 543 1111 ext: letter, or via e-mail, or 2500 recorded during public/community Postal address: interaction Welgelegen road 30, Cay Hill, Sint Maarten. Attn. Complaint Committee Grievance assessed and Significance assessed and 4 - 7 Days Significance criteria logged grievance recorded or upon receipt Level 1 - one off event; logged (i.e. in a log book) complaint Level 2 - complaint is widespread or repeated; Level 3- any complaint (one off or repeated) that indicates breach of law or applicable policy/regulation Grievance is acknowledged Acknowledgement of 4 - 7 Days upon Secretariat confirms grievance to complainant receipt complaint receipt of the complaint to the complainant via e-mail or letter Development of response -Grievance assigned to 4 - 7 Days upon CC appropriate party for receipt complaint resolution 10 - 14 Days -Proposal response with upon receipt input from management complaint and BOD SMMC Response signed off Redress action approved 14 - 18 Days CC and for level 2 and at appropriate levels upon receipt 3 complaints also Board of Directors (BOD) SMMC complaint October 2019 St. Maarten General Hospital ESMP Page 72 of 135 Implementation and Redress action 18 - 24 Days Project Management communication of response implemented and update of upon receipt Team to implement progress on resolution complaint redress action communicated to complainant Legal Counsel to Redress action recorded in communicate resolution to grievance log book complainant Complaints Response Obtain confirmation 24 - 30 Days CC complainant that grievance upon receipt can be closed or determine what follow up is necessary complaint Close grievance Record final sign off 30 - 34 Days Final sign off by CC and grievance upon receipt for level 2 and 3 If grievance cannot be complaint complaints the BOD closed, obtain expert SMMC advice third party, refer to mediation or ultimately court of law October 2019 St. Maarten General Hospital ESMP Page 73 of 135 3.2 SMMC Evacuation Plan October 2019 St. Maarten General Hospital ESMP Page 74 of 135 October 2019 St. Maarten General Hospital ESMP Page 75 of 135 October 2019 St. Maarten General Hospital ESMP Page 76 of 135 October 2019 St. Maarten General Hospital ESMP Page 77 of 135 October 2019 St. Maarten General Hospital ESMP Page 78 of 135 October 2019 St. Maarten General Hospital ESMP Page 79 of 135 October 2019 St. Maarten General Hospital ESMP Page 80 of 135 October 2019 St. Maarten General Hospital ESMP Page 81 of 135 October 2019 St. Maarten General Hospital ESMP Page 82 of 135 October 2019 St. Maarten General Hospital ESMP Page 83 of 135 October 2019 St. Maarten General Hospital ESMP Page 84 of 135 October 2019 St. Maarten General Hospital ESMP Page 85 of 135 October 2019 St. Maarten General Hospital ESMP Page 86 of 135 October 2019 St. Maarten General Hospital ESMP Page 87 of 135 October 2019 St. Maarten General Hospital ESMP Page 88 of 135 October 2019 St. Maarten General Hospital ESMP Page 89 of 135 October 2019 St. Maarten General Hospital ESMP Page 90 of 135 October 2019 St. Maarten General Hospital ESMP Page 91 of 135 October 2019 St. Maarten General Hospital ESMP Page 92 of 135 October 2019 St. Maarten General Hospital ESMP Page 93 of 135 October 2019 St. Maarten General Hospital ESMP Page 94 of 135 October 2019 St. Maarten General Hospital ESMP Page 95 of 135 October 2019 St. Maarten General Hospital ESMP Page 96 of 135 October 2019 St. Maarten General Hospital ESMP Page 97 of 135 October 2019 St. Maarten General Hospital ESMP Page 98 of 135 October 2019 St. Maarten General Hospital ESMP Page 99 of 135 October 2019 St. Maarten General Hospital ESMP Page 100 of 135 October 2019 St. Maarten General Hospital ESMP Page 101 of 135 October 2019 St. Maarten General Hospital ESMP Page 102 of 135 October 2019 St. Maarten General Hospital ESMP Page 103 of 135 October 2019 St. Maarten General Hospital ESMP Page 104 of 135 October 2019 St. Maarten General Hospital ESMP Page 105 of 135 October 2019 St. Maarten General Hospital ESMP Page 106 of 135 October 2019 St. Maarten General Hospital ESMP Page 107 of 135 October 2019 St. Maarten General Hospital ESMP Page 108 of 135 October 2019 St. Maarten General Hospital ESMP Page 109 of 135 October 2019 St. Maarten General Hospital ESMP Page 110 of 135 October 2019 St. Maarten General Hospital ESMP Page 111 of 135 October 2019 St. Maarten General Hospital ESMP Page 112 of 135 October 2019 St. Maarten General Hospital ESMP Page 113 of 135 October 2019 St. Maarten General Hospital ESMP Page 114 of 135 October 2019 St. Maarten General Hospital ESMP Page 115 of 135 October 2019 St. Maarten General Hospital ESMP Page 116 of 135 October 2019 St. Maarten General Hospital ESMP Page 117 of 135 October 2019 St. Maarten General Hospital ESMP Page 118 of 135 October 2019 St. Maarten General Hospital ESMP Page 119 of 135 October 2019 St. Maarten General Hospital ESMP Page 120 of 135 October 2019 St. Maarten General Hospital ESMP Page 121 of 135 3.3 SMMC Stake holder Engagement and Communication Plan 1. Introduction Overview This Stakeholder Engagement and Communications Plan (SECP) sets out the approach that the St. Maarten Medical Center (SMMC) will follow in order to engage and communicate with stakeholders over the life of the New General Hospital in St. Maarten (herein after the ‘Project’). Consultation is undertaken in order to interact and incorporate the viewpoints of Affected Parties. Special consideration will be given to vulnerable groups, including with relation to engagement and consultative activities. This plan is organized as follows: • Section 2 outlines the objectives of stakeholder engagement; • Section 3 introduces the Stakeholder Engagement Plan and related methods, in addition to previous and future activities; • Section 4 introduces the Communication Plan and outlines its goals and objectives; • Section 5 describes roles and responsibilities for grievance redress; 2. Objectives of Stakeholder Engagement The activities of engagement are guided by good international industry practice, as well as all applicable laws and regulations in St. Maarten. The objectives of stakeholder engagement, outlined in this plan, are to: • Promote the development of respectful and open relationships between stakeholders and the Project proponent (SMMC) and other relevant parties in the pre-construction and future phases; • Identify Project stakeholders and understand their interests, concerns and influence in relation to Project activities, particularly during the construction phase; • Provide stakeholders with timely information about the Project, in ways that are appropriate to their interests and needs, and also appropriate to the level of expected risk and potential adverse impacts; • Support alignment with financing standards and guidelines for stakeholder engagement, as necessary in the pre-construction phase; and • Record and resolve any grievances that may arise from Project-related activities through a Grievance Mechanism. October 2019 St. Maarten General Hospital ESMP Page 122 of 135 3. Stakeholder Engagement Plan Stakeholder Analysis Stakeholders and Affected Parties of the Project are identified based on the following information: • Stakeholders and Affected Parties identified during analysis of the immediate surroundings of the project • Stakeholders and Affected Parties in attendance at the public stakeholder consultation meeting held on 26 November 2018 after the Draft ESMP is made publicly available via the SMMC website. The following stakeholders and Affected Parties were identified for this project (to be adjusted after Consultation meeting) • Businesses ANTEK, BZSE, Emerald Funeral Home, Belair Community Center, Dental Care Clinic, Alpha Health Care Services, Bearing Point, SLS Laboratory, Fire Dept., Ambulance Dept., Raoul Illidge Sports Complex • Schools Learning Unlimited, NIPA, Hillside Christian School • Church Jehovah Witness • Residents Belair Residents Association, Hamster Drive contact person (Denicio Richardson) • Patients and their family, other visitors SMMC • SMMC management & staff Stakeholder Engagement Methods and Materials The engagement process encourages meaningful participation by stakeholders. The SMMC will employ a range of methods and channels for disclosing information in order to tailor disclosure to the interests and needs of the various stakeholder groups and will also produce materials appropriate for specific stakeholders and types of engagement. This may include typical disclosure and engagement methods, such as: • Local Newspaper Articles, Radio or Digital Media – Used to convey information to local audiences about proposed Project activities and progress. • Internet/Website/Social Media - Used to promote information or invite stakeholder queries and comments via email. • Grievance Mechanism - Used by the public to obtain information, ask questions or report and get responses to grievances. October 2019 St. Maarten General Hospital ESMP Page 123 of 135 The stakeholder engagement process includes two-way targeted engagement related to specific potential Project impacts. However, engagement activities will continue to be organized around specific topics of interest and known concerns of stakeholders. Feedback mechanisms are adapted to suit the needs and preferences of different stakeholders and their physical locations. A Grievance Mechanism will be established to provide a dedicated mechanism for interested stakeholders to provide Project-related feedback (discussed below). 4. Communication Plan The Communication Plan defines the communication goals and methods that the SMMC and INSO will pursue in order to communicate with stakeholders throughout the life of the Project. This plan sets out a framework to ensure consistent, efficient project communication throughout the Project planning and implementation process. Objectives It is important that communication with the public about the Project is consistent and easily understood by diverse audiences. Interest and knowledge levels will vary greatly – from highly-engaged individuals and organizations, to members of the general public that have limited familiarity and/or information about the project. Regardless of the interest and knowledge level of any individual, the objective is to provide easily digestible and practical information for the public to augment a smooth Project implementation process. Communication Goals The specific goal of this Communication Plan is to provide a strategic guide to: • Proactively engage stakeholders with up-to-date information regarding Project development, construction timeline, and any changes in scope or delays • Stress the Project’s commitment to minimal disruptions to daily life in Bel Air / Cay Hill and adherence to Project construction timeline • Establish public trust through credible, consistent, and open communication • Provide a variety of information tools and points of contact to satisfy a diverse public audience Key Messages This section will include key Project messages. Messages should address the following themes and/or categories: • Project benefits for St. Maarten and its future resilience • Public involvement opportunities • Key actors (SMMC, Construction Firm) • Other TBC Key messages should be developed internally and socialized with all Project staff as required for the audiences they might encounter such as Board of Directors, Management Team and Project Spokespersons, to construction site supervisors and social outreach team members. Communication Methods October 2019 St. Maarten General Hospital ESMP Page 124 of 135 Communication methods should be developed to convey information to target audiences and the public at large, maintain consistent messaging, and provide the public with the opportunity to offer feedback. Potential platforms and materials include: Informational Materials Clear, accurate, and comprehensive informational materials for use with stakeholders during formal consultation events and informal interactions will be produced. These materials will be updated as the Project evolves and supplemented with additional materials and can include: • Project fact sheet • Frequently Asked Questions • Advertisements for public meetings • Project maps • Handouts/flyers • Periodic direct e-mailings to stakeholders • Video (via monitor) of construction site • Physical signs near sites of Project components with visualizations and key information (purpose and dates for completion) All materials should include a link to the Project website (as part of the SMMC.sx website) where further information can be obtained as well as a point of contact for questions or concerns (as described below). Project Contact Vehicles To give stakeholders easy and convenient access to the Project, the following contact vehicles will be put in place: • Direct number for general Project inquiries of the PMU (Project Management Unit) which will be available 24/7 for urgent situations/complaints, PMU may wish to consider Whatsapp capabilities to provide easier access, • General e-mail address (PMU@smmc.sx); and • Mailing address (current SMMC address) and physical office location (Care Complex office of PMU). The contact vehicles will be monitored regularly and response protocols should be developed to ensure all inquiries are tracked for reporting purposes and that responses are provided. Monitoring will also allow for modifications or ramping up of certain contact vehicles should one method prove more effective than others. Stakeholder Point of Contact October 2019 St. Maarten General Hospital ESMP Page 125 of 135 A community and social coordinator for the Project should be established as a single point of contact for stakeholders. This person will be tasked with providing information and responding to questions, or should they not be able to adequately address enquiries, forwarding the question to a relevant authority. Information and Communications with Specific Stakeholders As Project development advances and specific construction plans are in place, the community and social coordinator should be responsible for conducting specific outreach with key stakeholders. The primary purpose of this outreach is to share information, answer questions and obtain stakeholders input on issues and concerns that need to be addressed. These meetings will also help to identify any new stakeholders to include in future outreach activities. Meetings can take place in many formats, from one- on-one casual conversations to small focused meetings. Public Information and Communications Beyond specific stakeholders, the public at large should be informed of the Project, its purpose, and key information that may affect daily life in the area. The key messages should always be reiterated during such efforts, in addition to addressing logistical Project updates. Formats for public information and communications should include: • Public Meetings • Media engagements especially via most-used media sources (print, radio, local television, online etc.) • Presentations to key stakeholder groups • Project milestone press releases to local media • Project website (part of SMMC.sx) with up-to-date information • Updated information via SMMC social media (Facebook, LinkedIn) 5. Contact with Complaint Committee (Grievance Mechanism) Feedback Process Stakeholders will be able to contact the Complaint Committee by letter, phone, or email. Also contact details for urgent matters will be made available. Contact information will be made available through the SMMC website and also on external publications and communications (including newspapers, leaflets, etc.). Stakeholders are invited to provide feedback and report grievances about the Project. This will allow the SMMC to monitor how the Project is doing, and will help to identify areas of improvement. The SMMC will treat all types of feedback with professional consideration and respect, and base its responses on open and honest communication. Feedback and grievances, where appropriate and necessary, will be investigated and closed out, and stakeholders will be informed of resulting decisions. Grievance Mechanism The SMMC will establish prior to construction a Complaint Committee (CC) to address any feedback and complaints associated with Project activities in good faith through a transparent and impartial process. October 2019 St. Maarten General Hospital ESMP Page 126 of 135 Specific objectives of the Grievance Mechanism are to: • Help identify issues and concerns early, so that they can be addressed quickly and proactively; • Continuously improve Project performance; and • Demonstrate the SMMC’s commitment to meaningful stakeholder engagement, and respect for local opinions and concerns. The CC provides opportunities for the receipt, investigation, and resolution of complaints at the Project level during the pre-construction through operations phases. Stakeholders will be notified about the CC in external publications and communications (including newspapers, leaflets, on the website, etc.). A dedicated telephone number and email option for public enquiries and feedback will also be shared. The SMMC will also undertake broader stakeholder engagement activities, including monitoring and reporting. Grievance Mechanism Structure and Process The following structure and process will be followed by the CC: October 2019 St. Maarten General Hospital ESMP Page 127 of 135 Process Description Time frame Responsibility & remarks Establish Set up of Complaint Committee (CC); 2 weeks Committee exists of Manager composition of before start facilities, New Hospital Project Complaint Publish article in newspaper and on of civil work Manager, Legal Counsel Committee members SMMC website: start date of works and & procedures contact information for complainants Identification of Complaints can be filed face to face, Day of complaints@smmc.sx; grievance via phone, via letter, or via e-mail, or receipt recorded during public/community complaint phone: 543 1111 ext: 2500 interaction Postal address: Welgelegen road 30, Cay Hill, Sint Maarten. Attn. Complaint Committee Grievance assessed Significance assessed and grievance 4 - 7 Days Significance criteria and logged recorded or logged (i.e. in a log book) upon receipt complaint Level 1 - one off event; Level 2 - complaint is widespread or repeated; Level 3- any complaint (one off or repeated) that indicates breach of law or applicable policy/regulation Grievance is Acknowledgement of grievance to 4 - 7 Days Secretariat confirms receipt of the acknowledged complainant upon receipt complaint to the complainant via e- complaint mail or letter Development of -Grievance assigned to appropriate 4 - 7 Days CC response party for resolution upon receipt complaint 10 - 14 Days -Proposal response with input from upon receipt management and BOD SMMC complaint Response signed off Redress action approved at 14 - 18 Days CC and for level 2 and 3 complaints appropriate levels upon receipt also Board of Directors (BOD) SMMC complaint Implementation and Redress action implemented and 18 - 24 Days Project Management Team to communication of update of progress on resolution upon receipt implement redress action response communicated to complainant complaint Redress action recorded in grievance log book Legal Counsel to communicate resolution to complainant Complaints Obtain confirmation complainant that 24 - 30 Days CC Response grievance can be closed or determine upon receipt what follow up is necessary complaint Close grievance Record final sign off grievance 30 - 34 Days Final sign off by CC and for level 2 upon receipt and 3 complaints the BOD SMMC If grievance cannot be closed, obtain complaint expert advice third party, refer to mediation or ultimately court of law October 2019 St. Maarten General Hospital ESMP Page 128 of 135 Recording and Assessing Complaints/Feedback All feedback/complaints are forwarded on to the CC. The CC will file the feedback in the Feedback Management System (comprising a Feedback Intake Form, see below, and a logging system) and determine the feedback’s initial categorization and severity. Severity levels for prioritization of feedback are as follows: • Level 1 – Low Priority: Isolated or ‘one-off’ feedback (within a reporting period of one year) and essentially local in nature; • Level 2 – Medium Priority: A feedback which is widespread and repeated e.g. dust or noise from construction vehicles; and • Level 3 – High Priority: A feedback that has resulted in a serious breach of laws or regulations, has led to or has the potential to lead to negative media coverage and/or is in breach of the SMMC’s own policies and procedures. E.g. a serious accident or a pollution incident. A Level 3 feedback will be referred to directly to the Project Coordinator. Assigning the Complaint/Feedback to a Responsible Party The CC will investigate the feedback or assign it to a qualified party in order to investigate it and seek resolution (if necessary). The investigative process can include (but is not limited to) site visits, face-to- face meetings, and interviews. All such activities will be documented. Resolving the Feedback After investigating the feedback, a resolution will be adopted. In some cases, the Project Management Unit can immediately address the feedback, while in other cases the feedback might need to be elevated to higher level management. Monitoring and Evaluating the Grievance Process The CC will be responsible for monitoring and evaluating the overall Grievance Mechanism and process. Using and maintaining a logging system, the CC will quarterly review the feedback process to assess that key milestones are met and feedback are closed out within 30 - 34 days of receipt. The system will allow for aggregation of data including: • Number of feedbacks received; • Types of feedback raised; • Who / what caused the issue; • Average resolution times; and • Feedback from complainants regarding satisfaction of the resolution. Monitoring these indicators will allow the CC to identify trends and to evaluate the effectiveness of the mechanism and identify areas for improvement. It may also allow for the identification of recurring issues that could warrant discussion and action by the Project Management Unit. October 2019 St. Maarten General Hospital ESMP Page 129 of 135 • Feedback Intake form FEEDBACK RECORD FEEDBACK REFERENCE DATE / TIME RECEIVED: TARGET DATE FOR RESOLUTION: NUMBER: NAME OF SUBMITTER: ADDRESS AND CONTACT DETAILS: FEEDBACK RECEIVED BY: NAME OF PERSON IN CHARGE / EMPLOYEE DEALING WITH THE GRIEVANCE: TYPE OF ISSUE/ TOPIC (E.G. DESCRIPTION OF FEEDBACK (INCLUDE DETAILS ON WHO / WHAT CAUSED NOISE, LAND, POLLUTION, THE ISSUE AND LOCATION OF ISSUE): VERBAL ABUSE ETC.): ASSESSMENT OF HIGH PRIORITY MEDIUM LOW PRIORITY FEEDBACK PRIORITY LEVEL PRIORITY (TICK RELEVANT BOX) SIGNATURE AND ROLE OF DATE: EMPLOYEE ACTIONS TO RESOLVE FEEDBACK DELEGATION TO: ACTION WHO WHEN COMPLETED Y/N/DATE RESPONSE/RESOLUTION: STRATEGY TO COMMUNICATE RESPONSE: SIGN-OFF: DATE: CONCLUSION IS SUBMITTER SATISFIED? (Y/N) COMMENTS FROM EMPLOYEE DEALING WITH THE FEEDBACK: SUBMITTER COMMENTS REGARDING RESOLUTION: FEEDBACK CLOSED? Y/N FEEDBACK Y/N RESUBMITTED? SIGNATURE AND ROLE: DATE: DATE: NEW FEEDBACK NUMBER: October 2019 St. Maarten General Hospital ESMP Page 130 of 135 APPENDIX 4: Stakeholder Meeting November 2018 Figure 1: Attendance List Minutes: Stakeholders meeting ESMP Date: November 26th, 2018 Location: Sint Maarten Medical Center, Patio Attendance: • (AC) Alberto Carty: Contract of Jehovah’s Witnesses • (AP) Alvin Peterson: Contract of Jehovah’s Witnesses • (KH) Kenovin Hendrickson: Contract of Jehovah’s Witnesses • (SJ) Shanell James: Fire Department • (KvS) Klaas van Sloten: Antek • (MT) Maarten Tevoort: Baker Tilly • (AP) Anthony Pantophlet: Sint Maarten Medical Center • (LB) Lydian Baneke: Sint Maarten Medical Center • (EvdH) Erika van der Horst: Sint Maarten Medical Center October 2019 St. Maarten General Hospital ESMP Page 131 of 135 • (EK) Esmé Klasens-Kerssens: Sint Maarten Medical Center • (BD) Bonnie Dekker: Sint Maarten Medical Center • (PD) Paul Dijkhoffz: Sint Maarten Medical Center • (JvdP) John van de Pol: Sint Maarten Medical Center • (SH) Sheila Hodge: Sint Maarten Medical Center • (KK) Kees Klarenbeek: Sint Maarten Medical Center • (HdZ) Henk de Zeeuw: KPMG English Summary stakeholders meeting Information During the stakeholders meeting there was a presentation with all the necessary information. In the presentation the ESMP plan was presented. The ESMP plan and the presentation are accessible on the website www.smmc.sx, World Bank – Procedures. The meeting The stakeholders meeting about the ESMP was opened by the moderator Mr A. Pantophlet, Manager Patient Care. After the intro he gives the word to Mr K. Klarenbeek, General Director. Mr. Klarenbeek presented the background of the project and explained the necessity of a new hospital. Mr H. de Zeeuw presented the project in more detail with a visual overview of the different phases of construction. Ms E. van der Horst presented the ESMP and Ms L. Baneke explained the complaint procedure. During and after the presentation the stakeholders had the opportunity to ask questions. The following questions were asked and provided with answers: Question Answer MT: KK: From 66 beds to 110 is that sufficient enough? This was based on calculations from the Care Demand How do you know that? model. Preformation, a consultant company with broad experience in this field, has performed an investigation/research to make the best possible estimate for the demand on Sint Maarten. If it would appear that this number of beds is not sufficient for the future, we still have the possibility to further expand the new building. That option is already included. SJ: HdZ: 1. The main concern that we have is the 1. We will do have clear signs and do patrols. The parking, around the hospital. At this fire truck and the ambulance need to be able to moment there are already problems with pass the street as well. SMMC agrees this is a parking. We don’t want that people are very important item to keep closely monitoring going to park on the roadside. during construction, and stay communicating 2. Floods by the roundabout? with neighbors to detect in early stage if something is not going as wanted. Therefore, the SMMC is organizing an alternative parking area. 2. The building is 1 meter higher; the flooding is not affecting the hospital. There is always another road to access the hospital. The October 2019 St. Maarten General Hospital ESMP Page 132 of 135 Question Answer benefit of this location is there are different escape routes. KvS: HdZ: Concerns about the Helipad, especially on the We reviewed all the options for the Helipad on top of Welgelegen Road, because that road is very the roof. On the roof there is technical equipment, with busy. Why is the Helipad not on the top of the the fumes, that is not a good idea. So that was not a roof? possibility. Solution is the helipad on the ground with control on the Welgelegen Road, with traffic lights and possibly guards. HdZ: MT: Yes. For the Helipad, the most important users are other islands in the region (Saba, St. Eustatius). Are the BES islands also contributing? KH: HdZ: Can we control the dust factor? We are placing dust screens and also, we want to keep the ground moist, if the constructors are working on it. We minimize the dust as much as possible. KvS: HdZ: Moving the ER to another location, Welgelegen Currently we don’t have included in the plan that there Road, is that a good idea? Because the road is will be traffic lights by the new ER entrance, but we very busy. Do you have traffic lights to arrange can consider that if it would appear to be necessary. the traffic? MT: HdZ: 1. Regarding the construction equipment, 1. Yes, the performance indicator is part of the this is going probably from the harbor to monthly report. SMMC, what about the traffic, and rush hour? Are you going to measure the traffic jams around the construction site as a performance indicator? 2. What about the regulations about the heavy equipment’s? EvdH: 2. This is a responsibility for the contractor. They will regulate the traffic on the construction site and follow the national laws and regulations in this respect. KvS: HdZ: Still concerns about the traffic. What if people Yes, this is very important. We can put extra signs, still parking on the road? The road is already too give the patient and staff additional information about small. parking (where to park) and we have security guards. We want to stay in close contact with stakeholders in the area and address any problems swiftly. AC: EvdH: October 2019 St. Maarten General Hospital ESMP Page 133 of 135 Question Answer Is there a work schedule? Are the employees There are specific hours that the construction workers working on Saturdays? By the Kingdom Hall are allowed to make noise. These hours are there is also a very large amount of traffic, so mentioned in the tender documents. But the working what to do with this problem? hours are from Monday until Friday (during day time 9- 6). HdZ: We need to communicate everything with each other. All the problems that you have discuss this with the contractor. If there are specific busy hours or days it would be good to communicate this beforehand and see how we can best work around this. KH: KK: In the new hospital will there be medical There is still no definite decision about the purpose of tourism? the additional wing. An option is renting it out for medical tourism; we want to give medical care close to home. The purpose of the additional wing must fit the hospitals business plan and strategy. We want the population of Sint Maarten to also benefit. The information session that was held for the stakeholders were greatly appreciated. This was the given feedback at the end of the presentation. October 2019 St. Maarten General Hospital ESMP Page 134 of 135 APPENDIX 5: INSO Health, Safety & Environment (HSE) Plan Full report available in separate file October 2019 St. Maarten General Hospital ESMP Page 135 of 135