Republic of Zimbabwe Ministry of Health and Child Care Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) _______________________________________ ENVIRONMENTAL AND SOCIAL MANAGEMENT FRAMEWORK (ESMF) ________________________________________ Prepared for: Ministry of Health and Child Care/CORDAID Harare Zimbabwe Page | i ________________________________ The Zimbabwe Covid-19 Response and Essential Health Services Additional Financing (P180160) Environmental and Social Management Framework (ESMF) is intended to provide complete documentation for the requirements of a holistic Environmental and Social Safeguards management system. This ESMF contains the findings of a study conducted for the health sector of Zimbabwe and the instrument has been developed based on local conditions and findings. Report no. 001 Issue no. 001 Date of issue ……….………………………………………… ………………. CHECKED DATE ……….………………………………………… ………………. APPROVED DATE This Report is available from: The Minister of Health and Child Care Attention: The Secretary of Health Ministry of Health and Child Care Harare Zimbabwe Page | ii TABLE OF CONTENTS TABLE OF CONTENTS .................................................................................................... III TABLE OF TABLES ............................................................................................................... V LIST OF FIGURES................................................................................................................ VI FOREWORD ..................................................................................................................... VI LIST OF ABBREVIATIONS .....................................................................................................VIII EXECUTIVE SUMMARY ........................................................................................................ XI 1. Introduction ......................................................................................................................... 1 1.1 PROJECT BACKGROUND .................................................................................................. 1 1.2 ESMF OBJECTIVES........................................................................................................ 2 1.3 SIGNIFICANCE OF THE ESMF ............................................................................................ 3 1.4 ESMF METHODOLOGY .................................................................................................. 3 1.5 PROJECT DESCRIPTION: THE ZIMBABWE COVID-19 RESPONSE AND ESSENTIAL HEALTH SERVICES ADDITIONAL FINANCING PROJECT (P180160) .......................................................................... 5 1.6 ENVIRONMENTAL AND SOCIAL RISK MANAGEMENT APPROACH ................................................ 9 1.7 RISK CLASSIFICATION ................................................................................................... 10 1.8 EXCLUSION CRITERIA/ NEGATIVE LIST ............................................................................... 10 2. Policy, Legal and Regulatory Framework .......................................................................... 12 2.1 INTRODUCTION .......................................................................................................... 12 2.2 THE CONSTITUTION OF ZIMBABWE .................................................................................. 12 2.3 OVERVIEW OF RELEVANT ZIMBABWE POLICES AND PLANS ..................................................... 13 2.4 RELEVANT ZIMBABWEAN LEGISLATION ............................................................................. 23 2.5 INTERNATIONAL CONVENTIONS AND TREATIES.................................................................... 42 2.6 WORLD BANK ENVIRONMENTAL AND SOCIAL FRAMEWORK (ESF) ........................................... 46 2.7 GAP ANALYSIS ........................................................................................................... 54 3.0 Environmental and Social Baselines ........................................................................................ 73 3.1 PROJECT BASELINE INFORMATION ................................................................................... 73 3.2 SITE VISITS AND WORKSHOP DISCUSSION ......................................................................... 73 3.3 ANALYSIS OF BASELINE ENVIRONMENTAL DATA .................................................................. 73 3.4 BIOPHYSICAL ENVIRONMENT ......................................................................................... 74 3.5 SOCIO-ECONOMIC ENVIRONMENT ................................................................................... 79 3.6 HEALTH CARE WASTE CONDITIONS ................................................................................. 92 3.7 AIR QUALITY ............................................................................................................. 97 3.8 INCINERATION ........................................................................................................... 97 4.0 Potential Environmental and Social Risks, Impacts and Mitigation ...................................... 100 4.1 INTRODUCTION ........................................................................................................ 100 4.2 ENVIRONMENTAL RISK/ IMPACT ANALYSIS ...................................................................... 101 4.3 SOCIAL IMPACT ANALYSIS ........................................................................................... 122 4.4 POSITIVE PROJECT IMPACTS ................................................................................. 126 Page | iii 5. Procedures to Address Environmental and Social Matters .................................................... 127 5.1 INTRODUCTION ........................................................................................................ 127 5.2 PROJECT ACTIVITY PREPARATION AND APPROVAL ............................................................. 127 5.3 EXCLUSION / ELIGIBILITY LIST ....................................................................................... 128 5.4 ASSIGNING ENVIRONMENTAL AND SOCIAL CATEGORY ........................................................ 129 5.5 ENVIRONMENTAL AND SOCIAL SCREENING ...................................................................... 133 5.6 MANAGEMENT OF IMPACTS ........................................................................................ 138 5.7 RISK REDUCTION AND MANAGEMENT OF IMPACT APPROACHES ............................................ 139 5.8 ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN .......................................................... 143 5.9 PPE REQUIREMENTS FOR PROJECT IMPLEMENTATION ........................................................ 192 5.10 MONITORING AND SUPERVISION OF PROJECT ACTIVITIES .................................................. 193 5.11 AREAS TO BE MONITORED ........................................................................................ 194 5.12 THE MONITORING PLAN ........................................................................................... 195 6. Project Complaints, Conflicts and Grievance Redress Mechanism ................................. 202 6.1 INTRODUCTION ........................................................................................................ 202 6.2 FACILITY LEVEL GRM SYSTEM ...................................................................................... 202 6.3 WORLD BANK GRIEVANCE REDRESS SYSTEM (GRS) .......................................................... 203 6.4 DISCLOSURE ............................................................................................................ 204 7. Stakeholder Engagement and Communication .............................................................. 205 7.1 STAKEHOLDER ENGAGEMENT ....................................................................................... 205 7.3 RISK COMMUNICATION AND COMMUNITY ENGAGEMENT (RCCE) ......................................... 205 8. Project Implementation Arrangements, Responsibilities and Capacity Building ........... 206 8.1 INTRODUCTION ........................................................................................................ 206 8.2 IMPLEMENTATION ARRANGEMENTS............................................................................... 206 8.3 MONITORING AND SUPERVISION OF E&S AND OVERALL PROJECT ......................................... 208 8.3 ANNUAL MONITORING, REPORTING AND REVIEWS............................................................ 209 8.4 ADAPTIVE MANAGEMENT ........................................................................................... 211 8.5 MONITORING INDICATORS .......................................................................................... 212 8.6 INSTITUTIONAL ARRANGEMENTS FOR ESMF IMPLEMENTATION ............................................ 214 8.7 PROJECT IMPLEMENTATION CAPACITY ............................................................................ 218 8.8 CAPACITY BUILDING REQUIREMENTS ............................................................................. 221 8.9 BUDGET ................................................................................................................. 224 8.10 CONCLUSIONS ........................................................................................................ 227 9. References ....................................................................................................................... 228 10. Appendices ............................................................................................................................ 230 APPENDIX 1 INDIGENOUS PEOPLE`S PLANNING FRAMEWORK .................................................... 230 APPENDIX 2 LABOUR MANAGEMENT PROCEDURES ................................................................. 238 APPENDIX 3 ARCHAEOLOGICAL CHANCE FINDS PROCEDURE ...................................................... 266 APPENDIX 4 CODE OF CONDUCT FOR CONTRACTOR’S PERSONNEL ............................................... 268 Page | iv APPENDIX 5 ENVIRONMENTAL AND SOCIAL SCREENING FORM ................................................... 272 APPENDIX 6 GUIDE TO IDENTIFYING AND DRAFTING KEY CHECKLIST ESMP CONTENTS ..................... 280 APPENDIX 7 E & S GENERAL SUPERVISION CHECKLIST ............................................................. 288 APPENDIX 8 ENVIRONMENTAL AND SOCIAL GUIDELINES FOR CONTRACTORS .................................. 290 APPENDIX 9 TEMPLATES FOR ENVIRONMENTAL & SOCIAL MONITORING PLANS ............................. 293 APPENDIX 10 EXPECTED LABORATORY SAFETY FEATURES AND CHECKLIST ..................................... 301 APPENDIX 11 REQUIREMENTS WHEN WORKING WITH ASBESTOS MATERIALS AND CONTAMINATED LAND308 APPENDIX 12 GENDER BASED VIOLENCE AND SEXUAL EXPLOITATION ABUSE AND HARASSMENT ........ 312 APPENDIX 13 VACCINE EMERGENCY PREPAREDNESS AND RESPONSE ........................................... 314 Table of Tables Table 1-1 Sources of Information ..................................................................................................... 4 Table 2-1 Relevant Policies ............................................................................................................. 14 Table 2-2 Relevant Operational Manuals, Procedures and Guidelines ......................................... 17 Table 2-3 Relevant Zimbabwe Legislation...................................................................................... 23 Table 2-4 Relevant Statutory Instruments (SI) ............................................................................... 30 Table 2-5 Relevant Licences and permits ....................................................................................... 35 Table 2-7 Zimbabwean Emission Standards for Motor Vehicles ................................................... 39 Table 2-8 EHSG Effluent Discharge Standards ............................................................................... 40 Table 2-9 Overview of the relevant International Conventions and Treaties ............................... 42 Table 2-10 Environmental and Social Standards ............................................................................ 46 Table 2-11 Gap Analysis - Zimbabwean Legislation and applicable WB Environmental, Health and Safety Guidelines ..................................................................................................................... 54 Table 3-1 Household Livelihood Coping Strategies (FNC, 2019) .................................................... 84 Table 3-2 Distribution of Health Facilities in Zimbabwe ................................................................ 85 Table 4-1 Potential Environmental Impacts .................................................................................. 118 Table 4-2 Potential Social Impacts ................................................................................................ 125 Table 5-1 Project Activity Exclusion List ...................................................................................... 128 Table 5-2 and Activity Eligibility List ............................................................................................ 129 Table 5-4 Classification of the project activities .......................................................................... 132 Table 5-5 Environmental and Social Analysis Levels for Types of Project Activities .................... 134 Table 5-6 Comprehensive ESMP of the ZCERP by Project Component ....................................... 145 Table 5-7 PPE Requirements for installation sites......................................................................... 192 Table 5-8 Possible Monitoring Activities and their Indicators........................................................ 196 Table 7-1 Stakeholder Engagement Error! Bookmark not defined. Table 8-1 Reporting arrangements............................................................................................... 210 Table 8-2 Monitoring Indicators ................................................................................................... 212 Table 8-3 Responsibilities of focal persons .................................................................................. 220 Table 8-4 Summary of Capacity Building Requirements and Cost Estimates ............................. 222 Table 8-5 Summary of the Budgetary Requirements................................................................... 225 Page | v List of Figures Figure 3-2 Topography of Zimbabwe ............................................................................................. 74 Figure 3-3 Zimbabwe Natural Regions ............................................................................................ 75 Figure 3-4 Geological map .............................................................................................................. 77 Figure 3-5 Zimbabwe Road Network.............................................................................................. 78 Figure 3-6 An example of a rural gravel untarred road ................................................................. 78 Figure 3-7 Population pyramid of Zimbabwe in 2021, (Zimbabwe National Statistics Agency) .... 80 Figure 3-8 Food Consumption Patterns (FNC, 2019) ..................................................................... 83 Figure 3-9 Households Engaging in Livelihood Coping Strategies by Province (FNC, 2019) .......... 84 Figure 3-10 Households with at Least One Member Living with a Chronic Condition .................. 86 Figure 3-11 Access to Treatment Services among Households with at Least One member Living with a Chronic Condition (FNC, 2019). .................................................................................... 86 Figure 3-12 Easy or difficult to obtain medical treatment - Zimbabwe - 2017 .............................. 87 Figure 3-13 General Service Availability index and domain scores for Zimbabwe ........................ 88 Figure 3-14 General Service readiness index and domain scores nationally, Zimbabwe .............. 89 Figure 3-15 Household Vulnerability Attributes (FNC, 2019) ........................................................ 91 Figure 3-16 Percentage Head of Families....................................................................................... 92 Figure 3. 17 Segregation of waste in a hospital ............................................................................. 94 Figure 3. 18 Temporary storage for waste ..................................................................................... 94 Figure 3. 19 Municipal Landfill and Open pit disposal ................................................................... 95 Figure 3.20 The incinerator and a lined pit at a hospital ............................................................... 95 Figure 3. 21 Concrete lined pit for sharps disposal at a Clinic ....................................................... 96 Figure 5-1 Flow for project activity identification, submission, evaluation, and monitoring ...... 137 Figure 8-1 Organisational Arrangements ..................................................................................... 218 Foreword The Constitution of Zimbabwe gives every citizen and permanent resident of Zimbabwe the right to have access to basic health-care services, including reproductive health-care services. Environmental rights enshrined in the constitution of the Republic also give every Zimbabwean the right to a clean environment that is not harmful to their health and well-being. Currently poor health care waste management is one of the pertinent issues confronting the health sector throughout Zimbabwe. The Covid-19 pandemic compounds these challenges. The Government of Zimbabwe (GoZ), through the Ministry of Health and Child Care (MoHCC), has received funding for the World Bank Global Financing Facility for the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160). The project development objective of the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) project is to support the support the Government of Zimbabwe to deploy and manage COVID-19 vaccines and strengthen related health system capacity for pandemic preparedness Page | vi and deliver essential health services, particularly reproductive, maternal, new-born, child, and adolescent health (RMNCAH). The Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) is consistent with Zimbabwe’s National Development Strategy 1 (NDS 1) 2021-2025 and the National Health Strategy (NHS) 2021-2025. The NHS 2021-2025 aims to improve health outcomes by strengthening essential health services and pandemic preparedness and response. The Project will have overall significant positive environmental and social impacts as it will contribute to epidemic/pandemic preparedness, monitoring, surveillance, and response, specifically about combating the transmission of COVID-19 and vaccine deployment and particularly reproductive, maternal, new-born, child, and adolescent health (RMNCAH). However, there are also substantial environmental and social risks and impacts that will need to be assessed and managed through a risk-based approach during implementation necessitating the preparation of this Environmental and Social Management Framework (ESMF). The ESMF has been prepared as a guide for the various activities of the proposed project and how to assess and mitigate any negative environmental and social impacts, which would require attention prior to project implementation. This ESMF is to be used by the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) project to ensure that all environmental and social safeguards are adequately addressed. The actions and activities in this ESMF will be underpinned by enablers such as capacity building, community mobilization, education and training, research, monitoring and review as well as awareness raising of all stakeholders to better understand and participate in project implementation to improve the environmental and social performance of the project. The framework supports effective stakeholder engagement and mobilization, strengthening of Environmental and Social Impact Assessment (ESIA), institutional arrangements to improve implementation and enforcement. The MOHCC hopes that implementation of this framework will improve environmental and social risk assessment, risk planning, reduction, mitigation and stakeholder participation. Lastly, we would like to thank the World Bank Global Financing Facility and Cordaid for the technical assistance and all those who made it possible to have this Environmental and Social Management Framework. ………………………………………………………………………… Dr. A Maunganidze Permanent Secretary for Health and Child Care Page | vii List of Abbreviations ACFP Archaeological Chance Finds Procedure ACRWC African Charter on the Rights and welfare of the Children AEFI Adverse Events Following Immunisation AIDS Acquired Immunodeficiency Syndrome CBO Community Based Organisation CFC Chlorofluorocarbon COVID-19 Corona Virus Disease 2019 CRC Convention on the Rights of the Child DoR Department of Roads DDF District Development Fund DC District Councils E&S Environment and Social EA Environmental Assessment EHS Environment, Health, and Safety EHSG Environment, Health, and Safety Guidelines EIA Environmental Impact Assessment EMA Environmental Management Agency EOC Emergency Operations Committee ESA Environmental and Social Assessment ESF Environmental and Social Framework ESIA Environmental and Social Impact Assessment ESIRT Environment and Social Incidence Response Toolkit ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan ESSC Expanded Supply Side Community FFS Food and Food Standards FTCT Fast Track COVID-19 Facility GBV Gender Based Violence GDP Gross Domestic Product GFF Global Financing Facility GIIP Good International Industry Practice GoZ Government of Zimbabwe GRM Grievance Redress Mechanism GWP Global Warming Potential HCRW Health Care Risk Waste HCW Health Care Waste HCWM Health Care Waste Management HCWMP Health Care Waste Management Plan HIV Human Immunodeficiency Virus HSDSP AF-(V) Health Sector Development Support Project, Additional Financing-V HPA Health Professions Authority HSSP Health Sector Strategic Plan ICC Interagency Coordinating Committee ICWMP Infection Control and Waste Management Plan Page | viii IECCD Integrated Early Childhood Care and Development IPPF Indigenous Peoples’ Planning Framework LMP Labour Management Procedure M&E Monitoring and Evaluation MNCH Maternal, New-born and Child Health MoHCC Ministry of Health and Child Care MOPSLSW Ministry of Public Service, Labour and Social Welfare MLGPW Ministry of Local Government, and Public Works. MECTHI Ministry of Environment, Climate, Tourism and Hospitality Industry NAC National Aids Council NEP National Environmental Policy NGO Non-Governmental Organization NIHR National Institute of Health Research NIP National Implementation Plan NMMZ National Museums and Monuments of Zimbabwe NMRL National Microbiology Reference Laboratory NVDP National Vaccine Deployment Plan OAU Organisation of African Union OHS Occupational Health and Safety ODS Ozone Depleting Substance PHC Primary Health Care PCU Program Coordination Unit PDO Project Development Objective PIE Project Implementing Entity POPs Persistent Organic Pollutants PPE Personal Protective Equipment PRS Poverty Reduction Strategy PSEAH Prevention of Sexual Exploitation, Abuse and Harassment PV Photovoltaic RBF Results Based Financing RMNCAH-N Reproductive Maternal, Neonatal, Child, and Adolescent Health and Nutrition SDD Solar Direct Drive SEA Sexual Exploitation and Abuse SEP Stakeholder Engagement Plan SGBV Sexual and Gender Based Violence SI Statutory Instrument TA Technical Assistance UN United Nations UNDP United Nations Development Programme UV Urban voucher CHW Community Health Workers WASH Water, Sanitation, and Hygiene WB World Bank WHO World Health Organization WHO EUL World Health Organisation Emergency Use Listing WHO VAC World Health Organisation Vaccine Acceptance Criteria Page | ix ZCERP Zimbabwe COVID-19 Emergency Response Project ZCEREHSP Zimbabwe COVID-19 Emergency Response and Essential Health Services Project Page | x Executive Summary Background The government of Zimbabwe, through the Ministry of Health and Child Care (MOHCC), received US$6.575 million for the Zimbabwe COVID-19 Emergency Response Project (ZCERP) and is also set to receive US$15.0 million grant from the Global Financing Facility (GFF) for the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160). Given the disruptions to the health systems caused by the COVID-19 pandemic, an acute economic challenge threatens to reverse gains made for Reproductive Maternal, Neonatal, Child, and Adolescent Health and Nutrition (RMNCAH) in Zimbabwe. Pre-pandemic, Zimbabwe had made progress in the provision of RMNCAH services at all levels of care. Findings from the 2019 Multiple Indicator Cluster Survey (MICS) reflect successes of the decade-long investments into the RMNCAH program by the government and its partners. In the second half of 2019, due to the decreased value of their salaries, over 500 junior doctors went on strike for several months, and nurses reduced their working hours. The Government introduced measures to remedy the situation (e.g., increasing its health sector budget, adjusting salaries, providing additional allowances, etc.) but was unable to fully cushion the impact of inflation rates that reached 522 percent by the end of 2019. The COVID-19 pandemic further affected health service delivery due to the national lockdowns and related social distancing restrictions to minimize the risk of COVID-19 transmission. While some RMNCAH indicators improved in 2022 when compared to the same reporting period in 2020 and 2021, their performance is still below pre-pandemic levels. The Global Financing Facility (GFF) has approved a US$15 million grant for the Government of Zimbabwe to support the continuity of essential health services (EHS). Given the nature of the EHS grants, which is to help countries adapt and strengthen their primary health care delivery system to address immediate needs as part of a comprehensive COVID-19 response, project preparation and implementation are expected to be carried out in the shortest possible time for recipient countries. Therefore, the EHS grants are incorporated into existing World Bank-supported projects. The EHS grant in Zimbabwe is proposed to be prepared as additional financing (AF) to the ongoing ZCERP. This way the AF would supplement the system strengthening interventions of the ZCERP and provide support to essential health services disrupted by COVID-19 and the concomitant major economic crisis. Rationale for the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) Environmental and Social Management Framework (ESMF) The objective of the ESMF is to assess and mitigate potential negative environment and social (E&S) risks and impacts of the Project consistently with the Environmental and Social Standards (ESSs) of the World Bank Environmental and Social Framework (ESF) and national requirements. Specific objectives of the ESMF are to: (a) assess the potential E&S risks and impacts of the proposed ZCERP and AF activities and propose their mitigation measures; (b) establish procedures for the E&S screening, review, approval, and implementation of activities; (c) specify appropriate roles and responsibilities, and outline the necessary reporting procedures, for managing and monitoring E&S issues/concerns related to the activities; (d) identify the training and capacity building needed to successfully implement the provisions of the ESMF; (e) address mechanisms for public consultation and disclosure of project documents as well as redress of possible grievances; and (f) establish the budget requirements for implementation of the ESMF. Page | xi The Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) will include vaccine deployment and related health system strengthening and will have considerable positive outcomes as it aims to prevent, detect, and respond to the threat posed by the COVID-19 and strengthen national systems for public health preparedness and support essential health services disrupted by COVID- 19. The intervention has positive implications for the social and economic wellbeing of individuals with benefits also accruing to the vulnerable and marginalized groups. However, the COVID-19 strengthening and preparedness and related health systems strengthening activities can also have potential adverse environmental, health and safety risks if an appropriate system for collection, transportation and disposal of health care waste is not put in place. Furthermore, Occupational Health and Safety risks may arise from fuelling and maintenance of vehicles (spills and waste disposal) as well as the installation and operation of energy generation equipment. These activities will be located at various locations throughout the country affecting their physical and social environments, requiring the preparation of safeguards instruments, and in this case the Environmental and Social Management Framework (ESMF). This ESMF, which builds on the ESMF prepared for the parent project, follows the World Bank ESF mandates defined in key documents issued for this AF: the ESMF, and the Stakeholder Engagement Plan (SEP). The ESMF contains Labor Management Procedures (LMP). This ESMF has been prepared as a guide for the various activities of the proposed project and how to assess and mitigate any negative environmental and social impacts, which would require attention prior to project implementation. This ESMF is to be used by the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing to ensure that all environmental and social safeguards are adequately addressed and that the relevant capacity building and training needs are established for the recommended measures to be implemented effectively. Furthermore, the ESMF has been prepared as a guide for the integration of environmental and social considerations into the design, planning and implementation of the proposed project activities. It also provides a basis for specific environmental and social assessments of all activities to be carried out under this proposed World Bank financing. The Zimbabwe COVID-19 Response project (ZCERP) component is national in scope and is being implemented over 18 months from April 2022 – August 2023. The vaccination activities as well as supply and installation of Solar Direct Drive (SDD) refrigerators, and installation of energy generation equipment is being conducted in existing health facilities. However, for vaccinatio0ns, some facilities are operating outreach centres for hard-to-reach areas. In addition, the ZCEREHSAFP is supporting the 25 facilities in 8 rural provinces across the country. This project will allow the country to strengthen the health system’s capacity to increase access, quality, and equity of RMNCAH services. This will be achieved through integrated outreach services, community health services including disease surveillance, procure and supply of commodities for RMNCAH, revitalization and utilization of maternity waiting homes, health system digitalisation and related innovations. Cordaid Zimbabwe is the Project Implementing Entity (PIE) and is receiving World Bank-GFF funds through a Designated Account. Cordaid is in the process of purchasing goods and services required for the successful implementation of the COVID-19 emergency response project in collaboration with the MoHCC to cover vaccine deployment and related risk communication and community engagement activities, climate friendly and related health system strengthening and overall project coordination, monitoring and evaluation. The AF Includes a new component called Sustaining Essential Health Services which will be financed by the US$15 million EHS Grant from the GFF. This will increase the total project amount to US$21.575 million. Page | xii The new component will include five subcomponents that will support the implementation of key priorities: (a) Integrated Outreach Service Delivery Model. To support the provision of a comprehensive package of essential health services closer to the communities even during lockdown restrictions, this sub- component will finance the procurement of (i) 300 solar-powered tricycles; (ii) 8 outreach vans equipped to provide a range of services, including those requiring privacy, to cover 8 rural provinces and target poorly performing districts; and (iii) equipment (e.g., solar power, refrigerators, exam couches, tents, screens, etc.). It will also support operational costs for the integrated outreach teams and costs related to the RMNACH mentorship program which involves specialists from central and provincial hospitals mentoring district level doctors. (b) Community Health Services including Disease Surveillance. This sub-component will finance: (i) training of 2,000 village health workers (VHWs); (ii) refresher trainings for 5,000 VHWs; (iii) supervision and mentorship of VHWs in three provinces; (iv) procurement of commodities to support VHWs; (v) strengthening community transport systems for transferring maternity and neonatal emergency cases from communities; as well as (vi) procurement of Environmental Health Technician (EHT) motorcycles for conducting community surveillance activities. (c) Commodity Security. In view of the 85 percent cut in contraceptive funding from development partners who traditionally financed Zimbabwe’s Family Planning Program, this sub-component will finance procurement of family planning commodities to cover the gap. It will also fund equipment for rural health facilities, beds, and sundries for RMNCH, and commodities to support Integrated Management of Childhood Illnesses and both basic and comprehensive emergency obstetric and new-born care (EmONC). (d) Revitalization of Maternity Waiting Homes (MWHs). This sub-component will support the revitalization and improvement of quality of services provided in the MWHs/shelters to ensure that MWHs are utilized. This will include (i) renovation and refurbishment of existing MWHs based on specific needs; (ii) provision of commodities including food items for nutritional support for mothers staying at the MWHs; and (iii) training of service providers in EmONC). (e) Health System Digitalization and Related Innovations. To complement the integrated outreach model, the AF will also fund the following: (i) capacity building on using Electronic Health Records (EHR) as well as data utilization at points of generation and subnational level managers; (ii) development of the EHR’s costing module; (iii) capacity building on blockchain technology within the MoHCC, particularly of the internal technical team that works on health informatics and data analytics, including the EHR Team. This phase’s outcome will then guide the MoHCC and the World Bank on the way forward regarding implementation of blockchain technology in the health sector; and (iv) strengthening the routine weekly monitoring system set up by the MoHCC to include private sector facilities that have not been reporting through rapid phone surveys. This will also entail implementing the Early Warning System using machine learning and artificial intelligence to detect service disruptions. The ESMF Development Process The ESMF development process consisted of the following aspects: (i) establishment of baseline socio-environmental conditions, (ii) review of policy, regulations, institutional framework, Page | xiii (iii) assessment of potential environmental impacts, (iv) assessment of potential social impacts, (v) preparation of the environmental mitigation plan and a monitoring plan, (vi) providing guidelines for the implementation of the measures. The process involved extensive review of related literature from published and unpublished documents, field surveys and investigations and a high degree of consultations with the various stakeholders. The rationale for these extensive consultations is to take on board views from a cross section of the stakeholders, at least from local level, district level, and central government level in the health sector and related sectors. Overall, the ESMF will ensure that the substantive concerns of the relevant World Bank Environmental and Social Standards (ESSs) and the Zimbabwean legislation will be considered during the implementation of the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) activities. Policy, Legal and Institutional Framework The policy and legal review established that the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) is being and will continue to be supported by a host of laws, regulations and institutions that promote a sustainable health environment and well-being of the people of Zimbabwe. The said instruments are guided by the governing laws and the Constitution which majors on sustainable development and the management of the environment so that current generation benefits but without endangering future generations’ full rights to the environment and benefits as well. The World Bank remains committed to mainstreaming social, environmental and climate change solutions into World Bank financed projects; thus Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) was designed and informed by the World Bank’s Environmental and Social Framework (ESF). The ten Environmental and Social Standards (ESSs) contained in the ESF serve to ensure the identification, avoidance and management of potential environmental and social risks and benefits associated with Bank operations. The ESMF describes a process that will ensure that the substantive concerns of the relevant World Bank applicable standards in the ESF and Zimbabwe legislation are addressed during the implementation of the selected activities. However, where the Bank ESSs are more stringent than the national standards, the Bank standards will prevail. It is important to also note that the World Bank Group Environmental, Health, and Safety Guidelines including the General Guidelines as well as those for Health Facilities and Retail Petroleum Networks (which may provide limited vehicle repair services) also guide the project on relevant reference levels and relevant management approaches. Project Categorization The World Bank environmental and social risk rating for Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) is substantial because of the enormity of the COVID-19 challenge (its infectiousness, mortality, pandemic nature), the new vaccines and Zimbabwe’s macroeconomic situation. The additional minor works associated with installing solar panels will be in already existing health care facilities and minimal risks are posed to cultural, natural habitats or biodiversity. The project will continue to support strengthening of medical waste management and Page | xiv disposal systems in permanent and temporary healthcare facilities on an as needed basis since the main environmental issue associated with this project’s activities is health care waste management.1 Considering the proposed AF activities, such as the integrated outreach service delivery model, community health services including disease surveillance, commodity security, revitalization of MWHs, and health system digitalization and related innovations, the most significant foreseen social risks are related to: (i) exclusion of vulnerable social groups (poor, disabled, elderly, isolated communities, refugees, and people and communities living far from the health facilities, etc.) from access to the essential health services, (ii) inadequate personal data protection under the health system digitalization and related innovations activities, which involve capacity building for using electronic health records and implementing the early warning system using machine learning and artificial intelligence to detect service disruption, (iii) poor labour and working conditions due to a failure to abide by national legislation and the ESS2 requirements on working hours, wages, overtime, compensation and/or benefits; and (iv) sexual exploitation and abuse (SEA), and sexual harassment (SH) among project workers, with stakeholders and/or local communities. The activities to revitalize MWHs will involve minor civil works such as renovation and refurbishment of existing MWHs, and no land acquisition or involuntary resettlement impacts are expected. Key Environment risks include i) construction related risks including EHS and Occupational Health and Safety (OHS) (dust, noise, construction waste, working at height, being hit by objects etc.) emanating from refurbishment of maternity waiting homes; ii) road traffic incidents due to operation of tricycles supporting community health services, vans and motorcycles for health centre monitoring ; iii) exposure to hazardous, medical and e-wastes emanating from immunization, and health care operations and digitization and solar powered equipment, if improperly managed; iv) OHS risks during operation of maternity waiting home and management of child illnesses including traps, falls and general wastes management. With the addition of the AF, the environmental risk classification for the project remains substantial under the World Bank ESF mainly due to risks linked to the management of biomedical waste and also risks linked to the renovation of Maternity Waiting Homes in health facilities. Labour management and health and safety risks will be taken into account given the grown capacity of the PIE on these issues. These risks will be mitigated by; capacity building activities, preparing required ESMPs for all renovations and ensuring the Environmental and Social Safeguards Specialists continue to support the MOHCC and PCU with the implementation of environmental and social provisions. Environmental and Social Assessment Process The proposed AF will expand on and complement the activities initiated under the parent project. In order to ensure that potential environmental and social impacts are identified and ultimately adequately addressed, a number of safeguards instruments have been developed for the ZCERP project and will be updated to reflect the AF project and its activities and they include (i) the Environmental and Social Management Framework (ESMF) which includes an Infection Control and Waste Management Plan (ICWMP), an Indigenous Peoples Planning Framework (IPPF – Appendix 1, and Labour Management 1 Temporary health care facilities will need to factor in safe water, sanitation, and hygiene facilities (meeting quality standards; separation of infected vs. non-infected patients). Page | xv Procedures (LMP) – Appendix 2); (ii) a Grievance Redress Mechanism (GRM); and (iii) a Stakeholder Engagement Plan (SEP). Although the Project does not anticipate any physical cultural resources, the ESMF contains an Archaeological Chance Finds Procedure (Appendix 3) in case such resources are unexpectedly encountered during project activities. The project also anticipates mitigating, handling and addressing cases of Gender Based Violence and a GBV Action Plan has also been appended to that effect (Appendix 12). The safeguards instruments, like this ESMF were developed with stakeholder consultations, which are part of an overall continuous stakeholder consultation process described in this ESMF. The process involves identifying the concerned/affected stakeholders for each project activity, soliciting their views and continuously checking if their views are being taken care of as the project implementation progresses. Because of the current limitations imposed by the COVID-19 Pandemic, full-scale site visits could not be conducted. The strategy that was applied included the following: • Limited site visits, • Virtual Zoom Meetings done with some of the key stakeholders like MoHCC management, Environmental Management Agency (EMA) head office, etc., • Administration of an electronic questionnaire was done to all key stakeholders in MoHCC, participating Ministries, and Agencies. The ESMF emphasizes the need for continuous consultations with stakeholders throughout the project cycle to achieve successful implementation and monitoring and the AF will ensure stakeholders are continuously engaged, appraised and meaningfully engaged. Detailed guidance on stakeholder engagement process is outlined in the project SEP which was disclosed in May 2023 with further details on this link https://healthprojectzim.org.zw/2023/05/12/strengthening-stakeholder-engagement-the- project-updates-its-stakeholder-engagement-plan/. The PIE will have the responsibility to effectively engage stakeholders in achieving the project objectives for the benefit of all. An important facet of the stakeholder consultation process is the Grievance Redress Mechanism (GRM). The GRM is a system by which queries or clarifications about the project will be responded to, problems with implementation will be resolved, and complaints and grievances will be addressed efficiently and effectively. The GRM was developed from what is generally being practiced in the Health Facilities. It is mainly serving the purpose of responding to the needs of beneficiaries and addressing and resolving their grievances. Page | xvi Environmental and Social Concerns and Mitigation of Impacts The potential risks and impacts associated with the project were analysed and mitigation measures for the identified impacts were proffered. The planned installation of solar panels to enhance energy generation, fuelling and maintenance of vehicles at facilities will not have any significant impacts. However, the enhanced vaccination activities will result in increased generation of infectious waste. Therefore, the main safeguards issues will be related to the management of infectious health care waste and the occupational health and safety of workers handling the waste, and community health and safety of the communities who may come into contact with infectious waste, and Adverse Events Following Immunizations (AEFIs) for the people who are vaccinated, The ESMF establishes a unified process for addressing all environmental and social issues in project activities from preparation, through review and approval, to implementation. The Project has an Infection Control and Waste Management Plan (ICWMP) to govern the management of healthcare waste. Installation of solar power equipment at facilities will be screened. The proponents of such installations, be they health care facilities or contractors, must then formulate an Environmental and Social Management Plan (ESMP) using as a basis ESMP formats and templates provided in Appendices 5 and 6. Those ESMPs will be reviewed and approved or rejected by the Project Implementing Entity, Cordaid, Environmental and Social Specialists. Solar power installation activities must have an ESMP approved by the PIE before they start. Screening (and potentially an ESMP) is required for truck installations of refrigerators if those activities will take place at only a few (like 4 or less) locations to prevent and avoid impacts from concentrated activities. If truck installations will take place at numerous locations (thus resulting in diffuse insignificant impacts), responsible project proponents or contractors are to apply the relevant measures in Table 5-5, although they do not need to be screened or to develop any ESMP. Facilities that will provide vaccinations with financing from Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) will develop their own facility level ICWMP guided by the ZCERP ICWMP and this ESMF to manage the impacts from generating waste, namely the infectious needles. All other project activities should apply the measures outlined in Table 6-6, the ZCERP general ESMF to manage their impacts. Appendix 4 contains the Code of Conduct and Appendix 8 contains Environmental and Social Guidelines for any contractors delivering project activities. The universe of possible mitigation measures, as part of the comprehensive ESMP for the ZCERP, in Table 6-6 provides guidelines for the management of potential environmental and social aspects at all possible project activities. The mitigation or enhancement measures will reduce the negative impacts and enhance the positive impacts. Implementation of the AF project activities will be positive and urgently needed. The Integrated Outreach Service Delivery Model, the Community Health Services including Disease Surveillance, the Commodity security component and the Revitalization of Maternity Waiting Homes (MWHs). have limited, if any, impacts. The risks and impacts from the implementation of these components need to be addressed. The upgrading and revitalization of several MWHs will require following practical environmental and social risk and impact management measures. The potential negative impacts from these activities are expected to be moderate, localized, and temporary that can be mitigated through the implementation of the existing Environmental and Social Management instruments of the Project. Attention is required to ensure all Good International Industry Practices (GIIP) and WHO guidance is applied to the COVID-19 waste stream and other infectious waste as part of the medical waste management system in place by the MOHCC. All civil works planned to be executed under this project will be located on public lands within the compound of health centres or referral hospitals. These rehabilitations/upgrades/renovations of WMHs at Page | xvii health care facilities may generate limited adverse impacts such as dust, noise, vibration, building waste, wastewater, traffic obstruction, safety issue, construction workers hygiene and sanitation to the environment and surrounding residents. These impacts are assessed to be site-specific, temporary and can be mitigated with good design and construction practices. A generic concern with such construction upgrades is exposure to asbestos if such materials were used in past building programs. The MOHCC will verify that asbestos is not present in existing structures and if that is not the case adhere to appropriate occupation health and environmental mitigation measures. These measures are addressed in the ESMP checklist for Renovations and Upgrades. As a result of the COVID-19 pandemic, the MOHCC created a call centre to support COVID-19 surveillance activities and for enquiries and other COVID-19 related calls. The Call Centre is an important communications link to the public and is a significant source of contact for public requesting information on COVID-19 and any other health related information, and the primary contact point for responding to public and media inquiries. The Call Centre centrally manages all calls coming into the centre via a dedicated toll-free hotline telephone number (2019) using normal simple phones. The project will mitigate the risk of SEA by applying the WHO Code of Ethics and Professional Conduct (“Codes of Conduct� using WB’s terminology) for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructure, such as segregated toilets and enough light in quarantine and isolation centres. The LMP also includes provisions to prevent SEA/SH and/or violence against children (VAC). Training on community interaction and SEA/SH/VAC will be provided for all teams, staff (civil servants and outsourced staff/contractors) to ensure the teams respect local communities and their culture and will not be involved in misconduct. The ESMP checklist also guides appropriate measures for dealing with SEA/SH and VAC risks in the contracts (for contracted workers) in line with relevant national laws and legislations to be adopted and applied under the project. The ESMF places special emphasis on the empowering of women and youth and their protection from any form of abuse. Of note are the measures to avoid, minimise, manage, and mitigate any Gender Based Violence (GBV)/ Sexual Exploitation and Abuse (SEA); Sexual Harassment (SH) risks, which may arise especially at the installation sites. These measures are detailed in the GBV Action Plan in Appendix 15. The World Bank Code of Conduct for Contractor has been incorporated as part of this ESMF (Appendix 4) and all contractor workers are expected to sign and abide before commencing any work. Capacity Building The successful implementation and monitoring of the ESMF will require that target groups and stakeholders who play a role in the implementation of the ESMF be provided with appropriate training and awareness. This is necessary because the implementation of the activities will require input, expertise and resources which will be adequately taken care of if the concerned parties are well capacitated. Careful and strategic identification of training recipients should be carried out at the beginning of the Project. The ESMF capacity building is directed to staff in the MOH, relevant government institutions, contractors and subcontractors, and communities. The capacity improvement and training program will be organized to cover a selection of key topics such as: - Training topics/themes will cover the following topics as mentioned above in section 8: - The Project ESMF approach - MOH actions and environmental and social considerations - Good international industry practices (e.g., WHO, CDC, OSHA) concerning OHS Page | xviii - Managing construction waste, general Medical Health Care Waste - Labor management practices - ESSs, OHS and COVID-19 Considerations for all Civil Works Subprojects – Contractors and Subcontractors - Grievance redress mechanisms - Consultations, communications and feedback - Ensuring all people are given equal access and rights. - Understanding concerns with gender-based violence, violence against children, social stigma - Monitoring and reporting at all levels These workshops will be funded as stipulated in the Budget section on training. Each workshop has a designated target audience, a time frame for delivery and identification of who will facilitate the workshop. A separate budget is also allocated for relevant ESIA studies that will be commissioned from independent consultants or consultancy firms. Based on social distancing protocols and COVID19 precautions, these workshops can be delivered via remote connections and distance learning. The MOHCC is well experienced in infection prevention and control, healthcare waste management, communication and public awareness for emergency situations. Regarding the COVID-19 experience, the MOHCC continues to lead sharing knowledge around the capacity to manage the project health risks across all project components. These initiatives have already been brought to the ESMF context across all environmental and social capacity training. Generally, MoHCC and the PIE at national, provincial, district and community levels have limited capacity in the application of the ESMF and the relevant environmental and social standards. The PIE has conducted trainings to increase their capacity on the implementation of ESMF for national, provincial and district MOHCC staff under HSDSP AF (V). In addition, the PIE and MOHCC will continue to participate in the planned ESF trainings from World Bank. ESMF Budget The total estimated amount needed to cover all the work to be carried out under the ESMF preparation and implementation for the project activities is US$214,000 for the eighteen months of project implementation. The key indicative aspects that would require a cost budget include training and capacity building for the project PIE; training and capacity building for the project district and local level teams; and Implementation of the stakeholder engagement plan. Conclusions and Recommendations The proposed project has the potential to significantly improve the country’s health delivery system and the emergence preparedness and response to the COVID-19 pandemic and deliver essential health services, particularly RMNCAH. Improved health systems benefit communities, which translates to improved livelihoods as people become productive again and this will ultimately improve the economy. The project is designed to address the COVID-19 threat reducing its risks and impacts through supporting Zimbabwe’s vaccination response as well as improving access and utilization of RMNCAH services. Most of the project’s activities will generate insignificant negative impacts which are localized and manageable. The enhanced health delivery system will result in increase in the generation of infectious waste and associated risks to the occupational health and safety of workers including to COVID-19 itself. These will be mitigated through the implementation of the project’s ICWMP which outlines the management of Page | xix infectious healthcare waste. These envisaged negative environmental and social impacts will be localized, minimal, short term and can be mitigated. The Project will have overall positive environmental and social impacts on community especially women by rehabilitating maternity waiting homes (MWHs), contributing to community/public health safety through treatment and surveillance of disease, and good environmental management practices by increasing efficiency and reducing waste paper through digitization of health system. The final benefits of this project to the nation will outweigh any potential negative effects. Further, the project will overall not have any significant environmental and social impacts if the recommended mitigation measures are carried out. Page | xx 1. Introduction 1.1 Project Background The Government of Zimbabwe (GoZ), through the Ministry of Health and Child Care (MoHCC), has prepared a Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) that will receive World Bank technical and financial support. The GoZ has prepared this Environmental and Social Management Framework (ESMF) to identify and address the environmental and social risks and possible impacts of the project. This ESMF fulfils the environmental and social assessment requirement by the Government of Zimbabwe through the Environmental Management Act (Chapter 20:27) and in line with the World Bank Environmental and Social Framework (ESF) through the Environmental and Social Standards on Environmental risk assessment and management (ESS1). The national legislation requires that environmental and social assessments be conducted on projects listed in Schedule 1 of the Act. GoZ and the WB require that the environmental and social assessments (ESA) (commensurate with project activity risks) be shared with stakeholders and project affected people. No project activity will require an in-depth full Environmental and Social Impact Assessment (ESIA) as understood by the WB. This ESMF covers the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) which include activities under the Energy Sector Management Assistance Program (ESMAP)2 grant and Health Emergency Preparedness Trust (HEPRT) Fund. The project will be co-financed by a US$5 million grant from the Health Emergency Preparedness and Response Trust Fund (HEPRTF)3 and the $1.575 million ESMAP grant. ZCERP is being implemented over 18 months (April 2022 to August 2023), complementing activities being supported under the Zimbabwe Health Sector Development Support Project (HSDSP AF (V)4. This Additional Financing (AF) will enable the Government of Zimbabwe to sustain essential health services during an acute economic challenge. The COVID-19 pandemic left many people in Zimbabwe unable to visit health clinics due to prevention and containment measures, national lock downs and associated fears of contracting the virus. As a result, many missed out on immunization, reproductive and maternal health services. More than 80 percent of health facilities reported a decline in uptake of essential health services prompting the Government of Zimbabwe to take action to ensure that communities could get the services 2 ESMAP is a partnership between the World Bank and 19 partners to help low and middle-income countries reduce poverty and boost growth through sustainable energy solutions. Through the World Bank Group (WBG), ESMAP works to accelerate the energy transition required to achieve Sustainable Development Goal 7 (SDG7) to ensure access to affordable, reliable, sustainable and modern energy for all. It helps to shape WBG strategies and programs to achieve the WBG Climate Change Action Plan targets. 3 The HEPR Umbrella Trust Fund/TF Program supports countries that are not eligible for IDA/IBRD funding such as Zimbabwe to improve their capacities to prepare for, prevent, respond, and mitigate the impact of epidemics on populations. It was set up as a flexible mechanism to provide catalytic, upfront, and rapid financing at times that other sources of funding are not available for health emergency preparedness and to fill specific gaps in terms of health emergency responses. The Partnership Council endorsed an allocation of $5m to Zimbabwe to support COVID-19 response. The funding was intended to support all aspects of Zimbabwe’s COVID-19 response, including COVID-19 vaccine deployment. 4 HSDSP AF-(V) is a continuation and enhancement of the ongoing Health Sector Development Support Project HSDSP; P173132), which is a US$53 million grant-funded project which has been supporting the GOZ to increase coverage and quality of maternal and child health (MCH) services using an RBF approach for the since 2011 and has had four additional funding since its approval in September 2011. Page | 1 they need while maintaining the safety of both patients and health workers. This AF will complement ongoing efforts by the GoZ, the private sector, and development partners. This Project will be national in scope, comprising various activities5 with different levels of environmental and social impacts and located at various locations throughout the country. The project activities have a bearing on physical and social environments, necessitating the preparation of environmental and social safeguards instruments that will be used to mitigate such impacts. The safeguards instruments for this project include: (i) This Environmental and Social Management Framework (ESMF) which includes an Infection Control and Waste Management Plan (ICWMP), an Indigenous Peoples Planning Framework (IPPF – Appendix 1), and Labour Management Procedures (LMP – Appendix 2) (ii) Grievance Redress Mechanism (GRM) and (iii) Stakeholder Engagement Plan (SEP) (iv) GBV Action Plan – Appendix 12. Although the Project does not anticipate any physical cultural resources, this ESMF contains an Archaeological Chance Finds Procedure in case such resources are unexpectedly encountered during project activities. This ESMF is to be used by Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) to ensure that all environmental and social risks and impacts are adequately addressed and that the relevant capacity building and training needs are established for the recommended measures to be implemented effectively. 1.2 ESMF Objectives The ESMF objectives are: • To establish clear procedures and methodologies for the environmental and social assessment, review, approval, and implementation of investments to be financed under Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160), • To specify appropriate roles and responsibilities, and outline the necessary reporting procedures, for managing and monitoring environmental and social concerns related to project investments, • To determine the training, capacity building and technical assistance needed to successfully implement the provisions of the ESMF, • To establish the project funding required to implement the ESMF requirements, 5 These are the individual activities within the ZCERP such as the installation of solar energy generation equipment in a facility. project activity Page | 2 • To provide practical resources for implementing the ESMF, including general guidance on development of ESMPs and their implementation. 1.3 Significance of the ESMF This ESMF was prepared because the location, design, and magnitude of the impacts of the eventual project activities is not yet known at project appraisal stage, even though the types of potential project activities are outlined. It provides a guide for the integration of environmental and social considerations into the planning and implementation of the ZCEREHSP, together with its expanded Emergency COVID-19 Response mandate and supporting the implementation of high-impact essential services to improve health outcomes for women, children, and adolescents with a focus on improving health service quality and addressing inequity that Zimbabwe is proposing. It further provides a basis for environmental and social assessments of all activities to be carried out under this proposed additional financing. This ESMF focuses on the nature and extent of significant adverse environmental and social impacts that may result from any of the ZCEREHSP activities including the COVID-19 emergency response and serves as a framework for screening environmental and social issues for all the possible activities that will be undertaken. It establishes a unified process for addressing all environmental and social safeguards issues of project activities from preparation, through review and approval, to implementation. This ESMF also describes a process that will ensure that the substantive concerns of the relevant World Bank Safeguard Policies and Zimbabwe law are addressed during the implementation of the selected response activities. 1.4 ESMF Methodology This ESMF builds on the ZCERP ESMF and provides principles and specific process and technical guidance to the Project implementing agencies and their stakeholders to assess the E&S risks and impacts of the Project activities. These include ensuring that individuals or groups who, because of their circumstances, may be disadvantaged or vulnerable, have access to the development benefits resulting from the Project. This ESMF will be applied to all activities (e.g., works, good/services, technical assistance, and research activities) to be financed by the AF and Parent Project and/or its subprojects. The primary source for describing institutional, policy and legal frameworks was existing legal instruments (Acts and Regulations) complemented by existing literature both physical and electronic. Information on the status and performance of Zimbabwe HCF was obtained from the consultant site visits and other reports contained in the HSDSP ICWMP on which the Zimbabwe COVID-19 Response and Essential Health Services Additional Financing (P180160) ICWMP is based, reports from Vital Medicines Availability and Health Services Survey, stakeholder consultations conducted for HSDSP, National Infection Prevention and Control Guidelines (2019) and the Country profile: Health care waste management in the context of COVID- 19 by UNDP among others. Secondary sources of information were obtained through a review of available documents, as well as consultations held with key stakeholders across the Country. From the literature, all possible envisaged environmental and social impacts were listed and evaluated based on policy and legal requirements. The data on geology and soils, climate, water resources, biodiversity, human and ecosystems were obtained from existing literature, especially from developing partners like the UNDP, World Bank, etc. The following table 1-1 shows some of the sources of information: Page | 3 Table 1-1 Sources of Information No. REFERENCES 1.0 UNDP, 2017; Zimbabwe Human Development Report, Climate Change and Human Development: Towards Building a Climate Resilient Nation, 2017, UNDP, Harare, Zimbabwe Issues covered: UNDP has looked into issues which affect pandemic responses and related activities in their book Zimbabwe Human Development Report, Climate Change and Human Development: Towards Building A Climate Resilient Nation (2017), health issue come into play. 2.0 WB 2009; Good Practice Note: Asbestos: Occupational and Community Health Issues, World Bank Group, Washington, May 2009 Issues covered: The World Bank Group Environmental Health and Safety General Guidelines (2007). 3.0 Ncube, G and G.M. Gomez, Remittances in rural Zimbabwe: From Consumption to Investment, in: International Journal of Development and Sustainability, Volume 4.2, p.181-195Trading Economics, Zimbabwe unemployment rate, accessed at: https://tradingeconomics.com/zimbabwe/unemployment-rate Issues covered: Ncube et al in remittances in rural Zimbabwe aptly states and shows how unemployment has a bearing on health issues and other downstream activities. 4.0 GoZ, 2016; Zimbabwe National Statistics Agency, Government of Zimbabwe. Zimbabwe Demographic and Health Survey, November 2016, accessed at: https://dhsprogram.com/pubs/pdf/FR322/FR322.pdf Issues covered: The Government of Zimbabwe journal, Zimbabwe national statistics agency (November 2016) demography and health issues are contrasted, and a direct relationship was shown to occur. 5.0 Maplecroft, 2018; Climate Change Vulnerability Index 2018, accessed at https://www.maplecroft.com/solutions/environment-climate-change/ Issues covered: Maplecroft in his analysis, of Climate Change Vulnerability Index (2018), looks at the way climate change has affected food security, health, and life expectancy of the general population. He emphasises the need to relate to the continuous change occurring in climate and adapt to it to maintain the health of the population on an acceptable index. 6.0 WB, 2018; Zimbabwe, Human Development Indices and Indicators, World Bank, 2018 Statistical Update, accessed at: http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/ZWE.pdf. Issues covered: Page | 4 No. REFERENCES Finally, the World Bank, Zimbabwe Human Development Indices, and Indicators Statistics (2018) show how development is related to the population and indicators of development are shown in this narrative. 1.5 Project Description: The Zimbabwe COVID-19 Response and Essential Health Services Additional Financing Project (P180160) The Zimbabwe Covid-19 Response and Essential Health Services Additional Financing (P180160) is funded by the Health Emergency Preparedness and Response Trust Fund (HEPRTF) and the Energy Sector Management Assistance programme (ESMAP), and the Global Financing Facility (GFF) through the World Bank. The Project Development Objective (PDO) of the parent ZCER project is to support the Government of Zimbabwe to deploy and manage COVID-19 vaccines and strengthen related health system capacity. support the Government of Zimbabwe to deploy and manage COVID-19 vaccines and strengthen related health system capacity Zimbabwe Covid-19 Emergency Response and Essential Health Services activities will be implemented by the Catholic Organisation for Relief and Development Aid (Cordaid). The parent ZCERP Project is currently filling critical gaps in technical areas that are noted in the country’s prepared and response plan. These include: • Risk Communication and Community Engagement interventions. • National laboratories. • Infection prevention and control. • Vaccine deployment, and • Response coordination, monitoring and evaluation. These were identified to immediately strengthen the local capacity to respond and address the current COVID-19 potential challenges in timely manner, while working within the country’s existing systems and providing technical assistance as needed for local entities. Emphasis will be placed on strengthening capacities at all levels. The new revised Project Development Objective (PDO) for the ZCEREHSP AF is “to support the Government of Zimbabwe to deploy and manage COVID-19 vaccines and strengthen related health system capacity for pandemic preparedness and deliver essential health services, particularly RMNCAH.� The ZCEREHSP AF will support prioritized but unfunded interventions in the National Health Strategy and Health Sector Investment Case 2021-2025 that contribute toward ensuring access to essential services. These proposed additional activities will be included under a new ZCEREHSP AF component. The additional activities will be incorporated through a new component of the parent project as described below: Components 1 and 2 remain unchanged. A new component for the activities financed by the proposed AF is added as Component 3, and Component 3 under the parent project is changed to Component 4. Component 1. Vaccine Deployment and Related Risk Communication and Community Engagement (HEPRTF: US$3.52 million). This component will support deployment of vaccines that meet World Bank Vaccine Approval Criteria (WB VAC). At present, Zimbabwe is using five vaccines that meet WB VAC: Sinopharm, Sinovac, Sputnik Page | 5 V, Covaxin, and Johnson and Johnson. The country expects to avail this year of World Health Organisation Emergency Use Listing (WHO EUL) vaccines from the African Union and COVAX Facility. Sub-component 1.1 Vaccine Deployment. This sub-component will contribute toward strengthening the public health system’s capacity to deploy vaccines through capacity building, eligible allowances, goods, and equipment. It will also monitor whether deployment is proceeding according to the National Deployment and Vaccination Plan (NDVP) and strengthen vaccine related waste management transportation systems. Activities to be funded include: • Outreach and vaccine distribution including fuel, repair, and maintenance service of vehicles used for vaccine distribution. • Supervision and monitoring of vaccine deployment including ensuring implementation of the NDVP. Special attention will be given to women, people with disabilities, and others among targeted groups who may face barriers to access information and services. • TA to the MOHCC to revise, update, and implement the safety monitoring plan to enable swift detection of any AEFI. • Procurement of PPE for public COVID-19 vaccination centres and capacity building for rational use of PPE, including the development of guidance tools and training through physical and virtual methods. • Supportive supervision and visits through strategic use of Information, Communication, and Technology (ICT). • Procurement of electronic data capturing tools for health facilities • Vaccine efficacy monitoring / checks. • Set up and implementation of Impilo COVID-19 Vaccination Authentication. This is an Electronic Health Record mobile application solution that will enable a QR code to be assigned to every COVID-19 vaccination certificate.6 This application captures personal information including patient health status, contract address while also keeping information secure. • Vaccine waste management training and logistics such as transport of wastes related to vaccine deployment for off-site incineration, and M&E. Sub-component 1.2. Risk Communication and Community Engagement. This sub-component will also finance TA, eligible allowances, equipment and supplies to support risk communication and engagement at the community level to complement NDVP implementation: • Community feedback mechanisms at local level such as the use of registers or rumour logbooks and suggestion boxes, Grievance Redress Mechanisms (GRMs), seconding Health Promotion Officers (HPOs) to EOCs, as well as ensuring community feedback is transmitted to high level meetings. • Psychosocial support systems for both healthcare workers and general population by building capacity of community health workers, and national psychosocial centre. • Community discussion forums with local and traditional leaders and school heads to share information about gender-based violence (GBV), sexual exploitation, abuse and harassment (SEA- H) and GRM. Priority will be given to the Tshwa and Doma districts which tend to be the most vulnerable and often forgotten areas. Page | 6 • Public-address vehicles.7 Component 2. Climate Friendly Related Health System Strengthening (ESMAP: US$1.575 million). This component will support complementary strategic activities to facilitate the implementation of the COVID- 19 NDVP, focusing on climate friendly health system strengthening activities that support vaccine deployment. It will finance capacity building, goods, purchase and use of climate-friendly cold chain equipment including cold boxes and 250 solar direct drive refrigerators; installation of refrigerators on 8 trucks; and installation and maintenance of solar energy in 29 health facilities. Component 3: Sustaining Essential Health Services (Original: US$0; AF: US$ 12.9 million, GFF TF). This is a new component that will support the continuity of EHS. The proposed activities to be financed under this component are: Subcomponent 3.1: Integrated Outreach Service Delivery (Original: US$0; AF:US$3.67 million, GFF TF). This subcomponent will support the provision of a comprehensive package of essential health services including immunization, antenatal and postnatal care to communities without access to health facilities. This sub- component will finance the procurement of: (i) 76 solar-powered tricycles to be used by health facilities for outreach services, within a 20km radius. There are 1950 registered health facilities, and prioritization of distribution of the 76 tricycles will be based on need. There is complementary support from other projects that are procuring 544 tricycles. To cover the remaining gap of 1218 tricycles, the project will work together with other development partners and the GoZ, to lobby for the necessary support. (ii) 8 well equipped outreach vans to provide a range of services, including those requiring privacy to cover 8 rural provinces while targeting poorly performing and prioritized districts, beyond the hard-to-reach areas. The equipment for each of the outreach vans includes an Ultrasound Scan, Laboratory, Solar Powered Refrigerators for medicines and vaccines, exam couches, tents, and screens to be used during the outreach. (iii) Procurement of eight by 18-seater rough terrain minibuses that will be used to carry the integrated outreach teams. This subcomponent will also support (iv) operational costs for the integrated outreach teams and (v) costs related to the RMNCAH mentorship program which involves specialists from central and provincial hospitals mentoring district level doctors. Subcomponent 3.2: Strengthening Community Health Services including Disease Surveillance (Original US$0; AF: US$1.07 million, GFF TF). This sub-component will finance: (VHWs); (i) Upskilling/refresher trainings and support for 5,450 VHWs on the new/expanded community health package of services; including how to handle climate-related shocks, integrating gender responsive service delivery and adolescent sexual and reproductive health education. Other funding streams will support upskilling of an additional 5000 VHWs, leaving a gap of approximately 11500. The project will support upskilling of VHWs, rather than train new cadres, as stipends for the additional VHWs are not assured and (ii) procurement of motorcycles for environmental health technicians to conduct community surveillance activities. Subcomponent 3.3: Commodity Security (Original US$0; AF:US$6.7 million, GFF TF). Maternal and Perinatal Death Surveillance and Response (MPDSR) reports show that most maternal and perinatal deaths in Zimbabwe are avoidable and are due to the 3rd delay i.e., delay in getting appropriate care at the health facility including Page | 7 inadequate biomedical equipment and commodities at health facilities. One of the focus areas of the Ministry of Health and Child Care is ensuring that health facilities are suitably equipped to provide safe deliveries in a bid to save the lives of women and babies. This subcomponent will fund (i) equipment for both basic and comprehensive emergency obstetric and new-born care to ensure that the supported facilities are able to offer both safe normal deliveries and Caesarean Section deliveries safely. Minor theatre renovation will be made to ensure adequate preservation and security of installed equipment and improved theatre outlook. Medical Oxygen reticulation will be included to suit some of the targeted facilities. Twenty-five (25) health facilities have been selected for this support to complement other MoHCC initiatives. The project will also support (ii) the procurement of family planning commodities to complement the major contribution from MoHCC in line with the Family Planning Investment Compact. Subcomponent 3.4: Revitalization of Maternity Waiting Homes (MWHs) (Original US$0; AF:US$0.5 million, GFF TF). This sub-component will support the revitalization and improvement of quality of services provided in the MWHs to increase the utilization of the MHWs to promote institutional deliveries by bringing pregnant women closer to health facilities. An assessment conducted in Zimbabwe in 2017 showed high utilization of the MWHs, which was also linked to high institutional deliveries. The study, however, identified quality of care for mothers admitted as a major gap. In line with the proffered recommendations, the Ministry developed guidelines setting the standards of operations and care provided in MWHs. Support from the project will therefore include (i) refurbishment and minor renovations of existing MWHs based on the guidelines including establishment of nutrition gardens. (ii) training of service providers at MWHs in emergency obstetric and neonatal care (EmONC) and sensitization on the MWHs guidelines. For a more comprehensive approach, this component will also support orientation of Health Care workers on the Maternity Waiting Homes guidelines which developed in 2020. Subcomponent 3.5: Health System Digitalization and Related Innovations (Original US$0; AF:US$0.96 million, GFF TF): This sub-component of the project aims to improve the efficiency and effectiveness of the health system in Zimbabwe through the use of digital technologies and innovations. To complement the integrated outreach model, the AF will finance the following activities: • Support decentralization of the Electronic Health Record (EHR) System implementation: This activity will involve supporting the decentralization of the EHR implementation to the 25 supported district hospitals. Some complementary activities will include: o Development of an e-learning platform on training on the use of EHR would be a strategic investment to scale up capacity building for EHR use in a sustainable way: This sub-activity will involve the development of an e-learning platform to train health care workers on the use of the EHR system. The platform will provide training on how to use the EHR system effectively and efficiently. o Develop SOPs and guidelines on EHR: This sub-activity will involve the development of Standard Operating Procedures (SOPs) and guidelines on the use of the EHR system. The SOPs and guidelines will provide a framework for the use of the EHR system and ensure that health care workers are using the system in a standardized manner. o Installation of EHR in the 25 supported district hospitals: This sub-activity will involve the installation of the EHR system in the 25 supported district hospitals. The installation will be done using the equipment that has already been procured by the Government of Zimbabwe with support from partners. o Capacitating health care workers in the 25 supported district hospitals on EHR: This sub- activity will involve the training of health care workers in the 25 supported district hospitals on the use of the EHR system. The training will be provided to ensure that health care workers are able to use the system effectively and efficiently. • Development of the Costing and Electronic Maternal and Perinatal Death Notification System (eMPDNS) modules in the EHR. This costing module will allow for billing of services while eMPDNS Page | 8 module will enable health care workers to report on timely notification of maternal and perinatal deaths. • Capacity building on blockchain technology within MOHCC, particularly of the internal technical team that works on health informatics, data analytics and M&E, including the EHR Team. This phase’s outcome will then guide the MOHCC and WB on the way forward regarding piloting and implementation of blockchain technology in the health sector. • Development and piloting of a Digitized Community Transport Dispatch System for emergency services. This innovation that is proposed to work as an “Uber� type of model to link women and children needing emergency services in the community with the nearest transport provider to transport them to the nearest health facility. Activities will entail undertaking a feasibility analysis, developing the system, enrolment of providers, and piloting in select sites. • Strengthening the MOHCC monitoring and evaluation system including implementation of an Artificial Intelligence driven Early Warning System on Health System Disruptions. The project will support operationalization of the health situation room system as a priority for data visualization from MoHCC Top management utilizing already existing infrastructure in MoHCC Top Management Offices and cover the gap where necessary. Leveraging an existing Early Warning System prototype developed in a previous collaboration between the Ministry and the World Bank, this activity will focus on implementation through use cases such as the Weekly Routine Monitoring System. Activities will include sensitization of health managers and training of a core technical team within MOHCC and at sub-national level, conducting integrated monitoring and supportive visit to supported districts and reviewing, printing and distribution of M&E tools including VHW registers and referral slips. The project will also support development of private sector reporting framework. Overall, this sub-component will enhance the capacity of the health system in Zimbabwe to utilize digital technologies and innovations, leading to improved health outcomes for the population. Component 4: Overall Response Coordination and Project Management, Monitoring & Evaluation (Original US$1.48 million, HEPR TF; AF: US$2.1 million, GFF TF). The implementation of activities under the parent project will continue as detailed in the Financing Agreement. Funding for the component is increased to support the new Component 3 activities and increase in overall costs of operation of PIE. 1.6 Environmental and Social Risk Management Approach The project will have overall positive environmental and social impacts as it will contribute to epidemic/ pandemic preparedness, monitoring, surveillance, and response specifically with regards to combating the transmission of COVID-19 and vaccine deployment and strengthening essential health services provision. However, there are substantial environmental and social risks that will need to be to be assessed and managed through a risk-based approach during the project implementation. The overall residual risk to achieving the PDO was and continues to be Substantial. Residual macroeconomic and fiduciary risks remain high. The key risks that may negatively impact AF project implementation are as follows: political and governance, macroeconomic, institutional capacity for implementation and sustainability, and environmental and social. Different safeguards instruments will be developed to guide the identification and management of project related risks and impacts. The SEP has been prepared and disclosed to guide the stakeholder engagement process. Since the ZCERP was an emergency project the development of the ESMF together with the ICWMP was required 45 days after the project effectiveness. The LMP, IPPF and a generic ESMP have been prepared as part of parent ZCERPESMF. Page | 9 Specific interventions will be identified during project implementation. This updated ZCEREHS AF ESMF provides guidelines for screening all project activities, determination of requirements for assessment, and preparation of any further documentation in accordance with the World Bank ESF including environmental and social safeguard instruments such as ESMPs. The parent ZCERP safeguards approach also emphasized the optimization of land-use to avoid/minimize adverse impacts such as resettlement footprints, deforestation, landslides/soil erosion and obstruction of communities from their resources. 1.7 Risk Classification The World Bank environmental and social risk classification of ZCEREHS remains Substantial because of the activities related to the renovations and refurbishment of maternity of waiting homes and the construction related risks, poor labour and working conditions, risks related to sexual exploitation, harassment and abuse, traffic incidents due to operation of tricycles supporting community health services, vans and motorcycles for health center monitoring, exposure to hazardous, medical and e-wastes emanating from immunization, and health care operations and digitization and solar powered equipment. Effective administrative, infection-controls, engineering controls and environmental safety controls must be put in place to minimize these serious risks. The parent ZCERP ICWMP outlines these measures to provide infection control and waste management in the project. 1.8 Exclusion Criteria/ Negative list The list below identifies activities which will not be eligible for financing under ZCEREHSP AF. • Acquisition of land and physical or economic displacement of people. • Block the access to or use of land, water points and other livelihood resources used by others. • Encroach onto fragile ecosystems, marginal lands or important natural habitats (e.g., ecologically sensitive ecosystems; protected areas; natural habitat areas, forests and forest reserves, wetlands, national parks or game reserve; any other environmentally sensitive areas)8. • Impact on physical or intangible cultural resources of national or international importance and conservation value.9 8 Fragile ecosystems include such places as wetlands, which quickly degrade if not properly used. Marginal lands include lands that has little or no agricultural or industrial value, often has poor soil or other undesirable characteristics and often located at the edge of desolate areas and can very easily be degraded if abused. So, these are ecologically sensitive areas which must be protected from any development that may adversely affect them. 9 A physical cultural resource (PCR) is a movable or immovable object or site of historical, architectural religious, or other cultural significance. Development should not impact on these important resources. Page | 10 • Have risks assessed as requiring biosafety levels BSL-310 and BSL-411 containment12. • Activities that may cause long-term, permanent and/or irreversible (e.g., loss of natural habitat) adverse impacts such as dam construction and other greenfield construction among others. • Activities that have high probability of causing serious adverse effects to human health and/or the environment not related to treatment of COVID-19 cases. • Activities that may have adverse social impacts and may give rise to significant social conflict. • Activities that may affect lands or rights of indigenous people or other vulnerable minorities. 10 Biosafety level-3 (BSL-3) laboratory is designed and provided for work with microbes that can either be indigenous and exotic and can cause serious or potentially lethal disease through respiratory transmission for example Yersinia pestis, Mycobacterium tuberculosis, SARS, rabies virus, west nile, hanta virus. 11 A biosafety level-4 (BSL-4) laboratory is designed for analysis of dangerous and exotic microbes posing high risk of aerosol transmission. Infections caused by these microbes are frequently fatal and without treatment or vaccines such as Ebola and small pox virus. 12 Biosafety level (BSL), or pathogen/protection level, is a classification system for the biocontainment precautions required to isolate dangerous biological agents in an enclosed laboratory facility. The levels of containment range from the lowest biosafety level 1 (BSL-1) to the highest at level 4 (BSL-4). At the lowest level of biosafety, precautions may consist of regular hand- washing and minimal protective equipment. At higher biosafety levels, precautions may include airflow systems, multiple containment rooms, sealed containers, positive pressure personnel suits, established protocols for all procedures, extensive personnel training, and high levels of security to control access to the facility. Page | 11 2. Policy, Legal and Regulatory Framework 2.1 Introduction In this chapter, relevant Zimbabwe regulations and policies are assessed that guide the environmental and social assessment for the Zimbabwe Covid-19 Emergency Response and Essential Health Services AF activities, as well as relevant World Bank Environmental and Social Standards and international conventions. The objective is to ensure that project activities and implementation processes are consistent with local laws and policies and World Bank ESF. Also, to point out possible gaps in local legislation in view of full compliance with World Bank standards. The proposed Zimbabwe Covid-19 Emergency Response and Essential Health Services AF project will be subject to a number of these pieces of legislation. The following list highlight some selected policies and laws which are applicable in the planning and implementation of the COVID-19 response project, and they include: • Constitution of Zimbabwe of 2013 • Public Health Act (CAP15:17) • Mental Health Act (CAP 15:12) • Labour Act (cap28:01) • Water Act 20:24 • Environmental Management Act (CAP 20:27) • Impact Assessment Policy 1997 • Environmental Management (Effluent and Solid Waste Disposal) Regulation SI 6 of 2007 • Environmental Management (Hazardous Substances Pesticides and Other Toxic Substances) Regulation (SI 218 of 2018) • Environmental Management (Atmospheric Pollution Control) S1 72 of 2009 • Environmental Management (Environmental Impact Assessment and Ecosystems Protection) SI 7 of 2007 • Hazardous Waste Regulation (SI 10 of 2007) • Local Government Act of 1997. 2.2 The Constitution of Zimbabwe Stipulates that Zimbabwe will adopt policies designed to protect and enhance the natural and cultural environment of Zimbabwe for the benefit of both present and future generations and shall endeavour to ensure all citizens a sound and safe environment adequate for their health and well-being. Section 73. Environmental rights The Constitution outlines the Environmental rights and stipulates that everyone has the right to: a) an environment that is not harmful to their health or well-being and b) have the environment protected for the benefit of present and future generations, through reasonable legislative and other measures that: i. prevent pollution and ecological degradation, ii. promote conservation and, iii. secure ecologically sustainable development and use of natural resources while promoting justifiable economic and social development. It further states that the State must take reasonable legislative and other measures, within the limits of Page | 12 the resources available to it, to achieve the progressive realization of the rights set out in this section. Section 76. Right to health care The Constitution of Zimbabwe also articulated health as one of the principles of Equality and Justice in the Constitution of The Republic of Zimbabwe. Health, according to the Constitution is important and the Zimbabwean government shall adopt policies aimed at ensuring the highest attainable standard of physical and mental health for its citizens, including policies designed to: 1. Every citizen and permanent resident of Zimbabwe has the right to have access to basic health- care services, including reproductive health-care services. 2. Every person living with a chronic illness has the right to have access to basic healthcare services for the illness. 3. No person may be refused emergency medical treatment in any health-care institution. 4. The State must take reasonable legislative and other measures, within the limits of the resources available to it, to achieve the progressive realisation of the rights set out in this section. The Zimbabwean Government further committed itself to give equitable access to standard quality health service to all its citizens without discrimination on religious, political, colour, income levels, disabilities, geographical location, and wealth. The Government has set a good baseline for the implementation of good health care delivery for all. The activities of the project will ultimately feed into the National Development Strategy 1 (2021-2025) and the 2030 National Vision. Since ZCERP activities may have a potential to disrupt the wellbeing of the environment and thus affect the people’s health, its implementation must adopt approaches that will conform to the requirement of the Constitution. 2.3 Overview of Relevant Zimbabwe Polices and Plans Over the years, the Government of Zimbabwe pursued national policies that had a major bearing on social protection outcomes. These policies sought to ensure that the poor and vulnerable are protected through a network of social transfer programmes. They ranged from policies on labour market participation; price controls; user fee exemptions for accessing basic social services; coordination of humanitarian assistance and regulating the work of non-governmental organizations (NGOs), among others. They also included policies that target specific vulnerable groups that included the Gender Policy; Orphan Care Policy; HIV/AIDS Policy Framework; National Action Plan for Orphans and other Vulnerable Children; agricultural inputs support; and others. Policies relevant to this project are listed in Table 3-1. Page | 13 2.3.1 Relevant Policies The table below outlines different policies in Zimbabwe that are relevant to the project. The table outlines the relevant policy and its interpretation in project context and finally describes it relevance to the project. Table 2-1 Relevant Policies RELEVANT RELEVANCE TO No. INTERPRETATION POLICIES ZCEREHSP 1. National Zimbabwe's National Environmental Policy is linked to its overall development policy and plans. Although this The policy goes a long way Environmental development model has been considered relatively successful, much of the country's natural resource base is in aiding health issues. Policy, 1998 being threatened by human activities. The environment In many respects, Zimbabwe is one of the leading countries in Africa in terms of work on the environment. determines the health This for example is reflected in the economically important wildlife sector. Although some species are issues i.e., air water and endangered due to habitat destruction, the country's rich wildlife resources have been professionally dust play a major role to managed. Several innovations, which have promoted sustainable utilisation of wildlife, could serve as a model name but a few. for other countries. Environmentally sensitive areas have been designed and gazetted as national parks and forest reserves. There is no lack of environmental legislation per se, but existing regulations are fragmented and difficult to enforce. This is also reflected in the large number of ministries responsible for enforcing environmental legislation. The National Response Conference to the Rio Earth Summit convened in Harare in late 1992 presented an elaborate set of future priorities. Building upon the National Conservation Strategy of 1987, the government is planning to develop a comprehensive Action Plan for the Environment. 2. Water policy Water use in Zimbabwe is governed by the Water Act of 1998. The Act is one of the key outcomes of the water Water is inextricably sector reforms which took place in the mid-90s. However, traditional systems also exist whereby traditional related to health of the leaders hold power to declare water protection areas especially where quality is an issue. population and to harness the health of the Page | 14 RELEVANT RELEVANCE TO No. INTERPRETATION POLICIES ZCEREHSP This policy designates Urban Local Authorities (ULAs or Urban Councils) and Rural District Councils (RDCs) as population, responsible Water Services Authorities who have a duty to ensure efficient, affordable, and sustainable access to water use of water must be services are provided for all their current and potential consumers done. This policy is The responsibility at operational level of providing water supply and sanitation services may be delegated by pertinent and relevant to a ULA or RDC to a designated Water Services Provider which is a legal entity capable of carrying out water ZCEREHSP supply and sanitation services on behalf of the ULA or RDC. Service Authorities will have the p ower and authority (through a revision of the Urban Councils Act and the Rural District Councils Act), to enter into contractual agreements with Service Providers if they do not supply the services themselves. Service Providers will be legal entities (public, private, or mixed) that have the capacity to provide water supply and sanitation services to Service Authorities The Constitution further provides, in Section 77 that every person has a right to safe, clean, and potable water, and sufficient food (Food Security, Quality and Safety). These human rights are related to peoples’ health as it not possible to divorce the living conditions of people from their health risks and status. This great national health strategy is indeed subordinate to these constitutional provisions and the State has the responsibility to create a conducive environment in which it is possible for all people in Zimbabwe to access basic health services whenever they need them. 3. Zimbabwe The policy aims to create an open defecation free Zimbabwe by 2030 in line with the Sustainable Development Particularly useful with National Goals. To achieve this, the demand-led Sanitation Focused Participatory Health and Hygiene Education regards to ZCEREHSP Sanitation and (SafPHHE) has been adopted and is being implemented in the 45 UNICEF-supported rural districts in the sanitation is the central Hygiene Policy country. item in health-related (Draft) issues and consequently if The Government, of Zimbabwe with support from UNICEF and other partners, has approved a new gender- executed correctly a sensitive Sanitation and Hygiene Policy. The policy aims to create an open defecation free Zimbabwe by 2030 healthy population in line with the Sustainable Development Goals in place. ensues. To achieve this, the demand-led Sanitation Focused Participatory Health and Hygiene Education (SafPHHE) has been adopted. Page | 15 RELEVANT RELEVANCE TO No. INTERPRETATION POLICIES ZCEREHSP 4. Environmental Environmental health is a fundamental public health approach that affects the whole population and provides Relevant to ZCEREHSP the Health Public a foundation for modern living. Neglect of this service has resulted in an increase in diseases associated with public must be protected Policy (Draft) environmental factors such as TB. at all costs and this policy The policy creates the legal framework for the protection of public health in Zimbabwe for this purpose makes it imperative to provides for powers of the administration to regulate and control slaughter of animals, food production and take care of the public handling, food and water supply, animal diseases and other related issues. environs 5. Food Security The Government of Zimbabwe is fully committed to strengthening national capacity in food and nutrition Without food security the and Nutrition security through primarily reinforcement and supporting local communities’ capacity for food and nutrition health of the population Policy security. is compromised. The The country is geared on ensuring that food security occurs because as a country the Policy in place will go a policy is relevant to long way in food production. A healthy population is thus assured. ZCEREHSP. 6. National The Zimbabwe Infection Control and Prevention (ZIPCOP) project will work to support the Ministry of Health Health and the citizens go Infection and Child Care (MOHCC) in improving infection control practices in health care facilities nationwide to prevent hand in glove; hence this Prevention the transmission of infectious diseases, including TB, among patients and staff. is relevant to ZCEREHSP. and Control The policy largely focuses on: Policy • Development and implementation of infection control plans. • Curriculum development, training, and development of IEC materials • Provide and adapt Infection Control tools that MSH has used internationally. • Capacity building to improve leadership, governance, and management structures. • Development of the National IPC policy, strategic plan, guidelines, and protocols Page | 16 2.3.2 Relevant Operational Manuals, Procedures and Guidelines The GoZ has a number of operational manuals, procedures and guidelines to facilitate the implementation of COVID-19 response activities and support to the health care delivery system. Table below outlines the relevant operational manuals, procedures and guidelines which and their relevance to the project. Table 2-2 Relevant Operational Manuals, Procedures and Guidelines No. RELEVANT OPERATIONAL INTERPRETATION RELEVANCE TO MANUALS, PROCEDURES ZCEREHSP AND GUIDELINES Environmental Health Standard Operating Procedures (SOPs) should be implemented to 1. Environmental Health ensure safe working procedures for staff have been identified and assessed. According to ZCEREHSP if Standard Operating Standard Operating Procedures (SOPs) are a required supplement to the Laboratory and the procedures of the Procedures Research Safety Plan to reduce the risks involved in working with hazardous materials or environmental health performing other potentially hazardous operations in the laboratory. In all working standard operating environments, these standards must be maintained and adhered to. These include SOP on procedures are adhered to Environmental Cleaning, SOP Waste Management, SOP on Admission of an Infectious Patient, then the health of the SOP on Disinfection and Environmental Cleaning, Laboratory Health and Safety Manual. population can be The guidelines go a long way in ensuring that environmental health standards are adhered safeguarded. Many SOPs to. to be observed are referenced or included in the ZCEREHSPICWMP which is part of this ESMF. The Blair toilet has been used in both rural and semi-rural Zimbabwe to ensure that waste is 2. BVIP Manual correctly managed and does not end up in the rivers, dams, and weirs. The “Blair� is popular Relevant to ZCEREHSP. Health population because Page | 17 No. RELEVANT OPERATIONAL INTERPRETATION RELEVANCE TO MANUALS, PROCEDURES ZCEREHSP AND GUIDELINES because it doubles as a washroom and the square spiral structure has become the most a hygienic Blair system popular amenity in rural areas. results in a super spreader The Blair toilet is easy to construct and a manual to assist in the process is available. This system of diseases. means that the initial cost is extremely low, but a range of moveable upgradeable structures can be built on top of the pit. Various methods of recycling the organic and constructional components of this unit are also possible. Various manuals related to this model and the construction of the standard BVIP are also available. 3. National Health Strategy The vision of the Zimbabwe Ministry of Health and Child Care is to have the highest possible The Strategy is relevant to level of health quality of life for all its citizens. To achieve this Government has placed several ZCEREHSP because it plans acts and SI s in place. This SI goes a long way in ensuring that the strategy succeeds. for eventualities and is The National Health Strategy (2021-2025) is the product of a long and complex process of proactive and avoids being intensive consultations, teamwork on specific assignments, detailed studies and information reactionary. gathering. The National Health Strategy 2021-2025 derives from the national vision and provides a framework for attaining health and health related goals and objectives. It assumes the spirit of the Zim-Asset that seeks to attain “quick wins� and is structured around the Results Based Management system that focuses on a clear vision, mission, values, key results areas, goals, and objectives. Unlike past strategies, the NHS 2016-20 is complemented by a detailed monitoring and evaluation framework that will be used to assess progress through mid-term and end term evaluations The Constitution further provides, in Section 77 that every person has a right to safe, clean, and potable water, and sufficient food (Food Security, Quality and Safety). These rights are Page | 18 No. RELEVANT OPERATIONAL INTERPRETATION RELEVANCE TO MANUALS, PROCEDURES ZCEREHSP AND GUIDELINES related to peoples’ health as it is not possible to divorce the living conditions of people from their health risks and status. Zimbabwe's National Action Committee on Water, Sanitation and Hygiene has developed a 4. National Sanitation sanitation and hygiene strategy. The Institute of Water and Sanitation Development (IWSD) Ensures and that health Hygiene Strategy says "the strategy puts in place key measures for sustained sanitation and hygiene service delivery occurs even in delivery in Zimbabwe to eliminate open defecation and other related ills. remote areas. Strategy In the year 2010, the Zimbabwe National Action Committee created its Water Sanitation and creates a nation that is Hygiene (WASH) Sector. WASH has helped to combine Zimbabwe’s urban and rural health conscious sanitization efforts to gain a more organized action plan on how to improve sanitation, restore leadership throughout urban and rural areas, institutionalize Government responsibilities and support sector development. 5. Approved Health Care Waste The Government of ZIMBABWE has put in place a mechanism to ensure that Health Care This plan is relevant to Management Plan for Waste (HCW) is taken care of within the institution so as not to endanger the public with ensure that citizens Zimbabwe (2011) contaminated waste. In place in hospitals are incinerators, bottle pits, autoclaves, and other benefit from Government safe waste disposal systems programs and waste is A temporary holding place should be in place in all hospitals. Colour coded lined bins should dealt with according to be at every waste collection point and the temporary waste holding place should be fenced, recommended methods. locked, and guarded. This plan was the The country is in the process of updating this plan. Environmental Assessment for ZCEREHS’s parent project, the Health Sector Development Support Project (HSDSP) Page | 19 No. RELEVANT OPERATIONAL INTERPRETATION RELEVANCE TO MANUALS, PROCEDURES ZCEREHSP AND GUIDELINES up until the fifth Additional Financing. 6. Draft Water Quality Zimbabwe does not have a comprehensive water quality and monitoring and evaluation plan It is a major input in the Monitoring and Water Safety in place, but EMA and ZINWA carry out monitoring and water quality evaluation on all seven ZCEREHSP. Quality water Plan catchment areas. A draft has been proposed which integrates all relevant issues. or portable water is important for the health of The plan involves several coordinated activities including river surveillance, water monitoring, the population. Water is and land use monitoring and other related activities. critical in the fight against COVID-19 pandemic EMA and ZINWA used to carry out water quality monitoring and evaluation. Building on this plan can go a long way in coming up with the required document. 7. National Sanitation and At the 2014 Sanitation and Water for All High-Level Meeting (SWA HLM), the Government of The plan is relevant to the Hygiene Investment Plan Zimbabwe made a commitment to develop a sanitation and hygiene policy. ZCEREHSP. The plan Zimbabwe also committed to the act of sustaining participatory health and hygiene makes possible to chart a education. Zimbabwe has plans to reach all disadvantaged groups such as the poor way forward and be populations and those living in the most remote or inaccessible areas. proactive. 8. Hygiene Promotion Poor hygiene that is now prevalent in urban areas of Zimbabwe should be dealt with through Health issues play a major Guidelines for Urban Areas the guidelines. To respond to the emerging challenges, stakeholders have embarked on part in ZCEREHSP without (draft) hygiene promotion programmes in urban areas but there are no clear guidelines in place to these urban areas can be a guide the Zimbabwean population hot bed of disease It should be noted that all HHP approaches should link water supply, sanitation and hygiene spreading and epicentre of promotion to service delivery and health. pandemics and epidemics Page | 20 No. RELEVANT OPERATIONAL INTERPRETATION RELEVANCE TO MANUALS, PROCEDURES ZCEREHSP AND GUIDELINES Infection Prevention and The guidance provides measures to reduce the risk of Covid-19transmission in health care This is relevant to Control Guidelines and settings. ZCEREHSP as without Standard Operating It also provides standards operating procedures for donning and doffing PPE, hand hygiene, these guidelines and Procedures in Health respiratory hygiene and cough etiquette, isolation precautions, linen management for Covid- procedures the risk of Facilities for Covid-19 (2020), 19 care areas, disinfection and sterilization of patient care equipment, environmental COVID-19 transmission in Addendum to the National cleaning for Covid-19 care areas, waste management for Covid-19 and handling of deceased health care settings is very Infection Prevention and bodies. high. Control Guidelines, 2019 Zimbabwe Covid-19 National This is a guiding document that provides an outline of strategies for planning, coordination, Relevant to ZCEREHSP for Deployment and Vaccination identification of target populations, preparation of supply chains, waste management, successful vaccine Strategy human resources management and training, management of adverse events and monitoring deployment. and evaluation. All these areas are key for successful deployment of vaccines. Covid-19 Risk Communication It is a guiding document for Risk Communication and Community Engagement (RCCE) This is relevant to the and Community Engagement activities. RCCE are essential components of a broader public health emergency ZCEREHSP as RCCE Preparedness, Readiness and preparedness and response action plans. prevents spread of Response Strategy, 2021 disease, saves lives, protects national and local economies. National Development The overarching goal of NDS1 is to ensure high, accelerated, inclusive and sustainable This is relevant to the Strategy 1, 2020-2025 economic growth as well as socio-economic transformation and development as the country ZCEREHSP. moves towards an upper middle-income society by 2030. The document will guide the country in attaining its 2030 Vision through interventions the government is going to take while also addressing global aspirations of SDGs and Africa Agenda 2063. Page | 21 No. RELEVANT OPERATIONAL INTERPRETATION RELEVANCE TO MANUALS, PROCEDURES ZCEREHSP AND GUIDELINES NDS1 identified among other national priorities climate resilience, environmental protection, health and wellbeing, human capital development, governance etc. it is underpinned by integrated Results Based Management (IRBM) system which inculcates a culture of high performance, quality service delivery, continuous improvement and accountability across the public sector. However, the success of NDS1 is preconditioned on a number of factors among them global recovery from Covid-19 pandemic. Guidelines for Household and This guidance document was developed to advise on the safe management of people with This is relevant to Community Infection suspected or confirmed COVID-19 infection in community and home settings, including ZCEREHSP since safe Prevention and Control (IPC) recommendations on the safe home care for suspected or confirmed COVID-19 patients management of Covid-19 presenting with mild symptoms. patients at community level will go a long way in reducing COVID-19 transmission. Zimbabwe Guidelines for The guidelines were adapted from WHO’s “Guidelines for Safe Disposal of Unwanted This is relevant to the Disposal of Expired and pharmaceuticals in and after Emergencies: Interagency Guidelines,� (Geneva 1999). They project to guide the Obsolete Pharmaceutical provide guidance on possible disposal methods and request that, before destroying any project in the safe disposal Supplies, 2012 expired medical supplies, approval be sought from the appropriate authority, as outlined in of expired pharmaceutical the treasury instructions. supplies. Page | 22 2.4 Relevant Zimbabwean Legislation 2.4.1 Relevant Zimbabwe Acts Table 2-3 below discusses the relevant Zimbabwe legislation, their interpretation and relevance to the ZCEREHSP Project. On implementation, ZCEREHSP must recognize the requirements of these acts. Table 2-3 Relevant Zimbabwe Legislation No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . 1. Environmenta An Act to provide for the sustainable management of natural resources and protection Implementation of the ZCEREHSP l of the environment; the prevention of pollution and environmental degradation; the This law requires the preparation of an Management preparation of a National Environmental Plan and other plans for the management and environmental assessment (which is the Act (2002) protection of the environment; the establishment of an Environmental Management purpose of this ESMF) and that each project Agency and an Environment Fund. activity be assessed for environmental and The Environmental Management Act attempts to harmonize all pieces of legislation social risks and impacts and an ESMP be governing the environment. It deals to satisfactory levels with both the brown and green prepared as necessary in accordance with issues. Environmental Impact assessments are also an integral part of the act and are the provisions of the EMA and that EIA now compulsory. regulations where applicable. No ZCERP Some of the objectives of this Act are to provide for the sustainable management of activities are expected to have natural resources and protection of the environment, and the prevention of pollution environmental or social impacts of such and environmental degradation. The Act, in section 3 (2) further states that if any other magnitude that would require a full law is in conflict or inconsistent with it, then the Environmental Management Act shall Environmental and Social Impact prevail. Assessment however some activities may require the preparation of an ESMP. 3. Labour Act This is an act to declare and define the fundamental rights of employees; to define unfair The project will involve employing project (CAP 28:01) labour practices; to regulate conditions of employment and other related matters; to staff, it will also involve working with (1985) provide for the control of wages and salaries; to provide for the appointment and MoHCC staff and staff of other participating functions of workers committees; to provide for the formation, registration and functions Ministries. The Labour act will be relevant to of trade unions, employers organizations and employment councils; to regulate the protect the welfare of all these workers. It negotiation, scope and enforcement of collective bargaining agreements; to provide for will take a pivotal role in how people will be Page | 23 No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . the establishment and functions of the Labour Court; to provide for the prevention of treated, including their employment trade disputes, and unfair labour practices; conditions. Furthermore, the act is there to regulate and control collective action; to regulate and However, it is worth noting that Health care control employment agencies; and to provide for matters connected with or incidental workers are considered essential services to the foregoing. and cannot freely exercise this right to The Labour Act hedges against malpractice against workers and against employees. In engage in collective job actions. The Law fact, the act puts in place best work practices. These ensure that all workers are given restricts the exercise of this right to equal opportunities, safe environment to work in, PPE and insurance. Most portions of maintain essential services. the act zero in on the rights of workers, the employer, and the employee. This requirement for Health staff not to However, no collective job action may be recommended or engaged in by persons who conduct job actions applies to all Health are engaged in an essential service. Essential services are defined in Section 102(a) of the Care Workers. Thus, this Act is important to Labour Act as “any services the interruption of which endangers immediately the life, the project because if the workers were to personal safety or health of the whole or any part of the public� and health care services go on strike, the project would be affected, are part of essential services. and delayed since its implementation is The Labour Act further requires employers not to punish the striking workers and essentially through the Health Care workers. prohibits hiring of replacement workers. The Law restricts the exercise of this right to Labour practices and conditions of work for maintain essential services. the different categories of project workers are outlined in detail in the Labour Management Procedures of this ESMF (Appendix 2). 4. The Public The Public Health Act has sections that deal with sanitation and buildings (housing). The Sanitation and state of health facilities must Health Act Act prohibits the creation of nuisance. The act looks at how actions of others may end up be such that the patient’s health is not (Chapter affecting the health of the public. Case in point is the air, water and land pollution which compromised. The act will be used to make 15:17) consequently leads to lung and other respiratory diseases. This Act has sections which sure that public health is at all times looked deal with emergency situations, epidemics, etc. such as COVID-19. after. Sections 35 to 45 deal with emergencies and epidemics: • Special Provisions Regarding Formidable Epidemic Diseases Page | 24 No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . • Powers of Minister where local authority fails adequately to deal with any formidable epidemic disease. • Regulations regarding formidable epidemic diseases. The public health act leaves no stone unturned in the pursuance of guarding the public against being violated and ensuring that citizens get health delivering. Some of the sections of the acts focus on how the public has their health safe guarded. 5. Health Service The health service act highlights the need to provide for the establishment of the Health This allows for safe work practices and Act (Chapter Service Board and its functions; to constitute the Health Service and to provide for its working conditions during project lifespan. 15:16) of 2004 administration and the conditions of service of its members, to provide for the transfer As doctors and nurses work the of persons engaged in public health service delivery from the Public Service to the Health environment should be conducive and their Service. welfare should be catered for since they are frontline workers. 6. Health The act seeks to establish a Health Professions Authority of Zimbabwe, Health issues are relevant to ZCEREHSP) Professions • a Medical and Dental Practitioners Council of Zimbabwe, people in this profession must have Act. Chapter • an Allied Health Practitioners Council of Zimbabwe, governing principles and work ethics which 27:19 of 2000. • a Natural Therapists Council of Zimbabwe, will ensure proper health delivery • a Nurses Council of Zimbabwe, • a Pharmacists Council of Zimbabwe, • a Medical Laboratory and Clinical Scientists Council of Zimbabwe, • an Environmental Health Practitioners Council of Zimbabwe and a Medical Rehabilitation Practitioners Council of Zimbabwe, • and to provide for the composition and functions of the Authority and those councils. • to provide for the registration of persons in health professions and the issue of practicing certificates to registered persons. • to provide for the exercise of disciplinary powers in relation to registered Page | 25 No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . persons. • to provide for disabilities of and offences by unregistered persons who perform acts specially pertaining to health professions in respect of which a register is kept or who represent themselves to be practitioners in any such health profession. • to provide for the registration and control of health institutions and the regulation of services provided therein or there from. 7. The Medical The act stipulates that every citizen and permanent resident of Zimbabwe has the right Relevant to ZCEREHSP since services from Services Act. to have access to basic healthcare services, including reproductive health care services, the medical fraternity should be regulated (1999). and Secondly: No person may be refused emergency medical treatment in any health and guided accordingly to ensure safe care institution in Zimbabwe. health all round. The Bill seeks to provide for the establishment of the Medical Aid Authority, confer functions on such authority in relation to registration and control of certain activities of medical aid societies, to provide for the appointment of the Registrar of Medical Aid Societies, to protect the interests of members of medical aid societies, to amend the Medical Services Act [Chapter 15:13] and the Income Tax Act [Chapter 23:06], and to provide for matters incidental to or connected with the foregoing, 8. Mental Health The Mental Health Act (1983) is the main piece of legislation that covers the assessment, The rights of this vulnerable group always Act, (1983) treatment, and rights of people with a mental health disorder. People detained under must be safeguarded during the lifespan of the Mental Health Act need urgent treatment for a mental health disorder and are at risk the project. If overlooked most may become of harm to themselves or others. affected by diseases which could otherwise The services of the Mental Health Department will be essential during this stressful have been preventable. Pandemic period. The Department of Mental Health Services coordinates provision of comprehensive mental health and psychiatric services (promotive, preventive, curative and rehabilitative) including substance abuse (Alcohol, Drug and Tobacco Control). Page | 26 No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . 9. Social Welfare The Social Service Act provides for the granting of social welfare assistance to persons in The population groups which are affected Assistance need and their dependents; and to provide for matters incidental thereto or connected and are vulnerable must fall back on the Act: Chapter therewith. Social Welfare contingency plans for 17:06, (1988) The social Welfare assistance applies to any destitute or indigent person, who can apply assisting them. to the Director in the prescribed form for social welfare assistance in terms of this Act. It must be noted that the Form of social welfare assistance that is granted under this act include financial form in such amount as, having regard to the circumstances of the beneficiary, the Director deems reasonable and sufficient, but shall not exceed such rate as may be prescribed. Various other financial forms may take any of the following forms • rehabilitation, institutional nursing, boarding or foster home care. • counselling services. • the provision of orthopaedic and orthotic appliances. • occupational training. • pauper burials. • the supply of food or clothing. 10. Local The Local Government Acts cover several pertinent acts which oil the Local Government The Government buy-in heavily depends on Government machines. The juridical framework for local government is set out in several pieces of the Local Government Acts being religiously Acts, (2009) legislation. adhered to. The local government is the The principal Acts governing local authorities in Zimbabwe, the Urban Councils Act and heart of the people and the acts will cover the Rural District Councils Act set local authorities as separate and autonomous legal the population and ensure their safety and corporate institutions. The main Acts for local governance purposes are the Urban wellbeing Councils Act (Chapter 29:15), Urban Councils Amendment Act (Chapter 29:16), Rural District Councils Act (Chapter 29:13), Chiefs and Headmen Act (Chapter 29:01), Communal Land Act (Chapter 20:04), the Provincial Councils and Administration Act, the Customary Law and Local Courts Act (No. 2) of 1990 and the Traditional Leadership Act of 1998. Page | 27 No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . In addition, there are several statutory instruments defining the legal parameters of local government 11. National The National Museum and Monuments Act looks at all issues dealing with archaeological This is relevant to the project in that the Museums and matters. The act protects all areas of historical, architectural, archaeological, and project activities should not alter areas of Monuments paleontological value. historical, archaeological and Act, (2006) Such sites cannot be altered, excavated, or damaged and material on them cannot be paleontological value. removed without the written consent of the Executive Director of the National Museums and Monuments of Zimbabwe [NMMZ]. The law requires that any monument or relic discovered must be reported in writing to the Executive Director of the NMMZ by the discoverer and the owner of the land on which it is found. Detailed chance find procedures are in Appendix 8 of this ESMF. 12. Medicines The act provides for the establishment of the Medicines Control Authority of Zimbabwe This is relevant to ZCEREHSP as all vaccines and Allied (MCAZ) which a regulatory board mandated to approve and register all medicines to be to be used are subject to approval and Substances introduced into the country. registration by MCAZ. Act (Chapter The act outlines the procedures required for the registration of medicines among other 33:10) things. Public The act provides for the control and regulation of acquisition and disposal of public This is relevant to ensure that any disposal procurement assets. The act ensures that the disposal of public assets is done in a manner that is of unusable, unserviceable or obsolete and Disposal transparent, fair, honest, cost effective and competitive. equipment is disposed of in a manner that is of Public fair, honest, cost effective and competitive. Assets Act (Chapter 22:23) Road Traffic An Act to provide for the licensing of drivers of motor vehicles; for the issue and The act is relevant to the ZCEREHSP since Act (Chapter recognition of international driving permits and foreign drivers licences; for compulsory safe use of motor vehicles will ensure safety 13:11) insurance against third party risks arising out of the use of motor vehicles; for traffic signs of passengers and the public. Proper and police directions; for the control of certain advertisements; for certain offences insurance of vehicle will provide cover for Page | 28 No LEGISLATION INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . connected with road traffic; for prohibition from driving and endorsement of licences the passengers and the vehicle in the event and for the powers and duties of various persons. of a road traffic accident. The project is going to provide support for the transportation vaccines, medical supplies, health care workers and ancillary staff and waste transportation. 15 Freedom of The act gives effect to section 62 of the Constitution of Zimbabwe which provides for the This is relevant to ZCEREHSP in that the Information right to access information as enshrined in the declaration of rights. information generated during the course of Act (CAP It sets out procedures for access to information held by public institutions or information project implementation has to be accessible 10:33) held by any person. It also sets out considerations for making available on a voluntary to the public. basis by entities, certain categories of information thereby removing the need for formal This ESMF is a public document and request for such information therefore to be disclosed as per national It also sets out the scope and limitations on the right of access to information environmental laws. Page | 29 2.4.2 Relevant Statutory Instruments Table 2-4 below further identifies the subsidiary legislation which supports the legislation in table 3-3. These are the regulations which give teeth to the legislation and on implementation, ZCEREHSP must recognize the requirements of these regulations. Table 2-4 Relevant Statutory Instruments (SI) No STATUTORY INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . INSTRUMENT 1. Environmental Of note is the fact that these regulations stipulate regulations for ecosystems protection, conditions Before, during and after the Management (EIA for clay and sand extraction and lay out conditions for the submission and review of environmental project the environment must and Ecosystems impact prospectus and reports. be protected so that future Protection) Failure to adhere to these regulations may result in a fine or imprisonment for a period not exceeding generations can utilize it. Regulations, 2007 five years. Once issued, a permit for extraction is valid for a period of one year and is not transferable. The proposed contractor to obtain permits through the EMA for the extraction of clay ZCEREHSP PIE will ensure and sand deposits for construction, and the extraction of gravel for the roads in accordance with proactive engagement of EMA requirements of these regulations. where such environmental Regarding fire, any land user, owner, or designated authority is required to put in place appropriate clearances are required for fire prevention measures on their land/premises. Aptly put, the regulations also prohibit the respective project activities. deliberate lighting of fire that cannot be extinguished and causes damage to the environment, Each such project activity will property, or life and the lighting of fire outside residential or commercial premises during 31 July to develop an approved ESMP 31 October each year. before any work can Considering the review periods for the Prospectus and ESIA report, the project activity commence. implementation scheduling needs to put the environmental clearances well ahead of the project implementation processes to ensure the environmental clearances will not be the bottleneck to the project implementation. ESMPs must be in place before any work can commence especially for the installation of solar energy. 2. Environmental This statutory instrument (SI 6 of 2007) covers sections (60-62, 69-70) of the Environment Waste disposal. solid or liquid Management Management Act (CAP 20:27). It goes on to set minimum requirements for the granting of an must be done within hygienic (Effluent and Solid effluent and solid waste disposal license as well as the conditions for the validity of the license. parameters. The project is to Waste Disposal) Page | 30 No STATUTORY INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . INSTRUMENT Regulations, (SI 6 of Section 23 specifically makes littering a criminal offence punishable by fine or imprisonment. function within this paradigm to 2007) Required licences, permits and clearances later in this section. achieve maximum efficiency. The regulation falls in line with the statute that requires all project vehicles have a waste receptacle that is emptied and a designated waste collection point. The project work areas should also be kept litter free through availability of waste receptacles and disposal in authorized points. Contractors shall also ensure that in all project areas that require and do not have toilets, they provide mobile toilets to ensure that there will be no open defecation. 3. SI 76 of 2020 This SI under the Civil Protection Act allows the civil protection authorities to use the special powers Declares Zimbabwe to be in a Civil Protection available to them under the Act to respond to a declared state of disaster. The declaration places state of disaster hence relevant. (Declaration of State the whole country in a state of disaster with effect from the promulgation of this notice. To make people ready for any of Disaster: Rural and eventualities. Urban Areas of Zimbabwe) 4. SI 77 of 2020 These regulations were made by the Minister of Health and Child Care under the “new� Public Health This SI is relevant to the Public Health Act of August 2018. The Act gives the Minister wide powers to legislate measures to prevent, contain ZCEREHSP because it looks at (COVID-19) and treat the incidence of “formidable epidemic diseases�. ways of prevention, how to Prevention, As a new virus, COVID-19 was not on the existing list of “formidable epidemic diseases� in section contain and treat the disease. Containment and 64 of the Public Health Act. It was, therefore, necessary for the Minister of Health and Child Care to Treatment) make it a “formidable epidemic disease� by a declaration in a statutory instrument under the same Regulations, 2020 section. Section 3 of these regulations contains that declaration called the “FED declaration�, which will be in effect until 20th May 2020, unless before that date the Minister extends it. The FED declaration allowed the Minister to invoke the special regulation-making powers conferred on him by section 68 of the Act. The scope of the regulations is indicated by the subjects covered in the headings to sections 5 to 8: • Prohibition of gatherings [of more than 100 persons, whether wholly or partly in the open air or in a building] • Compulsory testing, detention, etc., to contain COVID-19 Page | 31 No STATUTORY INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . INSTRUMENT • Places of quarantine and isolation • Ministerial orders [to be published in the Government Gazette, for controlling traffic and movements of persons, including curfews; closure of places of worship, entertainment, recreation, or amusement; controlling the sale of liquor; prohibiting gatherings of fewer than 100 persons; regulating removal of bodies and conducting of burials; compelling the evacuation, closing, alteration or demolition of premises likely to favour the spread of COVID-19]. • There are steep maximum penalties on conviction of breaches of the regulations or orders issued under them: a fine not exceeding level 12 [ZW $36 000] or one year’s imprisonment or both. The point of this bulletin is to draw attention to the statutory instruments and to outline what they say. A more in-depth examination of the statutory instruments is planned for a separate bulletin. 6. SI 78 of 2020 A board should be in place to monitor and regulate the usage of funds and resources during any ZCEREHSP will need this input. The Management Government project lifespan. Training will ensure that safe Training Bureau The board is made up people from various departments methods and the use of funds Regulations are adopted. 7. SI 81 of 2020Labour The minimum wage issue takes the forefront and conditions to exempt paying of the wages must be To provide or give incentives to Relations brought to the ministry for review. front line workers the issue of (Specification of wages and allowances must be Minimum Wages) looked at (Amendment) Notice, 2020 8. SI 82 of 2020 The SI puts in place regulations to reduce the number of people allowed to gather in groups. The SI Relevant for ZCEREHSP since it Public Health (COVID encourages law enforcing officers to ensure that regulations are adhered to. The issue of prevention, deals with prevention, -19 Prevention containment and treatment was dealt with. containment and treatment. Page | 32 No STATUTORY INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . INSTRUMENT Containment and Ministerial orders must be followed and adhered to according to laid down guidelines. Treatment) (Amendment) Regulation, 2020 9. SI 83 of 2020 The SI looks at the National Lockdown and the prohibition of gatherings and the extension of permits The SI is relevant to ZCEREHSP Public Health for residence of Foreign Nationals, closure of airports, and aerial transportation. because the issue of public (COVID-19 The power to close borders and enforcement issues are dealt with and the resultant penalty is dealt health is dealt with and Prevention, with. prevention, containment and Containment and A phased relaxation of the lockdown is also dealt with in this SI. treatment is pertinent. Treatment) (National Lockdown) Order 10. SI 84 of 2020 The SI focuses on the amendments on issues highlighted in SI 83. The number of hospital patients is The SI is relevant since issue of Public Health looked at and the issue that queuing people in cars should remain in cars until served. patients is highlighted and (COVID-19 People can go out to get basic foodstuff for ablution facilities and re-fuelling of cars, generators, and movement is allowed carefully Prevention, other engines. Containment and Treatment) (Amendment) regulations, 2020. 11. SI 86 of 2020 It deals with the production and distribution of medical supplies, the issue of funerals, funeral This is relevant because it deals Public Health parlours and making, manufacturing and sale of coffins. The conduct of agricultural activities on with funeral gatherings and how (COVID-19 farms and harvest of crops is closely monitored. to proceed. Prevention, Agricultural inputs and stock feed were also an issue and distribution of medical equipment for Containment and domesticated farm animals was regulated. Treatment) Page | 33 No STATUTORY INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . INSTRUMENT (National Lockdown) (Amendment) Order 12. S.I 103 of 2020 The SI makes screening and testing mandatory and must remain in force even after expiry of the Relevant since screening is Public health (COVID national lockdown. For all workers who were on lockdown and are coming to work should screened made mandatory to save the 19 prevention, and tested for the virus. lives of others. containment, and The use of Rapid Diagnostic Tests (RDT) in Zimbabwe according to the World Health Organisation treatment) guidelines is in place. (amendment) Persons who provide essential services should be tested regularly. Sanitizers and hand washers regulations, 2020 should be put on all office entrances. A law enforcement officer can randomly visit any workplaces without notice. The officer can close any premise as they see fit, by writing or other formal means. Persons who fail to comply will be fined 13. SI 102 of 2020 The SI empowers law enforcement officers to gain access to any land or premises where exempted Relevant since this allows Public health (COVID persons are present or employed and demand documentary proof of RDT or other tests. officers to enforce compliancy. 19) SI 102 of 2020. 14 Public Finance This SI provides for the acquisition, custody, control, issue, transfer and disposal of public assets. It This is relevant to ZCEREHSP Management applies to government ministries, agencies, and institutions. It provides guidance and procedures since the project is to support (Treasury for the disposal of unserviceable, obsolete and excess assets. the procurement and Instructions), 2019, The SI provides for the establishment of the disposal committee which shall preside over the disposal installation solar direct drive SI 144 of 2019 of the public assets following this SI and the parent Act. The disposal shall be done in a fair, refrigerators at health facilities. transparency, honest, cost effective and competitive manner. It will guide the disposal of the existing refrigerators and equipment which might be obsolete or in surplus. 16 Model Building The Model Building Bylaws have been published by the Ministry of Local Government and National They are relevant to the project Bylaws Housing in Zimbabwe in 1977 in accordance with the Urban Councils Act and the Rural District as there is going to be Councils Act. They cover issues related to structural design and control, foundations, masonry and installation of SDD refrigerators, Page | 34 No STATUTORY INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT . INSTRUMENT walling, water supply, lighting, drainage, and sewage, ventilation and fire protection and public and solar lighting and safety. In essence the bylaws define the aspects in construction of building alteration, subdivision, refrigeration conversion, reconstruction or addition to a building. 2.4.3 Relevant Licences and Permits Table 2-5 below outlines the licences and permits which are relevant to the implementation of ZCEREHSP. Participating institutions must apply for the relevant licences so that their operations may remain within the legal requirements of Zimbabwean law. Table 2-5 Relevant Licences and permits STATUTORY No. INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT INSTRUMENT 1. Environmental Hazardous Waste Transportation Licence Most of the project health care Management (Control The Hazardous Waste Transportation licences are issued by EMA, as per the Environmental facilities do not have of Hazardous Management (Control of Hazardous Substances) (General) Regulations, 2018. The licences are incinerators and depend on Substances) (General) issued according to the same classification system as the incinerator emission licences. other nearby health facilities Regulations, 2018. No operator can transport any type of a hazardous substance consignment whether by air, road, which have incinerators. To water, pipeline, or rail without a licence issued to the operator by the Agency. transport the waste the The permits can be obtained from the Environmental Management Authority upon submission institutions will need to apply for of facility details, quantity and quality of waste being handled, a hazardous waste It takes an average of two weeks to obtain the permit. transportation license. The average fee is $322.89 per annum. If they are using a private transporter, the transporter will need to apply for the permit. This is relevant to both ZCEREHSP Page | 35 STATUTORY No. INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT INSTRUMENT 2. Environmental Waste Enterprise Licence Businesses that handle waste, Management (Control A Waste Enterprise licence is a licence issued to a business that handles waste, i.e., collects, i.e., store, treat and dispose final of Hazardous stores, treats and disposes the final residue properly. Waste Enterprise licence is issued in terms residue need to have this license Substances) (General) of the Environmental Management (Control of Hazardous Substances) (General) Regulations, so health facilities and Regulations, 2018 2018. The licences are issued according to the same classification system as the incinerator transporters need this license. emission licences. This SI will be applicable to the The permits can be obtained from the Environmental Management Authority upon submission project as waste generated from of facility details, quantity and quality of waste being handled, the participating facilities will It takes an average of two weeks to obtain the permit. need to be treated and disposed The average fee is $ 134.65 per year. of properly. 4. Food and Food Among other things the SI provides for the management and monitoring of water quality for This SI will be utilised by the Standards (Inspection potable purposes, Section 9. (1) outlines that the Secretary shall monitor the quality and safety participating institutions which and Certification) of water and ascertain the status of drinking water in any area and, for that purpose, direct local will be assisted with Water Regulations, 2015 authority, environmental or other health officers or inspectors to collect and submit to the Tanks. The PIE will have to Government Analyst Laboratory for analysis, according to a specified regular schedule, water ascertain that the water quality samples from communal boreholes and distribution systems. of the source (Borehole) was analysed and if not cause it to be analysed. Also, the water quality will have to be periodically checked. 5. Zimbabwe Food and This SI, the Food and Food Standards (FFS), provides for the standardisation of Natural, Mineral This SI will be utilised by the Food Standards (FFS) Water and Bottled Water for potable purposes. The FFS are equivalent to the WHO Guidelines participating institutions which (Mineral and Bottled for Drinking Water Quality, 2011 and are used in determining the suitability of a water source will be assisted with Water Water) Regulations for drinking purposes. Tanks. The PIE will have to 2002 ascertain that the water quality of the source (Borehole) meets Page | 36 STATUTORY No. INTERPRETATION OF LEGISLATION RELEVANCE TO THE PROJECT INSTRUMENT the laid down standards in this SI. 6. in line with: Water Quality Analysis The drinking water quality of all � Section 9 (1) of the Once the borehole has been drilled for potable water purposes, the quality of the water has to participating Institutions which Food and Food be ascertained in line with Section 9 (1) of the Food and Food Standards (FFS) (Inspection and will get assistance in the drinking Standards Certification) Regulations, 2015, together with requirements of the Zimbabwe Food and Food water supplies, must tested (Inspection and Standards (FFS) (Mineral and Bottled Water) Regulations 2002 (Which are equivalent to the regularly; quarterly for Certification) WHO Guidelines for Drinking Water Quality). Poor quality water poses a serious risk to humans, groundwater and monthly for Regulations, 2015, crops, livestock and the environment. This is in line with the General EHSG 2007 “Water Quality� surface water sources. � the Zimbabwe Food states “water quality should comply with national acceptability standards or in their absence and Food Standards the current edition of with WHO Drinking Water Guidelines.� (Mineral and Bottled Water quality for more sensitive well-being-related demands such as water used in health care Water) Regulations facilities or food production require stringent, industry-specific guidelines or standards, as 2002 provided for by the FFS. 7. Environmental The legal provision provides for the prevention, control and abatement of air pollution to ensure This is relevant to the project as management clean and healthy ambient air. It covers pollution from static as well as mobile sources (motor emissions from incinerators and (Atmospheric Pollution vehicles). Incinerators need to be licenced by EMA to allow for a coordinated monitoring of as motor vehicles are subject to Control) regulations of well as receiving advice and guidance on best practices. EMA also monitors vehicle emissions. monitoring by EMA. 2009 Unlike point source monitoring, the regulations do not require motor vehicles to be licenced for emissions, but the vehicles may be stopped at road blocks for the purposes of testing these emissions. Page | 37 2.4.4 EHSG Emissions and Effluent Standards This section presents the emission standards for the project related to emissions from incinerators and motor vehicles. Emissions from project-supported vehicles will comply with national standards as outlined in the national Environmental Management (Atmospheric Pollution Control) regulations of 2009 in accordance with the EHSG General Guidelines for Environment: Air Emissions and Air Quality that vehicles should follow national programs. For the incinerators, the WB EHSG Guideline for Health Care Facilities, listed below in Table 3-6, is applicable. 13 Table 2.6 Air Emission Levels for Hospital Waste Incineration Facilities14 Air Emission Levels for Hospital Waste Incineration Facilitiesb Pollutants Units Guideline Value Total Particulate mg/Nm3 10 matter (PM) Total organic carbon 10 mg/Nm3 (TOC) Hydrogen Chloride 10 mg/Nm3 (HCl) Hydrogen Fluoride 1 mg/Nm3 (HF) Sulphur dioxide (SO2) mg/Nm3 50 Carbon Monoxide (CO) mg/Nm3 50 NOX mg/Nm3 200-400(a) Mercury (Hg) mg/Nm3 0.05 Cadmium + Thallium mg/Nm3 0.05 (Cd + Tl) Sb, As, Pb, Cr, Co, Cu, mg/Nm3 0.5 Mn, Ni and V 13 WB (2007) p. 14. 14 Source: Table 3 in the EHSG Guideline for Health Care Facilities, 2007, p14. Page | 38 Polychlorinated dibenzodioxin and ng/Nm3TEQ 0.1 dibenzofuran (PCDD/F) Notes: a. 200 mg/m3 for new plants or for existing incinerators with a nominal capacity exceeding 6 tonnes per hour; 400 mg/m3 for existing incinerators with a nominal capacity of 6 tonnes per hour or less b. Oxygen level for incinerators is 7 percent. Table 2-6 Zimbabwean Emission Standards for Motor Vehicles ZIMBABWE POLLUTANTS UNITS EMISSION STANDARD Total Particulate matter (PM10) mg/Nm3 50. Particulate matter (PM2.5) mg/Nm3 - Sulphur dioxide (SO2) mg/Nm3 500 Carbon Monoxide (CO) mg/Nm3 100 NOX mg/Nm3 200 Pb mg/Nm3 0.5-1 Ozone Ng/m3 120 The effluent guidelines below in Table 38 are applicable for direct discharges of treated effluents to surface waters for general use. They are taken from the EHSG Guidelines for Health Care Facilities (2007).15 Site- specific discharge levels may be established based on the availability and conditions in the use of publicly operated sewage collection and treatment systems or, if discharged directly to surface waters, on the receiving water use classification as described in the General EHSG Guidelines. These levels should be 15 Page 14. Page | 39 achieved, without dilution, at least 95 percent of the time that the plant or unit is operating, to be calculated as a proportion of annual operating hours. Any deviation from these levels in consideration of specific, local project conditions will be justified in the environmental assessment, the facility level ICWMPs to be produced. Table 3-8 lists the Healthcare Facility EHSG Effluent Discharge Standards (2007).16 Table 2-7 EHSG Effluent Discharge Standards17 Effluent Levels for Health Care Facilities Guideline Pollutants Units Value pH S.U 6-9 Biochemical oxygen mg/L 50 demand (BOD5) Chemical oxygen mg/L 250 demand (COD) Oil and grease mg/L 10 Total suspended solid mg/L 50 (TSS) Cadmium (Cd) mg/L 0.05 Chromium (Cr) mg/L 0.5 Lead (Pb) mg/L 0.1 Mercury (Hg) mg/L 0.01 Chlorine, total residual mg/L 0.2 Phenols mg/L 0.5 Total coliform bacteria MPNa / 400 100ml 16 p 14. 17 Source: Table 2 in the EHSG Guideline for Health Care Facilities, 2007, p14. Page | 40 Polychlorinated dibenzodioxin and Ng/L 0.1 dibenzofuran (PCDD/F) Temperature increase °C <3b Notes: a. MPN = Most Probable Number b. At the edge of a scientifically established mixing zone which takes into account ambient water quality, receiving water use, potential receptors and assimilative capacity 2.4.5 Noise Exposure Limits The country has no set limits for noise exposure. WHO noise exposure limits are used which state that The World Health Organization (WHO) recommends that noise exposure levels should not exceed 70 dB over a 24-hour period, and 85 dB over a 1-hour period to avoid hearing impairment Page | 41 2.5 International Conventions and Treaties Zimbabwe is a signatory and party to more than twenty-one international, conventions, treaties, and protocols. Of the many treaties, the following listed below in Table 2-9 are relevant to ZCERP: Table 2-8 Overview of the relevant International Conventions and Treaties INTERNATIONAL No. SUMMARY RELEVANCE TO ZCEREHSP CONVENTIONS 1 International The Minamata Convention is a legally binding agreement that aims to protect human health and Health of the population should Health Regulations the environment from the adverse effects of mercury. It includes a ban on primary mercury be safeguarded. Minamata mining; the phase-out of existing mines and the phase-out and phase-down of mercury use in Declaration several products and processes; control of mercury releases into the environment and management of contaminated sites The purpose and scope of the International Health Regulations (2005) are “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade� 2 Libreville The main outcome of that historic meeting was the adoption of the Libreville Declaration, which The declaration is relevant to declaration recognized that human health is intimately related to the state of the environment. The ZCEREHSP participating nations committed themselves to 11 priority actions for addressing the continent’s most pressing health and environment challenges. • It must be noted that the Libreville Declaration was a springboard for tackling the environmental risks to human health and ecosystem integrity across the African continent, including the great considerable health impacts of climate change. • WHO played a pivotal role in the in the development of the Declaration 3 Stockholm The Stockholm Convention on Persistent Organic Pollutants is a multilateral international The Convention specifically Convention environmental agreement to protect human health and the environment from chemicals, known targets incinerators. Among as POPs. These so-called POPs have harmful impacts on human health or on the environment at other actions, it will require large. countries to develop and Page | 42 INTERNATIONAL No. SUMMARY RELEVANCE TO ZCEREHSP CONVENTIONS The Stockholm Convention on Persistent Organic Pollutants is a global treaty to protect human implement actions to address health and the environment from chemicals that remain intact in the environment for long the release of dioxins and furans; periods, become widely distributed geographically, accumulate in the fatty tissue of humans and Article 5 will require measures to wildlife, and have harmful impacts on human health or on the environment reduce dioxin/furan releases from incinerators with the goal of their “ultimate elimination;� and countries are required to promote the use of alternatives including the use of the best available techniques/technologies. Under the Stockholm Convention, standard incinerators are not a preferred technique due to their potential to emit POPs. Only highly controlled incinerators with air pollution control equipment and operational practice specifically designed to minimize dioxin formation and release could be considered the best available technology. ZCEREHSP will use incineration technology. Page | 43 INTERNATIONAL No. SUMMARY RELEVANCE TO ZCEREHSP CONVENTIONS 5 The Basel The Basel Convention Technical Guidelines focus on reducing the impacts on health and the The activities of the ZCEREHSP Convention environment of biomedical and healthcare wastes that is based on the major classification in project may induce an increase in Annexes I, II, VII of the Basel Convention, but specified for practical use in the healthcare sector. the use of medical facilities and This guideline focuses on, (i) a strict definition and classification of the relevant waste streams, hence an increase in the (ii) the segregation at source of the waste and (iii) the access to the best available information for generation of Health care Waste. the identification of waste. The project will manage these anticipated increases through the ICWMP. Montreal Protocol This Protocol was subsequently adjusted and/or amended in London in 1990, Copenhagen in Use of refrigerant gases and 1992, Vienna in 1995, Montreal in 1997 and Beijing in 1999. blowing agents is governed by 18 Under the amendments and adjustments to the Protocol, non-Article 5 parties were required the Montreal Protocol on to phase out production and consumption of: halons by 1994; chlorofluorocarbons (CFCs), carbon Substances that Deplete the tetrachloride, hydrobromochlorofluorocarbons and methyl chloroform by 1996; Ozone Layer. ZEREHS supporting bromochloromethane by 2002; and methyl bromide by 2005. Article 5 parties were required to purchase and installation solar phase out production and consumption of hydrobromochlorofluorocarbons by 1996, direct drives refrigerators and bromochloromethane by 2002, and CFC’s, halons and carbontetrachloride by 2010. Article 5 19 installation of refrigeration units parties must still phase out production and consumption of methyl chloroform and methyl 18Parties to the Montreal Protocol that have an ODS consumption of greater than 0.3kg per capita on the date of entry of the Montreal Protocol, or at any time thereafter within ten years of the date of entry into force of the Protocol. 19Parties to the Montreal Protocol whose annual per capita consumption and production of ozone depleting substances (ODS) is less than 0.3 kg to comply with the control measures of the Protocol. Currently, 147 of the 196 Parties to the Montreal Protocol meet these criteria (they are referred to as Article 5 countries). Page | 44 INTERNATIONAL No. SUMMARY RELEVANCE TO ZCEREHSP CONVENTIONS bromide by 2015. Under the accelerated phase-out of HCFC’s adopted at Meeting of the Parties in trucks transporting Covid-19 19 to the Montreal protocol (MOP-19), HCFC production and consumption by non-article 5 Vaccines. parties was frozen in 2004 and is to be phased out by 2020, while for Article 5 parties, HCFC production and consumption is to be frozen by 2013 and phased out by 2030 (with interim targets prior to those dates, starting in 2015). There are exemptions to these phase-outs to allow for certain uses lacking feasible alternatives. Paris Agreement The Paris Agreement establishes the main framework for cooperative action on climate change Relevant to the ZCEREHSP beyond 2020 and will replace the Kyoto Protocol. The Agreement is a treaty as a matter of projects for adoption climate international law, which means that ratifying countries will be bound to one another by its terms friendly intervention when it comes into effect. The agreement aims to substantially reduce global greenhouse gas emissions in an effort to limit the global temperature increase in this century to 2 degrees Celsius above preindustrial levels, while pursuing the means to limit the increase to 1.5 degrees. The agreement includes commitments from all major emitting countries to cut their climate pollution and to strengthen those commitments over time. Page | 45 2.6 World Bank Environmental and Social Framework (ESF) The World Bank ESF contains ten (10) Environmental and Social Standards (ESS) that a establishes the responsibilities of the MOHCC and PIE to plan, evaluate, screen, manage and monitor environmental and social risks and impacts during the implementation of the Project at each stage. These standards seek to avoid or mitigate adverse impacts to people and the environment because of project implementation. The project activities to be implemented under ZCEREHSP are required to follow the ESF. Projects are expected to avoid, minimise, and mitigate adverse impacts in proportion to the size of the risk. That is greater risks and impacts get more attention than less important risks and impacts. A brief analysis of ESSs relevant to ZCEREHSP are discussed in the table below: 2.6.1 Relevant Environmental and Social Standards The World Bank ESF is intended to avoid, mitigate, or minimise adverse environmental and social impacts of projects supported by the Bank. Table 3-8 below is a summary of the ESS that are relevant to ZCEREHSP: Table 2-9 Environmental and Social Standards ENVIRONMENTAL No. AND SOCIAL Relevant Application STANDARDS 1. ESS1- Assessment Yes Potential environmental impacts related to the minor civil works and Management of activities such as minor renovations of the maternity waiting Environmetal and homes, operating theatres, the installation energy generation Social Risks equipment for health facilities, installation of direct drive solar refrigerators, fuelling and maintenance of vehicles under ZCEREHSP. The supported activities will increase generation of health care waste, issues related to supply and usage of Personal Protective Equipment (PPE), procurement and usage of family planning commodities. There are also risks as a result exposure to Covid-19 for health care workers, logistical challenges related to storage and transportation of vaccines, marginalised groups also not being able to access vaccine of provision, family planning commodities, facilities and services designed to enhance RNMCAHN services and to combat the Covid-19 disease, Gender Based Violence (GBV) and Sexual Exploitation and Abuse- Harassment (SEA-SH) among health care providers and patients in relation to the distribution of vaccines and family planning products, inappropriate data protection measures and insufficient stakeholder communication on access to family planning commodities, and vaccine deployment strategy and information about vaccines could result in rumours about the effects of vaccines on one’s health and also risks associated with AEFIs. The minor renovations and installation activities will be site-specific and will not have any significant environmental impacts on the ground. All of these project activities will have Page | 46 ENVIRONMENTAL No. AND SOCIAL Relevant Application STANDARDS environmental and social risks and impacts which must be analysed and assessed and so ESS1 is applicable to this project. The ESMF and ICWMP carry out ESS1 and will guide on the best practices for waste management and any other safeguards concern that may be identified including any necessary labour management measures (outlined in the Labour Management Procedures). The ICWMP will present mitigation measures that consider the limited capacity level of the health sector. To manage and mitigate GBV/ SEA-H risks, the project has prepared and will implement the GBV action plan, code of conduct and GBV/SEA-H. They shall also be integrated into all contracts and contracting documents. ESMPs will be prepared as needed during implementation. 2. ESS2- Labour and Yes The ZCEREHSPproject has project workers including (i) Direct Working Conditions workers such as civil servants employed by MOHCC, PIE personnel, (ii) Contracted workers such as construction workers for minor civil works for installation of solar sytems at health facilities, providers of transportation for vaccines and waste from vaccination activities under ZCEREHSP, (iii) community workers such as community health workers who will be engaged in community awareness raising, contact tracing and data collection of cases in the community. A main project risk is the spread of COVID-19 and other contagion illneses to project workers. The project will implement Occupational Health and Safety (OHS) measures as outlined in the ESMF, project ICWMP and WHO Guidelines (Water, sanitation, hygiene, and waste management for SARS-CoV-2, the virus that causes COVID-19: Interim guidance, 2020). The project will regularly integrate the latest guidance by WHO as it develops over time and experience addressing COVID-19 globally. There are also OHS risks from health care waste management,fueling and maintanence of vehicles, installation of energy generation equipment and its operation. The LMP will provide guidance on how workers’ safety including road traffic safety hazards, GBV/ SEA/SH, poor working conditions, risk of COVID-19 transmission at work places, will be managed in accordance with the national law as well as the requirements of ESS2. The project has a basic and responsive grievance redress mechanism (GRM) that will allow all workers to quickly inform their immediate management of labour issues. Page | 47 ENVIRONMENTAL No. AND SOCIAL Relevant Application STANDARDS 3. ESS3-Resource Yes COVID-19 contributes to the infectiousness of health care waste Efficiency and and contact with it could severely impact human health Pollution Prevention especially health care workers if it is not handled properly. Medical and chemical waste such as reagents, infected materials from health care facilities could have a significant environmental impact including on natural habitats and human health including nearby communities if not properly managed. Wastes that may be generated from health care facilities include liquid contaminated waste, sharps, chemicals and other hazardous materials. These wastes, wastes, if they have not been managed appropriately (such as incomplete burning, if they are left accessible to unauthorized personnel or if they have contaminated the soil) historically, could present a risk to the public, patients and workers. These waste could have emanated from improperly functioning incinerators and waste has not been fully destroyed and the area could be accessible to patients, staff and the community which could harm them. Medical waste will also be generated from the procure and utilisation of family planning commodities which the project will support. Waste from Electrical and Electronic Equipment maybe generated from procurement and use of solar powered tricycles, and motorcycles and solar direct drive refridgerators. Issues related to wastewater discharge from HFs include leakage of wastewater into the surrounding environmental due poorly functioning wastewater reticulation system contaminating the soil posing a risk to people._. The project short-term vaccination efforts represent a small amount of the wastewater stream produced by an HCF over very small period of time; therefore, this is not a significant concern. If vaccines are not stored, transported and administered at the right temperature can be rendered less potent and or/ less effective. The project will support MOHCC to develop and implement country specific vaccine cold chain supply management and operational precedures using WHO and CDC guidelines on vaccine cold chain supply management. The cold chain supply management should be managed for efficient use of inputs. Fueling and maintanence of vehicles could cause pollution if not managed appropriately. This ESMF contains measures to ensure these activities areadequately managed according to WB general EHSG (2007). However, under the Additional Financing, Page | 48 ENVIRONMENTAL No. AND SOCIAL Relevant Application STANDARDS sustainable and energy efficient solar powered tricycles will be procured and used for integrated mobile outreach activities. The cold chain system will be energy efficient, and will also rely on on sustainable energy sources whenever practable as supported by the ESMAP grant. WHO and CDC guidelines on vaccine cold chain supply management are examples of GIIPs [Good International Industry Practice) that Zimbabwe could use its own country-specific vaccine cold chain supply management plan and operational procedures. Contaminated land is of concern because of the potential risks to human health and ecology, and the liability it may pose to the polluter/ health facility owners. Land contamination can be due to anthropogenic releases of hazardous materials, wastes, or oil, including naturally occurring substances. Releases of these materials may be the result of historic or current site activities, including, but not limited to, accidents during their handling and storage, or due to their poor management or disposal. Contamination of land should be prevented to avoid risk to health and ecological receptors. The preferred strategy for land decontamination is to reduce the level of contamination at the site while preventing the human exposure to contamination. 4. ESS4- Community Yes Inappropriate handling of COVID-19 samples and patients can Health and Safety expose community and could lead to further spread of the disease. Non-provision of medical services to disadvantaged or vulnerable groups is a potental risk under the project. The project ICWMP will contain guidelines on specific measures to prevent the spread of diseases in the community from infectious medical waste. This ESMF contains measures to ensure health and safety in the community from project activities and safety of services as they relate to health care facilities, vaccine roll out, emergency preparedness measures including measures to address a plan for cold chain storage during power outages and natural disasters in Appendix 16. GBV/ SEA/SH risks will be ameliorated through training of every worker engaged in the project on OHS and GBV/ SEA/SH risks and be required to sign a code of conduct. COVID-19 vaccine safety and surveillance will be guided by the existing MOHCC’s Adverse Events Following Immunisation surveillance and the WHO Vaccines Safety Surveillance Manual. The project will regularly integrate the latest guidance by WHO as it develops over time and experience addressing COVID-19 globally especially with respect to reducing the risk of the project spreading COVID-19 to the public in general. Additionally, the Page | 49 ENVIRONMENTAL No. AND SOCIAL Relevant Application STANDARDS project will conduct risk communication and community engagement activities to raise awareness and dispel misnformation in the affected areas including the vulnerable and marginalised groups, use of proper PPE for COVID-19 prevention measures No one will be forced to get the vaccine. The project will abide by Section 3.3 (Life and Fire Safety) of the World Bank Group (“WBG�) General Environmental, Health and Safety Guidelines (EHSG) as it relates to fire and other safety standards for new buildings and existing buildings programmed for renovation with the use of the World Bank funding since the HCF are servicing the public which is relevant to ESS4’s coverage of Safety of Services. These requirements apply to buildings programmed for renovation, whether occupancy type is maintained (e.g., a hospital renovation) or changed (e.g., an office building is converted to a hospital). The use of the Military or Security Personnel is not currently envisioned for any activities related to the Project. Since the project will support vehicles and transportation (for waste, fuelling and maintenance and for vaccinations), procurement and use of solar powered tricycles, motorcycles and vans for integrated outreach services, EHSG and ESS4 guidance on Traffic and Road Safety are relevant. Finally, Emergency Preparedness and Response are pertinent to project activities since the HCFs are subject to natural disasters and man- made events. 5. ESS5- Land No No project activities require land acquisition or adversely impact Acquisation, livelihoods. Financing may support rehabilitation and minor Restrictions on Land upgrades at existing facilities which include minor renovations of Use and Involuntary the maternity waiting homes, operating theatre renovations Resettlement 6. ESS6- Biodiversity, No This project does not include significant civil works and is not Conservation and likely to impact natural resources, natural habitats or biodiversity Sustainable since any activities to set up energy-generating equipment will Management of be for already existing facilities. In addition, this ESMF has Living Natural screening procedures that would identify any project that may resources impact natural habitats. 7. ESS7- Indigenous Yes There is a possibility that indigenous communities could be Peoples/ Sub- present in or near several areas targeted by both projects. If their Saharan African presence is confirmed, the project will address any risks posed to Page | 50 ENVIRONMENTAL No. AND SOCIAL Relevant Application STANDARDS Historically them and measures put in place to ensure that they receive Underserved culturally appropriate benefits. This will be done through the Traditional- Local specific targeting of stakeholder engagement activities relevant Communities to Indigenous Peoples (IPs) that meet the requirements of ESS7 and that a Social Assessment (SA) is carried out prior to any activities that would impact them. Following the SA, and as appropriate: (i) a stand-alone plan or framework may be developed; (ii) or key elements of risk mitigation and culturally appropriate benefits will be included in the ESMF. In case where indigenous communities will be affected by quarantine provisions or other targeted impacts, site-specific approaches will ensure adequate consideration of their specific cultural needs in accordance with ESS7 to the satisfaction of the Bank. Public consultations with representatives of indigenous communities and their organizations are provided for in the ESMF and will be further developed in subsequent IPPFs as appropriate considering their circumstances. IP organizations and representatives will be consulted during the preparation of the ESMF and IPPFs as necessary. 8. ESS8- Cultural No The standard on Cultural Heritage is currently not relevant as the Heritage project does not involve any activities that may impact tangible or intangible cultural heritage or access to heritage sites. Most project sites are existing facilities so any culturally or historically important resources would most likely be already identified and secured. In any case, the ESMF contains chance finds procedures to be followed in case any archeological or other resources with historical or cultural value are discovered unexpectedly during the execution of project activities (Appendix 8 Archaeological Chance Finds Procedures). 9. ESS9- Financial No The standard on Financial Intermediaries is not currently relevant Intermediaries for the proposed project activities. 10. ESS10- Stakeholder Yes The project will establish a structured approach to engagement Engagement and with stakeholders that is based based upon meaningful Information consultation and disclosure of appropriate information, Disclosure considering the specific challenges associated with Covid-19. People affected by the project will be provided with accessible and inclusive means to raise their concerns an grievances. The Project guidance is in the SEP. 2.6.2 World Bank Group General Environmental Health and Safety Guidelines (EHSG) Page | 51 In addition to the Environmental and Social Standards, the project will follow the World Bank Group Environment, Health and Safety Guidelines (EHSG). For details, refer to: www.ifc.org/ehsguidelines. World Bank Group EHSG20 are technical reference documents with general and industry-specific examples of Good International Industry Practice (GIIP). They define acceptable pollution prevention and abatement measures and emission levels in World Bank financed projects. The EHSG contains the performance levels and measures that are generally considered to be achievable in new facilities by existing technology at reasonable costs. Application of the EHSG to existing facilities may involve the establishment of site-specific targets, with an appropriate timetable for achieving them. The environmental and social assessment process may recommend alternative (higher or lower) levels or measures, which, if acceptable to the World Bank, become project or site-specific requirements. 20 A complete list of industry-sector guidelines can be found at: www.ifc.org/ifcext/enviro.nsf/Content/EnvironmentalGuidelines Page | 52 Box 2. If less stringent levels or measures than those provided in the EHSG are appropriate, in view of specific project General EHSG circumstances, a full and detailed justification for any 1. Environmental proposed alternatives is needed as part of the site-specific 1.1 Air Emissions and Ambient Air environmental assessment. This justification should Quality demonstrate that the choice for any alternate performance 1.2 Energy Conservation levels is protective of human health and the environment. 1.3 Wastewater and Ambient Water When host country regulations differ from the levels and Quality measures presented in the EHSG, projects are expected to 1.4 Water Conservation achieve whichever is more stringent. 1.5 Hazardous Materials Management 1.6 Waste Management For this project, the WHO and the World Bank Group EHSG for Healthcare Facilities are directly relevant. Additionally, 1.7 Noise the World Bank Group General EHSG have important 1.8 Contaminated Land provisions which are applicable to various components of the proposed project namely hazardous waste management, 2. Occupational Health and Safety occupational health and safety (against biological and 2.1 General Facility Design and chemical hazards), community health and safety during Operation project operation, rehabilitation and decommissioning 2.2 Communication and Training 2.3 Physical Hazards works. Finally, the EHSG for Retail Petroleum Networks may 2.4 Chemical Hazards also have useful information for the project’s activities with 2.5 Biological Hazards respect to vehicles since retail petroleum networks may provide limited vehicle repair and servicing. 2.6 Radiological Hazards 2.7 Personal Protective Equipment (PPE) The Project will apply the General Guidelines, including (i) 2.8 Special Hazard Environments Environmental, (ii) Occupational Health and Safety, (iii) 2.9 Monitoring Community Health and Safety [with Life and Fire Safety (L&FS)] and (iv) Construction and Decommissioning, those for 3. Community Health and Safety Health Care Facilities (2007) as well as the EHSG for Retail 3.1 Water Quality and Availability Petroleum Networks. All buildings programmed for 3.2 Structural Safety of Project installation or renovation activities accessible to the public Infrastructure should be planned, executed, and operated in full 3.3 Life and Fire Safety (L&FS) compliance with Zimbabwe Model Building By-Laws of 1977. 3.4 Traffic Safety Other EHSGs may prove relevant during project 3.5 Transport of Hazardous Materials implementation. 3.6 Disease Prevention 3.7 Emergency Preparedness and Response 4. Construction and Decommissioning 4.1 Environment 4.2 Occupational Health and Safety 4.3 Community Health and Safety Page | 53 2.7 Gap Analysis 2.7.1 Zimbabwean Legislation and Applicable World Bank Environmental and Social Standards This section presents the gap analysis between the Zimbabwean Legislation and applicable World Bank ESSs. This gap analysis specifies aspects where there are gaps between national and international standards, analyses the gap and states actions to be undertaken by the HSDSP regarding these aspects. Table 2-10 Gap Analysis - Zimbabwean Legislation and applicable WB Environmental, Health and Safety Guidelines Page | 54 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP 1. ESS1- Assessment and Management of Environmetal and Social Risks 1.1 EA Process ESS1- Assessment and The Environment Management Act There are no significant gaps Screening of key Management of (CAP 20:27) of 2012 defines the between the ESS and national environmental and social Environmental and environmental management laws. risks and impacts of the Social Risks outlines principles for the country, including The EMA Act and WB ESSs project activities must Bank requirements for the consideration of people and their both require Environmental always be undertaken and the assessment and needs. It sets out environmental and Social Assessment appropriate mitigation management of standards that should be complied however national laws do not measures identified, as laid environmental and with, including waste management require as much detail on out in this ESMF. social risks of Bank- and hazardous substances social issues that WB ESS The project will use the financed projects. The management. require. The screening process ESMF, SEP and potentially funding recipient, in The Environmental Impact is different since EMA uses a future instruments to this case GoZ, is Assessment Policy (1997) guides the prescriptive list while the WB guide management of responsible for implementation of environmental uses a screening guideline. So, social issues not required environmental and impact assessments and was designed it is possible for some projects by the EMA Act. social assessment and to attract environmentally responsible that may not be in the EMA If a project activity has management; hence, it investment and development in prescribed list, to require ESIA adverse impacts, an ESMP is responsible for this Zimbabwe; maintaining the long-term from the WB required must be developed and ESMF. The funding ability of natural resources to support screening process or vice submitted to PIE for recipient undertakes human, plant and animal life; avoid versa. review. environmental and irreversible environmental damage Therefore, the screening This Project will apply the social screening of each and minimize such environmental process need to be merged as ICWMP waste and IPC proposed activity to damage where it cannot be avoided; follows: requirements as major Page | 55 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP determine the conserving broad diversity of plants, • If a project activity’s ESIA is mitigation measures. appropriate extent and animals and ecosystems and the prescribed by EMA while Depending on the type of mitigation. natural processes that they rely on; WB does not, ESIA will be screening outcomes, some Assessment is initiated conserving the social, historical and done. project activities may as early as possible in cultural values of people and their • If WB requirements for require site-specific project processing and communities; meeting the basic needs screening require ESIA ESMPs. is integrated closely of people affected or likely to be while EMA did not with the economic, affected by development proposals, prescribe the project for financial, institutional, including food, water, shelter; health ESIA, ESIA will be social, and technical and sanitation. conducted. analyses of all The first schedule of the Act stipulates For all assessment and proposed projects. the activities that are prescribed for management activities, in full environmental impact case of a conflict between assessments (EIA). This includes national and international drainage and irrigation, forestry, and requirements, the most water supply. stringent requirements will prevail unless local conditions or other agreed criteria make it unnecessary or impossible. 1.2 Project Screening and Categorization The World Bank The Zimbabwe legislation classifies The Bank requires that all Therefore, ZCEREHSP will requires that all projects and activities into three types projects be screened, and the use the environmental and projects financed by as follows: requisite environmental social screening process as the Bank are screened Type 1: listed in the Schedule, have assessment work be carried described in this report for their potential significant adverse impacts, projects out based on these screening Page | 56 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP environmental and require a full EIA. results. To ensure that future social impacts to Type 2: listed in the Schedule, less small-scale project activities determine the significant impacts, easy to predict. are implemented in an appropriate extent and Mitigatable, do not require a full EIA. environmentally and socially type of environmental Type 3: not listed in the Schedule, sustainable manner the work. The Bank unlikely to cause any significant project has developed an classifies proposed impacts, do not require any additional environmental and social projects into one of environmental assessment. screening process for small four categories as scale project activities with follows: WB ESF ESS1 High Risk, Substantial High risk and substantial risk Risk, Moderate Risk or project as per WB Low Risk. In classification are equivalent of determining the Zimbabwe’s Type 1 projects appropriate risk where the projects are classification, relevant classified as having significant issues are considered impacts. Moderate risk (WB such as the type, classification) and Type 2 location, sensitivity, projects in Zimbabwe have and scale of the less significant impacts and project; the nature and are predictable and magnitude of the mitigatable. In Zimbabwe, potential Projects under Type 3 environmental and category are not listed in the social risks and Schedule and are unlikely to impacts; and the cause any significant capacity and environmental impact and commitment of GoZ to thus do not require any Page | 57 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP manage the additional environmental environmental and assessment. social risks and impacts The Zimbabwe EA screening in a manner consistent procedures uses a prescriptive with the ESSs. The list while the WB ESF has a classification of a screening guideline. So, it is project can change possible for some projects throughout project that may not be in the EMA implementation. prescribed list, to require ESIA Changes in the from the WB screening classification of a process or vice versa. project will be disclosed on the Bank’s website. 1.3 Environmental and Social Management Framework (ESMFs) The World Bank The Zimbabwe legislation has no There is no provision for The project will use the recommends the use of provision for screening of project screening of project activities ESMF as a guiding tool for an ESMF as the form of activities where the sites and potential where the sites and potential assessment and the required adverse localized impacts cannot be adverse localized impacts management of Environmental and identified prior to the appraisal of the cannot be identified prior to environmental and social Social Assessment project. the appraisal of the project in risks and impacts where the sites and Currently the country has no law or Zimbabwe. associated with the potential adverse control guidelines on e-waste- Unavailability of e-waste laws project. Project activity localized impacts management in Zimbabwe. and regulation makes it risks will be evaluated once cannot be identified difficult for the existing sites and activities have Page | 58 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP prior to the appraisal of regulatory institutions to been identified and the project. police e-waste management selected. effectively. The project will use the project ESMF as a guiding instrument for risk assessment and management for risks and impacts associated with the project. 1.4 Environmental and Social Management Plans (ESMPs) The World Bank In addition to EIS for category 3 No provision for further EA ESMPs will be prepared for requires ESMPs for projects, in the EMA Act, no other work in Zimbabwean project activity as and each set of activities plans are prepared. Legislation. when required and will (e.g., project activities) include specific mitigation, that may require monitoring and specific mitigation, institutional measures to monitoring and be taken during institutional measures implementation to be taken during implementation 2 ESS2 Labour and Working Conditions Page | 59 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP The World Bank Factories and Works Act (CAP 14:08) National legislation only The project has adopted requires promotion of OF 1996 (S.I 168 of 2004) The Act aims protects formally contracted the higher standards in safety and health at at reducing occupational accidents, by workers. While minimum ESS2 and addresses the work, fair treatment prescribing a comprehensive safety wage is provided in legislation gaps in the LMP, which and equal and health management system is there is a lack of includes measures to opportunities, with an required at all workplaces. enforcement. address OHS risks, emphasis on including applying hte Labour Relations Act (1984). Sets out There have been prior bans project ICWMP and WHO protection of freedom of association, collective on protects and limitations on guidelines. The LMP also vulnerable workers, bargaining, and industrial relations. the ability to organise addresses workers’ safety respect for labour Labour Relations (Specification of collectively. in relation to road traffic organising and ability Minimum Wages) Notice from 1996 safety hazards, GBV/ for workers to raise sets out minimum wages. SEA/SH, poor working concerns in the conditions, risk of COVID- workplace. ESS2 19 transmission at work requires measures to places. prevent all forms of forced labour and child The project has a basic and labour. responsive grievance redress mechanism (GRM) that will allow all workers to quickly inform their immediate management of labour issues. 3 ESS3 Resource Efficiency and Pollution Prevention and Management The World Bank Environment Management Act (CAP In accordance with the WB It is anticipated that the requires the 20:27) of 2002 EHSGs, the project will follow ZCEREHSP activities will Page | 60 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP prevention of all forms The Act sets out environmental GoZ air pollution laws and generate medical and of pollution and the standards that should be complied policies. The GOZ has in place some minor waste from management of any with, including waste and hazardous emissions standards for equipment installation. waste generated substance management. It utilizes incinerators and motor The Project will thus through the the following statutory instruments: vehicles. ensure appropriate waste implementation of the The Environmental management and ESMPs. Projects should i) Statutory Instrument 6 o f Management act (Chapter pollution prevention promote the 2007 (water pollution control 20:27) and Atmospheric measures in all activities sustainable use of and waste management.) Pollution Control regulations and will be fully compliant resources, including The instrument defines the (Statutory Instrument 72) of with WB requirements energy, water, and raw EMA water pollution control and 2009 provide for the and the National Laws. materials. waste management objectives. prevention of control and Contractors will be ii) Statutory Instrument 12 of 2007 abatement of air pollution to required to prepare waste (Hazardous Substances, ensure clean and healthy management plans. Any Pesticides and Toxic Substances environment. The Statutory health facilities receiving Regulations) Instrument 72 of 2009, covers project support will also This statutory instrument defines pollution from static sources be required to prepare an the provisions and standards of (such as incinerators) as well ICWMP for their individual handling Hazardous Substances, mobile sources (motor facility before receiving Pesticides and Toxic Substances. It vehicles). Incinerators need to support. also stipulates the procedures to be registered by EMA to allow ZCEREHSP goes beyond be followed when there is an for coordinated monitoring as compliance with ESMAP accidental spillage of the well as receiving guidance and grant and GFF grant will substance. In addition, any person advice on best practices. EMA support energy efficient whose substances affect the also monitors motor vehicle investments such as a cold environment are liable to pay for emissions. Point source chain system and the cost of restoring the monitoring regulations do not transport systems such as environment. require motor vehicles to be solar powered tricycles Page | 61 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP i i i ) The Zimbabwe National licenced for emissions but that will rely on Sanitation and Hygiene Policy vehicles maybe be stopped at sustainable energy (2017) roadblocks for the purposes of sources whenever The Policy sets out safe or hygienic testing these emissions. practicable. separation of human excreta and The GOZ through the Ministry Vehicles supported by the other waste from human contact. of Energy is in the process of project will meet the It covers processes and behaviours for developing the National national emissions level establishing and managing domestic Energy Efficiency Policy. The requirements discussed in and workplace and public facilities main goal of the policy is to section 3.4.1. Additionally, necessary for waste or excreta encourage the adoption of ZCEREHSP will follow the containment, collection, treatment, energy efficiency strategies. EHSG: Air Emissions and and disposal This is a sub policy developed Ambient Air Quality The Public Health Act (Chapter 15:17) under the overall framework guidance on The Public Health Act (CAP 15:17) has of the National Energy Policy environmentally friendly sections that deal with sanitation and of 2012. The other subsidiary vehicle maintenance buildings (housing). The Act prohibits policies laid out under the practices. creation of nuisance. The act looks at same are the National how actions of others may end up Renewable Energy Policy of affecting the health of the public. Case 2019 and the Biofuels Policy of in point is the air, water and land 2020. pollution which consequently leads to lung and other respiratory diseases. Dangerous Drugs Control Act (Chapter 15:02) This Act controls the importation exportation, production, sale, and distribution and use of dangerous drugs, thus protecting people from Page | 62 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP direct ill health and poisoning from the dangerous drugs and ultimately pollution of the environment from the disposal of these drugs. 3.1 Managing Emergency Situations The World Bank SI 76 of 2020 Both the Zimbabwean The project is a response to requires the borrower Civil Protection (Declaration of State Legislation and the WB the current COVID-19 Environmental and of Disaster: Rural and Urban Areas of directives make provisions for pandemic emergency Social Assessment to Zimbabwe) emergency situations. So, whilst delivering essential analyse the risk of This SI under the Civil Protection Act there is no gap between the health services, emergency situations allows the civil protection authorities two. particularly RMNCAHN. In and to manage them if to use the special powers available to compliance with ESS4, this relevant in the ESMP. them under the Act to respond to a ESMF (including the declared state of disaster. The ICWMP) will describe any declaration places the whole country emergency preparedness in a state of disaster with effect from and response (EPR) the promulgation of this notice. measures which should Currently the country has not been address a plan for declared to be in a state of national safe cold disaster. However, this may change chain management from depending on the progression of during power outages or a the COVID-19 pandemic and other disaster (Appendix 16). emergency situations. SI 77 of 2020 to SI 103 of 2020 Page | 63 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP Public Health (COVID-19) Prevention, Containment and Treatment) Regulations, 2020 These regulations were made by the Minister of Health and Child Care under the “new� Public Health Act of August 2018. The Act gives the Minister wide powers to legislate measures to prevent, contain and treat the incidence of “formidable epidemic diseases�. As a new virus, COVID-19 was not on the existing list of “formidable epidemic diseases� in section 64 of the Public Health Act. It was, therefore, necessary for the Minister of Health and Child Care to make it a “formidable epidemic disease� by a declaration in a statutory instrument under the same section. Section 3 of these regulations contains that declaration called the “FED declaration�, and by way of this SI the Pandemic is handled. 4 ESS4- Community Health and Safety Page | 64 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP ESS4 recognises that Medicines and Allied Substances There are provisions in the All vaccines to be project activities, Control Act (Chapter 33:10) Zimbabwean laws on COVID- introduced in the country equipment and The Act provides for the establishment 19 prevention, containment are subject to approval by infrastructure can of the Medicines Control Authority of and treatment, licensing of MCAZ. increase community Zimbabwe (MCAZ), which is drivers of motor vehicles and The project will support exposure to risks and regulatory board mandated to motor vehicles, testing of the vaccine deployment impacts, including approve and register all medicines to safety and efficacy of vaccines activities for vaccines on GBV/SEAN/SH, disease be introduced in the country. and related medical products WHO emergency use transmission and pose The Act provides for the registration before use. Gaps exist on listing which will promote security risks. In and approval of all medicines to be Emergency preparedness and community health. addition, the introduced in Zimbabwe. Response measures related to The ESMF (including the communities are cold chain storage in case of ICWMP) will provide already subjected to Public Health Act (Chapter 15:17) power outages or natural measures to address the impacts of climate The Act deals with emergency disasters. safety of equipment, change. situations and epidemics such as safety of services related The use of the Military COVID-19. It sets out provisions for to health care facilities or or Security Personnel is prevention and control of a vaccination sites to not currently formidable epidemic disease. It also vaccinate target envisioned for any empowers the Minister responsible population (including activities related to the for Health to make regulations COVID-19 risk reduction Project. regarding prevention and practices), vaccine roll containment of such diseases. out, medical waste The Act also provides for the management, emergency development of health care waste preparedness and management strategies response measures with a plan to address cold chain SI 108 of 2020- Public Health (COVID- storage during power 19 prevention, containment and outages or natural Page | 65 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP treatment) (Amendment) disasters (see Appendix regulations, 2020 16). The regulations make screening and The project will ensure testing mandatory. that vehicle drivers are Persons who are essential services appropriately licensed should be tested regularly and and trained and that sanitisers, handwashing facilities vehicles are properly should be provided in all office and serviced in an workstation entrances environmentally sustainable way and Road Traffic Act maintained to ensure the The act provides for the licensing of health and safety of drivers and motor vehicles to ensure passengers and the public safety of the passengers and the from emissions, accidents public. and other pollution. Contractor’s workers must sign and adhere to the Project Code of Conduct and associated training will be provided to prevent OHS incidents as well as SEA/GBV/SH cases. The GRM provides a GBV sensitive reporting approach for potential survivors. Page | 66 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP 5. ESS5- Land Acquisition, Restrictions on Land Use, and Involuntary Resettlement The ESS5- Land The Zimbabwe Legislation that caters There are significant gaps in Where ESS5 impacts are is Acquisition, for involuntary displacements is the due process issues related to identified in the screening, Restrictions on Land “Land Acquisition (Disposal of Rural land acquisition in Zimbabwe. the project approach will Use and Involuntary Land) Regulations 1999� be to apply the provisions Resettlement standard People can easily be resettled of the specifically covering covers direct economic Subject to these regulations, the to make way for projects restrictions and livelihoods and social impacts that owner of any rural land, other than without due compensation. impacts both result from Bank- the State, a local authority, or a assisted investment statutory body, shall not sell the land The Zimbabwean projects, and are unless he has offered to sell it to legislation does not affect caused by (a) the the Minister and the implementation of the involuntary taking of i) If the owner of any rural land project since there is no land resulting in (i) which was the subject of an offer potential for resettlement. relocation or loss of in terms of section 3 rejects a shelter; (ii) loss of price proposed by the Minister The project will not assets or access to in terms of subsection (4) of support activities that assets, or (iii) loss of section 5, the Minister shall, require resettlement, and income sources or within ninety days after being all livelihoods will be means of livelihood, notified of the rejection, protected in accordance whether or not the commence negotiations with with ESS5 affected persons must the owner regarding the price to move to another be paid by the President for the location; or (b) the rural land concerned. involuntary restriction ii) If negotiations referred to in of access to legally subsection (1) conclude without designated parks and an agreement being reached on Page | 67 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP protected areas the price to be paid for the rural resulting in adverse land concerned, the Minister impacts on the shall, within forty-five days after livelihoods of the the conclusion of the displaced persons.. negotiations, issue the owner of the land with a certificate of no present interest; or notify the owner, in writing, that it is intended to acquire the land compulsorily in terms of this Act; or to resume ownership of the land in terms of any condition in the land’s title deed. iii) Negotiations shall be deemed to have concluded without agreement for the purposes of subsection (2) if no agreement is reached on the price payable for the rural land concerned within fourteen days from the commencement of the negotiations. 6 ESS7 - Indigenous Peoples/ Sub-Saharan African Historically Underserved Traditional- Local Communities Page | 68 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP ESS7 provides guidance The Government of Zimbabwe does There are significant gaps in Because the Zimbabwean to ensure that not identify any specific group as the Zimbabwean Legislation Legislation does not indigenous peoples indigenous, arguing that all (which argues that there are provide special protection benefit from Zimbabweans are indigenous peoples. no indigenous peoples) and for IPs. The project will development projects, the provisions of the World apply the provisions of the and to avoid or However, there are two peoples who Bank’s Indigenous Peoples/ World Bank’s ESS7- mitigate adverse self-identify as indigenous in Sub-Saharan African Indigenous Peoples/ Sub- effects of Bank- Zimbabwe; these are the: Historically Underserved Saharan African financed development i) Tshwa (Tyua, Cuaa) San, who Traditional- Local Historically Underserved projects on indigenous are found in the Tsholotsho Communities Standard which Traditional Local peoples. Measures to District of Matabeleland North gives guidance on how to Communities standard, address issues Province and the Bulilima- involve the IPs. whenever it encounters pertaining to Mangwe District of the IPs in the screening indigenous peoples Matabeleland South Province procedures through must be based on the in western Zimbabwe. special measures informed participation ii) Doma (Wadoma, Vadema) of contained in the IPPF. of the indigenous Chapoto Ward in Guruve people themselves. District and Mbire District of Project activities that Mashonaland Central Province would have negative and Karoi District of impacts on indigenous Mashonaland West Province in people will not be the Zambezi Valley of northern funded under the Zimbabwe. proposed project. 7. ESS8-Cultural Heritage Page | 69 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP Cultural Heritage Zimbabwe uses National Museums There are no significant gaps There are no envisaged (ESS8): The Bank’s and Monuments Act (CAP 25:11) to between the provisions of the impacts on any cultural general guidance protect Cultural Property World Bank’s ESS8 and heritage sites under the regarding cultural The Act protects all areas of Zimbabwe’s National Project since project sites property is to assist in archaeological, historical, Museums and Monuments are already existing their preservation, and architectural, geological, and Act (CAP 25:11). However, the facilities which would likely to seek to avoid their paleontological value or scientific national legislation does not have already uncovered elimination. interest. Such sites cannot be cover intangible heritage. any physical cultural Specifically, the Bank (i) altered, excavated, or damaged and resources. However, the normally declines to material on them cannot be removed Project may encounter finance projects that without the written consent of the cultural findings will significantly Executive Director of the National unexpectedly. If this damage non-replicable Museums and Monuments of occurs, the project will cultural property and Zimbabwe. The law requires that proceed according to the will assist only those any monument or relic discovered provisions of the Chance projects that are sited must be reported in writing to the Find Procedures outlined or designed so as to Executive Director of the National in this ESMF. prevent such damage; Museums and Monuments of The management of and (ii) will assist in the Zimbabwe by the discoverer and cultural heritage of a protection and the owner of the land on which it is country is the enhancement of found. responsibility of the cultural properties government. The encountered in Bank- government’s attention financed projects, should be drawn rather than leaving specifically to what is that protection to known about the cultural chance. property aspects of the Cultural heritage proposed project site and Page | 70 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP encompasses tangible appropriate agencies and intangible heritage (NMMZ), NGOs, or which can be university departments recognised and valued should be consulted; if at local, regional and there are any questions national level. concerning cultural property in the area, a brief reconnaissance survey should be undertaken in the field by a specialist. The project will apply the requirements of ESS8 on Cultural Heritage. The proposed project will not fund project activities that will have negative impacts on cultural property. 8. ESS 10 Stakeholder Engagement and Information Disclosure This ESS recognises the Environmental management (EIA and While the Act spells out right Upon completion of ESA importance of Ecosystems Protection) regulations, to information held by public reports, these must be: transparent 2007 bodies, the Bank recognizes • circulated for written engagement between The regulation provides for the the importance of open and comments from the the GOZ and the conduction of environmental impact transparent engagement vis- various agencies and project stakeholders. assessment, stakeholder engagement, à-vis project stakeholders by government agencies. the borrower. The act also Page | 71 RECOMMENDED ACTION No. WORLD BANK ESS ZIMBABWE LEGISLATION GAP ANALYSIS IN ZCEREHSP Effective stakeholder the production and disclosure of such provides for voluntary • notify the public of the engagement can reports by project developers. disclosure of information held place and time for its improve Freedom of Information Act (Chapter by them. review; and environmental and 33:10) • solicit oral or written social sustainability of The act gives effect to section 62 of comments from those project, enhance the Constitution of Zimbabwe which affected. project acceptance and provides for the right to access The project stakeholder make meaningful information as enshrined in the engagement processes are contribution to declaration of rights. described in the project successful project It sets out procedures for access to Stakeholder Engagement design and information held by public institutions Plan implementation or information held by any person. It WB requires ESA also sets out considerations for reports making available on a voluntary basis • to be disclosed for by entities, certain categories of written comments information thereby removing the • notify the public of need for formal request for such the time and place information of its review It also sets out the scope and • solicit oral and limitations on the right of access to written comments information from those affected. Page | 72 3.0 Environmental and Social Baselines 3.1 Project Baseline Information Zimbabwe is endowed with diverse natural resources, which include highlands, forest, and water resources, which accommodate diverse species of flora, fauna, and fish resources. However, these resources are under immense pressure from a complex interaction of several factors which include general development, over abstraction, unsustainable land use and climate change. The following paragraphs review some of the country’s key social, environmental, and natural resources such as demography, economy, nutrition, gender, land ownership, land resources, atmospheric resources, biological resources, and water resources as well as the health-related issue. 3.2 Site Visits and Workshop Discussion Because of the current limitations imposed by the COVID-19 Pandemic, full-scale site visits could not be conducted. The strategy that was applied included the following: • Limited site visits: – Mashonaland East, Harare, Bulawayo, Matabeleland South, and Matabeleland North were sampled for site visits. – In each province a central hospital, Provincial Hospital, District Hospital, Clinic, COVID designated Hospital, Isolation Centre, etc., were visited and staff at different levels interviewed. – Also participating ministries and Agencies like Ministry of Local Government and the Environmental Management Agency (EMA) were also visited. – As the situation allowed, face to face interviews, completion of Questionnaires and focus group meetings were conducted. • Several Virtual Zoom Meetings were made with some of the key stakeholders like MoHCC management, EMA Head office, etc. • All key stakeholders in MoHCC, participating Ministries, and Agencies were surveyed using an electronic questionnaire. Appendix 9 outlines the stakeholder engagement process and the stakeholders who were engaged. 3.3 Analysis of Baseline Environmental Data Baseline environmental data was readily available from literature and the internet. This data was compiled with the purpose of describing and evaluating the current environmental status of the Project area, which happens to be national. The baseline information included environmental information relevant to all Project components, drawing on existing information from Projects in the targeted areas. The description of the baseline environment was based on the bio-physical status of the country covering: (i) topography, (ii) geology, (iii) geomorphology, (iv) hydrology, (v) hydrogeology, (vi) soils, (vii) climate, (viii) ecosystem status, (ix) Natural hazards, Page | 73 3.4 Biophysical Environment 3.4.1 Topography Zimbabwe is a landlocked country in southern Africa lying well within the tropics. Much of the country is high plateau with the higher central plateau (high veldt) forming a watershed between the Zambezi and Limpopo River systems. The extensive high plateau drops northwards to the Zambezi valley where the border with Zambia is and similarly drops southwards to the Limpopo valley and the border with South Africa. The Limpopo and the lower Zambezi valleys are broad and relatively flat plains. The eastern end of the watershed terminates in a north-south mountain spine, called the Eastern Highlands. Figure 3-1 Topography of Zimbabwe About 75% of the country is semi-arid, with low and sporadic rainfall, which makes it prone to unpredictable droughts. Land use varies from intensive cropping to extensive cattle ranching, subsistence and small-scale agriculture, wildlife production, and mineral extraction. Approximately 60% of the country’s 14.9 million people live in rural areas. About 49% of the total land area is under forests and woodlands while 27% is cultivated. The former contains a wide range of fauna and flora that includes 4,440 species of plants, 270 mammals, and 532 bird species. Biodiversity is found in all the country’s land categories-namely state, communal and private lands. The country’s ecosystems are formally protected under six categories of protected areas as follows: 11 national parks, 6 gazetted forests, 14 botanical reserves, 3 botanical gardens, 16 safari areas and 15 recreational parks and sanctuaries. National parks and gazette forests constitute 13% and 3% of the country’s land area, respectively. Page | 74 The country is mostly savannah, although the moist and mountainous eastern highlands support areas of tropical evergreen and hardwood forests. Trees found in these Eastern Highlands include teak, mahogany, enormous specimens of strangling fig, big leaf, white stinkwood, chirinda stinkwood, knob thorn and many others. In the low-lying part of the country fever trees, mopane, combretum and baobabs abound. Much of the country is covered by miombo woodland, dominated by bracgystegia species and other. Among the numerous flowers and shrubs are hibiscus, flame lily, snake lily, spider lily, leonotus, cassia, tree wisteria and dombeya. 3.4.2 Climate The climate of Zimbabwe is tropical, although altitude and relief greatly affect both temperature and rainfall. There is a dry season, including a short cold season during the period May to September when the whole country has little rain. The rainy season is typically a time of heavy rainfall from November to March. The summer rainy season lasts from November to March. It is followed by a transitional season, during which both rainfall and temperatures decrease. The cool, dry season follows, lasting from mid-May to mid- August. Finally, there is the warm, dry season, which lasts until the onset of the rains. The whole country is influenced by the Intertropical Convergence Zone during January. In years when it is poorly defined, there is below average rainfall and a likelihood of serious drought in the country (as happened in 1983 and 1992). When it is well-defined then rainfall is average or well above average, as in 1981 and 1985. Figure 3-2 Zimbabwe Natural Regions 3.4.3 Climate Change Zimbabwe is dealing with significant climate change. Global Climate Models (GCM) indicate that most of Southern Africa, including Zimbabwe, is likely to experience higher temperatures (2-40C higher than the 1961-1990 baseline) in the coming decades, but the picture for rainfall is less clear. While average annual rainfall appears to have changed little over the last 50 years, adverse weather conditions have been increasing with droughts and floods having become more frequent and severe and the onset of the rains less dependable. Zimbabwe ranks 9 out of 16 countries (Angola, Botswana, Comoros, Democratic Republic Page | 75 of Congo, Eswatini, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, United Republic Tanzania, Zambia and Zimbabwe) on the Climate Change Vulnerability Index (CCVI). Climate models predict that Zimbabwe’s climate will be warmer than the 1961-1990 baseline with warming rates of 0.5-2oC by 2030. The climate change predictions for Zimbabwe are that the country will become hotter and drier, with an increase in violent storms. Floods are thereby the most frequent and dangerous hazard for the country, mostly hitting the northern and south-eastern lowlands (along the path of cyclones). The El Nino phenomenon has had ample impacts in the past, an estimated 4.1 million people in Zimbabwe experienced food insecurity in 2016 due to the phenomenon. 3.4.4 Geology The geology of Zimbabwe in southern Africa is centred on the Zimbabwe Craton, a core of Archean basement composed in the main of granitoids, schist and gneisses. It also incorporates greenstone belts comprising mafic, ultramafic and felsic volcanic which are associated with epiclastic sediments and iron formations. The craton is overlain in the north, northwest and east by Proterozoic and Phanerozoic sedimentary basins whilst to the northwest are the rocks of the Magondi Supergroup. Northwards is the Zambezi Belt and to the east the Mozambique Belt. South of the Zimbabwe Craton is the Kaapval Craton separated from it by the Limpopo Mobile Belt, a zone of deformation and metamorphism reflecting geological events from Archean to Mesoproterozoic times. The Zimbabwe Craton is intruded by an elongate ultramafic/mafic igneous complex known as the Great Dyke which runs for more than 500 km along an SSW/NNE oriented graben. It consists of peridotites, pyroxenites, norites and bands of chromitite (Wilson, 1979; Cahen et al, 1984). Page | 76 Figure 3-3 Geological map 3.4.5 Hydrology The country is divided into six drainage basins. The largest are the Zambezi and the Limpopo. Western parts of Matabeleland connect to the Okavango inland drainage basin through the Nata River. Most of the southern Mashonaland and adjacent parts of Masvingo drain through the Save River into the Indian Ocean. Two smaller drainage basins cover parts of Manicaland and drain into the Indian Ocean through Mozambique. These are the Pungwe River to the north and the Buzi River to the south. 3.4.6 Flora and Fauna The wildlife of Zimbabwe is mostly located in remote or rugged terrain in the national parks and private wildlife ranches; it is spread over the landscapes of miombo woodlands and thorny acacia or kopje. In the Rural areas the wildlife populations are drastically reduced due to the presence of large human populations. Natural vegetation varies with soil-type and hence influenced by geology to a certain extent. Other factors influencing vegetation type include climate, drainage conditions, altitude, and topography. The prominent wild fauna members which inhabit this landscape include hippopotamus, buffalo, elephant, leopard, lion, rhinoceros, baboon, okapi, giraffe, kudu, sable, zebra, warthog, porcupine, badger, otter, hare, and many more. In all, there are around 350 species of mammal. Snakes and lizards abound. The largest lizard, the water monitor, is found in many rivers, as are several species of crocodile. More than 500 species of birds like the ant-thrush, barbet, bee-eater, bishop bird, Page | 77 bulbul, bush-warbler, guinea fowl, emerald cuckoo, grouse, gray lourie, and pheasant. No insect species of conservation interest has been identified. 3.4.7 Road Network The figure below shows the road network in the country. The road network connects the national capital with provincial capitals, towns and growth points and other service centres in the country. About 5% of the road network in Zimbabwe is classi�ed as primary roads forming the major links to all major destinations within the country and outside. Some 14% of the network is classi�ed as secondary roads that link the main economic centres within the country, enabling internal movement of people and goods. The primary and secondary roads are collectively referred to as the trunk road system; they carry over 70% of the vehicular traf�c (measured in vehicle kilometres) and they are managed by the Department of Roads (DoR). A little more than 70% of the network is made up of tertiary feeder and access roads that link rural Figure 3-4 Zimbabwe Road Network areas to the secondary road network. These are managed by the District Development Fund (DDF) and by the District Councils (DC). The tertiary access roads, together with the unclassi�ed tracks, typically with traf�c volumes below 50 vehicles per day, provide for the intra-rural access movements. They link rural communities to social economic amenities, such as schools, health centres, and markets, and enable government services to reach rural areas. These will be important in the implementation of the projects both for being rehabilitated themselves and access to other Project sites. Figure 3-5 An example of a rural gravel untarred road 3.4.8 Natural Hazards Page | 78 Zimbabwe has endured various natural hazards including droughts, epidemic diseases, floods, and storms over the past century. From 1900 to 2017, the country encountered 7 drought events, 22 epidemic episodes, 12 floods, and 5 storms, which resulted in total deaths of roughly 7000 people, with more than 20 million people affected, and total damage of $950 million USD. The number of total people affected and economic loss caused by droughts have been observed to increase considerably. Epidemic diseases, particularly bacterial and parasitic types, contribute to significant portion of total deaths and total affected people by natural hazards. Floods are strongly associated with total economic loss. The country has experienced several riverine floods. During the same time period, 9 riverine floods are accounted, affecting over 300 thousand people, killing over 270 people and leading to above $270 million monetary loss. Zimbabwe is one of the six countries where the poor are overexposed (or 50% more likely) to be flooded than nonpoor people21. To mitigate and prepare for these and other hazards facing Zimbabwe, the Government of Zimbabwe (GoZ) created the Department of Civil Protection and charged it with the onus of coordinating and managing disasters and reducing hazards. 3.5 Socio-economic Environment The following is an outline of the social context within which the project is being designed. It covers the population and economic settings of the country: 3.5.1 Demography The population of Zimbabwe has grown during the 20th century in accordance with the model of a developing country with high birth rates and falling death rates, resulting in relatively high population growth rate (around 3% or above in the 1960s and early 1970s). After a spurt in the period 1980-1983 following independence, a decline in birth rates set in. Since 1991, however, there has been a jump in death rates from a low of 10 per 1000 in 1985 to a high of 25 per 1000 in 2002/2003. It has since subsided to just under 22 per 1000 (estimate for 2007) a little below the birth rate of around 27 per 1000 (CIA 2007). The high death rate is a result of poor medical facilities. This leads to a small natural increase of around 0.5%. Deaths due to HIV/AIDS have reduced due to improved methods of protection. However, the effects of the current pandemic are yet to be quantified. Based on the 2019 revision of the World Population Prospects, the population of Zimbabwe was estimated by the United Nations at 14,438,802 in 2018. About 38.9% comprised youths under 15, while another 56.9% grouped persons aged between 15 and 65 years. Only around 4.2% of citizens were apparently over 65. Figure 3-2 below illustrates the population pyramid for Zimbabwe for 2017. (UNDESA, 2019) 21 Unbreakable: Building the Resilience of the Poor in the Face of Natural Disasters (2017) by Stephane Hallegatte, Adrien Vogt-Schilb, Mook Bangalore, and Julie Rozenberg Page | 79 Figure 3-6 Population pyramid of Zimbabwe in 2021, (Zimbabwe National Statistics Agency) 3.5.2 Zimbabwe Economic Outlook and Macroeconomic Performance GDP contracted by 12.8% in 2019 due to poor performance in mining, tourism, and agriculture. Foreign currency and electricity shortages affected mining and tourism. Agriculture shrank about 15.8% due to cyclone Idai in March 2019, prolonged drought, livestock diseases, and currency shortages reducing the availability of inputs. Despite a global mineral price recovery, production in Zimbabwe dropped below 2018 levels. Austerity measures through the Transitional Stabilization Program 2018–20 and attendant monetary reforms constricted economic activity. Any 2020–21 recovery would depend on quick turnaround in the real sector. In the medium term, however, fiscal, and monetary reforms are expected to stabilize the economy and begin to generate positive results. Following the February 2019 unpegging of the exchange rate from the US dollar and the June 2019 introduction of the new currency—the Zimbabwe dollar —the exchange rate deteriorated from 2.5 Zimbabwe dollars per US dollar in February 2019 to 20 Zimbabwe dollars per US dollar in November 2019. Inflation spiked from single digits in 2018 to more than 200% in November 2019, occasioned largely by the exchange rate movements and by shortages of basic goods, including fuel, foodstuffs, and electricity. The current account deficit, at 2.2% of GDP in 2019, put pressure on urgently needed foreign exchange and made enhancing exports critical. The budget deficit narrowed from 9.9% of GDP in 2017 to 5.6% in 2018 and 6.0% in 2019, mainly due to government measures, which include frozen public sector employment, reduced investment and consumption spending, better revenue mobilization, and restrictions on government borrowing and the issue of government securities. (AfDB, 2020). Public debt remains above the statutory target of 70% of GDP. In June 2019, external debt constituted 87% of the debt, estimated at $8 billion, of which about $5.9 billion (73.75%) was accumulated arrears. Multilateral institutions are owed $2.6 billion (31.25% of external debt). Bilateral debt amounted to $5.1 billion, with Paris Club creditors owed $3.5 billion and others owed $1.6 billion. More than 60% of the population falls below the poverty line, while income inequality remains high. Employment opportunities continue to dwindle. About 2 million people in the rural areas were food insecure in April–June 2019—expected to rise to 5.5 million in January–March 2020—with 2.0 million more Page | 80 affected in urban areas. This economic outlook has a serious bearing on the health situation in Zimbabwe as most people will not be able to afford or even access health services (AfDB, 2020). 3.5.3 Human Development Zimbabwe’s Human Development index (HDI) improved from 0.427 in 2000, to 0.522 in 2015, and to 0.535 in 2017 and to 0.563 in 2018 despite the decline in the country’s economic performance. This put the country in the medium human development category—positioning it at 150 out of 189 countries and territories. Between 1990 and 2017, Zimbabwe’s life expectancy at birth increased by 3.8 years, mean years of schooling increased by 3.6 years and expected years of schooling increased by 0.5 years. Zimbabwe’s GNI per capita decreased by about 29.3% between 1990 and 2017 (UNDP, 2019). Zimbabwe has amongst the highest HIV prevalence and maternal mortality rates in the region. The country’s high mortality and morbidity rates are a result of an under-resourced health delivery system, which is overstretched by the high burden of HIV, tuberculosis (TB), malaria, maternal and childhood illnesses and recently by the COVID-19 pandemic. A decade of worsening economic conditions and rising costs have eroded a once vibrant health system, which now functions largely due to donor assistance. The health sector has produced notable results in the areas of HIV; TB; malaria; maternal, new-born and child health (MNCH); and family planning/reproductive health (FP/RH). The national response to the HIV epidemic has scaled up prevention and treatment interventions, resulting in an estimated 290,000 lives saved through antiretroviral treatment (ART) since 2009 and a 50% decrease in the number of new HIV infections over the last ten years. The TB treatment success rate increased from 67% in 2006 to 80% in 2015, which meets the National TB program objective and World Health Organization recommendations. Malaria incidence declined by 79%, from 136/1,000 in 2000 to 29/1,000 in 2015. Although the maternal mortality rate declined significantly from 960 deaths per 100,000 live births in 2010/11 to 614 deaths per 100,000 live births in 2014, this rate remains too high by regional standards. The contraceptive prevalence rate increased from 60% in 2006 to 67% in 2014. These are noteworthy gains given the general economic decline and political context and speak to the technical and financial support provided by the donor community. Sustaining these gains will require both continued donor engagement and collaboration with the Ministry of Health and Child Care (MOHCC) to improve the systems and implementation of policies that surround the delivery of health services. 3.5.4 Labour and Employment With regards to labour and employment, it is estimated that of 7 million economically active persons, approximately 11.3% are unemployed. The largest labour force at 52.3%, are ‘own account’ workers, being communal, peri-urban and resettlement farmers, working in agro-based businesses (UNDP, 2017). In Zimbabwe there are 1.6 physicians and 7.2 nurses for every 10000 people. In 2008, Zimbabwe implemented an Emergency Retention Scheme for the health sector with assistance from partners, which was felt to have somewhat stabilized the public health sector and has been credited with decreasing the number of resignations. Subsequently, a National Human Resources for Health Policy was developed to facilitate the optimum production, training, management and retention of health workers in the public health sector. Zimbabwe’s Human Resources for Health Strategic Plan, 2010 – 2014 (ZMOHCW, 2010), was then issued to operationalize this policy. In 2011, the government and external partners enacted Zimbabwe’s Health Transition Fund as a vehicle to reduce maternal and under-five mortality by abolishing user fees and supporting high impact interventions and health system strengthening. This 5-year pooled fund addressed four core elements, including specific measures to ensure retention of an adequate, skilled, and productive health workforce by providing satisfactory incomes and incentives, high-quality training and supervision, and adequate tools required for high quality care. Page | 81 3.5.5 Crime and Violence Crime, violence, and conflict are steadily increasing in the Zimbabwean communities due to dwindling livelihoods, increased poverty, and insecurity in general. In general, 35% of women in Zimbabwe experienced physical violence by the age of 15 and, 14% of women reported having experienced sexual violence during their lifetime (ZIMSTAT and ICF International, 2016). The effects of the current economic meltdown, compounded by the Pandemic Lockdowns have increased the vulnerabilities that exist for women, girls and other marginalized group’s exposure to crime and violence especially GBV/SEA. The unravelling of social fabric, as people are exposed to different stresses, can have ample effects on the traditional social protection systems. Where members of households have died or been injured, family-based protection systems may not be functioning anymore; or support through extended families may not be granted anymore, as many households have lost their livelihoods and assets. 3.5.6 Gender Equality and Women's Empowerment Women in Zimbabwe are under-represented in political decision-making, with their numbers in Parliament at 19%, far below the African Union and SADC target of 50%. Women are also disadvantaged in terms of health, with a high maternal mortality ratio at 960 per 100,000 live births. According to the 2011 Zimbabwe Demographic and Health Survey, 1 in 4 women reported that they had experienced sexual violence, and 1 in 3 women aged 15 to 49 have experienced physical violence since the age 15. The Project will benefit both men and women by reducing the risks of COVID-19. Based on both global and national trends of COVID-19 confirmed cases, men constitute around 60 percent of those afflicted with the disease while women comprise 40 percent. Furthermore, with families under quarantine, the incidence of domestic violence within a household can be expected to increase. As the Project addresses the effects of the pandemic across populations, it does not have a component dedicated exclusively for promoting women’s welfare in the communities and will not have a conscious preference over women beneficiaries while being implemented in various localities. However, the Project will ensure that both men and women are informed and consulted, and that gender-sensitive public information will be disseminated. It will also be sensitive to the needs of poor and vulnerable women who may not have access to information and health care. 3.5.7 Social Structure Bantu-speaking ethnic groups make up 98% of the population of Zimbabwe. The most populous people are the Shona, comprising 70% of the population. The Ndebele are the second most populous with 20% of the population. The Ndebele descended from Zulu migrations in the 19th century and together with other tribes with whom they intermarried on their way. Other Bantu ethnic groups make up the third largest with 2 to 5%: These are the Venda, Tonga, Shangaan, Kalanga, Sotho, Ndau, Nambya, Tswana, Xhosa and Lozi. Minority ethnic groups include white Zimbabweans, who make up less than 1% of the total population. White Zimbabweans are mostly of British origin, but there are also Afrikaner, Greek, Portuguese, French, and Dutch communities. There are two peoples who self-identify as indigenous in Zimbabwe; these are the Tshwa (Tyua, Cuaa) San, who are found in the Tsholotsho District of Matabeleland North Province and the Bulilima-Mangwe District of Matabeleland South Province in western Zimbabwe. The Doma (Wadoma, Vadema) of Chapoto Ward in Guruve District and Mbire District of Mashonaland Central Province and Karoi District of Mashonaland West Province in the Zambezi Valley of northern Zimbabwe. Page | 82 3.5.8 Social Protection Generally, Zimbabwe’s social protection system has been adversely affected by declining incomes, loss of livelihoods, and lack of economic opportunities. This has led to a general disintegration of social fabric with increasing levels of diseases such as HIV/AIDS. Households and communities have different opportunities at their disposal which they can use to deal with shocks and stressors they face. These include the following: • Formal social support – from government and NGOs, • Bonding Social Capital– support from other community members both relatives and nonrelatives, • Bridging Social capital - support from relatives and non-relatives leaving outside the community within Zimbabwe, • Informal safety net – support from churches and community groups, • Remittances – from outside Zimbabwe. Generally, the wellbeing of the general Zimbabwean has been sturdily decreasing as shown by the Food Consumption Patterns in Figure 4-7 below (FNC, 2019). • The proportion of households which were consuming an acceptable diet decreased from 55% in 2018 to 47% (2019), • The proportion of households consuming poor diets increased to 24% from 20% reported in 2018. This points towards deteriorating household food access, • Most of the households (53%) were consuming borderline to poor diets which is an 8 percentage points increase from the 45% in 2018 indicative of deteriorating food security status among the rural households. Figure 3-7 Food Consumption Patterns (FNC, 2019) 3.5.9 Coping strategies Table 3-1 outlines the Livelihood Coping Strategies that a household can employ. Zimbabwe as a Nation scored 5.7 on the Coping Capacity Index, indicating ‘lack of coping capacity’ (UNDP, 2017). Reasons cited for this are infrastructure and institutional challenges, including limited physical connectivity, access to health care, and communication. In addition, corruption, government ineffectiveness and poor governance exacerbate the already fragile situation where socio-economic challenges are linked to multi-dimensional poverty, deprivation, and inequality (UNDP, 2017) Page | 83 Table 3-1 Household Livelihood Coping Strategies (FNC, 2019) CATEGORY COPING STRATEGIES Stress • Borrowing money, spending savings, selling assets, and selling more livestock than usual. Crisis • Selling productive assets directly reducing future productivity, including human capital formation. • Withdrawing children from school • Reducing non-food expenditure. Emergency • Selling of one’s land thus affecting future productivity, more difficult to reverse /dramatic in nature. • Begging for food. • Selling the last breeding stock to buy food. Figure 3-8 below shows the households engaging in livelihood coping strategies by province (FNC, 2019). Manicaland (16%), Mashonaland Central (15%) and Matabeleland South (15%) had the highest proportion of households engaging in emergency coping strategies. Whilst the highest proportion of households employing stress strategies were in Manicaland (28%). Figure 3-8 Households Engaging in Livelihood Coping Strategies by Province (FNC, 2019) 3.5.10 Health At Independence in 1980, Zimbabwe adopted the Primary Health Care (PHC) Approach in line with the Alma Ata Declaration of 1978. The implementation of the PHC approach resulted in decentralization of health service provision from central level (cities and towns) to administrative wards at district level in the rural communities. Four tiers for health service delivery were established as follows: • Quaternary Level: Central Teaching Hospitals with specialist medical services in the capital city Harare, the second largest city Bulawayo and in Chitungwiza, • Tertiary Level: Provincial Hospitals with ambulatory and inpatient specialist services in the eight rural provinces of Zimbabwe, • Secondary Level: District Hospitals with emergency, ambulatory, and inpatient services in the sixty- two districts of Zimbabwe, Page | 84 • Primary Level: Rural Health Centres with primary care services in the 220 wards of Zimbabwe. The population of Zimbabwe is approximately 16 million (67% rural and 33% urban). Table 4-2 shows the number of hospitals and PHC facilities that serve this population. The public PHC workforce is largely nurse- led, with PHC nurses in rural clinics and nurses, midwives and clinical of�cers in urban municipality clinics, hospital outpatients and inpatients. Nurse-anaesthetists provide the majority of anaesthesia in urban and rural hospitals, where caesarean sections are the main surgical procedure. Doctors in public PHC provide supervision and teaching, develop guidelines and consult on referred cases. Nearly every district (±250 000 population) has at least two medical of�cers; every PHC centre has at least two quali�ed nurses; 59% of administrative wards have an environmental health technician and 60% of villages have access to a village health worker. In Zimbabwe 86% of the health facilities are located in the rural areas while 14% are in urban areas. Table 3-2 Distribution of Health Facilities in Zimbabwe Level Number of Facilities Quaternary Level 6 (3 in Bulawayo, 3 in Harare) Tertiary Level 8 Provincial hospital in all provinces Secondary Level 63 hospitals Primary Level 1634 (rural hospitals, rural health centres, clinics) This decentralization was associated with a significant improvement of most health indicators in the 1980s and early 1990s. 3.5.11 Experiences with Health Services Generally, the disease burden has been increasing in Zimbabwe as shown by figure 4-9 below. There was an increase in the proportion of households with at least one member living with HIV/AIDS from 12% (2018) 27% (2019), (FNC, 2019). Page | 85 Figure 3-9 Households with at Least One Member Living with a Chronic Condition (FNC, 2019) The presence of a member living with a chronic condition is likely to increase the household’s financial burden. However, even if one can afford healthcare it is not a guarantee that residents will be able to get the medical attention they need. It may also depend on whether qualified staff, functioning equipment, and sufficient drugs are available. Figure 3-10 below illustrates the ease with which households with at least one member Living with a chronic condition (FNC, 2019) could access treatment services. Approximately a third (27.9%) of households consisting of at least one member living with a chronic condition, reported failure to accessing treatment services. Failure to accessing treatment services for chronic health conditions was high in Manicaland (37.9%). Figure 3-10 Access to Treatment Services among Households with at Least One member Living with a Chronic Condition (FNC, 2019). In a similar study, Isbell and Krönke (2017) investigated how easy or difficult it was to obtain needed medical care. Of the 59% who had contact with a public hospital or clinic during the year preceding the survey, 54% said it was “easy� or “very easy,� while 46% describe it as “difficult� or “very difficult� (Figure 4-11). Page | 86 Figure 3-11 Easy or difficult to obtain medical treatment - Zimbabwe - 2017 (Isbell and Krönke 2017) Isbell and Krönke also found out that more rural (58%) than urban (45%) people found it easy to access health services, and those with no formal education (67%) are more likely than their more educated counterparts to find it easy to obtain care. However poor Zimbabweans struggle significantly more to obtain medical care than wealthier citizens. The Cholera Crisis of 2017 highlighted Zimbabwe’s shortcomings in the Basic Health Care Delivery System. Access to health care is particularly difficult in urban areas, which were the epicentres of the cholera outbreak and now the epicentres of the COVID-19 pandemic. 3.5.11.1 General Service Availability General Service availability refers to the physical presence of health service delivery components within the country. The general service availability index is computed as a composite of health infrastructure, health workforce, and service utilization indicators computed relative to a benchmark. The general service availability index score for Zimbabwe was 42% in 2015. (Figure 3-8) The health infrastructure domain score was highest at 69% while the lowest was 22% for service utilization. On average, both health workforce density and service utilization were below half of the expected target values. There was a clear need for more trained health professionals which would most likely result in an increase in health service utilization (MOHCC, 2015). Page | 87 Figure 3-12 General Service Availability index and domain scores for Zimbabwe (MOHCC, 2015) 3.5.11.2 General Service Readiness General Service readiness refers to the capacity of health facilities to provide general health services. It measures the availability of infrastructure, equipment and supplies necessary to provide services within the following five domains: basic amenities, basic equipment, standard precautions, diagnostic testing, and essential medicines. The general service readiness index is a composite score summarizing information from the five domains. Figure 3-13 below shows that the general service readiness index score was 78%. Urban locations had a higher overall readiness score compared to rural locations. There was not much variation on basic equipment scores between rural and urban locations (69% rural vs 66%) urban. Diagnostics were the lowest at 69%. Page | 88 Figure 3-13 General Service readiness index and domain scores nationally, Zimbabwe (MOHCC, 2015) 3.5.11. General Readiness for COVID-19 Response a) Quarantine Centres Over 24 quarantine centres in all the 10 provinces. b) Isolation hospitals 46 isolation hospitals in all 10 provinces in various states of readiness some are accepting patients, others are being renovated to suit purpose. It should be noted that most of these facilities did not have capacities to handle COVID-19 infections. Government of Zimbabwe has come up with various remedial measures to ensure compliancy, in line with the current WHO Guidance on COVID-19 covering “healthcare facilities�, “waste management�, “hazardous materials management�, and “construction and decommissioning.� The WHO Guidance on COVID-19 complies with the WBG EHSGs. c) Surveillance of COVID-19 Vaccines and AEFIs Management COVID-19 vaccine safety surveillance will be guided by already existing MoHCC’s Adverse Events Following Immunization (AEFI) surveillance guidelines and the WHO COVID-19 Vaccines Safety Surveillance Manual. Safety surveillance for COVID-19 surveillance will be further strengthened through additional: 1. Training of national stakeholders and investigation teams. 2. Training of national AEFI committee on causality assessment of adverse events following COVID-19 vaccination. 3. Training and preparation of health care workers on identification, management and reporting of potential cases of anaphylaxis and ensuring availability of comprehensive emergency tray at all vaccination points. The trainings will be provided as part of a comprehensive COVID-19 vaccine introduction trainings. 4. Instituting active surveillance of Adverse Events of Special Interest following COVID-19 vaccination. d) Zimbabwe AEFI Reporting-Routing, Timeline and Actions The MOHCC currently uses the following flow chart for AEFI management below. The health care workers at health facilities are responsible for identification of AEFI and immediate notification of the event to the district level. They also complete the AEFI reporting form within 24 hours. The district level is responsible for conducting detailed investigation of the AEFI and this should be done within 7 days of notification. The reporting and investigation forms are then sent to the national level through the province. The national AEFI committee then does causality assessment of the AEFI. Feedback is then provided to the national EPI program, the provincial level, districts level and to the health facility. Page | 89 Figure 0-13 Zimbabwe AEFI Reporting-Routing and Timeline 3.5.12 Nutrition The Government of Zimbabwe recognizes that adequate nutrition is a prerequisite for human growth and development, as it plays an important role in one’s physical and intellectual development, and consequentially work productivity. Since 76% of the rural households are considered poor and 23% extremely poor, on average, households are spending over half of their income on food and 33% suffer from food deprivation (ZimVAC, 2017). While households used fewer and less extreme coping strategies in 2017 than in previous years, there was a decrease in households consuming an acceptable diet and an increase in households consuming a poor diet, as defined by the food consumption score. Overall, 10% of rural households experienced severe hunger in 2017, based on the household hunger score (ZimVAC, 2017, USAID, 2018). The underlying causes of malnutrition include food insecurity, gender inequality, poor hygiene practices and lack of safe water and sanitation. Stunting levels among children under five improved from 32% in 2010–2011 to 27% in 2015, which is considered high according to WHO/UNICEF (ZIMSTAT and ICF 2016; WHO/UNICEF 2017). Stunting levels vary geographically from 19% in Bulawayo province to 31% in Matabeleland South and are higher in rural areas (29%) than urban areas (22 percent). Differences in stunting levels can also be seen according to maternal education and wealth levels—25% of children whose mothers have secondary education are stunted, while the prevalence rises to 45% of children whose mothers had no formal education. Similarly, 17% of children in the highest wealth quintile are stunted, while 33% of children in the lowest wealth quintile are stunted (ZIMSTAT and ICF 2016). 37% of children 6–59 months are anaemic, a substantial Page | 90 improvement from 2010–11 when over half of children suffered from anaemia. Anaemia prevalence varies regionally, from 29% in Masvingo to 40% in Manicaland (ZIMSTAT and ICF 2016). 3.5.13 Disadvantaged / Vulnerable Individuals and Groups The health delivery system must be able to serve even the most disadvantaged and vulnerable individuals, households, and other groups in the communities. Figure 4-15 shows the household vulnerability by province. Matabeleland South had the highest proportion of households with at least an orphaned child (22%) and Matabeleland North (18%). Manicaland and Midlands provinces had the highest proportion of physically/mentally challenged members (6%), whilst Manicaland, Mashonaland West and Midlands had the highest proportion of chronically ill people (4%). Figure 3-14 Household Vulnerability Attributes (FNC, 2019) 3.5.14 Sex and Age of the Rural Household Head Generally rural households have an average size of 5.4 and a mode of 5 persons in a household, of which 65.8% are male headed and 34.2% are female headed, (ZimVAC 2018). The average age of the household head is 49.3 years, and most members of the households are aged 18-59 years, suggesting that the rural population is relatively young. Page | 91 Male Headed 65.8% Female Headed 34.2% Figure 3-15 Percentage Head of Families 3.6 Health Care Waste Conditions While not discussed in depth here (because the consultant visits and evaluation upon which this ESMF and ICWMP are based are more recent), there was a 2016 assessment of how well HSDSP project facilities complied with the national Health Care Waste Management Plan (HCWMP) which was the project's main ESA instrument at that time conducted by Professor Sara Baisai Feresu of the University of Zimbabwe's Institute of Environmental Studies. Most of the HCFs sampled were found to not be segregating their waste properly which increased the amount of infectious waste. Another issue that was found mainly at hospitals was that infectious waste was in the majority of cases stored (temporarily) in places accessible to patients and visitors. On the other hand, the review found clinics to perform better in terms of final disposal since they had invested the project’s Results Based Financing (RBF) funds in constructing and fencing waste management infrastructure on-site. Hospitals used about 10-40% of the RBF subsidy for health care waste management. Importantly for this project whose vaccination activities will result in needles as the most serious environmental impact of the project, the assessment found that “the most understood concept was the handling of sharps, as this was properly done in all health facilities, both at hospital and clinic level and in all departments of the health facilities.�22 The report found that there was a need for training of HCF staff to practice proper health care waste management using the HCWMP. In conclusion, the assessment found that the RBF program led to the improvement of health care waste management although participants were not aware of the existence of the HCWMP. The main message of the report was that the RBF effectively financed health institutions to enable the majority of participating institutions to meet the minimum standards prescribed in the HCWMP. A large proportion of the facilities that in the beginning had no functional health care waste infrastructure, with the program acquired at least the basic infrastructure which help them to deliver services in a relatively safe non-infectious 22 Baisai Feresu, Sara. “Review of the Implementation of the HCWMP in 18 Rural Districts under the RBF Programme in Zimbabwe� Draft Report, University of Zimbabwe Institute of Environmental Studies. March 31, 2016. Page | 92 environment than before when an earlier baseline rapid assessment was carried out to develop the HCWMP. Thus, waste management improved across the system even though there is still room for improvement. Generally, in Zimbabwe the issue of Health Care Waste is still desperate and the responsible agencies currently do not have sufficient financial or human resources to adequately respond to it. Although MoHCC has institutionalised HCWM in the Health Care delivery system, the enabling environment for its efficient implementation is lacking such as adequate budgets for repair and / maintenance of waste management infrastructure and/ or installation of new infrastructure and equipment for waste treatment and disposal. To mitigate against the improper treatment and disposal of medical waste there is need for the construction on new incinerators in health facilities. Further, MoHCC has embarked on a nationwide HCWM related training and plans to continue in this drive not only to train staff but also to raise the awareness of the public. These topics are covered more fully in the ZCERP ICWMP. At each health facility there is an Infection Prevention and Control (IPC) Committee. The IPC Committee is responsible coordinating the implementation of the ICWMP. At smaller rural health centres, it is led by the Nurse in Charge and acts as the focal point on IPC issues. At secondary health facilities and provincial hospital, the IPC committee is led by the District Medical Officer who chairs the committee. The committees ensure regular IPC audits, review and implementation of the ICWMP. Poor waste management is one of the major challenges facing Health Care institutions. Some do not even have prescribed medical waste disposal methods. The medical waste is at times indiscriminately disposed and given less attention creating an immense threat to public health. Medical waste management still has inadequacies from segregation at source to the final disposal with some medical waste finding its way to the municipal dumpsite. Most incinerators at health care facilities are not operating efficiently and thus not treating the waste at all. Currently most of the HCWM facilities are old and broken down and the first step would be to bring them to some working condition. At the health care facilities, the following applies: 3.6.1 Waste Segregation In most health care facilities, the medical waste that is most often separated from the rest are needles which are placed in designated yellow containers or two litre plastic medicine bottles. The other waste may be segregated into infectious (pink) and non-infectious (black) lined bins (Figure 3-17). However, during transportation to the treatment facilities, the waste tends to be remixed. In some instances, medical waste is not being segregated and its handling poses serious challenges as it is not labelled, either on the bin or the plastic lining. Page | 93 Figure 3. 16 Segregation of waste in a hospital 3.6.2 Temporary storage Before treatment waste is stored under secure conditions (Figure 4-18). In most health centres there are no appropriate temporary storage facilities and where they are available, they are not being used. Figure 3. 17 Temporary storage for waste In small clinics where the sharps must be transported elsewhere for incineration, they are stored in one of the rooms in the clinic until transport is found. At smaller centres which use lined pits, the sharps containers were being recycled. The needles are tipped into the pit and the yellow sharps box retained and reused. Page | 94 3.6.3 Treatment and Disposal of Waste (i) General Waste Figure 3. 18 Municipal Landfill and Open pit disposal In urban areas general waste is land filled (Figure 4-21) and in rural areas it is burnt in open pits. The large local Authorities like Harare have landfills. The challenge they are facing is the proper running of the landfill sites as resources are scarce and the proper maintenance procedures are being left undone. There are no official disposal sites in the rural areas and each centre must manage its own waste. (ii) Infectious Waste Figure 3.19 The incinerator and a lined pit at a hospital In most facilities, infectious waste is incinerated or disposed of in lined pits (Figure 4-21). Under the project, all infectious waste will be incinerated in accordance with the EHSGs for HCFs. Most of the hospitals have incinerators which are mostly not working due to lack of maintenance and age. Some of the incinerators in health facilities do not operate to the recommended minimum temperature of 1200oC. Medical waste from health facilities with non-functional incinerators will be transported to facilities where there are functional incinerators including private companies. The project has funding for waste transportation Page | 95 under Component 1. In smaller facilities, the organic infectious waste is disposed of in the lined pits (Figure 4-21). Incineration residues such as fly ash, bottom ash and liquid effluents from flue gas cleaning are not being managed properly at most facilities. The ash is at times dumped in open pits and poses a danger of polluting the environment as they may contain Persistent Organic Pollutants (POPs) due to incomplete combustion in the old incinerators. (iii) Sharps Figure 3. 20 Concrete lined pit for sharps disposal at a Clinic In hospitals and clinics with incinerators, sharps are incinerated but in smaller Health Care Facilities sharps are disposed of in lined pits (Figure 4-21). The pits should be secure, and their base must be above the water table. In some instances, the pits were not lined. ZCERP supports vaccination activities so sharps usage is directly impacted by the project. In accordance with the EHSG for Health Care Facilities, sharps are to be incinerated. Medical waste incinerators in Zimbabwe do not generate power. (iv) E-waste Currently there is no law or guidelines on e-waste in Zimbabwe. This makes it difficult for existing regulatory institutions to enforce e-waste management effectively. However, there is a private company that has set up e-waste collection points in different outlets in Harare for collection of smaller type of e- waste. For larger types of e-waste, they are sent to another private company (Environserve) at their depot in Harare. These services are only available in Harare. 3.6.4 Sanitation Sanitation is either by pit latrines, septic tank system, or water borne sewage reticulation as in large urban areas. Most of the Health Care Facilities do not have adequate facilities for the patients and visitors that come to the institutions. The available facilities are either old and dilapidated or broken down altogether. The main problem is lack of maintenance. The existing infrastructure is old and needs replacement in most cases. 3.6.5 Health Care Waste Handling Licenses Page | 96 There are various licenses required for handling and managing health care waste, which include Incinerator Emission Licences, Hazardous Waste Transportation Licences, and Waste Enterprise Licence. All relevant licensing is explained in section 3-4, Table 3-4. Unfortunately, most facilities do not have the required licenses but the project will work with participating facilities to ensure that they will be in compliance with these national rules. Facilities will be trained on safe management of health care waste including on the requirements of relevant legislation such as the Environmental Management Act which requires facilities to be licenced as waste handlers and licensing of their incinerators. 3.7 Air Quality Globally, recent studies have linked air pollution to chronic health problems like cardiovascular and cardiorespiratory deaths in populations. Pollution in Harare, the capital of Zimbabwe, is a source of concern, (Mujuru et al; 2012). Mapira (2015) noted that the main human causes of air pollution in the country which he identifies include: transportation, industrial processes, industrial and non-industrial fugitive processes, energy production, waste management and agricultural activities. Most industries in Zimbabwe are located in urban centres such as Harare, Bulawayo, Gweru, Kwekwe and Mutare. They emit air pollutants like sulphur dioxide, Nitrogen oxide, carbon monoxide, methane and other organic compounds. Zimbabwe has experienced a rapid expansion in vehicular population especially in Harare which holds about two thirds of the vehicle population in Zimbabwe. Of which the vehicles are not roadworthy due to lack of proper maintenance and repair, and many do not have catalytic converters (Mujuru et al; (2012)) and Mapira (2015)). Another contribution to pollution in Harare is attributed to the use of old technology and equipment by industries. Data on air pollution in third world cities such as Harare is scanty or lacking with only a few studies on air pollution having been done in the past. In a study by Mujuru et al.;(2012) found that SO2 highest pollution of 820 µg/m3 was in the Southerton industrial area and the lowest pollution of 5 µg/m3 was in the Central Business District (CBD) of Harare. SO2 pollution was generally above the World Health Organization (WHO) 24-hour guideline value of 125 µg/m.3 The highest NO2 pollution was 46.14 µg/m3 at a site with a busy road nearby and the lowest was 11.09 µg/m3 in a high population residential area. NO2 pollution was generally lower than the WHO guideline value of 40.0 µg/m3 (annual mean). The air quality in Harare is compromised by the presence of particulate matter, lead, sulphur dioxide and nitrogen dioxide. Studies have found all these pollutants to be above the air quality guidelines provided by WHO, and of much concern were the levels of SO2 and particulate matter. The pollutants are transported by wind and travel far away from sources of pollution spreading to residential areas. SO2 and particulate matter is mainly from vehicles and industrial operations. Therefore, in accordance with the World Health Organization's guidelines, the air quality in Zimbabwe is considered moderately unsafe. The most recent data indicates the country's annual mean concentration of PM2.5 is 22 µg/m3 which exceeds the recommended maximum of 10 µg/m 3. Contributors to poor air quality in Zimbabwe include the mining, cement, and steel industries, fertilizer manufacturing, vehicle emissions, and waste burning. Available data indicates that Harare has consistently high levels of air pollution. So, in conclusion, while the airshed is a bit degraded, it does not really matter because the project emissions are insignificant at least from the cars and maybe from incinerators. 3.8 Incineration The WHO (2014) recommended the use of medium temperature double chambered incinerators with a minimum temperature of 8500C for the emergency HCW disposal. This includes disposal of pharmaceuticals except antineoplastic waste that requires a higher temperature of above 1200oC (WHO, Page | 97 2001, 2014). Correspondingly, two types of sharps containers permitted for use are disposable containers made of plastic or plasticized cardboard, and reusable containers made of metal or plastics (WHO, 2014). According to the WHO (2007), plastic containers are not supposed to be incinerated. In case incineration is the only available option, containers made of materials that emit toxic fumes, ozone depleting substances and gases with higher climate change potential are not permitted (WHO, 2007). Additionally, depending on the amount of waste generated and the other factors, HFs may operate on-site incinerators, or waste may be transported to an off-site incineration facility. Incinerators should have permits to accept health care waste and be properly operated and maintained. Health care waste should be disposed of using pyrolytic or rotary kiln incinerators. Single chamber incinerators should only be used in emergency situations (e.g. acute outbreaks of communicable disease) when other incineration options for infectious waste are not available23. 3.8.1 Types of Incinerators Incineration is controlled burning of solid, liquid, or gaseous combustible wastes to produce gases and residues containing little or no burnable material and will be safe to handle. Incineration is a high temperature dry oxidation process that reduces the volume and weight of waste. This process is usually selected to treat waste that cannot be recycled, reused, or disposed of in a landfill, thus healthcare waste. Health-care waste includes all waste generated by health care facilities, research facilities, laboratories and that produced in the course of health care undertaking in the home e.g. dialysis, insulin injections and home based care (needles, syringes, soiled bandages, disposable sheets, medical gloves, dialysis machine filters, plastic catheters and drip set, glass waste, urinary bags, expired medicines, medicine containers, pesticide containers, sanitary napkins, liquid waste and placenta) (WHO, 1998). Pyrolytic incinerator (Standard /modern incinerator): This is a standard incinerator consist of a primary combustion chamber, which has a treatment capacity of 200 to 10,000 kg/daily, with a maximum combustion temperature ranging from 800 to 900° C. Its requirements in terms of investment and maintenance are not very high; it needs trained staff to operate it hence found in most rural healthcare facilities. This is fuelled by firewood or coal; the residues of wastes are sent to the landfill disposal sites or ash-pits. Pyrolytic incinerator (Advanced): An advanced incinerator with two combustion chambers, primary and secondary combustion chambers. It has a treatment capacity ranging from 500 to 30,000 kg wastes daily, at a combustion temperature of 1200° or 1600° C. This incinerates even expired medicines, but its initial cost is very high. The incinerator is highly controlled with air pollution equipment and operational practice is specifically designed to reduce formation of dioxins. It needs fuel or electricity to function and highly qualified staff to operate it hence found in central hospitals. The residues of wastes are sent to landfill disposal sites or ash-pits. To install and operate an incinerator, a licence is required from the Environmental Management Agency (EMA). This is because treatment, disposal of hazardous waste and discharge is a high environmental hazard. 23 World Bank Environmental, Health and Safety Guidelines for Health Care Facilities Page | 98 3.8.2 Emissions Pollutants potentially emitted from health care waste incinerators (HWIs) include: • Heavy metals, • Organics in the flue gas, which can be present in the vapor phase or condensed or absorbed on fine particulates, • Various organic compounds (e.g. polychlorinated dibenzo-p-dioxins and furans [PCDD/Fs], chlorobenzenes, chloroethylenes, and polycyclic aromatic hydrocarbons [PAHs]), which are generally present in hospital waste or can be generated during combustion and post-combustion processes, • Hydrogen chloride (HCl) and fluorides, and potentially other halogens-hydrides (e.g. bromine and iodine); • Typical combustion products such as sulphur oxides (SOx), nitrogen oxides (NOx), volatile organic compounds (including non-methane VOCs) and methane (CH4), carbon monoxide (CO), carbon dioxide (CO2), and nitrous oxide (N2O).24 3.8.3 Climate Change Zimbabwe is dealing with significant climate change. Global Climate Models (GCM) indicate that most of Southern Africa, including Zimbabwe, is likely to experience higher temperatures (2-40C higher than the 1961-1990 baseline) in the coming decades, but the picture for rainfall is less clear. While average annual rainfall appears to have changed little over the last 50 years, adverse weather conditions have been increasing with droughts and floods having become more frequent and severe and the onset of the rains less dependable. Zimbabwe ranks 9 out of 16 countries on the Climate Change Vulnerability Index (CCVI). Climate models predict that Zimbabwe’s climate will be warmer than the 1961-1990 baseline with warming rates of 0.5-2OC by 2030. The climate change predictions for Zimbabwe are that the country will become hotter and drier, with an increase in violent storms. Floods are thereby the most frequent and dangerous hazard for the country, mostly hitting the northern and south-eastern lowlands (along the path of cyclones). The El Nino phenomenon has had ample impacts in the past, an estimated 4.1 million people in Zimbabwe experienced food insecurity in 2016 due to the phenomenon. The incineration of health care waste involves generation of climate relevant emissions. These are mainly emissions of CO2, but also of N2O, NOx, NH3 and organic carbon. It has also been observed that black carbon emissions from incinerators absorb heat radiation from the sun and reduce the light’s reflecting ability thus causing global warming. Black carbon emissions cause approximately 60% of global warming effects of carbon dioxide (Bond et al.; 2013 and Deangelis, 2011) making it the second most important climate change pollutant. 24 WB (2007) Health Care Facility EHSG, p6. Page | 99 4.0 Potential Environmental and Social Risks, Impacts and Mitigation 4.1 Introduction The ZCEREHSP Environmental and Social risk classification as per WB ESF is Substantial because of the enormity of the COVID-19 challenge (that is, its infectiousness, mortality and pandemic nature), the new vaccines and Zimbabwe’s macroeconomic situation. While the risks associated with COVID-19 and infectious medical waste are serious, with use of personal protective equipment and other behaviors outlined in WHO Guidelines, the risks are manageable and should not result in large-scale or significant impacts. Effective administrative, infection-controls, engineering controls and environmental safety controls must be put in place to minimize these serious risks. The project ICWMP outlines these measures to provide infection control and waste management in the project.Potential risks and impacts will be associated with the following ZCEREHSP activities: • Support of COVID-19 vaccination activities, setting up solar panels at health facilities, installation of refrigeration units in trucks • Fuelling, repair and maintenance of vehicles for vaccine distribution • Waste disposal from HCFs including both on-site and at off-site incinerators • Actual transportation of goods/materials (i.e., road safety, accidents, traffic, air emissions, etc) • Operation of solar panels (hence maintenance and waste disposal) • Potential use of on-site emergency generators in case of loss of power and/or issues with solar • Procurement and operation of solar powered tricycles (that is maintenance and disposal of solar panels and batteries), use of motorcycle (maintenance and waste disposal) • Minor renovations and refurbishment of maternity waiting homes, operating theatres, • Installation of medical oxygen reticulation systems, • It is expected that any potential negative environmental and social impacts associated with ZCEREHSP activities will be largely localized and of short-term duration and can be significantly mitigated through adequate planning and implementation of mitigation measures in ESMPs. This would depend on ensuring adequate disposal of medical waste. All project activities carry the risk of promoting COVID-19 infection since they are being carried out during the pandemic therefore all project workers will be supplied with appropriate PPE and will follow MOHCC and WHO protocols to reduce the possibility of transmission amongst themselves and to the public. Components 2 and 3 of the ZCEREHSP are mainly catalytic activities which will strengthen the capacity of MOHCC to respond to the COVID-19 pandemic. These activities will lead to the generation of medical waste including infectious waste. Covid-19 vaccine deployment activities will also have negative environmental, health and safety risks if an appropriate system for collection, transportation and disposal of medical waste is not put in place. The ZCERP will only support vaccine deployment and will not procure vaccines. The main environmental risks are related to the handling, transportation, treatment, and disposal of hazardous medical waste, including infectious waste, pharmaceutical waste, chemical waste such as Page | 100 formaldehyde25 and its waste, ash from incinerators and sharps. Additionally, environmental risks are also related to minor renovations and refurbishment of maternity waiting homes, operating theatres, installation of oxygen reticulation systems, maintenance and waste disposal from motorcycle repairs and service, e-waste from the use and maintenance of solar powered tricycles. Potential impacts are expected to be limited to the activity site and can be managed through established and proven mitigation measures, including instituting the ZCEREHSP Infection Control and Waste Management Plan (ICWMP). Air emissions from incinerators (or even the use of waste pits for wastewater and/or sharps) can lead to off-site (i.e.. outside of HCF boundaries) pollution and may not be reversible. Some important risks to the project include difficulties with sanitary and hygiene services and the larger national macroeconomic environment. For example, sometimes, temporarily, running water is not available in a given area or facility. Inadequate budget coupled with inflationary environment also makes it difficult to secure necessary supplies such as gloves, soap and other disinfectants. The budget might be adequate at the time of disbursement, but by the time facilities go on the market to procure the material, the prices will have gone up. The overall residual risk to achieving the new PDO for ZCEREHSP was and continues to be Substantial. Residual macroeconomic and fiduciary risks remain high. The key risks that may negatively impact project implementation are as follows: political and governance, macroeconomic, institutional capacity for implementation and sustainability, and environmental and social. Taking into consideration the proposed project activities, the potential environmental and social impacts were identified through desk study and a comprehensive stakeholder consultation process. The project is not expected to have any cumulative impacts as defined by the ESF. That is, no negative impacts from the past, and foreseeable developments (including unplanned but predictable activities enabled by the project are foreseen. The following is an analysis of the anticipated environmental and social impacts of the project. 4.2 Environmental Risk/ Impact analysis Support to COVID-19 vaccine deployment and related health system strengthening particularly RNMCAHN services will have considerable positive outcomes as it aims to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health to deliver quality RMNCAHN services. However, the COVID-19 vaccination an RMNCAHN activities can also have potential adverse environmental, health and safety (EHS) risks if an appropriate system for collection, transportation and disposal of medical wastes is not put place. Additionally, environmental risks from the project will include construction related risks including EHS and OHS (dust, noise, construction waste, working at height, being hit by objects etc.) emanating from refurbishment of maternity waiting homes; ii) road traffic incidents 25 In the medical field, formaldehyde in an aqueous solution is used for disinfection, sterilization, and preservation of preparations. It is an active gas against all micro-organisms except at low temperature (<20°C); This disinfecting product is recommended for Hepatitis and Ebola virus (but not for HIV/AIDS). The risk associated with formaldehyde is that it can cause cancer. in those applying it. This risk will be avoided by use of proper PPE, washing facilities and the fact that hazardous materials and wastes will be handled according to occupational health and safety guidance provided in the General EHSG Guidelines. The challenges of this disinfection method are that the disinfected wastes still need other methods of final elimination. This method gives highly efficient disinfection in good operating conditions, and some chemical disinfectants are relatively inexpensive. Page | 101 due to operation of tricycles supporting community health services, vans and motorcycles for health center monitoring ; iii) exposure to hazardous, medical and e-wastes emanating from immunization, and health care operations and digitization and solar powered equipment, if improperly managed; iv) OHS risks during operation of maternity waiting home and management of child illnesses including traps, falls and general wastes management. It is important to note that while the project will support the deployment of WB- eligible vaccines, it will not directly purchase or administer the vaccines. The project is only financing the enabling environment and infrastructure for vaccine delivery and other measures to address COVID-19 pandemic and provision of integrated RMNCAHN services. Vaccination programs or vaccines are not entirely without risk as adverse reactions /adverse events following immunization might sometimes occur following vaccination which may be due to the vaccine or by an error in the administration or handling of the vaccines. Hence, the project will contribute to an appropriate COVID-19 vaccines safety monitoring system to respond to adverse events following immunization (AEFI) cases, if any. Considering the proposed AF activities, such as the integrated outreach service delivery model, community health services including disease surveillance, commodity security, revitalization of MWHs, and health system digitalization and related innovations, the most significant foreseen social risks are related to: (i) exclusion of vulnerable social groups (poor, disabled, elderly, isolated communities, refugees, and people and communities living far from the health facilities, etc.) from access to the essential health services, (ii) inadequate personal data protection under the health system digitalization and related innovations activities, which involve capacity building for using electronic health records and implementing the early warning system using machine learning and artificial intelligence to detect service disruption, (iii) poor labor and working conditions due to a failure to abide by national legislation and the ESS2 requirements on working hours, wages, overtime, compensation and/or benefits; and (iv) sexual exploitation and abuse, and sexual harassment (SEA/SH) among project workers, with stakeholders and/or local communities. Despite Zimbabwe’s considerable capacity to manage the EHS risks associated with the activities, given the enormity of the Covid-19 challenge (its infectiousness, mortality, pandemic nature, etc.), the new vaccines and Zimbabwe’s macroeconomic situation, environmental risk of the ZCEREHSP is therefore rated as substantial. Environmental and Social risk management. To address these environmental and social risks and impacts, the Borrower has updated and re-disclosed through MOHCC and Cordaid websites, the safeguard instruments for the parent project (ESCP and SEP) prior to the Decision Meeting date to reflect the AF activities and associated risks, impacts, and mitigation measures. However, since the project is using the condensed procedures as defined in paragraph 12, section III of the Bank Policy (BP) for Investment Project Financing (IPF), the ESMF (which includes the LMP) will be updated and disclosed within 60 days of project’s effectiveness date. Due to the scope and type of waste generation in the parent project, the client prepared an Infection Control and Waste Management Plan, which will be reviewed for its adequacy in managing AF-generated wastes and updated accordingly. The current parent project provisions for grievance management, including measures for addressing SEA/SH, remain relevant and adequate for this AF. 4.2.1 Key Environmental Risks Project main environmental risks include the following in order of significance: (i) Infectious medical waste (including infectious materials, liquid effluents, reagents, etc.) generated from project activities. Improper handling, managing, transporting, treatment and disposing of these waste streams pose health and safety risks to health care workers, patients and the public in general from infectious materials, COVID-19 infected waste, radiological waste (from x-rays and the like) and other general waste. Lack of proper segregation of waste at source and non- Page | 102 availability of adequately designed and operated on-site treatment and disposal of the waste can pose risks to waste handling staff, other HCF staff, the environment and local community. The use of inadequate off-site waste treatment and disposal can cause similar risks and impacts, as well as potential risks due to the transport of medical waste to such sites (e.g., accidents, spills). (ii) The risk of COVID-19 spreading among project implementors (including health care workers, planners, etc.) and to the public (including those to be vaccinated) is present during all stages of the project discussed below. Poor practices during provision of medical services, blood testing, or analysis of samples without proper protective equipment would pose a risk of infection and possible mortality of healthcare workers. Infection Control and Prevention protocols and strategies are outlined in the ICWMP. Additionally, the project will supply appropriate PPE for all project activities and observe behaviours designed to reduce the spread of COVID-19. (iii) OHS risks to workers from installation and operation of solar energy generation equipment and refrigeration units in trucks for transporting vaccines. OHS risks may also include dust, noise, construction waste, working at height, being hit by objects etc.) emanating from refurbishment of maternity waiting homes; installation of oxygen reticulation systems, road traffic incidents due to operation of tricycles supporting community health services, vans and motorcycles for health center monitoring ; exposure to hazardous, medical and e-wastes emanating from immunization, and health care operations and digitization and solar powered equipment, if improperly managed; OHS risks during operation of maternity waiting home and management of child illnesses including traps, falls and general wastes management. General construction related impacts and risks to environment due to solar generation equipment instalation. (iv) Waste: o or oil and other substances emanating from fuelling, repair and maintenance of vehicles for Covid-19 vaccine deployment, motorcycles for disease surveillance and integrated outreach mobile vans o emanating from the installation and operation of solar or other energy generating equipment, e-waste from the disposal of solar panels and batteries from solar powered tricycles o Contaminated soil at HCFs due to past improper on-site waste treatment or disposal, including waste storage, incinerators and waste pits. o Wastewater from HCFs (v) Road safety risks from transportation of vaccines and public address vehicles, solar powered tricycles and vans for integrated mobile outreach services, and motorcycles for disease surveillance. (vi) Emissions from the incinerators and from the vehicles. Both are expected to be insignificant given the small scale of project activities (mostly needles from vaccination to be incinerated) and the small amount of time the project will operate . (vii) Health and safety risks from Installation and/ or repair of oxygen reticulation systems. A slow leak of oxygen gas from a flange, valve, coupling, etc. would most likely be due to poor maintenance, poorly fitted seal, etc., poor connection during filling operation or minor damage. These are mainly human errors of commission with a moderate probability. 4.2.2 Environmental Impact Analysis - Planning Phase The main impacts and risks related to health and safety during the planning phase are mostly related to generation of medical waste especially hazardous medical waste, HCFs that do not have all applicable EHS licenses/permits and/or do not comply with all regulatory EHS requirements, or those that have material EHS existing liabilities including historical contamination, inadequate present or past onsite medical waste or wastewater disposal or inadequate potable water. Individual facility ICWMPs will also address these issues. Page | 103 Well in advance of activities that may generate medical waste start, the entity that would generate such waste must submit a waste management plan (the WMP can be in the form of an individual facility ICWMP). The ZCEREHSP ICWMP provides guidance on the required contents of the WMP which should focus on waste management for sharps due to the vaccination activities. The PIE reviews the WMP and once approved, the project can begin the activities. All activities will be conducted within the footprint of the existing government facilities/grounds and no new land will be acquired or accessed and most planning will be for internal installations and vaccine support activities. Project screening including site visits will identify risks which must be mitigated. 4.2.3 Environmental Impact Analysis – Installation Phase Environmental impacts and risks during the installation phase will emanate from the following activities: a. Installation of solar energy panels b. Installation solar direct drive refrigerators c. Installation of refrigeration units in trucks d. Minor renovations and refurbishment of maternity waiting homes and operating theatres e. Installation of oxygen reticulation systems All of the activities pose OHS risks to workers, likely contractors, that will actually install equipment and conduct the minor works. Depending on the location of the installation and renovations, other workers at the facility and the public may also be at risk from work associated hazards. These activities also pose potential impacts and risks to the environment. a) Installation of Solar Plants Solar panels will be mounted on the ground. Since they are adopting ground mounting, there will be some ground excavation for the panel stands’ footing. Installation of the photovoltaic (PV) solar array (the ordered series of panels) involves mounting the array frame on the ground. Approximately 50 m2 of the ground must be assessed first to check if the existing area (soils) may be contaminated due to past improper waste storage or disposal activities (e.g., contaminated soil) before clearing the ground for installation works. Contaminated land is of concern because of the potential risks to human health and ecology, and the liability it may pose to the polluter/ health facility owners. Contamination of land should be prevented to avoid risk to health and ecological receptors. The preferred strategy for land decontamination is to reduce the level of contamination at the site while preventing human exposure to contamination (See Appendix 14). Solar works will include excavation of the footing (approximately 70 cm deep by 25 cm width depending on the ground stability for each leg stand) and pouring concrete footing for the array frame stand so there may result in generation of cement concrete waste, waste from used cement bags. Fabrication (the onsite process of bending, cutting, welding, moulding, steel structures to create beams, columns, and steel members26) for installation of the array stand and installation of PV solar array will likely involve working at heights and carries the risk of dangerous slips, trips and falls. Manual installation involves mounting of array frame, cabling (the process of putting electrical cables in place for the purposes of transmitting electrical current to the gadgets/ equipment), interconnecting PV solar arrays and connecting the batteries and the facility to the array power. There are risks of electrocution during installation and these solar modules will generate up to 5-10kilovolts of DC electricity when exposed to sunlight. In addition to the possibility of electrocution while working with the actual PV module, there is a 26 These are vertical structural streel columns used in construction to carry or transfer loads and in this case solar panels. Page | 104 risk of injury by accidentally coming into contact with nearby high-voltage power lines during the installation process. Twenty-nine (29) health facilities will be targeted for installation of solar panels. Solar stands will involve some welding and may pose risks to workers. Potential environmental impacts include clearing of vegetation, dust generation due to earth movement and concrete works, soil erosion from rainfall and storm water, noise, construction related wastes including potential spills. There is no possibility of mounting panels on roof tops because of the nature of the equipment which is expected to be installed: solar panels generating approximately 5 kV and 10 kV. These will require ground mounting. Therefore, there is little concern about asbestos containing materials that are commonly found on roofs nor is there much possibility of working at heights or fall and trip accidents. Additionally, wiring of the cables will involving also chiselling the walls and may require replastering and repainting afterwards. Solar panels will be installed where the power will be delivered (already existing health facilities). Ground clearing will generally take place on already existing healthcare facilities grounds; that is in areas that have previously been cleared for healthcare or other development. b. Installation of Solar Direct Drive Refrigerators (SDD). Two hundred fifty 75 litre refrigerators will be supplied as complete plug and play solar systems including a temperature monitoring device. The exterior dimensions of each refrigerator (height x length x depth) are 86.5cm x 82.5cm x 142.5cm. The refrigerators will use a R600a refrigerant which is natural and environmentally-friendly due to its low global warming gas potential (GWP). 250 health facilities will be supported (each receiving 1 refrigerator). The solar refrigerator cabinet must be installed in a secure room with adequate ventilation and where security is a concern, a burglar-proof grill has to be fitted. This involves some minor works again like wall drilling, welding and fabrication. Manual installation involves mounting of array frame, cabling interconnecting PV solar arrays and connecting the cabinet to the array power. c. Installation of different components of the refrigeration system in the trucks include condenser installation, evaporator installation, pipe connections, pulley installation, compressor installation as well as pumping in the refrigerant which must be free of chlorofluorocarbons. The units must be installed in the vehicle so there will be some welding and also punching of screw holes which can pose risks to workers and has waste implications. d. Minor Renovations of the waiting mothers' homes The activities to revitalize MWHs will involve minor civil works such as renovation and refurbishment of existing MWHs, operating theatres, and no land acquisition or involuntary resettlement impacts are expected. Key Environment risks include i) construction related risks including EHS and OHS (dust, noise, construction waste, working at height, being hit by objects etc.) emanating from refurbishment of maternity waiting homes e. Installation of oxygen reticulation system A slow leak of oxygen gas from a flange, valve, coupling, etc. would most likely be due to poor maintenance, poorly fitted seal, etc., poor connection during filling operation or minor damage. These are mainly human errors of commission with a moderate probability. Outdoors, this would be a negligible increase in the oxygen content having no adverse effects on people. Materials that are normally of low combustibility can become highly flammable in an oxygen enriched atmosphere. Dilution in the outdoors atmosphere would result in a negligible increase in the oxygen content and negligible increase in flammability of combustible materials. Exposed skin that comes into contact with the leaking gas may suffer cold burns requiring medical attention. Page | 105 The medical oxygen reticulation system to be installed inside the building and the main activities are purchasing, actual installation and operation. The purchase will take care of Environmental, Health and Safety (EHS), aspects to ensure that the equipment is environmentally friendly, and it has safety measures to avoid any avoidable accidents. At installation and operation, mainly it is OHS risks which can be included in the ESMF. The risks are generic and happening inside a building. (i) Soil and Land Degradation Although the minor construction work (essentially small-scale alterations) will be limited to the footprint of existing infrastructure, some project activities may involve works that will expose soil to erosion, conduct minor excavation, compaction or deterioration of the soil structure which will potentially decrease or decrease the drainage of the areas when installing equipment. This could generally result in small-scale soil erosion, and generation of dust. The activities will also result in waste generation which could cause soil and land degradation if not properly disposed. Improper operation of incinerators may result in air contaminants affecting both on-site and off-site soils (and humans if present). Furthermore, there is risk of accidental discharge of hazardous products like paint, leakage of hydrocarbons, oils or grease from machinery and fuelling of vehicles constitutes potential sources of soil, water and land pollution. Any soil, water and land degradation under the project would be insignificant and if it occurs, it will be minimized through adoption of this ESMF’s ESMP (see Table 6-6) that details suitable mitigation and management measures to be taken. No lead paint will be used. (ii) Installation Waste Installation activities may produce small amounts of wastes such as excavated soils (which may be potentially contaminated from before the project), cement bags, paint drums, brick and concrete rubble, scrap metal, asbestos containing materials and other debris. Concrete footing for solar panels will require cement for concrete mixtures, resulting in concrete rubble, Metal scrap could result from the cutting and welding of solar panel stands. This debris will be minor in quantity but could pollute the environment, obstruct the public, the movement of the workers and vehicles as well as affect the aesthetics of the environment if not appropriately managed. Since solar panels will be installed on the ground, it is unlikely that any asbestos will be encountered. Any asbestos containing materials (ACMs)27 pose serious threats to the health and safety of workers, passers- by and communities in which this work takes place or where the materials will be disposed. Exposure to asbestos may cause cancer. Workers can be accidentally exposed to asbestos through unsafe removal of asbestos. Particular tasks such as use of power tools for cutting, drilling, sanding and sewing can release significant numbers of fibres. However, due to the nature and scope of works, the risk of exposure is low because solar power installation will be on the ground. Roofing materials carry the biggest risk of possessing asbestos, but the project is unlikely to involve them. In the unlikely event that ACMs are found, 27 Guidance for prevention, minimization, and control of impacts from asbestos or asbestos containing Materials (ACM) is derived from the General EHSG and the WB Good Practice Note. Asbestos: Occupational and Community Health Issues (World Bank Group, May 2009) is outlined in Appendix 14 Page | 106 use of power tools especially on ACMs will be minimised. Precautions will be taken to reduce the chance of asbestos fibres becoming airborne and subsequently being inhaled. The workers’ exposure can be reduced by wearing PPE such as masks and appropriate clothing as well as other measures such as not using power tools or restricting access to areas where installations and reparative renovations are taking place. However, since the mounting of solar panels on roofs tops will not take place, it is unlikely that project activities will encounter any other ACM thus, the risk of exposure to asbestos is very low. Guidance for prevention, minimization, and control of impacts from asbestos or ACM is derived from the General EHS Guidelines and the WB Good Practice Note Asbestos: Occupational and Community Health Issues (World Bank Group, May 2009). Such activities are outlined in Appendix 14. (iii) Pollution of Ambient Air This would be very minor and insignificant if any at all from the installation of solar panels since the activities are so small and do not result in emissions directly. Air pollution during construction phase will emanate from dust emissions from ground excavation for solar panel stands and vehicles transporting materials to the project sites. However, during operation of the equipment, there are no air pollution concerns from the equipment as solar equipment will provide cleaner source of energy which does not pollute the atmosphere as fossil fuels would. (iv) Pollution of Water Resources Water quality may be impacted by wastewater discharges from the installation activities if wastes and activities are not appropriately managed. Since the installation activities are minor and being conducted within existing health facilities, and the resulting materials used or even temporarily left behind will be few, any runoff that may carry away waste or chemicals will not be impacted significantly. The discharge of this wastewater into surface waters could impact water quality temporarily if at all by causing changes to its physical, chemical, and biological properties. Given the possibility of generation of waste/spoil that will be generated, it is likely that the waste will be stockpiled on roadsides and in the health facilities premises before it is removed for final disposal. If it is not properly contained, rains could carry it along with runoff into surface waters, leading to a minor increase in turbidity and siltation and contamination. (v) Temporary Visual Intrusion Construction activities will require material, equipment, and barriers (to prevent unauthorized individuals from injuring themselves and disturbing works) at the health facilities. Since facilities where solar panel installation activities will take place may not be able to completely restrict public access, these activities and materials may cause temporary minor visual intrusion at all sites. Since the scale of activities is very small covering 29 health facilities for installation of solar panels (relatively small structures), these risks and possible impacts will be very minor, temporary and extremely reversible. This may be exacerbated in the unlikely case that the contractor will set up camp on or near the site. Camp accommodation for workers is not expected to be large and so this should not be a big or long-term concern. For these minor works an average of five (5) people may need to be accommodated on site. Contractors will be required to restore any extraction or other altered sites to avoid leaving marred landscapes. (vi) Noise The installation of solar panels may generate some minor noise which could be an issue at HCFs due to sensitive receptors. For the solar panel installation and other ZCERP activities, the use of heavy or loud machinery is not anticipated, so noise is considered a relatively minor possible yet unlikely impact which is unlikely to cause an issue. In any case, noise prevention and mitigation measures should be applied where Page | 107 predicted or measured noise impacts from a project facility or operations exceed the applicable noise level guideline at the most sensitive point of reception. General EHS Guidelines: Environmental Noise will be applied for management approach and reference levels. Since the EHSG are more for industrial processes and in this case, patients are the most sensitive receptors, the project will go beyond EHSG reference levels and instruct contractors and others that may carry out activities that may disturb patients to structure their work in such a way to reduce or avoid impacts by such measures as moving patients temporarily to another part of the hospital if possible, scheduling work at convenient times, or other means. (viii) Environmental, Health and Safety Impacts on Patients, Staff, and Other Stakeholders Installation work undertaken in the same buildings having patients, staff and visitors has potential to cause injuries to the occupants. At all sites, installation works will have the following potential hazards to patients, visitors and staff: • Noise and welding, soldering, • Injury from falling or flying debris when installing solar panels, • Exposure to refrigerants during installation of refrigeration units in vehicles • Fire from improper handling of refrigerants Although a small risk, the safety of the local population may be at risk during installation activities. Pollutants such as dust and noise, although not significant risks during the project could also have negative implications for the health of the nearby communities. Camp accommodation for workers is not expected to be large and so this should not be a big or long-term concern. For these minor works an average of five (5) people may need to be accommodated on site therefore, labour influx related issues are not expected to be significant or important. 4.2.4 Environmental, Health and Safety Impact Analysis – Implementation/Operational Phase Environmental impacts and risks during the implementation phase will emanate from the following project activities: • Increased infectious waste (used needles, etc.) and other non-infectious wastes from vaccination efforts, as well as waste water, that the project will support - and the storage transport and treatment/disposal of all solid and liquid wastes, • Unintentional increased opportunities to spread COVID-19 resulting from assembling people to be vaccinated, • General COVID - 19 response operations, • Provision of sustainable energy to the Covid-19 vaccination centres including the generation of waste from solar generation units and potential need to use backup generators in case solar panels are not functioning, • Enhanced cold chain supply for effective vaccine storage, • Transportation which generate potential traffic related risks (both to community and drivers) and increased noise and air emissions 1. Enhanced cold chain supply for effective vaccine storage transportation 2. Mobile public address systems will carry road safety risks and generate emissions • Project vehicles to be fuelled and maintained will generate emissions once in motion and will generate wastes (including petroluem based and others that need special disposal) and waste water, and potential worker OHS risks. Page | 108 • Potential EHS risks due to occurance of either natural hazard (e.g., flood, etc.) or man-made event (e.g., fire, etc.) • A slow leak of oxygen gas from a flange, valve, coupling, etc. would most likely be due to poor maintenance, poorly fitted seal, etc., poor connection during filling operation or minor damage. These are mainly human errors of commission with a moderate probability. (a) Healthcare and other Solid Waste: Infectious Waste Management Project activities generate healthcare waste which contains materials both hazardous to humans and the environment. Although HCFs are all different, most of the medical waste is non-infectious general waste, a small percentage is infectious medical waste which is hazardous. This infectious medical waste is expected to be the most significant environmental impact of project activities. Inadequate storage, transportation and disposal of infectious medical waste can pose health risks to workers and communities and the environment. The project ICWMP contains more details on the protocols and standards that will be used to manage this impact and its associated risks. ZCEREHSP is supporting the vaccine delivery system and RMNCAHN services in general causing the facilities to use more medical supplies and generate more health care waste such as sharps, other infectious and non-infectious waste mostly due to increased vaccinations. Non-infectious waste will be collected through municipal refuse collection system and destined for disposal sanitary landfills operated by the local municipalities. The project has also supported the purchase of PPE for over 1000 vaccination centres to protect worker health and safety from infectious medical waste as well as COVID-19. The ZCEREHSP is also strengthening the capacity of MOHCC to effectively deploy vaccines and deliver RMNCAHN services through various activities, overall project management, monitoring and evaluation. The project is not supporting procurement of vaccines but is instead enhancing vaccine deployment capacity causing facilities to use more medical supplies, including PPE and needles, and thus generate more health care waste. Installation of solar direct drive refrigerators will also result in the replacement of old vaccine refrigerators which could cause an accumulation of obsolete equipment at health facilities, and the potential for disposal of solar batteries and other wastes. In addition, solar powered tricycles, motorcycles and vans for integrated outreach activities will also be purchased and this may result in obsolete equipment when they come to the end of their useful life or during repairs and maintenance. At the end of their useful life, the project will dispose of old and obsolete refrigerators, solar powered tricycles, motorcycles, and vans in accordance with the Public Finance Management Act and Public Finance Management (Treasury instructions) regulations. These regulations provide for the processes and procedures to be followed when disposing of government assets. Increased generation of HCW will be mitigated by instituting the requirements of the project ICWMP. (b) Emissions from Health Care Waste Treatment Incinerators which are used to safely dispose of infectious waste will yield products such as emissions fly ash, bottom ash and liquid effluents from flue gas cleaning which are also hazardous waste as they may contain high concentrations of POPs which can pollute the air, waterways and other areas if not managed appropriately. Incineration provides very high disinfection efficiency and a drastic reduction of weight and volume of waste. Pyrolytic incinerators, also known as standard/modern incinerators, are the kind of incinerators used mainly for Zimbabwe healthcare waste. In conclusion, the health facilities and laboratories will generate increased amount of solid waste, such as infectious sharps, infectious wastewater and increased incinerator usage resulting in toxic emissions and ash from incompletely combusted clinical waste which could contain high levels of POPs. These will need to be managed properly to prevent environmental contamination and community exposure to POPs by Page | 109 implementing the requirements of the project ICWMP. Each health facility has a responsibility of managing its own waste. However, it has been noted that there are some facilities which lack proper waste management facilities such as incinerators, these will be supported to transport waste for offsite incineration and disposal. Each generator of waste is required by law to prepare and implement a waste management plan; hence the facilities will be supported to develop individual ICWMPs. Ash residues from incinerators will be disposed in lined pits at the facility. It is important to note that since sharps will not be disinfected with chlorine solutions, POPs are not expected to form during incineration. Health care waste will be properly segregated at the point of generation to prevent sending material that will produce POPs for incineration. The Project or MoHCC will provide the funds for storage, transportation and disposal. Waste handlers and practitioners must be provided with sufficient and appropriate PPE which must include face masks and eye protection (especially for cleaning of hazardous spills), and respirators (for spills or waste involving toxic dust or incinerator residue). (c) Pollution of Ambient Air Air quality will be impacted by emissions from vehicles and as previously discussed above and the incineration of infectious medical waste. Zimbabwe already has degraded air quality, with readings above the WHO Annual Air Quality Guidelines.2829 Incinerator emissions may contain Persistent Organic Pollutants (POPs) and other contaminants. POPs can arise from incompletely burnt hazardous waste, during cooling of combustion gases, and from hazardous waste contaminated with POPs, e.g., activated carbon filters used for flue gas cleaning in combustion installations. These POPs are not only emitted with the flue gases at the stack, but are also found in the incineration residues, predominantly in the fly and boiler ashes and in the flue gas cleaning residues. The challenge of hazardous waste incineration is to destroy POPs in the waste as completely as possible, while minimizing the formation and release of POPs that form during cooling of combustion gases. The sharps and PPE are the biggest sources of infectious waste under the project. As mentioned elsewhere, sharps used in vaccination will not be cleaned with chlorine prior to incineration so it is unlikely that the project will produce POPs. Due diligence of existing incinerators in facilities participating in the project will be conducted to examine their technical adequacy, process capacity, performance record, and operators’ capacities as part of each facility-level ICWMP. Each facility that will receive project support for infectious waste generating activities such as vaccination and provision of RMNCAHN services will be required to develop its own ICWMP. The ICWMP will be reviewed and approved by PIE and MOHCC. The Environmental Management Agency routinely conducts site visits to facilities to establish the status of incinerators, and remedial measures will be recommended to those performing below expected standards. Prosecution of a non-compliant facility will be instituted as a final resort. This includes implementation of operational controls including combustion and flue gas outlet temperatures (combustion temperatures should be above 850°C while flue gases need to be quenched very quickly to avoid formation and reformation of Persistent Organic Pollutants (POPs) as well as use of flue gas cleaning devices meeting international standards). 30Persistent Organic Pollutants are hazardous organic compounds that are resistant to environmental degradation 28 WHO Air Quality Guidelines for Particulate Matter, Ozone, Nitrogen dioxide and Sulphur dioxide, Global update 2005, Summary of Risk Assessment 29 Zimbabwe Environmental Management Agency, 2017 30 Refer to Guidelines on BAT/BEP practices relevant to Article 5 and Annex C of the Stockholm Convention on Persistent Organic Pollutants, Section V. Page | 110 through chemical, biological, or photolytic processes. This resistance means that they bioaccumulate in humans and wildlife with potential adverse impacts on human health and the environment. All rural health centres participating in the project have incinerators which use low-cost single chamber static grates. Their volume of waste is low. Unfortunately, there is not much maintenance of them. However, some urban, district and provincial healthcare facilities’ incinerators have broken down and are not working. Most of the few functioning incinerators in the country fail to reach the 850°C that is required to treat or destroy sharps. As result, some health care facilities are transporting waste to nearby health facilities or district and provincial incinerators for incineration. Pollutants potentially emitted from health care waste incinerators (HWIs) include: • Heavy metals, • Organics in the flue gas, which can be present in the vapor phase or condensed or absorbed on fine particulates, • Various organic compounds (e.g. polychlorinated dibenzo-p dioxins and furans [PCDD/Fs], chlorobenzenes, chloroethylenes, and polycyclic aromatic hydrocarbons [PAHs), which are generally present in hospital waste or can be generated during combustion and post-combustion processes, • Hydrogen chloride (HCl) and fluorides, and potentially other halogens-hydrides (e.g. bromine and iodine); • Typical combustion products such as sulphur oxides (SOx), nitrogen oxides (NOx), volatile organic compounds (including non-methane VOCs) and methane (CH4), carbon monoxide (CO), carbon dioxide (CO2), and nitrous oxide (N2O).31 The General EHS Guidelines: Health Care Facilities (2007) Table 3 contains the expected air emission levels for hospital waste incineration facilities. Pyrolytic incinerators, also known as standard/modern incinerators are the kind mainly used in Zimbabwe health care settings. Incineration provides very high disinfection efficiency and drastic reduction of weight and volume of waste. A typical incinerator used in Zimbabwe for medical waste incineration generates 150 tpy in emissions of NOx, 50 tpy of SO2 and 100 tpy of total PM if properly functioning.32 It is important to note that the use of incinerators for this project’s activities will not result in significant sources of air emissions since most of the infectious medical waste requiring incineration will be needles and small amounts of other infectious medical waste associated with vaccination. However, the infectious waste can be co-mingled with other non-infectious waste along the waste management value chain. Masks, gloves and gowns represents 75% of COVID-19 related medical waste that are non-hazardous if handled properly. However, the remaining 25% is hazardous COVID-19 vaccine waste which include COVID- 19 vaccine vials and safety boxes containing syringes and other sharp waste. District and provincial hospitals are expected to produce 2.5 kilogrammes (kg) of hazardous waste per day while primary level 31 WB (2007) Health Care Facility EHSGG, p6. 32 Walker and Cooper (2012) as cited in HSDSP AFV ESMF. Page | 111 facilities are expected to produce 0.2 kg per day of hazardous waste from vaccination activities.33 This will represent a small volume of the total waste from each facility going to each incinerator so the amount of emissions from actual project activities is actually less than the typical amounts of emissions from an incinerator listed above. Pollution prevention and control measures include: • A facility-based ICWMP and application of waste segregation and selection including removal of the following items from waste destined for incineration: halogenated plastics (e.g., PVC), pressurized gas containers, large amounts of active chemical waste, silver salts and photographic/ radiographic waste, waste with high heavy metal content (e.g. broken thermometers, batteries), and sealed ampoules or ampoules containing heavy metals.34 This removed waste should not be burned, incinerated, or landfilled. These wastes will be inertised and sent to safe storage site designed for final disposal of hazardous waste and / or transported to specialized facilities for metal recovery. Sharps and other acceptable categories of hazardous waste are to be incinerated (not deposited in on-site waste pits). • Incinerators should have permits issued by authorized regulatory agencies and be operated and maintained by trained employees to ensure proper combustion temperature, time, and turbulence specifications necessary for adequate combustion of waste.35 This includes implementation of operational controls including combustion and flue gas outlet temperatures (combustion temperatures should be above 850 °C while flue gases need to be quenched very quickly to avoid formation and reformation of POPs) as well as use of flue gas cleaning devices meeting international standards.36,37 The Ministry of Local Government, Public Works and Housing is in charge of all infrastructure at the HCF of which the incinerators are part therefore it is responsible for incinerator. Since repair or replacement of incinerators are too costly for the project, the project will rely upon transportation of infectious waste to properly functioning incinerators. Secondary air pollution control measures for hospital waste incinerators (HWI), while not widely used in Zimbabwe, could include the following: • Wet scrubbers to control acid gas emissions (e.g. hydrochloric acid [HCl)], sulphur dioxide [SO2, and fluoride compounds]). A caustic scrubbing solution will increase the efficiency for SO2 control. • Control of particulate matter may be achieved through use of cyclones, fabric filters, and / or electrostatic precipitators (ESP). Efficiencies depend on the particle size distribution of the particulate matter from the combustion chamber. Particulate matter from hospital incinerators is commonly between 1.0 to 10 micrometres (µm). ESPs are generally less efficient than baghouses in controlling fine particulates and metals from HWI, • Control of volatile heavy metals depends on the temperature at which the control device operates. Fabric filters and ESP typically operate at relatively high temperatures and may be less effective than those that operate at lower temperatures. Venturi quenches and venturi scrubbers are also 33 Waste Management for COVID-19 in Health Care Settings for Africa, Africa CDC. 34 WB (2007) Health Care Facility EHSGG, p6. 35 Technical information on the proper operation and maintenance of hospital waste incinerators may be obtained from WHO (1999) Chapter 8 and the US EPA Handbook on the Operation and Maintenance of Medical Waste Incinerators (2002). 36 Refer to Guidelines on BAT/BEP practices relevant to Article 5 and Annex C of the Stockholm Convention on Persistent Organic Pollutants, Section V. 37 WB (2007) Health Care Facility EHSGG, p9. Page | 112 used to control heavy metal emissions. The volatile heavy metals usually condense to form a fume (less than 2 µm) that is only partially collected by pollution control equipment, • Management of incineration residues such as fly ash, bottom ash and liquid effluents from flue gas cleaning as a hazardous waste (see General EHS Guidelines) as they may contain high concentrations of POPs.38 It is important to note that since sharps will not be disinfected with chlorine solutions, POPs are not expected to be formed during incineration. The vehicles that will be used for public address, vaccine delivery, and healthcare waste transportation, and vehicles used for coordination activities will generate an insignificant amount of emissions due to the small scale of activities (i.e., small number of vehicles which is about 58 vehicles) from this project. A typical diesel truck emits about 4.6 metric tons of carbon dioxide per year. This number can vary based on a vehicle’s fuel, fuel economy, and the number of miles driven per year.39 Similar to the incinerator combustion processes, emissions from vehicles include CO, NOx, SO2, particulate matter and volatile organic compounds. Given the insignificant amount of project vehicle emissions, the project will take a preventative management approach to ensure the proper maintenance of vehicles to avoid any unnecessary releases. The project is expected to support 9 national vehicles for coordination activities, 3 vehicles per province for 10 provinces, 2 public address vehicles, 9 refrigerated trucks for vaccine delivery and 8 trucks for waste transportation. Therefore, the vehicle fleet being supported is 58 vehicles which is far below the ESHG threshold of 540 vehicles which is assumed to represent a potentially significant emission based on individual vehicle travelling more than 100,000 km per year using average emission factors. Vehicles will be serviced throughout the country thus any impacts (albeit minor) will be diffuse (not concentrated). For the waste transportation trucks, each truck will cover one province collecting waste from central, designated points in districts and transporting it to provincial or regional incinerators. It is important to note that not all HCF require off-site incinerators. In addition to complying with national programmes, the following approaches will be considered: regardless of the size or type of vehicle, fleet owners/operators should implement the manufacturer recommended engine maintenance programs, drivers should be instructed on the driving practices that reduce both the risk of accidents and fuel consumption, including measured acceleration and driving within safe speed limits. Activities to modify buildings and HCF sites during installation could lead to dust (soil related) and cement dust and the release of carcinogenic asbestos fibres which can affect workers, patients, and staff. Deteriorated indoor air quality will be of critical effect to especially asthmatic construction workers, and patients, with either minor or severe health impact depending on level and duration of exposure. However, risk of asbestos exposure is low in the project since installation of solar panel will involve ground mounting. The Pollution of Ambient Air will be minimized through adoption of this ESMF’s ESMP (see Table 6-8) that details suitable mitigation and management measures to be taken, institution of dust suppression measures, as well as use of suitable clothing and protective equipment. (d) Pollution of Soil and Water 38 WB (2007) Health Care Facility EHSGG, p9. 39 United State Environmental Protection Agency, Office for Transportation and Air Quality, 2018 Page | 113 Pollution of solid ambient ground water or surface water may also occur from oils and fuels as a result of the fuelling and maintenance of vehicles. Similarly, improper disposal of medical waste such as sharps and all other construction and operation phase wastes (including wastewater) can also result in pollution of soil and water bodies. Contamination can also occur during construction due to erosion and subsequent sedimentation. Pollution of Ambient Water possibilities will be minimized through adoption of this ESMF’s ESMP (see Table 6-8) that details suitable mitigation and management measures to be taken. (e) Provision of sustainable energy to the COVID-19 vaccination centres The solar power is environmentally friendly (i.e. it is not fossil fuels which release air pollutants) and sustainable so this is actually an environmental benefit of the project. Solar power will be installed in select health care facilities depending on needs and resources. Back-up diesel generators will be used to supply power in case the solar power fails. However, the previously analysed installation process can pose occupational, health and safety (OHS) risks to the installers and it does generate some vegetation removal, exposed soils, solid wastes which should be disposed of appropriately in order to avoid pollution and contamination of land and water which would also pose potential risks to community health and safety. At the end of their useful life (25-30 years) solar panels and SDD refrigerators will need to be disposed of appropriately. Such waste constitute electronic waste. The current legal instruments are not clear on the management of electronic waste in Zimbabwe. Zimbabwe has no legislation or policy on electronic waste management. The available Environmental Waste Management Act (20:27) only prohibits the discharge of hazardous substances into the environment, but there is no specific legislation regulating electronic waste. (i) Enhanced cold chain supply for effective vaccine storage and transportation In order to maintain their effectiveness, the vaccines need to have a dependable cold chain supply to keep their temperature at the required level. One of the risks to the maintenance of this temperature are common power outages or electricity bills that may be too high for the health or other facility that would provide vaccinations. A mitigation measure to provide storage at a constant temperature and less expensively, the project is going beyond compliance to provide direct-drive solar vaccine refrigerators. As mentioned earlier, installation of the direct-drive refrigerators will also result in the replacement of old vaccine refrigerators which could cause an accumulation of excess refrigerators or obsolete equipment at health facilities and, depending on the model, some small batteries once used. Both the batteries and refrigerators will need to be disposed of appropriately at the end of their useful lives. Solar Direct Drive (SDD) refrigerators have a life span of about 15 years depending on the make. Therefore, installation of SDD refrigerators will displace refrigerators already in place. The disposal of obsolete, unusable, unserviceable or excess refrigerators will be guided by the Public Finance Management (Treasury Instructions) regulations of 2019, SI 144 of 2019. The Statutory instruments provides for the disposal of such equipment through i) transfer to another department with or without financial adjustment, ii) sale by public tender, iii) sale by public auction, iv) destruction, dumping, or burying, v) trade in or any other method recommended by the Procurement Regulatory Authority of Zimbabwe (PRAZ). Some refrigerators come with small batteries to power the fan. Typically, the batteries used in refrigerators have a life span of 5 years but can range up to 10 years. These smaller ancillary batteries used in SDD refrigerators are sealed gel batteries which are maintenance free and do not require topping up with distilled water. These are lower in cost than batteries used in other battery powered solar refrigerators. Ancillary batteries need to be replaced upon failure. It is important to have a scheduled battery replacement every few years to avoid unexpected systems failures. Upon reaching their life span, if the batteries are not disposed of properly can cause environmental and social challenges through contamination of the environment and water bodies with lead as well as causing lead poisoning in humans. The batteries need to follow proper Page | 114 disposal procedures which include recycling by sending them to recycling companies and in Zimbabwe there are companies such as Chloride Zimbabwe and Battery World which recycle these batteries. Transportation of vaccines (9 vehicles) and 3 vehicles for public address systems, and 8 vehicles for off-site waste transportation will carry common road safety risks. However the risk can can be compounded by poor and damaged roads which are in a state of disrepair. the risk will be minimal because the all drivers engaged by the MOHCC are licenced and in addition will have undergone a Defensive Driving Course prior to engagement. Pollution of land and water may also occur from improper management of oils, fuels and waste as a result of the fuelling and maintenance of vehicles one of the project activities. The risk of pollution can be minimized through adoption of mitigation and management measures detailed in this ESMF’s ESMP (see Table 6-6). (g) Occupational Safety and Health The movement of trucks to and from some HCFs for waste transportation, vaccination activities, operation and use of solar powered tricycles and vans for integrated outreach services, motorcycles during disease surveillance, and contractor workers involved in minor renovations and refurbishments of the maternity waiting homes and operating theatres will expose the workers to work-related accidents and injuries. Pollutants such as dust and noise could also have negative implications for the health of workers. There could be increased risk of work-related accidents as a result of lack of use of PPE by workers. Any cases of work related severe injuries or death (except for Covid-19 caused) must be reported to the PIE which will report to the World Bank with immediate effect such as within 24 hours of occurrence. Workers operating incinerators are exposed to the following: working at a high heat, which put the worker at a risk of burns. Heat may lead to fires, carbon monoxide poisoning. During burning of refuse, it may yield substances that may be hazardous or even poisonous. The incinerator operator’s job is physically hard and may lead to pain and other problems in hands, arms, the lower back parts. Working in hot and humid environment may cause tiredness and general ill feeling for the incinerator operator. To mitigate against the these OHS effects, there is need for appropriate PPE to be provided to the incinerator operator. Install effective exhaust ventilation to prevent air contamination and local exhaust ventilation if necessary. There is a need to arrange for the periodic inspection of incinerator vessel integrity to detect metal cracking as well as the training of incinerator operators of safe lifting and moving techniques for heavy or awkward loads. Health care providers and personnel may be exposed to general infections including COVID-19, blood- borne pathogens, and other potential infectious materials (OPIM) during care and treatment, as well as during collection, handling, treatment, and disposal of health care waste. The following measures are recommended to reduce the risk of transferring infectious diseases to health care providers: • Formulate an exposure control plan for blood-borne pathogens, • Provide staff members and visitors with information on infection control policies and procedures, • Establish Universal / Standard Precautions to treat all blood and other potentially infectious materials with appropriate precautions, including: • Immunization for staff members as necessary (e.g. vaccination for hepatitis B virus) • Use of appropriate PPE • Adequate facilities for hand washing. Hand washing is the single most important procedure for preventing infections (e.g. nosocomial and community). Hand washing should involve use of soap / detergent, rubbing to cause friction, and placing hands under running water. Washings of hands should be undertaken before and after direct patient contacts and contact with patient blood, body fluids, secretions, excretions, or contact with equipment or articles contaminated by patients. Washing of hands should also be undertaken before and after work shifts; eating; smoking; use of Page | 115 personal protective equipment (PPE); and use of bathrooms. The LMP and the ICWMP contain detailed procedures, based on WHO guidance, for protocols necessary for testing, administering vaccines and handling medical waste as well as environmental health and safety guidelines for staff, including the necessary PPE. Traffic accidents have become one of the most significant causes of injuries and fatalities among members of the public worldwide. Traffic safety should be promoted by all project personnel during displacement to and from the workplace, and during operation of project equipment on private or public roads. Prevention and control of traffic related injuries and fatalities should include the adoption of safety measures that are protective of project workers and of road users, including those who are most vulnerable to road traffic accidents; The following measures will be adopted to ensure safety of the workers and the public: Adoption of best transport safety practices across all aspects of project operations with the goal of preventing traffic accidents and minimizing injuries suffered by project personnel and the public. Measures should include: • Emphasizing safety aspects among drivers • Improving driving skills and requiring licensing of drivers • Adopting limits for trip duration and arranging driver rosters to avoid overtiredness • Avoiding dangerous routes and times of day to reduce the risk of accidents • Use of speed control devices (governors) on trucks, and remote monitoring of driver actions • Regular maintenance of vehicles and use of manufacturer approved parts to minimize potentially serious accidents caused by equipment malfunction or premature failure. However, implementation of mitigation measures stated above will held reduce OHS risks associated with the project. (h) Environmental, Health and Safety Impacts of Operational Activities on Patients, Staff, and Other Stakeholders Inappropriate handling of COVID-19 samples and patients can expose community and could lead to further spread of the disease. Non-provision of medical services to disadvantaged or vulnerable groups is a potental risk under the project. The project ICWMP will contain guidelines on specific measures to prevent the spread of diseases in the community from infectious medical waste. This ESMF contains measures to ensure health and safety in the community from project activities and safety of services as they relate to health care facilities, vaccine roll out, emergency preparedness measures including measures to address a plan for cold chain storage during power outages and natural disasters (Appendix 13). GBV/ SEA/SH risks will be ameliorated through training of every worker engaged in the project on OHS and GBV/ SEA/SH risks and be required to sign a code of conduct. COVID-19 vaccine safety and surveillance will be guided by the existing MOHCC’s Adverse Events Following Immunisation surveillance and the WHO Vaccines Safety Surveillance Manual. The project will regularly integrate the latest guidance by WHO as it develops over time and experience addressing COVID-19 globally especially with respect to reducing the risk of the project spreading COVID-19 to the public in general. Additionally, the project will conduct risk communication and community engagement activities to raise awareness and dispel misnformation in the affected areas including the vulnerable and marginalised groups, use of proper PPE for COVID-19 prevention measures No one will be forced to get the vaccine. The project will abide by Section 3.3 (Life and Fire Safety) of the World Bank Group (WBG) General Environmental, Health and Safety Guidelines (EHSG) as it relates to fire and other safety standards for new buildings and existing buildings programmed for renovation with the use of the Bank funding. These requirements apply to buildings programmed for renovation, whether occupancy type is maintained (e.g., a hospital renovation) or changed (e.g., an office building is converted to a hospital). Page | 116 The use of the Military or Security Personnel is not currently envisioned for any activities related to the Project. (h) Adverse Events Following Immunization (AEFIs) For the Government of Zimbabwe through MOHCC, vaccine protection is an integral aspect of immunization programs and requires the participation of multiple stakeholders whose primary mandate is to control immunization safety. In partnership with ZEPI, the National Pharmacovigilance and Clinical Trials Committee, MCAZ, are the main drivers of this enterprise. COVID-19 vaccine safety surveillance will be guided by already existing MoHCC’s Adverse Events Following Immunization (AEFI) surveillance guidelines and the WHO COVID-19 Vaccines Safety Surveillance Manual. Safety surveillance for COVID-19 surveillance will be further strengthened through additional training of MOHCC health care workers on causality assessment of adverse evets following COVID-19 vaccination, identification, management and reporting of potential cases of anaphylaxis and ensuring availability of comprehensive emergency tray at all vaccination points. The trainings will be provided as part of a comprehensive COVID-19 vaccine introduction trainings. The project will also hire a Social Specialist to oversee the management of social risks and impacts associated with the project as well as the implementation of the project GRM and Gender Based Violence Action Plan (Appendix 12). 4.2.5 Risks Associated with Hazardous Work Hazardous manual tasks include lifting, lowering, pushing, pulling, carrying which require sudden use of force, repetitive movements and awkward posture. Lifting, carrying and/or pushing cement, sand and other construction materials to storage areas or from storage areas to the working zones for on-site mixing of concrete and other activities as well as lifting heavy construction equipment like generators, doors and windows may involve situations that put undue stress on the waist, central spine and other body parts of site workers. Another type of hazardous manual tasks is hand, arm and/or body vibrations resulting from the single or prolonged use of jack hammers and power drills on site. Sprayers, painters, labourers, and steel benders working on new constructions, rehabilitation and installation at the selected EmONC (hub) facilities, One Stop GBV Centres, school clinics and POE may be expose to emissions, dust and naked oxy acetylene flames respectively during treatment of wood to be used as roof members and form work, painting as well as cutting and wielding during the construction or rehabilitation of the selected project facilities. During mixing and carting of concrete and masonry, concrete may also splash into the eyes of the workers involved in the aforementioned activities. Similarly, dripping paints, oils and lubricants from high elevation may come into contact with the eyes of site workers, adversely affecting the eyes. These incidents may lead to immediate or long-term visual impairment and/or blindness, therefore eye hazards are of major consequences with a likely occurrence. The health risks associated with hazardous tasks under the QEHSSSP will be limited to site workers and hired hands for loading and off load building materials and equipment. Incidence of Work-Related Accidents Accidents may occur during the new constructions, installation and rehabilitation works leading to injuries and potential loss of life involving employees of Sub Project Contractor, their Sub-Contractors and suppliers as well as employees of the selected facilities to be rehabilitated or during new constructions. Common accidents related to civil and rehabilitation works as well as installation of equipment and facilities include burns, cuts, slips and falls resulting from poor housekeeping and signage on site, installation and operation of equipment. Other causes of work related accidents are failure to adhere to equipment manufacturers’ specifications and the use of Personal Protective Equipment (PPEs). Poor Conditions of Service Page | 117 Sub Project Contractors and Sub-Contractors as well as suppliers may practice unfair/discriminatory recruitment practices (e.g., against women) and may attempt to subvert the national labour laws with practices such as paying wages lower than the national minimum wage, asking workers to work overtime without pay, denying women maternity leave and corresponding allowances and employ persons without formal contracts. Health/allied health workers and other ancillary workers, who will be recruited or posted to work in the rehabilitated EmONC facilities and POEs as well as the newly constructed pilot Bio-medical Waste Treatment Facility, One Stop GBV Centres and School Clinics can also be subjected to similar infractions. Incidence of Child Labour Sub Project Contractors, their sub-contractors and suppliers may recruit unqualified or under aged persons to work on site and other related activities. Exposure to Infectious Diseases Waste handlers, health and allied health workers at the selected EmONC (Hub) Facilities, school clinics, POEs and One Stop GBV Centres may pick up infections including COVID-19 leading to morbidity and mortality in the line of duty. Incidence of Gender Based Violence, Sexual Harassment and Sexual Exploitation and Abuse Teachers, health and allied health workers employed within the selected EmONC (Hub)/ health facilities, those to be employed within the new One Stop GBV Centres and site workers can become survivors or perpetuators of Gender Based Violence, Sexual Harassment and Sexual Exploitation and Harassment. Accidents involving Contractors and Suppliers Trucks and Equipment Haulage and trucks and equipment belonging to Project Suppliers, Sub Project Contractors and Subcontractors may be involved in accidents leading to the loss of life and property, injuries and spillage of materials within project catchment communities and along haulage routes. 4.2.6 Potential Environmental, Health and Safety Impacts The table below outlines potential environmental impacts from planning, installation and operation phases of the project. Table 4-1 Potential Environmental Impacts PARAMETER UNDER CONSIDERATION REF: CATEGORY CAUSE IMPACT PLANNING PHASE (i) Physical • Project activities will not acquire any • presence of hazardous and Restrictions new land flammable materials on building • Solar power equipment installations • presence of Asbestos Containing space will be on already-existing building Materials (ACM) sites • Page | 118 PARAMETER UNDER CONSIDERATION REF: CATEGORY CAUSE IMPACT INSTALLATION AND OPERATION PHASE (i) Increased • Use of more medical supplies by the • Generation of more health care generation enhanced Health Delivery system waste such as sharps, infectious of Health • Increased utilization of health and non-infectious waste, and Care waste services toxic fly ash • Availability of more vaccines • Increased PPE waste generation • Increased use of PPE because of • Increased generation of clinical COVID-19 precautions and infectious waste • Replacement of obsolete • Increased accumulation of refrigerators, equipment for the care obsolete equipment and management of new-borns • Contamination of the • Poor disposal of small ancillary environment with lead from the barriers for refrigerator’s batteries batteries and community health • Refrigerant with CFCs and safety issues for people who • Incinerator operation to mitigate come into contact with battery health care waste generated lead and acid • CFCs can cause ozone depletion • Incinerators: a) improperly operated can cause the release of unsafe wastes that can harm humans and pollute the environment b) pose OHS risks to operators and other health care workers that may come in contact with an incinerator (ii) Soil and Land • Minor installation work (essentially • Decrease or increase the degradation small-scale alterations) may expose drainage of the areas soil to erosion, compaction, or • Soil erosion deterioration of the soil structure • Generation of dust • Accidental discharge of hazardous • Soil and water pollution substances such as fly ash, bottom • Air contaminants affecting on- ash from incinerators site and offsite soils (and • Improper incinerator operations humans if present) (iv) Pollution of � Emissions from vehicles � Pollution of air Ambient Air � Emissions from building equipment � Deteriorated indoor air quality and released particulate matters � Increases in bronchial disorders (dust) � Impaired visibility on the roads � Cement dust from demolitions � Emissions from incinerators Page | 119 PARAMETER UNDER CONSIDERATION REF: CATEGORY CAUSE IMPACT (v) Pollution of � Wastewater discharges from the � Discharge of this wastewater Soil and installation activities and HCF into surface waters impacts on Water operations water quality by causing � Erosion processes introduce changes to its physical, pollutants and particulates into the chemical, and biological water properties � Rainwater run-off from the health � Effluent pollutes soil and water facility sites resources � Liquid effluents from flue gas � Littering and indiscriminate cleaning of incinerators are a dumping of solid waste pollutes hazardous waste land and water resources � Oils from fuelling, repair, and � Poisoning of aquatic and inland maintenance of vehicles ecosystems. � Loss of ordinary use of water � Oil discharges pollute water and inland ecosystems (vii) Temporary � Installation requires materials to be � Change of the aesthetics of Visual stored at site project area Intrusion (viii) Disruptions from Installation Activities (b) Temporary � Blocking sections of the facility for � Shortages of working space or disruption of installation inconvenience Health Care Services (c) Occupational � Weak technical capacity and/or � Temporary and permanent Health and negligence on operation of vehicles and physical injuries Safety Issues machinery � Bronchial diseases from dust � Lack or inadequate use of safety gear � Loss of life may also contribute to accidents that � Injuries to personnel may result in trauma and other � Loss of life casualties � Damage to vehicles � Road safety risks from transportation of vaccines, personnel and public address vehicles (d) Impacts of � Noise and vibrations during works. � Temporary and permanent Installation � Spillages and dust during physical injuries activities on transportation of materials. � Bronchial diseases from dust Patients, Staff, � Falling from tripping on building � Loss of life and Other materials. � Cracking of existing structures Stakeholders � Falling or flying debris from vibrations Page | 120 PARAMETER UNDER CONSIDERATION REF: CATEGORY CAUSE IMPACT (e) Installation � Installation wastes may include: � Pollution of the environment and � Demolition debris � Obstruction of the public, and the Construction � ACM movement of the workers and Waste � Excavated soils vehicles � Cement bags � Affect the aesthetics of the � Paint drums environment if not professionally � Brick and concrete rubble managed � Scrap metal � Other debris Page | 121 4.3 Social Impact Analysis The social risk classification of the Project is Substantial. There are risks associated with exclusion of marginalized and vulnerable groups who may be unable to access services which would increase vulnerability and undermine the general objectives of the project. This risk of exclusion to vulnerable groups could be due to poor road infrastructure, and lack of accurate information on vaccine roll out. There are also risks associated with AEFIs and social conflict resulting from limited availability of vaccines and social tension due to the pandemic situation. The other social risk is that COVID-19 having triggered misinformation across social networks, and this could lead to lack of confidence in vaccinations and vaccine hesitancy. Need for a Grievance Redress Mechanism The potential impacts will infringe on people’s rights, and they may be aggrieved in one way or another. To address this a grievance redress mechanism is being strengthened under the ZCEREHSAFP will use the existing GRM under the HSDSP AF-V. The current project GRM is based on both MOHCC conflict-resolution mechanisms as well as project-based steps to ensure that beneficiaries and all stakeholders have opportunities and means to raise their concerns and/or provide suggestions regarding project-related activities. In addition, as part of the COVID- 19 response, the MOHCC has established an EOC using a toll-free number to report suspected cases and grievances can be reported through provincial call centres. The current AF-V GRM has been improved to integrate GBV-sensitive measures, including multiple channels to initiate a complaint and specific procedures for GBV/SEA/SH, such as confidential and/or anonymous reporting with safe and ethical documenting of GBV/SEA/SH cases. It is important that the project continues to link client satisfaction surveys with the GRM. The current national COVID-19 response Toll Free Number is 2019 is being used for GRM issues. 4.3.1 Key Social Risks There are several key social risks which include: (i) Enhanced community transmission and exposure of health care workers, health care mobilisers and community workers to COVID-19: Increased exposure due to non-adherence to public health guidelines and lack of/or poor management of PPE, (ii) Risks to vulnerable Groups: Vulnerable groups include people with chronic conditions/disabled, poor people, migrants, the elderly and, disadvantaged sub-groups of women, Indigenous Peoples (IPs). They face several risks which include exclusion from consultations, difficulty to access services, potential displacements, etc., (iii) Handling of Project and Personal Information: Will cover (i) general project information which must be shared with all stakeholders for the smooth running of the project, (ii) handling and storage of Personal data collected in the process of project implementation in COVID-19 response, and (iii) misinformation in social media networks related to COVID-19, (iv) Exclusion of disadvantaged groups in consultations: Vulnerable groups are at risk of being left out in the consultation processes and hence in the implementation of the projects. There is need for representation of vulnerable groups in different structures e.g., HCC, Ward committee, CHWs so that their voices are heard. (v) Disruptions from installation activities: Disruptions may include disruptions of utilities in maternity waiting homes and operating theatres that may be caused by the contractors, temporary disruption of health care services as sections of the health facility utilities is cut off, and impacts of construction activities on patients, staff, and other stakeholders. However, most installation and Page | 122 renovation activities are short term not taking more than 21 days to complete. Therefore, no major services will be disrupted for a prolonged period, and this is a low risk. (vi) GBV/SEA/SH risks among health care providers and communities: Risks especially in relation to distribution life-saving vaccines and family planning commodities, and access to outreach services. These can be at the vaccination centres and outreach centres and maternity waiting homes. Other abuses can be by the health care trainers, supervisors and community members who may be subject to surveillance and follow up. (vii) Social conflicts and risks to human security: resulting from testing, limited availability of vaccines and family planning commodities and tension related to the difficulties in accessing mobile outreach services. (viii) Public perception risks: Risks associated with Adverse Events Following Immunisation (AEFIs). 4.3.2 Social Impact Analysis - Planning Phase (i) Project Timing The project support is being delivered at a time when the country is already implementing COVID-19 response RMNCAHN activities. Vaccination and risk communication and community engagement are already taking place. Hence the project will fill a gap in identified priority areas including health systems strengthening for effective response and delivering of RMNCAHN services. Stakeholder consultations will be ongoing and the processes for stakeholder engagements are detailed in project SEP. The project will help Zimbabwe vaccinate the target population eligible for vaccines according to the National Vaccine Deployment Plan (NVDP), which is based on the World Health Organisation’s (WHO) Strategic Advisory Group of Experts (SAGE) Values framework. Based on this, the social risk rating of the project is considered substantial. 4.3.3 Social Impact Analysis – Installation/Implementation Phase (i) Risks to vulnerable Groups a) Difficulties in Access to Services by Vulnerable Social Groups Difficulties in access to services by vulnerable social groups through Exclusion in consultations, (i.e. people with chronic conditions/disabled, poor people, migrants, the elderly and, disadvantaged sub- groups of women, Indigenous Peoples (IPs)). Vunerable groups may have difficulties in accessing services and facilities designed to combat the disease and improve RMNCAHN services. (ii) Handling of Project and Personal Information a) Personal Data Protection Possible personal data protection concerns which may arise in relation to the collection, storage or use of personal data. Large volumes of personal data, personally identifiable information and sensitive data are likely to be collected and used in connection with the COVID-19 response and RMNCAHN services under circumstances where measures to ensure the legitimate, appropriate and proportionate use and processing of data may not feature in national law or data governance regulations, or be routinely collected and managed in health information systems. b) General Project Information Full participation of key stakeholders during project preparation and implementation is important to the successful implementation of the project. Thus, the ZCEREHSP will ensure that information is meaningful, timely, and accessible to populations that are most at risk (such as women, youths, persons living with disabilities, and elderly people densely populated areas), and contribute to Page | 123 strengthening the capacities of community structures in promoting prevention messages and messages related to access of the RMNCAHN services in the community. Component 1b of ZCEREHSP is focused on complementing efforts to ensure communication is strengthened in communities, enhancing provision of clear information related to risks and prevention measures. Proper communication and advocacy will result in social, and behaviour change and health delivery strengthening down to village level by changing the perceptions of the implementers and villagers through various training programmes. c) Misinformation in Social Media Networks Related to COVID-19 Misinformation in social media networks related to COVID-19 and stigma for those who will be admitted to isolation or treatment centres may contribute to propagate false information. Some of the vaccine recipients may experience adverse events following immunisatins.Furthermore, This can be countered by continous consultations, publicising and communication of the correct information through various media. This can be countered with correct handling of project and personal communication and tracking of media to correct myth and misconceptions on how to deal with the pandemic, and response measures and vaccinations in particular. Call centres (Emergency Operation Centres) being supported under AF-V will be communicated to project beneficiaries to provide adequate and proper information to project affected persons on regarding vaccines and reporting AEFIs. The national EOC is has been established at Parirenyatwa Hospital and each province will be supported to establish a Provincial EOC. d) Use of security or military personnel The engagement of security or military personnel in the implementation of project activities is not anticipated. In the event of military engagement, this action will be subjected to Bank approval before enforcement. Cordaid will ensure that prior to engagement of security personnel, (i) a written notice will be sent to the Bank indicating the name of the security unit; and (ii) ensure that all activities carried out by security personnel will be supervised by MoHCC, working closely with Cordaid as the Project implementing entity to ensure compliance with environmental and social provisions. MoHCC through the COVID-19 National Coordinator’s office will engage the Ministry of Home Affairs and Cultural Heritage and the Ministry of Defense and War Veterans Affairs in setting out the arrangements for the engagement of the military or security personnel under the Project, including compliance with the relevant requirements of this project. Furthermore, the Cordaid will assess risks associated with engagement of security personnel and implement appropriate mitigation measures to manage such risks and impacts, including a stand-alone Security Management Plan, guided by the principles of proportionality and GIIP, and by applicable national law. MoHCC, working closely with Cordaid will be required to adopt codes of conduct for security personnel and screen such personnel to verify that they have not engaged in past unlawful or abusive behavior, including GBV, SEA and SH or excessive use of force. Security personnel will be adequately instructed and trained, prior to deployment and on a regular basis, on the use of force and appropriate conduct. Any concerns related to security conduct will be addressed through the project GRM. 4.3.4 Potential Social Impacts Table 4-2 outlines potential social impacts from the ZCERHSEP activities from planning to installation and operational phases of the project. Page | 124 Table 4-2 Potential Social Impacts PARAMETER UNDER CONSIDERATION REF: CATEGORY CAUSE IMPACT 4.4.2 Planning phase impacts (i) Project Design � Limited Stakeholder Involvement � Low chances of success and � Inadequate dissemination/sharing of sustainability information � Failure to take up ownership of the � Unclear roles and responsibilities project � Predominance of the top-down approach. � Anxiety and anticipation Limited � Negative perception cooperation � Lack of transparency from the Authorities � Suspicion and hence concealing � Lack of proper timelines for the different important of information phases of the project � Dragging the planning phase too long 4.4.3 Implementation Phase (i) Enhanced community transmission and exposure of Health Workers To infectious diseases (a) Potential Risks � Staff executing their duties. � Community transmission of diseases of healthcare � Engagement with Community and Village � Transmission of diseases at health care workers Health workers. centres. � (ii) Risks to vulnerable Groups (a) Difficulties in � Exclusion from consultations of disadvantaged � Failure to access services. Access to groups � Exclusion from essential services. Services by � Vaccination Services not reaching targeted � Long-term hardship, impoverishment, Vulnerable beneficiaries and social unrest among the affected Social Groups � Occupational health and safety issues related community to civil works, working in the health care � Vulnerable and marginalized groups not setting and handling health care waste being protected from Covid-19 and other � Females, in project beneficiary districts or infectious diseases those seeking to access the RMNCAHN nutritional support to vulnerable patients- predominantly-new-borns, children and pregnant and breastfeeding women may be survivors of Gender-Based Violence (GBV), Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH); (iii) Handling of Project and Personal Information (a) Personal Data � Collection, storage or use of personal data � Abuse of personal information and data. Protection � Legitimate, appropriate and proportionate use and processing of data may not feature in national law or data governance regulations. (b) General � Limited sharing of project information. � Weak community structures to promote Project � Information not readily available to RMNCAHN and prevention messages Information populations that are most at risk. Page | 125 PARAMETER UNDER CONSIDERATION REF: CATEGORY CAUSE IMPACT (c) Misinformatio � Social media networks spreading various � Stigma for young people accessing n in Social information about COVID-19 vaccines and reproductive health services including Media family planning products and RMNCAHN family planning and stigma for those Networks services. infected by COVID 19. Related to � Lack of correct information of how to COVID-19, deal with the pandemic. Family Planning (e) AEFIs � Inadequate training of health care workers to � Community members react to vaccines inoculate vaccines including Covid-19 after immunisation. Vaccines � Vaccine hesitancy among community � Improper storage and transportation of members vaccines � Hesitancy in accessing family planning. � Inadequate advice on community about vaccination and family planning services. GBV/SEA-H � Lack of training on GBV/SEA-H among health � Abuse of health care providers and care providers community members and patients � Failing to abide by the SEA-H Code of Conduct 4.4 POSITIVE PROJECT IMPACTS The project is expected to produce many positive impacts. These include the following: (i) Improvement of Quality of Care and Utilization of Public Health Facilities The project will positively impact the health delivery programmes leading to improved health conditions. The project will also result in the improvement of the health of the populace. At the same time Government and other international organisations are working on similar initiatives in the concerted fight against the COVID-19 pandemic. All these efforts will result in a cumulative improvement in the quality of care and the increase of utilization of public health facilities. (ii) Improvement of Health and Hygiene Government and other international organizations are spreading the same message of hygiene improvement, washing of hands, sanitizing hands, and surfaces etc. as they fight to control the spread of the COVID-19 virus. All these efforts will result in a cumulative improvement in the health and hygiene of the populace. (iii) Improvement in Livelihoods and Local Economies Improved health care delivery will improve the health of the children, mothers, and adolescents, resulting in increased productivity and household incomes and long-term benefit of improved local economies. This improvement will be compounded by the efforts of Government and other development partners who are fighting to improve the health of the population after years of during regression the COVID-19 pandemic. On the other hand, there will be some negative cumulative impacts even from mitigated activities. For example, although ZCEREHSP’s contribution to overall medical waste (most importantly the Page | 126 vaccination needles) is relatively small, it does add to the overall volume of solid waste and once the infectious waste is incinerated, HCF’s will add to the amount of air pollution being generated already from vehicles, industry, and other sources. Project transportation activities, albeit minor, also contribute to the air pollution levels in Zimbabwe. 5. Procedures to Address Environmental and Social Matters 5.1 Introduction The ZCEREHSP site-selection criteria will, among others, include environmental and social appraisal as needed after a screening process. The selection of the institutions to be supported with installation of solar panels, installation of solar direct drive refrigerators, installation of refrigeration units in trucks, minor renovations and refurbishments of the maternity waiting homes and operating theatres, and installation of oxygen reticulation systems will be done by MOHCC based on their needs and priorities. The sections below (6.2 – 6.5) detail the stages of the environmental and social screening process leading towards the review and environmental and social approval of any project activity that will be undertaken in the ZCEREHSP. This will be used in conjunction with the ZCEREHSP site-selection criteria. 5.2 Project Activity Preparation and Approval The following is an outline of the process that will be undertaken to oversee project activity identification, preparation, screening, approval, and implementation process for all activities that may require Environmental and Social Assessment (ESA) work before final approval for implementation as discussed in Table 6-1 below. The process will be guided by the Environmental Management Act, EIA regulations and World Bank ESF and EHS Guidelines to address environmental and social management considerations under the project. The ZCEREHSP is aligned to COVID-19 response through supporting COVID-19 vaccine deployment activities and strengthening capacity for the MOHCC systems for effective vaccine deployment Page | 127 and delivery of RMNCAHN services. This project will target RCCE activities, infection prevention and control supply to facilities conducting vaccinations, vaccine deployment activities, cold chain supply through procurement and supply of solar direct drive refrigerators and setting up energy generation equipment, minor renovations of maternity waiting homes and operating theatres, installation of oxygen reticulation systems, procurement and supply of solar powered tricycles, motorcycles, and mobile outreach vans. MOHCC will identify facilities for support such as installation of solar power generation equipment, installation of refrigeration units in trucks and supply of solar direct drive refrigerators at health facilities, minor renovations of maternity waiting homes and operating theatres, installation of oxygen reticulation systems, procurement, and supply of solar powered tricycles, motorcycles, and mobile outreach vans. 5.3 Exclusion / Eligibility List 5.3.1 Exclusion List Table 5-1 below lists project activities that are not eligible for financing under ZCERP due to high environmental and/or social risks. Table 5--1 Project Activity Exclusion List No. NEGATIVE SUB PROJECT LIST 1 Require acquisition of land and physical or economic displacement of people. 2 Block the access to or use of land, water points and other livelihood resources used by others. 3 Encroach onto fragile ecosystems, marginal lands, or important natural habitats (e.g., ecologically sensitive ecosystems; protected areas; natural habitat areas, forests and forest reserves, wetlands, national parks, or game reserve; any other environmentally sensitive areas).40 4 Impact on physical cultural resources of national or international importance and conservation value.41 5 Activities that may cause long-term, permanent and/or irreversible (e.g., loss of natural habitat) adverse impacts such as dam construction and other greenfield construction among others. 6 Activities that have high probability of causing serious adverse effects to human health and/or the environment not related to treatment of COVID-19 cases. 7 Activities that may have adverse social impacts and may give rise to significant social conflict. 8 Activities that may affect lands or rights of indigenous people or other vulnerable minorities. 40 Fragile ecosystems include such places as wetlands, which quickly degrade if not properly used. Marginal lands include lands that has little or no agricultural or industrial value, often has poor soil or other undesirable characteristics and often located at the edge of desolate areas and can very easily be degraded if abused. So, these are ecologically sensitive areas which must be protected from any development that may adversely affect them. 41 A physical cultural resource (PCR) is a movable or immovable object or site of historical, architectural religious, or other cultural significance. Development should not impact on these important resources. Page | 128 9 Have risks assessed as requiring biosafety levels BSL-3 and BSL-4 containment.42 10 All other excluded activities set out in this ESMF. 5.3.2 Eligibility List Table 5-2 below provides criteria on which project activities which will be eligible for financing under ZCEREHSP. Table 5-2 and Activity Eligibility List No. SUB PROJECT ELIGIBILITY LIST 1 Participating laboratories must possess working eyewash, safety showers, sink, autoclave, etc. 2 Sites where there are no negative significant impacts on natural habitats or cultural sites. 5.4 Assigning Environmental and Social Category The assignment of the appropriate environmental category will be based on the World Bank ESF categorization and on the provisions of the EMA EIA Regulations. For ZCEREHSP, although most impacts and risks stem from minor works with a small footprint that have limited and manageable adverse environmental impacts in addition to medical waste which can also be mitigated and managed with the application of appropriate mitigation measures, the unprecedented ZCEREHSP COVID-19 and RMNCAHN related risks are classified as Substantial. The project will continue to support strengthening of medical waste management and disposal systems in permanent and temporary healthcare facilities on an as needed basis since the main environmental issue associated with this project’s activities is health care waste management.43 So, with respect to categorisation the World Bank and Zimbabwe systems will be considered: (i) The Zimbabwe legislation classifies projects and activities into three types as follows: Table 5-3 Zimbabwe Legislative Project Classification 42 Biosafety level (BSL), or pathogen/protection level, is a set of biocontainment precautions required to isolate dangerous biological agents in an enclosed laboratory facility. The levels of containment range from the lowest biosafety level 1 (BSL-1) to the highest at level 4 (BSL-4). At the lowest level of biosafety, precautions may consist of regular hand-washing and minimal protective equipment. At higher biosafety levels, precautions may include airflow systems, multiple containment rooms, sealed containers, positive pressure personnel suits, established protocols for all procedures, extensive personnel training, and high levels of security to control access to the facility. 43 Temporary health care facilities will need to factor in safe water, sanitation, and hygiene facilities (meeting quality standards; separation of infected vs. non-infected patients). Page | 129 TYPE INTERPRETATION Type 1 Projects under this category are listed in the Schedule and are likely to have significant adverse environmental impacts whose scale, extent and significance cannot be determined without in-depth study. Appropriate mitigation measures can only be identified after such study. From the assessment of the project prospectus the projects are classified as requiring a full EIA. Type 2 Projects under this category are listed in the Schedule and are likely to cause environmental impacts, some of which may be significant unless mitigation actions are taken. Such projects cause impacts which are relatively well known and easy to predict. Also, the mitigation actions to prevent or reduce the impacts are well known. From the assessment of the project prospectus the projects are classified as not requiring a full EIA. Type 3 Projects under this category are not listed in the Schedule and are unlikely to cause any significant environmental impact and thus do not require any additional environmental assessment. The World Bank projects are screened for their potential environmental and social impacts to determine the appropriate classification of the proposed projects into one of four categories as follows: World Bank Project ESF Risk Classification World Bank classifies environmental and social risks for projects using the following criteria; • High (H) risk • Substantial (S) risk • Moderate (M) risk • Low (L) risk Risk classification considers relevant issues, such as the type, location, sensitivity, and scale of the project; the nature and magnitude of the potential environmental and social risks and impacts; and the capacity and commitment of GoZ/Cordaid. This project risk is overall considered to be Substantial. Support to COVID-19 vaccine deployment and related health system strengthening particularly delivery of RMNCAHN services will have considerable positive outcomes as it aims to prevent, detect, and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. However, the Project activities can also have potential adverse environmental, health and safety (EHS) risks if an appropriate EHS mitigation and monitoring system is not implemented during both implementation and operation, including among other aspects the collection, transportation, and disposal of medical wastes. It is important to note that while the project will support the deployment of WB-eligible vaccines, it will not directly purchase or administer the vaccines. The project is only financing the enabling environment and infrastructure for vaccine and RMNCAHN services delivery. Vaccination programs or vaccines specifically carry the risk of adverse reactions/adverse events following immunization which may be due to the vaccine or by an error in the administration of or handling of the vaccines. Hence, the project will contribute to an appropriate COVID-19 vaccines safety monitoring system to respond to adverse events following immunization (AEFI) cases, if any. Taking into consideration the uniqueness and complexity of the vaccine safety monitoring of COVID-19 vaccine, MOHCC’s capacity to identify, report, investigate, and analyse adverse events following immunization and determine the cause of and respond to safety issues should be Page | 130 given due attention. Furthermore, an appropriate cold chain system should be in place to maintain the potency of the vaccines and the quality of the immunization service. Immunization programs also entail safe injection practices so that potential risks to the patients, healthcare personnel, and others could be avoided or minimized as unsafe injection practices can result in disease transmission. Similarly, patients gathered for vaccination are at risk for COVID-19 infection. MOHCC should therefore establish and maintain an appropriate EHS risk management system for the following risks and possible impacts among others: monitoring and surveillance of AEFIs; safe injections; for proper collection, transportation, and disposal of all hazardous medical wastes (including from this project); and for minimization of occupational health and safety risks. Some other more minor risks will issue from minor renovations and refurbishments of the maternity waiting homes and operating theatres, installation of oxygen reticulation systems, OHS risks (including from improper use or lack of PPE, dust emissions, trips and falls, and COVID-19 exposure), fueling and maintenance of vehicles (i.e., spills, waste disposal), actual truck transportation of goods/materials, use of motorcycles and solar powered tricycles (i.e., road safety, accidents, traffic, air emissions, etc), installation of solar panels for energy generation, installation of refrigeration units in trucks. Potential use of on-site emergency generators in case of loss of power and/or issues with solar. Contaminated soil at HCFs due to past improper on-site waste treatment or disposal, including waste storage, incinerators and waste pits. Emissions from the incinerators (as we dispose of infectious medical waste) and from the vehicles, as well as the construction and operation of solar power equipment depending on the equipment. The client’s relatively low capacity to manage the EHS risks associated with the activities (given lack of financial resources, hyperinflation, and several national challenges) and given the enormity of the Covid-19 challenge (its infectiousness, mortality, pandemic nature, etc.), the vaccines and Zimbabwe’s macroeconomic situation, environmental risk of the ZCEREHSP is therefore rated as Substantial at this stage. As mentioned above, the minor environmental impacts associated with installing solar panels, minor renovations of the maternity waiting mothers, and operating theatres, and installation of oxygen reticulation system will all be in already existing health care facilities and so minimal risks are posed to cultural heritage, natural habitats, or biodiversity. A more complete list of potential EHS impacts and risks is in Section 5 of this ESMF. The key social risk related to this operation is that vulnerable social groups (poor, disabled, elderly, isolated communities, refugees, and people and communities living far from the health facilities, etc.) may be unable to access facilities, vaccines, RMNCAHN services and other and services, which could increase their vulnerability and undermine the general objectives of the project. This risk of exclusion is due to vulnerable groups being in the low-income bracket with limited access to health services; the long distance to health facilities due to the remoteness of particularly rural areas with poor road infrastructure (which may affect vaccine transportation and access by outreach teams for RMNCAH services); and the lack of accurate information on the roll out of vaccinations and RMNCAH services as well as implementers perhaps not having the full appreciation for the eligibility criteria for vaccines and RMNCAH services. There are also risks of social conflict resulting from the limited availability of vaccines and RMNCAH services and social tensions related to the inherent difficulties of a pandemic situation and the inappropriate handling of personal data. The other social risk is the swift spread of misinformation (labelled “infodemic�) across social networks. This infodemic threatens to erode confidence in vaccination, which could lead to COVID- 19 vaccine hesitancy and decrease public trust in the program. Furthermore, the planned activities may present risks to project workers (healthcare workers and PIE staff) and civil servants who may be potentially exposed to COVID-19 due to prolonged engagement with the target communities or samples/materials contaminated with COVID-19. No forced vaccination will be permitted under this project. The project will help vaccinate the target population eligible for vaccines according to the Page | 131 Zimbabwe’s National Vaccine Deployment Plan (NDVP), which is based on the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) Values Framework. Based on this assessment, the social risk rating of this project is Substantial. The following table shows the risk classification of the different types of project activities: Table 5-3 Classification of the project activities No. ACTIVITIES WB Zimbabwe Classification Classification 1. 2 3 Transport (motor cycles and solar powered M 3 tricycles). (i) Early reporting and community psychosocial M 3 support for victims of GBV/SEA/SH including linkages/referrals to care. All interventions will incorporate gender mainstreaming through involvement of both females and males in the communities. (i) Procurement of PPE and Family Planning L 3 items (ii) Fuel, repair, and maintenance service of M 3 vehicles used for vaccine distribution (Component 1 ZCEREHSP) (iii) Activities that generate, manage, or transport or S dispose infectious medical waste (vi) Outreach, family planning and vaccine L 2 distribution including fuel, repair, and maintenance service of vehicles 4 5 Provision of PPE for health care workers L 3 6 Grievance Redress Mechanisms (GRMs); L 3 Psychosocial support systems for both healthcare workers and general population by building capacity of community health workers and support to national psychosocial centre; community discussion forums with local and traditional leaders and school heads to share information about gender-based violence (GBV), sexual exploitation, abuse and harassment (SEA-H) and GRM 7 Vehicle maintenance and fuel for key National L 3 Response Pillar leads to coordinate and monitor COVID-19 response activities 8 Audits, reviews, and other activities to ensure L 3 governance and accountability 10 Page | 132 No. ACTIVITIES WB Zimbabwe Classification Classification 11 Minor renovations of the maternity waiting homes L 3 12 Minor renovations of the operating theatre L 3 13 Installation of oxygen reticulation systems L 3 14 Use, repair and maintenance of solar powered L 3 tricycles, motorcycles, and vans 15 Delivery of RMNCAH services S 3 Zimbabwe EIA procedures are generally consistent with the Bank’s ESF. 5.5 Environmental and Social Screening This section outlines the stages of the environmental and social screening process (the screening process) leading towards the review and environmental approval of any project activity that will be undertaken on the ZCEREHSP. To facilitate environmental and social screening, the ESMF has provided a checklist for project activity types that will assist stakeholders, proponents, and project staff with the identification of environmental and social issues relating to the location surrounding environment based on available knowledge and field investigations. 5.5.1 Environmental Screening MOHCC will identify project activities and MOHCC District Technical Teams (see Figure 6-1) and participating facilities, with support from the PIE Environmental Specialist and Social Safeguards Specialist, will be responsible for the environmental and social screening of an activity. The PIE Environmental and/or Social Safeguards Specialists will give overall guidance in the screening process approving or rejecting ultimately, whilst MOHCC participating facilities will conduct the screening and submission for approval (i.e., filling out the form and doing the on-site evaluation). The screening will be conducted to identify possible site-specific impacts and safeguard issues associated with a particular activity. Commensurate with the significance of activity impacts, screening is only required for installation activities. Facilities that will install solar panels are required to screen those activities for environmental and social risks. Screening is required for truck installations if those activities will take place at only a few (like 4 or less) locations to avoid impacts from concentrated activities. If truck installations will take place at numerous locations (thus resulting in diffuse insignificant impacts), responsible project proponents or contractors are to apply the relevant measures in Table 5-5 and below in Table APP9.1 although they do not need to be screened. The initial stage is a desk appraisal of the activities planned, including designs. The screening process will be carried out by the MOHCC participating facilities with support from PIE. This initial screening will be carried out using the Environmental and Social Screening Form (Appendix 5). Completion of the screening form will facilitate the identification of potential environmental and social impacts, determination of their significance, assignment of the appropriate environmental and social category, identification of appropriate environmental and social mitigation measures, determine if any further environmental and social work is necessary, if necessary. The Environmental and Social Screening Process is outlined in Figure 6-1 below. Once drafted, the PIE Environmental Specialist will review the Screening Form before any activities take place just in case the activity is not eligible or does not contain Page | 133 the necessary information. MOHCC will identify facilities to be supported with installation of solar panel for sustainable energy generation and supply of solar direct drive refrigerators. MOHCC vehicles will also be supported with fuel, maintenance, and repair therefore MOHCC will be responsible for identifying vehicles to be supported. MOHCC with support from PIE is responsible for screening project activities for environmental and social risks and/ impacts. The screening forms will be submitted to the PIE for review and approval. The extent of further environmental and social work required to mitigate adverse impacts for the project activities will depend on the outcome of the screening process. The following activities may be screened: installation of refrigeration units in trucks for vaccine delivery, fuelling, repair and maintenance of vaccine delivery trucks. Table 5-4 outlines activities that will require screening and preparation of an ESMP. Table 5-4 Environmental and Social Analysis Levels for Types of Project Activities NO. PROJECT ACTIVITY TYPE ADDITIONAL ESA WORK REQUIRED 1. 2. 3. 4 Fuel, repair and PIE will communicate guidance (from this ESMF and EHSGs) to maintenance of vehicles, those carrying out vehicle fuel, repair and maintenance service motorcycles, and tricycles. activities from the beginning and note any repair/maintenance activities that are in or near natural habitats (such as rivers, parks, etc.) since those should receive increased supervision attention and ad hoc monitoring. These requirements will be reflected in the contract/s for such services. If MoHCC facilities are used, then the requirements must be provided in writing and there must be agreement that they will be implemented. If activities will be carried out at 4 or less sites, such sites will be screened and shared with WB for no objection. The Environmental, Health, and Safety Guidelines for Retail Petroleum Networks contains information relevant for this project activity. 5 Transportation of Obtain any necessary licenses/permits prior to use of any such hazardous waste and all Transporter and follow requirements of the project ICWMP. For medical waste contracted Transporters all EHS requirements are to be specific in-service contract. PIE to verify license/permit. 6. Vaccine and Family Waste Management: PIE to communicate ESMF and ICWMP Planning items distribution waste management standards (including national environmental and social requirements) for sharps and other waste segregation and management to HCFs (participants). Participating facilities must have an approved facility level ICWMP with details on sharps and all medical waste management. Facility ICWMPs will be reviewed and approved (or denied) for project support by the PIE. Facilities will be advised on how to improve any unacceptable ICWMPs. Health & Safety: PIE to verify that AEFI safety and efficacy monitoring plan and activities in place to enable swift detection Page | 134 NO. PROJECT ACTIVITY TYPE ADDITIONAL ESA WORK REQUIRED of anomalies. Plan must be in place before vaccine distribution starts. 7. 8 Medical waste disposal by All regulatory permits. Compliance with all ESMF and ICWMP incinerator or acceptable requirements. EHSG requirements established in contract if other type third-party service provider. Verified by PIE. 9 Minor renovations of the Requires screening and checklist ESMP. All EHS requirements to Waiting Mothers’ Homes be included in construction works contract. Requirements: (WMH), operating theatres Compliance with all ESMF and ICWMP requirements. For third- party service providers, EHS requirements will be established in contracts to be verified by PIE. 10 Installation of oxygen Requires screening and checklist ESMP. All EHS requirements to reticulation system be included in construction works contract. Requirements: Compliance with all ESMF and ICWMP requirements. For third- party service providers, EHS requirements will be established in contracts to be verified by PIE. 11 Delivery of RMNCAHN Waste Management: PIE to communicate ESMF and ICWMP services waste management standards (including national environmental and social requirements) for sharps and other waste segregation and management to HCFs (participants). Participating facilities must have an approved facility level ICWMP with details on sharps and all medical waste management. Facility ICWMPs will be reviewed and approved (or denied) for project support by the PIE. Facilities will be advised on how to improve any unacceptable ICWMPs. Disposal of electronic waste The disposal of electronic will be is accordance with the public finance management, procurement, and disposal of public assets regulations Figure 5-1 below depicts the steps for project activity identification, submission, screening, approval, and monitoring. Page | 135 STAGE OF PROJECT CYCLE AND ACTIVITY RESPONSIBILITY SUB-PROJECT IDENTIFICATION Selection of AND SELECTION Participating sites DESK APPRAISAL. Screening of Sub-project activities and sites. (To be based on screening form: Appendix 5) • Desk appraisal of the sub-project activities (Dist. Tech. Team) • Identification of Environmental and social impacts • Determination of Significance of impacts • Assignment of appropriate environmental category, If Category is high, substantial, medium or low or lower, then: Review the recommendations in the screening form. Conduct public consultation. Environmental and social screening Adverse Impacts Present process of the No Adverse identified sub- Impacts projects THEN UNDERTAKE FIELD APPRAISAL • Determine any further EA work. Adopt ESMP • Prepare Site Specific Checklist ESMP template in (Appendix 10) ESMF. Review all documentation. Submit to PIE Head Office for approval of Checklist ESMPs Public consultation and disclosure Sub-project approval Project Approval Sub-project implementation MONITORING: Implementation of Health Activities Sub-Project Inclusion of environmental design features. Annual Reviews Implementation & Annual Report Page | 136 Figure 5-1 Flow for project activity identification, submission, evaluation, and monitoring44 5.5.3 Evaluation and Approval of Environmental and Social Evaluation and Instruments Zimbabwe environmental and social evaluation requirements are generally consistent with the Bank’s ESF. The completed screening form, along with any additional planning reports, will be forwarded to the review authority (Evaluations Committee), which is the Ministry of Health at National Level, represented by the PIE Environmental and Social Specialists. Project activities such as installation of refrigeration units in vaccine delivery trucks, and the supply of reagents for genomic sequencing which are low risk and do not have significant environmental and social implications, do not require the preparation of an ESMP. Installation of refrigeration units in vaccine delivery trucks only need to be screened if the installation will take place in a limited number of places (for example, if a particular site will install units in 20 or so vehicles) to determine whether any steps must be taken to avoid or minimize impacts for example to nearby natural habitats but all of them will require use of proper PPE, waste disposal and application of EHS General Guidelines. The supply of reagents for genomic sequencing and other laboratory related activities will require screening to ensure the exclusion of activities requiring BSL3 and 4 capacity. The PIE (or other deputised party) will monitor the management of environmental and social issues of these types of project activities as a part of project supervision and monitoring. Installation of energy generation equipment (for solar power) as a relatively higher risk project activity, requires a checklist ESMP based on its screening together with the requirements of this ESMF as its safeguards instruments before the activity starts. Facilities that will distribute vaccines must have an approved facility-level ICWMP with details on sharps management as well as an AEFI safety and efficacy monitoring plan and arrangements in place to enable swift detection of anomalies both of which (ICWMP and AEFI Safety & Efficacy Plan) must be in place before vaccine distribution starts. Transportation of hazardous waste is to be detailed in a facility ICWMP and should obtain any necessary licenses/permits and follow requirements of the project ICWMP. PIE to verify license/permits as a part of project supervision. At least the first 3 project screening, ESMPs, ICWMPs and AEFI Plans (for each activity type) require WB No Objection before the activity starts. The project implementer will ensure each facility develops ESMPs when necessary for every project activity based on its screening in line with the requirements of this ESMF as its safeguards instruments before the activity starts. For this project, the installation of solar panels for energy generation is the only project activity that will require screening and development of an ESMP. Project proponents (either HCFs or contractors) are required to use the ESMP templates in Appendices 6 and 10 to draft their ESMPs for solar power installation. Solar power installation activities must have an ESMP approved by the PIE before they start. An ESMP is required for truck installations if those activities will take place at only a few (like 4 or less) locations to avoid impacts from concentrated activities. If truck installations will take place at numerous locations (thus resulting in diffuse insignificant impacts), responsible project proponents or contractors are to apply the relevant measures in Table 5-5 and in Table APP 9.1 although they do not need to be screened or to develop any ESMP. 44 The term� subproject� in this diagram refers to individual project activities. Page | 137 Each facility participating in COVID-19 vaccine deployment activities is required to prepare and implement an approved ICWMP (which is the form the ESMP takes for this activity) in accordance with the requirements of this ESMF. Generally, many of the project activities that will be financed by ZCEREHSP will not need any further EA work beyond a checklist ESMP to guide the implementation of this ESMF. So, no further EMA approvals will be required except for those required by HCF for its waste management activities. 5.6 Management of Impacts The proposed mitigation measures for the Zimbabwe ZCEREHSP (Table 6-6), provides guidelines for the management of potential environmental and social aspects at all possible project activity sites. The mitigation or enhancement measures will reduce the negative impacts and enhance the positive impacts. The information from the screening process will be used in the preparation of ESMPs as necessary. An ESMP template is included in Appendix 9. Very low risk activities, such as installation of refrigeration equipment in vaccine delivery trucks and transportation of medical waste, do not require screening. Project implementers carrying out this activity should just observe the ICWMP guidance respecting the safe handling and disposal of reagents as well as any laboratory safety protocols therein or in this ESMF. ESMPs will be developed by the Provincial/District Technical teams as necessary under the oversight and guidance of the PIE Environmental Specialist (see section 1.7 and 6.1). Appendix 6 presents directions for ESMP formulation. The solar power installation project activities will adopt the checklist approach. The checklist methodology is a more streamlined approach to preparing an ESMP especially for low-risk projects. The checklist approach covers typical mitigation approaches to common low-risk activities with temporary, localised impacts. However, in case a project activity requires the development of a specialised ESMP or any other safeguard instrument, the instrument may require a No Objection from the World Bank and will be publicly disclosed once completed as all project ESMPs will be publicly disclosed. The ESMPs will capture the potential impacts, mitigation, monitoring and institutional measures to be taken during the project implementation to avoid or eliminate negative environmental impacts. For each impact, mitigation measures should be identified and listed. Estimates are made of the cost of mitigation actions. Most of the project activities will adopt and adapt mitigation measures listed in the projects comprehensive ESMP in Table 6-6 of this ESMF and will only be required to complete screening. Based on the screening, some activities may be directed to draft a site-specific environmental and social management plan prior to commencement of the activity, but the majority will use a checklist ESMP. For the ZCEREHSP low-risk activities, an alternative to the commonly used “full text� EMP format is to use a checklist approach. The goal is to provide a more streamlined approach to preparing ESMPs. This checklist- type approach (“Guide to Identifying Key ESMP Contents,� see Appendix 6) has been developed to provide “pragmatic good practice� designed to be user-friendly. It covers typical mitigation approaches to common low-risk activities with temporary localized impacts. This format provides the key impact and mitigation concerns of an ESMP to meet World Bank Environmental and Social Assessment requirements under ESS1 (see Appendix 5). This list is not comprehensive. Refer to other identified risks, impacts and mitigation measures discussed elsewhere in this ESMF such as Table 6-2 and Appendix 10 which may also be required in an ESMP. Table 6-6 contains activities and mitigation measures for COVID-19 and social standards related matters. The Environmental and Social Guidelines for Contractors (Appendix 8) are to be observed for all project activities as appropriate. The already introduced Table 6-2 outlines the ZCERP activities that will require preparation of an ESMP. Page | 138 5.7 Risk Reduction and Management of Impact Approaches 5.7.1 COVID-19 Transmission The purpose of the project itself is to reduce the transmission of COVID-19 through supporting vaccination efforts. The project will follow WHO guidance and GIIP to reduce the risk of spreading COVID-19 among project implementers and patients. 5.7.2 Occupational Health and Safety One of the ways the project will reduce the risk of transmission of COVID 19 is through provision of PPE to project implementers including health care facilities and general project administrators at all levels such as masks, sanitizer, soap, and the like. Contractors will be required to provide PPE to workers. All will be trained in its proper use. In addition, construction contractors and service providers (e.g., Transporters, vehicle maintenance) will require adequate OHS risk mitigation measures, as well as all medical waste disposal sites (e.g., incinerators). 5.7.3 Vaccine Readiness and Prioritisation The Government, with the assistance of donor partners including the Bank, has prepared a draft COVID-19 National Deployment and Vaccination Strategy (NVDS) that outlines detailed procedures and protocols for implementation of COVID-19 vaccination and proposes measures for effective vaccination procedures for the population. Through this plan, the Government plans to vaccinates all eligible people according to the Strategic Advisory Group of Experts on Immunization (SAGE) recommendations. The vaccinations will be phased according to level of risk starting with the highest risk individuals in 2021. This group is comprised mainly of frontline health care and social workers, the elderly above 60 years, those with comorbidities, PLWHIV and those living in high risk areas including prisons and refugees. This represents about 22% of the total population. The vaccination strategies for phase 1 and phase 2 will include static, outreach and mobile vaccinations. 5.7.4 Community Health and Safety In activities that interface with the public such as vaccinations, COVID-19 risk reducing behaviours will be observed such as taking temperatures upon entry, provision of adequate information/signs/safety measures to and for patients regarding potential infection hazards within the facility and associated waste disposal sites, worker use of PPE, etc. there are situations where vaccine cold chain breaks and can result in vaccine emergencies. This may occur, if necessary, steps are not taken quickly. The situation can be: 1. Partial/ complete failure of the fridge making it unable to hold temperatures between 2oC & 8oC. Fridge failures include situations when the fridge gets too cold (without being adjusted too cold) 2. Loss of electrical power to the fridge motor (local power outages, electrical circuit breaker shut-off in the building, fridge power switch shut off, unplugging, damaged electrical cord) Vaccine handling issue (e.g., not transferring vaccines to the fridge promptly after picking them up, after taking a dose from a package not returning the remainder to the fridge). Vaccine Preparedness and Response measures are outlined in Appendix 17. Since the project activities will involve minor renovations and refurbishments of the maternity waiting homes and operating theatres, these renovations may involve painting, glazing, repair of roofs and since Page | 139 some of the roofs are made of asbestos, ACMs are likely to be encountered during these activities., Should any ACMs be encountered, it must be properly bagged (enclosed) and disposed of at an approved site. The project will accordingly make it impossible for the public to reuse the ACM containing materials through physical and other barriers. 5.7.5 Adverse Events Following Immunisation (AEFIs) Monitoring the safety of vaccines is an essential part of immunisation programmes which requires the involvement of various stakeholders. There is much public concern about vaccine safety and so the project will monitor its vaccination efforts for any problems. The National Pharmacovigilance Centre, Medicines Control Authority of Zimbabwe (MCAZ) in collaboration with the Zimbabwe Expanded Programme on Immunisation (ZEPI)- are the main drivers of Zimbabwe’s monitoring system for Adverse Events Following Immunisation (AEFIs). They will use the AEFI surveillance system which is in place to collect, detect, assess, monitor, prevent and manage AEFIs. Health workers will be guided on the procedures for the management of AEFI, submission of complete AEFI forms and case investigation forms and on causality assessment of the AEFI and risk benefit assessment. These activities will allow ZCERP to monitor and react as needed to any AEFI. 5.7.6 Infectious Medical Waste Management Project activities will generate two main types of waste: general waste (which similar in composition to domestic waste, generated during administrative, housekeeping, and maintenance functions) and hazardous health care waste such as the used needles from vaccinations that will be indirectly supported by the project. General waste practices will follow national and local guidance and requirements. See project ICWMP as well as Sections 5 and 6 of this ESMF for details on how infectious waste will be managed. 5.7.7 Air Emissions The project will not be a significant source of emissions from either vehicles or incineration. However, in accordance with the WB EHS Guidelines for Health Care Facilities, where possible, the project will avoid, minimize, and control adverse impacts to human health, safety, and the environment from emissions to air from vehicles and incineration. Project activities will abide by WB EHSG for HCFs and national emissions rules.45 a) Incinerator Emissions: Pollutants potentially emitted from health care waste incinerators (HWIs) include: • Heavy metals, 45 WB, GENERAL EHSG GUIDELINES: ENVIRONMENTAL AIR EMISSIONS AND AMBIENT AIR QUALITY, April 30, 2007, p 3. Page | 140 • Organics in the flue gas, which can be present in the vapor phase or condensed or absorbed on fine particulates, • Various organic compounds (e.g., polychlorinated dibenzo-p dioxins and furans [PCDD/Fs], chlorobenzenes, chloroethylenes, and polycyclic aromatic hydrocarbons [PAHs]), which are generally present in hospital waste or can be generated during combustion and post-combustion processes, • Hydrogen chloride (HCl) and fluorides, and potentially other halogens-hydrides (e.g., bromine and iodine). • Typical combustion products such as sulphur oxides (SOX), nitrogen oxides (NOX), volatile organic compounds (including non-methane VOCs) and methane (CH4), carbon monoxide (CO), carbon dioxide (CO2), and nitrous oxide (N2O).46 b) Pollution Prevention and Control Pollution prevention and control measures include: • Application of waste segregation and selection including removal of the following items from waste destined for incineration: halogenated plastics (e.g., PVC), pressurized gas containers, large amounts of active chemical waste, silver salts and photographic / radiographic waste, waste with high heavy metal content (e.g., broken thermometers, batteries), and sealed ampoules or ampoules containing heavy metals47. This waste should not be burned, incinerated, or landfilled. These wastes will be inertised and sent to a safe storage site designed for final disposal of hazardous waste and / or transported to specialized facilities for metal recovery. • Incinerators should have permits issued by authorized regulatory agencies and be operated and maintained by trained employees to ensure proper combustion temperature, time, and turbulence specifications necessary for adequate combustion of waste.48 This includes implementation of operational controls including combustion and flue gas outlet temperatures (combustion temperatures should be above 850 °C while flue gases need to be quenched very quickly to avoid formation and reformation of POPs) as well as use of flue gas cleaning devices meeting international standards.49,50 c) Management of Air Pollution and Incinerator Residue 46 WB (2007) Health Care Facility EHSGG, p6. 47 WB (2007) Health Care Facility EHSGG, p6. 48 Technical information on the proper operation and maintenance of hospital waste incinerators may be obtained from WHO (1999) Chapter 8 and the US EPA Handbook on the Operation and Maintenance of Medical Waste Incinerators (2002). 49 Refer to Guidelines on BAT/BEP practices relevant to Article 5 and Annex C of the Stockholm Convention on Persistent Organic Pollutants, Section V. 50 WB (2007) Health Care Facility EHSGG, p9. Page | 141 In accordance with the EHS Guidelines for Health Care Facilities, secondary air pollution control measures for hospital waste incinerators should include the following where technically and financially feasible: • Wet scrubbers to control acid gas emissions (e.g., hydrochloric acid [HCl]), sulphur dioxide [SO2, and fluoride compounds]). A caustic scrubbing solution will increase the efficiency for SO2 control. • Control of particulate matter may be achieved through use of cyclones, fabric filters, and / or electrostatic precipitators (ESP). Efficiencies depend on the particle size distribution of the particulate matter from the combustion chamber. Particulate matter from hospital incinerators is commonly between 1.0 to 10 micrometres (µm). ESPs are generally less efficient than baghouses in controlling fine particulates and metals from HWI, • Control of volatile heavy metals depends on the temperature at which the control device operates. Fabric filters and ESP typically operate at relatively high temperatures and may be less effective than those that operate at lower temperatures. Venturi quenches and venturi scrubbers are also used to control heavy metal emissions. The volatile heavy metals usually condense to form a fume (less than 2 µm) that is only partially collected by pollution control equipment, • Management of incineration residues such as fly ash, bottom ash, and liquid effluents from flue gas cleaning as a hazardous waste (see General EHS Guidelines) as they may contain high concentrations of POPs.51 It is important to note that since sharps will not be disinfected with chlorine solutions, POPs are not expected to be formed during incineration. • Incineration residues (including those which may contain POPs) will be disposed of in an ash pit to control emissions to the environment. Installing new ash pits is not the goal of the project but refurbishing the ones already in existence is possible. However, Zimbabwe is a low-income country and the standard incinerators which are used in healthcare facilities generally do not have pollution control devices. They adhere to air emission standards prescribed by EMA. For this project, participating facilities will need to install or use an air pollution control measure acceptable to the Bank. d) Emergency Preparedness and Response Emergency incidents occurring in a HCF may include spillage, occupational exposure to infectious materials or radiation, accidental releases of infectious or hazardous substances to the environment, medical equipment failure, failure of solid waste and wastewater treatment facilities, and fire. These emergency events are likely to seriously affect medical workers, communities, the HCF’s operation and the environment. The ZCEREHSP ICWMP contains guidance on some of the measures to deal with these emergencies. Each HCF should develop an Emergency Response Plan (ERP) that is commensurate with the risk levels as part of its ICWMP. The key elements of an ERP are defined in ESS 4 Community Health and Safety (paragraph 21) and are as follows: (a) engineering controls (such as containment, automatic 51 WB (2007) Health Care Facility EHSGG, p9. Page | 142 alarms, and shutoff systems) proportionate to the nature and scale of the hazard; (b) identification of and secure access to emergency equipment available on-site and nearby; (c) notification procedures for designated emergency responders; (d) diverse media channels for notification of the affected community and other stakeholders; (e) a training program for emergency responders including drills at regular intervals; (f) public evacuation procedures; (g) designated coordinator for ERP implementation; and (h) measures for restoration and cleanup of the environment following any major accident. Emergency Preparedness and Response measures related to cold chain storage are elaborated in Appendix 13. e) Motor Vehicle Emissions Emissions from motor vehicles include CO, NOx, SO2, particulate matter and Volatile Organic Compounds (VOCs). Emissions are expected from the project vehicles although this is insignificant, considering that the national air quality is degraded, any small increases should be avoided or minimized to the extent possible. Given the insignificant amount of project vehicle emissions, the project will take a preventative management approach to ensure the proper maintenance of vehicles to avoid any unnecessary releases. Emissions from the project vehicles will comply with the Environmental management (Atmospheric Pollution Control) regulations of 2009. The regulations prescribe maximum permissible emission limits per given compound including recommendations which may be determined by EMA to reduce vehicle emissions. In addition, project vehicles will: i) implement manufacturer recommended engine maintenance programmes, ii) instruct drivers on the benefits of safe driving practices that reduce both the risk of accidents and fuel consumption, including measured acceleration and driving within safe speed limits, iii) replace older vehicles with those that are newer and more fuel efficient, iv) install and maintain emission control devices, and v) implement a regular vehicle maintenance programme.52 The EHSG for Retail Petroleum Networks is silent on vehicle emissions since it focuses on petroleum delivery. Table 6-6 outlines the comprehensive ESMP for this ESMF. It presents the potential adverse impacts of the Project, which include direct impacts on sites, the generation of solid and liquid waste, the generation of medical waste and the disposal thereof, as well as occupational risks faced by workers in the healthcare facilities or during the minor civil works that will be done and sets forth possible and mitigation measures. 5.8 Environmental and Social Management Plan An Environmental and Social Management Plan (ESMP) details the specific environmental and social conditions for the project in response to identified risks. The use of ESMPs ensures that mitigation measures identified through environmental and social assessment are implemented and monitoring is carried out. The ESMP in Table 6-6 outlines the mitigation, compensation, enhancement, and monitoring needed to manage the environmental and social impacts associated with ZCERP including details on when 52 WB (2007), General EHSGG: Environmental Air Emissions and Ambient Air Quality, p9. Page | 143 each action should occur and who is responsible for its delivery. For those that require it, individual project activities will also formulate checklist ESMPs based on Table 5- 6. Page | 144 Table 5-5 Comprehensive ESMP of the ZCEREHSP by Project Component PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES For all components • Provision of PPE (including hand sanitizers and masks, etc. as necessary) and promotion and observation of COVID-19 protocols to halt the spread among project implementers, from • OHS and CHS COVID-19 project implementers to the public and risks. between project beneficiaries (for example, those being vaccinated). The project will Continuous data from regularly integrate the latest guidance by WHO • the PPE tracking PIE as it develops over time and experience system; visits and spot • Natural or human-made addressing COVID-19 globally. checks to confirm disaster or other large protocols being scale emergency event observed. Monitoring • Follow Emergency Measure guidance in this Each will be conducted • Risks/impacts on ESMF. Individual facilities should follow the HCF/MoHCC monthly over 18 community health and procedures detailed in their individual ICWMPs. months. safety HCFs, their contractors and other project implementors will design, construct, operate and decommission the structural elements of ZCEREHSP (such as incinerators, solar panels, solar drive refrigerators, etc.) in accordance with national legal Page | 145 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES requirements, the EHSGs and other GIIP, taking into consideration safety risks to third parties and affected communities. Structural elements of ZCEREHSP will be designed and constructed by competent professionals and certified or approved by competent authorities or professionals. Further, HCFs and the PIE will consider the incremental risks of the public’s potential exposure to accidents or natural hazards (including extreme weather events especially for high-risk locations in accordance with ESS4 Community Health and Safety and the WB Fire Safety Guidelines in Section 3.3 of the General EHSG2007). Component 1: Covid-19 Deployment and Related Risk Communication and Community Engagement Sub Component 1.1 Vaccine Deployment This sub-component • Exclusion of vulnerable • Implementation of Covid-19 National MOHCC and PIE NDVS adopted and component will and marginalised groups Deployment and Vaccination Strategy being implemented by contribute toward from services and facilities (NVDS) that outlines detailed all beneficiary strengthening the necessary to combat the procedures and protocols for institutions. public health system’s disease. implementation of COVID-19 capacity to deploy • Risk of COVID-19 vaccination and proposes measures Presence of Waste vaccines through Fuel, transmission among the for effective vaccination procedures management plan for repair and for the population. Page | 146 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES maintenance service community, patients, and • Ensure phasing of vaccinations every waste of vehicles used for workers according to the level of risk and generator. vaccine distribution • Waste or oil and other starting with the highest risk in 2021 will support: substances emanating • The risk of elite capture and corruption Supervision and from fuelling, repair, and will be mitigated through monitoring of vaccine maintenance of vehicles government’s vaccine oversight, deployment including for Covid-19 vaccine verification and monitoring and ensuring deployment. evaluation implementation of the • Waste emanating from the • Strengthen feedback mechanisms for NVDP. Special installation and operation the public (detailed in GRM) attention will be given of solar or other energy • Each generator of waste is required by to women, people generating equipment. law to prepare and implement a waste with disabilities, and • Infectious waste from management plan; hence the facilities others among vaccinations will be supported to develop individual targeted groups who • Contaminated soil at HCFs ICWMPs. may face barriers to due to past improper on- • Formulate an exposure control plan for access information site waste treatment or blood-borne pathogens, and services. disposal, including waste • Provide staff members and visitors Procurement of storage, incinerators and with information on infection control electronic data waste pits. policies and procedures, capturing tools for • Wastewater from HCFs • Establish Universal / Standard clinic level, and data • Road safety risks from Precautions to treat all blood and Support outreach transportation of vaccines, other potentially infectious materials activities – fuel, other project goods and with appropriate precautions, procurement, and including: service of vehicles Page | 147 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Support vaccine supplies and public • Immunization for staff members as efficacy monitoring / address vehicles. necessary (e.g., vaccination for check • Emissions from the hepatitis B virus) Procurement of PPE incinerators for (infectious • Use of appropriate PPE for public COVID-19 medical waste disposal) vaccination and from the vehicles • Adoption of best transport safety centres and capacity practices across all aspects of project building for rational operations with the goal of preventing use of PPE, including OHS risks to staff operating or traffic accidents and minimizing the development of around incinerators injuries suffered by project personnel guidance tools and and the public. Measures should training through include: physical and virtual o Emphasizing safety aspects methods among drivers Vaccine Waste o Improving driving skills and Management and requiring licensing of drivers Transportation to o Adopting limits for trip Regional hubs duration and arranging driver Monitoring and rosters to avoid overtiredness. Evaluation on Waste o Avoiding dangerous routes Management and times of day to reduce the National Trainer of risk of accidents. Trainers (ToT) on o Use of speed control devices Vaccine waste (governors) on trucks, and management Page | 148 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Set up of Impilo remote monitoring of driver COVID-19 Vaccination actions Authentication. This is Regular maintenance of vehicles and use of an Electronic Health manufacturer approved parts to minimize Record mobile potentially serious accidents caused by application solution equipment malfunction or premature that will enable a QR failure. Pollution prevention, avoidance code to be assigned to and mitigation measures as discussed in every COVID-19 this ESMF and dictated by the EHSGs. vaccination certificate.53 Environmental and community • In order to mitigate the risks MOHCC, PIE, HCFs • Number of related risks from inadequate associated with medical waste reported storage, handling, management and disposal, the Project waste transportation, and disposal of will invest in the procurement of transportation health care waste appropriate PPE, as well as training of related medical, and waste management 53 The GoZ and MOHCC, in collaboration with the Harare Institute of Technology, developed this solution for the production of authentic and secure COVID-19 vaccination certificates. Page | 149 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES personnel to ensure compliance with accidents/ the ICWMP, WHO guidance and GIIP. incidents This will be documented in the • Amount of ICWMP. There is no current estimate medical waste of what these needs are either generated at nationwide or in facilities which may HCF participate in the project. • Amount • Proper and adequate treatment of all transported waste through incineration. Facilities (and with non-functional incinerators will confirmed by be supported to transport waste for hazardous off-waste incineration. waste • Adoption of relevant transport safety transportation practices across all aspects of project return) operations with the goal of preventing • Amount and traffic accidents and minimizing location of injuries suffered by project personnel disposal and the public. Measures should include: Percentage of Disposal o Emphasizing safety aspects sites (e.g., incinerator) among drivers operating properly per o Improving driving skills and Project requirements requiring licensing of drivers (ESMF, ICWMP) Page | 150 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES o Adopting limits for trip duration and arranging driver rosters to avoid overtiredness. o Avoiding dangerous routes and times of day to reduce the risk of accidents. o Use of speed control devices (governors) on trucks, and remote monitoring of driver actions o Regular maintenance of vehicles and use of manufacturer approved parts to minimize potentially serious accidents caused by equipment malfunction or premature failure. • Follow guidance as outlined in ZCEREHSP ICWMP, this ESMF, individual facility ICWMP and the EHSGs with respect to appropriate labeling, handling, and packaging of the hazardous medical waste being transported Page | 151 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Improper handling, • Each healthcare facility that will MOHCC/ PIE storage, and participate in the project will be transportation of waste to required to develop its own infection • Number of regional incinerators for control and waste management plan drivers trained disposal which will assess and address the of safe transportation • HCFs that do not have all needs. The plan must in place before implementation of any waste of waste applicable EHS licenses/permits and/or do generating activity, and the plan to be • Percentage of not comply with all shared with PIE and MOHCC for incinerator regulatory EHS approval. The ICWMP contains operators requirements guidance on this individual facility trained on waste management plan. proper HCFs that have material EHS operation and • Training of drivers on safe existing liabilities including maintenance transportation of hazardous waste historical contamination, of inadequate present or past Regular servicing and maintanance of incinerators, onsite medical waste or motor vehicles Percentage of wastewater disposal, incinerators inadequate potable water, licenced by the Environmental Management Agency, Page | 152 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Amount of medical waste generated at HCF • Amount transported (and confirmed by hazardous waste transportation return) • Amount and location of disposal • Percentage of Disposal sites (e.g., incinerator) operating properly per Project requirements (ESMF, ICWMP), Page | 153 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Percentage of HCF appropriately segregating waste at point of generation • shipping manifest (as applicable) confirmation of final disposal of hazardous materials Environmental degradation Manage fuel, emissions and wastes Vehicle Operators • Percentage of from mismanaged fuelling, generated from vehicle fueling and (ultimately MOHCC fuelling facilities repair, and maintenance of maintenance in accordance with the and PIE to monitor with adequate and vehicles General and Retail Petroleum Networks and enforce) proper equipment EHGs; and adequately manage and dispose for management of of such wastes. For example, Oil water oil and other separators and grease traps should be petroleum related installed and maintained as appropriate at waste. refueling facilities, workshops, parking • Percentage of areas, fuel storage and containment workers with appropriate PPE, Page | 154 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES areas.54 Document disposal of all • Percentage of hazardous wastes (including petroleum facilities disposing related) with governmental authorized petroleum related facility. waste at an authorised Emissions from vehicles must comply with disposal facility. Environmental Management (Atmospheric Pollution Control) Regulations, 2009. Number of vehicles Additional recommendations include: complying with national • operators should implement the environmental manufacturer recommended engine emission standards. maintenance programs • Implement a regular vehicle maintenance and repair program.55 • Securing fire extinguishers / fire alarms systems and appropriate storage of fuel. 54 WB (2007) General EHSG: Environmental—Wastewater and Ambient Water Quality, p29. 55 WB (2007) General EHSG: Environment—Air Emissions, p9. Page | 155 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Plan the signals and the appropriate signage to be placed close to potential areas of danger Adverse Events Following • The profiling and screening of MOHCC (including • Percentage of Immunisations candidate individuals to be vaccinated Medicines Control AEFIs reported and should be performed to avoid the risk Authority of documented of vaccine contraindications; Zimbabwe) and PIE • Revised and Surveillance of AEFI through updated safety registration of all recipients of Covid-19 monitoring plan in vaccines and capturing of all adverse place events in the Medicines Control Number of health care Authority of Zimbabwe system for easy workers trained on tracking of AEFIs identification, • Implementation of the existing MOHCC management and AEFIs surveillance guidelines and the WHO vaccine safety manual reporting of • TA to MoHCC to revise, update, and anaphylaxis implement the safety monitoring plan to enable swift detection of any AEFI • training and preparation of health care workers on identification, management and reporting of potential cases of anaphylaxis Page | 156 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES provision of comprehensive emergency tray at all vaccination points GBV/ SEA-SH risks among • prepare, adopt, and implement a MOHCC and PIE • GBV/ SEA/SH patients and health care GBV/SEA/SH Action Plan (as part of the Action plan in place providers, especially in relation ESMF). (Reference: Annex to outreach campaigns • ensure that the codes of conduct and 15) distribution of family planning GBV/SEA/SH prevention provisions are Number of services and items integrated into all contractual and Contractors signing contracting documents (ToRs, tender the GBV/SEA/SH Code documents, and workers’ contracts) of Conduct training of staff on SEA/SH risks and sign the codes of conduct before starting work on any project activities Loss of vaccine potency due to • The deployment plan and standard MOHCC and PIE • percentage of poor storage, handling and operating procedures (SOPs), including facilities with transportation maintaining cold chain, will be Vaccine standard communicated to all levels of the operating supply chain managers. (In accordance procedures or with WHO and CDC guidelines) deployment plan • ensure vaccines are stored at the • percentage of correct temperatures. facilities storing • Provision of direct-drive solar vaccine vaccines at correct refrigerators temperatures Page | 157 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Health professionals, including • number of health vaccinators, will be trained in infection care workers prevention control measures and cold trained on cold chain maintenance. chain maintenance continuous monitoring of data recording and IPC and reporting mechanism for vaccines and percentage of health cold chain equipment facilities with direct- drive solar vaccine refrigerators OHS issues related to the • The LMP and the ICWMP will contain MOHCC and PIE • Number of availability, supply, and proper detailed procedures, based on WHO facilities Using usage of personal protective guidance, for protocols necessary for tracking system to equipment (PPE) and exposure testing, administering vaccines and check on PPE to COVID-19 for healthcare handling medical waste as well as distribution, workers environmental health and safety • Monitor worker guidelines for staff, including the loss-time incidents. necessary personal protective • Spot checks during equipment (PPE). Proper disposal of site visits. sharps disinfectant protocols, and Analyse, record, and regular testing of healthcare workers report the Quality will be included. Workers to be trained regularly in the use of PPE and Checklist data on this techniques for reducing exposure to on a biannual basis. COVID-19. Page | 158 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • The project will regularly integrate the latest guidance by WHO as it develops overtime and experience addressing COVID-19 globally especially with respect to ESS2 and reducing the risk of the project spreading COVID-19 among project workers or to the public in general Hazards related to • Adequately manage and dispose of Healthcare facilities, • Number of road transportation (of infectious health care wastes (including, vaccines) vaccination centres. accidents. and other waste from and other types of hazardous and non- Ultimately MOHCC • Percentage of vaccination centres to regional hazardous wastes in accordance with and PIE for following- drivers with hubs for incineration and the ICWMP and the individual facility up to ensure. adequate indirect risks related to project waste management plan if applicable. documentation vehicle maintenance and • Proper labelling of waste containers (driver’s licences, fueling activities • Providing transportation defensive drivers’ documentation (shipping manifest). licence, positive • Ensuring adequate vehicle medical report), specifications • Number of drivers • Ensuring that the volume, nature, trained on safe integrity and protection of packaging transportation of and containers used for transport are hazardous waste. appropriate for the type and quantity of hazardous materials Page | 159 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Training employee involved in the Number of incidents transportation of health care waste or accidents where regarding proper transportation and healthcare workers, handling procedures and emergency waste handlers or procedures drivers meet waste. • Using labelling and placarding (external signs on vehicles as required). • Providing necessary means for emergency response on call 24 hours/ day. • Follow road safety protocols as found in the WB General EHSGs. • Ensure proper vehicle maintenance to reduce emissions and safety risks. Consult the Retail Petroleum Networks EHSG as necessary. Vehicle drivers will be appropriately licensed and trained and that vehicles are properly serviced and maintained to ensure the safety of passengers and the public Routine Accidents and Spills in • Follow spills, fire and emergency HCF, PIE Number of accidents HCFs procedures as detailed in ZCERP and serious spills/incidents to be Page | 160 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES ICWMP and in individual facility reported in PIE ICWMP. Safeguards Progress Report any serious accidents such as those reports. with fatalities to the PIE which will report to the Bank (except for COVID-19 cases) immediately following any timeline requirements as detailed in the ESCP and elsewhere in this ESMF Sub-component 1.2: Risk Communication and Community Engagement Page | 161 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES This subcomponent • Rumours and false • When developing communication MOHCC/ PIE Covid-19 affected will support: information in the messages about COVID-19, it is benefit from the Support research, electronic media causing important to have social stigma issues psychosocial monitoring, panic. in mind and choose language that does support evaluation, and not exacerbate stigma. Call centre teams documentation of all • It is best to not refer to people with the incentivised. RCCE activities at all disease as “COVID-19 cases�, “victims� Information levels through “COVID-19 families� or “the diseased�. Communication, community dialogues, It is better to refer as “people who capacity building trainings of have COVID-19�, “people who are and stakeholder community being treated for COVID-19�, or engagement influencers, political “people who are recovering from Use of proper PPE leaders, school health COVID-19�. It is important to separate supplies such as teams and a person from having an identity face masks, hand community, defined by COVID-19, to reduce sanitisers, aprons, sensitization stigma. This language should be used overalls etc meetings, throughout all communication development of IEC materials. materials on COVID- Ensure accurate information about the 19 and vaccination, virus is dissemination of widely disseminated, and that there is provided and messages through also a focus on people recovered. observed. radio, TV, social Page | 162 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES media, and bulk short Risk of fear and/or stigma When developing communication MOHCC/ PIE Number of people SMS. towards the virus, which may materials, refer to WHO information on reached to IEC Strengthening of make people hide symptoms, social stigma: material Interpersonal avoid getting tested and even https://www.who.int/docs/default- Communication (IPC) reject hygiene measures or source/coronaviruse/COVID19-stigma- at Community Level wearing PPE equipment (or guide.pdf. through door-to-door masks if recommended) Page | 163 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES and street level • Inappropriate information • It is best to not refer to people with MOHCC/ PIE Number of people awareness campaigns and communication the disease as “COVID-19 cases�, reached with Strengthening increase social stigma with “victims� “COVID-19 families� or “the information on community feedback those who expose or are diseased�. It is better to refer as COVID-19 mechanisms at local infected by virus. “people who have COVID-19�, “people level such as the use who are being treated for COVID-19�, of registers or rumour or “people who are recovering from logbooks or COVID-19�. It is important to separate suggestion boxes, a person from having an identity Grievance Redress defined by COVID-19, to reduce Mechanisms (GRMs), stigma. This language should be used seconding Health throughout all communication Promotion Officers materials. (HPOs) to EOCs, as Ensure accurate information about the well as ensuring virus is widely disseminated, and that community feedback there is also a focus on people recovered is transmitted to high level meetings Strengthening psychosocial support systems for both HCWs and general population by building capacity of community health Page | 164 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES workers, and national psychosocial center Community discussion forums with local and traditional leaders, school heads to share information about GBV, SEA and GRM (priority for the tshwa and doma districts) Procure 2 purpose- built public-address branded vehicles Safeguard instruments validation, dissemination, and capacity building Page | 165 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES OHS risks to health workers • Use of PPE and other COVID-19 MOHCC/ PIE Number of OHS prevention protocols. related accidents or The project will regularly integrate the incidents reported latest guidance by WHO as it develops over time and experience addressing COVID-19 globally especially with respect to ESS2 and reducing the risk of the project spreading COVID-19 among project workers or to the public in general Road hazards/vehicle • Ensure proper vehicle maintenance MOHCC/ PIE Number of motor safety/emissions and safety protocols as found in WB vehicle related General EHSG accidents reported • Follow road safety protocols as found in the national laws and WB General EHSG. Vehicle drivers will be appropriately licensed and trained Air Pollution from project • implementing a regular vehicle repair MOHCC and PIE Number of vehicle vehicles and maintenance programme emission tests • Installing and maintaining emission conducted control devices • Replacing older vehicles with newer, fuel-efficient vehicles Page | 166 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Implementing manufacturer recommended engine maintenance programmes Communication materials may • The SEP provides measures for MOHCC and PIE Number of people not reach the most vulnerable, stakeholder engagement at reached with including the elderly, participating health facilities to inform communication vulnerable groups and workers local communities of project activities, materials from the informal sector, a lot seek their feedback on potential risks number of people of whom are women, who and mitigation measures. The following reached through social tend to have lower levels of measures will also be applied. media/ mobile education, lower incomes and • Develop clear and concise awareness, may lack access to reliable communication materials and ensure that it is in a format/language that is # of people reached to information materials. understandable to all people, the most interpersonal vulnerable. communication, • When developing communication number of materials, refer to WHO information on Information education social stigma: material distributed. https://www.who.int/docs/default- source/coronaviruse/COVID19-stigma- guide.pdf • Use different media (social media, radio, tv) plus engaging existing formal Page | 167 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES and informal public health and community-based networks (schools, healthcare service providers at local level, etc). Ensure that information is accessible in sign language, braille, illustrations/pictorial and in Sesotho. • Ensure messages relating to COVID-19 reach all groups of people, the most vulnerable (the poor, elderly, women single heads of household, those with a disability, vulnerable groups, any marginalized group). This may include having a multi-faceted approach to consultations and disclosure of information and information sharing, such as by loudspeaker (by community authorities or district health authorities), radio, TV, newspapers, WhatsApp broadcast messages, Facebook, SMS, You Tube videos, community announcement, social influencers/religious leaders, etc. • A focus of information materials should be on women, as they tend to be the best avenue of communication for Page | 168 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES children, disabled and the elderly in the household. • Communication materials must reinforce the positive contribution of health care workers and other essential workers and their need to be supported by community members. • Communication materials should make clear the steps health workers and others are taking to protect themselves against the virus and their use of PPE Social conflicts: May result • The ESMF’s continuous stakeholder MOHCC and PIE Dissemination of from false rumours and engagement strategy will be utilised to correct COVID-19 misinformation, especially for continuously consult the stakeholders Information to the project supported facilities, in the process of implementing the public, project beneficiaries, and project. Peoples’ grievances other services. If stakeholders • Ensure the continuous consultations on being addressed are not properly consulted, timeously. this ESMF include relevant government information is not disclosed agencies, NGOs and other organizations Number of public and people are not informed working on health and gender, consultations about their rights, options for including GBV, as well as vulnerable conducted grievance redress or project groups. Ensure women, and women’s timelines, there could be groups, are targeted during the Page | 169 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES misunderstandings, conflict, continuous consultations on the ESMF, stigma, gender-based violence, as well as information campaigns. false rumours, or loss of • Identify trusted community groups confidence in the community (local influencers such as community regarding the project. leaders, religious leaders, health workers, community volunteers, celebrities) and local networks (such as women’s groups, youth groups, business groups, and traditional healers) that can help to disseminate messages. Define clear and easy mechanisms to disseminate messages and materials based on community questions and concerns. Subcomponent 2: Climate Friendly Related Health Systems Strengthening Page | 170 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES This component will Cold Chain Operation- The use Use of more energy-efficient technology MOHCC/ PIE Testing of direct drive support of refrigerants56 in the cold for the refrigeration system solar refrigerators complementary chain system (in refrigerators temperatures daily. To include relevant technical strategic activities to and transportation trucks) can Record and act on specifications as part of procuring cold facilitate the cause depletion of the ozone anomalies. storage/chain equipment and transport implementation of the layer and can contribute to and/or stipulating performance standards Number of accidents COVID-19 NDVP, greenhouse gas emissions that for the cold chain service providers reported focusing on climate cause global warming friendly health system However, the cold chain will be strengthening activities that support energy efficient and will vaccine deployment involve the use of sustainable solar energy in some health Cold chain equipment care facilities including Solar Direct Solar Drive Refrigerators and cold boxes purchase 56 In the 2017 UNEP Report of the Technology and Economic Assessment Panel (Montreal Protocol on Substances that deplete the ozone layer), industrial refrigeration accounts for approximately 2% of HFC consumption in terms of CO2-eq and is projected to grow by approximately 6.7% annually between 2015 and 2050. Page | 171 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Installation and maintenance of solar energy in health facilities Training of HCWs Installation of refrigeration units in trucks for vaccine delivery Installation of solar panels for sustainable energy generation at health facilities The lack of proper Ensure that the refrigeration system MOHCC/ PIE Percentage of installed maintenance and knowledge including its maintenance and servicing, refrigerators with very often translates into an complies with the requirements of the protocols on ODS inadequate management of Montreal Protocol on Ozone Depleting the life cycle of refrigerant Substance (ODS) gases. More refrigerant Improve energy efficiency of refrigeration leakage results to less efficient systems through maintenance of the equipment and higher refrigeration systems, implementation of emission of high global procedures and best practices that Page | 172 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES warming potential (GWP) reduces energy consumptions of chillers gases into the atmosphere. and refrigeration systems, e.g. closing the doors of cold rooms during operation, switching-off mobile refrigeration units while opening doors of refrigerated trucks, parking refrigerated trucks in the shade, regular controls and monitoring of all equipment parameters, such as energy performance, pressure, and temperature. Refrigerants are toxic and Observe proper handling of refrigerants MOHCC/ PIE Workers with proper some are flammable and could and during servicing and ensure that PPE form explosive mixture with air workers involved in servicing are trained to Number of accidents if leakage occurs, posing risk to avoid leakage of refrigerant in the reported people’s health and safety. atmosphere and use PEEs to avoid exposure to refrigerants. Page | 173 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Procure solar direct drive refrigerators from WHO Prequalified suppliers- prequalified solar refrigeration systems.57 Hazards (including Site assessment for potential hazards by MOHCC and PIE, • Number of environmental and OHS the contractors contractors accidents or related) associated with incidents Provision of adequate and proper PPE for installation of solar panels workers which include hard hats, gloves, include falls from ladders, cuts • EHS performance goggles, steel toed shoes, harnesses from metal and power tools, of contractors eye injuries, soldering burns, Contractors will be required to follow the installing solar sun burn, shocks from electric Labour Management Procedures panels - such as currents (Appendix 2) and Environmental and Social noise, waste Guidelines for Contractors (Appendix 8) to disposal, mitigate and reduce OHS and Disposal/repurposing environmental risks associated with the of any obsolete installation of energy generating equipment removed equipment. 57 A formal definition for ‘qualified supplier’ can be found in WHO PQS E03/PV01.2 (available at: http://apps.who.int/immunization_standards/vaccine_quality/pqs_catalogue/ Page | 174 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Contractors or others installing solar power equipment to decide to reduce noise impacts on patients as necessary such as (in consultation with medical professionals) having patients moved, scheduling works at times that won’t disturb patients or limiting the timing of works, etc. Operation of solar panels, HCFs, MLGPW maintenance, and waste Potential use of on-site emergency diesel disposal. generators in case of loss of power and/or issues with solar Risk of electrocution during repair and maintenance Page | 175 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Risk of environmental Disposal of the batteries using the PIE % of facilities following contamination with battery procedures defined in the Public Finance appropriate lead because of improper management (Treasury Instructions) procedures in the disposal and lead poisoning in regulations, disposal of assets humans including batteries Sending or selling the batteries to registered recycling companies. % of facilities utilising registered battery recycling companies for disposal of old batteries Component 4: Sustaining Essential Health Services Subcomponent 4.1: Integrated Outreach Service Delivery Procurement of 76 OHS risks to health workers • Use of PPE and other infection MOHCC/ PIE Number of OHS solar-powered prevention and control protocols. related accidents or tricycles, 8 well The project will regularly integrate the incidents reported equipped outreach latest guidance by WHO as it develops over vans, eight by 18- time and experience addressing COVID-19 seater rough terrain and other health care associated infections mini buses, globally especially with respect to ESS2 and operational costs for reducing the risk of the project spreading the integrated outreach teams, costs Page | 176 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES related to the healthcare associated infections among RMNCAH mentorship project workers or to the public in general Road hazards/vehicle safety • Ensure proper tricycles maintenance MOHCC/ PIE Number of motor and safety protocols as found in WB vehicle related General EHSG accidents reported • Follow road safety protocols as found in the national laws and WB General EHSG. • Tricycle riders will be appropriately licensed and trained Air Pollution from project • implementing a regular vehicle repair MOHCC and PIE Number of vehicle vehicles and maintenance programme emission tests • Installing and maintaining emission conducted control devices • Replacing older vehicles with newer, fuel-efficient vehicles • Implementing manufacturer recommended engine maintenance programmes Subcomponent 4.2: Strengthening Community Health Services including Disease Surveillance Page | 177 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Upskilling/refresher Road hazards/vehicle • Ensure proper motorcycle MOHCC/ PIE Number of motorcycle trainings and support safety/emissions maintenance and safety protocols as related accidents for 5,450 VHWs, found in WB General EHSG reported procurement of • Follow road safety protocols as found motorcycles for in the national laws and WB General environmental health EHSG. technicians • Motorcycle riders will be appropriately licensed and trained Subcomponent 4.3: Commodity Security Procurement of Risk of environmental • Disposal of the equipment using MOHCC and PIE Presence of Waste equipment for both contamination with obsolete the procedures defined in the management plan for basic and equipment because of Public Finance and Procurement every waste comprehensive improper disposal Act, and the Public Finance generator. emergency obstetric management (Treasury and new-born care, Instructions) regulations, procurement of family planning commodities Infectious health care waste • Each generator of waste is required by MOHCC and PIE Presence of Waste generation from the law to prepare and implement a waste management plan for management and care of new- management plan; hence the facilities every waste born and the mothers, and use will be supported to develop individual generator. of family planning ICWMPs. commodities Page | 178 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Formulate an exposure control plan for blood-borne pathogens, • Provide staff members and visitors with information on infection control policies and procedures, • Establish Universal / Standard Precautions to treat all blood and other potentially infectious materials with appropriate precautions, including: • Immunization for staff members as necessary (e.g., vaccination for hepatitis B virus) • Use of appropriate PPE OHS risks from installation • Fire detection and alarm. Healthcare facility, • Facilities and/ or repair of oxygen • Early response to external fire. MOHCC, adhering to reticulation system • daily and weekly user care and health and PIE safety preventive maintenance of the • Damage to fittings equipment precautions with release of oxygen • proper storage of oxygen cylinders for reticulated will vigorously support • ensure appropriate fire safety oxygen the fire escalating the • Facilities with precautions including fire seriousness of the fire. reticulated extinguishers that are properly • Future works local to oxygen working and regularly inspected. liquid oxygen installed pipework could Page | 179 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES damage or rupture the • Unwanted cylinders to be according to pipework, causing a returned to the vendor and not set standards. serious leak of liquid vented into the environment, • Facilities oxygen. • Ensure safe handling of oxygen conducting • A leak from the LPG cylinders daily and tank in the presence of weekly an enriched-oxygen preventive atmosphere could maintenance cause a jet fire on the LPG tank above ground connections. Subcomponent 4.4: Revitalization of Maternity Waiting Homes (MWHs) Refurbishment and Occupational Safety and • The contractor(s) shall comply with all • Health facility • Use of Proper PPE minor renovations of Health: The movement of national and good practice regulations Contractor(s) is adhered to existing MWHs, trucks to and from the site, the regarding workers’ safety. always. operation of various • The contractor(s) shall have or receive • Safety precautions training of service minimum required training on and signs installed equipment and machinery and providers at MWHs in occupational safety regulations and COVID-19 prevention the actual refurbishment emergency obstetric use of personal protective equipment. materials available. activities will expose the and neonatal care workers to work-related • The contractor(s) shall provide safety (EmONC) and measures as appropriate during works accidents and injuries. sensitization on the such as installation of fences, fire Pollutants such as dust and MWHs guidelines extinguishers, first aid kits, restricted noise could also have negative Page | 180 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES implications for the health of access zones, warning signs, overhead workers. protection against falling debris, lighting system to protect hospital staff and patients against construction risks. • To manage potential COVID-19 infection risk as an OHS issue among construction workers, wash stations should be provided regularly throughout site, with a supply of clean water, liquid soap, and paper towels (for hand drying), with a waste bin (for used paper towels) that is regularly emptied. Wash stations should be provided wherever there is a toilet, canteen/food and drinking water, or sleeping accommodation, at waste stations, at stores and at communal facilities. Where wash stations cannot be provided (for example at remote locations), alcohol-based hand rub should be provided. Relevant GIIP including WBG ESH Guidelines will be complied with. Page | 181 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • Communication materials on COVID- 19 prevention and control should be put in workplaces. • All work will be carried out in a safe and disciplined manner designed to minimize impacts on neighbouring residents and environment. • Workers’ PPE will comply with international good practice (always hardhats, as needed masks and safety glasses, harnesses and safety boots) Appropriate signposting of the sites will inform workers of key rules and regulations to follow. Hazardous Waste: The risk of • Contractor(s) will ensure proper Contractor(s) Type of Hazardous accidental discharge of storage and labelling of hazardous materials produced. hazardous products like paint, materials. leakage of hydrocarbons, oils • Temporarily storage on site of all or grease from machinery, hazardous or toxic substances will be Records of waste electronic waste from repair in safe containers labelled with generated available and maintenance of solar details of composition, properties, powered tricycles constitutes and handling information. potential sources of soils and • The containers of hazardous land pollution. substances should be placed in a Page | 182 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES However, use of solar powered leak-proof container to prevent weekly site inspection tricycles will be energy spillage and leaching. reports available efficient and minimise • Maintain an inventory of hazardous emission of greenhouse gases materials when used in work sites. through use of sustainable • Use proper protective equipment and energy source. procedures for managing spill, exposures, and other incidents. • Hazardous materials should be handled in accordance with the accepted practices. Only trained personnel should handle the materials with precautions by using required protection equipment. The wastes are transported by specially licensed carriers and disposed in a licensed facility. Paints with toxic ingredients or solvents or lead-based paints will not be used To include relevant technical specifications as part of procuring solar powered tricycles and/or stipulating performance standards for the solar powered tricycles to service providers Page | 183 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Disposal of electronic waste from solar powered tricycles should be in accordance with the provisions of the public finance and disposal of public assets regulations. Asbestos Containing Materials In reconstruction, demolition, and • Health Facility Site inspections, (ACM): The risk of accidental removal of damaged infrastructure, Contractor(s) Disposal site records discharge of asbestos asbestos hazards should be identified, and containing materials (ACM) a risk management approach adopted generated from construction, that includes disposal techniques and rehabilitation, or minor civil end-of-life sites. Techniques for works. The risk of ACMs during prevention, minimization, and control of the refurbishment, facility impacts from asbestos or asbestos improvement, isolation ward containing Materials (ACM) and guidance formation and other similar from the General EHS and Good Practice activities is high since most of Note: Asbestos: Occupational and the old buildings have asbestos Community Health Issues (World Bank roofs and some old hospital Group May 2009) include: equipment has asbestos components. • Avoiding the use of asbestos containing materials (ACM) in renovation activities. • Undertaking an asbestos/hazardous products audit prior to/at the beginning of the refurbishment. Page | 184 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES • If asbestos is located on the project site, mark clearly as hazardous material. • When possible, the asbestos will be appropriately contained and sealed to minimize exposure • The asbestos prior to removal (if removal is necessary) will be treated with a wetting agent to minimize asbestos dust • Use of specially trained personnel to identify and selectively remove potentially hazardous materials (ACMs) in building elements prior to dismantling or demolition, • Repair or removal and disposal of existing ACM in buildings should only be performed by specially trained personnel, following, internationally recognized procedures. (WB, 2007) • If asbestos material is be stored temporarily, the wastes should be securely enclosed inside closed Page | 185 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES containments and marked appropriately. • Managing the treatment and disposal of ACMs according to Sections 1.5 and 1.6 on Hazardous Materials and Hazardous Waste Management, respectively. • Transporting ACM in leak-tight containers to a secure landfill operated in a manner that precludes air and water contamination that could result from ruptured containers. (WB, 2007) The removed asbestos will not be reused Construction Waste • The contractor(s) shall develop and Contractor(s) Noise levels below Management: Activities at follow a brief site-specific solid waste limits in EHS General construction sites will produce control procedure (storage, provision Guidelines construction wastes such as of bins, site clean-up, bin clean-out demolition debris, excavated schedule, etc.) before commencement soils, cement bags, paint of any financed rehabilitation works. Records of waste drums, brick and concrete • The contractor(s) shall use litter bins, generated available rubble, scrap metal, broken containers, and waste collection glass, timber waste and other facilities at all places during works. debris. This debris could • The contractor(s) may store solid waste temporarily on site in a Page | 186 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES obstruct the public, the designated place prior to off-site weekly site inspection movement of the workers and transportation and disposal through a reports available, vehicles as well as affect the licensed waste collector. aesthetics of the environment. (a) The contractor(s) shall dispose of waste at designated place identified and approved by local authority. Open burning or burial of solid waste at the hospital premises shall not be allowed. It is prohibited for the contractor(s) to dispose of any debris or construction material/paint in environmentally sensitive areas (including watercourse). Recyclable materials such as wooden plates for trench works, steel, scaffolding material, site holding, packaging material, etc. shall be segregated and collected on-site from other waste sources for reuse or recycle (sale). Whenever feasible the contractor will reuse and recycle appropriate and viable materials (except asbestos) (b) Waste collection and disposal pathways and sites will be identified for all major waste types expected Page | 187 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES from demolition and construction activities. (c) Mineral construction and demolition wastes will be separated from general refuse, organic, liquid and chemical wastes by on-site sorting and stored in appropriate containers. (d) Construction waste will be collected and disposed properly by licensed collectors (e) The records of waste disposal will be maintained as proof for proper management as designed. Soil and Land Degradation: • The contractor(s) is responsible for • Health Care • Level of WASH Although construction work compliance with relevant national Facility issue. will be minor and limited to the legislation with respect to soil and land Contractors Quality of Facility footprint of existing degradation. sanitation infrastructure, mitigation The contractor(s) should implement Good measures are needed for International Industrial Practices (GIIP) and unlikely circumstances of soil other international guidelines such as the disturbances. WBG EHS Guidelines. Page | 188 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES Ambient air quality: Air quality • compliance with relevant national • Health Care Dust levels are below will be temporarily impacted legislation with respect to indoor and Facility recommended levels by the construction activities. ambient air quality. Contractor(s) in EHS General Interior demolition to upgrade • ensuring that the generation of dust is Guidelines. and refurbish healthcare minimized, and dust suppression facilities etc, this will generate measures instituted indoors and dust and debris which can outside. affect workers, patients, and • Keep demolition debris in controlled staff. Deteriorated indoor air area and spray with water mist to quality may pose risks to reduce debris dust workers and patients, with • Keep surrounding environment either minor or serious health (sidewalks, roads) free of debris to impact depending on level and minimize dust duration of exposure. • There will be no open burning of construction / waste material at the site • There will be no excessive idling of construction vehicles at sites Subcomponent 4.5: Health System Digitalization and Related Innovations Support decentralization of Page | 189 PROJECT COMPONENT and RESPONSIBILITY FOR MONITORING RISK/ IMPACTS MITIGATION MEASURES IMPLEMENTATION INDICATORS PROJECT ACTIVITIES the Electronic Health Record (EHR) System implementation, Development of the Costing and Electronic Maternal and Perinatal Death Notification System (eMPDNS) modules in the HER, Capacity building on blockchain technology within MOHCC, Development and piloting of a Digitized Community Transport Dispatch System for emergency services, Strengthening the MOHCC monitoring and evaluation system Page | 190 Page | 191 5.9 PPE Requirements for Project Implementation Personal Protective Equipment (PPE) will be used during the project. PPE will be required for vaccination activities and during installation of solar panels at health facilities, installing refrigeration units in vaccine delivery trucks, fuelling and maintenance of vehicles, processing of medical waste among others. Additionally, since the Project takes place during the COVID-19 pandemic and seeks to address it, PPE and risk reducing behaviours are required for all project activities even administrative office tasks. The following sections outline the recommended PPE for these activities. 5.9.1 PPE Requirements for Installation Sites PPE is important for working in the solar project, minor renovations for maternity waiting homes, installation of oxygen reticulation system, minor renovations of the operating theatres, and delivery of RMNCAHN services. The site should be assessed for hazards and necessary PPE provided for worker safety. The following are the PPE Requirements for installation of solar panels at health facilities. Table 5-6 PPE Requirements for minor works No. PPE PURPOSE OF THE PPE 1 Heavy duty gloves Offer protection from harsh substances such as lead, acid, electrical shocks, cuts 2 Overalls Body protection 3 Gumboots/ steel toed To protect from drop hazards shoes with rubber sores 4 Hard hats To provide protection from falling objects or electrical hazards 5 Safety goggles/ eye For eye protection against splattering hot solder, flying shields particles, dust, or debris 5.9.2 PPE for COVID-19 Proper use of PPE is essential for the protection against COVID-19. The indications should be based on the setting, target audience, risk of exposure (e.g., type of activity) and the transmission dynamics of the pathogen (e.g., contact, droplet or airborne). The recommended PPE for COVID-19 is outlined in the National PPE guidelines for COVID-19 which have been adapted from the WHO guidelines; “the Rational use of personnel protective clothing (PPE) March (2020)�. The recommended PPE for health care workers for COVID-19 and other routine risks for Zimbabwe are detailed in the project’s ICWMP. Page | 192 5.9.3 PPE for Incinerator Operators PPE must be selected to protect against risks specific to incinerator operators. The major risks to these staff are encountered either during direct contact with medical waste or when incinerator operators are exposed to heat or fumes emitted by the incinerator while burning health care waste. Wearing PPE reduces risk from sharps, germs, exposure to blood and other bodily fluids, splashes from chemicals, inhalation of exhaust, and sparks from the incinerator. The recommended PPE for incinerator operators for Zimbabwe is outlined in the project’s ICWMP. 5.10 Monitoring and Supervision of Project Activities MoHCC with the support of the lead implementing agent, CORDAID, and the other implementing partners (relevant authorities) must monitor the environmental effects of project implementation and the success of mitigation measures. The implementing partners include: • The Environmental Management Agency (EMA), • Ministry of Public Service, Labour, and Social Welfare (MOPSLSW), • Ministry of Local Government and Public Works (MLGPW), • Ministry of Environment, Climate, Tourism and Hospitality Industry (MECTHI). This monitoring is an important part of managing the impacts of the project. This section presents the monitoring plan for the ZCERP. Contractors will be required to formulate ESMPs for specific project activities under the guidance of the PIE Environmental Specialist. The PIE reviews and approves contractor ESMPs. From time-to-time, the PIE Environmental Specialist or his or her designees will visit sites to determine compliance with the ESMPs. Appendices 6 and 7 contain ESMP monitoring templates which both contractors and the PIE can use to monitor project compliance with environmental and social safeguards. Additionally, the measures detailed in tables 6-6, 6-7 and 6-8 will also be used to monitor project compliance with environmental and social standards. Supervision and monitoring are key components of the ESMF during project implementation and must be undertaken during ZCERP implementation phase to authenticate the effectiveness of impact management, including the extent to which mitigation measures are being successfully implemented. The aim of monitoring will be to: • Improve environmental and social management practices, • Check the efficiency and quality of the assessment processes, • Establish the scientific reliability and credibility of the EA for the project and • Provide the opportunity to report the results on safeguards and impacts and proposed implementation of mitigation measures. The three main components of the Supervision and monitoring are: • Compliance monitoring, • Impact and risk monitoring and • Cumulative impact monitoring. 5.10.1 Compliance Monitoring This is to authenticate that the required mitigation measures, which are the environmental and social commitments agreed on by the implementing agency, local implementing agencies and contractors are being adhered to. A monitoring framework was developed based on agreed prototype project activities as Page | 193 they are specified in the positive list of projects; it is in section 9. The PIE will be responsible for undertaking compliance monitoring. 5.10.2 Impact Monitoring The PIE will monitor project activity impacts and mitigation measures. The Environmental and Social Safeguards agreed in the contract specifications should be monitored to ensure that works are proceeding in accordance with the laid down mitigation measures. The PIE and implementing entities should ensure that the project implementers submit reports on work progress and any challenges in observing the Environmental and Social Safeguards. The monitoring results should form a major part of the compliance reports to be submitted by the PIE to EMA. The EHS requirements of the project will be monitored during project implementation through site visits by the MOHCC, PIE and Environmental Management Agency, the quarterly Quality-of-Care Supervision Checklist results and other HCF generated reports. The District Health Executives and Provincial Health Executives will on a quarterly basis visit HCF for monitoring and supervision on provision of quality services including infection prevention control and waste management. Progress on implementation of the requirements of the ESMF will also be reviewed periodically as outlined in the monitoring plan. 5.11 Areas to be Monitored It is recommended that all environmental parameters mentioned above be monitored during the implementation and operation stages and any impacts should be mitigated as soon as possible. Frequency of monitoring depends on the activity and parameters. Consult the ESMP Table 6-6 for more details. Contractors (Supervising Engineer, site foreperson or other relevant on-site supervisor) are expected to note and report any environmental or socially related issues or accidents daily during works. WHO COVID-19 protocols should be checked for updates at least once per year. While monitoring, when any significant impacts are detected, the monitoring team should meet and address the issue. All team members should keep records of such meetings. 5.11.1 Health Care Waste Project activities will generate medical waste which will include hazardous materials such as infectious waste, radiological waste, and laboratory reagents. Therefore, participating facilities will be monitored to ensure that they are managing the waste according to agreed-upon protocols including their own entity- specific ICWMP. Table 6-6 and the project ICWMP contain more details. 5.11.2 Installation Waste and construction waste Solid and liquid waste will be generated from these activities; therefore, contractors and others performing installations and minor renovations will need to ensure that waste is properly managed until final disposition. The management of asbestos waste is of particular importance due to its hazardous nature and so its disposal will be reported and monitored when it is present. Waste or other materials could lead to pollution of the water and the soil. Therefore, should the need arise, the project will monitor the amount of pollutants in the soil or water. 5.11.3 Ambient Air Quality Page | 194 All air polluting activities need to be checked regularly to minimise their effect on air quality. Some examples are the emissions from incinerators being used to process infectious healthcare waste. See the ICWMP for more information on emissions levels. The emissions levels of incinerators must be measured to ensure compliance with requirements. Dust levels from renovation/upgrading and other related activities should also be monitored and controlled. Motor vehicles emissions to be tested on a quarterly basis to ensure compliance with emissions standards for motor vehicles as prescribed in the regulations. Table 6-8 further discusses the mitigation measures. 5.11.4 Occupational Health and Safety The work force should be monitored in order identify any threats, requirements for compliance are set out in the LMP (Appendix 2). Contractors are to record and report accidents, fatalities, illnesses, and incidents daily. The health and safety of other workers participating in project-financed activities will similarly be monitored for accidents and any project related illnesses. Table 6-6 further elaborates mitigation measures. 5.12 The Monitoring Plan The monitoring plan lists issues of concern in Table 9-1 below. It provides specific details including parameters, frequency, and responsible entities. Appendix 7 presents a template monitoring form which can be used for each activity or healthcare facility. Page | 195 Table 5-7 Possible Monitoring Activities and their Indicators RESPONSIBLE ISSUE METHOD OF MONITORING AREAS OF CONCERN INDICATOR FREQUENCY AUTHORITIES Noise Noise monitoring should be carried out • Noise Levels. Regularly and ongoing as • PIE Noise levels at the nearest on an ad-hoc basis by the • Adherence to restricted sensitive receiver would be project is implemented. • MoHCC Environmental Monitor or the PIE to working times. kept to a minimum so as • Contractor estimate noise levels in the work areas • Use of low noise equipment. not to disturb the peace of controls noise and adherence to working times • Noise suppression the patients or other levels neighbours if applicable. EHS General Guidelines on noise level for construction applies. Health PIE must ensure that education and • Public health • Reduction in number of Regularly and ongoing as • PIE awareness campaigns are • Waste management at Project cases of such diseases project is implemented • MoHCC implemented. The Ministry of Health activity sites. as, HIV/STD related • Project related • RDCs should carry out awareness campaigns • Disease outbreak due to diseases recorded at accidents, incidents or • Local on Hospital Acquired diseases. concentration of people at the hospital and medical fatalities are to be Leadership Project activity sites. clinic reported to the PIE as • Contractor PIE must mainstream HIV/AIDS and • Disease outbreak due to dust soon as they occur, or COVID-19 issues into the project and water pollution. • Worker OHS: project officials find implementation programme. • Worker OHS: Project related 1. Low or decreasing out. PIE will report to accidents, incidents, or accidents, incidents, the WB as soon as it Site visit observation for worker OHS fatalities and fatalities. finds out. Follow-up and contractor reporting on accidents, • Health and Nutrition status 2. Observed proper PPE, investigations will be incidents, and fatalities. • Use of proper PPE and other use of safety supplies conducted, as necessary supplies such as and equipment. necessary. sanitizer • WASH facilities are inspected on a Page | 196 • special COVID-19 • Percentage of facilities quarterly basis, occupational health and with adequate and together with the safety guidelines and functional sanitation whole health Care practices facilities for both staff facility by the • case detection and patients at agreed Environmental Health • psychosocial support. standards. Depart of MoHCC. • Level of WASH issue. • Quality of Facility sanitation (WASH). Waste For minor works and renovations: • Hazardous waste• Hazardous waste Regular, weekly • PIE Management Observations should be made on how identification if any. properly delineated and monitoring of hazardous • MoHCC the HCF, and any contractor/activity • Waste segregation on site. stored construction waste and • Contractor implementer is handling general • Waste handling facilities. • Proper transportation of hazardous medical waste. • the health care waste, hazardous waste including • Waste temporary storage hazardous waste facilities asbestos containing materials (ACM) areas. available and liquid waste in accordance with • Waste transportation• designated waste the ESMF, ICWMP and project activity methods. management site that ESMP. • Functioning incinerator complies with ESMF and • Use of proper PPE ICWMP requirements For medical waste, which is hazardous, • being used for facilities will develop waste hazardous waste management plans (ICWMP) which disposal. will be monitored for compliance. • Hazardous Waste Consult the ICWMP for further details. properly classified. • EHS performance of contractors installing solar panels - such as noise level, waste disposal, Page | 197 • Disposal/repurposing of any obsolete equipment removed • Amount and location of waste disposal • Data confirming Disposal site (e.g., incinerator) is operating properly per Project requirements (ESMF, ICWM • Number of drivers trained in safe transportation of waste Percentage of incinerator operators trained on proper operation and maintenance of incinerators, • Percentage of incinerators licenced by the Environmental Management Agency, • Amount of medical waste generated at HCF Amount of hazardous waste transported • Amount and location of disposal Page | 198 • Percentage of disposal sites (e.g., incinerator) operating properly per Project requirements (ESMF, ICWMP), • Percentage of HCF appropriately segregating waste at point of generation • Relevant Quality-of- Care Supervision Checklist quarterly data • Number of traffic accidents from project activities Air Pollution Observations should be made on the • Levels of dust emissions • Deposition of dust on Weekly monitoring of dust • EMA level of dust generated during the solar • Controlled areas for debris surfaces should decrease suppression measures as • MoHCC panel installation activities by the • Dust suppression measures with increased necessary. • PIE Environmental Monitor or PIE. • Proper PPE provided dampening. • RDCs Dampening should be carried out if • Appropriate PPE for To be determined taking levels are unacceptable and there protection from dust into consideration EMA or should be no open burning of always provided. (See other national testing construction waste. IWCMP for details) schedule. • Incinerator emissions EMA testing of project supported • Vehicle exhaust emissions • Number of motor Quarterly monitoring of • EMA, vehicles to ensure compliance with vehicles within the exhaust emissions MOHCC, national regulations on vehicular permissible limits for CO, PIE emission for Pb, CO, NOx, SO2 and NOx, SO2, PM emissions Page | 199 PM2.5. EMA already has the required equipment. Water • Water resources should be managed • Watercourses and • Water resources should • Tests for water quality • MoHCC resources in accordance with WB EHSG, ESF impoundments. be managed to carter from installed water • PIE and national laws and regulations • Surface water quality for environmental distribution devices to • Project activity • HCF should test its water quality in • Ground water quality concerns. be done regularly (at implementers supplied to ascertain the suitability • Recommended distances from • Pollution of water least once per year) for human usage and/or watercourses. resources • If supplied by borehole, consumption monitored/detected boreholes should be • Project activities should not pollute early, and remedial tested at least once a or unduly disturb water resources. measures taken on time year if there is no All waste should be managed problem, but if properly and not lead to pollution of pollution is suspected, water resources. a more frequent regime is adopted depending on the incident. • Testing and monitoring HCF wastewater discharge for parameters outlined in the Environmental management (waste water and effluent disposal) regulations on annually at relevant discharge point/s for municipal sewer and on-site septic tanks Page | 200 Cold ChainRefrigeration in the cold chain system for • Temperature • Number of health • Daily at health facility • PIE Supply vaccine storage and distribution is • Power availability facilities with cold chain level • MOHCC necessary to maintain efficacy of the • Vaccine distribution equipment maintaining • Monthly for Provincial vaccines. Through proper refrigeration, mechanisms temperature between level the potential to generate vaccine rejects • Cold chain storage +2oC and +8oC is also avoided. • Cold chain transportation Complaints The PIE should inspect the record of • Complaints Number of Cases resolved Monthly monitoring of the • PIE complaints made by residents, to be • Remuneration of HCWs within stipulated time complaint registers. • MoHCC kept by the beneficiaries, and should • Work safety measures frame of 3 working days for • RDCs check that action is taken quickly and • accidents caused by project priority 1 and 3 working • EIA that the number of complaints does not activities and reported weeks for priority 2. Department rise significantly. The GRM should be • Safety equipment (PPE) employed. available • Information, communication, capacity building • Working conditions for workers • Incidences of GBV/SEA • No underage employed • Incidences of utility disruptions Page | 201 6. Project Complaints, Conflicts and Grievance Redress Mechanism 6.1 Introduction Implementation of project activities under ZCEREHSP will take place in various locations in all the target areas of the country. The implementation may generate several challenges and complaints, especially those which relate to infringement of rights of sections of society. As part of addressing such complaints and in the spirit of the continuous consultation process, a GRM has been developed for HSDSP AF-V and will be used under ZCEREHSP. The GRM will consist of two parallel systems. These systems are: i) the Facility level GRM system for project implementation feedback including challenges and complaints and ii) the Word Bank Grievance Redress System (GRS) for non-compliance with environmental and social safeguards policies. The GRM for the ongoing HSDSP AF-V is monitored by the PIE Social Safeguards and Communications Specialists with the support from MoHCC Health Promotion, Public Relations Units and Quality Assurance and Patient Safety Department. Under the ZCEREHSP, the Social Safeguards Specialist engaged during the implementation of HSDSP AFV and ZCERP will continue to further support the implementation and monitoring of the GRM. The GRM will be a system by which queries or clarifications about the project will be responded to, problems with implementation will be resolved, and complaints and grievances will be addressed efficiently and effectively. The purpose of the grievance redress mechanism is to: • be responsive to the needs of beneficiaries and to address and resolve their grievances, • serve as a conduit for soliciting inquiries, inviting suggestions, and increasing community participation, • collect information that can be used to improve operational performance, • enhance the project’s legitimacy among stakeholders, • promote transparency and accountability, • deter fraud, corruption and mitigate project risks. 6.2 Facility Level GRM System The rationale for the facility level GRM, is because the CBOs and HCCs in the villages indicated that they were getting minimum assistance from the establishment and that they were dealing with community grievances through the police and the local elders. The Grievance Redress Mechanism consists of the following components: • The access point for impacted/concerned patients or people will be situated as close to the Project Affected Person (PAP) as possible. o Notices written indicating the process to be taken when aggrieved, o At all health facilities there will be various channels to communicate grievances (suggestion boxes, clients comments book, phone numbers, etc.) some of which will be situated in designated areas. The responsible committee or person(s) will oversee management of grievances at each level o At the various health facilities and MoHCC Offices there will be a designated officer who receives, classifies, and log all grievances, o At all project activity and CORDAID offices there will be various channels of communicating grievances (suggestion box, emails, SMS, phone calls, etc.) and a designated CORDAID staff will be responsible for receiving the grievances, classifying, and logging them Page | 202 o All the communication channels should be open daily • The patient would normally be asked to submit a written down grievance to the person in charge of recording, who then takes it up with the immediate supervisor, who will try to resolve it, failure to do so appropriate steps will be taken by the next higher level of management. • The responsible person should give the complainant an acknowledgement of receipt containing an expectation of when they will receive a response, • The Facility Manager assigns a member of staff to be responsible for the case, who ten assess and investigates the grievance to identify all the key facts, • The responsible staff member in consultation with the Facility Manager then makes a resolution and the proposed actions are confirmed with CORDAID/MoHCC responsible committee, • A response is then communicated to the complainant within the timescale promised: ✓ For Priority 1 – urgent, potential high health and high business impact. This requires a response to the Complainant within three (3) working days, ✓ Priority 2 - non-urgent, lower health, environmental and social impact. This requires a response to the complainant within 2 working weeks, • The complainant is given room to appeal to the MoHCC Head Office if they are not satisfied with the response. The appeal can be lodged with the Public relations Manager, MoHCC, Kaguvi Building, 4th Floor, Central Avenue, Harare. If the complainant is not satisfied, then they can appeal to the Courts of Law • Once done the case is brought to a closure and all the staff members of the Facility are made aware of the complaint, any underlying issues and plans to prevent any future recurrence of the issue, ✓ All complaints should be reviewed monthly as part of the quality assurance review meetings, ✓ Any complaints where action can be taken to avoid recurrence must be acted upon and raised with the appropriate managers/teams across the Facility, ✓ A monthly summary incident report is submitted to the Communications Specialist of CORDAID for record keeping and consolidation. He/she will ensure that all grievances are being recorded and resolved in a timely manner. NB: The GRM system at each level should accommodate anonymous reports. ✓ For all internal grievances, the existing MoHCC grievances handling procedures will be used 6.3 World Bank Grievance Redress System (GRS) Communities and individuals who believe that they are adversely affected by a World Bank supported project may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed to address project-related concerns. Project affected communities and individuals may submit their complaint to the WB’s independent Inspection Panel which determines whether harm occurred, or could occur, because of WB noncompliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank’s attention, and Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS), please visit http://www.worldbank.org/en/projects- operations/products-and-services/grievanceredress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org Page | 203 6.4 Disclosure To meet the consultation and disclosure requirements of the Bank, once the EMA, the approval or licensing authority, has approved the ESMF, GoZ will issue a disclosure letter to inform the Bank of (i) the Government’s approval of the ESMF; (ii) the actual disclosure of these documents to all relevant stakeholders and potentially affected persons in Zimbabwe, and (iii) the Government’s authorization to the Bank to disclose these documents on its website. Usually, disclosure of the safeguard documents must be completed prior to appraisal of the Project as per ESS10. However, since this is an emergency project, the disclosure of this ESMF was deferred to six weeks after project effectiveness. This ESMF, the ICWMP and other future safeguards instruments for the project will be disclosed both in-country and by the World Bank, in English. In country the safeguards instruments will be disclosed both on the MoHCC and Cordaid websites as well as the project website. Page | 204 7. Stakeholder Engagement and Communication 7.1 Stakeholder Engagement The ZCEREHSP project will engage, gather information from, consult with and disseminate project information to a variety of stakeholders. It is important to note that stakeholder engagement is an ongoing process and not an event. This engagement process will provide a framework for achieving effective stakeholder involvement and promoting greater awareness and understanding of issues so that the project is carried out effectively, within budget and on time. A detailed and updated SEP can be found on this link: https://healthprojectzim.org.zw/2023/05/12/strengthening-stakeholder-engagement-the-project- updates-its-stakeholder-engagement-plan/ 7.3 Risk Communication and Community Engagement (RCCE) A clear and integrated RCCE strategy and response is vital for community uptake of essential public health interventions to prevent and control the spread of disease. The strategy will ensure dialogue and participation of all stakeholders and affected communities during preparedness, readiness, and response (during and after) the project. The RCCE must promote the uptake of public health services. Individuals who are at risk, the infected and those who have been affected need to be part of the solution to their own problems. This can be achieved when the community actively participate from problem identification, preparedness, response/action, and after-action activities. Continuous dialogues and statutory instruments that came in with COVID-19 prevention protocols can also be used for RCCE activities. The COVID-19 pandemic response has been affected by infodemics (misinformation, disinformation, rumours, myths and misconceptions, etc., that makes it difficult for people to make decisions and practice the recommended Public Health and Social Measures (PHSM). A multi-sectoral approach is therefore important in addressing COVID-19 prevention and control. More details on stakeholder engagement activities for the Zimbabwe COVID-19 Emergency Response Project are contained in the project SEP prepared separately. Page | 205 8. Project Implementation Arrangements, Responsibilities and Capacity Building 8.1 Introduction Safeguard implementation monitoring is critical to the success of the implementation of the project and its activities to ensure adherence to the World Bank Environmental and Social Standards and national laws and regulations. 8.2 Implementation Arrangements CORDAID serves as the PIE for the project and will lead the execution of project activities. CORDAID is already the PIE for the ongoing HSDSP (including for COVID-19 emergency response) financed by the WB- GFF. The PIE has designated environment and social focal points for HSDSP AF V implementation, who were responsible for the preparation of the ZCERP environmental and social instruments. The Environmental Specialist, Social Safeguards Specialist and the Communication Specialist are the focal points working together to ensure coordination with the MOHCC staff on environmental and social risk management during the project implementation, including supervision of waste management practices and OHS issues related to COVID-19 risks. Vaccine pharmacovigilance is a critical aspect in public health and a key indicator for pharmacovigilance. The Medicines Control Authority of Zimbabwe (MCAZ) is the statutory body responsible for protecting public and animal health by ensuring that all medicines, medical devices, allied substances, and other health commodities are safe, effective, and of good quality. This is achieved through registration of medicines; licensing of persons and premises that handle medicines; review, approval, and monitoring of clinical trials that involve the use of medicines; and quality testing and safety monitoring of all health commodities granted market authorisation. At national level the MCAZ in collaboration with the Expanded Programme on Immunization- Ministry of Health and Child Care (EPI-MoHCC), have continuously worked to develop vaccine pharmacovigilance in Zimbabwe through participation in World Health Organisation (WHO) projects, development and implementation of the Adverse Events Following Immunization (AEFI) surveillance guidelines and conducting trainings for health care professionals on AEFI reporting and case investigations. MOHCC has an Environmental Health Department which is made up of Environmental Health Officers (EHOs) and Environmental Health Technicians (EHTs). The Environmental Health Department is structured from the national level to primary care facility level. In each province there is a Provincial EHO (PEHO) whose role is to provide technical oversight to districts on environmental, health and safety issues. S/he ensures that the district implements measures to ensure safe management of health care waste. Working closely with the Infection Prevention and Control (IPC) Focal Person in each healthcare facility, the PEHO ensures Infection prevention and prevention measures are adhered to. They routinely conduct support and supervision to district levels ensuring the requirements of health care waste management plans are adhered to. At district level, the District Environmental Health Officer oversees the implementation of environmental, health and safety activities. The DEHO works in collaboration with the IPC Focal Person to ensure the lower level rural health facilities adhere to the requirements of the facility health care waste management plans. At each provincial and district hospital, there is an IPC committee. The committee is composed of the Health Services Administrator, Environmental Health Officer, a pharmacist and a laboratory scientist/technician. The committee promotes adherence to the requirements of the IPC policy at facility level. The District Environmental Health Officer leads a team of Environmental Health Technicians (EHTs) Page | 206 with each EHT stationed at a rural health facility. The EHT is the focal person for environmental, health and safety activities at rural health facility level. Working closely with the nurse in charge at rural health facility/ clinic, the EHT ensures proper health care waste management at primary care facility level. They receive regular support from the District Environmental Health Officer and the IPC focal person. The number of EHTs in each district varies depending on the size of the district. The MoHCC Environmental Health Service Department (EHSD) also leads Environmental Health Teams in the districts and provinces consisting of: • MoHCC - Environmental Health Department, • Ministry of Environment, Water and Climate (MoEWC)- Environmental Management Agency (EMA) District Officers and the Zimbabwe National Water Authority (ZINWA), • Ministry of Public Service, Labour and Social Welfare (MOPSLSW)- Department, • Ministry of Local Government, Public Works, and National Housing (MLGPWNH)- Public Works Department, • Cordaid The MoHCC can mobilize its Provincial Officers, as well as Health Centre Committees which include community representatives from youth groups, women’s associations, religious entities, etc. for various purposes. The District Development Committee with the District Environmental Health Officer (DEHO) and District Infection Prevention and Control (IPC) Focal Person conduct monthly inspections in public spaces, raise awareness and educate the community to reinforce infection control practices for COVID-19. Finally, the MOHCC’s EHSD and Nursing Directorate Infection Control Department are responsible for training healthcare workers on infection prevention and healthcare waste management at provincial level through the Provincial Environmental Health Department (PEHD) and Provincial IPC Department. The MoHCC provincial and district environmental health practitioners have been trained on environmental health, safety precautions and IPC including on COVID-19. The current E&S performance of the HSDSP project has been assessed as moderately satisfactory demontrating that the PIE has adequate capacity to carry out this ESMF and the project’s ICWMP since these documents (and the arrangements they describe) are in large part based on and similar to the HSDSP arrangements and safeguard instruments. The PIE will work closely with the MOHCC which will, in turn, coordinate with the COVID-19 EOC at national and subnational levels. The PIE will handle all project funds. It may contract other UN agencies such as UNDP to procure equipment and goods. In addition, given that the MOHCC has delegated the National Pharmaceutical Company (NatPharm, a state-owned enterprise) to handle storage and distribution of all COVID-related goods and equipment, the PIE will also enter into an agreement with NatPharm. The PIE will manage: vehicle fueling and maintenance, as well as selection and purchase of the energy-efficient equipment. The health care facilities themselves will operate the new energy-efficient equipment. The PIE will ensure that all project-financed goods and equipment are geo-tracked and monitored to ensure that they are used for their intended purpose. It will also mobilize Provincial Officers, as well as Health Center Committees that include community representatives from youth groups, women’s associations, religious entities, etc., to confirm availability of equipment, supplies and services. The Community Working Group on Health (a network of community-based/civil organizations), international NGOs, such as CORDAID and development partners also participate in the National RBF Steering Committee and several COVID-19 Response Committees. The Project Implementation Manual Page | 207 (PIM), developed under ZCERPwill be updated, among other things, to clarify key stakeholders’ (public and private) roles and responsibilities. Additional TA involving the WB Governance, Disaster Risk Management and HNP teams will be provided to improve coordination and governance of COVID-19 and essential health services activities including strengthening public financial management. The project will also finance regular internal and external financial audits. As a health care NGO, CORDAID is also on the forefront of COVID-19 responses as well as delivery key RMNCAHN services that require an agile approach to ESF implementation. CORDAID is therefore assessed to have the experience and capacity to carry out the necessary environmental and social due diligence associated with ESF requirements aligned with the COVID-19 and RMNCAHN context, have the experience and capacity to carry out the necessary environmental and social due diligence. It already has an Environmental Specialist. However, it is recognized that the COVID-19 pandemic has posed a unique set of challenges given the importance of immediate actions required to be implemented over a broad geographic space with many key stakeholders. However, CORDAID has been implementing environmental and social safeguards supported under the HSDSP AF (V) and ZCERP as guided by the ESF. the project would need to continue strengthening these areas to address environmnetal and social challenges posed by the new project and also taking into account new and emerging threats. The Environmental and Social Commitment Plan (ESCP) and the ESMF will include targeted support to build their capacity including training in COVID-19 and support from third-party entities to deliver on the objectives of the COVID-19 response and RMNCAHN operation. Moreover, given the need for a comprehensive stakeholder engagement and communications strategy in the context of COVID-19 management, vaccine deployment, and delivery of RMNCAHN services, the PIE has a Social Safeguards Specialist in place who will be maintained in the ZCEREHSP. 8.2.1 Environmental and Social Screening Process MOHCC will identify project activities and MOHCC District Technical Teams (see Figure 6-1) and participating facilities, with support from the PIE Environmental Specialist and Social Specialist, will be responsible for the environmental and social screening of the project activity (Figure 6-1). The PIE Environmental and/or Social Specialists will give overall guidance in the screening process, approving or rejecting ultimately, whilst MOHCC participating facilities will conduct the screening and submission for approval (i.e., filling out the form and completing the on-site evaluation). The extent of further environmental and social work required to mitigate adverse impacts for the project activities will depend on the outcome of the screening and environmental and social assessment process. 8.3 Monitoring and Supervision of E&S and Overall Project HCFs, and MoHCC more broadly, will prepare ESMPs as appropriate, the PIE will review and approve or deny such ESMPs before works begin. Similarly, HCFs and MoHCC more broadly will draft facility-specific ICWMPs and submit them to the PIE for review and approval or rejection before any project-supported activities that produce infectious medical waste begin. The PIE will ensure the inclusion of all applicable EHS terms and conditions in any Project contract (for construction or service provider). While HCFs are responsible for the operation of medical waste disposal facilities, the MLGPW is responsible for incinerators and all physical infrastructure at the HCFs such as the buildings, incinerators, etc. Similarly, while HCFs/the MoHCC is responsible for behavioural aspects of EHS measures, the MLGPW is responsible for structural (that is, the physical infrastructure) EHS controls. Page | 208 In terms of the overall project, the NVDP provides for further strengthening of the existing DHIS2 and EHR systems to incorporate vaccination and AEFI specific modules. These components have been planned for under this project to monitor vaccination coverage and adverse events post vaccination at disaggregated levels (region, population groups and risk groups, target group prioritization) like the surveillance and case management activities. The strategies cited in the NVDP include developing electronic COVID-19 vaccination registers and vaccination cards (with bar codes and other security features), upgrading the web based DHIS2 and EHR immunization register systems to reflect the COVID-19 vaccination coverage and uptake and harmonizing the AEFI monitoring system with EHR and DHIS2 interoperability of the systems. NDVP implementation includes routine collection of data and reporting on the number of people that would have received the first and second dose of COVID vaccine, the uptake and dropout rates, turnaround times in distribution, coverage of essential COVID-19 vaccine messages, temperature monitoring at facility level as well as the number of AEFI reported and investigated within 24 hours. The Electronic Logistics Management Information System (eLMIS) will be upgraded to collect and track data on the vaccine distribution and the key performance indicators up to facility level. Leveraging on recent investments in strengthening commodity tracking under the HSDSP AF V, the logistics system will allow for the tracking of batch numbers, expiration dates, manufacturer, quantity, date, origin, receipt at destination and beneficiary (last mile). The project will invest in further strengthening the interoperability between the eLMIS, DHIS 2.0 and the EHR systems in this regard. Recognizing that vaccine protection is an integral aspect of immunization programs and requires the participation of multiple stakeholders the country established a partnership across the ZEPI, the National Pharmacovigilance & Clinical Trials Committee and MCAZ as a key driver in monitoring vaccination safety. With the aid of Standard Operating Procedures for use across facilities, sentinel cohort monitoring, mass communication and awareness raising and use of grievance redress mechanisms; the combined efforts will seek to achieve timely reporting of adverse events as well as detection of incidences of misallocation or elite capture of vaccines that should otherwise be allocated to priority groups under the national plan. Strengthening the linkages between the EHR and eLMIS for commodity tracking presents opportunities to extend the progress made to date in the production and scaling of these digital solutions to the response to COVID-19 including vaccination. MOHCC developed a mobile-based application known as Baobab1 and is being piloted with the possibility of its use for surveillance, case management and AEFI at household level. 8.3 Annual Monitoring, Reporting and Reviews Environmental and social monitoring needs to be carried out during the implementation of the project activities. Monitoring of the activity’s compliance with the mitigation measures set out in the ESMP, will be carried out by the PIE, where relevant, jointly with the support from community leaders and local authorities and, extension teams. MoHCC Local Offices will supervise or carry out the monitoring activities and are required to report annually on activities during the year. The PIE will submit biannual monitoring reports on safeguards matters and ESMF implementation to the World Bank. Starting from the Effective Date, bi-annual reports shall be submitted with the general project progress report. In case no general progress report is drafted, the ESHS progress report is to be submitted no later than 20 days after the end of each reporting period, throughout Project implementation. Project activity specific ESMPs, the project ICWMP and ESMF will be disclosed but HCF specific ICWMPs will not. Page | 209 The PIE will report, as required in the Project ESCP, any incident or accident related to the project which has or likely to have a significant adverse impact on the environment (including any materially non- compliant emission from an incinerator used for Project wastes), the affected communities the public or project workers including any allegation of GBV/SEA/SH, project-related occupational incidents or fatalities, labour strikes or social unrest. Enough details will be provided regarding the incident or accident, indicating immediate action taken or are planned to be taken to address it and any information provided by the contractor whilst ensuring confidentiality especially GBV/SEA/SH related incidents. The report will be made within 48 hours after learning of the incident or accident in line with the World Bank Environment and Social Incidence Response Toolkit (ESIRT). COVID-19 illness and/or fatalities are only to be reported to the WB if any of the following conditions are present: 1. The infection rate in the workforce increases to the point that the PIE, the HCFs, other implementing partners (including MoHCC) or a contractor’s ability to implement the project is compromised. 2. Project implementors (including the PIE, HCFs and contractors) are unable to ensure that infected workers are receiving proper care. 3. Project implementors (including the PIE, HCFs and contractors) are failing to deliver preventative measures adequately. Especially report to us if a fatality occurs and the information available suggests that the fatality may be a result of the implementor failing to deliver preventative measures adequately. 4. Incinerator and vehicle emissions need to be tested and recorded on a quarterly basis. Testing of these emissions will be completed by the Environmental Management Agency in line with the Environmental Management (Atmospheric Pollution control) regulations of 2009. Incinerator operators will monitor daily their operations and conduct periodic preventive maintenance as outlined in the standard operating procedures contained in the ICWMP. Those that are found not complying with the prescribed standards as set out in the mentioned regulations and the WB EHS Guideline for Health Care Facilities, EMA will determine the measures (which must be acceptable to MoHCC and WB) that institution or facility with non-compliant vehicle or incinerator to take necessary measures to rectify the short comings or bring it into compliance. EMA has the tools and equipment to conduct such tests. However, only the test and equipment are centralised at the national office. Capacity building of the subnational level/ provincial and district officers is required. Hence, the project will support the training of provincial and district EMA officers on air quality monitoring. For the safety of passengers, the project ensures that the drivers are appropriately licenced to drive the class of vehicle. Furthermore, once any new driver is engaged in the project, the Transport Officers58 will ensure such driver is appropriately licenced. In addition, the project will support the training drivers on safe transportation of waste as well as basic road safety. Table 8-1 below details the reporting arrangements for the environmental and social safeguards implementation: Table 8-1 Reporting arrangements. No. Issue/report Reporting entity Recipient of Frequency of report reporting 58 Transport Officers are responsible for fleet management and transport logistics at all levels of the MOHCC including transport logistics, ensuring that vehicles are services and repaired, drivers are adequately instructed for safe transportation of goods and people. Page | 210 1 Biannual progress reports on • PIE Env. Specialist • World Bank Biannual safeguards status and the • PIE • MoHCC implementation of Communications instruments (i.e., the ESMF, Specialist SEP, GRM, LMP, ESMPs, • PIE Social checklists, etc.) Safeguards Specialist 2 Vehicle and incinerator • PIE Env. Specialist • World Bank Quarterly to emissions monitoring • EMA • MoHCC MOHCC and • PIE biannual to World Bank 3 Project related accidents, • PIE project • World Bank As soon as project incidents, and fatalities personnel • MoHCC personnel become • PIE Team Leader • PIE aware of them and • Project activity within 48 hours in leaders line with ESIRT 4 Consultation of Indigenous • Project activity • affected As and when an Peoples, project progress applicants indigenous incident has and any unexpected and • PIE Env. Specialist communities occurred. unintended events affecting • PIE • PIE Indigenous Peoples Communications • World Bank Specialist • MoHCC 5 GBV/SEA/SH reporting and RBF activity by • PIE Monthly and as community psychosocial community health • World Bank soon as when an support workers (CHW). • MoHCC incident has occurred. Compliance monitoring comprises on-site inspection of activities to verify that measures identified in the ESMP, are being implemented. This type of monitoring is like the normal tasks of a supervising engineer whose task is to ensure that the Contractor is achieving the required standards and quality of work. An annual inspection report must be submitted (together with the annual monitoring report) to WB for review and approval. 8.4 Adaptive Management Annual reviews may be carried out by an independent local consultant, NGO or other service provider that is not otherwise involved with ZCERP. Annual reviews should evaluate the annual monitoring report from MoHCC Local Offices and the annual inspection report from PIE. The purpose of the reviews is two-fold: • To assess compliance with the ESMF requirements, learn lessons, and improve future ESMF performance, • To assess the occurrence of, and potential for, cumulative impacts due to project-funded and other development activities. The annual reviews will be a principal source of information to the PIE for improving performance, and to Bank supervision missions. Thus, they should be undertaken after the annual report on monitoring has been prepared and before Bank supervision of the project. Page | 211 The review should identify areas of adaptive management, including training of project staff to ensure that the ESMF remains an iterative and adaptive to any changes or unforeseen circumstances (e.g., staff turnover, funding, political and environmental change) which may have an impact on project decision making, design and activities, requiring ESMF operational adjustments. 8.5 Monitoring Indicators The purpose of monitoring indicators is to measure the extent to which the interventions in the management of environment and social impacts have achieved expected result and decide if further interventions are needed. To be able to assess the effectiveness and safety of the proposed rehabilitations, installations, health care supplies and the subsequent implementation, operation and maintenance, the following are possible indicators for monitoring EHS performance of project activities: Table 8-2 Monitoring Indicators ANTICIPATED IMPACTS OF No. ZCEREHSP POSSIBLE MONITORING INDICATORS PROJECT ACTIVITIES 1.0 installation waste • Number of specific areas for waste disposal in appropriate formal management dumping sites. • Volumes of Toxic waste Segregated. (Hazardous chemicals, infected samples, obsolete chemicals, Asbestos Containing Materials (ACM)) • Number of human resources employed in waste management • Number of Obstructions of roads and walkways. 2.0 Hazardous and • Conditions of the waste handling System (Segregation at source, medical waste handling, managing, transporting, treatment and disposal) including e-waste • Volumes of Infectious waste generated from facilities • Number of vehicles complying with national environmental emission standards. • Percentage of fuelling facilities with adequate and proper equipment for management of oil and other petroleum related waste. • Number of drivers trained of safe transportation of waste • Percentage of incinerator operators trained on proper operation and maintenance of incinerators, • Percentage of incinerators licenced by the Environmental Management Agency, • Amount of medical waste generated at HCF • Amount transported (and confirmed by hazardous waste transportation return) • Amount and location of disposal • Percentage of disposal sites (e.g., incinerator) operating properly per Project requirements (ESMF, ICWMP), • Percentage of HCF appropriately segregating waste at point of generation, Page | 212 ANTICIPATED IMPACTS OF No. ZCEREHSP POSSIBLE MONITORING INDICATORS PROJECT ACTIVITIES • Amount of e-waste disposed according to the national regulations, • Amount of e-waste sent for recycling 3.0 Land • Surface areas rehabilitate with terraces, erosion ditches, etc. degradation/Soil developed. erosion • length of storm water channels rehabilitated. • Areas of Patches revegetated or regressed 4.0 State of • Area with planted trees and shrubs/grasses vegetation • Areas of Patches revegetated or regressed 5.0 Ambient Air • Level of air Quality vs national and WB standard. pollution • Availability of Correct PPE. 6.0 Noise generation • Level of noise within an allowable limit and o Close to Patient Wards the noise levels should not be more than 30 Db Leq. • Noise making period complying with the work time (7am-6pm). 7.0 Occupational • Incidences of work-related injuries and fatalities at sites. health and safety • Number of non-health care staff at project sites with health problems. (OHS), and • Number of Health Care workers infected during operations (Incidences Community of infection at work). Transmission and • COVID-19 cases emanating from or related project sites or Health Exposure Facilities. • Number of accidents, incidents, and fatalities caused by project activities and reported. • Number of workers accessing HIV/AIDS services needed. • Number of non-compliance events to labour/employment act and other applicable obligations (compliance to the Health Care Workers code of conduct, labour contracts, and labour rights). • Number of complaints regarding the project. • Number of Safety equipment (PPE) available at construction site for workers. • Number of speed control ramps with appropriate road signs in case of roads. • Percentage of drivers with adequate documentation (driver’s licences, defensive drivers’ licence, positive medical report), • Number of drivers trained on safe transportation of hazardous waste. Page | 213 ANTICIPATED IMPACTS OF No. ZCEREHSP POSSIBLE MONITORING INDICATORS PROJECT ACTIVITIES 8.0 Gender • Proportion of women among contract workers or employees mainstreaming • Number of reported sexual abuse case involving project workers. • Ratio of men to women trained (ensure equity in the training processes). 9.0 Risks to • Number of vulnerable persons served (Easy of access of services). vulnerable (vulnerable persons include people with chronic conditions/disabled, Groups poor people, migrants, the elderly and, disadvantaged sub-groups of women, Indigenous Peoples (IPs).) 10.0 Handling of • Number of complaints of known leakage of patient personal Project and information. Personal • Number of safeguards training courses conducted for staff and Information beneficiaries in safe handling of personal information. 11.0 Training • Dates. /induction and • number of trainings. capacity building • and topics covered. 12.0 Handling of • Percentage of grievances addressed and closed within 4 weeks of initial Grievances complaint being recorded. 13.0 Cold Chain Supply • Number of facilities with equipment maintaining cold chain temperatures between 2-8 degrees Celsius. 14.0 AEFIs • Percentage of AEFIs identified and managed according to protocol 8.6 Institutional Arrangements for ESMF Implementation 8.6.1 Project Implementers To assure the successful implementation and monitoring of the ESMF, the target groups and stakeholders who will play a role in the implementation of the ESMF must be provided with appropriate training and awareness. This is because the implementation of the activities will require inputs, expertise and resources which will be adequately conducted if the concerned parties are well-trained. These people include the following: (a) National level i) Ministries and other Government Entities This project is being implemented by and for the MoHCC. Both the MoHCC Environmental Health and Health Promotion Departments have primary roles to play in the environmental and social management of project impacts. The MLGPW also has a central role as the owner and determiner of the physical Page | 214 elements/infrastructure of the HCFs. Close communication and coordination between MoHCC and MLGPW are required for successful implementation of this project. The other government entities that will support the project include: � MoEWC - EMA District Officers and ZINWA, � MOPSLSW - Social Welfare Department, These other institutions such as MoEWC - EMA District Officers, MOPSLSW - Social Welfare Department, and MLGPW - Public Works Department have roles to ensure that national environmental and other standards are met through monitoring, site visits, permit obligations and other means. EMA plays a central role in supporting the project and HCFs for screening, capacity building (including training) and other environment, health, and safety aspects. For the smooth implementation of this ESMF, staff at national level must understand the environmental and social issues pertinent to their involvement. The groups that may need training at national level will include: • PIE staff, • MoHCC staff, • Other collaborating institutions such as MLGPW. ii) Project Implementation Unit (PIE) The Project Implementation Unit (PIE) is primarily responsible for implementing the project and reporting on the use of World Bank-GFF funds. CORDAID will remain as the PIE and will receive World Bank-GFF funds through a Designated Account. The roles and functions of CORDAID are elaborated in section 1.7. The PIE has strengthened its capacity to implement the project’s environmental and social safeguards and this ESMF, by engaging a Communications Specialist, Social Safeguards Specialist for social issues and an Environmental Specialist for environmental matters. The Communications Specialist and Environmental Specialist were engaged under the HSDSP AFV and oversaw the implementation of social and environmental issues for the project. The Environmental Specialist will oversee the implementation of environmental matters for both AFV and ZCEREHSP activities. The Social Safeguards Specialist is supporting the implementation of social issues for the parent project and ZCEREHSP. Sections 6 and 9.2.1 describe the roles of the PIE in preparation and approval of screening forms, ESMPs, facility ICWMPs and other safeguards responsibilities in more detail. The MOHCC PCU will continue to be the national purchaser for RBF services its roles are also elaborated in section 1.7. PIE Environment Specialist The PIE Environmental Specialist will ensure the provisions of this ESMF are implemented, all Environmental and Social Safeguards are adhered to and that the ESMPs are formulated, reviewed, and adhered to. He/she will need to have a Masters’ or advanced degree in Environmental Health, Environmental Sciences, Public Health, Nursing, Infection Prevention and Control, Natural Resource Management, Development Studies, Social Sciences, or any other relevant field. Page | 215 His or her main functions are (i) capacity building, (ii) analytical and technical support and (iii) Operations, Management, and Implementation of the ESMF. In capacity building, conduct or ensure continuous training on the project’s safeguards instruments to all CORDAID staff, MoHCC staff (National, Provincial and District), etc. The training will be in the form of initial awareness and refresher workshops on specific safeguards issues together with on-the-job practical demonstrations of the development and implementation of the ESMPs. Another important function of the PIE Environmental Specialist will be to ensure quality control and clearance of ESMPs and any other environmental documentation including instruments. In terms of analytical and technical support he/she will assist the PIE in ensuring that the project is environmentally and socially compliant with the ESMF and ICWMP requirements. He/she will provide technical support and guidance and clearance functions (as necessary) during project activity proposal development, Environmental and Social screening and assist in the inclusion of environmental and social issues in the activity selection process, operations, management, and implementation of the ESMF. He/she will advise on administrative measures and actions required for ensuring the compliance with requirements set regarding environmental and social safeguard measures and undertake periodic monitoring and evaluation of project activities against standards of the safeguard guideline. PIE Social Safeguards Specialist The PIE Social Safeguards Specialist will serve the purpose of making sure the social provisions of this ESMF are implemented, all Social Safeguards are adhered to and that the capacity of the beneficiaries to implement the ESMPs is enhanced. He/she will also be responsible for the implementation of the project’s GRM. The project has engaged the Social Safeguards Specialist to oversee the implementation of the social provisions of the ESMF. His/her main functions are (i) capacity building, (ii) Analytical and Technical support and (iii) Operations, Management, and Implementation of the GRM. In capacity building Conduct continuous training on the project’s social safeguards instruments and the project’s GRM, to all CORDAID staff, MoHCC staff (National, Provincial and District) etc. The training will be in the form of initial awareness and refresher workshops on specific safeguards issues together with on-the-job practical demonstrations of the implementation of the project’s GRM. In terms of analytical and technical support he/she will assist the PIE in ensuring that the project is socially compliant with the ESMF requirements. He/she will provide technical support and guidance during activity proposal, formulation, social screening activities and assist in the inclusion of social issues in the project as it is executed. With respect to the operations, management, and implementation of the ESMF, this Specialist advises on administrative measures and actions required for ensuring the compliance with requirements set regarding social safeguard measures and undertake periodic monitoring and evaluation of project activities against standards of the safeguard guideline. v) PIE Communication Specialist The Communication Specialist will support the Social Safeguards in the successful implementation of the GRM, working with focal points from MoHCC. She will provide overall policy and technical direction for all risk communication and community engagement activities working closely with Health Promotion Department, as well as public relations management issues under the Project as defined by the Page | 216 Environmental and Social Commitment Plan (ESCP), Environmental and Social Management Framework (ESMF), Stakeholder Engagement Plan (SEP) this LMP and the ICWMP such as AEFI, GRM, etc. (b) Provincial, District and Local level Technical Teams The PIE Environmental Specialist together with the Communications Specialist/ Social Safeguards Specialist, will be assisted in their duties by the Provincial and District Technical Teams (See Section 6.1), who will be led by MoHCC - Environmental Health Department, Health Promotion department and Public Relation Unit and consist of representatives of the following institutions at each level: a. MoHCC - Public Relation Unit b. MoHCC - Health Promotion Department, MoHCC - Environmental Health Department c. MoEWC - EMA District Officers d. MOPSLSW - Social Welfare Department e. MLGPW - Public Works Department f. ZINWA g. Cordaid The technical teams will be responsible for completing the environmental and social screening form (Appendix 5) to be able to identify and later mitigate the potential environmental and social impacts of ZCEREHSP project activities. At Facility Level, the groups that will receive environmental and social training to enable them to implement the ESMF of the project will include the following: • CHW, • Environmental Health Technicians/ Officers, • Nurse in Charge. Figure 8-1 below outlines the roles and responsibilities of different institutions and various levels in the implementation of the ESMF. Page | 217 Figure 8-1 Organisational Arrangements 8.7 Project Implementation Capacity 8.7.1 Planning and Coordination of the Vaccine Introduction In March 2020, the Zimbabwe National Preparedness and Response Plan for COVID-19 was launched and with it a national COVID-19 Response Task Force and the Inter-Ministerial Committee. In August, to strengthen the National COVID-19 response, the Cabinet decided to merge the COVID-19 response into a single response plan comprising the Command Centre, Office of the COVID-19 Chief Coordinator and Ministry of Health and Child Care. The overall COVID-19 response is being coordinated by the COVID-19 National Response Committee directed from the Office of the President and Cabinet. The COVID-19 vaccine Page | 218 will be coordinated by the Interagency Coordinating Committee (ICC). The country has appointed the ICC as the COVID-19 National Coordinating Committee (CNCC) with multi-sectoral representation. The Zimbabwe National Immunization Technical Advisory Group (ZIMNITAG) will provide evidence-based recommendations and policy guidance specifically related to COVID-19 vaccines, to facilitate fully informed decision-making by the government. 8.7.2 The Medicines Control Authority of Zimbabwe (MCAZ) Vaccine pharmacovigilance is a critical aspect in public health and a key indicator for pharmacovigilance. The Medicines Control Authority of Zimbabwe (MCAZ) is the statutory body responsible for protecting public and animal health by ensuring that all medicines, devices, allied substances, and other health commodities are safe, effective, and of good quality. This is achieved through registration of medicines; licensing of persons and premises that handle medicines; review, approval, and monitoring of clinical trials that involve the use of medicines; and quality testing and safety monitoring of all health commodities granted market authorisation. The MCAZ in collaboration with the Expanded Programme on Immunization- Ministry of Health and Child Care (EPI-MoHCC), have continuously worked to develop vaccine pharmacovigilance in Zimbabwe through participation in World Health Organisation (WHO) projects, development and implementation of the Adverse Events Following Immunization (AEFI) surveillance guidelines and conducting trainings for health care professionals on AEFI reporting and case investigations. 8.7.3 The roles of the ICC in COVID-19 vaccination • The responsibilities of the ICC include, but not limited to: o reviewing global-level information related to COVID-19 vaccines and incorporating it into the planning and preparation for COVID-19 vaccine deployment at country level. o considering the recommendations issued by the ZIMNITAG. o defining the deployment plan with clear functions, responsibilities, and deadlines for different stakeholders. The plan needs to be aligned with the national COVID-19 preparedness and response plan. o estimation of costs to facilitate budget advocacy and resource allocation. o establishing an operations process for coordination, information, and communication. o ensuring integration with existing immunization programmes and coordination across programmes and different sectors embedding the vaccination programme into existing health system structures. o coordinating and/or supporting the implementation of health services readiness and capacity assessments (at facility and community level) to identify bottlenecks and guide delivery of vaccines and other essential supplies; and o monitoring progress using methods such as a dashboard with key indicators, readiness assessment tools, etc. 8.7.4 The roles of the ZIMNITAG ZIMNITAG will be responsible for the following activities: • Reviewing recommendations from the Strategic Advisory Group of Experts on Immunization (WHO/SAGE), the Regional Immunization Technical Advisory Group (RITAG) and/or other NITAGs. • Periodic reviewing of Zimbabwe’s relevant data on the national/regional epidemiology of COVID- 19, including laboratory confirmed cases, hospitalization and deaths associated with COVID-19 and data on natural immunity. Page | 219 • Updating the advice and issue vaccine-specific recommendations as new information comes in on the characteristics of COVID-19 vaccines under development; changes in the landscape of non- pharmacological interventions, COVID-19 diagnosis, and treatment; and COVID-19 vaccine-specific recommendations from SAGE and RITAGs • Advising the MoHCC on priority groups and vaccination strategies based on the evidence collected and available global and regional guidance, i.e., values framework. • Advising the MoHCC on the best communication approaches regarding COVID-19 vaccine introduction, considering vaccine characteristics and public acceptance dynamics. 8.7.5 Roles and Responsibilities of Focal Persons For the effective deployment of vaccines, the National EPI Programme will be responsible for the implementation of Covid-19 vaccination activities. The table below highlights some of the responsibilities of the focal persons: Table 8-3 Responsibilities of focal persons Title Responsibilities EPI Manager Responsible for managing a country’s overall pandemic response in coordination with the National Response team. – Organizes and oversees implementation capacity building for health workers – Delegates responsibilities for deployment of vaccine and vaccination to the logistics and vaccination focal points. – In collaboration with the logistics team, drafts the deployment and implementation plan. – Collects and organizes contact information for members of deployment committees, other key authorities Surveillance Officer Responsible for the monitoring COVID 19 vaccine and injection safety. – Update processes for data collection, analysis, visualisation, and communication using management information systems. – Strengthening post-deployment surveillance and management of Adverse Events Following Immunization (AEFI), monitoring and evaluating vaccination activities. – Participate in Pharmacovigilance committee Logistician Oversees process for forecasting, vaccine reception, storage, transport distribution and waste management. Responsible for deployment COVID 19 vaccine & supplies – Ensures that there is appropriate mode of transport of each shipment. – Strengthening the logistics management information systems, inventory management system and health facility service capacity assessments. Monitoring and Evaluation – Update indicators for monitoring & evaluation Officer – Establishes process for monitoring and evaluating COVID-19 deployment activities. – Update processes for COVID-19 data collection, analysis, visualisation, and communication using management information systems. – Ensures timely and continuous monitoring of activities to make activities are implemented as planned – Monitoring of COVID-19 vaccine acceptance level. Page | 220 Title Responsibilities Advocacy, Communication Developing of a communication plan and monitoring framework for COVID and Social Mobilisation 19 vaccine – Engagement of key national & subnational stakeholders – Development of communication materials for COVID 19 – Coordination of demand creation & media campaign – Establishment of media monitoring and community feedback mechanism – Coordinate national launch of COVID 19 vaccine – Establish ethical codes/patients charter 8.7.6 Vaccine Safety Monitoring and Management of AEFI and Injection Safety COVID-19 vaccine safety surveillance will be guided by already existing MoHCC’s Adverse Events Following Immunization (AEFI) surveillance guidelines and the WHO COVID-19 Vaccines Safety Surveillance Manual. Safety surveillance for COVID-19 surveillance will be further strengthened through additional training of MOHCC health care workers on causality assessment of adverse evets following COVID-19 vaccination, identification, management and reporting of potential cases of anaphylaxis and ensuring availability of comprehensive emergency tray at all vaccination points. The trainings will be provided as part of a comprehensive COVID-19 vaccine introduction trainings. The project will also hire a Social Specialist to oversee the management of social risks and impacts associated with the project as well as the implementation of the project GRM and Gender Based Violence Action Plan. 8.8 Capacity Building Requirements The proposed Zimbabwe ZCEREHSP activities are ambitious, and the Social Safeguards Specialist together with the Communication Specialist, will oversee some of the capacity building and awareness raising requirements of the project. Successful implementation of the project activities will require dynamic and multi-disciplinary professionals. Therefore, regular short and tailor-made training courses and seminars will be required to reinforce the capacity and skills of project implementers at all levels during the entire project period. The stakeholders have different training needs ranging from awareness, sensitization, and comprehensive training. • Awareness raising will cause the participants to acknowledge the significance or relevance of the issues, but without in-depth knowledge of the issues, • Sensitization will cause the participants to be familiar with the issues to the extent of demanding precise requirements for further technical assistance, • Comprehensive training will raise the participants to a level of being able to train others and to competently act on project environmental and social matters in their areas such as vaccine waste management, social issues related to coordination of an RMNCAHN integrated outreach model, identification, reporting and management of AEFIs, and GBV/SEA-H. Training and seminars will be undertaken and table 8-4 below provides costs estimates for the identified capacity building activities. The basis of the estimates is on some of the following: • Prevailing costs of goods and services offered in typical urban or rural areas, • An average number of 10 people for a District/local level team, • The length of training sessions will depend on the course and will vary from 3 days to about 5 days, Page | 221 • The estimated costs include training costs/fees, hire of rooms, food for participants, per diems, and transport costs. Training subsistence allowances have been estimated at US $75 per participant per day. In addition, the project Social Safeguards Specialist is overseeing the implementation of social safeguards related matters of the project including capacity building on GBV/ PSEA-H, operation of the project GRM. Table 8-4 Summary of Capacity Building Requirements and Cost Estimates MEANS OF No. TRAINING ACTIVITY TARGET GROUP COST ESTIMATES VERIFICATION 1. Refresher Training on • District In each District: 4 people/district for Environmental and Social Health Office • 10 members 25 districts x $75/day Safeguards for the 25 Teams of District for 3days districts– ESMPs of the • District EMA Health Office =$ project activities: Units Team are - Screening process. • District trained. - Use of checklists health • 5 members of - Preparation of terms of Workers each relevant reference. • Extension line ministry - Identification of Impacts workers in trained. - EIA report preparation project and processing impact areas. - Strategic action planning • Relevant Line for Environmental Ministries Management • Community - Policies and laws in Members Zimbabwe - Grievance Redress TRAINER: Mechanism and Incident Department of Management and Environment or Reporting private World Bank Environmental consultant and Social safeguards Policies. 2. Refresher training and • National, 30 PROs and 30 people x $75/day x capacity building on the Provincial and Focal Persons 3 Days Grievance Redress District level Trained Mechanism, Incident • Social Training Reports Total - $6750 Reporting, GBV/SEAH Safeguards Specialist • Communicati on Specialist 3. Refresher Medical Waste • All HCW and In each District: 450 people at $15/ Management Training for the all involved in • 10 members person for 5 days 25 districts supported under- the of District =$33,750 the ZCERPEHSP: implementati Health Office on of the Team are project trained. Page | 222 MEANS OF No. TRAINING ACTIVITY TARGET GROUP COST ESTIMATES VERIFICATION • Use of the three-bin • Incinerator • 3 provincial system (colour coded operators team bins) • All waste members • How to operate an handlers trained incinerator • Importance of Personnel Protective Equipment (PPE) • Safe management of waste from mobile or outreach vaccination sites • Safe transportation of vaccination waste • Waste weighing and record keeping • GBV/ SEA-H • Grievance Redress Mechanism • Preparation of facility-level HCF ICWMP 4. Training of Technical Teams • PIE Env, In each District: 305 people@ $15 on construction site waste Social • 6 members of person per day for 35 management appropriate for Safeguards District days minor works such as and technical renovations of the maternity Communicati Team are $22,875 waiting homes and operating on Specialists trained. theatres, installation of • Contractors • 5 members of oxygen reticulation systems • All waste each including handlers Provincial GBV/ SEA-H technical GRM team trained. 6. Training of Contractors on • Contractors In each Province: $8,000 GBV/ SEA-H and the Code of • PIE • 15 Conduct Contractors/ Signing of the Code of contractor Conduct workers 9 Monitoring and Support • MOHCC Quarterly Each quarterly visit Support and Supervision in National monitoring visits • 8 People $75/ provinces and districts • PIE Social day for 5 days per Safeguards quarter x 3 Specialist and quarters= Page | 223 MEANS OF No. TRAINING ACTIVITY TARGET GROUP COST ESTIMATES VERIFICATION Environment $9,000 al Specialist and Communicati on Specialist TOTAL BUDGET $220,675 NOTE: • District Health Office Teams are to be trained including: o Environmental Health officers, o Nurse in Charge, o Public Relations Officers o Health Promotions Officers etc • Relevant line ministries to be trained: o MoHCC, o PIE Staff, o EMA, o MoLGPW. o MoPSLSW 8.8.1 Proposed Approach in Executing the Training Activities The ZCEREHSP will adopt a strategy of running workshops and refresher courses to disseminate the safeguards instruments as well as convey respective roles to project implementers. It will also use the training of trainers and community exchange visits approach. The training activities on the ESMF can be conducted by the PIE Specialists. This will have to be done at the beginning of the project, before the project activities start, so that the participants are ready in time to apply the knowledge during implementation of the project activities. Skills in the screening process will be extremely useful for assessing the environmental and social implications of the project activities before they start. Training in Project Planning and Implementation should be done before any project activities start to prepare the participants to use their knowledge during project implementation. The training should be done once during the project life. The training can be conducted by private consultants. 8.9 Budget The budget for implementing and monitoring the recommended mitigation measures throughout the project life includes capacity building activities and is presented here. The budget will be integrated into the overall project costs to ensure that the proposed mitigation measures are implemented. Additionally, the MOHCC is already implementing some of the mitigation measures associated with identified risks and Page | 224 impacts associated with the COVID-19 vaccination programme of the Government of Zimbabwe. These mitigation measures being implemented and funded by the government of Zimbabwe and partners such as The Global Fund, Infection Control Association of Zimbabwe (ICAZ) include procurement and supply of waste management equipment to HCF, procurement and supply of PPE to health care workers involved in COVID-19 vaccination activities, cleaning materials, detergents and equipment, training of health care workers on infection prevention and control including waste management, and funding for the overall project coordination through the Environmental Health Services and the Nursing Departments. Some of the costs of the many mitigation measures are not yet known since the specific sites and health facilities are not yet identified. However, the PIE safeguards team is already providing technical support through the HSDSP AFV and ZCERP through support and supervision activities to some of the project facilities. Some of the proposed environmental activities will be funded directly by the project resources in accordance with the proposed plan laid out below. A summary of the budgetary requirements for the proposed activities is given in table 9-4 below: Table 8-5 Summary of the Budgetary Requirements No. ACTIVITY TARGET BUDGET SOURCE (US $) OF FUNDS 1.0 Environmental and Social • District Health Office $18,900 ZCEREHSP Safeguards – ESMPs of the project Teams activities. • District EMA Units • District health Workers • Extension workers in project impact areas. • Relevant Line Ministries • Community Members TRAINER: Dept. of Environment or private consultant • 3.0 Medical Waste Management • All HCW and all $33,750 ZCEREHSP Training: involved in the implementation of the project • Incinerator operators • All waste handlers 4.0 Training of Technical Teams on • PIE Env. Specialist $22,875 ZCEREHSP construction site waste • PIE Social Safeguards management appropriate for Specialist minor works such renovation for • Contractors waiting mothers’ homes and • All waste handlers theatres and upgrading, Page | 225 No. ACTIVITY TARGET BUDGET SOURCE (US $) OF FUNDS awareness on GBV/ SEA-H, GRM capacity strengthening • 6 Training of Contractors on GBV/ • Contractors $8,000 ZCEREHSP SEA-H and the Code of Conduct PIE 9 Monitoring and Support • MOHCC National $9,000 ZCERPEHSP Support and Supervision in PIE provinces and districts TOTAL $214,000 Page | 226 8.10 Conclusions The proposed ZCEREHSP requires effective coordination and capacity building of all participating agents to foster an enabling environment for its success. As a multisectoral approach it requires active participation of all stakeholders especially those at the fore front of working with the communities, i.e., the Community Health Workers (CHW), Village Health Workers, Extension Officers, etc. Clear cut roles for all stakeholders and institutions needs to be delineated to make sure that there are no conflicts resulting from the unclear job descriptions. In this vein the PIE will analyse the operating environment at the local levels and then implement the requisite remedies for the success of the project. The PIE will systematically apply all the available environmental and social management safeguards to ensure that the impacts on the natural and social environment are adequately identified, assessed, and minimised. The PIE Environmental Specialist together with the Social Safeguards Specialist, will ensure that all project activities are screened and where needed, ESMPs are developed, adopted, and applied to minimise and avoid adverse impacts in all phases of project activity execution. The proposed project has potential to significantly improve the health delivery system in all the target areas. The improvement in health that the communities will benefit, will translate to improved livelihoods as people become productive again and this will translate ultimately to an improved economy. The ZCEREHSP project will pose more positive than negative potential environmental and social impacts. The envisaged negative environmental and social impacts will be localized, minimal, short-term and can be mitigated by simple measures. The PIE (CORDAID) undertakes to ensure that: • The ICWMP will be applied to deal with any resultant increase in Health Care Waste generation from the Facilities, • Stakeholder organizations such as EMA, NGOs and other interested developmental parties will be continuously involved and kept informed of the implementation progress so that they can play their part, • The mitigation measures recommended in the ESMF, will be implemented to avoid any significant environmental and social impacts. The ESMP presented in the ESMF will be used to mitigate the impacts during and after the implementation of the ZCERP. The final benefits of this project to the nation will, by far, outweigh any potential negative effects. Further, the project will overall not have any significant environmental and social impacts if the recommended mitigations are carried out. Page | 227 9. References AfDB (2020), Zimbabwe Economic Outlook, Macroeconomic performance, and outlook. African Development Bank, accessed at:https://www.afdb.org/en/countries/southern- africa/zimbabwe/zimbabwe-economic-outlook 1. Africa CDC (2021), Waste Management for COVID-19 in Health Care Settings for Africa, Africa CDC 2. Cahen et al., (1984), the geochronology and evolution of Africa. Clarendon Press, Oxford, 512 pp 3. CIA (2007), CIA Factbook 2007, CIA publications. Washington D.C. 4. FNC (2019), Zimbabwe Vulnerability Assessment Committee (ZimVAC). Food and Nutrition Council (FNC) housed at SIRDC: 1574 Alpes Road, Hatcliffe, Harare 5. GoZ (2016) Zimbabwe National Statistics Agency, Government of Zimbabwe. Zimbabwe Demographic and Health Survey, November 2016, accessed at: https://dhsprogram.com/pubs/pdf/FR322/FR322.pdf 6. GoZ (2017), Zimbabwe Vulnerability Assessment Committee (ZimVAC). 2017. Zimbabwe Vulnerability Assessment Committee 2017 Rural Livelihoods Assessment Report. Harare: Food and Nutrition Council 7. GoZ (2018), Zimbabwe Vulnerability Assessment Committee (ZimVAC). 2018. Zimbabwe Vulnerability Assessment Committee 2017 Rural Livelihoods Assessment Report. Harare: Food and Nutrition Council 8. IFC (2007), Environmental, Health, and Safety (EHS) Guidelines, General EHS Guidelines, International Finance Corporation (IFC), World Bank Group, April 30, 2007, Washington DC USA, https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sust ainability-at-ifc/policies-standards/ehs-guidelines i 9. Isbell T. and Krönke M, (2017), Ill-prepared? Health-care service delivery in Zimbabwe, Afrobarometer Dispatch No. 240 10. Maplecroft (2018), Climate Change Vulnerability Index 2018, accessed at https://www.maplecroft.com/solutions/environment-climate-change/ 11. MOHCC (2015), Zimbabwe Service Availability and Readiness Assessment 2015 Report, Ministry of Health and Child Care, Harare, Zimbabwe 12. Mujuru M, McCrindle RI, Gurira RC, Zvinowanda CM, Maree J (2012), Air Quality Monitoring in Metropolitan Harare, Zimbabwe. J Environment Analytic Toxicol 2:131. doi:10.4172/2161- 0525.1000131 13. Ncube, G and G.M. Gomez, Remittances in rural Zimbabwe: From Consumption to Investment, in: International Journal of Development and Sustainability, Volume 4.2, p.181-195, Trading Economics, Zimbabwe unemployment rate, accessed at: https://tradingeconomics.com/zimbabwe/unemployment-rate 14. NMMZ (2001), National Museums and Monuments of Zimbabwe; archaeological impacts assessment guidelines for Planning Authorities and Developers 2001 Page | 228 15. UNDESA (2019), ""Overall total population" – World Population Prospects: The 2019 Revision. Population.un.org (custom data acquired via website). United Nations Department of Economic and Social Affairs, Population Division. Retrieved November 9, 2019 16. UNDP (2017), Zimbabwe Human Development Report, Climate Change and Human Development: Towards Building a Climate Resilient Nation, 2017, UNDP, Harare, Zimbabwe 17. UNDP (2019), Human Development Report 2019. Inequalities in Human Development in the 21st Century Briefing note for countries on the 2019 Human Development Report Zimbabwe 18. USAID (2018), “Zimbabwe Nutrition Status.� Available at:https://www.usaid.gov/sites/default/files/documents/1864/Zimbabwe-Nutrition-Profile- Mar2018-508.pdf 19. Vincent, V and Thomas, R (1960), An Agricultural Survey of Southern Rhodesia: Part I: Agro- Ecological Survey. Salisbury: Government Printer 20. WB (2007), Environmental, Health, and Safety (EHS) Guidelines, Final General EHS Guidelines, The World Bank Group, Washington, April 30, 2007, (pp. 71, 91, 94) 21. WB (2007), Environmental, Health, and Safety (EHS) Guidelines, Health Care Facilities, The World Bank Group, Washington, April 30, 2007 22. WB (2009), Good Practice Note: Asbestos: Occupational and Community Health Issues, World Bank Group, Washington, May 2009 23. WB (2018), Zimbabwe, Human Development Indices and Indicators, World Bank, 2018 Statistical Update, accessed at: http://hdr.undp.org/sites/all/themes/hdr_theme/country- notes/ZWE.pdf 24. World Bank (2017), The World Bank Environmental and Social Framework 25. WHO Air (2005), WHO Air Quality Guidelines for Particulate Matter, Ozone, Nitrogen Dioxide and Sulphur Dioxide, Global update 2005, Summary of risk assessment 26. WHO/UNICEF (2017, WHO and UNICEF. 2017. Report of the Fourth Meeting of the WHO- UNICEF Technical Expert Advisory Group on Nutrition Monitoring (TEAM). Geneva: WHO and New York: UNICEF 27. Wilson (1979) A Preliminary reappraisal of the Rhodesia Basement Complex. Spec. Pbu. Geol. Soc. S. Afr., 5, 1-23 28. ZIMSTAT (2016), Zimbabwe Demographic and Health Survey 2015: Final Report. Rockville, Maryland, USA: Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International Page | 229 10. Appendices Appendix 1 Indigenous People`s Planning Framework The ZCEREHS Project will adopt the IPPF for the ZCERP. App 1.1 Introduction This Indigenous Peoples Planning Framework (IPPF) has been prepared to ensure that the World Bank’s ESS7 on Indigenous Peoples and Sub-Saharan African Historically Underserved Traditional Local Communities is applied to ZCERP supported projects. The objectives of the policy are to avoid adverse impacts on Indigenous Peoples and to provide them with culturally appropriate benefits. The Indigenous Peoples policy recognizes the distinct circumstances that expose Indigenous Peoples to different types of risks and impacts from development projects. As social groups with identities that are often distinct from dominant groups in their national societies, Indigenous Peoples are frequently among the most marginalized and vulnerable segments of the population. As a result, their economic, social, and legal status often limit their capacity to defend their rights to lands, territories, and other productive resources, and restricts their ability to participate in and benefit from development. At the same time, the policy, together with the Involuntary Resettlement policy, recognizes that Indigenous Peoples play a vital role in sustainable development and emphasizes that the need for conservation should be combined with the need to benefit Indigenous Peoples to ensure long-term sustainable management of critical ecosystems. The IPPF describes the policy requirements and planning procedures that project activities of ZCERP will follow during their preparation and subsequent implementation. It also describes the role of ZCERP. App 1.2 ZCERP and indigenous peoples Some of the Health Facilities where ZCERP will invest serve areas or territories traditionally owned, customarily used, or occupied by Indigenous Peoples (IPs). The potential impacts of the project, both negative and positive will directly affect the IPs impacting on their intrinsic ways of life and their healthy ecosystems on which they depend for their survival. Therefore, ZCERP project activities can provide valuable long-term opportunities for sustainable development for Indigenous Peoples and other local communities if the positives of the project are implemented. However, several risks are relevant for the type of projects supported by ZCERP: • Customary and Indigenous Peoples’ rights: Rights of Indigenous Peoples are recognized in international agreements and for World Bank-supported projects by the Bank’s own policy. Such rights may also be recognized in national legislation. ZCERP project activities will need to identify and recognize these rights to ensure that activities are not adversely affecting such rights. • Loss of culture and social cohesion: Given Indigenous Peoples’ distinct cultures and identities and their frequent marginalization from the surrounding society, interventions may run the risk of imposing changes to or disruption of their culture and social organization, whether inadvertently or not. This can happen if the participation of the IPs is not appropriate: o The engagement techniques used are not cultural appropriate, causing the IPs to hold back since they may have special cultural requirements for engagement or even service delivery. o Inappropriate selection of methods for disclosure of information (including such topics as format, language, and timing). Page | 230 o Inappropriate selection of location and timing for engagement event(s) (avoiding busy work times, which may be seasonal, and days/times when special events may be occurring). o Not agreeing on the mechanisms for ensuring stakeholder attendance at engagement event(s) (if required). o Failure to identify the appropriate feedback mechanisms to be employed. While indigenous communities may welcome and seek change, they can be vulnerable when such change is imposed from external forces and when such change is rushed. • Inequitable participation: The level of participation which the IPs will be afforded may not yield the intended results because: o The local communities may not see the benefit of taking their time and resources to participate in project activities when they do not expect to receive culturally appropriate benefits. o The design of the participation may not include appropriate capacity building (when needed) or take into consideration local decision-making structures and processes with the risk of leading to alienation of local communities or even conflicts with and/or between local communities. o Participation design may not include appropriate representation of Indigenous Peoples in decision-making bodies. This can be averted by conducting specific targeting of stakeholder engagement activities relevant to Indigenous Peoples (IPs) that meet the requirements of ESS7. This may involve carrying out a Social Assessment (SA) prior to any activities that would impact on them, coming up with a stand- alone plan or framework of how to deal with the IPs and developing site-specific approaches that will ensure adequate consideration of their specific cultural needs in accordance with ESS7. Projects affecting Indigenous Peoples, whether adversely or positively, therefore, need to be prepared with care and with the participation of affected communities. The requirements include social analysis to improve the understanding of the local context and affected communities; a process of free, prior, and informed consultation with the affected Indigenous Peoples’ communities to fully identify their views and to obtain their broad community support to the project; and development of project-specific measures to avoid adverse impacts and enhance culturally appropriate benefits. App 1.3 Policy requirements The level of detail necessary to meet the requirements is proportional to the complexity of the proposed project and commensurate with the nature and scale of the proposed project’s potential effects on the Indigenous Peoples, whether adverse or positive. This needs to be determined based on a subjective assessment of project activities, circumstances of local communities, and project impacts. Minimum requirements for projects working in areas with Indigenous Peoples are identification of Indigenous Peoples and assessment of project impacts, consultations with affected communities, and development of measures to avoid adverse impacts and provide culturally appropriate benefits (in projects with no impacts this could be limited to consultations during implementation to keep local communities informed about project activities). App 1.3.1 Screening for Indigenous Peoples. Page | 231 The ZCERP PIE will know if Indigenous Peoples are present in a project activity area and can proceed to the social assessment and consultations (see next section). However, if this is not the case ZCERP project activity applicants (the Health Facilities) are required to screen for the presence of Indigenous Peoples early on in project preparation, using the screening form (Appendix 5). The characteristics of Indigenous Peoples (a distinct, vulnerable, social, and cultural group)59 mentioned in ESS7 will be used. Health Facilities in Tsholotsho, Bulilima-Mangwe, Guruve and Mbire Districts can confirm by screening if they are not sure of the presence of the IPs in their areas since the two peoples who self-identify as indigenous in Zimbabwe are found.60 App 1.3.2 Social assessment Once it has been determined that Indigenous Peoples are present in the project area, the applicant assesses the circumstances of affected indigenous communities and assesses the project’s positive and adverse impacts on them. This is to ensure that the project design takes IP needs and views into account. The level of detail of the assessment depends on project activities and their impacts on local communities. If the project is small and has no or few adverse impacts, this assessment is done as part of early project preparation by the applicant, mainly based on secondary sources and the applicants own experience working in the area. In larger and more complex projects, the assessment may be a separate exercise done by the applicant or contracted experts as appropriate and may include primary research (Note that assessments for large projects is not envisaged in this Project). In all cases the assessment will be based on consultations with the affected communities. The main purpose of the social assessment is to evaluate the project’s potential positive and adverse impacts on the affected Indigenous Peoples. It is also used to inform project preparation to ensure that project activities are culturally appropriate, will enhance benefits to target groups, and is likely to succeed in the given socioeconomic and cultural context. In this way the assessment informs the preparation of the 59 “Indigenous Peoples� are a distinct, vulnerable, social, and cultural group possessing the following characteristics in varying degrees: self-identification as members of a distinct indigenous cultural group and recognition of this identity by others. collective attachment to geographically distinct habitats or ancestral territories in the project area and to the natural resources in these habitats and territories7 customary cultural, economic, social, or political institutions that are separate from those of the dominant society and culture. an indigenous language, often different from the official language of the country or region. 60 The Indigenous Peoples of Zimbabwe are the: Tshwa (Tyua, Cuaa) San, who are found in the Tsholotsho District of Matabeleland North Province and the Bulilima-Mangwe District of Matabeleland South Province in western Zimbabwe Doma (Wadoma, Vadema) of Chapoto Ward in Guruve District and Mbire District of Mashonaland Central Province and Karoi District of Mashonaland West Province in the Zambezi Valley of northern Zimbabwe. Page | 232 design of the project as well as any measures and instruments needed to address issues and concerns related to Indigenous Peoples affected by the project. The findings of the social assessment are described in a separate report and reflected in the activity proposal application. For small scale projects with no direct impacts on indigenous communities, the report is short and includes a brief overview of the indigenous communities affected by the project activities as they relate to the local communities, how project implementation will address the circumstances of Indigenous Peoples, and how they will participate and be consulted during implementation. For more complex projects a more elaborate report is required and should include the following elements, as needed: • A description, on a scale appropriate to the project, of the legal and institutional framework applicable to Indigenous Peoples, • Baseline information on the demographic, social, cultural, and political characteristics of the affected indigenous communities, and the land and territories which they traditionally owned, or customarily used or occupied and the natural resources in which they depend, • Description of key project stakeholders and the elaboration of a culturally appropriate process for consultation and participation during implementation, • Assessment, based on free, prior, and informed consultation with the affected Indigenous Peoples’ communities, of the potential adverse and positive effects of the project. Critical to the determination of potential adverse impacts is an analysis of the relative vulnerability of, and risks to, the affected indigenous communities given their distinct circumstances, close ties to land, and dependence on natural resources, as well as their lack of opportunities relative to other social groups in the communities, regions, or national societies they live in, • Identification and evaluation, based on free, prior, and informed consultation with the affected Indigenous Peoples’ communities, of measures to ensure that the Indigenous Peoples receive culturally appropriate benefits under the project and measures necessary to avoid adverse effects, or if such measures are not feasible, identification of measures to minimize, mitigate, or compensate for such effects. App 1.3.3 Free, prior, and informed consultation The Applicant undertakes a process of free, prior, and informed consultation with the affected Indigenous Peoples’ communities during project preparation to inform them about the project, to fully identify their views, to obtain their broad community support to the project, and to develop project design and safeguard instruments. In most cases, this process is best done as part of the social assessment although consultations are likely to continue after its completion. The extent of consultations depends on the project activities, their impacts on local communities and the circumstances of affected Indigenous Peoples. At a minimum (for projects with no impacts or direct interventions with the indigenous communities), local communities (villages or dwellings neighbouring the Health Facility, Staff of the Health Facility, and other potential Clients of the Health Facility) are informed about the project, asked for their views on the project, and assured that they will not be affected during project implementation. For projects affecting indigenous communities, whether positively or adversely, a more elaborate consultation process is required. This may include, as appropriate: • Inform affected indigenous communities about project objectives and activities, • Discuss and assess possible adverse impacts and ways to avoid or mitigate them, • Discuss and assess potential project benefits and how these can be enhanced, Page | 233 • Identify and discuss (potential) conflicts with other communities and how these might be avoided, • Elicit and incorporate indigenous knowledge into project design, • Facilitate and ascertain the affected communities’ broad support to the project, • Develop a strategy for indigenous participation and consultation during project implementation, including monitoring and evaluation. All project information provided to indigenous peoples should be in a form appropriate to local needs. Local languages should usually be used, and efforts should be made to include all community members, including women and members of different generations and social groups (e.g., clans and socioeconomic background). The applicant is responsible for the consultation process. The consultation process for the IP Communities will generally take the following form: • Identify appropriate customary approaches to deal with the communities in question, • Using the identified approaches, inform the affected indigenous communities about project objectives and activities, • Identify the elected and natural leaders in these communities who will be used as representatives as the project progresses, • Discuss and assess possible adverse impacts and ways to avoid or mitigate them, • Discuss and assess potential project benefits and how these can be enhanced, • Discuss and assess the Health Facilities at their disposal and the most appropriate ways they can derive benefits from them, • Identify and discuss (potential) conflicts with other communities in the use of these Facilities and how these might be avoided, • Elicit and incorporate indigenous knowledge into project design, • Facilitate and ascertain the affected communities’ broad support to the project, • Develop a strategy for indigenous participation and consultation during project implementation, including monitoring and evaluation. However, if the communities in question are organized in community associations or umbrella organizations, these should usually be consulted. In some cases, it may be appropriate or even necessary to include or use in the process independent entities that have the affected communities’ trust. The experience of (other) locally active NGOs and Indigenous Peoples experts may also be useful. When seeking affected indigenous communities’ support to project activities, two aspects should be considered: Who and what is the “community,� and how is “broad support� obtained. Communities are complex social institutions and may be made up of several fractions; it may be difficult finding persons who are representatives of the community. Interest in the project may vary among different groups (and individuals) in the community, and they may be affected differently. It is important to keep this in mind during the consultation process, and in some cases, it may be more appropriate to consider the needs and priorities of sub-communities rather than those of a whole village. When seeking “broad community support� for the project, it should be ensured that all relevant social groups of the community have been adequately consulted. When this is the case and the “broad� majority is overall positive about the project, it would be appropriate to conclude that broad community support has been achieved. Consensus building approaches are often the norm, but “broad community support" does not mean that everyone must agree to a given project. The agreements or special design features providing the basis for broad community support should be described in the Indigenous Peoples Plan; any disagreements should also be documented. Page | 234 App 1.3.4 Indigenous Peoples Plan Based on the consultation and social assessment processes, project design is refined, and measures and instruments are prepared to address issues pertaining to Indigenous Peoples. The documents are prepared with the participation of affected indigenous communities during the consultation process. The instrument to address the concerns and needs of Indigenous Peoples is usually an Indigenous Peoples Plan (IPP). ZCERP will facilitate the development of the activity specific IPPs for onward submission to the Bank for review and approval. In cases where Indigenous Peoples are the sole or most direct project beneficiaries, the elements of an IPP should be included in the overall project design, and a separate IPP is not required. In this case the project application becomes the IP and must respond to the requirements outlined in the above. It should be noted that very few ZCERP project activities are likely to need such an elaborate plan. It may be appropriate to include a process of further social analysis and consultations during project implementation to determine specific activities (this is particularly so given the limited funds for preparing ZCERP projects). At minimum the IPP should include a description of the Indigenous Peoples affected by the project; summary of the proposed project; detailed description of the participation and consultation process during implementation; description of how the project will ensure culturally appropriate benefits and avoid or mitigate adverse impacts; a budget; mechanism for complaints and conflict resolution; and the monitoring and evaluation system that includes monitoring of particular issues and measures concerning indigenous communities. The following elements and principles may be included in the IPP, as appropriate: • Specific measures for implementation, along with clear timetables of action, and financing sources. These should be incorporated into the general project design as appropriate. Emphasis should be on enhancing participation and culturally appropriate benefits. Adverse impacts should only be contemplated, when necessary, • Formal agreements reached during the free, prior, and informed consultation during project preparation, • Clear output and outcome indicators developed with affected Indigenous Peoples, • Project design should draw upon the strengths of Indigenous Peoples Organizations and the IP communities and consider their languages, cultural and livelihood practices, social organization, and religious beliefs. It should avoid introducing changes that are considered undesirable or unacceptable to the Indigenous Peoples themselves, • Efforts should be made wherever possible and appropriate to make use of, and incorporate, Indigenous knowledge and local resource management arrangements into project design, • Special measures for the recognition and support of customary rights to land and natural resources may be necessary, • Special measures concerning women and marginalized generational groups may be necessary to ensure inclusive development activities. If the grantee does not possess the necessary technical capacities, or if their relationship with Indigenous Peoples is weak, the involvement of experienced local community organizations and NGOs may be appropriate; they should be acceptable to all parties involved, • Capacity building of other implementing agencies should be considered, • Capacity building activities for the indigenous communities to enhance their participation in project activities may be useful or necessary; this may also include general literacy courses, • Grievance mechanism considering local dispute resolution practices, Page | 235 • Participatory monitoring and evaluation exercises adapted to the local context, indicators, and capacity. App 1.4 Disclosure Before finalising an IPP a draft should be disclosed together with the social assessment report (or its key findings) in a culturally appropriate manner to the Indigenous Peoples affected by the project. Language is critical and the IPP should be disseminated in the local language or in other forms easily understandable to affected communities – oral communication methods are often needed to communicate the proposed plans to affected communities. The ZCERP will then disclose the IPP with the Bank. After the Bank has reviewed and approved the IPP as part of the overall proposed project for funding, the sub-project will share the final IPP again with the affected communities. The final IPP will also be disclosed at the ZCERP website. App 1.5 Roles and responsibilities Project activity applicants are responsible for following the requirements of this Framework. They will ensure that Indigenous Peoples are consulted and benefit in culturally appropriate ways. They will avoid adverse impacts on indigenous communities, or where this is not possible develop with the participation of affected communities, measures to mitigate and compensate for such impacts. Finally, they are responsible for reporting to both affected indigenous communities and ZCERP on project progress and any unexpected and unintended events affecting Indigenous Peoples. ZCERP) is responsible for the implementation of this Framework and will ensure that the participation of Indigenous Peoples in project activities in culturally appropriate ways is encouraged. ZCERP responsibilities include: • Inform applicants and other stakeholders, including local communities, of this Framework and policy requirements, • Assist applicants, and subsequently grantees, in the implementation of the Framework and policy requirements, • Screen for projects affecting Indigenous Peoples. • Review and approve project proposals, ensuring that they adequately apply the World Bank’s Indigenous Peoples Policy, • Assess the adequacy of the assessment of project impacts and the proposed measures to address issues pertaining to affected indigenous communities. When doing so project activities, impacts and social risks, circumstances of the affected indigenous communities, and the capacity of the applicant to implement the measures should be assessed. If the risks or complexity of issues, • Assess the adequacy of the consultation process and the affected indigenous communities’ broad support to the project—and not provide funding until such broad support has been ascertained and Monitor project implementation, and include constraints and lessons learned concerning Indigenous Peoples and the application of this IPPF in its progress and monitoring reports; it should be assured that affected indigenous communities are included in monitoring and evaluation exercises. Page | 236 App 1.6 Grievance mechanism Indigenous Peoples and other local communities and stakeholders may always raise a grievance to project activity applicants and ZCERP about any issues covered in this Framework and the application of the Framework. Affected communities should be informed about this possibility and contact information of the respective organizations at relevant levels should be made available. These arrangements should be described in the project-specific frameworks and action plans along with the more project-specific grievance and conflict resolution mechanism. As a first stage, grievances should be made to the project activity applicants, who should respond to grievances in writing within 15 working days of receipt. Claims should be filed, included in project monitoring, and a copy of the grievance should be provided to the ZCERP PIE. If the claimant is not satisfied with the response, the grievance may be escalated to MoHCC Head office. Page | 237 Appendix 2 Labour Management Procedures LABOUR MANAGEMENT PROCEDURES 1. INTRODUCTION ZCEREHSP project is being prepared under the World Bank Environmental and Social Framework (ESF). The project is adopting the Labour Management Procedures laid out under the ZCERP. Under the Environmental and Social Standard on Labour and Working Conditions (ESS2) on Labour and working Conditions the project is required is develop Labour Management Procedures (LMP) to promote sound worker management relationships and enhance the development benefits of a project by treating workers fairly and providing safe and healthy working environment. The purpose of this LMP is to facilitate the planning and implementation of the project by identifying the main labour requirements and associated risks and determining the resources necessary to address the project related labour issues. It sets out guidance on general labour issues on different forms of labour and issues related to COVID-19 considerations. 2. OVERVIEW OF LABOR USE IN THE PROJECT The LMP for ZCERP will apply to Project workers including fulltime, part-time, or temporary. It is not expected that the Project will rely on seasonal or migrant workers. It will apply to the following workers engaged in the Project: (a) Direct Workers. People employed directly by Cordaid to work specifically in relation to the Project in the Project Implementation Entity (PIE) at the Head Office in Harare, and in the Provincial Offices as Provincial Results Based Financing Officers (PRBFOs) in Manicaland, Mashonaland East, Mashonaland Central, Mashonaland West, Matabeleland North, Matabeleland South, Midlands, and Masvingo Provinces. Cordaid has about 25 employees who will be working on the Project providing support but with different levels of effort ranging from 20% to 50%. However, under the ZCERP, a fulltime Social Specialist will be engaged with 100% level of effort. Consultants will also be engaged to provide different services. Not more than 5 consultants will be engaged throughout the life of the Project. In addition, the Government civil servants will support the Project implementation, generally referred to as Health Care Workers (HCWs). These are civil servants engaged by Government of Zimbabwe through the Ministry of Health and Child Care (MOHCC) to provide health care services and these include nurses, doctors, pharmacists, laboratory workers, general cleaners, radiographers, and nurse aides. HCWs will be engaged in several activities including triaging of patients, treating and reporting cases and suspected, vaccination of the public, reinforcing Infection Prevention and Control measures, providing correct public health information, health care waste management (segregation and point of generation, transportation, treatment, and disposal). During mobile vaccination campaigns, mobile teams will be set up and will require some of the workers to be engaged. Mobile teams may camp out in the field or in communities where vaccinations will be conducted. Government civil servants are subject to the public sector working agreement or arrangement. Recruitment and engagement of health workers will be as per government procedures. (b) Contracted Workers. People employed by contractors for the Project who are engaged to install solar panels. The contractors will be engaged for short durations with on average with a maximum of 6 workers on each site. Contracted Workers will be engaged directly by Cordaid’s competitively chosen contractors to set up solar panel equipment; install refrigeration units in vaccine delivery trucks; transport and deliver Page | 238 solar direct refrigerators; treat, transport and/or provide other waste management services, providers of transport or storage of vaccines. Migrant workers are not anticipated in this project. (c) Community Workers/ Volunteers. MOHCC engages many Community Health Workers61 (CHWs) within the health sector. CHWs are mainly engaged in health promotion, preventive, and treatment support, and in a more limited capacity regarding actual treatment. The CHWs are people employed or engaged in providing community-based project interventions on voluntary basis. These will include Village Health Workers (VHWs). These will include community members/ volunteers who will be working with Health Care Workers to mobilise the communities and raise awareness on COVID-19, vaccination, and vaccines, planning for vaccine introductions and identification of target groups, tracking and follow-up and infection prevention and control and vaccination sites. These CHWs are trained before being deployed to conduct their activities. Current Community Health Workers have been trained by MOHCC on COVID-19 infection prevention and control measures so that they will in turn capacitate their communities. Community Health Workers were provided with Personal Protective Equipment (PPE), including masks and sanitisers to reduce the risk of COVID-19 transmission. In addition to VHWs and CHWs, there are Health Centre Committees (HCCs) and Community Based Organisations (CBOs) who provide a link between the health services and the communities and further the CBOs remain the voice of the people through client satisfaction surveys. All CHWs, CBOs and HCCs are subject to the terms and conditions of the MOHCC engagements agreement or arrangement. (d) Primary Supply Workers:62 Primary suppliers will be for the supply of PPE, SDD refrigerators, solar panels. However, these suppliers are not yet known at this stage and PIE will require such suppliers to identify potential for labour risks such forced labour, underage employment. Where necessary the PIE will require specific monitoring and reporting mechanisms related to labours issues. 3. ASSESSMENT OF KEY POTENTIAL LABOR RISKS As part of the labour risk and impacts identification, the following project activities outline some possible exposure pathways: • VHWs/CHWs are involved in health promotion and preventive activities to increase uptake of vaccinations through community meetings, interpersonal communication, door to door campaigns. They will also be involved in infection prevention and control at vaccination sites. • Contracted workers will be setting up energy generation equipment and installing refrigeration units in vaccine delivery trucks. 61 Community Health Workers or Village Health Workers are members of the communities where they work, selected by the communities, answerable to the communities for their activities, supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers. The terms CHW and VHW are used interchangeably depending on the context (Urban or Rural) 62 There are Primary Supply Workers associated with items procured under the Project. These include suppliers of PPE, medical supplies, and equipment. However, such suppliers will only be known subject to competitive bidding for contracts. Page | 239 • HCWs will be involved in triaging, treating, collecting, transporting, and analysing COVID-19 samples, public vaccinations, contact tracing of COVID-19 cases, reporting cases, waste segregation, • Cleaners will be involved in waste segregation, in facility transportation, treatment and disposal of waste. • Counsellors at psychosocial support centres will offer counselling to clients by virtual and face-to- face interactions. • HCF workers who provide environmental management services, including medical waste management, at the HCFs involved in the Project. • Drivers will be involved in transportation of health care waste to regional incinerators for treatment and disposal. Drivers will also be involved in the transportation of vaccination staff, vaccines and medical supplies related to COVID-19 response activities. • Direct workers at Cordaid will provide technical assistance to the MOHCC workers at different levels and will involve trainings on guidelines and protocols on how to protect themselves and the communities from the spread of COVID-19. • Workers to the sites/facilities that provide medical waste disposal of wastes generated by the Project. The table below highlights and analyses the potential labour related risks and in view of the anticipated labour utilisation. Table 3-1 Risk Analysis (magnitude, extent, timing, likelihood, and significance) Poor working conditions HCWs in Zimbabwe have, over an extended period, engaged in (working environment, protest poor working environment and underpayment. HCWs are underpayment, rights) paid in accordance with national law (app. $50/month for nurses and $100-150 for doctors), but, due to inflation, the salary’s value is rapidly eroding purchase power. This leads to significant vacancies in the health system that is difficult to fill. This challenge is likely to persist throughout the Project’s implementation. Given the lack of employment opportunities, there is a risk that contracted workers could be engaged without adhering to required provisions, including low wages/rates and delays of payment, working conditions (particularly overtime payments and adequate rest breaks). Where any class of worker raises questions, there is a risk that employers may retaliate against them for demanding legitimate working conditions, or raising concerns regarding unsafe or unhealthy work situations, or any grievances; such situations could lead to labour unrest and work stoppage. COVID-19 infection Zimbabwe has suffered from a lack of PPE, an issuing pre-dating the COVID-19 pandemic with health care worker infection rates at 11% and accounting for about 3% of health care worker infections in Africa. Zimbabwe has suffered from a lack of PPE, an issue pre-dating the COVID-19 pandemic. MOHCC has set up a Health Worker Page | 240 Infection (HWI) surveillance system in all the country’s 10 provinces. All provincial situation reports to include HWI indicators. HCWs will be more at risk of infection without the provision of PPE and the use of disinfectants that will be provided by the Project. The risks include pathogen exposure, infection and associated illness or death. Fortunately, the WB Procurement Team has worked with HSDSP to ensure timely provision of PPE supplies and will also be able to assist ZCERP with the same. Without adequate testing, tracing and vaccinations, the risk of co-infection is significant. All ZCERP workers are at risk of exposure to COVID-19 since the pandemic is still active. Given the nature of energy and other installation activities (i.e., minimum to no contact with patients), those contracted workers are not expected to be at significant risk of co-infection. Such work will only require a few workers on each work site, provided that appropriate PPE is used to prevent infection, the risk is considered low as tasks can be phased and distanced. Contracted workers that transport infectious medical waste are at a higher risk of exposure to COVID-19. Health care workers that will work directly with the public to facilitate or provide vaccinations will have a lower yet still possible risk of COVID-19 infection since they will be in contact with the public which will have both infected and uninfected members. All workers will be supplied PPE to reduce the risk of exposure. Occupational health and safety The project will support the setting up of energy generation (OHS) equipment, installation of solar direct drive refrigerators and the installation of refrigeration units in trucks for vaccine transportation. Potential risks to construction workers include slip and falls from manual handling of heavy objects, injuries from working on heights, burns from hot works (welding), electrocution, injury from moving machinery and dust from construction vehicles, exposure to refrigerants and working in small or confined spaces. However, these installations are small-scale and so the magnitude and impact of the risks are minimal overall. There are also risks of COVID-19 exposure for all workers involved in project activities because of the pandemic. HCWs as well as VHW/CHW have increased risk of general OHS given the added burden due to the COVID-19 pandemic, which includes long working hours, psychological distress, fatigue/ burnout, and stigma associated with COVID-19. The Project also involves the transport of vaccines and medical waste which presents potential risks to drivers and the community HCW and community exposure Components 1 and 2 entails generation of health care waste that to infectious or hazardous include infectious sharps, syringes, swabs, used PPE, obsolete health care waste refrigeration equipment thereby exposing community to the risk of infection and hazardous substances exposure. Where procedures are Page | 241 not adequately followed, this can pose a health threat to HCWs and community members, including those who provide medical waste transport and disposal. Sexual harassment, Exploitation There are concerns about the potential for GBV, increased risk of and Abuse abuse and exploitation for vulnerable women workers, increased risk of sexual exploitation and violence for persons in health facilities and during vaccinations. Other abuses maybe experienced by health care workers, supervisors, trainers, and community members who may be subjected to surveillance and follow up. Discrimination and exclusion of If unmitigated vulnerable group pf people maybe be subject to risk of vulnerable groups exclusion from employment opportunities under the project. such groups include vulnerable and marginalized groups, as well as women and Persons Living with Disabilities (PLWD). Sexual harassment and other forms abuse have the potential to compromise safety and wellbeing of the vulnerable groups. 4. BRIEF OVERVIEW OF LABOUR LEGISLATION: TERMS AND CONDITIONS This section reviews the available legal provisions within the laws of Zimbabwe that will complement ESS2 (Labour and Working Conditions) and ESS4 (Community Health and Safety). The chapter also identifies requirements of ESS2 that are not covered by legislation. This LMP will outline how the project will address any relevant gaps. Zimbabwe is a member of the International Labour Organization (ILO) and signatory to the core ILO Labour Conventions which include fundamental principles and rights at the workplace, freedom of association, right to collective bargaining, discrimination and equal remuneration, child labour and forced labour. The Constitution of Zimbabwe 2013, sections 65(1) enshrine labour rights to fair and safe labour practices and standards, and the right to a fair and reasonable wage. Membership to ILO and the provisions of the constitution create a solid platform for progressive and sustainable labour and working conditions to be mainstreamed in the various workplaces in Zimbabwe in general and ZCERP. The fundamental legislation on labour and working conditions in Zimbabwe is the Labour Act (CAP 28:01). The Act declares and defines the fundamental rights of employees and gives effect to the International Obligations of the Republic of Zimbabwe as a member state of the ILO and as a member of or party to any other international organisation or agreement governing conditions of employment, which Zimbabwe would have ratified. The Act provides for: • definition of unfair labour practices • regulates conditions of employment and other related matters like wages and salaries, provide for the appointment and functions of workers committees. • provides for the formation, registration and functions of trade unions, employers organizations and employment councils • regulates the negotiation, scope, and enforcement of collective bargaining agreements and • provides for the establishment and functions of the Labour Court and prevention of trade disputes. Page | 242 The project will involve engaging project staff. It will also involve working with MoHCC staff and staff of other participating Ministries. The Labour Act will be relevant to protect the welfare of all these workers. It governs how workers will be treated, including their employment conditions. However, it is worth noting that Health Care Workers are considered essential services and cannot freely exercise this right to engage in collective job actions. The Law restricts the exercise of this right to maintain essential services. Essential services are defined in Section 102(a) of the Labour Act as “any services the interruption of which endangers immediately the life, personal safety or health of the whole or any part of the public� and health care services are part of essential services. The Act is supported by Statutory Instruments targeting specific labour related issues including: a. Labour Relations (Employment of Children and Young Persons) Regulations, 1997. The regulations define minimum age for employment as sixteen. Exception is given in cases where such work is an integral part of a course of education or training for which the school or training institution is primarily responsible; and does not prejudice such child’s education, health, safety, social or mental development. A child may be employed in an activity in which it receives adequate specific instructions or vocational training in that activity. b. Labour Relations (Workers Committees) (General) Regulations, 1985 . The regulations safeguard the employee’s right to participate in the formation of a workers committee and to undertake tasks on behalf of a workers committee. A workers committee shall be formed when a group of employees or any one employer appoint or elect some of the employees to represent them in the works council composed of an equal number of employer representatives and employee representatives. The works council is a platform where employee engages in negotiations on all work-related matters with the employer including wages and other employee benefits. c. Labour Relations (Employment Codes of Conduct) Regulations, 1990. The regulation provides for the registration of codes and conduct agreed between an employer and the representatives of the employees as rules of conduct to be observed at the workplace, undertaking or industry concerned. The codes will include and not limited to; i. Precise definition of those acts or omissions that shall constitute misconduct, and the categorization of those acts or omissions according to their seriousness. The acts of misconduct include: • any act of conduct or omission inconsistent with the fulfilment of the express or implied conditions of his or her contract • wilful disobedience to a lawful order • wilful and unlawful destruction of the employer’s property • theft or fraud • absence from work for a period of five or more working days without leave or reasonable cause in a year • gross incompetency or inefficiency in the performance of his or her work; or • habitual and substantial neglect of his or her duties • lack of a skill which the employee expressly or implied held himself or herself to possess. ii. Procedures for settling any grievances that may arise between or against employees, managerial employees, or the employer; and Page | 243 iii. Procedures to be followed in the event of any breaches of the code, including a requirement that any breach be investigated before any proceedings are commenced against an employee. iv. Penalties for any breaches of the rules or procedures of the code, which may include oral or written warnings, fines, reductions in pay for a specified period, demotion, suspension with or without pay or on reduced pay for a specified period, and dismissal from employment. v. Person, committee or authority which will be responsible for implementing and enforcing the rules, procedures, and penalties of the code. vi. Notification in writing to any person who is alleged to have breached any of the rules or procedures of the code of the nature of the misconduct or breach alleged against him and the date when proceedings are to be commenced against him. vii. Right of an accused employee to have his case heard by the appropriate person, committee or authority referred to in paragraph (e) before any decision in his case is made. viii. Written record or summary to be made of any proceedings and decisions taken in terms of the code, which record, or summary shall be made at the time such proceedings and decisions are taken and shall be kept for a period of not less than 12 months; and ix. Procedure for an appeal within a specified period to such person, committee or authority as may be specified. d. Labour (Settlement of Disputes) Regulations, 2003. The regulations provide for dispute resolution with public service through the involvement of the Labour Officer within the Ministry of Public Service, Labour, and Social Welfare. The provision has means to engage the disputing parties until the worst-case scenario manifests and arbitration is sought before engaging the formal court system. As part of the dispute resolution, a local company disciplinary meeting is held, if no resolution is found the matter can be escalated to the labour officer in respective National Employment Council, if no resolution the matter is referred to the Labour Court, the High Court, the Supreme Court, and the Constitutional Court if no resolution is found. The Constitutional Court’s decision on the matter is final. e. Labour Relations (HIV and AIDS) Regulations, 1998. The regulations protect the rights of HIV infected employees and aspiring employees by guarding against any form of victimization or segregation, including, and not limited to HIV testing before employment or compulsory disclosure of one’s status at the workplace. The statutory instrument also calls for employers to invest in HIV and AIDS awareness within the workplace. This may include, health talks, free testing and counselling, free distribution protection materials and employee access to sick leave where required. f. Labour Relations (Specification of Minimum Wages) Notice, 1996. The statutory instrument provides for the setting of minimum wages applicable to public service by the Minister of Public Service, Labour, and Social Welfare. The various employment council also set their respective minimum wages based on negotiations during collective bargaining as provided for in the Labour Act. These requirements will be enforced through contractor management of all Cordaid contracts. The PIE will provide full awareness of the applicable codes and conduct at recruitment through induction and implementation during employment through labour audits. The project will refer to National Employment Councils for the health sector and construction sector since the project activities cut across these sectors for its contracted employees. g. Health Service Regulations, Statutory Instrument (SI) 117 of 2006. The SI provides for the conditions of service for members employed in the health service that is it guides conditions of service for Ministry of Page | 244 Health and Child Care employees. The SI sets out the grievance procedures, leave (vacation, annual, sick, special, maternity) conditions, disciplinary procedures as well as recruitment, advancement, and promotion of the members of the health service. The MOHCC embarked on flexible working arrangements where alternate arrangements or schedules are granted to workers to decongest the workplace for the prevention of COVID-19 spread. h. Civil Protection Act Chapter (10:06) This Act provides for the declaration of state of disaster if it appears that there is a disaster which needs extra-ordinary measures to be implemented and protect the persons affected or likely to be affected by the disaster in any area in Zimbabwe. After such a declaration is made, it is required to be published in a statutory instrument. The GoZ declared the pandemic a national disaster in terms of Section 27 of the Civil Protection Act. This was done by the gazetting of the Civil Protection (Declaration of State of Disaster: Rural and Urban Areas of Zimbabwe) (COVID-19) Notice. The declaration of a state of disaster allows the President to take extra-ordinary measures to assist the affected population or to contain the effects of the disaster. In the case of COVID 19, the extra-ordinary measure put in place through the relevant ministries include a national lockdown, with the severe curtailment of various freedoms that include freedom of movement, expression, conscience, assembly, and association. It also resulted in the closing down of most major commercial and social enterprises, except for the food industry, health, and other deemed essential public services. The Civil Protection Act provides that the state of disaster may be extended, curtailed, or terminated by the President through a Statutory Instrument. Despite the national disaster declaration, no labour provisions (such as overtime compensation, annual or sick leave, or severance) have been suspended or curtailed for project workers, e.g., health care workers or other essential workers. To enforce the lockdown laws, the police and army were deployed to patrol the streets. However, the currently the lockdown regulations have been relaxed, hence the use of the Military or Security Personnel is not currently envisioned for any activities related to the Project. If, however, during Project implementation, the Recipient decides to use its military or security forces, the GoZ shall: (a) prior to any involvement of its military and/or security forces in the carrying out of Project activities, send a written notice to the Bank communicating such decision, including the name of the military or security unit; and (b) ensure that all activities carried out by military or security personnel under the Project are under the control of MoHCC, working closely with Cordaid as the Project implementing entity and undertaken exclusively for the purposes related to the Project and in compliance with the ESSs and the provisions set out under this provision. Should the military be used in the project, the Ministry of Health through the COVID-19 National Coordinator’s office, engages the Ministry of Home Affairs and Cultural Heritage and the Ministry of Defence and War Veterans Affairs in setting out the arrangements for the engagement of the military or security personnel under the Project. 5. BRIEF OVERVIEW OF INTERNATIONAL GUIDANCE AND LABOR LEGISLATION: OCCUPATIONAL HEALTH AND SAFETY 5.1 International Guidance i. International Labour Organisation-COVID-19 action checklist for the construction industry, December 2020 This action checklist provides practical measures designed to help employers, workers and the self- employed in the construction industry work safely on site and thus prevent and mitigate the spread of Page | 245 COVID-19 at work. This tool provides information applicable to any construction site and should be further informed by national legislation and guidelines. ii. A safe and healthy return to work during the COVID-19 pandemic, ILO Policy Brief, May 2020 Safe and healthy working conditions are fundamental for decent work and are the foundation upon which policy guidance for the return to work must be based. This guidance note aims to: (1) assist governments and employers’ and workers’ organisations in developing national policy guidance for a phased and safe return to work, and (2) provide guidelines for workplace level risk assessments and implementation of preventive and protective measures according to a hierarchy of controls.63 iii. ILO Policy Brief Hand hygiene at the workplace: an essential occupational safety and health prevention and control measure against COVID-19 The Safety and Health in Construction Convention, 1988 (No. 167), provides that men and women workers should be provided with separate sanitary and washing facilities. The ILO code of practice on safety and health in construction (1992) indicates that the scale of provision of sanitary facilities should comply with the requirements of the competent authority. In addition, adequate washing facilities should be provided as near as practicable to toilet facilities. Washing facilities should not be used for any other purpose and should be kept clean and maintained. There should be enough appropriate washing facilities for use if workers are exposed to skin contamination. iv. ESF/Safeguards interim note: Covid-19 considerations in construction/civil works projects This note emphasizes the importance of careful scenario planning, clear procedures and protocols, management systems, effective communication and coordination, and the need for high levels of responsiveness in a changing environment. It recommends assessing the current situation of the project, putting in place mitigation measures to avoid or minimize the chance of infection, and planning what to do if either project workers become infected, or the work force includes workers from proximate communities affected by COVID-19. v. WB Environmental and Social Standard 2 (ESS2)- Labour and Working Conditions ESS2 recognizes the importance of employment creation and income generation in the pursuit of poverty reduction and inclusive economic growth. The project can promote sound worker-management relationships and enhance the development benefits of a project by treating workers in the project fairly and providing safe and healthy working conditions. vi. WB Environmental and Social Standard 4 (ESS2)- Community Health and Safety ESS4 recognizes that project activities, equipment, and infrastructure can increase community exposure to risks and impacts. In addition, communities that are already subjected to impacts from climate change may also experience an acceleration or intensification of impacts due to project activities. vii. WB EHS General Guidelines These are technical reference documents with industry specific statements of Good International Industry Practice (GIIP). The EHSGs contain performance levels and measures that are generally considered achievable in new facilities by existing technology at reasonable cost. For complete reference consult the 63 For practical guidance at the workplace level, see: ILO, Safe Return to Work: Ten Action Points, see also: Safe Return to Work: Guide for Employers on COVID-19 Prevention, in addition to: Prevention and Mitigation of COVID-19 at Work: Action Checklist. Page | 246 World Bank Group Environmental, Health, and Safety Guidelines, http://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/ifc+sustainability /our+approach/risk+management/ehsguidelines. viii. WB Guideline for Health Care Facilities The EHS Guidelines for Health Care Facilities include information relevant to the management of EHS issues associated with health care facilities (HCF) which includes a diverse range of facilities and activities involving general hospitals and small inpatient primary care hospitals, as well as outpatient, assisted living, and hospice facilities. Ancillary facilities may include medical laboratories and research facilities, mortuary centres, and blood banks and collection services. ix. WB Life Safety Guidance This guidance requires that all buildings which are accessible to the public must be designed, constructed and operated in full compliance of the local building codes and in accordance with an internationally accepted life and fire safety (L &FS) standard. 5.2 National Legislation i. National Social Security Authority Statutory Instrument 68 (Accident Prevention and Worker’s Compensation Scheme) 1990 The Statutory Instrument provides for the protection of health and safety of workers, prevention of accidents and compensation for employees or their dependents in the event of an injury, contracting diseases or death out of and in the course of employment. The third schedule of Section 15 defines the collective duties of employers, workers, and other persons in accident prevention at the workplace. In principle, the employer is required to provide a healthy and safe environment and to formulate and implement a health and safety policy at the workplace. Employees are required to identify and report health and safety hazards while executing their duties without posing risks to their health and safety. Part I, section 2 provides for the establishment of a worker’s compensation scheme in respect of injury, occupational illness, or death and for the promotion of occupational health and safety to which all employers and employees are required to contribute. Cordaid will ensure adherence to comprehensive occupational safety and health provisions for the project related activities to prevent accidents at the workplace. All contractors will be required to have Safety and Health personnel that is commensurate with the scope of their contracted work. The PIE together with MOHCC and Ministry of Public Service, Labour and Social Welfare (MPSLSW) will carry out inspections and audits to ensure the required occupational safety and health standards are maintained at all project activities through the contractor checklist. 5.1. Gap Analysis between National Legislation and ESF (ESS2 and ESS4) This section compares National Legislation with the objectives of ESS2 and ESS4 and provides a means for the bridging of the gap to ensure effective implementation and monitoring of the LMP. Table below presents the gap assessment. Table 5-1 Gap Analysis ESF Objective National Requirement Recommendation ESS2 Labour and Working Conditions Page | 247 ESF Objective National Requirement Recommendation To provide Labour Act (CAP 28:01) Section 12 compels Contract of employment shall be employee with the employer to inform the employee on signed between the contractor and information and the details of employment, duration, the employee upon engagement and documentation that particulars, and termination of the contractor will avail the is clear and employment contract in writing. The details agreements for inspection upon understandable include name and address of the employer, request by the PIE, MOHCC and regarding their the period of time, if limited, for which the Ministry of Public Service, Labour, and terms and employee is engaged, the terms of Social Welfare (MPSLSW). conditions of probation, the terms of any employment employment. code, particulars of the employee’s remuneration, its manner of calculation and the intervals of payment, benefits receivable in the event of sickness or pregnancy, hours of work, particulars of any bonus or incentive production scheme, particulars of vacation leave and vacation pay and particulars of any other benefits provided under the contract of employment. To promote the fair Labour Act (CAP 28:01), section 5 protects The PIE will make all Contractors treatment, employees or prospective employees aware of the Labour Act requirement non-discriminatory against discrimination on grounds of race, for compliance in their recruitment and equal tribe, place of origin, political opinion, processes. opportunity of colour, creed, gender, pregnancy, HIV/AIDS Contractors shall show the PIE, project workers. status or disabled. The prohibition relates MOHCC and MPSLSW the evidence of to advertisement of employment, induction of employees on the legal recruitment for employment, the creation, requirements for non-discrimination. classification or abolition of jobs or posts, determination or allocation of wages, salaries, pensions, accommodation, leave or other such benefits, choice of persons for jobs or posts, training, advancement, apprenticeships, transfer, promotion or retrenchment, provision of facilities related to or connected with employment, or any other matter related to employment. To support the Labour Act (CAP 28:01) Section 23 provides Due to the shortness of the typical principles of for the formation of workers committees employment contracts for most freedom of through appointment or election by activities and the voluntary basis of association and workers to represent their interests, membership, most collective provided that no managerial employee contracted workers may bargaining of shall be appointed or elected to a workers not have access to the full privilege project workers in a committee, nor shall a workers committee and protection of this legal provision manner represent the interests of managerial and some contractors may take consistent with employees, unless such workers committee advantage of this gap. national law. is composed solely of managerial Page | 248 ESF Objective National Requirement Recommendation employees appointed or elected to The PIE shall require all contractors to represent their interests. Section 25 be aware of, and implement as pronounces that the collective bargaining minimum employment conditions, agreements negotiated by workers those applicable to the committees with their employer and respective National accented to by their affiliated Trade Union Employment Council shall be binding on both the employer and (NEC), e.g., Construction (NEC) the employees. MOHCC should engage with health However, it is worth noting that Health care workers to address issues Care Workers are considered essential relating to their working conditions services and cannot freely exercise the right and terms of employment. Alternative to engage in collective job actions. The Law mechanisms may include recognizing restricts the exercise of this right to worker committees/ associations, and maintain essential services. Essential allowing workers to choose their own services are defined in Section 102(a) of the representatives for dialogue and Labour Act as “any services the interruption negotiation on terms and conditions of which endangers immediately the life, of employment in a manner personal safety or health of the whole or that does not contravene national law. any part of the public� and health care The project will not restrict project services are part of essential services. workers from developing alternative Therefore, there are no collective mechanisms to collective job actions agreements applicable to the project. to express their grievances and protect their rights regarding working conditions and terms of employment. GoZ should not seek to influence or control these alternative mechanisms. GoZ should not discriminate or retaliate against project workers who participate, or seek to participate, in such workers’ organizations and alternative mechanisms to collective bargaining. To prevent the use The Labour Act (Cap 28:01) establishes the No project worker and contracted of all forms of child minimum age for work as 16 inclusive of worker under the age of eighteen will labour. where a child is engaged in vocational/ be employed. The ages will be verified technical or apprenticeship training. using National identification. To prevent the use Labour Act (CAP 28:01) section 4A prohibits All contractors will ensure consent of of all forms of forced labour. The Act excludes any labour employees to work through written forced labour. required by virtue of an enactment during agreements. a period of public emergency or in the event of any other emergency or disaster that threatens the life or well-being of the community, to the extent that the requiring of such labour is reasonably justifiable in the circumstances of any situation arising or existing during that period or as a result Page | 249 ESF Objective National Requirement Recommendation of that other emergency or disaster, for the purpose of dealing with that situation from being forced labour. To promote safety National Social Security Authority Statutory Contractors shall have appropriate and health in the Instrument 68 (Accident Prevention and Health and Safety plans in place and workplace. Worker’s Compensation Scheme) 1990 will provide daily OHS talks and compels all employers to ensure safe and trainings for workers as well as PPE. healthy working conditions including: (a) Contractors will ensure that there are Identification of potential hazards to sanitation facilities and waste project workers, particularly those that collection bins in all applicable work may be life threatening. (b) Provision of areas. Contractors and project preventive and protective measures, proponents/implementers will adhere including modification, substitution, or to the ESMF and ICWMP elimination of hazardous conditions or implementing measures to promote substances. (c) Training of project workers safety and health in the workplace. and maintenance of training records. (d) Contractors will not Documentation and reporting of victimise any contracted workers that occupational accidents, diseases, and remove themselves from unsafe or incidents. (e) Emergency prevention and unhealthy work environments. preparedness and response arrangements Contractors will ensure that all to emergency situations. (f) Remedies for workers adverse impacts such as occupational have access and can effectively use injuries, deaths, disability, and disease. appropriate personal protective The Labour Act also prohibits against unfair equipment (PPE). labour practices in the form of demanding The workers engaged in the project from an employee or prospective will utilise the project GRM which is employee any sexual favour as a condition GBV sensitive. of recruitment, provision of facilities related to employment or engaging in sexually determined behaviour towards any employee. To provide project Labour (Settlement of Disputes) Contractors will be required to comply workers with Regulations, 2003. The regulations provide with appropriate means for dispute resolution with public service general legal requirements where to raise workplace through the involvement of the Labour they do not have a code of conduct concerns. Officer within the Ministry of Public registered with the Ministry of Labour Commission, Labour, and Social Welfare. or enforce their respective codes of The provision has means to engage the conduct where registered. Contractor disputing parties until the worst-case will be required to induct their scenario manifests and arbitration is employees on the grievance sought before engaging the formal court procedure. PIE will require system. Labour Act (CAP 28:01) provides for contractors to report grievances the registration of a code of conduct by raised within one month and progress employers. The Code of conduct will on resolution monthly. include (a) Disciplinary rules to be observed including the precise definition of Community Health workers and misconduct. (b) Procedures in case of any Village health will use the already Page | 250 ESF Objective National Requirement Recommendation breach of the code. Penalties for breach of GRM being strengthened through the the code, which may include oral or written existing World Bank project. warnings, fines, reductions in pay for a specified period, suspension with or without pay or on reduced pay, demotion, and dismissal from employment. (d) Person, committee, or authority that shall be responsible for implementing and enforcing the rules, procedures, and penalties of the employment. (e) Notification to any person who is alleged to have breached the t code that proceedings are to be commenced against him in respect of the alleged breach. (f) Right of an accused person to be heard by the appropriate person, committee or authority referred to in paragraph (d) before any decision in his case is made; (g) Written record or summary to be made of any proceedings or decisions taken in terms of the code, which record, or summary shall be made at the time such proceedings and decisions are taken. ESS4 Community Health and Safety To anticipate and Environmental Management (Effluent and Contractors will ensure that there are avoid adverse Solid Waste Disposal) regulations, 2007; adequate toilet facilities for staff and impacts on the Environmental management (hazardous waste collection bins in all applicable health and safety of Waste Management) regulations, 2007; work areas, especially spaces open to project affected Environmental Management (Atmospheric the community, patients and visitors communities during Pollution Control) regulations, 2009. These that will have many people at the project lifecycle regulations provide for the protection of same workplace that may not have from both routine the environment (and people by extension) toilet facilities. However, the and non-routine through prohibition of discharge into the construction sites are not anticipated circumstances. environment include air, water, land of any to have many workers and visitors. waste or harmful substances that may have Waste collection will support negative impact thereof. All waste appropriate waste treatment and final generators are required to adhere to the disposal which will protect the health provisions of these regulations and apply and safety of communities. for relevant permits for the generation, The national legislation is very limited storage, transportation, and disposal of and broad application of ESS 4 will be such waste. used, e.g., related to GBV. The project will implement a GBV Action Plan (Appendix 15) as part of this ESMF, contractors will put in place grievance redress mechanisms which is accessible to employees for raising Page | 251 ESF Objective National Requirement Recommendation work related concerns and grievances to their management. Train and sensitise community and project workers on GBV/ SEA-H The PIE will enforce this as part of the Contractor Management Contractor workers will sign and adhere to the Code of Conduct on GBV/SEAH (Appendix 14 of the ESMF) Civil Protection Act Prior to any involvement of its military This Act provides for the declaration of and/or security forces in the carrying state of disaster if it appears that there is a out of Project activities, send a written disaster which needs extra ordinary notice to the Bank communicating measures to be implemented and protect such decision, including the name of the persons affected or likely to be affected the military or security unit; and (b) by the disaster in any area in Zimbabwe. ensure that all activities carried out by After such a declaration is made it is military or security personnel under required to be published in a statutory the Project are under the control of instrument. The GoZ declared the MoHCC, working closely with Cordaid pandemic a national disaster in terms of as the Project implementing entity Section 27 of the Civil Protection Act. This and undertaken exclusively for the was done by the gazetting of the Civil purposes related to the Project and in Protection (Declaration of State of Disaster: compliance with the ESSs and the Rural and Urban Areas of Zimbabwe) provisions set out under this (COVID-19) Notice. To enforce the provision. Should the military be used lockdown, the police and/ or the army may in the project, the Ministry of Health be deployed to patrol the streets. through the COVID-19 National Coordinator’s office, engages the Ministry of Home Affairs and Cultural Heritage and the Ministry of defence and War Veterans Affairs in setting out the arrangements for the engagement of the military or security personnel under the Project. Freedom of Information Act Chapter During project implementation (10:33) information will be generated and The act gives effect to section 62 of the that information must be accessible to Constitution of Zimbabwe which provides the public. for the right to access information as The ESMF which will contain the LMP enshrined in the declaration of rights. is a public document and therefore It sets out procedures for of access to will be disclosed as per national laws. information held by public institutions or information held by any person. It also sets out considerations for making available on a voluntary basis by entities, certain categories of information thereby Page | 252 ESF Objective National Requirement Recommendation removing the need for formal request for such information It also sets out the scope and limitations on the right of access to information - Issues related to; Inappropriate handling of COVID-19 During project planning a project samples and patients can expose IVCWMP will be developed and - ESS4 Safety of community and could lead to further disclosed. Each participating health Services given at spread of the disease. Non-provision of facility will be required top prepared HFs that will service medical services to disadvantaged or an approved ICWMP to be shared with public vulnerable groups is a potental risk under PIE and MOHCC for approval. the project. The project ICWMP will contain Project will ensure that all project - ESS4 Traffic and guidelines on specific measures to prevent drivers are appropriately licenced. Road Safety as the the spread of diseases in the community Trainings will also be conducted for Project will involve from infectious medical waste. This ESMF drivers for safe handling and the use of trucks for contains measures to ensure health and transportation of medical waste. transportation safety in the community from project activities and safety of services as they - ESS4 Emergency relate to health care facilities, vaccine roll Preparedness and out, emergency preparedness measures Response as the including measures to address a plan for HCFs would be cold chain storage during power outages subject to both and natural disasters. GBV/ SEA/SH risks natural disasters will be ameliorated through training of and man-made every worker engaged in the project on events OHS and GBV/ SEA/SH risks and be required to sign a code of conduct. COVID-19 vaccine safety and surveillance will be guided by the existing MOHCC’s Adverse Events Following Immunisation surveillance and the WHO Vaccines Safety Surveillance Manual. The project will regularly integrate the latest guidance by WHO as it develops over time and experience addressing COVID-19 globally especially with respect to reducing the risk of the project spreading COVID-19 to the public in general. Additionally, the project will conduct risk communication and community engagement activities to raise awareness and dispel misnformation in the affected areas including the vulnerable and marginalised groups, use of proper PPE for COVID-19 prevention measures No one will be forced to get the vaccine. Page | 253 ESF Objective National Requirement Recommendation The project will abide by Section 3.3 (Life and Fire Safety) of the World Bank Group (“WBG�) General Environmental, Health and Safety Guidelines (“EHSG�) as it relates to fire and other safety standards for new buildings and existing buildings programmed for renovation with the use of the Bank funding. These requirements apply to buildings programmed for renovation, whether occupancy type is maintained (e.g., a hospital renovation) or changed (e.g., an office building is converted to a hospital). The use of the Military or Security Personnel is not currently envisioned for any activities related to the Project. 6. RESPONSIBLE STAFF This section identifies the functions and/or individuals within the project responsible for the implementation of this Labour Management Procedures. The PIE will be responsible for: (i) the day-to-day management and execution of project activities; (ii) the preparation of annual activity and procurement plans; (iii) the drafting of contract documents; (iv) collecting and compiling all data relating to their specific indicators; (v) evaluating results; (vi) reporting results to the World Bank prior biannually; and (vii) the preparation of a consolidated report on the implementation of the project components. The PIE will also closely follow up with the Directorate of Finance, Director Internal Audit, Procurement Unit and relevant technical directorates in MOHCC. The PIE will perform its functions as described in the Project Implementation Manual (PIM). The Project Implementation Entity (PIE) will be responsible for the overall project management and coordination, including compliance with safeguards requirements such as those contained herein. Specifically, the Social Safeguards Specialist will oversee and manage all social development and related matters under the project ensuring that all project activities are carried out in line with the World Bank Environmental and Social Framework (ESF) and safeguard documents guiding Project implementation: the ESMF, Labour Management Plan (LMP) and Stakeholder Engagement Plan (SEP). This includes: ensuring that all activities are screened for adverse social impact prior to commencement, implementation of Environmental and Social Management Plans, including aspects related to Indigenous Peoples, organize and conduct the trainings on Social Safeguards aspects of the project including: preparation of mitigation checklists, ESMP implementation, conducting monitoring, Grievance Redress Mechanism (GRM) and Community Consultations, oversee the project-related Grievance Redress Mechanism (GRM) and as part of this, ensure the sound establishment of feedback and GRM, track reporting, ensuring any issues are resolved in a timely manner and close out issues and prepare a comprehensive Gender Based Violence (GBV) as well as Sexual Exploitation and Abuse (SEA) Risk Assessment for the project, including outputs, activities, indicators and targets and monitoring mechanisms, to address the key recommendations identified through the assessment. The PIE will engage other line ministries and institutions with expertise in environmental, social, OHS issues. These include Page | 254 Environmental Management Agency (EMA). The PIE will be responsible for the following tasks: Undertake the overall implementation of this LMP; Engage and manage consultants and contractors in accordance with this LMP and the applicable Procurement Documents; Monitor project contractors and workers to ensure their activities are aligned with the provisions of the LMP and the applicable Procurement Documents. Monitor the potential risks of child labour, forced labour and serious safety issues in relation to primary suppliers; Provide training to mitigate social risks for project workers and community volunteers; Ensure that the GRM for project workers is established and implemented and that project workers are informed about it; Monitoring the implementation of the Worker Code of Conduct; and Report to the World Bank on Labour and OHS performance and key risks and complaints. The Social Safeguards Specialist and an Environmental Specialist under PIE shall be responsible for the implementation of the LMP and OHS requirements of the project. They will be responsible for promoting implementation of the LMP and OHS requirements within the project. The entire PIE has responsibility for the implementation of these components which are integral to the project. The team will be responsible for the following: a. Supervise workers’ adherence to the LMP, b. Maintain records of recruitment and employment of contracted workers (including subcontractors). c. Provide induction and regular training to contracted workers on environmental, social and OHS issues, d. Require primary supplier(s) to identify and address risks of child labour, forced labour and serious safety issues, and undertake due diligence to ensure this is done, e. Develop and implement the GRM for contracted workers, including ensuring that grievances received from the contracted workers are resolved promptly, and report the status of grievances and resolutions regularly to the PIU and World Bank, f. Ensure all contractor and subcontractor workers understand and sign the CoC prior to the commencement of works and supervise compliance with the CoC, g. The Environmental and Social Safeguards Specialists are responsible for reporting accidents, incidents, fatalities, and project Covid 19 outbreaks to the WB. Health Care Workers working in various health facilities being supported by the project are contracted by the MOHCC and work under the terms and conditions of the Ministry of Health and child Care. Each health facility has a Head of Institution. Provincial Hospitals are headed by the Medical Superintendent, District Hospital is headed by the Medical Superintendent or District Medical Officer and the rural health facility is led by a Nurse in Charge. Head of institutions oversee day to day management of the facility. The HCF will be responsible for (i) the day-to-day management of activities during planning, installation, and operational phases; (iv) collecting and compiling all data relating to their specific indicators; (v) evaluating results; (vi) providing the relevant performance information to the MoHCC and PIE. The HCF will work closely with the PIE. Protocols developed will clearly assign responsibilities to each of the members by providing the necessary oversight as shown in table below: Page | 255 Table 6-1 Roles and Responsibilities for the PIE Position Roles and responsibilities Social Safeguards - The project Social Safeguards Specialist will continue to ensure Specialist effective implementation of the social provisions of the ESMF such (PIE) as: - Overseeing the implementation of the GRM in collaboration with MOHCC, Following, up on the feedback mechanisms between the contractors and their workers and flagging any issues for redress, - Ensure appropriate stakeholder consultation, - Provide overall policy and technical direction for all social relations management issues under the Project as defined by the Environmental and Social Commitment Plan (ESCP), Environmental and Social Management Framework (ESMF), Stakeholder Engagement Plan (SEP) this LMP and the ICWMP such as AEFI, GRM, GBV/SEAH Action Plan etc. - The Social Specialist will ensure that the GRM functions for the project and follow-up on complaints, record keeping, resolutions, etc. Communication - The Communication Specialist will support the successful Specialist (PIE) implementation of the GRM, working with focal points from MoHCC. She will provide overall policy and technical direction for all risk communication and community engagement activities working closely with Health Promotion Department, as well as public relations management issues under the Project as defined by the Environmental and Social Commitment Plan (ESCP), Environmental and Social Management Framework (ESMF), Stakeholder Engagement Plan (SEP) this LMP and the ICWMP such as AEFI, GRM, etc. Environmental - Implementing the ESMF and ICWMP including the LMP. Specialist Monitoring, guiding, and reporting on project environmental, (PIE) health and safety issues (including those relating to COVID-19). - Raising awareness and advising on or providing pertinent training for direct workers, contracted workers and community volunteers as needed. - Ensuring the integration of LMP requirements in procurement and worker’s contracts. - On a regular basis conduct monitoring, supervision, and reporting on health and safety issues related to COVID-19. - Advising on and establishing reporting arrangements from contractors to Cordaid. - The Social Safeguards Specialist and Environmental Specialist will ensure that the LMP, ESMF and ICWMP requirements are addressed including engagement with other entities involved in the project. Page | 256 Position Roles and responsibilities - Following up on any health and safety feedback from contractors and their workers and flagging any issues for redress; and - Reporting on a regular basis on the overall project progress on environmental or other agreed matters. Logistics and - Lead the procurement activities of the project and coordinate with Procurement Officer the technical teams and stakeholders assigned to implement the (PIE) subcomponents. - Ensure that all the procurement documents adequately reflect environment and social issues, where relevant. Monitoring and - Update indicators for monitoring & evaluation Establishes process Evaluation Officer for monitoring and evaluating COVID-19 deployment activities. - Update processes for COVID-19 data collection, analysis, visualization, and communication using management information systems. - Ensures timely and continuous monitoring of activities to make activities are implemented as planned - Monitoring of COVID-19 vaccine acceptance level. Expanded - Responsible for managing a country’s overall pandemic response in Programme on coordination with the National Response team. Immunisation - Organizes and oversees implementation capacity building for Manager health workers (MOHCC) - Delegates responsibilities for deployment of vaccine and vaccination to the logistics and vaccination focal points. - In collaboration with the logistics team, drafts the deployment and implementation plan. - Collects and organizes contact information for members of deployment committees, other key authorities Health Promotion - Developing of a communication plan and monitoring framework for Manager COVID 19 vaccine (MOHCC) - Engagement of key national & subnational stakeholders - Development of communication materials for COVID 19 Coordination of demand creation & media campaign - Establishment of media monitoring and community feedback mechanism - Coordinate national launch of COVID 19 vaccine - Establish ethical codes/patients charter Contractor - Contractors must appoint a minimum of one safety representative onsite (someone with first aid expertise and access to materials such as a first aid kit). Smaller contracts may permit the safety representative to carry out other assignments as well. The safety representative ensures day-to-day compliance with specified safety Page | 257 Position Roles and responsibilities measures and records of any incidents. Contractors are expected to give daily OHS talks and trainings to workers including awareness raising, prevent and mitigate the spread of COVID-19. Promptly notify the PIE of any incident or accident related to the Project which has, or is likely to have, a significant adverse effect on the environment, the affected communities, the public or workers, including, cases of sexual exploitation and abuse (SEA), sexual harassment (SH), and accidents that result in death, serious or multiple injuries. The PIE should then notify the Bank as per the ESCP requirements. Subsequently, prepare a report on the incident or accident and propose any measures to address it and prevent its recurrence. Contractors will keep records in accordance with specifications set out in this LMP. PIE may at any time require records to ensure that labour conditions are met. The PIE will review records against actuals at a minimum on a monthly basis and can require immediate remedial actions if warranted. A summary of issues and remedial actions will be included in biannual reports to the World Bank. - Contractors will be required to present a worker grievance redress mechanism which responds to the minimum requirements in this LMP. The PIE Social Safeguards Specialist will review records monthly. Where worker concerns are not resolved, the national system will be used as set out in the section, but the PIE will keep abreast of resolutions and reflect in biannual reports to the World Bank. - Contractors will need to prepare a C-ESMP (for works/construction) and meet applicable OHS requirements in their contracts for service providers (for example, transport/drivers, medical waste disposal, etc.). 7. POLICIES AND PROCEDURES Occupational Health and Safety (OHS): • Access to psychosocial support services. The psychosocial support centre at Parirenyatwa Hospital is being strengthened under the HSDSP AF-V and services will be provided to all those who may require them including health care workers and community. Provision is being made for those who may require services virtually. The project will also promote the strengthening of existing referral pathways for GBV/ SEA-H at local levels. • Appoint a dedicated team with responsibilities to identify and implement actions that can mitigate the effects of COVID-19 on the facility and community around it. • Develop and provide information on good practices for preventing COVID-19 transmission, particularly observing recommendations on social distancing, and for training staff to recognize the symptoms of COVID-19 and understand their required response. Page | 258 • Training medical staff on the latest WHO advice and recommendations on the specifics of COVID- 19, and principles on fair, equitable and inclusive access, and allocation of Project benefits, including vaccines. • Training medical staff on the priority groups for allocation of vaccines and the timetable for these groups, as well as why they are required to only vaccinate persons from the priority group at the particular time (for example, because that group is at higher risk, for reasons of inclusion and equity etc. where there is limited supply of vaccines). • Ask workers to stay away from work in cases where they exhibit any COVID-19 symptoms or have been in close contact with a confirmed COVID-19 patient during the previous 14 days. • Provide enough water/soap handwashing facilities in all workplaces and provide disposable tissues and garbage bins. People should be encouraged to speak up if they encounter non-conforming behaviour. • Adjust workplace designs and work processes to minimize close contact among workers. This may include working in shifts and/or expanding the work areas. • Provide suitable personal protective equipment (PPE) to all project personnel (including cleaners) as appropriate. Obtaining adequate supplies of medical PPE, including gowns, aprons, curtains; medical masks and respirators (N95 or FFP2); gloves (medical, and heavy duty for cleaners); eye protection (goggles or face screens); hand washing soap and sanitizer; and effective cleaning equipment. Where relevant PPE cannot be obtained, the plan should consider viable alternatives, such as cloth masks, alcohol-based cleansers, hot water for cleaning and extra handwashing facilities, until such time as the relevant supplies are available. • Follow the manufacturers’ instructions for use of cleaning and disinfection products. • For vaccination sites, ensuring that the space is organized in a safe and socially distant manner, and necessary logistical controls and waste management are planned for in advance. • For the deployment and use of vaccines, safe cold-chain practices, checking that vaccines are approved for use by WHO or another regulatory authority agreed by the Bank, selecting safe injection equipment, immunization practices for vulnerable people such as pregnant women or children under 5, immunization waste-disposal plan, supervision and reporting on implementation of immunization practices as required under national legislation. • Conducting enhanced cleaning arrangements, including thorough cleaning (using adequate disinfectants) of catering facilities/canteens/food/drink facilities, latrines/toilets/showers, common areas, including door handles, floors and all surfaces that are touched regularly. • At HCF and all facilities which provide medical waste disposed for the Project implement the necessary OHS measures to protect HCF workers and patients/visitors from potential HCF risks including those identified in WB EHS Guideline for Health Care Facilities • For construction related works at the HCFs, ensure all Contractors implement the necessary OHS measures to protect HCF workers and patients/visitors from potential HCF risks including those identified in WB EHS General Guideline and measures included in their respective contact • For all service providers, including those who provide truck transportation and maintenance implement the necessary OHS measures to protect workers as included in their respective contact In addition, direct workers engaged by the PIE, the PIE has standard operating procedures which every employee engaged by Cordaid must follow to mitigate against the transmission of COVID-19. The following guidelines are in place and have been developed following guidance from international organisations such as WHO: i.) Pretravel checklist and risk assessment travel of Cordaid employees; ii) Cordaid standard Operating procedures Mitigating Transmission of COVID-19; iii) Self Quarantine guidance. Page | 259 Health care waste exposure: To minimise exposure to health care waste, handling, transportation, and disposal of health care waste will be done in accordance with the ZCERP Infection Control and Waste Management Plan (ICWMP) and all HCF specific ICWMPs and any project activity ESMPs For projects involving installation of equipment, contractors should develop specific procedures or plans so that adequate precautions are in place to prevent or minimize an outbreak of COVID-19, and it is clear what should be done if a worker gets sick. Details of issues to consider are set out in Section 5 of the World Bank’s Interim Note: COVID-19 Considerations in Construction/Civil Works Projects and include: • Assessing the characteristics of the workforce, including those with underlying health issues or who may be otherwise at risk • Confirming workers are fit for work, to include temperature testing and refusing entry to sick workers • Considering ways to minimize entry/exit to site or the workplace and limiting contact between workers and the community/general public. • Training workers on hygiene and other preventative measures, and implementing a communication strategy for regular updates on COVID-19 related issues and the status of affected workers • Treatment of workers who are or should be self-isolating and/or are displaying symptoms • Assessing risks to continuity of supplies of medicine, water, fuel, food and PPE, taking into account international, national and local supply chains • Reduction, storage, and disposal of medical waste • Adjustments to work practices, to reduce the number of workers and increase social distancing • Organizing for the treatment of sick workers • Siting worker accommodations further apart or having one worker accommodation in a more isolated area. • Establishing a procedure to follow if a worker becomes sick (following WHO guidelines) • Implementing a communication strategy with the community, community leaders and local government in relation to COVID-19 issues on the site as relevant. GBV/ Sexual Exploitation and Abuse: Given the implementation context GBV, sexual exploitation, abuse and harassment of co-workers is a likely risk. • All Contractor workers engaged under the project should sign a Code of Conduct (Appendix 4) outlining the expected standards of behaviour and consequences of such actions. The project has adopted the World Bank Code of Conduct for Contractor workers. • Provide and implement GRM for addressing GBV and SEA complaints • training of PIE staff and contracted workers on SEA-H risks and signing of the codes of conduct before starting work on any project activities. Health care workers will be trained on GBV/ SEA-H as part of ongoing capacity building activities. Additional resources with relevant COVID-19-related information include the following: • For health workers rights, roles and responsibilities, including on OHS, consult WHO COVID-19 interim guidance Page | 260 • For guidance on infection prevention and control (IPC) strategies for use when COVID-19 is suspected, consult WHO IPC interim guidance • For rational use of PPE, consult WHO interim guidance on use of PPE for COVID-19 • For workplace-related advice, consult WHO guidance getting your workplace ready for COVID-19 • For guidance on water, sanitation and health care waste relevant to viruses, including COVID-19, consult WHO interim guidance • For projects requiring management of medical waste, consult guidance issued by WHO Safe management of wastes from health-care activities • For guidance on immunization and vaccine safety, consult WHO Immunization Safety guidance • For guidance on implementation of mass vaccination campaigns in the context of COVID-19, consult WHO framework for decision-making 8. TERMS AND CONDITIONS Minimum Wages: The official minimum wage will be governed by the national employment council for that industry for example The Employment Council for the Construction Industry will schedule minimum wages for the industry. All efforts will be made to ensure that contractors do not underpay and overwork their workers, more so temporary (casual) workers. There is need to ensure they comply with minimum wages for the respective industry. Direct workers engaged by the PIE are governed by the National Labour laws. Hours of Work: The normal hours of work of a project worker shall not exceed 8 hours a day. Hours worked in excess of the normal hours shall be entitled to relevant allowances. Rest per week: Every worker shall be entitled rest on Saturday and Sunday. Workers shall also be entitled to rest on public holidays recognized as such by the Government of Zimbabwe. Annual leave: Workers (apart from consultants and temporary workers) shall be entitled to 30 days’ leave with pay for every year of continuous service. An entitlement to leave with pay shall normally be acquired after a full year of continuous service. This requirement applies to direct workers Maternity leave: A female worker shall be entitled, on presentation of a medical certificate indicating the expected date of her confinement, to 90-days maternity leave, provided that she has been employed by the employer for at least 12 months without any interruption on her part except for properly certified illness. Deductions from remuneration: No deductions other than those prescribed in labour laws shall be made hereunder or any other law or collective labour agreement shall be made from a worker’s remuneration, except for repayment of advances received from the employer and evidenced in writing. The employer shall not demand or accept from workers any cash payments or presents of any kind in return for admitting them to employment or for any other reasons connected with the terms and conditions of employment. Death benefit: In case of death of a worker during his/her contract of employment, the employer shall pay to his/her remuneration as death benefits in-line with the provisions of the relevant laws. Written Contracts: These terms deal with contents of written contracts. Termination is provided for under the law and a written contract shall be terminated: (a) If the period for which it was given has expired; or (b) If the employee has died; or (c) In any other way a contract of service may be lawfully terminated. (d) Due to sickness or accident, an employee is unable to fulfil a written contract; it may be terminated on the report of a registered medical practitioner. Flexible working arrangements: the MOHCC has implementing an alternate arrangements or schedules from the traditional work arrangements. These flexible working arrangements has been put in place to decongest the workplaces and mitigate against the spread of COVID-19. These flexible working Page | 261 arrangements allows project workers to use the workplace on prearranged weekdays. This arrangement gives the worker greater scheduling freedom in how they fulfil their job responsibilities and may therefore meet personal, and family needs and achieve better work-life balance. This arrangement is reviewed from time-to-time depending how the COVID-19 pandemic involves. The project will not restrict project workers from developing alternative mechanisms to collective job actions to express their grievances and protect their rights regarding working conditions and terms of employment. GoZ should not seek to influence or control these alternative mechanisms. GoZ should not discriminate or retaliate against project workers who participate, or seek to participate, in such workers’ organisations and alternative mechanisms to collective bargaining. 9. GRIEVANCE MECHANISM GRIEVANCE REDRESS PROCEDURE General Principles: Typical workplace grievances include demand for employment opportunities; labour wage rates; delays of payment; disagreement over working conditions; and health and safety concerns in work environment. Although SEA occurs in workplaces it is not always reported on for fear of victimization. There is already a grievance redress mechanism within the MOHCC system which is being strengthened under AF V. Below is an outline of the GRM process in place: Facility Level GRM The rationale for the facility level GRM, is because the CBOs and HCCs in the villages indicated that they were getting minimum assistance from the establishment and that they were dealing with community grievances through the police and the local elders. The Grievance Redress Mechanism consists of the following components: • The access point for impacted/concerned patients or people will be situated as close to the project affected person (PAP) as possible. o At the various Health Facilities phone numbers will be posted and notices written indicating the process to be taken when aggrieved, o At the various Health Facilities there will be Suggestion Boxes (Also used as grievances boxes) situated in the reception area, where anonymous reports can be deposited. The community, the CBO and HCC will oversee the keys to the boxes, o At all Ministry of Health and Child Care (MoHCC) Offices there will be Suggestion boxes situated in the reception area, where anonymous reports can be deposited, o At the various Health Facilities and MoHCC Offices there will be a designated officer who receives, classifies, and log all grievances, o At all project activity and CORDAID offices there will be a Suggestion box and a designated CORDAID staff will be responsible for receiving the Grievances, classifying, and logging them. o All Suggestions boxes should be opened daily. • The patient would normally be asked to submit a written down grievance to the Person in Charge of recording, who then refers the patient to see the sister in charge, who will try to resolve it, failing which the next steps will be taken. This is done so that a different person handles the case from the one who recorded it, • The Administrator should give the complainant an acknowledgement of receipt containing an expectation of when they will receive a response, Page | 262 • The Facility Manager assigns a member of staff to be responsible for the case, who ten assess and investigates the grievance to identify all the key facts, • The responsible staff member in consultation with the Facility Manager then makes a resolution and the proposed actions are confirmed with CORDAID/MoHCC senior members of staff, • A response is then communicated to the complainant within the timescale promised: ✓ For Priority 1 – urgent, potential high health and high business impact. This requires a response to the Complainant within three (3) working days, ✓ Priority 2 - non-urgent, lower health, environmental and social impact. This requires a response to the complainant within 2 working weeks, • The complainant is given room to appeal to the MoHCC Head Office or the Courts of Law if they are not satisfied with the response. The appeal can be lodged with the Public relations Manager, MoHCC, Kaguvi Building, 4th Floor, Central Avenue, Harare. • Once done the case is brought to a closure and all the staff members of the Facility are made aware of the complaint, any underlying issues and plans to prevent any future recurrence of the issue, ✓ All complaints should be reviewed monthly as part of the quality assurance review meetings, ✓ Any complaints where action can be taken to avoid recurrence must be acted upon and raised with the appropriate managers/teams across the Facility, ✓ A monthly summary incident report is submitted to the Communications Specialist of CORDAID for record keeping and consolidation. He/she will ensure that all grievances are being recorded and resolved in a timely manner. However, Contractors will establish a separate grievance redress mechanism for its workers at each project site, as required in ESS2. Handling of grievances should be objective, prompt, and responsive to the needs and concerns of the aggrieved workers. The mechanism will also allow for anonymous complaints to be raised and addressed. Individuals who submit their complaints or grievances may request that their name be kept confidential, and this should be respected. • The project will contract Contractors who sign an undertaking to comply with the provisions of the Labour Act for Contracted workers. • Contractor inducts the employee on the applicable grievance redress mechanism. Induct all project workers to be aware of their rights. All records of induction shall be kept and made available for inspection by PIE and MOHCC or World Bank. • In case of violation, the aggrieved employee must capture and present the details of the grievance to the person they report to or the supervisor’s superior in case of conflict of interest. • The supervisor will verify the details and seek to address the mater within the shortest time up to 48 hours. • The supervisor will escalate the matter if not resolved within 48 hours until a resolution is found or not found. • Where no resolution is found, the employee will escalate the matter to the sector specific National Employment Council, to the Labour court, High Court or Supreme Court who will resolve the matter between employer and employee. The Supreme Court’s decision is final. • Where no resolution is found between employees, the aggrieved employee will escalate the matter to the Labour court, High Court or Supreme Court who will resolve the matter between employer and employee. The Supreme Court’s decision is final. Page | 263 • The Contractor shall keep records of all proceedings of grievance redress that are within their jurisdiction and furnish PIE/ MOHCC as part of the periodic progress reporting to the PIE. • All grievances of sexual nature (GBV/sexual harassment/Sexual Exploitation and Abuse) should follow the existing national GBV/SEA and Child Abuse referral pathways and complaints resolution mechanism. Cordaid has a grievance or complaints procedure that deals with complaints from Cordaid’s stakeholders such as donors, consultants, the MOHCC, suppliers and staff members. The complaint can be submitted to Cordaid through phone, email or by letter. The complaint can be sent to anyone in the organisation, however, at the contact person at the national office is the Finance and Administration Specialist The receiver of the complaint registers the complaint database which is posted in the server. The receiver of the complaint will pass the complaint to the responsible person who will send confirmation of receipts within two working days to the complainant. After sending confirmation of receipt to the complainant the complaint is examined to determine its validity within 14 working days. If a complaint can be solved immediately a response is send to the stakeholder. Corrective action can also be taken depending on the nature of the complaint for instance deviations from procedures (errors are corrected and person concerned is addressed), violation of the code of conduct (disciplinary action). Most complaints or objection will be handled by the responsible contact person and his or her supervisor, but some may require input from Cordaid officers. If the solution is not to the satisfaction of the stakeholder, the Complaints and Objections Committee at Cordaid in Zimbabwe will give advice. The Complaints and Objections Committee will only be created if contact person and his/her supervisor does not come to an agreement with the stakeholder. The contact person ensures that the customer receives the response even if the complaints are unfounded. After the handling of the complaint the file and all correspondence, is put in a complaints folder and on the server. Once per quarter the Finance and Administration makes an analysis and report on all complaints received and a summary of issues and their status is provided to the World Bank in the biannual progress reports. Additional GRM Approaches Besides the Project GRM, aggrieved persons can also employ additional channels to air their complaints. These include the World Bank Grievance Redress System (GRS) and the inspection Panel. The objective of the World Bank’s Complaints Procedure is to ensure that appropriate mechanisms are in place to allow individuals and communities to contact the World Bank directly and file a complaint if they believe they are or might be adversely affected by the Project not complying with the World Bank’s Environmental and Social Safeguards Standards. Complaints must concern environmental, social and climate issues only and should not be accusations of fraudulent or corrupt activities in relation to project implementation – these are dealt with by the Offices of Audit and Oversight. All project workers will be made aware of the grievance redress mechanism through a number of platforms that include project website, displays on notice boards, emails, trainings on GRM, emails, various awareness activities. 10. CONTRACTOR MANAGEMENT Page | 264 Each contractor engaged by the Project to provide services (such as construction of isolation/ quarantine centres, setting up energy generation equipment, installation of refrigeration units in trucks, collection of waste, delivery of communication materials at the community level, etc.) will be expected to adopt the protective measures outlined in this LMP document and any specified in the respective contracts. The PIE will make reasonable efforts to ascertain that third parties64 who engage contracted workers are legitimate and reliable entities that have in place labour management procedures applicable to the project that will allow them to operate in accordance with the relevant requirements of ESS2, Labour and Working Conditions. The contracts drawn by the PIE will include provisions, measures and procedures to be put in place by the contractors to manage and monitor relevant OHS issues. Measures required of Contractors will include: a) As part of the bidding/tendering process, specific requirements for certain types of contractors, and specific selection criteria (e.g., for medical waste management, certifications, previous experience). b) Provision of medical insurance covering treatment for COVID-19, sick pay for workers who either contract the virus or are required to self-isolate/quarantine due to close contact with infected workers and payment in the event of death. c) Specific procedures relating to the workplace and the conduct of the work (e.g., creating at least 6 feet between workers by staging/staggering work, limiting the number of workers present), daily safety talks, regular training of workers on health and safety at work. d) Specific procedures and measures dealing with specific risks. For example, for healthcare contractors - infection prevention and control (IPC) strategies, health workers’ exposure risk assessment and management, developing an emergency response plan as per WHO Guidelines. For community workers, measures will include ensuring their security and addressing stigma. e) Appointing a COVID-19 focal point with responsibility for monitoring and reporting on COVID- 19 issues, and liaising with other relevant parties; and f) Including contractual provisions and procedures for managing and monitoring the performance of contractors, considering changes in circumstances prompted by COVID-19. g) Contractor workers must sign the Code of Conduct (Appendix 4) and the Code of Conduct on GBV/SEAH (Appendix 15). They are expected to adhere to the ESHS matters as laid out in the standard WB procurement documents for small construction works Code of Conduct. h) Relevant noncompliance remedies. Contractors will be required to identify focal points and communication channels (for example, WhatsApp, SMS and email) within the company to address workers’ concerns on an ongoing basis and ensure that such channels are adequately resourced (for example, 24-hour staffing of the emergency response call line). Workers shall not be victimized in any way for reporting a grievance. 11. COMMUNITY WORKERS Community surveillance, mobilization and sensitization will be undertaken by community volunteers who will include community health workers, Community Based Organisations, Health Centre Committees, and 64 This may include contractors, subcontractors, brokers, agents, or intermediaries. Page | 265 other volunteers as appropriate. The following safety measures will be put in place to prevent or minimize exposure to COVID-19, as well as for addressing situations where there are cases of symptomatic workers: a) Set up a system at the community level that links up with health facilities and sub-county system for the management of COVID-19 related matters (this could be an e-system). b) Set up an online system (use WhatsApp for instance) to provide the CHWs with updates on COVID-19. c) Establish a referral system that will allow the CHWs to refer people with various COVID-19 related symptoms and questions. The online system could also assist with the triage of sick community members as necessary. d) Develop training materials that will also give the volunteers accurate information on COVID-19 including prevention and control measures. e) Equip the CHWs with basic protective equipment such as masks and sanitisers. f) Provide information on the GRM to be used in case of a community complaint (abuse, stigma, etc.); and establish a monitoring system on the performance of the CHWs. 12. PRIMARY SUPPLY WORKERS Primary suppliers will be for the supply of PPE, solar direct drive refrigerators, refrigeration units for trucks transporting vaccines. These suppliers are not known at this stage. When sourcing for primary suppliers, the PIE will require such suppliers to identify risk of child labour or forced labour and serious safety risks. Where appropriate, the project will include specific monitoring and reporting requirements related to child labour or forced labour and work safety issues in all purchase orders and contracts. Appendix 3 Archaeological Chance Finds Procedure ZIMBABWE ARCHAEOLOGICAL CHANCE FINDS PROCEDURE FOR THE ZIMBABWE COVID-19 RESPONSE and ESSENTIAL HEALTH SERVICES PROJECT (ZCEREHSP) 1.0 INTRODUCTION Page | 266 The purpose of this document is to address the possibility of archaeological deposits, finds and features becoming exposed during earthmoving and ground altering activities associated with the ZCERP and to provide procedures to follow in the event of a chance archaeological find. The objectives of these procedures are to identify and promote the preservation and recording of any archaeological material that may be discovered and notify the relevant Rural District Council (RDC), the Environmental Management Agency (EMA) and the National Museums and Monuments of Zimbabwe (NMMZ) to resolve any archaeological issue that may arise (NMMZ, 2001). 2.0 ARCHAEOLOGICAL CHANCE FINDS PROCEDURE During the project induction meeting/training, all contractors/construction teams will be made aware of the need to be on the lookout for objects of archaeological interest as they carry out their refurbishments/ minor civil works (excavation) activities. For example, the sanitary facilities may require excavation. Generally, the following procedure is to be executed if archaeological material is discovered: • Stop all construction activity in the vicinity of the find/feature/site immediately, • Delineate the discovered find/ feature/ site immediately, • Record the find location, and make sure all remains are left in place, • Secure the area to prevent any damage or loss of removable objects, • Contact, inform and notify the RDC, EMA and NMMZ authorities immediately, • The Authorities so notified will avail an archaeologist, • The archaeologist will assess record and photograph the find/feature/ site, • The archaeologist will undertake the inspection process in accordance with all project health and safety protocols under direction of the RDC Health and Safety Officer, • In consultation with EMA, NMMZ and MoHCC authorities, the Archaeologist will determine the appropriate course of action to take, • Finds retrieval strategy: All investigation of archaeological soils will be undertaken by hand, all finds, osteological remains and samples will be kept and submitted to the National Museum as required. If any artefacts need to be conserved, the relevant licence (Licence to Alter) will be sought from the NMMZ, • An on-site office and finds storage area will be provided, allowing storage of any artefacts or other archaeological material recovered during the monitoring process, • In the case of human remains, in addition to the above, the Local Leadership will be contacted and the guidelines for the treatment of human remains will be adhered to. If skeletal remains are identified, an osteoarchaeologist will be available to examine the remains, • Conservation: A conservator should be made available to the project, if required, • The on-site archaeologist will complete a report on the findings as part of the licensing agreement in place with the NMMZ, • Once authorisation has been given by the responsible statutory authorities, the client will be informed when works can resume. Page | 267 Appendix 4 Code of Conduct for Contractor’s Personnel Code of Conduct for Contractor’s Personnel (ES) Form CODE OF CONDUCT FOR CONTRACTOR’S PERSONNEL We are the Contractor, [enter name of Contractor]. We have signed a contract with [enter name of Employer] for [enter description of the Works]. These Works will be carried out at [enter the Site and other locations where the Works will be carried out]. Our contract requires us to implement measures to address environmental and social risks related to the Works, including the risks of sexual exploitation, sexual abuse and sexual harassment. Note to the Bidder: The minimum content of the Code of Conduct form as set out by the Employer shall not be substantially modified. However, the Bidder may add requirements as appropriate, including to consider Contract-specific issues/risks. The of This Code Conduct Bidder shallis of our part and initial measures submit to deal the Code with environmental of Conduct and its social form as part of bid. risks related to the Works. It applies to all our staff, labourers and other employees at the Works Site or other places where the Works are being carried out. It also applies to the personnel of each subcontractor and any other personnel assisting us in the execution of the Works. All such persons are referred to as “Contractor’s Personnel� and are subject to this Code of Conduct. This Code of Conduct identifies the behaviour that we require from all Contractor’s Personnel. Our workplace is an environment where unsafe, offensive, abusive or violent behaviour will not be tolerated and where all persons should feel comfortable raising issues or concerns without fear of retaliation. REQUIRED CONDUCT Contractor’s Personnel shall: 1. carry out his/her duties competently and diligently Page | 268 2. comply with this Code of Conduct and all applicable laws, regulations and other requirements, including requirements to protect the health, safety and well-being of other Contractor’s Personnel and any other person 3. maintain a safe working environment including by: a. ensuring that workplaces, machinery, equipment, and processes under each person’s control are safe and without risk to health b. wearing required personal protective equipment c. using appropriate measures relating to chemical, physical and biological substances, and agents; and d. following applicable emergency operating procedures. 4. report work situations that he/she believes are not safe or healthy and remove himself/herself from a work situation which he/she reasonably believes presents an imminent and danger to his/her life or health 5. treat other people with respect, and not discriminate against specific groups such as women, people with disabilities, migrant workers, or children 6. not engage in Sexual Harassment, which means unwelcome sexual advances, requests for sexual favours, and other verbal or physical conduct of a sexual nature with another Contractor’s or Employer’s Personnel 7. not engage in Sexual Exploitation, which means any actual or attempted abuse of position of vulnerability, differential power, or trust, for sexual purposes, including, but not limited to, profiting monetarily, socially, or politically from the sexual exploitation of another 8. not engage in Sexual Abuse, which means the actual or threatened physical intrusion of a sexual nature, whether by force or under unequal or coercive conditions 9. not engage in any form of sexual activity with individuals under the age of 18, except in case of pre-existing marriage 10. complete relevant training courses that will be provided related to the environmental and social aspects of the Contract, including on health and safety matters, Sexual Exploitation and Abuse (SEA), and Sexual Harassment (SH) 11. report violations of this Code of Conduct; and 12. not retaliate against any person who reports violations of this Code of Conduct, whether to us or the Employer, or who makes use of the grievance mechanism for Contractor’s Personnel or the project’s Grievance Redress Mechanism. RAISING CONCERNS If any person observes behaviour that he/she believes may represent a violation of this Code of Conduct, or that otherwise concerns him/her, he/she should raise the issue promptly. This can be done in either of the following ways: 1. Contact [enter name of the Contractor’s Social Expert with relevant experience in handling sexual exploitation, sexual abuse and sexual harassment cases, or if such person is not required under the Contract, another individual designated by the Contractor to handle these matters] in writing at this address [ ] or by telephone at [ ] or in person at [ ]; or Page | 269 2. Call [] to reach the Contractor’s hotline (if any) and leave a message. The person’s identity will be kept confidential, unless reporting of allegations is mandated by the country law. Anonymous complaints or allegations may also be submitted and will be given all due and appropriate consideration. We take seriously all reports of possible misconduct and will investigate and take appropriate action. We will provide warm referrals to service providers that may help support the person who experienced the alleged incident, as appropriate. There will be no retaliation against any person who raises a concern in good faith about any behaviour prohibited by this Code of Conduct. Such retaliation would be a violation of this Code of Conduct. CONSEQUENCES OF VIOLATING THE CODE OF CONDUCT Any violation of this Code of Conduct by Contractor’s Personnel may result in serious consequences, up to and including termination and possible referral to legal authorities. FOR CONTRACTOR’S PERSONNEL: I have received a copy of this Code of Conduct written in a language that I comprehend. I understand that if I have any questions about this Code of Conduct, I can contact [enter name of Contractor’s contact person(s) with relevant experience] requesting an explanation. Name of Contractor’s Personnel: [insert name] Signature: __________________________________________________________ Date: (day month year): _______________________________________________ Countersignature of authorized representative of the Contractor: Signature: ________________________________________________________ Date: (day month year): ______________________________________________ Page | 270 ATTACHMENT 1: Behaviours constituting Sexual Exploitation and Abuse (SEA) and behaviours and behaviours constituting Sexual Harassment (SH) ATTACHMENT 1 TO THE CODE OF CONDUCT FORM BEHAVIORS CONSTITUTING SEXUAL EXPLOITATION AND ABUSE (SEA) AND BEHAVIORS CONSTITUTING SEXUAL HARASSMENT (SH) The following non-exhaustive list is intended to illustrate types of prohibited behaviours. (1) Examples of sexual exploitation and abuse include, but are not limited to: • A Contractor’s Personnel tells a member of the community that he/she can get them jobs related to the work site (e.g., cooking and cleaning) in exchange for sex. • A Contractor’s Personnel that is connecting electricity input to households says that he can connect women headed households to the grid in exchange for sex. • A Contractor’s Personnel rapes, or otherwise sexually assaults a member of the community. • A Contractor’s Personnel denies a person access to the Site unless he/she performs a sexual favour. • A Contractor’s Personnel tells a person applying for employment under the Contract that he/she will only hire him/her if he/she has sex with him/her. (2) Examples of sexual harassment in a work context • Contractor’s Personnel comment on the appearance of another Contractor’s Personnel (either positive or negative) and sexual desirability. • When a Contractor’s Personnel complains about comments made by another Contractor’s Personnel on his/her appearance, the other Contractor’s Personnel comment that he/she is “asking for it� because of how he/she dresses. • Unwelcome touching of a Contractor’s or Employer’s Personnel by another Contractor’s Personnel. • A Contractor’s Personnel tells another Contractor’s Personnel that he/she will get him/her a salary raise, or promotion if he/she sends him/her naked photographs of himself/herself. Page | 271 Appendix 5 Environmental and Social Screening Form MINISTRY OF HEALTH AND CHILDCARE ENVIRONMENTAL AND SOCIAL SCREENING FORM FOR ZCEREHSP Name of Activity Representative: …………………………………………………………….…. Project activity Name: ……………………………………………………………………. Project activity Address: ……………………………………………………………………. ………………………………………………………………...... Name of Extension Team Representative……………………………………………………………. Address: ………………………………………………....……………. …………………………………………………………………. Description of Project activity (include: ………………………………………………………………. dimensions, associated activities …………………………………………………………………. necessary to the project and any …………………………………………………………………. other relevant information) …………………………………………………………………. Phase 1 1.0 SITE SELECTION: When considering the location of a project activity, rate the sensitivity of the proposed site in the following table according to the given criteria. Higher ratings do not necessarily mean that a site is unsuitable. They do indicate a real risk of causing undesirable adverse environmental and social effects, and that more substantial environmental and/or social planning may be required to adequately avoid, mitigate, or manage potential effects. Page | 272 Site Sensitivity Rating Issues Low Medium High Natural • No natural habitats • No critical natural • Critical natural habitats65 present of any habitats66 habitats present. 5kind • other natural habitats occur Water • Water resources • Water resources • Water resources not quality and exceed any existing relatively available. readily available. water demand. • multiple water users. • multiple water resource • water quality issues users. • Potable water that availability are important • water quality issues and use meets national are important requirements for piped water. • no potential water quality issues Natural • no potential • some erosion • steep slopes. hazards stability/erosion potential. • unstable soils. vulnerability problems. • medium risks from • high erosion , floods, soil • no known volcanic/seismic/ potential. stability/ volcanic/seismic/ flood/ hurricanes • volcanic, seismic or erosion flood risks flood risks Cultural • No known or • Suspected physical • Known physical or Resources suspected cultural cultural resources. intangible cultural heritage sites, • known physical or sites in project rites, or tangible/ intangible cultural activity area intangible resources in broader resources activity area of influence 65 Natural habitats1 are land and water areas where (i) the ecosystems' bio-logical communities are formed largely by native plant and animal species, and (ii) human activity has not essentially modified the area's primary ecological functions. (See OP 4.04, Annex 1 for full definition). 66 Critical natural habitats are (1) legally protected, (2) officially proposed for protection, or (3) unprotected but of known high conservation value. (i) existing protected areas and (ii) areas officially proposed by governments as protected areas, (iii) areas initially recognized as protected by traditional local communities (e.g., sacred groves) (of known high conservation value), and (iv) sites that maintain conditions vital for the viability of these protected areas (See OP 4.04, Annex A Para. I.[b] for full definition.) Page | 273 Site Sensitivity Rating Issues Low Medium High Compliance • All requirements • All material • Some material with all are met requirements are met requirements are relevant not met Zimbabwe EHS requirement s including permits/aut horizations (see Section 3 of ESMF for details) Potential • No known • Some potential exists • Known historical potential contamination exists contaminati on (soil, ground water, etc.) NOTE: ZCERP will not fund any project that will involve any involuntary resettlement, dam construction, encroach into natural habitats, impact cultural heritage, adversely affect human health, cause significant social conflicts, require biosafety levels 3 (work with microbes that can either be indigenous and exotic and can cause serious or potentially lethal disease through respiratory transmission for example Yersinia pestis, Mycobacterium tuberculosis, SARS, rabies virus, west nile, hanta virus) and/or 4 (analysis of dangerous and exotic microbes posing high risk of aerosol transmission. Infections caused by these microbes are frequently fatal and without treatment or vaccines such as Ebola and small pox virus) or block access to important resources. Page | 274 2.0 COMPLETENESS OF ACTIVITY APPLICATION: The project activity application document must contain, as appropriate, the following information: Yes No N/ Comment A Description of the proposed project and where it is located Information about how the site was chosen, and what alternatives were considered A map or drawing showing the location and boundary of the project including any land required temporarily during construction The plan for any physical works (e.g., layout, buildings, other structures, construction materials) Any new access arrangements or changes to existing road layouts A work program for construction, operation and decommissioning the physical works, including any site restoration needed afterwards List of all present and past on-site waste storage, treatment and disposal – including waste pits, septic systems, incinerators, etc. Information about measures to avoid or minimize adverse environmental and social impacts Details of any permits required for the project 3.0 ENVIRONMENTAL AND SOCIAL CHECKLIST Yes No ESMF Guidance/ Comment A Type of activity – Will the project activity support: Page | 275 Yes No ESMF Guidance/ Comment 1 Installation of energy generation equipment in at health care facilities? 2 Installation of refrigeration equipment trucks 3 Support Health Delivery Systems? 4 Provide on-site medical infectious waste disposal 5 Contract (use) off-site facility for medical infectious waste disposal 6 Be located in or near an area where there are physical cultural resources such as important historical, archaeological or cultural heritage sites, artefacts or intangible resources such as locations of sacred or traditional rites? 7 Be located within or adjacent to any areas that are or may be protected by government (e.g., national park, national reserve, world heritage site) or local tradition, or that might be a natural habitat? If the answer to any of questions 1-5 is “Yes�, please use the indicated Resource Guide in Appendix 6 of the ESMF for guidance on how to identify key ESMP contents for typical impacts and risks B Environment – Will the project activity: 8 Potentially affect the quality of any close surface waters (e.g., rivers, streams, wetlands), or groundwater (e.g., wells)? 9 Cause waste management difficulties (beyond known project accepted processes) or increase Page | 276 Yes No ESMF Guidance/ Comment the risk of illness due to toxic or hazardous waste? 10 Cause the production of waste which may include asbestos waste or asbestos containing materials. 11 Cause the discharge of any pollutants into the environment such as emissions into the air (incinerators, etc.)? 12 Produce, or increase the production of, solid or liquid wastes (e.g., water, medical or other wastes)? 13 Does applicant/project activity proponent or facility have all applicable EHS licenses/permits, and does it comply with all regulatory EHS requirements? 14 Does applicant/project activity proponent or facility have material EHS existing liabilities including historical contamination, inadequate present or past onsite medical waste or wastewater disposal, inadequate potable water, If the answer to any of questions 8-12 or 14 is “Yes� or if the answer to 13 is “No�, please include an Environmental and Social Management Plan (ESMP) with the project activity's application addressing the applicable issue. C Social: Gender, Land acquisition and access to resources – Will the project activity: 13 Require that land (public or private) be acquired (temporarily or permanently) for its development? 14 Displace individuals, families, or businesses? 15 Result in and maintain adverse gender balances? Page | 277 Yes No ESMF Guidance/ Comment 16 Exacerbate existing gender imbalances? 17 Positively address gender imbalances in the health sector? 18 Include less privileged potential beneficiaries? (i.e., youths, disabled persons, child headed households, the poorest). 19 Include disadvantaged and vulnerable groups? (i.e., ethnic minorities, Indigenous Peoples, etc.). D Cumulative Impacts – in the project area will there be: 20 Any current or planned development with similar impacts 21 Any current or planned development with potential to negatively impact on the environmental and social performance of the project E Exclusion Criteria– Will the project activity (including procurement of laboratory chemicals or materials) 22 Result in Laboratory activities that may require Biosafety Levels 3 (BSL-3) or 4 (BSL-4) lab facilities. 23 Cause activities that have high probability of causing serious adverse effects to human health and/or the environment not related to treatment of COVID-19 cases 24 Acquisition of land and physical or economic displacement of people Page | 278 Yes No ESMF Guidance/ Comment 25 Block the access to or use of land, water points and other livelihood resources used by others 26 Encroach onto fragile ecosystems, marginal lands or important natural habitats (e.g., ecologically sensitive ecosystems; protected areas; natural habitat areas, forests and forest reserves, wetlands, national parks or game reserve; any other environmentally sensitive areas) 27 Impact on physical or intangible cultural resources of national or international importance and conservation value 28 Activities that may cause long- term, permanent and/or irreversible (e.g., loss of natural habitat) adverse impacts such as dam construction and other greenfield construction among others 29 Activities that may have adverse social impacts and may give rise to significant social conflict 30 Activities that may affect lands or rights of indigenous people or other vulnerable minorities If the answer to any of questions 13-17 is “Yes�, please include an Environmental and Social Management Plan (ESMP) with the activity’s application. If the answer to questions 22-30 is “Yes� then the project activity is ineligible for ZCERP funding/support. CERTIFICATION We certify that we have thoroughly examined all the potential adverse effects of this project activity. To the best of our knowledge, the project activity described in the application and associated planning reports (e.g., ESMF, IPP), if any, will be adequate to avoid or minimize all adverse environmental and social impacts. SIGNATURES: ……………………………………………….. …………………… EXTENSION TEAM REPRESENTATIVE DATE Page | 279 Appendix 6 Guide to Identifying and Drafting Key Checklist ESMP Contents Guide to Identifying Key ESMP Contents Will the site Activity and potential issues Status Additional references activity and/or impact include/invol ve any of the following 1. Installation [] Yes [] No See Section B below potential • Site-specific vehicular issues and/or traffic impacts: • Increase in dust and noise from activities • Waste 2. Historic building(s) and [] Yes [] No See Section C below districts • Risk of damage to known/unknown historical or archaeological sites • Acquisition of land [] Yes [] No See Section D below • Encroachment on private property • Relocation of project affected persons • Involuntary resettlement • Impacts on livelihood incomes 3. Hazardous or toxic [] Yes [] No See Section E below 67 materials • Storage, treatment, Removal or on-site or off- 67 Toxic / hazardous material includes and is not limited to asbestos, toxic paints, removal of lead paint, etc. Page | 280 site disposal of toxic and/or hazardous installation waste • Storage of machine oils and lubricants 4. Impacts on forests and/or [] Yes [] No See Section F below protected areas. • Encroachment on designated forests, buffers and /or protected areas • Disturbance of locally protected animal habitat 5. Handling / management [] Yes [] No See Section G below of medical waste • Clinical waste, sharps, pharmaceutical products (cytoxic and hazardous chemical waste), radioactive waste, organic domestic waste, non-organic domestic waste • On site or off-site disposal of medical waste 6. Traffic and Pedestrian [] Yes [] No See Section H below Safety • Site-specific vehicular traffic • Site is in a populated area ACTIVITY PARAMETER GOOD PRACTICES MITIGATION MEASURES CHECKLIST A. General Notification and 1. Appropriate PPE to be provided to the incinerator Conditions Worker Safety operator. 2. Install effective exhaust ventilation to prevent air contamination and local exhaust ventilation if necessary. Page | 281 3. There is a need to arrange for the periodic inspection of incinerator vessel integrity to detect metal cracking. 4. Training of incinerator operators of safe lifting and moving techniques for heavy or awkward loads. 5. All work will be carried out in a safe and disciplined manner designed to minimize impacts on neighboring residents and environment. 6. Workers’ PPE will comply with international good practice (always hardhats, as needed masks and safety glasses, harnesses and safety boots) 7. Measures to prevent/reduce COVID-19 contraction and transmission to others (non-workers) are required for all ESMPs. 8. Formulate an exposure control plan for blood-borne pathogens, 9. Provide staff members and visitors with information on infection control policies and procedures, 10. Establish Universal / Standard Precautions to treat all blood and other potentially infectious materials with appropriate precautions, including: 11. Immunization for staff members as necessary (e.g. vaccination for hepatitis B virus) 12. Use of appropriate PPE 13. Adequate facilities for hand washing. B. General Air Quality 1. As necessary, use debris-chutes above the first floor Installation 2. Keep any debris in controlled area and spray water mist Activities to reduce debris dust 3. Suppress dust during pneumatic drilling/wall destruction by ongoing water spraying and/or installing dust screen enclosures at site as necessary 4. Keep surrounding environment (sidewalks, roads) free of debris to minimize dust 5. There will be no open burning of waste material at the site Page | 282 Noise 1. Construction noise will be limited to restricted times agreed to in the permit 2. During operation, the engine covers of generators, air compressors and other powered mechanical equipment should be closed, and equipment placed as far away from residential areas as possible Water Quality 1. The site will establish appropriate erosion and sediment control measures such as e.g., hay bales and / or silt fences to prevent sediment from moving off site and causing excessive turbidity in nearby streams and rivers as necessary. Waste 1. Waste collection and disposal pathways and sites will be management identified for all major waste types expected from installation activities. 2. Installation wastes will be separated from general refuse, organic, liquid, and chemical wastes by on-site sorting and stored in appropriate containers as necessary. 3. As necessary, installation waste will be collected and disposed properly by licensed collectors. 4. The records of waste disposal will be maintained as proof of proper management as designed. 5. Whenever feasible the contractor will reuse and recycle appropriate and viable materials (except asbestos) 6. Each facility participating in COVID-19 vaccine deployment activities is required to prepare and implement an approved ICWMP in accordance with the requirements of this ESMF C. Historic Cultural Heritage 1. If the activity takes place in or is very close to a building(s) designated historic structure or site, or located in a designated historic district, notify, and obtain approval/permits from local authorities and ensure all activities take place in line with local and national Page | 283 legislation. Any such activity’s screening will require a No Objection from the World Bank. 2. Ensure that provisions are put in place so that artifacts or other possible “chance-finds� encountered in excavation for installation are safeguarded, officials contacted immediately, and activities delayed or modified to account for such finds. D. Land Acquisition 1. This is not permitted under this project Acquisition Plan/Framework of land E. Toxic Asbestos See Appendix 14 for further guidance. Materials management 1. If asbestos is located on the project site, clearly identify and secure as hazardous material 2. When possible, the asbestos will be appropriately contained and sealed to minimize exposure 3. The asbestos, prior to removal (if removal is necessary), will be treated with a wetting agent to minimize asbestos dust 4. Asbestos will be handled and disposed by skilled and experienced professionals 5. If asbestos material is to be stored temporarily, the waste should be securely enclosed inside closed containers, marked appropriately and left in such a state so as to discourage scavengers and reuse 6. The removed asbestos will not be reused Toxic / 1. Temporarily storage on site of all hazardous or toxic hazardous waste substances will be in safe containers labeled with details management of composition, properties, and handling information 2. The containers of hazardous substances should be placed in a leak-proof container to prevent spillage and leaching Page | 284 3. The waste is transported by specially licensed carriers and disposed of in a licensed facility. Obtain any necessary licenses/permits prior to use of any such Transporter and follow requirements of the project ICWMP. For contracted Transporters, all EHS requirements are to be specific in-service contract. PIE to verify license/permit. 4. Waste containing heavy meatal is inertised and sent to safe storage site designed for final disposal of hazardous waste and / or transported to specialized facilities for metal recovery. 5. Paints with toxic ingredients or solvents or lead-based paints will not be used. Historically • Limiting or preventing access to contaminant by receptors (actions targeted at the receptor may include contaminated signage with instructions, fencing, or site security) soils • Imposing health advisory or prohibiting certain practices leading to exposure such as fishing, crab trapping, shellfish collection • Educating receptors (people) to modify behaviour to reduce exposure (e.g., improved work practices, and use of protective clothing and equipment) • Providing an alternative water supply to replace, for example, a contaminated groundwater supply well • Capping contaminated soil with at least 1m of clean soil to prevent human contact, as well as plant root or small mammal penetration into contaminated soils • Paving over contaminated soil as an interim measure to negate the pathway of direct contact or dust generation • and inhalation • Using an interception trench and pump, and treat technologies to prevent contaminated groundwater from discharging into fish streams • In situ biological treatment (aerobic and/or aerobic) In situ physical/chemical treatment (e.g., air sparging, zero- valent iron permeable reactive barrier) • Ex situ biological, physical, and or chemical treatment (i.e., groundwater extraction and treatment) Page | 285 • Containment (e.g., slurry wall or sheet pile barrier) • Natural attenuation F. Affects Protection 1. All recognized natural habitats, protected, vulnerable or forests sensitive areas in the immediate vicinity of the activity and/or will not be damaged or exploited. All staff will be strictly protected prohibited from hunting, foraging, logging or other areas damaging activities. 2. For large trees in the vicinity of the activity, mark and cordon off with a fence, protect the root system and avoid any damage to the trees 3. Adjacent wetlands and streams will be protected from installation site or vehicle fueling/servicing or waste run- off with appropriate erosion and sediment control features to include, but not limited to hay bales, silt fences and the like. 4. There will be no waste dumps in adjacent areas, especially not in protected areas. G. Disposal of Infrastructure 1. In compliance with national regulations the project will medical for medical ensure that activities supported by the project that will waste waste produce infectious medical waste include sufficient management infrastructure for medical waste handling and disposal. Such activities or facilities must develop their own ICWMP specifying sharps management. The infrastructure should include, but is not limited to: ▪ Special facilities for segregated healthcare waste (including soiled instruments “sharps�, and human tissue or fluids) from other waste disposal: a. Clinical waste: yellow bags and containers b. Sharps – Special puncture resistant containers/boxes c. Domestic waste (non-organic): black bags and containers Page | 286 ▪ Appropriate storage facilities for medical waste are in place; and ▪ If the activity includes facility-based treatment, appropriate disposal options are in place and operational ▪ All regulatory permits. Compliance with all ESMF and ICWMP requirements. EHS requirements established in contract if third-party service provider. Verified by PIE. H. Traffic and Direct or indirect 2. In compliance with national regulations, the contractor Pedestrian hazards to public will ensure that the installation site is properly secured Safety traffic and and project-related traffic regulated. This includes, but is pedestrians by not limited to: construction ▪ Signposting, warning signs, barriers and traffic diversions: activities sites will be clearly visible and the public warned of all potential hazards as appropriate ▪ Traffic management system and staff training, especially for site access and near-site heavy traffic. Provision of safe passages and crossings for pedestrians where installation interferes with traffic. • Emphasizing safety aspects among drivers • Improving driving skills and requiring licensing of drivers • Adopting limits for trip duration and arranging driver rosters to avoid overtiredness • Avoiding dangerous routes and times of day to reduce the risk of accidents • Use of speed control devices (governors) on trucks, and remote monitoring of driver actions • Regular maintenance of vehicles and use of manufacturer approved parts to minimize potentially serious accidents caused by equipment malfunction or premature failure. ▪ ▪ Ensuring safe and continuous access to office facilities, shops and residences during installation activities, if the buildings stay open to the public. [2] Toxic / hazardous material includes and is not limited to asbestos, toxic paints, removal of lead paint, etc. Page | 287 Appendix 7 E & S General Supervision Checklist Environmental and Social Safeguards Implementation Ensure that documentation on specific sites and project activities, environmental and social impacts monitoring reports, and reports on the status of safeguards implementation are furnished to the mission team at or before the kick-off meeting. • Meet with key beneficiaries and other stakeholders, • Review a random sample of project activities, making sure all safeguard issues are evaluated, • Get an overview of all the project activities and their categories in terms of impacts, • Identify projects with applicable environment safeguards, • Identify projects with applicable social safeguards, • Based on the reports, determine projects that have potential critical safeguards issues, and focus on those, • Discuss findings and significant noncompliance issues if any with the TTL and agree on correcting actions, • Assess the project’s experience in managing social and environmental risks, • Field visits to review recently completed project activities, where possible review project proposals and impact monitoring records, • Assess the use of environmental and social screening checklists contained in the Environmental and Social Management Framework (ESMF) for proposed project activities/investments, • Assess implementing agencies’ awareness and use of the ESMF and the ICWMP, Page | 288 • Find out if there is an established ESMF/ICWMP monitoring and tracking system to ensure effective oversight of project activities at the national level, • Identify weaknesses in procedures, internal control mechanisms, supervision, and post reviews, • Has there been/Is there any training plan to improve the awareness and capacity of implementing agencies on the use of the ESMF and ICWMP, • Assess the project activity implementer’s capacity and commitment to plan and implement safeguard policy issues, • Make practical recommendations for the project activity-specific action plans, • Assess the impacts from any changes in the project design or new components. If required agree upon a revised safeguards management plan, monitoring and reporting requirements, • Agree with the PIE on additional measures required, and if non-compliance or unresolved safeguards issues remain, establish a plan for follow on supervision. Methodology: • Examine project activity design, review and approval process, social and environmental safeguards compliance, quality, and effectiveness of project outputs. Page | 289 Appendix 8 Environmental and Social Guidelines for Contractors The guidelines: • Cover provisions for proper management of construction sites, safe storage of construction materials and safe disposal of wastes, • Will be included in the bidding documents and eventually be part of the contract document. (This guideline to be used in conjunction with Appendix 4, Code of Conduct for Contractors). General Considerations • The contractor shall follow the World Bank Group Environment, Health and Safety Guidelines which should become the basis for preparing the EHS Plan. For details, please refer to: www.ifc.org/EHSguidelines, • The contractor in all his activities ensure maximum protection of the environment and the socio-economic wellbeing of the people affected by the project, whether within or outside the physical boundaries of the project area, • Before any construction works begin, the contractor shall ensure that the relevant environmental and land acquisition certificates of authorization for the works have been obtained from the relevant authorities, • In general, the contractor should become familiar with the environmental and social screening process. The contractor shall work in cooperation and in coordination with the Project Management Team and/or any other authority appointed to perform or to ensure that the social and environmental work is performed according to the provisions of the safeguards documents, • The contractor shall pay close attention to health and safety requirements for workers who must wear protective clothing if required. The artisan should also ensure the health and safety of the community adjoining any construction areas, • The contractor must ensure that all COVID -19 protocols are adhered to and orient all staff about COVID-19 protection requirements. The following must be enforced: o Always maintain physical distance of 2 meters (6’) from others, o always wearing masks, o Regular hand washing, o Minimum conducting of activities at proximity, o Segregating construction crews and allocating tasks so that they do not overlap, o establishing crew shifts to be also applied for break, and lunch, Page | 290 o Meetings on site should be always avoided, o Instruction to workers should be given in open spaces and maintaining physical distance. • In case of a chance finds of archaeological materials the contractor must adhere to the chance-find procedures (Appendix 1), which will also be part of the contract, • The contractor shall always keep on site and make available to Environmental Inspectors or any authorized persons, copies of the ESMPs for the monitoring and evaluation of environmental and social impacts and the level or progress of their mitigation, • The contractor shall ensure that construction materials such as sand, quarry stone, soils or any other construction materials are acquired from approved suppliers and that the production of these materials by the suppliers or the contractor does not violate the environmental regulations or procedures. The contractor will restore any extraction sites prior to completing works. Site restoration is considered as part of works, • The movement and transportation of construction materials to and within the construction sites shall be done in a manner that generates minimum impacts on the environment and on the community, as required by the ESMP, • Construction materials shall be stored in a manner to ensure that: o There is no obstruction of service roads, passages, driveways, and footpaths, o Where it is unavoidable to obstruct any of the service paths, the contractor shall provide temporary or alternate by-passes without inconveniencing the flow of traffic or pedestrians, o There is no obstruction of drainage channels and natural water courses, o There is no contamination of surface water, ground water or the ground, o There is no access by public or unauthorized persons, to materials and equipment storage areas, o There is no access by staff, without appropriate protective clothing, to materials and equipment storage areas, o Access by public or unauthorized persons, to hazardous, corrosive, or poisonous substances including asbestos lagging, sludge, chemicals, solvents, oils, or their receptacles such as boxes, drums, sacks, and bags is prohibited, • Access by staff, without the appropriate protective clothing, to hazardous, corrosive, or poisonous substances including asbestos lagging, sludge, chemicals, solvents, oils, or their receptacles such as boxes, drums, sacks, and bags is prohibited. • Construction waste includes but is not limited to combustion products, dust, metals, rubble, timber, water, wastewater, and oil. Hence construction waste constitutes solid, liquid, and gaseous waste and smoke, • In performing his activities, the contractor shall use the best practical means for preventing emissions of noxious or offensive substances into the air, land, and water. He shall make every effort to render any such emissions (if unavoidable) inoffensive and harmless to people and the environment. The means to be used for making the emissions harmless or for preventing the emissions shall be in accordance with the ESMPs and with the approval of the relevant Local Authority or EMA, Page | 291 • The contractor shall comply with the regulations for disposal of construction/demolition wastes, wastewater, combustion products, dust, metals, rubble, and timber. Wastewater treatment and discharge will conform to the applicable regulations by the relevant guidelines, • Asbestos wastes, PCBs and other hazardous wastes shall be treated and disposed of in conformity with the national regulations and World Bank Group standards where applicable, with the supervision of qualified personnel, • The contractor shall protect the health and safety of workers by providing the necessary and approved protective clothing (to include at a minimum safety boot (with steel toe cap), hard hat and high visibility vest. Eye and ear protection will be required if operating power tools and dust masks if mixing concrete on site) and by instituting procedures and practices that protect the workers from dangerous operations. The contractor shall be guided by and shall adhere to the relevant national Labour Regulations for the protection of workers. Appropriate information and awareness on HIV/AIDS shall be conducted at each construction site. Page | 292 Appendix 9 Templates for Environmental & Social Monitoring Plans The following is the template environmental and social monitoring plan for i) solar panel Installation, ii) solar power drive refrigerator installation and iii) minor renovations for the maternity waiting homes, and operating theatres. Project activity proponents or contractors should identify the pertinent matters based on their PIE approved ESMP, delete any that are irrelevant and add any that are necessary but missing in the template. Page | 293 Table APP 9.1 Environmental Monitoring Template for Installation and Fuelling/Maintenance Activities RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN POSITIVE INDICATOR FREQUENCY AUTHORITIES 1. Noise Noise monitoring should be carried out • Noise Levels • Noise levels at the nearest Quarterly and • PIE on an ad-hoc basis by the Environmental sensitive receiver would ongoing as project Officer from EMA to monitor noise levels be kept to a minimum so is implemented. • MoHCC in the work areas. The relevant noise as not to disturb the piece • EIA Department of level standards are in the General EHSG. of the patients. EMA • Level of noise complying with the work time (7am- 6pm) 4. Air Observations should be made on the • Levels of dust • Deposition of dust on Quarterly • EMA Pollution level of dust generated during the emissions surfaces should decrease renovation and rehabilitation activities • MoHCC with increased by the Environmental Monitor or PIE. dampening • PIE Dampening should be carried out if levels • Level of pollution vs are unacceptable. national and WB • RDCs standard • Number of speed control ramps with appropriate road signs in case of roads 6. Complaints The PIE should inspect the record of • Complaints Speed with which PIE Quarterly • PIE complaints made by residents, to be kept resolves cases, Conforming by the beneficiaries, and should check with the stipulations of 3 • MoHCC that action is taken quickly and that the working days for priority 1 Page | 294 RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN POSITIVE INDICATOR FREQUENCY AUTHORITIES number of complaints does not rise and 3 working weeks for • RDCs significantly. The GRM should be priority 2. employed. • EIA Department Page | 295 Table APP 9.2 Environmental Monitoring Template for Vaccinations RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN INDICATOR FREQUENCY AUTHORITIES 1. AEFI Get the numbers from MCAZ • Health of vaccination Number and types of cases quarterly and • PIE recipients among staff. ongoing as project is implemented • MoHCC • • RDCs • Local Leadership 2. Medical Waste and • The PIE Environmental• Hazardous materials • Number of facilities• Quarterly and • PIE Hazardous materials Specialist must ensure that all used and generated implementing ICWMP ongoing as the Management Health Facilities are aware of during the provision requirements. Health Care • MoHCC - the developed ICWMP and of COVID-19 • Facilities are Environmental Number of Incinerators Health Dept. start implementing it. diagnosis, care, and and other treatment operating. • All Health Facilities must make treatment services facilities working properly. • Health Facility sure their waste treatment • Hazardous • Number of HCW trained in facilities are operating well or Laboratory reagents handling Home Based • Local EMA Officer that the waste is transported such as Health Care Waste. to the nearest facility with a formaldehyde, at• Availability of hazardous functional Incinerator. Health care centres material management procedures and • procedures for reporting of incidents. Page | 296 RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN INDICATOR FREQUENCY AUTHORITIES • The PIE, MOHCC and EMA to • Hazardous waste • Number of facilities with• Ongoing during • PIE check availability of treatment and hazardous waste project • MOHCC incinerator licences at facility disposal incinerator licences implementation level • Hazardous waste • Percentage of Facilities • EMA • The PIE, MOHCC and EMA to transportation with appropriate PPE for check availability hazardous • Handling and incinerator operators waste transportation licences Operation of the • PIE to check on availability of incinerator appropriate PPE for Incinerator operators • PIE, MOHCC and EMA to • Contamination of • Number of facilities with• Ongoing • PIE screen facilities for historical land due to past and past and present land contamination of land present improper contamination • MOHCC hazardous waste • EMA disposal 3. Exclusion of • PIE will check and make sure • The poor, elderly,• Number of programme• quarterly and • PIE Vulnerable people that vulnerable groups are indigenous peoples, packages geared to reach ongoing as the being catered for in each and people living out to the vulnerable. Health Care • MoHCC - Environmental Health facility by checking the with a disability with • Availability of Clear Facilities are numbers being served no access to social operating Health Dept. Communication materials • PIE will follow-up in areas media. targeting the vulnerable. • Health Facility known to have IPs to make • testing and treatment • Vulnerable people in • sure they are catered for. centres being disability remote areas. inclusive Page | 297 RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN INDICATOR FREQUENCY AUTHORITIES 4. Staff Contracting • PIE will make sure that there • Provision of• Number of staff with• continuous and • PIE COVID-19 at work is continuous regular testing appropriate and COVID-19 quarterly • MoHCC of all staff involved in COVID adequate PPE for all• Safety precautions being testing (including staff administering diagnosis and treatment. staff including VHWs. enforced • Health Facility • Records of these tests should • Number and adequacy of vaccines, cleaners, • Knowledge of Safety be shared with PIE for its PPE available etc.) precautions by assessments. • Number of accidental workers • The PIE will make sure that pricks (of staff) all workers are trained on • OHS issues • Number of staff trained in special occupational health special COVID-19 and safety guidelines and • Personal Hygiene for occupational health and practices to follow during staff safety guidelines and the COVID-19 crisis in line • Protective measures practices with WB & WHO guidelines. for staff. 5. Water Pollution • The PIE Environmental • Discharge of poor-• Level of Management at• continuous and • PIE Environmental Specialist together with the quality effluents into Laboratories quarterly Specialist. Environmental Health the environment • Quality Monitoring of • MoHCC - department of MoHCC will do water bodies close to continuous inspections of • Waste storage poor facility Environmental and getting washed Health Dept. facilities to check if there any • Level of maintenance of unexpected discharges of away chemical storage areas • Health Facility effluents into the • Accidental release of• Availability of spill environment. hazardous solvents mitigation equipment. • PIE will ensure that from laboratories Environmental Health department of MoHCC is Page | 298 RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN INDICATOR FREQUENCY AUTHORITIES continuously monitoring the drugs and chemicals storage facilities. 7. Sanitation • Facilities to report any • Poor sanitary • Provision of safe water,• quarterly • PIE deviations or agreed follow-up conditions at sanitation, and hygienic • MoHCC - matters from the facility vaccination centres conditions related to ICWMP. related to vaccination services. Environmental vaccination services. Health Dept. • Availability of enhanced • Health Facility • Improper cleaning arrangements, management of including deep cleaning wastewater related related to vaccination to vaccination services. services. • Availability of proper PPE for cleaning staff for vaccination services. 8. Complaints The PIE should inspect the record • Complaints Number of Cases resolved quarterly • PIE Social Safeguards of complaints made by residents, within stipulated time frame Specialist. to be kept by the beneficiaries, of 3 working days for priority and should check that action is 1 and 3 working weeks for • MoHCC taken quickly and that the priority 2. • EIA Department. number of complaints does not rise significantly. The GRM should be employed. Page | 299 RESPONSIBLE No. ISSUE METHOD OF MONITORING AREAS OF CONCERN INDICATOR FREQUENCY AUTHORITIES Page | 300 Appendix 10 Expected Laboratory Safety Features and Checklist Laboratories receiving support under the project (including procurement of reagents or materials) are encouraged to complete this checklist, using it as a self-audit to help ensure that personnel are proactively addressing concerns about chemical hazards and potential health exposures. The National Microbiology Reference Laboratory (NMRL) expected to be supported is deemed to have biosafety level (BSL) 3 because of the nature of its equipment. District and provincial labs by virtue of the nature of their equipment are considered to have biosafety level 2 containment. Genomic sequencing requires BSL-2. The checklist below contains safety considerations for BSL-2 labs therefore in meeting these standards which are more stringent, a lab will adequately meet the needs of the BSL-1 and 2 activities allowed under the project. Outlined below are basic rules for operating a laboratory at BSL-2. This is not comprehensive. Refer to the references below for additional rules that may apply to the lab’s specific research and activities. After the BSL-2 Checklist is the BSL-3 Checklist which only applies to the NMRL as no project activities must require any BSL above 2. All requirements in each checklist are superseded by World Bank Environment, Health and Safety Guidelines which prevail in any conflict. The Principal Investigator (PI) is ultimately responsible for the enforcement of these practices. Contact an EH&S biosafety officer for assistance. BSL-2 Checklist68 FACILITY ROOM #s PRINCIPAL INVESTIGATOR (PI) PI PHONE # PERSON COMPLETING CHECKLIST: ____________________________ No. CHECKLIST ISSUE POTENTIAL MITIGATION MEASURES 1.0 Access 68Source is BIOSAFETY LEVEL 2 (BSL-2) LABORATORY PRACTICES, BSL2-info.pdf (washington.edu) accessed Oct 5, 2022. Page | 301 1.1 Keep lab doors closed and post a BSL-2 (or BSL-3 if this is for the NMRL) biohazard warning sign while infectious agents are in use. 1.2 Store infectious agents in a lockable freezer or lab room. 2.0 Training Checklist 2.1 Do laboratory personnel receive specific laboratory safety instruction for the activities they are involved with? The PI and lab staff must complete EH&S Biosafety training every three years. The PI must ensure and document lab-specific biosafety training and demonstrated proficiency for lab personnel. 2.2 The EH&S Bloodborne Pathogens training is required if working with human source material or bloodborne pathogens (e.g., Hepatitis C Virus, HIV). 3.0 Facilities 3.1 Chairs and other furniture are covered in a non-fabric, non-porous material that can easily be decontaminated. . 3.2 No carpets or rugs permitted. 3.3 A sink for hand washing must be available. 4.0 Aerosol Containment 4.1 Perform aerosol-generating procedures (e.g., vortexing, sonicating, pipetting, harvesting infected tissues from animals) inside a certified biological safety cabinet (BSC). 5.0 Decontamination 5.1 Decontaminate all cultures, stocks, biohazardous waste, and other potentially infectious materials prior to disposal using an appropriate method such as autoclaving or chemical disinfection. Decontaminate work surfaces and lab equipment after completion of work and after spills or splashes. 6.0 Sharps 6.1 Collect sharps in a red plastic sharps container. If needles are used, do not bend, shear, break, recap, or otherwise manipulate by hand before disposal. Package non-disposable sharps in a hard-sided container for decontamination. 7.0 Personal Protective Equipment (PPE) Checklist 7.1 Are laboratory staff supplied with the following standard BSL-2 PPE to be worn when working with infectious agents: gloves, eye protection and dedicated lab coats. Page | 302 Other PPE may be required based on specific lab activities. PPE is not to be worn in public areas. 8.0 Transport 8.1 Place biohazardous waste in a leak-proof secondary container labeled with a biohazard symbol. 8.2 Decontaminate the outside of the container prior to transport since PPE should not be needed for transport 9.0 Emergency Preparedness Checklist 9.1 Are there emergency eyewashes at the Laboratory? 9.2 Are there emergency showers at the Laboratory? 9.3 is there someone responsible for flushing the eyewashes each week? 9.4 Is there a protocol for dealing with an accidental exposure to a hazardous chemical? BSL-3 Checklist This checklist is only for the NMRL. FACILITY: NMRL ROOM #s PRINCIPAL INVESTIGATOR (PI) PI PHONE # PERSON COMPLETING CHECKLIST DATE OF LAST PLAN REVISION Page | 303 No. CHECKLIST ISSUE POTENTIAL MITIGATION MEASURES 1.0 Experiment Planning, SOP Checklist Is an approval required before conducting an experiment? 1.1 Are chemical experiments thoroughly researched before they are applied? 1.2 Are the resources used for planning experiments and bench-top operations readily available? 2.0 Training Checklist 2.1 Do laboratory personnel receive specific laboratory safety instruction for the activities they are involved with? 2.2 Have all laboratory staff obtained formal hazardous waste/material training from a recognized accreditation body? 3.0 Chemical Inventory, Storage, Labelling Checklist 3.1 Is the chemical inventory kept completed, up to date, and available for inspection? 3.2 Are chemical reagents segregated by compatibility/reactivity? 3.3 Are hazardous liquids stored in secondary containment? 3.4 Are all chemicals and solutions properly labelled? 4.0 Hazardous Waste Checklist 4.1 is hazardous waste being properly collected and managed? Page | 304 No. CHECKLIST ISSUE POTENTIAL MITIGATION MEASURES 4.2 Is the hazardous waste inspection log being checked weekly? 4.3 are old, unwanted, or expired chemicals are promptly submitted for proper disposal? 5.0 Chemical Hazard Information checklist 5.1 Are hard copies of Material Safety Data Sheets (MSDS) and other chemical hazard information located where its accessible to all staff? 5.2 Is there a readily accessible computer/printer that all staff can use to internet access any additional chemical hazard resources and MSDS? 5.3 Are all staff made aware of useful web links? 6.0 Ventilation checklist 6.1 Are there sufficient, operational chemical fume hood(s), located in the laboratories? 6.2 Are the fume hoods working properly? 6.3 Is there a routine of maintaining the fume hoods? 6.4 Are all hazardous chemicals used inside the fume hood(s)? 6.5 If not sure whether a particular chemical must be used in a hood rather than on the bench-top, is there a way we ask or look up toxicity and other information? Page | 305 No. CHECKLIST ISSUE POTENTIAL MITIGATION MEASURES 7.0 Personal Protective Equipment (PPE) Checklist 7.1 Are laboratory staff supplied with the following PPE: gloves, goggles, aprons, lab coats, face shields and other PPE? 7.2 s information about which PPE is suitable for different chemicals readily available? 7.3 Is there a “work-related health� contact person at the laboratory? 8.0 Emergency Preparedness Checklist 8.1 Are there emergency eyewashes at the Laboratory? 8.2 Are there emergency showers at the Laboratory? 8.3 is there someone responsible for flushing the eyewashes each week? 8.4 Are there emergency contingency plans, strategically posted around the laboratories? 8.5 Are means of communication readily accessible, e.g., telephones? 8.6 Is there emergency spill equipment at the laboratories? 8.7 Are the nearest fire alarm pull stations conveniently located? 8.9 Are there fire extinguishers in the laboratories? 8.10 Is there a protocol for dealing with an accidental exposure to a hazardous chemical? Page | 306 No. CHECKLIST ISSUE POTENTIAL MITIGATION MEASURES Page | 307 Appendix 11 Requirements When Working with Asbestos Materials69 and Contaminated Land Requirements when working with asbestos A. Evaluation of alternatives 1. Determine if the project could include the installation, replacement, maintenance, or demolition of: • Roofing, siding, ducts, or wallboard • Thermal insulation on pipes, boilers, and ducts • Plaster or fireproofing • Resilient flooring materials • Other potentially asbestos-containing materials 3. In many cases, it can be presumed that ACM are part of the existing infrastructure that must be disturbed. If there is a need to analyse samples of existing material to see if it contains asbestos, provide information on how and where that can be arranged. 4. Once the presence of ACM in the existing infrastructure has been presumed or confirmed and their disturbance is shown to be unavoidable, incorporate the following requirements in tenders for construction work in compliance with applicable laws and regulations. B. Understanding the regulatory framework 1. Review the host country laws and regulations and the international obligations it may have entered (e.g., ILO, Basel conventions) for controlling worker and environmental exposure to asbestos in construction work and waste disposal where ACM are present. Determine how the qualifications of contractors and workers who maintain and remove ACM are established, measured, and enforced. 2. Determine whether licensing and permitting of the work by authorities is required. 3. Review how removed ACM are to be disposed of to minimize the potential for pollution, scavenging, and reuse. 4. Incorporate the following requirements in tenders involving removal, repair, and disposal of ACM. C. Considerations and possible operational requirements related to works involving asbestos. 1. Contractor qualification • Require that contractors demonstrate having experience and capability to observe international good practice standards with asbestos, including training of workers and supervisors, possession of (or means of access to) adequate equipment and supplies for the scope of envisioned works, and a record of compliance with regulations on previous work. 2. Related to the technical requirements for the works 69 World Bank, Operations Policy, and Country Services Page | 308 • Require that the removal, repair, and disposal of ACM shall be carried out in a way that minimizes worker and community asbestos exposure and require the selected contractor to develop and submit a plan, subject to the engineer’s acceptance, before doing so. • Describe the work in detail in plans and specifications prepared for the specific site and project, including but not limited to the following: - Containment of interior areas where removal will occur in a negative pressure enclosure, - Protection of walls, floors, and other surfaces with plastic sheeting, - Construction of decontamination facilities for workers and equipment, - Removing the ACM using wet methods, and promptly placing the material in impermeable containers, - Final clean-up with special vacuums and dismantling of the enclosure and decontamination facilities, - Disposal of the removed ACM and contaminated materials in an approved landfill, - Inspection and air monitoring as the work progresses, as well as final air sampling for clearance, by an entity independent of the contractor removing the ACM. • Other requirements for specific types of ACM, configurations and characteristics of buildings or facilities, and other factors affecting the work shall be enumerated in the plans and specifications. Applicable regulations and consensus standards shall be specifically enumerated. 3. Related to contract clauses • Require that the selected contractor provide adequate protection to its personnel handling asbestos, including respirators and disposable clothing. • Require that the selected contractor notifies the relevant authorities of the removal and disposal according to applicable regulations as indicated in the technical requirements and cooperates fully with representatives of the relevant agency during all inspections and inquiries. 4. Related to training and capacity building • Determine whether specialist industrial hygiene expertise should be hired to assure that local contractors learn about and apply proper protective measures in work with ACM in existing structures. D. Guidance for prevention, minimization, and control of impacts from ACM • Avoiding the use of asbestos containing materials (ACM) in renovation activities. • Undertaking an asbestos/hazardous products audit prior to/at the beginning of the refurbishment. • If asbestos is located on the project site, mark clearly as hazardous material. When possible, the asbestos will be appropriately contained and sealed to minimize exposure. The asbestos prior to removal (if removal is necessary) will be treated with a wetting agent to minimize asbestos dust Page | 309 • Use of specially trained personnel to identify and selectively remove potentially hazardous materials (ACMs) in building elements prior to dismantling or demolition, • Repair or removal and disposal of existing ACM in buildings should only be performed by specially trained personnel, following, internationally recognized procedures. (WB, 2007) • If asbestos material is be stored temporarily, the wastes should be securely enclosed inside closed containments and marked appropriately. • Managing the treatment and disposal of ACMs according to Sections 1.5 and 1.6 on Hazardous Materials and Hazardous Waste Management, respectively. • Transporting ACM in leak-tight containers to a secure landfill operated in a manner that precludes air and water contamination that could result from ruptured containers. (WB, 2007) • The removed asbestos will not be reused. E. REQUIREMENTS WHEN WORKING CONTAMINATED SOILS This section provides a summary of management approaches for land contamination due to anthropogenic releases of hazardous materials, wastes, or oil, including naturally occurring substances. Releases of these materials may be the result of historic or current site activities, including, but not limited to, accidents during their handling and storage, or due to their poor management or disposal. Contaminated land is of concern because of the potential risks to human health and ecology, and the liability it may pose to the polluter/ health facility owners. Contamination of land should be managed to avoid risk to health and ecological receptors. The preferred strategy for land decontamination is to reduce the level of contamination at the site while preventing the human exposure to contamination. When the three risk factors are present (despite limited data) under current or foreseeable future conditions, the following steps should be followed: 1. Risk screening This step is also known as “problem formulation� for environmental risk assessment. Where there is potential evidence of contamination at a site, the following steps are recommended: Identification of the location of suspected highest level of contamination through a combination of visual and historical operational information; Sampling and testing of the contaminated media (soils or water) according to established technical methods applicable to suspected type of contaminant Evaluation of the analytical results against the local and national contaminated sites regulations. In the absence of such regulations or environmental standards, other sources of risk-based standards or guidelines should be consulted to obtain comprehensive criteria for screening soil concentrations of pollutants. Verification of the potential human and/or ecological receptors and exposure pathways relevant to the site in question 2. Interim risk management Page | 310 Interim risk management actions should be implemented at any phase of the project life cycle if the presence of land contamination poses an “imminent hazard�, i.e., representing an immediate risk to human health and the environment if contamination were allowed to continue, even a short period of time. 3. Detailed quantitative risk assessment, and As an alternative to complying with numerical standards or preliminary remediation goals, and depending on local regulatory requirements, a detailed site-specific, environmental risk assessment may be used to develop strategies that yield acceptable health risks, while achieving low level contamination on-site. An assessment of contaminant risks needs to be considered in the context of current and future land use, and development scenarios 4. Permanent risk reduction measures. The underlying principle is to reduce, eliminate, or control any or all the three risk factors. Regardless of the management options selected, the action plan would include, whenever possible, contaminant source reduction (i.e., net improvement of the site) as part of the overall strategy towards managing health risks at contaminated sites, as this alone provides for improved environmental quality. The mitigation measures would include ground water, surface water and leachate management, risk mitigation measures for receptors, and pathways. 5. Occupational Health Safety Considerations Investigation and remediation of contaminated lands requires that workers be mindful of the occupational exposures that could arise from working in close contact with contaminated soil or other environmental media (e.g., groundwater, wastewater, sediments, and soil vapor). Occupational health and safety precautions should be exercised to minimize exposure, as described in Section 2 on Occupational Health and Safety. In addition, workers on contaminated sites should receive special health and safety training specific to contaminated site investigation and remediation activities. Page | 311 Appendix 12 Gender Based Violence and Sexual Exploitation Abuse and Harassment Action Plan for the HSDSP AF V and ZCEREHSP Projects This Action Plan is derived from a review of every recommendation presented in the ESMF and for activities to mitigate any social risks that may arise during implementation of the two projects. The primary actions include: - Development of materials that incorporate or raise awareness of GBV/SEA-H - Build capacity of health care workers, contractors, and communities on GBV and SEA and H. - Raise awareness on reporting of GBV/SEA-H such as well as referrals - Strengthen operational processes to address GBV/SEA and H - Raise awareness internally and externally - Ensure continuous learning to improve capacity to address GBV/SEA-H issues during project implementation and beyond Detailed activities derived from these broad thematic areas are presented below. Gender Based Violence and Sexual Exploitation Abuse and Harassment Plan- January 2022- April 2023 Thematic Area Detailed activity Timeline Responsible person Build capacity of - Train contractors on GBV/SEA-H Social Safeguards health care upon engagement and Code of As soon as Specialist, workers, Conduct (CoC) requirements they are Environmental contractors, and contracted Specialist and communities on On-going Communications GBV/SEA-H Specialist Page | 312 Thematic Area Detailed activity Timeline Responsible person - Train and sensitize community and Q1 2022 project workers on GBV/ SEA-H - Workers to affirm CoC - training of staff on SEA-H risks Q4 2021- Q1 2022 Raise awareness - Incorporate GBV/SEA-H in all On-going Environmental internally and planned ESMF trainings as well as Specialist, Social externally RCCE activities Safeguards Specialist and Communication Specialist and Cordaid Staff - Conduct Community discussion Q1-4 2022 Social Safeguards forums with local and traditional Specialist and leaders, school heads to share Communication information about GBV, SEA-H and Specialist GRM (priority for the Tshwa and Doma districts) - Conduct sensitization meeting Q1-2, 2022 Social Safeguards with influencers Specialist and - Conduct meetings with local level Communication referral pathway players Specialist - Incorporate GBV/SEA-H messaging Q1-2, 2022 Communication and awareness in interpersonal Specialist communication campaigns (IPC) planned under the COVID-19 component - Promote early reporting and Q1 2022- Social Safeguards community psychosocial support Q22023 Specialist and for victims of GBV/SEA/SH Communication including linkages/referrals to care Specialist Strengthen - Inclusion of GBV/SEA-H in the Q4 2021- Social Safeguards operational current development of the GRM Q1 2022, Specialist processes to system address GBV/SEA- - forge strategic alliances with local Q1 2022-Q2 Team leader, Social H women’s support groups, 2023 Safeguards Specialist organizations and institutions that and Communication can provide the timely and Specialist immediate support that girls and women require - The project will identify and work with already existing GBV-SEA/H service providers (health, Mapping of phycological & legal) in the project referral pathways area and ensure that GBV-SEA/H referral pathway is operation. Page | 313 Thematic Area Detailed activity Timeline Responsible person - Review of existing GBV-SEA/H service provider referral lists - Disseminate the referral pathways to stakeholders, including service providers Development of - Inclusion of GBV/SEA-H in project Q1-2022 Communication IEC material on IEC materials to be produced under Specialist GBV/SEA-H Urban Voucher and Q2 for Rural RBF Incorporate GBV- Where ESMPs are developed, incorporate Ongoing Env Specialist and SEA/H risk in consideration for GBV/SEA/H in the ESMP Social Safeguards Project ESMPs Specialist Appendix 13 Vaccine Emergency Preparedness and Response A. Prevention and Preparation: Preventing a vaccine emergency is preferable to having to respond to one. The following are steps to prepare and avoid the most common Cold Chain Breaks and vaccine fridge and handling issues: 1. Check and record fridge temperatures twice daily. contact Cold Chain Technician right away for advice if temperatures go out of the +2°C to +8°C cold chain range. 2. Have a latch and/or closure-spring on the fridge door to make sure it closes properly 3. Put “Vaccine Fridge - Do Not Un-Plug� stickers on the fridge, electrical plug receptacle, and fridge circuit breaker on the electrical panel 4. Temperature-buffer (i.e. water bottles, gel blankets) in the fridge to slow temperature changes 5. Keep fridges: • away from hot equipment and out of direct sunlight • level & stable (i.e., adjust the legs if necessary) 6. Temperature adjustment: If you need to adjust the FRIDGE and/or FREEZER (even if they’re in separate compartments) temperature, to avoid making the fridge too cold/hot make only small changes, then re- check a few hours later to see the results and repeat if needed. Check the Fridge Manual if necessary to confirm how to adjust the temperature. Preparing: 7. If possible, pre-arrange an alternate, monitored fridge to move your vaccines to if needed 8. Make sure all Staff responsible for vaccine handling & fridge monitoring know the details of the Vaccine Emergency Plan, their roles in it, and where the office copy is located. B Response Steps: Responding to a Vaccine Emergency (fridge/power failure, vaccine handling issue) Page | 314 If vaccine storage temperatures go out of the +2°c to +8°C range: 1. Quarantine the exposed vaccines: • (If possible) Keep the exposed vaccine under refrigeration. If alternate refrigeration space is not available onsite then take measures to keep the vaccines cool, but not freezing, (e.g., transfer them to a transport cooler with any gel blankets/ ice packs available) • Clearly mark (tag/ label) the vaccines and fridge ‘QUARANTINE – Do Not Use Until Further Notice’ • Contact EPI Manager for guidance on the next steps to take • Maintain the Quarantine until the EPI Manager provides guidance and follow • Do not discard any vaccines regardless of their condition. If EPI Manager advises that some of the vaccines are unusable then return the exposed products to EPI programme as Cold Chain Break wastage. 2. Investigate Cause(s): Inspect and Correct (if possible) Simple Causes can be any of the following (e.g., fridge door open, power cord unplugged) correct and continue to monitor Maximum-Minimum thermometer: Is it displaying the 0C or 0F scale, the ‘OUT’ (i.e., fridge temperature) 3. Power and Fridge Failures: Vaccine temperature monitoring and recording - Maintain monitoring throughout a power/ fridge failure and/or vaccine relocation. - At the time the incident is discovered: • record ‘Maximum’ or ‘Minimum’/ and current temperature from the Maximum -Minimum thermometer then reset or clear it, and • record the date, time, and any other relevant info [e.g., observations/ causes] -Provide monitoring records/details to EPI Manager as soon as possible to ensure the quickest response possible. 4. Fridge Failure: (breakdown or running but unable to maintain temperatures between +2°C and +8°C) Transfer vaccines to either: • A monitored back-up fridge onsite, or • (If a back-up fridge is not available) a cooler box with any cold chain supplies (gel blankets, ice packs) available for transfer off-site Power failures Less than 4 hrs – keep the fridge door closed and continue to monitor temperatures More than 4 hrs – move vaccines to a running back-up, monitored fridge or, if that’s not available transfer them to a cooler box with cold chain supplies Page | 315