REPUBLIC OF BURUNDI Minister of Public Health and the fight against AIDS BURUNDI HEALTH EMERGENCY PREPAREDNESS, Response AND RESILIENCE PROJECT (P504531) USING THE MULTIPHASE PROGRAMMATIC APPROACH STAKEHOLDER ENGAGEMENT PLAN FEBRUARY 2024 1| P a g e Contents ABBREVIATIONS AND ACRONYMS .......................................................................................... 3 DEFINITION OF KEY CONCEPTS .............................................................................................. 5 1. INTRODUCTION .................................................................................................................... 7 1.1. Description of the context of the project......................................................... 7 1.2. Project description ..................................................................................................... 8 2. THE OBJECTIVES OF THE SEP .................................................................................. 11 3. SUMMARY OF PUBLIC CONSULTATIONS................................................................ 12 4. STAKEHOLDER IDENTIFICATION AND ANALYSIS ............................................. 14 4.1. Methodology ................................................................................................................ 14 4.2. Affected stakeholders .............................................................................................. 15 4.3. Other parties involved ............................................................................................ 15 4.4. Disadvantaged or vulnerable individuals or groups ................................... 16 4.5. Summary of the needs of the Project stakeholders ................................... 17 5. STAKEHOLDER ENGAGEMENT PLAN....................................................................... 19 5.1. Objectives and timeline of the stakeholder engagement program ..... 19 5.2. Proposed strategy for information dissemination ...................................... 21 5.3. Proposed strategy for consultations ................................................................. 23 5.4. Proposed strategy for taking into account the views of vulnerable groups 25 5.5. Calendars....................................................................................................................... 25 5.6. Review of comments ................................................................................................ 26 5.7. Subsequent phases of Project implementation............................................ 27 6. RESOURCES AND RESPONSIBILITIES FOR IMPLEMENTING STAKEHOLDER ENGAGEMENT ACTIVITIES ..................................................................... 27 6.1. Resources ...................................................................................................................... 27 6.2. Management functions and responsibilities ................................................. 28 7. SEA/SH SENSITIVE GRIEVANCE REDRESSMENT MECHANISM (GRM) .... 28 7.1. Description of the SEA/SH -sensitive GRM................................................... 29 7.2. Basic principles and criteria for effectiveness of GRM ............................ 30 7.3. Actors authorized to submit a complaint....................................................... 32 7.4. Complaint resolution levels and description of committees ................. 32 7.5. Complaints management procedures ............................................................... 40 8. MONITORING AND REPORTING .................................................................................. 48 8.1. Participation of the various stakeholders concerned in monitoring activities ....................................................................................................................................... 48 8.2. Reporting to stakeholder groups ........................................................................ 48 CONCLUSION ................................................................................................................................... 49 Annex : Summary of stakeholders consultations ........................................................... 50 2| P a g e ABBREVIATIONS AND ACRONYMS ABREMA Autorité Burundaise de Régulation des Médicaments à usage humain et des Aliments ABREVPA Autorité Burundaise de Régulation des produits vétérinaires, des pesticides et des aliments AIDS Acquired Immuno-Deficiency Syndrom AMR Anti-Microbial Resistance BDS Bureau de District Sanitaire BMWMP Biomedical Waste Management Plan BPS Bureau Provincial de Santé CCGP Communal Complaints Management Committee CHWs Community Health Workers CMC Hill Mediation Committee COSA Comité de Santé CPGP Provincial Complaints Management Committee CSOs Civil Society Organizations DGP Director General of Planning DGR Director General of Resources DGSSLS Director General of Health Services and fight against AIDS DHIS2 District Health Information Software 2 EBS Event-Based Surveillance EONC Emergency Obstetric and Neonatal care ESCP Environmental and Social Commitment Plan ESF Environmental and Social Norms ESMF Environmental and Social Management Framework ESS Environmental and Social Standards GASC Groupement d’Agents de Santé Communautaire GBV Gender-Based Violence GDP Gross Domestic Product GHSI The Global Health Security Index HEs Health Emergencies IDA International Development Association IDSR Infection Diseases Surveillance and Ripost IHR International Health Regulations INSP Institut National de Santé Publique IPC Infection prevention Control IPFSC Health Community Nurse Focal Point IPPF Indigenous People Planning Framework JEE Joint External Evaluation LMP Labor Management Plan ML Mamans Lumières 3| P a g e MOH Ministry of Health NAPHS National Action Plan for Health Security NCDs Non-Communicable Diseases NGOs Non-Governmental Organizations PCSAN Plateforme Communale de Sécurité Alimentaire et Nutrition PEV Programme Elargi de Vaccination PHEOC Public Health Emergencies Operations Center PIU Project Implementation Unit PMSAN Plateforme Multisectorielle Communale de Sécurité Alimentaire et Nutrition PNSR Programme National de Santee de la Reproduction PPSAN) Plateforme Provinciale de Sécurité Alimentaire et Nutrition PRONIANUT Programme National Intégré d’Alimentation et de Nutrition RCCE Risk Communication and Community Engagement RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health SEA/SH Sexual Exploitation and Abuse/Sexual Harrassment SEP Stakeholder Engagement Plan SLIPTA Stepwise Laboratory Improvement Process Towards Accreditation SMS Short Message Service SOP Standard Operating Procedure SPAR State Party Self-Assessment Annual Report TPS Health Promition Technician UNFPA United Nations Population Fund UNICEF United Nations International Children’s Emergency Fund VAC Violence Against Children WHO World Health Organization 4| P a g e DEFINITION OF KEY CONCEPTS Stakeholder: according to the World Bank Environmental and Social Framework (ESF)/Environmental and Social Norms (ESS) 10/World Bank, digital version, page 2) the term “stakeholders� refers to individuals or groups who: a) are or could be affected by the Project (parties affected by the Project); and b) may have an interest in the Project (other interested parties). Parties affected by the Project: People likely to be affected by the Project because of its actual effects or the risks it may present for the physical environment, health, safety, cultural practices, well-being or livelihood of these people. These can be individuals or groups, including local populations (ESS 10 ESF-/World Bank, digital version, page 2, guidance note 5.1). Parties concerned by the Project: Any individual, group or organization having an interest in the Project, either because of its location, its characteristics or its effects, or for matters of public interest. These may include regulatory bodies, public authorities, representatives of the private sector, the scientific community, academia, trade unions, women's organizations, other civil society organizations and cultural groups . Other interested parties: Any individual, group or organization with an interest in the Project, either because of its location, characteristics or effects, or for matters of public interest. These may include regulatory bodies, public authorities, representatives of the private sector, the scientific community, academia, trade unions, women's organizations, other civil society organizations and cultural groups (ESS 10 ESF, digital version, page 2, guidance note 5.2). Disadvantaged or vulnerable people: Individuals or groups of individuals who are more likely to suffer from the effects of the Project and/or are more limited than others in their ability to benefit from the benefits of a Project. These individuals or groups are also likely to be excluded from the general consultation process or unable to participate fully in it and may therefore require specific measures and/or assistance (ESS 10 ESF /World Bank, page 19, footnote 28). Beneficiaries: People who will directly benefit from the activities implemented within the framework of the Project. These are people directly targeted by the Project's interventions. Direct beneficiaries are the people who will directly participate in the Project and thus benefit from its existence; As for the indirect beneficiaries, these are all people or families who live in the area of influence of the Project. Complaints management mechanism: A system or process accessible and open to all which serves to take timely note of complaints and suggestions for improvements to the Project, and to facilitate the resolution of problems and complaints related to the Project. An effective complaints management mechanism provides parties affected by the Project with solutions that will correct problems at an early stage. (ESS 10 ESF /World Bank, digital version, page 8, guidance note 26.1). Sexual Assault: Sexual activity with a non-consenting person. Sexual assault is a violation of physical integrity and sexual autonomy which covers a broader reality than rape, in particular because it: a) can be committed by means other than force or violence; (b) does not 1necessarily involve penetration. 1 WorldBank Good Practice Note, Environmental and Social Framework for REIT Operations, Combating Sexual Exploitation and Abuse as well as Sexual Harassment in the Financing of Investment Projects Involving Major Civil Engineering Works , Second edition 5| P a g e Sexual exploitation: Taking advantage or attempting to take advantage of a state of vulnerability, an unequal balance of power or relationships of trust for sexual purposes, including but not exclusively with a view to obtaining a financial advantage. social or political 2. Sexual abuse: Any physical intrusion of a sexual nature committed by force, under duress or through an unequal relationship, or the threat of such an intrusion. Sexual Harassment: Any unwelcome sexual advances or requests for sexual favors or any other verbal or physical behavior with a sexual connotation 3. Environmental and social impacts: Environmental and social impacts refer to any potential or actual risk: (i) to the physical, natural, or cultural environment, and (ii) to the impacts on the surrounding community and workers resulting from the activity of the Project to be financed. Environmental and social risk: Environmental and social risk is a combination of the probability of the occurrence of certain hazards and the severity of the impacts due to this occurrence. Gender-based violence: An umbrella term for any harmful act committed against a person's will and based on the differences that society establishes between men and women (gender). It includes acts that cause physical, sexual, or psychological harm or suffering, the threat of such acts, coercion, and other forms of deprivation of liberty. These acts can occur in the public or private sphere (Guidelines of the Inter- Agency Standing Committee on Gender-Based Violence, 2015, p.5). 2 WorldBank Good Practice Note, Environmental and Social Framework for REIT Operations, Combating Sexual Exploitation and Abuse as well as Sexual Harassment in the Financing of Investment Projects Involving Major Civil Engineering Works , Second edition 3Ibid . 6| P a g e 1. INTRODUCTION 1.1. Description of the context of the project Burundi is a densely populated low-income country, with low and volatile economic growth and a weak human capital outlook. An estimated 71 percent of its population lived below the poverty line in 2022.4 With an estimated 463 inhabitants per square kilometer, Burundi faces serious pressures on arable land contributing to high prevalence of food insecurity and malnutrition, compounded by poverty, vulnerability to climate shocks, lack of access to basic health and other social services, as well as rapid population growth. The country has the seventh highest fertility rate in the world (5.5 children per woman), and its population is expected to double by 2040. Per capita Gross Domestic Product (GDP) is among the lowest in the world, at US$303.9.5 The recent shocks of COVID-19 and the Russian invasion of Ukraine have intensified macroeconomic imbalances through the widening of the fiscal and current account deficits and weakening of foreign exchange reserves. GDP growth was estimated at 2.9 percent in 2023 and is projected to 4.2 percent in 2024. Despite some progress in education and health sectors, a child born in 2020 in Burundi is expected to be only 39 percent as productive as an adult as she would have been with optimal education and health, according to the World Bank’s Human Capital Index. Low levels of learning and a high stunting rate (55.8 percent in 2022)6 are among the contributing factors to this human capital trajectory. While Burundi has made strides in improving key health indicators related to under-5 and maternal mortality, it grapples with some persistent challenges which are likely to worsen further during Health Emergencies (Hes). The country has seen positive trends, with 94 out of 100 children surviving from birth to school age, and a decline in maternal mortality from 499 to 299 per 100,000 live births. These achievements are attributed to improved healthcare outputs during the 2012- 2022 period, such as increased skilled attendance at births (from 78.4 percent to 97.2 percent) and higher rates of complete vaccination among children aged 12-23 months (from 70.3 percent to 78.9 percent). However, Burundi faces one of the world's highest and worsening rates of child stunting, which rose from 52.6 percent to 55.8 percent between 2020 and 2022, necessitating urgent community-level inter- ventions. The exacerbating factors include the COVID-19 pandemic, high inflation, fuel and sugar shortages, and severe food insecurity. The use of modern contracep- tives increased marginally from 18 percent to 21 percent among married women, leaving a 30 percent unmet need for family planning. The country's high fertility rate has only slightly decreased, from 6.4 in 2010 to 5.5 children in 2022. Non-Communi- cable Diseases (NCDs) constitute a heavy burden but remain poorly documented. According to the WHO country outlook 2023, the age-standardized mortality rate across four major NCDs (cardiovascular disease, chronic respiratory disease, cancer, and diabetes) was 720 per 100,000 in males and 582 in females in 2021. It is esti- mated that non communicable diseases have caused 37% of deaths in 2019. Multiple assessments, including by the World Bank, find that Burundi remains insufficiently prepared to prevent, detect, and respond to HEs. The Global Health Security Index (GHSI) indicates that Burundi scored 22.1/100 in 2021 and decreased 4 Based on an international poverty line of $2.15 a day, 2017 PPP (World Bank Macro Poverty Outlook, October 2023) 5 World Bank Macro Poverty Outlook, October 2023 6 National survey on the nutritional and mortality situation in Burundi based on SMART methodology 2022 7| P a g e by 0.6 compared to 2019, ranking Burundi 181/195 globally and 47/54 in Africa. The scores for the distinct categories are as follows: 14.2/100 for prevention, 14.2/100 for detection and reporting, 21.5/100 for rapid response, 9.1/100 for health system, 34.4/100 for compliance with international norms and 39.4/100 for risk environment. The World Health Organization Joint External Evaluation 2023 indicates some progress in response to outbreaks, but several gaps. Burundi has made some pro- gress compared to the previous assessment carried out in 2018 which gave an overall score of 33%, but many gaps remain. In fact, many capacities had scores less than or equal to 2 out of 5. It is the case for 19 capacities out of 22 in the prevent axis, 9 capacities out of 11 in the detect axis and 13 capacities out of 16 in the respond axis. Improvements have been made in the legal framework of the International Health Regulations (IHR), the setting up of a budget line dedicated to HEs, the development of a national plan for anti-microbial resistance (AMR), and the development of a na- tional vaccination strategy. However, several weaknesses remain: the country has not yet ratified the IHR (2005) and the existing legal instruments do not cover all the areas concerned by the IHR (2005), the absence of a “One Health� platform, the ir- regularity of simulation exercises, an inadequate health epidemic information sys- tem, and the absence of officially designated entry points. 1.2. Project description The Project Development Objective (PDO) is “to strengthen health system resili- ence and multisectoral preparedness and response to health emergencies in Bu- rundi�. The project will be implemented nationwide. Project components and main activities Component 1: Strengthening the Preparedness and Resilience of the Health Sys- tem to Manage Health Emergencies (US$ 28.9 equivalent). This component will support the strengthening of essential institutions and activities that directly con- tribute to the resilience of the health system to cope with HEs and complement other HSS activities conducted by the Government, other World Bank operations and de- velopment partners. The component has four sub-components. Sub-component 1.1. Supporting multisectoral cross-border planning, financ- ing, and governance for improved resilience to HEs (US$ 2.1 million equivalent) by: (a) establishing a “One Health� implementation committee to serve as a mecha- nism for collaboration among the relevant ministries, ensure accountability and sus- tain political commitment; (b) supporting coordination meetings for the intersectoral and cross-border response; (c) updating the 2018 National Action Plan for Health Security (NAPHS); (d) developing a national multisectoral costed action plan for One Health, a national clinical case management guidelines for priority health events with focus on gender gaps, a gender-specific health risk map and multi-risk plan; (e) elab- orating a national climate and health adaptation plan, with attention to gender and other equity and inclusion measures ; (f) updating annually the health and nutrition contingency plan; (g) conducting non-communicable disease risk factor assessments using World health Organization (WHO)’s Stepwise approach to NCD risk factor sur- veillance (STEPS) approach; (h) strengthening capacity of point of entry screening, isolation, and quarantine; (i) providing technical assistance to strengthen the imple- mentation of formal coordination and communication mechanisms between the hu- man health/public health, animal health, and environmental health sectors for mul- tisectoral response to zoonotic with a One Health focus. Climate change is a major 8| P a g e focus and driver of this activity and given critical impact of climate change on zoonotic diseases, vector borne diseases, and water borne diseases, the impacts of climate change on animal, human, and environmental health will be purposively integrated throughout all activities using specific tools and materials. Sub-component 1.2. Supporting health workforce skills development (US$ 6.7 million equivalent) by: (a) strengthening the capacity of the health workforce in field epidemiology (basic, intermediate and advanced), IDSR guidelines, HE preparedness and response, monitoring of maternal and perinatal deaths and response, Emergency Obstetric and Neonatal care (EONC), nutrition and food security, antimicrobial re- sistance, maintenance of biomedical equipment, health informatics, human re- sources management, occupational health and safety of health workers during emer- gencies (including IPC measures); (b) ensuring gender equity in the training of pro- fessionals, by addressing existing gaps in the selection/recruitment and deployment of personnel; (c) providing scholarships for key medical specialties in short supply in the country, including for expanding cadre of and laboratory professionals, prioritiz- ing people from climate vulnerable areas; (d) developing/updating the national strat- egy for human resources development; (e) developing regulatory and management mechanisms to enable the swift mobilization and deployment of health workers in times of crisis. Ensuring adequate health workforce for climate vulnerable locations and to deploy health workers during climate shocks is a is a primary impetus and focus of updating the human resource development strategy and developing mecha- nisms for rapidly deploying health workers during crises. Sub-component 1.3 Provision of health commodities (US$ 16.5 million equiva- lent) by: (a) purchasing and deploying vaccines for routine immunization and emer- gency situations, as well as drugs to treat HEs, including NCDs; (b) providing micro- nutrient powder, other nutritional products and auto-injectable contraceptive Sayana Press to contribute to address malnutrition and high fertility issues; (c) procuring energy efficient equipment for health facilities and veterinary services; (d) renovating gender-sensitive isolation areas in health facilities; (e) strengthening the capacity of the national regulatory authority for drugs and food (ABREMA); (f) strengthening the capacities of the Burundian regulatory authority for veterinary medicines, pesticides, and foods (ABREVPA) in terms of quality control of veterinary medicines and pesti- cides; (g) enhancing capacities for drug and food quality analysis at national level; (h) establishing strategic stockpile of commodities and framework contracts to ensure prompt deliveries of HE commodities during emergencies, with a primary focus on stockpiling for climate shocks. Sub-component 1.4. Supporting Information systems for HEs and the digitali- zation of the health sector (US$ 3.6 million equivalent) by: (a) extending the digitalization of health facilities and community health information system, and en- suring the interoperability of applications used, with the national health information system (DHIS2); (b) developing a multisectoral epidemiological surveillance system to improve the integration of critical public health, laboratory, healthcare services dis- ruption, environment, port health, and veterinary data, that disaggregates all data by sex, age (for women 15-49 years of age) and pregnancy status; (c) monitoring human and animal health risks, public health events, NCDs, climate shocks, and their im- pacts on health systems and services, disaggregated by gender and other measures of vulnerability; (d) developing media screening software allowing early detection of HEs alerts in the media; (e) supporting the call center developed by the Public Health Emergencies Operations Center (PHEOC). Climate change related shocks are primary focus and impetus of the latter three activities. 9| P a g e Component 2: Improving Early Detection of and Response to HEs through a multisectoral approach (US$ 17.1 million equivalent). This component will fi- nance expenditures related to strengthening operational readiness and capacities across the critical subsystems to respond to HEs. This will have three subcompo- nents: Sub-component 2.1. Supporting collaborative multisectoral surveillance and laboratory diagnostics (US$ 5.2 million equivalent) by: (a) expanding IDSR third edition at the national and intermediate levels, including incorporation of data on sex, age, and pregnancy status; (b) expanding routine indicator and event-based surveillance (EBS) at health facilities and community health structures, with data disaggregated by sex, age, and pregnancy status; (c) ensuring timely verification, investigation, and risk assessment of alerts (feeding from the early warning and alert systems); (d) strengthening rapid response teams capacities and functionality; (e) strengthening laboratory and testing capacity for human, animal and environmental health threats, including adherence to quality standards WHO Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA), provision of reagents, commodities and energy efficient laboratory equipment; (f) acquiring mobile laboratories; (g) renovating the PHEOC and the national veterinary laboratory; (h) enhancing five laboratories for WHO SLIPTA accreditation. Climate change emergency preparedness, response, and climate sensitive diseases will be incorporated throughout the subcomponent. Sub-component 2.2. Supporting emergency management, coordination, and es- sential service continuity (US$ 7.8 million equivalent). Climate change prepar- edness and response is a primary impetus and focal area of the following activities: (a) developing/updating a package of essential health services (EHS) and plans for continuity of EHS that includes reproductive, maternal, new born, child and adoles- cent health (RMNCAH) services and supplies, and NCDs in emergencies at na- tional/intermediate levels; (b) conducting multi-sectoral simulation exercises and in- tra- or after-action reviews for a public health emergency that has occurred; (c) as- sessing the national PHEOC performance for activation of a coordinated response after receiving notification of an event or other relevant emergency; (d) conducting advocacy for increasing the public financing for responding to HEs and development of swift mechanisms to mobilize these funds; (e) supporting implementation/coordi- nation of JEEs, State Party Self-Assessment Annual Reports (SPARs), and other peer to peer IHR capacity assessment tools in coordination with WHO, including the Gen- der Equality JEE core capacities. The subcomponent will also finance: (f) implement- ing interventions to support equitable and inclusive NCD prevention and treatment; (g) providing support to the PHEOC, the national immunization program, the national institute of public health, the national veterinary laboratory and the IHR focal point; (h) contributing to finance the national free health care policy for under five and preg- nant women associated with a performance-based financing scheme to ensure the continuity of essential maternal and child services; (i) providing energy efficient equipment and support to three one stop centers initiated by the Great Lakes Gender Based Violence (GBV) and Women’s Health Project (P147489), closed in December 2019, as well as support to GBV survivors. Sub-component 2.3. Supporting Risk Communication and Community Engage- ment (RCCE), empowerment, and social protection for all HEs (US$ 1.6 million equivalent). Climate change preparedness and response is a primary impetus and focal area of the following activities: (a) developing multisectoral RCCE plans, SOPs, guidelines, policies, and procedures for routine and emergency contexts at national and subnational level, to inform decision-making, as well as appropriate safety nets for the most vulnerable; (b) strengthening capacities of Community Health Workers 10| P a g e (CHWs) and health promotion technicians on community based surveillance and re- sponse IPC, Water, Sanitation and Hygiene (WASH), including equipping CHWs with designated kits; (c) developing mechanism for real-time information exchange, advice, and opinions during unusual and unexpected events/emergencies. The subcompo- nent will also finance: (d) contributing to the existing Performance Based Financing scheme at community level that aim to increase the use of health services, communi- cate on health issues (including HEs) for behavior change and provide some health commodities and treat selected diseases at community level. Sub-component 2.4. Climate change adaptation and resilience (US$2.5 million equivalent). Climate change is mainstreamed throughout the project and in addition, the project will make targeted investments to address the impact of flooding, droughts, and climate sensitive diseases on health and the health system in Burundi. The subcomponent will finance: (a) a climate and health vulnerability assessment for the country; (b) development of a national climate and health adaptation plan, with attention to gender and other equity and inclusion measures; (c) development and operations of a platform for integrating meteorological data with health data to im- prove understanding of and planning for the impacts of climate change on relevant diseases; (d) development of a climate and health emergency preparedness and re- sponse curriculum for health workers and execute trainings on climate emergency preparedness and response for health workers; (e) assessment of health system per- formance against floods, droughts, and high heat; train rapid response teams in cli- mate emergency preparedness and response; (f) development of a climate resilient infrastructure construction and rehabilitation guidelines to prepare facilities for flooding, high heat, and flood-induced mud and landslides; (g) cash transfers to peo- ple who has lost housing, water and sanitation facilities, and/or access to food due to flooding to reduce the health impacts of flooding; and (h) developing mechanisms for engaging community health workers in climate emergency preparedness and re- sponse, including trainings, and designated roles and responsibilities. Component 3: Project Management (US$ 4 million equivalent). This will finance (i) Monitoring and Evaluation (M&E) (US$2 million equivalent), (ii) the learning agenda (US$ 1 million equivalent) and (iii) other aspects of program management, equipment and coordination (US$ 1 million equivalent). In Burundi, the learning agenda will leverage on other participating countries and regional institutions and will be particularly focused on analysis and studies on multisectoral PPR and the One Health agenda, burden of NCDs, gender-based differences in risks and exposure, cli- mate-related and other emerging threats to the health system. Component 4: CERC (US$0), to be activated as needed based to support immediate response to an Eligible Crisis or Emergency. 2. THE OBJECTIVES OF THE SEP The overall objective of this SEP is to define a program for stakeholder engagement, including information publication and consultation, throughout the project life cycle. The SEP succinctly describes how the project team will communicate with stakeholders and includes a mechanism through which people can express concerns, give feedback or lodge complaints regarding the project and any related activities. The participation of local people is essential to the success of the project, to ensure harmonious collaboration between project staff and local communities, and to minimize and mitigate environmental and social risks associated with the proposed project activities. In the context of health emergencies, large-scale awareness-raising activities adapted to local culture and realities are particularly important to properly educate populations about the risks associated with diseases. 11| P a g e The overall objective of the SEP is to define a stakeholder engagement program, including information disclosure and stakeholder consultation, throughout the project cycle. Indeed, ESS 10 requires that stakeholders be mobilized to improve the environmental and social sustainability of the Health Emergency Preparedness, Response and Resilience Project in Burundi, strengthen support for the project, and contribute significantly to the successful design and implementation of the project. In accordance with ESS 10, this requirement should be met through: • The establishment of a systematic approach to mobilizing stakeholders which will allow the government of the Republic of Burundi to properly identify them, to establish and maintain a constructive relationship with them, in particular the stakeholders affected by the Project; • Evaluating the level of interest and support of stakeholders and allowing their opinions to be taken into account in the design of the Health Emergencies Project and its environmental and social performance; • Encouraging the effective mobilization of all parties affected by the Project throughout its lifespan on issues that could potentially impact them and providing the means to achieve this; • Ensuring that stakeholders receive information relating to the environmental and social risks and effects of the Project in a timely, understandable, accessible and appropriate manner; • providing parties affected by the Project with the means to easily raise their concerns and file complaints, and for the government to respond and manage them. Therefore, the SEP describes how the Health Emergencies Project will communicate with stakeholders and includes a mechanism by which individuals can raise concerns, provide feedback or file complaints regarding the project and any activity related to the project. Stakeholder participation is essential to the success of the project to ensure harmonious collaboration between the project and local communities and to minimize and mitigate environmental and social risks related to the activities of the proposed project. In the context of health emergencies, culturally appropriate and adapted community mobilization activities are particularly important to achieve the objectives of the Burundi Health Emergency Preparedness, Response and Resilience Project. 3. SUMMARY OF PUBLIC CONSULTATIONS Stakeholder mobilization is an essential step in the project preparation process and constitutes one of the fundamental requirements of the World Bank EES. The objective of mobilization is to obtain buy-in and open and transparent commitment from stakeholders towards the project. The engagement of all stakeholders is a factor in improving the project’s sustainability and social acceptability and allows them to contribute significantly to the design and successful implementation of the project. Public consultations have carried out with Project stakeholders. Four regional workshops were organized and took place respectively in Muyinga on 26 February 2024, in Ngozi on 27 February 2024, in Gitega on 28 February 2024 and in Cibitoke on 29 February, 2024. These regional workshops brought together participants from all provinces of the country. Several categories of stakeholders attended these workshops, including administrative officials at the provincial and communal level, those responsible for provincial technical services such as the health, education, environment, agriculture and livestock sectors, gender and solidarity, provincial 12| P a g e directors of family and social development, provincial representatives of the National Women's Forum, CHWs, women's groups and representatives of Women's Associations indigenous Batwa populations , etc. took part in these workshops. The main objective of these public consultation workshops was to share essential information on the Burundi Health Emergency Preparedness, Response and Resilience Project using the multi-phase programmatic approach and its consistency, including aspects related to environmental and social safeguards. The participants expressed their satisfaction with the relevance of the project, their concerns and recommendations following the presentation of the project and possible solutions in the form of suggestions/recommendations were formulated. At the end of the meetings, focus groups and individual interviews were organized, targeting groups of stakeholders to specifically take into account their fears and especially their recommendations to minimize possible environmental and social impacts to guarantee good implementation of the project. The summaries of the fears/concerns, suggestions/recommendations of the stakeholders consulted are presented in the annex. 13| P a g e 4. STAKEHOLDER IDENTIFICATION AND ANALYSIS 4.1. Methodology The objective of stakeholder identification is to determine the structures and people likely to have an interest or to be directly or indirectly affected by the project. Identifying stakeholders requires regular reviews and updates. The project stakeholders were identified upstream to guarantee the establishment of solid, constructive relationships conducive to the efficient implementation of the project for preparation, response, and resilience to health emergencies in Burundi using the multiphase programmatic approach. This identification facilitated communication actions based on the specificities of each of them in order to collect their opinions, concerns and suggestions and to involve them in the planning, implementation and monitoring-evaluation of the project. The stakeholders identification criteria were linked to the components of the project, namely (i) improving resilience to health emergencies and early detection and response to health emergencies through a multi-sector approach; (ii) support for information systems for health emergencies and the digitalization of the health sector, collaborative multisectoral surveillance and laboratory diagnostics, emergency management, as well as communication on risks and community engagement, (iii) empowerment and social protection for all health emergencies as well as coordination and continuity of essential services. To date, many potentially affected and interested parties have been identified through the contacts and consultations that the project has already established with communities, authorities, technical services, and civil society as part of the preparation of other safeguard instruments: Environmental and Social Management Framework (ESMF), Indigenous People Planning Framework (IPPF), Labor Management Plan (LMP), Biomedical Waste Management Plan (BMWMP). To respect best practices, the project will apply the following principles for stakeholder engagement: • Openness and project lifecycle approach: Public consultations on the project(s) will be organized throughout the project lifecycle, in an open manner, without external manipulation, interference, coercion or intimidation. • Informed participation and feedback: Information will be provided to and widely disseminated to all stakeholders in an appropriate format; opportunities are pro- vided to record stakeholder reactions, as well as to analyze and address comments and concerns. • Inclusivity and sensitivity: Stakeholder identification is undertaken to promote better communication and establish efficient relationships. The project participa- tion process is inclusive. All stakeholders are encouraged to always participate in the consultation process. Equal access to information is ensured for all stakehold- ers. Sensitivity to stakeholder needs is the key principle underlying the selection of engagement methods. Particular attention is paid to vulnerable groups who risk being excluded from project benefits, in particular women, the elderly, people with disabilities, albinos, and indigenous peoples. • Flexibility: if cultural context (e.g. particular gender dynamics) or governance fac- tors (e.g. high risk of retaliation) prevent traditional forms of face-to-face engage- ment, the methodology must accommodate other forms of engagement, including various forms of communication by separate groups (e.g. women separated from 14| P a g e men, youth separated from adults, Batwa indigenous people separated from other segments of the population, etc.), by internet or by telephone. Stakeholders include parties affected by the project and other interested parties. Project-affected parties are those who are or could be affected by the project. Other parties involved are those who may have an interest in the project and could: • Influence positively or negatively the opinions of affec ted parties • Compromise the implementation of the project or the sustainability of its results. Within the meaning of the Health Emergency Preparedness, Response and Resilience Project in Burundi, the stakeholders include: Stakeholders include parties affected by the project and other interested parties. Project-affected parties are those who are or could be affected by the project. Other parties involved are those who may have an interest in the project and could: • Affect positively or negatively the opinions of affected parties; • Compromise the implementation of the project or the sustainability of its results. Within the meaning of the Preparation, Response and Resilience to Health Emergencies in Burundi Project, the stakeholders include: 4.2. Affected stakeholders This is the category of primary stakeholders who are the beneficiaries of the Project activities or those who are directly affected positively or negatively by it. This category of stakeholders includes: Community Health Workers (CHWs), local communities in general and in particular those close to Health Facilities and who may be directly affected by the management of waste from medical care, vulnerable and disadvantaged groups at the community level not having the means to access health care on their own. For these groups, specific measures will be taken to facilitate their access to the benefits of the project. These are essentially the following stakeholders: • Sick people living in the project intervention areas; • Communities neighboring health facilities and laboratories; • Staff working in beneficiary establishments (medical and non-medical staff); • Staff from companies recruited by the project to carry out renovation work on health structures; • Suppliers of medical equipment and services as well as their staff; • Various service providers. 4.3. Other parties involved These are secondary stakeholders who are those who influence the Project or are indirectly affected by project activities. These are individuals/groups/entities who may not directly feel the impacts of the Project but who consider or perceive their interests as being affected by the Project and/or who could affect the Project and the process of its implementation somehow. These parties, particularly community representatives, will play an important role in raising awareness and mobilizing local communities. These parties will be involved throughout the entire life cycle of the project. The Project Implementation Unit (PIU) 15| P a g e will work closely with these interested parties of the project in order to optimize the objectives and expected results. These include: • stakeholders from ministries and agencies involved in the implementation of the project through the steering committee; • public/private health personnel (doctors, nurses, public health inspectors, midwives, laboratory technicians, maintenance workers, hygienists, bio- cleaning personnel and other medical assistants) from the target sites; • staff from provincial health offices and health districts from the ministry in charge of health and the ministry in charge of the environment, agriculture and livestock; • local administrative authorities, Civil Society Organizations (CSOs), and CHWs who will be involved in the implementation of the project, • Contracting companies, firms and consultants who will be contacted by the project; • the general public and rural communities; • community organizations, national civil society groups and NGOs; • suppliers of goods and services involved in the wider project supply chain; • Agencies and control bodies; • media and other interest groups, including social media; • national and international health organizations/associations; • interested international NGOs, diplomatic missions and United Nations agencies (notably UNICEF, WHO, UNFPA, etc.); • interested companies. • Local administrative services, in particular: Departments of health provinces, provincial and municipal administration; • community development committees; • officials from the Ministry of Public Health and the Fight against AIDS; • provincial technical services (health, agriculture, social affairs, etc.). 4.4. Disadvantaged or vulnerable individuals or groups It is particularly important to identify individuals and groups who may have more difficulty participating and those likely to be unevenly or disproportionately affected by the Project, due to their vulnerable situation. These individuals may be better served by the project compared to any other group and therefore require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with project activities. Vulnerability can arise from the person's age, state of health, economic deficiency and financial insecurity, from their professional status which exposes them to illness, from their social status which directly deprives them of or indirectly from the benefits of the project, its dependence on other individuals or other institutions, etc. • The vulnerable people or groups identified as part of this project are: • Old people ; • People with chronic illnesses and previous medical conditions; • People with disabilities; • Pregnant women and women in general; • Women in situations of economic and social vulnerability; • Children aged 0 to 14; • Adolescents aged 14-18 • Healthcare workers and their families, as they may be more exposed to various conditions; 16| P a g e • Those who live below the poverty line; • The unemployed, unemployed, prisoners, sex workers; • Communities in remote and inaccessible areas; • Households headed by women, etc. These vulnerable groups have a disability or marital situation or are subject to marginalization and stigmatization which could prevent them from fully participating and in this case, will benefit from specific measures in terms of displacement or reunification. by group categories. Constraints that could prevent these vulnerable groups from participating in the Project or understanding the information or participating in the consultation process could relate to difficulties of travel to the meeting place, access to their area, availability for the period or place of consultation in relation to domestic or agricultural activities . Also, to cope with these constraints, additional support or resources will be provided to vulnerable groups to enable them to participate in the consultation process: provision of translation services in sign language, large print or Braille  ; the choice of accessible places for gatherings ; transport services to the nearest meeting for people living in isolated places ; holding targeted, smaller-sized meetings during which vulnerable stakeholders would feel more comfortable asking their questions or expressing their concerns. If there is no active organization in the Project area that works with vulnerable groups, particularly people living with disabilities, the PIU will contact health professionals in the Offices Health Districts (BDS), which will be better able to provide information about marginalized groups and how best to communicate with them, the PIU will determine how these vulnerable groups usually obtain information about the community, Projects, activities, and especially what recent engagements the Projects (notably health) have had with vulnerable stakeholders and their representatives. 4.5. Summary of the needs of the Project stakeholders The table below presents a summary of the needs of the Project stakeholders disaggregated by group, namely affected stakeholders and other relevant stakeholders. Particular attention is paid to vulnerable individuals or groups within each of the stakeholder groups. Table 1: Needs of Project stakeholders Stakeholder Main characteristics Language Preferred means of Special needs group needs notification Affected Potential beneficiaries of Kirundi (local Community Information on parts the Project language) Meetings/Assemblies the Project People affected by the French Information poster; and its Project Media, television components; and/or radio press Information on release patient rights; Plan and inform in advance Other Project Implementation French Official letters Emails Plan and parties Unit (PIU), Health Kirundi Telephone inform in involved programs involved in the WhatsApp group advance implementation of the Video conference Information Project: PHEOC, PNSR, and training PRONIANUT, PEV, INSP, 17| P a g e etc., Institutional and private state actors, Care providers in health facilities and regulatory bodies (Health Centers, Hospitals, Health Districts and Health Provinces), Ministries involved (Ministry in charge of the environment, agriculture and water), Communication Department of the Ministry, partner NGOs Local, municipal and French Official letters Emails Plan and provincial authorities Telephone inform in Sector managers advance (provincial technical Meetings services) Process NGOs and Associations information NGOs and Associations French Television and/or Plan and working in the area radio press release inform in covered by the Project. Online broadcast advance WhatsApp group Meetings Information posters Media (TV, Radios, French Official letters Emails Plan and Community Radios, English Telephone Press inform in Written Press, Online Kirundi release advance Press, etc.) Meetings Vulnerable People living with a Kirundi Community Targeting with individuals disability (physical or Meetings/Assemblies focal point or groups of mental); Television and or assistance people Pregnant women without radio press release Inform and financial means; Information displays train victims of GBV;(Women Plan and and girls ) inform in Female heads of advance, household or single taking into mothers; account the Sick people, particularly specificities of people with HIV/AIDS or vulnerable other serious or incurable groups illnesses; disables, (accessibility Older people, especially and proximity when they live alone; to meeting Households where the places, etc.) head of the family has no financial resources; People belonging to certain ethnic, cultural or religious minorities; Widows and orphans living in precarious conditions, and Indigenous people. 18| P a g e 5. STAKEHOLDER ENGAGEMENT PLAN 5.1. Objectives and timeline of the stakeholder engagement program The aim of the SEP is to encourage stakeholder participation in the design and implementation of the Project, and to improve its environmental and social sustainability through maintaining dialogue. adequate with stakeholders and transparency throughout the Project cycle. This will specifically involve: ▪ Identify the various stakeholders in the Project with a view to taking their opinions and concerns into account; ▪ Define the roles and responsibilities of stakeholders, as well as deadlines for implementation of activities and costs (if necessary) of consultations and participation activities; ▪ Define strategies for disseminating information, consultations and considering the points of view of vulnerable groups; ▪ Establish a complaints management mechanism that allows the expression and processing of grievances and complaints from stakeholders including cases of gender-based violence/violence against children and sexual exploitation and abuse/sexual harassment (VAC and GBV/SEA/SH). Project stakeholders will be mobilized using distinct and appropriate means, depending on their different interests and situations. The SEP will be translated into a budgeted activity program which clearly defines the stages of completion of the Project (start and end of activities), the costs of the different interventions as well as the responsibilities of the stakeholders. Continuous monitoring and flexible adjustment of social and environmental risk management will make it possible to adapt the SEP to the Project implementation situation. The Project may adopt precautionary measures each time a risk, health emergency, epidemic or pandemic is identified, to minimize the risks of propagation during the dissemination of information and the conduct of consultation activities. The Project will engage in meaningful consultations on policies, procedures, processes, and practices (including grievances) with all stakeholders throughout the Project cycle, and equip them with real-time, relevant, understandable, and accessible information. The consultations will provide information on risks related to the Project, including sexual exploitation and abuse (SEA) and sexual harassment (SH), risks of increased incidents of SEA/SH and particularly partner violence intimate relationships and the reporting and response measures proposed, with particular attention to vulnerable groups, including those with reduced mobility, as well as women and children. Community consultations on risk mitigation of SEA/SH incidents with women and girls will be conducted in safe and supportive environments, such as in same-sex groups and with female facilitators and will focus on risks and vulnerabilities of women and girls, as well as issues related to their well- being, health and safety, as they relate to Project activities. More specifically, this plan aims to: ▪ Systematically and exhaustively identify all stakeholders affected by the Project, concerned by the Project or likely to have an influence on the Project; 19| P a g e ▪ Establish and maintain a constructive dialogue between the Project and its stakeholders during the remaining stages of its life cycle, drawing on and drawing lessons from the information and consultation activities carried out to date; ▪ Manage the resettlement and restoration of livelihoods of affected people; ▪ Design and plan the implementation of the Project's information and consultation activities with its stakeholders in an appropriate, efficient and accessible manner; ▪ Ensure social inclusion by identifying vulnerable groups likely to be excluded or marginalized in the consultation process, including women and girls, and design tools that guarantee that they are fully included in this process with real listening and real consideration of their points of view; ▪ Share information and dialogue on the Project, its impacts and its benefits to create and maintain a climate of trust between stakeholders and the Project; ▪ Guide the design and implementation of the Project and reduce technical, social and budgetary risks; ▪ Ensure a transparent, open, accessible, inclusive and fair process, in a spirit of trust and respect, without manipulation, interference, coercion and intimidation and without participation fees; ▪ Establish a complaints management mechanism that allows the expression and processing of grievances and complaints from people affected and interested in the Project or who experience gender-based violence and especially sexual exploitation and abuse or sexual harassment (GBV/SEA/SH). The SEP implementation schedule is as follows (Table 2): Table 2: Overall SEP schedule Actions Indicative period Manager(s) Identify Stakeholders Consult During the preparation Project Implementation Unit Stakeholders on their and implementation (PIU) Consultants understanding of the Project phases of the Project including the risks and impacts (continuous activity). associated with the Project, recommended mitigation measures and gather their concerns and expectations Integrate relevant points into the Project design Consult and ensure the Project preparation and PIU (Experts in charge of social, participation of Stakeholders in implementation phases. environmental and the implementation of the communication safeguards) Project Develop, validate and During the preparation PIU disseminate the SEP phase and the accompanied by the MGP implementation phase of according to the the Project communication strategy defined in this SEP 20| P a g e Conduct a communication Before and during Project PIU campaign so that beneficiaries implementation prepare for the opportunities that will be offered by the Project Continue implementing the During Project PIU Experts in social SEP implementation safeguarding and GBV, SEA/SH, environmental and Communication Expert Carry out a mid-term Halfway through Project PIU world Bank evaluation of the implementation implementation of the SEP Conduct a final evaluation of At the end of the Project PIU SEP implementation World Bank 5.2. Proposed strategy for information dissemination 4.2.1. Brief description of the information to be communicated For the dissemination of information, a communication plan will be established as part of the Project. This plan will support stakeholder engagement by considering their categories and ensuring appropriate channels are identified. The specialists in environmental protection and social development, the GBV specialist, SEA/SH and the communication specialist from the PIU will ensure the popularization of the SEP. Mass media (newspapers, radios, televisions, websites, social networks) offer possibilities for disseminating information on a large scale through press releases, reports on the Project, information campaigns, interviews with different categories of stakeholders, etc. The PIU will communicate the following information to the various stakeholders: ▪ The object, nature and scope of the Project; ▪ The duration of Project activities; ▪ The potential risks and effects of the Project on local communities, including risks related to SEA/SH and proposed measures to mitigate them, highlighting risks and effects likely to disproportionately affect vulnerable groups and disadvantaged; ▪ The environmental and social issues of the Project activities: hygiene, health, safety, sexual violence, child labor during work, waste management, including risks linked to biomedical waste; ▪ Eligibility criteria for affected people and vulnerable people; ▪ The participation and involvement of stakeholders and local populations; ▪ The process envisaged to mobilize stakeholders; ▪ The dates and locations of the planned public consultation meetings, as well as the process that will be adopted for notifications and minutes of these meetings; ▪ The complaints management mechanism sensitive to SEA/SH incidents. 21| P a g e 4.2.2. Formats and modes of communication that will be used As part of the Health Emergencies Preparedness, Response and Resilience Project in Burundi using the multiphase programmatic approach (P504531), the Project will promote the use of communication and awareness tools in the following formats and modes: Assemblies with communities: These are generally formal public hearings, chaired by the local authority, sanctioned by a duly written and signed report. These meetings are useful for sharing general information about an activity, when we do not always require everyone to speak. In these cases, they reassure the local public about the support that the Project has received from the authorities; they are appreciated as an effort at transparency and information sharing; they provide the opportunity to transmit information to large numbers of people and complement small meetings by reassuring the local public that communication exchanged in small meetings corresponds to “official� communication. Focus Groups: This is a very useful method for obtaining the opinions of a group of people on certain specific issues. These meetings generally target people interested in the same issues (for example, land compensation or assistance to vulnerable groups, indigenous populations, or women's employment). These discussion groups can be established by age category, by gender, by type of activity, etc. Posters and messages in community radios will be used to mobilize stakeholders throughout the Project, for example to communicate with groups such as IPs, women, youth, children for better circulation of information and an opportunity for them to express themselves. When organizing focus groups, it is important to ensure (i) that all divergent opinions are expressed; (ii) the discussion is focused on the issue to be discussed; and (iii) conclude with concrete proposals and next steps if applicable. Individual interviews: This approach targets in particular local authorities, local elected officials, leaders of religious denominations, opinion leaders, etc. This method is an excellent way to involve these stakeholders. Mass Media: Mass media (newspapers, radios, televisions, websites) offer possibilities for disseminating information on a large scale, through press releases; reports on the Project; launch campaigns, interviews with Project coordination; organized site visits; etc. Forums and workshops: Holding forums and workshops bringing together various stakeholders is a tool for sharing information on the Project, establishing consensus and promoting the commitment of the various stakeholders involved. Thematic workshops can be organized around a specific topic where relevant stakeholders at local and national levels are involved. Visits to Project sites: Visits to Project sites consist of bringing small groups of stakeholders (local authorities, journalists, representatives of civil society organizations, representatives of religious faiths, Community Health Workers, etc.). ) to visit Project sites and transmit information on environmental and social impacts and mitigation measures. Visiting Project facilities by groups of young people can also be effective because it can give an idea of the overall objective of the Project, generate interest, local ownership and provide information on higher education courses supported by the Project. Brochures on the Project: A simplified brochure presenting information on the Project and its urgent nature, the Project Consultation Mechanism, contacts, etc., could be published for wide distribution. This brochure will be updated periodically during the implementation of the Project by integrating the key achievements of the 22| P a g e Project, the activities to be carried out, important events, social responsibility activities or others; etc. Image box: An image box relating to the specific themes of the Project could be developed. This box will have to include several simple and colorful designs which, for their durability, are laminated and enclosed in a plywood box. The image box will help local communities, especially the illiterate population and indigenous peoples, to better understand the Project through the illustrations. Local commissions or committees: Committees and commissions can be established at the local level (hill or municipal), to monitor certain activities, such as epidemics and other health emergencies, which are sensitive to the Project. These committees and commissions mixing Project representatives, civil society representatives, representatives of CHWs, the community and local administrative authorities can enable regular and effective engagement with stakeholders. Management of feedback and sharing of information with stakeholders: Suggestions, complaints/complaints and other contributions from stakeholders will be collected in a feedback form which will be completed during consultation meetings. In addition, stakeholders will have the opportunity to send their feedback by email and physical mail or interactively by telephone, via social networks or the Project website. Feedback compiled by dedicated Project staff is shared with Project management for rapid response. Forward-looking provisions: It is important that comments on the proposed mobilization plan as well as suggestions for improving it are welcome. For more remote stakeholders, it may be necessary to consider the use of an additional journal or a separate meeting, or additional materials that should be placed in the public domain (newspapers, posters, radio, television; brochures, leaflets, posters, documents and non-technical summary reports; correspondence, official meetings ; website, social media ). Furthermore, for decisions not yet taken regarding public meetings, locations, and schedules of said meetings, the Project will clearly communicate to populations how they will be informed of upcoming opportunities to examine this information, including the Environmental and Social Commitment Plan (ESCP) and to submit their points of view. 5.3. Proposed strategy for consultations Stakeholders will be kept informed as the Project progresses, particularly regarding the environmental and social performance of the Project, the implementation of the SEP and the Grievance Resolution Mechanism, as well as the general progress of the implementation of the Project. It is within this framework that messages will be defined and targeted for the dissemination of information, awareness, communication, and education of Project stakeholders. The implementation of this communication strategy will be ensured by the Ministry of Health and the PIU. Over time, based on the views and comments received through the Complaints Mechanism and other platforms, the information disseminated should also address frequently asked questions from the public and the various concerns raised by parties. stakeholders. Opinion leaders and local associations must be mobilized to better communicate with populations and influence behavior but also and above all to understand the concerns, attitudes, beliefs, and obstacles that prevent populations at the grassroots level, or the public to systematically follow health recommendations and instructions, and to provide a response. 23| P a g e The Project will coordinate and monitor all communication interventions and material development at the national level. In this regard, communication, mobilization, and community engagement activities must be better designed to be adapted to the intended objective while minimizing the risk that the actors in charge of their implementation are exposed. As highlighted in the different paragraphs, a broad consultation process requires the use and combination of different methods considering the characteristics of the target audience. The aim of the stakeholder mobilization plan is to identify the stakeholders and their concerns, define the roles and responsibilities of the different actors involved in its implementation as well as the deadlines for execution of the activities and the costs (at need), consultations and participation activities. Thus, the stakeholder mobilization plan will be translated into a budgeted activity program which clearly defines the stages of carrying out the Project (start and end of activities), the costs of the different interventions as well as the responsibilities of the stakeholders. During implementation, continuous monitoring and flexible adjustment of social risk management will adapt the SEP to the Project implementation situation. Notification and dissemination of information will be carried out through the mass media, notably radio and television, newspapers, the Project website, town criers, posters, etc. Posters will be posted on sites or in well- identified health centers and hospitals accessible to all. To reach the maximum number of people likely to be impacted. Information will be widely disseminated before the meetings by local means accessible to the public. Table 3: Stakeholder engagement plan Type of Proposed Calendar: Targeted Responsibilities information to be Strategies locations/dates stakeholders disseminated as part of the Project Description of the Correspondence During all Political and PIU, MOH Project, objectives, and formal occasions of administrative scope, duration, meetings with public authorities, and stakeholders authorities; interventions, medical of the Project Public following the personnel; consultations; needs of beneficiaries; Field visits; preparation and Partners, the interviews… implementation State; NGOs ; the of the Project / media... at the capital of the municipalities and provinces Workforce Consultations, Provincial and All Project MOH management sharing and District Health stakeholders PIU procedures, application of management (affected and infectious disease International teams, PIU concerned) protocol and Good Practices offices; MOH Project Staff; barrier gestures, in the sector of and World Bank Health workers; protocols and activity to website Project actors; good practices for ensure Community the prevention of compliance with agents epidemics and international pandemics and standards and 24| P a g e other health practices related emergencies to the management of the health crisis; Official meetings; Training; Public consultations Environmental Awareness and Continuous All Project MOH and social issues training; awareness stakeholders PIU of the Project; Posters; Non- raising in (affected and Mitigation technical activity centers concerned). measures adopted summary (Health Center, by the Project documents and hospitals, lab, reports; Public etc.); consultations; Training and Brochures; retraining at the Radio start of work and as needed during the life of the Project Management of Information and Start of activities Health Workers PIU accidents and training on and Project work incidents procedures for Workers managing accidents and incidents at work 5.4. Proposed strategy for taking into account the views of vulnerable groups From the outset, consultations with communities will be open to the public and all mobilization mechanisms will be implemented to reach all stakeholders. However, if it turns out that certain PAPs, whose vulnerability is proven, refuse or are physically unable to participate in the meetings, the Project will organize consultations in conjunction with them and according to their convenience in places they would consider appropriate. To facilitate contacts, some of the options for reaching vulnerable groups are suggested: identifying the leaders of vulnerable and/or marginalized groups, the associations and groups concerned so that the latter can relay information to the grassroots; involve leaders, men and women, young people from the community, civil society organizations and NGOs in all phases of the implementation of the Project; organize individual interviews and focus groups, with an approach mindful of gender and age dimensions (groups of women separated from those of men, groups of children separated from those of adults, etc.) with vulnerable and/or marginalized people; facilitate access for vulnerable people to the complaints management mechanism put in place by the Project. 5.5. Calendars The environmental and social management plan and other documents are prepared and approved by the Government of Burundi and the World Bank. Consultations with stakeholders are undertaken during Project preparation and will continue throughout 25| P a g e the Project implementation phase to consider management updates as well as impacts occurring during implementation. There is a need to engage stakeholders to review and comment on the plans, as they are designed to mitigate the negative impacts of the Project and ensure the scaling of Project benefits to affected stakeholders. Each time the consultation process concludes, the Project will ensure that all feedback is incorporated into a report and that updated/final versions of the plans are shared with Project stakeholders, particularly affected people. Information popularization sessions and dissemination of updated/final versions of reports are the two main means of dissemination chosen. The information will be uploaded to the announced websites and printed versions of the final documents will be made available in easily accessible public places (e.g. public meeting places, libraries, health centers and/or local administrations). This part will need to be updated as the Project progresses. It will include: ▪ A summary of the main objectives of the stakeholder engagement plan; ▪ A schedule for all operations related to the Project through its various components. The table below provides timeline information listing Project phases, major decisions and deadlines for submission of comments. Table 4: Information relating to timetables and deadlines Project Phases List of information and major Deadlines for submitting decisions comments Preparation Potential risks and effects of the Project Start of start-up of work on on local communities, and mitigation activities measures, particularly for vulnerable and disadvantaged groups Eligibility criteria for affected and End of production of ESMPs and vulnerable people PPAs and start of implementation Process envisaged to mobilize At the end of the first semester of stakeholders (Participation and the first year of implementation involvement of actors and local populations) Complaints management mechanism At the end of the first semester of the first year of implementation Works Environmental and social issues of Halfway through the duration of PMNS activities: hygiene, safety, GBV- the work EAS/HS; child labor during works; waste management Functioning Maintenance and management at the end of each year measures Biomedical waste management at the end of each year 5.6. Review of comments For better processing and proper consideration of comments, the Environmental Protection and Social Development Specialists of the Project Management Unit will be responsible for regularly examining and considering comments from stakeholders throughout the duration. implementation of the Project. A register will be opened for this purpose. Suggestions, complaints and other contributions from stakeholders will be compiled into a feedback form which will be completed during the consultation 26| P a g e meetings. In addition, stakeholders will have the opportunity to send their feedback by email and physical mail or by telephone, via social networks or the Project website. For specific groups without a level of education and who cannot use certain communication tools (telephone, email, computers, social networks, etc.), an oral communication mechanism with focal points will be put in place. Feedback will be compiled by dedicated PIU staff and will be shared with the coordinator for support, as needed. If applicable, the decision will be formally notified to the interested party by mail. The terms of the letter must be adapted to the recipient on an intellectual and cultural level. This response may include: (i) a summary of the understanding of the comment submitted, (ii) explanations of the proposed solution(s); (iii) the solution adopted; (iv) the procedure for implementing the chosen solution, including deadlines. Comments (written and oral) will be collected in a register opened for this purpose and will be subject to examination and return by official mail to the persons concerned within a maximum period of three (03) weeks. 5.7. Subsequent phases of Project implementation Stakeholders will be kept informed of progress in the implementation of the Project, through quarterly/semi-annual/annual reports on environmental and social performance, as well as on the implementation of the SEP and the management mechanism, complaints, Civil Society Organizations (CSOs) representing stakeholder groups, local media, community leaders will serve as information relays in all provinces of Project intervention. Surveillance and monitoring of the implementation of this SEP and the GRM will be done periodically through quarterly and annual reports. Annual meetings will be organized for stakeholders to inform them of the progress of activities, discuss the problems encountered, propose solutions and readjust the strategies for conducting activities accordingly. The results of complaints management will also be communicated to stakeholders. 6. RESOURCES AND RESPONSIBILITIES FOR IMPLEMENTING STAKEHOLDER ENGAGEMENT ACTIVITIES 6.1. Resources The implementation of the Stakeholder Mobilization Plan mainly concerns the following resources: Persons responsible for implementing the SEP The MOH, through its various services and other branches, notably the PIU and the IEC service of the Ministry in charge of health, will implement the activities. The General Directorate of Health Services and the Fight against AIDS (DGSSLS) will coordinate stakeholder mobilization activities. Some day-to-day coordination responsibilities will fall to the PIU. As such, the Specialists in Social Safeguarding (SSS) and GBV, the Specialist in Environmental Safeguarding (SSE) and the Communication Specialist will be responsible, each and under the supervision of the Project Coordinator, of support to the Ministry structures responsible for implementing the SEP. The PIU will make available the contact details of the people responsible for responding to comments or questions about the Project or the consultation process, namely their telephone number, address, email and position. Stakeholder engagement budget The resources allocated to mobilization activities and stakeholder engagement will be integrated into the Project components. 27| P a g e 6.2. Management functions and responsibilities The PIU will incorporate stakeholder engagement activities into the Project management system, the Project document and the Project procedures manual. The Social Safeguards and GBV Specialist as well as the Environmental Safeguards and Communication Specialists of the PIU are responsible for implementing the SEP and leading each of the stakeholder mobilization activities. For this, they will be supported by the Head of the Finance Unit (RUF) of the PIU, the Procurement specialist and the Monitoring-Evaluation Manager (RSE) in the implementation of the Mobilization Plan stakeholders. The PIU Coordinator will have a major coordination and supervision role in the implementation of the SEP. Furthermore, this system will be reinforced by: ▪ the establishment of a platform (interactive website, Facebook page, Twitter page) will serve as a means of accessing all information: articles, procurement, announcements, final reports and documents relating to the Project. While social networks will make it possible to disseminate additional information; ▪ the creation of email and postal addresses and a telephone number, dedicated to complaints; ▪ the recruitment of a manager in charge of the information management system including the grievance recording and monitoring system. Thus, the PIU will be responsible for: (i) coordinating the implementation of Project activities, (ii) coordinating procurement, financial management, disbursements and environmental and social aspects of the Project in accordance with the provisions of the loan agreement, (iii) ensure timely delivery and updating of the implementation manual, annual work plan, procurement plan and disbursement projections, (iv) ensure coordination with the main stakeholders, (v) monitor the evolution of all Project results indicators and (vi) attend the main meetings concerning the Project. The MOH and PIU will be responsible for carrying out stakeholder engagement activities, while working closely with other entities, such as local administrative authorities, media, health workers, religious leaders and community, etc. Stakeholder mobilization/engagement activities will be documented in quarterly progress reports, to be shared with the World Bank. 7. SEA/SH SENSITIVE GRIEVANCE REDRESSMENT MECHANISM (GRM) As prescribed by the new ESMF, the MoH has put in place a procedure for resolving complaints/grievances (according to the specifications of ESS No. 10 as soon as possible in the development phase of the Project). This will be adapted so that it considers the specificities of the Project for preparation, response, and resilience to health emergencies in Burundi using the multiphase programmatic approach (P504531). The objective is to ensure the reception and processing of concerns, complaints, and disputes in an impartial and transparent manner. Therefore, to help resolve grievances as quickly as possible, in an effective and efficient manner that satisfies all parties concerned. The main objective of an SEA/SH Sensitive GRM is to help resolve grievances in a timely, effective and efficient manner that satisfies all parties concerned. It is a transparent and credible way of achieving equitable, effective, and sustainable results, while creating a climate of trust and cooperation, an essential element of the process of consultation of the entire population which facilitates the establishment of corrective actions. 28| P a g e In particular, the SEA/SH sensitive complaints management mechanism: ▪ Provides data subjects with the means to lodge complaints or resolve any dispute that may arise in connection with the execution of a Project; ▪ Ensures that appropriate and mutually acceptable remedies are defined and applied to the satisfaction of the complainants; ▪ Avoid having to initiate legal proceedings. It should be noted that as a preventative measure, consultation and participation measures, in particular individual meetings with stakeholders, can reduce the number of claims/complaints. The procedure is simple and accessible at the local level, open to different types of evidence. It will allow: ▪ Make adjustments and take corrective actions early in the process of resolving stakeholder grievances and developing the Project; ▪ Increase the transparency of the process; ▪ Reduce potential delays in Project implementation associated with unresolved disputes by minimizing the risk of recourse to the courts. Types of complaints and conflicts to deal with In practice, complaints and conflicts that appear during the implementation of the Project can be justified by the following elements: ▪ Errors in identifying and assessing stakeholders; ▪ Conflicts of responsibilities between stakeholders; ▪ Disagreement over the roles of other stakeholders; ▪ Poor communication between stakeholders; ▪ Complaints related to Sexual Exploitation and Abuse, as well as Sexual Harassment (SEA/SH) 7.1. Description of the SEA/SH -sensitive GRM The general objective of the establishment of the GRM is to ensure that complaints and concerns expressed by the beneficiaries of the various Projects are promptly listened to, analyzed, and processed with the aim of satisfying the complainants and ensuring the smooth running of the activities of the Projects. The specific objectives pursued by the GRM are as follows: ▪ Establish a system for receiving, recording and handling complaints and concerns in a timely manner with particular attention to vulnerable groups; ▪ Establish a system for receiving, recording and processing complaints relating to sexual exploitation and abuse (SEA) and sexual harassment (SH) based on an approach centered on the needs of survivors; ▪ Provide an effective, transparent, timely, fair and non-discriminatory system that would allow aggrieved persons to have a framework for expressing, listening and restoring their rights by submitting complaints and avoiding litigation; ▪ Promote mediation and amicable settlement of complaints (except complaints related to SEA/SH which are not subject to amicable settlement); ▪ Provide clarification following requests for information. 29| P a g e 7.2. Basic principles and criteria for effectiveness of GRM To ensure that the complaints management system is effective, trustworthy, and used, the following fundamental principles should be observed and taken into account: Table 5: Basic principles of GRM Principles Enforcement measures Indicators a. All complaints The complaint is made according to the Number of are admissible convenience of the complainant: electronic complaints filed, messaging will also be subject to examination recorded and by the Project. Only the designated person can processed decide to hear a complaint (in the office or by telephone) before proceeding in writing. If the complainant refuses to file a complaint in writing or to sign it, the Project will take care of transcribing the verbal complaints and will take them into account like other complaints. As for anonymous or verbal complaints or those relating to a private dispute, the Project may carry out additional investigations. b. Participation - Develop the GRM with strong participation of Percentage of representatives of all stakeholder groups; stakeholders - Fully integrate the MGP into Project activities; involved in the - Involve populations, or user groups, at each entire process stage of the processes, from design to monitoring and evaluation, including implementation; - Consult specifically with women and girls (in small, separate groups led by a woman) to confirm the accessibility and security of entry points and procedures for handling complaints related to SEA/SH. C. Confidentiality - Protect the anonymity of complainants if Absence of necessary; reprisals - Ensure the necessary confidentiality in the following event of complaints of a sensitive nature (cases denunciations of SEA/SH); - Limit the number of people with access to sensitive information. d. No It is essential that GRM reaches as many people Percentage of discrimination as possible from different stakeholder groups, vulnerable people particularly those who are often excluded or supported by the who are most marginalized or vulnerable. GRM 30| P a g e e. Survivor- Any response and prevention action regarding % of centered approach SEA/SH cases will require balancing respect for GBV/SEA/SH to SEA/HS the legality of the process with the demands of complaints incidents a survivor-centered approach in which choices, received referred needs, safety, and good -being survivors remain to support at the center for all questions and procedures. services within As such, all measures taken should be guided the stipulated by respect for the choices, needs, rights, and time frame. dignity of survivors, who must be favored in the complaint management process. In addition, obtaining informed consent, maintaining confidentiality, referral to support services (with consent of the survivor) are fundamental principles of this approach. f. Approach focused All of the guiding principles listed above apply % of child-related on the well-being to children, including the right to participate in complaints and best interests decisions that affect them. If a decision is made processed within of the child on behalf of a child, the best interests of the the specified time child must be the primary guide, and the child's frame. legal guardian must be involved in this decision whenever possible and without expose a child to additional risks. Regarding confidentiality , this is a very important principle as well as to create an environment where people can more easily raise concerns, you have to have confidence in the mechanism and be sure that it there will be no reprisals if they use it, confidential procedures must be guaranteed (not disclosing the identity of the complainant, recording by codes, processing of the case by people chosen by the complainant, etc.). Confidentiality helps ensure the safety and protection of those who file a complaint and those affected by it. To do this, it is necessary to limit the number of people with access to sensitive information. All complaints handling procedures are conducted with the greatest respect for all, by all parties and, where applicable, in the strictest confidentiality. For SEA/SH cases, the confidentiality of complainants, survivors, and other parties must be always respected. All information relating to GBV must be kept confidential, identities must be protected, and personal information about survivors should be collected and shared only with the informed consent of the person concerned. Additionally, physical documents and data collection tools should be stored securely and in locked filing cabinets with strictly limited access. Sensitive or personal information that identifies the survivor should never be shared without their informed consent. As part of reporting, data regarding SEA/SH complaints will be shared only anonymously and in an aggregated manner (e.g. type of GBV, link to the Project, sex and age of complainants). In short, the mechanism is intended to be rapid, effective, participatory, and accessible to all stakeholders, to prevent or resolve conflicts through amicability, negotiation, dialogue, joint investigation, etc. Regarding the principle of non-discrimination, this includes identifying and establishing various entry points that consider gender, culture and context. When the risk of exclusion is high, particular attention must be paid to safe mechanisms that do not require the ability to read and write. Stakeholders will recognize in these principles’ elements of usual good development practices and many of them will already put them into practice. It would also be important to ensure the establishment of a basic anonymous system for monitoring cases of SEA/SH, 31| P a g e allowing them to make anonymous reports and provide aggregated information on cases. incidents of SEA/SH which refused referral to the GRM, which will strengthen monitoring of the accessibility of the system. In addition, regular consultations with complainants and other community members, including groups most vulnerable to violence, to assess their knowledge, confidence and satisfaction with the system, or other comments and suggestions, will be important in strengthening accessibility. The mechanism is intended to be rapid, effective, participatory, and accessible to all stakeholders, to prevent or resolve conflicts amicably, negotiation, dialogue, joint investigation, etc. 7.3. Actors authorized to submit a complaint Any community, population, organization, and individual can submit their complaint and obtain responses at the appropriate time. However, not all complaints are eligible, but a response will be given each time a complaint is submitted. In principle, the GRM in the implementation of health sector projects should directly affect the actors implementing the action as well as the beneficiaries of the projects. However, potential beneficiaries, indirect beneficiaries or non-beneficiaries may also have conflicts inherent to the Projects. We can cite, for example, residents living near health facilities who breathe in air infected by poorly installed incinerators or noise caused by infrastructure rehabilitation work. At the community level, complaints can come from several sources such as the dissatisfaction of potential beneficiaries of the activities and benefits of the Projects such as (i) during the distribution of different inputs at the household level (micronutrient powder and the diagnosis of children suffering related malnutrition, small farm animals, etc.), (ii) during the identification of members of the different community structures involved in the implementation of Project activities (CHWs, Mamans Lumières, local steering committees, etc.), (iii) during the identification of potential beneficiaries of the various training courses organized within the framework of the Projects, etc. Complaints may also come from certain segments of the population sidelined during the execution of the Projects in this case the community of indigenous peoples (Batwa) and other vulnerable groups. In short, the complainant can be any individual, group of individuals or structure affected directly or indirectly by the activities of the Projects as well as those who may have interests in a Project or the capacity to influence its results. This may include local populations, indigenous peoples, grassroots administrative authorities, or other state services, local or national civil society, private sector companies or any other structures whose activities would be affected by the activities of the Projects of the Ministry in charge of health. 7.4. Complaint resolution levels and description of committees In order to ensure effective management of complaints and the sustainability of the intervention, this GRM sensitive to SEA/SH recommends a more inclusive and empowering approach through the establishment of complaints management committees composed of members of the structure concerned. This approach will allow the staff of the structure to take ownership of the complaints recorded and to combine efforts for a good resolution of these complaints and harmonious management of the structure. Thus, for participatory and effective management of complaints arising from the implementation of health sector Project activities, the 32| P a g e different levels of complaint management are put in place according to the levels of the MOH structure. The health structure is made up of: (i) central level composed of the Minister's Office, the Permanent Secretariat, the General Health Inspectorate, 4 General Directorates (the General Directorate of Health Services and the Fight against AIDS, the General Directorate of Offering Care, Modern and Traditional Medicine, Food and Accreditations, the General Directorate of Planning, the General Directorate of Resources), 4 general directorates with personalized management, namely the National Institute of Public Health ( INSP), the National Blood Transfusion Center (CNTS), the Burundian Regulatory Authority for Medicines for Human Use and Foods (ABREMA), the Central Purchasing of Essential Medicines of Burundi (CAMEBU), two personalized Directorates [the National Reference Center for Physiotherapy and Medical Rehabilitation (CNRKR), and the National Reproductive Health Program (PNSR) as well as the National Third Reference Hospitals. (ii) intermediate level made up of 18 Health Province Offices (BPS) of which each BPS is made up of 3 districts on average, (iii) peripheral level corresponding to the Health Districts which are basic operational entities of the health system and made up of a BDS office, a district hospital and municipal hospitals serving as first reference as well as a network of health centers (10 at 15 health centers per district), as well as; (IV) community level made up of community relays (health committees (COSA), groups of community health workers (GASC) and mothers of light (ML) as community relays working with health sector projects)7. The establishment of the various complaint management structures will follow this logic. 6.4.1. Community Level Committees For the NKURIZA Project (P165253), which is essentially implemented at the community level, the structures for receiving and managing complaints follow the following path: At the provincial and municipal level, there already exists a Provincial Food Security and Nutrition Platform (PPSAN) and a Municipal Food Security and Nutrition Platform (PCSAN) established respectively by Order of the Prime Minister and by Ministerial Order of the Minister of Agriculture. Interior, Community Development and Security. Both constitute decentralized multisectoral structures of the Multisectoral Food Security and Nutrition Platform (PMSAN). The establishment of complaints management committees at the municipal and provincial level will be inspired by these already existing structures but will be modified for operationalization purposes given that the main role of these structures is essentially the role of orientation and control. Thus, the various community complaints management committees are constituted as follows: 7Health standards for the implementation of the 2021-2027 sectoral strategy, TOM I 33| P a g e Table 6: Constitution of Complaints Management Committees at community level Instance/Structure Complaint Committee Criteria management level composition/profile Administrative Hill Hill Mediation 5 people (including a - Be a unifying person: quiet, internally peaceful, who Committee (CMC) president, a vice-president, listens well to others and who pacifies others; a secretary, a focal point for - Be a person of integrity: capable of keeping secrets, all complaints and another living harmoniously with others, capable of listening focal point (preferably a to everyone without distinction, being able to help eve- woman) for GBV/ SEA/SH ryone without distinction of ethnicity, gender, religion complaints) elected in a , political party, opinion, standard of living, etc.; hillside general assembly - Be a helpful person: capable of helping in the form of volunteering, without counting on a return; - Be aged 21 and over; - Be of Burundian nationality; - Be a resident or carry out a Project on the hill con- cerned. - The CMC secretary must know how to read and write Kirundi well. Knowledge of French is desired; - Considering women and vulnerable groups is recom- mended; - For each hill sheltering a Batwa site, a person of this category must be part of the CMC Municipality Communal Complaints - The Advisor to the Munici- Among the members of the CCGP, the appointment of Management pal Administrator responsi- the municipal administrator which will be made on the Committee (CCGP) ble for social issues (CTAS); proposal of the Project, must also designate the - The municipal veterinary president, the vice-president, and the secretary of the technician; committee. He will also designate a focal point for all - The Director of the munic- complaints and another focal point (preferably a ipal hospital or his deputy; woman) for GBV/ SEA/SH complaints. - An advisor to the munici- pal Director of Education (choose an advisor from one Page 34of 55 of the areas covered by the Project); - The Municipal Manager of Family and Social Develop- ment. Province Provincial Complaints - The Governor's Advisor in Among the members of the CPGP, the Provincial Management charge of socio-cultural is- Governor must also designate the president, vice- Committee (CPGP) sues; president and secretary of the committee. He will also - A BPS supervisor; designate a focal point for all complaints and another - A Head of Department at focal point (preferably a woman) for GBV/ SEA/SH the Provincial Office of Envi- complaints. ronment, Agriculture and Livestock or his representa- tive; - An Advisor to the Provin- cial Director of Education or his Representative; - The Provincial Director of Family and Social Develop- ment. Page 35of 55 6.4.2. Health pyramid and central level committees Peripheral level: This is the level of execution of most health system activities. Thus, 3 levels of complaint management are required: these are the Health Centers, the hospital and the health district office. Thus, complaints management committees named respectively CGP/Health Center, CGP/Hospital and CGP/District will be set up . At the intermediate level, a Complaints management committee named “ CGP/BPS � which will be set up in each Office of each Health Province in addition to the Complaints Management Committee which exists at the national level. At central level: a complaints management committee will also be set up. It will be called the central level Complaints Management Committee “ CGP/National �. The table below shows the composition of these different committees as well as the mission assigned to each committee. Page 36of 55 Table 7: Composition and mission of the complaints management committees of the health pyramid. Structure Complaint Committee composition/profile Mission of the complaints management management level committee Health Center Health Complaints - Health Center holder; Serves as the entry point for all patient complaints, Management - The Health Promotion Technician manages them but also welcomes and processes Committee (TPS)/or Community Health Focal complaints from the staff of this CDS. Point Nurse (IPFSC); - The Head of the laboratory depart- The CGP/Health Center will be set up by the Chief ment; Medical Officer of the Health District on the - The head of the Family Planning proposal of the Health Center holder, and will (PF) department; transmit its report to the Health Holder who will - The Head of the vaccination de- submit it to the Chief Medical Officer of the Health partment. District Hospital Hospital Complaints - The Director of the hospital or the Its mission is to manage complaints from patients Management Deputy Director in charge of care; who visit it on the one hand and those from Committee - The Chairman of the Hygiene, hospital staff on the other. Health and Safety at Work Commit- tee; The CGP/District Hospital will also be set up by - The Chief Nursing Officer; the Chief Medical Officer of the Health District - The Emergency Manager; within the jurisdiction of the hospital on the - The Head of the Maternity Depart- proposal of the Hospital Director. The committee's ment. report will be transmitted to the Director of the hospital who will forward it to the Chief Medical Officer of the Health District concerned. BDS BDS Complaints - The chief medical of the Health Dis- It will have the mission of receiving and managing Management trict; complaints coming from its staff on the one hand Committee - The Health Information System and, on the other hand, those which have not Manager (SIS); found solutions at lower levels of complaint - 2 Supervisors among the district management, in this case complaints transmitted focal points; by CGP/CDS and CGP/Hospitals. - Dstrict manager. The CGP/District will be set up by the Medical Director of the Health Province within his jurisdiction on the proposal of the Chief Medical Page 37of 55 Officer of the Health District. The committee's report will be sent to the Chief Medical Officer of the Health District who will forward it to the Medical Director of the Health Province. BPS BPS Complaints - Director of the Health Prov- It will have the mission of receiving and managing Management ince/BPS; complaints coming from its staff on the one hand Committee - Provincial Coordinator for Health and those which have not found solutions at the Promotion (CPPS); level of the health district complaints management - Responsible for the health infor- committees on the other hand. mation system (SIS); - BPS supervisor; The CGP/BPS will be set up by the Director - BPS Secretary. General of Health Services and the Fight against AIDS (DGSSLS) on the proposal of the Medical Director of the Health Province. The committee's report will be sent to the Medical Director of the Health Province who will forward it to the DGSSLS. On a national CGP/National - The DGSSLS and Principal Project The CGP/National will have the mission of level Coordinator; receiving and managing complaints coming from - The Director General of Resources central level staff on the one hand and, on the (DGR); other hand, those which have not found solutions - The Director General of Planning at the level of the FOSA complaints management (DGP); committees and those at the community level - An executive from the Department which will be transmitted to them. This committee of Health Promotion, Healthcare De- will also be responsible for verifying SEA/SHcases mand, Community and Environ- with a view to establishing links between the case mental Health (DPS-DSCE); and its author and one of the Projects. - The Expert in Social Safeguards and GBV for MoH/IDA Projects; The CGP/National will be set up by the Permanent - The Expert in Community and En- Secretary of the MOH and the committee's report vironmental Health for MOH/IDA will be transmitted to this same authority. Projects; - The Expert in Monitoring-Evalua- tion of MOH/IDA Projects; Page 38of 55 - The Expert in Communication and Behavioral Change for MOH/IDA Projects; - The Head of the IEC depart- ment/Minister's Office; - A Member of the Technical Unit for Performance-Based Financing (CT- FBP); - An Advisor from the DGSSLS. For operational purposes, each committee must have a President, a Vice-President and a Secretary of the committee. In addition, each committee will designate two Focal Points including one person who will play the role of focal point or entry point for all complaints received by the MGP and another focal point, preferably a woman, to play the role of point of contact. entry of complaints related to GBV/ SEA/SH. To allow the various complaints management committees to work in complete independence, the office of the committee (i.e. the President, the Vice-President and the Secretary) will be elected by all the members of the management committee. complaints based on people's performance and personality. Thus, the number 1 manager of the health structure does not necessarily have to be the president of the complaints management committee. Page 39of 55 6.4.3. Role of GRM Committees The role of the various complaints management committees is summarized in these points: • Receive, record and acknowledge receipt of complaints; • Regularly inform the PIU (through the social safeguards Expert) of the status of complaints received, recorded and processed; • Carry out in-depth investigations to identify all the issues surrounding the complaint; • Engage with the complainant in negotiations for an amicable resolution of the complaint, except for GBV- SEA/SH complaints; • Organize complaints analysis sessions and give the results to the complain- ants; • Prepare, in collaboration with the complaints management level concerned, as well as the local administration, the restitution sessions of the resolutions taken regarding the complainants; • Transfer unresolved complaints to the next level; • Regarding complaints related to GBV- SEA/SH, the GBV- SEA/SH Focal Point designated and trained to receive SEA/SH complaints must refer them to GBV- SEA/SH service providers. His role will be limited to reception and referencing. The management of GBV- SEA/SH complaints will be carried out by GBV- SEA/SH service providers. As for verifying the existing link between the case and the Project, the service providers are supported by the Project through the National Complaints Management Committee; • Prepare minutes or complaints management reports in two (02) copies, one for the entity's internal archives and another for the higher hierarchical level of complaints management; • Etc. 7.5. Complaints management procedures 6.5.1. Complaint channels Out of respect for the principle of accessibility and context, the method of filing complaints will be diversified. Thus, for the filing of complaints, a combination of different approaches will be used: ✓ By self-referral to the various complaints management committees based on supervision reports, community consultation activities, radio broadcasts, pub- lications on social networks; ✓ Suggestion boxes; ✓ Reports from community stakeholders such as GASC, COSA, Mamans Lu- mière, etc. ; ✓ In person face to face; ✓ By formal mail sent (directly or by transport agency except EAS/HS); ✓ By email transmitted; ✓ By telephone call or verbal complaints: on the toll-free number (open for the PHEOC), cases of Covid-19) or on other available telephone numbers; ✓ By sending an SMS, a WhatsApp text to the available telephone numbers. 6.5.2. Complaint reception and recording levels The levels for receiving and recording complaints correspond to the levels for managing complaints. Page 40of 55 At the community level, there are four (4) complaint management bodies: i) hill level (CMC), ii) municipal level (CCGP), iii) provincial level (CPGP) and iv) central level. (CNGP). At the health facility, four levels (4) also exist: i) the health center complaints management committee (CGP/health center) located at the same level as the hospital complaints management committee (CGP/ Hospital), ii) complaints management committee at the health district office level (CGP/District), iii) complaints management committee at the health province level (CGP/BPS) and v) complaints management committee at the central level (CGP/National). The CGP/health center and the CGP/Hospital are located at the same level since both structures report to the health district. Furthermore, there is no hierarchical link between the two types of health facilities. Note that it is not excluded to resort to the competent courts in the event of exhaustion of all possible amicable avenues of appeal and/or if the complainants find that the court remains the best avenue of recourse. For SEA/SH complaints, informed consent from survivors will be obtained before any legal recourse and these complaints will never be resolved amicably. At each level, the complaint can be addressed to any member of the Committee regarding the accessibility of the mechanism. The member concerned has the obligation to bring the information to the Focal Point designated for general complaints. The latter will communicate it without delay to the Chairman of the complaints management committee who will bring together the members and the complainant to obtain further information on the complaint. At this meeting, the complainant officially files his complaint which is recorded by the secretary of the committee. The complainant is informed of the steps and an indicative timetable for processing their complaint. For SEA/SH complaints, these will be received by the person designated as SEA/SH Focal Point among the committee members. This entry point must be a secure and very accessible person whose sole role will be to receive SEA/SH complaints while respecting the principle of confidentiality and anonymity, refer them to the locally available GBV service provider and communicate them quickly to the National Complaints Management Committee through the Expert responsible for social safeguards and GBV. The SEA/SH Focal Points must have the telephone number and email address so that this communication is carried out within an appropriate time frame. The verification of SEA/SH complaints will consist of establishing the link with the Project, ensuring that survivors access services and that the approach centered on the needs of survivors is respected. However, regardless of the level of processing of complaints related to SEA/SH /GBV, these complaints will be recorded like other complaints in the monthly report of each entity. It is important to note that the objective of the verification process is to examine the existence or not of a link between the alleged perpetrator of the act of SEA/SH and the MOH Projects financed by IDA. The objective of the verification process is also to ensure accountability by recommending disciplinary measures against the alleged perpetrator, which are reliable and substantiated within a disciplinary procedure. Verification does not establish the criminal innocence or guilt of an individual, which remains solely the responsibility of the justice system. Additionally, any final decision regarding sanctions to be applied remains solely with the alleged perpetrator's employer or manager. Page 41of 55 6.5.3. Complaint processing circuit and response times to provide The work assigned to the complaints management committees is done in seven stages: 1. Access to information concerning the operation of the complaints filing and man- agement system; 2. The filing, acknowledgment of receipt and recording of complaints by the Project; 3. Sorting and processing complaints; 4. Verification and action; 5. Feedback to persons who have filed complaints and to the public, and 6. Monitoring and evaluation of mitigation measures; 7. Resolution, closure and archiving of complaints Concretely, these seven steps should make it possible to answer the following ques- tions: Step 1: Awareness/communication/information to beneficiaries: How are users informed of the existence of the mechanism? How are complaints received? Are there different methods of transmission (oral/written submission on site, mail, telephone message, text message, mailbox, etc.)? How to ensure inclusive access to information regarding MGP? Different methods of accessing information/communication: It is essential that the population living in the Project intervention area is informed of the possibility of filing a complaint through the mechanism, rules and procedures for managing complaints and avenues of appeal. This information must be disseminated to all stakeholders and at all levels to allow the complainant to know it well in order to be able to use it if necessary. To this end, different methods will be used, notably: awareness sessions, radio, television, advertising spots, radio broadcasts, media synergies, etc. Thus, an entity/person injured following the implementation of Project activities will send their complaints to the complaints management committees set up for this purpose. Another method consists of directly informing Project beneficiaries through broad communication followed by complaint filing procedures. In the implementation of this Project, communities and stakeholders are informed of the grievance resolution mechanism through public consultations (meetings including meetings after community development works, communicated to churches, public announcements at markets, etc.), information-awareness sessions, image boxes, posters, leaflets, etc. The information thus concerns the levels, roles, composition of the bodies, filing, processing of complaints and feedback to allow complainants to know them well in order to use them for their own purposes. if necessary. Step 2: Submission, reception and recording of complaints : Is an acknowledgment of receipt provided? How are complainants informed of the progress of the processing of their complaints? Filing a complaint can be done through the following channels: ✓ In person or face to face; ✓ By telephone call to the President, secretary or focal point of the complaints management committee that beneficiaries can call to file an anonymous com- plaint about a sub-project ; Page 42of 55 ✓ Green number ; ✓ By SMS/text message sent to the Secretary of the complaints committee; ✓ By well-placed complaint boxes accessible to everyone in communities or in health facilities and health structures where beneficiaries can submit anony- mous complaints in writing ; ✓ During community awareness sessions and morning health information and education sessions; ✓ Electronic message sent to the Project coordination following the electronic addresses to be communicated; ✓ During administrative meetings with managers of health facilities and other health structures with the presence of a member of the complaints manage- ment committee. ✓ Etc. All complaints received will be recorded upon receipt. GBV complaints will be received by the SEA/SH Focal Points established and trained in all complaints management committees at all levels and recorded in a register separate from that of other complaints. They will be directly communicated to the GBV/ SEA/SH Specialist of the Health Sector Projects. All SEA/SH Focal Points, as well as the GBV-SEA/SH specialist, must ensure the confidentiality and security of data. The Complaints Management Committee will send a letter of acknowledgment of re- ceipt within a maximum of three days. The letter will inform the recipient of the next steps. In this letter, we will ask for clarifications or additional information if necessary for a better understanding of the problem. Acknowledgment will be systematized only in the case of written complaints, where a file number is given with a release. To a lesser extent, it will also be possible when complaints are expressed during meetings, to record them in the minutes of the meeting. At the addresses indicated, all complaints received, whether by telephone, email or post directly from the complainant, will be recorded. Registers will be opened at the level of each Complaints Management Committee set up. Complaints that have not received satisfaction at a given level will be escalated to the next level. For each complaint, a complaint file will be opened, containing: - The complaints form (which records complaints, details of the complaint, name, CNI number (if available), address of the requester, date of request, type of request and names of persons receiving the grievance); - Acknowledgment of receipt of the recording, to be given to the complainant; - The complaint follow-up sheet (measures taken, corrective measures); - The closure sheet, a copy of which will be given to the complainant after his approval of the resolution and his signature; NB: Complaints will be registered within 2 days of receipt; a provisional response will be sent within 7 to 10 days and a final response will be provided to the complainant within a maximum of 20 days. Closing a complaint does not automatically mean that the complainant is satisfied with the action taken (in cases where a complaint is not justified). Closure means that the complainant approves that action has been taken by a committee to address the complaint without necessarily being satisfied with the outcome. Step 3: Sorting, classification and processing of complaints: How are complaints categorized, recorded and filed? Who are they addressed to? How are they treated? Page 43of 55 It is important to clearly define who is responsible for recording, sorting, and handling different types of complaints, establish clear timetables for the complaints handling process and assign each complaint a unique identifier (number). A sorting process is carried out following the submission of the complaint by the committee concerned, with a view to determining the type of complaint registered (sensitive or non-sensitive), its validity (related to the Project or not) and the appropriate examination procedure. Thus, this sorting will allow the members of the different committees to know whether the examination of the complaint requires an investigation in the field, the intervention of other members of the Projects team or of certain resource people. Likewise, sorting will make it possible to know whether the complaint is the responsibility of the PIU, the service providers or suppliers, or the responsibility of other actors outside the Projects. The social and GBV issues specialist of the Projects and the other members of the PIU concerned (members of the national complaints management committee) will be informed after this sorting and classification phase, to collect their opinions and suggestions in the event of complaints. more complex and complicated. In cases of SEA/SH, only the service provider will have access to confidential and identifiable information regarding the complainant. Only non-identifiable information will be shared with the PIU and the World Bank such as the type of case, the alleged perpetrator's relationship to the Project, the age and gender of the survivor. For each level of complaints management, the president of the Committee or the focal point for general complaints acknowledges receipt of the complaints transmitted and sets a date for holding a session of the committee within three (03) working days, to receive the complainant(s) to obtain further information about the complaint and its registration. Thus, the Committee may have seven (07) additional working days for in-depth investigations to rule on the complaint. The committee must meet and make a final decision on the complaint within ten (10) working days from the date of filing the complaint. After this period, the complaint will be systematically transferred to the higher-level committee for examination. • If the complaint is deemed founded and admissible, after in-depth investi- gations, the complaints management committee concerned notifies the com- plainant(s) and begins negotiations for an amicable solution. If a satisfactory agreement is reached between the complainant(s) and the committee mem- bers, the complaint is closed at this level. • If the complaint is deemed unfounded and inadmissible (when the com- plaint has no relation to the activities of one of the Projects of the Ministry in charge of health and financed by the IDA) this is notified to the complainants, with the clarification that they have the possibility of using other legal remedies to resolve the problem posed. • If the complaint is deemed well-founded and the solution proposed by the complaints management committee is not accepted by the complainant, it is brought before the higher-level committee. To do this, it will be neces- sary to transmit to the higher-level committee, a copy of the complaint regis- tration form and the Minutes (Minutes) of the complaint resolution session, within 72 hours. working days that follow. In any case, complaints reported to the complaints management committee will be processed diligently and feedback will be provided to the complainant. Page 44of 55 For complaints that have not found solutions and are transferred to the national level, the complaints management committee at the central level must meet and make a definitive decision on the complaint within ten (10) working days from the date of receipt of the complaint. In the event of continued non-conciliation, the Presidency will indicate other available remedies, including administrative and judicial mechanisms. Regardless of the outcome, the PIU will document and archive all discussions and choices offered. Complaints Management Committees at the health facility, district (BDS) and provin- cial (BPS) levels, as well as those at the hill and communal level t will be set up and will be responsible for sorting and registering all requests and complaints in the reg- ister. management of complaints or conciliation book so that they are processed or transferred through the secretary of the local complaints management committee. Each complaints management committee will be set up and will periodically be re- sponsible for analyzing complaints received, their treatment and the responses pro- vided, promoting amicable settlement. An unresolved complaint will be transferred to the next level Complaints Management Committee. Step 4: Verification and actions: How is the necessary information collected to re- solve the complaint? Who is responsible for implementing the corrective action? Complaints must be evaluated objectively based on the facts by implementing actions that are proportionate to them. Verification and action are the responsibility of the Complaints Management Committee responsible for managing this complaint, except for SEA/SH complaints where verification will only be the responsibility of the Na- tional Complaints Management Committee which will have to verify a probable link between the alleged perpetrator and the Project. Step 5: Monitoring and evaluation of complaints: What is the complaints moni- toring system? How is complaint data analyzed? The monitoring of complaints is carried out directly by the National Complaints Man- agement Committee, which committee will ensure the improvement of the system for receiving and monitoring complaints to avoid several problems in advance and im- prove the acceptability of the activities of its subordinates. -Projects. Particular atten- tion will be given to complaints from vulnerable people. These will be clearly specified through the reports transmitted by the committees at all levels. The objective of monitoring-evaluation is to verify whether the principles and values conveyed by the mechanism are respected, namely: participation, accessibility and inclusion, security/confidentiality, transparency, absence of reprisals, proactive information, impartiality/objectivity/neutrality as well as the use and exploitation of different complaint management tools to monitor and progressively improve the mechanism and enable good reporting. The evaluation also aims to ensure that the information associated with complaints is used to correct actual or potential problems encountered during operations. Data from the complaint management mechanism can be used to determine whether the concern relates to a particular location or group requiring the entity's attention, or whether it is a broader issue. Complaints are monitored directly by the Project Safeguards Specialists (social safeguards and GBV expert and the environmental safeguards expert as well as the monitoring-evaluation expert for reporting on Project indicators) in close collaboration with other PIU actors involved in this GRM. However, the PIU is responsible for the overall implementation and monitoring of this MGP. As such, the members of the PIU Page 45of 55 working on behalf of the Projects will ensure the improvement of the system for receiving and monitoring complaints. Thus, particular attention will be given to sensitive complaints (GBV- SEA/SH) and those coming from vulnerable people. In accordance with the principles of ethics, security and confidentiality, no information that could identify the survivor, her family or the perpetrator should be included in a data report. Monitoring will make it possible to share the progress of case processing, constraints, additional needs in terms of assistance and support. This role will be carried out by the social and GBV expert of the Projects who will be the contact person for reporting and support services. Using the data collected in the complaints register, the monitoring sheets and the closing sheets, a quarterly monitoring report will be produced to highlight the major trends. Do certain types of complaints come up systematically? Do more complaints come from a certain health facility or hill? Are there lessons to be learned from the complaints received? Are the solutions replicable to other contexts? How should we proceed in the future to avoid these types of complaints? All these questions must be asked in light of the data collected during complaints. The answers to these questions will be used to make changes to the operations and management structure of the mechanism to reduce complaints. The objective of the quarterly monitoring report is to evaluate long-term performance and avoid overlooking complaints. A dedicated report, compliant with confidentiality requirements, will also be required by the GBV service provider(s) on behalf of the Projects. It will address questions such as: Are there forms of SEA/SH that are more frequently reported, even if not verified (given the different barriers to verifying this type of complaint ) ? Are there groups of beneficiaries who appear to be particularly at risk? Should any SEA/SH risk mitigation measures or messages be modified/strengthened? The principles to be respected when documenting and monitoring cases include (i) completing incident report forms in accordance with the guiding principles; (ii) ensure the confidentiality of information; (iii) respect survivors and (iv) keep completed incident forms in locked cabinets with restricted access. The monitoring indicators linked to the GRM include: • Number of mass awareness campaigns on GRM in Project intervention areas; • Types and number of trainings received by GRM stakeholders; • Number of people trained (disaggregated by gender); • Types of complaints recorded; • Remedies for resolving complaints; • Duration of processing complaints including SEA/SHcomplaints; • Number and percentage of complaints received, including vulnerable people and disaggregated by gender; • Number and percentage of complaints resolved; • Number and percentage of unresolved complaints; • Number and percentage of complaints that were submitted to mediation; • Number of complaints resolved amicably; • Number of complaints brought before the competent courts; • Minutes of complaint resolution; • Number and percentage of SEA/SH complaints that were referred to support services within the proposed time frame; • Number and percentage of female focal points in the GRM; • etc. Page 46of 55 Step 6: Feedback to complainants: How are users of the mechanism and the public informed of the results and measures taken to resolve complaints? It is important to contact complainants to explain how their complaints were resolved. It will be necessary to make the results of actions linked to the complaints manage- ment mechanism more widely known, to improve its visibility and strengthen public confidence. Note that for complaints related to SEA/SH, the judicial authorities must be con- tacted immediately after the facts. No amicable arrangement is possible as it is pun- ishable by Burundian law. Indeed, amicable resolution will never be used as a means of resolution for this type of complaint. The merits and acceptability of receiving SEA/SH complaints is not to be determined by the various committee members. The objective of the verification process is to examine whether a link exists between the alleged perpetrator of the SEA/SH act and the Projects. The focal points of the com- mittees at all levels have 24 hours to do the referencing and notify the SEA/SH cases to the national committee (through the social safeguards and GBV officer) and, in turn, to the World Bank, using a pre-established notification form. A separate, secure, and confidential register for recording complaints will be managed by SEA/SH Focal Points and GBV service providers. A separate notification form for SEA/SH complaints will be used to allow the service provider to escalate the complaint to the national MGP committee. The GBV service provider continues to play a supporting role with the survivor while respecting the latter's choices and wishes. NB: Any amicable solution found between a GRM Committee at the community, peripheral and intermediate levels and the complainant(s) who require compensation is systematically transferred to the national complaints management committee for examination and assessment. Step 7: Resolution, closure and archiving of complaints: Once the solution is accepted and successfully implemented, the complaint is closed. In addition, it may be necessary to ask the complainant to provide feedback on their level of satisfaction with the complaint handling process and the outcome. If it happens that a solution is not found despite the intervention of the different levels of mediation and the complainant initiates external legal recourse, the complaint is not closed. It will be after the court verdict and the PIU will have to document the conclusions. Beyond the complaints database, the Project's Social Safeguarding and GBV Expert will set up, in collaboration with the committees in place, a physical and electronic archiving system. This system will provide access to information on i) complaints received, ii) solutions found, iii) unresolved complaints requiring further interventions and iv) actors involved. The Expert in social safeguarding and GBV as well as the Expert in monitoring and evaluation of health portfolio projects are responsible for archiving complaint files (complaint registration and processing form, conciliation, and non-compliance minutes). -conciliation, etc.). A database on complaints management will be created for this purpose by the two experts for permanent reference whenever necessary. The support of Projects IT (in its capacity as Programmer Analyst) will also provide support for the database to be available online. Regarding cases of SEA/SH, the complainant must be informed by the National Complaints Management Committee and the GBV- SEA/SH service provider (for their nature of being found near the survivors) of the outcome of the verification once it has been concluded. Before that, the GBV- SEA/SH service provider supporting the national complaints management committee will have put in place a security plan for Page 47of 55 the complainant, if this proves necessary and in agreement with the survivor. The author is also notified by the appropriate representative within his or her structure, only after the complainant has been informed. The GBV service provider continues to play a supporting role with the survivor while respecting the choices and wishes of the latter. 8. MONITORING AND REPORTING 8.1. Participation of the various stakeholders concerned in monitoring activities The Project management unit guarantees the participation of stakeholders in monitoring Project’s activities or the associated impacts All stakeholders will participate in the monitoring and mitigation programs of the Project's impacts through the visits organized by the Project, and the restitution workshops, in particular those contained in the safeguard instruments (ESMF, LMP, GRM, Environmental Plan), GBV actions - SEA/SH, IPP, ESMP). Activities relating to the Stakeholder Engagement Plan will be detailed in the implementation action plans (monthly, quarterly, and annual). These action plans specify, among other things, for each action or activities planned, the person responsible, the actors involved, the necessary resources (budget) and the implementation deadlines. The following indicators will be used to monitor and evaluate the effectiveness of stakeholder engagement activities: ▪ Number of meetings of different kinds (public hearings, workshops, meetings with local administrative authorities, etc.) held with each category of stakeholders and number of participants; ▪ Number of stakeholders included in the dedicated register; ▪ Number of suggestions and recommendations received by using various feedback mechanisms; ▪ Number of publications covering the Project in the media; ▪ Percentage of survivors who present within 72 hours of a rape incident are referred for medical care; ▪ Number of SEA/SH complaints (without target) that are received by the GRM; ▪ Percentage of complaints to the GRM that are resolved within the expected time frame; ▪ Percentage of complaints to the GRM that are not resolved within the expected time frame; ▪ Number of awareness campaigns on GBV, prohibited behaviors, and GRM; ▪ Number of populations targeted/sensitized broken down by sex and age. Other relevant indicators may be collected annually. The SEP will be updated during operations whenever necessary. 8.2. Reporting to stakeholder groups The objective of a stakeholder engagement plan is to provide an opportunity for interested and affected Project stakeholders to express their opinions, interests, and concerns about the Project, ensuring that the benefit of the Project goes to the members of the community. It is mandatory that the PIU, through existing communication channels, reports to stakeholders, showing how stakeholder inputs and concerns were addressed as well as those that were not included and why. If stakeholders are dissatisfied, they can use the PMM to submit complaints relating to the impacts of the Project or, indeed, the consultation and engagement process implemented by the Project. The results of stakeholder engagement activities will be communicated both to the various stakeholders involved and to broader stakeholder groups in the forms and Page 48of 55 according to the timetables established in the previous sections. Corresponding monitoring tools (monthly, quarterly, and annual reports) will be developed to be capitalized in the overall project activity monitoring document. The reports established for this purpose will be based on the same communication sources as those provided for notifications to the various stakeholders concerned. The monitoring reports will highlight the gaps between forecasts and achievements in terms of activities, the achievements of the implementation of activities, the difficulties and the solutions envisaged. The person responsible for monitoring the implementation of the activities included in the Stakeholder Mobilization Plan is the Social Safeguard Specialist who will be supported by the environmental safeguard specialists and the monitoring-evaluation specialist. The existence of the complaints management mechanism will be systematically reminded to stakeholders each time a communication opportunity arises. CONCLUSION The SEP constitutes one of the essential tools for managing social risks in project’s implementation. As part of the measures of the new environmental and social framework of the World Bank, the SEP is an integral part of the contractual documents to be developed before the approval of any Project. This SEP is developed as part of the submission of the Burundi Health Emergency Preparedness, Resilience and Response Project (P504531), for negotiation of financing from the World Bank. This is a dynamic document which will evolve as the preparation and implementation of the Project progresses, to consider the consultation and participation needs of stakeholders whose actions should provide greater -considerable value in achieving the Project's objectives. Page 49of 55 Annex : Summary of stakeholders consultations Actors Points discussed Relevance of the Project Positive Concerns and Suggestions and environmental fears recommendations and social for mitigation impacts resulting from the implementation of the project North-East • Participants' opinions on the The Project is relevant because it • Improvement • Risk of increase in • Staff training on axis in relevance of the Project; responds to the challenges of hygiene and biomedical waste; waste manage- Muyinga • The potential positive envi- observed in the population health environmental • Environmental ment; bringing ronmental and social impacts sector (malnutrition, low sanitation; risks linked to the • Waste destruc- together that could result from the im- accessibility to primary health • Improved ac- construction of tion sites in compli- the plementation of the Project ; care, high population growth, etc. cessibility to health infrastruc- ance with stand- provinces of • Potential negative environ- ); quality health ture; ards; Muyinga , mental and social impacts that • Reduction in the rate of infant care; • Risks of discrimi- • Release a return Kirundo , could result from the imple- and maternal morbidity and mor- • Strengthening nation against cer- commitment con- Cankuzo , mentation of the Project; tality; the population's tain marginalized tract within a pe- Ruyigi and • Proposal of recommenda- • Endowment of the country with knowledge on groups ( Batwa , albi- riod specified by Karusi tions/measures for optimal im- capital capable of developing it galloping de- nos, disabled, etc.); plementation of the Project in the government; and competitive in the interna- mographics; • Risk of brain drain • Expand health order to avoid, reduce/mitigate tional labor market; after specialization • Strengthening coverage in infra- these risks and effects • Job creation ; training; the population's structure accord- • the project is relevant when it knowledge on cli- • Environmental ing to WHO stand- responds to the government's pri- mate change; and health risks ards; orities: contribution to improving • Decreasing linked to the destruc- • Improve social the health of the population, pre- cases of tion of end-of-use dialogue as a driver vention and treatment of GBV; GBV/SEA/SH; products; and instrument of • Good health for all; • Country well • Risk of not taking governance for sus- • The project comes at the right prepared for pos- the gender aspect tainable develop- time because it will reinforce the sible health into account if it is ment; achievements of previous projects emergencies; not well clarified (free healthcare); • Implement the • Availability of when setting up the work system based • Improvement in the quality of project; emergency kits in on the performance care; • Risk of the event of natu- contract in the en- ral disasters; GBV/SEA/SH follow- tire health sector; Page 50of 55 Actors Points discussed Relevance of the Project Positive Concerns and Suggestions and environmental fears recommendations and social for mitigation impacts resulting from the implementation of the project • Community involvement in pre- • Availability of ing the financial in- • Motivate medical paring for and responding to trained emer- come from the pro- staff (adequate sal- health emergencies; gency personnel; ject; ary); • Strengthening existing struc- • Increase and • Strengthening staff • Make equipment tures in response to health emer- improvement of capacity without sta- available in suffi- gencies; health infrastruc- bilization measurest; cient quality and • There is multisectorality at all ture and equip- • Risk of devaluation quantity (health); levels in emergency preparedness ment; of Burundian cul- • Include in the and response. ture; • Improvement of project the stabili- hygiene and sani- • Risk of social in- zation bonus at the tation in justice in the imple- workplace; healthcare envi- mentation of the Pro- • Adapt the pro- ronments; ject; jects to Burundian • Taking into ac- • Risk of gender con- customs; count the gender flict ( following the • Involve all stake- and vulnerable prioritization of holders in the im- group aspect in women) if this is not plementation of the implementa- explained and under- projects (at all lev- tion of the Project; stood by all stake- els); • Strengthening multisectorality holders. • Organize an orienta- • Reduction of tion workshop before corruption cases project implementation. Western • Participants' opinions on the • The Project is relevant because • Job creation ; • Relocation of certain • Plant trees, refo- Axis in relevance of the Project its implementation involves devel- • Improvement in people; rest; Cibitoke • Potential positive environ- opment activities which will lead the health status • Risk of Conflict of In- • Raising aware- bringing mental and social impacts that to a change in mindset of the ben- of the population; terest; ness among the pop- together the could result from the imple- eficiary populations; • Rehabilitation of • Risk of Sexual Exploi- ulation to adopt Provinces of mentation of the Project • The Project embraces all sectors health infrastruc- tation; constructive atti- Cibitoke , • Potential negative environ- • It brings innovations, e.g.; One ture; • Risk of destruction of tudes; Bubanza , mental and social impacts that Health; plant cover; Page 51of 55 Actors Points discussed Relevance of the Project Positive Concerns and Suggestions and environmental fears recommendations and social for mitigation impacts resulting from the implementation of the project Bujumbura could result from the imple- • The Project responds to the • Capacity Build- • The project seems not • Raise awareness Rural, mentation of the Project 2040-2060 vision of the Govern- ing ; to promote the ex- against GBV and Bujumbura- • Proposal of recommenda- ment of Burundi; • High-perfor- pected role of the as- popularize the law Mairie and tions/measures for optimal im- • It provides support in reducing mance human re- sociative sector; against GBV; Rumonge plementation of the Project in childhood illnesses and infant sources; • How to mitigate? • Manage com- order to avoid, reduce/mitigate mortality; • Improved hy- • Include/identify activ- plaints at all levels. these risks and effects • It will contribute to socio-eco- giene and sanita- ities to share with as- nomic, environmental develop- tion; sociations by area of ment and biodiversity; • Improvement of intervention, particu- • Decline in chronic and acute sectoral minis- larly in environmental diseases; tries; areas; • Integration of vulnerable people • Improved fam- • Risk of increasing in the decision-making process; ily well-being; cases of unwanted • Health facilities will be sup- • Improved mu- pregnancies and ported in personnel management, tual respect in the cases of GBV. including surface technicians workplace. Central and • Participants' opinions on the The Project is relevant because • Improvement of • Polluting actions • Maintain national South Axis relevance of the Project; it : public health; following the use of coverage of the Pro- in Gitega • potential positive environmen- • Will contribute to the implemen- • Reduction of so- non-standard materi- ject; bringing tal and social impacts that tation of the vision of the country cioeconomic ine- als and equipment; • Conduct awareness together the could result from the imple- emerging in 2040 and developed qualities; • Brain drain ; sessions for benefi- Provinces of mentation of the Project ; in 2060: No nation can be devel- • Improved food • Degradation of bio- ciaries for good Gitega, • Potential negative environmen- oped with a population in poor and nutritional se- diversity and poor sus- ownership of the Bururi , tal and social impacts that health; curity; tainable management Project activities; Mwaro , could result from the imple- • Improvement in the quality of • Increased of natural resources; Rutana, mentation of the Project; health care: strengthening staff productivity; • Effects of toxicity Interventions Makamba • Proposal of recommenda- capacities, staff loyalty, new • Protection of the from used medical within the tions/measures for optimal im- equipment; workforce and pro- equipment; framework of this plementation of the Project in • This project responds to the real order to avoid, reduce/mitigate ject beneficiaries; • Negative social im- project must needs of the population taking these risks and effects into account the state of health pacts: respect the facilities; following Page 52of 55 Actors Points discussed Relevance of the Project Positive Concerns and Suggestions and environmental fears recommendations and social for mitigation impacts resulting from the implementation of the project • It helps prevent chronic malnu- • Improved health • Risk of increased recommendations trition; which was precari- debauchery; in the baseline • Establishment of a permanent ous; • Risk of increased studies: unit for early warning and re- • Job creation; unwanted pregnan- sponse to disasters and epidem- • Social cohesion ; cies; • Assessment and ics; • Household in- • Risk of increased management of envi- • will help to reduce the trends of come; sexual transmitted dis- ronmental and social chronic malnutrition; eases; risks and effects; • Mitigation of the • empowerment of social groups • Employment and effects of climate • Risk of increased from the conception of the child working conditions; change; polygamy/polyandry; (Family/households/Country); • basic hygiene • Polluting actions • Rational use of re- • The Project aligns with the prior- and sanitation following the use of sources and preven- ities described in national and lo- cal planning documents; conditions non-standard materi- tion and manage- • The Project sheds light on the als and equipment; ment of pollution; consideration of the rights of the • Health and safety child as the future driving force of of the population; the nation; • Preservation of bi- • Emphasizes the role of health odiversity and sus- care providers in community tainable manage- care; ment of natural bio- • The Project will initiate a change logical resources; in reproductive health mindset; • Historically Disad- • The Project will strengthen the vantaged Indigenous coordinated response to health Peoples/Traditional and environmental emergencies; Local Communities • The Project will promote the of Sub-Saharan Af- strengthening of personnel in so- rica; cial areas in terms of community • Cultural Heritage ; resilience; • Financial interme- • The Project will promote the qual- diaries; ity of services in social areas. Page 53of 55 Actors Points discussed Relevance of the Project Positive Concerns and Suggestions and environmental fears recommendations and social for mitigation impacts resulting from the implementation of the project • Stakeholder mobi- lization and infor- mation; • Rationally manage medical equipment; • Make condoms available and raise awareness among the population about their use; • Organize various training courses for project beneficiaries. Ngozi axis • Participants' opinions on the • maternal -fetal mortality ; • Reduction of ma- • Waste and misalloca- • Implement appro- bringing relevance of the Project; • Accessibility of health care hence ternal and child tion of donations; priation measures together the • The potential positive environ- the reduction in mortality; mortality rate ; • Difficulties in identi- to guarantee the provinces of mental and social impacts that • Improvement in the quality of • Improvement in fying vulnerable sustainability of the Ngozi, could result from the imple- care; the socio-eco- groups; project's achieve- Kayanza , mentation of the Project ; • Economic recovery of vulnerable nomic standard • Conflicts linked to ments; Muramvya • Potential negative environmen- households; of living; the identification of • Establish monitor- tal and social impacts that • Reduction in morbidity and mor- • Promotion of vulnerable group due ing and evaluation could result from the imple- tality; birth limitation to limited envelope; bodies; mentation of the Project; • Improvement in the living condi- and spacing; • Risk of demographic • Evaluation of the • Proposal of recommenda- tions of the population in general; • Strengthen pre- explosion (rapid de- implementation of tions/measures for optimal im- • Improvement of the hygiene of vention capaci- mographics) linked the project by the plementation of the Project in the population; ties and prepar- stakeholders; to good infant-ma- order to avoid, reduce/mitigate • Reduction in dirty hand diseases; edness to re- • Concerted develop- ternal living condi- these risks and effects • Improved population health; spond to epidem- ment of criteria for tions; • Reduction of greenhouse gases; ics; identifying target • Reduction in the • Disturbance of biodi- groups; • Family solidarity; versity; • Reduction in land and family rate of deaths • Improvement of conflicts; caused by epi- working conditions; demics; Page 54of 55 Actors Points discussed Relevance of the Project Positive Concerns and Suggestions and environmental fears recommendations and social for mitigation impacts resulting from the implementation of the project • Family well-being • Provision of • Risk of air pollution • Raising awareness equipment and respiratory dis- on the importance adapted to the eases; of limiting births prevention of • Sexual vagrancy, de- and family plan- health emergen- linquency, drunken- ning; cies and their ness, cohabitation, • Reforestation; management; polygamy; • Secure destruction • Education and of waste; • Non-biodegradable awareness of the • Commit to re- packaging of prod- population on be- specting the pro- havior change. ucts distributed to the population; fessional code of • Improvement in ethics; the socio-eco- • Distribution of some medical products • Help raise aware- nomic conditions without in-depth ex- ness so that the of the population; • Reduction of dis- pertise; project's achieve- eases linked to • Increased family con- ments are sustain- lack of hygiene flicts; able. (dirty hand dis- • Increase in gender- eases) and their based sexual vio- transmission; lence including • Reduction of nat- SEA/SH; ural disasters; • Professional ex- periences Page 55of 55