The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 04/14/2023 | Report No: ESRSAFA546 Apr 14, 2023 Page 1 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Senegal WESTERN AND CENTRAL AFRICA Project ID Project Name P181056 Second Additional Financing for the Senegal COVID-19 Response Project Parent Project ID (if any) Parent Project Name P173838 Senegal COVID-19 Response Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 4/24/2023 6/16/2023 Population Financing Public Disclosure Proposed Development Objective To prevent, detect and respond to the COVID-19 disease outbreak in Senegal. Financing (in USD Million) Amount Current Financing 20.00 Proposed Additional Financing 0.00 Total Proposed Financing 20.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] The proposed project aims to strengthen Senegal' s national public health preparedness and response capacity to prevent, detect and respond to the COVID-19 and future public health emergencies. The objectives of the project and activities included are fully in line with the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Apr 14, 2023 Page 2 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020, and the vaccines AF to the SPRP approved on October 13, 2020. This project supports the implementation of the National COVID-19 Emergency and Response Plan endorsed by the Ministry of Health and Social Action and has three components: Component 1. Emergency COVID-19 Response (US$145.5 million). Under this component, the MoHSA is strengthening disease surveillance and epidemiological capacity for early detection and confirmation of cases and active contact tracing as well as health system strengthening, social and financial support to households, COVID-19 vaccine acquisition and distribution and pharmacovigilance and patient safety. Component 2. Community Engagement and Risk communication (US$5 million). This component aims to ensure effective risk communication and community/citizen engagement to raise public awareness and knowledge on prevention and control of COVID-19 and COVID-19 vaccination among the general population. Component 3. Implementation Management and Monitoring (US$ 3.5 million). The proposed project will be managed by the MoHSA's Project Coordination Unit (PCU). The project will share the cost of running the PCU along with other projects funded by the World Bank (REDISSE, ISMEA). Details of the implementation arrangements are described in section III. Implementation Arrangements. The proposed Second AF aims to maintain access to essential health services for women, children and adolescents to ensure the impact of COVID-19 on EHS delivery is minimized. This will financed by an EHS grant of US$15m from the Global Financing Facility for Women, Children and Adolescents (GFF) and an additional component will be added: Public Disclosure Component 4: Maintaining Essential Health Services (US$15m). This is a new component that will enhance the continuity of EHS in 8 regions in Senegal that are not covered under the ISMEA operation (P162042). This will include strengthening the resilience and performance of the health system to address the disruptions caused by the COVID-19 pandemic in essential RMNCAH-N services at the primary healthcare level. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] This second additional financing (AF2) will be implemented in the 8 regions in Senegal (Dakar, Diourbel, Fatick, Kaolack, Louga, Matam, Saint-Louis, and Thiès). The availability and continuity of essential RMNCAH-N services were disrupted across the country and therefore, this AF2 aims to support the regions that are not covered under the ISMEA operation (P162042), which is also supporting the continuity of essential health services due to COVID-19. The AF2 will support the costs of expanding the activities of the Senegal COVID-19 Response Project (P173838) under the COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020, and the vaccines AF to the SPRP approved on October 13, 2020. Senegal experienced moderate overall disruptions during the pandemic with a decline in several key Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH-N) indicators. However, several essential RMNCAH-N services such as antenatal consultations (ANCs) and institutional deliveries were severely impacted. The proposed AF2 will form part of an expanded health response to the pandemic, which is being supported by development partners under the coordination of the GoS. The Project Development Objective (PDO) of the parent project, AF1 and the proposed AF2 is to prevent, detect, and respond to the COVID-19 disease outbreak in Senegal. Apr 14, 2023 Page 3 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) The latest situation of the pandemic shows that Senegal was the second country in Sub-Saharan Africa to report its first imported case of COVID-19, on March 2, 2020, which led to the Government’s activation of emergency management mechanisms and request for World Bank financing. After several waves of the disease in the country, COVID-19 cases and deaths have declined. As of April 12, 2023, the cumulative number of confirmed cases is 88,989 (an increase of 665 cases since September 22, 2022) with 87,009 recovered, 8 patients under treatment (a reduction of 100 patients since September 22, 2022), and 1,971 deaths (no additional deaths since June 15, 2022). Senegal is ranked third in the highest number of cumulative cases and second in the highest number of cumulative deaths due to COVID-19 in West Africa. D. 2. Borrower’s Institutional Capacity The progress toward achievement of the PDO and overall implementation progress (IP) was rated Moderately Satisfactory in the last Implementation Status and Results Report (ISR) of April 4, 2023. Fiduciary processes, including procurement and FM, and Environmental and Social performance are rated Moderately Satisfactory. As of April 12, 2023, the parent project is fully disbursed (US$20 million equivalent) and AF1 has a disbursement rate of 34 percent (US$45.03 million equivalent). Currently, 48 percent of the AF1 budget (US$64.7 million) is committed to COVID-19 vaccine acquisition. The PCU experienced significant challenges in implementing environmental and social activities regarding ICPBWM in the health facilities. An assessment of the situation was carried out with the support of the World Bank and measures were put in place to ensure that implementation is back on track. As of April 12, 2023, four out of the six PDO indicators already surpassed their targets. The intermediate indicators are also progressing well and out of the 18 indicators, nine have already surpassed their final targets and five have achieved their final targets. Public Disclosure The MoHSA will remain the implementing ministry of the proposed AF2. The SG of the MoHSA will continue to be responsible for the overall coordination and oversight of the implementation of the project and the MoHSA’s DAGE will continue to be the unit responsible for the FM and procurement functions of the project. The DGSP will continue to be responsible for the technical coordination of the project. The DP under the DGSP will continue to take the operational lead for the preparation, deployment, and monitoring of COVID-19 vaccines. The National Interagency Coordinating Committee for the EPI (Comité National de Coordination Inter Agence du Programme Elargi de Vaccination, CCIA) ensures the political validation of strategies and plans related to immunization. For activities proposed under AF2, a focal point was nominated under the DGSP to closely monitor the activities and the Directorate of Maternal and Child Health (Direction de la Santé de la Mere et de l’ Enfant – DSME) will provide the operational lead in the implementation of the activities. Activities that will be financed under the new sub-component 4.1 will support the National Supply Pharmacy (Pharmacie Nationale d'Approvisionnement, PNA) to ensure essential medicines and products are available on a continuous basis, particularly those of vital importance up to the last mile (ORS/ZINC, vitamin A, amoxicillin, family planning products, calcium gluconate, etc.); the availability of family planning products, equipment and materials in health facilities (health posts, health centers, and public health facilities); strengthen the capacities of the regional management teams, district management teams, and healthcare providers in RMNCAH-N through scholarships as well as training ; Centers of Recovery and Nutritional Education (Centre de Récuperation et d’Éducation Nutrionelle - CREN) in hospitals and Recovery and Nutritional Education Units in health centers to adapt to the COVID-19 context and to ensure that they have sufficient resources to provide substantive care for children with acute and chronic malnutrition procure equipment for health facilities part of the EmONC network in non-ISMEA regions; procure equipment such as oxygen therapy devices and other pediatric emergency materials for non-ISMEA regions; and strengthen the availability of health services, particularly as it relates to the newly approved Sexual and Reproductive Apr 14, 2023 Page 4 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Health package, adapted to adolescents, particularly girls. PNA has experience with bank-financed projects such as ISEA which is still being implemented. The PCU will continue to be responsible for the day-to-day management of the project, including fiduciary management (procurement, financial management [FM] and safeguards). The PCU has extensive experience in World Bank’s fiduciary, safeguards and technical implementation arrangements and will be the implementing agency for AF2. They have sufficient staff to undertake activities including an environmental specialist, a social specialist, an environmental and social specialist, and a part-time Occupational Health and Safety specialist. The budget for program management from AF1 is sufficient to undertake the additional activities for Component 4. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The environmental risks for this AF2 remain Substantial due to medical waste management and disposal; (b) continued spread of the COVID-19 virus among healthcare workers and the population at large; (c) occupational and community health and safety issues related to testing, handling, transporting, disposing of supplies and medical samples. The activities under the AF2 will also broaden the scope of the activities of the parent project and AF1, facilities treating patients may also generate biological, chemical waste, and other hazardous by-products that could be detrimental to human health. These risks will be mitigated with OHS standards and specific infectious-control strategies, guidelines, and requirements as recommended by the WHO. Specifically, the different identified risks will Public Disclosure be mitigated by the measures that will be integrated in the different safeguard instruments that will be updated within this AF2. Sub-component 4.1 also provides for the purchase of materials and equipment for the health facilities (oxygen therapy devices and other pediatric emergency materials). The risk related to the use of these equipment and materials during the operation phase will be evaluated with adequate mitigation measures that will be integrated in the safeguard instruments that will be updated. Social Risk Rating Substantial The social risk rating is Substantial as there is continued spread of the COVID-19 virus among healthcare workers and the population at large; occupational and community health and safety issues related to testing, handling, transporting, disposing of supplies and medical samples; marginalized and vulnerable social groups being unable to access EHS; social conflict, and risks to human security resulting from diagnostics testing, limited availability of routine vaccines, and social tensions related to the difficulties experienced during the COVID-19 pandemic; and SEA/SH risks among patients and healthcare providers. The proposed AF2 will mitigate these risks by the SEP and ESMP that the client has prepared and will support activities to enhance risk communication to various stakeholders and through community structures to dispel incorrect notions. This includes credible and culturally appropriate health and risk communication and clear and consistent communication by government officials and more specifically by religious and traditional leaders to build public confidence. Moreover, activities to build the capacity of key national-, regional- and community-level stakeholders on advocacy, communication and social mobilization to strengthen accountability and transparency will be implemented. Sexual Exploitation and Abuse/Sexual Harassment (SEA/SH) Risk Rating Moderate The SEA/SH Risk Rating is Moderate Apr 14, 2023 Page 5 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: ESS1 remains relevant for this AF2. Activities under the AF2 will fill a critical gap in the scope of the parent project and AF1, providing financing for maintaining essential RMNCAH-N services. However, it could also pose risks to the environment, health, and safety due to the continued exposure of healthcare workers and the population to COVID- 19 when seeking care. Activities of Sub-component 4.1 also provides for the purchase of materials and equipment for the health facilities (oxygen therapy devices and other pediatric emergency materials). The risk related to the use of these equipment and materials during the operation phase could have potential environmental issues. This risk will be evaluated, and adequate mitigation measures will be integrated in the safeguard instruments that will be updated. Project activities are also likely to have significant or potential negative social impacts on the poor and / or other vulnerable groups and have the potential to directly contribute to increased social fragility or conflict. The COVID-19 pandemic and the launch of COVID-19 vaccinations has generated misinformation globally. This has led to the slow uptake of COVID-19 vaccines in Senegal as well as in many neighboring countries. Moreover, mistrust in the COVID-19 vaccine brought up sentiments of institutional mistrust and the quality of the health system. The proposed AF2 will mitigate these risks by supporting activities to enhance risk communication to various stakeholders and through community structures to dispel incorrect notions. This includes credible and culturally appropriate Public Disclosure health and risk communication and clear and consistent communication by government officials and more specifically by religious and traditional leaders to build public confidence. Moreover, activities to build the capacity of key national-, regional- and community-level stakeholders on advocacy, communication and social mobilization to strengthen accountability and transparency will be implemented. We have also risk of SEA/SH risks among patients and healthcare providers, especially in relation to distribution of routine vaccines and other key medications such as family planning products. The following environmental and social instruments (ESMF, LMP, SEP, ESCP, GRM, SEA/SH Plan, ICPBWM) for the parent project and AF1 have been developed and publicly disclosed on the Bank's website and at country level respectively in June 2020 and October 2021. The latest environmental and social performance of the project was rated moderately satisfactory. The PCU experienced significant challenges in implementing environmental and social activities regarding Biomedical Waste Management Plan in the health facilities. An assessment of the situation was carried out with the support of the Bank and measures were put in place to ensure that implementation is back on track. Currently, the PCU is in the process of updating the following instruments (ESMF, LMP, GRM, VBG Plan and ICPBWM) for the AF2. These documents will be finalized no later than one month after the effective date, prior to the implementation of relevant project activities. The ESMF will contain provisions for storing, transporting, and disposing of contaminated medical waste and will outline guidance (in line with international good practice and WHO standards on COVID-19 response) on limiting viral contagion in healthcare facilities. In addition to the ESMF, the Borrower will implement and supervise the activities listed in the updated ESCP. Apr 14, 2023 Page 6 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) ESS10 Stakeholder Engagement and Information Disclosure As with the parent project, the additional finance project will closely abide by the provisions of the SEP which the client has prepared. This will provide the parties affected by the project with the means to easily raise their grievances, complaints and the project and borrowers to respond and manage them by describing the complaint management mechanism with the specific procedures developed to ensure the prompt, ethical, and survivor- centered treatment of people experiencing gender-based violence (GBV), sexual exploitation and abuse (SEA), and sexual harassment (HS).This SEP will also build on the consultations and engagement carried out under the parent project. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions The client will prepare an LMP to be updated, disclosed, consulted upon, and adopted no later than one month after the Effective Date and prior to the implementation of relevant Project activities. The LMP will include notably the implementation of adequate occupational health and safety measures (including emergency preparedness and response measures), measures addressing SEA/SH risks in the workplace, the establishment of complaint management mechanisms for Project workers, and the incorporation of labor provisions and relevant provisions of other instruments, including the ICPBWM and SEA/SH Action Plan in the EHSS specifications of procurement files and contracts with suppliers and service providers. Public Disclosure ESS3 Resource Efficiency and Pollution Prevention and Management ESS3 remains relevant for this AF2. The activities of the parent project and AF1 currently being implemented as well as the activities planned with the AF2 are likely to have impacts on the environment and human health. Indeed, biomedical waste from health facilities with current activities and those planned with vaccination constitute potential risks of contamination of the soil and water bodies if they are not managed properly. Health personnel, patients who frequent health facilities as well as certain neighboring populations may also be exposed to the risks of contamination with the COVID-19 virus or other pathogens. The activities planned under the AF2 will accentuate these risks and the main environmental and social impacts/risks identified are related to: the acquisition of health care products and medicines; the transport of products and equipment to the last mile; the management of stocks of health care products and medicines; the management of biomedical and common waste produced during health care activities; the establishment of waste storage areas, especially at the level of the health centers, which are used as unauthorized dumps; the means of transport used in most of the structures are inadequate; the irregular/inadequate treatment of biomedical waste. We note that almost all health facilities use burners and the few incinerators that exist are poorly operated. The updated ICPBWM budget for FY1 takes into account the purchase of 40 electromechanical incinerators, 60 banalyzers and 990 wall devices. These actions will be followed up in this FY2 for a successful management of biomedical waste in health facilities. ESS4 Community Health and Safety Apr 14, 2023 Page 7 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) The ESMP includes measures to minimize the risk of population exposure to communicable diseases; ensure that individuals or groups who, because of their specific circumstances, may be disadvantaged or vulnerable, have access to the development benefits of the Project; manage the risks associated with the use of security personnel; manage the risks associated with the influx of labor; and prevent and combat SEA/SH in accordance with an updated SEA/SH Action Plan annexed to the ESMF. Hazardous materials in the project are related to biomedical waste (infectious waste). Biomedical waste contaminated with pathogens pose a high risk of causing infectious disease. If the disease is contagious and the untreated waste is released in public area, it can cause a potential public health problem of large proportion. The reason to treat medical waste before disposal is to substantially reduce (actual goal is eliminating it) disease transmission. Diseases in humans may contract due to biomedical waste include HIV, cholera, tuberculosis, typhoid, Hepatitis B, SARS and also disease due to Radioactive materials. The biomedical waste can be a major source of health-related problems and infection or injury to community. The ESMF has provided an Infection Control Plan and Biomedical Waste Management (ICPBWM) covering key aspects of (handling, storage, transportation, and disposal) of such wastes for the safety and security of the environment and community, while ensuring reference to and guidance provided in the WBG Environmental, Health, and Safety Guidelines for Health Care Facilities (Table 5.1.1 and Section 6.2.11). The PCU will ensure during site specific E&S screening and development of ESIA/ESMP, identification of activities that are likely to expose communities to such risks and recommend appropriate mitigation measures for adoption during implementation. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Public Disclosure This standard is not relevant. Project activities are unlikely to require land acquisition, physical or economic displacement, or restriction of access to natural resources as no construction or major civil works are expected. Nonetheless, the Borrower will conduct regular E&S screening before the start of the works to ensure AF activities will not lead to any resettlement issues. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources This ESS is not relevant for the Senegal COVID-19 Intervention Project. No construction or major rehabilitation activities are expected in this project and all works will be conducted within existing facilities. Hence, likely impacts of the project on natural resources and biodiversity are low. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities This standard is not considered relevant as there are no Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities currently identified in the project area. Should the presence of indigenous communities be confirmed through further screening during implementation, the necessary assessments, consultations and instruments will be undertaken per the requirements of this standard. ESS8 Cultural Heritage Apr 14, 2023 Page 8 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) Since there is no planned construction or major rehabilitation, this standard is not relevant at this time. However , the updated ESMF will include measures for “Chance Finds” of archaeological or other cultural heritage. ESS9 Financial Intermediaries This standard is not relevant for the suggested project interventions as no financial intermediaries will be used. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No OP 7.60 Projects in Disputed Areas No B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Is this project being prepared for use of Borrower Framework? No Areas where “Use of Borrower Framework” is being considered: Public Disclosure N/A IV. CONTACT POINTS World Bank Contact: Djibrilla Karamoko Title: Senior Health Specialist Telephone No: 5352+4208 / 221-33-8594208 Email: dkaramoko@worldbank.org Contact: Fatoumata Binta Maama Barry Title: Health Specialist Telephone No: +1-202-473-3908 Email: fbarry1@worldbank.org Contact: Moussa Dieng Title: Senior Economist Telephone No: 5354+4165 / 221-33-8594165 Email: mdieng@worldbank.org Borrower/Client/Recipient Implementing Agency(ies) Apr 14, 2023 Page 9 of 10 The World Bank Second Additional Financing for the Senegal COVID-19 Response Project (P181056) V. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Fatoumata Binta Maama Barry, Djibrilla Karamoko, Moussa Dieng Practice Manager (ENR/Social) Maria Sarraf Cleared on 14-Apr-2023 at 15:58:36 EDT Public Disclosure Apr 14, 2023 Page 10 of 10