Tuvalu Tuvalu Health System Strengthening Project (P175170) ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) [May 2022] 1|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN 1. The Republic of Tuvalu (hereinafter the Recipient) shall implement the Tuvalu Health System Strengthening Project (the Project), with the involvement of the Ministry of Health, Social Welfare and Gender Affairs (MOH) and the Ministry of Finance and Economic Development (MFED). The International Development Association (hereinafter the Association) has agreed to provide financing for the Project. 2. The Recipient shall ensure that the Project is carried out in accordance with the Environmental and Social Standards (ESSs) and this Environmental and Social Commitment Plan (ESCP), in a manner acceptable to the Association. The ESCP is a part of the Financing Agreement between the Recipient and the Bank for the Project. Unless otherwise defined in this ESCP, capitalized terms used in this ESCP have the meanings ascribed to them in the referred agreement(s). 3. Without limitation to the foregoing, this ESCP sets out material measures and actions that the Recipient shall carry out or cause to be carried out, including, as applicable, the timeframes of the actions and measures, institutional, staffing, training, monitoring and reporting arrangements, and grievance management. The ESCP also sets out the environmental and social (E&S) instruments that shall be adopted and implemented under the Project, all of which shall be subject to prior consultation and disclosure, consistent with the ESS, and in form and substance, and in a manner acceptable to the Association. Once adopted, said E&S instruments may be revised from time to time with prior written agreement by the Association. 4. As agreed by the Association and the Recipient, this ESCP will be revised from time to time if necessary, during Project implementation, to reflect adaptive management of Project changes and unforeseen circumstances or in response to Project performance. In such circumstances, the Recipient through the Tuvalu Health System Strengthening Project Management Unit and the Association agree to update the ESCP to reflect these changes through an exchange of letters signed between the Association and the Recipient representative assigned to the Project. The Recipient shall promptly disclose the updated ESCP. 2|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY ESS 1: ASSESSMENT AND MANAGEMENT OF ENVIRONMENTAL AND SOCIAL RISKS AND IMPACTS 1.1 ORGANIZATIONAL STRUCTURE The E&S Officer shall be appointed no MoH The Ministry of Health, Social Welfare and Gender Affairs (MoH) Project Management later than 60 days after the Effective Unit (PMU) shall engage a qualified staff who shall act as the project's national E&S Date and before the carrying out of the Ministry of Finance and Safeguard Officer, and who together with the E&S management experts within the relevant Project activities. Economic Development Central Project Management Office (CPMO) (as engaged by Ministry of Finance and (MFED) as sponsoring Economic Development) shall support the Project Manager in the management of ESHS Ministry for the Central risks and impacts of the Project. Project Management Office (CPMO) 1.2 ENVIRONMENTAL AND SOCIAL ASSESSMENT The additional assessment and updating Update the preliminary assessment of environmental and social risks and impacts of the of the ESMP and related instruments, Project in line with the detailed design of Project activities, including architectural including the LMP and SEP, shall be MoH designs of the Princess Margaret Hospital (PMH) hospital expansion and outer island undertaken in parallel to the conduct of clinic upgrades, terms of reference (TORs) for operational systems technical assistance detailed design (i.e., preparation of activities (TAs) and screening services, and including the Contingent Emergency architectural designs, TORs for Response Component (CERC), and update accordingly the preliminary ESMP into a final operational systems TAs and screening ESMP together with updates to the SEP and LMP. services) and consultations with stakeholders prior to procurement of any civil works and TA. The final ESMP and SEP instruments shall be updated and finalized within 15 days after the detailed designs have been approved for the PMH hospital expansion and outer island clinic upgrades. Procurement of goods and consultancy activities can be initiated as soon as the project is effective, however the distribution of goods shall not commence prior to the finalization of the ESMP. Any activities that have been screened for environmental and social risks shall not be carried out without the completed, consulted, and disclosed ESMP 3|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY 1.3 In further defining and specifying the architectural designs and TORs for operational The updated assessment and updating MoH systems TAs and screening services, the MoH shall take into consideration the proposed of the ESMP and related instruments, mitigation measures listed in the Preliminary ESMP for the following risks: (i) risk of i.e., the SEP and LMP, shall be inundation of the health care facilities during cyclone and coastal flooding events; (ii) risk undertaken in parallel to the of environmental contamination due to lack or inadequate onsite wastewater preparation of architectural designs, treatment; (iii) risk of service interruptions due to inadequacy of water supply system; TORs for operational systems TAs and (iv) risk of service interruptions due to inadequacy of power supply system; (v) risk of screening services and consultations contamination of the environment with healthcare wastes; (vi) risk of fire on the health with stakeholders. care facility; and (vii) lack of universal accessibility of the facilities. 1.4 The MoH shall, as part of the update of the assessment (in 1.2 above) of the project's The final ESMP, SEP and LMP, including MoH risks and impacts based on the architectural designs, and TORs for operational systems the architectural designs and TORs for TA and screening services. Based on the results of the assessments, MOH shall update the operation systems TAs, shall be the project's Environmental and Social Management Plan (ESMP) and other related approved, adopted and publicly instruments including the SEP and LMP, including the preparation of TORs for the disclosed at least fifteen (15) days prior following operations systems TAs: (i) Infection Prevention and Control Plan/System (IPC); the start of any physical construction (ii) Healthcare Waste Management (HCWM) Plan/System; (iii) HCF Disaster Preparedness activities. and Response Plan; (iv) HCF Fire Prevention and Evacuation Plans; (v) Hazardous Spill Prevention, Containment and Clean Up Procedure; (vi) Water Conservation and Water Supply Contingency/Drought Scenario Plan; and (vii) Power Interruption Contingency and Energy Conservation Plan. 1.5 MONITORING AND REPORTING Prepare and submit to the Association regular monitoring reports on the status of the Every six months, throughout Project MoH implementation of this ESCP, including the status of preparation, updates, and implementation. The report shall be implementation of the ESMP, and other instruments such as the SEP. The regular available in time for the regular World monitoring reports shall also include evidence-based appraisal of environmental, social, Bank Implementation Support Mission. health and safety (ESHS) performance of the Project, and the functioning of the grievance mechanism(s) including the grievances log. 1.6 INCIDENTS AND ACCIDENTS Minor incidents shall be reflected in the MoH Promptly notify the Association of any incident or accident related to the Project which six-monthly reports to the Association, has, or is likely to have, a significant adverse effect on the environment, the affected major incidents shall be reported to the communities, the public or workers. Sufficient details shall be provided regarding the incident or accident, indicating immediate measures taken or that are planned to be taken to address it, and any information provided by any contractor and supervising entity, as appropriate. Subsequently, as per the Association’s request, prepare a report on the incident or accident and propose any measures to prevent its recurrence. 4|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY Association within 24 hours1. A report shall be provided to the Association, as requested. 1.7 MANAGEMENT OF CONTRACTORS Incorporate the relevant aspects of the ESCP, including the relevant E&S documents Procurement specifications shall be and/or plans, ESS2 requirements, and any other required environment, social, health reviewed and cleared by the E&S MoH and safety (ESHS) measures, and the Labor Management Procedures, into the ESHS Safeguards Officer of the PTU and the specifications of the procurement documents with contractors and CESMPs (as per 3.2 E&S experts of the CPMO prior to below). Thereafter ensure that the contractors comply with the ESHS specifications of tender. This shall be undertaken before their respective contracts. commencing the procurement process for the relevant Project activities, and thereafter throughout the carrying out of such activities. 1.8 TECHNICAL ASSISTANCE Throughout Project implementation. Ensure that the consultancies, studies (including feasibility studies, if applicable), capacity MoH building, training, and any other technical assistance activities under the Project, including, inter alia, TORs for operational systems TAs and screening services are carried out in accordance with terms of reference acceptable to the Association, and that are consistent with the ESSs. Thereafter ensure that the outputs of such activities comply with the terms of reference. 1.9 CONTINGENT EMERGENCY EARLY RESPONSE FINANCING a) The adoption of the CERC-ESMF in a) Adopt a CERC-specific Environmental and Social Management Framework (ESMF) and form and substance acceptable to the MoH CERC Operations Manual, which include as description of eligible CERC activities and a Association is a withdrawal condition description of the ESHS assessment and management arrangements for the under Section III.B of Schedule 2 of the implementation of CERC component Part 4, in accordance with the ESSs. FA for the Project. 1Clarification as to what is a minor incident and what is a major incident shall be provided in the updated ESMP. 5|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY b) Adopt any environmental and social (E&S) instruments which may be required for b) Adopt any required E&S instrument activities under CERC Component 4 of the Project, in accordance with the CERC-ESMF and include it as part of the respective and the ESSs, and thereafter implement the measures and actions required under said bidding process, if applicable, and in E&S instruments, within the timeframes specified in said E&S instruments. any case, before the carrying out of the relevant Project activities for which the E&S instrument is required. Implement the E&S instruments in accordance with their terms, throughout Project implementation. ESS 2: LABOR AND WORKING CONDITIONS 2.1 LABOR MANAGEMENT PROCEDURES The existing LMP shall be updated and MoH Update, adopt, and implement the Labor Management Procedures (LMP) that have been finalized, disclosed and adopted within developed for the Project. 15 days once labor requirements are known and before the carrying out of the relevant Project activities. All measures specified in the LMP shall be implemented throughout the Project implementation period. 2.2 GRIEVANCE MECHANISM FOR PROJECT WORKERS Update, adopt and implement the MoH Establish, maintain, and operate a grievance mechanism for Project workers, as Grievance Redress Mechanism within described in the LMP and consistent with ESS2. 15 days once labor requirements are known and before the carrying out of the relevant Project activities. 2.3 OCCUPATIONAL HEALTH AND SAFETY (OHS) MEASURES Final ESMP reflecting OHS measures to MoH Prepare, adopt, and implement occupational, health and safety (OHS) measures specified be prepared, disclosed and adopted in the ESMP. within 15 days once labor requirements are known and before the carrying out of the relevant Project activities. All OHS measures specified in the ESMP shall be implemented throughout the Project implementation period. 2.4 CHILD LABOR AND MINIMUM AGE; FORCED LABOR Prohibit the engagement and/or use of child labor (i.e., persons below 14 years of age) in MoH any of the project activities and the use of forced labor. 6|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY Throughout the Project implementation period once they have been included in the updated and finalised ESMP and LMP. 2.5 Prohibit the hiring of people below 18 years of age in construction works and other Throughout the Project implementation MoH hazardous work situations. period once they have been included in the updated and finalised ESMP and LMP 2.6 Undertake due diligence on project suppliers regarding the risk of involvement or use of Throughout the Project implementation MoH child labor or forced labor in production of the goods and materials supplied to the period once they have been included in project. the updated and finalised ESMP and LMP ESS 3: RESOURCE EFFICIENCY AND POLLUTION PREVENTION AND MANAGEMENT 3.1 RESOURCE EFFICIENCY AND POLLUTION PREVENTION AND MANAGEMENT MoH Ensure that the updated assessments of the environmental and social impacts and risks Relevant pollution control and resource MFED and the updating of the Preliminary ESMP described under Action 1.2 above shall cover conservation measures shall be risks and impacts relating to ESS3 Relevant aspects of this standard shall be considered undertaken during the implementation reflected in the ESMP, and implemented, as needed, under action 1.2 above, including in period and in the operations phase of the assessment and undertaking of necessary improvements of: (i) the onsite the project. wastewater systems; (ii) the water supply systems; (iii) the power supply systems; and (iv) the health care waste management systems of the individual health care facilities. 3.2 MEASURES DURING CONSTRUCTION AND CIVIL WORKS During construction phase of the MoH The MoH shall implement the relevant management measures as provided in the final project MFED ESMP, including pollution control measures in the construction and demolition activities. The MoH shall require Contractors of any civil works to prepare their own contractors ESMP (CESMP) which shall be reviewed and approved by E&S Specialist of the PTU and the CPMO. 3.3 HEALTHCARE WASTE MANAGEMENT During Project implementation once TA MoH The development of the country's health care waste management system (under have been delivered (as per 1.8). Component 2), shall be guided by the TOR prepared under item 1.8 and shall conform with the World Bank ESHG for Health Care Facility and GIIP. 3.4 WATER AND ENERGY CONSERVATION Throughout Project implementation MoH Adopt and implement: (i) a Water Conservation and Water Supply Contingency/Drought once they have been included in the Scenario Plan; and (ii) a Power Interruption Contingency and Energy Conservation Plan, updated and finalised ESMP. as provided in Action 1.2 above. ESS 4: COMMUNITY HEALTH AND SAFETY 7|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY 4.1 COMMUNITY HEALTH AND SAFETY During the updating of the preliminary MoH The Recipient shall ensure that the updated assessment of the environmental and social assessment and preliminary ESMP, and impacts and risks and the updating of the Preliminary ESMP described under Action 1.2 prior to the commencement of relevant above shall cover risks and impacts relating to ESS4 Project activities. 4.2 MEASURES AGAINST RISK OF COASTAL FLOODING AND CYCLONE The design of the healthcare facilities (i.e., the PMH hospital and outer island clinics) and their ancillary facilities (i.e., wastewater treatment, healthcare waste disposal, water During detailed design preparation for MoH supply, power supply, etc.) shall take into considerations the design measures identified the relevant activities. The design in the Preliminary ESMP, against the risks of coastal flooding. The final design measures measures shall be finalized prior to the adopted shall be described in the final ESMP and implemented in accordance with the updating of the ESMP into a final ESMP final ESMP. and implemented throughout the Project implementation period. 4.3 DISASTER PREPAREDNESS AND RESPONSE PLAN During detailed design preparation. The MoH Adopt and implement a Disaster Preparedness and Response Plan (DPRP) focusing on TOR for the development of the DPRP coastal flooding and/or cyclone events for each of the HCFs and the entire network of shall be included in the final ESMP. The HCFs. The TOR for the TA of the development of this plan shall be included in the final DPRP shall be completed and adopted ESMP. prior to the closure of the project. 4.4 MEASURES AGAINST RISK OF FIRE AT HEALTHCARE FACILITIES During detailed design preparation. The The design of the healthcare facilities (i.e., the PMH hospital and outer island clinics) and design measures shall be finalized prior their ancillary facilities shall take into consideration the design measures identified in the to the updating of the ESMP into a final MoH Preliminary ESMP, against the risks of fire. The final design measures adopted shall be ESMP, and thereafter implemented described in the final ESMP and implemented as part of the implementation of the throughout the Project implementation ESMP. period. 4.5 FIRE PREVENTION AND EVACUATION PLAN During detailed design preparation. The MoH Adopt and implement a Fire Prevention and Evacuation Plan (FPEP) as identified in TOR for the development of the FPEP Action 1.2 above. The TOR for the TA in the development of such a plan shall be included shall be included in the final ESMP. The in the final ESMP. FPEP shall be completed and adopted prior to the operation of the relevant Health Care Facility and thereafter implemented during the Project implementation period. 8|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY 4.6 MEASURES AGAINST RISK OF WATER SUPPLY INTERRUPTION During detailed design preparation. The design of health care and ancillary facilities that shall be funded under the project Design measures shall be finalized prior shall take into considerations the design measures suggested in the Preliminary ESMP to the updating of the ESMP into a final MoH against the risk of water supply interruption. Final design measures adopted shall be ESMP and thereafter implemented described in the final ESMP and implemented as part of the implementation of the throughout the Project implementation ESMP. period. 4.7 WATER CONSERVATION AND DROUGHT SCENARIO PLAN During detailed design preparation. The MoH Adopt and implement a Water Conservation and Drought Scenario Plan. The TOR for the TOR for the development of the Water TA in the development of this plan shall be included in the final ESMP. Conservation and Drought Scenario Plan shall be included in the final ESMP. The Plan shall be completed and adopted prior to the closure of the project. 4.8 MEASURES AGAINST RISK OF POWER SUPPLY INTERRUPTION The design of health care and ancillary facilities that shall be funded under the project shall take into considerations the design measures suggested in the Preliminary ESMP During detailed design preparation. MoH against the risk of power supply interruptions. Final design measures adopted shall be Design measures shall be finalized prior described in the final ESMP and implemented as part of the implementation of the to the updating of the ESMP into a final ESMP. ESMP and thereafter implemented throughout the Project implementation period. 4.9 POWER SUPPLY INTERRUPTION CONTINGENCY PLAN During detailed design preparation. The MoH Adopt and implement a Power Supply Interruption Contingency Plan. The TOR for the TA TOR for the development of the Power in the development of this plan shall be included in the final ESMP. Supply Interruption and Contingency Plan shall be included in the final ESMP. The Plan shall be completed and adopted prior to the closure of the project. 4.10 MEASURES AGAINST RISK OF ACCIDENTAL SPILL OF HAZARDOUS MATERIALS The design of health care and ancillary facilities that shall be funded under the project During detailed design preparation MoH shall take into considerations the design measures suggested in the Preliminary ESMP Design measures shall be finalized prior against the risk of accident spill of hazardous materials. Final design measures adopted to the updating of the ESMP into a final shall be described in the final ESMP and implemented as part of the implementation of ESMP and thereafter implemented the ESMP. throughout the Project implementation period. 9|Page ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY 4.11 SPILL PREVENTION, CONTAINMENT AND CLEAN UP PROTOCOL During detailed design preparation. The MoH Adopt and implement a Spill Prevention, Containment and Clean Up Protocol. The TOR TOR for the development of the Spill for the TA in the development of this protocol shall be included in the final ESMP. Prevention, Containment and Clean Up Protocol shall be included in the final ESMP. The Plan shall be completed and adopted prior to the closure of the project. 4.12 SEA AND SH RISKS Throughout the Project implementation MoH Implement SEA/SH actions as part of the ESMP and LMP, to assess and manage the risks period. of SEA and SH. ESS 5: LAND ACQUISITION, RESTRICTIONS ON LAND USE AND INVOLUNTARY RESETTLEMENT 5.1 The Recipient shall ensure that once the detailed footprint of the outer island clinicIn case of identified impacts under upgrades and land access requirements, a resettlement action plan (RAP) shall be ESS5, adopt and implement the respective RAP prior to any land adopted and implemented consistent with ESS5 in case of any identified land acquisition, restrictions on land use and involuntary resettlement impacts. acquisition and physical or economic displacement including ensuring that before taking possession of the land and related assets, full compensation has been provided and, if applicable, displaced people have been resettled and moving allowances have been provided. ESS 6: BIODIVERSITY CONSERVATION AND SUSTAINABLE MANAGEMENT OF LIVING NATURAL RESOURCES 6.1 Not relevant ESS 7: INDIGENOUS PEOPLES/SUB-SAHARAN AFRICAN HISTORICALLY UNDERSERVED TRADITIONAL LOCAL COMMUNITIES 7.1 Not relevant ESS 8: CULTURAL HERITAGE 8.1 The Recipient shall ensure that the Chance Find Procedure in the preliminary ESMP is Throughout the Project implementation finalized in the final ESMP, and the final version is adopted, and is thereafter period implemented. ESS 9: FINANCIAL INTERMEDIARIES 9.1 Not relevant ESS 10: STAKEHOLDER ENGAGEMENT AND INFORMATION DISCLOSURE 10 | P a g e ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) – Tuvalu Health System Strengthening Project MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY 10.1 STAKEHOLDER ENGAGEMENT PLAN PREPARATION AND IMPLEMENTATION The preliminary SEP has been adopted, MoH Update, adopt, and implement the Stakeholder Engagement Plan (SEP) consistent with and shall be updated and re-adopted in ESS10, in a manner acceptable to the Association. line with the update and finalisation of the ESMP and LMP (as per 1.2 and 1.4), and thereafter implemented throughout the Project implementation period 10.2 PROJECT GRIEVANCE MECHANISM The preliminary SEP includes a MoH Prepare, adopt, maintain and operate a grievance mechanism, as described in the SEP. grievance redress mechanism and shall be updated as needed part of the updated SEP in line with the update and finalisation of the ESMP and LMP (as per 1.2 and 1.4), and thereafter implemented throughout Project implementation. CAPACITY SUPPORT CS1 Train the MoH PMU and other relevant implementing support staff responsible on the Within 90 days of the Effective Date MoH Project’s ES instruments, code of conduct and provisions to prevent SEA/SH, the relevant and as a new Project team member join MFED requirements of the ESMF, ESIA and other instruments to be prepared under action 1.2 the Project throughout implementation. above, and the roles and responsibilities of key agencies in the ESF implementation. CS2 Contractors to receive training on the relevant aspects of the Project ES instruments and Prior to work commencing and MoH relevant ESHS requirements. throughout Project implementation. MFED 11 | P a g e