Dominican Republic Program to Support the Strengthening of the National Health System (P180349) ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) Negotiated Version October 26, 2023 ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN 1. The Dominican Republic (the “Borrower”) will implement the “Program to Support the Strengthening of the National Health System” (P180349) (the “Project”) with the involvement of the Ministry of Health and Public Assistance (MISPAS) and the Ministry of Housing and Constructions (MIVHED) and with the support of the National Health Service (SNS) as set out in the Loan Agreement. The International Bank for Reconstruction and Development (the “Bank”) has agreed to provide financing for the Project, as set out in the referred agreement. 2. The Borrower shall ensure that the Project is implemented in accordance with the Bank's Environmental and Social Standards (ESSs) and this Environmental and Social Commitment Plan (ESCP), in a manner acceptable to the Bank. The ESCP is part of the Legal Agreement. Unless otherwise defined in this ESCP, capitalized terms used in this ESCP have the meanings ascribed to them in the referred agreement. 3. Without limitation to the foregoing, this ESCP sets out material measures and actions that the Borrower 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 Bank. Once adopted, said E&S instruments may be revised from time to time with prior written agreement by the Bank. 4. As agreed between the Bank and the Borrower, 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 assessment of the Project’s performance. In such circumstances, the Borrower, through MISPAS and MIVHED, and the Bank agree to update the ESCP to reflect these changes through an exchange of letters signed between the Bank and the Ministers of MISPAS and of MIVHED. The Borrower shall promptly disclose the updated ESCP. Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) MATERIAL MEASURES AND ACTIONS TIMEFRAME RESPONSIBLE ENTITY MONITORING AND REPORTING A REGULAR REPORTING a) Submit semiannual reports to the Bank throughout MISPAS with inputs from a) Prepare and submit to the Bank regular monitoring reports on the Project implementation, commencing after the MIVHED and SNS Project's Environmental, Social, Health and Safety (ESHS) Effective Date of the Loan Agreement. Submit each performance, including, among other things, implementation of the report in conjunction with the Project Reports within ESCP, status of preparation and implementation of Environmental 45 days after the reporting period, as required under and Social (E&S) documents required under the ESCP, stakeholder the Loan Agreement. engagement activities, functioning of the grievance mechanism(s) and other aspects to be detailed in the Environmental and Social Management Framework (ESMF), the Stakeholder Engagement Plan (SEP), the Resettlement Policy Framework (RPF), and the Labor Management Procedures (LMP). b) Additional to the E&S section in the Project Operational Manual b) The POM is an effectiveness condition under the Loan (POM), include an annex in the POM indicating the minimum content Agreement. and format of the reports, as well as their regularity and other relevant E&S related procedures. B INCIDENTS AND ACCIDENTS Notify the World Bank no later than forty-eight (48) hours MISPAS and MIVHED Promptly notify the Bank of any incident or accident related to the Project after learning of the incident or accident. which has, or is likely to have, a significant adverse effect on the environment, the affected communities, the public or workers including, Provide subsequent report to the Bank within a inter alia, cases of sexual exploitation and abuse (SEA), sexual harassment timeframe acceptable to the Bank. (SH), occupational accidents that result in death, serious or multiple injury, gender-based violence, and impacts on natural habitats. Provide sufficient details regarding the scope, severity and possible causes of the incident or accident indicating immediate measures to address it, and any information provided by any contractor and/or supervisory firm as appropriate. Subsequently, at the Bank’s request, prepare a report on the incident or accident and propose any measures to address it and prevent its recurrence. Include a section in the POM and ESMF describing the reporting procedure, including the minimum content of the initial notification and the minimum content of the incident or accident report. Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) C CONTRACTORS’ AND SUPERVISORY FIRMS’ MONTHLY REPORTS a) Submit to the MISPAS and the MIVHED PEUs (as MISPAS and MIVHED a) Cause contractors and supervisory firms to submit monthly monitoring applicable) monthly reports during Project reports on ESHS aspects, explaining the status of compliance with the implementation, as specified in the contracts. E&S mitigation measures. The report shall cover, inter alia: • Preparation and implementation of Contractor's ESMP (C-ESMP) • ESHS incidents. • ESHS supervision. • Use of personal protective equipment (PPE) such as helmets, safety shoes and safety vests by workers. • Training of workers. • Worker complaints. • Project related community complaints. b) At the request of the Bank, submit said reports to the Bank. b) Upon request, throughout project implementation. MISPAS EAS 1: ASSESSMENT AND MANAGEMENT OF ENVIRONMENTAL AND SOCIAL RISKS AND IMPACTS 1.1 ORGANIZATIONAL STRUCTURE Establish and maintain the PEUs as set out in the Loan MISPAS and MIVHED MISPAS and MIVHED shall establish and maintain two different Project Agreement. Hire or appoint the Environmental Execution Units (PEUs) with qualified personnel and resources to support Specialists, Social Specialists and Grievance Mechanism the management of ESHS risks and impacts of the Project. In MISPAS, this Officer no later than two (2) months from the Effective shall include a minimum of one (1) Environmental Specialist, one (1) Social Date of the Loan Agreement and maintain throughout Specialist and one (1) Grievance Mechanism Officer. In MIVHED, this shall the implementation of the Project. include a minimum of one (1) Environmental Specialist and one (1) Social Specialist. In all cases, these positions shall be full-time dedicated staff with qualifications and experience acceptable to the Bank. 1.2 ENVIRONMENTAL AND SOCIAL INSTRUMENTS a) (i) Prepare, disclose and adopt the ESMF no later than MISPAS and MIVHED a) Elaborate, consult, adopt, disclose, and implement an Environmental ninety (90) days after the Effective Date of the Loan and Social Management Framework (ESMF), in accordance with the Agreement; and, thereafter, (ii) implement the ESMF World Bank Group's (WBG) Environmental and Social Standards (ESS), throughout Project execution. the WBG General Environmental, Health, and Safety Guidelines (ESHS), and other relevant Good International Industrial Practices (GIIPs), and in a manner acceptable to the Bank. The ESMF shall build on the Preliminary Environmental and Social Risk Analysis that was prepared for the Project and shall expand it in accordance with terms of reference acceptable to the Bank. The ESMF shall include, inter alia, procedures and requirements for carrying out Environmental and Social Management Plans (ESMPs) for the works with their Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) respective environmental and social assessments, as well as the criteria by which construction ESMPs need to be revised and b) Prepare, submit for the Bank’s review and approval approved, and generic environmental and social plans applicable to the construction ESMPs, prior to the launch of the MISPAS and MIVHED the works that will inform the ESMPs. procurement process and, thereafter, include them in contracts with contractors and implement them b) Prepare, consult, adopt, and implement the construction ESMPs, as throughout the execution of such works or activities. required, in accordance with the ESMF. Review and exclude from the No new construction and renovation works shall be Project any works or activities that may fall within the exclusion tendered nor initiated under Part 1.1 (a), Part 2 (a), criteria to be established in the ESMF. ESMPs shall include (b), (c), and (e)(ii), and Part 3.6(ii) (as set forth in the stakeholder engagement actions, consistent with the provisions of Loan Agreement) before the construction ESMPs the Stakeholder Engagement Plan (SEP). have been approved and disclosed. c) (i) Prepare, submit for the Bank’s review and app roval c) Prepare, adopt, and subsequently implement operating ESMPs that the operating ESMPs prior to the completion of MISPAS with input from include measures of integral solid waste management, health and construction or civil works; and, thereafter, (ii) MIVHED and SNS safety, life and fire safety guidance and emergency response implement the ESMPs. measures. 1.3 MANAGEMENT OF CONTRACTORS a) During the term of all contractual activities of the MIVHED and MISPAS a) Incorporate the relevant aspects of the ESCP, including the provisions Project, prior to the preparation of procurement of the LMP, as well as the applicable Occupational, Health, and Safety documents and contracts, and before the mobilization (OHS) provisions of the ESMF, code of conduct, and other relevant of each contractor and maintained throughout the E&S instruments, into the ESHS specifications of the procurement construction period. documents and contracts with contractors. Thereafter, ensure that the contractors comply and cause subcontractors to comply with the ESHS specifications and codes of conduct of their respective contracts. b) Throughout the implementation of the Project and MIVHED and MISPAS b) Ensure adequate supervision of contractors during Project reported in the monthly and quarterly (if applicable) implementation by monitoring that all relevant ESHS specifications reports to the PEU. and codes of conduct are met as specified in their respective contracts and take corrective actions as necessary. c) Cause contractors to prepare and implement the Contractor's ESMP c) The C-ESMPs shall be (i) reviewed and approved prior MIVHED and MISPAS (C-ESMP) in line with the respective ESMP and E&S instruments as to the start of works, and (ii) implemented throughout appropriate, and to be reviewed and approved by the PEU. the execution of works. 1.4 PERMITS, LICENSES, CONSENT AND AUTHORIZATIONS Obtain permits, consents and authorizations, as required MIVHED and MISPAS Obtain or assist in obtaining, as appropriate, permits, consents and by, and in compliance with, national legislation, prior to authorizations that are applicable to the Project from the relevant Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) national authorities. Comply with or enforce, as applicable, the conditions initiating activities that require them. Keep permissions established in these permits, consents, and authorizations throughout in order throughout Project implementation. the implementation of the Project. 1.5 TECHNICAL ASSISTANCE Submit the terms of reference for technical assistance MISPAS and MIVHED Ensure that consultancies, studies, capacity building, training and any activities for approval by the Bank before tendering such other technical assistance activities under the Project are carried out in activities. Throughout the implementation of the Project. accordance with terms of reference acceptable to the Bank, which incorporate and take into consideration the requirements of the ESSs and the environmental and social management instruments of the Project referred to in actions 1.2, 2.1, and 10.1 as appropriate. 1.6 SUPERVISORY FIRMS a) During the term of the supervisory firms’ contracts. MIVHED and MISPAS a) Incorporate relevant ESHS measures in tender and contract documents for all supervisory firms. Ensure that supervisory firms have incorporated and reported ESHS measures during their periodic oversight functions. b) Submit reports to MISPAS and MIVHED as corresponds, for MISPAS to b) Throughout project implementation. MISPAS and MIVHED consolidate and submit to the Bank upon request. ESS 2: LABOUR AND WORKING CONDITIONS 2.1 LABOR MANAGEMENT PROCEDURES (LMP) (i) Elaborate, adopt, and disclose the LMP within ninety MISPAS and MIVHED Elaborate, adopt, disclose and implement the LMP for the Project in (90) days of the Effective Date of the Loan Agreement; accordance with ESS 2. The LMP should include, inter alia, provisions on: and, thereafter, (ii) implement the LMP during the (i) working conditions and non-discrimination, and equal opportunities in execution of the Project. the recruitment of labor; (ii) occupational health and safety (including personal protective equipment and emergency preparedness and response measures); (iii) mechanisms for dealing with grievances of Project workers, including channels and provisions for addressing complaints of gender-based violence, sexual harassment and sexual exploitation and abuse; (iv) the code of conduct for workers; (v) forced labor and child labor; and (vi) requirements for contractors, subcontractors and supervisory firms. 2.2 GRIEVANCE MECHANISM FOR PROJECT WORKERS The same timeline as for measure 2.1 above and MISPAS and MIVHED Establish and operate a grievance mechanism for Project workers, as maintain it in operation during the implementation of the described in the LMP and in accordance with ESS 2. Project. 2.3 OCCUPATIONAL HEALTH AND SAFETY (OHS) MEASURES a) The same time frame as for action 1.2 and 2.1 above. MISPAS and MIVHED Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) a) Develop and implement an Occupational Health and Safety Plan b) Before the tender of each package of works and MISPAS and MIVHED (OHSP) as part of the development and implementation of the ESMP, supervision contract. in accordance with relevant guidelines to be specified in the ESMF and LMP. c) Before the contracting of supervisory firms. MISPAS and MIVHED b) Incorporate relevant OHS measures into tender and contract documents for all contractors and supervisory firms. d) During the execution of each of the works. MISPAS and MIVHED c) Ensure that supervisory firms hire OHS specialists. d) Ensure that the specified occupational safety and health measures are applied in each of the workplaces. 2.4 EMERGENCY PREPAREDNESS AND RESPONSE The same time frame as for measure 1.2 above. MISPAS and MIVHED Develop and implement an Emergency Response Plan (ERP) as part of the ESMPs for site specific works, in accordance with the guidelines to be specified in the ESMF. Ensure that workers and contractors are trained and implement the plan. 2.5 TRAINING OF PROJECT WORKERS From the process of incorporation of any worker MISPAS and MIVHED Implement and require contractors and supervisory firms to conduct participating in the Project, with reminder sessions training activities with their personnel for Project workers, designed to throughout the execution of the works. increase awareness of health and safety risks and management measures associated with Project activities, as specified in the LMP, ESMF, and work specific ESMPs. In particular, this will include: • Codes of conduct and other topics related to managing the risks arising from the provision of labor for contractors and supervisory firms. • Guidance on OHSP and ERP. • Knowledge of the labor grievance mechanism for all workers within the framework of the Project. 2.6 CODE OF CONDUCT As part of the preparation of procurement documents MISPAS and MIVHED Establish provisions in procurement documents for contractors and and respective contracts. Supervise throughout the supervisory firms to establish a Code of Conduct to be accepted by all implementation of the Project. workers, including subcontractors, and establish the minimum content of such code. The Code of Conduct shall be based on the guidelines contained in the LMP and should address, among other issues, the risk of Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH) in the workplace. ESS 3: RESOURCE EFFICIENCY AND POLLUTION PREVENTION AND MANAGEMENT Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) 3.1 RESOURCE EFFICIENCY AND POLLUTION PREVENTION AND The same time frame as for measure 1.2 above. MISPAS and MIVHED MANAGEMENT, AND CLIMATE CHANGE MANAGEMENT AND RESILIENCE Include measures on resource efficiency and pollution prevention and management, and climate change management and resilience in the ESMF and ESMPs to be prepared in action 1.2 above. 3.2 BUILDING MATERIALS The same time frame as for measure 1.2 above. MISPAS and MIVHED Prepare, adopt and implement appropriate measures and actions for the management of building materials as part of the ESMPs to be developed in action 1.2 above. 3.3 CHEMICALS AND HAZARDOUS MATERIALS The same time frame as for measure 1.2 above. MISPAS and MIVHED Prepare, adopt and implement appropriate measures and actions for the management of hazardous chemicals and materials as part of the ESMPs to be developed in action 1.2 above. ESS4: COMMUNITY HEALTH AND SAFETY 4.1 TRAFFIC AND ROAD SAFETY The same time frame as for measure 1.2 above. MISPAS and MIVHED Adopt and implement measures and actions to assess and manage traffic risks and road safety, in accordance with the provisions of the ESMPs to be prepared in accordance with the ESMF. 4.2 COMMUNITY HEALTH AND SAFETY The same time frame as for measure 1.2 above. MISPAS and MIVHED Prepare, adopt and implement measures and actions to assess and manage the specific risks and effects to the community arising from Project activities, including, among other things, the behavior of Project workers, risks of labor influx, emergency response, informal waste collection, and include these measures in the ESMPs to be prepared in accordance with the ESMF. 4.3 PREVENTION OF SEXUAL EXPLOITATION AND ABUSE (SEA) AND SEXUAL The same time frame as for measures 1.2 above. MISPAS and MIVHED HARASSMENT (SH) As part of the ESMF, develop an action plan on SEA/SH to assess and manage the risks of SEA and SH. Include concrete measures in the specific ESMP, based on the provisions of the SEA/SH Action Plan, as part of the ESMF. 4.4 UNIVERSAL ACCESS The same time frame as for measures 1.2 above. MIVHED and MISPAS Include the concept of universal access as part of the design of the civil works of all new constructions and to the extent feasible rehabilitation of existing infrastructure, as described in the ESMF and work specific ESMPs (e.g., the construction/restoration/replacement of ramps for persons Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) with disabilities, the incorporation of new or additional universal access provisions, and adequate signage within buildings). 4.5 LIFE AND FIRE SAFETY For construction ESMPs, the same time frame as for MIVHED and MISPAS The ESMF and subsequent construction ESMPs and operating ESMPs will measures 1.2(b) above. include management measures for the issues related to the life and fire safety guide and according to the requirements of the applicable national For operation ESMPs, the same time frame as for MISPAS, with input from legislation, the ESS4 and the ESMF, as applicable and relevant to the work measures 1.2(c) above. MIVHED y SNS and/or activity to be financed. ESS 5: LAND ACQUISITION, LAND USE RESTRICTIONS AND INVOLUNTARY RESETTLEMENT 5.1 RESETTLEMENT POLICY FRAMEWORK (i) Prepare, consult, adopt and disclose the RPF no later MIVHED and MISPAS Develop, consult, adopt, disclose, and implement a Resettlement Policy than ninety (90) days after the Effective Date of the Loan Framework (RPF) based on terms of reference acceptable to the Bank and Agreement; and, thereafter, (ii) implement the RPF in accordance with the requirements of ESS5. during the execution of the Project. 5.2 RESETTLEMENT ACTION PLANS (RAP) a) Same timeframe as for measure 1.2 above. MIVHED and MISPAS a) Establish in the ESMF’s exclusion list that activities that may cause involuntary resettlement will not be eligible for funding under the Project. b) Develop, consult, disclose, adopt, and implement Resettlement b) Submit each required RAP for approval by the Bank MISPAS and MIVHED Action Plans (RAPs) when Project activities or works require the and, if approved, implement it before carrying out preparation of such plans, as set forth in the RPF and ESS5. any Project activity or works that require a RAP under Part 1.1 (a), Part 2 (a), (b), (c), and (e)(ii), and Part 3.6(ii) (as set forth in the Loan Agreement). ESS 6: BIODIVERSITY CONSERVATION AND SUSTAINABLE MANAGEMENT OF LIVING NATURAL RESOURCES 6.1 BIODIVERSITY RISKS AND IMPACTS MIVHED and MISPAS a) Include in the ESMF an exclusion list of activities that will not be a) Same time frame as for measure 1.2 above. financed by the Project because they may result in long-term, permanent, or irreversible negative risks and impacts in highly sensitive areas in terms of their importance for biodiversity. b) Incorporate and implement procedures, as will be specified in the b) Same time frame as for measures 1.2 above. MIVHED and MISPAS ESMF and detailed, where required, in works ESMPs, to ensure that Project activities do not take place or negatively impact biodiversity and environmentally sensitive areas, particularly natural or critical habitats. ESS 7: INDIGENOUS PEOPLES Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) This standard is not relevant. ESS 8: CULTURAL HERITAGE 8.1 CULTURAL HERITAGE The same time frame as for measure 1.2 above. MIVHED and MISPAS Carry out, in accordance with the requirements to be specified in the ESMF and as part of the specific ESMPs, an assessment of the tangible and intangible cultural heritage present in areas that may be affected by the Project. Provided the ESMP identifies the need for a Cultural Heritage Management Plan (CHMP), develop, adopt and implement said CHMP based on the requirements of ESS 8. 8.2 CHANCE FINDS The same time frame as for measure 1.2 above. MIVHED and MISPAS Prepare, adopt and implement the chance find procedure described in the ESMF developed for the Project and incorporate and implement these procedures in ESMPs as required. ESS 9: FINANCIAL INTERMEDIARIES This standard is not relevant. ESS 10: STAKEHOLDER ENGAGEMENT AND DISCLOSURE OF INFORMATION 10.1 STAKEHOLDER ENGAGEMENT PLAN (SEP) PREPARATION AND The draft SEP previously prepared and disclosed shall be MISPAS and MIVHED IMPLEMENTATION (i) updated, adopted and redisclosed no later than ninety Update, consult, disclose, adopt and implement the SEP developed for the (90) days after the Effective Date of the Loan Agreement; Project, which will include measures to, inter alia, provide stakeholders and, thereafter, (ii) implemented during the execution of with timely, relevant, understandable and accessible information, and the Project. consult them in a culturally appropriate manner, free from manipulation, interference, coercion, discrimination or intimidation. The SEP will describe the consultation process for the Project, the site-specific works and the ESMPs and RAPs developed for the site-specific works (as appropriate), with differentiated strategies to promote participation and access to benefits for vulnerable groups, as well as details of the Project's grievance and grievance mechanism (including complaints related to gender-based violence). 10.2 PROJECT GRIEVANCE MECHANISM a) The same time frame as for action 10.1 above. MISPAS and MIVHED a) Establish, disclose, maintain, and operate an accessible grievance mechanism, to receive and facilitate resolution of concerns and grievances in relation to the Project, promptly and effectively, in a transparent manner that is culturally appropriate and readily accessible to all Project-affected parties, at no cost and without retribution, including concerns and grievances filed anonymously, in a Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349) manner consistent with ESS10. The grievance mechanism shall be equipped to receive, register, and facilitate the resolution of SEA/SH complaints, including through the referral of survivors to relevant gender-based violence service providers, all in a safe, confidential, and survivor-centered manner. This mechanism should be based on the provisions set out in the SEP. b) Include a report on the functioning of the grievance mechanism in the b) The same time frame as for action A (periodic MISPAS with inputs from semi-annual reports referred to in section A (periodic reporting), reporting) at the beginning of this ESCP. MIVHED and SNS describing at least the number and type of complaints received, the average time to be resolved, whether there are complaints pending resolution, and other pertinent data to be discussed and agreed upon with the Bank. CAPACITY-BUILDING (TRAINING) CS1 a) Develop and implement an environmental and social training plan a) A detailed plan to be submitted no later than 90 days MISPAS and MIVHED acceptable to the Bank to ensure the capacity required for the from the Effective Date of the Loan Agreement. environmental and social implementation of the Project. The plan will include a timetable, budget, objectives and indicators. Training will focus on Project workers, contractors and community organizations. b) Conduct regular training activities for government workers and b) Once approved, implement the Environmental and MISPAS and MIVHED relevant government officials, contractors, supervisory firms, and Social Training Plan throughout the implementation other actors, as appropriate. Jointly identify training topics with the of the Project and update it annually according to the Bank, which could include, but are not limited to, the following: emerging needs of the Project. • Environmental and social management instruments of the Project; • Risks of gender violence, SEA and SH; • Codes of conduct for Project workers; • Emergency Preparedness and Response Legislation and Plan; • Management of hazardous and non-hazardous wastes, including biomedical waste; • Infectious disease response and prevention procedures for potential communicable infectious diseases, including COVID-19; • Inclusion of vulnerable groups; • Universal Access and actions for the inclusion of People with Disabilities; • Mechanisms for dealing with Project-related and worker-related complaints. Dominican Republic - “Program to Support the Strengthening of the National Health System” (P180349)