Republic of Belarus Ministry of Health Republican Scientific and Practical Center of Medical Technologies Belarus Emergency COVID-19 Response Project Environment and Social Management Framework Minsk, January , 2022 Contains Executive Summary 1. Project background 2. Project description 3. Policy, Legal and Regulatory Framework 3.1 National environmental and social assessment rules and procedures 3.2 Sanitary and epidemiological welfare of the population, including on COVID-19 infection control activities and medical waste management 3.3 Life, Fire and Oxygen equipment risks 3.4 Labor protection and safety 3.5 Environmental, health and social national institutional setup 3.6 World Bank's Environmental and Social Framework and Standards 3.7 World Bank Group Environmental Health and Safety (EHS) Guidelines 3.8 World Health Organization COVID-19 Guiding documents 3.9 International environmental treaties 4. Environmental and Social Baselines 4.1 Environmental baseline 4.2 Economic baseline 4.3 Population, disadvantaged and vulnerable groups 4.4 Social and gender issues 4.5 Health care sector and status of COVID-19 in the country 5. Potential Environment and Social Risks and Mitigation 5.1 Environmental and social risks and impacts 5.2 WB Environmental and Social Standards mitigation requirements 5.3 Mitigation of environmental and social risks and impacts at different project development stages 6. Procedures to Address Environmental and Social Issues 6.1 Stages of environmental and social assessment 6.2 Institutional Arrangements, Responsibilities and Capacity Building 7. Labor management 8. ESMF disclosure and public concultation 9. Grievance Redress Mechanism 10. Stakeholder Engagement Annexes I. List of national laws and regulations on environmental protection, labor safety and sanitary wellbeing of the population II. Labor Management Procedure III. World Bank Group COVID related guiding documents IV. World Health Organization COVID-19 related guiding documents V.Response to COVID-19: Health and Safety issues while purchasing vaccines, therapeutics, goods and supplies VI. Technical Specifications for COVID-19 Medical Equipment VII. Technical Specifications for Invasive and Non-Invasive Ventilators for COVID-19 VIII. Screening Form for Potential Environmental and Social Issues IX. Template for environmental and social management plan, including infection control and healthcare wastes management X. Infection and Prevention Control Protocol XI. COVID-19 Preparedness report template 2 3 Abbreviations and Acronyms AFB Acid-Fast Bacilli AMR Antimicrobial Resistance BLS Basic life support BMBL Biosafety in Micro Biological and Biomedical Laboratories BMW Bio Medical Waste Management BSC Biological Safety Cabinets BSL Biosafety Level CDC Centre for Disease Control and Prevention COVID-19 Coronavirus Disease 2019 EOC Emergency Operating Centre ESF Environmental and Social Framework ESIA Environmental and Social Impact Assessment ESHS Environmental, Social, Health and Safety EHS Environmental, Health and Safety ERP Emergency Response Plan ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan GBV Gender Based Violence GIIP Good Internatonal Industry Practice HCF Healthcare Facility HEPA High Efficiency Particulate Air filter HIV Human Immunodeficiency Virus HWM Healthcare Waste Management HVAC Heating, Ventilation and Air Conditioning ICMWM Infection Control and Medical Waste Management IPC Infection Prevention and Control L&FS Life and Fire Safety MW Medical Waste MWM Medical Waste Management OHS Occupational Health and Safety POE Point of Entry PPE Personal Protective Equipment PPSD Project Procurement Strategy for Development SEA Sexual Exploitation and Abuse SEP Stakeholder Engagement Plan SOP Standard Operating Procedures TA Technical Assistance TB Tuberculosis WB World Bank WHO World Health Organization 4 Executive Summary Scope of updated Environmental and Social Management Framework (ESMF). Based on information on implementing WB COVID 19 projects worldwide there was noticed an increasing number of deadly fires in hospitals treating COVID-19 patients. Reviews of some of the incidents suggest that the increased risk may be related to the expanded use of oxygen and pressure on hospital electrical systems. In this regard, the document need to be updated, providing necessary guidance on Life and Fire Safety (L&FS) as well as Oxygen risk management in HCF. The updated document should be also considering the status of project implementation including the fact that all minor civil work for refurbishing of the limited number of selected HCFs are done and the vaccination campaign is done outside the current project. Project Development Objective. The PDO is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Belarus. Project Components and activities. This a an IPF Project which will consist of two components to support the government to curb the spread of COVID-19 pandemic and strengthen health system to detect and treat cases. Component 1: Emergency COVID-19 Measures and Rapid Emergency Response (US$ 99 million). This component will have 4 subcomponents: Subcomponent 1.1 Strengthening capacity of Healthcare Facilities (HCFs), including Intensive Care Units (ICUs). This subcomponent will finance medical equipment, including oxigen supply and supplies required for diagnosis and treatment of COVID-19 patients in intensive care, as well as limited operating expenses, in repurposed COVID-19 hospitals and selected regional centers across Belarus. The subcomponent will also finance PPE for health workers in ICUs and the broader hospital setting, pain medication, antibiotics and other routine medicines for the ICUs as well as training in COVID-19 care and infection prevention, as well as longer-term capacity building in critical care provision, for staff at all ICUs, both existing and new, is also included. Subcomponent 1.2 Strenthening pre-hospital emergency medical services. This subcomponent will support the acquisition and distribution of modern ambulance vehicles and the essential equipment needed for those vehicles, for pre-hospital and in-hospital emergencies, in order to ensure timely access of COVID- 19 patients to hospital care, as well as referral between facilities if needed. Subcomponent 1.3 Support to the national surveillance system. This subcomponent will support strengthening of public health laboratories and epidemiological capacity for early detection, confirmation and reporting of cases. It will finance medical supplies and equipment needed to detect COVID-19 infection, including personal protective equipment, COVID-19 testing kits, laboratory reagents and other consumables. Subcomponent 1.4 Improving risk communication. This subcomponent will support information and communication activities to increase the commitment of government, private sector, and civil society to curbing the COVID-19 pandemic, raise awareness and knowledge among the general population about the risk and potential impact of the pandemic, and to develop multi-sectoral strategies to address the pandemic. Communication efforts will be supplementary to the activities already planned by the Delegation of the EU in Belarus. Up to the end of December 2021 all civil works have been finished, - under the poject there was not financed any new construction or expansion of HCFs, but only minor refurbishments needed in order to add new fully- equipped beds to existing ICUs, or to establish new ICUs within existing hopitals. Also, no modular COVID 19 facilities have been supported as the country has in place enough capacity to accommodate the COVID sick people. Furthermore, as decided since the beginning of the project design, the national COVID 19 vaccination is done outside of the project by the MoH institutions and respectively the project does not finance vaccines deployment (only those that the HCFs are doing their day to day work, and, respectively the project didn’t support and will not support new activities on vaccine cold chain storage/management. 5 Component 2. Project Implementation and Monitoring [US$1 million]. This component will support the administrative and human resources needed to implement the Project and monitor and evaluate progress. It will finance staff and consultant costs associated with project management, procurement, financial management, environmental and social satandards implementation, monitoring and evaluation, reporting and stakeholder engagment; operating and administrative costs; technical assistance to strengthen the Project’s emergency response (e.g. improvement of testing, treatment, referral and discharge protocols); and longer-term capacity-building for pandemic preparedness. Project environmental risks and impacts. The project's environmental risks are significant. The project will have positive impacts as it should improve COVID-19 surveillance, monitoring and containment. However, it can also cause significant environment, health and safety risks due to the dangerous nature of the pathogen (COVID-19) and reagents and other materials to be used in the project-supported HCFs, and participating in the project laboratories. Infections due to inadequate adherence to occupational health and safety standards can cause spread of virus for medical staff, laboratory staff and population at large in due course of detection, transportation of patients/tests/chemicals and reagents, and treatment stages. Also, this can lead to illness and death among health workers. Furthermore, the HCFs, ICUs and laboratories involving COVID-19 diagnostic testing and treatment will generate medical waste and other hazardous biproducts which, in the case of inadequate management during their collection, transportation and disposal, also may cause additional health risks. In additiona there might be risks of deadly fires in hospitals treating COVID- 19 patients related to expanded use of oxygen and pressure on hospital electrical systems. Lastly, proposed refurbishing civil works may generate a series of well known associated risks and impacts such as dust; noise; construction solid wastes; vibration; Ocupational Health and Safety (OHS) issues, which will be short term and site specific and can be mitigated by implementing best civil works practices and proposed in the Template for Environmental and Social Management Plan (ESMP) to be prepared and implemented by each participating in the project HCF. Project Social Risks. The Social Rating is “Moderate�. The major areas of social risks are linked to environmental ones and related to: (i) spread of the virus among health care workers; and (ii) the spread of COVID-19 among the population at large. The key social issues/risks to be managed will be focused on: (i) ensuring a soothing environment so as to avoid panic/conflicts resulting from false rumors and social unrest; (ii) assuring proper and quick access to appropriate and timely medical services, educate hand hygiene and PPE, that is not based on ability to pay or other factors; (iii) anticipating and addressing issues resulting from people being kept in quarantine; and (iv) managing labor risks that may arise during implementation, including risks associated with working conditions for health care workers. Most of these impacts and the risks can be contained by an effective and inclusive outreach program encompassing stakeholder engagement throughout the project cycle. As the project will not finance any new construction but potentially only minor refurbishing works that would be done inside the existing health care facilities and laboratories, the project will not cause any land acquisition or physical and economic displacement. Given that the project will be implemented nationwide, particular emphasis will be made to enable access to facilities and services to vulnerable social groups (low income, disabled, and elderly). The project will also need to ensure that public health guidelines that require restrictive measures do not contribute to existing vulnerabilities (for example, to gender-based violence, GBV). To mitigate these and other potential risks, a Stakeholder Engagement Plan (SEP) has been prepared. Moderate social risk is also explained by the fact that MoH has prior experience in handling WB-financed projects, and has overall been responsive in following the WB team’s suggestions on various social safeguards issues (including strengthening of the GRM, regular reporting, etc.). Participating HCFs. The project will be implemented country wide in HCFs in which ICUs to treat COVID-19 patients are or will be created and in COVID-19 assigned laboratories. These will be identified based on an assessment of existing service availability and the need to expand the availabiity of relevant specialist care in order to ensure equitable access. 6 Relevance of WB Environmental and Social Standards (ESS). The conducted project Environmental and Social Assessment (ESA) show most of the WB ESSs are relevant to the Project except for: ESS5 (Land Acquisition, Restrictions on Land Use and Involuntary Resettlement), - as no needs for land acquisition or resettlement issues are anticipated; ESS6 (Biodiversity Conservation and Sustainable Management of Living Natural Resources) – as all project activities will be implemented within selected HCFs and no impacts of Biodiversity or living organisms are anticipated; ESS7 (Indigenous Peoples/Sub- Saharan African Historically Underserved Traditional Local Communities) – as no such group of communities are in Chisinau city; ESS8 (Cultural Heritage) – as no buildings included in the national or city’s list of CH objects will be financed under the Project; and ESS9 (Financial Intermediaries) – as the Project will not use FIs. Environmental and Social Management Framework (ESMF). The ESMF specifies the Environmental and Social Assessment (ESA) rules and procedures which will guide the ESA process during the project implementation, including measures in terms of L&FS and oxygen risks management. The document also provides the detailed procedures, based on WHO guidance, for treating patients and environmental health and safety guidelines for HCFs, ICUs and laboratories’ staff, including the necessary PPE. Furthermore, it provides requirements for adeqaute medical waste (MW) management, including proper disposal of sharps. All these provisions will then be used for preparing the the Environmental and Social Management Plan that includes Infection Prevention and Control (IPC) and Medical Waste Management (MWM) activities, which is based on the best international practices in COVID-19 diagnostic, testing and COVID-19 response and treatment activities, based on the relevant WB Environmental Health and Safety Guidelines, Good Internatonal Industry Practice (GIIP), and COVID-19 Quarantine Guideline and WHO COVID-19 bio-safety guidelines. The ESMP template to be adopted and implemented by all participating HCFs has also (i) a monitoring plan for ensuring compliance and efficient ESMP implementation; and (ii) ESMF’s implementing arrangements, as well as capacity building activities for carrying on E&S requirements. ESMF Implementing arrangements. The Ministry of Health of the Republic of Belarus will bear overall responsibility for the implementation and coordination of the Project while the day to day implementation, coordination, monitoring and evaluation of the implementation of project activities, as well as responsibilities in terms of ESF, will be assigned to the Republican Scientific and Practical Center of Medical Technologies (RSPCMT). The RSPCMT is currently assigned as the Project Implementation Unit (PIU) for the ongoing WB-supported Health System Modernization Project (P156778) in the country and, respectively, has experience in terms of implementing WB safeguards requirements under old Operational Policies (OPs). The project environmental and social management until now was considered as satisfactory. The PIU has in its staff a Safeguards Specialist (SS) with overall responsibilities of coordinating all safeguards issues, including preparing subproject Environmental and Social Management Plans and ensuring their implementation. As the proposed project is among the first projects in the country under the new WB Environmental and Social Framework (ESF) and Environmental and Social Standards (ESSs), the PIU and its SS do not have experience and adequate knowledge on the new requirements, especially in terms labor safety and working conditions, hazardous waste management, community health and safety issues. Furthermore, the country’s capacity to manage risks associated with COVID-19 is a major concern as the ICUs and involved laboratories personnel may not have the detailed know-how on the bio-safety risk management. Equally, Belarus has no experience in handling social concerns around COVID-19 as well as related measures, including quarantine. The Project will provide funding to address these short-comings and it will be important that the Project sources international expertise to achieve international best practices on these matters in line with WB EHS and WHO guidelines. To strengthen the PIU capacity, under the project will be hired an additional Environmental and Social Specialist (ESS), which will receive from the WB team an intial training on ESF requirements. ESA supervision and reporting. The status of the compliance with the ESMP requirements shall be provided on monthly basis by the participating HCFs to the PIU, and then to the Bank by PIU in form of their 7 quarterly reports. Environmental and social monitoring of ESMPs implementation should provide information about (i) COVID-19 infection control; (ii) MWM, particularly its impacts; (iii) social consequences of impacts; and (iv) the effectiveness of taken mitigation measures. Such information enables participating HCFs and the PIU to evaluate the success of COVID-19 risk mitigation measures as part of project supervision and allows corrective action(s) to be implemented in a timely manner, when needed. Environmental and social monitoring. Environmental and social monitoring during the implementation of project activities shall contain information on key environmental and social aspects of subprojects, their impact on the environment, social consequences of impacts and the effectiveness of measures taken to mitigate the consequences. Such information will allow the PIU and the World Bank to evaluate the success of measures to mitigate the consequences within the framework of project supervision, and allow, if necessary, to take corrective actions. Labor management. ESS 2 is relevant for Belarus Emergency COVID-19 Response Project. ESS2 categorizes the workers into direct workers, contracted workers, community workers and primary supply workers. The Concept Stage ESRS envisaged that the project would include direct workers (administration staff, public servants, workers in health care facilities and centers for social work and consultants) as well as contracted workers (employees of contractors and sub-contractors). Community workers will not be employed in relation to this Project. Primary supply workers will be engaged for delivering of PPE, medical equipment, etc.). No risks of child labor or trafficking people during Project implementation are expected. This ESMF include requirements for worker’s health and safety according to the national legislation and World Bank ESS. This document provides the detailed procedures, based on WHO guidance, for necessary protocols for treating patients and handling medical waste as well as environmental health and safety guidelines for staff, including the necessary PPE. All of these requirements and guidelines provided in Labor Management Procedures (LMP) and OHS plan as part of this ESMF. Grievance Redress Mechanism (GRM). A built-in robust grievance redress mechanism within the project will also ensure that Project-affected population and healthcare workers can accessibly file their complaints and to receive timely resolution for them. The GRM will be established and maintained by the PIU to ensure a functional, transparent and responsive system for handling grievances. Where appropriate, this system can be mainstreamed to other activities of the implementing agency beyond those of the current project to strengthen governmental systems. In this mechanism, beneficiaries can turn to register any grievances on all issues related to the Project. The PIU’ safeguard specialist will keep a record of the grievances received. This will be done by applying multiple absorption channels such as mail, email, phone, project website, local and national media, etc. Every grievance shall be tracked and assessed if any progress is being made to resolve them. The project monitoring and evaluation information system should also include indicators to measure grievance monitoring and resolution. ESMF disclosure and public consultation. This document passed public discussions on the website of the Ministry of Health of the Republic of Belarus without comments and suggestions from 08/10/2020 to 08/23/2020. Sent for approval to the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus, the Ministry of Housing and Communal Services of the Republic of Belarus, the Ministry of Labor and Social Protection of the Republic of Belarus, State Institution “Republican Center for Hygiene, Epidemiology and Public Health�. As of 09/04/2020, approvals were received from the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus, the Ministry of Housing and Communal Services of the Republic of Belarus, the State Institution “Republican Center for Hygiene, Epidemiology and Public Health�. The revised ESMF document was posted on the website (https://belcmt.by/en/proekt-ekstrennoe-reagirovanie-na-covid-19-v-respublike-belarus/obshchestvennoe- obsuzhdenie-proekta) on February 3, 2022. Stakeholders’ participation and Engagement Plan. Project has prepared a preliminary SEP which serves the following purposes: (i) stakeholder identification and analysis; (ii) planning engagement modalities 8 viz., effective communication tool for consultations and disclosure; and (iii) enabling platforms for influencing decisions; (iv) defining roles and responsibilities of different actors in implementing the Plan; and (iv) a grievance redress mechanism (GRM) building on the existing health project in Belarus. Rapid project preparation has included preliminary mapping of the stakeholders. Individuals and groups likely to be affected (direct beneficiaries) have been identified. The speed and urgency with which this project has been developed to meet the growing threat of COVID-19 in the country has limited the project’s ability to develop a complete SEP before this project is approved by the World Bank. This initial SEP was developed and disclosed prior to project appraisal, as the starting point of an iterative process to develop a more comprehensive stakeholder engagement strategy and plan. It will be updated periodically as necessary, with more detail provided in the first update was already done after the project approval. 9 1. Project background While health outcomes in Belarus have improved over time, life expectancy is relatively low and non-communicable diseases (NCDs) are an important risk factor. Belarus has made good progress in the control of communicable diseases and in reducing infant and maternal mortality. However, Belarus’ life expectancy is lower than that of every European Union (EU) country. It is 10.1 years higher for women (79 years) than for men (68.9 years), mainly as a result of the growing incidence of NCDs, cardiovascular diseases, due to poor diet, smoking, alcohol consumption, and sedentary lifestyles. The population of Belarus is aging, with implications for health system organization and costs. It is estimated that there are currently 2.3 million elderly people (post working age) in Belarus, out of whom 1.4 million people are over the age of 60. In 1990, the percentage of people aged 65 and above was 10.7 percent. By 2017 this share had increased to 14.9 percent, and it is projected to grow to 25 percent by 2050. The share of people over the age of 80 is projected to grow from 3.5 percent to 7.5 percent over the same period. By 2025, the proportion of the population over people 65 in the total population will overtake the proportion of people aged 0-14. Health care delivery is skewed towards hospital care with a large, over-sized hospital network. Belarus lacks a strong primary care system that will be necessary to address the health challenges associated with aging and a growing NCD burden in a cost-effective manner. For its population size, Belarus has many hospitals, hospital beds, doctors, nurses, and other personnel – a legacy of the pre-independence service delivery structures. Moreover, discrepancies exist in the internal efficiency of hospitals, with significant variation in the average length of stay and unit costs for similar treatments across the country. Enhancing the efficiency and quality of services and the use of public resources will, over the longer term, require strengthening primary health care services to manage the growing incidence of NCDs (especially in the context of an aging population), eliminate disparities in health care provision between urban and rural areas, reorganize and reprofile the hospital network, improve integration of care between different levels of services, and meet the increasing need for long-term care. Available assessments suggest Belarus might not be sufficiently prepared to prevent, detect, and respond to epidemics on the scale of COVID-19. Belarus’ score on the Global Health Security Index is 35.3, ranking 108 out of 195 countries 1 . Capacity for detection and reporting (which encompasses laboratory systems, real-time surveillance and reporting, the epidemiological workforce, and data integration across human/animal/environmental health sectors) is considered satisfactory and the country’s capacity for rapid response is considered quite strong. Belarus scores 46.6 against an average of 38.4, with particularly high capacity to implement response plans, implement trade and travel restrictions, ensure access to communications and infrastructure, and undertake risk communication activities. In March 2020, WHO assessed country prepared capacity for COVID-19 as Level 3, which is similar to most other developing countries in the ECA region.2 However, Belarus has not undertaken a Joint External Evaluation of the implementation of International Health Regulations (2005)3 which would provide more detailed information. In sum, while there a paucity of information on overall readiness, available assessments suggest an insufficiency of preparedness but also a strong general capacity to respond in times of emergency that can be leveraged to combat the COVID-19 pandemic. The number of cases confirmed by the COVID-19 epidemic in Belarus is growing rapidly. The first confirmed case of COVID-19 in Belarus was detected on February 28, 2020. By the end of August a total of 1 497 421 tests were tested and 71 165 people have been identified as positive to COVID-19 virus. About 69 650patients who had previously been diagnosed with COVID-19 have recovered and about 373 patients have died. 1 https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Health-Security-Index.pdf 2 Country preparedness capacity: a rating of 5 implies the country has a high capacity to comply with International Health Regulation (IHR) activities of preventing, detecting and responding to a public health emergency, a rating of 1 implies little to no capacity. 3 https://www.who.int/ihr/procedures/joint-external-evaluations/en/ 10 2. Project description Project Development Objective. The PDO is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. Project components and proposed activities. The Project will consist of two components to support the government to curb the spread of COVID-19 pandemic and strengthen health system to detect and treat cases. The specific activities financed by the Project will: (i) rapidly address the COVID-19 emergency by identifying, isolating and providing care for patients with COVID-19 to minimize disease spread, morbidity and mortality; (ii) implement effective communication campaigns for mass awareness and education of the population on how to tackle the COVID-19 emergency; and (iii) strengthen the short- and long-run capacity of the public health system to provide intensive care. Component 1: Emergency COVID-19 Measures and Rapid Emergency Response (US$ 99 million) Subcomponent 1.1 Strengthening capacity of healthcare facilities, including ICUs. This subcomponent will address the immediate health system needs for medical equipment, supplies and training to treat the severe cases affected by COVID-19 emergency. It will finance medical equipment (including medical equipment required for oxygen -therapy4 ), and supplies required for diagnosis and treatment of COVID-19 patients in intensive care, as well as limited operating expenses, in repurposed COVID-19 hospitals and selected regional centers across Belarus. The hospitals in which ICUs to treat COVID-19 patients will be established have been identified based on an assessment of existing service availability and the need to expand the availabiity of relevant specialist care in order to ensure equitable access. The subcomponent will also finance PPE for health workers in ICUs and the broader hospital setting, as well as pain medication, antibiotics and other routine medicines for the ICUs. Training in COVID-19 care and infection prevention, as well as longer-term capacity building in critical care provision, for staff at all ICUs, both existing and new, is also included. The subcomponent will not finance any construction, but only minor refurbishments needed in order to add new fully-equipped beds to existing ICUs, or to establish new ICUs within existing hopitals. Subcomponent 1.2 Strenthening pre-hospital emergency medical services. This subcomponent will support the acquisition and distribution of modern ambulance vehicles and the essential equipment needed for those vehicles, for pre-hospital and in-hospital emergencies, in order to ensure timely access of COVID- 19 patients to hospital care, as well as referral between facilities if needed. Subcomponent 1.3 Support to the national surveillance system. This subcomponent will support strengthening of public health labooratories and epidemiological capacity for early detection, confirmation and reporting of cases. It will finance medical supplies and equipment needed to detect COVID-19 infection, including personal protective equipment, COVID-19 testing kits, laboratory reagents and other consumables. Subcomponent 1.4 Improving risk communication. This subcomponent will support information and communication activities to increase the commitment of government, private sector, and civil society to curbing the COVID-19 pandemic, raise awareness and knowledge among the general population about the risk and potential impact of the pandemic, and to develop multi-sectoral strategies to address the pandemic. Communication efforts will be supplementary to the activities already planned by the Delegation of the EU in Belarus. Component 2. Project Implementation and Monitoring [US$1 million] This component will support the administrative and human resources needed to implement the Project and monitor and evaluate progress. It will finance staff and consultant costs associated with project management, procurement, financial management, environmental and social safeguards, monitoring and 4 Oxygen cylinders, oxygen concentrators, oxygen plant and oxygen liquid plan 11 evaluation, reporting and stakeholder engagment; operating and administrative costs; technical assistance to strengthen the Project’s emergency response (e.g. development of testing, treatment, referral and di scharge protocols); and longer-term capacity-building for pandemic preparedness. Status of project implementation. Up to the end of December 2021 all refurbushing civil works have been finished, - under the project there was not financed new construction or expansion of HCFs, but only minor refurbishments needed in order to add new fully-equipped beds to existing ICUs, or to establish new ICUs within existing hopitals. Also, no modular COVID 19 facilities have been supported as the country has in place enough capacity to accommodate the COVID – 19 sick people. Furthermore, as decided since the beginning of the project design, the national vaccination is done outside of the project by the MoH instituions and respectively it does not covering vaccines deployment (only those that the HCFs are doing their day-to- day work, and respectively, the project didn’t support and will not support new activities on vaccine cold chain storage/management. In terms of medical equipment, the project financed purchasing: 16 purchased computer tomographs (that are put into operation); 140 pieces of ventilators; and 1030 oxygen concentrators (and will buy additionally 2000 more), along with 5000 dispensers for oxygen-air mixture with humidification (oxygen inhalers). The project also supported a series of COVID 19 information dissemination campaign along with a solid institutional and human capacity building activities Program. The expected project beneficiaries. These will be the population at large given the nature of the disease, infected people, at-risk populations, particularly the elderly and people with chronic conditions, medical and emergency personnel, medical and testing facilities, and public health agencies engaged in the response in the Republic of Belarus. The number of beneficiaries would be 9.5 million people, 22.1 percent of whom are older than 60 years (age bracket in which case fatalities are concentrated). In the general population, the Project is expected that the men will be more affected by disease since men are at greater risk of COVID-19 related morbidity and mortality, due to their higher incidence of co-morbidities. However, women will benefit disproportionately from the Project’s investments to protect health workers since they comprise a larger share of the health workforce. Potential Environmental and Social Risks. The project was prepared under the World Bank’s Environment and Social Framework (ESF) with an Environmental Risk Rating of "Substantial" and a Social Risk Rating of “Moderate�, resulting in an overall ESF Risk Rating of Substantial. The four major areas of risks for the project are: (i) risks related to spread of the virus among health care workers and primary suppliers; (ii) risks related to medical waste management and disposal, including risks associated to L&FS and Oxygen equipment risks; (iii) risks related to the spread of COVID-19 among the population at large; and (iv) civil works associated risks and impacts during refurbising of HCFs such as dust; noise; construction solid wastes; vibration; OHS issues, which will be short term and site specific. These risks are covered by the following Environmental and Social Standards (ESSs): ESS 1, ESS 2, ESS 3, ESS 4, and ESS 10. The small- scale works related to refurbishing ICUs are expected to take place on the property of existing facilities; therefore, they will be mostly community-based activities and environmental issues (and impacts thereof) are expected to be temporary, predictable, and easily mitigable. There will be no land acquisition. The more substantial risks are around ensuring contagion vectors are controlled through strict adherence to standard procedures for medical waste management and disposal; the use of appropriate Personal Protective Equipment (PPE) for all health care workers; and working with local governments and communities to ensure that social distancing measures and quarantine regimes are strictly adhered is also vital for lowering the speed and incidence of infection. Scope of the initial project Environmental and Social Assessment. As the proposed activities will generate a series of adverse environmental and social impacts, as per WB Environmental and Social Standards (ESS) as well as per national legislation it is required to conduct project Environmental and Social Assessment. Considering at this stage of project development there are not yet selected the HCFs that will be participate in the project as well as there have been not yet identified concrete activities to be financed, to address these impacts and risks, MoH prepared this Environmental and Social Management Framework (ESMF) which includes the requirements of the World Bank's ESSs relevant to the Project, along with the description of the national policies, legal, and administrative framework regarding environmental and social 12 assessment and management, occupation health and safety requirements and the health sector in the country. Furthermore, it includes requirements on the COVID-19 diagnostic, testing and COVID-19 response and treatment activities, based on the relevant WB Environmental Health and Safety Guidelines, Good Internatonal Industry Practice (GIIP), and COVID-19 Quarantine Guideline and World Health Organization (WHO) COVID-19 bio-safety guidelines. The ESMF also provides guidelines for the development of appropriate prevention and mitigation measures for adverse impacts that might result from project activities and includes a template of the site specific Environmental and Social Management Plan (ESMP) that specifies also the Infection Control and Health Care Waste MWM issues. The template aims to provide an overarching action plan for the management of environmental, social, health and safety (ESHS) issues associated with the operation of ICUs in response to COVID-19 and it is focused on proper infection control and healthcare waste management practices during operation of HCFs. It contains also a Monitoring Plan that would allow to assess the efficiency of proposed risks mitigation measures and to undertake corrective measures, as needed and description of GRM established for the Project. Scope of updated Environmental and Social Management Framework (ESMF). Based on information on implementing WB COVID 19 projects worldwide there wes noticed an increasing number of deadly fires in hospitals treating COVID-19 patients. Reviews of some of the incidents suggest that the increased risk may be related to the expanded use of oxygen and pressure on hospital electrical systems. In this regard, the document need to be updated, providing necessary guidance on L&FS as well as oxygen risk management in HCF. The updated document should be also considering the status of project implementation including the fact that all minor civil work for refurbishing of the limited number of selected HCFs are done and the vaccination campaign is done outside the current project. The updated ESMF covers all applicable provisions of the relevant ESSs. Additionally, other environmental and social instruments as required by the ESF, such as the Stakeholder Engagement Plan (SEP), are appropriately summarized or referenced in the ESMF document and labor management procedure (LMP) as part of this document. The type of environmental and social instruments and their timings of development and implementation are defined in the project Environmental and Social Commitment Plan (ESCP). E&S risk classification for each participating in the project HCF and exclusion criteria. The ESMF updated document specifies that each participating in the project HCF will be screened to assess their potential risks while operating in the contexts of COVID-19 circumstances, including in terms of L&FS risks. Section 6.1 of the document provides criteria and procedures for the screening process and sets out a list of questions on the screening of E&S risks and impacts, identifies the relevant ESSs and the type of assessments and management tools that should be developed. Based on the screening process will be identified those HCFs that cannot be included in the project due to the following main reasons: (a) HCFs, ICUs and the labs with a high probability of causing serious adverse effects to human health and/or the environment not related to COVID-19 treatment, - unless the appropriate human and institutional capacity and infrastructure is in place. (b) with significant adverse social impacts which may give rise to significant social conflict; and, (c) operation of ICUs or involved laboratories which don’t have an approved ICWMP and the capacity to implement it properly. 3. Policy, Legal and Regulatory Framework This section includes an overview of the COVID-19 and project related National regulatory documents, WB standards and guidelines, as well as Guiding documents of World Health Organization. Over the last three decades Belarus have developed a well design regulatory framework which covers all three related to COVID-19 issues and the current project sectors: environmental protection; labor safety and social inclusion as well as sanitary epidemiological servises of the population. The list of main laws and regulations, as well as norms and rules is provided in the Annex 1. 3.1 National environmental and social assessment rules and proceduresn 13 Although the national environmental protection legislation does not use the term “environmental assessment�, Belarus has legislated and elaborated a detailed procedure of the state environmental review/expertise of projects, which represent an analog of the environmental impact assessment (EIA) procedure. Furthermore, the country has assigned the Republican Unitary Enterprise “Glavstroyexpertiza� of the State Standardization Committee which is the main responsible institution in this regard. These procedures are consistent with the “environmental assessment� concept adopted by the WB and in many countries worldwide. Relations in the field of state environmental expertise, strategic environmental assessment and environmental impact assessment (EIA) are regulated by the Law of the Republic of Belarus dated July 18, 2016 No. 399-З "On State Environmental Expertise, Strategic Environmental Assessment and Environmental Impact Assessment", is aimed at ensuring the environmental safety of the planned economic and other activities, as well as preventing harmful effects on the entire environment. Objects subject to state ecological expertise and EIA are established, respectively, by Articles 5 and 7 of the Law of the Republic of Belarus "On State Ecological Expertise, Strategic Environmental Assessment and Environmental Impact Assessment". State ecological expertise is carried out by organizations subordinate to the Ministry of Natural Resources and Environmental Protection, which have specialists trained in conducting state ecological expertise and meet the requirements established by the Council of Ministers of the Republic of Belarus. The state environmental expertise is carried out on a paid basis in the manner established by the Council of Ministers of the Republic of Belarus. Currently, such an organization is the State Educational Institution "Republican Center for State Environmental Expertise and Advanced Training of Executives and Specialists" of the Ministry of Natural Resources. Implementation of design solutions without a positive conclusion of the state ecological expertise is prohibited. EIA is carried out by customers, design organizations that have specialists in their staff who have been trained in environmental impact assessment and meet the requirements established by the Council of Ministers of the Republic of Belarus. The regulation on the procedure for conducting environmental impact assessments, requirements for the composition of an environmental impact assessment report, requirements for specialists carrying out environmental impact assessments was approved by the Resolution of the Council of Ministers of the Republic of Belarus dated January 19, 2017 No. 47. The EIA report is submitted for public discussions in the manner approved by the Resolution of the Council of Ministers of the Republic of Belarus dated June 14, 2016 No. 458. Objects that are not included in the list of objects of the state ecological expertise are considered by the RUE "Glavgosstroyexpertiza" of the State Committee for Standardization with the issuance of the conclusion of the state (construction) expertise. The regulation on the procedure for conducting state examination of urban planning projects, architectural, construction projects, the construction queues allocated in them, start-up complexes and estimates (estimate documentation) was approved by the Resolution of the Council of Ministers of the Republic of Belarus dated September 30, 2016 No. 791. The Belarus COVID-19 project would not involve any activities producing significant environmental impacts and also will not support any civil works which might increase air pollutant emissions, discharge of wastewaters and generation of industrial waste, etc., and, respectively, does not require an EIA (Part 2 of Article 13 of the Law of the Republic of Belarus “On State Environmental Expertise�). Waste management legislation is based on the Constitution of the Republic of Belarus and consists of acts of the President of the Republic of Belarus, this Law, other acts of legislation on waste management, as well as international treaties of the Republic of Belarus in the field of waste management. The legal basis for waste management is defined in the Law of the Republic of Belarus dated July 20, 2007 No. 271-З "On Waste Management", which is aimed at reducing the volume of waste generation and preventing their harmful effects on the environment, health of citizens, property located in property of the state, property of legal entities and individuals, as well as for the maximum use of waste, including the involvement of waste in civil circulation. 14 According to the Law of the Republic of Belarus "On Waste Management", state regulation and management in the field of waste management in the Republic of Belarus is carried out by: the President of the Republic of Belarus, the Council of Ministers of the Republic of Belarus, as well as the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus, the Ministry of Housing and Communal Services Of the Republic of Belarus, the Ministry of Health of the Republic of Belarus, the Ministry of Emergency Situations of the Republic of Belarus, the Ministries of Antimonopoly Regulation and Trade of the Republic of Belarus, local Councils of Deputies, local executive and administrative bodies, other state bodies within their competence, determined by legislation. The Ministry of Natural Resources and Environmental Protection of the Republic of Belarus takes measures to implement a unified state policy in the field of waste management and coordinates the activities of other republican government bodies in the field of waste management, with the exception of coordination of activities in the field of handling secondary material resources. In accordance with the Decree of the President of the Republic of Belarus dated September 1, 2010 No. 450 "On licensing certain types of activities", the Ministry of Drive Resources and Environmental Protection of the Republic of Belarus also licenses activities related to environmental impact in terms of the use of waste classes 1-3 danger, neutralization, waste disposal. Measures for the implementation of a unified state policy in the field of municipal waste management, as well as coordination of activities in the field of secondary material resources management, are carried out by the Ministry of Housing and Communal Services of the Republic of Belarus. The Ministry of Health of the Republic of Belarus in the field of waste management establishes the procedure for the disposal of waste generated as a result of the destruction of medicines, medical products and medical equipment, and also carries out state sanitary supervision in the field of waste management. The main principles in the field of waste management are: application of the best available technical methods for waste management; priority of waste use in relation to their neutralization or disposal, subject to compliance with the requirements of the legislation on environmental protection; payment for the disposal of production waste; responsibility for violation of environmental requirements when handling waste and others. Legal entities handling waste are obliged, among other things, to ensure the collection of waste and their separation by type, disposal and (or) use of waste, their storage in authorized waste storage sites or disposal in authorized waste disposal sites, and also comply with other requirements, norms and rules established by the Law of the Republic of Belarus "On Waste Management" and other legislative acts on waste management. Individuals are obliged to ensure the collection of waste and their separation by type, if for this, legal entities serving residential buildings have been created in accordance with the Law of the Republic of Belarus "On Waste Management" and other legislative acts on waste management, the necessary conditions. Requirements for the management of production waste are established by acts of legislation on waste management, including those mandatory for compliance with technical regulatory legal acts, as well as instructions for the management of production waste, developed and approved in accordance with the established procedure by legal entities that handle waste, as agreed with the territorial bodies of the Ministry of Natural Resources and Environmental Protection. Municipal waste is subject to collection and disposal in accordance with the schemes for the management of municipal waste, developed and approved by local executive and administrative bodies in agreement with the territorial bodies of the Ministry of Natural Resources and Environmental Protection, authorized state bodies and institutions exercising state sanitary supervision. 3.2 Sanitary and epidemiological welfare of the population, including on COVID-19 infection control activities and medical waste management The legislation in the sphere of sanitary and epidemiological welfare of the population is based on the Constitution of the Republic of Belarus and consists of the Law of the Republic of Belarus dated 07.01.2012 № 340-З “On the sanitary and epidemiological well-being of the population� and other pieces of 15 legislation, and also international treaties of the Republic of Belarus. The law specifies that the sanitary and epidemiological welfare of the population is ensured by means of the following: (a) implementation of state and regional programs in the sphere of sanitary and epidemiological welfare of the population; (b) prevention of disease distribution taking into account sanitary and epidemiologic situation and its projected change; (c) carrying out of sanitary and epidemiological measures by state bodies, other organizations, physical bodies, including individual entrepreneurs; (d) compliance with the legislation in the sphere of sanitary and epidemiological welfare of the population by state bodies, other organizations, physical bodies, including individual entrepreneurs; (e) setting state sanitary and epidemiological limits; (f) confirmation of compliance of the human habitat factors with the requirements of the legislation in the sphere of sanitary and epidemiological welfare of the population, including safety requirements and requirements of harmlessness to the human organism, and also of the use and (or) development and approval of corresponding methods (methodologies) of the specified factors determination; (h) state sanitary and hygienic expert review; state registration; (g) social and hygienic monitoring; (j) sanitation-and-epidemiological audit; (i) provision of information about sanitation-and-epidemiological situation, state of the human environment, carried out sanitation and epidemic measures; and (k) carrying out of measures for hygienic education and upbringing of the population; The “Sanitary norms and rules, hygienic regulations�, approved by the Ministry of Health of the Republic of Belarus for various aspects, are a part of the legislation in the sphere of sanitary and epidemiological welfare of the population. Based on the law it is compulsory for state bodies, other organizations, physical bodies, including individual entrepreneurs, to observe sanitary norms and rules, hygienic regulations. The sanitary norms and rules, hygienic regulations, applied at conducting construction activity, are approved by the MOH by agreement with the Ministry of Architecture and Construction of the Republic of Belarus. Among most important such documents related to the current project are the following: (a) Sanitary Norms and Rules: (i) General requirements for prevention of infectious diseases 17-69 РБ-98, from April 29, 1998 г. № 18; (ii) Requirements for organization and implementation of anti-epidemiological measures for flu prevention and dissemination, from December 29, 2012, № 217; (iii) Resolution of the Council of Ministers dated 03.03.2020 No. 130 "On the approval of specific sanitary and epidemiological requirements"; and (b) Hygienic standard "Permissible values of sanitary and microbiological indicators of the air environment of premises, organizations providing medical care". A significant number of Sanitary Norms and Rules are still in power in the country which are inherited from the Soviet Union period: standards for buildings design, hospital ventilation, natural and artificial lights, equipment and furniture, work of medical staff, maintenance or rooms, personal hygiene norms for patients and medical staff, sanitary conditions for food units, construction of new HCFs. National COVID-19 related national documents. On March 13, 2020 the MOH issues an order (№7- 19 / 4568) "On prevention of coronavirus infection�. It contains recommendations for contingency planning in the event of unforeseen circumstances to prevent the spread of COVID-19, including on preparing workers for the possible spread of the virus COVID-19; the displacement of employees, training and planning of measures in the event of a disease outbreak on the basis of WHO recommendations; emergency planning for an outbreak; communicating the action plan to employees. 3.3 L&F and oxygen equipment risks Fire safety of HCFs is regulated by the Law "On Fire Safety" adopted in 1993 and amended on November 11, 2019 (No. 251-З), by “General requirements for fire safety�, approved by the Decree of the President of the Republic of Belarus (November 23, 2017 No. 7) and “Specific requirements for ensuring fire safety for health care facilities and those specially designed for children, approved by the Government of Belarus on August 22, 2019 (No.561). These laws and decrees contain all necessary requirements in the field, including: (i) fire prevention instructions and programs, which describe the HCFs and their staff responsibilities to prevent fires, - such programs are mandatory for all HCFs and should include a training program for staff; (ii) evacuation plans; (iii) maintenance plan for L&FS systems in hospitals, and (iv) emergency preparedness and response plan existence and effectiveness; and other important aspects of L&F risks management. Furthermore, based on these regulatory requirements, the Ministry of Extremal Situations 16 (which by law is the main responsible institution in the country in fire safety) has approved a series of bylaws and specific instructions which prescribe in details all key fire safety issues and specifically: • Instructions on the procedure for training workers on fire safety issues and testing their knowledge in this area, approved by the Resolution of the Ministry of Emergency Situations of the Republic of Belarus on May 22, 2018 No. 36; • Programs of the fire-technical minimum training; approved, by the Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 2, 2018 No. 30; • Requirements for the content of general facility fire safety instructions; approved by the Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated April 28, 2018 No. 28; • The form of the plan for the evacuation of people in case of fire; approved by the Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated April 20, 2018 No. 21; • Standards for equipping facilities with primary fire extinguishing equipment; approved by Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 18, 2018 No. 35; • Instructions on the procedure for checking the state of external and internal fire-fighting water supply; approved by the Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 15, 2018 No. 34; and, • Instructions on the procedure for storing anti fire substances and materials; approved by the Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated April 26, 2018 No. 24. The full list of all laws and bylaws regulating fire safety in the country is presented in the box below. Box. 1 List of laws and bylaws regulating fire safety in the Republic of Belarus 1. Law of the Republic of Belarus of June 15, 1993 No. 2403-XII "On fire safety". 2. Resolution of the Council of Ministers of the Republic Belarus dated December 31, 2009 No. 1748 "On approval of technical regulations of the Republic of Belarus “Buildings and structures, construction materials and products. Security "(TR 2009/013 / BY)"; 3. Resolution of the Council of Ministers of the Republic of Belarus dated February 29, 2016 No. 163 "On increasing the effectiveness of control over the implementation of legislation on fire security"; 4. General fire safety requirements for the maintenance and operation of capital structures (buildings, structures), isolated rooms and other facilities belonging to business entities, approved by the Decree of the President of the Republic of Belarus dated November 23, 2017 No. 7 "; 5. Specific requirements for ensuring fire safety for facilities specially designed for the stay of children, as well as facilities with a simultaneous stay of over 300 people, social and health care facilities with round- the-clock stay of people, approved by the Resolution of the Council of Ministers of the Republic of Belarus dated August 22, 2019 No. 561; 6. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated April 20, 2018 No. 21 "On establishing the form of a plan for the evacuation of people in case of fire"; 7. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated April 26, 2018 No. 24 "On approval of the Instruction on the procedure for storing substances and materials"; 8. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated April 28, 2018 No. 28 "On the establishment of requirements for the content of general facility fire safety instructions" 9. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 2, 2018 No. 30 "On approval of programs for the fire-technical minimum"; 10. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 15, 2018 No. 34 "On approval of the Instruction on the procedure for checking the status external and internal fire- fighting water supply"; 17 11. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 18, 2018 No. 35 "On the establishment of standards for equipping facilities with primary fire extinguishing means"; 12. Resolution of the Ministry of Emergency Situations of the Republic of Belarus dated May 22, 2018 No. 36 "On approval of the Instruction on the procedure for training employees on fire safety issues and testing their knowledge in this area"; 13. Order of the Chief State Inspector of the Republic of Belarus for Fire Supervision of October 29, 2004 No. 221 “On the Approval and Implementation of Fire Safety Standards of the Republic of Belarus“ Fire Elevators. General technical requirements. NPB 14-2004 "; 14. Order of the Chief State Inspector of the Republic of Belarus for Fire Supervision of December 10, 2007 No. 167 "On approval of the Fire Safety Standards of the Republic of Belarus" Scope of automatic fire alarm systems and fire extinguishing installations. NPB 15-2007; 15. Order of the Chief State Inspector of the Republic of Belarus for Fire Supervision dated February 12, 2010 No. 21 "On approval of fire safety standards of the Republic of Belarus", According to the law "On Fire Safety" in healthcare facilities (hereinafter HCF), a Fire Safety Plan (hereinafter referred to as the Plan) must be developed, which is approved by the chief physician of the healthcare organization and then the Plan is coordinated with the district or city departments (departments) for emergency situations. In the annex to the Plan there is an evacuation plan approved by the chief doctors of the health care facility and signed by the person in charge for fire safety. In accordance with the Plan, educational trainings are held in the healthcare facility once every six months. While the national legal framework doesn’t provide specific requirements regarding ogygen equipment safety, all general requirements specified in the documents above are relevant to these also. The details on ensuring safety during installing this equipment and its operation are included in Technical documents that are provided along with the equipment itself and must be obeyed while operation. 3.4 Labor protection and safety The labor protection and employees safety regulated by Labor Code of Republic of Belarus (1999) which apply to all workers and employers who signed the employment contract in the territory of the Republic of Belarus and Law “On Labor protection� which directed to regulation of the public relations in the field of labor protection and realization of the right of citizens to healthy and safe working conditions established by the Constitution of the Republic of Belarus. According to the Law “On Labor protection� all employees have the right on labor protection, receiving reliable information from the employer regarding labor conditions at workplace as well as PPE against harmful and (or) dangerous impacts; trainings in safe working methods and techniques of work and labor safety; personal participation or participation through representative person in consideration of issues related to ensuring safe working conditions. Also, according to the “On Labor protection� employees have the right on a workplace that meets labor protection requirements; provision with necessary PPE; sanitary facilities equipped with necessary devices and means; refusal to perform the assigned work in the event of a direct danger to life and health of him and others until the elimination of this danger, as well as failure to provide him with personal protective equipment that directly provides safety. According to the Law of Republic of Belarus “On Trade-Unions�, Trade unions shall have a right to participate in examination of safety labor conditions. Trade unions shall have a right to participate in the development of state programs on labor protection and environmental control, as well as other normative documents regulating labor protection, preventive treatment and ecological safety. In case of violations threatening life and health of workers, trade unions (or public inspectors of trade unions on labour protection) have a right to demand from employer immediate elimination of these violations and address state authorities 18 to take necessary measures. If demands to eliminate violations (especially those threatening life and health of workers) are not fulfilled, trade unions (or public inspectors of trade unions on labour protection) shall have a right to demand from the employer to stop the work until a decision is taken by relevant bodies. The detailed description of labor management procedures, legislative framework and safety actions which will be taken during Project implementation described in LMP which is a part of this document (Annex 2). 19 3.4 Environmental, health and social national institutional setup The Ministry of Natural Resources and Environmental Protection of the Republic of Belarus (hereinafter - the Ministry of Natural Resources) is a state body responsible for the implementation of a unified state policy in the field of environmental protection and rational use of natural resources, the use and protection of subsoil, as well as hydrometeorological activities in accordance with the law. The system of the Ministry of Natural Resources includes: territorial bodies of the Ministry of Natural Resources (regional and Minsk city committees of natural resources and environmental protection, district, city, city and district inspections of natural resources and environmental protection); state organizations subordinated to the Ministry of Natural Resources (RUE Central Research Institute for the Integrated Use of Water Resources, RUE BelNITs Ecology, RUE Center for International Environmental Projects, Certification and Audit Ecologiainvest, State Educational Institution Republican Center for State Environmental Expertise and Advanced Training executives and specialists "Ministry of Natural Resources, State Institution" Republican Center for Analytical Control in the Field of Environmental Protection ", RUE "Belarusian State Geological Center", State Institution "Republican Center for Hydrometeorology, Control of Radioactive Pollution and Environmental Monitoring", RUE "Research and Production Center for Geology").The main tasks of the Ministry of Natural Resources are: implementation of a unified state policy in the field of environmental protection and rational use of natural resources, use and protection of subsoil, as well as hydrometeorological activities in accordance with the legislation; implementation of state management in the field of study, protection, reproduction and rational use of natural resources, including subsoil, waters, fauna and flora, environmental protection, as well as state regulation in the field of hydrometeorology; participation in state regulation of certification activities in the field of environmental protection; coordination of the activities of other republican government bodies, local executive and administrative bodies, organizations in the field of environmental safety, environmental protection and rational use of natural resources, including subsoil, hydrometeorological activities, protection of atmospheric air, ozone layer, rational use and protection of water resources, climate change mitigation and adaptation to climate change; implementation of state regulation of activities for the geological study of subsoil and hydrometeorological activities, as well as the creation of conditions for the development of organizations of all forms of ownership, carrying out these types of economic activities; interaction within the limits of its competence with local executive and administrative bodies in solving environmental issues; control in the field of environmental protection, rational use of natural resources; ensuring the conservation and sustainable use of biological diversity, participation in the development and implementation of measures for the reproduction of flora and fauna; providing republican government bodies, local executive and administrative bodies, citizens with environmental and hydrometeorological information, organizing the promotion of environmental knowledge, participating in the creation of a system of education, education and training in the field of environmental protection; implementation of international cooperation, study, generalization and dissemination of international experience in the field of environmental protection and rational use of natural resources, hydrometeorological activities, as well as protection of atmospheric air, ozone layer, rational use and protection of water resources, mitigation of climate change consequences and adaptation to climate change , environmental certification. State Committee for Standardization. State bodies of expertise of the Republican Unitary Enterprise "Glavstroyexpertiza" are subordinate to the State Committee for Standardization. This body, in accordance with the established legislation, conducts state expertise of urban planning projects, feasibility studies of construction projects, architectural and construction projects and their stages, construction stages, start-up facilities and cost estimates. This expertise also includes the review and approval of the EIA studies, which are included in the design documentation. 20 State bodies of expertise of the republican unitary enterprise "Glavstroyexpertiza" are subordinate to the State Committee for Standardization. This body should carry out, in accordance with the legislative procedure, the state examination of urban planning projects, feasibility studies of construction projects, architectural and construction projects and their stages, construction stages, start-up complexes and cost estimates. This expertise also includes the consideration and approval of the draft EIA, which should be included in the design documentation. Thus, the design documentation for the reconstruction of existing facilities within the framework of the COVID-19 project, if it is provided, is subject to state examination by the State Committee for Standardization with the obligatory development of an environmental protection section in the design documentation, if necessary. Ministry of Health. This is the government body implementing the uniform government policy in the health sector including COVID-19 infection control and MWM and control over the condition of material and technical assets of health facilities and technical maintenance of the building-level engineering systems in a timely manner. Treatment and training process in health facilities is regulated by the Health Departments of the Oblast Executive Committees and the Health Committee of the Minsk Municipal Executive Committee. The system of institutions of the Ministry which exercise state sanitary supervision, includes the following: (i) Department for Hygiene, Epidemiology and Prophylaxis of the Ministry of Health of the Republic of Belarus; (ii) Republican, Regional Centers for Hygiene, Epidemiology and Public Health; (iii) Minsk city, district, area, district in the cities centers for hygiene and epidemiology; and (iv) Republican Unitary Enterprise “Scientific and Practical Centre of Hygiene�. Among others, the main responsibilities of these institutions are the following: monitoring of an unfolding sanitation-and-epidemiological situation on the administrative territory, sanitary supervision in form of preventive and current supervision over implementation of the legislation, which regulates the issues of sanitary and epidemiological welfare of the population, by organizations, individuals, including individual entrepreneurs. The main responsibilities regarding infection control and MWM are assigned with the MoH institutions - Republican Centre for Hygiene, Epidemiology and Public Health. The main controlling functions are delegated to the rayon Centers for hygiene and epidemiology which must conduct necessary inspection of all HCFs in the country and provide relevant conclusions and recommendations. The implementation of the MWM is full responsibility of the HCF staff. Ministry of Labor and Social Protection of the Republic of Belarus. The Ministry of Labor and Social Protection of the Republic of Belarus (hereinafter referred to as the Ministry of Labor) is a republican government body that implements state policy, exercises management in the field of labor and labor protection, employment, and social protection. The main tasks of the Ministry of Labor are: development of proposals and implementation of the main directions and priorities of state policy on promoting employment of the population, pay, labor conditions and safety, state social insurance and pensions, demographic security, social partnership, settlement of collective labor disputes, social services and social assistance, alternative service, improving the socio-economic conditions of family life, ensuring equal rights and equal opportunities for men and women, social guarantees for the population; improvement of the legislation on labor, employment and social protection of the population, on guardianship and trusteeship in relation to adults who are recognized as incapacitated or partially incapacitated; control over compliance with legislation on state social insurance, supervision over compliance with labor legislation and labor protection; implementation of international cooperation in these areas of activity. Central office of the Ministry of Labor includes the Department of State Labor Inspection. The Regulation on the Department of State Labor Inspection of the Ministry of Labor and Social Protection of the Republic of Belarus was approved by the Resolution of the Council of Ministers of the Republic of Belarus No. 959 dated July 29, 2006. The tasks of the State Labor Inspection are: (i) supervision of compliance with labor legislation and labor protection; (ii) identification and suppression of violations of labor legislation and labor protection. The system of the Ministry of Labor also includes the subdivisions of the regional executive committee and the Minsk city 21 executive committee, exercising state and authoritative powers in the sphere of labor, employment and social protection, as well as territorial administration bodies. Ministry of Emergency Situations. Ministry of Emergency Situations (MES) is the republican state administration body, which exercises regulation and control in the sphere of prevention and management of emergency situations of natural and technogenic occurrence and civil defense, ensuring fire safety, industrial, nuclear and radiation safety, mitigation of consequences of the Chernobyl disaster, creation and safeguarding of state and mobilization material reserves, and also regulation in the sphere of safety of shipping of small ships on the inland water-ways of the Republic of Belarus. Its main aims and tasks: (a) organization of activities for emergency management and participation in emergency management; (b) participation in implementation of the state policy in the sphere of prevention and control of emergencies, civil defense and ensuring the fire safety; (c) within its competence, in support of functioning of state systems for prevention and control of emergencies, civil defense and ensuring the fire safety, systems for monitoring and forecast of emergency situations; (d) coordination, within its competence, of activity of state bodies, other organizations in the sphere of prevention and control of emergencies, civil defense and ensuring the fire safety; (e) exercise of state supervision, control, licensing and other special functions in the sphere of protection of the population and territories from emergency situations, civil defense and ensuring the fire safety; and (f) civil defense administration. 3.5 World Bank's Environmental and Social Framework and Standards The World Bank Environmental and Social Framework (ESF), - sets out the World Bank’s commitment to sustainable development, through a Bank Policy and a set of Environmental and Social Standards that are designed to support Borrowers’ projects, with the aim of ending extreme poverty and promoting shared prosperity. The Environmental and Social Standards (ESSs) set out the requirements for Borrowers relating to the identification and assessment of environmental and social risks and impacts associated with projects supported by the Bank through Investment Project Financing. The Bank believes that the application of these standards, by focusing on the identification and management of environmental and social risks, will support Borrowers in their goal to reduce poverty and increase prosperity in a sustainable manner for the benefit of the environment and their citizens. The standards will: a) support Borrowers/Clients in achieving good international practices relating to environmental and social sustainability; b) assist Borrowers/Clients in fulfilling their national and international environmental and social obligations; c) enhance non-discrimination, transparency, participation, accountability and governance; d) enhance the sustainable development outcomes of projects through ongoing stakeholder engagement. The ten Environmental and Social Standards establish the standards that the Borrower and the Project will meet through the project life cycle, as follows in Table 1 below. Risk assessment under the ESF. As part of the environmental and social procedures, The Bank classifies all projects into one of four classifications: High Risk, Substantial Risk, Moderate Risk or Low Risk. In determining the appropriate risk classification, the Bank takes into account relevant issues, such as the type, location, sensitivity, and scale of the project; the nature and magnitude of the potential environmental and social risks and impacts; and the capacity and commitment of the Client to manage the environmental and social risks and impacts in a manner consistent with the Environmental and Social Standards5. 5 Only those ESS which are relevant for the Project are covered. 22 Table 1. WB Environmental and Social Standards and their relevance to the Project Environmenta Re Main requirements and conducted activities to ESMF provisions in terms of addressing ESSs l and Social levant to meet them requirements Standards (ESS) Project (Yes/No) ESS1 – Ye ESS1 sets out the Client’s responsibilities for The project will have positive environmental and social Assessment and s assessing, managing and monitoring environmental and impacts as it should improve COVID-19 surveillance, monitoring, Management of social risks and impacts associated with each stage of a and containment as well as provide targeted support for the more Environmental and project supported by the Bank through Investment Project vulnerable households. However, the project could also cause Social Risks and Financing, in order to achieve environmental and social significant environmental, health, and safety risks due to the Impacts outcomes consistent with the Environmental and Social dangerous nature of the pathogen and reagents and other materials Standards (ESSs). to be used in the project supported ICUs, as well as due to possible As required by this standard, the ESIA should be refurbishing activities which may generate associated with civil conducted based on current information, including a works impacts: dust, noise, OHS, etc. To manage these risks, the description and delineation of the project and any MOH has prepared this ESMF, which includes template for an associated aspects, and environmental and social baseline ESMP and Infection Control and Medical Waste Management data at an appropriate level of detail sufficient to inform measures, so that the HCFs, ICUs, laboratories, and quarantine characterization and identification of risks and impacts and facilities to be supported by the Project will apply international mitigation measures. The assessment evaluates the best practices in COVID-19 diagnostic testing and other COVID- project’s potential environmental and social risks and 19 response activities. The ESMF has an exclusion list for COVID- impacts, with a particular attention to those that may fall 19 ICU and lab activities that may not be undertaken at the labs disproportionally on disadvantaged and/or vulnerable unless the appropriate capacity and infrastructure is in place or an social groups; examine project alternatives; identify ways ESMP has been prepared and approved. This ESMF has been of improving project selection, siting, planning, design and reviewed and accepted by the World Bank and has been disclosed implementation in order to apply the mitigation hierarchy both in country on the MOH website and on the World Bank for adverse environmental and social impacts and seek website. opportunities to enhance the positive impacts of the project. ESS2 – Labor Ye ESS2 recognizes the importance of employment The project will involve the use of both direct workers and and Working s creation and income generation in the pursuit of poverty contracted workers. Direct workers could be either government Conditions reduction and inclusive economic growth. Borrowers can civil servants (MoH staff), workers in health care facilities and promote sound worker- management relationships and centers for social work, or technical consultants engaged enhance the development benefits of a project by treating specifically in relation to the project, such as PIU consultants. The workers in the project fairly and providing safe and healthy ESMF includes a special section on requirements for worker health working conditions. ESS2 applies to project workers and safety. As workers in ICUs and laboratories are particularly vulnerable to COVID-19, infections due to inadequate adherence 23 including fulltime, part-time, temporary, seasonal and to occupational health and safety standards can lead to illness and migrant workers. death among health and laboratory works as well as the wider Considering specified requirements, the Borrower spreading of the disease within communities. Respectively, the must develop and implement written labor management document provides the detailed procedures, based on WHO procedures applicable to the project. These procedures guidance, for necessary protocols for treating patients and handling should set out the way in which project workers will be medical waste as well as environmental health and safety managed, in accordance with the requirements of national guidelines for staff, including the necessary PPE, all of which are law and this ESS. The procedures should address the way documented in Labor Management Procedures (LMP). in which this ESS will apply to different categories of Requirements for proper disposal of sharps, disinfectant protocols, project workers including direct workers, and the way in and regular testing of healthcare workers have been also included. which the Borrower will require third parties to manage In addition, the updated ESMF document providfes guidance in their workers in accordance with ESS2. terms of L&F and oxygen risk mnanagement. All these provisions have been included in the ESMP tempalte to be used for adopting by and then implemented by the HCFs, ICUs and laboratories participating in the project. The civil works contracts for minor refurbishing activities, if any, will include industry standard Codes of Conduct that include measures to prevent Gender Based Violence/Sexual Exploitation and Abuse (GBN/SEA). A GRM specifically for direct and contracted workers will be established and documented in the LMP. In line with ESS 2 and Belarus law, the use of forced labor, child, or conscripted labor is prohibited in the project, including for construction and operation of ICUs and laboratories. Based on the ESS2 requirements the client prepared the LMP, specifying direct workers contractors and subcontractors. ESS3 – Ye ESS3 recognizes that economic activity and The medical wastes and chemical wastes (including water, Recourse and s urbanization often generate pollution to air, water, and reagents, infected materials, etc.) from the HCFs, ICUs and labs, Efficiency, Pollution land, and consume finite resources that may threaten to be supported (drugs, supplies and medical equipment) can have Prevention and people, ecosystem services and the environment at the a significant impact on the environment and human health. Wastes Management local, regional, and global levels. The current and projected that may be generated from HCFs, ICUs and laboratories could atmospheric concentration of greenhouse gases (GHG) include liquid contaminated waste, chemicals, and other hazardous threatens the welfare of current and future generations. At materials, and other waste from labs and quarantine and isolation the same time, more efficient and effective resource use, centers including sharps, used in diagnosis and treatment. Each pollution prevention and GHG emission avoidance, and beneficiary HCF, ICU and laboratory, following the requirements mitigation technologies and practices have become more of the ESMF will prepare and follow an ESMP to prevent or accessible and achievable. This ESS sets out the minimize such adverse risks and impacts. The ESMP document requirements to address resource efficiency and pollution will mandate that any waste associated with COVID-19 testing or 24 prevention and management throughout the project life treatment will be incinerated on site whenever possible and where cycle consistent with GIIP. appropriate infrastructure is available. It will also contain strict protocols for disinfecting and packing such waste for transportation to the nearest medical waste incinerator if on site destruction is not possible. The ESMF also includes guidance related to transportation and management of samples and medical goods or expired chemical products. Resources (water, air, etc.) used in HCFs, ICUs and laboratories will follow standards and measures in line with National Sanitary Hygienic Service and WHO environmental infection control guidelines for medical facilities. ESS4 – Ye ESS4 recognizes that project activities, equipment, There is a possibility for the infectious microorganism to Community Health and s and infrastructure can increase community exposure to be introduced into the environment if not well contained within the Safety risks and impacts. In addition, communities that are laboratory or due to accidents/ emergencies e.g. a fire response. already subjected to impacts from climate change may also The participating HCFs, ICUs and laboratories will thereby have experience an acceleration or intensification of impacts to follow procedures detailed in the ESMF and ESMP (see ESS 3 due to project activities. above). The operation of HCFs, ICUs and laboratories need to be done in a way that staff, patients, and the wider public follow and ESS4 addresses the health, safety, and security are treated in line with international best practice, as outlined in risks and impacts on project-affected communities and the WHO guidance for COVID-19 response as above under ESS 1 and corresponding responsibility of Borrowers to avoid or ESS 2. minimize such risks and impacts, with particular attention In case ICUs are to be protected by security personnel, it to people who, because of their particular circumstances, will be ensured that the security personnel follow a strict code of may be vulnerable. conduct and avoid any escalation of situation, taking into consideration the above noted needs of quarantined persons as well as the potential stress related to it. All these issues are provided in the ESMF document. The SEP will also ensure widespread engagement with communities in order to disseminate information related to community health and safety, particularly around social distancing, high risk demographics, self-quarantine, and mandatory quarantine. The SEP also will ensure the awareness of population about locations and medical care facilities which designated for work with COVID -19 infected persons and about measures which has been taken to avoid contamination of population living in 25 proximity from these facilities. The project will mitigate the risk of Sexual Exploitation and Abuse by applying the WHO Code of Ethics and Professional Conduct for all workers in the HCFs, as well as the provision of gender-sensitive infrastructure, such as segregated toilets and enough light. Sexual Exploitation and Abuse (SEA), and Sexual Harassment (SH) risks are substantial and could emerge in and around HCFs and at the household-level of beneficiaries. Female healthcare workers or patients may be subject to harassment. In addition, there are project-related SEA/SH risks at the household level. Global evidence suggests that safety net interventions, including cash/in-kind transfers, and income-generating schemes, among others, can affect household power dynamics, which can exacerbate incidents of GBV/SEA/SH violence. Global evidence also suggests that intimate-partner violence and unequal gender dynamics can limit women’s ability to access these interventions. The Project will mitigate these risks by taking the following steps. (1) The Project will disseminate key messages to the public focusing on: (i) no sexual or other favor can be requested in exchange for medical assistance; (ii) medical staff are prohibited from engaging in sexual exploitation and abuse; and (iii) any case or suspicion of sexual exploitation and abuse can be reported to the Project GRM. (2) The Project will make information available to health service providers on where SEA/SH psychosocial support and emergency medical services can be accessed. (3) The Project will promote two-way communication between health authorities and communities that would allow information on instances. (4) The project will also ensure via the above-noted provisions, including stakeholder engagement, that HCFs are operated effectively throughout the country, without aggravating potential conflicts between different groups. (5) In case HCFs are to be protected by security personnel, it will be ensured that the security personnel follow strict rules of engagement and avoid any escalation of the situation, taking into consideration the above-noted needs of quarantined 26 persons as well as the potential stress related to it. ESS5 – Land No ESS5 recognizes that project-related land There will be no new construction or reconstruction Acquisition, t relevant acquisition and restrictions on land use can have adverse activaties, except minor refurbishing activities. The Project Restrictions on Land impacts on communities and persons. Project-related land activities take place HCFs which are in public ownership and no Use, and Involuntary acquisition or restrictions on land use may cause physical activities will be funded under the project that may cause economic Resettlement displacement (relocation, loss of residential land or loss of or physical displacement or additional land acquisition. shelter), economic displacement (loss of land, assets or access to assets, leading to loss of income sources or other means of livelihood), or both. The term “involuntary resettlement� refers to these impacts. ESS6 – No ESS6 recognizes that protecting and conserving All proposed activities will be implemented within the Biodiversity t relevant biodiversity and sustainably managing living natural existing HCFs and there will be no impacts to the biodiversity and Conservation and resources are fundamental to sustainable development. living organisms. Sustainable Impacts on biodiversity can therefore often adversely Management of Living affect the delivery of ecosystem services. ESS6 recognizes Natural Resources the importance of maintaining core ecological functions of habitats, including forests, and the biodiversity they support. This standard aims to safeguard natural habitats and their biodiversity; avoid significant conversion or degradation of critical natural habitats, and to ensure sustainability of services and products which natural habitats provide to human society. ESS7 - No This ESS contributes to poverty reduction and No such social groups in the project area. Indigenous t relevant sustainable Peoples/Sub-Saharan development by ensuring that projects supported African Historically by the Bank enhance opportunities for Indigenous Underserved Peoples/Sub-Saharan African Historically Underserved Traditional Local Traditional Local Communities to participate in, and Communities benefit from, the development process in ways that do not threaten their unique cultural identities and well-being. ESS8 – No ESS8 recognizes that cultural heritage provides This ESS is not relevant as there will be not supported any Cultural Heritage t relevant continuity in tangible and intangible forms between the activities that may generate risks and impacts for the CH sites. past, present and future. The Borrower will implement globally recognized practices for field-based study, documentation and protection of cultural heritage in connection with the project, including by contractors and other third parties. A chance finds procedure is a project- 27 specific procedure which will be followed if previously unknown cultural heritage is encountered during project activities. It will be included in all contracts relating to construction of the project, including excavations, demolition, movement of earth, flooding or other changes in the physical environment. ESS9 – No FIs are required to monitor and manage the The project will not use Financial Intermediary bodies. Financial t relevant environmental and social risks and impacts of their Intermediaries portfolio and FI subprojects, and monitor portfolio risk, as appropriate to the nature of intermediated financing, as well as to develop and maintain, in the form of an Environmental and Social Management System (ESMS), effective environmental and social systems, procedures and capacity for assessing, managing, and monitoring risks and impacts of subprojects, as well as managing overall portfolio risk in a responsible manner. ESS10 – Ye This ESS recognizes the importance of open and A Stakeholder Engagement Plan (SEP) for effective Stakeholder s transparent engagement between the Borrower and project outreach and citizen participation, a SEP has been prepared and Engagement and stakeholders as an essential element of good international disclosed both in country on the MOH website and on the World Information Disclosure practice. Effective stakeholder engagement can improve Bank website. the environmental and social sustainability of projects, enhance project acceptance, and make a significant The project recognizes the need for effective and inclusive contribution to successful project design and engagement with all relevant stakeholders and the population at implementation. The client will engage with stakeholders large. Considering the serious challenges associated with COVID- throughout the project life cycle, commencing such 19, dissemination of clear messages around social distancing, high engagement as early as possible in the project development risk demographics, self-quarantine, and, when necessary, process and in a timeframe that enables meaningful mandatory quarantine is critical. Meaningful consultation, consultations with stakeholders on project design. The particularly when public meetings are counter to the aims of the nature, scope and frequency of stakeholder engagement SEP, and disclosure of appropriate information assume huge will be proportionate to the nature and scale of the project significance for ensuring public health and safety from all and its potential risks and impacts. In consultation with the perspectives – social, environmental, economic, and medical/ Bank, the Borrower will develop and implement a health. In this backdrop, the project has prepared a SEP which Stakeholder Engagement Plan (SEP) proportionate to the serves the following purposes: (i) stakeholder identification and nature and scale of the project and its potential risks and analysis; (ii) planning engagement modalities viz., effective impacts. communication tool for consultations and disclosure; and (iii) enabling platforms for influencing decisions; (iv) defining roles and responsibilities of different actors in implementing the Plan; 28 (iv) the description of public disclosure of all safeguards documents; and (v) a grievance redress mechanism (GRM). Project preparation has included a detailed mapping of the stakeholders. Individuals and groups likely to be affected have been identified. Risk-hot spots on the international borders as well as in-country have been delineated. Mapping of other interested parties such as government agencies/authorities, NGOs and CSOs, and other international agencies have also been completed. Drawing upon their expectations and concerns, a SEP has been prepared by the Government of Belarus and disclosed publicly. This SEP is currently being updated and is expected to be ready and disclosed within 30 days of project effectiveness. The PIU has also developed and put in place a GRM to enable stakeholders to air their concerns/ comments/ suggestions, if any. 29 3.6 The World Bank Group Environmental Health and Safety (EHS) Guidelines6 The EHS Guidelines are technical reference documents with general and industry-specific examples of Good International Industry Practice (GIIP) and are referred to in the ESF. The EHS Guidelines contain the performance levels and measures that are normally acceptable to the World Bank Group, and that are generally considered to be achievable in new facilities at reasonable costs by existing technology. The World Bank Group requires borrowers to apply the relevant levels or measures of the EHS Guidelines. When host country regulations differ from the levels and measures presented in the EHS Guidelines, projects will be required to achieve whichever is more stringent. In the case of the Belarus Emergency COVID-19 Project, the General EHS Guidelines apply. The implementing agency will pay attention to the following General EHS Guidelines: (a) EHS 2.5 – Biological Hazards; (b) EHS 2.7 – Personal Protective Equipment (PPE); (c) EHS 3.5 – Transportation of Hazardous Materials; (d) EHS 3.6 – Disease Prevention; and (e) WBG EHS Guidelines for Waste Management Facilities. Additionally, the IFC EHS for Health Care Facilities7 also apply to the project. These Guidelines include information relevant to the management of EHS issues associated with health care facilities (HCF) which includes a diverse range of facilities and activities involving general hospitals and small inpatient primary care hospitals, as well as outpatient, assisted living, and hospice facilities. Ancillary facilities may include medical laboratories and research facilities, mortuary centers, and blood banks and collection services. Main provisions of these WNG documents are provided in the Annex 3 of the document. 3.7 World Health Organization COVID-19 Guiding documents The WHO is maintaining a website specific to the COVID-19 pandemic8 with up-to-date country and technical guidance. As the situation remains fluid it is critical that those managing both the national response as well as specific health care facilities and programs keep abreast of guidance provided by the WHO and other international best practice. Current technical guidance provided by the WHO includes the following topics, which are updated regularly: WHO resources include technical guidance on the following: (i) laboratory biosafety, (ii) infection prevention and control, (iii) rights, roles and responsibilities of health workers, including key considerations for occupational safety and health, (iv) water, sanitation, hygiene and waste management, (v) quarantine of individuals, (vi) rational use of PPE, (vii) oxygen sources and distribution for COVID-19 treatment centers. An overview of the main provisions and requirements of these documents is provided in the Annex 4. 3.8 International environmental treaties The country is part of several international treaties which are relevant to the current project. Among them are the following Convention which related to the project: 6 http://documents.worldbank.org/curated/en/157871484635724258/Environmental-health-and-safety-general-guidelines 7 https://www.ifc.org/wps/wcm/connect/960ef524-1fa5-4696-8db3-82c60edf5367/Final%2B- %2BHealth%2BCare%2BFacilities.pdf?MOD=AJPERES&CVID=jqeCW2Q&id=1323161961169 8 https://www.who.int/emergencies/diseases/novel-coronavirus-2019 30 (a) UNUECE Convention on Environmental Impact Assessment in a Transboundary Context, adopted by Decree of the President of the Republic of Belarus of 20 October 2005 №487, and, respectively the provisions of this international treaty which provide rules and procedure for ESIA in the case proposed projects might affect other national jurisdiction, are mandatory for all national development projects with potential transboundary impacts; (b) Stockholm Convention on Persistent Organic Pollutants (POPs), to which the Republic of Belarus acceded in accordance with the Decree of the President of the Republic of Belarus dated December 26, 2003 No. 594, undertaking obligations to address the problem of POPs. (c) Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal, to which the Republic of Belarus acceded in accordance with Decree of the President of the Republic of Belarus No. 541 dated September 16, 1999. The Convention establishes general requirements for the transboundary movement of hazardous wastes for countries that have ratified this convention. Import and (or) export of waste must be carried out in accordance with this international treaty. 31 4. Environmental and Social Baselines 4.1 Environmental baseline The Republic of Belarus is an independent unitary state situated in the Eastern Europe, with the territory of 207,6 thousand km2. Belarus borders in the west with Poland, in the northwest – with Lithuania, in the north – with Latvia, in the east and in the northeast – with Russia, in the south – with Ukraine. The country does not have access to the sea, but due to its geographical location Belarus is an important trade and transportation corridor between Europe and the CIS countries. The territory of the country is mainly even. Sparse highlands, which refer to Belarusian Ridge, do not exceed in height 300 m (Minsk Highland – 345 m, Novogrudok Highland – 323 m, Oshmyany Highland – 320 m). An average height of the surface of Belarus makes 160 m. The north of the republic is occupied by Belarusian Lake District (Belarusian Poozeriye), the largest part of which is occupied by Polotsk Lowland (absolute altitudes are 110-150 m), surrounded on all sides by ridges and highlands, and in the southeast – by Chashniki Plain. Eastern Lake District (Eastern Poozerye) is occupied by Luchosa Lowland and Surazhskaya Lowland, which are separated by Vitebsk Highland (up to 295 m). Narochansko-Vileyskaya Plain, surrounded by Minsk, Oshmyany and Sventsyany Highlands, is situated in the southwest of Poozerye. A part of Srednenemanskaya Lowland, Verkhneberezinskaya and Verkhnevileyskaya Lowlands also belong to Poozerye. Belarusian Ridge includes Volkovyssk, Grodno, Minsk, Novogrudok, Orsha, Oshmyany, Slonim Highlands and Kopyl Ridge. Belarusian Ridge is surrounded by Baranovichi, Bykhovsko-Checherskaya, Goretsko-Mstislavskaya (plateau-like), Lida, Orshansko- Mogilevskaya, Stolbtsy and Tsentralnoberezinskaya Plains, and Verkhnenemanskaya Lowland. Narevo- Yaseldinskaya and Pribugskaya Plains, and Belovezhskaya Ridge are situated in the southwest of BrestOblast. The district to the south of Belarusian Ridge is combined into conventional PredPolesie, and Orsha Highland, Orshansko-Mogilevskaya and Goretsko-Mstislavskaya Plains – in the geomorphological region of Eastern-Belarusian Plain. The south of Belarus is occupied by Polesie, which is primarily of plain nature (absolute altitudes are 120-150 m). From the geographical point of view, Polesie is divided (from west to east) into Brestskoye, Pripyatskoye, Mozyrskoye and Gomelskoye. Multiple ancient inland dunes rise above Polesie, which formed Mozyr Ridge (up to 208 m), Yurovichy Ridge, Logishin and Khoiniksko-Braginskaya Highlands, and also Zagorodye Plain. The territory of Belarus is situated within the west region of the north temperate zone and has a moderately continental climatic pattern. Geographic latitude of location of the territory between 56° and 51° of northern latitude determines the sun angle, which, in its turn, influences the amount of incoming solar radiation. Moderately continental climate with frequent Atlantic cyclones, with mild and humid winter, warm summer, damp autumn prevails in Belarus. An average annual air temperature is from +7,4 °С in the southwest to +4,4 °С in the northeast. An average temperature of January ranges from - 4 °С to - 8 °С, of July – from +17 °С to +19 °С. Average duration of vegetation period is 184 – 208 days. Climatic conditions of Belarus are favorable for cultivation of the main cereal crops, vegetables, fruit trees and bushes of the midland of the Eastern Europe and for cultivation of potato, linen flax, annual grasses, feeding root crops. Atmospheric pressure gradually rises from the north and the northwest to the south and the southeast. For example, in Vitebsk it is equal to 994,9 Pa, in Gomel– 1001,5 Pa. Average pressure at sea level makes 1013,2 Pa. Maximum pressure over the whole territory of the country is set in January. In summer pressure reduces over the warmed-up land. Within the territory of Belarus, atmospheric air drop is from the west to the east. The lowest atmospheric pressure on the territory of the country is recorded in July. Annual atmospheric air stroke leads to the fact that that winds of west and north-westerly directions prevail in summer. Periodical alternation of zonal western air-mass transport to meridional transfer is observed in the system of general atmospheric circulation, with air masses displacement from the south to the north or from the north to the south. Atmosphere circulation nature determines the type and characteristics of air masses coming to the territory of the country. 32 Air temperature on the territory of the country is characterized by variability and changeability. Minimum average monthly temperatures are observed in January and maximum – in July. Long-time average annual temperature of January in Minsk is -6,9 °С, but quadrennially it drops lower than -9 °С or higher than -4 °С. Long-time average annual temperature of July in Minsk is +17,8 °С, but once in 30 years it exceeds +30 °С. Air mass circulation and thermal conditions determine peculiarities of hydrological cycle and precipitation regime, Annual absolute humidity course coincides on the whole with the annual cycle of temperature: maximum is observed in summer, minimum – in winter. Relative humidity reaches the maximum level during the winter period and makes 88-90%, and in summer and in spring it falls to 65-70%. Annual average relative humidity is about 80%. The lowest relative humidity of air (about 30%) is observed in May and in June, which leads to dry weather (especially in the southeast of the country). The territory of Belarus is situated in the sufficient moistening zone. Relief and cyclonic activity nature affect distribution of precipitation. The amount of precipitation is increased on the highlands, especially on their back slopes. Lowlands and downwind slopes of highlands receive significantly fewer precipitations. Annual amount of atmospheric precipitations makes 550-650 mm on the lowlands and 650- 750 mm on the plains and on the highlands. Forest resources of Belarus hold a key position among its natural resources. Forestlands occupy the area of more than 9 thousand ha, which makes 38,8 % of the whole territory of the country. Bogs occupy about one third of the whole territory of the country, they are especially widely spread in Polesskaya and Pridneprovskaya Lowlands. Pripyat bogs, which are the largest boggy district in Europe, occupy the territory of 39 thous. km2 in the south of Belarus in Polesie. Belarus is rich in water resources. There are more than 20 thousand rivers on its territory, the total length of which is 90 thousand kilometers. The largest rivers are the Dnieper River (with feeders Pripyat, Sozh, Berezina), Western Dvina, Viliya, Goryn, Western Bug, Neman combined by a number of canals (Dnieper-Bug, Dnieper-Neman, Berezinsky). Rivers in Belarus belong to the basin of the Black (58% of the territory) and the Baltic Seas (42% of the territory). About 93 % of all rivers belong to small (with the length up to 10 km). River run-off during the average water years amounts to 57,9 km3. Water impurity index of the main Belarusian rivers fluctuates from “moderately clean� to “moderately contaminated�. There are about 11 thousand lakes in Belarus, their total area is about 2 thousand km2, Total water volume is about 6 km3. The majority of lakes are situated in the north and in the northwest. The number of specially protected natural areas in the Republic of Belarus is 1289 objects, including 1 nature reserve (Berezinsky biosphere reserve), 4 national parks ("Belovezhskaya Pushcha", "Braslav lakes", "Pripyatsky", "Narochansky"), 99 nature reserves of the republican significance, 282 nature reserves of local significance, 326 natural monuments of republican and 577 - local significance. 33 4.2 Economic baseline The economy of Belarus is world's 72nd largest by GDP based on purchasing power parity (PPP), which in 2019 stood at $195 billion, or $20,900 per capita. Industry plays a leading role in the economy of Belarus, responsible for about 34 percent of its GDP. It includes more than 100 sectors and 2,000 enterprises, many of which are fully self-supporting, and employs nearly 1 million people (26 percent of the Belarusian labor force). The most developed branches of industrial production in Belarus are machine building, metal working, chemical and petrochemical industry, mining industry (potassium and rock-salt mining), electrical energy industry, food, light, wood processing and forestry industry. The country is particularly known for its machine building, especially tractors, large trucks, machine tools, and automation equipment. Belarus also manufactures and exports motorcycles, refrigerators, textiles, radios, and televisions. Although the government has allowed private companies to invest in the manufacturing industry, it maintains control over major industries. Belarus’s largest trading partners are Russia and the European Union (mainly Netherlands, Germany, and Poland), China, Ukraine, and United Kingdom. Agriculture holds an important place in the economy of the country and ensures almost 8% of the GDP (Gross Domestic Product), in which about 10% of the whole working population of the country is engaged. The main sown crops and agricultural products are cereals, oilseed, potatoes, carrots, onions, cucumbers, cabbage, melons, vines, milk, wool, honey and eggs. Kitchen gardens and smallholdings are also considered an important part of the local economies. These include apples, peaches, mulberries and walnuts produced from the homestead plots in addition to the crops. The country can be divided into three major agricultural regions: north (flax, fodder, grasses, and cattle), central (potatoes and pigs), and south (pastureland, hemp, and cattle). Belarus' cool climate and dense soil are well suited to fodder crops, which support herds of cattle and pigs, and temperate-zone crops (wheat, barley, oats, buckwheat, potatoes, flax, and sugar beets). The country has a very well-developed transport network which facilitates development of the economy of the republic. At the same time the economy of the republic depends on energy supply to a large extent, mainly from Russian Federation. Peat, the country's most valuable mineral resource, is used for fuel and fertilizer and in the chemical industry. Belarus also has deposits of clay, sand, chalk, dolomite, phosphorite, rock, potassium, and salt. Forests cover about a third of the land, and lumbering is an important sector. 4.3 Population, disadvantaged and vulnerable groups The country's population is 9,475.2 thousand people. In recent decades, there has been a tendency for population growth. It is estimated that there are currently 2.35 million elderly people (over working age) in Belarus, of whom 2.1 million are over 60 years old. In 1990, the percentage of people aged 65 and over was 10.7 percent. By 2018, this share increased to 14.8 years, and by 2050 - up to 25 percent. According to forecasts, the proportion of people over 80 years old will grow from 3.5 percent to 7.5 percent over the same period. By 2025, the proportion of people over 65 in the total population exceeds the proportion of people aged 0-14. (Fig. 1). Figure 1. Demographic pyramid of the Republic of Belarus, 2018 34 Between 1996 and 2000, real GDP growth averaged around 6.3 percent per year, and in 2001-2008 it accelerated even more to 8.3 percent per year. In 2009–2014, annual growth averaged 3 percent, and in 2015–2016, the economy entered a recession - the first since 1995. In 2017-18, a rapid cyclical recovery was observed, with growth reaching 3 percent in 2018, which was supported by measures of macroeconomic stabilization, policies aimed at promoting the development of the private sector, increasing domestic demand and moderate recovery economies of trading partners. However, by the beginning of 2019, economic growth had slowed to 1.2 percent due to worsening external conditions and continuing structural weaknesses The country is located in Eastern Europe and has an area of 207.6 thousand km2. It borders with Poland, Lithuania, Latvia, Russia and Ukraine. In 2018 the population of Belarus was about 9491,8 thous. Of them, 7394,1 thous. (77,9%) is urban population, and 2097,7 thous. (22,1%) – rural. 46,58% of the population are men and 53,42% are women. The greater part of the population resides within Minsk agglomeration. The age distribution is the following: (i) people younger than 15 years – 14,2% or 1347,8 thous. (of which 51,4% are men, 48,6% are women); (ii) people at the age from 15 to 65 years – 71,7% or 6805,6 thous. (of which 48,4% are men, 51,6% are women); (iii) people older than 65 years – 14,1% or 1338,3 thous. (of which 31,7% are men, 68,3% are women). Elderly people and people of ripe years prevail in the age structure. The number of pensioners at the end of 2017 made about 2.6 mln. people (27,4% of the total amount of population). In respect of the administrative and territorial division, the Republic of Belarus is subdivided into 6 oblasts (Brest, Grodno, Minsk, Vitebsk, Mogilev and Gomel) and 118 districts. The capital of the republic is the city of Minsk, which is also the separate administrative territorial unit along with the oblasts. The population of the republic lives in 202 cities and urban settlements and 23181 rural-type settlements 35 4.4 Social and gender issues The system of legal guarantees and benefits for vulnerable segments of the people is widely developed in the Republic of Belarus, as well as the system of state targeted social assistance, which is aimed at rendering temporary material support to financially disadvantaged citizens and families who are in hardship and is aimed at supporting of the disadvantaged citizens` income at the level of the minimum subsistence budget on the average per capita. According to the Constitution of Republic of Belarus and Law “On health services� the main principles of State health policy in Belarus are: ensuring access to medical services by all citizens of Belarus, priority in providing of medical services for women, elderly people and people with disabilities. The project provides for introduction of additional benefits for socially vulnerable segments of the people who will be also beneficiaries from Project implementation. Project will help to ensure the access for the population including people with vulnerabilities to medical aid and diagnostic of COVID. Project will take measure to ensure that women, elderly people, and other vulnerable groups are able to access messaging around social isolation, prevention methods and government streamlined messaging pathways by radio, short messages to phones. More detailed information about benefits for vulnerable segments of the people has described in SEP. Disseminating information to the population about social benefits from the Project implementation and taking into account wishes and remarks of the population will be executed in the course of holding of public consultations. Article 32 of the Constitution of the Republic of Belarus establishes that “Women are provided with equal with men possibilities in getting education and professional training, in labor and professional advancement (work), in social and political, cultural and other scopes of activity, and also arrangement of conditions for their labor protection’. The task of the gender politics in the republic is achievement of real gender equality, establishing gender balance in all spheres of the society`s life. The National plan of actions for provision of gender equality in the Republic of Belarus for 2017 – 2020, which is the fifth program document in this direction, was approved by Resolution of the Council of Ministers of the Republic of Belarus dated 17.02.2017 № 149. Sequential implementation of national plans of actions for ensuring gender equality, activities of government programs on different aspects of improvement of women’s status allowed the Republic of Belarus to make decisive progress in settling the issues of equal rights and possibilities both inside the country, and on the international arena. Active measures of labor policy at the state level facilitated decline in women’s unemployment: the level of registered unemployment made 0,7% among women and 1,2% among men. The principles of gender equality supported by the state will be complied with in the course of implementation of the Project. 4.5 Health Care Sector and status of COVID-19 in the country This section is focused on providing some details in this regard being also focused on the HCFs capacities in ensuring COVID-19 infection control and MWM. Overall characteristic of country’s capacity to cope with the COVID-19 pandemic. The health care system of the Republic of Belarus is a multi-level system of health care organizations, from feldsher-obstetric points of republican scientific and practical centers. The provision of medical care has been focused on inpatient care for many years. International organizations have repeatedly mentioned the health care system of the Republic of Belarus in connection with the excessive bed capacity. In recent years, the Ministry of Health has taken a course towards its gradual reduction. So, over the past 5 years, the reduction in the number of beds in the republic amounted to about 7000 beds, of them in the regions - 6500 beds. At present, all ongoing activities are aimed not so much at reducing the bed capacity as at its effective use, namely: further development of palliative care, medico-social, rehabilitation and the redistribution of the volume of medical care from expensive and resource-intensive inpatient to inpatient-substituting forms. At the same time, in recent years, a course has been taken to change the format of primary care by introducing the institution of a general practitioner. 36 According to the Ministry of Health, as of 01.01.2020, the number of doctors is 49018, average medical workers are 115,030. The indicator of provision with doctors is 56.0 per 10 thousand of the population, and with average medical personnel - 122.5 per 10 thousand of the population. At the same time, the presence of a sufficient network of inpatient care, bed capacity and human resources allowed the republic to cope with the peak of the epidemiological situation of coronavirus infection, avoiding overloading the healthcare system, including due to the preservation of infectious beds that were left "on standby". The urban population of the republic has an advantage in obtaining specialized medical care, since in the regional centers and large cities there is a network of specialized hospitals for almost all profiles of medical care. The provision of specialized medical care to the rural population is carried out on the basis of the Central Regional Hospital, where mainly somatic beds are located, and only emergency surgical care is provided in surgical beds. Hospitalization in hospitals in urban centers and cities of regional subordination is not always available for residents of the district, due to its location at a great distance from the place of residence, which requires time and financial resources to pay for travel. The level of centralization of laboratory research in district, regional, city health organizations is also insufficient at the present time due to their inadequacy to the requirements of material and technical equipment. The Ministry of Health plans to create interregional centers for high-tech and specialized medical care, has developed a Concept for the creation of interregional centers and centers for the collective use of specialized and high-tech care in the Republic of Belarus, which will require significant amounts of funding to equip them with high-tech equipment and train personnel. Current status of COVID-19 in the country. The COVID-19 statistics in the country is based on the “COVID-19 Health system response monitor� (HSRM) which is a joint undertaking of the WHO Regional Office for Europe, the European Commission, and the European Observatory on Health Systems and Policies (https://www.covid19healthsystem.org/countries/belarus/countrypage.aspxhas) and has been designed in response to the COVID-19 outbreak to collect and organize up-to-date information on how countries are responding to the crisis. It focuses primarily on the responses of health systems but also captures wider public health initiatives. By August 27, 2020, more than 71165 cases of infection were registered in the country and 662 died. COVID-19 surveillance system and testing. The disease surveillance system, testing capacity and communications need strengthening to respond effectively to the COVID-19 outbreak. Disease surveillance is the responsibility of the Sanitary and Epidemiological Service, under the MOH. It includes a system of institutions performing state sanitary supervision at national and local level. There are 7 laboratories performing COVID-19 tests in Belarus, located in 4 institutions: the National Scientific and Practical Centre for Epidemiology and Microbiology [RRPCEM] (4 laboratories), the National Centre for Hygiene, Epidemiology and Public Health [RCHEPH] (1 laboratory), the Mogilev regional Centre for Hygiene, Epidemiology and Public Health [Mogilev CHEPH] (1 laboratory), the Gomel regional Centre for Hygiene, Epidemiology and Public Health [Gomel CHEPH] (1 laboratory). The number of tests per day to date and the potential capacity currently available are as follows: RRPCEM - 750/900, RCHEPH - 250/300, Mogilev CHEPH - 150/270, Gomel CHEPH - 50/360. Additionally, 5 other laboratories are planned to be used for COVID-19 testing: Brest regional Centre for Hygiene, Epidemiology and Public Health [Brest CHEPH] (1 laboratory), Vitebsk regional Centre for Hygiene, Epidemiology and Public Health [Vitebsk CHEPH] (1 laboratory), Grodno regional Centre for Hygiene, Epidemiology and Public Health [Grodno CHEPH] (1 laboratory), Minsk regional Centre for Hygiene, Epidemiology and Public Health [Minsk CHEPH] (1 laboratory), Minsk city Centre for Hygiene, Epidemiology and Public Health [Minsk city CHEPH] (1 laboratory). WHO Regional Office for Europe in collaboration with ECDC has sent a checklist for the overall laboratory capacity self-assessment to Belarus and received it back. At the request of the Ministry of Health, WHO has provided 6,000 tests for COVID-19 from the Robert Koch Institute in Germany, which is a WHO Collaborating Centre. 37 According to the Ministry of Health, there are 2,575 intensive care beds in the Republic of Belarus in 360 hospitals with intensive care units. This means 26 beds per 100,000 population, while in Germany there are 33 beds per 100,000 population, in the USA - 20. In Moldova, Poland and the UK, the rate of provision of intensive care beds is significantly lower - 16, 9 and 6, respectively. In general, a Level 1 ICU can provide oxygen, non-invasive monitoring and more intensive care than a ward, while a Level 2 ICU can provide invasive monitoring and basic life support for a short period of time. Level 3 Intensive Care Unit provides a full range of monitoring technologies and basic life support. It should be noted that in the Republic of Belarus 15 years ago, a program was implemented to modernize and equip intensive care and resuscitation units of all inpatient institutions of the republic, including the level of the Central District Hospital. However, currently, in the context of a coronavirus pandemic and in order to ensure the readiness of the health care system to fight other dangerous infections, it is necessary to equip the ICU (anesthesiology and resuscitation) with modern high-tech equipment, as well as improve the qualifications of personnel. Physical infrastructure. Considering the COVID-19 risks, a series of hospital premises throughout the country were repurposed, and resources were redirected to serve the infected and those who contacted them. As of 27 March 2020, the Ministry of Health reports that there is enough beds, equipment, medications and PPE for staff in the country. The current total number of hospitals with intensive care units is 360, including in the following areas: Brest - 60, Vitebsk - 59, Gomel - 54, Grodno - 49, Minsk - 54, Mogilev - 39, Minsk - 45. The current total number of ICU beds is 2575, including in the following areas: Brest - 285 beds, Vitebsk - 333 beds, Gomel 356 beds, Grodno 287 beds, Minsk region 310 beds, Mogilev 285 beds, Minsk city 719 beds. The government has allocated 11 hospitals located in all seven regions of the republic to provide specialized medical care to patients with confirmed cases of COVID-19, including in intensive care beds (in total, there are 123 beds in 11 reference hospitals). If it is necessary to increase the need for specialized medical care for the management of severe acute respiratory infections, it is planned to increase the number of reference healthcare organizations to 38 with an increase in the number of intensive care beds to 343. As for the process of transporting patients to medical institutions: at present in the Republic of Belarus, out of 1160 ambulance vehicles (hereinafter referred to as ambulance vehicles), only 57 belong to the ambulance vehicles of class C (reanimobile). About half of the vehicles are over 5 years old. Three out of six regions have only 3 reanimobiles. At the prehospital stage, resuscitation vehicles are necessary to create conditions for carrying out medical and diagnostic measures, monitoring, correcting vital functions, as well as carrying out resuscitation measures during the process of transporting a patient to a hospital. Country’s COVID-19 response. The MOH has taken several actions with respect to COVID-19 prevention, case detection and care. On March 16, 2020, it issued an order listing the hospital requirements for care of patients with COVID-19, remuneration policies for health workers, actions to be taken by outpatient care facilities, and set up a call center. By the order of the Prime Minister of the Republic of Belarus on March 17, 2020, an inter-agency working group was established to coordinate the work on COVID -19. Information on the course of the epidemic and recommendations for the public are being constantly updated on the website of the MOH. Quarantine measures have been introduced for all close contacts of individuals who test positive for COVID-19. Persons subject to quarantine will be tested and hospitalized for observation for 14 days. Persons returning from abroad are asked to limit the number of contacts within the first 14 days after arrival and are being tested for COVID-19 at the points of entry. The MOH reports that the country has 22 ventilators per 100 000 population (although the age and quality is not known). On 4 April, a one-week extension of spring vacation for schools was announced by the Ministry of Education of Belarus. On 10 April, another one-week extension followed. On 9 April, a mandatory 14-day self-isolation requirement was issued for foreign and Belarussian citizens with either confirmed COVID-19 diagnosis, or the status of first- or second-level contact. 38 Isolation and quarantine. Measures on social distancing were introduced quite early in the country, long before the first patient with COVID-19 was identified on 27 February 2020. These measures started from mid-January 2020 and consisted of mandatory quarantine measures for all students and workers coming from the People’s Republic of China. After identification of the first case, quarantine measures were implemented for confirmed cases and their close contacts regardless of the presence of symptoms. All suspected cases underwent testing and were advised to self-isolate until confirmation of a negative test result. Distant learning and working were organized for those educational institutions where confirmed cases were identified. Elderly homes, prisons and detention centers were closed to visitors. Food delivery for elderly has been organized by the Belarusian Red Cross/Red Crescent Society and National Youth Union. At the primary care level, remote drug prescription and medical consultations were organized to reduce the number of visits to medical facilities; all routine medical check-ups have been postponed. On 8 April 2020, mandatory measures on self-isolation were broadened and strengthened quite substantially and were reinforced by the introduction of administrative and criminal liability for breaching these restrictive measures, especially if other persons were infected or if death occurs as a result of infection. The Government order covered citizens, non-citizens of the Republic of Belarus, and foreigners, and introduced mandatory self-isolation for three groups of people: (1) those infected with COVID-19; (2) those of first-level contact even if they showed no symptoms of coronavirus infection, for the period of two-weeks from the day of the last contact; (3) those of second-level contact, in case of appearance of symptoms attributable to COVID-19, for the period of presence of those symptoms. Paid sick leaves certificates were supposed to be issued by general practitioners after home visits, however, it was not clear what measures would be put in place for those living in the same households with first- and second-level contacts. People in self-isolation were only allowed to leave home to go to the nearest grocery shop or pharmacy, or to bring out household waste. Wearing masks while leaving home was obligatory. In case of deteriorating of health condition, the general practitioner or ambulance should be called. COVID-19 communication. Expert advice on hand hygiene, respiratory etiquette and social distancing was issued long before the first patient with COVID-19 was identified in Belarus (on 27 February 2020) through multiple press briefings and Ministerial speeches in January-February 2020. Information materials have been published on the MOH website which has a specific page for COVID-19 and included instructions on when, where and how to wash hands, wear masks and keep physical distance. No travel restrictions were put in place. As the situation with COVID-19 in Belarus evolved, expert advice was regularly updated and communicated through official channels, by expanding the scope and content of prophylactic measures, and targeting specific population groups (elderly, people with chronic conditions, detained people, etc.). The list of countries with high risk of COVID-19 and therefore not recommended for visiting is updated on a regular basis. Workforce. As of 27 March 2020, the Ministry of Health reports that there is no shortage of staff regarding response to the COVID-19 situation in Belarus. It was announced that health care professionals working with COVID-19 would be granted special salary increases. Medical waste management The main issues of medical waste management are defined in the Sanitary Norms and Rules "Sanitary and Epidemiological Requirements for the Management of Medical Waste", approved by the Resolution of the Ministry of Health of the Republic of Belarus dated February 7, 2018 No. 14, establishing sanitary and epidemiological requirements for disinfection, collection, disposal waste medical products, blood, other biological fluids, as well as for the collection, temporary storage of medical waste for human health protection (medical waste) in organizations of all forms of ownership and from individual entrepreneurs providing medical care. 39 Medical waste includes used medical devices that have undergone disinfection, biological material formed after medical interventions, as well as the remains of biological material after selection of biopsy, sectional material for pathological studies. Waste medical products are disposable and reusable (not subject to further use) medical products formed in organizations during the preparation and use of cytostatic drugs, contaminated with blood, other biological fluids and (or) in contact with the mucous membrane and (or) damaged skin of the human body. According to the Sanitary Norms and Rules, all medical waste is disinfected (by chemical, physical, combined and other methods) in accordance with the requirements of the legislation of the Republic of Belarus. Collection of medical waste is carried out in conditions that exclude their direct contact with workers and patients. Collection of secondary material resources in organizations (structural units) for patients with infectious diseases that represent or may constitute an emergency in the field of public health of international importance, when working with opportunistic microorganisms and pathogenic biological agents, as well as in pathological organizations (structural units) is not allowed. In other cases, the resulting secondary material resources are subject to collection and transfer for use. Medical waste is handled using personal protective equipment. The Resolution of the Ministry of Health of the Republic of Belarus dated November 22, 2002 No. 81 also approved the Instruction on the rules and methods for the disposal of waste of medicines, medical devices and medical equipment. Any generated medical waste must be identified in accordance with the national classifier of the Republic of Belarus OKRB 021-2019 “Classifier of waste generated in the Republic of Belarus�. Medical waste belongs to Block 7 OKRB 021-2019, in which 7 groups of such waste are distinguished: medical waste of human health protection; medical waste from veterinary services; waste from pharmaceutical and pharmaceutical services; waste from research in the field of health protection. Waste generated as a result of the provision of medical care and as a result of the provision of veterinary care includes waste generated directly in the process of providing such assistance; this waste does not include waste from administrative and economic and other similar activities of medical institutions and other organizations. Waste generated as a result of medical care does not include waste of cooking and consumption of food that does not infect food products, does not infect containers and other wastes that are identified in other blocks of OKRB 021-2019. Wastes from the production of medicines, as well as waste of finished medicines, include individual containers used for packaging medicines. In health facilities, when handling medical waste, the following requirements must also be observed: authorized persons responsible for waste management should be appointed; training of workers in the field of waste management should be carried out, as well as their instructions, knowledge testing and advanced training; instructions for waste management should be developed and approved, and their observance should be ensured; a record of waste should be kept, and their inventory carried out; standards for the generation of industrial waste to be stored at waste storage facilities or buried at waste disposal facilities and others must be developed and approved. Currently, there are several methods for the disposal of medical waste. The most common are autoclaving, chemical disinfection, and waste incineration. There are 14 waste disposal facilities in the Republic of Belarus: ME "Gomel Regional Clinical Oncological Dispensary" (Gomel), ME "Mogilev Regional Oncological Dispensary" (Mogilev), ME "Brest Regional Hospital" (Brest), Municipal Unitary Enterprise for Waste Management " ME "Grodno Regional Clinical Hospital" (Grodno, Ekores" (Minsk), ME "Brest Regional Oncological Dispensary" (Brest), APU "Mogilev Regional Veterinary Laboratory" (Mogilev), ME "Grodno Regional Clinical Hospital" (Grodno), ME "City Clinical Emergency Hospital of Grodno" (Grodno), 40 LLC "VitEcoline" (Vitebsk), OJSC "Pig complex Negnovichi" (village Bolshiye Negnovichi, Borisov district), Municipal Unitary Enterprise "Specialized Combine of Public Utilities" (Minsk region, crematorium), Unitary Enterprise for the provision of services "Sinlab-EML" (Minsk), ME "12 city clinical dental clinic" (Minsk), OJSC "Lakokraska" Lida (Lida). Neutralization of medical waste at these enterprises is carried out by the method of high-temperature incineration in equipment specially designed for this purpose - in furnaces, cremators, incinerators at temperatures up to 1200 ° C. The most modern equipment - the Muller incinerator and the BRENER-200 incinerator, respectively, operating on the principle of two-stage pyrolytic waste incineration - are installed at the EKORES waste management unit, the Grodno Regional Clinical Hospital and VitEcoline LLC. incineration of waste at a temperature of 650-900 ° C, in the second chamber (afterburning) the flue gases formed in the first chamber burn out at a temperature of 1200 ° C. UE for the provision of services "Sinlab-EML" (Minsk), UZ "12 city clinical dental clinic" (Minsk), UZ "City clinical infectious diseases hospital" (Minsk), NRU "Institute of Nuclear Problems" BSU ( Minsk) carry out the neutralization of medical waste by the microwave method, which is based on the effect of a microwave electromagnetic field on microorganisms. According to the state statistical reporting data, in 2019, 64.11 thousand tons of medical waste were generated in the Republic of Belarus, which are mainly determined by the formation of medical waste for protecting human health (62.83 thousand tons), presented mainly in the form of waste contaminated with blood or biological fluids, waste disposable syringes and others. Of the total volume of medical waste generated in 2019, 49.86 thousand tons or 78% were neutralized, 10.97 thousand tons or 17% - used, 3.52 thousand tons or 6% - buried. Mainly, disinfected pharmaceutical and veterinary drugs, pharmaceutical substances, medicines and goods are buried. Burial of non-neutralized medical waste at solid municipal waste disposal facilities is prohibited. Based on the HCFs preliminary assessment, the MoH will help HCFs develop action plans and provide them financing to fill capacity gaps to meet all critical MWM requirements in line with this ESMF, in particular those provided in “Template for environmental and social management plan, including infection control and healthcare wastes management� (Annex 9). The ESMP to be prepared for each HCF will specify the actions that need to be undertaken before it can participate in the project. The project might finance these actions. MWM capacity building. MoH and Republican Center for Hygiene, Epidemiology and Public Health keeps in their attention the capacity building for MWM, organizing periodically training for HCFs staff. The focus of these trainings is on the implementation of the Regulations on “Sanitary and epidiemiological requirements for MWM � as well as on supervision and control of infectious diseases and, on ensuring the sanitary and hygienic conditions for HCFs. Simultaneously the HCFs management require from its staff to improve their knowledge on MWM individually, based on self-learning. Based on provided training and self- learning the Republic Center and HCFs management periodically organize staff examination on MWM requirements. Fire and oxygen risk management issues. As specified in point 3.3, the country has in place a very well developed legal framework on fire safety which includes: Law "On Fire Safety" adopted in 1993 and amended on November 11, 2019 (No. 251-З); “General requirements for fire safety, approved by the Decree of the President of the Republic of Belarus (November 23, 2017 No. 7) and “Specific requirements for ensuring fire safety for health care facilities and those specially designed for children, approved by the Government of Belarus on August 22, 2019 (No.561). Along with these main fire safety regulatory documents the country has in place a series of other well-designed bylaws presented in a special box in point 3.3. Based on these documents all HCFs in the country have in place Anti-Fire Management plan (under specified law called “Instruction�) which is approved by the chief physician of the healthcare organization and then the Plan is coordinated with the district or city departments (departments) for emergency situations. These plans are subject to periodical revision and reapproval each 3 years. As a special annex these documents 41 include a detailed fire evacuation plan with indication of fire evacuation ways and information means. In accordance with the Plan, educational trainings are held in the healthcare facility once every six months. The health facility maintains a log of fire safety trainings. In accordance with the Plan, the chief physician of the healthcare facility and deputies of the chief physician and the person responsible for fire safety in the healthcare facility undergo training at the "Center for Advanced Training of Industrial Safety Executives". The heads of the structural units of the HCF for fire safety undergo training on the fire-technical minimum with passing the test. Upon completion, a pass of a fire-technical minimum (hereinafter referred to as FTM) is issued - a system of knowledge, skills and abilities that allows an employee of an organization to ensure fire safety in the framework of activities in the position (profession), including when carrying out high-risk work without special education in this area. Frequency of training once every 3 years for persons not associated with explosion and fire hazard (fire hazard) production, - and once a year - for managers and employees of organizations associated with explosive and fire hazardous production (for example, hot work). The trainings are recorded in the logbook of training under the FTM program. Upon completion of the training, the commission (at least 3 people, including the employee who conducted the training) appointed by the order of the head of the organization in which the training was conducted, conducts a knowledge test. The knowledge test includes a theoretical and practical part and is carried out in the scope of the training program. It can test the knowledge of the theoretical part using tests, including using software. Persons who have successfully passed the test are issued a coupon of the established form. The number of the coupon is entered in the logbook of training under the PTM program, in the column "knowledge test". All HCFs have also appointed responsible persons for the fire safety management plans implementation, and creating special offices and posting allocating spaces for informative materials and anti- fire technical means, including fire extinguishing equipment and water supply systems, etc. These antifire equipment is periodically (once a year) checked to ensure their function ability. In addition, the HCFs conduct periodical training for its staff regarding fire safety and keep in operation an effective fire safety alarm system, - such programs are also subject to revision by the local branches of Ministry of Extremal Situation The previous experience while implementing WB projects in the country shows the fire safety is considered by the national authorities as a priority issue and overall conclusion is the compliance with the regulatory framework in this regard is at the high level. Ensuring ogygen equipment safety during its installation and operation are done by strictly following the requirements specified in the technical documents that are provided along with the equipment, - this is done overall well as until December 2021 there were no accidents in this regard. As the country’s regulatory framework doesn’t have in place a special document in terms of ensuring oxygen risk management, the current updated ESMF document includes necessary mitigation and monitoring activities in this regard, based on the best international practice. Sanitation and the sewage systems. Conducted assessment of water supply and sanitation show all HCFs have permanent access to drinking water and sanitation. 5. Potential Environment and Social Risks and Mitigation 5.1 Environmental and social risks and impacts Overall, the project will have positive environmental and social impacts as it should improve COVID- 19 surveillance, monitoring and containment. At the same time, although the project itself will finance mostly purchasing various equipment to combat the COVID-19, and public awareness campaign and capacity building activities, which as such do not generate any risks, the project implementation might cause a series of environmental risks and impacts related to the following: (a) spread of the COVID-19 among health care workers and among the population at large. Respectively, ensuring contagion vectors are controlled through strict adherence to WHO standard procedures and personal protective equipment (PPE) for all health care workers is critical. Additionally, working with local governments and communities it is necessary to ensure that social distancing measures and quarantine 42 regimes are strictly adhered for lowering the speed and incidence of infection among project workers and affected persons; (b) medical waste management and disposal. The wastes that will be generated from HCFs, ICUs and labs have a high potential of carrying micro-organisms that can infect people who are exposed to it, as well as the community at large if it is not properly disposed of. Respectively, the project must ensure an efficient medical waste managemtn and disposal in line with the WHO and WB EHS Guidelines; (c) L&F and oxygen safety risks. During the project implementation might be generated risks of deadly fires in hospitals treating COVID-19 patients which may be related to the expanded use of oxygen and pressure on hospital electrical systems. (d) refurbishing civil works. The potential risks and impacts of proposed activities under Component 1 related to minor refurbushing activities would be very low and may be associated with some dust, noise, OHS issues and insignificant volume generation of solid wastes. All identified above environmental risks and impacts are expected to be temporary, predictable, and easily mitigable by ensuring fulfillment of the prescribed by WHOOVID-19 safety measures and and WB EHS Guidelines. Overall, Belarus has good capacity in place in terms of MWM. In additional to specified environmental risks the project might generate also social risks, which are: (a) Risks related to social unrest, panic/conflicts resulting from false rumors; (b) Risks related to quick access to appropriate and timely medical services, educate hand hygiene and PPEs; and, (c) Risks related to anticipating and addressing issues resulting from people being kept in quarantine and their relatives. 5.2 Addressing the WB Environmental and Social Standards mitigation requirements The PIU and participating HCFs, ICUs and laboratories will be primarily responsible for ensuring the environmental and social risks are mitigated at each stage of project operation. Since the World Bank ESF applies to the project, these involved parties will address risk mitigation through the relevant ESSs. ESS 1 - Assessment and Management of Environmental and Social Risks and Impacts. Although the project will have positive environmental and social impacts as it should improve COVID-19 surveillance, monitoring, and containment, it could also cause significant environmental, health, and safety risks due to the dangerous nature of the pathogen and reagents and other materials to be used in the project supported HCFs. To manage these risks, the MOH has prepared two major instruments: This ESMF, which includes templates for site specific Environmental and Social Management Plans (ESMP) that includes Infection Control and Medical Waste Management measures so that the HCFs, ICUs, and laboratories to be supported by the Project will apply international best practices in COVID-19 diagnostic testing and other COVID-19 response activities. The ESMF has an exclusion list for COVID-19 ICU and lab activities that may not be undertaken at the labs unless the appropriate capacity and infrastructure is in place; and, A Stakeholder Engagement Plan (SEP) for effective outreach and citizen participation, that has been prepared and disclosed both in country on the MOH website and on the World Bank website. To achieve the above mentioned positive environmental and social impacts, the aforementioned major areas of risks must be addressed and mitigated as discussed below: Health Care Medical Waste Management and Disposal. Given that the medical waste generated by laboratories and health care facilities is a potential vector for the contagion, improper handling of medical waste runs the risk of further spread of the disease. Therefore, the ESMF includes an ICWMP template specifically designed for COVID-19 identification, testing, and treatment, as well as for an efficient WMP. Worker Health and Safety. Workers in HCFs are particularly vulnerable to contagions like COVID- 19. Healthcare-associated infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among health and laboratory works as well as the wider spreading of the disease within communities. The ESMP contains detailed procedures, based on WHO guidance, for protocols necessary for treating patients and handling medical waste as well as environmental health and safety guidelines for staff, including the necessary PPE. Proper disposal of sharps (, disinfectant protocols, and regular testing of healthcare workers is included. 43 Community Health and Safety. The SEP is a key instrument for outreach to the community at large on issues related to social distancing, higher risk demographics, self-quarantine, and quarantine. It is critical that these messages be widely disseminated, repeated often, and clearly understood. Each participating in the project HCFs ICU and laboratory will apply ESMP that includes ICMWM provided in this ESMF, which includes those under the national law, and relevant EHS Guidelines, GIIP, and WHO. The ESMF covers environmental and social infections control measures and procedures for the safe handling, storage, and processing of COVID-19 materials including the techniques for preventing, minimizing, and controlling environmental and social impacts during the operation of project supported laboratories and medical facilities. It will also clearly outline the implementation arrangement to be put in place by MOH for environmental and social risk management; training programs focused on COVID-19 laboratory biosafety, operation of HCFs, as well as compliance monitoring and reporting requirements, including on medical waste management. ESS 2 – Labor and Working Conditions. The project shall be carried out in accordance with the applicable requirements of ESS 2, in a manner acceptable to the World Bank, including through, inter alia, implementing adequate occupational health and safety measures (including emergency preparedness and response measures), setting out grievance arrangements for project workers, and incorporating labor requirements into the ESHS specifications of the procurement documents and contracts with contractors and supervising firms. The project is expected to encompass the following categories of workers: direct workers and contracted workers, Direct workers could be either government civil servants or those deployed as ‘technical consultants’ by the project. The former will include health care providers and workers in health care facilities. The latter includes chiefly construction workers involved in the minor civil works. The civil servants will be governed by a set of civil services code and the ‘technical consultants’ by mutually agreed contracts. The project proposes some small-scale civil works and the expectation is that majority of labor will be locally hired and hence no labor influx is envisaged. This ESMF includes ESMP templates for the works and those templates contain a section on worker health and safety requirements. The workers will not work in contaminated areas and will be safeguarded with protective measures as appropriate. As the project may support refurbishing civil works, the ESMF also contains sections on Occupational Health and Safety (OHS). Civil works contracts should incorporate social and environmental mitigation measures based on the World Bank Group’s EHS Guidelines and the ESMF; other referenced plans e.g. SEP. All civil works contracts will also include standard Codes of Conduct that include measures to prevent Gender Based Violence (GBV) and Sexual Exploitation and Abuse (SEA) or Sexual Harassment (SH). A locally based GRMs specifically for direct and contracted workers will be provided. ESS 3 – Resource and Efficiency, Pollution Prevention and Management. The medical and chemical wastes (including water, reagents, infected materials, etc.) from the HCFs to be supported (drugs, supplies and medical equipment) can have a significant impact on the environment and human health. Each beneficiary HCFs, following the requirements of the ESMF, WHO COVID-19 guidance documents, and other best international practices, will prepare and follow an ESMP to prevent or minimize such adverse impacts. The document mandates that any waste associated with COVID-19 testing or treatment will be incinerated on site whenever possible. It also contains strict protocols for disinfecting and packing such waste for transportation to the nearest medical waste incinerator if on-site destruction is not possible. The ESMF includes requirements related to transportation and management of samples and medical goods or expired chemical products. The site specific ESMPs will include procedures for handling construction waste. Resources (water, air, etc.) used in HCFs will follow standards and measures in line with State Sanitary Hygienic Service of MOH and WHO environmental infection control guidelines for medical facilities. ESS 4 – Community Health and Safety. As there is a possibility for the infectious microorganism to be introduced into the environment if not well contained within the HCFs or due to accidents/ emergencies 44 e.g. a fire response or natural phenomena event (e.g., seismic), these institutions will thereby have to follow procedures detailed in the ESMPs. Their operation needs to be implemented in a way that staff, patients, and the wider public follow and are treated in line with international best practice as outlined in WHO guidance for COVID-19 response as above under ESS 1 and ESS 2. The SEP will also ensure widespread engagement with communities in order to disseminate information related to community health and safety, particularly around social distancing, high risk demographics, self-quarantine, and mandatory quarantine. ESS 10 – Stakeholder Engagement and Information Disclosure. The project recognizes the need for effective and inclusive engagement with all relevant stakeholders and the population at large. Considering the serious challenges associated with COVID-19, dissemination of clear messages around social distancing, high risk demographics, self-quarantine, and, when necessary, mandatory quarantine is critical. Meaningful consultation, particularly when public meetings are counter to the aims of the SEP, and disclosure of appropriate information assume huge significance for ensuring public health and safety from all perspectives – social, environmental, economic, and medical/ health. In this backdrop, the project has prepared a SEP which serves the following purposes: (i) stakeholder identification and analysis; (ii) planning engagement modalities viz., effective communication tool for consultations and disclosure; and (iii) enabling platforms for influencing decisions; (iv) defining roles and responsibilities of different actors in implementing the Plan; and (iv) a grievance redress mechanism (GRM). Project preparation has included a detailed mapping of the stakeholders. Individuals and groups likely to be affected have been identified. Risk-hot spots on the international borders as well as in-country have been delineated. Mapping of other interested parties such as government agencies/authorities, NGOs and CSOs, and other international agencies have also been completed. Drawing upon their expectations and concerns, a SEP has been prepared by the MOH and disclosed publicly (put in website where it has been disclosed). This SEP is currently being updated and disclosed on the MoH website. The PIU has also developed and put in place a GRM to enable stakeholders to air their concerns/ comments/ suggestions, if any. 5.3 Mitigation of environmental and social risks at different stages of project development At different stages of project design and implementation there will be generated various risks and impacts and respectively, there will be necessary to undertake different measures to address them. As the project will finance mainly COVID-19 preparedness, monitoring, and surveillance, and response and will not support construction or expansion of HCFs, but only minor refurbishments will be carried out in the existing ICUs and laboratories, this section is focused on providing necessary mitigation measures mainly for (i) planning and design stage; and (ii) operational of participating in the project HCFs. 5.3.1 Planning and Design Stage The key E&S activities and issues that should be undertaken and considered at the planning and design stage are the following: Procurement of vaccines, therapeutic, goods and supplies: As specified in the description of the project activities, the project will finance the procurement of goods and supplies, including vaccines, therapeutics. Respectively, this should be done taking into consideration transparency and needs of the vulnerable and disadvantaged social groups, as well as based on the specific protocols and technical specifications, recommended by the WHO guidelines (see Annex 4 and 5 with the references to these documents). This Annex also includes an outline of the L&FS measures 9 in line with national L&FS 9 Passive fire protection (such as smoke/fire compartmentation, smoke/fire motorized dampers, smoke.fare doors, doors holders) , fire alarm systems ( such as smoke, heat, flame detectors) and active fire protection systems (such as extinguishers, dry chemical powder, CO2 type extinguishers, sprinklers, foam system, hydrant &hose stations) 45 regulations and an internationally accepted L&FS standards10. Potential environmental and social risks and mitigation measures during the procurement of goods and supplies are provided in the Table 2 below. 10 Such as US NFPA 99 and NFPA 101 46 Table 2. Health and Safety issues while purchasing vaccines, therapeutics, goods, including oxygen equipment and supplies A. Vaccines and Therapeutics Activity Risks and Impacts Mitigation Measures Distributi A non-transparent and poorly Attention should be given to the distribution system, to ensure effective and on of vaccines managed distribution system and efficient use of the goods and services and avoid capturing of the rich, powerful and and medicines practice could worsen the current privileged, particularly at this time of short supply. shortage situation, affecting the max and efficient use of the resources. The disadvantaged and Awareness and communication outreach targeting poor and vulnerable groups vulnerable population groups could will be carried out to make sure that they have equal if not better access to these face disproportionate difficulties in resources. Regarding to the SEP this procedure will include among others, household- accessing the available resources, outreach through SMS, telephone calls, etc., depending on the social distancing exposing them to greater risks. requirements, in local language, the use of verbal communication, audiovisuals or pictures instead of text. Further, while country-wide awareness campaigns will be established, specific communications in every district, at local & international airports, hotels, for schools, at hospitals, quarantine centers and laboratories will be timed according to the need, and also adjusted to the specific local circumstances of the individual islands. B. Goods and Services Purchase Surfaces of imported materials Although coronavirus can stay on surfaces for a few hours to several days and stocking of may be contaminated and handling depending upon the type of surface (and the differing conditions and temperatures emergency during transportation may result in through which the equipment is moved), it is very unlikely that that the virus will persist rooms, clinics spreading. on a surface, even if originating in China or other country reporting COVID-19 cases. and other medical facilities, No special measures are required for handling imported goods and equipment, including with except regular hand washing. Laboratory equipment, Projects should ensure that adequate handwashing facilities with soap (liquid), supplies or goods. water and paper towels for hand drying (warm air driers may be an alternative), plus closed waste bin for paper towels are available. Alcohol-based hand rub should be provided where handwashing facilities cannot be accessed easily and regularly. Also ensure awareness campaigns and reminder signs are regularly posted around site to encourage workers regularly wash hands when handling goods, and that they do not touch their face. 47 If concerned (for example when dealing with goods that have come from countries with high numbers of infected people) a surface or equipment may be decontaminated using disinfectant. After disinfecting, workers should wash hands with soap and water or use alcohol -based hand rub. Purchase Incorrect standard or quality of Medical personal protective equipment (PPE) includes: of PPE for PPE leads to spread of infection to Medical mask healthcare healthcare workers and cleaners. Gown workers and Apron health facility Eye protection (goggles or face shield) cleaners Respirator (N95 or FFP2 standard) Boots/closed work shoes WHO interim guidance on rational use of PPE for coronavirus disease 2019 provided further details on the types of PPE that are required for different functions. Distributi A non-transparent and poorly Attention should be given to the distribution system, to ensure effective and on of goods or managed distribution system and efficient use of the goods and services and avoid capturing of the rich, powerful and services on basis practice could worsen the current privileged, particularly at this time of short supply. of need shortage situation, affecting the maximum and efficient use of resources. Awareness and communication outreach targeting poor and vulnerable groups will be carried out to make sure that they have equal if not better access to these The disadvantaged and resources vulnerable population groups could Regarding to the SEP this procedure will include among others, household- face disproportionate difficulties in outreach through SMS, telephone calls, etc., depending on the social distancing accessing the available resources, requirements, in local language, the use of verbal communication, audiovisuals or exposing them to greater risks. pictures instead of text. Further, while country-wide awareness campaigns will be established, specific communications in every district, at local & international airports, hotels, for schools, at hospitals, quarantine centers and laboratories will be timed according to the need, and also adjusted to the specific local circumstances of the individual islands. Hand Inadequate handwashing Projects should ensure that adequate handwashing facilities with soap (liquid), wash stations facilities are provided for handling. water and paper towels for hand drying (warm air driers may be an alternative), plus closed waste bin for paper towels are available. 48 If water and soap handwashing facilities are not possible, alcohol-based hand rubs may be provided. file:///C:/Users/wb456721/Downloads/WHO-2019-nCoV-IPC_WASH-2020.3-eng.pdf Alcohol-based hand sanitizers Alcohol-based Alcohol-based hand sanitizers are not considered hand rubs may not be as as effective as hand washing with soap and water and affective at controlling should therefore only be used in locations where full hand infection as hand washing washing facilities cannot be provided. Advice should be with soap and water. provided to remind users where full handwashing facilities can be found. Medical waste contaminated with COVID-19 virus The collection, There is no evidence that direct, unprotected processing, treatment and human contact during the handling of healthcare waste has disposal of medical wastes resulted in the transmission of COVID-19. The treatment becomes a vector for the of healthcare waste produced during the care of COVID-19 spread of the virus. patients should be collected safely in designated containers and bags, treated and then safely disposed. Open burning and incineration of medical wastes can result in emission of dioxins, furans and particulate matter, and result in unacceptable cancer risks under medium (two hours per week) or higher usage. If small-scale incinerators are the only option available, the best practices possible should be used, to minimize operational impacts on the environment. Best practices in this context are: • effective waste reduction and segregation, ensuring only the smallest quantities of combustible waste types are incinerated; • an engineered design with sufficient residence time and temperatures to minimize products of incomplete combustion; • siting incinerators away from health-care buildings and residential areas or where food is grown; • construction using detailed engineering plans and materials to minimize flaws that may lead to incomplete destruction of waste and premature failures of the incinerator; 49 • a clearly described method of operation to achieve the desired combustion conditions and emissions; for example, appropriate start-up and cool-down procedures, achievement and maintenance of a minimum temperature before waste is burned, use of appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures, proper disposal of ash and equipment to safeguard workers; • periodic maintenance to replace or repair defective components (including inspection, spare parts inventory and daily record keeping); and • improved training and management, possibly promoted by certification and inspection programs for operators, the availability of an operating and maintenance manual, visible management oversight, and regular maintenance schedules. Single-chamber, drum and brick incinerators do not meet the Best Available Techniques (BAT) requirements under Stockholm Convention. Alternative treatments should be designed into longer term projects, such as steam treatment methods. Steam treatment should preferably be on site, although once treated, sterile/non-infectious waste may be shredded and disposed of in suitable waste facilities. See: WHO Safe management of wastes from health-care activities. Water, sanitation, hygiene and waste management COVID-19 virus There is no evidence that COVID-19 virus persists for COVID-19 is transmitted through in drinking water, sewage, or medical wastes, and inappropriate sanitation following of good hygiene practices will provide effective arrangements or through control. See WHO guidance on water, sanitation and waste drinking water and management for COVID-19 for guidance on control contaminated waste. measures. Purchasing and distribution of oxygen equipment L&FS during Where the project includes procurement of installation and operation equipment for oxygen therapy such as oxygen cylinders, 50 oxygen concentrators, oxygen plant, installation, or expansion of the oxygen pipeline systems in the health care facilities the PIU will assess the L&FS risks and propose mitigation measures in line with requirements of WBG General EHS guidelines. Identification and diagnosis Collection of Collection of samples, transport of samples and samples and testing for testing of the clinical specimens from patients meeting the COVID19 could result in suspect case definition should be performed in accordance spread of disease to with WHO interim guidance Laboratory testing for medical workers or coronavirus disease 2019 (COVID-19) in suspected human laboratory workers, or cases. Tests should be performed in appropriately during the transport of equipped laboratories (specimen handling for molecular potentially affected testing requires BSL-2 or equivalent facilities) by staff samples. trained in the relevant technical and safety procedures. National guidelines on laboratory biosafety should be followed. There is still limited information on the risk posed by COVID-19, but all procedures should be undertaken based on a risk assessment. For more information related to COVID-19 risk assessment, see specific interim guidance document: WHO interim guidance for laboratory biosafety related to 2019-nCoV. Samples that are potentially infectious materials (PIM) need to be handled and stored as described in WHO document Guidance to minimize risks for facilities collecting, handling or storing materials potentially infectious for polioviruses (PIM Guidance). For general laboratory biosafety guidelines, see the WHO Laboratory Biosafety Manual, 3rd edition. 51 To gauge the need for supplies/equipment and health work force requirements during the COVID-19 pandemic, WHO has developed a suite of complimentary surge calculators - one for supplies and two for health workforce. All tools use the same base epidemiologic assumptions and classify health workforce using standardized International Labor Organization International Standard Classification of Occupations codes, but their outputs are intentionally different due to their primary focus. Forecasting supplies, diagnostics and equipment requirements. For this purpose, the WHO has prepared the “COVID-19 Essential Supplies Forecasting Tool (ESFT)� 11 which is designed to help governments, partners, and other stakeholders to estimate potential requirements for essential supplies to respond to the current pandemic of COVID-19. Although it provides an estimation of the number of cases, this calculator is not an epidemiological calculator. The focus of this tool is to forecast essential supplies: it includes estimation of personal protective equipment, diagnostic equipment, biomedical equipment for case management, essential drugs for supportive care, and consumable medical supplies. The recommended Priority Medical Devices in the context of COVID-1912. The WHO also prepared a list of priority goods and supplies to be purchased in the context of COVID-19, which can be accessed at specified below website. The list provides descriptions for the management of patients with severe acute respiratory infection (SARI) when a COVID-19 virus infection is suspected at different levels of health care provision. The first level, for outpatient; second level includes general hospitals and laboratories; and third level, includes specialized hospitals with intensive care units and SARI units. The technologies listed are for the interventions and should be adapted to the health care workforce, infrastructure and technological resources available. On the same WHO website 13 are provided “Technical Specifications for Medical Equipment for COVID-19� (provided in Annex 6) and “Technical Specifications for Invasive and Non-Invasive Ventilators for COVID-19� (provided in Annex 7). These documents describe the minimum requirements for medical equipment to be purchased in the case of COVID-19 and the requirements that invasive and non-invasive ventilators must comply with to ensure quality, safety and effectiveness when used for the management of COVID-19. The document specifies all these ventilators should be provided with accessories, consumables and spare parts as required to operate for minimum duration of 3 months. Oxygen sources and distribution for COVID-19 treatment centers. WHO issued also an interim guidance on oxygen sources and distribution strategies for COVID-19 treatment that has been adapted from WHO and UNICEF’s technical specifications and guidance for oxygen therapy devices . This guidance is intended for health facility administrators, clinical decision-makers, procurement officers, planning officers, biomedical engineers, infrastructure engineers and policymakers. It describes how to quantify oxygen demand, identify oxygen sources that are available, and select appropriate surge sources to best respond to COVID-19 patients’ needs, especially in low-and-middle income countries. National requirements for procuring medical goods and devices. Belarus has adopted its own Sanitary Norm and Rules in this regard which should be also taken into account while organizing procurement process: (a) Requirements for medical goods and devices; (b) Hygienic normative on indicators for medical goods, devices and materials, used for their manufacturing; and (c) Normative on disinfection materials safety. Specified in these documents’ requirements will be considered while organizing the procurement process. 11 See: Coronavirus disease (COVID-19) technical guidance: Essential resource planning (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/covid-19-critical-items) 12 See: Coronavirus disease (COVID-19) technical guidance: Essential resource planning (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/covid-19-critical-items) 13 (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/covid-19-critical-items) 52 Assessment of location, type and scale of healthcare facilities participating in the project L&F risks and associated waste management facilities, including waste transport routes . This will include the following activities: (a) Location of facilities: In addition to normal considerations regarding proximity to sensitive areas such as a cultural heritage site or a nature reserve, while preparing the participating in the project HCFs, ICUs and laboratories environmental and social assessment and ESMP, it is necessary to examine nearby sensitive social receptors such as a residential area or school and availability of municipal services such as public water supply, sewage and waste collection services at the location; and (b) Type and scale of MWM facilities: The assessment should identify and examine the salient characteristics and carrying/disposal capacity of the facility. The assessment should consider the waste processing and transportation arrangements, operational procedures and working practices, and the required capacity of the type of disposal facility needed for the volume of the wastes generated. For example: a general hospital, a high-level biosafety laboratory for coronavirus testing; a temporary hospital or quarantine area, a pyrolytic incinerator or a hazardous waste landfill for medical waste disposal; and (c) L&F and oxygen safety risks. While selecting the participating HCFs, the issues of L&F and oxygen safety risk management will be assessed and taken into consideration. Proper functional layout of healthcare facilities, which may involve several aspects: i) structural and equipment safety, universal access14; ii) nosocomial infection15 control; iii) waste segregation, storage and processing. In this regard the WHO Manual of Severe Acute Respiratory Infections Treatment Center (March 2020)16 requirement should be followed; Estimate of healthcare waste streams, including wastewater, solid wastes and air emissions (if significant), in a healthcare facility; Screening HCFs. The PIU will screen each project participating HCF, ICU and laboratory for potential environmental and social risks per World Bank Group EHS Guidelines, WHO COVID-19 Guidelines17, and the screening form is contained in Annex 8. The screening table provided in that Annex is part of the package each participating HCF should prepare before being included in the project and includes besides the design documents, the ESMP which altogether provide answers to the following issues: (a) Determination of any needed design changes in the facility or its operation such as ICUs, structural and equipment safety, universal access, nosocomial infection control, medical waste disposal, etc.; (b) Identification of the scope of works expected (i.e. wards rehabilitated into ICUs, installation of box chambers, installation/augmentation of water supply and installation of sanitary stations, etc.); (c) Determination that utilities (power, water, heat, etc.) are adequate for planned works; (d) Identification of how such works might interfere with normal operation of the HCF; (e) Determination as to whether external or additional security personnel are needed; and, (f) Preparation of a site-specific ESMP that includes IPC and MWM activities based on the template provided in in Annex 9. Requirements for protecting healthcare workers. The PIU will conduct a review of the HCF’s protocols for protecting healthcare workers from infections disease based on current WHO Guidelines for COVID-19 and the Infection Prevention and Control Protocol contained in Annex 10. The review will include: (a) Determination if training given to healthcare workers and other HCF employees is adequate; (b) Determination if HCF staff are trained on how to deal with the remains of those who might 14Refer to ESS 4 Community Health and Safety 15Nosocomial infection can be descried as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. Also called “hospital acquired infection�. 16 See: https://www.who.int/publications-detail/severe-acute-respiratory-infections-treatment-centre 17 The World Bank ESF, including ESS 4, also contain relevant information. See https://www.worldbank.org/en/projects-operations/environmental- and-social-framework 53 die from COVID-19, including those conducting autopsies; (c) Determination if adequate stores of PPE are available on-site; and (d) Identification of supply lines for required PPE. The main risks among healthcare facility workers are related to spread of the virus. Workers in HCFs include medical staff (doctors, nurses etc.) and non-medical staff (drivers, supporting workers) which could contact COVID-19 patients. It is expected that HCF`s worker would experience risks and personal health issues by providing health care to patients visiting to get treatment. Such health-related risks include severe illness, physical and mental exhaustion, occupational burnout, passing on infectious to family and community, stigma, long shifts, exposure to infectious waste, SEA/SH. These risks are temporary and can be mitigated through following measures: • The PIU will conduct a review of the HCF’s protocols for protecting healthcare workers from infections disease based on current WHO Guidelines for COVID-19 and the Infection Prevention and Control Protocol contained in Annex 10; • The PIU will conduct training for HCF staff on site on the signs and symptoms of COVID-19, how it is spread, how to protect themselves (including regular hand washing and social distancing) and what to do if they or other people have symptoms; • Placing posters and signs around the site, with images and text about protection measures in local languages.; • Establish adequate rest areas, washing and cleaning facilities, regular testing during the working hours; • Conduct regular and thorough cleaning of all site facilities, including offices, accommodation, canteens, common spaces (for further information see WHO interim guidance on water, sanitation and waste management for COVID-19 https://www.who.int/publications/i/item/water-sanitation- hygiene-and-waste-management-for-covid-19); • WHO provides detailed advice on what should be done to treat a person who becomes sick or displays symptoms that could be associated with the COVID-19 virus (for further information see WHO interim guidance on infection prevention and control during health care when novel coronavirus infection is suspected; https://www.who.int/publications/i/item/infection-prevention-and-control-during-health-care-when- novel-coronavirus-(ncov)-infection-is-suspected-20200125). The ESMP to be prepared for each HCF will include gap filling measures that need to be undertaken before an HCF can particulate in the project. In preparing ESMP, social screening will be carried out in order identify categories of workers who are at deferent risk levels (low, moderate, high), and location and institutionally specific measures will be included in the ESMP. 5.3.2 Implementing refurbishing civil works At this stage of project implementation, the PIU will ensure that all refurbishing civil works activities will be carried out in compliance with a site-specific ESMP prepared based on the template found in Annex 9. The ESMP is an integrated document which includes also the COVID 19 Infection Prevention and Control issues along with the MWM. Thus, the ESMF proposes preparing for each participating HCF one unified document without the need to have a separate IPC and MWM plan. The PIU will also ensure that the site- specific ESMP will be included in any works or supervision contracts entered for a specific HCF. The site- specific ESMP will include: (a) Environmental and social risks and issues such as resource efficiency, material supply and 54 health and safety of local communities; (b) Construction related solid wastes, wastewater, noise, dust and emission management; (c) Hazardous materials management; (d) Infection Prevention and Control issues; (e) Medical Waste Management; (f) Occupational Health and Safety (OHS) and Environmental Health and Safety (EHS) issues; (g) Security personnel management, GBV/SEA/SH risks, gender issue; and, (h) Labor and working conditions. The summary of potential environmental and social impacts during the refurbishing civil works, along with the detailed mitigation measures in provided in the Table 3 below. 55 Table 3. Health and safety risks to be considered for project civil works (conversion and refurbishing of medical facilities including isolation facilities) Activ Risks and Impacts Mitigation Measures ity HCF The focus on treatment Ensure that the designs for medical facilities also consider the collection, segregation and design and care is progressed treatment of medical waste. activity disproportionately with the need for adequate medical waste There is no evidence that direct, unprotected human contact during the handling of infrastructure. healthcare waste has resulted in the transmission of COVID-19. The treatment of healthcare wastes produced during the care of COVID-19 patients should be collected safely in designated containers and bags, treated and then safely disposed. Open burning and incineration of medical wastes can result in emission of dioxins, furans and particulate matter, and result in unacceptable cancer risks under medium (two hours per week) or higher usage. If small-scale incinerators are the only option available, the best practices possible should be used, to minimize operational impacts on the environment. Best practices in this context are: ✓ effective waste reduction and segregation, ensuring only the smallest quantities of combustible waste types are incinerated; ✓ an engineered design with sufficient residence time and temperatures to minimize products of incomplete combustion; ✓ siting incinerators away from health-care buildings and residential areas or where food is grown; ✓ construction using detailed engineering plans and materials to minimize flaws that may lead to incomplete destruction of waste and premature failures of the incinerator; ✓ a clearly described method of operation to achieve the desired combustion conditions and emissions; for example, appropriate start-up and cool-down procedures, achievement and maintenance of a minimum temperature before waste is burned, use of appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures, proper disposal of ash and equipment to safeguard workers; ✓ periodic maintenance to replace or repair defective components (including inspection, spare parts inventory and daily record keeping); and ✓ improved training and management, possibly promoted by certification and inspection programs for operators, the availability of an operating and maintenance manual, visible management oversight, and regular maintenance schedules. 56 Single-chamber, drum and brick incinerators do not meet the BAT requirements under Stockholm Convention. Alternative treatments should be designed into longer term projects, such as steam treatment methods. Steam treatment should preferably be on site, although once treated, sterile/non-infectious waste may be shredded and disposed of in suitable waste facilities. See: WHO Safe management of wastes from health-care activities (https://www.ifc.org/wps/wcm/connect/29f5137d-6e17-4660-b1f9-02bf561935e5/Final%2B- %2BGeneral%2BEHS%2BGuidelines.pdf?MOD=AJPERES&CVID=jOWim3p; and https://www.ifc.org/wps/wcm/connect/be37221a-fc47-4379-b539- eca3fe72c3e6/General%2BEHS%2B-%2BRussian%2B- %2BFinal_.pdf?MOD=AJPERES&CVID=jqeI79F&ContentCache=NONE&CACHE=NONE Refur Injury during Apply ESHGs to implementation of projects bishing civil refurbishment of existing (https://www.ifc.org/wps/wcm/connect/be37221a-fc47-4379-b539- works in buildings. eca3fe72c3e6/General%2BEHS%2B-%2BRussian%2B- HCFs %2BFinal_.pdf?MOD=AJPERES&CVID=jqeI79F&ContentCache=NONE&CACHE=NONE Desig The design of the For patients with possible or confirmed COVID-19, isolation rooms should be provided n and facility and the operating and used at medical facilities. Isolation rooms should: operation of procedures will help prevent ✓ be single rooms with attached bathrooms (or with a dedicated commode); HCFs spread of infection ✓ ideally be under negative pressure (neutral pressure may be used, but positive including pressure rooms should be avoided); triage, ✓ be sited away from busy areas (areas used by many people) or close to vulnerable isolation (or or high-risk patients, to minimize chances of infection spread; quarantine) ✓ have dedicated equipment (for example blood pressure machine, peak flow meter facilities and stethoscope), but should avoid excess equipment or soft furnishings; ✓ have signs on doors to control entry to the room, with the door kept closed; ✓ have an ante-room for staff to put on and take off PPE and to wash/decontaminate before and after providing treatment. The design or refurbishment will be based on the Principles of Life & Fire safety for public access in existing buildings and specific requirements is stipulated in the General EHS guidelines (see https://www.ifc.org/wps/wcm/connect/eeb82b4a-e9a8-4ad1-9472- f1c766eb67c8/3%2BCommunity%2BHealth%2Band%2BSafety.pdf?MOD=AJPERES&CVID=l s62Gai. An operation manual should be prepared prior to the opening of isolation rooms to describe the working procedures to be taken by healthcare workers to protect themselves and prevent 57 infection escape while providing treatment. The operational procedures should be of a standard to meet guidance from WHO and/or CDC on infection control: ➢ WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; ➢ WHO technical brief water, sanitation, hygiene and waste management for COVID-19; ➢ WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources);WHO interim practical manual for improving infection prevention and control at the health facility; ➢ CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; and ➢ CDC guidelines for environmental infection control in healthcare facilities. Impr Some vulnerable groups Project team together with local authority will carry out assessments/census of vulnerable ove access to (especially the elderly or those and disadvantaged persons in each locality and specific actions to get access for treatment, whether support and with pre-existing medical in medical facilities or in the community. treatment for conditions) may be severely the affected by COVID-19 and may disadvantage need additional support to d vulnerable access treatment. groups Empl Workers do not receive Contractors should ensure that contracted workers have medical insurance, covering oyment of the care needed if infected with treatment of COVID-19. workers COVID-19. Trans Workers that travel Expats or transient workers should adhere to national requirements and guidelines with ient and expat from other regions may provide respect to COVID-19. workforce a vector for passing infection Expats or transient workers coming from countries/regions with cases of the virus: onto work sites. • Should not return if displaying symptoms • Should self-isolate for 14 days, following their return. For self-isolation, workers should be provided with a single room that is well-ventilated (i.e., with open windows and an open door). If a single room is not available for each worker, adequate space should be provided to maintain a distance of at least 1 m between workers sharing a room. Workers in isolation should limit their movements in shared space, for example through timed use of shared spaces (such as kitchens and bathrooms) with cleaning prior to and after use of the facilities. Visitors should not be allowed until the worker has shown no signs and symptoms 58 for 14 days, and the number of staff involved in caring for those in isolation should eb kept to a minimum. Healthcare professionals and cleaners should visit each day (wearing the appropriate PPE and observing hygiene requirements and make appropriate arrangements for supplying food and water to the kitchens for the workers in isolation. Further information is provided by WHO in Home care for patients with suspected novel coronavirus (COVID-19). 59 Workplaces and ensuring workers general hygiene. Before refurbishing civil works start it is necessary to communicate the requirements on workplaces setup general hygiene that should include: • Training staff on the signs and symptoms of COVID-19, how it is spread, how to protect themselves (including regular handwashing and social distancing) and what to do if they or other people have symptoms (for further information see WHO COVID-19 advice for the public). • Placing posters and signs around the working site, with images and text in local languages. • Promoting good respiratory hygiene in the workplace: displaying posters promoting respiratory hygiene and combining this with other communication measures such as offering guidance from occupational health and safety officers, briefing at meetings and information on the intranet etc.; ensuring that face masks are available at your workplaces, for those who develop a runny nose or cough at work, along with closed bins for hygienically disposing of them. • Ensuring handwashing facilities supplied with soap, disposable paper towels and closed waste bins exist at office premises. Where handwashing facilities do not exist or are not adequate, arrangements should be made to set them up. Alcohol based sanitizer (if available, 60-95% alcohol) can also be used. COVID-19 reporting. The ESMF requires outbreaks of diseases to be reported. It is important that the Bank team is informed of an outbreak on a site to better coordinating the necessary responses with project management protocols. Such reporting should be done following the guidance in ESIRT for a ‘Serious’ incident, to ensure that the Bank team is informed and that the event is managed accordingly at the project level. An investigation into an outbreak of COVID-19 does not need to be undertaken by the MOH, but the PIU should keep teams informed of any concerns or problems associated with providing care to infected workers on project sites, particularly if infection rate is approaching 50% of the workforce. 5.3.3 OPERATION PHASE AND EMERGENCY PREPAREDNESS As specified above, the operation of HCFs may generate a series of various COVID-19 related risks and, respectively, require undertaking the following actions: Medical management and disposal. The ESMP should contain detailed instructions on handling medical waste at a given HCV, given the options available. Medical waste, including any waste suspected to contain pathogens should be segregated and marked “infectious� with international infectious symbol in a strong, leak proof plastic bag, or a container capable of being autoclaved. Medical waste should be sterilized via chemical disinfection, wet thermal treatment (i.e. autoclave), microwave irradiation, or incineration prior to disposal. Sharps, including needles, scalpels, blades, knives, infusion sets, saws, broken glass, and nails etc. should be segregated in a rigid, impermeable, puncture-proof container (e.g. steel or hard plastic) container for sterilization and disposal in accordance with the guidelines. Additionally, needles and syringes should undergo mechanical mutilation (e.g. milling or crushing) prior to treatment, particularly chemical, wet thermal treatment, and microwave irradiation. The PIU and HCF, through the HCFs preliminary assessment, the ESMPs, and the action plans to fill capacity gaps, and by financing some of gap filling measures, will ensure the following: (a) Each HCF is operated in accordance with the ESMP which includes IC MWM measures (see Annex 9) prepared for the project; (b) Waste segregation, packaging, collection, storage disposal, and transport is conducted in compliance with the ESMP and WHO COVID-19 Guidelines;(c) Onsite waste management and disposal will be reviewed regularly and training on protocols contained in the ESMP conducted on a weekly basis; (d) The PIU will audit any off-site waste disposal required on a monthly basis and institute any remedial measures required to ensure compliance; and (e) Waste generation, minimization, reuse and recycling are practiced where practical in the COVID-19 context. Ensuring health workers general hygiene. The necessary activities in this regard should include: (a) Training staff on the signs and symptoms of COVID-19, how it is spread, how to protect themselves (including regular handwashing and social distancing) and what to do if they or other people have symptoms; 60 (b) Promoting good respiratory hygiene in the workplace: displaying posters promoting respiratory hygiene and combining this with other communication measures such as offering guidance from HCF management, briefing at meetings and information on the intranet etc.; and, (c) Ensuring handwashing facilities supplied with soap, disposable paper towels and closed waste bins exist at office premises. Alcohol based sanitizer (if available, 60-95% alcohol) can also be used. Protecting healthcare workers. The PIU and HCF will ensure the following: (a) Regular delivery and proper storage of goods, including samples, pharmaceuticals, disinfectant, reagents, other hazardous materials, etc.; (b) Ensure protocols for regular disinfection of public rooms, wards, ICUs, equipment, tools, and waste are in place and followed; and (c) Ensure equipment such as autoclaves are in working order. Personal Protective Equipment (PPE). In addition to the World Bank Group EHS Guidelines on PPEs, the WHO has published guidelines on the rational use of PPEs during the COVID-19 pandemic18, which highlight the issues faced by the global shortage of PPEs. The ESMP will require to take these guidelines into account and ensure that healthcare workers involved in the critical care of COVID-19 patients have the necessary protection and that patients, particularly those who do not require hospitalization, understand their responsibilities for obtaining and wearing PPEs when around others. Life and Fire Safety risk management: EHS management system of the participating in the project HCF should contain: • The suitably qualified professional from Ministry of Extremal Situations (MoES) conduct a review of L&FS Master Plan of participating HCFs, presenting their results to the HCF that should be presented in the updated site specific ESMP. The findings and recommendations of the review are used as the basis to establish the conditions of a Corrective Action Plan, if needed, and a time frame for its implementation. Following completion of the Corrective Action Plan, the state fire departments will certify that the facility meets the L&FS Master Plan. • Fire Safety documentation which should provide detailed information on the systems installed in the building and it typically contains following information: plans of the systems, data sheets of all components, list of necessary spare parts, supplier list, system certificates, fire safety design documentation. • Fire prevention and training program (typically describes the staff responsibilities to prevent a fire. It should also include a training program for staff. • Maintenance and test plan for all fire protection system: (a) Fire protection systems require maintenance by qualified persons. A maintenance plan should be available, that shows what systems are maintained with a certain frequency; (b) The plan should include checklists with the tasks done in-house and the tasks done by maintenance contractors; (c) Maintenance contracts should be available for all tasks done by external parties. • Emergency preparedness and response plan. Oxygen risk management in HCF: As the project includes procurement of equipment for oxygen therapy such as oxygen cylinders, oxygen concentrators, oxygen plant, installation, or expansion of the oxygen pipeline systems in the health care facilities the PIU will assess the L&FS risk and propose mitigation measures in line with requirements of WBG General EHS guidelines. Furthermore, oxygen, oxygen cylinders and oxygen concentrators are hazardous materials that must be managed (that is, used, stored, and handled) in accordance with WBG EHSGs requirements from Section 1.5 “Hazardous Materials�. Their use must include a hazard assessment of the potential for uncontrolled reactions such as fire and explosions and actions to manage these materials safely and the safety specifications for these materials and equipment. All these should be assessed, and adequate safety measures must be put in place in all participating HCF that receives 18 https://apps.who.int/iris/bitstream/handle/10665/331695/WHO-2019-nCov-IPC_PPE_use-2020.3-eng.pdf 61 and use such equipment. Regarding medical oxygen fire risk WHO issued special guidelines presented in the figures below. (Figure 1. Medical Oxygen Fire Risk. 62 63 Overall, the L&F and oxygen risks require a systemic approach and includes a series of public awareness, training, capacity building activities along with the technical activities that would reduce them or would create a opportunities for timely and efficient response (see Box 1 below). Box 1. L&F and Oxygen risks and recommended measures for addressing them 1. Awareness: • Raise awareness among hospital management, to be transported throughout the whole organization, including all medical staff, infrastructure and maintenance departments, and cleaning and housekeeping staff. • Inform the entire network of ICU personnel of their part in reducing risk of fire from oxygen- enriched environments. • Awareness raising should be routine, reinforced with ongoing training, drills, signage (WHO Medical Oxygen Fire Risk poster) and in safety meetings with staff. 2. Active risk monitoring and management: • Medical staff should be observant of increased risk in ICU due to the rise in number of patients on oxygen therapy, ventilators that show signs of excessive wear, presence of debris, presence of solvents in the area, etc. • Have standard protocols for reporting and addressing risk. • Hospital operations and maintenance must consider electrical capacities and loading, as well as the regular maintenance, in light of the surge in usage of electrical equipment. • Room ventilation must be assessable to minimize buildup of an elevated oxygen concentration. • Minimize or avoid use by cleaning staff of solvent-based cleaning agents, such as ethyl alcohol, in elevated-oxygen atmospheres. • Establish routines for timely exchange of information between different functions about circumstances that negatively impact risk. 3. Assessment of electrical loading: • Confirmation by an electrician that the power circuit can handle the new electrical load, including power surges, before assigning a ward for use of intensive care with oxygen ventilation or increasing the number of beds in a ward. 4. Inspection and maintenance: • Regularly inspect, test, and maintain all electrical and electro-mechanical equipment for wear, heat loading (especially when in continuous use), blocked fans and ventilation ducts. • Withdraw defective equipment. • All air ducts and cooling fans must be clean and unobstructed by hair, dust and other debris. • Motors, switches and other electrical contacts should be clean and in good condition to avoid sparking. 5. Oxygen detection: • Install fixed or mobile devices to frequently (i.e., hourly) measure oxygen excess in ambient air. • Promptly address any excess in oxygen consumption that does not correspond to the demand ensued by patients currently under treatment (e.g., oxygen leak in the storage, distribution system or the endpoints). 6. Room ventilation: • Ensure adequate room air flow in areas where elevated oxygen concentration may be expected. • Efforts to reduce the air flow and mixing among areas adjacent to the ICU to prevent the spread of the airborne infection should allow adequate ventilation to reduce oxygen concentration. 64 • While not always possible to do immediately in the face of an emergency such as the pandemic, necessary adjustments should be made as soon as possible to adapt air circulation in ICUs in the face of a sudden upsurge in oxygen therapy patients. 7. Oxygen pipeline supply systems: • Maintain and ensure correct operation of the gas supply system, including those that supply oxygen. • Train maintenance and operations personnel on operation procedures and carry out regular maintenance to check for leaks, wear and other potential deteriorations in mechanical integrity. 8. Oxygen cylinder handling and storage: • In hospitals dependent on oxygen cylinders, ensure that appropriate storage conditions (e.g., clean, dry, well-ventilated, away from flammable substances, etc.) are rigorously observed, including when temporary storage arrangements need to be established. Temporary storage limits must be respected. (BOC Healthcare UK, Cylinder storage and handling). • Train and ensure staff follow correct handling procedures, for example by using the Failure Mode Effect Analysis for analyzing risks associated with use of medical gas in hospitals. See also WHO Oxygen Cylinder Safety poster. 9. Enhanced product stewardship across industry and downstream users: • Seek proactive product stewardship of producers of industrial gases and medical equipment via outreach to downstream users is a key ingredient of oxygen risk management. It should be a priority for these producers. • Producers of industrial gases and medical equipment should proactively provide to hospitals and other healthcare providers comprehensive communication of hazards from the commissioning phase, as well as timely notification of any recent safety developments. 10. Management of change: • Raise awareness of hospital management that changes in room use, number of beds, increases in ventilation with oxygen, increases in the number of highly infectious patients, etc. affect hospital safety. • Assess these changes for their impacts on other aspects of the system, in particular the creation of new hazards or increasing the risks of existing hazards. • Ensure risk assessment results are taken into final decisions about whether and how required changes are implemented. Document the assessment and resulting decisions. 11. Open communication: • Encourage all staff at any level in the hierarchy to speak up about changes that could elevate risk. • Following identification of an important change, communicate about those changes and implications for expected behaviors and procedures. • Proactively communicate changes as they are unfolding (e.g., a sudden rise in COVID-19 patients in the ICU). • Inform competent technical personal so they can address deviations from expected performance or function of equipment, loading of the electrical supply, tripping of fuses, etc. • Communicate, ideally through routine channels (e.g., as part of exchanges at the start of every shift and in staff meetings), changing circumstances, deviations from the norm, equipment performance, and any other anomalies that raise concerns about heightened risk. 12. Accident investigation and lessons learning: • Hospital administrators should actively engage in understanding and communicating incidents of the past. 65 • Lessons learned from previous fires should be reviewed and communicated across all levels of management and areas of operations in order to promote medical staff’s awareness of fire hazards related to oxygen enriched atmospheres. 13. Emergency preparedness: • In the event of an oxygen-related fire, personnel in the immediate vicinity should immediately switch off all sources of oxygen if possible. • Hospital management should make sure that COVID-19 measures to minimize the contagion do not hinder emergency preparedness. A comprehensive fire risk assessment prior to any modification should take place to determine the effect on fire safety and emergency preparedness. Regular testing of healthcare workers and patients. The ESMP template include requirements for regular testing of healthcare workers exposed to COVID-19 as well as patients who present symptoms. The testing procedures may vary between HCFs depending on the availability of testing kits and laboratories in different parts of the country and at different times. Containment of COVID-19. The PIU and HCF will ensure the following: (a) Quarantine procedures for COVID-19 patients are maintained; (b) When practical, COVID-19 patients are given access to phone or other means of contact with family and friends to lessen the isolation of quarantine; (c) The public is regularly updated on the situation and reminded of protocols to prevent the spread of COVID-19; and, (d) Members of the general public (family and friends) who have been exposed to confirmed COVID-19 patients are tested when practical. Requirements for handling dead bodies. The WHO Guidelines include guidance on the management of dead bodies in the COVID-19 context19. Healthcare workers, mortuary staff, and others handling bodies should apply standard precaution including hand hygiene before and after interaction with the body, and the environment; and use appropriate PPE according to the level of interaction with the body, including a gown and gloves. If there is a risk of splashes from the body fluids or secretions, personnel should use facial protection, including the use of face shield or goggles and medical masks. HCFs Emergency Preparedness. Operation and Maintenance involves preparing schedules for mandatory regular maintenance and testing of life and fire safety features to ensure that mechanical, electrical, and civil structures and systems are always in conformance with life and fire safety design criteria and required operational readiness. In addition, an Emergency Response Plan should be prepared/updated for all participating HCFs which contains a set of scenario–based procedures to assist staff and emergency response teams during real life emergency and training exercises. This Plan should include an assessment of local fire prevention and suppression capabilities. Such Plan is to be prepared by suitably qualified professional and include preliminary drawings and specifications and certifies that the design meets the requirements of these Life and Fire Safety (L&FS) as per national Fire Regulations and guidelines provided in the WBG EHS document (see: https://www.ifc.org/wps/wcm/connect/eeb82b4a-e9a8-4ad1-9472- f1c766eb67c8/3%2BCommunity%2BHealth%2Band%2BSafety.pdf?MOD=AJPERES&CVID=ls62Gai). The findings and recommendations of the review, if needed, are then used to establish the conditions of a Corrective Action Plan and a time frame for implementing the changes. 19 https://apps.who.int/iris/bitstream/handle/10665/331538/WHO-COVID-19-lPC_DBMgmt-2020.1-eng.pdf 66 6. Procedures to Address Environmental and Social Issues 6.1 Stages of environmental and social assessment Implementation of this ESMF will include the following stages and activities, to be undertaken by the PIU working closely with the individual HCFs: HCFs screening. All HCFs to be included in the project and proposed activities to be undertaken by the project will be screened using the form found in Annex 8 to exclude certain risky activities, identify potential environmental and social issues, and classify the environmental and social risks, or to prepare an action plan to improve the HCF conditions to be able to participate in the project. Copies of each of these screening forms will be kept at the PIU and individual HCFs. The PIU’s quarterly report to the World Bank will include copies of each screening undertaken during the subject quarter. Conducting E&S assessment and developing project Environmental and Social Management Plan. For each selected to be included in the project HCF, the HCF will prepare and implement a site specific ESMP. The ESMP document will be based on the template found in Annex 9 and will include small-scale refurbishing civil works to be conducted at an associated HCF including the creation or rehabilitation of ICUs, the installation of box chambers, the rehabilitation of laboratories, the rehabilitation or installation of sanitary stations and handwashing facilities, and the rehabilitation or installation of medical waste incinerators. As its integral part the ESMP includes COVID-19 ICMWM activities and protocols that specify all requirements in this regard. Once approved (see below), the ESMP will be included as an integral part of any works or supervision contract for the activity. If the HCF undertakes the works on its own, the ESMP will remain applicable for the activities being undertaken. Consultation and Disclosure. Given the need for social distancing during the COVID-19 pandemic, stakeholder consultations for the environmental and social instruments will be conducted virtually whenever possible as per WB guiding document20. The PIU and individual HCFs will identify key stakeholders for each of the three instruments and organize consultations via phone, email, and, for HCF employees, small meetings of no more than ten individuals at a time. Key stakeholders must include patients and their families – meaning consultations will need to be continuous as new patients are identified. During the consultation it is necessary to also inform the public around a given HCF, therefore some sort of public call for input will be made via print and/or broadcast media. The ESMP documents will be disclosed on the PIU and individual HCF’s websites with print copies also available, on demand, at both. Copies of prepared ESMP documents will be included in the PIU’s Quarterly Report to the World Bank. The stakeholder engagement should focus among other important issues on awareness raising about L&FS risk management in general and on oxygen safety issues and mitigation. This aspect is important for the staff, patients and visitors of the health care facilities. Review and Approval. The ESMP documents will be prepared by the concerned HCFs and then reviewed and approved by the PIU before implementation. The first two ESMPs will also be submitted to the World Bank by the PIU for review and approval before implementation. Thereafter, the World Bank will conduct a post-review of each ESMP document via the PIU’s Quarterly Report and provide comments when necessary. If, during post review, it is evident that the ESMP are not meeting World Bank standards, the Bank may change the procedures and require prior review of new instruments. Implementation, monitoring and reporting. To ensure proper implementation of the environmental mitigation activities and infection control and MW management measures the ESMP Template contains as part 3 of the document a generic Monitoring Plan which will be adjusted to the concrete HCF that will 20 Technical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings 67 participate in the project. The Monitoring plan provides the indicators to be monitored, along with the details on the site for monitoring activities, timing, monitoring tool and required financing. Based on the monitoring activities, during project implementation the HCFs and PIUs will ensure regular reporting, providing two types of reports: Monthly from the HCFs to the PIU and Quarterly from the PIU to the Bank; (a) Monthly Reports - individual HCFs will prepare monthly reports to the PIU on each activity being undertaken and ESMP implementation. These reports will include progress on any on-going small works, statistics related to the implementation of the ESMP, statistics related to local hotlines, any grievances received via the GRM and information on their resolution, and any other relevant information. The template for HCF reporting is presented in the Annex 11. (b) Quarterly Reports – the PIU will submit an overall report of project implementation to the Bank every quarter the project is active. These reports will include statistics on national project implementation; a summary of grievances received and their resolution, a summary of activities for each individual HCF, and copies of screenings and individual HCF instruments prepared during the subject quarter. 6.2 Institutional Arrangements, Responsibilities and Capacity Building Institutional arrangemens and responsibilities. The Ministry of Health of the Republic of Belarus will bear overall responsibility for the implementation and coordination of the Project while the day to day implementation, coordination, monitoring and evaluation of the implementation of project activities, as well as responsibilities in terms of ESF, will be assigned to Project Management Uit (PMU), based on the Republican Scientific and Practical Center of Medical Technologies (RSPCMT). The RSPCMT is currently assigned as the Project Implementation Unit (PIU) for the ongoing WB-supported Health System Modernization Project (P156778) in the country and, respectively, has experience in terms of implementing WB safeguards requirements under the old Operational Policies (OPs). The project environmental and social management until now was considered as satisfactory. The PMU includes a director and specialists in procurement, financial management, monitoring and evaluation (M&E), and environmental and social safeguards. Currently it has in its staff a Safeguards Specialist (SS) with overall responsibilities of coordinating all safeguards issues, including preparing under the Health System Modernization Project subprojects’ Environmental and Social Management Plans and ensuring their implementation. Building on this project ESF management capacity is critical for rapid implementation of COVID-19 project activities. To address the need for complementary technical expertise to effectively implement the COVID-19 Emergency Response Project, the PMU will be supported by technical specialists of the MOH, and WHO that would provide regular guidance of pandemic control. Also, additional staff will be recruited to the PMU as needed (upon agreed terms of reference and prior no-objection from the World Bank (WB), such as a Strategic Coordination Advisor, ESF specialist a Communications Advisor, and an Interpreter/Translator. Furthermore, technical consultants will be hired, as needed, for various project activities, who will be on a sole source basis. The PMU will support the MOH and directly implement project activities, including procurement of medical supplies, equipment, and facility refurbishment for activities under Component 1. Some other activities, such as coordination, communication and training may be outsourced to third parties through contract agreements acceptable to the World Bank. The PMU will also oversee preparation of the consolidated annual workplan, procurement plan, and a consolidated activity and financial report for the project components, as well as assist the MOH in monitoring compliance with WB ESF and fiduciary policies. The PMU will be also responsible for carrying out stakeholder engagement activities, while working closely together with other entities, such as local government units, media outlets, health workers, etc. supported under Component 1.4 of the Project. The stakeholder engagement activities will be documented through quarterly progress reports, to be shared with the World Bank. The new ESF Specialist to be hired will have overall responsibility on ensuring that project implementation is compliant with the World Bank’s ESF, particularly the relevant ESSs; the World Bank Group’s EHS Guidelines; WHO COVID-19 Guidelines; and this ESMF. She/he will oversee the project’s work nationally and ensure that each HCF complies with all project procedures and receive professional implementation and project management support, including for procurement. While hiring the ESF specialist 68 PMU will make sure she/he have experience with implementation of national or WB ESF/environmental or social safeguards, medical waste management and disposal systems as well as some knowledge of general occupational health and safety issues for healthcare workers and civil works. Participating HCFs. Each selected individual HCF will assign one staff member who will be responsible for ESMP implementation. It is important the assigned for the ESMP implementation HCF representative is delegated from the management level – HCF Director, or its Deputy, or Chief HCF Doctor. He/she takes overall responsibility, leads an intra-departmental team and regularly reviews issues and performance of the infection control and waste management practices in the HCF. Among his/her responsibilities are the following: a. Defining roles and responsibilities along each link of the chain along the cradle-to-crave infection control and MWM process; b. Ensuring adequate and qualified staff are in place, including those in charge of infection control and biosafety and waste management facility operation. c. Involving all relevant departments in an HCF, and build an intra-departmental team to manage, coordinate and regularly review the issues and performance in terms of ESMP implementation; d. Establishing an information management system to track and record the waste streams in HCF; e. Organizing and conducting capacity building and training that should involve medical workers, waste management workers and cleaners. Third-party waste management service providers should be provided with relevant training as well; f. Supervising the implementation of refurbishing civil works and compliance with the ESMP requirements; g. Ensuring specified in the ESMP requirements regarding MWM are met; h. Reporting to the MOH PMU on the results of ESMP implementation as well as on COVID- 19 cases. i. Handling of grievances from workers and patients/ their families. Ensuring the L&FS risk management procedures in place, training for staff, maintenance plans for active and passive fire safety systems and fire safety alarm systems; and j. Emergency preparedness and response repose and drills. Capacity building. As the proposed project is among the first projects in the country under the new WB Environmental and Social Framework (ESF) and Environmental and Social Standards (ESSs), the curent MOH PMU for Health Modernization Project and its Safeguards Specialist do not have experience and adequate knowledge on the new requirements, especially in terms labor safety and working conditions, hazardous waste management, community health and safety issues. Furthermore, the country’s capacity to manage risks associated with COVID-19 is a major concern as the ICUs and involved laboratories personnel may not have the detailed know-how on the bio-safety risk management. Equally, Belarus has no experience in handling social concerns around COVID-19 as well as related measures, including quarantine. The Project will provide funding to address these short-comings and it will be important that the Project sources international expertise to achieve international best practices on these matters in line with WB EHS and WHO guidelines. The capacity building and training should involve medical workers, waste management workers and cleaners. Third-party waste management service providers should be provided with relevant training as well. At this stage of project development it is proposed to include in the training topics the following: (a) COVID- 19 Infection Prevention and Control Recommendations; (b) Laboratory biosafety guidance related to the COVID-19; (c) WB ESF, EHS Guidelines and ESSs requirements; (d) Standard precautions for COVID-19 patients; (e) Risk communication and community engagement; (f) WHO guidelines on COVID-19 quarantine; and (g) WHO and National Sanitary Regulations and Norms in terms of MWM. During the inception phase of project implementation, the PMU will prepare a detailed plan for proposed training activities to be submitted to the WB for its review and approval. 69 7. Labor Management Under ESS 2, The project is expected to encompass direct workers and contracted workers. Direct workers could be healthcare workers, government civil servants, or those deployed as ‘technical consultants’ by the project. The healthcare workers and civil servants will be governed by a set of civil services code and the ‘technical consultants’ by mutually agreed contracts. There will be guidance on occupational health and safety for these workers as well as how they can register workplace grievances, should they arise. Contracted workers will be chiefly construction workers involved in minor civil works, who are expected to be locally hired. This ESMF includes ESMP templates for the works and those templates contain a section on worker health and safety requirements. The workers will not work in contaminated areas and will be safeguarded with appropriate protective measures that will be detailed in the site specific ESMP to be prepared. The ESMP will also include information on how workplace grievances can be registered should they arise. Contracted workers will be chiefly construction workers involved in minor civil works, who are expected to be locally hired. This ESMF includes ESMP templates for the works and those templates contain a section on worker health and safety requirements. The workers will not work in contaminated areas and will be safeguarded with appropriate protective measures that will be detailed in the site specific ESMP to be prepared. The ESMP will also include information on how workplace grievances can be registered should they arise. The more detailed information about Labor Management Procedure attached in Annex 2. 8. ESMF Disclosure and Public Consultation Consistent with requirements for stakeholder engagement, this section describes the consultation process and how project specific information would be disclosed during development for this ESMF. The speed and urgency with which this project has been developed to meet the growing threat of COVID-19 in the country has limited the project’s ability to have full scale public consultation on this ESMF before this project is approved by the World Bank. During the implementation of the Project, site specific ESMPs will be prepared per this ESMF by implementing agency. Information on subprojects will be posted on the respective health care facilities and MoH and PIU’s websites, and public consultations organized. Then draft ESMP prepared by local implementation agencies will be disclosed and consulted upon. Project stakeholders particularly local communities will continue to be consulted in the development of the ESMP. Public feedback will be included in the drafting of these documents before their completion. Draft ESMPs will be reviewed to consider inputs from consulted parties, information on public consultation added to ESMPs and the final versions of the ESMPs will be re-disclosed. Stakeholder engagement will be carried out at health institutions where COVID-19 activities are conducted by dissemination about COVID-19 protection, using prevention measures via relevant information posters; posts on social networks and health facilities’ websites, following the Bank’s echnical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings .21 Facility level focal points will be available to answer questions that COVID- 19 patients, their families and local communities may have. Disclosure of relevant project information helps stakeholders including those who may be negatively affected by the project to understand the Project environmental and social risks, impacts, opportunities and mitigation measures. Target of the information disclosure and communication will be: • to provide a schedule and information on activities that will be arranged to local communities, together with the mechanisms for gathering the feedback. 21 https://worldbankgroup.sharepoint.com/sites/wbunits/opcs/Knowledge%20Base/Public%20Consultations%20in%2 0WB%20Operations.pdf 70 • to inform key stakeholders of environmental and social risks and impacts associated with project activities. • to improve the knowledge about the Project’s COVID-19 related activities as well as associated risks and risk mitigation measures, • to ensure the best practices in terms of environmental protection and health and safety for workers and contractors, • to make available to the public a grievance procedure, in order to collect the feedback and to undertake corrective actions in cases that may lead to unnecessary risks or a negative opinion about project implementation. Care should be exercised to minimize COVID-19 infection risks in stakeholder engagement and consultation processes (such as minimum use of face-to face meeting and application of online tools). The table below, which is currently being further expanded as part of the update of the SEP, summaries the methods used to consult with key informants. Consultation Methods Timetabl Topic of Metho e: Target Responsibiliti consultation ds used Location stakeholders es and dates one-on-one Developme Project meetings, nt donor, design where possible international health organizations Sectoral Health and Institutional Interviews institutions Context management Project Implementi implementation Discussions ng agency arrangements Communit Focus Group Medical y outreach Discussion with educators approaches communities Hospital Managemen readiness Site visit report t and staff of assessment hospitals Behavior Summary children and Rapid Assessment findings adolescents The ESMF passed public discussions on the website of the Ministry of Health of the Republic of Belarus without comments and suggestions from 08/10/2020 to 08/23/2020. Sent for approval to the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus, the Ministry of Housing and Communal Services of the Republic of Belarus, the Ministry of Labor and Social Protection of the Republic of Belarus, State Institution “Republican Center for Hygiene, Epidemiology and Public Health�. As of 09/04/2020, approvals were received from the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus, the Ministry of Housing and Communal Services of the Republic of Belarus, the State Institution “Republican Center for Hygiene, Epidemiology and Public Health�. The revised ESMF document was posted on the website (https://belcmt.by/en/proekt-ekstrennoe-reagirovanie-na-covid- 19-v-respublike-belarus/obshchestvennoe-obsuzhdenie-proekta) on February 3, 2022. 71 9. Grievance Redress Mechanism (GRM) The right to appeal is a universal legal category, which is reflected in the legislation of most countries, even though the forms and procedural mechanism for the implementation of this right vary significantly. Working with citizens' appeals is one of the most important tasks of the Belarusian state in protecting the rights and legitimate interests of citizens, creating conditions for the free development of the individual and improving the quality of life of people based on the implementation of constitutional requirements for the mutual responsibility of the state to citizens and citizens to the state. According to Article 3 of the Constitution of the Republic of Belarus, the only source of state power and bearer of sovereignty in the Republic of Belarus is the people who exercise their power directly, through representative and other bodies in the forms and limits defined by the Constitution. Also, in accordance with Article 40 of the Constitution, every citizen has the right to send personal or collective appeals to state bodies. State bodies, as well as officials, are obliged to consider the appeal and give an answer on the merits within the time period specified by the legislation. Refusal to consider the submitted application must be in writing motivated. The fundamental legislative act of the Republic of Belarus in the field of resolving issues related to appeals of citizens is the Law of the Republic of Belarus dated July 18, 2011 No. 300-Z “On Appeals of Citizens and Legal Entities�. Transparency and accountability are fundamental principles of the Project. To this end, the MPO was created as part of the project. The purpose of the GRM is to strengthen accountability to the beneficiaries of the Project and to provide ways for feedback from the stakeholders of the Project on issues related to the activities of the Project. This mechanism allows you to identify and solve problems that affect the project. The GRM aims to reduce the risk that the Project will inadvertently harm citizens / beneficiaries and will serve as an important feedback mechanism to improve the impact of the Project. This mechanism is aimed not only at receiving and registering appeals, but also at the process of their consideration. The GRM does not apply to complaints related to procurement, record keeping on applicants' appeals to be examined in accordance with the legislation on constitutional proceedings, civil, civil procedural, economic procedural, criminal procedure legislation, legislation determining the administrative procedure, for - legislation on administrative procedures, other appeals, in relation to which legislative acts establish a different procedure for their submission and consideration. Procurement complaints are dealt with in accordance with the Purchasing Rules. The handling of complaints filed by project affected individuals financed by the World Bank is an important component of project risk management. GRM serves as an effective tool for the early detection, assessment and resolution of complaints and, therefore, for enhancing accountability to beneficiaries. GRM serves as an important feedback mechanism that can improve the impact of a project and mitigate unwanted Addressing grievances raised by individuals affected by World Bank-funded projects is an important component of managing project risks. A GRM serves as an effective tool for early identification, assessment and resolution of grievances and therefore for strengthening accountability to beneficiaries. The GRM serves as an important feedback mechanism that can improve project impact and mitigate the undesirable ones The GRM will be established at 3 levels: Level 1. Health facility site. All beneficiary health institutions will establish a GRM at the facility level. The channels for grievance submission will be disclosed near reception area of the healthcare facility, chief doctor’s office or the construction site if applicable. Special grievance box will be available for submitting grievances (including anonymous). The complainant can submit the grievance to the subproject level focal point (chief doctor or supervision engineer on construction related grievances only) with the help 72 of those easily accessible channels. The local focal point during 3 days should decide who is responsible for addressing the grievance (responsible persons within the health facility, PIU or the Contractor) and forward it accordingly. In case if the Contractor is responsible, local focal point controls progress with grievance resolution, terms of their addressing (no more than 30 days according to the national law) and respond to the complainant. The technical supervisor will be responsible for collecting the grievance from local residents and Contractor`s personnel if applicable and construction related. Collected information will be documented at health facility level GRM log and submitted to the central level PIU for GRM Focal Point attention and acknowledgment in project GRM log. Those who are not satisfied with response at the level 1 can appeal to level 2. Level 2. Local Authorities- the channels for grievance submission will be publicly available at local administration. Local authorities also could receive the grievances or appeals related to the project activity. The period for grievance addressing can’t exceed more than 14 days (as envisaged by Law of Republic Belarus "On citizens and legal entities appeals"). The PIU focal point will periodically request info regarding grievances received by local authorities and incorporate it to the grievance log with status of grievance/appeal resolution. Designated local authority representative will collect information and maintain an internal complaints/appeals journal for their record. He/she will submit this information to the central level PIU for GRM Focal Point attention and acknowledgment in project GRM log. Level 3. PIU – In case if the Complainant has not been satisfied with the results of grievance consideration at the local level, he/she can also submit the grievance to PIU which have designated focal person. The designated person should review the complaint during 3 business days and identify relevant circumstances of the situation. After that the corrective measures and responsible parties should be assigned during 5 business days. The corrective measures should take place within 10 business days and the response provided to the complainant during 5 business days after closing of the grievance. In case, if more time needed for addressing the complaint, the complainant will be further notified. MoH has an existing GRM based on the currently ongoing Belarus Health System Modernization Project building on the provisions of Belarus Law on “On Citizens and Legal Entities Appeals�) Project- related grievances will be handled at the Project Implementation Unit level by the Environmental and Social Consultant. Complaints and inquiries can be related to any aspects of the project activities, including allegations of Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH). In case such allegations are received by the GRM, the PIU must create an environment that will be safe, gender-sensitive, and appropriate to the context of the allegations. Necessary procedural steps should be developed in consultation with affected communities, particularly those most vulnerable, and linked to services for survivors. If necessary, a SEA risk assessment and a contextualized needs assessment will inform the development of new complaint channels and reinforce existing channels. Deadlines will not be imposed to complaints pertaining to SEA and SH, and confidentiality will have to be ensured to protect the victim(s) from any retaliation. 9.2 GRM Definition GRM in this ESMF is the procedure for receiving, evaluating and considering applications related to the Project that come from individuals and legal entities, and which are covered by the Project. 73 9.3 Operation and use of GRM Action: The project includes GRM, which is provided to project participants for questions, comments, suggestions and / or statements, or any form of feedback for all activities financed by the Project. Circle of persons: beneficiaries of the Project; Persons to whom the Project applies (i.e. those who will and / or may be affected by the Project directly or indirectly). Management: GRM is managed by the PMO within the framework of the Project. Filing appeals: appeals can be submitted at any time during the implementation of the Project. a) Ways to submit grievances/inquiries: (i) Email: pmsz@belcmt.by; (ii) on the website of RSPC MT: http://www.belcmt.by; (iii) written appeals are sent to the address: Republic of Belarus, Minsk, str. P. Brovki, 7A, 220013; (iv) by fax: 331-34-84; (v) where appropriate, personal reception by the Head of the PIU or his deputy, but with strict following of public health guidelines. b) Complaints may be submitted anonymously, in accordance with Article 23 of the Law of the Republic of Belarus “On Citizens and Legal Entities Appeals�, that will be used for this project too. Confidentiality must be ensured in all cases, including the case when the person submitting the appeal choses anonymity. c) Collection / receipt of requests. The specialist (Project administrator), as the person accepting the application, must fill out the registration form for applications (Appendix A of the List of amendments and additions No. 2 to the Operational Guide) or provide the applicant with a form for self-completion, in accordance with the requirements of Article 12 of the Law “On appeals of citizens and legal entities. � Then, the appeal should be sent to the general registration system for sorting and redirection to the appropriate department or directly to the PIU, if the appeal is related to a specific project activity. The director of the RTSC MT determines who should send the appeal to prepare a response, whether the non-procurement complaint requires investigation. In determining who will be the responsible officer to review the appeal, the director of the RTSC MT ensures that there is no conflict of interest, i.e. all persons participating in the review process should not have any material, personal or professional interest in the results and no personal or professional connection with the applicants. The specialist (Project administrator), as the person responsible for registering appeals, enters this data into the electronic journal of registration of appeals. Incoming applications of applicants are registered on the day of their receipt in the prescribed manner. The applicants' applications received on a non- working day (non-working time) shall be registered no later than on the first working day following it. Envelopes from written applications from applicants are saved when it is only possible to establish the address of the applicant from them or when the date on the stamp of the calendar stamp confirms the date of their sending and receiving. When an applicant submits several identical appeals or appeals containing clarifying (supplementing) documents and (or) information, before sending him a response (notice) to the initial appeal, such appeals are considered as one appeal under the registration number of the initial appeal. Repeated calls, upon their receipt in the PMO, are assigned the registration number of the first call by adding an additional serial number. The number, type of proposals and questions should also be recorded and discussed at the PMO meetings so that they can be analyzed to improve the implementation of the Project. d) Review Responses to the applicants' appeals are given within the time period established in Article 17 of the Law of the Republic of Belarus “On Appeals of Citizens and Legal Entities�/ Applications should be considered no later than fifteen days, and applications requiring additional study and verification, no later than one month, unless otherwise specified by legislative acts. If, in order to solve the issues set forth in the appeals, certain actions must be taken (additional consultations to ensure an answer, the appeal is serious and 74 additional materials must be studied for an answer), receiving information from a foreign state in time exceeds Within one month, the applicants shall be notified in writing no later than one month from the day following the day of receipt of the application on the reasons for exceeding the one-month period and on the timing of such actions or the timing of consideration of the merits. The results of the consideration of the application and the proposed response to the applicant are presented to the head of the hydraulic fracturing and the Director of the Republican Scientific and Practical Center for Signature. e) Response to the applicant The answer should be based on the consideration of the application, and, if necessary, contain references to the legislation of the Republic of Belarus. The response to the applicant by e-mail is sent by a specialist (Project administrator). Written and (or) electronic appeals of citizens and legal entities and documents related to their consideration are formed into cases in accordance with the approved nomenclature of cases. 9.5 Publication The specialist (Project Administrator), as the person responsible for filling the RTSC MT website (http://belcmt.by) with information on the implementation of the Project, will publish on the site, after the appeal has been reviewed, the essence of the application and the text from Answer to the applicant (measures taken to resolve) without disclosing the applicant’s personal data. 9.6 Staffing and capacity building Tasks and responsibilities: The Director of the RTSC MT distributes the responsibilities among the Project staff in accordance with the Operational Manual. If necessary, information may be periodically updated with respect to: - general management of the GRM system; - measures aimed at raising public awareness; - collection of appeals; - registration of appeals; - notification of the applicant; - sorting appeals or their distribution into categories; - review / investigation; - making decisions based on the results of the review / investigation; - publication of response measures to appeals; - organization and implementation of information materials and awareness-raising campaigns; - Submission of reports and comments based on the results of the GRM. 9.7 Transparency, monitoring and reporting a. Transparency Policies, procedures and regular updates in the GRM system, submitted and resolved applications will be available on the Internet. They will be updated quarterly. b. Periodic internal monitoring and reporting The Project Monitoring Specialist will quarterly evaluate the functioning of the GRM for: - inclusion in the quarterly reports of the results of the GRM, including any suggestions and questions; - a review of the stages of the review of complaints to track those that have not yet been resolved, and suggestions of necessary corrective measures. During meetings, the PIU should discuss and consider the effectiveness and use of GRM, as well as submit proposals on how to improve this mechanism. c. Reporting submitted to the WB: 75 Quarterly reports should include an GRM section that will contain information on the following: - status of the establishment of the GRM (procedures, staffing, training, public awareness campaigns, budgeting, etc.); - quantitative data of appeals, the number of appeals that really were related to the Project and the number of appeals that were considered; - Qualitative data on the type of appeals and the answers provided on them, problems that remained unresolved; - the time required to resolve appeals; - factors that may affect the use of the feedback system of the GRM / beneficiaries; - any corrective measures taken. During public consultation the people, who feel negative impact by the project activities will receive contact information for communication with GRM focal point specialist The GRM will include the following steps: • Receipt and recording of complaints – 2 business days • Determination of the appropriate department/authority to investigate the complaint – 3 business days • Investigation of complaint by the appropriate department – 10 business days • Response – 2 business days Once all possible redress has been proposed and if the complainant is still not satisfied then they should be advised of their right to legal recourse and appeal in accordance with local legislation and in line with ESF principles. 76 10. Stakeholder Engagement The speed and urgency with which this project has been developed to meet the growing threat of COVID-19 in the country has limited the project’s ability to develop a complete SEP before this project is approved by the World Bank. The initial SEP was developed and disclosed prior to project appraisal, as the starting point of an iterative process to develop a more comprehensive stakeholder engagement strategy and plan. It will be updated periodically as necessary, with more detail provided in the first update planned after project approval. The following stakeholder engagements have happened prior and during the preparation of this operation. They have been used to consult with and inform the actions of the Belarus authorities: The Ministry of Health has collaborated with the World Bank, World Health Organization (WHO), United Nations Population Fund (UNFPA), United Nations International Children’s Emergency Fund (UNICEF) and the United Nations Development Program (UNDP) on several health care sector reforms, including on primary health care, non-communicable diseases, tobacco control, TB prevention and the efficiency of health spending. These partnerships are currently leveraged to support the Government’s COVID-19 coordinated response, including through partners’ support to the design and implementation of this Project. Specifically, the WHO has helped in the assessment of the Government’s readiness to respond to the COVID-19 outbreak, determine the appropriateness of the activities planned under this Project, and review the list of equipment to be procured. UN agencies will support procurement, including the direct procurement of medical supplies. The Project’s Stakeholder Engagement Plan has more information on the methods to be used for stakeholder engagement, following the Bank’s Technical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings.22 The Stakeholder Engagement Plan is currently being updated and disclosed within 30 days of project effectiveness. 22 https://worldbankgroup.sharepoint.com/sites/wbunits/opcs/Knowledge%20Base/Public%20Consultations%20in%2 0WB%20Operations.pdf 77 Belarus Emergency COVID-19 Project ESMF Annex 1. Main laws regulating questions of environmental protection, labor protection and safety measures and sanitary and epidemiologic well-being of population in the Republic of Belarus № Laws and regulations i. Environmental Protection 1 The Law of the Republic of Belarus dated 11.26.1992 № 1982-XII “On environmental protection� 1 2 The Law of the Republic of Belarus dated 16.12.2008 № 2-З “On atmospheric air protection� 2 3 The Law of the Republic of Belarus dated 12.11.2001 № 56-З “On the protection of the ozone 3 layer� 4 The Law of the Republic of Belarus dated 14.06.2003 № 205-З “On plant world� 4 5 The Law of the Republic of Belarus dated 15.11.2008 №150-З “On specially protected natural 5 areas� 6 The Law of the Republic of Belarus dated 20.07.2007 № 271-З “On waste management� 6 7 The Law of the Republic of Belarus dated 10.07.2007 № 257-З “On wildlife� 7 8 The Law of the Republic of Belarus dated 18.07.2016 № 399-З “On state ecological expertise, 8 strategic environmental assessment and environmental impact assessment� 9 The Law of the Republic of Belarus dated 09.01.2006 № 93-З “On hydrometeorological 9 activities� 1 Decree of the President of the Republic of Belarus dated 01.09.2010 № 450 “On licensing of 10 certain types of activities� 1 Decree of the President of the Republic of Belarus dated 17.11.2011 № 528 “On integrated 11 environmental permits� 1 Decree of the President of the Republic of Belarus dated 24.06.2008 № 348 “On the rates to 12 determine the amount of compensation for harm caused to the environment� 1 Decree of the President of the Republic of Belarus dated 20.10.2005 № 487 “On ratification by 13 the Republic of Belarus of the Convention on environmental impact assessment in a cross-border context� 1 Resolution of the Council of Ministers of the Republic of Belarus dated 29.10.2010 №1592 “On 14 approval of the Regulations on the procedure of conducting public environmental expert review� 1 Resolution of the Council of Ministers of the Republic of Belarus dated April 28, 2004 No. 482 15 "On approval of provisions on the procedure for conducting monitoring of surface water, groundwater, atmospheric air, local environmental monitoring and the use of these monitoring data as part of the National Environmental Monitoring System in the Republic of Belarus" 1 Resolution of the Council of Ministers of the Republic of Belarus dated 19.01.2017 № 47 “About 16 some measures for implementation of the Law of the Republic of Belarus from 18.07.2016 № 399 -З “About the state ecological expertise, strategic environmental assessment and environmental impact assessment� 1 Resolution of the Council of Ministers of the Republic of Belarus of June 14, 2016 No. 458 "On 17 Approval of the Regulation on the Procedure for Organizing and Conducting Public Discussions of Draft Environmentally Significant Decisions, Environmental Reports on Strategic Environmental Assessment, Reports on Environmental Impact Assessment, Taking into Account Environmentally Significant Decisions and Making Changes and additions to some resolutions of the Council of Ministers of the Republic of Belarus " 1 Resolution of the Council of Ministers of the Republic of Belarus dated July 17, 2008 No. 1042 18 "On approval of the Regulation on the procedure for calculating the amount of compensation for harm 78 Belarus Emergency COVID-19 Project ESMF caused to the environment, and drawing up an act on establishing the fact of causing harm to the environment, changing and invalidating certain resolutions of the Council of Ministers of the Republic of Belarus" 1 Resolution of the Council of Ministers of the Republic of Belarus of 05/21/2009 No. 664 “On 19 Approval of the Regulation on the Procedure for Issuing Permits for Emissions of Pollutants into the Air, Amendments and (or) Additions, Suspension, Renewal, Extension of atmospheric air, termination of their action " 2 Resolution of the Council of Ministers of the Republic of Belarus dated November 28, 2019 No. 20 818 "On the procedure for waste management" 2 Resolution of the Council of Ministers of the Republic of Belarus dated January 22, 2020 No. 36 21 "On the list of hazardous waste, transactions with which are subject to registration" 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 22 Belarus dated 18.07.2017 №5-Т “On approval of the environmental standards and rules� 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 23 Belarus dated 07.06.2013 No. 25 "On approval of the Instruction on the procedure for maintaining an enterprise's ecological passport and invalidating the Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus No. 107 dated December 1, 2008" 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 24 Belarus dated 01.02.2007 No. 9 "On approval of the Instruction on the procedure for conducting local environmental monitoring by legal entities carrying out economic and other activities that have a harmful effect on the environment, including environmentally hazardous activities " 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 25 Belarus dated 04.05.2015 No. 18 "On requirements for the design and development of projects for water protection zones and coastal strips of water bodies" 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 26 Belarus dated 04.05.2015 № 19 “On approval of the Instruction on establishment of basin Councils� 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 27 Belarus dated 04.05.2015 No. 20 "On some issues of obtaining a permit for special water use" 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 28 Belarus dated 05/04/2015 No. 21 "On some issues of developing technological standards for water use" 2 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 29 Belarus dated 08.12.2014 No. 42 "On accounting for ozone-depleting substances, inventory of equipment and technical devices containing ozone-depleting and (or) ozone-safe substances" 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 30 Belarus dated 19.12.2008 № 122 “On approval of the Instruction on the management of ozone-depleting substances� 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 31 Belarus of 20.12.2011 No. 53 "On the forms of documents for obtaining and issuing integrated environmental permits" 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 32 Belarus of 23.06.2009 No. 42 "On Approval of the Instruction on the Procedure for Inventorying Pollutant Emissions into the Air" 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 33 Belarus of 23.06.2009 No. 43 “On Approval of the Instruction on the Procedure for Establishing Standards for Permissible Emissions of Pollutants into the Air 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 34 Belarus dated May 26, 2017 No. 16 "On the standards of permissible discharges of chemical and other substances in wastewater" 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 35 Belarus dated 05/29/2009 No. 30 "On approval of the Instruction on the procedure for classifying objects of influence on the atmospheric air into certain categories" 79 Belarus Emergency COVID-19 Project ESMF 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 36 Belarus of 05/29/2009 No. 31 “On approval of the list of pollutants, categories of objects of influence on the atmospheric air, for which the standards of permissible emissions of pollutants into the atmospheric air are established, and the list of objects of influence on the atmospheric air, sources of emissions for which the standards of permissible emissions of pollutants into the air are not established, and the decree of the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus of February 28, 2005 No. 10 is invalidated " 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 37 Belarus dated 30.03.2015 № 13 “On establishment of quality standards of water in surface water objects� 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 38 Belarus dated 22.10.2010 № 45 “On approval of the Instruction on the procedure for drafting and approval of instructions for industrial waste management� 3 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 39 Belarus dated 29.02.2008 №17 “On approval of the Instruction on the procedure of production wastes inventory� 4 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 40 Belarus dated 09.12.2008 No. 112 "On establishing the form of an accompanying passport for the transportation of industrial waste and approving instructions on the procedure for its registration" 4 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 41 Belarus dated 20.06.2014 No. 27 "On accounting for used natural resources, emissions and discharges of pollutants into the environment, waste management, and other types of harmful effects on the environment" 4 Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of 42 Belarus, the Ministry of Health of the Republic of Belarus and the Ministry of Emergency Situations of the Republic of Belarus dated November 29, 2019 No. 41/108/65 "On the procedure for determining the degree of hazard of production waste and hazard class of hazardous production waste" 4 National Classifier of the Republic of Belarus OKRB 021-2019 "Classifier of Wastes Generated 43 in the Republic of Belarus", approved by the Resolution of the Ministry of Natural Resources and Environmental Protection of the Republic of Belarus dated 09.09.2019 No. 3-T 45 Water Code of the Republic of Belarus� dated 30.04.2014 46 Land Code of the Republic of Belarus dated 23.07. 2008 47 Code of the Republic of Belarus on Subsoil Resources dated 14.07.2008 48 Forest Code of the Republic of Belarus dated 24.12.2015 ii. Sanitary and epidemiologic well-being of population 1 The Law of the Republic of Belarus dated 17.06.1993 № 2435-XII “On health care� 2 The Law of the Republic of Belarus dated 07.01.2012 № 340-З “On the sanitary and 2 epidemiological well-being of the population� 3 Resolution of the Ministry of Health of the Republic of Belarus dated 11.10.2017 № 91 “On 3 approval of the sanitary standards and rules “Requirements to sanitary protection zones of the organizations, constructions and other objects making impact on health of the person and the environment� 4 Resolution of the Ministry of Health of the Republic of Belarus dated 30.12.2016 № 141 “On 4 approval of the sanitary standards and rules “Requirements to atmospheric air of settlements and places of population rest� 5 Resolution of the Ministry of Health of the Republic of Belarus dated 08.11.2016 №113 “On 5 statement and enforcement of standards of threshold limit values of pollutants in atmospheric air and approximately safe levels of pollutants influence in atmospheric air of settlements and places of mass rest of the population and revocation of selected resolutions of the Ministry of Health of the Republic of Belarus� 6 Resolution of the Ministry of Health of the Republic of Belarus dated 21.12.2010 г. №174 “On 6 approval of danger classes of pollutants in atmospheric air, an order of reference of pollutants to certain 80 Belarus Emergency COVID-19 Project ESMF danger classes of pollutants and revocation of Resolution of the Ministry of Health of the Republic of Belarus dated 30.06.2009 № 76� iii. Labor safety 1 The Law of the Republic of Belarus dated 23.06.2008 № 356-З “On labor protection� 2 The Law of the Republic of Belarus dated 15.06.1993 № 2403-XII “On fire safety� 3 The Law of the Republic of Belarus dated 05.01.2016 № 354-З “On industrial safety� 4 The Law of the Republic of Belarus dated 06.06.2001 № 32-З “On the transport of dangerous goods� 5 The Law of the Republic of Belarus dated 05.01.2008 № 313-З “On road traffic� 6 The Code of the Republic of Belarus dated 26.07.1999 № 296-З “Labor Code of the Republic of Belarus� 7 The Code of the Republic of Belarus dated 07.12.1998 № 218-З “Civil Code of the Republic of Belarus� 8 Decree of the President of the Republic of Belarus of 25.08.2006 No. 530 "On insurance activities" 9 Resolution of the Council of Ministers of the Republic of Belarus dated January 15, 2004 No. 30 "On investigation and registration of industrial accidents and occupational diseases" 81 Belarus Emergency COVID-19 Project ESMF Annex 2. Labor Management Procedure 1. INTRODUCTION 1.1. Project Background. The purpose of this annex is to provide the basic capabilities of the Project in the field of labor resources management, as well as the applied procedures and methods. Workforce management to ensure compliance, transparency and accountability in the use of workforce management procedures, and it will work throughout its implementation. 1.2 Environmental and Social Aspects. This project addresses the environmental and social aspects through the World Bank’s Environmental and Social Standards (ESS) approach/ framework. One of the Standard- ESS 2- relates to Labor and Working Conditions and expects the Borrowers to develop labor management procedures (LMP). The LMP enables identify main labor requirements and risks associated with it and help the Borrower to determine the resources necessary to address labor issues. The LMP is a living document, which is initiated early in project preparation, and is reviewed and updated throughout development and implementation of the project. Accordingly, this document details out the type of workers likely to be deployed by the project and the management thereof. 2. OVERVIEW OF LABOR USE ON THE PROJECT ESS 2 categorizes the workers into: direct workers persons hired or engaged directly by the Borrower (including the project initiator and the responsible department) specifically to perform work in connection with the project), contracted workers (hired or engaged by a third party to perform work related to the main functions of the project, regardless of the place of its implementation (contractors, subcontractors, brokers, agents or intermediaries, consultants, employees of the main suppliers (hired or hired by the main suppliers of the Borrower). At the ESRS concept stage, it was envisaged that the project would include both direct employees (PIU) and employees under an employment contract (contractors, subcontractors, brokers, agents or intermediaries, consultants). While HCF workers employed in hospitals and laboratories do not strictly fall under the ESS2 definition of project workers, due to occupational health and safety risks to which they can be exposed during the COVID- 19 pandemic, they have been included in this LMP to ensure that they are provided with adequate health and safety measures in the workplace. 2.1. Number of Project Workers. Direct Workers. Preliminary, the total number of the Project staff is estimated 7 but will be clarified when project implementation begins. Contracted Workers. The number of project contracted workers who will be employed are not known as of now. This will become known as and when implementation begins. It will be clarified when project implementation begins. Community workers: there are not expected to be any community workers in this project 2.2. Characteristics of Project Workers. General guidance for the implementation of the Project in the Republican Scientific and Practical Center of MT will be carried out by the Director (his substitute), Deputy Director for Economic Technologies and International Projects (according to competence). The overall management of the financial management, accounting and reporting of the Project is entrusted to the chief accountant of the Republican Scientific and Practical Center for MT. Direct management of the Project is entrusted to the head of the PIU of the Republican Scientific and Practical Center of MT. To implement the Project, a PIU will be created, consisting of: specialist (coordinating project components) - team leader; legal adviser; specialist (project administrator); 82 Belarus Emergency COVID-19 Project ESMF specialist (monitoring and evaluation); specialist (financial support); specialist (in accounting); specialist (for organizing purchases); specialist (for organizing purchases); other specialists if necessary. Direct management of the procurement process of the Project is entrusted to the head of the PMO procurement organization sector, direct management of the financial management, accounting and reporting of the Project is entrusted to the head of the PMO financial support sector. To implement the Project Components, RSPC MT will attract consultants in the following areas: civil engineer, engineer (specialist) for protective provisions, communications consultant. Given that the repair works will be small in volume, contractors for repairs will use local labor. Most likely, these will be predominantly men (especially for low-skilled workers). The project will only finance minor refurbishing civil works on the property of existing HCFs. These works, which might include the provision and/or repair of handwashing and hygiene facilities, upgrading electrical work to safely operate medical equipment, maintenance, and cleaning of COVID wards, other emergency internal repairs to ensure patient and staff safety and infection prevention and control, and, possible rehabilitation or installation of medical waste incinerators, will be mostly community-based activities and environmental issues (and impacts thereof) are expected to be temporary, predictable, and easily mitigable. Timing of Labor Requirements: The direct workers at the Project will generally be required full time and around the year for the project duration. Other experts/consultants will be hired on demand basis throughout the project period. Timing for involvement of contracted workers will be known at later stages, however they will be engaged depending on implementation of various sub-components on specific time slots. Contracted workers will be required as per as needed. The work hours should not exceed 8 hours a day, with the provision of at least 1 hour for the rest. Migrant workers: there are not expected to be any community workers in this project 3. ASSESSMENT OF KEY POTENTIAL LABOR RISKS In this section, based on the provided information, the potential risks are described. Labor risks associated with contracted workers at subproject level. There is non-existence of construction activities under most of the proposed project components and no major risks are envisaged. Construction- repair works will be implemented by local contractors and where possible contracted workers will be hired locally. Labor risks including labor influx and associated Gender-Based Violence (GBV), and risk of child labor use. The Project adherence to the national labor code which prohibits forced labor. Since construction works to be supported under the under subproject will be very small in scale and prioritized by Project, and no outside labor force deployed, the risks of forced labor or GBV related issues not expected. Nonetheless, the contractors will be required in the contract to commit against the use of forced labor, in addition to prior screening of contractor suitability, Project staff in charge of contractor supervision will monitor and report the absence of forced labor. Occupational Health and Safety (OHS) risks are low to moderate and will depend on the type of sub- components works to be implemented. All contractors hired for small-scale renovation works under sub- component 1.1. will be required to develop and implement written labor management procedures, including procedures to establish and maintain a safe working environment as per 7 requirements of ESS2. All contractors under sub-component 1.1. will be required under the Environmental and Social Management Plan 83 Belarus Emergency COVID-19 Project ESMF (ESMP) to ensure workers will use basic safety gears, receive basic safety training and other preventive actions as provided in the Project’s Environmental and Social Management Framework (ESMF). Risks related to employment conditions. Workers will be hired by the Project - directly (as direct employees) or indirectly (under contracts with consultants or service providers). Practice shows that construction contractors enter into employment contracts with their employees, providing for one-time payments for an individual type of service or the performance of services. The period of time that employees will be attracted will be limited to the number of months. Overtime work risks. There is a risk that the current practice of unrecorded working hours and no compensation for overtime work will continue. According to the Labor Code of the Republic of Belarus, with the consent of the employer, direct workers will receive other hours of rest on another day as compensation for overtime work (Article 147). The project will be aimed at eliminating the risk by informing direct workers about their rights and creating grievance mechanisms in the Republican Scientific and Practical Center of MT. The risks of COVID-19 infection among direct workers (PIU) on the project are substantial. The risks of COVID-19 infection among HCF`s staff on the project are high Workers in HCFs are particularly vulnerable to contagions like COVID-19. Healthcare-associated infections due to inadequate adherence to occupational health and safety standards can lead to illness and death among health and laboratory works as well as the wider spreading of the disease within communities. The ESMP contains detailed procedures, based on WHO guidance, for protocols necessary for treating patients and handling medical waste as well as environmental health and safety guidelines for staff, including the necessary PPE. Proper disposal of sharps, disinfectant protocols, and regular testing of healthcare workers is included. These risks are temporary and can be mitigated through following measures: • The PIU will conduct a review of the HCF’s protocols for protecting healthcare workers from infections disease based on current WHO Guidelines for COVID-19 and the Infection Prevention and Control Protocol contained in Annex 10. • The PIU will conduct training for HCF staff on site on the signs and symptoms of COVID-19, how it is spread, how to protect themselves (including regular hand washing and social distancing) and what to do if they or other people have symptoms; • Placing posters and signs around the site, with images and text about protection measures in local languages.; • Establish adequate rest areas, washing and cleaning facilities, regular testing during the working hours; • Conduct regular and thorough cleaning of all site facilities, including offices, accommodation, canteens, common spaces (for further information see WHO interim guidance on water, sanitation and waste management for COVID-19 https://www.who.int/publications/i/item/water-sanitation- hygiene-and-waste-management-for-covid-19); • WHO provides detailed advice on what should be done to treat a person who becomes sick or displays symptoms that could be associated with the COVID-19 virus (for further information see WHO interim guidance on infection prevention and control during health care when novel coronavirus infection is suspected; https://www.who.int/publications/i/item/infection-prevention-and-control-during-health-care-when- novel-coronavirus-(ncov)-infection-is-suspected-20200125). The ESMP to be prepared for each HCF will include gap filling measures that need to be undertaken before an HCF can particulate in the project. In preparing ESMP, social screening will be carried out in order identify categories of workers who are at deferent risk levels (low, moderate and high), and location and 84 Belarus Emergency COVID-19 Project ESMF institutionally specific measures will be included in the ESMP. 4. BRIEF OVERVIEW OF NATIONAL LEGISLATION 4.1. National labor legislation: Terms and conditions. The legislation of the Republic of Belarus on labor protection is based on the Constitution of the Republic of Belarus and consists of the Labor Code of the Republic of Belarus, the Law of the Republic of Belarus "On labor protection" and other regulatory legal acts of the Republic of Belarus. The Constitution of the Republic of Belarus on working conditions and labor protection grants everyone the right to: safe work - the use of forced and child labor is prohibited. (Article 41); right to rest - workers have the right to rest. For employees, this right is ensured by the establishment of a working week not exceeding 40 hours, a reduced duration of work at night, the provision of annual paid leaves, and days of weekly rest. (Article 43); social security - everyone is guaranteed social security in old age, in the event of illness, disability and disability or loss of a guardian in cases and in the manner prescribed by law. (Article 47). THE CONSTITUTION OF THE REPUBLIC OF BELARUS is the legal basis for organizing work on labor protection. (Article 41. Citizens of the Republic of Belarus are guaranteed the right to work as the most worthy way of self-affirmation of a person, that is, the right to choose a profession, occupation and work in accordance with vocation, abilities, education, vocational training and taking into account social needs, as well as healthy and safe working conditions. The state creates conditions for full employment of the population. In case of unemployment for reasons beyond his control, he is guaranteed training in new specialties and advanced training, taking into account social needs, as well as unemployment benefits in accordance with the law. Citizens have the right to protection of their economic and social interests, including the right to associate in trade unions, collective bargaining (agreements) and the right to strike Forced labor is prohibited, except work or service determined by a court verdict or in accordance with the law of emergency and martial law. The Labor Code of the Republic of Belarus (hereinafter referred to as the Labor Code of the Republic of Belarus) applies to all employees and employers who have entered into an employment contract on the territory of the Republic of Belarus, unless otherwise provided by legislative acts or international treaties of the Republic of Belarus. The main tasks of the TC RB are: 1) regulation of labor and related relations; 2) development of social partnership between employers (their associations), employees (their associations) and government bodies; 3) the establishment and protection of the mutual rights and obligations of employees and employers. Wages and deductions In accordance with Article 57 of the Labor Code of the Republic of Belarus, wages are remuneration for work that the employer is obliged to pay to the employee for the work performed, depending on its complexity, quantity, quality, working conditions and employee qualifications, taking into account the actual hours worked, as well as for the periods included in work time. The employee's salary is not limited by the maximum amount. According to Article 58 of the Labor Code of the Republic of Belarus, the indexation of wages is carried out in connection with inflation, as well as in case of its untimely payment in the manner and under the conditions stipulated by law. Minimum wage (monthly and hourly) - the state minimum social standard in the field of labor remuneration, which the employer is obliged to apply as the lower limit of remuneration of employees for work under normal conditions during normal working hours when performing the employee's duties arising from local legislation. legal acts and employment contract. (Article 59 of the Labor Code of the Republic of Belarus). The size of the minimum wage is set by the Government. This right is granted to the Government by the fourth part of Article 4 of the Law of the Republic of Belarus "On the establishment and procedure for 85 Belarus Emergency COVID-19 Project ESMF increasing the minimum wage" and today it is 375 rubles. (Resolution of the Council of Ministers of the Republic of Belarus dated August 29, 2019 No. 582 "On establishing the amount of the monthly minimum wage"). The procedure for establishing and increasing the minimum wage is determined by legislation. Working hours Working hours are 40 hours per week for workers. For each hour of work in overtime, on public holidays, holidays (part one of Article 147 of the Labor Code of the Republic of Belarus) and weekends in excess of the wages accrued for the specified time, an additional payment is made: 1) employees with piecework wages - not lower than piece rates; 2) employees with time wages - not lower than hourly wage rates (wages), salaries. The specific number of additional payments in budgetary organizations and other organizations receiving subsidies, whose employees are equal in remuneration to employees of budgetary organizations, is established by the Government of the Republic of Belarus, in other organizations - by an employment contract and (or) a local legal act. For overtime work and weekends, another unpaid rest day may be provided in exchange for the additional payment with the consent of the employee. At the same time, for hours of overtime work, one unpaid rest day shall be provided at the rate of an eight-hour working day (one rest day for eight hours of overtime work). If work on public holidays and holidays (part one of Article 147) was performed in excess of the monthly norm of working time, the employee, at his request, in addition to the additional payment, is given another unpaid rest day. All project employees receive daily and weekly leave in accordance with labor legislation. Rest time (breaks) In those jobs where it is necessary due to the special nature of work, as well as in the production of work, the intensity of which is not the same during the working day (shift), the working day can be divided into separate parts with breaks of at least two hours, including a break for rest and nutrition. At the same time, the total duration of working hours should not exceed the established duration of daily work. Break times during the working day are not included in the working hours. The decision to divide the working day into parts is taken by the employer in agreement with the trade union (Article 127). Leaves Employees, regardless of who is their employer, the type of employment contract they have concluded, the form of organization and remuneration, are entitled to basic leave, unless otherwise provided by legislative acts (Article 154 of the Labor Code of the Republic of Belarus). Obligated persons who are employed under a court order on employment are entitled to basic work leave of seven calendar days. The duration of the main vacation is provided to the employee for at least 24 calendar days. The duration of the main labor leave for civil servants, employees of the Investigative Committee and military personnel doing military service under contract is established respectively by the Law of the Republic of Belarus of June 14, 2003 N 204-З, Decree of the President of the Republic of Belarus of November 10, 2011 N 518, Decree of the President of the Republic of Belarus of 25.04.2005 N 186. Lists of organizations and positions of employees, as well as categories of employees with the duration of the main leave of more than 24 calendar days, the conditions for granting and the specific duration of this leave are established by the Government of the Republic of Belarus in agreement with the President of the Republic of Belarus. The length of the main leave is compulsory for all employers. (Article 155 of the Labor Code of the Republic of Belarus). Employees employed in jobs with harmful and (or) dangerous working conditions, on the basis of certification of workplaces for working conditions, are granted additional leave for work with harmful and (or) dangerous working conditions. 86 Belarus Emergency COVID-19 Project ESMF Employees whose work is related to the peculiarities of the work are provided with additional leave for the special nature of the work. Overtime work For each hour of work in overtime, on public holidays, holidays (part one of Article 147 of the Labor Code of the Republic of Belarus) and weekends in excess of the wages accrued for the specified time, an additional payment is made: 1) employees with piecework wages - not lower than piece rates; 2) employees with time wages - not lower than hourly wage rates (wages), salaries. The specific amount of additional payments in budgetary organizations and other organizations receiving subsidies, whose employees are equal in remuneration to employees of budgetary organizations, is established by the Government of the Republic of Belarus, in other organizations - by an employment contract and (or) a local legal act. For overtime work and weekends, another unpaid rest day may be provided in exchange for the additional payment with the consent of the employee. At the same time, for hours of overtime work, one unpaid rest day shall be provided at the rate of an eight-hour working day (one rest day for eight hours of overtime work). If work on public holidays and holidays (part one of Article 147) was performed in excess of the monthly norm of working time, the employee, at his request, in addition to the additional payment, is given another unpaid rest day. Labor disputes The procedure for resolving individual labor disputes is governed by Chapter 17 of the Labor Code of the Republic of Belarus (Articles 233-251), and collective labor disputes - by Chapter 36 of the Labor Code of the Republic of Belarus (Articles 377-399). Individual labor dispute - unresolved disagreements between the employer and the employee (the person who was refused to conclude an employment contract, the dismissed employee) on the application of labor legislation, collective agreement, agreement, other local legal acts, compliance with the terms of the employment contract. Individual labor disputes are considered: 1) commissions for labor disputes; 2) by courts (Article 233 of the Labor Code of the Republic of Belarus). The Labor Dispute Commission (if established) is a mandatory primary body for the consideration of labor disputes, except for cases when the Labor Code of the Republic of Belarus and other legislative acts establish a different procedure for their consideration. Grievances The Law of the Republic of Belarus "On Appeals of Citizens and Legal Entities" contains legal provisions on the established information channels through which citizens can submit their complaints, inquiries and complaints. Article 17 of the Law sets the deadlines for considering complaints: 15 days from the date of receipt, which do not require additional study and research, and 30 days for applications that require additional study. A brief overview of national legislation: health and safety. Labor protection issues are regulated by the Constitution of the Republic of Belarus. According to article 41, citizens of the Republic of Belarus are guaranteed the right to work as the most worthy way of self-affirmation of a person, that is, the right to choose a profession, occupation and work in accordance with vocation, abilities, education, professional training and taking into account social needs, as well as healthy and safe working conditions. Women are provided with equal opportunities with men in obtaining education and vocational training, in labor and promotion (work), in social, political, cultural and other spheres of activity, as well as the creation of conditions for the protection of their labor and health (Article 32). Relations in the field of labor protection are governed by labor protection legislation, as well as international treaties of the Republic of Belarus and international legal acts constituting the law of the Eurasian Economic 87 Belarus Emergency COVID-19 Project ESMF Union, including technical regulations of the Customs Union and the Eurasian Economic Union, containing labor protection requirements. The Law of the Republic of Belarus "On labor protection" is a fundamental act regulating legal relations in the field of labor protection (hereinafter - the Law on Labor Protection), which is aimed at regulating public relations in the field of labor protection and the implementation of the citizens' right to healthy and safe working conditions established by the Constitution of the Republic of Belarus 5.ESS2 AND POLICY GAP 5.1. The World Bank Environmental and Social Standards (ESS): Standard 2. The World Bank’s requirements related to labor are outlined in its ESS2. Implementing agency promotes sound worker- management relationships and provides safe and healthy working conditions. Key objectives of the ESS 2 are to: • Promote safety and health at work; • Promote the fair treatment, nondiscrimination and equal opportunity of project workers; • Secure protection of project workers, including vulnerable workers such as women, persons with disabilities, children (of working age, in accordance with this ESS) and migrant workers, contracted workers, community workers and primary supply workers, as appropriate; • Prevent the use of all forms of forced labor and child labor; • Support the principles of freedom of association and collective bargaining of project workers in a manner consistent with national law; and • Provide project workers with accessible means to raise workplace concerns. ESS2 applies to project workers including fulltime, part-time, temporary, seasonal and migrant workers. Where government civil servants are working in connection with the project, whether fulltime or part-time, they will remain subject to the terms and conditions of their existing public sector employment agreement or arrangement, unless there has been an effective legal transfer of their employment or engagement to the project. ESS2 will not apply to government civil servants. Working conditions and management of worker relationships. CSP will develop and implement internal labor management procedures applicable to the project. These procedures will set out the way in which project workers will be managed, in accordance with the requirements of national law and this ESS. The procedures will address the way in which this ESS will apply to different categories of project workers including direct workers, and contract workers. Project workers will be provided with information and documentation that is clear and understandable regarding their terms and conditions of employment. The information and documentation will set out their rights under national labor law and ESS requirements (which will include collective agreements), including their rights related to hours of work, wages, overtime, compensation and social package. This information will be provided at the beginning of the working relationship and when material changes occur. 5.2. Policy Gap. Comparison of key OHS related World Bank Requirements with Belarus Republic Legal Requirements: Major WB requirements Key ESS & Topic Major WB requirements requirements/gaps in Belarus Republic legal framework A. Working • Written labor management procedures • Written employment contract conditions and • Terms and conditions of employment required, including procedures and management of • Nondiscrimination and equal employment conditions. labor relations opportunity • Non-discrimination and equal • Worker’s organizations opportunity requirements exist. • Elaborate Labor Management Plans • Availability provision for Labor including Contractor’s ESMP Management Plans. 88 Belarus Emergency COVID-19 Project ESMF B. Protecting the • Child labor prohibition • Child labor prohibited (under 14). work force • Forced labor prohibition • No forced labor is allowed. C. Grievance Grievance Redress Mechanism should be • Grievance Redress Mechanism will mechanism developed and placed for direct and be developed and placed for direct contracted workers (GRM). and contracted workers (GRM). • Grievance registration and follow-up procedures also are available through the “Law on Appeals of Citizens�. D. Occupational • Detailed Procedure required for every • Detailed procedure specific to every Health and project. project. Safety • Requirements to protect workers, train • Requirements to protect workers, workers, document incidents, emergency train workers, document incidents, preparation, addressing issues; and emergency preparation. emergency situations Monitor OHS performance E. Category of Specifies categories of workers No such classification workers F. Minimum age • Minimum age for employment is 14; • Employment permissible for 14 plus of workers • A child between 14-18 may be employed age, but with guardian permission. or engaged only in certain conditions • 14-18 years are not permitted to work under difficult and unsafe working conditions. 6. RESPONSIBLE STAFF The project will be directly controlled by the RSPC MT. The coordinator will coordinate daily the activities of the project, including relations with direct workers, contractors and suppliers. A direct environmental and social worker will be responsible for coordinating all safeguards matters, including preparing and enforcing sub-draft Environmental and Social Management Plans. 7. POLICIES AND PROCEDURES As specified in the Labor Code, employment of project workers will be based on the principles of non- discrimination and equal opportunity. There will be no discrimination with respect to any aspects of the employment relationship, including recruitment, compensation, working conditions and terms of employment, access to training, promotion or termination of employment. The following measures, highlighted in the ESMF, will be followed by contractors and monitored by the CSP M&E Specialist, to ensure fair treatment of all employees: • recruitment procedures will be transparent, public and non-discriminatory, and open with respect to ethnicity, religion, sexuality, disability or gender. • applications for employment will only be considered if submitted via the official application procedures established by the contractors. • clear job descriptions will be provided in advance of recruitment and will explain the skills required for each post. • all workers will have written contracts signed, describing terms and conditions of work and will have the contents explained to them (the conditions will be explained to workers additionally). • unskilled labor will be preferentially recruited from the surrounding communities (minimum 50%); • the contracted workers will not be required to pay any hiring fees. If any hiring fees are to be incurred, these will be paid by the Employer. 89 Belarus Emergency COVID-19 Project ESMF • depending on the origin of the employer and employee, employment terms and conditions will be communicated in two languages, in the state language and the language that is understandable to both parties. • in addition to written documentation, an oral explanation of conditions and terms of employment will be provided to workers who may have difficulty understanding the documentation. • it is noted that language-related problems are not expected, but if they are, interpretation will be provided for workers as necessary. • all workers will be 18 years old or above for civil works. This will be a requirement in Project contracts with construction contractors. • normal working time should not exceed 40 hours per week. With a five-day working week, the duration of daily work is determined by the internal work regulations approved by the employer after prior consultation with the representatives of the workers (in compliance with the established working week duration). The Contractors will be responsible for the following: • to obey requirements of the national legislation and this labor management procedure; • maintain records of recruitment and employment process of contracted workers; • communicate clearly job description and employment conditions to contracted workers; • have a system for regular review and reporting on labor, and occupational safety and health performance. 8. AGE OF EMPLOYMENT The minimum working age in this project for persons is under 18. So an agreement with a persons from 14 to 16 years old can be concluded only with the written consent of one of the parents and only for performing light types of work, the list of which is established by law. For employees under 18 years of age, there is a reduction in working hours, production rates. Labor law prohibits persons under the age of 18 from engaging in hazardous work. The list of jobs in which it is prohibited to employ persons under 18 years of age is given in the decree of the Ministry of Labor and Social Protection of the Republic of Belarus dated June 27, 2013 No. 67 "On establishing a list of jobs in which the employment of persons under eighteen years of age is prohibited." Persons under the age of 18 are prohibited from engaging in hazardous, hard or harmful work and night work. Minors are prohibited from being used in work related to gambling, nightclubs, erotic or pornographic products, pharmaceutical and toxic substances and other work specified in the decree of the Ministry of Labor and Social Protection of the Republic of Belarus dated June 27, 2013 No. 67. The Labor Code of the Republic of Belarus prohibits forced labor (Article 13). The Criminal Code of the Republic of Belarus lists various categories of trafficking in persons as criminal offenses and provides for punishment in the form of imprisonment for a term of 3 to 15 years with a fine (Article 181 of the Criminal Code of the Republic of Belarus). 9. TERMS AND CONDITIONS The terms of employment applicable to Project employees will be set out in this document. These internal work rules will apply to all workers assigned to work on the project (direct workers). The terms and conditions of direct part-time workers are determined by their contracts in accordance with national legislation. The exact number of project workers with whom the contract will be concluded is currently unknown. This will be known when the implementation starts. The contractor labor management procedure will establish conditions for contracting and subcontracting workers. These conditions will, at a minimum, be consistent with this human resource management procedure, the Labor Code of the Republic of Belarus and are specified in the standard contracts that will be 90 Belarus Emergency COVID-19 Project ESMF used within the project. In addition to these professionals, RSPC MT should hire as many individual consultants as necessary to assist in the implementation of specific project activities during implementation. All consultants will receive training on World Bank policies and procedures and receive additional implementation support once the project is effective. 10. GRIEVANCE MECHANISM 10.1. The GRM for Project workers and HCF workers employed in hospitals and laboratories. A GRM will be provided for all direct and contracted workers to raise workplace contractual and OHS concerns. Such workers will be informed about the GRM at the time of recruitment and the measures put in place to protect them against any retaliation for its use. The GRM put in place will be easily accessible by all project workers (direct and contracted), will be sufficiently meet the WB ESS2 requirements and will be comply with the national labor and OHS legislation. Each HCF will appoint a GRM focal person who will be in charge of Details of the GRM for Project Workers and HCF workers are provided in the Chapter 9 of the ESMF. The person who will be designated in the PIU will be follow up registration of all grievances from all employees to the Grievance logbook and monitor their addressing. The template of the logbook attached in the Annex 13. All employees always have rights, according to the Belarus labor and to access judicial/legal grievance management system. The Project workers’ grievance mechanism will not prevent workers to use judicial procedure. In additional, the project workers’ GRM will be accessible to all employees and contracted workers directly by the following coordinate: special email address: pmsz@belcmt.by; on the website of the RSPC MT: http://www.belcmt.by; written requests are sent to the following address: Republic of Belarus, Minsk, st. P. Brovki, 7A, 220013; by fax: 331-34-84; personal reception by the Head of the PMO or a person replacing him. 10.2 World bank Grievance Redress System. The project workers may submit complaints to existing project-level grievance redress mechanisms or the WB’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address project-related concerns. Project workers may submit their complaint to the WB’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of WB non-compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank’s attention, and Bank Management has been given an opportunity to respond. For information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS), please visit http://www.worldbank.org/en/projectsoperations/products-and-services/grievance-redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org. 11. CONTRACT MANAGEMENT The PIU will manage and monitor the performance of contractors in relation to contracted workers, focusing on compliance by contractors with their contractual agreements (obligations, representations, and warranties) and labor management procedures. This may include periodic audits, inspections, and/or spot checks of project locations and work sites as well as of labor management records and reports compiled by contractors. Contractors’ labor management records and reports that may be reviewed would include: (a) representative samples of employment contracts or arrangements between third parties and contracted workers, (b) records relating to grievances received and their resolution, (c) reports relating to safety inspections, including fatalities and incidents and implementation of corrective actions, (d) records relating to incidents of non- 91 Belarus Emergency COVID-19 Project ESMF compliance with national law, (e) records of training provided for contracted workers to explain occupational health and safety risks; record of training provided for contracted workers on general safety measures. 12. COMMUNITY WORKERS As noted above, there are not expected to be any community workers in this project 13. PRIMARY SUPPLY WORKERS The risk of child and forced labor is not expected on this Project. In addition, the Belarus legislation includes of strong regulations regarding child and forced labor that comply with ESS2. 92 Belarus Emergency COVID-19 Project ESMF Annex 3. World Bank Group COVID-19 related guiding documents Document Main requirements and proposed actions General EHS Specifies that employers are obliged to implement all reasonable precautions to protect the health and safety of Guidelines: workers and provides guidance and examples of reasonable precautions to implement in managing principal risks to Occupational Health occupational health and safety, - specifically regarding Biological hazards. It provides also the classification of biological and Safety - EHS 2.5 agents and the Group 3 of such substances can cause severe human disease, present serious hazard to workers and can readily Biological Hazards spread to the community. Group 4 of these agents can cause severe human disease, are serious hazard to workers and present high risk of spreading to the community and likely to require very extensive additional controls. Furthermore, there is no effective prophylaxis or treatment, - which is the case of COVID-19 virus. Respectively, the section provides a series of preventive measures to be undertaken (avoiding use of any harmful biological agents and replace with an agent that, under normal conditions of use, is not dangerous or less dangerous to workers; working processes, engineering, and administrative controls should be designed, maintained, and operated to avoid or minimize release of biological agents into the working environment; reviewing and assessing known and suspected presence of biological agents at the place of work and implement appropriate safety measures, monitoring, training, and training verification programs). Measures to eliminate and control hazards from known and suspected biological agents at the place of work should be designed, implemented and maintained in close co-operation with the local health authorities and according to recognized international standards. The document provides also special considerations when handling Groups 3 and 4 biological agents which include the following: • (i) the employer should always encourage and enforce the highest level of hygiene and personal protection; (ii) work involving these agents should be restricted only to those persons who have received specific verifiable training in working with and controlling such materials; (iii) areas used for the handling these biological agents should be designed to enable their full segregation and isolation in emergency circumstances, include independent ventilation systems, and be subject to SOPs requiring routine disinfection and sterilization of the work surfaces; (iv) HVAC systems serving areas should be equipped with High Efficiency Particulate Air (HEPA) filtration systems. Equipment should readily enable their disinfection and sterilization and maintained and operated to prevent growth and spreading of disease agents, amplification of the biological agents, or breeding of vectors. General EHS • This section specifies that the PPE is considered a last resort, above and beyond the other controls and Guidelines: provides worker with an extra level of personal protection and recommends a series of measures for use of PPE in the Occupational Health workplace. It requires that: active use of PPE if a hazard cannot be eliminated or sufficiently reduced; provision of appropriate and Safety - EHS 2.7 – that offers protection to workers and occasional visitors, without incurring unnecessary inconvenience to the individual; PPE Personal Protective must be properly maintained. Recurrent training for employees on proper use of PPE; and Selection of PPE should be based Equipment [PPE] on hazard and risk ranking, as well as criteria on performance and testing established. General EHS It is indicated that a special hazard environment work situation is considered where all previously described hazards, Guidelines: including biological ones, may exist under unique or especially hazardous circumstances. Accordingly, extra precautions or Occupational Health 93 Belarus Emergency COVID-19 Project ESMF and Safety - EHS 2.8 – rigor in application of precautions is required. In such circumstances it is needed to permanently conduct monitoring of OHS Special Hazard issues. Environments Monitoring programs should verify the effectiveness of prevention and control strategies. The selected indicators should be representative of the most significant occupational, health, and safety hazards, and the implementation of prevention and control strategies. The monitoring programs for OHS should include: Regular safety inspection, testing and calibration of all safety features and hazard control measures focused on PPE features, places of work, work procedures, etc.; Surveillance of the working environment: employers should document compliance using internationally recognized methods and standards; Surveillance of workers health: e.g. when dealing with biological agents Groups 3 and 4 or hazardous compounds, workers should be provided appropriate and relevant health surveillance prior to first exposure, and at regular intervals thereafter. Surveillance should be continued after termination of employment (if deemed necessary); Training: training activities and emergency exercises should be monitored and documented. Contractors should be required to submit adequate training documentation before assignment starts. Additionally, the document requires to do the accidents and diseases monitoring which should enable the employees report (immediately) any situation that poses a danger to life and health, occupational injuries and near misses, suspected cases of occupational disease, and dangerous occurrences and incidents. Employer/management should investigate these reports to determine cause and identify measures necessary to prevent recurrence. General EHS This section complements the guidance provided in the preceding environmental and occupational health and safety Guidelines: sections, specifically addressing some aspects of project activities taking place outside of the traditional project boundaries, Occupational Health but nonetheless and Safety - EHS 3 – related to the project operations, as may be applicable on a project basis. It covers a series of aspects: Water Quality Community Health and and Availability; Structural Safety of Project Infrastructure; Life and Fire Safety (L&FS); Applicability and Approach; Safety Specific Requirements for New Buildings; L&FS Master Plan Review and Approval; Specific Requirements for Existing Buildings. Additionally, this section provides requirements regarding transport safety and especially transportation of hazardous materials. Lastly it contains the requirements and actions for Diseases Prevention and Emergency Preparedness and Response. General EHS This subsection of the ESH document provides details on Disease Prevention in the case of communicable diseases Guidelines: such as COVID-19. Recommended interventions at the project level include94: (a) Providing surveillance and active Occupational Health screening and treatment of and Safety - EHS 3.6 – Workers; (b) Preventing illness among workers in local communities by: (i) Undertaking health awareness and Disease Prevention education initiatives, for example, by implementing an information strategy to reinforce person-to-person counseling addressing systemic factors that can influence individual behavior as well as promoting individual protection, and protecting others from infection, by encouraging condom Use; (iii) Training health workers in disease treatment; (iv) Conducting immunization programs for workers in local communities to improve health and guard against infection; Providing health services; (c) Providing treatment through standard case management in on-site or community health care facilities. Ensuring ready access to medical treatment, confidentiality and appropriate care, particularly with respect to migrant workers; and (f) Promoting collaboration with local authorities to enhance access of workers families and the community to public health services and promote immunization. 94 Belarus Emergency COVID-19 Project ESMF IFC – The document covers EHS guidelines for Health Care Facilities (HCFs) and Occupational Health and Safety Environmental, Health, requirement for healthcare and includes main requirements and activities with regard to a series of related issues: (a) Waste and Safety Guidelines Management. It specifies that infectious and hazardous wastes should be identified and segregated into categories using a for Healthcare Facilities color-coded system. Such waste includes waste suspected to contain pathogens (e.g. bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts as well as pathological and anatomical material (e.g. tissues, organs, body parts, human fetuses, animal carcasses, blood, and other body fluids), clothes, dressings, equipment / instruments, and other items that may have come into contact with infectious materials. It provides guidance on waste segregation strategy, treatment and disposal; (b) Wastewater management in HCFs; (c) Occupational Health and Safety; (d) Exposure to Infections / Diseases. It provides staff member and visitors with information on infection control policies and procedures and establish Universal/Standard Precautions to treat all blood and potentially infectious materials with appropriate precautions including: (i) immunization of staff members as necessary; (ii) use of gloves, masks, and gowns; (e) adequate facilities for hand washing; (f) recommendations when using and handling needles / sharps; and, (g) providing adequate supplies of Personal Protective Equipment PPE for personnel. ESF/Safeguards This note provides guidance to the WB teams on how to support Borrowers in addressing key issues associated with Interim Note: COVID- COVID-19. It emphasizes the importance of careful scenario planning, clear procedures and protocols, management systems, 19 Considerations in effective communication and coordination, and the need for high levels of responsiveness in a changing environment. It Construction/Civil recommends assessing the current situation of the project, putting in place mitigation measures to avoid or minimize the Works Projects, issued chance of infection, and planning what to do if either project workers become infected or the work force includes workers on April 7, 2020 from proximate communities affected by COVID-19. The document emphasizes that the Borrowers should understand the obligations that contractors have under their existing contracts (providing all details in Section 3), and requires contractors to put in place appropriate organizational structures (Section 4) and develop procedures to address different aspects of COVID- 19 (Section 5). Technical Note: This Note offers suggestions to World Bank task teams for advising counterpart agencies on managing public Public Consultations consultation and stakeholder engagement in their projects, with the recognition that the situation is developing rapidly, and and Stakeholder careful regard needs to be given to national requirements and any updated guidance on COVID-19, issued by WHO. It is Engagement in WB- important that the alternative ways of managing consultation and stakeholder engagement discussed with clients are in supported operations accordance with the local applicable laws and policies, especially those related to media and communication. Where projects when there are are under preparation and stakeholder engagement is about to commence or is ongoing, such as in the project E&S planning constraints on process, stakeholder consultation and engagement activities should not be deferred, but rather designed to be fit for purpose conducting public to ensure effective and meaningful consultations to meet project and stakeholder needs. While conducting consultations it is meetings, issued on recommended to avoid public gatherings (taking into account national restrictions), including public hearings, workshops and March 20, 2020 community meetings, and minimize direct interaction between project agencies and beneficiaries / affected people. It is also necessary to diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders, as well as employ traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, public announcements and mail) when stakeholders do not have access to online channels or do not use them frequently. Such 95 Belarus Emergency COVID-19 Project ESMF channels can also be highly effective in conveying relevant information to stakeholders and allow them to provide their feedback and suggestions. Technical Note The note is intended as technical advice to help teams support clients on SEA/H risk rolling out mitigation measures. on SEA/H for HNP It focuses exclusively on addressing SEA/H risk posed by project activities themselves, and not the broader SEA/H risks COVID Response posed by the COVID pandemic. The teams are not required to conduct SEA/H risk assessments given the emergency context Operations and the information already available on increased risk of SEA/H during humanitarian situations. The note is presented in the Annex 6. Technical Note As it is expected that military or security forces will be utilized in different ways in response to COVID-19 it is on Use of Military necessary to address the following issues: (a) what are the positive aspects of using security forces (human rights; civil actions; Forces to Assist disciplined response); (b) what are the things to watch for (human rights violation; international and national media reaction; COVID-19 Operations putting WB staff at risk); (c) what are the ways to address these risks. The whole text of the document is presented in the Annex 7. 96 Belarus Emergency COVID-19 Project ESMF Annex 4. WHO COVID-19 related guiding documents Document Main requirements and recommendations Laboratory Biosafety Guidelines This document provides a series of requirements and actions to be undertaken for ensuring health (COVID-19) safety and an efficient MWM in laboratories which will be involved in COVID-19 related activities. Among main recommendations are the following: • All procedures must be performed based on risk assessment and only by personnel with demonstrated capability, in strict observance of any relevant protocols at all times; • Initial processing (before inactivation) of all specimens should take place in a validated biological safety cabinet (BSC) or primary containment device; • Non-propagative diagnostic laboratory work (for example, sequencing, nucleic acid amplification test [NAAT]) should be conducted at a facility using procedures equivalent to Biosafety Level 2 (BSL-2); • Handling of materials with high concentrations of live virus (for example, virus propagation, isolation or neutralization assays) should be conducted at a containment laboratory with inward directional airflow (BSL-3); • Appropriate disinfectants with proven activity against enveloped viruses should be used (for example, hypochlorite [bleach], alcohol, hydrogen peroxide, quaternary ammonium compounds, and phenolic compounds); • Patient specimens from suspected or confirmed cases should be transported as UN3373, “Biological Substance Category B�. Viral cultures or isolates should be transported as Category A, UN2814, “infectious substance, affecting humans�; • Appropriate PPE as determined by detailed risk assessment should be worn by all laboratory personnel handling these specimens. Annex 1 of the document contains the details on Core requirements including: (a) Good microbiological practice and procedure (GMPP); (b) Personnel competence and training; (c) Specimen receipt and storage; (d) Decontamination and waste management; (e) Personal Protective Equipment; (f) Laboratory Equipment; (g) Emergency/Incident Response Plan; and (h) Occupational Health. It contains also “Additional Recommendations Addressing Minimal/Essential Working Conditions Associated with Specific Manipulations in Laboratory Settings�. Annex II of the document provides the risk assessment template. Infection prevention and control This is the guidance on infection prevention and control (IPC) strategies for use when infection with during health care when novel a novel coronavirus (2019-nCoV) is suspected and intended for healthcare workers, healthcare managers coronavirus (nCoV) infection is suspected, and IPC teams at the facility level but it is also relevant for the national and district/provincial level. It provides the following: (a) Principles of IPC strategies associated with health care for suspected COVID- 19 which include the following: (i) Ensuring triage, early recognition, and source control; (ii) Applying standard precautions for all patients; (iii) Implementing empiric additional precautions (Contact and droplet 97 Belarus Emergency COVID-19 Project ESMF precautions; Airborne precautions for aerosol-generating procedures; (iv) Implementing administrative controls; (v) Using environmental and engineering controls; (b) Duration of contact and droplet precautions for patients with COVID-19; and (c) Recommendation for outpatient care. Coronavirus disease (COVID-19) This document highlights the rights and responsibilities of health workers and managers of HCFs, outbreak: rights, roles and responsibilities including specific measures needed to protect occupational safety and health. Among these are the of health workers, including key following: considerations for occupational safety and • assume overall responsibility to ensure that all necessary preventive and protective health measures are taken to minimize occupational safety and health risks1; • provide information, instruction and training on occupational safety and health, including; o Refresher training on infection prevention and control (IPC); and, • use, putting on, taking off and disposal of personal protective equipment (PPE) and provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for suspected or confirmed; • implementation of occupational safety and health management systems to identify hazards and assess risks to health and safety; infection prevention and control (IPC) measures; zero-tolerance policies towards workplace violence and harassment. It is important to emphasize that COVID-19 patients, such that workers do not incur expenses for occupational safety and health requirements; • familiarize personnel with technical updates on COVID-19 and provide appropriate tools to assess, triage, test and treat patients and to share infection prevention and control information with patients and the public; • as needed, provide with appropriate security measures for personal safety; • provide a blame-free environment for workers to report on incidents, such as exposures to blood or bodily fluids from the respiratory system or to cases of violence, and to adopt measures for immediate follow-up, including support to victims; • advise workers on self-assessment, symptom reporting and staying home when ill; • maintain appropriate working hours with breaks; • consult with health workers on occupational safety and health aspects of their work and notify the labour inspectorate of cases of occupational diseases; • honour the right to compensation, rehabilitation and curative services if infected with COVID-19 following exposure in the workplace. This would be considered occupational exposure and resulting illness would be considered an occupational disease, Health workers should: • follow established occupational safety and health procedures, avoid exposing others to health and safety risks and participate in employer-provided occupational safety and health training; • use provided protocols to assess, triage and treat patients; • treat patients with respect, compassion and dignity; 98 Belarus Emergency COVID-19 Project ESMF • maintain patient confidentiality; • swiftly follow established public health reporting procedures of suspect and confirmed cases; • provide or reinforce accurate infection prevention and control and public health information, including concerned people who have neither symptoms nor risk; • put on, use, take off and dispose of personal protective equipment properly; • self-monitor for signs of illness and self-isolate or report illness to managers, if it occurs; • advise management if they are experiencing signs of undue stress or mental health challenges that require support interventions; and, • report to their immediate supervisor any situation which they have reasonable justification to believe presents an imminent and serious danger to life or health. Water, sanitation, hygiene and This document summarizing WHO guidance on water, sanitation and health care waste which is waste management for COVID-19 relevant for viruses (including coronaviruses). This Technical Brief is written for water and sanitation (https://www.who.int/publications- practitioners and providers. detail/water-sanitation-hygiene-and- These practitioners should work to enable more frequent and regular hand hygiene by improving waste-management-for-covid-19) facilities and using proven behavior-change techniques. Existing recommendations for water, sanitation and hygiene measures in health care settings are important for providing adequate care for patients and protecting patients, staff, and caregivers from infection risks. The following actions are particularly important: (i) managing excreta (faeces and urine) safely, including ensuring that no one comes into contact with it and that it is treated and disposed of correctly; (ii) engaging in frequent hand hygiene using appropriate techniques; (iii) implementing regular cleaning and disinfection practices; and (iv) safely managing health care waste. Other important measures include providing sufficient safe drinking-water to staff, caregivers, and patients; ensuring that personal hygiene can be maintained, including hand hygiene, for patients, staff and caregivers; regularly laundering bedsheets and patients’ clothing; providing adequate and accessible toilets (including separate facilities for confirmed and suspected cases of COVID-19 infection); and segregating and safely disposing of health care waste. Considerations for quarantine of The purpose of this document is to offer guidance to the Governments on quarantine measures for individuals in the context of containment individuals in the context of COVID-19. It is intended for those responsible for establishing local or national for coronavirus disease (COVID-19), policy for quarantine of individuals, and adherence to infection prevention and control measures. issued on 19 March 2020 Rational use of personal protective This document summarizes WHO’s recommendations for the rational use of personal protective equipment for coronavirus disease 2019 equipment (PPE) in health care and home care settings, as well as during the handling of cargo; it also (COVID-19), issued on 27 February 2020 assesses the current disruption of the global supply chain and considerations for decision making during severe shortages of PPE. 99 Belarus Emergency COVID-19 Project ESMF Advice on the use of masks in the This document provides advice on the use of masks in communities, during home care, and in health context of COVID-19 Interim guidance 6 care settings in areas that have reported cases of COVID-19. It is intended for individuals in the community, April 2020 public health and infection prevention and control (IPC) professionals, health care managers, health care workers. This updated version includes a section on Advice to decision makers on the use of masks for healthy people in community settings. It specifies that medical masks should be reserved for health care workers. Also, persons with symptoms should wear a medical mask, self-isolate, and seek medical advice as soon as they start to feel unwell. The document provides requirements for manufacturing the masks as well as rules for their wearing. Operational considerations for This document is intended for health ministers, health system administrators, and other decision- case management of COVID-19 in health makers. It is meant to guide the care of COVID-19 patients as the response capacity of health systems is facility and community Interim guidance challenged; to ensure that COVID-19 patients can access life-saving treatment, without compromising 19 March 2020 public health objectives and safety of health workers. It promotes two key messages: 1. Key public health interventions regardless of transmission scenario; and 2. Key action steps to be taken by transmission scenario to enable timely surge of clinical operations. The public health objectives at all stages of the preparedness and response plan are to: • Prevent outbreaks, delay spread, slow and stop transmission. • Provide optimized care for all patients, especially the seriously ill. • Minimize the impact of the epidemic on health systems, social services, and economic activity. Oxygen sources and distribution This interim guidance on oxygen sources and distribution strategies for COVID-19 treatment is for COVID-19 treatment centers intended for health facility administrators, clinical decision-makers, procurement officers, planning officers, biomedical engineers, infrastructure engineers and policymakers. It describes how to quantify oxygen demand, identify oxygen sources that are available, and select appropriate surge sources to best respond to COVID-19 patients’ needs, especially in low-and-middle income countries. 100 Belarus Emergency COVID-19 Project ESMF Annex 5. Response to COVID-19: Health and Safety issues while purchasing vaccines, therapeutics, goods including oxcygen equipment and supplies a. Vaccines and Therapeutics Activit Risks and Impacts Mitigation Measures y Distrib A non-transparent and poorly Attention should be given to the distribution system, to ensure effective and ution of managed distribution system and efficient use of the goods and services and avoid capturing of the rich, powerful and vaccines and practice could worsen the current privileged, particularly at this time of short supply. medicines shortage situation, affecting the max and efficient use of the resources. The disadvantaged and Particular attention and efforts should be given to the disadvantaged and vulnerable population groups could face vulnerable groups to make sure that they have equal if not better access to these disproportionate difficulties in accessing resources. the available resources, exposing them to greater risks. b. Goods and Services Purcha Surfaces of imported materials Although coronavirus can stay on surfaces for a few hours to several days se and stocking may be contaminated and handling depending upon the type of surface (and the differing conditions and temperatures of emergency during transportation may result in through which the equipment is moved), it is very unlikely that that the virus will persist rooms, clinics spreading. on a surface. and other No special measures are required for handling imported goods and equipment, medical except regular hand washing. facilities, Projects should ensure that adequate handwashing facilities with soap (liquid), including with water and paper towels for hand drying (warm air driers may be an alternative), plus Laboratory closed waste bin for paper towels are available. Alcohol-based hand rub should be equipment, provided where handwashing facilities cannot be accessed easily and regularly. supplies or Also ensure awareness campaigns and reminder signs are regularly posted goods. around site to encourage workers regularly wash hands when handling goods, and that they do not touch their face. If concerned (for example when dealing with goods that have come from countries with high numbers of infected people) a surface or equipment may be decontaminated using disinfectant. After disinfecting, workers should wash hands with soap and water or use alcohol -based hand rub. 101 Belarus Emergency COVID-19 Project ESMF Purcha Incorrect standard or quality of Medical personal protective equipment (PPE) includes: se of PPE for PPE leads to spread of infection to Medical mask healthcare healthcare workers and cleaners. Gown workers and Apron health facility Eye protection (goggles or face shield) cleaners Respirator (N95 or FFP2 standard) Boots/closed work shoes WHO interim guidance on rational use of PPE for coronavirus disease 2019 provided further details on the types of PPE that are required for different functions. Purcha Life and fire safety (L&FS) Where the project includes procurement of equipment for oxygen therapy such sing and during installation and operation as oxygen cylinders, oxygen concentrators, oxygen plant, installation, or expansion of distribution of the oxygen pipeline systems in the health care facilities the PIU will assess the L&FS oxygen risk and propose mitigation measures in line with requirements of WBG General EHS equipment guidelines. Distrib A non-transparent and poorly Attention should be given to the distribution system, to ensure effective and ution of goods managed distribution system and efficient use of the goods and services and avoid capturing of the rich, powerful and or services on practice could worsen the current privileged, particularly at this time of short supply. basis of need shortage situation, affecting the maximum and efficient use of resources. The disadvantaged and Particular attention and efforts should be given to the disadvantaged and vulnerable population groups could face vulnerable groups to make sure that they have equal if not better access to these disproportionate difficulties in accessing resources. the available resources, exposing them to greater risks. Hand Inadequate handwashing Projects should ensure that adequate handwashing facilities with soap (liquid), wash stations facilities are provided for handling. water and paper towels for hand drying (warm air driers may be an alternative), plus closed waste bin for paper towels are available. If water and soap handwashing facilities are not possible, alcohol-based hand rubs may be provided. Alcoho Alcohol-based hand rubs may Alcohol-based hand sanitizers are not considered as effective as hand washing l-based hand not be as affective at controlling with soap and water and should therefore only be used in locations where full hand sanitizers infection as hand washing with soap and washing facilities cannot be provided. Advice should be provided to remind users where water. full handwashing facilities can be found. Medica The collection, processing, There is no evidence that direct, unprotected human contact during the handling l waste treatment and disposal of medical wastes of healthcare waste has resulted in the transmission of COVID-19. The treatment of contaminated 102 Belarus Emergency COVID-19 Project ESMF with COVID- becomes a vector for the spread of the healthcare waste produced during the care of COVID-19 patients should be collected 19 virus virus. safely in designated containers and bags, treated and then safely disposed. Open burning and incineration of medical wastes can result in emission of dioxins, furans and particulate matter, and result in unacceptable cancer risks under medium (two hours per week) or higher usage. If small-scale incinerators are the only option available, the best practices possible should be used, to minimize operational impacts on the environment. Best practices in this context are: • effective waste reduction and segregation, ensuring only the smallest quantities of combustible waste types are incinerated; • an engineered design with sufficient residence time and temperatures to minimize products of incomplete combustion; • siting incinerators away from health-care buildings and residential areas or where food is grown; • construction using detailed engineering plans and materials to minimize flaws that may lead to incomplete destruction of waste and premature failures of the incinerator; • a clearly described method of operation to achieve the desired combustion conditions and emissions; for example, appropriate start-up and cool-down procedures, achievement and maintenance of a minimum temperature before waste is burned, use of appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures, proper disposal of ash and equipment to safeguard workers; • periodic maintenance to replace or repair defective components (including inspection, spare parts inventory and daily record keeping); and • improved training and management, possibly promoted by certification and inspection programs for operators, the availability of an operating and maintenance manual, visible management oversight, and regular maintenance schedules. Single-chamber, drum and brick incinerators do not meet the Best Available Techniques (BAT) requirements under Stockholm Convention. Alternative treatments should be designed into longer term projects, such as steam treatment methods. Steam treatment should preferably be on site, although once treated, sterile/non-infectious waste may be shredded and disposed of in suitable waste facilities. See: WHO Safe management of wastes from health-care activities. Water, COVID-19 virus is transmitted There is no evidence that COVID-19 virus persists in drinking water, sewage, sanitation, through inappropriate sanitation or medical wastes, and following of good hygiene practices will provide effective hygiene and arrangements or through drinking water control. See: WHO guidance on water, sanitation and waste management for COVID- waste and contaminated waste. 19 for guidance on control measures. 103 Belarus Emergency COVID-19 Project ESMF management for COVID-19 Identifi Collection of samples and Collection of samples, transport of samples and testing of the clinical specimens cation and testing for COVID19 could result in from patients meeting the suspect case definition should be performed in accordance diagnosis spread of disease to medical workers or with WHO interim guidance Laboratory testing for coronavirus disease 2019 (COVID- laboratory workers, or during the 19) in suspected human cases. Tests should be performed in appropriately equipped transport of potentially affected samples. laboratories (specimen handling for molecular testing requires BSL-2 or equivalent facilities) by staff trained in the relevant technical and safety procedures. National guidelines on laboratory biosafety should be followed. There is still limited information on the risk posed by COVID-19, but all procedures should be undertaken based on a risk assessment. For more information related to COVID-19 risk assessment, see specific interim guidance document: WHO interim guidance for laboratory biosafety related to 2019-nCoV. Samples that are potentially infectious materials (PIM) need to be handled and stored as described in WHO document Guidance to minimize risks for facilities collecting, handling or storing materials potentially infectious for polioviruses (PIM Guidance). For general laboratory biosafety guidelines, see the WHO Laboratory Biosafety Manual, 3rd edition. 104 Belarus Emergency COVID-19 Project ESMF Annex 6. Technical Specifications for COVID-19 Medical Equipment Equipment / Technical Specification(s) Notes Process PPE – • Solid-front or wrap- For aerosol-generating procedures performed on COVID-19 patients, Body/Leg around non-sterile gowns, scrub suits, or water-proof aprons should also be used if gowns are not fluid resistant. coveralls with long sleeves • Boots, closed-toe shoes or dedicated shoes PPE – Hand • Disposable gloves made • Single-use gloves (nitrile or latex) should be discarded after each of rubber or synthetic materials use and not reused. (Neoprene); powder-free, non-sterile • Check glove packaging for expiration date and the word “virus� • Soap and water under the biohazard symbol. • Alcohol-based hand • Cleaning personnel should wear disposable gloves when cleaning sanitizer surfaces or handling clothing or linen soiled with body fluids, and they should • Heavy duty gloves for perform hand hygiene before putting on and after removing their gloves. cleaners • Use chlorinated water (0.05%) only if soap and alcohol-based sanitizers are not available or feasible. However, this is not ideal because frequent use may lead to dermatitis, which could increase the risk of infection and asthma and because prepared dilutions might be inaccurate. • Functional hand hygiene facilities should be present for all health care workers at all points of care and in areas where PPE is put on or taken off. • Functional hand hygiene facilities should be available for all patients, family members, and visitors, and should be available within 5 m of toilets, as well as in waiting and dining rooms and other public areas. PPE – • Medical (surgical or • Risk assessment should inform the use of respiratory protection. Respiratory procedure) masks that are flat or pleated or • It is critical that medical masks and respirators be prioritized for cup-shaped health care workers. • tested according to a set of • Do not reuse single-use mask. standardized test methods (ASTM F2100, • Using one respirator for longer than 4 hours can lead to discomfort EN 14683, or equivalent) that aim to and should be avoided. balance high filtration, adequate • The use of masks made of other materials (e.g., cotton fabric), also breathability and optionally, fluid known as nonmedical masks, in the community setting has not been well evaluated. penetration resistance. There is no current evidence to make a recommendation for or against their use in this setting. 105 Belarus Emergency COVID-19 Project ESMF • Fit-tested particulate • Cotton cloth masks are not considered appropriate for healthcare respirator (e.g., European Union [EU] workers. But in situations of shortage or stock out, a local authority should assess standard FFP2, US 6 National Institute for the proposed PPE according to specific minimum standards and technical Occupational Safety and Health [NIOSH]- specifications before use in healthcare settings. certified N95 or equivalent, or higher • For non-medical masks; numbers of layers of fabric/tissue, protection) breathability of material, water repellence/hydrophobic qualities, shape of mask, and fit of mask should be taken into consideration. PPE – Face • Safety goggles or face shield (wraparound, soft frame, indirect vent Disinfectants • Sodium hypochlorite at • COVID-19 may be susceptible to these disinfectants if used (Surfaces & Reusable 1% (Bleach – 10 000 parts per million according to the manufacturer’s recommendations Equipment) [ppm] for daily disinfection of surfaces) • Other biocidal agents like 0.05–0.2% benzalkonium chloride or • Sodium hypochlorite at 0.02% chlorhexidine digluconate can be less effective 1% (10 000 ppm) for disinfection of blood • Equipment should be either single-use and disposable or dedicated spills equipment. • 70% ethyl alcohol to • If equipment needs to be shared among patients, clean and disinfect small areas between uses, such as disinfect it between use for each individual patient. reusable dedicated equipment (for • Clean and disinfect frequently touched surfaces − such as bedside example, thermometers, stethoscopes, and tables, bed frames and other bedroom furniture − daily with regular household blood pressure cuffs) disinfectant containing a diluted bleach solution (that is, 1-part bleach to 99 parts • 0.5% hydrogen peroxide water). • Quaternary ammonium • For surfaces that cannot be cleaned with bleach, 70% ethanol can compounds be used. • Phenolic compounds Disinfectants • Hot water and soap • Clean clothes, bed linens, and bath and hand towels using regular (Laundry – • 0.05% chlorine for soiled laundry soap and water or machine wash at 60-90 °C (140–194 °F) with common clothes, bed linens, bath linens laundry detergent, and dry thoroughly. and hand towels, • 0.5% sodium hypochlorite • Linens should be soaked in 0.05% chlorine for approximately 30 aprons, gloves) solution for utility gloves or heavy duty, minutes after handwashing. and reusable plastic aprons • The laundry should be rinsed with clean water and the linens allowed to dry fully in sunlight. • Clean utility gloves or heavy duty, reusable plastic aprons with soap and water and then decontaminate them with 0.5% sodium hypochlorite. 106 Belarus Emergency COVID-19 Project ESMF Oxygen • Liquid oxygen plants • Healthcare facilities treating COVID-19 should be equipped with (Source) • Cryogenically produced pulse oximeters, functioning oxygen systems including single-use oxygen delivery liquid oxygen generated off-site (not at a interfaces. medical facility). • Oxygen plants and concentrators require a reliable source of • Large bulk tanks in power for proper functioning. It is best practice to also have cylinders as a backup medical facilities that are refilled supply. periodically by a truck from a supplier • The appropriate choice of oxygen source depends on many factors, • PSA oxygen plant – A including: the amount of oxygen needed at the treatment center; the available pressure swing adsorption (PSA) oxygen infrastructure, cost, capacity and supply chain for local production of medicinal plant serves as a large, central source of gases; the reliability of electrical supply; and access to maintenance services and oxygen generation using PSA technology spare parts, etc. (like concentrators) that can be located on- • Liquid oxygen will accommodate great volumes; however, health site at medical facilities. systems must leverage existing facilities’ operations where they exist • Oxygen concentrators – (geographically). designed for portable medical support are • More localized (e.g. in-facility) PSA plants are an option, but if not available in models that can deliver already in-situ, there will be some lead-time for delivery and operationalization. maximum flow rates of between 5 and 10 • Bedside oxygen concentrators are a very tangible plug-and-play L/min options, that are limited in terms of sheer volume that could be delivered. Oxygen • Oxygen cylinders – • The most common source of oxygen storage used in health-care (Storage) require several accessories and fittings to settings is a cylinder. deliver oxygen, such as pressure gauges, • Requires periodic maintenance, commonly provided by gas regulators, flowmeters, and in some cases, suppliers at the point of refilling. humidifiers. • Pipeline intra-hospital • Advantage: obviate the need for handling and transporting heavy distribution networks – supply oxygen at cylinders between hospital wards. high pressure to equipment such as • Disadvantages: High cost and complexity of installation; and the anesthetic machines and ventilators associated specialized maintenance required make pipeline systems less accessible for turn-key installation Water • Filtration For effective centralized disinfection, there should be a residual Treatment • Disinfection with UV concentration of free chlorine of ≥0.5 mg/L after at least 30 minutes of contact time light at pH <8.0. A chlorine residual should be maintained throughout the distribution • Chlorine and other system. oxidant disinfection processes • Boiling • High-performing ultrafiltration or nanomembrane filters 107 Belarus Emergency COVID-19 Project ESMF • Solar irradiation • UV irradiation and appropriately dosed free chlorine, in non- turbid waters Infectious • Plastic or metal with a • Not all plastic bags can withstand temperatures of 121 °C, and Waste Containers recommended thickness of 70 µm some can melt during an autoclave process (ISO 7765 2004). • Place specimens for transport in secondary containers that have a • Plastics used for either plastic biohazard specimen bag, with the patient’s label on the specimen container containers or bags should be chlorine-free. (the primary container), and a clearly written laboratory request form • Containers should have • Document clearly each patient’s full name, date of birth and well-fitting lids, either removable by hand “suspected COVID-19� on the laboratory request form. or preferably operated by a foot pedal. • Leak-proof specimen bags (secondary containers) that have a separate sealable pocket for the specimen (a plastic biohazard specimen bag) 108 Belarus Emergency COVID-19 Project ESMF Annex 7. Technical Specifications for Invasive and Non-Invasive Ventilators for COVID-19 a. Invasive Ventilators for Intensive-care Adult and Pediatric Patients Description Designed to provide temporary ventilatory and respiratory assistance to adult and pediatric patients who cannot breathe on their own or who require assistance to maintain adequate ventilation. This equipment is usually connected to a 50-psi gas supply. Some ventilators have their own air compressor but still need an oxygen source. General Technical • The medical oxygen and air high-pressure input ports (50 psi) provide a means to limit Requirements reverse gas flowrate (leakage) and cross leakage when flowrate is < 100 mL/min. • Each high-pressure input port with a filter should have a pore size ≤ 100 μm. • Medical air compressor is integral to unit. Air turbine is an alternative. • Possibility of using external low-pressure oxygen, as source, preferable. • Mechanical safe valve that opens at 80 cm H2O. • Internal function testing/leak testing. Event log for errors traceability, preferable. • All parts withstand high disinfection procedures. • At least IP21 degree of protection to the harmful ingress of water (fluid spill resistance). • Polyvinyl chloride (PVC) materials must be avoided in the patient gas pathway. • Mechanical shock resistance, mechanical vibration, electromagnetic compatibility and electrical safety testing. • Operating temperature and humidity 5 to 40 °C and 0 to 95% RH. • Storage temperature and humidity -20 to 60 °C, 0 to 95% RH. Ventilation Modes • Pressure Regulated Volume Control (PRVC), or similar. • Pressure Control (PC) • Volume Control (VC) • Synchronized Intermittent Mandatory Ventilation (SIMV) • Pressure Support Ventilation (PSV) • Non-Invasive ventilation capability Monitored and controlled • FiO2: 21 to 100%; parameters (by user) • Tidal Volume: 20 - 2,000 mL, ideally; • Inspiratory flow: 1 - 160 [L/min]; Inspiratory pressure: 0 – 40 [cmH2O]; • I:E ratio; I:E inverse ratio; • RR: 10 to 60 [breaths/min], minimum; • Inspiratory pause manoeuver capability to measure plateau pressure; • Peak pressure limitation/pressure-cycling mechanism adjustable range of 5 - 20 cmH2O above 109 Belarus Emergency COVID-19 Project ESMF • measured peak pressure. • PEEP: 0 to 20 [cmH2O], minimum. Displayed parameters (color • Display easily readable in low ambient light and sunlight. and graphic are preferable) • 3 scalar waveforms: pressure, volume and flow. • 3 loop (axis) displays: pressure-volume, flow-volume and pressure-flow, preferable. • Status indicators for ventilator mode, battery status, patient data, alarm settings. • FiO2; I:E ratio • Airway pressures (peak, plateau mean and PEEP). • Tidal volume (inspired and expired). • Minute volume (inspired and expired). • RR (spontaneous and mechanical) • End-tidal CO2. Alarms, related to gas Adjustable, visual and audible for: delivered • High/low FiO2; • High/low inspiratory pressure and PEEP; • High/low tidal volume (not achieved or exceeded); • Apnoea, adjustable from 10-30 sec; • High/low respiratory rate; • Continuously high pressure/occlusion; • Breathing circuit disconnect. Alarms, related to Visual and audible for: equipment operation • Gas supply failure; • Power failure; • Low battery Consumables, labelled Breathing circuits: double limb with standard outlet/inlet connectors with 30 per “single use�, (included and 22 mm of outside diameter. equipment mentioned in a disaggregated list) Bacteria filters, if applicable 30 per equipment Accessories, reusable Breathing circuits: double limb with standard outlet/inlet connectors with 10 per (included and mentioned in a 22 mm of outside diameter. Expiratory housing with in-built bacteria filters; as equipment disaggregated list) well as the possibility to accommodate heat moisture exchangers (HMEs). Flex adapters for placement between the circuit way-adapter and the ETT 10 per (protects from unnecessary trauma from eve small circuit repositioning. equipment Exhalation valve 10 per equipment 110 Belarus Emergency COVID-19 Project ESMF CO2 sensors 1 per equipment Servo-controlled heated humidifier; alternatively access to HMEs. 1 per equipment Internal air compressor capacity (or high-performance turbines) As required Connector 30 mm, if required for the gas exhaust port to operate Standard connectors to air and oxygen wall pipelines Spare parts (included and • 1-year spare parts kit as per preventive maintenance program, preferable. mentioned in a disaggregated list) Portability • Mounting tray and support stand (cart for transport with at least 2 castors fitted with breaks) Power supply, Voltage, • Operates from AC power electric line: 100 to 240 V~ / 50 to 60 Hz. Frequency and Plug vary across the • Built-in rechargeable battery. countries • Automatic switch from AC power electric-line mode to battery operating mode and vice versa. • Continuous in battery operating mode with standard ventilation not less than 1 hour. • Total re-charging time not greater than 6 hours. • Equipment must be connected to a reliable and continuous source of energy Documentation (included) • Instruction for use; service manual and product information to be provided in English language, at least Primary Packaging • Labelling on the primary packaging to include name and/or trademark of the manufacturer. • Model or product’s reference. • Information for particular storage conditions (temperature, pressure, light, humidity). Standards; for the • Certified quality management system for medical devices (e.g. ISO 13485, or good manufacturer manufacturing practice (GMP)). Standards, for the product • Free sales certificate (FSC) provided by any of the following countries; Australia, Canada, performance Japan, USA and European Community (e.g. FDA and/or CE certificate given by a third certified party for the specific medical devices proposed (no only declaration of conformity). • If the FSC comes from other national regulatory agencies, it should be supported by the following certificates of quality performance, while alternative national equivalent tests are acceptable: ➢ ISO 18562-1:2017: Biocompatibility evaluation of breathing gas pathways in health-care applications — Part 1: Evaluation and testing within a risk management process. ➢ ISO 20789:2018: Anesthetic and respiratory equipment — passive humidifiers. ➢ ISO 80601-2-12:2020 Medical electrical equipment — Part 2-12: Particular requirements for basic safety and essential performance of critical care ventilators. 111 Belarus Emergency COVID-19 Project ESMF ➢ ISO 80601-2-74:2017 Medical electrical equipment — Part 2-74: Particular requirements for basic safety and essential performance of respiratory humidifying equipment. ➢ ISO 80601-2-79:2018 Medical electrical equipment — Part 2-79: Particular requirements for basic safety and essential performance of ventilatory support equipment for ventilatory impairment. ➢ IEC 60601-1-1:2015 Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems. ➢ IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests. Warranty • Minimum 2 years. • Availability of accessories, consumables and spare parts for at least 2 years. b. Invasive Ventilators for Transport/Mass-casualty Care for Adult and Pediatric Patients Description Like intensive care ventilators, these devices are capable of providing temporary ventilatory assistance by controlling flow, rate, FiO2 and PEEP. The degree of portability (including weight and manageability), as well as battery life, are important considerations. The equipment should have the ability to operate on an external battery for 4 hours, minimize the oxygen consumption, and operate without any compressed gas source (e.g. by a turbine). It should work when connected to a 50 psi or a low-flow oxygen supply. Simplicity of use and low cost are advantages, in addition to advanced ventilatory features. General Technical • Medical air compressor integral to unit, with inlet filter. Requirements ➢ External low-flow oxygen, preferable. ➢ If oxygen high-pressure input port (> 35 psi). • Each high-pressure input port with a filter having a pore size ≤ 100 μm. • O2 - air mixture accuracy of 4%. • O2 consumption with 660 L (E) tank: ➢ 104 minutes with 16 L/min, FiO2 50%. ➢ 280 minutes with 6 L/min, FiO2 50%. • O2 conserve feature, preferable. Internal function testing/leak testing. • Event log for errors traceability, preferable. All parts withstand high disinfection procedures. • At least IP21 degree of protection to the harmful ingress of water. • Polyvinyl chloride (PVC) materials must be avoided in the patient gas pathway. Ventilation Modes • Pressure Regulated Volume Control (PRVC), or similar. • Pressure Control (PC) • Volume Control (VC) • Synchronized Intermittent Mandatory Ventilation (SIMV) 112 Belarus Emergency COVID-19 Project ESMF • Pressure Support Ventilation (PSV) • Non-Invasive ventilation capability Monitored and controlled • Air and externally supplied oxygen mixture ratios fully controllable. parameters (by user) • FiO2: 21 to 100%; • Tidal Volume: 20 - 1,000 mL, ideally; • Inspiratory pressure: 0 – 40 [cmH2O]; • I:E ratio; • RR: 10 to 60 [breaths/min], minimum Displayed parameters (color • Display easily readable in low ambient light and sunlight. and graphic are preferable) • Real time scalar waveforms for flow, volume and pressure at least 2 simultaneously. • Status indicators for ventilator mode, battery status, patient data, alarm settings. • Airway pressures (Peak, Mean and PEEP). • Tidal volume (Expired); Minute volume (Expired). • I:E ratio; • RR; • FiO2. • Inspiration and expiration times; Spontaneous Minute Volume. • Occlusion pressure detection; • Air and oxygen pressure; • Spontaneous ventilation; • Leak percentage. Alarms, related to gas Adjustable, visual and audible for: delivered • High/low FiO2; High/low Flow; High/low Inspiratory pressure; • Breathing circuit disconnect; • Apnoea. Alarms, related to Visual and audible for: equipment operation • Gas supply failure; • Power failure; • Low battery Consumables, labelled Breathing circuits: double limb with standard outlet/inlet connectors with 30 per “single use�, (included and 22 mm of outside diameter. equipment mentioned in a disaggregated list) Bacteria filters, if applicable 30 per equipment 113 Belarus Emergency COVID-19 Project ESMF Accessories, reusable Breathing circuits: double limb with standard outlet/inlet connectors with 10 per (included and mentioned in a 22 mm of outside diameter. Expiratory housing with in-built bacteria filters. equipment disaggregated list) Exhalation valve 10 per equipment CO2 sensors, preferable. 1 per equipment Internal air compressor capacity (or high-performance turbines) 1 per equipment Standard connectors to air and oxygen wall pipelines As required to operate Spare parts (included and • 1-year spare parts kit as per preventive maintenance program, preferable. mentioned in a disaggregated list) Portability • Portable equipment with mechanical strength to lever rough handling. Power supply, Voltage, • Operates from AC power electric line: 100 to 240 V~ / 50 to 60 Hz. Frequency and Plug vary across the • In-built rechargeable battery. countries • Automatic switch from AC power electric-line mode to battery operating mode and vice versa. • Continuous in battery operating mode with standard ventilation not less than 4 hours. • Total re-charging time not greater than 6 hours. • Equipment must be connected to a reliable and continuous source of energy Documentation (included) • Instruction for use; service manual and product information to be provided in English language, at least Primary Packaging • Labelling on the primary packaging to include name and/or trademark of the manufacturer. • Model or product’s reference. • Information for particular storage conditions (temperature, pressure, light, humidity). Standards; for the • Certified quality management system for medical devices (e.g. ISO 13485, or good manufacturer manufacturing practice (GMP)). Standards, for the product • Free Sales Certificate (FSC) provided by any of the following countries; Australia, Canada, performance Japan, USA and European Community (e.g. FDA and/or CE certificate given by a third certified party for the specific medical devices proposed (no only declaration of conformity) • If the FSC comes from other national regulatory agency, it should be supported by the following certificates of quality performance, alternative national equivalent tests are acceptable: ➢ ISO 18562-1:2017: Biocompatibility evaluation of breathing gas pathways in health-care applications — Part 1: Evaluation and testing within a risk management process. ➢ ISO 20789:2018: Anesthetic and respiratory equipment — Passive humidifiers. 114 Belarus Emergency COVID-19 Project ESMF ➢ ISO 10651-5:2006: Lung ventilators for medical use — Particular requirements for basic safety and essential performance — Part 5: Gas-powered emergency resuscitators. ➢ ISO 80601-2-74:2017 Medical electrical equipment — Part 2-74: Particular requirements for basic safety and essential performance of respiratory humidifying equipment. ➢ IEC 60601-1-1:2015 Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems ➢ IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests. Warranty • Minimum 2 years. • Availability of accessories, consumables and spare parts for at least 2 years. c. Non-Invasive Ventilators: Continuous Positive Airway Pressure (CPAP) for Adult and Pediatric Use Description Designed to apply continuous positive airway pressure to the non-intubated adult or pediatric patient. Can be used in spontaneously breathing patients who require short-term mechanical assistance. These units can deliver air or a mixture of air and oxygen at high flow rates and a single set pressure, typically between 3 and 20 cmH2O, through a circuit and patient interface. The effectiveness of the treatment is closely related to the proper sealing of the nasal or oral-nasal mask to the face of the patient. General Requirements • Maintains continuous positive pressure in airway at high flow rate. • User interface to be easy to operate, numbers and displays to be clearly visible. • Inspiration trigger for auto start. • Leakage compensation capability. • Servo-controlled heated humidifier. • Noise level to be less than 35 dbA at mid pressure range. • In-built air compressor. • O2 inlet • All parts withstand high disinfection procedures. • Expiratory relief features that reduce the pressure slightly at the end of each breath to make it easier for the patient to exhale, preferable. • Pressure ramp option that starts pressure at low level and slowly increases over a period, preferable Monitored and controlled • FiO2: 21 to 100%; parameters (by user) • Pressure: 3 – 20 [cmH2O]. Displayed parameters (color • Display easily readable in low ambient light and sunlight. and graphic are preferable) • Pressure [cmH2O]; FiO2 [%]. • Flow; Air leak [%]; RR, preferable 115 Belarus Emergency COVID-19 Project ESMF Alarms, related to gas Visual and audible for: delivered • High/low Temperature; • Breathing circuit disconnect. Alarms, related to Visual, audible and clearly indicating the problem for: equipment operation • Lack of water; • System failure; • Air filter to be replaced; • Power failure; • Low battery. Consumables, labelled Inlet bacteria filter, if applicable 30 per “single use�, (included and equipment mentioned in a disaggregated list) Expiratory filters high efficiency 30 per equipment Nasal mask for adult and pediatric, with tubing. 30 per equipment Oral/nasal mask for adult and pediatric, with tubing 30 per equipment Helmet for adult and pediatric, with tubing 30 per equipment Accessories, reusable Nasal mask for adult and pediatric with tubing; withstands high level 10 per (included and mentioned in a disinfection and sterilization. equipment disaggregated list) Oral/nasal mask for adult and pediatric use with tubing; withstands high 5 per level disinfection and sterilization. equipment Helmet for adult and pediatric patients with tubing; withstands high level 10 per disinfection and sterilization. equipment Humidifier accessory if not integrated in-built. 2 per equipment Connectors for air and oxygen outlets, adaptable for most connectors As required including barb, NF, DISS and NIST. to operate Mains power cable to have length ≥2. Spare parts (included and • 1-year spare parts kit as per preventive maintenance program, preferable. mentioned in a disaggregated list) Portability • Portable equipment with mechanical strength to lever rough handling. 116 Belarus Emergency COVID-19 Project ESMF Power supply, Voltage, • Operates from AC power electric line: 100 to 240 V~ / 50 to 60 Hz. Frequency and Plug vary across the • In-built rechargeable battery. countries • Automatic switch from AC power electric-line mode to battery operating mode and vice versa. • Equipment must be connected to a reliable and continuous source of energy. Documentation (included) • Instruction for use; service manual and product information to be provided in English language, at least Primary Packaging • Labelling on the primary packaging to include name and/or trademark of the manufacturer. • Model or product’s reference. • Information for particular storage conditions (temperature, pressure, light, humidity). Standards; for the • Certified quality management system for medical devices (e.g. ISO 13485, or good manufacturer manufacturing practice (GMP)). Standards, for the product • Free Sales Certificate (FSC) provided by any of the following countries; Australia, Canada, performance Japan, USA and European Community (e.g. FDA and/or CE certificate given by a third certified party for the specific medical devices proposed (no only declaration of conformity) • If the FSC comes from other national regulatory agency, it should be supported by the following certificates of quality performance, alternative national equivalent tests are acceptable: ➢ ISO 18562-1:2017: Biocompatibility evaluation of breathing gas pathways in healthcare applications — Part 1: Evaluation and testing within a risk management process. ➢ ISO 20789:2018: Anesthetic and respiratory equipment — Passive humidifiers. ➢ ISO 17510:2015 Medical devices - sleep apnoea breathing therapy - masks and application accessories. ➢ IEC 60601-1-1:2015 Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems. ➢ IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests. Warranty • Minimum 2 years. • Availability of accessories, consumables and spare parts for at least 2 years. d. Non-Invasive Ventilators: Bi-Level Positive Airway Pressure Unit (BiPAP) for Adult and Pediatric Use Description Designed to apply continuous positive airway pressure to non-intubated adult or pediatric patient, allowing clinicians to adjust two different pressures during the inspiratory and expiratory phases of a breath. Can be used in spontaneously breathing patients who require short-term mechanical assistance. General Requirements • Maintains continuous positive pressure in airway at high flow rate • User interface to be easy to operate, numbers and displays to be clearly visible. • Provides a higher positive pressure airway upon inhalation than upon exhalation. 117 Belarus Emergency COVID-19 Project ESMF • Built-in air compressor. • Oxygen inlet. • Servo-controlled heated humidifier. • Spontaneous timing (S/T). • CPAP (Spontaneous), T (Timed), Pressure Assisted Control/Pressure Control (PAC/PC), preferable. • Trigger sensitivity range: 1-10 cm H2O, increments of 1 or automatic. • Noise level to be less than 35 dBA at mid pressure range. • Expiratory relief features that reduce the pressure slightly at the end of each breath to make it easier for the patient to exhale, preferable • Pressure ramp option that starts pressure at low level and slowly increases over a period • Automatic positive airway pressure, also called Auto PAP or APAP, preferable • All parts withstand high disinfection procedures. Monitored and Controlled • FiO2: 21 to 100 %. Parameters (by user) • Pressure: 4 to 25 [cmH2O] Displayed Parameters • Display easily readable in low ambient light and sunlight. (color and graphic are preferable) • Inspiratory and Expiratory pressure; Inspiratory and Expiratory time; • FiO2 [%]; • Mean Airway Pressure (MAP); Air leak [%]. Alarms, related to gas Visual and audible for: delivered • High/Low Temperature; • High/Low Pressure; • Breathing circuit disconnect. Alarms, related to Visual, audible and clearly indicating the problem for: equipment operation • Lack of water; • System failure; • Air filter to be replaced; • Power failure; • Low battery. Consumables, labelled Inlet bacteria filter, if applicable 30 per “single use�, (included and equipment mentioned in a disaggregated list) Expiratory filters high efficiency 30 per equipment Nasal mask for adult and pediatric, with tubing. 30 per equipment 118 Belarus Emergency COVID-19 Project ESMF Oral/nasal mask for adult and pediatric, with tubing 30 per equipment Helmet for adult and pediatric, with tubing 30 per equipment Accessories, reusable Nasal mask for adult and pediatric with tubing; withstands high level 10 per (included and mentioned in a disinfection and sterilization. equipment disaggregated list) Oral/nasal mask for adult and pediatric use with tubing; withstands high 5 per level disinfection and sterilization. equipment Helmet for adult and pediatric patients with tubing; withstands high level 10 per disinfection and sterilization. equipment Humidifier accessory if not integrated in-built. 2 per equipment Connectors for air and oxygen outlets, adaptable for most connectors 2 per including barb, NF, DISS and NIST. equipment Mains power cable to have length ≥2. As required to operate Spare parts (included and • 1-year spare parts kit as per preventive maintenance program, preferable. mentioned in a disaggregated list) Portability • Mounting tray and support stand with at least 2 castors fitted with breaks. Power supply, Voltage, • Operates from AC power electric line: 100 to 240 V~ / 50 to 60 Hz. Frequency and Plug vary across the • Built-in rechargeable battery. countries • Automatic switch from AC power electric-line mode to battery operating mode and vice versa. • Equipment must be connected to a reliable and continuous source of energy. Documentation (included) • Instruction for use; service manual and product information to be provided in English language, at least Primary Packaging • Labelling on the primary packaging to include name and/or trademark of the manufacturer. • Model or product’s reference. • Information for particular storage conditions (temperature, pressure, light, humidity). Standards; for the • Certified quality management system for medical devices (e.g. ISO 13485, or good manufacturer manufacturing practice (GMP)). 119 Belarus Emergency COVID-19 Project ESMF Standards, for the product • Free Sales Certificate (FSC) provided by any of the following countries; Australia, Canada, performance Japan, USA and European Community (e.g. FDA and/or CE certificate given by a third certified party for the specific medical devices proposed (no only declaration of conformity) • If the FSC comes from other national regulatory agency, it should be supported by the following certificates of quality performance, alternative national equivalent tests are acceptable: ➢ ISO 18562-1:2017: Biocompatibility evaluation of breathing gas pathways in health-care applications — Part 1: Evaluation and testing within a risk management process. ➢ ISO 20789:2018: Anesthetic and respiratory equipment — Passive humidifiers. ➢ ISO 17510:2015 Medical devices - Sleep apnoea breathing therapy - Masks and application accessories. ➢ IEC 60601-1-1:2015 Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems. ➢ IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests. Warranty • Minimum 2 years. • Availability of accessories, consumables and spare parts for at least 2 years. e. Non-Invasive Ventilators: High-Flow Nasal Cannula (HFNC) for Adult and Pediatric Use Description Designed to deliver high flow rates with heated humidification to the non-intubated adult or pediatric patient. The maximum flow varies according to the manufacturer and can go up to 50 to 70 L/min. A specialized flowmeter and a heated humidifier are incorporated into the unit to deliver warm, humidified gases through a patient interface (nasal cannula). There is a low level of positive pressure at the patient’s airway. The FiO2 can be set by the clinician. The effectiveness of the treatment is related to the high flow generated rather than the proper sealing of the nasal cannula (reduced exhaled air dispersion). General Requirements • Ability to generate flow from room air and mix with oxygen. The oxygen source could be an oxygen concentrator or cylinder. • User interface to be easy to operate, numbers and displays to be clearly visible. • The mixed gas of air and oxygen is warmed up to 37 °C and 100% relative humidity. • FiO2: 21 to 100 %. • Flow: 2 to 50 L/min (minimum). • Controls to be easy to operate, numbers and displays to be clearly visible. • Digital display of Temperature [°C], Flow [L/min], Oxygen concentration [%]. • Humidity compensation system. • Noise level to be less than 35 dB A at mid pressure range. • Trigger sensitivity range: 1-10 cmH2O, increments of 1 cmH2O or automatic. 120 Belarus Emergency COVID-19 Project ESMF • In-built air compressor. • All parts withstand high disinfection procedures Displayed Parameters • Display easily readable in low ambient light and sunlight. (color and graphic are preferable) • Gas temperature; Tidal volume; Inspiratory pressure; • Inspiratory and Expiratory time; • FiO2 [%]; I:E ratio; • Mean Airway Pressure (MAP); Air leak [%]. Alarms, related to gas Visual and audible for: delivered • High/Low FiO2; • Incorrect Temperature/Humidity; • System leakage or blockage. Alarms, related to Visual, audible and clearly indicating the problem for: equipment operation • Lack of water; • System failure; • Air filter to be replaced; • Power failure; • Low battery. Consumables, labelled Inlet bacteria filter, if applicable 30 per “single use�, (included and equipment mentioned in a disaggregated list) Expiratory filters high efficiency 30 per equipment Housing and patient interface for adult and pediatric use 30 per equipment Accessories, reusable Housing and patient interface for adult and pediatric use; withstands high 10 per (included and mentioned in a level disinfection and sterilization. equipment disaggregated list) Flowmeter graduated in L/min. Humidifier. 5 per equipment Humidifier 2 per equipment Water chamber 2 per equipment Connectors for air and oxygen outlets, adaptable for most connectors As required including barb, NF, DISS and NIST. to operate Mains power cable to have length ≥2. Internal air compressor capacity 121 Belarus Emergency COVID-19 Project ESMF Spare parts (included and • 1-year spare parts kit as per preventive maintenance program, preferable. mentioned in a disaggregated list) Portability • Mounting tray and support stand with at least 2 castors fitted with breaks. Power supply, Voltage, • Operates from AC power electric line: 100 to 240 V~ / 50 to 60 Hz. Frequency and Plug vary across the • Built-in rechargeable battery: 12 or 24 V. countries • Automatic switch from AC power electric-line mode to battery operating mode and vice versa. • Continues in battery operating mode for at least 1 hour. • Equipment must be connected to a reliable and continuous source of energy. Documentation (included) • Instruction for use; service manual and product information to be provided in English language, at least Primary Packaging • Labelling on the primary packaging to include name and/or trademark of the manufacturer. • Model or product’s reference. • Information for particular storage conditions (temperature, pressure, light, humidity). Standards; for the • Certified quality management system for medical devices (e.g. ISO 13485, or good manufacturer manufacturing practice (GMP)). Standards, for the product • Free Sales Certificate (FSC) provided by any of the following countries; Australia, Canada, performance Japan, USA and European Community (e.g. FDA and/or CE certificate given by a third certified party for the specific medical devices proposed (no only declaration of conformity) • If the FSC comes from other national regulatory agency, it should be supported by the following certificates of quality performance, alternative national equivalent tests are acceptable: ➢ ISO 18562-1:2017: Biocompatibility evaluation of breathing gas pathways in healthcare applications — Part 1: Evaluation and testing within a risk management process. ➢ ISO 20789:2018: Anesthetic and respiratory equipment — Passive humidifiers. ➢ ISO 17510:2015 Medical devices - Sleep apnoea breathing therapy - Masks and application accessories. ➢ IEC 60601-1-1:2015 Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems. ➢ IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests. Warranty • Minimum 2 years. • Availability of accessories, consumables and spare parts for at least 2 years. 122 Belarus Emergency COVID-19 Project ESMF 123 Belarus Emergency COVID-19 Project ESMF Annex 8. Screening Form for Potential Environmental and Social Issues This form is to be used by the Ministry of Health (MOH) Project Implementation Unit (PIU) and relevant healthcare facilities (HCF) to screen potential environmental and social risk levels of a proposed subproject under the COVID-19 Emergency Project. The screening will determine the relevance of Bank environmental and social standards (ESS), propose its environment and social risk levels, and the instrument to be prepared for the sub project. Subproject Name Subproject Location Subproject Proponent (HCF) Estimated Investment Start/Completion Date Questions Answer ESS Due yes no relevance diligence / Actions if “yes� Does the subproject involve civil works ESS 1 ESMP23, including upgrading or refurbishing of the HCF SEP and/or associated waste management facilities? Does the subproject involve acquisition ESS5 Activity of assets to hold patients (including yet-to- excluded confirm cases for medical observation or isolation purpose)? Is the subproject associated with any ESS3 ESMP, external waste management facilities such as a SEP sanitary landfill, incinerator, or wastewater treatment plant for healthcare waste disposal? Is there sound regulatory framework, ESS1 ESMP, institutional capacity in place for HCF infection SEP control and healthcare waste management? Does the subproject involve recruitment ESS2 ESMP, of workforce including direct, contracted, LMP primary supply, and/or community workers? Does the subproject involve ESS3 ESMP, transboundary transportation of specimen, SEP samples, infectious and hazardous materials? Does the subproject involve use of ESS4 ESMP, security personnel during construction and/or LMP operation of healthcare facilities? Does the project area present ESS1 ESMP, considerable Gender-Based Violence (GBV), SEP Sexual Exploitation and Abuse (SEA), and Sexual Harassment (SH) risks? 23 The ESMP template includes the infection control and MWM measures 124 Belarus Emergency COVID-19 Project ESMF Conclusions: 1. Proposed Environmental and Social Risk Ratings (High, Substantial, Moderate or Low). Provide Justifications. 2. Proposed environment and social Instruments. 125 Annex 9. Template for environmental and social management plan, including infection prevention and control and medical wastes management Introduction. The scope and the components of this project are fully aligned with the COVID-19 Fast Track Facility. The project design also considered good practice in the component design from other COVID-19 projects. The COVID-19 Emergency Project is being implemented by the Ministry of Health (MOH) through a Project Implementation Unit (PIU) being established specifically for the project. Environmental and Social Risk. The project was prepared under the World Bank’s Environment and Social Framework (ESF) with an Environmental Risk Rating of "Substantial" and a Social Risk Rating of “Moderate�, resulting in an overall ESF Risk Rating of Substantial. The four major areas of risks for the project are: (a) Risks related to refurbishing of existing healthcare facilities; (b) Risks related to medical waste management and disposal; (c) Risks related to L&F and oxygen safety issues; (d) Risks related to spread of the virus among healthcare workers; and (e) Risks related to the spread of COVID-19 amongst the population at large. These risks are covered by the following Environmental and Social Standards (ESSs): ESS 1, ESS 2, ESS 3, ESS 4, and ESS 10. The project will finance procurement of COVID-19 goods and supplies as well as sub-projects at existing healthcare facilities (HCFs) around the country. Once potential HCFs and sub-projects are identified, they will be screened by the PIU based on the Screening form found as Annex 5 to the ESMF. The project will only finance minor refurbishing civil works on the property of existing HCFs. These works, which might include the provision and/or repair of handwashing and hygiene facilities, upgrading electrical work to safely operate medical equipment, maintenance, and cleaning of COVID wards, other emergency internal repairs to ensure patient and staff safety and infection prevention and control, and, possible rehabilitation or installation of medical waste incinerators, will be carried out on the local level and environmental issues (and impacts thereof) are expected to be temporary, predictable, and easily mitigable. There will be no land acquisition. The more substantial risks are around ensuring contagion vectors are controlled through strict adherence to standard procedures for medical waste management and disposal; the use of appropriate Personal Protective Equipment (PPE) for all health care workers; and working with local governments and communities to ensure that social distancing measures and quarantine regimes are strictly adhered is also vital for lowering the speed and incidence of infection. This Environmental and Social Management Plan (ESMP) Template is designed to help the PIU and the individual HCF apply the ESMF to an individual sub-project. The ESMP is comprehensive and includes along with the Environmental and Social impacts and mitigation measures also the Infection Control and MWM activities. An ESMP, based on this Template, will therefore be prepared and implemented for each sub-project. The ESMP will identify expected environmental and social risks and outline measures to be undertaken in order to mitigate those risks and covers all applicable provisions of the relevant ESSs. The ESMP Template contains activities for three project stages: (i) design; (ii) construction, and (iii) operation. The activities for each stage the ESMP stresses management of environment and social risks as well as avoiding and minimizing environmental pollution and chances of infection and protecting public health and properly managing environment and social risks associated with COVID-19 responses serves the purpose. Thus, professional efforts should be made throughout these project stages. The issues and risks presented in the matrix are based on studies of COVID-19 responses thus far, issues of similar Bank financed healthcare sector projects. They should be expanded and/or updated during the project environmental and social assessment process, including stakeholder engagement. Many pertaining mitigation measures and good practices are well documented in World Bank Group Environmental Health and Safety (EHS) Guidelines 24 , WHO COVID-19 Guidelines 25 , and other Good 24 http://documents.worldbank.org/curated/en/157871484635724258/Environmental-health-and-safety-general-guidelines 25 https://www.who.int/emergencies/diseases/novel-coronavirus-2019 126 International Industry Practices (GIIPs). They should be followed in general, considering country context. Proper stakeholder engagement including close involvement of medical and healthcare waste management professional should be conducted in determining the mitigation measures. 127 128 PART 1: INSTITUTIONAL & ADMINISTRATIVE Country Belarus Project title Emergency COVID-19 Response Project Scope of The Development Objective of the project is to to prevent, detect and project and activity respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Belarus. The Project will : (i) strengthen the short- and long-run capacity of the public health system to provide intensive care; (ii) rapidly address the COVID-19 emergency by identifying, isolating and providing care for patients with COVID-19 to minimize disease spread, morbidity and mortality, (iii) implement effective communication campaigns for mass awareness and education of the population on how to tackle the COVID-19 emergency. Institutional WB Project Local HCF arrangements (Project Management (Name and Team Leader) …….. contacts) Project Implementation Unit under the MoH Mr. Implementation ESF Local Local Contactor arrangements Supervision Counterpart state (Name and Supervision institutions contacts) Mrs/Mr Supervision SITE DESCRIPTION Name of HCF Describe site Address ; location within the city; distance from residential or industrial location, including areas. Attachement with the Site Map Brief Brief characteristics of climate conditions, relief; geology and surface and Geographic description ground waters, nearby green areas. Describe the Type: e.g. general hospital, clinics, inpatient/outpatient facility, medical participating laboratory; healthcare facility (HCF) Special type of HCF in response to COVID-19: E.g. existing assets may be acquired to hold yet-to-confirm cases for medical observation or isolation; Describe the design requirements of Functions and requirement for the level infection control, e.g. biosafety the HCF, which may levels; include specifications for general design and Location and associated facilities, including access, water supply and safety, separation of sanitation, district heating wards, heating, ventilation and air Capacity: beds conditioning (HVAC), autoclave, and waste Life&Fire and oxygen risks and their management. management facilities. 129 HCF Infection Overview of infection control and waste management in the HCF: Control and Waste • Type, source and volume of MW generated in the HCF, including Management solid, liquid and air emissions (if significant); • Classify and quantify the MW (infectious waste, pathological waste, sharps, liquid and non-hazardous) following WGB EHS Guidelines for Healthcare Facilities. Given the infectious nature of the novel coronavirus, some wastes that are traditionally classified as non-hazardous may be considered hazardous. It’s likely the volume of waste will increase considerably given the number of admitted patients during COVID-19 outbreak. Special attention should be given to the identification, classification and quantification of the healthcare wastes. • Describe the MWM system in the HCF, including material delivery, waste generation, handling, disinfection and sterilization, collection, storage, transport, and disposal and treatment works; • Describe applicable performance levels and/or standards; • Describe institutional arrangement, roles and responsibilities in the HCF for infection control and MWM. Applied Management Measures: • Waste minimization, reuse and recycling: practices and procedures to minimize waste generation. • Delivery and storage of specimen, samples, reagents, pharmaceuticals and medical supplies: practices and procedures to minimize risks associated with delivering, receiving and storage of the hazardous medical goods. • Waste segregation, packaging, color coding and labeling: conducting waste segregation at the point of generation and applying internationally adopted method for packaging, color coding and labeling the wastes should be followed. • Onsite collection and transport: adopting practices and procedures to timely remove properly packaged and labelled wastes using designated trolleys/carts and routes and disinfection of pertaining tools and spaces, ensuring hygiene and safety of involved supporting medical workers such as cleaners. • Waste storage: having multiple waste storage areas designed for different types of wastes and their proper maintenance and disinfection as well as removing infectious wastes from HCF’s storage area for disposal within 24 hours. • Onsite waste treatment and disposal (e.g. an incinerator): conducting the due diligence of the existing incinerator and examining its technical adequacy, process capacity, performance record, and operator’s capacity, based on what, - providing corrective measures. • Transportation and disposal at offsite waste management facilities: these offsite waste management facilities may include incinerators, hazardous wastes landfill, which also need a due diligence to examine its technical adequacy, process capacity, performance record, and operator’s capacity, providing, if needed, corrective measures agreed with the government agency or the private sector operators. • Wastewater treatment: as wastewater is discharged into municipal sewer sewerage system, please provide evidence that the HCF ensures that wastewater effluent comply with all applicable permits and standards, and the municipal wastewater treatment plant (WWTP) can handle the type of effluent discharged. 130 Emergency Provide an overview of the existing practices to deal with the emergency Preparedness and situations (due to spillage, occupational exposure to infectious materials or Response radiation, accidental releases of infectious or hazardous substances to the environment, medical equipment failure, failure of solid waste and wastewater treatment facilities, and fire), and if an Emergency Response Plan (ERP) that is commensurate with the risk levels is recommended is in place or needs to be developed. The key elements of an ERP are defined in ESS 4 Community Health and Safety (para. 21). LEGISLATION Identify The regulatory framework for the project includes a series of National national & local laws and regulations, WBG Environmental and Social Standards and Guidelines, legislation & permits as well as WHO Guiding documents: that apply to project Law dated 18.07.2016 № 399-З “On state ecological expertise, strategic activity environmental assessment and environmental impact assessment�; Resolution of the Council of Ministers of the Republic of Belarus dated 19.01.2017 № 47 “About the state ecological expertise, strategic environmental assessment and environmental impact assessment�; Law of the Republic of Belarus dated 07.01.2012 № 340-З “On the sanitary and epidemiological well-being of the population�; National Regulation on “Sanitary and epidiemiological requirements for MWM � aproved by MoH in 2018; Law of the Republic of Belarus dated 23.06.2008 № 356-З “On labor protection�; Law "On Fire Safety" adopted in 1993 and amended on November 11, 2019 (No. 251-З); “General requirements for fire safety�, approved by the Decree of the President of the Republic of Belarus (November 23, 2017 No. 7); “Specific requirements for ensuring fire safety for health care facilities and those specially designed for children, approved by the Government of Belarus on August 22, 2019 (No.561). MOH order on hospital requirements for care of patients with COVID-19; Order of the Prime Minister of the Republic of Belarus (March 17, 2020) on creation of an inter-agency working group to coordinate the work on COVID -19; GoB order on mandatory 14-day self-isolation requirement for foreign and Belarussian citizens with either confirmed COVID-19 diagnosis, or the status of first- or second-level contact; WB Environmental and Social Standards: ESS1 – Assessment and Management of Environmental and Social Risks and Impacts; ESS2 – Labor and Working Conditions; ESS3 – Recourse and Efficiency, Pollution Prevention and Management; and, ESS4 – Community Health and Safety; The WBG Environmental Health and Safety (EHS) Guidelines (General EHS Guidelines: (a) EHS 2.5 – Biological Hazards; (b) EHS 2.7 – Personal Protective Equipment (PPE); (c) EHS 3.5 – Transportation of Hazardous Materials; and, (d) EHS 3.6 – Disease Prevention); IFC Environment, Health and Safety Guidelines for Health Care Facilities; World Health Organization technical guidance on the following issues: (viii) laboratory biosafety, (ix) infection prevention and control, (x) rights, roles and responsibilities of health workers, including key considerations for occupational safety and health, (xi) water, sanitation, hygiene and waste management, (xii) quarantine of individuals, 131 (xiii) rational use of PPE, (xiv) oxygen sources and distribution for COVID-19 treatment centers. ESMP DISCLOSURE AND PUBLIC CONSULTATION Identify when / Provide information when and where the ESMP document has been where the document disclosed and the results of virtual consultation (an overview and/or attaching the has been disclosed and minutes with the summary of received comments and answers) conducted public consultation INSTITUTIONAL ARRANGEMENTS AND CAPACITY BUILDING Implementing The following aspects should be described: institutional • Define roles and responsibilities along each link of the chain along arrangements the cradle-to-crave infection control and waste management process; and • Ensure adequate and qualified staff are in place, including those in proposed/conducted charge of infection control and biosafety and waste management facility operation. capacity building • Stress the chief of an HCF takes overall responsibility for infection activities control and waste management; • Involve all relevant departments in an HCF, and build an intra- departmental team to manage, coordinate and regularly review the issues and performance; • Establish an information management system to track and record the waste streams in HCF; and • Capacity building and training that should involve medical workers, waste management workers and cleaners. Third-party waste management service providers should be provided with relevant training as well. • Dedicate HCF representatives from the management level who will be responsible for grievances for HCF workers. 132 133 Part 2 - Environmental and Social Risks and Mitigation and Infection Control and Medical Wastes Management activities Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing A. Planning and Design stage Identify the • Construction • Proper HCF HCF needs and scope of and medical workers OHS design which will ensure refurbishing and risks potential of COVID-19 other related for • Solid wastes infection impacts and risks HCF operation in • Air pollution would be reduced the context of with dust COVID-19 – i.e. for • Physical separation of wards, impacts (vibration; noise) heating, ventilation and air conditioning (HVAC) ICU, installation of box chambers isolation facilities, universal access, nosocomial infection control 26 Provide where possible, required resources, their magnitude or source of financing 134 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Determine • Resources • Ensuring HCF that utilities (power, efficiency adequate supply and water, heat, etc.) are • Environmental efficiency of public utilities adequate for pollution for selected HCFs planned works and if the installation/ augmentation of water supply and installation of sanitary stations, rehabilitation or installation of medical waste incinerators, medical waste disposal, sanitary stations/ handwashing facilities is needed Identify the • Resources • Ensuring HCF needs for ancillary efficiency adequate supply and works and • Environmental efficiency of public utilities associated facilities, pollution for associated facilities such as supplies of water and power, sewage system 135 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Estimates • Health risks • Improving HCF of MW streams in for HCF workers MW management the HCF Identify • Environmental • Ensuring HCF onsite medical pollution adequate type and capacity of waste management • Health risks the MW collection and facilities for HCF workers disposal facility (incinerators, pits • Improving for burning, pits for MW facilities operation burial, disinfecting, storage for further transport, etc.) Identify the • Fires and explosions Implementing a special HCF needs in terms of review. oxygen equipment Preparing or updating L&F deployment and Action Plan. strengthening the Conducting necessary L&F risks training. management Ensuring information dissemination. Undertaking upgrading of the facilities for oxygen generation. Strengthening the L&F alarm system; etc. 136 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Identify • Environmental • Providing HCF offsite medical pollution specialized and authorized waste management • Communities’ vehicles for MW facilities, if any, and service providers’ health transportation transportation risks • Selecting routes, and service offsite MW service providers providers which are closer to the HCF • Selecting best operating MW facilities Identify • Environmental • Selecting best HCF regular waste pollution operating facilities management • Communities’ facilities, and service providers’ health procedures, and risks service providers Identify • Communities’ • Providing HCF needs for and service providers’ health specialized and authorized transboundary risks vehicles for transportation of movement of samples, specimen, reagent, samples, specimen, and other hazardous materials reagent, and other hazardous materials Identify • OHS issues • Ensure Labor needs for workforce • Gender Based Guidelines are included in and type of project Violence/Sexual Exploitation conducting minor refurbishing workers and Abuse (GBN/SEA) civil works and operation stage matrices 137 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Identify the • Human rights • USE WB HCF needs for using issues Note on security in COVID- additional security • HCF workers 19 projects personnel operation risks stage HCF design • Structural • Ensuring HCF – general safety risk facilities sustainability by • Asbestos strengthening its structure insulation or lagging present • Identifying • Functional asbestos containing materials layout and engineering control (ECM) and preparing ACM for nosocomial infection action plan Determine • Disturbance of • Prepare and HCF how normal HCF the HCF operation implement measures for operations will be ensuring efficient HCF affected by planned operation small-scale refurbishing works 138 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing HCF design • Increased risks • Providing in HCF – considerations for for vulnerable groups the HCF design equal differentiated opportunities for all social treatment for groups groups and especially for of higher sensitivity vulnerable and those with or vulnerable higher sensivity (potentially the elderly, those with preexisting conditions, or the very young) HCF design • Lack of access • Providing in HCF – considerations for of the social group with the HCF design special access those with disabilities for those with disabilities disabilities, taking into consideration the principle of universal access as and when appropriate; Grievance • Potential • Ensure proper HCF Redress social conflicts registering and mechanisms Mechanisms for addressing all received complaints B. Minor refurbishing civil works, adjustment of the ICUs in existing HCFs and installation of medical equipment 139 General • Notification • All legally Contractor, refurbishing and Worker Occupational required permits have been HCF activities Health and Safety (OHS); acquired for civil works; • Resource • All works will efficiency issues, including be carried out in a safe and raw materials, water and disciplined manner designed to energy use; minimize impacts on neighboring residents and environment; • Applying civil works technologies and approaches that ensure high level of resource efficiency; • If required, the local construction and environment inspectorates and communities have been notified of upcoming activities; • Workers’ PPE will comply with international good practice (always hardhats, as needed masks and safety glasses, harnesses and safety boots); • Appropriate signposting of the sites will inform workers of key rules and regulations to follow. General • Construction • Waste Contractor, refurbishing solid waste collection and disposal HCF activities – • Construction pathways and sites will be pollution wastewater identified for all main waste management • Nosie types expected from civil • Vibration works; • Dust • Mineral civil works wastes will be separated 140 • Air emissions from general refuse, organic, from construction equipment liquid and chemical wastes by on-site sorting and stored in appropriate containers; • Civil works waste will be collected and disposed properly by licensed collectors; • The records of waste disposal will be maintained as proof for proper management as designed; • Whenever feasible the contractor will reuse and recycle appropriate and viable materials (except asbestos); • Keep civil works waste in controlled area and spray with water mist to reduce debris dust; • Suppress dust during pneumatic drilling/wall improvement by ongoing water spraying and/or installing dust screen enclosures at site; • Keep surrounding environment (sidewalks) free of debris to minimize dust; • Construction noise will be limited to restricted times agreed to in the permit; • During operations the engine covers of 141 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing generators, air compressors and other powered mechanical equipment should be closed, and equipment placed as far away from HCF as possible. 142 General • Fuel, oils, • Temporarily Contractor, refurbishing lubricant storage on site of all hazardous HCF activities – • Asbestos or toxic substances will be in hazardous waste insulation or pipe lagging safe containers labeled with management details of composition, properties and handling information; • The containers of hazardous substances should be placed in a leak-proof container to prevent spillage and leaching; • The wastes are transported by specially licensed carriers and disposed in a licensed facility; • Paints with toxic ingredients or solvents or lead-based paints will not be used; • If asbestos is located on the project site, mark clearly as hazardous material; • When possible, the asbestos will be appropriately contained and sealed to minimize exposure; • The asbestos prior to removal (if removal is necessary) will be treated with a wetting agent to minimize asbestos dust; • Asbestos will be handled and disposed by skilled & experienced professionals. 143 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing • If asbestos material is be stored temporarily, the wastes should be securely enclosed inside closed containments and marked appropriately • The removed asbestos will not be reused and buried at the city’s landfill. General • Potential • The Contractor, refurbishing conflicts related to labor issues Contractor assign liaison HCF activities – Labor person in charge of issues communication with and receiving requests/ complaints from HCF workers and local population • HCF workers and local communities should be consulted to identify and pro-proactively manage potential conflicts. General • GBV/SEA/SH • GBV/SEA/SH HCF, PIU refurbishing issues issues should be included in the activities – Labor civil works contracts Codes of issues Conduct and followed during the project implementation 144 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Civil works • Medical • Ensure Contractor, related to onsite workers health risks and implementation, as relevant, HCF waste management impacts provided above mitigation facilities, including measures for refurbishing civil temporary storage, works incinerator, improving sewerage system and wastewater treatment works C. Operation stage 145 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing General • Solid wastes, • Monitoring HCF HCF operation – wastewater and air emissions and controlling of generated environmental solid wastes, contracting of pollution authorized wastes operator; • Ensuring proper functioning of onsite MW disposal installations technological equipment and complying conditions of Sanitary Authorization for its operation; • Monitoring and controlling of air emissions from MW disposal facility, ensuring proper functioning of its equipment; • Monitoring and controlling of generated wastewaters, ensuring contractual conditions of discharge to the municipal sewerage system. 146 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing General • OHS Risks • Ensuring of HCF HCF operation – personnel periodic medical OHS issues control, workspaces risk assessment and preparing and implementing adequate mitigation action plans, as relevant HCF • Potential • Assigning a HCF operation – Labor conflicts related to labor issues person in charge of issue communication with and receiving requests/ complaints from HCF workers • HCF workers are consulted to identify and pro-proactively manage potential conflicts. 147 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Life and Fire Risks of fires Conduct a review of L&FS HCF Safety risk Master Plan of participating management: HCFs, Updating site specific ESMP as needed along with a Corrective Action Plan, if needed, and a time frame for its implementation. State fire departments will certify that the facility meets the L&FS Master Plan. Prepare and implement a training program Prepare and implement a L&F maintenance plan. Prepare an emergency preparedness and response plan. 148 Oxygen equipment Fires and explosions Awareness: HCF deployment and operation Raise awareness among hospital management, to be transported throughout the whole organization, including all medical staff, infrastructure and maintenance departments, and cleaning and housekeeping staff. Inform the entire network of ICU personnel of their part in reducing risk of fire from oxygen-enriched environments. Active risk monitoring and management: Medical staff should be observant of increased risk in ICU due to the rise in number of patients on oxygen therapy, ventilators that show signs of excessive wear, presence of debris, presence of solvents in the area, etc. Have standard protocols for reporting and addressing risk. Hospital operations and maintenance must consider electrical capacities and loading, as well as the regular maintenance, in light of the surge in usage of electrical equipment. 149 Room ventilation must be assessable to minimize buildup of an elevated oxygen concentration. Minimize or avoid use by cleaning staff of solvent-based cleaning agents, such as ethyl alcohol, in elevated-oxygen atmospheres. Establish routines for timely exchange of information between different functions about circumstances that negatively impact risk. Assessment of electrical loading: Confirmation by an electrician that the power circuit can handle the new electrical load, including power surges, before assigning a ward for use of intensive care with oxygen ventilation or increasing the number of beds in a ward. Inspection and maintenance: Regularly inspect, test, and maintain all electrical and electro-mechanical equipment for wear, heat loading (especially when in continuous use), blocked fans and ventilation ducts. 150 Withdraw defective equipment. All air ducts and cooling fans must be clean and unobstructed by hair, dust and other debris. Motors, switches and other electrical contacts should be clean and in good condition to avoid sparking. Oxygen detection: Install fixed or mobile devices to frequently (i.e., hourly) measure oxygen excess in ambient air. Promptly address any excess in oxygen consumption that does not correspond to the demand ensued by patients currently under treatment (e.g., oxygen leak in the storage, distribution system or the endpoints). Room ventilation: Ensure adequate room air flow in areas where elevated oxygen concentration may be expected. necessary adjustments should be made as soon as possible to adapt air circulation in ICUs in the face of a sudden upsurge in oxygen therapy patients. 151 Oxygen pipeline supply systems: Maintain and ensure correct operation of the gas supply system, including those that supply oxygen. Train maintenance and operations personnel on operation procedures and carry out regular maintenance to check for leaks, wear and other potential deteriorations in mechanical integrity. Oxygen cylinder handling and storage: In hospitals dependent on oxygen cylinders, ensure that appropriate storage conditions (e.g., clean, dry, well- ventilated, away from flammable substances, etc.) are rigorously observed, including when temporary storage arrangements need to be established. Train and ensure staff follow correct handling procedures, for example by using the Failure Mode Effect Analysis for analyzing risks associated with use of medical gas in hospitals. See also WHO 152 Oxygen Cylinder Safety poster. Enhanced product stewardship across industry and downstream users: Producers of industrial gases and medical equipment should proactively provide to hospitals and other healthcare providers comprehensive communication of hazards from the commissioning phase, as well as timely notification of any recent safety developments. Management of change: Raise awareness of hospital management that changes in room use, number of beds, increases in ventilation with oxygen, increases in the number of highly infectious patients, etc. affect hospital safety. Assess these changes for their impacts on other aspects of the system, in particular the creation of new hazards or increasing the risks of existing hazards. Ensure risk assessment results are taken into final decisions about whether and how 153 required changes are implemented. Document the assessment and resulting decisions. Open communication: Encourage all staff at any level in the hierarchy to speak up about changes that could elevate risk. Following identification of an important change, communicate about those changes and implications for expected behaviors and procedures. Proactively communicate changes as they are unfolding (e.g., a sudden rise in COVID- 19 patients in the ICU). Inform competent technical personal so they can address deviations from expected performance or function of equipment, loading of the electrical supply, tripping of fuses, etc. Communicate, ideally through routine channels (e.g., as part of exchanges at the start of every shift and in staff meetings), changing circumstances, deviations from the norm, equipment 154 performance, and any other anomalies that raise concerns about heightened risk. Accident investigation and lessons learninLessons learned from previous fires should be reviewed and communicated across all levels of management and areas of operations in order to promote medical staff’s awareness of fire hazards related to oxygen enriched atmospheres. Emergency preparedness: In the event of an oxygen- related fire, personnel in the immediate vicinity should immediately switch off all sources of oxygen if possible. Hospital management should make sure that COVID-19 measures to minimize the contagion do not hinder emergency preparedness. A comprehensive fire risk assessment prior to any modification should take place to determine the effect on fire safety and emergency preparedness. HCF • GBV/SEA/SH • Monitoring of operation - issues the GBV/SEA/SH issues GBV/SEA/SH issues 155 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing HCF • Increased risks • Ensuring HCF operation – for vulnerable groups permanently equal considerations for opportunities for all social differentiated groups and especially for treatment for groups vulnerable and those with of higher sensitivity higher sensivity. or vulnerable (potentially the elderly, those with preexisting conditions, or the very young) HCF • Lack of access • Ensuring HCF operation – of the social group with permanently in good considerations for disabilities conditions the special access those with for those with disabilities disabilities, taking into consideration the principle of universal access as and when appropriate; 156 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Delivery • Health risks • Strictly follow HCF and storage of for HCF workers the national and HCF protocols specimen, samples, on safe handling of specimen, reagents, samples, reagents, pharmaceuticals pharmaceuticals and medical and medical supplies supplies Storage and • Health risks • Strictly follow HCF handling of for HCF workers the national and HCF specimen, samples, protocols on safe handling of reagents, and specimen, samples, reagents, infectious materials pharmaceuticals and medical supplies Medical • Health risks • Strictly HCF waste (MW) for HCF workers; following National Regulation segregation, • Environmental on MWM; packaging, color pollution. • Providing coding and labeling adequate and in enough quantity supplies for MW segregation, packaging, coding and labeling; • Conducting HCF worker training 157 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing MW onsite • Health risks • Strictly HCF collection and for HCF workers; following National Regulation transport • Environmental on MWM; pollution. • Use special and authorized vehicles; • Provide drivers with training Waste • Health risks • Strictly HCF storage for HCF workers; following National Regulation • Environmental on MWM; pollution. • Follow safety National and HCF safety rules for waste storage Onsite • Health risks • Strictly HCF waste treatment and for HCF workers; following National Regulation disposal • Environmental on MWM pollution • Provide training for health workers; • Control and ensure proper operation of MW disposal facilities Waste • Health risks • Use only HCF transportation to for HCF workers; special and authorized and disposal in • Environmental vehicles; offsite treatment pollution • Provide and disposal training for drivers and facilities disposal facilities workers 158 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Integration • Human rights • Apply HCF of additional issues requirements and security personnel • HCF workers recommendations provided in into HCF operations risks the WB Note on security in COVID-19 projects HCF • Transboundary • Strictly follow HCF, MOH, operation – health risks and infection the protocols for ensuring PIU transboundary safety of handling specimen, movement of samples, reagents, medical specimen, samples, equipment, and infection reagents, medical materials; equipment, and • Use only infection materials special and authorized vehicles; • Provide drivers with training Operation • OHS risks • Strictly follow HCF of acquired assets the technical specifications of for holding the acquired equipment, potential COVID- ensuring avoiding OHS risks 19 patients 159 Key Potential Proposed Mitigation Responsibilities Timeline Budget Activities environment and social Measures – if not issues and risks included in HCF or project budget (Bel. Ruble/USD)26 and source of financing Emergency • Spillage, • Emergency HCF events • Occupational Response Plan that provides exposure to infectious actions to be undertaken in the • Exposure to case of occurrence of specified radiation, emergency events • Accidental releases of infectious or hazardous substances to the environment, • Medical equipment failure, • Failure of solid waste and wastewater treatment facilities, -fire • Other emergent events PART 3: Environmental and social monitoring plan Environmental What Where How When Cost Who and Social Aspects (Is the (Is the (Is the (Define the (if not (Is parameter to be parameter to be parameter to be frequency / or included in project responsible for monitored?) monitored?) monitored?) continuous?) budget) monitoring?)27 A. Minor refurbishing civil works, adjustment of the ICUs in existing HCFs and installation of medical equipment 27 Each HCF will assign a responsible person for ESMP and its monitoring, - this might be the HCF Director, or Deputy Director – Chief Doctor 160 Environmental What Where How When Cost Who and Social Aspects (Is the (Is the (Is the (Define the (if not (Is parameter to be parameter to be parameter to be frequency / or included in project responsible for monitored?) monitored?) monitored?) continuous?) budget) monitoring?)27 Notification Obtained At the HCF Checking Before Included HCF legally required provided by starting civil works in project budget permits; contractors/HCF required permits; Provided Checking if notifications; notifications have been provided Worker Provided HCF; Contractor or Before To be HCF; Occupational Health and OHS training; HCF records; starting civil works included in the Contractor Safety (OHS); At working Accident and then contract for civil Provided places register; Training continuously works PPE; register; Visual Security observations barriers; Onsite signposts on OHS. Resource Applied At working Contractor or Before To be HCF efficiency issues, technologies and places HCF records; starting civil works included in the including raw materials, approaches Visual and continuously contract water and energy use; observations Pollution Construction Survey on Visual During Operation Contractor management solid waste; site during civil monitoring; works costs included in Construction works Contractor Daily contract wastewater; records and reports; Noise; Checking out Vibration the procedures and Dust records on waste transportation 161 Environmental What Where How When Cost Who and Social Aspects (Is the (Is the (Is the (Define the (if not (Is parameter to be parameter to be parameter to be frequency / or included in project responsible for monitored?) monitored?) monitored?) continuous?) budget) monitoring?)27 Air emissions from construction equipment Air pollution Technical Working site; Regular Weekly Included Contractor, from equipment condition of Onsite car technical inspection in the contract HCF equipment and cars parking area Hazardous Fuel, oils, Survey on Visual During Operation Contractor, waste management lubricant; site during civil monitoring; works costs included in HCF Asbestos works Contractor Daily contract containing material records and reports action plan Material Are the truck Onsite for Visual Unannounc Constructi Road police transportation loads covered or civil works/ observations ed inspections on costs wetted; municipal streets during civil works Compliance with legislation (restricted working hours; haul routes) dust suppression methods where required Labour and Sanitary Survey at the Visual During Included HCF working condition conditions: supply construction site observations; civil works in the costs of with fresh drinking Checking out the Contractors water; restrooms and OHS procedures lockers; separate eating areas, etc. Grievance Complaints HCF Received During Included HCF, PIU Redress Management from HCF workers complaints records works daily in the project and the public costs B. Operation stage 162 Environmental What Where How When Cost Who and Social Aspects (Is the (Is the (Is the (Define the (if not (Is parameter to be parameter to be parameter to be frequency / or included in project responsible for monitored?) monitored?) monitored?) continuous?) budget) monitoring?)27 Environmental Solid wastes, HCF, Visual Monthly Operation HCF, pollution wastewater; observations; costs of the HCF City’s and MW disposal Records on environmental and air emissions facilities waste management sanitary authorities and on MW disposal; Records on wastewater discharges Medical wastes MW HCF Visual Weekly Operation HCF segregation, observations; costs of the HCF packaging, color Records on coding and labeling; MW management and training; Health care Performance HCF; Visual Weekly Operation HCF waste temporary storage of the operation of observations; costs of the HCF and onsite disposal onsite MW disposal MW disposal Records on facility; facility MWM and training; HCF Checking the Protocol on MWM; documentations Health workers training on MWM Health Care Used special HCF Records on Weekly Operation HCF Waste transportation to and authorized MW transportation to costs of the HCF offsite disposal facility vehicles; the offsite disposal Provided facility drivers with training OHS risks Workers HCF; HCF records Quarterly Operation HCF medical examination; costs of the HCF Conducted MW disposal workspaces risk facilities assessment 163 Environmental What Where How When Cost Who and Social Aspects (Is the (Is the (Is the (Define the (if not (Is parameter to be parameter to be parameter to be frequency / or included in project responsible for monitored?) monitored?) monitored?) continuous?) budget) monitoring?)27 Provided training; Provided PPE; Prepared OHS risks mitigation action plans or protocols L&F and Fires and HCFs Visual Continous Included HCF, MoES Oxygen risks explosions observations and in the HCFs management L&F and Oxygen operation equipment checking procedures Labour and Sanitary Survey at the Visual Continuous Included HCF working condition conditions: supply workplaces observations; in the HCF with fresh drinking Checking out the operation costs water; restrooms and OHS procedures lockers; separate eating areas, etc. Labor issues Social HCF GRM records Monthly Operation HCF conflicts costs of the HCF GBV/SEA/S H Differentiated Risks and HCF HCF records, Monthly Operation HCF treatment for vulnerable lack of access Visual costs of the HCF groups and groups with observations disabilities Storage of Risks of HFC storage Visual Weekly Operation HCF specimen, samples, infection spaces observations and costs of the HCF reagents, HCF records pharmaceuticals, infectious materials and medical supplies 164 Environmental What Where How When Cost Who and Social Aspects (Is the (Is the (Is the (Define the (if not (Is parameter to be parameter to be parameter to be frequency / or included in project responsible for monitored?) monitored?) monitored?) continuous?) budget) monitoring?)27 Grievance Received HCF HCF records Weekly Operation HCF Redress Management complaints costs of the HCF Emergency Spillage; HCF HCF records Monthly Operation HCF events Occupational costs of the HCF exposure to infectious; Exposure to radiation; Accidental releases of infectious or hazardous substances to the environment; Medical equipment failure; Failure of solid waste and wastewater treatment facilities, fire; Other emergent events. COVID-19 Infected HCF HCF HCF records; Daily Operation HCF statistics workers on the Emergency costs of the HCF working place; Action Plans 165 Annex 10. Infection Prevention and Control Protocol (adapted from the CDC Interim Infection Prevention and Control Recommendations for patients with confirmed COVID-19 or persons under investigation for COVID-19 in Healthcare Settings) HEALTH CARE SETTINGS 1. Minimize Chance of Exposure (to staff, other patients and visitors) • Upon arrival, make sure patients with symptoms of any respiratory infection to a separate, isolated and well-ventilated section of the HCF to wait, and issue a facemask • During the visit, make sure all patients adhere to respiratory hygiene, cough etiquette, hand hygiene and isolation procedures. Provide oral instructions on registration and ongoing reminders with the use of simple signs with images in local languages • Provide alcohol-based hand sanitizer (60-95% alcohol), tissues and facemasks in waiting rooms and patient rooms • Isolate patients as much as possible. If separate rooms are not available, separate all patients by curtains. Only place together in the same room patients who are all definitively infected with COVID-19. No other patients can be placed in the same room. 2. Adhere to Standard Precautions • Train all staff and volunteers to undertake standard precautions – assume everyone is potentially infected and behave accordingly • Minimize contact between patients and other persons in the HCF: health care professionals should be the only persons having contact with patients and this should be restricted to essential personnel only • A decision to stop isolation precautions should be made on a case-by-case basis, in conjunction with local health authorities. 3. Training of Personnel • Train all staff and volunteers in the symptoms of COVID-19, how it is spread and how to protect themselves. Train on correct use and disposal of personal protective equipment (PPE), including gloves, gowns, facemasks, eye protection and respirators (if available) and check that they understand • Train cleaning staff on most effective process for cleaning the HCF: use a high-alcohol based cleaner to wipe down all surfaces; wash instruments with soap and water and then wipe down with high- alcohol based cleaner; dispose of rubbish by burning etc. 4. Manage Visitor Access and Movement • Establish procedures for managing, monitoring, and training visitors • All visitors must follow respiratory hygiene precautions while in the common areas of the HCF, otherwise they should be removed • Restrict visitors from entering rooms of known or suspected cases of COVID-19 patients Alternative communications should be encouraged, for example by use of mobile phones. Exceptions only for end-of-life situation and children requiring emotional care. At these times, PPE should be used by visitors. • All visitors should be scheduled and controlled, and once inside the HCF, instructed to limit their movement. • Visitors should be asked to watch out for symptoms and report signs of acute illness for at least 14 days. CONSTRUCTION SETTINGS IN AREAS OF CONFIRMED CASES OF COVID-19 1. Minimize Chance of Exposure • Any worker showing symptoms of respiratory illness (fever + cold or cough) and has potentially been exposed to COVID-19 should be immediately removed from the site and tested for the virus at the nearest local hospital • Close co-workers and those sharing accommodations with such a worker should also be removed from the site and tested • Project management must identify the closest hospital that has testing facilities in place, refer workers, and pay for the test if it is not free 166 • Persons under investigation for COVID-19 should not return to work at the project site until cleared by test results. During this time, they should continue to be paid daily wages • If a worker is found to have COVID-19, wages should continue to be paid during the worker’s convalescence (whether at home or in a hospital) • If project workers live at home, any worker with a family member who has a confirmed or suspected case of COVID-19 should be quarantined from the project site for 14 days, and continued to be paid daily wages, even if they have no symptoms. 2. Training of Staff and Precautions • Train all staff in the signs and symptoms of COVID-19, how it is spread, how to protect themselves and the need to be tested if they have symptoms. Allow Q&A and dispel any myths. • Use existing grievance procedures to encourage reporting of co-workers if they show outward symptoms, such as ongoing and severe coughing with fever, and do not voluntarily submit to testing • Supply face masks and other relevant PPE to all project workers at the entrance to the project site. Any persons with signs of respiratory illness that is not accompanied by fever should be mandated to wear a face mask • Provide handwash facilities, hand soap, alcohol-based hand sanitizer and mandate their use on entry and exit of the project site and during breaks, via the use of simple signs with images in local languages • Train all workers in respiratory hygiene, cough etiquette and hand hygiene using demonstrations and participatory methods • Train cleaning staff in effective cleaning procedures and disposal of rubbish. 3. Managing Access and Spread • Should a case of COVID-19 be confirmed in a worker on the project site, visitors should be restricted from the site and worker groups should be isolated from each other as much as possible; • Extensive cleaning procedures with high-alcohol content cleaners should be undertaken in the area of the site where the worker was present, prior to any further work being undertaken in that area. 167 Belarus Emergency COVID-19 Response Project ESMF Annex 11. COVID-19 Preparedness report template COVID-19 RESPONSE report should follow the template format provided below. Make sure to provide breakdown between different subprojects, construction sites and/or contractors. Analyze discrepancies and assess their causes, as well as necessary adjustments. Refer to guidance documents provided previously – COVID-19 Considerations on Construction Civil Works documents (Guidance for Borrower and Guidance for Contractor), Advisory Note on Contingency Planning for existing operations – for examples of mitigation measures/practices for COVID-19 spread prevention/containment etc. GENERAL INFORMATION Name of the project/subproject, Date of the report Provide identifying information Brief description of activities/subprojects Describe level of activity for each project/subproject (PIU is operational in Client’s premises; ongoing civil works on sites, etc.), as well as types of civil works (if ongoing) and number of workers on each site separately and for each subproject/contractor collectively (a) ASSESSING WORKFORCE CHARACTERISTICS Information on workers accommodation Provide information on how many workers live in residential accommodations, hotels, etc.; how many live in their own private residences. Transportation to/from work sites and for other work-related reasons If workers need to commute to/from work sites from the place of residence, specify the type of transportation (public transport, own vehicle, arranged transportation by the Employer, etc.) COVID-19 PREPAREDNESS/RESPONSE MEASURES (b) Entry/exit to the work site and checks on commencement of work Describe measures taken to secure entrance procedure and medical checks. € General hygiene Describe what are requirements on general hygiene applied for project-related workforce (both PIU and project workers) and how these requirements are communicated (d) Cleaning and waste disposal Provide review of cleaning protocols (including disinfection) for all site facilities, including offices, accommodation, canteens, common spaces, as well as key construction equipment. € Adjusting work practices Describe what changes to work processes and timings have been done to reduce or minimize contact between workers (f) Project medical services Provide assessment whether existing project medical services on site are adequate, taking into account existing infrastructure (size of medical post, number of beds, isolation facilities), medical staff, equipment and supplies, procedures and training. If not, describe what measures have been taken to upgrade. (g) Local medical and other services Provide overview of resources and capacity of local medical services, what procedure is established for the event of ill workers needing to be referred. Availability of health facility nearby to refer the patient and agreement between the Contractor and the facility. (h) Instances or spread of the virus 168 Belarus Emergency COVID-19 Response Project ESMF Describe what is planned to be done to treat a person who becomes sick or displays symptoms that could be associated with the COVID-19 virus (j) CONTINGENCY PLANNING FOR AN OUTBREAK Measures to address COVID-19 may be presented in different ways – as a contingency plan, as an extension of the existing project emergency and preparedness plan or as standalone procedures. Describe, how such measures are presented for each individual subproject/contractor and when such plan/procedures came into force. AWARENESS AND COMMUNICATION (k) Training and communication with workers Workers should be made aware of the procedures that have been put in place by the project, and their own responsibilities in implementing those procedures. Provide description of awareness/preparedness building exercises (issue of specific work instructions, public announcements on medical check-ins procedures, access to health care center, etc.) for workforce. (l) Communication and contact with the community The community may be concerned about the presence of non-local workers, or the risks posed to the community by local workers presence on the project site. Describe risk-based procedures to be followed for communication with local community stakeholders. Grievance Redress Mechanism Project-related GRM log needs to include additional column monitoring COVID-19 related complains/reports/grievances. Provide an update on number of COVID-related GRM log entries since last regular report. (m) COVID-19 REPORTING Number of COVID-19 cases – confirmed and suspected/under investigation Provide information on project-related employees who are confirmed or suspected of being infected with COVID-19 virus: number, date of isolation, severity of the case. No private information should be provided! Reporting arrangements ESIRT requires outbreaks of diseases to be reported. PIU/Contractor should report an outbreak following the guidance in ESIRT for a ‘Serious’ incident. Borrower informed of any concerns or problems associated with providing care to infected workers on project sites, particularly if infection rate is approaching 50% of the workforce. Confirm, that these reporting requirements are accepted by the relevant/responsible staff within PIU/Contractor’s organizational structure. 169 Belarus Emergency COVID-19 Response Project ESMF Annex 13 – Grievance logbook template for employees Date of Project Type of Location of Complainant Complainant Brief of Brief of Grievance Date of № complaint name grievance complainant name contacts grievance response status response 170