BHUTAN: COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS Preparedness Project (P173787) Stakeholder Engagement Plan (SEP) Ministry of Health (MOH) April 09, 2020 Updated on December 17 2021 Table of Contents 1. Introduction/Project Description .......................................................................................................... 3 2. Project Components ............................................................................................................................. 3 3. Environment and Social risks .................................................................................................................... 4 4.Objective of the Stakeholder Engagement Plan (SEP) ............................................................................... 5 5.Stakeholder identification and analysis ..................................................................................................... 6 5.1 Methodology................................................................................................................................. 7 5.2 Affected parties ................................................................................................................................... 7 5.3 Other interested parties ............................................................................................................. 11 5.4 Disadvantaged / vulnerable individuals or groups ..................................................................... 11 6. Stakeholder Engagement Program ......................................................................................................... 12 6.1 Summary of stakeholder engagement done..................................................................................... 12 6.2 Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement ............................................................................................................................................ 13 6.3 Proposed strategy for information disclosure .................................................................................. 14 6.4 Stakeholder engagement plan .......................................................................................................... 16 6.5 Proposed strategy to incorporate the view of vulnerable groups .................................................... 17 7. Future of the project ............................................................................................................................... 24 7.1 Reporting back to stakeholders ........................................................................................................ 24 8. Resources and Responsibilities for implementing stakeholder engagement activities ......................... 24 8.1 Resources .......................................................................................................................................... 24 8.2 Management functions and responsibilities ..................................................................................... 24 9. Grievance Mechanism ............................................................................................................................. 24 9.1. Description of GM ............................................................................................................................ 24 9.2 Venues to register Grievances - Uptake Channels ............................................................................ 26 9.3 Grievance Redress Committee (GRC) for COVID-19 ......................................................................... 26 9.4 Recommended Grievance Redress Timeframe ................................................................................. 26 10. Monitoring and Reporting..................................................................................................................... 27 10.1. Reporting back to stakeholder groups ........................................................................................... 27 1. Introduction/Project Description The Bhutan COVID-19 Emergency Response and Health Systems Preparedness Project (P173787) aims to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Bhutan. An outbreak of Coronavirus disease (COVID-19 has been spreading rapidly across the world since December 2019. As of 20 October 2021, more than 242 million cases globally have been recorded with a death toll of near 4.91 million. The World Health Organization (WHO) on March 11, 2020 declared the rapidly spreading Coronavirus outbreak a pandemic, acknowledging what has seemed clear for some time —the virus will likely spread to all countries on the globe. As of September 30, in Bhutan the number of reported cases is 2,601. A total of 2,594 have fully recovered, and 4 are active cases. Since the first confirmed COVID-19 cases in Bhutan in March 2020, Bhutan has initiated actions to prevent COVID-19 from moving to the community transmission stage and subsequently into an epidemic. These include mandatory quarantine for anyone coming from countries affected by COVID-19, closing borders to prevent transmission from further travelers, contact tracing of those found positive, stopping mass gathering and raising awareness, closing down schools, continuing to isolate high risk neighborhoods and increasing the number of Polymerase chain reaction (PCR) to identify infections. The closure of international borders since late March 2020 has impacted the economy adversely with the tourism and service industries coming to a standstill. Given the novelty, transmission method and lack of effective antidotes, the outbreak is causing a great loss of life, disruptions in global supply chains, travel and associated industries, financial markets, commodity prices and availability of basic essentials, and economic losses in both developed and developing countries. Economic activity has fallen and is expected to remain low compared to previous years. To address the pandemic, the World Bank as on August 16, 2021 gave a total commitment of US$4.2 billion to combat COVID-19. Several projects are being restructured to include vaccine related procurement. Implementation is being guided by Bank teams working in parallel in other health related projects, including Additional Financing operations supporting vaccine procurement and deployment efforts in countries. The proposed Restructuring of COVID-19 Emergency Response and Health Systems Preparedness Project aims to prevent, detect and respond to the threat posed by COVID-19 and to strengthen national systems for public health preparedness in Bhutan. 2. Project Components Component 1: Emergency COVID-19 Response (Original cost-US$4.35 million; Revised cost- unchanged): This component provides immediate support to Bhutan to prevent COVID-19 or limiting local transmission through containment strategies. • Subcomponent 1.1: Case Detection, Confirmation, Contact Tracing, Recording, Reporting (Original cost-US$1.70 million; Revised cost-US$0.50 million). This sub-component would help (i) strengthen disease surveillance systems, public health laboratories, and epidemiological capacity for early detection and confirmation of cases; (ii) combine detection of new cases with active contact tracing; (iii) support epidemiological investigation; (iv) strengthen risk assessment, and (v) provide on-time data and information for guiding decision-making and response and mitigation activities. Due to technical assistance provided through other partners, there is cost saving under this component. • Sub-component 1.2: Health System Strengthening (Original Cost- US$2.65 million; Revised cost- US$1.85 million). Assistance was provided to the health care system for preparedness planning to provide optimal medical care, maintain essential community services and to minimize risks for patients and health personnel, including training health facilities staff and front-line workers on risk mitigation measures and providing them with the appropriate protective equipment and hygiene materials. Due to technical assistance provided through other partners, there is cost saving under this component. • Sub-component 1.3: COVID-19 vaccination: (New- estimated cost US$2 million). This is a new sub- component added to support the COVID-19 vaccination, including, inter alia, purchase, delivery and distribution of the Project COVID-19 Vaccines, cold chain facilities, other goods, services and operating costs necessary for safe immunization service delivery. Funding under this subcomponent could include the partial payment of a contract with Moderna for approximately 90,000 doses (out of approximately 250,000 doses). Component 2: Community Engagement and Risk Communication (Original cost-US$0.4 million; Revised cost unchanged) This component will continue to support information and communication activities to raise awareness, knowledge and understanding among the general population about the risk and potential impact of the pandemic, including social distancing measures, health promotion, social mobilization, stakeholder engagement and community engagement, as well as vaccination and deployment and address vaccine hesitancy. Component 3: Implementation Management and Monitoring and Evaluation (Original cost-US$0.25 million; Revised Cost- Unchanged). This component will continue to support the strengthening of the MOH structures and agencies for the coordination and management of the COVID-19 response, including coordination of project activities, financial management, procurement, social and environmental safeguards- adherence to the Stakeholder Engagement Plan (SEP and the Environment and Social Commitment Plan (ECSP). This component would also support monitoring and evaluation of prevention and preparedness, building capacity for clinical and public health research and joint learning across and within countries. Component 4: Contingency Emergency Response Component (CERC) (US$0). This component will provide immediate response to an eligible crisis or health emergency. The Restructuring of COVID-19 Emergency Response and Health Systems Preparedness Project is being prepared under the World Bank’s Environment and Social Framework (ESF). As per the Environmental and Social Standard ESS 10 Stakeholders Engagement and Information Disclosure, the implementing agencies should provide stakeholders with timely, relevant, understandable and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination and intimidation. In response to the pandemic, the RGOB strengthened surveillance capacities and mobilized case investigation and contact tracing teams in all 20 districts. All hospitals and primary health centers were provided with Personal Protective Equipment (PPE) and other COVID-19 commodities, test kits and equipment. ICUs were prepared in four COVID centers (total of 54 beds) to manage COVID-19 patients needing critical care. Lab capacities for COVID-19 testing were strengthened. 3. Environment and Social risks Environmental Risks. The environmental risks of the project are considered ‘Substantial’ as the major environmental risks are: (i) the occupational health and safety issues related to testing and handling of supplies; (ii) MWM and community health and safety issues related to the handling, transportation and disposal of healthcare wastes; and (iii) minor/moderate scale construction impacts related to air, water, noise emissions and waste. Waste that will be generated from labs, quarantine facilities and screening posts could include liquid contaminated waste (e.g. blood, other body fluids and contaminated fluid) and infected materials (water used; lab solutions and reagents, syringes, bed sheets, majority of waste from labs and quarantine and isolation centers, etc.) which require special handling and awareness, as it may pose an infectious risk to healthcare workers who come in contact with or handling the waste. Poor infection control and occupational health and safety practices due to lack of proper Personal Protective Equipment (PPE) and lack of training, awareness and understanding of health risks can contribute to increased risk of infection (can be fatal in case of Covid-19) in HCFs. When the healthcare workers exposed to the hospital environment do not use appropriate personal protective equipment (PPE) they become vulnerable to diseases. Other environmental concern related to medical facilities are limited number of color-coded and labeled waste bins in HCFs. This compromises the medical waste segregation at the source of generation. Infectious and non-infectious wastes are stored and transported in a plastic bag. This poses operational risks to waste workers. The service coverage and quality of incineration/treatment facilities is limited, temporary incinerators, open burning or/and disposed in the general waste bins while exposing the public and environment to additional risks. Inadequate storage, poor collection and untimely disposal can attract stray animals and rag pickers and become breeding grounds for vector-borne, water-based and fecal-oral infections. There is also the risk of contamination of water bodies which can potentially affect a larger community beyond the hospital workers. The minor civil works may cause noise and emissions from vehicles and machinery, waste generation and may involve risks regarding workplace and community health and safety. Like the parent project the key environmental risks for these activities will continue to revolve around properly managing, transporting, and disposing the medical waste generated by the vaccination. In addition, there will be a risk of exposure to a wide range of potentially affected communities and individuals, starting with medical and health care workers, and extending from there to a wide swath of the professional and civic community. Social Risks. The social risk is anticipated to be substantial in Bhutan because the project will support renovation/refurbishment of selected health facilities, but only within existing footprints. Therefore, no land acquisition is envisaged as civil works involved will be within existing health facilities. No new infrastructure is planned, to be built on either public or private property. The refurbishment and rehabilitation of the health facilities will entail employment of local labor, but the number is not likely to cause any significant labor influx and its associated risks and impacts. However, given that work will take place in potential COVID-19 environments where workers are likely be exposed to the virus, especially, if necessary, PPEs, training and enforcement of mitigation measures are not provided, workers’ occupational health and safety may be detrimentally affected. Further, the healthcare workers who will be assigned in the healthcare facilities will also face similar exposure risks which may affect their health and without adequate mitigation measures in line with WHO and Governmental guidelines it will also affect the availability of medical staffs, constraining already stretched resources. The project includes specific Behavioral Risk and Communication (BRC) aspects to inform the general public about the disease personal health and hygiene issues, provision of correct and updated information to reduce social risks from the spread of misinformation. Given the nature of the outbreak and potential lack/shortage of support/ equipment/ manpower, vulnerable and disadvantageous people may be left out of much needed and in-demand services. Vital information and other physical medical resources may also be less available to marginalized sections of the community. It is of paramount importance that vulnerable and disadvantaged people are provided with equal access to the services of the project and are consulted equally. in addition to the existing risk of the parent project activities there could be broader social risk of inequity in access to vaccines, such as due to political pressures to provide vaccines to groups that are not prioritized due to need or vulnerability or should target groups be misaligned with available vaccines. This includes possible exclusion of population groups based on gender, race, ethnicity, refugee status, religion, or others. 4.Objective of the Stakeholder Engagement Plan (SEP) The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make complaints about project and any activities related to the project. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases, need for vaccines and its aftereffects (if any). In essence the stakeholder engagement for this project gives attention to: • General awareness raising and stakeholder engagement activities more specifically, involvement of all relevant stakeholders, including the local population (especially the frontline health and social workers, those above 60 years of age, and those with comorbidity condition). • Culturally appropriate, and adapted awareness raising activities that are particularly important to properly sensitize the communities and ensure an adequate mechanism for grievance redressal under the project. • Awareness raising and stakeholder engagement with disadvantaged or vulnerable individuals or groups on vaccination, in particular, adapted to take into account their particular sensitivities, concerns and to ensure a full understanding of vaccination activities and benefits. For COVID-19 vaccination programs, stakeholder engagement is key to communicating the principles of prioritization of vaccine allocation and the schedule for vaccine rollout, reaching out to disadvantaged and vulnerable groups, overcoming demand-side barriers to access (such as mistrust of vaccines, stigma, cultural hesitancy), and creating accountability against misallocation, discrimination and corruption. 5.Stakeholder identification and analysis Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e. the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. Community representatives, cultural leaders and women leaders may also be helpful intermediaries for information dissemination in a culturally appropriate manner, building trust for government programs or vaccination efforts. Especially for Indigenous People, stakeholder engagement should be conducted in partnership with Indigenous Peoples’ organizations and traditional authorities. Among other things, they can provide help in understanding the perceptions of Indigenous Peoples’ on the causes of the virus, which will influence their opinions around the vaccination campaigns as a proposed solution. Women can also be critical stakeholders and intermediaries in the deployment of vaccines as they are familiar with vaccination programs for their children and are the caretakers of their families. Verification of stakeholder representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. With community gatherings limited or forbidden under COVID-19, it may mean that the stakeholder identification will be on a much more individual basis, requiring different media to reach affected individuals. 5.1 Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole life cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback : information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns. • Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the projects is inclusive. All stakeholders at all times are encouraged to be involved in the consultation process. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, in particular women, youth, elderly, persons with disabilities, displaced persons, those with underlying health issues, and the cultural sensitivities of diverse ethnic groups. • Flexibility: if social distancing inhibits traditional forms of engagement, the methodology should adapt to other forms of engagement, including various forms of internet communication. (See Section 3.2 below). For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) can be divided into the following core categories: • Affected Parties persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; • Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way; and • Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status1, and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. 5.2 Affected parties Affected Parties include local communities (particularly the frontline health and social workers, those above 60, law enforcing agencies and those with comorbidities). These are the persons who are targeted first for the vaccination program. Further, the following individuals and groups fall within this category: Table 1: Categories of Stakeholders Categories of Stakeholders Risks and Impacts 1 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. • COVID-19 infected people in • Stigmatization and discrimination due to being infected hospitals and their families & or beingassociated with the infected. relatives. • Lack of dignified treatment and attentiveness to servicingrequirements • Lack of attention to specific, culturally determined concerns,especially of vulnerable groups • Feelings of isolation affecting mental wellbeing. The primary project beneficiaries are these infected people who will benefit from the emergency health system capacity strengthening for COVID-19 case management under the project which includes strengthening ICU, laboratory and diagnostic capacity; and assistance for containment and treatment efforts in HCFs • People in quarantine/isolation centers • Exclusion of eligible beneficiaries from receiving the vaccine. & homes and their families &relatives. • Inability to access information, facilities & vaccination services, • At-risk populations (e.g. those with hence unable to benefit from project interventions. co-morbidities) • Lack of minimum accommodation and servicing requirements • Patients in the health facilities other • Risks of GBV and SEA/SH in quarantine/isolation & vaccination than those affected by COVID-19 centers and in homes. • Health risks due to Adverse Effects Following Immunization (AEFI) • Stigmatization and discrimination due to viewed as potential vectors of the virus or due to biases based on gender, ethnicity, religion etc. • Being pressured to take the vaccine and other services without consent. • Feelings of isolation affecting mental wellbeing. • The type, quantities & quality of items in the food packs do not meet the required needs of the quarantined households. The at-risk populations (particularly the elderly and people with underlying comorbidities) and people in quarantine/isolation units are another major project beneficiary group. They will benefit from the emergency health system capacity strengthening for COVID-19 case management which will include strengthening laboratory and diagnostic capacity; and assistance for containment and treatment efforts in health care facilities. Those with underlying comorbidities will benefit from the vaccination program. • Elderly, Persons with disabilities and • Community health and safety risks in relation to COVID-19 due chronic kidney disease patients (CKD) to increased interactions with outsiders (GNs/SOs, postmen, from low-income households banks etc.). • Health risks due to Adverse Effects Following Immunization (AEFI) • Risk of SEA/GBV during vaccinations due to lack of safety measures for women, and military personnel are involved in supporting logistics of the vaccine program. • Being pressured to take the vaccine and other services without consent. • Social tensions between project beneficiaries and non-project beneficiaries, especially if there is lack of transparency in the application and decision-making process. • Public/private health care workers • Occupational health and safety risks. (Doctors, Nurses, Public Health • Lack of access to adequate PPEs, training and facilities (e.g. Inspectors, Midwives, laboratory transport, accommodation etc. during night shifts) required for technicians/staff) effective & efficient functioning. • Medical Corps of Tri-forces conducting • Exclusion of eligible workers from receiving vaccines due to vaccinations & providing other health targeting errors, discriminatory practices linked to gender, services ethnicity, religion etc. • Workers in quarantine/isolation • Special needs of female health workers including those who are facilities, hospitals, diagnostic pregnant are not met. laboratories, flu-clinics. • Health risks due to Adverse Effects Following Immunization (AEFI). • Being pressured to take the vaccine and other services without consent. • Stigmatization and discrimination of being associated with the infected. • Increased stress due to overwork and being isolated from families for long periods. • Poor working conditions, terms of employment, lack of access to GRM • GBV, SEA and SH risks, especially for female workers These groups will benefit from the component on emergency response for COVID-19 prevention which includes: procurement of essential protective equipment and other essential items; and risk communication, community engagement and behavior change; as well as the component on emergency health system capacity strengthening for COVID-19 case management which includes: strengthening ICU, laboratory and diagnostic capacity; and assistance for containment and treatment efforts in health care facilities. They will also benefit from the streamlined labor management procedures developed for the project. Health Workers and Frontline workers will benefit from the vaccination program. • Communities in the vicinity of the • Risk of social tensions due to misinformation/rumors regards project’s planned quarantine/isolation risks of contamination facilities, quarantines homes, • Community health and safety risks due to improper hospitals, laboratories and vaccination management of medical waste including waste generated from clinics. the vaccination program. • Stigmatization and discrimination of the communities being in the vicinity of COVID treatment centers or quarantined households. Measures to ensure effective waste management, containment efforts, and contingency plans in HCFs are put in place to address risks associated with community health and safety. In addition, activities on risk communication, community engagement and behavior change, are focused primarily on benefiting this population group. • People at risk of contracting COVID- • Stigmatization and discrimination due to being associated with 19 (e.g. tourists, tour guides, hotels the infected. and guest house operators & their • Inability to access information and facilities, hence unable to staff, associates of those infected, benefit from project interventions. inhabitants of areas where cases have • Occupational health and safety risks. been identified). • Lack of access to adequate PPEs, training and facilities. The procurement of protective equipment and other essential items, activities relating to risk communication, community engagement and behavior change, will benefit this group. Further, the strengthening of laboratory and diagnostic capacity and assistance for containment and treatment efforts in health care facilities, will also impact this group especially since they are in the high-risk category of contracting COVID-19. • Government Officials (Ministry of These officials are part of the essential services work force Health officials, Provincial & district responsible for managing the overall Covid Emergency operations of Health Officers, Provincial Councils, the country including vaccinations. Key risks and impacts include: Municipal Councils, District, Divisional • Occupational health and safety risks. Secretaries, Village government • Lack of access to adequate PPEs, training and facilities required administrations in affected regions) for effective & efficient functioning. • Other public authorities (e.g. • Increased stress due to over work. Bhutan’s Civil Aviation Authority, • Exclusion of eligible workers from receiving vaccines due to Department of Immigration, targeting errors, discriminatory practices linked to gender, Ministry of Defense) ethnicity, religion etc. • Airline and border control staff, law • Health risks due to Adverse Effects Following Immunization (AEFI). enforcement authorities, tri-forces and • Being pressured to take the vaccine and other services without their staff (e.g. Police, Army, Navy, Air consent. Force etc.) especially those deployed to This group will benefit from procurement of protective equipment search suspected cases and quarantine and other essential items, containment and treatment, occupational them, establish treatment/isolation health and safety measures, especially as outlined in the LMP. centers and support the vaccination Frontline workers will benefit from the vaccination program. program. • Staff of janitorial & security services • Occupational health and safety risks • Waste collection and disposal • Lack of access to adequate PPEs, training and facilities required workers in affected regions for effective & efficient functioning. • Community health and safety risks due to improper management of medical waste. • Exclusion of eligible workers from receiving vaccines due to targeting errors, discriminatory practices linked to gender, ethnicity, religion etc. • Health risks due to Adverse Effects Following Immunization (AEFI). • Being pressured to take the vaccine and other services without consent. These groups will benefit from: procurement of essential protective equipment and other essential items; risk communication, community engagement and behavior change; and assistance for containment and treatment efforts in health care facilities. They will also benefit from the streamlined labor management procedures developed for the project, including those relating to occupational health and safety. Frontline workers will benefit fromthe vaccination program. 5.3 Other interested parties The projects’ stakeholders also include parties other than the directly affected communities, including: • Officials of Government agencies, directly and indirectly linked with project, either local or central • Traditional media • Participants/ influencers of social media • Politicians • Other national and international health organizations • Other national & International NGOs • Businesses with international links • The public at large • Hospital administrators • Elected officials and local politicians • Businesses and service providers in health sector (e.g. Pharmacists, etc.) • Suppliers, contractors and contractors’ workforce, etc. • National and local media • Participants/ influencers of social media 5.4 Disadvantaged / vulnerable individuals or groups It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project and to ensure that awareness raising and stakeholder engagement with disadvantaged or vulnerable individuals or groups on infectious diseases and medical treatments in particular, be adapted to take into account such groups or individuals particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from person’s origin, gender, age, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g. minorities or fringe groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project-related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: • Elderly (especially those of 60 years and above) who may or may not know about the vaccination program and those who may shy away from the vaccines altogether • Patient with chronic diseases and preexisting health conditions/comorbidity (cardiovascular disease, diabetes, chronic respiratory disease, hypertension, cancer etc) • People living en masse in close quarters (i.e. slums) • Less educated people • Ethnic and religious minorities • People with disabilities • Those living in remote or inaccessible areas • Female-headed households • People living in poverty • People living in close quarters (hostels and prison population) • Illiterate people • Ethnic/religious minorities and indigenous peoples • Drug addicts • Disaster affected populations Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. Description of the methods of engagement that will be undertaken by the project is provided in the following sections. For any vaccination program, the SEP includes targeted, culturally appropriate and meaningful consultations for disadvantaged and vulnerable groups before any vaccination efforts begin. Ethnic Minorities For this vaccination program, the ethnic minorities are beneficiaries. Thus, the Project Implementation Unit (PIU) will carry out targeted, culturally appropriate and meaningful consultations before any vaccination efforts begin. Consultations and vaccination campaigns will be conducted through partnership with relevant Indigenous Peoples organizations and traditional authorities. Consultations will clearly communicate that there are policies ensuring that there is no forced or mandatory vaccination. The PIU to ensure that stakeholder engagement and vaccinations are conducted with extra precautions to minimize COVID-19 transmission risks, especially for ethnic minorities living in more remote areas or in voluntary self-isolation. This may require testing or vaccinating intermediaries conducting consultations who may travel in and out of communities. Further, the GRM to be culturally appropriate and accessible for ethnic minorities, taking into account their customary dispute settlement mechanism. 6. Stakeholder Engagement Program 6.1 Summary of stakeholder engagement done For the parent project two rounds of consultations were conducted first one involving contractors, ERRH Engineers and supervisors at Mongar on 1st May 2021 and 2nd one Discussion on the construction of Flu clinics on 19th may 2021. Besides Community Awareness events had been organized and a dedicated call centre was established to share reliable information about the COVID-19 virus (Hotline 2121 for the public and 6060 for elderly citizens). Due to the emergency situation and the need to address issues related to COVID-19, the characteristics of the virus spread/ transmission, consultations during the project preparation phase have been limited to relevant government officials, health experts, hospital administrators, international airports, border crossings, media and others from institutions working in health sector. The District Health Sectors focuses on educating people in remote areas and underprivileged communities. In addition, the Risk Communication Team of the Ministry of Health uses community radio stations to broadcast radio spots. These radio stations are located in remote communities that also have ethnic minorities. Video clips and voice messages on the multilingual COVID-19 norms and protocols were shared via WeChat and WhatsApp media. The information on the registration for vaccination is shared through multilingual radio points. To reach to all communities the RCCE materials were developed into four different languages (Dzongkha, Tsangla, Lhotsampkha and English. So far, under the parent project 246 numbers awareness campaigns were launched consisting of a dashboard and other posters to reach the whole community. A dedicated call centre was established to share reliable information about the COVID-19 virus (Hotline 2121 for the public and 6060 for elderly citizens). To reach remote communities the vaccines were flown to eight districts by helicopter service. Home-based vaccination services were provided for people with reduced mobility, such as people with visual disabilities and the elderly. Risk communication is being carried out through various channels including media, broadcasting via radio, TV, website information, and placement of print materials at strategic locations. Specifically, 145 different types of awareness campaigns have been launched; 98 different types of video spots and infographic videos were produced and disseminated, and 47 different types of posters, pamphlets, and travel advisories were printed and disseminated. Bhutan has developed a comprehensive National Vaccination Development Plan (NVDP) to immunize the whole nation in four phases. They have completed vaccination of Restructuring intends to support especially the Phase 4 priority group as per the NVDP. Bhutan has vaccinated more than 96% of eligible adult population with 1st dose and 91% with 2nd dose of COVID-19 vaccines. 6.2 Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement A precautionary approach will be taken to the consultation process to prevent infection and/or contagion, given the highly infectious nature of COVID-19. The following are some considerations for selecting channels of communication, in light of the current COVID-19 situation: • Avoid public gatherings (taking into account national restrictions or advisories), including public hearings, workshops and community meetings; • If smaller meetings are permitted/advised, conduct consultations in small-group sessions, such as focus group meetings. If not permitted or advised, make all reasonable efforts to conduct meetings through online channels; • Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chat groups appropriate for the purpose, based on the type and category of stakeholders; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, and mail) when stakeholders do not have access to online channels or do not use them frequently. Traditional channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a context specific combination of email messages, mail, online platforms, dedicated phone lines with knowledgeable operators; • Each of the proposed channels of engagement should clearly specify how feedback and suggestions can be provided by stakeholders. • Identify trusted local civil society, ethnic organizations, community organizations and similar actors who can act as intermediaries for information dissemination and stakeholder engagement; engage with them on an ongoing basis. For effective stakeholder engagement on COVID-19 vaccination, prepare different communication packages and use different engagement platforms for different stakeholders, based on the stakeholder identification above. The communication packages can take different forms for different mediums, such as basic timeline, visuals, charts and cartoons for newspapers, websites and social media; dialogue and skits in plain language for radio and television; and more detailed information for civil society and media. These should be available in different local languages. Information disseminated should also include where people can go to get more information, ask questions and provide feedback. In line with the above precautionary approach, different engagement methods are proposed and cover different needs of the stakeholders as below: • Structured Agenda; • Focus Group Meetings/ Discussions; • Community consultations; • Formal meetings; • One-on-one interviews; • Site visits 6.3 Proposed strategy for information disclosure The following strategy will be followed as part of the information disclosure. Table 2: Strategy for Information disclosure PROJEC TARGET LIST OF INFORMATION METHODS AND TIMING PROPOSED T STAGE STAKEHOLDERS TO BE DISCLOSED Government Project concept, E&S Electronic publications representatives principles and Information leaflets, posters and brochures (Central, provincial and obligations, Appropriate adjustments to be made to take into local, Aviation Consultation account the need for social distancing (use of audio- Authority) process/SEP, ESMF, visual materials, technologies such as telephone calls, Preparation ESCP, GRM procedure, SMS, emails, etc.) project information Health workers Project concept, E&S Information boards, project websites, project leaflets NGOs principles and and brochures; Appropriate adjustments to be made Media representatives obligations, to take into account the need for social distancing (use Health agencies Consultation of audio-visual materials, technologies such as Academics telephone calls, SMS, emails, etc.) process/SEP, ESMF, GRM procedures Affected Project concept, E&S Public notices, press releases in the local media and on people/communities procedures, the project website, information leaflets and Neighboring Consultation process/ brochures at health facilities, airing of messages communities SEP, Standardized through health programs through local FM radio, Vulnerable groups health messages and emails, text messages including IP information, ESMF, SEP, Separate focus group meetings with vulnerable groups GRM procedures, while making appropriate adjustments to consultation formats in order to take into account the need for social distancing (e.g., use of mobile technology such as telephone calls, SMS, etc.) Information disclosure and engagement with the indigenous people to be conducted in a culturally appropriate manner considering their special circumstances and potential for being excluded. Government Scope of project and Project Update Reports, Emails, Radio and print representatives activities, regular Electronic publications as well as dissemination of (Central, provincial and updates on project hard copies local) development ESMF, SEP and GRM procedures. Health workers Scope of project and Information boards, project websites, project leaflets Implementation Workers at construction specific activities, Electronic publications and dissemination of hard sites, waste disposal regular updates on copies sites, airport and border project development control ESMF, SEP and GRM procedures. Affected individuals and Scope of project and Public notices, press releases in the local media and on their families specific activities, the project website, information leaflets and neighboring regular updates on brochures at health facilities, airing of messages communities project development through health programs through local FM radio, Vulnerable groups ESMF, SEP and GRM emails, text messages procedures. Information desk at health facilities and local Health messages government offices. In line with WHO guidelines on prioritization, the initial target for vaccination is to reach 20% of the population, prioritizing health care workers, other essential workers, and the most vulnerable, including the elderly and people with underlying co-morbidities. As all people will not receive vaccination all at the same time, inadequate or ineffective disclosure of information may result in distrust in the vaccine or the decision-making process to deliver the vaccine. Therefore, the government will ensure that information to be disclosed: • Is accurate, up-to-date and easily accessible; • Relies on best available scientific evidence; • Emphasizes shared social values; • Articulates the principle and rationale for prioritizing certain groups for vaccine allocation; • Includes an indicative timeline and phasing for the vaccination of all the population; • Includes explanation of measures that will be used to ensure voluntary consent, or if measures are mandatory that they are reasonable, follow due process, do not include punitive measures and have a means for grievances to be addressed; • Includes explanation of vaccine safety, quality, efficacy, potential side effects and adverse impacts, as well as what to do in case of adverse impacts; • Includes where people can go to get more information, ask questions and provide feedback; • Includes the expected direct and indirect economic costs of the vaccines and addresses measures should there be serious adverse impact on stakeholders due to the vaccine, such as serious side effects; and • Is communicated in formats taking into account language, literacy and cultural aspects. • Over time, based on feedback received through the Grievance Mechanism and other channels, information disclosed should also answer frequently asked questions by the public and the different concerns raised by stakeholders. • Misinformation can spread quickly, especially on social media. During implementation, the government to assign dedicated staff to monitor social media regularly for any such misinformation about vaccine efficacy and side effects, and vaccine allocation and roll out. The monitoring should cover all languages used in the country. • In response, the government will disseminate new communication packages and talking points to counter such misinformation through different platforms in a timely manner. These will also be in relevant local languages. There are no plans to deploy security forces for the project activities. If the engagement of security or military personnel is being considered for deployment of vaccines, ensure that a communication strategy is in place to inform stakeholders of their involvement and ensure that any concerns or grievances regarding the conduct of Security Personnel are received, monitored, documented (taking into account the need to protect confidentiality), resolved through the Project’s grievance mechanism and reported to the Association no later than 30 days after being received. 6.4 Stakeholder engagement plan MOH has a comprehensive National COVID-19 Vaccination and Deployment Plan (NVDP) with four phases through which more than 96% of eligible adult population were vaccinated with 1st dose and 91% with 2nd dose. Restructuring will be utilized in fourth phase for 90,000 vaccines. Table 3: Stakeholders Engagement Plan Project Topic Of Consultation / Method Used Target Stakeholders Responsibilities Stage Message Prepar • Need of the project • Phone, email, letters • Government officials Environment and ation • Planned activities • Appropriate adjustments from relevant agencies Social Specialist • E&S principles, risk to be made to take into • Health institutions and impact, account the need for • Health workers and PIU management/ESMF social distancing (use of experts • Grievance Redress audio-visual materials, mechanisms (GRM) technologies such as • Health and safety telephone calls, SMS, impacts emails, etc.) • Need of the project • Outreach activities that • Affected individuals Environment and • Planned activities are situation appropriate and their families Social Specialist • E&Sl risk and • Appropriate adjustments • Local communities impact, to be made to take into • Vulnerable groups PIU management/ESMF account the need for including IP • Grievance Redress social distancing (use of mechanisms (GRM) audio-visual materials, technologies such as telephone calls, SMS, emails, etc.) Imple • Project scope and • Online Training and • Government officials Environment and mentat ongoing activities workshops from relevant agencies Social Specialist ion • ESMF and other • Disclosure of information • Health institutions instruments through Brochures, flyers, • Health workers and PIU • SEP website, etc. experts • GRM • Information desks at • Health and safety municipalities offices and • Environmental health facilities concerns • Appropriate adjustments to be made to take into account the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, etc.) • Project scope and • Public meetings in • Affected individuals Environment and ongoing activities affected and their families Social Specialist • ESMF and other municipalities/villages • Local communities instruments • Brochures, posters • Vulnerable groups PIU • SEP • Information desks in local • Indigenous peoples • GRM government offices and • Health and safety health facilities. • Environmental • Appropriate adjustments concerns to be made to take into account the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, radio, tv etc.) 6.5 Proposed strategy to incorporate the view of vulnerable groups The project will carry out targeted stakeholder engagement with vulnerable groups to understand concerns/needs in terms of accessing information, medical facilities and services and other challenges they face at home, at workplaces and in their communities. Special attention will be paid to engage with women as intermediaries. In addition to specific consultations with vulnerable groups and women, the project will partner with agencies like UNICEF, to engage children and adolescents to understand their concerns, fears and needs. UNICEF is currently supporting the Royal Government of Bhutan in strengthening the cold chain system to store the vaccines and provided critical logistical and operational support. Some of the strategies that will be adopted to effectively engage and communicate to vulnerable group will be: ➢ Women including survivors of GBV, SEA/SH: to ensure that community engagement teams are gender- balanced and promote women’s leadership within these; design online and in -person surveys and other engagement activities so that women in unpaid care work can participate; consider the literacy levels of women while developing communications materials; consider provisions for childcare, transport, and safety for any in-person community engagement activities, discuss measures to respond to GBV issues, about the available support systems & psychosocial services for survivors of GBV, SEA, SH. ➢ o ensure equitable targeting of vaccines among women especially high-risks groups during vaccine deployment by working with PH midwives and CSOs which work on women’s rights to ensure information around the vaccines and have access to the vaccine and by conducting sessions with families, religious leaders and community leaders within communities to educate them on the importance of gender equitable access to the vaccine while addressing misinformation which may prevent families from getting vaccinated. ➢ Develop education materials for pregnant women on basic hygiene practices, infection precautions, and how and where to seek care based on their questions and concerns. ➢ During vaccinations, organize separate queues for and help pregnant mothers including mothers with infants, including for elderly, have segregated toilets and have at least one female staff or female military cardre in place etc. at vaccination centers. ➢ Elderly and people with existing medical conditions: develop information on specific needs and explain why they are at more risk and what measures to take to care for them; tailor messages and make them actionable for particular living conditions (including assisted living facilities), and health status; target family members, health care providers and caregivers. ➢ People with disabilities: provide information in accessible formats, like braille, large print; offer multiple forms of communication, such as text captioning or signed videos, text captioning for hearing impaired, online materials for people who use assistive technology. ➢ Illiterate or those with limited education - use audio and visual communication techniques to engage, which would include use of graphics, photos, drawings, videos and storytelling techniques. ➢ Daily wage earners, unemployed & homeless - assess/understand their sources of information, use audio and visual communication techniques to engage as some may be illiterate, work with social service/protection agencies to better understand the issues of this category and better target the communications and interventions. ➢ Children: design information and communication materials in a child-friendly manner & provide parents with skills to handle their own anxieties and help manage those in their children. ➢ Other vulnerable groups (e.g. Veddas), including those in remote and inaccessible areas - assess/understand their sources of information, prepare public awareness and dissemination materials in relevant languages, tailor messages to the cultural contexts and work with relevant institutions to engage this category of people and disseminate information. The details of strategies that will be adopted to effectively engage and communicate to vulnerable group will be considered during project implementation. For information disclosure and engagement with the indigenous people culturally appropriate strategy will be undertaken taken into consideration their special circumstances and potential for being excluded. The details of strategies that will be adopted to effectively engage and communicate to vulnerable group are given below. 19 Table 4: Strategy to Engage with and Incorporate Views of the Vulnerable Groups Vulnerable Characteristics and Barriers to Participation Preferred means of notification/ consultation and Additional Resources Required Groups and communication feedback Individuals Elderly People ▪ They are the most vulnerable of the ▪ Listing out of elderly people and people with co- ▪ Consultations with NGOs (Over 60) and population against COVID. morbidities and other support people with co- ▪ They may face societal stigma which may ▪ Guided focus group discussions with potential organizations to develop severely discourage them from eligible people in this group in close proximity to initial listing of elderly and morbidity participating the any consultation, their own locations for awareness raising, co-morbidity people. engagement and broader project behavior change communication and consultation ▪ Preparation of information activities. on project activities. materials, including website ▪ Their age and other health concerns may ▪ Community mobilization, distribution of leaflets & and leaflet/brochure for the deter them to travel for consultation, brochure and social networks can play vital role in project which may be bolstered by their families’ order to enable voluntary participation ▪ Provision of, participation discouragement. ▪ Access to psychosocial support and counseling on grants, covering ▪ They may even be unwilling for a case-by-case basis. transportation, pocket vaccination ▪ Social media account for proposed program to money and meal for allow individualized solicitation of information. attendance. ▪ Assign, involve and consult with family members ▪ Promote informal for communication and motivation networking systems among them and other relevant stakeholders People with ▪ Societal stigma against those disabled ▪ Listing out of eligible persons with disabilities ▪ Consultations with Partner Disability may severely discourage those with ▪ Guided focus group discussions with potential Organizations to develop disabilities from participating the any eligible PWDs in close proximity to their own initial listing of potential consultation, engagement and broader locations for awareness raising, behavior change PWD in their areas. project activities. communication and consultation on project ▪ Subsequent focus group ▪ Those with physical, speech, hearing and activities. discussions with PWDs. intellectual disabilities often remain in ▪ Community mobilization, distribution of leaflets & ▪ Provision of, participation the fringes of commonly used means of brochure and social networks can play vital role in grants, covering communication, demonstrated through order to enable voluntary participation transportation, and basic their limited knowledge of COVID. As ▪ Access to psychosocial support and counseling on sustenance for attendance such, more targeted sensitization and a case-by-case basis. in participation and access mobilization campaign would be ▪ Social media account for proposed program to to transportation as required to access and incentivize their allow individualized solicitation of information. needed. participation. ▪ Disclosed list of partner organizations providing ▪ Psychosocial support ▪ Those with disabilities also experience information materials on the vaccination and offered by trained Case higher need for assistance, and mental additional follow-up if desired. Management and support. Enterprise Development 20 ▪ Failure to communicate where persons Officers within Partner with disabilities in non-accessible Organizations and locations may cause deterrence to their additional arrangements to involvement in vaccination. facilitate their participation ▪ Challenges posed by their specific ▪ Preparation of information disability may force them to stay out of materials, including website consultation process and brochure for the project ▪ Promote informal networking systems among PWD and other relevant stakeholders ▪ Allowances for support organizations to reach the doors of PWD since their movement may be restricted Women, Female- ▪ Conservative gender norms and social ▪ Female-led community mobilization, distribution ▪ Consultations with Partner headed stigma may prevent women to come out of leaflets & brochure and social networks can play Organizations to develop Household of their homes to participate in the vital role in order to enable voluntary participation initial listing of potential consultation. ▪ Soliciting of listing of female-headed households, eligible female ▪ Aforementioned customs are also tied to families left behind, women from households beneficiaries. limitations on women’s safety and hardest hit (or without dual incomes), and other ▪ Additional consultations mobility, which can be mitigated by vulnerable women with lack of access to with successful female through provision of transportation information through consultation with persona, politicians, facilities for them to jointly travel community-based organizations, women support traditional leaders and together to access consultation. organizations and past beneficiaries in areas most influential figures to ▪ Lack of access to childcare facilities and affected by the pandemic. encourage other women for inability to find suitable replacement ▪ Focus group discussions with successful female consultation during assigned consultation can persona, to bring women for sensitization and ▪ Provision of, participation dissuade participation. Likewise, those mobilization to project activities. grants, covering requiring to prepare meals and support ▪ Access to psychosocial support and counseling on transportation, and basic through other forms of domestic labor a case-by-case basis. sustenance for attendance directly contributing to household ▪ Provision of separate space for consultation, meal in consultation and access income may choose to not join. and transport facilities to pooled transportation if ▪ Taken further, attempting to reach them ▪ Timing of consultation suitable for women ding possible. through heads of households, in the chores and performing caregiver roles ▪ Psychosocial support absence of successful social behavior offered by trained Case change communication campaign, may Management and not only exclude them, but also subject Enterprise Development them to further domestic abuse. Officers within Partner 21 Organizations, females in this case to reflect their concerns more keenly ▪ Preparation of information materials, including website and brochure for the project ▪ Promote informal networking systems among females and other relevant stakeholders Ethnic Minority ▪ Their status as ethnic minorities mean ▪ Use of local interlocutors for consultation in a ▪ Consultations with Partner more targeted outreach and advocacy culturally appropriate manner. Organizations to develop strategies may be required in order to ▪ Local community mobilization, distribution of initial listing of potential encourage their participation leaflets & brochure in their own language ethnic minority ▪ Different linguistic and cultural barriers ▪ Soliciting of listing of potential beneficiaries beneficiaries in their project mean that engagement should be through consultation with organizations working areas. adapted in a manner that can with these ethnic communities, ▪ Culturally appropriate focus accommodate their circumstances ▪ Guided focus group discussions with potential group discussions to raise ▪ With many individuals from communities eligible beneficiaries for awareness raising, awareness of and mobilize such as these living in hard to reach consultation on project activities. them to vaccination areas, attention should be provided to ▪ Use of village heads, clan heads in the consultation activities. bearing costs of their transportation. process ▪ Provision of, participation ▪ Their local medicinal practices may ▪ Disclosed list of partner organizations, include grants, covering become conflicting with the idea of others working with these communities, providing transportation, and basic vaccination that has to be curbed information materials on the vaccination to deter sustenance for attendance through culturally appropriate rumor and encourage participation in consultation communication ▪ Engagement of interlocutors from their tribes for consultation ▪ Preparation of information materials, including website and brochure for the project ▪ Promote informal networking systems among ethnic people and other relevant stakeholders People living in ▪ Their location might be a hindrance for ▪ Listing of areas hard-to-access and engage NGOs, ▪ Engage NGOs and other remote areas reaching out and hence they may be left local community groups and local leaders for partners to reach these out completely from the consultation consultation inaccessible places for process. ▪ Community mobilization, distribution of leaflets & consultation. brochure and social networks can play vital role in ▪ Community mobilization, order to enable voluntary participation distribution of leaflets & 22 ▪ They also may be reluctant to engage ▪ Use of local radio and TV channels to engage brochure and social with consultation due to obstacles faced ▪ Provision of transportation cost and meal for the networks can play vital role by the remoteness of their location consultation period in order to enable voluntary participation ▪ Use of local radio and TV channels to engage ▪ Provide transportation cost and meal for the consultation period People living in ▪ Their economic status itself pose an ▪ Community mobilization, distribution of leaflets & ▪ Consultations with Partner poverty obstacle for selection for consultation brochure and social networks can play vital role in Organizations to develop and may be left out of the process. order to enable voluntary participation and initial listing of people living ▪ They may have immediate chores, registration of the people living in poverty in poverty money earning engagement deterring ▪ Care must be taken for face-to-face engagement ▪ Use of local leaders, NGOs them to join due to lack of time. since they may lack online consultation access and other support ▪ They may feel that their involvement ▪ Focus group discussions in proximity to their own organization to provide would not make any difference locations for awareness raising and consultation information and encourage on vaccination activities. participation ▪ Offer a physical space/ office location/ telephone ▪ Use of local radio and TV number for complaint or information exchange channels to engage ▪ Provision for meal and remuneration for ▪ Provide transportation cost consultation period and meal for the consultation period Indigenous ▪ Different linguistic and cultural barriers ▪ Use of local interlocutors for consultation in a ▪ Culturally appropriate focus People mean that engagement should be culturally appropriate manner. group discussions to raise adapted in a culturally appropriate ▪ Local community mobilization, distribution of awareness of and mobilize manner that can accommodate their leaflets & brochure in their own language them to vaccination circumstances ▪ activities ▪ With many individuals living in hard to ▪ Engage NGOs and other reach areas, attention should be partners to reach them for provided to bearing costs of their consultation transportation. 23 7. Future of the project Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the Stakeholder Engagement Plan and the grievance mechanism. This will be important for the wider public, but equally and even more so for suspected and/or identified COVID-19 cases as well as their families. Changes in preparedness and response interventions will be announced and explained ahead of time and will be developed based on community perspectives. Responsive, empathic, transparent and consistent messaging in local languages through trusted channels of communication, using community-based networks and key influencers and building capacity of local entities, is essential to establish authority and trust. 7.1 Reporting back to stakeholders Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the stakeholder engagement plan and grievance mechanism. 8. Resources and Responsibilities for implementing stakeholder engagement activities 8.1 Resources The MOH, as the Implementing Agency (IA) is in charge of stakeholder engagement activities through Project Implementation Unit (PIU). The contact point for the stakeholder engagement is the Project Director (PD). The Project has budgetary provisions for SEP implementation and the ES experts to be hired as a part of the PIU will monitor it. The budget for the SEP included in component 2 of the project. 8.2 Management functions and responsibilities The project implementation arrangements are as follows: MOH is responsible for carrying out stakeholder engagement activities, while working closely with other entities, such as local government units, media outlets, health workers, hospital administration etc. The stakeholder engagement activities will be documented through progress reports, to be shared with the World Bank. 9. Grievance Mechanism The main objective of a Grievance Mechanism (GM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects; ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. At the time of this SEP was updated, no grievance had been received. 9.1. Description of GM The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects; 24 ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. ▪ The GRM should be culturally appropriate and accessible for indigenous people, taking into account their customary dispute settlement mechanism Grievances is handled at the national level by MOH. The GRM includes the following steps: Step 1: Submission of grievances: The submission of grievances to be available through multiple channel (email, letter, hotline, toll free number, MOH website. Anonymous grievance may also be submitted. The process will be shared via MOH website, social, print and electronic media. Given the nature of the COVID- 19 virus, face to face communication for grievance submission may not be encouraged. Step 2: Recording of grievance and providing the initial response: All the grievances received will be logged, both electronically and on paper documents. Each record will be given a number which will be intimated to the one submitting the grievance. Within seven (7) days of the date a complaint is submitted, the responsible person will communicate with the complainant and provide information on the likely course of action and the anticipated timeframe for resolution of the complaint. If complaints are not resolved within 15 days, the responsible person will provide an update about the status of the complaint/question to the complainant and again provide an estimate of how long it will take to resolve the issue Step 3: Investigating the grievance: This step involves gathering information about the grievance to determine the facts surrounding the issue and verifying the complaint’s validity, and then developing a proposed resolution. Depending on the nature of the complaint, the process can include site visits, document reviews, a meeting with the complainant (if known and willing to engage, may not be face to face given COVID-19 transmission characteristics), and meetings with others (both those associated with the project and outside) who may have knowledge or can otherwise help resolve the issue. It is expected that many or most grievances would be resolved at this stage. All activities taken during this and the other steps will be fully documented, and any resolution logged in the register. Step 4: Complainant Response: This step involves informing those to submit complaints, feedback, and questions about how issues were resolved, or providing answers to questions. Whenever possible, complainants should be informed of the proposed resolution in person. If the complainant is not satisfied with the resolution, he or she will be informed of further options, which would include pursuing remedies through the World Bank, as described below. Data on grievances and/or original grievance logs will be made available to World Bank missions on request, and summaries of grievances and resolutions will be included in periodic reports to the World Bank. Step 5: Grievance closure/ Appeal Process: If a person who submits a grievance is not satisfied with the resolution at the first or second tiers, he or she may request it be elevated to the next tier. If they are not satisfied with the ultimate resolution, they may pursue legal remedies in court or pursue other avenues. Throughout the entire process, PIU at the Project Level will maintain detailed record of all deliberations, investigations, findings, and actions, and will maintain a summary log that tracks the overall process. The GM provides an appeal process if the complainant is not satisfied with the proposed resolution of the complaint. Once all possible means to resolve the complaint has been proposed and if the complainant is still not satisfied then they should be advised of their right to legal recourse. Under the parent project the MOH put in place a Grievance Redress Mechanism for any kind of Health-related issues, including COVID -19 (Toll free No.1414). Grievance related to COVID-19, is received from Toll-free No 2121 and 6060. These numbers have been publicly disclosed throughout the country in the broadcast and print media. Besides the PIU is advised to continuously assess functioning of the GRM including information dissemination about the GRM and other feedback channels to allow people to raise concerns and provide feedback. For the project, GRM has been developed in LMP for laborer and in SEP for stakeholders. Contractors and focal engineers have been trained on ESMF, LMP, and GBV. Till now, no grievance is received. 25 It is important to have multiple and widely known ways to register grievances. Anonymous grievances can be raised and addressed. Several uptake channels under consideration by the project include: • Toll-free telephone hotline / Short Message Service (SMS) line • E-mail • Letter to Grievance focal points at local health facilities and vaccination sites • Complaint form to be lodged via any of the above channels • Walk-ins may register a complaint on a grievance logbook at healthcare facility or suggestion box at clinic/hospitals The project will have other measures in place to handle sensitive and confidential complaints, including those related to Sexual Exploitation and Abuse/Harassment (SEA/SH) in line with the WB ESF Good Practice Note on SEA/SH. The GRM is equipped to handle cases of SEA/SH and will be modified as rapid guidance on how to respond to these cases will be developed and shared with operators. The GRM will also be adopted to address issues of SEA/SH that might occur during vaccination program. Any SEA/SH related complaints will be handled in a survivor-centric manner in line with the World Bank guidelines provided in the WB good practice note. SH/SEA-related complaints will be dealt with strict confidentiality, based on the wishes of the SEA/SH-survivor. Training on SEA/SH GRM will be imparted to grievance redress personnel. Once a complaint has been received, by any and all channels, it should be recorded in the complaints logbook or grievance excel-sheet/grievance database. 9.2 Venues to register Grievances - Uptake Channels A complaint can be registered directly at COVID-19 GRC through telephone, email, letters and walk-in and registering in grievance books in health facilities. The addresses will be established/updated/ setup and intimated to the stakeholders before project implementation. Once a complaint has been received, it should be recorded in the complaints logbook or grievance excel-sheet- grievance database. The MOH under the parent project put in place a Grievance Redress Mechanism for any kind of Health-related issues, including COVID -19 (Toll free No.1414). Grievance related to COVID-19, especially during lockdown, is received from Toll-free No 2121 and 6060. These numbers have been publicly disclosed throughout the country in the broadcast and print media. Till now,no grievance is received. 9.3 Grievance Redress Committee (GRC) for COVID-19 According to the GRM, a Grievance Redress Committee (GRC) is established at Project Level through PIU as under: Project Director – Convener Chief Implementation Officer- Secretary Social/ Environmental Specialist- Member Health Specialist - Member External Monitor-Member 9.4 Recommended Grievance Redress Timeframe The Table below presents the recommended time frames for addressing grievance or disputes: Table 5: Proposed GRM Time Frame Step Process Time frame 1 Receive and register grievance and acknowledgment of receipt within 24 hours 2 Assess grievance Within 24 hours 26 3 Assign responsibility Within 2 Days 4 Development of response within 7 Days 5 Implementation of response if agreement is reached within 7 Days 6 Close grievance within 2 Days 7 Initiate grievance review process if no agreement is reached within 7 Days of the serial 6 8 Implement review recommendation and close grievance within 14 Days 9 Grievance taken to court by complainant - 10. Monitoring and Reporting 10.1. Reporting back to stakeholder groups The SEP to be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. [Monthly] summaries and internal reports on public grievances, enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. The [monthly] summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways: • Publication of a standalone annual report on project’s interaction with the stakehol ders. • A number of Key Performance Indicators (KPIs) will also be monitored by the project on a regular basis, including the following parameters: o number of public hearings, consultation meetings and other public discussions/forums conducted within a reporting period (e.g. monthly, quarterly, or annually); o frequency of public engagement activities; o number of public grievances received within a reporting period (e.g. monthly, quarterly, or annually) and o number of those resolved within the prescribed timeline; o number of press materials published/broadcasted in the local, regional, and national media 27