The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 12/01/2021 | Report No: ESRSAFA297 Dec 01, 2021 Page 1 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Mozambique AFRICA EAST Ministry of Economy and Ministry of Health Finance Project ID Project Name P178068 COVID-19 Strategic Preparedness and Response Project Additional Financing Parent Project ID (if any) Parent Project Name P175884 COVID-19 Strategic Preparedness and Response Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 11/18/2021 12/13/2021 Population Financing Public Disclosure Proposed Development Objective To support the Government of Mozambique to acquire, manage, and deploy Project COVID-19 vaccines, and to strengthen its pandemic preparedness, response, and health systems’ capacity. Financing (in USD Million) Amount Current Financing 115.00 Proposed Additional Financing 100.00 Total Proposed Financing 215.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] This project responds to a request by the Government of Mozambique to receive support from the World Bank for the Dec 01, 2021 Page 2 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) acquisition and deployment of COVID-19 vaccines as enabled by the Global COVID-19 Multiphase Programmatic Approach Additional Financing (P175450). The operation builds on ongoing support provided through CERC activation through the Mozambique Cyclone Idai & Kenneth Emergency Recovery and Resilience Project (P171040), partly replenished through the Immediate Response Mechanism (IRM) of the parent project of the Global COVID-19 MPA (P173789), among other sources. The project objective is to support the Government of Mozambique in COVID-19 vaccine acquisition, management, and deployment, and to strengthen its pandemic preparedness, response, and health systems' capacity. The project will support the procurement of COVID-19 vaccines, medical supplies and equipment, including for vaccine distribution and cold chain upgrading. It will also support vaccine administration, follow-up and community engagement. Technical assistance, training, and support will be provided for key institutions in the immunization system. This will be guided by the development of an appropriate and costed vaccination plan, in line with the WHO Strategic Advisory Group of Experts on Immunization (SAGE) framework, to ensure safe, effective, and equitable distribution, with measures to improve data quality and data use for decision-making. The project will also support the development of a national risk-communication plan, and activities to ensure community engagement in COVID-19 vaccination efforts and outreach to vulnerable groups. The project includes a component co-financed by the Global Financing Facility to strengthen continuity of essential services during the vaccine roll out, focused on primary and community care, and maternal, child, and adolescent health. A functional Program Implementation Unit in the Ministry of Health will be established to support effective implementation and monitoring to achieve development objectives. Public Disclosure D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] The Additional Financing will enable a scale up of Component 1, and is not adding new activities or components thus maintaining the same scope, geographic coverage and goals as the parent project. The parent project will continue to have a national geographical scope and aiming at supporting Government’s efforts to implement the National Preparedness and Response Plan, protect basic services and the population from COVID-19, and strengthen resilience of the health system. The objectives of the AF are aligned with that of the parent project, which is to support the Government of Mozambique in the acquisition and deployment of COVID-19 vaccines and to strengthen its immunization capacity. It particularly seeks to support the Government of Mozambique in the acquisition and deployment of COVID-19 vaccines and to strengthen immunization capacity through five components: (i) vaccines, medical supplies and equipment; (ii) technical assistance, training, and institutional support; (iii) information systems and community engagement; (iv) continuity of essential services, as well as project implementation and monitoring. The US$60 million in additional financing will be used to retroactively finance the US$44 million paid by the Government to Gavi to secure the eight million Sinopharm doses, and to replenish the US$11 million reallocated to finance ancillary costs of shipment and supplies for these doses through the project. Remaining funds will be utilized for their original intended purpose under component 2 of financing vaccine management and deployment and strengthening related systems for preparedness and response. Mozambique is a low-income country in Southeast Africa with a gross national income of USD 490 per capita and a population of 31 million. The country is naturally endowed with a diverse landscape characterized by flat terrain, extending from coastal plains in the east to mountain ranges in the west. Mozambique is one of Africa’s most Dec 01, 2021 Page 3 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) vulnerable countries to climate change and particularly the northern and central coastal districts that are frequently exposed to several climate hazards – including floods and cyclones. The security situation in the Northern provinces of Mozambique has degraded significantly in the past few years, due to armed attacks in the gas-rich province of Cabo Delgado, which has been ongoing since 2017 and as of September 2021, around 1.3 million people have been affected by the crisis, including 863,000 displaced persons. This situation multiplies by the COVID-19 pandemic that is further deepen poverty and worsen the socio-economic and development indicators in the country. Since the outbreak in February 2020, livelihoods, food security, and nutrition have worsened with reduced incomes in Mozambique. The pandemic has had a particularly severe impact on the poor in urban and peri-urban areas, more affected by containment measures and business closures as of October 18th, 2021, a total of 151,102 cases and 1,926 deaths have been reported. Mozambique’s urban poverty rate was projected to increase from 32 to at least 34.1 percent by the end of 2020, widening inequalities and pushing an additional 250,000-300,000 urban people into poverty on account of employment and income losses, price increases and a deterioration of public services directly or indirectly due to the pandemic. The pandemic is also likely to exacerbate pre-existing factors of fragility, aggravate existing gender inequalities, and increase risks of gender-based violence (GBV). Additionally, COVID-19 threatens to reverse gains in human capital outcomes by exposing weakness in health, education, and social protection systems. Investing and protecting frontline health-workers and teachers is crucial to ensure the safe service provision and minimize impact on children’s learning, safety, and well-being. The Government of Mozambique’s COVID-19 vaccine coverage and purchase plan is a central part of its national vaccination readiness. It aims to reach a substantial segment of the population so that transmission is reduced. The Public Disclosure government has planned to cover 20 percent of the population in the first year of vaccine introduction, and these cover professional groups (frontline workers, teachers from public schools, police force, nurses at elderly centers and orphanages), elderly population, people with co-morbidities and Informal market and transport workers. The AF will be used for the purchase of more vaccines in order to expand vaccination process to people aged between 18-50 years. Additionally, the armed insurgency in the north of Mozambique (Cabo Delgado province) has hampered the delivery of services due to destruction of health facilities and the displacement of some 863,000 people who are at particular risk of infectious disease break out due to unsanitary living conditions. No significant Greenfield civil works are still expected to be financed. The works involved will continue to be small in scale and within the footprint of existing health facilities and other designated establishments with the focus on establishing specialized isolation units. The expected works will include maintenance of existing cold chain equipment, warehouses, vehicles, and other logistical infrastructure, the refurbishment and maintenance of facilities to make them resistant to climate shocks. No new construction is expected. D. 2. Borrower’s Institutional Capacity As the parent project, MISAU will be the primary implementing agency for the AF. The National Directorate for Monitoring and Evaluation of the Ministry of Economy and Financing (MEF) has been the Coordination Authority responsible for coordinating the implementation of the COVID-19 emergency activities under the Immediate Response Mechanisms, in close coordination with the Ministry of Health (MISAU) and the National Social Assistance Institute (INAS) under the Ministry of Gender, Children and Social Assistance. The existing Project Implementation Unit (PIU) in MISAU, which supports the management of the South Africa Tuberculosis and Health Systems Strengthening Project (P155658) and the Primary Health Care Strengthening Project (P163541), is responsible for fiduciary and environmental and social risk management and implementation of their respective activities, including Dec 01, 2021 Page 4 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) coordination with key internal and external counterparts. The MISAU's PIU relies on the Centre of Medicines and Medical Supplies (CMAM) to manage the pharmaceutical waste from expired or damaged articles within the distribution chain and on Department of Environmental Health (DSA) to supervise the management of medical waste in the Health Units whereas the management of medical waste in Central and Provincial Hospital are autonomous. In addition to the PIU that is the responsible in day-to-day work, the project involves other organic units (National Directorate and Departments) of the MISAU to implement other project related activities (e.g., community engagement and communication). Also, the project may involve third party (primarily private sector) in the logistics of the vaccine. While MISAU (PIU) has implemented projects under the Bank’s safeguards policies, it has limited experience in applying the Environmental and Social Framework (ESF). The parent project is MISAU’s first ESF operation, but currently MASAU is preparing a second one: Investing in Inclusive Human Capital Development in Mozambique (P175298). Given the expanded scope of the ESF and the client’s lack familiarity with its requirements, overall, the Recipient’s institutional capacity to oversee the implementation and monitoring of E&S issues under the new ESF is considered weak. The environmental specialist and social specialist to be recruit under the Parent Project have been already selected but the processes are yet to be finalized no later than 2nd December 2022. The capacities considered relevant for these positions included knowledge of infectious waste management, occupational and community health and safety, impacts on vulnerable groups and gender issue, among others. Meanwhile the project team is being supported by an experienced environmental and social consultant. To strengthen PIU capacity, the consultant and other MISAU staff have recently attended a 3 day ESF course administrated by the WB team. Public Disclosure A key environmental risk and impact of the parent project and AF relates to waste. The capacity to manage waste disposal varies from central to local levels and the Vaccine Introduction Readiness Assessment Tool (VIRAT) and the Vaccine Readiness Assessment Framework (VRAF) updated by MISAU in in mid-2021 has identified the needs of strengthening this capacity through provisioning of standard operating procedures (SOPs) or guidelines for collection and disposal of medical waste. MISAU has already started training the professionals who will be directly involved in the vaccination process, based on training modules developed by the WHO. In addition to these trainings, there will be a need to build capacity in the implementation and monitoring of hospital waste management procedures. The total cost estimated for the implementation of the ESMF includes the sensitization and capacity building on environmental & social instruments. The environmental and social performance rating for the Parent Project is considered moderately satisfactory. Under the Parent Project and AF, the project achieved some of the ESCP material measures and actions, such as the preparation, consultation, and disclosure of ESF instruments [ESCP, SEP and ESMF an Infection Control and Waste Management Plan (ICWMP), Labor Management Procedures (LMP), a Social Assessment (SA), an Emergency Response Plan (ERP), and a Security Risk Assessment (SRA), and a GBV/SEA/SH Risk Assessment, a Stakeholder Engagement Plan (SEP), and a COVID-19 Protocol]. Notwithstanding, the rating has been downgraded, given that the project is facing delays on the implementation of some E&S measures and actions, including the delivery of quarterly monitoring reports on environmental, social, health and safety (ESHS) performance, and recruitment of one fully dedicated environmental specialist and one social development specialist for the Project. As referred above, the appointed consultant and organic units are provisionally supporting project E&S management issues during this transition period. Recent MISAU experience with WB funded projects including the parent project suggests that not only support will be required in overall ESF implementation, but also more importantly on issues of pollution and waste management, community health and safety, and other social aspect relating to COVID, including GBV/SEA/SH, GRM, Dec 01, 2021 Page 5 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) inclusion and gender, outreach, and community engagement. This will be done not only through training, development of systems and processes, but also, through hiring dedicated personnel, including the institutionalization of an Environmental and Social Management System (ESMS) within MISAU. Given the delays in implementation, the ESMF does not need to be updated to reflect the AF. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The environmental risk rating is substantial given that AF activities will be the same of parent project including scale up of Component 1 on Vaccines, Medical Supplies, and Cold Chain Equipment that supports vaccine acquisition and ancillary supplies and equipment for deployment systems. The risks and impacts stemming from the acquisition and deployment of COVID-19 vaccines and medical consumables and from impacts generated by activities under Component 1 that will involve civil works such as maintenance and restructuring of warehouses and other logistic infrastructure. The parent project continues to implement activities likely to generate direct, indirect and cumulative risks and impacts: under Component 2, investments in waste management and disposal infrastructure, collection and transportation of waste and disposal plants (no new construction is expected) operationalization of a network of high-quality laboratories, and under component 3, finance routine maternal, child and adolescent health services at the primary health care level. These activities have the potential to bring about environmental risks and impacts Public Disclosure regarding: (a) medical and pharmaceutical waste management issues related to waste handling and collection, transportation and disposal of hazardous and infectious healthcare and laboratory waste; (b) occupational health and safety issues (infections from COVID-19, injuries and accidents during civil works and deployment and administration of vaccines); c) pollution (soil and water contamination from health and pharmaceutical waste); and (d) community health and safety due to increased risk of exposure and contact with COVID-19 virus vaccination campaigns or at healthcare facilities. The above potential risks and impacts are considered mostly temporary, predictable and/ or reversible. Civil works are expected to continue to be of small to medium scale but will occur simultaneously in many distinct locations which raises the magnitude of risks and impacts to medium to large scale although no significant cumulative impacts are foreseen to arise. Moreover, civil works may generate some adverse environmental risks and impacts particularly when refurbishing existing and functioning facilities such as warehouses, other logistic infrastructure, and waste management and disposal infrastructure. These potential environmental risks and impacts include: (i) nuisances related to dust and air pollution; (ii) noise and vibration; (iii) disposal and management of construction waste; and (iv) workplace injuries and accidents. These risks are expected to be localized, temporary and easily manageable through good practice construction environmental management procedures. Moreover, Components 2 and 4 will enhance capacity of implementation which will be undertaken through technical assistance activities including training and policy review that have diffuse and induced impacts, often playing out over a longer term. To mitigate the above risks and impacts, the parent project has prepared, consulted upon, and disclosed an Environmental and Social Management Framework (ESMF) including an ICWMP and a LMP. The ESMF covers a broad range of environmental aspects including: ESS1 – environmental risks screening forms, Environmental and Social management Plans (ESMPs), and training requirements (vaccine delivery and health care waste management); ESS2 – occupational health and safety measures as per the WHO, CDC, WB Environment Health and Safety (EHS) Guidelines and other Good International Industry Practice (GIIP); ESS3 – pollution, water and Dec 01, 2021 Page 6 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) energy resource consumption and management of the WASH facilities and equipment of the cold chain; ESS4 – infection control and prevention measures to limit the spread of COVID-19 during the vaccination activities and Emergency Response Plan. The AF does not make relevant any new ESSs or brings new environmental risks and impacts to the parent project. Social Risk Rating Substantial Similar to parent project, Social risks associated with AF are assessed as Substantial. Proposed project activities are likely to generate positive social and economic benefits and impacts. They will save lives currently at risk due to the pandemic, and broadly contribute to economic recovery of the economy of the country. Nonetheless, if appropriate mitigation measures are not considered, some planned interventions are likely to result in adverse social risks and impacts. Activities under Component 1 will include supporting acquisition of vaccines, medical supplies and equipment and strengthening of distribution and Cold chain equipment including reinforcement of dry storage and cold chain capacity and distribution network and waste management. Key risks and impacts under this component include labor issues as the project will hire direct workers, and other workers might be hired through third parties (private sector involved in outsourced functions, e.g., rental of spaces and cold chain supply), community health and GBV/SEA/SH. LMP will be prepared under the project to ensure that all relevant categories of workers are provided working conditions and a Grievance Redress Mechanism (GRM) is in place, in line with ESS2 and national labor laws. Interventions under Component 2 are also likely to lead to social risks and impacts, particularly concerning labor issues and stakeholder conflicts. Due to the involvement of various parties, chances are that there will be conflicting and competing interests among stakeholders at various levels over the project benefits. There are also risks related to lack of fair, equitable and inclusive policy for in-country vaccine access and allocation. Therefore, planned interventions under components 2 and 3 will involve vaccine targeting, vaccine safety and surveillance, data quality Public Disclosure and community engagement. If improperly managed, vaccine targeting might lead to social conflicts among interested parties and exclusion of marginalized groups. There is also a risk that they may not receive information about access and services unless communication is managed. TA activities under Component 2 may entail certain social risks and impacts such as discrimination and exclusion, reprisals in the formulation and implementation of vaccination policies, which requires assessment of downstream impacts under ESS1, ESS2 and ESS4. SEP was prepared by appraisal, and it outlines all types of stakeholders (particularly disadvantaged and vulnerable groups and means of consulting, engaging, and informing them. The SEP outlines means of reducing social conflict through improved and timely communication to stakeholders. Vaccine distribution systems need to consider marginalization and exclusion issues related to accessibility of vaccination locations for persons with disabilities; risk of vulnerable groups unable to access facilities, services, and access to vaccination due to their income and distance from health centers. The ESMF assessed issues related to marginalization and exclusion in accessing vaccines particularly regarding IDPs in the Northern provinces. There are also risks related to GBV/SEA/SH during community consultations and outreach and risks related to the spread of COVID-19 infections. A GBV/SEA/SH Risk Assessment prepared for the project recommends actions in line with the risk level (assessed as low to moderate, also based on the Bank’s GBV screening tool), and a GBV/SEA/SH Action plan shall be ready before any commencement activities. The Action plan will describe any codes of conduct in place and/or to be adopted for both health personnel and contracted workers. A COVID-19 protocol will also be developed and implemented across the range of project activities. Other relevant social risks and impacts include the potential of incidents and reprisals and retaliations, especially against healthcare workers and researchers during the project implementation lifecycle. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered Dec 01, 2021 Page 7 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: Similar to the parent project, ESS1 is relevant for the AF. The project finances the acquisition and deployment of COVID-19 vaccines and strengthen the national immunization system capacity under the Strategic Preparedness and Response Project and the AF will scale up up of Component 1. The project activities will have positive impacts such as the overall improvement of institutional capacity for surveillance, monitoring and control of COVID-19 infections in Mozambique. However, the project can also cause environment, health, and safety risks due to the hazardous nature of the COVID-19 and related equipment from the project activities. These risks are associated with transportation, distribution and storage of clinical supplies, and disposal of biomedical and chemical waste. The laboratories and health care facilities supported by the project can also pose threats and increase exposure to COVID-19, leading to serious illness or potentially harm to workers, patients, suppliers, and surrounding communities. Therefore, effective good OHS practices and control are considered and in place to minimize these risks. Furthermore, it is expected that the parent project and AF finances civil works which involve maintenance and restructuring of warehouses and other logistic infrastructure. Key environmental risks and impacts are associated with the civil works interventions, including occupational and community health and safety issues related to physical hazards (injuries from using tools, equipment, and heavy machinery) and chemical hazards (handling of solid waste and sewage); waste generation, water bodies contamination and soil pollution (debris from civil works and sewage sludge); uncontrolled spillages of fuel, oil and lubricants; emission of dust and generation of noise and vibration, etc. The exact location of project physical intervention is not known at this stage of preparation, as a result, the parent Public Disclosure project prepared, consulted upon and disclosed an Environmental and Social management Framework (ESMF) with readily available and reliable mitigatory mitigation measures, that is being implemented and will be applied to AF activities. The AF does not make relevant any new ESSs or brings new environmental risks and impacts to the parent project. Components 2 and 4 consist mainly of Technical Assistance (TA) activities which include expenditure primarily on consultancy services, training and capacity building therefore are likely to have minimal or no adverse environmental impacts. However, there are environmental risks related to transmission of communicable diseases such as COVID-19 that could stem through workers and public gathering for capacity building workshop and trainings. COVID-19 risk from this source is expected to be minor since public institutions have been enforcing national protocols for prevention of the disease at workplace. This measure has been reinforced by World Bank guidelines such as "Technical Note: Public Consultations and Stakeholder Engagement in WB – supported operations when there are constraints on conducting public meeting”. In addition, other downstream environmental and social risks may arise from TA that will result in policy and institutional reforms (e.g., technical assistance to assess and enhance policies and institutional frameworks around safe and effective vaccine and to develop immunization waste management policies and standard operating procedures). In these cases, the nature of risks and impacts of the outputs justifies the need for the WB to prior review the Terms of Reference for TA to include relevant ESF aspects. The project will also provide assistance to MISAU for the establishment of policies related to ensuring that there is no forced vaccination. Current national plan suggests largely voluntary approach to vaccination. Component 2 will also support TA activities aimed at developing fair, equitable and inclusive access to vaccines by disadvantaged and vulnerable groups (including people with disabilities). All of the activities to be financed under the project will be done in line Dec 01, 2021 Page 8 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) with WHO SAGE guidelines and WHO Framework for Allocation and Prioritization of COVID 19 vaccination. Notably, IDPs and Refugees will be included as priority groups as well. The project under Component 3 will continue to ensure provision of essential services to maternal, child and adolescent health services at the primary health care level, however in doing so may unitedly negatively impact the physical environment and local community. In compliance with principles and requirements of ESS1, the project prepared an environmental and social screening tool and included in the ESMF to determined the need of subsequent site-specific Environmental and Social Management Plans (ESMPs) , as appropriate, to mitigate any adverse risks and impacts related to any civil works. To date, no subproject instruments have been prepared pursuant parent project ESMF. Relevant social risks and impacts include labor issues, community health, GBV/SEA/SH, stakeholder conflict and potential exclusion of vulnerable groups. To manage these risks, the project has prepared a social assessment based on secondary data given the time constraints and the emergency nature of the project. Nonetheless, a comprehensive Social Impact Assessment will be conducted before project effectiveness. The secondary data-based SIA assessment is an integral part of the ESMF prepared for the project. The ESMF outlines procedures to avoid, minimize and, where possible, mitigate negative social impacts. It provides guidance for assessment of environmental and social management systems of third-party entities. The ESCP reflects third-party monitoring as one of the commitments. A Stakeholder Engagement Plan (SEP) has been prepared and it lays out the procedures for consultations, information dissemination and grievance redress. The ESMF also contains guidance on health and Safety procedures. Public Disclosure Site-specific ESMPs for each sub-project will be developed to manage social, health, exclusion, and safety risks. Further, the security risk posed by the ongoing armed insurgency in Cabo Delgado will require the presence of armed security that can increase GBV/SEA/SH risks as well as risks of conflicts with local communities. The WB SEA/SH risk assessment tool was applied to project anticipated activities and mitigation measures generated. The SEA/SH risk was rated a Low Risk and mitigation measures are provided under the ESMF and a standalone report of GBV risk assessment. Security Risk Assessment was carried out is presented under the ESMF annex 3. Both the parent project and the AF will not use security forces in its operations. Security risks are mostly associated with the context under which the parent project and the AF will be implemented as the northern Mozambique has been confornted with insurgency for the past three years or so. The project Environmental and Social Commitment Plan (ESCP) has been updated to reflect the AF, and it contains material measures and actions required for the project to meet the ESSs over a specified timeframe and commitments to undertake the required assessments and production of the necessary instruments for the project. Mitigation measures for site-specific impacts will be managed through the implementation of required environmental and social management instruments as provided by the ESMF. Relevant capacity building measures are included in the ESMF and ESCP. In conclusion, the following instruments have been prepared for the parent project and will apply to the AF: An Environmental and Social Management Framework (ESMF) with an Infection Control and Waste Management Plan (ICWMP), Labor Management Procedures (LMP), a Social Assessment (SA), an Emergency Response Plan (ERP), and a Security Risk Assessment (SRA), and a GBV/SEA/SH Risk Assessment, a Stakeholder Engagement Plan (SEP), and a COVID-19 Protocol. A site-specific Security Risk Management Plan (SRMP) will be prepared during project implementation, and GBV/SEA/SH Action Plan will be prepared before commencing the activities. Dec 01, 2021 Page 9 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) ESS10 Stakeholder Engagement and Information Disclosure Like for the parent project, ESS10 is relevant for the AF. The project has developed a SEP prior to appraisal, which includes a program for stakeholder engagement, including public consultation and information disclosure, throughout the entire project cycle. It also outlines a communication strategy with the project stakeholders, and offers mechanisms for them to raise concerns, provide feedback, or make complaints regarding the project. Vulnerable and disadvantaged groups include informal and formal public transport workers, market workers and IDPs, elderly, the ill, young people, mothers, the poor, the displaced, and the marginalized), and people with underlying health conditions). Consultation will be carried out on prepared safeguard instruments focusing on the Ministry of Health and with affected and interested parties prior to appraisal. Results and process will be summarized in the SEP, including describing how the results of consultation will be taken into consideration. The SEP also ensures widespread engagement with communities to disseminate information related to community health and safety, particularly around social distancing, high risk demographics, self-quarantine, and mandatory quarantine. The project will ensure that communication materials are created in a way that can reach all groups of people, in particularly the most vulnerable, and that are in a format and manner that is applicable to them. Various approaches will be used to improve “vaccine literacy” among the general population, specially related to disadvantaged or vulnerable groups identified by the project. Some of the key priorities will include conducting online consultations regarding beneficiary perceptions and obstacles to vaccine uptake; sensitization to counter misconceptions about the disease, vaccine introduction and any negative perceptions and disseminating in time Public Disclosure vaccination-related information such as overview of the COVID-19 vaccine program, priority risk groups, commodity availability, and tracking of those who need to receive a second dose, etc. The SEP will be shared with relevant stakeholders via culturally appropriate means (and having regard to logistical and technological constraints). The SEP will be disclosed on the MISAU website and printed copies will be placed in health centers in all provinces and hospitals in Mozambique. The project will ensure that there is no prejudice or discrimination toward project-affected individuals or communities, including other interested parties. Consideration will continue to be given to the disadvantaged and vulnerable groups including elderly and people with pre- conditions, especially where adverse impacts may arise, or development benefits are to be shared. The GRM which is laid out in the SEP will respond to complaints throughout the project’s lifecycle and it has been devised to promptly respond to any project grievances. It defines ways in which users can submit their grievances. The project GRM will also be enhanced by using additional channels to register and respond to complaints/feedback linked with deployment of vaccination as the primary objectives of the project is to enable affordable, transparent, and equitable access to COVID-19 vaccines in Mozambique. For the parent project a series of engagement activities were carried out. For instance, in mid 2020, the GoM established a National Coordination Committee for the Introduction of the COVID-19 Vaccine, which acts as the National Technical Advisory Group on Vaccination. This Committee is made up of different departments of MISAU, but also of other ministries, such as the Ministry of Gender, Children and Social Action, Ministry of Education and Dec 01, 2021 Page 10 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) Human Development and partner organizations of MISAU, namely the World Health Organization (WHO), UNICEF, Gavi, World Bank, DFID, USAID, FGH. The Committee has met at least fortnightly making the process participatory. The parent project has also reported on various consultation meetings on introduction of the vaccine and dissemination of the vaccination plan. The meetings, which started in March 2021 included communities, local leaders and vulnerable groups. Also, as part of the parent project, various consultation meetings on E&S instruments were held. The initial consultations on E&S instruments were held in April 2021. Also, as part of the parent project a GRM is in place through hotlines ALOVIDA and 110Covid. Since the beginning of the pandemic, AlôVida has been used as a line to clarify issues around COVID-19. The line has 20 attendants, who serve 24/7 in 11 local most spoken languages. The 110Covid (free) line was created in April 2020, to respond to the identification of COVID-19 cases. It also operates 24/7, in several local languages. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions ESS2 is relevant for the parent project and AF. The project will use direct, contracted, and primary supply workers and no community workers are envisaged. Most activities supported by the project will be conducted by direct workers of the project such as health and laboratory workers, i.e., civil servants employed by the government. The project may outsource minor works to contractors involved and the minor civil works of refurbishment and maintenance of Public Disclosure existing facilities. Although the number of workers may not be estimated at this stage, no large-scale labor influx is expected. As mitigation measures, the recipient will implement adequate occupational health and safety (OHS) measures (including emergency preparedness and response measures) provided in the ESMF and the in-force WHO guidelines on COVID-19 in all facilities. The existing ESMF includes (i) procedures for entry into health care and quarantine facilities, including minimizing visitors and undergoing strict checks before entering; (ii) procedures for protecting workers against infections and hazardous waste; (iii) training and toolbox meetings on OHS procedures to all categories of workers including direct and contracted workers; (iv) post signage to isolate and moderate risks exposure; and (v) mandatory use of Personal Protective Equipment (PPE), both direct and contracted workers. Moreover, procedures and measures related to OHS will also be included in worker’s contracts and code of conduct. An assessment of labor implications under the project was required, particularly reflecting on issues such as labor and working conditions, including child labor and forced labor, lack of equal employment opportunities from women and occupational health and safety (OHS) (e.g., World Bank Interim Note on COVID-19 Considerations in Construction/ Civil Works Project, World Bank EHS Guidelines and other GIIP including WHO Guidelines) to ensure health and safety of workers during the vaccine administration. Measures related to occupational health and safety, to project workers from injuries, illness, or impacts associated with exposure to hazards encountered in the workplace or while working, are documented in the Labor Management Procedure (LMP) developed by MISAU as part of the ESMF. The LMP are applicable to the project in accordance with the requirements of ESS2 and labor laws in Mozambique. The OHS measures consider the World Bank Group General Environment, Health and Safety Guidelines (EHSGs), the EHSGs for Health Care Facilities and other Good International Industry Practices (GIIP). The LMP include measures to avoid discrimination and grant equal opportunities and measures related to occupational health and safety (OHS). Dec 01, 2021 Page 11 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) A Grievance Redress Mechanism (GRM) for all direct, contracted, primary supply and community workers (this includes full-time, part-time, seasonal and migrant workers) on all project-related matters, including terms and conditions of employment; non-discrimination and equal opportunity; workers 'organizations; occupational health and safety, harassment and other behavioral complaints are anticipated in the LMP. Labor camps are not anticipated. As part of the planned institutional capacity assessment, the capacity of MISAU to manage labor and working conditions will be assessed ad appropriate technical expertise will be procured. ESS3 Resource Efficiency and Pollution Prevention and Management ESS3 is relevant for the parent project and AF. Downstream indirect effects from biomedical waste procedures and management are anticipated from the Technical Assistance (TA) provided under Component 2, particularly from TA that are not intended to be implemented as part of the Project, as such the Terms of Reference from these TA will be prior reviewed by the Bank team and will have to follow the provisions set forth under the ESMF. Risks of environmental pollution exist from the generation of waste from labs, screening points, vaccine delivery and treatment facilities and these will be managed using the mitigation measures included in the Infectious Control and Waste Management Plan (ICWMP). However, for the upgraded labs, a gap filling measures will have to be developed through site-specific ESMPs. Waste can include liquid contaminated waste (e.g., blood, other fluids, and contaminated fluids), infected materials (water used; lab solutions and reagents, syringes, bed sheets, etc.), and expired vaccines that require special handling Public Disclosure and awareness. Those may pose an infectious risk to healthcare workers in contact with waste. When not properly disposed, the biomedical waste might contaminate soils and groundwater. Mozambique has in place regulations and decrees on waste management: Regulation for the Management of Hazardous Waste and Regulation for Disposal of Pharmaceutical Products). However, according to the updated VIRAT/VRAF assessments tool the waste management has challenges but there are weaknesses in implementing national standards for biomedical and pharmaceutical waste, particularly at the district and facility levels. As such, the project support the development of waste management policies, standard operating procedures, and related tools as well as investing in waste management and disposal infrastructure to remedy the situation following an mitigation hierarchy tohandling vaccine related wastes (e.g. use of low cost and efficiency technology options for treating infectious medical waste, including incineration, chemical treatment, autoclaving, microwaving, and shredding/compacting, etc. The ICWMP was developed for the project as part of the ESMF and included general measures for medical and pharmaceutical waste management and specific measures tailored for COVID-19 waste management including sharps, used and expired vaccine vials, waste from testing (PCR, RDTs, etc.), transportation and management of vaccines, expected volume of biomedical waste to be generated and existing capacity to manage, mechanism to collect, handling, transport and dispose biomedical waste including proper disposal of the human corpses confirmed or suspected to have been infected with COVID-19. The prepared ICWMP for this project follows WHO COVID-19 guidance documents, World Bank EHS guidelines and other best international practices to prevent or minimize contamination from inadequate waste management and disposal. The necessary training in the implementation of the ICWMP will be provided to medical and laboratory workers, as well as the workers contracted, as needed. The ICWMP applies an adaptive management approach in which the implementation of mitigation and management measures are responsive to changing conditions or unforeseen circumstances and to the results of project monitoring Dec 01, 2021 Page 12 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) as such the ICWMP shall be updated as needed during project implementation to adjust management actions. In addition, the establishment of warehouses, other logistic infrastructure and waste management may pose risks related to environmental pollution including air quality, noise, construction waste, land degradation, etc. General mitigation measures for these risks was included in the ESMF. Site-specific ESMPs will be prepared as necessary to manage any pollution resulting from civil works for rehabilitation of facilities, and will be implemented by contractors. The use of project equipment and vehicles will generate negligible emissions of GHG, may be except for the cold chain which can generate direct emissions to the atmosphere from leaking hydrofluorocarbon (HFC) refrigerants gases used to cool the refrigerators or given the increase demand of energy (indirect emissions) to maintain cold chain facilities. To mitigate these, the project will deploy energy efficient cold storage and provide solar or other renewable energy technology (e.g. Solar Direct Drive Refrigerators and WHO PQS certified climate friendly refrigerators/freezers) to power facility based and mobile cold chains as well as build energy efficiency improvements across all new and existing national, subnational, and local facilities used for vaccine delivery, storage and distribution. The cold chain and logistics system may require additional use of energy to secure conservation and viability of COVID 19 vaccines, but it is not envisaged large demand. Therefore, where technical and economically feasible, the project will employ efficiency energy use measures placing emphasis in using clean energy solutions (such as solar and battery systems) which may require to upgrade cold chain and health facilities to ensure energy efficiency is achieved. These measures may involve installing and upgrading energy capacity including climate friendly solutions, such as acquisition of solar panels, energy-efficient generators and ventilation. These measures were included in the ESMF. Public Disclosure ESS4 Community Health and Safety ESS4 is relevant for the AF. Ensuring the safety of communities from COVID-19 infections is core of the project. Biomedical and waste from labs, health centers, quarantine, and isolation centers have a high potential of carrying microorganisms that can infect communities at large scale if not property disposed of. There is a possibility for the infectious microorganisms to be introduced into the environment if not properly contained by the laboratories or due to accidents or emergencies, e.g., fire response or natural phenomena. An Emeregy Response Plan (ERP) as part of the ESMF has been prepared and address these, particularly on: (I) how project activities will be conducted in a safe manner, with low incidents or accidents, in line with the Good International Industry Practice (GIIP) guidelines; (ii) measures in place to prevent or minimize the spread of infectious diseases, (iii) emergency preparedness measures; and (iv) monitoring adverse impacts and side effects of vaccines on recipients. The safety systems, protocols and emergency preparedness measures for the storage, transport, use and disposal of vaccines to ensure community health and safety. Any ESMPs to be prepared during implementation contain measures to monitor, investigate and respond to adverse events following immunization, infrastructure and management capacity for cold chain, and any incidents and accidents, as per the project’s ESMF. There are other risks related to community health and safety due to increased risk of exposure and contact with COVID-19 virus during vaccination campaigns or at healthcare facilities. There are also associated risks of contamination from biomedical and pharmaceutical waste disposal if not properly undertaken. The incorrect disposal of medical and pharmaceutical waste can also enter in contact with communities through fumes from incinerators or percolation of rainwater or through waste or groundwater. As such, health facilities will follow specific procedures Dec 01, 2021 Page 13 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) and protocols, in line with WHO and CDC guidance, on appropriate waste management of contaminated materials; on transport of samples; and on workers disinfection before leaving the workplace back into their communities. These issues are captured in the ESMF and ICWMP. The project will ensure adequate investment in cold storage and logistic to avoid vaccines being wasted. This is likely to involve storage at ultra-cold temperatures of –70C. The use of security and emergency management personnel is not anticipated in the project. In event that security force is used, the ESMF has made general provisions to managing cases of such use and also the requirement of specific security management plans. Laboratories, quarantine, isolation centers, and screening points will follow respective procedures with focus on appropriate waste management of contaminated materials as well as protocols on the transport of samples and workers. The project will thereby follow the requirements established by WHO and to be adapted in the project ESMF. Project activities (training, vaccination, and community engagement) may increase the risk of gender-based violence (GBV), sexual exploitation and abuse (SEA) and/or sexual harassment (SH). The ESMF includes a GBV risk assessment and preventive measures. The project will promote prevention of GBV/SEA/SH by relying on the government and international best practices of Ethics and Professional Conduct for all workers (including any security personnel that may be retained for transportation purposes) in the quarantine facilities as well as the provision of gender-sensitive infrastructure such as segregated toilets ad enough light in those centers, and this will be documented in the ESMF for the project. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Public Disclosure ESS5 is not relevant for the AF as all civil works under Component 1 and 2 will be conducted within existing government health facilities. No land acquisition, use or involuntary resettlement is expected in the project. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources ESS6 is not relevant for the project and AF as no greenfield works are expected in the project. No adverse impacts on natural resources or biodiversity are anticipated because of the project activities. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS7 is not relevant for the AF as there are no Indigenous People/ Sub Saharan African Historically Underserved Traditional Communities in Mozambique. ESS8 Cultural Heritage While the AF will finance civil works which involve maintenance and restructuring of existing warehouses and other logistic infrastructure, impacts to cultural heritage are not expected. Therefore, ESS8 is not considered relevant for the AF as there are no expected impacts on cultural heritage. Nonetheless, the ESMF for the parent project does already include measures for "Chance Finds’ archaeological or other cultural heritage. Dec 01, 2021 Page 14 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) ESS9 Financial Intermediaries ESS9 is not considered relevant as there are no financial intermediaries. B.3 Other Relevant Project Risks N/A C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No OP 7.60 Projects in Disputed Areas No B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Is this project being prepared for use of Borrower Framework? No Areas where “Use of Borrower Framework” is being considered: Public Disclosure None IV. CONTACT POINTS World Bank Contact: Miguel Angel San Joaquin Polo Title: Senior Economist, Health Telephone No: 5333+2368 Email: msanjoaquinpolo@worldbank.org Contact: Courtney Price Ivins Title: Health Specialist Telephone No: +1-202-458-7724 Email: civins@worldbank.org Borrower/Client/Recipient Borrower: Ministry of Economy and Finance Implementing Agency(ies) Implementing Agency: Ministry of Health V. FOR MORE INFORMATION CONTACT Dec 01, 2021 Page 15 of 16 The World Bank COVID-19 Strategic Preparedness and Response Project Additional Financing (P178068) The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Miguel Angel San Joaquin Polo, Courtney Price Ivins Practice Manager (ENR/Social) David Seth Warren Cleared on 30-Nov-2021 at 15:49:24 GMT-05:00 Safeguards Advisor ESSA Peter Leonard (SAESSA) Concurred on 01-Dec-2021 at 10:37:10 GMT-05:00 Public Disclosure Dec 01, 2021 Page 16 of 16