STP COVID-19 EMERGENCY RESPONSE PROJECT SEP DEMOCRATIC REPUBLIC OF SÃO TOMÉ E PRINCIPE MINISTRY OF HEALTH STAKEHOLDER ENGAGEMENT PLAN (SEP) COVID-19 EMERGENCY RESPONSE PROJECT 31 July of 2020 1 CONTENTS 1. INTRODUCTION AND BACKGROUND .................................................................................................... 3 2. PROJECT DESCRIPTION .......................................................................................................................... 4 3. PURPOSE AND OBJECTIVE OF THE STAKEHOLDERS ENGAGEMENT PLAN (SEP) ................................... 5 4. LEGISLATIVE AND ENVIRONMENTAL AND SOCIAL STANDARDS REQUIREMENTS ................................ 6 4. STAKEHOLDER IDENTIFICATION AND ANALYSIS ................................................................................... 6 4.1 Methodology ................................................................................................................................... 6 4.2. Affected parties .............................................................................................................................. 7 4.3. Other interested parties................................................................................................................. 8 4.4. Disadvantaged / vulnerable individuals or groups......................................................................... 8 5. STAKEHOLDER ENGAGEMENT PROGRAM ............................................................................................ 9 5.1. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement .......................................................................................................................................... 9 5.2. Proposed strategy for information disclosure and consultation process .................................... 14 5.3: Learning and Feedback ................................................................................................................ 18 5.4 Future of the project ..................................................................................................................... 18 6. RESOURCES AND RESPONSIBILITIES FOR IMPLEMENTING STAKEHOLDER ENGAGEMENT ACTIVITIES ................................................................................................................................................................ 18 6.1. Resources ..................................................................................................................................... 18 6.2. Management functions and responsibilities ................................................................................ 21 7. GRIEVANCE MECHANISM .................................................................................................................... 21 7.1. Description of GRM ...................................................................................................................... 21 7.2 Venues to register Grievances - Uptake Channels ........................................................................ 22 7.3 Grievances Relating to Gender-Based Violence (GBV) ................................................................. 23 8. MONITORING AND REPORTING .......................................................................................................... 23 8.1. Involvement of stakeholders in monitoring activities ................................................................. 23 8.2. Reporting back to stakeholder groups ......................................................................................... 23 ANNEX I: ...................................................................................................................................................... 25 PUBLIC CONSULTATION MINUTES .............................................................................................................. 25 2 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 1. INTRODUCTION AND BACKGROUND After the emergence of the new coronavirus, called COVID-19, in China and its spread outside China, on January 30, 2020, the Director-General of the World Health Organization (WHO) declared COVID-19 as a public health emergency of international concern (PHEIC), based on the opinion of the International Emergency Committee and within the framework of the International Health Regulations (2005). This Declaration implies that all countries must increase their preparedness for detection and containment of cases, including active surveillance, early detection, isolation and case management, follow-up contacts and prevention of the spread of COVID Disease 19. The proposed project aims to reinforce and maintain the country capacity to: (i) limit the transmission of COVID 19 in the population including health workers, (ii) strengthen early detection notification and confirmation of cases of COVID-19, (iii) effectively manage isolation and case management for all suspected and confirmed cases of COVID-19, (iv) support health promotion and community mobilization for the protection and prevention to COVID-19, and (v) reinforce the multisector coordination of partners to improve preparedness and response and to minimize the socio-economic impact of a potential outbreak of COVID-19. The World Bank Group has created a dedicated, COVID-19 Fast Track facility to help developing countries address emergency response to and impacts of the outbreak. The WBGs COVID-19 Fast Track facility will be a globally-coordinated, country-based response to support health systems and emergency response capacity in developing countries, focused largely on health system response, complemented by support for economic and social disruption. The Republic of São Tomé and Príncipe (STP) located in the Gulf of Guinea is a small low-middle-income country comprised of two main islands. It has a total population of approximately 200,000 people, 42.6 percent of whom are 14 years of age or younger. In 2017, the country’s per capita gross domestic product (GDP) was US$1,921. In addition to having a small population and a remote location, there is a high fixed cost of public goods— all factors that affect the country’s trade, fiscal accounts, and human development outcomes. The government of São Tome and Príncipe finalized its National Contingence Plan to face COVID-19 infection. The budget of the Government Plan US$ 2.7 million for the different phases of preparedness, response and recovery is correlated to the current low capacities of the country. The epidemiological profile of Sao Tome and Principe continues to be dominated by communicable diseases with high incidences of acute respiratory diseases , diarrheal diseases, the persistence of some foci of neglected tropical diseases and other related diseases to the environment, the habits and behaviors of the populations. Non-communicable diseases (high blood pressure, diabetes and cancer) are increasing and represent today more than 60% of all health consultations. The Joint External Evaluation (JEE) of the country capacity to comply with the International Health Regulations (IHR) was performed in May 2019. Overall, the external evaluation team noted limited capacity in most of the 19 technical areas with the exception of vaccination where capacity is sustained. An ad-doc committee under the coordination of the Ministry of Health meets and monitors the situation daily with WHO support. On February 12, the Ministry of Health and WHO had a working session in the Council of Ministers on the IHR and the COVID-19 epidemic with the aim of providing early information on the threat, strengthening coordination and preparing for the country to deal with COVID 19 and similar public health emergencies and their health and socio-economic impacts. Following this session, the 3 Government decided to mobilize US$500 000 from its national budget to support preparation for COVID- 19. On February 18, the Ministry of Health held a working session with the agencies of the Nations, which aimed to inform about the government's preparatory actions and coordinate the contributions of each other. The Government, through the Ministry of Foreign Affairs, supported by Ministry of Health and WHO has had 2 information meetings with the international community in the country. The country has taken measures to strengthen surveillance at the point of entry: The surveillance has been strengthened (health screening including temperature control and the introduction of passenger tracking sheets), hands washing facilities have been established as well as a temporary isolation space and an ambulance to refer suspected cases to a dedicated isolation room in the national hospital. Travelers have passport checked, fill COVID 19 respective health forms and receive information on protection and measures to take if presenting symptoms. Seven alerts cases have been identified - based on provenance and not symptoms- have been isolated and followed for 14 days. 3 of these follow-up have been closed while four are still under surveillance at home. A risk communication strategy is in place. Communication sessions with the general public on general measures for the prevention of acute respiratory diseases are carried out on television and radio, focus on frequent hand washing, respiratory etiquette, and maintaining distance and care in front of a person with symptoms of acute respiratory infection. The communication plan is being finalized. 2. PROJECT DESCRIPTION The specific objectives of the project, aligned with the STP’s draft NAPHS and São Tomé e Príncipe’s COVID- 19 Plan are: (i) To strengthen coordination of preparedness and response operations at national and subnational levels; (ii) To strengthen surveillance capacity for early detection of cases, alert/rumor management and contact tracing; (iii) To strengthen nationwide IHR core laboratory capacities including the diagnosis of COVID-19; (iv) To improve national strategy for risk communication and community engagement thus increasing awareness and informed decision-making among communities; (v) To reinforce IHR core capacities at points of entry, including screening for COVID19 when applicable ; (vi) To increase the capacity to rapidly isolate and provide optimized care for persons suspected or confirmed to have COVID-19; (vii) To implement optimal infection and control measures in healthcare settings and communities; ; and (vii) To provide and pre-position medical supplies and commodities, and other logistics for COVID-19 management. The STP COVID-19 Emergency Response Project comprises the following components: Component 1. Case detection, case confirmation, contact tracing, case recording and reporting [US$ 650,000]: Establish an EOC within MoH to coordinate multisectoral (One Health) COVID19 preparedness and response activities; Operationalize Indicator and Event base surveillance to respond to COVID19; establish protocols, processes and regulations for reporting to WHO, OIE and FAO on public health emergencies, including regular reporting on COVID19 epidemiology in STP; establish FETP Frontline program in country to provide epidemiology training and develop public health workforce to better respond to emergencies; strengthen Rapid Response Teams in country to respond to PHE; Strengthen National laboratory diagnostic and referral system to conduct COVID19 diagnostic tests as well as key priority diseases in accordance to WHO guidance; Implement IHR core capacities and contingency plans for COVID19 at PoEs; Component 2. Risk communication and community engagement including social distancing measures 4 [US$ 350,000]: Establish national risk communication and community engagement strategy; Production of communication materials; Train resources for risk communication; Proactive public outreach on a mix of platforms (newspapers, radio, television, social media, Internet); Stakeholders mapped and decentralized system in place for community engagement for COVID-19 social distancing measures; Component 3. Healthcare systems strengthening, procurement of medical equipment and supplies [US$ 1,300,000]: Establish nationwide healthcare referral systems for highly infectious disease hazards including COVID19; Establish a triage system for COVID19 at all HFs; upgrade and equip 20 isolation ICU centers (selecting the most adequate HFs in STP) with medical equipment and supplies for COVID19 severe patients management1; establishment and Training of Emergency Medical Teams (EMTs) for COVID19 and other infectious hazards; Draft and disseminate guidance on home isolation for mild cases and ICU management of severe cases with proper IPC; ensure water supply, sanitation and hygiene services and medical waste management in health care facilities; procurement of COVID19 testing kits for 200 patients; ensure IPC implementation at all HCFs; procurement of commodities for IPC precautions (personal protection equipment); develop and implement plans to ensure that non-COVID19 patients receive the care necessary by ensuring some HFs are non-COVID19 facilities and ensure continuity of care for chronic or acute patients; develop plan to support critical functions that must continue during a community widespread outbreak of COVID19 (e.g. water and sanitation; fuel and energy; food; telecommunication/internet; finance; law and order; education; and transportation0, necessary resources, and essential workforce; and Component 4. Project management, M&E, and institutional strengthening [US$ 200,000]: Implementing the Project will require administrative and human resources that exceed the current capacity of the implementing institutions in STP. 3. PURPOSE AND OBJECTIVE OF THE STAKEHOLDERS ENGAGEMENT PLAN (SEP) The WB ESS 10- Stakeholders engagement and information disclosure requires that Borrowers engage with stakeholders throughout the project life cycle, commencing such engagement as early as possible in the project development process and in a timeframe that enables meaningful consultations with stakeholders on project design. The nature, scope and frequency of stakeholder engagement will be proportionate to the nature and scale of the project and its potential risks and impacts. The objectives of this SEP: • To establish a systematic approach to stakeholder engagement that will help STP Government identify stakeholders and build and maintain a constructive relationship with them, in particular project-affected parties. • To assess the level of stakeholder interest and support for the project and to enable stakeholders’ views to be taken into account in project design and environmental and social performance. • To promote and provide means for effective and inclusive engagement with project-affected parties throughout the project life cycle on issues that could potentially affect them. • To ensure that appropriate project information on environmental and social risks and impacts is disclosed to stakeholders in a timely, understandable, accessible and appropriate manner and format. • To provide project-affected parties with accessible and inclusive means to raise issues and grievances, and allow Borrowers to respond to and manage such grievances. 1 WHO Operational Support & Logistics Disease Commodity Packages – available at - https://www.who.int/publications-detail/disease-commodity-package---novel-coronavirus-(ncov) 5 4. LEGISLATIVE AND ENVIRONMENTAL AND SOCIAL STANDARDS REQUIREMENTS Under STP Legislation, stakeholders´ engagement is required during environmental and social impact assessment. According to decree 37/99 of 30th November– Regulation for Environmental Impact Assessment, public consultation process is a compulsory activity for all projects subjected to to Impact Assessment process. The public consultation process is fully described in Article 7 of the decree. In order to carry out the public consultation during the EIA process the governmental entity responsible for the environment should adopt the methods which, on a case-by-case basis, are adequate for the achievement of the intended objectives, anticipating a full access to all information in your possession on the matter. The World Bank’s Environment and Social Standard 10 sets out that a Borrower has to engage with stakeholders as an integral part of a Project’s environmental and social assessment and project design and implementation. The nature, scope and frequency of the engagement should be proportional to the nature and scale of the Project. Consultations with stakeholders have to be meaningful and be based on stakeholder identification and analysis, plans on how to engage stakeholders, disclosure of information, actual consultations, as well as responses to stakeholder grievances, and reporting back to stakeholders.2 4. STAKEHOLDER IDENTIFICATION AND ANALYSIS The nature of COVID-19 makes everyone an important stakeholder in the project, either to avoid virus from spreading in the country or minimizing a risk of affecting others if one becomes infected. 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 Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. 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. 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 Project outcomes. 4.1 Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: 2 World Bank, Environmental and Social Framework. Setting Environmental and Social Standards for Investment Project Financing, August 2016. 6 • 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. Due to the nature of the project which everyone in the country has got interest in this topic, mass means of communication should be considered (TV, Radios, Newspapers, banners, sms, telephone lines, e-mails and public audiences) • 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 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 to be given to vulnerable groups – in particular, women, persons with disabilities, youth, the elderly, and those with chronic illnesses. For the purposes of effective and tailored engagement, stakeholders of the proposed project 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 status3, and that may require special engagement efforts to ensure their equal representation in the consultation and decision- making process associated with the project. 4.2. Affected parties Although the nature of the diseases and its impacts makes everybody affected, either direct or indirectly, for the purpose of this SEP we will consider Affected Parties individuals, groups, and communities directly affected by project interventions and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category: • COVID-19 infected people as a result of the project or using project facilities or services • People under COVID-19 quarantine, including workers in the quarantine facilities • Hospital patients • Relatives of COVID-19 infected people • Relatives of people under COVID-19 quarantine • Neighboring communities to laboratories, quarantine centers, and screening posts • Workers at construction sites of laboratories, quarantine centers and screening posts • Public health workers 3 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, illness, physical or mental disability, poverty or economic disadvantage, or dependence on unique natural resources. 7 • Health workers in contact with or handling medical waste • Municipal waste collection and disposal workers • Ministry of Health officials • People and businesses affected by or otherwise involved in project-supported activities • District Chambers (�gua Grande, Me-zoche, Lobata, Lembá, Canta Galo, Caué e Região Autónoma de Príncipe (RAP) • General Directorate for the Environment • Ministry of Agriculture • Organization who have to implement the measures in their organizations • Staff responsible for handling supplies at air or sea ports 4.3. Other interested parties The projects’ stakeholders also include parties other than the directly affected people, including: • Traditional media: Capital, Jornal de São Tomé, Jornal Tropical, Diário Vitrina, Jornal Transparência ST, Agência STP-Press, O Parvo, TV São Tomé, RDP Africa, RTP internacional, Radio Nacional de STP, Voz da América. • Participants of social media • Politicians: Movimento de Libertação de São Tomé e Príncipe, Acção Democrática Independente (ADI), Partido Social Democrata (MLSTP-PSD), Partido de Convergência Democrática/Grupo de Reflexão (PCD/GR), União dos Democratas para Cidadania e Desenvolvimento da Mudança (UDD), MDFM, • National and international health organizations: World Health Organizations, • National and International NGOs and Associations; National Association of Nurse Midwives (ANEP); National Union of Nurses and Midwives (SINEP); FONG; Ordem dos médicos, Associaçao dos médicos, Sindicato dos enfermeiros, • Businesses with international links • The public at large 4.4. 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 related medical treatments] be adapted to take into account the needs of such groups or individuals, their 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 status and financial situation, disadvantaged status in the community (e.g. minorities or fringe groups), or dependence on other individuals and/or the state. Engagement with vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in project- related decision-making so that their awareness of and input to the overall process are commensurate to those of other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: • Elderly • Illiterate people • Ethnic or religious minorities 8 • People with disabilities- Blind and partially sighted Association (ACASTEP), Association of prostate patients São Tomense, Association of Physically Disabled • People living in remote or inaccessible areas • Female-headed households • Patients with chronic illnesses • Daily wage earners, • Those living below poverty line, • Unemployed, Vulnerable groups affected by the project will be further confirmed and consulted during project implementation. Description of the methods of engagement that will be undertaken by the project is provided in the following sections. 5. STAKEHOLDER ENGAGEMENT PROGRAM In order to incorporate stakeholders´ view and concerns about the project a public consultation meeting was held on 27th June where ESMF, LMP, ICPWM and SEP were presented to the public. Due to the limitations imposed by COVID-19, a virtual meeting was held supplemented by a present meeting respecting physical distancing imposed by health authorities. Zoom platform was used for virtual meeting. The stakeholders that attended the meeting are: Representatives of the Ministry of Health of São Tomé and Príncipe; Representatives of the Fiduciary Agency for Project Management (AFAP); Representatives of the São Tomé and Príncipe District Chambers; Representatives of the General Directorate for the Environment of São Tomé and Príncipe; Representative Ministry of Agriculture; Representatives of the Blind and partially sighted Association (ACASTEP); Representatives of the National Association of Nurse Midwives (ANEP); Representatives of the National Union of Nurses and Midwives (SINEP); Community members in general. A complete least of the attendees (see attendance sheet and full consultation report in Annex 1). Issues raised during the consultation meeting with stakeholders included: - A need to include food security component into the project, to ensure there is enough food for vulnerable in São Tomé and Príncipe amid the pandemic. Also because food is essential to strengthen immunity. - A need to ensure that project benefits to ordinary people, and to identify objective criteria for selection of activities to be financed by the project by assessing the positive impact on the community in general. - The final destination of waste generated in COVID treatment installation, giving an example of the tent - A need for the project to consider buying agricultural surpluses from small farmers who have not found a market in this pandemic moment, suggesting that these products could be used to feed COVID 19 patients. - A need to develop activities to provide food for disabled people during pandemic, since there is movement limitation imposed by the authorities. - Lack of protective equipment (masks, gloves, etc.) in hospitals, which puts health professionals exposed to infection with the new coronavirus More consultation will happen during the project implementation and closure, in order to allow stakeholders views to be continuously taken into consideration. 5.1. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement The WHO “COVID-19 Strategic Preparedness and Response Plan -- Operational Planning Guidelines to Support Country Preparedness and Response--� (2020) outlines the following approach in Pillar 2 Risk Communication and Community Engagement, which will be the basis for the Project’s stakeholder engagement: It is critical to communicate to the public what is known about COVID ‑19, what is unknown, what is being done, and actions to be taken on a regular basis. Preparedness and response activities should be conducted in a participatory manner, and be informed by and continually optimized according to community feedback to detect and respond to 9 concerns, rumours and misinformation. Changes in preparedness and response interventions should be announced and explained ahead of time and 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. The table 1 outlines methods to be employed for stakeholder engagement activities including consultations and information dissemination. The methods vary according to the characteristics and needs of stakeholders, and will be adapted according to circumstances related to the COVID-19 public health emergency. 10 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP Table 1: Stakeholders needs Matrix Target Key Specific Needs Language Position with Preferred Level of (High, Appropriate stakeholders Characteristics ((accessibility, large needs regards to the notification low) engagement print, child care, project means influence approach daytime meetings (support, (email, radio, medium, etc.) neutral, phone, letter) opposition) Government Literate None Portuguese Support e-mail, High E-mail Ministries and newspaper, correspondence, Health Radio, TV, videoconference Authorities Website, meetings, outdoor, Interviews with International Literate Support Virtual Public Health Organizations meetings, Experts, Virtual Workshops consultation Local NGOs, (where meetings, surveys, religious Literate Support feasible) sms, whatsup, leaders telephone calls, mails Other Literate Support Institutional Stakeholders, comunicação social COVID-19 Press releases, Infected Information People Literate Português, leaflets, Radio, /not Literate Information santome, Support Radio, TV, Low television, accessibility lung'Ie phone, newspaper and People in angolar e o outdoor, social media Quarantine kabuverdianu folhetos announcements, sms, whatsup, 11 Target Key Specific Needs Language Position with Preferred Level of (High, Appropriate stakeholders Characteristics ((accessibility, large needs regards to the notification low) engagement print, child care, project means influence approach daytime meetings (support, (email, radio, medium, etc.) neutral, phone, letter) opposition) outdoors, booklets, handouts, using actors on TV and Other Hospital radio Patients Toll-free hotline for information dissemination and grievance uptake Health Sector Literate None Portuguese Support e-mail, High E-mail Workers newspaper, correspondence, Radio, TV, videoconference Website, meetings, Project outdoor, Interviews with Workers Virtual Public Health meetings, Experts, Virtual Workshops consultation (where meetings, surveys, feasible) sms, whatsup, telephone calls, mails Vulnerable Not literated Specific Portuguse Support Radio, TV, Low Limited Individuals and messages/awareness santome, phone, consultation Groups targeting lung'Ie outdoor, meetings (where (women, women/girls will also angolar e o Liflets, feasible), radio, TV, children, old be disseminated on kabuverdianu meetings sms, outdoors, people, risks and safeguard (where 12 Target Key Specific Needs Language Position with Preferred Level of (High, Appropriate stakeholders Characteristics ((accessibility, large needs regards to the notification low) engagement print, child care, project means influence approach daytime meetings (support, (email, radio, medium, etc.) neutral, phone, letter) opposition) Disabled measures to prevent feasible), people) GBV/SEA in Virtual quarantine facilities, consultation managing increased meetings, burden of care work surveys, sms, and also as female whatsup, hospital workers. telephone calls, mails 13 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 5.2. Proposed strategy for information disclosure and consultation process Stakeholder engagement activities should be inclusive and carried out in a culturally-sensitive manner, and care must be taken to ensure that the vulnerable groups identified above will have opportunities to be included in consultations and project benefits. Methods typically include household-outreach and focus-group discussions in addition to community public consultation meetings, and where appropriate verbal communication or pictures should be used instead of text. The project will have to adapt to different requirements. While country-wide awareness campaigns will be established, specific communication around ports of entry and airports as well as quarantine centres and laboratories will have to be timed according to need and adjusted to local circumstances. Given the current context resulting from recent measures put in place to address the pandemic and the timeline in which the project is being prepared, there are limited opportunities available to engage and consult with stakeholders during project preparation. Restrictions on social gatherings, which limit face- to-face social interactions, will constrain the project’s stakeholder engagement processes and require the implementation of innovative communication and consultation methods. Given the wide range of stakeholders (potentially affected people and other interested parties) in this project, a robust stakeholder engagement and communication strategy will need to be developed; the project component on “Risk Communication and Community Engagement� (RCCE), encompassing behavioural and sociocultural risk factors assessment, production of RCCE strategy and training documents, production of communication materials, media and community engagement, and documentation in line with WHO “Pillar 2: Risk communication and community engagement� will be implemented to address this. As indicated above, it may be necessary to: • 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, public announcements and mail) when stakeholders do not have access to online channels or do not use them frequently. Such channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Employ online communication tools to design virtual workshops in situations where large meetings and workshops are essential, given the preparatory stage of the project. Webex, Skype, and in low ICT capacity situations, audio meetings, can be effective tools to design virtual workshops. The format of such workshops could include the following steps: o Virtual registration of participants: Participants can register online through a dedicated platform. o Distribution of workshop materials to participants, including agenda, project documents, presentations, questionnaires and discussion topics: These can be distributed online to participants. o Review of distributed information materials: Participants are given a scheduled duration for this, prior to scheduling a discussion on the information provided. o Discussion, feedback collection and sharing: 14 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP ▪ Participants can be organized and assigned to different topic groups, teams or virtual “tables� provided they agree to this. ▪ Group, team and table discussions can be organized through social media means, such as webex, skype or zoom, or through written feedback in the form of an electronic questionnaire or feedback forms that can be emailed back. o Conclusion and summary: The chair of the workshop will summarize the virtual workshop discussion, formulate conclusions and share electronically with all participants. In situations where online interaction is challenging, information can be disseminated through digital platform (where available) like Facebook, Twitter, WhatsApp groups, Project weblinks/ websites, and traditional means of communications (TV, newspaper, radio, phone calls and mails with clear description of mechanisms for providing feedback via mail and / or dedicated telephone lines. All channels of communication need to clearly specify how stakeholders can provide their feedback and suggestions. In general, after engagement with stakeholders at list a period of 7 days should be provided to allow stakeholders to raise and send their comments through the channels provided during the engagement. The specific needs for each stakeholders group will be discussed in every consultation meeting, and the list below will be updated throughout the project. Data related to stakeholder needs will be inserted in table below. The table 2 below summarizes the stakeholders’ engagement strategy. 15 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP Table 2: Stakeholders Engagement Strategy Project stage Target stakeholders List of Methods of engagement timing proposed Evidence of engagement information to be disclosed Preparation/planning - Government Ministries and - Project description - Virtual consultations/information During preparation of -Minutes ad action plans, Health Authorities - SEP sharing (online platforms, TV and radio Environmental and attendance register, records - public Health staff - ESCP interactive/informative programs, radio, Social instruments, of online interaction or other - International Organizations - ESMF sms, e-mail, set up a dedicated before funds approval evidences, public - National NGOs - GRM website, outdoors, newspaper) or made available announcements released in - Other Institutional - Communication - Interviews with Public Health Experts the media Stakeholders lines (phone in public media - Vulnerable groups number, e-mail - Virtual consultation meetings - Municipal workers address, office -Construction companies location, contact - Neighboring communities to person) laboratories, quarantine -need of the project centers, and screening posts - planned activities -District Chambers - Environment and -staff responsible for handling social risk and medical supplies impact -general public -Health and safety impacts -Social Component Implementation - General Public - SEP - Press releases - Before activities take -Minutes, attendance register, - COVID-19 Infected People - ESCP - Information leaflets place in a specific records of online interaction - People in Quarantine - ESMF - Radio, television, newspaper and location, or other evidences, public - Vulnerable Individuals and - GRM social media announcements - During announcements released in Groups implementation - Focus groups with affected parties implementation the media, pictures - Hospital Patients - Communication and vulnerable groups (quarterly - Health Sector Workers lines (phone - Community consultation meetings refreshments ), - Project Workers number, e-mail (where feasible) -after monitoring and -waste removal staff and address, office - Toll-free hotline for information evaluation missions municipality staff location, contact dissemination and grievance uptake - involved construction workers person) - dedicated Website updates -Public servants in country -Project Monitoring -sms entry points (airport, port, land and Evaluation borders,) - Health and safety 16 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP -Neighboring communities to -Environmental laboratories, quarantine concerns centers, and screening posts; -Training and -District Chambers workshops -staff responsible for handling medical supplies - Government officials -Emergency services Closure - General Public Final Evaluation - Press releases During final M&E -Minutes, attendance register, - former COVID-19 Infected Reports - Information leaflets process, before records of online interaction People -public consultation signing off the closure or other evidences, public - Former people in Quarantine -dedicated website report announcements released in - Vulnerable Individuals and the media Groups - former Hospital Patients - Health Sector Workers - Project Workers -waste removal staff and municipality staff - involved construction workers -Public servants in country entry points (airport, port, land borders,) -Neighboring communities to laboratories, quarantine centers, and screening posts; -District Chambers -staff responsible for handling medical supplies - Government officials 17 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 5.3: Learning and Feedback Feedback is essential in stakeholder’s engagement process, hence there is a need to: • Systematically establish community information and feedback mechanisms including through social media monitoring, community perceptions, knowledge, attitude, and practice surveys, and direct dialogues and consultations. • Ensure changes to community engagement approaches are based on evidence and needs, and ensure all engagement is culturally appropriate and empathetic. • Document lessons learned to inform future preparedness and response activities. • For stakeholder engagement relating to the specifics of the project and project activities, different modes of communication will be utilized. • Policy-makers and influencers might be reached through weekly engagement meetings with religious, administrative, youth, and women’s groups will be carried out virtually to prevent COVID 19 transmission. • Individual communities should be reached through alternative ways given social distancing measures to engage with women groups, youth groups, training of peer educators, etc. Social media, ICT & mobile communication tools can be used for this purpose. • For public at large, identified and trusted media channels including: Broadcast media (television and radio), print media (newspapers, magazines), trusted organizations’ websites, Social media (Facebook, Twitter, etc.), Text messages for mobile phones, Hand-outs and brochures in community and health centers, at offices of Local Governments, Community health boards, Social Assistance Centers, will be utilized to tailor key information and guidance to stakeholders and disseminate it through their preferred channels and trusted partners. 5.4 Future of the project Stakeholders will be kept informed as the project develops, with reporting on project environmental and social performance and implementation of the stakeholder engagement plan and grievance mechanism. This will be important for the wider public, but especially for suspected and/or identified COVID-19 cases. Project implementation is expected to take place over a period of 24 months. Stakeholder engagement, involving meaningful consultation and appropriate and timely dissemination of information, should occur throughout the life of the project. The grievance mechanism should be accessible to affected parties and project workers throughout the entire duration of the project, and during a period following closure. 6. RESOURCES AND RESPONSIBILITIES FOR IMPLEMENTING STAKEHOLDER ENGAGEMENT ACTIVITIES 6.1. Resources The Ministry of Public Health will be responsible for implementing stakeholder engagement activities. The budget for the SEP implementation is $ 150 000, 00, which will come from project’s Component 1, under subcomponent 1.2: Risk communication and community engagement including social distancing measures [$500 000,00 USD]. Table 3 presents the budget for SEP implementation. 18 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP Table 3: Proposed Budget for SEP implementation List of Budget ($US) Project stage Target stakeholders information to be disclosed Methods of engagement Year Year 2 Year 3 1 Preparation/planning - Government Ministries and Health Authorities - Project content and need of - Virtual consultations/information - public Health staff the project sharing (online platforms, TV and radio - International Organizations - SEP interactive/informative programs, - National NGOs - ESCP radio, sms, e-mail, set up a covid 19 - Other Institutional Stakeholders - ESMF dedicated website, outdoors, $25 - Vulnerable groups - GRM newspaper) 000 - Municipal workers - Communication lines (phone - Interviews with Public Health Experts -Construction companies number, e-mail address, office in public media - Neighboring communities to laboratories, location, contact person) - Virtual consultation meetings quarantine centers, and screening posts - planned activities -outdoors -District Chambers - Environment and social risk -limited meetings where possible -staff responsible for handling medical supplies and impact -general public -Health and safety risks and -need of the project impacts -Social Component Implementation - General Public - SEP - Press releases - COVID-19 Infected People - ESCP - Information leaflets - People in Quarantine - ESMF - Radio, television, newspaper and $100 - Vulnerable Individuals and Groups - GRM implementation social media announcements 000 - Hospital Patients - Communication lines (phone - Focus groups with affected parties - Health Sector Workers number, e-mail address, office and vulnerable groups where feasible - Project Workers location, contact person) - Community consultation meetings -waste removal staff and municipality staff -Project Monitoring and (where feasible) - involved construction workers Evaluation - Toll-free hotline for information -Public servants in country entry points (airport, - Health and safety risks and dissemination and grievance uptake port, land borders,) mitigation - dedicated Website updates -Neighboring communities to laboratories, -Environmental concerns -sms quarantine centers, and screening posts; -Training and workshops on -Workshops (virtual or face to face -District Chambers environmental, social, health where feasible) -staff responsible for handling medical supplies and safety - Government officials -Emergency services -Community and religious leaders 19 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP Closure - General Public Final Evaluation Reports - Press releases - former COVID-19 Infected People - Information leaflets - Former people in Quarantine -public consultation - Vulnerable Individuals and Groups -dedicated website - former Hospital Patients $25 000 - Health Sector Workers - Project Workers -waste removal staff and municipality staff - involved construction workers -Public servants in country entry points (airport, port, land borders,) -Neighboring communities to laboratories, quarantine centers, and screening posts; -District Chambers -staff responsible for handling medical supplies - Government officials TOTAL $ 150 000,00 20 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 6.2. Management functions and responsibilities The Ministry of Health (MOH) will be responsible for the overall implementation of project activities. The MOH will work closely with other health and non-health agencies, including the Ministry of Finance and AFAP (Fiduciary Agency for Project Management), on project implementation. The PCU will be established under the MOH to strengthen the technical capacity of the MOH. With a PCU for the project. The staff of the PCU will include experts in project implementation, environmental and social safeguards, and monitoring and evaluation. Once the Project becomes effective, the Project will also hire short-term consultants to support implementation as needed. MOH will be responsible for carrying out stakeholder engagement activities, while working closely with other government entities, as well as local government units, media outlets, health workers, etc. The stakeholder engagement activities will be documented via quarterly progress reports, to be shared with the World Bank. 7. GRIEVANCE MECHANISM A grievance redress mechanism (GRM) will be implemented at the project level to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. The GRM will provide a transparent, inclusive, and credible process for fair, effective and lasting outcomes. It is an integral component of community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people with avenues for presenting a complaint, request for information/clarification, or resolving any dispute that may arise during the course of the implementation of the project; ▪ 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. 7.1. Description of GRM There is no ideal model or one�size�fits�all approach to grievance resolution. The best solutions to conflicts are generally achieved through localized mechanisms that take account of the specific issues, cultural context, local customs, and project conditions and scale. Grievances will be handled at the national level by MOH. The GRM will include the following steps: Step 1: Grievance received and registered by MOH Focal Point or Grievance Officer Step 2: Acknowledge, assess and assign Step 3: Develop and propose a response Step 4: Communicate proposed response to complainant and seek agreement on the response Step 5: Implement the response to resolve the grievance Step 6: Review the response if unsuccessful Step 7: Close out or refer the grievance Once all possible redress has been proposed, if the complainant is still not satisfied, they should be advised of their right to legal recourse. The Diagram below summarizes GRM process. 21 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP The grievance should be addressed at health center or treatment center, as first line of intervention within 3 days after grievance has been raised. If the grievance is not immediately addressed by the focal point at the treatment centre, the following steps should be followed: (i) The management of the Treatment center or project site should intervene and solve the matter within 5 days. (ii) Project coordination unit (PCU) should intervene if the management of the treatment center can´t solve the issue. This intervention is done through the Social Specialists assistance as a third second level recourse. Finally. The complaint should be settled within 10 working days. (iii) Should a case not be resolvable internally, it may be referred by the PCU to the Ministry of Health. The complaint should be settled within 20 working days. (iv) In addition, should either party be dissatisfied, the affected party may bring the complaint to court, where it will be treated in accordance with STP law. PCU, will ensure that a centralized "Complaints Register" is maintained throughout the project lifecycle. The complaint records should contain: i) the complainant's contact details and information on the complaint itself, ii) the results of investigations and responses provided, , iii) necessary follow-up actions and v) internal communications made in response to complaints and the outcome. 7.2 Venues to register Grievances - Uptake Channels A complaint can be registered directly with COVID-19 (Grievance Redress Committee – GRC) through any of the following modes and, if necessary, anonymously or through third parties. • By telephone at [toll free to be established] , sms and whatsup • By e-mail to [e-mail address to be activated) 22 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP • By letter to the healthcare authorities/GRC • By letter to contracted NGOs • By complaint form • Walk-ins and registering a complaint on grievance logbook at healthcare facility or suggestion box at clinic/hospitals • By logging the complaint in a website Once a grievance has been received, it should be recorded in the complaints logbook or grievance database. A web based grievance register will be adopted by AFAP for a better follow up and documentation. 7.3 Grievances Relating to Gender-Based Violence (GBV) There will be specific procedures in place for addressing GBV, with confidentiality provisions as well as safe and ethical documenting of GBV cases. Multiple channels will be in place for a complainant to lodge a complaint relating to GBV. Specific GRM considerations for addressing GBV under COVID-19 are: • Establishment of a separate GBV GRM, potentially run by a Services Provider with feedback to the project GRM; operators are to be trained on how to document GBV cases confidentially and empathetically; • The project is to make available multiple complaints channels; • No identifiable information on the survivor should be stored in the GRM logbook or database. • The GRM should assist GBV survivors by referring them to GBV Services Provider(s) for support immediately after receiving a complaint directly from a survivor. The GRM should have in place processes to immediately notify both MOH and the World Bank of any GBV complaints with the consent of the survivor. 8. MONITORING AND REPORTING 8.1. Involvement of stakeholders in monitoring activities Monthly reports for SEP implementation, including grievance management, will be prepared and key indicators monitored by the implementation team at the PIU. Bi-monthly stakeholders’ meetings will be convened to discuss and review key stakeholder engagement indicators. Stakeholders (affected and interested parties) will be given opportunities to indicate whether they are satisfied or not with the project consultation process and what should be changed in the SEP implementation process so as to make it more effective. The project evaluation (external and internal review) will include aspects of the stakeholder engagement plan (notably key SEP indicators and activities) and recommend improvements. 8.2. Reporting back to stakeholder groups The SEP will 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 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: 23 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP • Publication of a standalone biannual report on project’s interaction with the stakeholders. • A number of Key Performance Indicators (KPIs) will also be monitored by the project on a regular basis The indicators to monitor the participation of stakeholders in the Project's activities include: • Number and percentage of affected households consulted during a planning phase: • Level of participation of affected people in decision making; • Level of understanding of the impacts and mitigation of the project by the parties; • Effectiveness of local authorities in making decisions; • Frequency and quality of meetings with those affected; • Degree of participation of disadvantaged women or groups in discussions and other vulnerable groups • Number of grievances raised and handled by the project . 24 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP ANNEX I: PUBLIC CONSULTATION MINUTES Project: Emergency Project in Response to COVID-19 Objectives: • Disseminate the project to interested and affected parties (PI&A); • Listening to PI&A about the Project and its Environmental and Social Management Framework (ESMF) and collect contributions, suggestions and recommendations to incorporate in the aforementioned documents. Infrastructure Used Realization Date: 05/27/2020 Place: • Meeting Room of the Fiduciary Agency for Project Management (AFAP); • Meeting Room of the Ministry of Health of São Tomé and Príncipe and • ZOOM digital platform Time: 9:00 am to 10:30 am Was there a photographic record? (x) No ( )Yes. Insert photo below. About Content Proposed Theme / Justification: • Disclosure of the Emergency Project in Response to COVID-19 and its Environmental and Social Management Framework (ESMF). About the Participants Estimated Quantity: 50 Accomplished Quantity: 45 25 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP - Representatives of the Ministry of Health of São Tomé and Príncipe - Representatives of the Fiduciary Agency for Project Management (AFAP) - Representatives of the São Tomé and Príncipe District Chambers - Representatives of the General Directorate for the Environment of São Tomé and Príncipe - Representative Ministry of Agriculture - Representatives of the Blind and partially sighted Association (ACASTEP) - Representatives of the National Association of Nurse Midwives (ANEP) - Representatives of the National Union of Nurses and Midwives (SINEP) - Community members in general About the Meeting Main Topics Discussed • The meeting was opened by the AFAP representative, Mr. Adilson Silva, who thanked everyone for their presence, and called for the active participation of everyone for the success of the meeting. After this step, he invited Dr. Cármen Carpio (TTL the project) to make a brief presentation of the project. • Following the meeting, the Consultant (Mr. Custódio Judião), made the presentation of the ESMF which included topics such as: (i) Project Components; (ii) Eligibility criteria for subprojects (iii) Institutional arrangements; (iv) Legal Framework for BM's STP and NASs; (v) Why the ESMF; (vi) Procedures to address the subproject's environmental and social Issues; (vii) Environmental and Social Risks for the Project; (viii) Complaints Management Mechanisms; (ix) Stakeholder and Affected Engagement Plan. • After the presentation, a session of comments, questions and answers was opened, in which the following questions were raised: Name of Participant Question / Comment 1. Mr. Celso Garrido - Ministry of Agriculture: was concerned with the issue of food security for the population, questioning what projects will be carried out in the area of agriculture to guarantee the supply of food goods in São Tomé and Príncipe amid the pandemic. He emphasized that projects of this nature should include the agricultural component that is essential to strengthen immunity. R. Mr.Adilson –AFAP environmental safeguard specialist- Responded that this project does not include food production/security component, however projects for the agricultural sector have not yet been designed to address to this situation. 2. Mr. Lourenço Monteiro - General Director for the Environment, questioned what types of projects will be developed and how they can directly benefit ordinary people, since it is extremely important that they have a positive impact on the community in general. He also questioned the criteria for choosing subprojects. 26 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP R. Mr. Custódio Judião- the consultant – clarified that this project will benefit to general community due to the nature of the disease. The vulnerable groups will have special attention in this project in a way they will be engaged and communicated about the project, and also ensure that prevention messages and means reach to them. The SEP for this project highlights different types of project stakeholders and presents most suitable engagement methods for each group of stakeholders to ensure they get the most out of the project. As far as subproject selection, the ESMF requires that all subprojects are subject to environmental and social screening before implementation. This process allows identification of E&S risks and development of appropriate E&S management instruments. 3. Mr. Desidério Paquete - Responsible for Information and Communication of the Chamber: asked about the final destination of the material (tarpaulins) used in the campaign hospital to respond to the COVID-19 pandemic. He was also concerned about the issue of agricultural surpluses for small farmers who have not found a market in this pandemic moment, suggesting that these products could be used to feed patients. R. Mr. Custódio- responded that the tarpaulins used as Covid 19 should be disinfected and disposed as contagious material to avoid any future disease spread. About the surplus of the local farmers, Mr. Adilson said that it is something that the Ministry of Health can consider in future as a way of supporting small farmers. 4. Francisco Norgueira - Secretary-General of ACASTEP: he said that in addition to disinfecting hands and common contact surfaces, a healthy and balanced diet is necessary to prevent COVID-19. He added questioning how people with disabilities can benefit from foodstuffs in this pandemic period, as the movement of people is limited. In this context, he suggested that a project be created to help vulnerable groups in São Tomé and Príncipe. R. Mr. Adilson responded by saying that the question is very relevant and Government should support people in need. However the project does not include food supply to the vulnerable groups. 5. Eugénia Neto - President of ACASTEP: she repeated the suggestion of Mr. Francisco Norgueira to develop a project to help people with disabilities, who are mostly citizens without favourable financial conditions to meet basic needs. 6. Aleixo Rodrigues - District Council of Cantagalo and Doctor: he was concerned about the lack of protective material (masks, gloves, etc.) in hospitals, which leaves health professionals exposed to infection with the new coronavirus and other diseases infectious. The other point raised was the need to strengthen agricultural production and the conservation of locally produced agricultural products. R. Mr. Adilson responded saying that this is the reason why we need this project to start immediately, because it will finance protective equipment for medical staff. At the end, the AFAP representative thanked everyone for their presence and participation in the public consultation meeting of the Emergency Project in Response to COVID-19 and mentioned the importance of all parties having participated in the meeting. 27 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP ATTENDANCE LIST 28 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 29 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 30 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 31 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 32 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 33 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 34 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP DETAILS ABOUT THE PRESENTATION 35 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 36 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 37 STP COVID-19 EMERGENCY RESPONSE PROJECT SEP 38