The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 07/14/2020 | Report No: Jul 30, 2020 Page 1 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Cabo Verde AFRICA WEST Ministério das Finanças National Health Directorate Project ID Project Name P174299 Cabo Verde: COVID-19 Response PEF Additional Financing Parent Project ID (if any) Parent Project Name P173857 Cabo Verde: COVID-19 Emergency Response Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 8/4/2020 Population Financing Public Disclosure Proposed Development Objective Project development objective is to prepare and respond to the COVID-19 pandemic in Cabo Verde Financing (in USD Million) Amount Current Financing 0.00 Proposed Additional Financing 0.00 Total Proposed Financing 0.00 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 Appraisal Document (PAD) describes the emergency response in Cabo Verde under the COVID-19 Strategic Preparedness And Response Program (SPRP) using the Multi-phase Programmatic Approach (MPA), approved by the World Bank’s Board of Executive Directorson March 20, 2020. The Project is structured around two Jul 30, 2020 Page 2 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) complementary components, which will support the Government of Cabo Verde in the implementation of its National COVID-19 Preparedness Plan. The project will provide immediate support to the government of Cabo Verde to prevent COVID-19 from arriving into the country or limiting local transmission. The Project will finance laboratory equipment, diagnostic supplies to ensure prompt case finding, adequate personal protective equipment (PPE) for health and laboratory personnel, increasing the number of available beds, equipping intensive care units, providing treatment and life-support equipment to national and regional tertiary and secondary hospitals, as well as creating response capacity for primary health care facilities in isolated geographic areas. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] This Additional Financing (AF) has been prepared to scale up the parent project’s (PP) activities to better respond to the COVID-19 threat in Cabo Verde. As for the PP, the AF will be implemented nationwide in existing health facilities in urban as well as remote areas. The exact locations of the AF implementation have yet to be identified. No construction or rehabilitation of civil infrastructures are expected to be financed under this operation. The AF will continue supporting enhancement of disease detection capability through provision of laboratory equipment and diagnostic supplies to ensure prompt case finding. It will also enable Cabo Verde to mobilize surge response capacity through well-equipped frontline health workers, increasing in the number of available beds, equipping intensive care units, providing treatment and life-support equipment to national and regional tertiary and secondary hospitals, as well as creating response capacity for primary health care facilities in isolated geographic areas. The AF is not expected to lead to any land acquisitions, involuntary resettlement and labor influx nor is it expected to impact Public Disclosure natural habitats or cultural sites. D. 2. Borrower’s Institutional Capacity As with the Parent Project, this AF will be implemented by the Ministry of Health and Social Security through the Special Projects Management Unit, also called the Unidade de Gestão de Projetos Especiais (UGPE). The UGPE has prior experience with World Bank investment projects and has already applied the Environmental and Social Framework (ESF). The UGPE staff benefited from several rounds of training on the World Bank Operational Policies and, more recently, on the ESF. To date, a senior E&S consultant has been preparing the environmental and social risk management aspects of the PP and AF and will remain engaged throughout implementation. The UGPE is currently recruiting a full time Environmental and Social (E&S) Specialist, who is responsible of managing and supervising the AF’s overall E&S aspects. The COVID-19 pandemic poses a unique set of challenges in terms of preventive, responses and control measures that go beyond the current UGPE capacity. This AF will strengthen the national capacity to coordinate and collaborate with other agencies currently responding to the crisis, such as WHO and UNICEF. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial The project’s environmental risk rating is substantial under the World Bank ESF. As this AF is an extension of the activities of the Parent Project, the risks are similar to those identified for the PP : The main environmental risks include: (i) production and management of medical healthcare wastes; (ii) environmental and community health Jul 30, 2020 Page 3 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) related risks from inadequate storage, transportation and disposal of infected medical waste; (iii) occupational health and safety (OHS) issues related to the testing of sick individuals and handling of potentially contaminated materials. The OHS issues are also related to the availability and supply of personal protective equipment (PPE) for healthcare workers and the logistical challenges in transporting PPE across the country in a timely manner; and (iv) community health and safety risks given close social contact and limited sanitary and hygiene services (clean water, soap, disinfectants) and isolation capabilities at health facilities across the country. Social Risk Rating Substantial As the AF is a scaling up of the parent project's activities, the SRR remains the same of the PP, i.e., substantial. The AF social risks are also the same of the PP and they include: i) difficulties in accessing health facilities and services for the overall population, and specifically for the most marginalized and vulnerable groups; ii) issues resulting from people being kept in quarantine, including stigma, loneliness and lack of basic services provision; iii) risks of GBV/SEA/SH to project workers and beneficiaries; iv) social conflicts and unrest resulting from the crisis challenges, including resource scarcity over daily essential goods; v) inappropriate behavior resulting from false rumors and misinformation that can hinder the required behavior change aspect; and vi) institutional contextual risk, given the Borrower’s first exposure to a World Bank-financed health project and the unique set of challenges in terms of preventive, responses and control measures related to the epidemic. These risks are classified as mostly temporary, predictable and/or reversible, although they could become widespread. The PP’s ESMF outlines how these risks will be managed, through both project design that focuses on public disclosure, communications, and behavior change around the pandemic, and specific application of WHO protocols for managing quarantine and isolation facilities. The PP has also developed a SEP, which details how vulnerable groups and those most in need will be reached and how they will benefit from the project’s interventions. Both the PP’s ESMF and SEP will be updated to reflect the details of the AF. Public Disclosure B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered 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: Overall, this AF is expected to have positive impacts on the Cape Verdean society by improving COVID-19 responses, surveillance, and containment mechanisms. However, the AF, like the Parent Project, could also cause significant environmental, health and safety risks due to the nature of the pathogen and reagents and other materials to be used in the project-supported Healthcare facilities. The AF activities will also generate medical health care waste, which can affect the health of local communities and Cabo Verde’s population if not well managed. Working with patients and materials infected with COVID 19 can potentially expose health workers and medical staff to contamination, hence presenting health and safety issues. All specific sites and activities under the AF remain to be defined, but there will be no civil works under the project. The proposed AF, like the Parent Project, will largely provide medical supplies for public health facilities (diagnostic, electronic, and life-support equipment; durable medical equipment, such as beds and carts) and virology laboratory supplies; Personal Protective Equipment for health personnel involved in patient case management; vehicles for transport of medications and laboratory samples , training on Monitoring and evaluation; and the procurement of goods and their distribution across health facilities within Cabo Verde. Jul 30, 2020 Page 4 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) The AF is expected to reflects the PP’s same social risks as mentioned above. The AF’s Sexual Exploitation, Abuse, and Harassment (SEA/H) risks are deemed minor as per the PP. During implementation, the SEA/SH risks will be further assessed, and mitigation measures put in place. As per the PP, the AF’s social assessment identified also the most vulnerable population, which entails: chronically ill and immune depressed persons; pregnant girls and women; population with previous health problems; persons with disabilities and their caregivers; homeless, including street children; female-headed households or single mothers with underage children; the unemployed; illiterate people; and population living in remote and isolated area. As part of the project’s overall strategy to prevent and mitigate the social risks, the AF, like the Parent Project, will ensure that the medical isolation of individuals does not increase their vulnerability, especially for those that are already vulnerable. To mitigate the project’s risks and impacts of the Parent Project, the Client has prepared an Environmental and Social Management Framework (ESMF) , which should be cleared and disclosed by the end of June 2020. The ESMF inlcude a Medical Waste Management Plan that builts on best international practice and WHO protocols for its collection, storage, transportation and final disposal. The relevant parts of the WHO COVID-19 quarantine guidelines and COVID-19 biosafety guidelines have been integrated into the ESMF prepared for the Parent Project so that all relevant occupational and community health and safety risks and mitigation measures will be covered. These guidelines include provisions to address the needs of patients, including the most vulnerable. They also include provisions on the establishment of quarantine and isolation centers and their operation considering the dignity and needs of patients. The ESMF serves as a mechanism/tool to prepare specific E&S Management Plans (ESMP) when sites and activities are known and the ESMF screening suggests one is needed. To properly address SEA/SH risks, the ESMF maps out and assesses GBV prevention and response actors in communities adjoining the project and include a Public Disclosure SEA/SH Prevention and Response Action Plan including an Accountability and Response Framework. Relevant capacity building measures have been included in the ESMF as well to provide the Borrower with the needed support to properly address the project’s E&S risks. The PP has also prepared a Stakeholder Engagement Plan (SEP) that identifies project stakeholders, what information will be in the public domain, in what languages, and where it will be available. The ESMF, ESCP and SEP will be updated to integrate the AF details. ESS10 Stakeholder Engagement and Information Disclosure To ensure a participatory, inclusive, and culturally appropriate approach during the project’s life cycle, the Borrower has prepared a draft Stakeholder Engagement Plan (SEP) consistent with ESS10 requirements. Given the tight timeline, the project has been discussed just among main institutional counterparts. Nonetheless, the SEP identifies main stakeholders, including those directly and indirectly affected by the virus, health care professionals and institutions, local authorities and businesses. Specific vulnerable groups have been identified and this include elderly people; chronically ill and immune depressed persons; pregnant girls and women; population with previous health problems; persons with disabilities and their caregivers; homeless, including street children; female-headed households or single mothers with underage children; the unemployed; illiterate people; and population living in remote and isolated areas. Jul 30, 2020 Page 5 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) Information dissemination: Considering the precautionary measures necessary to contain the spread of the disease, the proposed AF will support a communication, mobilization, and community engagement campaign to raise public awareness and knowledge on prevention and control of COVID-19 among the general population and contribute to strengthening the capacities of community structures in promoting coronavirus prevention messages. Current outreach modalities entail: small-group sessions, such as focus group meetings, when permitted; social media and online channels, such as dedicated online platforms and chatgroups; traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, and mail) especially when access to online channels is not granted or is not the preferred communication channel. Outreach and engagement measures will be constantly adjusted to accommodate government precautious requirements. The Bank will also continue advising the client on various approaches to engage stakeholders without raising medical risks. The SEP also releases routine information on the project’s environmental and social performance, including opportunities for consultation. To date the project consulted some of the institutional counterparts, further consultations will be conducted among the main identified stakeholders and vulnerable groups. The SEP describes the project’s grievance redress mechanism (GRM) for instances where members of the public require information or would like to address questions or grievances related to the project. The GRM, proportionate to the potential risks and impacts of the project.The GRM integrates GBV-sensitive measures, including multiple channels to initiate a complaint and specific procedures for SEA/SH, such as confidential and/or anonymous reporting with safe and ethical documenting of SEA/SH cases. The finalized SEP recongizes the importance of applying the risk communication and community engagement (RCCE) strategy in line with WHO provisions “Risk communication and community engagement (RCCE ) readiness and responses to COVID-19. The SEP will be updated to reflect the AF and it will continue to be periodically updated along Public Disclosure the PP and AF’s life cycle. 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 Project activities of this AF will be performed by mostly healthcare and laboratory personnel, the majority of whom are government civil servants. As part of the PP’s ESMF, the Borrower has prepared Labor Management Procedures (LMP) to respond to the specific health and safety issues posed by COVID-19 and protect workers’ rights as set out in ESS2. The LMP clarifies that civil servants are bound by their public sector employment contracts, but the project will also ensure they meet ESS 2 requirements regarding child labor, forced labor and OHS. The main risk related to working condition is contamination with COVID 19. The AF will ensure the application of OHS measures as outlined in WHO guidelines, which have been captured in the updated ESMF. This encompasses procedures for entry into health care facilities, including minimizing visitors and undergoing strict checks before entering; procedures for protection of workers in relation to infection control precautions; provision of immediate and ongoing training on the procedures to all categories of workers, and post signage in all public spaces mandating hand hygiene and personal protective equipment (PPE); ensuring adequate supplies of PPE (particularly facemask, gowns, gloves, handwashing soap and sanitizer); and overall ensuring adequate OHS protections in accordance with World Bank Environmental and Health Safety Guidelines (EHSGs) and industry specific EHSGs (on PPE or biological Risk Hazards) and follow evolving international best practice in relation to protection from COVID-19. Also, the Jul 30, 2020 Page 6 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) project will regularly integrate the latest guidance by WHO as it develops over time and experience addressing COVID-19 globally. The AF will also ensure a GRM for labor-related complaints and sensitive to SEA/SH issues, based on national laws and procedures, as well as the requirements of ESS 2 to allow workers to quickly inform management of labor issues. A GBV Code of Conduct (CoC) will be developed and signed by all workers. The CoC will be associated with the SEA/SH Prevention and Response Action Plan, which includes an Accountability and Response Framework. The CoC will include provision for addressing SEA/SH and prohibitions against sexual activity with anyone under the age of 18. ESS3 Resource Efficiency and Pollution Prevention and Management Pollution prevention and management – specifically medical waste management – will continue to be a particularly important activity under the Project. Medical waste, including chemicals, contaminated PPE and equipment, and lab testing kits from healthcare facilities will need to be safely stored, transported and disposed of. Hospitals in Cape Verde have Medical waste Incinerators within each facility. In addition, the incineration of Medical waste follows an established procedure. The waste generated will have to be treated in these special facilities. The ESMF, which includes specific Medical Waste Management (MWM) Plan and prepared for the Parent Project, complements the already existing procedures and also includes WHO COVID-19 guidance and other international good practice, to prevent or minimize contamination from inadequate waste management. This Medical Waste Management Plan describes the entire process and responsibilities between the generation of the infectious medical Public Disclosure waste and its disposal. It also takes into account the challenge of moving within and between Cabo Verde islands and describes the measures to be taken for the most remote islands. The MWM plan is adapted to the islands where the project will be implemented, in particular for the landfill or incineration of infectious waste. The Plan takes into account of the specific features of each island and the available waste management services and systems. ESS4 Community Health and Safety Medical wastes and general waste from the health care facilities have a high potential of carrying the SARS-CoV-2 and other microorganisms that can infect the community at large if they are not properly disposed of. There is a possibility for the infectious microorganism to be introduced into the environment if not well contained within the health care facilities or due to accidents/emergencies e.g. a fire or natural disasters such as volcanic eruption. The PP’s ESMF has included measures on Infectious Medical Waste including: • how activities will be carried out in a safe manner with (low) incidences of accidents and incidents in line with Good International Industry Practice (WHO guidelines); • measures to prevent or minimize the spread of infectious diseases; • emergency preparedness measures. The ESMF has taken into account the difficulty of moving between Cabo Verde islands and describe the measures to be taken for the most remote islands. The health care facilities will follow specific procedures and protocols, in line Jul 30, 2020 Page 7 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) with WHO Guidance, on appropriate waste management of contaminated materials; on the transport of samples; and on workers disinfection before leaving the workplace back into their communities. These issues have been captured in the updated ESMF and Medical Waste Management Plan. With regards to the risk of Gender Based Violence (GBV), in particular Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH) risks, the ESMF maps out and assesses SEA/SH prevention and response actors in the project implementation area and include a SEA/SH Prevention and Response Action Plan including an Accountability and Response Framework. The SEA/SH mapping and action plan will be updated to reflect the AF details. The AF will also implement specific measures to prevent SEA risks as described in the action plan. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement This standard is not relevant as the AF’s will not invest in any land acquisition, infrastructures’ construction and/or rehabilitation that would result in physical or economic displacement. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources This Standard is not currently relevant, however Infectious Medical Waste could affect natural resources, if handled and disposed of inappropriately. All personnel involved in the project must following the requirements delineated in the ESMF/ESMPs and Medical Waste Management Plan to ensure safe handling and disposal of medical and hazardous waste, outlined in ESS1 and ESS3. Public Disclosure ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities This standard is not relevant as there are no Indigenous Peoples/Sub-Saharan Historically Underserved Traditional Local Communities in Cabo Verde. ESS8 Cultural Heritage This Standard is not currently relevant, as there are no civil works planned under this AF. ESS9 Financial Intermediaries This standard is not relevant for the suggested project interventions as no financial intermediaries will be used C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways OP 7.60 Projects in Disputed Areas Jul 30, 2020 Page 8 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) III. BORROWER’S ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) DELIVERABLES against MEASURES AND ACTIONs IDENTIFIED TIMELINE ESS 1 Assessment and Management of Environmental and Social Risks and Impacts ORGANIZATIONAL STRUCTURE: The Ministry of Health and Social Security (MSSS) and the Ministry of Finance shall establish and maintain a PIU with qualified staff and resources to support management 06/2020 of environmental and social risks and impacts of the Project. This unit will include an environmental and social risk management specialist. Update, consult upon and disclose the PP’s Environmental and Social Management Framework 06/2020 Once the PP’s ESMF is updated and disclosed, provide medical and emergency supplies based on the 06/2020 urgency of the need, in line with the latest data related to the prevalence of the cases. ESS 10 Stakeholder Engagement and Information Disclosure STAKEHOLDER ENGAGEMENT PLAN: Update, consult upon and disclose the PP’s Stakeholder 06/2020 Engagement Plan (SEP) consistent with ESS10, in a manner acceptable to the Association. GRIEVANCE MECHANISM: Accessible grievance arrangements shall be made publicly available to receive and facilitate resolution of concerns and grievances in relation to the Project, consistent with 06/2020 Public Disclosure ESS10, in a manner acceptable to the Association. ESS 2 Labor and Working Conditions Update, consult upon and disclose the PP’s Labor Management Procedures 06/2020 ESS 3 Resource Efficiency and Pollution Prevention and Management Update, consult upon and disclose the PP’s Medical Waste Management Plan (MWMP) 06/2020 ESS 4 Community Health and Safety Update, consult upon and disclose the PP’s relevant provisions in ESMF 06/2020 ESS 5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement ESS 6 Biodiversity Conservation and Sustainable Management of Living Natural Resources ESS 7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities ESS 8 Cultural Heritage ESS 9 Financial Intermediaries B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Jul 30, 2020 Page 9 of 10 The World Bank Cabo Verde: COVID-19 Response PEF Additional Financing (P174299) Is this project being prepared for use of Borrower Framework? No Areas where “Use of Borrower Framework” is being considered: None IV. CONTACT POINTS World Bank Contact: Edson Correia Araujo Title: Senior Health Specialist Telephone No: 5761+1092 / 55-61-32291092 Email: earaujo@worldbank.org Borrower/Client/Recipient Borrower: Ministério das Finanças Implementing Agency(ies) Implementing Agency: National Health Directorate Public Disclosure V. FOR MORE INFORMATION CONTACT 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): Edson Correia Araujo Practice Manager (ENR/Social) Maria Sarraf Cleared on 14-Jul-2020 at 07:56:36 EDT Jul 30, 2020 Page 10 of 10