The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
Additional Financing Appraisal Environmental and
Social Review Summary
Appraisal Stage
(AF ESRS Appraisal Stage)
Public Disclosure
Date Prepared/Updated: 06/23/2021 | Report No: ESRSAFA222
Jun 24, 2021 Page 1 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
BASIC INFORMATION
A. Basic Project Data
Country Region Borrower(s) Implementing Agency(ies)
Liberia AFRICA WEST Republic of Liberia Ministry of Health
Project ID Project Name
P176336 Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines
Parent Project ID (if any) Parent Project Name
P173812 Liberia COVID-19 Emergency Response Project
Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date
Health, Nutrition & Investment Project 6/3/2021 6/28/2021
Population Financing
Public Disclosure
Proposed Development Objective
The development objective is to prepare and respond to the COVID-19 pandemic in Liberia
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?
Yes
C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and
Relationship to CPF]
The Liberia COVID-19 response project aims to strengthen the Government of Liberia’s immediate capacity to respond
to the COVID-19 outbreak and in the longer-term strengthen its capacity to respond to disease outbreaks and
emergencies. The project will have fivecomponents: Emergency Preparedness and Response , Laboratory system
Jun 24, 2021 Page 2 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
strengthening, Case management and clinical care , Risk communication, community engagement and advocacy and
Project management and coordination including monitoring and evaluation.
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 primary objectives of the AF are to enable the affordable and equitable access to COVID-19 vaccines and to
ensure effective vaccine deployment in Liberia through vaccination system strengthening. The Liberia COVID-19 ERP
additional financing seeks to support the Government of Liberia to procure COVID-19 vaccines to vaccinate its eligible
population in phases with a strategy of targeting sub-groups using a risk-based approach and subsequently rollout the
exercise to all segments of the population depending on the availability of additional vaccines and the evolution of the
pandemic. Specifically, the proposed AF and restructuring will include (i) support to operationalize COVID-19 rollout,
including data collection, of the priority populations, in-country transportation, cold chain system strengthening,
training of vaccinators, and waste management for COVID-19 vaccination; (ii) case detection, diagnostics, contact
tracing, and vaccine safety monitoring, (iii) COVID-19 case containment and management in health facilities, schools
and other public places, (iv) scale up of COVID-19 purchase beyond 20 percent of the total population, subsidized
within the framework of COVAX and under other agreements; (v) intensify risk communication to increase vaccine
literacy, intensify community engagement for vaccination and establish a reporting system of adverse events
following immunization. (vi) engagement with other government agencies to regulate and evaluate COVID-19 for in-
country use.
Public Disclosure
The proposed additional financing will help vaccinate 52% of the country’s population. This is inclusive of the 20%
coverage that will be provided by the COVAX facility vaccines initiative. Bank financing for the COVID-19 vaccines and
deployment will follow Bank’s VAC. The availability and terms of vaccines remain fluid and prevent the planning of a
firm sequence of vaccine deployment, especially as the actual delivery of vaccines is unlikely to be immediate. Rather,
the proposed financing enables a portfolio approach that will adjust during implementation in response to
developments in the country pandemic situation and the global market for vaccines.
Priority Groups: The AF will support four priority groups in Liberia and will be implement in four phases. The first
phase will target 45,265 Health Care Workers (i.e., clinicians who primary intent is to deliver health services). The
second phase will target 226,325 Elderly people (i.e., people 60 + years as defined by their age-based risk and
mortality). The third phase will target People with co-morbidities (people with pre-existing health conditions
especially those associated significantly with higher risk of death), The fourth phase will target 181,060 others
(essential workers who cannot social distance due to the work they performed or carried out daily e.g., teachers,
bartenders, waiters, and waitresses).
Access to Vaccine: There are no cost barriers anticipated to access the vaccines by the priority groups, since the
government is providing the vaccine free of charge. However, there could be barriers relating to physical access,
gender, and geographic and functional proximity to sites for vaccination. There could also be potential supply chain
issues relating to the disruptions to or constraints on the distribution, and delivery of vaccines to some hard-to-reach
locations. Many of these barriers need to be identified and are addressed by the Ministry of Health (MOH).
Jun 24, 2021 Page 3 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
Vaccine Deployment Plan: The national COVID-19 vaccine deployment plan notes that, in order to ensure the viability
and integrity of the COVID-19 vaccine, and to address the identified CCE gap, the COVAX Facility for CCE will be used
to procure: i) walking-cold room (30 square meters), ii) on grid ILR with freezer component, iii) remote temperature
monitoring, iv) standard vaccine carrier, and v) standard vaccine cold boxes on or before the deployment of the
vaccine in Liberia at the primary and secondary levels.
Vaccine Readiness Assessment: Liberia has conducted a vaccine readiness assessment to identify gaps and options to
address them, as well as to estimate the cost of vaccine deployment, with the support of international organizations
(WBG, WHO, UNICEF/PAHO, GAVI, other). Considering the uncertainties related to the COVID vaccine market,
including testing, approval, availability and pricing, which require flexibility and close monitoring and strong Bank
support during implementation, the assessment will continue to be an evolving process and will be dynamically
revised and updated as necessary to continue to improve project implementation.
Under the parent project (P173812), the MOH prepared the Environmental and Social Commitment Plan (ESCP), the
Environmental Social Review Summary (ESRS) and the Stakeholder Engagement Plan (SEP). These documents were
disclosed on the World Bank website on March 26, 2020. The SEP was updated and disclosed on August 17, 2020. The
Environmental and Social Management Framework (ESMF) was disclosed on the World Bank website on June 11,
2021. To effectively manage E&S risks related to the deployment and rollout of vaccines and other activities under
this AF, a ESCP has been prepared and the SEP of the parent project has been updated. Both documents have been
disclosed. The ESMF will be updated to provide information on cold chain management, training and deployment of
vaccinators and volunteers at the community level, infection Prevention and Control (IPC) materials at the vaccination
Public Disclosure
sites and Vaccine Waste Management. The updated ESMF will be disclosed prior to the AF effectiveness. This will
require the preparation of ESMPs for vaccine cold chain temperature monitoring plan, occupational health and safety
and surveillance of adverse events following immunization plan when required.
Liberia reported its first confirmed case of COVID 19 on March 14, 2020 in Monrovia, the country’s capital and by
March 15, 2021, a staggering 2045 COVID-19 cases, including 85 deaths, were reported . 49 (11%) health care workers
have been infected with COVID-19, and 4 (8%) have died. Most cases are concentrated in the capital city,
Montserrado county (374 cases, 84%), where more than 45% of the 4.7 million population of Liberia reside. The risk of
infection among health care workers and the community remains high, largely due to the frequent and high volume of
travel across counties with active transmission. The overall trends in COVID -19 may be going down but the threat of
new waves remains and hence the importance of ensuring increased protection measure through vaccination of the
population as close to herd immunity as possible.
Along with the COVID-19 related morbidity and deaths, Liberia has also experienced significant secondary impacts of
the outbreak which include (i) shortages of essential medical supplies and commodities due to disruptions in the
global supply chain; (ii) hospitals and health facilities providing routine health services have closed following exposure
to cases of COVID-19; (iii) health facilities providing routine health services have turned patients away for fear of the
virus and (iv) recovered patients have been stigmatized and shunned by their communities when returning home.
The social distancing measures and lockdown implemented by the Government to reduce the spread of the virus have
had a negative social and economic impact, directly impacting the livelihoods of households, especially among the
poor.
Jun 24, 2021 Page 4 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
The Ebola Virus Disease (EVD) outbreak of 2014 devasted a health system which was already weakened by conflict,
and recovery has been slow. Following the end of the second civil war in 2003, Liberia’s health system slowly
recovered to the point where health outcomes started improving. Between 2003-2012, life expectancy increased
from 54 to 61 years, child deaths declined from 149 to 88 deaths per 1,000 live births, and Liberia became one of the
first countries in Sub-Saharan Africa to achieve the child-related Millennium Development Goal11. However, the EVD
crisis devastated the healthcare system and severely constrained the GOL’s ability to deliver essential health services,
which led to many preventable deaths.
D. 2. Borrower’s Institutional Capacity
The parent COVID-19 Emergency Preparedness and Response Project (P173812), and this proposed AF are being
implemented through the Project Implementation Unit (PIU) of the Health, Nutrition & Population under the Ministry
of Health (MoH). The PIU has a project coordinator, deputy coordinator, environment specialist and communication
specialist. The PIU had committed to hire a social safeguard officer with experience in SEA/H risks management but
the commitment was not fulfilled and lack of sufficient manpower delayed preparation of safeguards instruments and
its disclosure. In view of this, the recruitment of Social Safeguards Officer will be finalized as a condition of
effectiveness of the AF. MoH will designate E&S focal persons at the regional, district and community levels to
monitor and supervise safeguards activities. The deployment of all staffs for the AF shall be completed prior to
effectiveness. MoH will also coordinate with the relevant stakeholders with respect to environmental and social
management of the AF and the treatment and disposal of different categories of wastes. Extensive stakeholder
engagement and consultation will be undertaken to provide insight regarding the scope of coordination. The team will
continue engagement with communities to manage the community perception and expectations and engage
Public Disclosure
vulnerable groups and people living with disability and allocate resources for CSOs and CBOs for downstream
engagement and engage with them in constructive manner. The weak capacity of Project’s E&S team will remain a
challenge in project implementation, so the Bank E&S team shall continuously monitor the item wise progress and
periodic reporting to anticipate E&S risks, if any, emerges.
Further, the country has limited experience in handling social concerns around COVID-19 as well as related measures,
including quarantine and vaccinations. In the face of existing E&S capacity challenges, recent review of the
performance of the parent project undertaken to determine the level of progress made on agreed actions in the
parent project’s ESCP indicated delays in E&S staff recruitment and weaknesses in the implementation arrangements
of the parent project. The review recommended the hiring a social safeguards officer with experience in SEA/H to
support implementation of SEP, LMP and ESMF and to manage risks related to GBV.
The review also pointed to the weakness in monitoring and reporting, noting in particular, the failure to provide to
the Bank quarterly and semi-annual monitoring and performance reports, and recommended the recruitment of the
social officer in the PIU and the conducting of targeted E&S training for relevant staff.
The Project will provide funding to address these shortcomings and it will be important that the Project source
international expertise to achieve international best practices on these matters in line with WHO guidelines.
The project is required to undertake/update the Institutional Capacity Assessment and Institutional Capacity
Strengthening Plan prior to project effectiveness date.
Jun 24, 2021 Page 5 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
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. The risk ratings take into consideration the E&S risk and impacts
associated with the proposed activities under the AF EPRP and the institutional capability of MoH and other
implementing agencies to manage them. The activities under AF EPRP include the (i) support to operationalize
COVID-19 rollout, including data collection, of the priority populations, in-country transportation, cold chain system
strengthening, training of vaccinators, and waste management for COVID-19 vaccination; (ii) case detection,
diagnostics, contact tracing, and vaccine safety monitoring, (iii) COVID-19 case containment and management in
health facilities, schools and other public places, (iv) scale up of COVID-19 purchase beyond 20 percent of the total
population, subsidized within the framework of COVAX and under other agreements; (v) intensify risk
communication to increase vaccine literacy, intensify community engagement for vaccination and establish a
reporting system of adverse events following immunization; (vi) engagement with relevant agencies of government
and other institutions to regulate and evaluate COVID-19 for in-country use. The potential risks and impacts include
medical waste generation, infections and pollutions from medical waste, hazardous and liquid waste generation
from treatment and vaccination centers, air pollution from incineration, road safety hazards, public health and
safety issues, occupational health and safety hazards and discrimination of disadvantaged or vulnerable groups and
adverse events following vaccinations. These expected risks and impacts are, however, are mostly predictable,
Public Disclosure
temporary, but readily mitigated.
Social Risk Rating Substantial
The social risk rating for the AF remains substantial, same as the Parent Project . The national scale of the planned
COVID-19 vaccine rollout under the AF is likely to have significant social risks. Negative social risks and impacts may
impact vulnerable and marginalized people who are likely to have limited access to the vaccine and this will lead to i)
inequality and exclusion, ii) socio-cultural and religious affiliated groups and their leaders not likely to support the
vaccine rollout which is likely to contribute to vaccine hesitancy and access, iii) disability and geographical locations
(e.g. people in hard to reach communities and slum communities) will likely limit people access to vaccination
locations/sites and, iv) political pressure to provide vaccines to non priority groups could lead to resentment and
lack of trust. People living in remote or isolated communities, persons with disabilities, the elderly, homeless, slums
communities, and women could potentially miss out on vaccination due to elite capture, distance and poor road
network to health facilities, and barriers in communication. If not well managed, vaccine targeting may lead to social
conflict among interested groups and exclusion of marginalized groups (women, elderly, poor). These risks will be
mitigated through transparent and equitable vaccine access plan. GoL’s vaccination approach prioritizes equity and
universal health coverage (UHC) principles with the vision to leaving no one behind. The government’s plan is that
every person in Libera will receive a free vaccine regardless of residency status. Liberia’s National Deployment and
Vaccination Plan (NDVP) for COVID-19 Vaccine does not discriminate against foreign nationals. Communication risk
due to disinformation, misperception, rumors and, inequitable information dissemination may give rise to COVID-19
vaccine hesitancy. This could lead to; a) lack of trust and could reduce demand for the vaccine, b) limit access to
vaccine services (especially among vulnerable groups), refusals within communities and reprisals and retaliation
especially against healthcare workers and c) people not receiving accurate information about vaccine access and
services unless communication is adequately managed. Beyond these risks, there are also risks of commercialization
Jun 24, 2021 Page 6 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
of the vaccines and forced vaccination as well as SEA/SH risks in which girls may be forced into exchanging sexual
favors for access to testing, treatment, vaccines facilities and basic hygiene supplies. These risks will be mitigated by
robust messaging and communication activities to be supported by Component 4: Surveillance, Community
Engagement. Other potential social risks associated with the AF are the likelihood of using open waste dumps and
discharge of contaminated water that may contaminate land and surface water or injury to waste pickers. This
practice will create or exacerbate poor waste management conditions and will impact on community health and
safety.
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:
The assessment undertaken is proportionate to the potential risks and impacts of the project, and has assessed, in an
integrated way, relevant environmental and social risks and impacts throughout the project life cycle, including those
specified in ESSs 2-10, as relevant, with a primary focus on direct immediate environmental and social risks and
impacts.
A review of the implementation of the parent project revealed delays in preparation of relevant E&S instruments.
Public Disclosure
The project shall be required to address the above shortfalls and consolidate and improve upon the positive impacts
made under the parent and AF at improving the capacity for containment of COVID-19 through the provision of the
critical supporting medical facilities for rolling out vaccination countrywide. The activities expected to be undertaken
to support effective vaccination have the potential to cause substantial risk and impacts. These risks and impacts
include infections and pollutions from medical waste, hazardous and liquid waste generation from treatment centers,
air pollution from incineration, road safety hazards from transport of vaccines, public health and safety issues, and
occupational health and safety hazards.
One obvious type of social risk related to this kind of operation is that marginalized and vulnerable social groups
including undocumented migrants, groups with health states such as pregnancy/lactation women, groups with
comorbidities and disabled population unable to access facilities and services designed to combat the disease, in a
way that supports the central objectives of the project. To mitigate this risk, MoH, in the ESCP will commit to the
provision of services and supplies based on urgency and need, in line with the current data related to the prevalence
of the cases and according to the guidelines of the ESMF. The COVID-19 National Deployment and Vaccination Plan
prepared by the MoH as part of this project will provide arrangement for inclusion and outreach to all vulnerable and
disadvantage groups and foreign national. The plan will be consistent with the core principles of the WHO Strategic
Advisory Group of Experts (SAGE) values framework for the allocation and prioritization of COVID-19 vaccination and
the prioritization roadmap.
Also the risk of adverse impacts following vaccinations will be monitored. To tackle this, the AF includes a vaccine
safety monitoring component that require the MoH to establish an active surveillance system for adverse events
following immunization (AEFI) and adverse events of special interest (AESI) to monitor the safety of vaccines and
Jun 24, 2021 Page 7 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
safeguard the health of the people and communities. The MoH is also making arrangement to use only Auto Destruct
(AD) syringes, which will be provided with safety boxes during vaccinations. Additionally, each vaccination point
would be required to carry an emergency kit that includes adrenalin and hydrocortisone.
The project implementation will also ensure appropriate stakeholder engagement, proper awareness raising and
timely information dissemination to (i) avoid conflicts resulting from false rumors; (ii) ensure equitable access to
services for all who need it; and (iii) address issues resulting from people being kept in quarantine. The project will
rely on standards set out by WHO as well as international good practice to (i) facilitate noted appropriate stakeholder
engagement and outreach towards a differentiated audience (concerned citizens, suspected cases and patients,
relatives, health care workers, etc.); and (ii) promote the proper handling of quarantining interventions (including
dignified treatment of patients; attention to specific, culturally determined concerns of vulnerable groups; and
prevention of Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH) as well as minimum accommodation
and servicing requirements). The SEP activities will be financed by Component 4: Surveillance, Community
Engagement resources/allocation.
The AF will adopt the updated ESMF prepared for the parent project (P173812) which provides guidance for the
Updating of various safeguards instruments for addressing the environmental and social risks and impacts of the
Covid19. The National Guidelines for the Safe Management of Healthcare Waste in Liberia, updated in May 20, 2020
by MoH, describing all the practices for handling, storing, treating, and disposing of hazardous and non-hazardous
waste, will be adopted for AF. The project has updated the Stakeholder Engagement Plan (SEP) including Grievance
Redress Mechanism prepared under the parent project to undertake adequate consultations with stakeholders and
Public Disclosure
address project related complaints. The ESMF will include an exclusion list for project activities that may not be
undertaken unless the appropriate OHS capacity and infrastructure is available, and the WHO standards on COVID-19
response, which outlines the International best practice for the WHO “Operational Planning Guidelines to Support
Country Preparedness and Response”. In addition to the ESMF, the AF will also implement the updated and disclosed
SEP and LMP as per the timeline based on the ESCP.
ESS10 Stakeholder Engagement and Information Disclosure
The covid19 vaccine roll outs presents many risks, which include ensuring: (i) public willingness and acceptance to
participate in the vaccination campaign; (ii) those in greatest need of health services and vaccinations receive it first
and timely; (iii) health services and vaccinations are performed effectively; and (iv) the results of vaccine support
services, including beneficiary feedback, are thoroughly captured and used to inform the project.
ESS10 is relevant to address these challenges by building public trust through public awareness creation, identifying
and reaching those in greatest need (especially those who are often left out of the public health system), timely
identification of rollout weaknesses and taking immediate corrective measures to improve the quality of services, and
learning from experiences and beneficiary feedback to strengthen the response. In sum ESS10 is relevant to increase
vaccine literacy and mitigate misconceptions and rumors around COVID-19 vaccines while continually improving the
quality of services.
Jun 24, 2021 Page 8 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
A review of the implementation of the parent project revealed the need for additional measures to consciously target
vulnerable groups and people living with disability and allocate resources for CSOs and CBOs for downstream
engagement and for strengthening of the GRM at the treatment and isolation facilities for staff, patients and their
families, and general citizenry.
Measures will be taken under the AF to ensure a more conscious targeting of vulnerable groups, as well as the
availability of a fully operational GRM by effectiveness.
The project has included a component on “Risk communication and Community Engagement” (RCCE). This
component focuses on behavioral and sociocultural risk factors assessment, production of RCCE strategy and training
documents, production of communication materials, media and community engagement, and documentation. The
project has updated the SEP for parent project to include stakeholder engagement requirements under AF activities
as well as relevant WHO guidance on “Pillar 2: Risk communication and community engagement”. The SEP further
identifies various stakeholders and establish a structured ways of information disclosure and getting feedback with
special reference to vulnerable and disadvantaged parties. The SEP would be used to minimize to close contact in
instances where there is a likelihood of more vulnerable groups in attendance, such as women, elderly and those
with compromised immune systems or related pre-existing conditions. People affected by project activities should be
provided with accessible and inclusive means to raise concerns and grievances through clearly articulated and
operationalize grievance redress mechanism. The project will also ensure establishing a functional Grievance Redress
Mechanism, including strengthening of the existing and available functional GRC/GRM and the establishment of a
dedicated hotline. The GRM and its related activities shall be functional prior to effectiveness of the project.
Public Disclosure
The approaches taken will ensure meaningful consultation and information disclosure as well as timely and accessible
information and feedback to all affected stakeholders, including usage of different languages, addressing cultural
sensitivities and challenges deriving from illiteracy or disabilities. Due to the expected countrywide implementation
of activities, the differences in areas and socioeconomic groups will equally be taken into consideration during the
rollout of the RCCE.
It will be important that care management in quarantine and isolation centers is managed systematically, allowing
patients to access information as well as patients’ relatives to get necessary information about the quarantined; if
feasible by enabling two-way-communication.
The SEP activities will be financed by Component 4: Surveillance, Community Engagement resources/allocation as
well as by Risk communication and Community Engagement component under the parent project. Lesson learned
from the parent project will be used and the imperative that the information disclosure takes place in an on-going
and satisfactory manner, with clear and accessible messaging on safety of vaccines, principles of fair, equitable and
inclusive vaccines access and allocation, as well as rationale for prioritizing certain groups will be critical .
The project required to conduct consultations with more focus on vulnerable people and updated and disclosed the
Stakeholder Engagement Plan (SEP) prior to ROC.
B.2. Specific Risks and Impacts
Jun 24, 2021 Page 9 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
A brief description of the potential environmental and social risks and impacts relevant to the Project.
ESS2 Labor and Working Conditions
Health and laboratory workers, i.e. civil servants employed by the Government of Liberia, will conduct most activities
supported by the project. Activities encompass thereby treatment of patients as well as assessment of samples. The
key risk is contamination with COVID-19 (or other contagious illnesses as patients taken seriously ill with COVID-19
are likely to suffer from illnesses, which compromise the immune system, which can lead to illness and death of
workers). Workers under the project could be exposed to OHS risks due to the dangerous nature of the pathogen
(COVID-19) and reagents and equipment used in the project-supported activities. Health facilities treating patients
administering vaccines may also generate biological, chemical waste, and other hazardous by-products that could be
injurious to human health. Transportation of COVID-19 vaccines from one location to the other and operation of light
and refrigerated vehicles, use of medical drone technology to supplement rapid delivery of COVID-19 vaccines to
hard-to-reach communities also present the risks of accidents to drivers, drone operators; albeit marginal and
insignificant risk.
These risks will be mitigated through adherence to occupational health and safety standards and specific infectious-
control strategies, guidelines and requirements as recommended by WHO and CDC and other recommended OHS
measures based on the World Bank EHS guidelines provided in the updated parent project ESMF. In line with WHO
Interim Guidance (February 12, 2020) on “Laboratory Biosafety Guidance related to the novel coronavirus (2019-
nCoV)”, and other guidelines, the parent project followed National Guideline for the safe Management of Health Care
Wastes in Liberia updated in May 20,2020. The plan includes training of staff to be aware of all hazards they might
encounter in the COVID-19 response and provides for the application of international best practices in COVID-19
Public Disclosure
diagnostic testing and handling of medical supplies, disposing of the generated waste, and road safety. Other
measures include posting of signages in all public spaces mandating hand hygiene and use of PPEs (particularly face
mask, gowns, gloves, hand washing soap and sanitizers). The AF will ensure the application of OHS measures as
outlined in the ESMF as well as WHO guidelines already noted. 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; and post signage in all public spaces mandating hand hygiene
and PPEs.
The project may outsource minor works to contractors. The envisaged works will thereby be of minor scale and thus
pose limited risks. The workers will not work in contaminated areas. Also, no large-scale labor influx is expected due
to the same circumstance. There could be some SEA and GBV risks associated with labor. Workers will sign code of
conduct. Workers’ GRM will be established.
In line with ESS2 as well as the applicable laws of Liberia, use of forced or child labor is prohibited both for
construction and operation of health care facilities. The project will also ensure a basic, responsive grievance
mechanism to allow workers to quickly inform management of labor issues, such as a lack of PPEs or any other
grievances they may to MoH. To manage labor related risks, project will update the Labor Management Procedures
(LMP) which has been prepared as part of ESMF for parent project, as part of ESMF update process and follow
throughout the project.
Jun 24, 2021 Page 10 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
A review of the parent project revealed inadequate incorporation of ESHS requirements in the procurement
documents and contracts with contractors and recommended a further assessment of LMP implementation in places
where rehabilitations were carried out.
The project is required to prepare and disclose the draft Labor Management Procedures (LMP) with full attention to
ESHS requirements before project effectiveness date.
ESS3 Resource Efficiency and Pollution Prevention and Management
Relevant. Medical wastes and chemical wastes (including water, reagents, infected materials, etc.) from the,
quarantine, and screening posts to be supported (drugs, supplies and medical equipment) can have significant impact
on the environment and human health. Wastes that may be generated from medical facilities/ laboratories could
include liquid contaminated waste, chemicals and other hazardous materials, and other waste from laboratories and
quarantine and isolation centers including of sharps, used in diagnosis and treatment. Audit report for the parent
projects reveals that during the implementation of the parent project, sorting and collecting of hazardous medical
waste has been done properly in line with National Guidelines for the Safe Management of Healthcare Waste in
Liberia. However, final disposal of hazardous medical waste through incineration facilities showed some malpractices
regarding OHS and EHS. The Borrower will address these malpractices through identified ESF corrective actions. As
for the AF, Borrower will implement ESMF thoroughly including hazardous material and medical waste handling and
disposal, monitor progress, and report outcomes regularly through regular reporting to the Bank.
Public Disclosure
Each beneficiary medical facility/lab, following the requirements of the ESMF to be updated for the AF, National
Guidelines for the Safe Management of Healthcare Waste in Liberia, updated in May 20, 2020, WHO COVID-19
guidance documents, and other best international practices, will be followed to prevent or minimize any adverse
impacts. The National Guidelines for the Safe Management of Healthcare Waste in Liberia that has been used for the
parent project will be thoroughly assessed for use in AF . The updated ESMF will include guidance related to
transportation and management of samples and medical goods or expired chemical products. Resources (water, air,
etc.) used in quarantine facilities and labs will follow standards and measures in line with US-Center for Disease
Control (CDC) and WHO environmental infection control guidelines for medical facilities and national requirements
The movement and distribution of COVID-19 related supplies especially vaccines will require use of fuel for which the
AF project will adopt best practice measures to optimize the use of fuel. During minor civil works, ESMPs will ne
prepared as required by the ESMF and pollution management and resources efficiency measures will be put in place.
GHG emissions are not expected to be significant hence GHG emission estimation is not needed.
ESS4 Community Health and Safety
Community health and safety risks identified for the COVID-19 Vaccine deployment include: (i) environmental and
community health related risks related to the inadequate storage, transportation and disposal of infectious medical
waste; (ii) community health and safety risks given close social contact and limited sanitary and hygiene services
(clean water, soap, disinfectants); (iii) possible risks around social exclusion related to access to healthcare facilities
Jun 24, 2021 Page 11 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
and services, especially for the poorest, those living far from health facilities, the elderly or those living with disability
who may not have access to the vaccination centers; (iv) risks of corruption that could lead to diversion of vaccine
from the most marginalized and SEA/SH risks for women and girls; (v) sociopolitical risks related to residency
requirements and demands of citizenship for vaccination; (vi) potential adverse side effects from the vaccine; (vii)
requirement of vaccination record/certification for any health, occupational, education and travel purposes; and (vi)
Disinformation and conspiracy theories about vaccine efficacy coupled with low trust in the government which could
lead to the rejection of public health intervention/information and violence against those providing services.
Protecting the safety of communities from increased risk of COVID-19 transmission and adverse events following
vaccination is a central part of the nation-wide vaccination exercise. The deployment of safe and efficacious vaccines
against COVID-19 in Liberia is expected to protect livelihood, restore economic activities and put the country on
course to recovery.
These identified risks will be managed in several ways through the ESMF, a robust risk communication strategy, SEP,
(SRA and SEA/SH action plan) where applicable. ESMF will be expanded following WHO and CDC guidelines for
assuring quality control of the vaccines during storage, transportation, handling, and disposal throughout the
country. The vaccine Deployment Plan of Action includes a safety monitoring system for new vaccines that would
employ enhanced spontaneous reporting, active surveillance of adverse events of special interest and post
authorization studies by marketing authorization holders. The MOH will closely monitor the potential side effects of
vaccines. Capacity building sessions for health workers on AEFI (Adverse Events Following Immunizations) will be
conducted. Emergency drugs for AEFI management will be available at each post. Supervisors at all levels will monitor
Public Disclosure
investigation and management of AEFIs during the campaign. Laboratories, health and vaccination centers and
screening posts, will have to follow respective procedures with a focus on appropriate waste management of
contaminated materials as well as protocols on the transport of samples and workers cleaning before leaving the
workplace back into their communities.
The MOH will address concerns of health care professionals and maintain community confidence by creating and
sharing a COVID-19 vaccine safety communication plan with communities and relevant stakeholders. The various
stakeholders and the appropriate communication channel and format has been outlined in the Stakeholder
Engagement Plan (SEP) and will be outlined in the Risk Communication Strategy.
Residency requirements – including official documentation in the form of an identification or residency card prior to
receiving the vaccine might not only affect undocumented migrants and refugees but also nationals in rural areas
who may not be able to produce the required documentation. Such requirement will be in non-compliance with the
ESF’s provisions on social inclusion under ESS1 and under this Standard - Community Health and Safety, and might
affect the productive purposes and objectives of the project to prevent and respond to the threat posed by COVID-19
and strengthen national systems for public health preparedness. Whereas the Vaccine Deployment Plan does not
clearly outline need for residency requirements for vaccination, the project will ensure that neither such
requirements nor forced vaccination are included in the Bank financed vaccination project.
Training will be provided for all community workers involved in the vaccination campaign as well as stakeholders
involved in the safety monitoring of COVID-19 vaccines to ensure the safety of the vaccine recipients and also obtain
Jun 24, 2021 Page 12 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
accurate data for decision. Supportive supervision to ensure that activities are being carried out as expected and data
generated will be performed.
The project AF is not likely to employ security forces to ensure law and order around the Vaccination Centers or to
force vaccination; but if the situation changes, the project will undertake a Security Risk Assessment (SRA) to review
the security force’s rules of engagement with the community and identify the specific risks related to providing
increased security at the various health and vaccination centers. The project would then propose adequate mitigation
measures, and strengthen existing measures, where necessary, to ensure that the use of the security forces will not
result in adverse consequences to community health and safety, including in matters relating to GBV and SEA/SH. The
project will ensure that the security personnel follow a strict code of conduct and avoid any escalation of situation,
taking into consideration the protocols included in the ESMF and SEP, and the guidance provided in the World Bank
technical note, “USE OF MILITARY FORCES TO ASSIST IN COVID-19 OPERATIONS SUGGESTIONS ON HOW TO MITIGATE
RISKS.
The project will continue to promote the avoidance of SEA/SH by relying on the WHO Code of Ethics and Professional
Conduct for all workers in the quarantine facilities. The risks and mitigation measures are addressed in the ESMF,
drawing on input from project stakeholders, as documented in the SEP. The ESMF will also incorporate an
accountability and response framework, including a worker code of conduct, worker and community training and
sensitization, and adaptation of the project GRM to ensure the ethical and confidential management and resolution,
including timely service referrals, of SEA/SH claims.
Public Disclosure
The project is required to prepare Gender Analysis and GBV risks assessment and Environmental Health and Safety
Plan before project effectiveness.
ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement
Based on the scope of the AF project activities, this standard is considered not relevant. Under the AF, the
renovations and civil works such as covid19 vaccination centers, vaccine storage facilities, and vaccine materials
disposal sites, minor rehabilitation of exisitng facilities will take place in order to install equipment to store the
COVID-19 vaccine and for the proper disposal and management of vaccine waste materials, vaccination points and
mobile teams to reach remote locations will be established are expected to be undertaken within existing
government health facilities. Thus the AF is not expected to lead to any additional land acquisition as it is not
expected to invest in activities that will cause land acquisition and involuntary resettlement or restrictions on land
use and access to natural resources. In the unlikely event of land acquisition and involuntary resettlement leading to
displacement of people and their livelihood in connection with any project activities that have not yet been
identified. This standard will become relevant and used to inform the preparation and implementation of
Resettlement Action Plan(s) (RAPs to address compensation and livelihood needs of Project-Affected Persons (PAPs),
if any decisions may be made to convert land uses or acquire land for construction of separate quarantine and
isolation centers, vaccine storage rooms, and sites for the disposal of vaccine waste materials.
ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources
Jun 24, 2021 Page 13 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
This Project is not anticipated to affect or involve activities with negative impact on biodiversity or natural resources.
However, minor construction or rehabilitation activities may be anticipated in this project and all works will be
conducted within existing facilities. Hence, likely impacts of the project on natural resources and biodiversity are low.
ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities
This standard is not considered relevant. The preliminary assessment suggests that there are no distinct social and
cultural groups in the project area who exhibit characteristics akin to the criteria for indigenous or traditionally
under-served communities as spelled out in the ESS7.
ESS8 Cultural Heritage
This standard is currently considered Not Relevant as the project is not expected to support major construction or
rehabilitation activities that would involve the movement of earth (thereby potentially having an impact on tangible
cultural heritage), or other activities that could have an impact on intangible cultural heritage. In the unlikely event of
major construction or the movement of earth in connection with any project activities that have not yet been
identified, a chance finds procedure will be prepared and integrated into the ESMF for the project.
ESS9 Financial Intermediaries
This stand is not relevant for the suggested project interventions, as no financial intermediaries will be used.
Public Disclosure
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:
The parent COVID-19 Emergency Preparedness and Response Project, including this proposed AF is being
implemented through the Project Implementation Unit (PIU) of the Health, Nutrition & Population under the Ministry
of Health (MoH). The MoH is the primary implementing agency for the ERP and intends to appoint a Social Safeguards
Officer with experience SEA/H and GBV risks management to support E&S implementation. MoH will designate E&S
focal persons at the regional, district and community levels to monitor and supervise safeguards activities. MoH will
also coordinate with the relevant stakeholders with respect to environmental and social management of the ERP and
Jun 24, 2021 Page 14 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
the treatment and disposal of solid and liquid waste. Extensive stakeholder engagement and consultation will be
undertaken to provide insight regarding the scope of coordination.
Further, the country has limited experience in handling social concerns around COVID-19 as well as related measures,
including quarantine and vaccinations. The Project will provide funding to address some of these shortcomings and it
will be important that the Project source international expertise to achieve international best practices on these
matters in line with WHO guidelines. To this end, the government has updated ESMF prepared for the Liberia COVID-
19 Emergency Response Project (P173812) incorporating the WHO standards on COVID-19 response particularly and
it will update incorporating concern on the vaccinations and related issues. It will also outline the processes, which
will be followed to ensure compliance with the ESF. Facilities to be supported by the Project will apply international
best practices in COVID-19 response activities. This will also include further identification of capacity gaps and
detailed measures to address any gaps identified.
IV. CONTACT POINTS
World Bank
Contact: Noel Chisaka Title: Senior Health Specialist
Telephone No: +1-202-473-1317 Email: nchisaka@worldbank.org
Public Disclosure
Contact: Anthony Theophilus Seddoh Title: Senior Health Specialist
Telephone No: 5269+4612 / 233-30-221-4612 Email: aseddoh@worldbank.org
Contact: Opope Oyaka Tshivuila Matala Title: Senior Health Specialist
Telephone No: 5331+3483 Email: otshivuilamatala@worldbank.org
Borrower/Client/Recipient
Borrower: Republic of Liberia
Implementing Agency(ies)
Implementing Agency: Ministry of Health
V. FOR MORE INFORMATION CONTACT
Jun 24, 2021 Page 15 of 16
The World Bank
Liberia COVID-19 Emergency Response Project Additional Financing on Vaccines (P176336)
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): Noel Chisaka, Anthony Theophilus Seddoh, Opope Oyaka Tshivuila Matala
Practice Manager (ENR/Social) Senait Nigiru Assefa Cleared on 23-Jun-2021 at 12:21:8 GMT-04:00
Safeguards Advisor ESSA Nathalie S. Munzberg (SAESSA) Concurred on 23-Jun-2021 at 22:43:59 GMT-04:00
Public Disclosure
Jun 24, 2021 Page 16 of 16