ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN (ESMP) Isolation Ward – Former CID Building Retrofit St. Georges Hospital, Grenada OECS Regional Health Project (P168539) Prepared February 2021 by Government of Grenada Ministry of Health, Social Security, and International Business Acronyms and Abbreviation BWMP – Biomedical Waste Management Plan CARPHA – Caribbean Public Health Agency CERC – Contingency Emergency Response Component CID – Criminal Investigation Division EPRP - Emergency Preparedness and Response Plan ESMF – Environmental and Social Management Framework ESMP – Environmental and Social Management Plan ESHS – Environment, Social, Health and Safety GoG – Government of Grenada HPU – Health Planning Unit IMPACS - Implementing Agency for Crime and Security MoHWE – Ministry of Health, Wellness and the Environment MSDS – Material Safety Data Sheet MIU – Mobile Isolation Unit OECS – Organisation of Eastern Caribbean States OECSRHP – OECS Regional Health Project PAHO – Pan American Health Organisation PPE – Personal Protective Equipment RCCE – Risk Communication and Community Engagement SOP – Standard Operating Procedure WBG – World Bank Group WHO – World Health Organisation 1 Table of Contents ACRONYMS AND ABBREVIATION ................................................................................................................1 CHAPTER 1 INTRODUCTION AND BACKGROUND ...................................................................................... 4 CHAPTER 2 PROJECT DESCRIPTION ........................................................................................................... 5 2.1 PROJECT SCOPE AND CONTEXT .............................................................................................................5 2.2 PROJECT DESIGN ..............................................................................................................................7 CHAPTER 3 LEGAL AND ADMINISTRATIVE FRAMEWORK ......................................................................... 13 3.1 NATIONAL LEGISLATIONS .................................................................................................................. 13 3.2 WORLD BANK SOCIAL AND ENVIRONMENTAL OPERATIONAL POLICIES ......................................................... 14 SAFEGUARD POLICIES ............................................................................................................................ 14 3.3 INTERNATIONAL STANDARDS ............................................................................................................. 14 CHAPTER 4 POTENTIAL ENVIRONMENTAL AND SOCIAL IMPACTS ............................................................ 18 4.1 DESIGN AND CONSTRUCTION ............................................................................................................. 18 4.2 OPERATION ................................................................................................................................... 19 4.3 DECOMMISSIONING ........................................................................................................................ 19 CHAPTER 5 MITIGATION MEASURES ...................................................................................................... 20 5.1 PHASE 1: DESIGN AND CONSTRUCTION ................................................................................................ 21 5.2 PHASE 2: OPERATIONS ..................................................................................................................... 22 5.3 PHASE 3: DECOMMISSIONING ............................................................................................................ 24 CHAPTER 6 PROJECT MANAGEMENT AND INSTITUTIONAL ARRANGEMENTS .......................................... 25 6.1 ESMP IMPLEMENTATION RESPONSIBILITIES .......................................................................................... 25 6.2 CONTRACTOR RESPONSIBILITIES ......................................................................................................... 25 6.3 SUPERVISION, MONITORING AND REPORTING .................................................................................... 26 CHAPTER 7. STAKEHOLDER ENGAGEMENT ............................................................................................. 28 7.1 DISCLOSURE OF ESMP ..................................................................................................................... 28 7.2 COMMUNITY ENGAGEMENT .............................................................................................................. 28 7.3 GRIEVANCE AND REDRESS MECHANISM ............................................................................................... 29 ANNEX 1. SCREENING TOOL FOR E&S RISKS............................................................................................ 31 2 ANNEX 2. INFECTION AND PREVENTION CONTROL PROTOCOL (IPCP) ..................................................... 33 ANNEX 3. HEALTH AND SAFETY GUIDELINES FOR RETROFITTING/REHABILITATION OF MEDICAL FACILITIES .............................................................................................................................................................. 37 ANNEX 4. EVIDENCE OF WORKS COMPLETED ......................................................................................... 43 ANNEX 5. DUE-DILIGENCE FOR RETROACTIVE REIMBURSEMENT ............................................................ 48 3 Chapter 1 Introduction and Background The Government of Grenada (GoG) is implementing the OECS Regional Health Project (OECSRHP) with funding from the World Bank Group (WBG). The objectives of the Project are to improve the resilience of the health system and to improve the responsiveness of health service delivery during public health emergencies. The Project consists of four components as follows: 1. Improved Health Facilities and Laboratory Capacity 2. Strengthening Public Health Surveillance and Emergency Management 3. Institutional Capacity Building, Project Management and Coordination 4. Contingency Emergency Response Component (CERC) Details of the OECSRHP can be found on the GoG1 and WBG2 websites for the project. Under emergency actions in Component 4, The GoG is enhancing its capacity to care for patients with the virus and mitigate and control the spread of the COVID-19 virus. These activities include the rehabilitation of an existing building to serve as an isolation ward for COVID-19 patients. The facility has already been refurbished and sits within the former Criminal Investigation Building (CID) on the grounds of the St Georges Hospital complex. The construction and rehabilitation activities have already been completed and the GoG is seeking retroactive reimbursement for costs incurred. To achieve this, this ESMP provides a due-diligence assessment of the work done to date, and lays out the environmental and social measures to be undertaken during operations, to verify and lay out the strategy for compliance with applicable safeguards requirements. The environmental and social risks of this activity are addressed under the Environmental and Social Management Framework (ESMF) for the project, as amended to include additional safety measures for the pandemic under the Contingency Emergency Response Component (CERC).3 Based on the screening conducted for this project (see Annex 1) an Environmental and Social Management Plan (ESMP, this document) is required to identify and appropriately manage environmental and social risk. This ESMP provides guidelines and requirements to ensure the protection of healthcare workers, waste handlers, and the community from environmental and social risks associated with the isolation facility, mainly waste management, infection control, worker and community health and safety, and timely and clear public information. The ESMP will ensure that the rehabilitation and operation of the facility is compliant with national and regional environmental regulations, and consistent with international best practices and World Bank safeguards policies, in accordance with the ESMF created for the project. This ESMP will be disclosed on the GoG website and the records of the disclosure will be documented and recorded. 1 http://www.gov.gd/................. 2 https://projects.worldbank.org/en/projects-operations/project-detail/P168539 3 The Environmental and Social Management Framework (ESMF) for the OECSRHP in Grenada can be found at: http://www.gov.gd............ ` 4 Chapter 2 Project Description This section focuses on the existing conditions and specific works related to the retrofitting of the building and the establishment of the isolation facility. General information of the environmental and social baseline conditions relevant to the Grenadian context is provided in the project ESMF document, and is not repeated here. 2.1 Project Scope and Context The “old CID Building” was rehabilitated and retrofitted to act as a standalone isolation facility for the treatment of persons with infectious diseases. The facility will provide care for patients suffering with COVID-19. The facility will be outfitted with all necessary medical equipment, furniture and fittings and ancillary structures. It will be staffed with the necessary medical personnel which will include doctors, nurses including registered nurses and nursing aides, and other ancillary staff. Purpose The Ministry of Health, Social Security and International Business, Grenada, intends to seek retroactive financing for the retrofit of the old CID building, as a key deliverable of the Contingency Emergency Response Component (CERC) of the OECS Regional Health Project. Background Saint George’s Hospital is the main public health care facility in Grenada. The original hospital dates from the 1800’s when Grenada was under both British and French rule. In 2003, a new Grenada General Hospital was inaugurated within the same hospital complex grounds. The hospital complex is bordered to the west by the Caribbean Sea and to the south and east by the harbor (Figure 1). Cruise ship terminals are located northwest of the hospital complex. Historic Fort George occupies the hilltop to the east of the hospital (grey buildings in Figure 2). The complex is accessed by Grand Etang Road to the north and east (Figure 2). The CID Building is in the southeast part of the hospital complex. 5 Figure 1. Georgetown area and location of the Hospital Figure 2. St George’s Hospital complex and location of former CID Building 6 The main site, General Hospital, offers a range of services which may require hypoxemia treatment including Intensive Care Units (ICU), operating rooms, accident and emergency (A&E) and dialysis and outpatient treatments. 2.2 Project Design The old CID Building is situated along Marie Villa Road in the St Georges Hospital complex, St. Georges, Grenada. Figure 3 shows the as-built layout for the isolation ward, as it was after rehabilitation was complete. Works were done to two sections or wards of the building. Figure 3. Engineering diagram of existing building Retrofitting and Rehabilitation of Building Works to the building included the following: supply and installation of tiles in bathroom walls and floor, flooring finish, painting in walls and ceilings, demolitions, construction of new 7 partitions, and reparation on exiting ceilings (including construction of new ceiling in the Preparation and Nurses area). Electrical installation included: main connection for electrical meter, 220 V circuit, 110 V circuit, main panels, grounding works, lamps and wiring for cameras and security. Annex 4 contains documentary evidence of the works completed. No clearing of land was needed as the works took place entirely within the existing hospital facility. No accidents or incidents occurred during the works. Annex 5 contains a summary of the due-diligence performed of the completed retrofitting and rehabilitation works. Operation and Decommissioning The facility will be operated to cater for the needs of the health care system and facilities on the island. Safety protocols for operations and maintenance will be provided by the equipment suppliers, along with training. An audit of biomedical waste management practices was conducted in 20024 and recommended revisions to the Waste Management Act of 2001 as well as improvements in training and equipment. In 2005 a Biomedical Waste Management Manual for Healthcare Personnel in Grenada was created as part of an HIV/AIDS prevention and control project.5 The Manual provides guidance for waste classification, segregation, storage, and transport of biomedical wastes. At the present time, the policy itself has not been fully implemented; however, protocols exist for the collection of sharps in sharp containers, the segregation (using colour coded bags) and disposal of waste as required, either through the municipal garbage disposal system for non- hazardous waste or incineration for hazardous waste. There is a programme in place for the scheduled collection and disposal of sharps. There are also documented procedures for the management of cytotoxic waste. The four (4) major public hospitals in Grenada generate a approximately 1300 kilograms (Kg) of waste hospitals daily (General Hospital, Princess Alice, Princess Royal and Mt. Gay Psychiatric Hospital). Estimates for the 30 public medical stations is 750 Kg , whereas approximately 420 Kg is generated by the six (6) health centers and a further 400 kg by private healthcare facilities. 2.3 Project Status The project was completed in May, 2020 at a cost of approximately, US$ 101,076.00. This cost includes the repair and retrofitting of the existing structures, electrical installations, and 4 Audit of Biomedical Waste Management Practices – Grenada. Prepared by E&ER Group for Natural Resource Management Unit (NRMU) of Organization of Eastern Caribbean States (OECS), April 29, 2002. 5 Biomedical Waste Management Manual for Healthcare Personnel in Grenada. Prepared by Dept. of Public Health & Preventive Medicine, St George’s University, Grenada, December 30, 2005. 8 installation of closed circuit camera. Photographs of the completed building are provided in the following figures below: 9 10 Construction of the isolation unit is complete and the GoG is seeking retroactive reimbursement for costs incurred. To achieve this, this ESMP provides a due-diligence of the works accomplished to date, and the evidence and certification that the isolation unit has and will continue to be undertaken in compliance with applicable safeguards requirements. 11 This due-diligence is based on a review of the available information related to the isolation unit, and a remote site visit by the Safeguards Specialist assigned to the project by the GoG. It provides assurances that the project has been designed and constructed in conformance that the appropriate safeguards mitigation measures have been done as detailed in the ESMP. It also identifies any exceptions and provides a time frame to correct them as necessary. This information appears in Annex 5. Further, it lays out the environmental and social measures to be undertaken during operations to ensure the safe operation of the facility. 12 Chapter 3 Legal and Administrative Framework 3.1 National Legislations Grenada has promulgated numerous laws, regulations, and policies that are relevant to small civil works. For a thorough discussion of these, please refer to the OECSRHP ESMF document, which also describes the various ministries and agencies and their respective roles. A summary table appears below: Area Sections of County laws and policies Corresponding WB policy relevant to this project and standard EIA Scope Physical Planning and Development Control OP. 4.01 and annexes Act 23 of 2016 sec 22 Public health law Cultural heritage Physical Planning and Development Control OP. 4.11 Cultural protection and Act 23 of 2016 sec 38 Heritage procedures during CAP 204 National Heritage Protection Act construction No 18 1990 Amended by SRO 22 of 2009 National Trust Act 207 of 1967 Vector control pesticide Pesticide Control Act N0.28 1973 Amended Op 4.09. Pest procedure by Act No, 88 1979 Management, BP 4.01 annex B Waste Management Act Cap 334 A Waste Management Act No. 16 of 2001 Solid and liquid waste management Occupational health and CAP 100 Factories Act No. 22 of 1973 safety Labour Department of Labour Act /Employment CAP 89 Act No.14 of 1999 Labour Relations CAP 157 A Labour Relations Act No.15 of 1999 Land acquisition CAP 159 Land Acquisition Act OP 4.12 Involuntary Amended by Act No. 16 of 1991 Resettlement Act No. 20 of 1998 Building code and OECS Building Code and standards Standards/Grenada Building code Zoning regulation Grievance redress Grievance Redress Mechanism- OECS Mechanism/complaint regional Health Project -Grenada handling 13 Protection of wildlife Birds and other Wildlife Protection Act Cap 34 1957 Amended by Act N0, 10 of 1990 Public consultation for OP 4.01 social and Environmental Impact Assessments 3.2 World Bank Social and Environmental Operational Policies Safeguard Policies The WBG has developed Safeguards Policies that guide the development of projects including the OECSRHP. Most relevant to the retrofitting is OP4.01 (Operational Policy 4.01), which requires environmental and social assessment of any proposed project activity. Accordingly, the ESMF was prepared for the OECSRHP as a general guidance document, and currently this ESMP has been prepared for the specific activity of clinic retrofitting/rehabilitation of the old CID Building. There are other WBG safeguards policies that cover aspects such as land acquisition, public disclosure, natural habitat, and antiquities protection, among others. These are not relevant to the OECSRHP project, or the retrofitting. (For more information about these, please refer to the ESMF document or the WBG website.) EHS Guidelines Environmental, Health and Safety guidelines have also been prepared by the WBG. There are general guidelines that cover most activities related to construction projects for new facilities. Some parts of these general guidelines are applicable to the retrofitting activity, particularly such aspects as traffic safety, dust and noise control, worker health and safety, and control of runoff from work sites. Also relevant to the retro fitting activity are the sector-specific WBG guidelines for Health Care Facilities, which cover waste minimization, waste segregation, handling and storage of wastes on site, transport to external facilities, and options for treatment and disposal. For more information refer to the EHS Guidelines on the WBG website under the category of Health Care Facilities. 3.3 International Standards The Caribbean Public Health Agency (CARPHA), the Pan American Health Organization (PAHO), the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) have issued several guidance documents specific to the health sector, including the activities that 14 will fall under the CERC-ESMF. In addition, there are protocols dealing with potential exposure to infectious agents, such as COVID-19. Particularly relevant are the following: • Guidance on Management of Solid Healthcare Waste at Primary Healthcare Centres6 • Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings7 3.3.1 Caribbean Public Health Agency (CARPHA) On March 11, 2020, the World Health Organization (WHO) announced that the COVID-19 outbreak is a pandemic). The rapidly evolving situation now requires a shift in mindset in all countries from preparedness to readiness and rapid response. CARPHA has upgraded the risk of disease transmission to the Caribbean Region to Very High. CARPHA is working closely with CARPHA Member States (CMS) and Caribbean coordinating partners and mechanisms to respond to the threat and to prepare CMS to prevent further transmission from exported cases if they were to happen in countries. Key actions by CARPHA to date8: • CARPHA has activated its Incident Management Team (IMT) and is coordinating the regional preparedness and response to this new incident. • CARPHA has issued Situation Reports (SITREPS) to CARPHA Member States (CMS) and other regional stakeholders. • Travellers’ guidelines have been developed and shared with stakeholders • Air and seaport guidelines have been disseminated • Press releases have been shared with the media and other regional stakeholders • The Security Cluster has been activated for tracking of passengers from China through CARICOM Implementing Agency for Crime and Security (IMPACS) 3.3.2 Pan American Health Organisation (PAHO) The Pan American Health Organization (PAHO) has developed specific technical guidance for COVID 199: • Biosafety • Clinical Management 6 http://www.who.int/water_sanitation_health/publications/manhcwm.pdf 7 https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html 8 https://www.carpha.org/What-We-Do/Public-Health/Novel-Coronavirus 9 https://www.paho.org/en/technical-documents-coronavirus-disease-covid-19 15 • Detection and Diagnosis • Disability related information • Ethics • Emergency Medical Teams (EMT) – Medical Surge • Essential Medicines • Prehospital Emergency Medical Services Readiness • Health Workers • Health Services • Health Aging • Hospital Readiness • Infection Prevention and Control • Medical Devices • Requirements and Technical Specifications – PPE • Risk Communication • Social distancing and travel related measures • Surveillance • Water sanitation 3.3.3 World Health Organisation (WHO) WHO works worldwide to promote health, keep the world safe, and serve the vulnerable. Its goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well- being. Specific to COVID 19 the WHO has developed country and technical guidance10: • Critical preparedness, readiness and response actions for COVID 19 • Country-level coordination, planning and monitoring • The Unity Studies: Early Investigations Protocols • Risk communication and community engagement • Naming the coronavirus disease (COVID 19) • Surveillance, rapid response teams, and case investigation • Clinical care • Essential resource planning • Virus origin/Reducing animal-human transmission • Humanitarian operation, camps, refugees/migrants in non-camps and other fragile settings • National laboratories 10 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance 16 • Infection prevention and control/WASH • Guidance for schools, workplace & Institutions • Points of entry/mass gatherings • Health Workers • Maintaining Essential Health Services and Systems 17 Chapter 4 Potential Environmental and Social Impacts General information of environmental and social baseline conditions relevant to the clinic rehabilitation is provided in the project ESMF document for Grenada. Notwithstanding the numerous positive benefits, there is also a risk of negative impacts in the social and environmental areas if certain activities are not appropriately managed. The sections below describe those potential negative impacts from the perspective of retrofitting the facility for COVID-19, operating it, and shutting down the facility after it is no longer needed. Anticipated mitigation measures are discussed in Chapter 5. 4.1 Design and Construction The selection of a site must take into account land ownership and community safety. Given that the CERC objective is to support immediate priority activities, the activities or subprojects with resettlement issues were avoided. As regards design, the location was chosen due to its position within the St George Hospital complex in an unused building owned by the hospital. The refurbishments were undertaken to work within the existing building footprint and so avoid costly expansion of the building structure. During the actual works, attention was paid to avoid impacts such as controlling runoff, having safe areas for waste storage bins or receptacle storages, and adequate facilities for the collection, storage and eventual treatment of sanitary wastewater. Standard measures to avoid impacts from traffic safety, dust, and noise were observed, as well as those dealing with occupational health and safety for site workers. As well, construction waste and debris were required to be disposed of properly. The works for the facility retrofit and rehabilitation have already been accomplished. Any remaining risks that have not been properly identified and addressed are discussed and evaluated in Annex 5 of this ESMP. Items that remain pending to be completed are also identified in Annex 5, along with schedule and dates to form an Action Plan. 18 4.2 Operation Once operational, the facility will have biomedical waste which will require proper treatment and disposal. These will include sharps, infectious wastes, chemical or pharmaceutical waste, as well as non-hazardous or general waste. The health and safety of health care workers could be affected by improper /inadequate waste management practices as well as by hygienic conditions, isolation and storage procedures for bio-infectious, radiologic or genotoxic waste. Air conditioners and filtration systems must be operated and maintained properly, and the filters treated as biomedical waste. The use of personal protective equipment (PPE) or medical supplies will also need proper management and disposal. The entrance and exit of trucks or vehicles carrying supplies will require access controls and security clearance. The security at the facility will need to be enhanced by barrier mechanisms such as fencing to prevent unauthorized access and keeping the general public out. Liquid waste disposal systems (septic tanks and soakaways) must be checked periodically and maintained to prevent overflow or leakage. 4.3 Decommissioning The isolation facility is an integral part of the health system of the Ministry of Health for the treatment of infectious disease. After the facility ceases to operate as an active isolation facility, any materials must be adequately sanitised, wastes removed and disposed of, and supplies and equipment must be sanitised and safely stored and maintained for future use. 19 Chapter 5 Mitigation Measures This section of the ESMP provides the mitigation measures to address each of the risks identified in the previous chapter. For the construction phase they are meant as a checklist for the due- diligence in Annex 5, and for the operation and decommissioning phases they are meant as a plan to guide future efforts. The mitigation measures include the following: • Management of environmental and social issues related to the operation of the facility. • Disposal of construction waste and debris, control of noise, dust and traffic, control of runoff, restrictions of public or visitor access or entry, occupational health and safety for workers. • Procedures for bio-medical waste management on site, liquid and solid wastes, autoclaves, incineration sites, waste pits, landfills, and/or other disposal locations. • Maintenance and care standards for biomedical waste treatment equipment, i.e. autoclave and incinerator, air handling and filtration equipment, wastewater collection and disposal systems. • Standard Operating Procedures (SOP) and engineering options for infection control such as quarantine and voluntary self-isolation procedures, contact and airborne precautions, cleaning and disinfection procedures, monitoring and managing exposed healthcare personnel. • Training on occupational health and safety (equipment operations, Personal Protective Equipment) for public health staff, visitors and workers. • Reporting requirements within and between health facility and the Ministry of Health and Wellness. • Public information and outreach to sensitize the public on infection control precautions within the location(s) of the isolation facility through posters, communications via the mass media, and other means using messages designed with WHO messaging advice and tools. The paragraphs below describe the ESHS risks at each of the stages or phases of the AIF subproject. The subsequent matrix describes the associated mitigation measures. Additional references and sources of information are provided in Annex 3 of this ESMP. 20 5.1 Phase 1: Design and Construction Aspect Potential Impacts Proposed Mitigation Site selection for There may be anxiety Community outreach with institutional stakeholder construction/assembly area and complaints from was conducted. Community engagement with the those living in or using community was not necessary at this stage. And nearby areas about follow the level of outbreak guidance on Risk potential impacts of Communication and Community engagement COVID-19 (RCCE) readiness and response to the 2019 novel coronavirus (2019-nCoV) published by the WHO. Hazardous materials The risk of accidental Avoid the storage of hazardous substances around handling, storage, use and discharge of hazardous water bodies transportation products, leakage of Ensure that storage containers of hazardous hydrocarbons, oils or substances are always in good condition and tightly grease from construction closed machinery Ensure that storage facilities are provided impervious surfaces and bunds to control spill in case of accidental spillage Develop spill response plan as part of the construction ESMP Secondary containment for fuels to avoid spill contamination and inspection during operation Some training in fuel and waste handling should be part of the orientation for workers Maintain the MSDS for hazardous materials onsite Construction wastes and Improper storage and/or The contractor shall handle construction materials debris disposal of materials and waste in accordance with approved procedures. Dispersion of materials in nearby canals, The contractor should only dispose of materials in ditches, rivers streets areas approved by the Municipality or relevant and adjacent properties authority The contractor shall contain excavated materials in the vicinity of the worksite within berms to prevent dispersion and sedimentation of drains, creeks, streets and adjacent properties In case of accidental waste dispersion, the environmental authority shall be informed, and restoration measures shall be applied. Dust and noise from Impaired air quality due Dust suppression methods such as wetting materials construction activity to emissions from or slowing work should be employed as needed to vehicles and dust avoid visible dust generated • Gas masks / respirators when working in closed Respiratory impacts on areas such as access manholes, etc. (according to site workers, nearby approved procedures) residents and pedestrians • Document requirements and standards in the Noise generation from Contract the use of machines and • Hearing protection for working around machinery construction equipment where the noise exceeds 85 dB (according to with its impact on approved procedures) workers and •The location of noisy machinery (including neighborhoods generators) can be positioned away from sensitive sites such as schools or residential areas • Maintain vehicles and Contractors machinery according to maintenance requirements 21 Community Health and Movement of heavy Ensure that a Traffic Management Plan is in place Safety trucks and equipment where this might be an issue may cause traffic • Ensure that sites are properly barricaded during problems and create construction and temporary pedestrian walkways are unsafe situations for provided when required local motorists; • Restrict hospital staff and public from going to the Unauthorized entry of construction site during and outside working hours local persons may place by placing posters, reflecting tapes and erecting them in jeopardy if they barriers are on work locations • Contractor must develop a Community Health and Safety Plan (CHSP) Worker health and safety Accidents to workers on • Train workers on prevention of accidents and the construction site managing incidents • Workers must wear protective gear • Provide first aid kit and emergency plan for accidents or incidents • Proper supervision of the construction workforce Worker health and Safety – Exposure and spread of • For COVID -19 management on the construction COVID -19 Risks infection site follow the infection control protocol in this ESMP Water pollution from runoff Clogging of ditches or • Prepare the ground where any equipment or waste or infiltration of wastes on drains with sediment or will be placed by compacting, lining, coating, and different sites where silt; fouling of otherwise ensuring it is impervious to water facilities or equipment may waterways with infiltration or percolation, as needed be deployed pollutants of any kind • Sensitize the workers to appropriately manage construction materials and wastes • Use berms, silt traps or silt fences, pits or other measures to ensure that any runoff from the site is controlled Medical Waste Improper handling of • Contractor to prepare a Medical Waste Management medical waste could Management Plan for handling any items found expose nearby during the works communities or workers to infection 5.2 Phase 2: Operations Aspect Potential Impacts Proposed Mitigation Community Exposure of visitors • Control and restrict access to the facility following COVID-19 Health and protocols and guidance from the WHO for health facility, and the Safety COVID-19 risk communication package for healthcare facilities • Implement the Infection control protocol in the annexes of this ESMP 22 Aspect Potential Impacts Proposed Mitigation Occupational Infection of health care • Train staff on how to use PPE and ensure there is adequate supply Health and workers • Regularly monitor performance and conduct maintenance of Safety equipment • Train staff in infection control and SOPs for equipment • Use the checklist tool from WHO “Risk assessment and management of exposure of health care workers in the context of COVID-19 for any instances where facility staff are exposed to a confirmed COVID 19 person • Determine how illness among isolation facility staff will be managed in terms of required reporting, self-isolation, and workers compensation. Share this approach to all facility staff Waste Exposure of workers • Segregate and store waste according to international standards Management and local regulations • Provide training on waste management and infectious disease management training and surveillance programs Air emissions Air pollution • Ensure the SOPs from the oxygen plant component supplier(s) from generator, are followed and that training is received from supplier manifold or • Sensitize and train staff to adequately segregate, store, and pipes transport containers and waste products • Provide appropriate PPE for technicians and staff that work near the compressor • Regularly monitor and maintain equipment to ensure they are working properly in accordance with SOPs Hazardous Contamination of soils, • Sensitize staff to avoid spillage of wastewater on the ground waste air, or runoff waters surface management • Sensitize staff and users of the facility to appropriately use the waste collection and disposal facilities Non-hazardous Unintended mixing of • Segregate liquid and solid wastes where possible liquid and solid wastes, vector control, • Construct the septic tank and soak -pit according to the design waste waste and debris specifications accumulation • The latrines or septic tank and soak pit site should be regularly monitored and serviced to prevent problems or overflow • Ensure that wastewater disposal is adequately budg eted for maintenance Traffic Unauthorized entry to • Control visitor access and movement into and out of the facility Management facility of vehicles or and surrounding areas and Access persons • Establish dedicated loading and unloading areas for supply Control vehicles and emergency vehicles Stakeholder Incorrect or misleading • Develop and implement a communication plan for all media Engagement information types with key messages on prevention for facility visitors, local and community, and national level following the tool from the WHO Communication “Risk Communication and Community Engagement (RCCE) Action Plan Guidance COVID-19 Preparedness and Response The plan will target the general population as well as specific messages for key vulnerable populations groups such as the elderly and their careers. The plan will take guidance from WHO COVID- 19 guidance for preventing and addressing stigma and WHO COVID-19 guidance risk communication package for healthcare facilities 23 5.3 Phase 3: Decommissioning Aspect Potential Impacts Proposed Mitigation Site clean-up Risk of pollution from • Remove and recycle or properly dispose of old equipment contaminated runoff, • Clean building interior and exterior grounds, properly dust, or soil dispose of waste materials Contaminated Risk of infection from Provide appropriate PPE for staff for cleaning equipment in equipment contaminated all areas used equipment Clean all equipment used following standards provided by WHO 24 Chapter 6 Project Management and Institutional Arrangements 6.1 ESMP Implementation Responsibilities The overall responsibility for ensuring that the mitigation measures under this ESMP were implemented lies with the Project Coordination Unit (PCU) and the Project Coordinator. Ultimately the Ministry of Health, Social Security, and International Business (MoH) has the final responsibility for the implementation of the works. The MoH also facilitated specific COVID-19 training to the contractor, consultant and related teams engaged for the works. . Accordingly, the MoH provided briefings to the contractor’s team in relation to safety, accessing of work site, protocols to be followed for carrying out work in areas, and other requirements of the ESMP. The MoH engaged a consulting firm to provide support for the supervision of the works. The consulting firm acted as supervisor to document the contractor’s compliance with all work specifications and reported to the PCU. The consulting firm engaged the services of an expert for daily monitoring of compliance. The Contractor was required to have trained personnel as part of its team that are experienced in working within health facilities with ongoing operations. The Contractor was responsible for the on-ground implementation and ensuring compliance with the contract clauses, recommendations, and mitigative measures detailed for management of ESHS risks. The Contractor’s personnel included among others environmental and social health and safety personnel that were responsible for monthly ESHS reporting. Monitoring included weekly meetings to determine site changes, health, safety, social and environmental conditions, and the adequacy of the mitigative measures, and the overall ability of the contractor to execute the works as specified and in a sustainable manner. 6.2 Contractor Responsibilities The general responsibilities of Contractors are described in the Contract and the ESMF, including standard environmental and social measures such as: • Permits and Approvals • Site Security • Discovery of Antiquities (Chance Find Procedure) • Worker Occupational Health and Safety • Noise Control • Use and Management of Hazardous Materials, fuels, solvents and petroleum products • Use and Management of Pesticides • Use of Preservatives and Paint Substances • Site Stabilization and Erosion Control • Traffic Management 25 • Management of Standing Water • Management of Solid Wastes, trash and debris • Management of Liquid Wastes • Management of Medical Waste during construction These generic clauses were incorporated into all contracts, as applicable. In addition, specific project-related recommendations appear in Annexes 2 and 3 of this ESMP for construction as well as operation, including: • Infection Prevention and Control Protocol (IPCP) • Environmental, Social, Health and Safety (ESHS) Risks and Mitigation Measures for small civil works at health care facilities where COVID19 may be present For purposes of cost estimation and budgeting, any contractors were made aware of the existence of the environmental mitigation measures and associated ESMP requirements and should include or have included cost items for such purposes in their proposals. 6.3 Supervision, Monitoring and Reporting Construction It is ultimately the responsibility of the PCU to ensure that the ESMP was followed by the contractor(s) and site workers. During the construction phase, environmental and social monitoring was carried out by the MoH. A Supervision Consultant was engaged to provide oversight on technical aspects including safeguards. In addition, the contactor was required to provide monthly ESHS reports to the MoH. The Contractor was also responsible for ensuring that its personnel complied with the code of conduct and the approved protocols prescribed by the Department of Labour for health and safety. The Consultant submitted monthly written progress reports to the PCU as well as provided weekly updates on all ESHS matters. Operations During operations, the following reporting will occur: • On-going Monitoring and Infraction Reporting • Accident and Incident Reporting • Follow-up Monitoring Activities 26 These may be updated as a result of the updates to the Health Waste Management Strategy which his being developed under the OECSRHP. The strategy and corresponding plans will apply to all public sector health facilities throughout the state of Grenada. 27 Chapter 7. Stakeholder Engagement 7.1 Disclosure of ESMP The ESMP was disclosed on the Gog website on http://www.gov.gd A printed copy of this ESMP is available at the offices of the MoH and the Project Coordination Unit. 7.2 Community Engagement The works in particular the external works did not require a rigorous or formal community engagement because they were relatively minor works that took place entirely within an existing building within the hospital complex grounds, thus there would have been insignificant potential impact to neighborhoods or community members. However, consultations were done internally with governmental institutions through meetings, emails and discussions in order to design the most safe and appropriate work strategies, to verify the ESMP due-diligence, and to onboard the ESMP for the operations phase. For working ongoing or in the future (for example, worker training), consultations will be conducted with institutional stakeholder through the same mediums. In addition, any updated ESMP or additional information (if required) will be disclosed through the Ministry of Health and the Government of Grenada websites. Public gatherings are a common approach to stakeholder consultation. However, where there is a disease outbreak this approach to stakeholder engagement will need to change. There are numerous alternatives that may be used. However, the key criteria for stakeholder engagement remains the same, and that is meaningful dialogue with project effected people with attention given to the most vulnerable. The method used for stakeholder consultation must allow for feedback and suggestions to be provided by stakeholders. Recommended approaches for community engagement during a COVID-19 outbreak are listed below. • Avoid public gatherings (taking into account national restrictions), including public hearings, workshops and community meetings; • If smaller meetings are permitted, conduct consultations in small-group sessions of no more than 10 people, such as focus group meetings held in an outside area with chairs placed 6 feet apart; 28 • If in person meetings are not permitted, make efforts to conduct meetings through online channels, including WebEx, zoom Microsoft teams and Skype; • Try social media and online channels to share activity information. The project should establish a Facebook Page which will be used to allow for such exchanges. Other possible and appropriate, dedicated online platforms and chatgroups appropriate for the purpose will be created; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone- lines, and mail) if a stakeholder does to do not have access to online channels or does not use them frequently; • Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a combination of email messages, mail, online platforms, dedicated phone lines with knowledgeable operators, or direct calling by the project team. Communication and engagement activities under the CERC will also follow the publication from the WHO “Risk communication and community engagement (RCCE) readiness and response to the 2019 novel coronavirus (2019-nCoV)” which will guide messaging about the COVID -19 preparedness and response measures under the CERC and gives broader guidance and checklists for national level communication during different phases of a disease outbreak. 7.3 Grievance and Redress Mechanism The Grievance Redress Mechanism (GRM) developed for the OECS Regional Health Project (P168539) was applicable to the rehabilitation of the Old CID Building. The GRM is described in detailed in a stand-alone document available at: www.gov.gd Grievances can be submitted through the following channels: Channel Details 29 In person 1. Permanent Secretary Ministry of Health, Social Security and International Business Attn; Ms. Ministry of Health, Social Security and International 2nd Floor Ministerial Complex Sir Eric Matthew Gairy Botanical gardens Tanteen St. George Grenada 2. During public/community interaction Project Manager, OECS Health Project Email ps@health.gov.gd, min- healthgrenada@spiceisle.com Telephone (473) 440 -2649 /3485 Letter Permanent Secretary Ministry of Health, Social Security and International Business Attn; Ms. Ministry of Health, Social Security and International 2nd Floor Ministerial Complex Sir Eric Matthew Gairy Botanical gardens Tanteen St. George Grenada All grievances submitted through the available channels were accepted, considered and responded in a timely manner. The GRM was socialized with stakeholders through emails and meetings with governmental and institutional stakeholders. References and sources of further information https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance#guidance-for-health- Professional https://worldbankgroup.sharepoint.com/sites/wbsites/coronavirus/Pages/index.aspx 30 Annex 1. Screening Tool for E&S Risks The form below identifies potential impacts of the proposed activities envisioned under CERC activities. Many of the actions or activities have low or negligible potential negative impacts, such as purchase of equipment or supplies. Some may have impacts that are typical for small construction or rehabilitation projects, such as repair of damaged infrastructure, buildings, or clinics. Others, particularly those dealing with management of infectious disease control such as COVID-19, may have moderate to substantial risk. The form below is highlighted for the former CID Building rehabilitation, and identifies the potential environmental and social risk levels for the works as Moderate. Due to the potential presence of COVID-19 in the isolation wards, additional safety precautions are warranted for technicians and personnel associated with the work. Accordingly, the results of this screening indicate that an ESMP needs to be prepared for the sub project, using the tools in the general ESMF for the OECSRHP project along with the additional safety guidance and information provided in the CERC-ESMF. 31 Subproject Name St George’s CID Building Retrofitting Subproject Location St Georges, Grenada Subproject Proponent MoH Estimated Investment Start/Completion Date Subprojects / Activities Potential E&S Risks or Impacts E&S Risk Level 1 Purchase of medical equipment and None Low supplies 2 Repair of damaged infrastructure Increased dust, noise, water Moderate including, but not limited to: water pollution, solid/hazardous/ supply and sanitation systems, dams, toxic wastes, waste oil/fuels, reservoirs, canals, roads, bridges and public health and safety; transportation systems, energy and possible use of asbestos power supply, telecommunication, and contaminated as construction other infrastructure damaged by the materials and land acquisition; event and impacts on ethnic and vulnerable groups. 3 Re-establish of the urban and rural solid Same as (2) above Moderate waste system, water supply and sanitation (including desilting and drainage) 4 Repair of damaged public buildings, Same as (2) above Moderate including schools, hospitals and administrative buildings 5 Repair, restoration, rehabilitation, retro- Same as (2) above Moderate fit of schools, offices, warehouses 6 Rehabilitation of hospital wards, Spread of infectious disease, Moderate to substantial establishing isolation and quarantine community information and facilities concerns, occupational health and safety 7 Removal and disposal of debris Improper waste management Moderate to substantial associated with any eligible activity and disposal of infectious waste 8 Disposal of medical wastes (at camp site, Increase health risks, need Moderate to substantial small clinic/hospitals), asbestos-based management of medical materials, other toxic/hazardous wastes waste, toxic materials, asbestos-contaminated debris 9 Temporary toilets for emergency Improper hygiene or waste Moderate to substantial facilities management and disposal 32 Annex 2. Infection and Prevention Control Protocol (IPCP) The following information was adapted from the CDC Interim Infection Prevention and Control Recommendations for patients with confirmed COVID-19 or persons under investigation for COVID-19 in Healthcare Settings. The original reference should be consulted for any updates. HEALTH CARE SETTINGS 1. Minimize Chance of Exposure (to staff, other patients and visitors) o Upon arrival, make sure patients with symptoms of any respiratory infection to a separate, isolated and well-ventilated section of the health care facility to wait, and issue a facemask o During the visit, make sure all patients adhere to respiratory hygiene, cough etiquette, hand hygiene and isolation procedures. Provide oral instructions on registration and ongoing reminders with the use of simple signs with images in local languages o Provide alcohol-based hand sanitizer (60-95% alcohol), tissues and facemasks in waiting rooms and patient rooms o solate patients as much as possible. If separate rooms are not available, separate all patients by curtains. Only place together in the same room patients who are all definitively infected with COVID-19. No other patients can be placed in the same room. 2. Adhere to Standard Precautions o Train all staff and volunteers to undertake standard precautions - assume everyone is potentially infected and behave accordingly o Minimize contact between patients and other persons in the facility: health care professionals should be the only persons having contact with patients and this should be restricted to essential personnel only o A decision to stop isolation precautions should be made on a case-by-case basis, in conjunction with local health authorities. 3. Training of Personnel o Train all staff and volunteers in the symptoms of COVID-19, how it is spread and how to protect themselves. Train on correct use and disposal of personal protective equipment (PPE), including gloves, gowns, facemasks, eye protection and respirators (if available) and check that they understand o Train cleaning staff on most effective process for cleaning the facility: use a high-alcohol based cleaner to wipe down all surfaces; wash instruments with soap and water and then wipe down with high-alcohol based cleaner; dispose of rubbish by burning etc. 4. Manage Visitor Access and Movement o Establish procedures for managing, monitoring, and training visitors o All visitors must follow respiratory hygiene precautions while in the common areas of the facility, otherwise they should be removed 33 o Restrict visitors from entering rooms of known or suspected cases of COVID-19 patients. Alternative communications should be encouraged, for example by use of mobile phones. Exceptions only for end-of-life situation and children requiring emotional care. At these times, PPE should be used by visitors. o All visitors should be scheduled and controlled, and once inside the facility, instructed to limit their movement. o Visitors should be asked to watch out for symptoms and report signs of acute illness for at least 14 days. CONSTRUCTION SETTINGS IN AREAS OF CONFIRMED CASES OF COVID-19 1. Minimize Chance of Exposure • Any worker showing symptoms of respiratory illness (fever + cold or cough) and has potentially been exposed to COVID-19 should be immediately removed from the site and tested for the virus at the nearest local hospital • Close co-workers and those sharing accommodations with such a worker should also be removed from the site and tested • Project management must identify the closest hospital that has testing facilities in place, refer workers, and pay for the test if it is not free • Persons under investigation for COVID-19 should not return to work at the project site until cleared by test results. During this time, they should continue to be paid daily wages • If a worker is found to have COVID-19, wages should continue to be paid during the worker’s convalescence (whether at home or in a hospital) • If project workers live at home, any worker with a family member who has a confirmed or suspected case of COVID-19 should be quarantined from the project site for 14 days, and continued to be paid daily wages, even if they have no symptoms. 2. Training of Staff and Precautions • Train all staff in the signs and symptoms of COVID-19, how it is spread, how to protect themselves and the need to be tested if they have symptoms. Allow Q&A and dispel any myths. • Use existing grievance procedures to encourage reporting of co-workers if they show outward symptoms, such as ongoing and severe coughing with fever, and do not voluntarily submit to testing • Supply face masks and other relevant PPE to all project workers at the entrance to the project site. Any persons with signs of respiratory illness that is not accompanied by fever should be mandated to wear a face mask • Provide handwash facilities, hand soap, alcohol-based hand sanitizer and mandate their use on entry and exit of the project site and during breaks, via the use of simple signs with images in local languages • Train all workers in respiratory hygiene, cough etiquette and hand hygiene using demonstrations and participatory methods • Train cleaning staff in effective cleaning procedures and disposal of rubbish 3. Managing Access and Spread 34 • Should a case of COVID-19 be confirmed in a worker on the project site, visitors should be restricted from the site and worker groups should be isolated from each other as much as possible; • Extensive cleaning procedures with high-alcohol content cleaners should be undertaken in the area of the site where the worker was present, prior to any further work being undertaken in that area. DURING OPERATIONS 1. Minimize Chance of Exposure (to staff, other patients and visitors) • Upon arrival, make sure patients with symptoms of any respiratory infection to a separate, isolated and well-ventilated section of the health care facility to wait, and issue a facemask • During the visit, make sure all patients adhere to respiratory hygiene, cough etiquette, hand hygiene and isolation procedures. Provide oral instructions on registration and ongoing reminders with the use of simple signs with images in local languages • Provide alcohol-based hand sanitizer (60-95% alcohol), tissues and facemasks in waiting rooms and patient rooms • Isolate patients as much as possible. If separate rooms are not available, separate all patients by curtains. Only place together in the same room patients who are all definitively infected with COVID-19. No other patients can be placed in the same room. 2. Adhere to Standard Precautions • Train all staff and volunteers to undertake standard precautions - assume everyone is potentially infected and behave accordingly • Minimize contact between patients and other persons in the facility: health care professionals should be the only persons having contact with patients and this should be restricted to essential personnel only • A decision to stop isolation precautions should be made on a case-by-case basis, in conjunction with local health authorities. 3. Training of Personnel • Train all staff and volunteers in the symptoms of COVID-19, how it is spread and how to protect themselves. Train on correct use and disposal of personal protective equipment (PPE), including gloves, gowns, facemasks, eye protection and respirators (if available) and check that they understand • Train cleaning staff on most effective process for cleaning the facility: use a high-alcohol based cleaner to wipe down all surfaces; wash instruments with soap and water and then wipe down with high-alcohol based cleaner; dispose of rubbish by burning etc. 4. Manage Visitor Access and Movement • Establish procedures for managing, monitoring, and training visitors • All visitors must follow respiratory hygiene precautions while in the common areas of the facility, otherwise they should be removed • Restrict visitors from entering rooms of known or suspected cases of COVID-19 patients Alternative communications should be encouraged, for example by use of mobile phones. Exceptions only for end-of-life situation and children requiring emotional care. At these times, PPE should be used by visitors. 35 • All visitors should be scheduled and controlled, and once inside the facility, instructed to limit their movement. • Visitors should be asked to watch out for symptoms and report signs of acute illness for at least 14 days. 36 Annex 3. Health and Safety Guidelines for Retrofitting/Rehabilitation of Medical Facilities Activity Risks and Impacts Mitigation Measures Design activity – The focus on Ensure that the designs for medical facilities also consider the collection, segregation and treatment of hospitals, clinics treatment and care medical waste. is progressed The treatment of healthcare wastes produced during the care of COVID-19 patients should be collected disproportionately safely in designated containers and bags, treated and then safely disposed. with the need for Open burning and incineration of medical wastes can result in emission of dioxins, furans and particulate adequate medical matter, and result in unacceptable cancer risks under medium (two hours per week) or higher usage. If waste infrastructure. small-scale incinerators are the only option available, the best practices possible should be used, to minimize operational impacts on the environment. Best practices in this context are: ✓ effective waste reduction and segregation, ensuring only the smallest quantities of combustible waste types are incinerated; ✓ an engineered design with sufficient residence time and temperatures to minimize products of incomplete combustion; ✓ siting incinerators away from health-care buildings and residential areas or where food is grown; ✓ construction using detailed engineering plans and materials to minimize flaws that may lead to incomplete destruction of waste and premature failures of the incinerator; ✓ a clearly described method of operation to achieve the desired combustion conditions and emissions; for example, appropriate start-up and cool-down procedures, achievement and maintenance of a minimum temperature before waste is burned, use of appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures, proper disposal of ash and equipment to safeguard workers; ✓ periodic maintenance to replace or repair defective components (including inspection, spare parts inventory and daily record keeping); and ✓ improved training and management, possibly promoted by certification and inspection programs for operators, the availability of an operating and maintenance manual, visible management oversight, and regular maintenance schedules. Single-chamber, drum and brick incinerators do not meet the BAT requirements under Stockholm Convention. 37 Small-scale incineration should be viewed as a transitional means of disposal for health-care waste. Alternative treatments should be designed into longer term projects, such as steam treatment methods. Steam treatment should preferably be on site, although once treated, sterile/non-infectious waste may be shredded and disposed of in suitable waste facilities. See WHO Safe management of wastes from health-care activities Construction Land taking for the Follow OP4.12 and IPF Policy para 12 on E&S requirements in situations of urgent need of assistance. activity – construction of new hospitals, and expansion of Apply safeguards to implementation of projects. clinics, existing hospitals. mortuary Injury during the construction of new buildings or refurbishment of existing buildings. Design and The design of the For patients with possible or confirmed COVID-19, isolation rooms should be provided and used at medical operation of facility and the facilities. Isolation rooms should: facilities, operating ✓ be single rooms with attached bathrooms (or with a dedicated commode); including triage, procedures will help ✓ ideally be under negative pressure (neutral pressure may be used, but positive pressure rooms should be isolation(or prevent spread of avoided); quarantine) infection ✓ be sited away from busy areas (areas used by many people) or close to vulnerable or high-risk patients, to minimize chances of infection spread; facilities ✓ have dedicated equipment (for example blood pressure machine, peak flow meter and stethoscope), but should avoid excess equipment or soft furnishings; ✓ have signs on doors to control entry to the room, with the door kept closed; ✓ have an ante-room for staff to put on and take off PPE and to wash/decontaminate before and after providing treatment. An operation manual should be prepared prior to the opening of isolation rooms to describe the working procedures to be taken by healthcare workers to protect themselves and prevent infection escape while providing treatment. The operational procedures should be of a standard to meet guidance from WHO and/or CDC on infection control: 38 ➢ WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; ➢ WHO technical brief water, sanitation, hygiene and waste management for COVID-19; ➢ WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); ➢ WHO interim practical manual for improving infection prevention and control at the health facility; ➢ CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; and ➢ CDC guidelines for environmental infection control in healthcare facilities. Improve access Some vulnerable Projects should develop and commit to specific actions to ensure disadvantaged and vulnerable groups to support and groups (especially have effective treatment, whether in medical facilities or in the community. treatment for the elderly or those Similarly, where IP communities are involved, need to follow ESS7 and IPF policy Para 12 on emergency disadvantaged with pre-existing provision. vulnerable medical conditions) groups may be severely affected by COVID- 19 and may need additional support to access treatment. Employment of Workers do not Contractors should ensure that contracted workers have medical insurance, covering treatment of COVID- workers receive the care 19. needed if infected with COVID-19. Transient and Workers that are Expats or transient workers should adhere to national requirements and guidelines with respect to COVID- expat workforce mobilized from 19. abroad or returning Expats or transient workers coming from countries/regions with cases of the virus: from abroad become • Should not return if displaying symptoms vectors for • Should self-isolate for 14 days following their return transmission of disease to 39 construction For self-isolation, workers should be provided with a single room that is well-ventilated (i.e., with open projects. Workers windows and an open door). If a single room is not available for each worker, adequate space should be that travel from provided to maintain a distance of at least 1 m between workers sharing a room. Workers in isolation other regions may should limit their movements in shared space, for example through timed use of shared spaces (such as also provide a vector kitchens and bathrooms) with cleaning prior to and after use of the facilities. Visitors should not be allowed for passing infection until the worker has shown no signs and symptoms for 14 days, and the number of staff involved in caring onto work sites. for those in isolation should be kept to a minimum. Healthcare professionals and cleaners should visit each day (wearing the appropriate PPE and observing hygiene requirements and make appropriate arrangements for supplying food and water to the kitchens for the workers in isolation. Further information is provided by WHO in Home care for patients with suspected novel coronavirus (COVID-19). Labor camps Close working and Develop contingency plans with arrangements for accommodation, care and treatment for: living conditions of • Workers self-isolating workforce may • Workers displaying symptoms create conditions for • Getting adequate supplies of water, food and supplies the easy transmission of Contingency plans also should consider arrangements for the storage and disposal arrangements for COVID-19 and the medical waste, which may increase in volume and which can remain infectious for several days (depending infection of large upon the material). numbers of people. Ensure medical facilities are stocked with adequate supplies of medical PPE, as a minimum: ✓ Gowns, aprons ✓ Medical masks and some respirators (N95 or FFP2) ✓ Gloves (medical, and heavy duty for cleaners) ✓ Eye protection (goggles or face screens) Medical staff at the facilities should be trained and be kept up to date on WHO advice and recommendations on the specifics of COVID19. The medical staff/management should run awareness campaigns and posters on site advising workers: • how to avoid disease spread (cough/sneeze in crook of elbow; keep 1m or more away, sneeze/cough in tissue and immediately through tissue away, avoid spitting, observe good hygiene) 40 • the need to regularly wash hands with soap and water – many times per day • to self-isolate if they think they may have come in contact with the virus • to self-isolate if they start to display any symptoms, but alert and seek medical advice Wash stations should be provided regularly throughout site, with a supply of clean water, liquid soap and paper towels (for hand drying), with a waste bin (for used paper towels) that is regularly emptied. Wash stations should be provided wherever there is a toilet, canteen/food and drinking water, or sleeping accommodation, at waste stations, at stores and at communal facilities. Where wash stations cannot be provided (for example at remote locations), alcohol-based hand rub should be provided. Enhanced cleaning arrangements should be put in place, to include regular and deep cleaning using disinfectant of catering facilities/canteens/food/drink facilities, latrines/toilets/showers, communal areas, including door handles, floors and all surfaces that are touched regularly (ensure cleaning staff have adequate PPE when cleaning consultation rooms and facilities used to treat infected patients) Worker accommodation that meets or exceeds IFC/EBRD worker accommodation requirements (e.g. in terms of floor type, proximity/no of workers, no ‘hot bedding’, drinking water, washing, bathroom facilities etc.) will be in good state for keeping clean and hygienic, and for cleaning to minimize spread of infection. To minimize pressure on PPE resources: WHO advice on the effectiveness and use of PPE by general public should be followed to ensure that the supplies are not exhausted through ineffective use – this is equally important on construction sites. Other measures (such as working water sprinkling systems at crushers and stock piles, covered wagons, water suppression or surfacing of haul roads etc.) should be used for dust suppression on site before relying upon the use of dust masks (which could unnecessarily reduce the availability of N95/FFP2 masks for use by medical staff performing some duties) 41 References and sources of further information https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance#guidance- for-health-professionals https://worldbankgroup.sharepoint.com/sites/wbsites/coronavirus/Pages/index.aspx 42 Annex 4. Evidence of Works Completed 43 44 45 46 47 Annex 5. Due-Diligence for Retroactive Reimbursement I. PURPOSE This Annex represents a Due-Diligence exercise for the Environmental, Social, Health and Safety (ESHS) measures described in this ESMP for the work performed to date on the retrofitting and rehabilitation of the Former CID Building . This Due-Diligence is based on a review of the available information related to the facility, and a virtual site visit by the Safeguards Specialist assigned to the project by the Government of Grenada MoH. It provides assurances that the project has been designed and constructed in conformance that the appropriate safeguards mitigation measures have been done as detailed in the ESMP. It also identifies any exceptions and provides a time frame to correct them as necessary. II. COMPLIANCE CHECKLIST The checklist below references the major safeguards elements for screening, design, supervision, and construction elements covered in the ESMP. For each of the major ESHS elements within the ESMP related to the works, the checklist below provides a response (Yes / No) to each query and summarizes the compliance status of each, using the following assessment scheme: • Highly Satisfactory (HS) – the sub-project is in full compliance with requirement(s). • Satisfactory (S) – the sub-project complied to the most relevant aspects of the requirements(s). • Partly Satisfactory (PS) – the sub-project did not comply with certain requirement(s), and to address the gap(s) or pending item(s) an Action Plan has been proposed. • Unsatisfactory (U) – the project did not comply with the requirement(s). The checklist below also states which aspects or issues are pending or which have resulted in impacts or risks that have not been addressed or resolved, and are included in the Action Plan in section III. 48 Table 1. Compliance Checklist ESHS Element Due-Diligence Aspect / Compliance Variance / Explanation Issue Status SCREENING Was the sub-project No / Partly The screening was done screened using the ESMF Satisfactory after site selection and is screening tools? included in Annex 1 of the ESMP. BUDGET Was an ESMP prepared that No / Satisfactory The ESMP did not require included a budget? additional expenditures. The budget for operations is included in the ESMP. DESIGN Is the facility design as Yes / Satisfactory None described in this ESMP? CONTRACT Did the contractor receive No / Partly The contractor was aware ESHS requirements? Satisfactory of general ESHS requirements but did not receive written guidelines or requirements NATIONAL Was the facility constructed Yes / Satisfactory None LAWS in accordance with national laws and applicable regulations? MITIGATION Were the mitigation Yes / Satisfactory The ESMP describes the MEASURES measures described in the general mitigation actions ESMP adhered to? that were done Were any accidents or No / Highly None incidents reported? If so Satisfactory were they followed up? Were precautions taken to Yes / Satisfactory None avoid infectious disease (e.g. COVID-19) by the contractor and work teams? Has the site been cleaned up Yes / Satisfactory None and restored, all wastes removed, and ready for operation? Were any biomedical wastes No / Satisfactory None encountered and if so were 49 they managed appropriately as described in the ESMP? SUPERVISION Was there a Supervisor Yes / Satisfactory A clerk-of-works was on encharged with ESHS on the site. site? Were supervision reports No / Partly No reports are available prepared and were they Satisfactory but a discussion with the available for review? clerk-of-works did not reveal any issues during construction. PUBLIC Was the ESMP disclosed on No / Partly Publication will be done INFORMATION the GoSVG website? Satisfactory once ESMP is in final form GRIEVANCE Is the GRM operational for Yes / Satisfactory None REDRESS the project and works? Were any complaints No / Satisfactory None received about the project? III. ACTION PLAN The inspection and due-diligence process has noted that the following items remain to be accomplished, and the timetable to complete them is in Table 2 below: Table 2. Action Plan Variance / Explanation Action Item Schedule Publish ESMP Finalize ESMP and publish on March 12th, 2021 website 50 IV. SIGNATURES The inspection and due-diligence was conducted by and approved by the following individuals: Name: Ms. Camille St. Louis PMP, MSc., B.Sc (FENG) Name: E. Francis Martin (DR) M.D. MPH Title: Chief Planner Ministry of Health Title: Permanent Secretary w.r.f. General and Health Administration ___________________________________ ___________________________________ Signature/Date: March 15th, 2021 Signature/Date: March 15th 2021 V. PHOTOGRAPHS AND OTHER DOCUMENTARY EVIDENCE Attach site photographs, inspection records, and/or other relevant information. Provide annotations and use as support for compliance and explanation for pending items. (See main report for photographs and other supporting information.) 51