The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage (AF ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 05/25/2021 | Report No: ESRSAFA202 Jun 10, 2021 Page 1 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) BASIC INFORMATION A. Basic Project Data Country Region Borrower(s) Implementing Agency(ies) Mauritania AFRICA WEST Islamic Republic of Ministry of Health Mauritania Project ID Project Name P176526 Mauritania COVID-19 Response Project - Additional Financing Parent Project ID (if any) Parent Project Name P173837 Mauritania COVID-19 Strategic Preparedness and Response Project (SPRP) Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 7/6/2021 7/15/2021 Population Financing Public Disclosure Proposed Development Objective To strengthen the national public health preparedness capacity to prevent, detect and respond to the COVID-19 pandemic in Mauritania 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 MoH has developed a National COVID-19 Vaccination Strategy along with drafts costed operational and implementation plans through 2022 aimed at covering all its adult population. The AF in the amount of 15,000,000 Jun 10, 2021 Page 2 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) US$ equivalent IDA would support the costs of expanding activities of the Covid-19 Strategic Preparedness and Response Project (SPRP) (P173837), in an amount of US$5.2 million equivalent using the Multiphase Programmatic Approach (MPA), approved by the Board on April 2, 2020, and the AF to the SPRP approved on October 13, 2020 . The primary objectives of the proposed AF are to enable affordable and equitable access to Covid-19 vaccines, ensure effective vaccines deployment in Mauritania through health system strengthening, and to further strengthen preparedness and response activities under the parent project. This Project was not included in the Borrower’s Country Partnership Framework (CPF) for the Period FY18-FY23 , but the pandemic has increased the priority of health protection and treatment in Mauritania. The need to invest in health systems to ensure the productive capabilities of the population is recognized, as is the challenge of overcoming a legacy of limited investment in human capital and social resilience systems. The parent project was prepared to allow the country to respond to urgent preparedness and response needs related to the COVID-19 outbreak. It complements the REDISSE (P161163), which aims to strengthen human health, animal health, and disaster response system in West Africa to ensure resilience to outbreaks and health emergencies. This project which is in the early stages of implementation, supports Mauritania in establishing a coordinated approach to detecting and swiftly responding to regional public health threats and to strengthening health information systems, including disease surveillance capacity for early detection and response to disease outbreaks. The AF, like the parent project, is also aligned with both global health priorities and IBRD/IDA priorities on improving pandemic preparedness. The proposed Project includes two components supporting the country’s detection and response efforts in the fight against COVID-19. With the proposed AF this support will be maintained to ensure that the health system have the Public Disclosure response capacity to continue to prevent, detect, and treat COVID-19 cases. The AF will support investments to bring immunization systems and service delivery capacity to the level required to successfully deliver COVID-19 vaccines at scale, through Component 1 of the parent project. The new subcomponent 1.4 will finance (i) procurement, importation, storage and distribution of the COVID-19 vaccines and procurement of vaccination supplies and PPE such as surgical masks and face shields for vaccinators. To support the Government of Mauritania’s vaccination planning, the AF may finance upfront technical assistance to support Mauritania to establish institutional frameworks for the safe and effective deployment of vaccines. This will be done through the addition of a new subcomponent 2.3. D. Environmental and Social Overview D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic, environmental, social] Additional Financing (AF) has been prepared to scale up the parent project’s (PP) activities to better respond to the COVID-19 threat in Mauritania and to prepare the immunization systems for the deployment for the COVID-19 vaccine. The AF will strengthen the national immunization and related health delivery system in a way that will promote an effective COVID-19 response and generate, as far as feasible, long-lasting resilience. Purchasing vaccines is just one step in a complex, multi-dimensional effort that involves detailed planning and implementation of a vaccine deployment program in Mauritania. This includes a variety of issues such as effective microplanning, safe and appropriate transportation, storage, training, ancillary materials, registration, and effective vaccine logistics and a suitable information management system. Political support, technical assistance services, training, social mobilization campaigns, and mechanisms that remove demand-side barriers to access are also essential to foster confidence and promote the early up-take of vaccines. As for the PP, the AF will be implemented nationwide in existing health Jun 10, 2021 Page 3 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) facilities in urban as well as remote areas. The AF will form part of an expanded health response to the pandemic. The activities will build on COVID-19 MPA-Program Covid-19 Strategic Preparedness And Response Project (SPRP) (P173837) as well as on the Bank’s existing health portfolio Health System Support (P156165), Health System Support Additional Financing (P170585) and REDISSE (P161163), as well as support of other developing partners in the context of the overall Government’s COVID-19 response. The AF will continue supporting enhancement of disease detection capability through provision of technical expertise, diagnostic supplies to ensure prompt case finding and contact tracing. It will also enable Mauritania to mobilize its response capacity through well-equipped frontline health workers and creating response capacity for primary health care facilities in isolated geographic areas. All activities of the health component will be conducted within existing government facilities and within existing footprints, and as such no new land will be acquired or accessed. The specific locations where project sub-components will be implemented have been identified in urban as well as in remote areas. The AF is organized around three components: Component 1: Emergency COVID-19 Response: Through this component, the AF will continue to support the ongoing activities of the PP, including procurement of COVID-19 tests and reagents, as well as the additional activity related to COVID-19 vaccine procurement and deployment and pharmacovigilance, respectively (under sub-component 1.4). This sub-component would support the MoH to implement its National COVID-19 Vaccination Strategy and Plan. This sub-component will also strengthen Mauritania’s ability to respond to outbreaks of climate-sensitive vaccine preventable diseases such as Malaria, Dengue and Zika. Key activities to be supported under the AF are: (i) Public Disclosure procurement, importation, storage and distribution of the COVID-19 vaccines (e.g, COVAX, African Union and others); (ii) procurement of vaccination supplies and PPE such as surgical masks and face shields for vaccinators; (ii) adoption of global tools and adaptation of the supply chain system to best practices, including the procurement of cold chain equipment (refrigerators, deep freezers, rehabilitation of existing cold rooms) and environmentally friendly waste management such as Solar Direct Drive Refrigerators (SDDs) and WHO Performance, Quality, Safety (PQS) certified climate-friendly refrigerators/freezers and waste management equipment to reduce greenhouse gas (GHG) emissions, and sustainable end-of-life options for old or high-polluting Coordination Centre for Effects; and (iii) strengthening of remote temperature monitoring systems including the purchase of freeze-tag/fridge-tags. Component 2: Implementation Management and Monitoring and Evaluation: under this component, the AF will finance among others: the collection and transport of biological samples from cases of AEFI to designated laboratories, and analysis of samples; procure and disseminate emergency KITs for anaphylactic shock management and reinforce health structures with resuscitation equipment; organize the transport of persons who are victims of severe AEFI to referral facilities and cover costs related to their medical care. Component 3 (Project Management and M&E) will include additional support to the PCU and other implementing entities for vaccination efforts. The AF is not expected to lead to any land acquisitions, involuntary resettlement and labor influx nor is it expected to impact natural habitats or cultural sites. The AF may finance upfront technical assistance to support Mauritania to establish institutional frameworks for the safe and effective deployment of vaccines. These will include: (a) establishment of policies related to ensuring that there is no forced vaccination; (b) acceptable approved policy for prioritized intra-country vaccine allocation; (c) regulatory standards at the national level, including pharmacovigilance; Jun 10, 2021 Page 4 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) (d) appropriate minimum standards for vaccine management including cold chain infrastructure (with financing as well for the investment to meet those standards as described below); and (e) the creation of accountability, grievances, and citizen and community engagement mechanisms. The policies for prioritizing intra-country vaccine allocations will follow principles established in the WHO Allocation Framework, including targeting an initial coverage of 20 percent of a country’s population; focusing first on workers in health and social care settings; and then focusing on the elderly and younger people with an underlying condition which places them at higher risk and finally essential workers. D. 2. Borrower’s Institutional Capacity As with the Parent Project, this AF will be implemented by the Ministry of Health, as the main recipient and executing agency of the project. The MoH has previous experience implementing the parent projet and INAYA project (P156165), as well as its Additional Finaning (P170585). The Department of Public Hygiene of the Ministry of Health has been responsible for INAYA environmental and social safeguards implementation and will continue with the COVID-19 activities. The scope of the proposed project can be accommodated by drawing on existing capacity in the Directorate of Public Health as well as the environmental and social specialist in the INAYA project. Environmental and social safeguards compliance in the INAYA project is Moderately Satisfactory. Project-appropriate EMP checklists have been prepared for each participating health facility. The Department of Public Hygiene has carried out a strong, nation-wide training program on public health and hygiene for health workers and community-based health and sanitation workers. The MoH has prior experience with World Bank investment projects and has already applied the Environmental and Social Framework (ESF). The MoH staff benefited from several rounds of training on the World Bank Operational Public Disclosure Policies and, more recently, on the ESF. To date, a senior E&S consultant has been preparing the environmental and social risk management aspects of the Project Parent and AF and will remain engaged throughout implementation. The recruited full time Environmental and Social (E&S) Specialist and who is responsible of managing and supervising the PP will be also responsible for the overall E&S aspects of the AF. To date the PP and its first AF’s implementation allow to share some main learned lessons. The COVID-19 pandemic poses a unique set of challenges in terms of preventive, responses and control measures that go beyond the current MoH capacity. Specifically: i) the challenges in implementing the agreed E&S measures on time due to the extreme pressure posed by the pandemic to the MoH and to the health structures and to the subsequent need of reassessing priorities and act upon them; ii) the need of additional human and financial resources to timely and properly address the specific needs imposed by the pandemic; iii) the criticality of coordination among the different units managing the pandemic. To this end, the MoH hired a full time E&S to better support and coordinate the implementation and supervision of the E&S measures in timely manner. In addition, this AF will strengthen the national capacity to coordinate and collaborate with other agencies currently responding to the crisis, such as WHO UNICEF and Gavi. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Environmental Risk Rating Substantial Jun 10, 2021 Page 5 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) The environmental risk classification for the project is Substantial. The project will have long term positive environmental impacts, as it should improve COVID-19 surveillance, monitoring, treatment and containment. Nevertheless, there is a number of substantial short-term environmental risks that need to be addressed The main environmental risks identified are: (i) the Occupational Health and Safety issues related to testing and handling of supplies, transportation and conservation of vaccines, etc. during treatment to a large extent as well as due to civil works renovations inside functional health care facilities to a lesser extent. The OHS issues are also related to the availability and supply of personal protective equipment (PPE) for healthcare workers and the logistical challenges in transporting PPE across the country in a timely manner; (ii) production and management of medical healthcare waste (especially handling highly infectious medical wastes such as COVID-19),; and (iii) community health and safety issues related to the handling, transportation and disposal of hazardous and infectious healthcare waste, as well as disposing of supplies and medical samples and rehabilitation of health centers. As no civil works other than refurbishing facilities on existing hospital grounds or other government owned sites are to be undertaken, environmental risks associated with these works are expected to be minor and readily mitigated. Health care waste and chemical wastes (including water, reagents, infected materials, etc.) generated from disease detection capacities to be supported can have substantial impact on the environment and human health. Wastes that may be generated from health facilities/ labs could include liquid contaminated waste, chemicals and other hazardous materials, and other waste from labs/quarantine/isolation centers including sharps used in diagnosis and treatment. All of this requires special handling and awareness as it may pose a risk to health care workers from occupational infections and to the communities if not disposed properly. Social Risk Rating Moderate As for the PP, the anticipated overall social risks for the AF remain Substantial. The proposed AF is anticipated to Public Disclosure have positive social impacts both at the individual and community levels as it addresses the health sector responses to the COVID-19 emergency. Nonetheless, social risks related to the challenges of the COVID-19 epidemic are anticipated. These include: i) difficulties in accessing health facilities and services for the overall population; ii) marginalized and vulnerable social groups being unable to access vaccines, facilities, and services designed to combat the disease; iii) s complain regarding the vaccin administration process, and risks to human security resulting from diagnostics testing, limited availability of vaccines and social tensions related to the difficulties of a pandemic situation; iv) SEA/SH risks among patients and health care providers, especially in relation to distribution of lifesaving vaccines; v); inappropriate data protection measures and insufficient / ineffective stakeholder communication on the vaccine roll-out strategy; vi) risks associated with Adverse Events Following Immunization (AEFI); vii) the risk of elite capture and/or corruption as the Covid-19 vaccine will be in short supply relative to the demand. There is also an institutional contextual risk, given the unique set of challenges in terms of preventive responses and control measures related to the pandemic. The Borrower will not make use of security personnel for the vaccines deployment. Under sub-component 1.1: Strengthen national and sub-national COVID-19 case detection and clinical management capacities, the AF will invest in small works to rehabilitate existing health facilities. It will not however finance new construction or expansion of existing ones. As such, no new land will be acquired or accessed. Possible risks and impacts are considered mostly temporary, predictable and/or reversible, but some could become widespread given the highly infective nature of the COVID-19 virus. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment Jun 10, 2021 Page 6 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: The AF is expected to result in positive environmental and social impacts as it seeks to improve planning, processes and on-the-ground service delivery for COVID-19 surveillance, containment and response. Nonetheless, AF activities still present significant E&S risks. Environmental and social risks and impacts under Component 1 are related to risks associated with labor and working conditions, medical waste, and community health and safety. Under component 2,small rehabilitation are expected in order to upgrade existing health facilities. Land acquisition is not expected as the project will focus on existing facilities. Risks and impacts related to rehabilitation of selected health care facilities are anticipated to be moderate and site-specific. Key environmental risks are related to: (i) management of biomedical waste, and (ii) occupational health and safety (OHS) issues related to testing, handling, transporting, disposing of supplies and medical samples, and upgrading of designated health facilities. There is a possibility for adverse risks and impacts to human health and the environment from infectious microorganisms if adequate control measures are not in place within labs and/or health facilities. The expected healthcare infectious waste also includes wastes streams generated from COVID-19 patients. Medical wastes may also include chemicals and other hazardous materials used in diagnosis and treatment. Contamination may cause severe human disease, present a serious hazard to workers, and/or present a risk of spreading to the community. Among the main social risks there is the potential inability of disadvantaged /vulnerable individuals or groups to access facilities, services and vaccines. The SEP has identified main disadvantaged/vulnerable individuals/groups, including: the elderly; chronically ill and immuno-depressed persons; pregnant girls and women; population with previous health problems; persons with disabilities and their caregivers; homeless, including street children; female- Public Disclosure headed households or single mothers with underage children; the unemployed; illiterate people; and populations living in remote and isolated area. Their vulnerability varies and is related to their origin, gender, age, health condition, income, distance from health centers, marginalization and disadvantaged status in the community, and dependence on other individuals, among others. These persons may be exposed to additional risks due to their vulnerable status, including risks of missing out on vaccination given their inability to reach health facilities. This might be the case for the elderly, disabled people or people living in remote and marginalized area. Homeless, illiterate people and people with no/limited access to main communication channels might also be at risks of not being aware of vaccination processes. Chronically ill, immuno-depressed persons, and population with previous health problems are also at higher risks given their already precarious health condition and the risk of exposure to COVID-19 and other infectious diseases when accessing health facilities, including during the vaccination. Also, increased morbidity and mortality due to interruption of essential services associated with COVID-19 containment measures hinder access to care for other health needs of the population, including maternal and childcare services, routine immunization services have been affected, threatening polio eradication and potentially leading to new outbreaks of preventable diseases, with their own related deaths, illnesses and long-term costs. Services needed to address the needs of people with chronic health conditions, and mental and substance use disorders have been also disrupted. The National COVID-19 Vaccination Plan (NVP) includes an equitable and inclusive policy for in-country vaccine access and allocation. Specific attention will be devoted to disadvantaged / vulnerable individuals or groups to ensure their current vulnerabilities won’t jeopardize their access and rights to vaccination and to any information related to it. The NVP also includes measures and/or policies to ensure voluntary consent for vaccination. To date, the Borrower has not planned mandatory vaccination for the public or a defined group of people. If vaccination will be made mandatory for the public or a defined group of people, regulations will be integrated into the NVP including any provisions for exceptions, due process, grievance mechanisms and restrictive measures, such as measures that Jun 10, 2021 Page 7 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) may interfere with labor and working standards described in ESS2. Priority groups for vaccination have been defined in accordance with WHO and the SAGE values framework for the allocation and prioritization of vaccination for the 20 percent of the Mauritanian’s population. Submission to the COVAX facility aims to have enough doses to cover 20% of the Mauritanian population according to a prioritization agenda as follows : (1) health care personnel; (2) people over 65 years of age; (3) people with chronic illnesses; and (4) other essential workers and most at risk adults. For the first phase (FY21), in the other essential workers and most at risk category, the following groups have been identified: 1) employees at gateways; 2) public transport drivers; 3) national education personnel (public + private); 4) armed and security forces personnel; 5) subjects aged 60-65; 6) prison population; 7) public administration employees; 8) subjects aged 45-59; 9) butchers; and 9) hotel and restaurant personnel. In a second phase (FY22), the Government would like to vaccinate in priority an additional 10% covering informal sector workers whose age exposes them, to a lesser extent, to Covid-19 and whose mobility and number of contacts exposes other, more vulnerable people to the risk of morbidity and mortality related to Covid-19. The third phase is not covered under this AF. However, under Mauritania’s strategic priorities, the Government would aim to vaccinate an additional 30% of its population, to reach 60% coverage as recommended by Africa CDC. The additional 30% would cover in priority the remainder of the informal sector workers whose mobility and number of contacts exposes other, more vulnerable people to the risk of morbidity and mortality related to Covid-19. The identification of people belonging to the priority groups for vaccination will be carried out locally by the health centers, using the registration systems of the National Health Service and, if necessary, through the collaboration of existing services outside the SNS. According to the respective institutional context, for frontline workers the identification of target population will be done by the managing entity or employer, in consultation with the health/police stations. Through the parent project, medical equipment, vehicles, personal protective equipment Public Disclosure (PPE), chemical / biological reagents and other medical or laboratory supplies or materials have been provided to health service workers. Infectious medical wastes generated by the health facilities have been managed in accordance with the MWMPs. To manage the risks, the MoH will prepare the following instruments: 1. An updated ESMF - the Borrower will update the PP’s ESMF to reflect the proposed new activities under the AF, identify additional potential risks and E&S impacts, and outline appropriate mitigation measures based largely on adopting WHO guidance, World Bank Group EHS Guidelines and other good international industry practices (GIIP). The ESMF will be updated and finalized by Effectiveness. This ESMF will include an ESMP template for minor works associated with the rehabilitation of the health facilities; cold chain needs assessment for vaccine transport, storage and distribution and associated mitigation measures, MWMP template; updated Labor Management Plans (LMPs) for contracted workers to ensure proper working conditions and management of worker relationships, OHS, and to prevent potential sexual harassment; and updated GBV/SEA/H Prevention and Response Action Plan (SEA/SH AP) to propose mitigation measures to address SEA/SH risks related to the AF activities. The ESMF will also devote specific attention to data protection concerns and to risks of exclusion/elite capture. The ESMF will be prepared to a standard acceptable to the World Bank and disclosed on the Ministry of Health (MoH) website and on the World Bank website by Effectiveness. Until the ESMF has been approved, the Project will strictly follow current WHO Guidance and avoid activities such as establishment of isolation units and treatment facilities at scale. 2. An updated MWMP - the Borrower prepared the PP’s MWMP. Wastes that may be generated from labs, screening posts and treatment facilities to be supported by the COVID-19 readiness and response could include liquid contaminated waste and infected materials, both of which require special handling and awareness, as they may pose an infectious risk to healthcare workers in contact with the waste. Informal disposal may lead to contamination of soil and groundwater and/or further spreading of the virus to nearby communities. In order to mitigate the risks associated with MWM and disposal, the Project will ensure all medical waste is transported safely to the existing Jun 10, 2021 Page 8 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) incinerators and invest on the procurement of appropriate waste management equipement, including containers and PPE, as well as training of medical, lab and waste management personnel to ensure compliance with MWMPs, WHO guidance and GIIP. Healthcare workers are particularly vulnerable to contagions. Healthcare-associated infections due to inadequate adherence to OHS standards can lead to illness or death. The MWMPs will contain protocols necessary for treating patients and handling medical waste as well as EHS guidelines for staff, including necessary PPEs, Proper disposal of sharps, disinfectant protocols, and regular testing of health workers. ESS10 Stakeholder Engagement and Information Disclosure Like the Parent Project, the social risks of the Additional Funding remain substantial. The project Component 2: Community Engagement and Risk Communication, original activities will be maintained to ensure effective risk communication and community/citizen engagement to raise public awareness and knowledge on prevention and control of COVID-19 among the general population. New activities will be added to Subcomponent 2.2, Comprehensive Behavioral Change and Risk Communication to enhance multifaceted communications campaign as part of a broader social engagement and mobilization strategy to address vaccine hesitancy, with tailored content and channels, to target priority groups. The communication campaign will be implemented in all stages of the national vaccination rollout, and will leverage mass media, social media, and healthcare workers. Activities that will be financed include: (i) implementation of national risk-communication and outreach campaign, demand creation and community engagement plans for COVID-19 vaccines; (ii) ensure vaccines reach the target populations; and (iii) strengthen and adapt Pharmacovigilance System (PVS) to be sensitive to detect AEFI for the COVID-19 vaccine. Stakeholder engagement is a critical tool for social and environmental risk management, project sustainability and Public Disclosure success. To ensure a participatory, inclusive, and culturally appropriate approach during the project’s life cycle, the Borrower prepared a Stakeholder Engagement Plan (SEP) for the parent project in compliance with ESS10 requirements. The AF project will take advantage to review the PP SEP to introduce the vaccines requirements and including potential new stakeholders, other interested stakeholders and vulnerable groups and/or persons. For the updated SEP During the consultations for the updated SEP, specific attention will be given to the vaccine roll-out strategy. The SEP will be updated and disclosed by Effectiveness. The SEP will also release routine information on the project’s environmental and social performance, including opportunities for consultation. An assessment of the current GRM will be conducted as part of the SEP updating to ensure the current GM includes the requirements in relation to the potential risks and impacts of the AF and includes measures that are accessible to potential new stakeholders. Based on the assessment outcomes, the current GM which has already recommendations regarding the SEA/SH will be strengthened to include SEA/SH-sensitive measures related to the vaccine aspects, including multiple channels to initiate a complaint and specific procedures for SEA/SH, such as confidential and/or anonymous reporting with safe and ethical documenting of SEA/SH. Further training will be conducted among selected FPs to enhance their capacity of handling potential cases related to vaccines deployment. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions Jun 10, 2021 Page 9 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) This standard is relevant. Most of the activities financed by the AF will be carried out mainly by health and laboratory staff. The project also intends to work with the army to secure certain sites and transport equipment. During implementation, the client will include the existing Labor Management Procedures (LMP) in the contracts which will define how the project workers are to be managed in accordance with the requirements of national law and ESS2. Due diligence is also necessary to ensure that the client meets the requirements for child labor, forced labor, and occupational health and safety. The LMP will include measures to ensure that labor is provided on a voluntary basis and further ensure that the health and safety of workers, especially women, receives adequate attention. As such, these measures will also address the risks related to SEA as well as Health and Safety in the workplace for project staff. As for the parent project, the workers who will be recruited under the AF will have to sign the code of conduct and they will be trained and sensitized on SEA / SH and GBV issues. The prevention strategy adopted with the parent project will be maintained and reinforced as needed with a procedure for entering health care facilities, including minimizing visitors and submitting to strict checks before entering. The provisions referred to in the Infection Control Plan and Biomedical Waste Management will be enforced along with a worker protection procedure with regard to infection control precautions and these requirements will be included in workers' contracts. All workers will be continuously trained on preventive measures and adequate signage will be placed in the appropriate places (public spaces, offices, etc.) Likewise, it will also have the details of the GRM for workers and the roles and responsibilities for monitoring these workers; As for the project, the GRM for workers will also outline specific procedures to ensure the ethical and confidential management and resolution of SEA / SH complaints, including prompt referral of survivors to appropriate support services. These different arrangements for dealing with the SEA / HS risk for workers with external Public Disclosure companies must also be included in the supplier's tender and contractual documents. For health and laboratory personnel, a key issue to be addressed in PML will be contamination by COVID-19. The project will ensure the application of occupational health and safety measures in accordance with WHO guidelines. The availability of PPE (especially a face mask, gowns, gloves, hand washing soap and disinfectant) should be ensured at all times to minimize the risk of virus proliferation with adequate OHS protections in accordance with EHSGs general and industry-specific EHSGs and follow evolving international best practices in COVID-19 protection. ESS3 Resource Efficiency and Pollution Prevention and Management This Standard is relevant. Pollution prevention and management – specifically medical waste management – will be a particularly important activity under the Project. Medical waste, including chemicals, contaminated PPE and equipment, and lab testing kits from healthcare facilities will need to be safely stored, transported and disposed. Wastes generated from labs, screening posts and treatment facilities to be supported by the COVID-19 emergency response project could include contaminated waste (e.g. blood, other body fluids and contaminated fluid) and infected materials (water used; lab solutions and reagents, syringes, bed sheets, majority of waste from labs and isolation centers, etc.) require special handling and awareness, as they may pose an infectious risk to healthcare workers in contact with the waste. Informal disposal may lead to contamination of soil and groundwater, but more importantly, to further spreading of the virus to nearby communities. Special attention should also be paid in the updated ESMF to the cold chain for vaccine transport, storage and distribution. An assessment and management of Jun 10, 2021 Page 10 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) the risks associated with this activity should be added to the ESMF. The curent ESMF, which includes a Medical Waste Management (MWM) Plan, complements the already existing procedures and also includes WHO COVID-19 guidance and other international good practice, to prevent or minimize contamination from inadequate waste management. This Medical Waste Management Plan describes in detail the entire process and responsibilities between the generation of the infectious medical waste and its disposal. It also takes into account the challenge of moving within and between Mauritania urban area and describes the measures to be taken for the most rural areas. ESS4 Community Health and Safety Medical wastes and general waste from the health care facilities have a high potential of carrying the SARS-CoV-2 and other microorganisms that can infect the community at large if they are not properly disposed of. There is a possibility for the infectious microorganism to be introduced into the environment if not well contained within the health care facilities or due to accidents/emergencies e.g. a fire or natural disasters. The curent ESMF includes measures on Medical Waste Management including: (j) how Project activities will be carried out in a safe manner with (low) incidences of accidents and incidents in line with Good International Industry Practice (WHO guidelines); (ii) measures to prevent or minimize the spread of infectious diseases; and (iii) emergency preparedness measures. The health care facilities will follow specific procedures and protocols, in line with WHO Guidance, on appropriate waste management of contaminated materials; on the transport of samples; and on workers disinfection before leaving the workplace back into their communities. With regards to the risk of Sexual Exploitation and Abuse (SEA) and Sexual Harassment (SH) risks, the UGPE has prepared and updated a SEA/H. Public Disclosure Prevention and Response Action Plan, which includes an Accountability and Response Framework. As part of the Plan, the UGPE will map out and assess SEA/SH prevention and response actors in the project implementation area. The Plan is integrated in the ESMF and will be disclosed by effectiveness. The Project will also implement specific measures to prevent SEA/SH risks relying on the WHO Code of Ethics and Professional Conduct for all workers in the facilities, as well as the provision of gender-sensitive infrastructure such as segregated toilets and enough light in quarantine and isolation centers. The Project will also ensure via the above-noted provisions, including stakeholder engagement, that facilities are operated effectively throughout the country, including in remote areas. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement This standard is not relevant. As such, project activities are unlikely to lead to involuntary resettlement issues, such as land acquisition, physical or economic displacement, or restriction of access to natural resources. Nonetheless, the Borrower will conduct regular E&S screening before the start of the works to ensure AF activities will not lead to any resettlement issues. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources This Standard is not currently relevant. No construction or major rehabilitation activities are expected 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. However, infectious medical waste could affect natural resources, if handled and disposed of inappropriately. Special attention must be paid to the potential risks associated with the contamination of certain Jun 10, 2021 Page 11 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) primates (e.g. local monkeys). All personnel involved in the project must following the requirements delineated in the ESMF/ESMPs and Medical Waste Management Plan to ensure safe handling and disposal of medical and hazardous waste, outlined in ESS1 and ESS3. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities This standard is not relevant as there are no Indigenous Peoples/Sub-Saharan Historically Underserved Traditional Local Communities in the project areas. ESS8 Cultural Heritage Since there is no planned construction or major rehabilitation, this standard is not relevant at this time. However, out of an abundance of caution, the ESMF will include measures for “chance finds” of archaeological or other cultural heritage. ESS9 Financial Intermediaries This standard 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: N/A IV. CONTACT POINTS Jun 10, 2021 Page 12 of 13 The World Bank Mauritania COVID-19 Response Project - Additional Financing (P176526) World Bank Contact: Moussa Dieng Title: Senior Economist Telephone No: 5354+4165 / 221-33-8594165 Email: mdieng@worldbank.org Contact: Djibrilla Karamoko Title: Senior Health Specialist Telephone No: 5352+4208 / 221-33-8594208 Email: dkaramoko@worldbank.org Borrower/Client/Recipient Borrower: Islamic Republic of Mauritania Implementing Agency(ies) Implementing Agency: Ministry of Health V. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Public Disclosure Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Djibrilla Karamoko, Moussa Dieng Practice Manager (ENR/Social) Maria Sarraf Cleared on 25-May-2021 at 08:54:41 GMT-04:00 Jun 10, 2021 Page 13 of 13