Environmental and Social Management Plan (ESMP) Clinic Rehabilitation (St. James Facility) – Dominica OECS Regional Health Project (P168539) June 18, 2020 Table of Contents Chapter 1. Introduction and Background ................................................................................................. 3 Chapter 2. Project Description ................................................................................................................. 5 2.1 Location and Regional Setting .................................................................................................. 5 2.2 Design and Retrofitting ............................................................................................................ 5 2.3 Operation and Decommissioning ............................................................................................. 7 2.4 Project Status ........................................................................................................................... 7 Chapter 3. The Legal and Administrative Framework ............................................................................... 9 3.1 Relevant National Laws and Policies for the project ................................................................. 9 3.1.1 Solid Waste Management Act (2002) .............................................................................. 9 3.1.2 Dominica Solid Waste Guidelines (2014) ......................................................................... 9 3.2 World Bank Social and Environmental Safeguards .................................................................. 10 3.2.1 Safeguard Policies .......................................................................................................... 10 3.2.2 EHS Guidelines ............................................................................................................... 10 3.3 International standards .......................................................................................................... 10 3.3.1 Caribbean Public Health Agency (CARPHA).................................................................... 11 3.3.2 Pan American Health Organization (PAHO) ................................................................... 11 3.3.3 World Health Organization (WHO) ................................................................................ 12 Chapter 4. Potential Environmental and Social Impacts ......................................................................... 13 4.1 Design and Retrofitting .......................................................................................................... 13 4.2 Operation .............................................................................................................................. 13 4.3 Decommissioning................................................................................................................... 14 Chapter 5. Mitigation Measures ............................................................................................................ 15 5.1 Design and Retrofitting .......................................................................................................... 16 5.2 Operation .............................................................................................................................. 18 5.3 Decommissioning................................................................................................................... 20 Chapter 6. Project Management and Institutional Arrangements .......................................................... 22 6.1 ESMP Implementation Responsibilities .................................................................................. 22 6.2 Contractor Responsibilities .................................................................................................... 22 6.3 Supervision, Monitoring and Reporting .................................................................................. 23 Chapter 7. Stakeholder Engagement ..................................................................................................... 24 1 7.1 Disclosure of ESMP ................................................................................................................ 24 7.2 Community outreach ............................................................................................................. 24 7.3 Grievance and Redress Mechanism ........................................................................................ 25 Chapter 8. ANNEXES .............................................................................................................................. 27 Annex 1. Screening Tool for E&S Risks ................................................................................................... 27 Annex 2. Infection and Prevention Control Protocol (IPCP) .................................................................... 29 Annex3. Health and Safety Guidelines for Retrofitting/Rehabilitation of medical facilities .................... 31 Annex 4. Recommended Biomedical Waste Management Procedures .................................................. 37 Annex 5. Due-Diligence for Retroactive Reimbursement........................................................................ 41 2 Chapter 1. Introduction and Background The Government of the Commonwealth of Dominica (GoCD) 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. There are three Components of the OECSRHP, which are: 1) Improved health facilities and laboratory strengthening 2) Strengthening public health surveillance and emergency management and 3) Institutional capacity building, project management and coordination 4) A fourth component, with a zero (0) allocation, called the contingency emergency response component (CERC) will be activated in the event of a nationally declared emergency. The St James COVID-19 center is being done under this 4th component. The St James COVID-19 Center is being done under component 4, the CERC. Under component 4, efforts are to include Emergency Equipment - to enhance health emergency and disaster response efforts. This includes the retrofitting of existing facilities and establishing mobile isolation units to act as part of the Advanced Medical Post, mobile decontamination chambers, stretchers, small equipment, and supplies. At this time, the GoCD is enhancing its capacity to control and mitigate against theCovid-19 (Coronavirus) pandemic by retrofitting the St James facilities (former Ross University Building) to create an isolation unit where COVID-19 patients would be cared for. This activity is centered on the retrofitting the St. James facilities by creating three major areas: ICU for critical care, an area for infected patients requiring hospitalization and, the nurses’ area with clean and dirty service spaces. The adjoining examination center building was included in order to create accommodation for persons requiring quarantine or for provision of overflow space. The environmental and social risks of this activity is 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). The Saint James facility has already completed construction and the GoCD is seeking retroactive reimbursement for costs incurred. To achieve this, this ESMP also provides an update of the status of the project, due-diligence of the works accomplished to date, and the evidence and certification that the facility has and will continue to be undertaken in compliance with applicable safeguards requirements. Based on the screening conducted for this project (see Annex 1), an Environmental and Social Management Plan (ESMP) is required to identify and appropriately manage environmental and social risk. This ESMP is prepared to provide processes that the implementing agencies (Local 3 Government Authorities, and Healthcare Facilities Management) will follow to ensure the protection of healthcare workers, waste handlers, and the community from environmental and social risks associated with the retrofitting of the St. James Facility activity, such as waste management, infection control, health and safety, and providing timely and clear public information. The ESMP will ensure that the retrofitting project is done in compliance with national and regional environmental regulations, and consistent with international best practices and World Bank safeguards policies, and the environmental and social management framework created for the project.1 This ESMP will be disclosed at the project sites and on the GoCD websitewww.dominica.gov.dm, and the records of the disclosure will be documented and recorded. 1 The Environmental and Social Management Framework (ESMF) for the OECSRHP in Dominica can be found at: To be identified by Management of MOHWNHI and PHC at time of need. 4 Chapter 2. Project Description 2.1 Location and Regional Setting The proposed site is the St. James facility (formerly known as the Ross University School of Medicine which is located in Portsmouth towards the northern end of Pickard along the Edward Leblanc Highway (Figures 1 and 2). Access to the buildings is along a secondary public roadway immediately off the Highway. The buildings are part of the former Ross University School of Medicine complex and were used as the training and testing site for students of the University. The proposed site was selected on the basis of the existing infrastructure being suitable to accommodate COVID patients that are required to be quarantined as well as provision of overflow space. Figure 1: St. James Facility Figure 2: Location Map 2.2 Design and Retrofitting Prior to undertaking the retrofitting works a number of site visits were conducted with health care professionals, including infection control staff, the Minister for Health, the Permanent Secretary for Health, the Minister for Public Works, the Permanent Secretary for Public Works, the Minister for Tourism and other technical personnel in the various ministries. The site visits were undertaken in order to establish the accommodation capacity of the facilities, the upgrades required to transform the facilities into functional health care facilities and, to plan for the implementation of other related matters while preparing for COVID-19. Designs were prepared by the drafting staff of the Ministry of Health and the Ministry of Public Works, reviewed and approved by the Infection control staff. The site was also visited by PAHO technical personnel, while the retrofit works were being undertaken, who made additional recommendations for better functionality of the space. 5 No site preparation will be required as the site is classified as “a brown field site”. A brownfield site is an area that has been used before and tends to be disused. The St. James Facility was previously used by Ross School of Medicine and as a result all utility services are already available and connected including water and sewerage, electricity, data and telephone (Figures 3 -6). The project will entail minor retrofitting works which will include: • Carpentry (construction of partitions for separation of spaces and installation of doors to create safe zones, construction of cupboards, painting, etc.), • Plumbing works (installation of toilets, hand wash basins, showers, installation of sluice basins, erection of security fence, etc.) • Electrical works (additional lighting and switches, 110/220v sockets outlets, water heaters, control panels), • Air Conditioning (supply and installation of split units, cleaning and maintenance of existing units). Figure 3: Access Road Figure 4: Existing Building Figure 5: Existing Building Figure 6: Existing Building 6 The urgent nature of retrofitting the St. James Facility, requires the Ministry of Health to engage the services of experienced contractors with whom they have an established working relationship. Where applicable, the retrofitting works will comply with the relevant planning, environment and health laws of Dominica and World Bank Environmental and Social Standards. 2.3 Operation and Decommissioning The St. James facility will be operated as stand-alone facilities and the day to day operations of the facility will be managed by the Ministry of Health, Wellness and New Health Investment personnel. Additionally, the CDC Interim Infection Prevention and Control Recommendations for patients with confirmed COVID-19 or persons under investigation for COVID-19 in Healthcare Settings will be implemented (Annex 2). The operational hours will be 24 hours, until the Ministry has deemed that the facilities are no longer required to support the COVID 19 pandemic. Sanitation/medical waste will have been collected in sealed waste bins, stored and disposed of in accordance with established Ministry of Health, Wellness and New Health Investment guidelines and at disposal site authorized by Dominica Solid Waste Management Corporation (DSWMC). This facility is an integral component of the Ministry’s strategy to control the spread of COVID 19 as it will offer the government of Dominica the option of safely isolating affected patients from the general population in keeping within the WHO quarantine protocols and not burden the health care facilities at New Dominica China Friendship Hospitals. The decommissioning of facility will be authorized by the Ministry of Health, Wellness and New Health Investment and will be undertaken by a preferred contractor or the maintenance staff of the main hospital. Decommissioning will entail complete sanitization of the building. 2.4 Project Status The Saint James facility was retrofitted at a cost of approximately US$134,650.53 (EC$361,967.54). The works have already been completed and GoCD is seeking retroactive reimbursement for costs incurred. To achieve this, this ESMP also provides an update of the status of the project, due diligence of the works accomplished to date, and the evidence and certification that the facility will continue to be utilized in compliance with applicable safeguards requirements. Annex 5 of this ESMP 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 retrofit of the Saint James facility. This Due-Diligence is based on a review of the available information related to the Saint James facility, and a site visit by the Safeguards Specialist(s) assigned to the project by the GoCD. It 7 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. 8 Chapter 3. The Legal and Administrative Framework This ESMP is developed in line with relevant laws and regulations of Dominica and the World Bank Environmental and Social Standards (ESS) and Environmental, Health and Safety Guidelines. A more comprehensive review of the policy, regulatory and legal framework in Dominica are described within the general ESMF for the OECS Regional Health Strengthening Project. The current ESMP deals with those most relevant to the proposed isolation unit and response to covid-19 pandemic, in particular biomedical waste management, health reporting, quarantine laws, etc. 3.1 Relevant National Laws and Policies for the project 3.1.1 Solid Waste Management Act (2002) Provided storage facilities for solid waste; (b) procure equipment for the collection, transportation and disposal of solid waste; (c) provide collection and storage facilities at ports, and anchorages for the reception of ship-generated waste; develop and manage new sanitary landfill sites and other disposal methods; (g) provide facilities for the treatment and disposal of biomedical and hazardous wastes; (h) introduce measures to encourage recovery of recyclable items from solid waste 3.1.2 Dominica Solid Waste Guidelines (2014) Provides strategic direction for waste minimization, collection and disposal of solid waste, including hazardous wastes. Bio-medical waste is considered hazardous and must be managed in accordance with Environmental Health Guidelines. Biomedical waste includes: • Equipment, instruments, utensils, and formites of a disposable nature from the rooms of patients who are suspected to have or have been diagnosed as having a communicable disease and must, therefore, be isolated as required by public health agencies; • laboratory wastes, such as pathological specimens (e.g., all tissues, specimens of blood elements, excreta, and secretions obtained from patients or laboratory animals) and disposable fomites (any substance that may harbor or transmit pathogenic organisms) attendant thereto; • surgical operating room pathologic specimens and disposable fomites attendant thereto, and similar disposable materials from outpatient areas and emergency rooms. Dominica has developed guidelines for infection control for the prevention of health care related diseases and conditions and includes management of medical waste at the point of generation (Infection Prevention and Control Manual-2015 Edition). Health care staff are familiar with these guidelines and facilities are provided for adhering to these guidelines. The draft plan for health care waste management requires formal review and adoption. A summary of recommended biomedical waste management practices is included in Annex 4. 9 In Dominica, laboratory waste is treated prior to disposal, other biomedical waste generated nationally is not being treated. Medical waste generated at the main hospital is presently being disposed at the national landfill in a special hole dug for that purpose and covered after disposal. Waste generated at other facilities, including private facilities, are collected in the general waste stream and disposed in the landfill. The Investment and Social Services with the assistance of PAHO is presently installing two incinerators at the New China Friendship Hospital that will serve as the disposal site for medical waste. These incinerators have been installed and are expected to become operational soon. 3.2 World Bank Social and Environmental Safeguards 3.2.1 Safeguard Policies The WBG has developed Safeguard Policies that guide the development of projects including the OECSRHP. Most relevant to the project is OP4.01 (Operational Policy 4.01), which requires environmental and social assessment of any proposed project. Accordingly, the ESMF was prepared for the OECSRHP as a guidance document, and currently the ESMP has been prepared for this project. World Bank Environmental and Social Standards (ESSs) triggered by COVID 19cover aspects such as land acquisition, labour, community health, pollution prevention and management, public disclosure, natural habitat, and antiquities protection, among others. For a thorough discussion of these, please refer to the ESMF document or the WBG website.2 3.2.2 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 project, particularly such aspects as dust and noise control and worker health and safety. Quite relevant to the project are the sector specific WB 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.3 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 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: 2 https://projects.worldbank.org/en/projects-operations/environmental-and-social-policies 3 https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainability-at- ifc/policies-standards/ehs-guidelines 10 1. Guidance on Management of Solid Health-care Waste at Primary Health-care Centres4 2. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings5 3. Standard Operating Procedures (SOPs) for autoclaves, incinerators, and ventilation systems. These SOPs should be supplied with the equipment along with the necessary training. 3.3.1 Caribbean Public Health Agency (CARPHA) On March 11, 2020, the World Health Organization (WHO) announced that this 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 date6: • 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 IMPACS 3.3.2 Pan American Health Organization (PAHO) The Pan American Health Organization (PAHO) has developed specific technical guidance for COVID 197: • Biosafety • Clinical Management • Detection and Diagnosis • Disability related information • Ethics • Emergency Medical Teams (EMT) – Medical Surge • Essential Medicines • Prehospital Emergency Medical Services Readiness • Health Workers 4 http://www.who.int/water_sanitation_health/publications/manhcwm.pdf 5 https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html 6 https://www.carpha.org/What-We-Do/Public-Health/Novel-Coronavirus 7 https://www.paho.org/en/technical-documents-coronavirus-disease-covid-19 11 • 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 Organization (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 guidance8: • 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 • Infection prevention and control / WASH • Guidance for schools, workplace & Institutions • Points of entry / mass gatherings • Health Workers • Maintaining Essential Health Services and Systems 8 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance 12 Chapter 4. Potential Environmental and Social Impacts Notwithstanding the numerous positive benefits expected to accrue from the project, 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 potentially negative impacts from the perspective of retrofitting, operating, and decommissioning of the St. James Facility. Mitigation measures for each of the risks identified are presented in Chapter 5. 4.1 Design and Retrofitting The retrofitting of the facility has potential issues that need to be addressed, that are typical for any kind of activity involving minor physical works. The potential negative impacts for the project are: • There are also occupational health and safety risks typically associated with retrofitting works such as those arising from not using safety equipment (PPE), or workers not properly operating tools/equipment within manufacturers standard operating procedures. • Biomedical waste generated by the facility must be collected in a sealed waste bin, stored in a secure area, transported and disposed of in accordance with Ministry of Health, Wellness and New Health Investment, New Dominica China Friendship Hospital and biomedical waste guidelines and procedures. The current installation and commissioning of incinerator will facilitate safe disposal of biomedical wastes. The disposal of biomedical waste ash from the incinerator must be at a disposal site approved by the Dominica Solid Waste Management Corporation. • Retrofitting waste and debris will need to be disposed of properly as will any hazardous material such as asbestos, mercury, chemicals which may also be used, as well as items such as paint, adhesives or glue, plastics, and other solid waste or debris. • Diesel generators may also be used for power or emergency back-up, requiring adequate ventilation, fuel storage, and safety measures. The works for the clinic 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. 4.2 Operation Once operational, the facility will generate quantities of biomedical waste that require proper treatment and disposal. These may include sharps, infectious wastes, chemical or pharmaceutical waste, as well as non-hazardous or general waste. The health and safety of health 13 care workers could be affected by improper waste management practices as well as by poor hygiene conditions, non-compliance with isolation and storage procedures for bio-infectious, radiologic or genotoxic waste. Such risks, if not mitigated, may also affect nearby communities. 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 of facility is fenced to prevent unauthorized access and keeping the general public out. Operation of the autoclave and/or incinerator is also a source of risk if not properly done. Air pollution from particulate matter, or runoff of ash or waste to nearby drains or canals, could occur if not properly controlled. Thermal injuries, or chemical burns could also arise in the context of disinfection, sterilization or waste treatment activities. If the incinerator or autoclave area is offsite then describe how biomedical waste will be stored, transported, and disposed of at the offsite location. 4.3 Decommissioning Once the facility is no longer being used, there still may be environmental and social risk or impacts remaining on the site. Potential health risks could arise from opening the area to the general public without proper disinfection and establishing precautionary measures to safely access the site. The grounds must be adequately sanitized, waste materials removed and disposed of at a disposal site approved by the DSWMC, and supplies and equipment must be safely stored or transported elsewhere for storage. 14 Chapter 5. Mitigation Measures This section of the ESMP provides the mitigation measures to address each of the environmental and social risks identified in Chapter 4. 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: 1. Management of environmental and social issues related to the retrofitting of the facility and associated equipment. 2. Disposal of retrofitting waste and debris, control of noise, dust and traffic, restrictions of public or visitor access or entry, occupational health and safety. 3. Management of environmental and social issues related to the operation and decommissioning of the facility and associated equipment. 4. Procedures for managing biomedical waste management on site, liquid and solid wastes, autoclaves, incineration, waste pits, landfills, and/or other disposal locations. 5. Maintenance and care standards for biomedical waste treatment equipment, i.e. autoclave and incinerator, air handling and filtration equipment, wastewater collection and disposal systems. 6. 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. 7. Training on occupational health and safety (equipment operations, Personal Protective Equipment) for public health staff, contractors, visitors and workers. 8. Reporting requirements within and between facility and the Ministry of Health, Wellness and New Health Investment and the OECS Regional Health PIU. 9. Dissemination of project information to sensitize the public on infection control precautions within the location(s) of the facility through posters, communications via the mass media, and other means using messages compatible with Ministry of Health, Wellness and New Health Investment messaging advice. Detailed/specific mitigation measures are provided in the sections 5.1, 5.2 and 5.3 below for retrofitting, operation and decommissioning, respectively. Additional mitigation measures are provided in Annex 3 of this ESMP. 15 5.1 Design and Retrofitting Aspect Potential Impacts Proposed Mitigation Retrofitting building There may be Conduct community outreach once site has been concerns and finalized. Follow the level of outbreak guidance on complaints from Risk Communication and Community engagement persons living in (RCCE) readiness and response to the 2019 novel close proximity or coronavirus (2019-nCoV) published by the Ministry neighboring of Health, Wellness and New Health Investment. community about potential impacts of COVID 19 Hazardous materials The risk of • Avoid the storage of hazardous substances handling, storage, use accidental discharge around water bodies and transportation of hazardous • Ensure that storage containers of hazardous products, leakage of substances are always in good condition and hydrocarbons, oils tightly closed. or grease from • Ensure that storage facilities are provided construction impervious surfaces and bunds to control spill machinery in case of accidental spillage . • Develop spill response plan as part of the construction ESMP • Secondary containment for fuels to avoid spill contamination and inspect during operation • Training in fuel and waste handling should be part of the orientation for workers • Maintain Material Safety Data Sheets (MSDS) for hazardous materials onsite Retrofitting Wastes and • Improper • The contractor shall handle construction Debris storage and/or materials and waste in accordance with disposal of approved Ministry of Health, Wellness and New materials Health Investment/ New China Friendship • Dispersion of Hospital procedures, as well as Dominica Solid materials in Waste Management Corporation (DSWMC). nearby canals, • The contractor should only dispose of materials ditches, sea, in areas approved by the DSWMC. streets and • The contractor shall contain excavated adjacent materials in the vicinity of the worksite within properties berms to prevent dispersion and sedimentation of drains, creeks, streets and adjacent properties • In case of accidental waste dispersion, the relevant environmental authority shall be informed, and restoration measures shall be applied. 16 Aspect Potential Impacts Proposed Mitigation Dust and noise from • Poor air quality • Dust masks / respirators when working in retrofitting activity due to closed areas such as access manholes, etc. emissions from (according to approved procedures) vehicles and • Document requirements and standards in the dust generated Contract • Respiratory • Hearing protection for working around impacts on site machinery where the noise exceeds 85 dB workers, nearby (according to approved procedures) residents and • The location of noisy tools (including pedestrians generators) can be positioned away from • Noise sensitive sites such as schools’ and residential generation from areas etc. the use of tools • Maintain vehicles and Contractors machinery and equipment according to maintenance requirements. with its impact on workers and neighborhoods Community Health and • Movement of • Ensure that a Traffic Management Plan is in Safety supply vehicles place where this might be an issue. and equipment • Ensure that sites are properly barricaded during may cause construction and temporary pedestrian traffic problems walkways are provided when required and create • Restrict hospital staff and public from going to unsafe the construction site during and outside situations for working hours by placing posters, reflecting local motorists. tapes and erecting barriers. • Unauthorized • Contractor must develop a Community Health entry of local and Safety Plan (CHSP). persons may place them in jeopardy if they are on work locations. Worker health and Workers accidents • Train workers on prevention of accidents and safety on the construction managing incidents. site • Workers must wear personal protective equipment (PPE). • Provide first aid kit and emergency plan for accidents or incidents • Proper supervision of the construction workforce. Worker health and Exposure and For COVID -19 management on the construction Safety – COVID19 Risks spread of infection site follow the infection control protocol in Annex 2 and 3 of this ESMP. 17 Aspect Potential Impacts Proposed Mitigation Medical Waste Improper handling A Medical Waste Management Plan for handling Management of medical waste any items during the site preparation could expose nearby communities or workers to infection During retrofitting works, installation of equipment and making ready the facility, the contractor may have to deal with medical waste. In this case the following shall be applied: • The contractor shall provide the contracting officer with a biomedical waste management plan as part of a site waste management plan that conforms to the waste management policies and regulations of the relevant authorities. The plan shall include a description of how these wastes will be stored, collected and disposed of in accordance with current law. The contractor must ensure that all persons handling biomedical wastes are provided with proper protective clothing. All biomedical wastes must be secured in specially labelled and sealed containers, and disposed of according to relevant local legislation at specified disposal sites. Biomedical wastes must be kept separate from the other waste streams on site. • The waste management plan provided by the contractor must ensure that all persons handling biomedical wastes are provided with proper protective clothing and equipment. All biomedical wastes must be treated as hazardous. All medical wastes must be secured in specially labelled and sealed containers separate from other wastes streams. All biomedical wastes must be disposed of according to Ministry of Health, Wellness and New Health Investment/ New China Friendship Hospital procedures, as well as Dominica Solid Waste Management Corporation (DSWMC) at specified disposal sites. 5.2 Operation Aspect Potential Impacts Proposed Mitigation Community Exposure of visitors • Control and restrict access to the facility following Health and COVID-19 protocol and guidance from the WHO for Safety health facility, and the COVID-19 risk communication package for healthcare facilities. • Implement the Infection control protocol in the annexes of this CERC-ESMF. 18 Aspect Potential Impacts Proposed Mitigation Occupational Injury to healthcare • Train staff on how to use PPE and ensure there is Health and workers adequate supply Safety • Regularly monitor performance and conduct Infection of health maintenance of equipment care workers • 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 and Ministry of Health, Wellness and New Health Investment/ New China Friendship Hospital. Biomedical Exposure of nearby • Use procedures from the Ministry of Health, Wellness Waste communities and New Health Investment/ New China Friendship Management Hospital, WHO, PAHO, CARPHA, and national plans to Exposure of workers properly classify, segregate, label, store, handle, and dispose of biomedical wastes • Provide training on waste management and infectious disease management training and surveillance programs Air emissions Air pollution from • Ensure the SOPs from the incinerator supplier are from inadequate followed and that training is received from supplier incinerator incineration of • Sensitize and train staff to adequately segregate, waste store, and transport the waste to the incinerator and/or autoclave • Provide appropriate breathing masks/respirator to incinerator operators and other staff that work near the incinerator • Regularly monitor and maintain incinerators to ensure they are working properly in accordance with SOPs Air emissions Spread of airborne • Control airflow and provide filtration for from isolation particles or aerosols intake/exhaust unit filtration • Manage air filters as medical waste systems • Regularly monitor and maintain the filtration system to ensure they are working properly in accordance with SOPs 19 Aspect Potential Impacts Proposed Mitigation Hazardous Spread of infection • Liquid wastes to be stored, neutralized, and disposed liquid waste Contamination of of so that it is not infectious management streams or • Sensitize staff to avoid spillage of wastewater on the groundwater ground surface • Sensitize staff and users of the facility to appropriately use the wastewater collection and disposal facilities Non- Unintended mixing • Segregate liquid and solid wastes where possible hazardous of wastes, vector • Construct the septic tank and soak-pit according to the liquid and control, waste and design specifications solid waste debris 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 budgeted for maintenance Traffic Unauthorized entry • Control visitor access and movement into and out of Management to facility of vehicles the facility and surrounding areas and Access or persons • Establish dedicated loading and unloading areas for Control supply vehicles and emergency vehicles. Community Misinformation • Develop and implement a communication plan for all Concerns on about the spread of media types with key messages on prevention for COVID -19 the disease may facility visitors, local community, and national level result in the public following the tool from the WHO “Risk Communication not taking the and Community Engagement (RCCE) Action Plan appropriate Guidance COVID-19 Preparedness and Response” preventative • The plan will target the general population as well as measures, which may specify messages for key vulnerable populations result in the isolation groups such as the elderly and their careers. The plan facility being will take guidance from WHO COVID-19 guidance for overwhelmed with preventing and addressing and stigma and cases. WHOCOVID-19 risk communication package for healthcare facilities 5.3 Decommissioning After the facility is finished operating, it will be decommissioned. The building and grounds must be adequately sanitized, waste materials removed and disposed of, and supplies and equipment must be safely stored or transported elsewhere. Similar precautions should be applied as during the operations of the facility. The table below outlines the necessary mitigation measures to be applied during decommissioning of the St. James Facility. Aspect Potential Impacts Proposed Mitigation Site clean-up Risk of infection from • Incinerate or bury contaminated solid waste and contaminated runoff, dispose ash in approved sites dust, or soil • Remove or seal and encapsulate any wastewater system elements 20 Aspect Potential Impacts Proposed Mitigation Contaminated Risk of infection from • Provide appropriate PPE for staff for cleaning equipment contaminated equipment used in all areas used equipment • Clean all equipment used following standards provided by Ministry/ New Dominica China Friendship Hospital and WHO, PAHO and CARPHA. 21 Chapter 6. Project Management and Institutional Arrangements 6.1 ESMP Implementation Responsibilities The overall responsibility of ensuring that the mitigation measures under this ESMP are implemented are with the OECS Regional Health Project PIU and the Project Coordinator. The figure below provides an overview of the structure that will support and implement the OECSRHP Project as a whole in Dominica. The PIU will have the overall responsibility for project implementation. The Project Implementation Unit (PIU) will be physically located at the New Dominica China Friendship Hospital. A Project Manager will lead the day-to-day implementation of the project and will report to the Permanent Secretary in the Ministry of Health, Wellness and New Health Investment on the coordination of efforts with other partners, and for technical coordination of activities financed under the project. The PIU team will include the following specialists: • Monitoring and Evaluation Specialist • Project Financial Management Specialist • Procurement Specialist In addition, an Environmental and Social Specialist will be included in the PIU team and will be responsible for monitoring the Project and implementing the ESMF, including supervision of construction works to verify compliance with the applicable BMP and mitigation measures, Workers’ Code of Conduct and with the Project-level GRM, as well as with the Contractor-level GRM. Additionally, the Environmental and Social Specialist(s) in the PIU will also be responsible for all consultation and stakeholder engagement activities. Furthermore, the PIU team will be supported by technical staff of the Investment for specific areas of the project, such as health financing, public health, human resources for health, health information systems, epidemiology, among others. Additional technical support will be provided by the Implementation Support Team (IST). 6.2 Contractor Responsibilities Engagement of Contractors will be managed by the OECS Regional Health Project PIU. Standard environmental and social related clauses will be developed and appended to or incorporated into contracts and shall remain in force throughout the contract period. This will include but not be limited to: • Permits and Approvals • Site Security 22 • 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 • Traffic Management • Management of Standing Water • Management of Solid Wastes, trash and debris • Management of Liquid Wastes • Management of Medical Waste during construction It is expected that these generic clauses will be incorporated into all contracts, as applicable. In addition, specific project-related recommendations may also be forthcoming from statutory bodies that are part of the permitting agencies such as and these can be added to contract clauses as well. For purposes of cost estimation and budgeting, the contractors should be aware of the existence of the environmental mitigation measures and associated ESMP requirements and include cost items for such purposes in their proposals. 6.3 Supervision, Monitoring and Reporting It is the responsibility of the PIU to ensure that the ESMP is being followed by the contractor(s) and site workers. During the construction phase, environmental and social monitoring was carried out by the clerk of works, with support from a Supervision Consultant who was engaged to provide oversight on technical aspects including ESHS. In addition, the contactor was required to prepare and submit reports (monthly/quarterly) to the Supervision Consultant and/or PIU. During the operation phase reporting will occur in relation to management of biomedical waste. 23 Chapter 7. Stakeholder Engagement 7.1 Disclosure of ESMP A variety of methods will be utilized to disclose information to project stakeholders. Disclosed information will allow stakeholders to understand the risks and impacts of the project, and the precautionary measures the Government of Dominica and Ministry of Health, Wellness and New Health Investment is implementing to prevent and avoid the spread of COVID 19. Project information will be disclosed in a variety of ways including on relevant government websites (on the website of the ministries of the participant countries, that will be implementing the project), and local offices, in a manner that is accessible and culturally appropriate, taking into account any specific needs of groups that may be differentially or disproportionately affected by the project or groups of the population with specific information needs (such as, disability, literacy, gender, mobility, differences in language or accessibility). The ESMP was disclosed on the GoCD website at www.dominica.gov.dm A printed copy of the ESMP is available at: Office of the Project Coordinator Ministry of Health, Wellness and New Health Investments Dominica China Friendship Hospital Goodwill Roseau Commonwealth of Dominica 7.2 Community outreach Under conditions of a COVID 19 outbreak a common approach to stakeholder engagement where large gathering of the public is encouraged will need to change. There are numerous alternatives, but 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. Every alternative must still include what feedback and suggestions were provided by stakeholders. Some suggestions 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 in an outside area which chairs place 6 feet apart; 24 • If in person meetings are not permitted, make efforts to conduct meetings through online channels, including webex, zoom and skype; • Try social media and online channels to share activity information. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose; • 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 this 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 project and its associated activities may have some short term and reversible impacts. In order to ensure the implementation of the Project in a timely manner and effectively address any anticipated and unanticipated risks that would be encountered during implementation, including the development of the necessary actions of mitigation and avoidance, a robust Grievance Redressal Mechanism (GRM) was developed and is outlined in the OECS Regional Health ESMF. The Grievance Mechanism for the project will be the same as that used in the OECS Regional Health Project. The GRM will enable the OECS Regional Health PIU to address any grievances against the Project. It must be noted that this GRM covers grievances that relate to the impacts that the project may have on people and communities. The PIU will be responsible for registering, tracking, addressing and resolving any complaints raised by individuals or groups. The required grievance reports will report issues and will include a name, date and contact information with a detailed description of the case and complainant. It is expected that there will be a normal response time of 7 days for each case; however high- level cases may require up to 14 or more days to respond. The PIU will report high level cases to the WB where necessary. The PIU will maintain a Data Base, managed by the administrative Officer, to log all complaints and to track each from date received to date resolved and highlight how each case was investigated and resolved. If not resolved, or in case the complainant does not feel comfortable filing a complaint with the PIU, the complainant can access directly the 25 Permanent Secretary of the Ministry of Health, Wellness and New Health Investment, who will engage with the PIU Project Manager. These complaints will also be recorded and tracked by the Administrative Officer. All GRM records will be available to WB staff during supervision missions. Relevant points to underscore in the context of the project include: • Information about the Project level Grievance Redress Mechanism within the PIU will be provided to the community via notice boards as the facility and on printed material as relevant. • The contact details for submitting complaints under the project are as follows: a. Physical address for sending a letter, or coming in person: Send Letter to: Project Coordinator Ministry of Health, Wellness and New Health Investment Fourth Floor Government Headquarters Kennedy Avenue, Roseau Commonwealth of Dominica In Person: Office of the Project Coordinator Ministry of Health, Wellness and New Health Investments Dominica China Friendship Hospital Goodwill Roseau Commonwealth of Dominica b. Phone number(s)- can receive text message complaints: 1 767 275 8352 c. Email address that is checked frequently: hendersons@dominica.gov.dm sonsyl900@gmail.com 26 Chapter 8. ANNEXES Annex 1. Screening Tool for E&S Risks The form below identifies potential impacts of the proposed activities envisioned under CERC actions. 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 high risk. The project is determined to be of Moderate to Substantial risk (shaded box below) and therefore this ESMP was prepared. Subproject Name Subproject Location Subproject Proponent Estimated Investment Start/Completion Date Subprojects / Activities Potential E&S Risks or Impacts E&S Risk Level 1 Purchase of medical equipment and supplies None Low 2 Repair of damaged infrastructure including, Increased dust, noise, water Moderate but not limited to water supply and pollution, solid/hazardous/ sanitation systems, dams, reservoirs, canals, Toxic wastes, waste oil/fuels, roads, bridges and transportation systems, public health and safety; possible energy and power supply, use of asbestos contaminated as telecommunication, and other infrastructure construction materials and land damaged by the event; acquisition; 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 urban drainage); 4 Repair of damaged public buildings, Same as (2) above Moderate including schools, hospitals and administrative buildings; 5 Repair, restoration, rehabilitation, retrofit, Same as (2) above Moderate schools, clinics, or hospitals; 6 Establishing emergency isolation and Highly variable depending on Moderate to substantial quarantine facilities and locations for mobile locations chosen, risks associated facilities. with community concern, information sharing, and occupational health and safety. 7 Removal and disposal of debris associated Waste management and disposal Moderate to substantial with any eligible activity 8 Disposal of medical wastes (at camp site, Increase health risks, need Moderate to substantial small clinic/hospitals), asbestos-based management of medical waste, materials, other toxic/hazardous wastes toxic materials, asbestos- contaminated debris 27 9 Temporary toilets for emergency facilities Hygiene, waste management Moderate to substantial Activities and actions with low potential E&S risk require no further safeguards actions. Those with moderate potential risk will be managed using the general ESMF for the OECS Regional Health System Strengthening project, and will typically require that an ESMP be developed. Those with moderate to substantial potential risk will be managed using the tools in the general ESMF for the OECS Regional Health Project along with the additional safety guidance and information provided in this CERC-ESMF, and in the case of the Saint James facility also required that this ESMP be developed. 28 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) • 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. 29 • 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. 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 • 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. 30 Annex3. Health and Safety Guidelines for Retrofitting/Rehabilitation of medical facilities The following table lists the health and safety risks and impacts associated with small civil works financed by the Bank for retrofitting and rehabilitation of medical facilities (including isolation units and respiratory facilities) in response to the COVID-19 outbreak. Potential mitigation measures and references to sources of additional advice and information are provided as guidelines for the PIU to use in preparing the appropriate environmental instrument such as the Environmental and Social Management Plan (ESMP). Activity Risks and Impacts Mitigation Measures Design activity – The focus on Ensure that the designs for medical facilities also consider the collection, segregation and hospitals, clinics treatment and care is treatment of medical waste. progressed The treatment of healthcare wastes produced during the care of COVID-19 patients should disproportionately be collected 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 adequate medical and particulate matter, and result in unacceptable cancer risks under medium (two hours waste infrastructure. per week) or higher usage. If 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: ü effective waste reduction and segregation, ensuring only the smallest quantities of combustible waste types are incinerated; ü an engineered design with sufficient residence time and temperatures to minimize products of incomplete combustion; ü siting incinerators away from health-care buildings and residential areas or where food is grown; ü construction using detailed engineering plans and materials to minimize flaws that may lead to incomplete destruction of waste and premature failures of the incinerator; ü 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; ü periodic maintenance to replace or repair defective components (including inspection, spare parts inventory and daily record keeping); and 31 Activity Risks and Impacts Mitigation Measures ü 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. 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 ESS5 and IPF Policy para 12 on E&S requirements in situations of urgent need of activity – construction of new assistance. hospitals, clinics, and expansion of mortuary existing hospitals. Apply ESHGs to implementation of projects. 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 operation of facility and the used at medical facilities. Isolation rooms should: facilities, operating ü be single rooms with attached bathrooms (or with a dedicated commode); including triage, procedures will help ü ideally be under negative pressure (neutral pressure may be used, but positive isolation (or prevent spread of pressure rooms should be avoided); quarantine) infection ü be sited away from busy areas (areas used by many people) or close to vulnerable or facilities high-risk patients, to minimize chances of infection spread; ü have dedicated equipment (for example blood pressure machine, peak flow meter and stethoscope), but should avoid excess equipment or soft furnishings; ü have signs on doors to control entry to the room, with the door kept closed; ü have an ante-room for staff to put on and take off PPE and to wash/decontaminate before and after providing treatment. 32 Activity Risks and Impacts Mitigation Measures 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: Ø WHO interim guidance on Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; Ø WHO technical brief water, sanitation, hygiene and waste management for COVID-19; Ø WHO guidance on infection prevention and control at health care facilities (with a focus on settings with limited resources); Ø WHO interim practical manual for improving infection prevention and control at the health facility; Ø CDC Guidelines for isolation precautions: preventing transmissions of infectious agents in healthcare settings; and Ø 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 to support and groups (especially vulnerable groups have effective treatment, whether in medical facilities or in the treatment for the elderly or those community. disadvantaged with pre-existing Similarly, where IP communities are involved, need to follow ESS7 and IPF policy Para 12 on vulnerable medical conditions) emergency provision. 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 workers receive the care treatment of COVID-19. needed if infected with COVID-19. Transient and Workers that are Expats or transient workers should adhere to national requirements and guidelines with expat workforce mobilized from respect to COVID-19. abroad or returning Expats or transient workers coming from countries/regions with cases of the virus: 33 Activity Risks and Impacts Mitigation Measures from abroad become • Should not return if displaying symptoms vectors for • Should self-isolate for 14 days following their return transmission of disease to For self-isolation, workers should be provided with a single room that is well-ventilated (i.e., construction with open windows and an open door). If a single room is not available for each worker, projects. Workers adequate space should be provided to maintain a distance of at least 1 m between workers that travel from sharing a room. Workers in isolation should limit their movements in shared space, for other regions may example through timed use of shared spaces (such as kitchens and bathrooms) with also provide a vector cleaning prior to and after use of the facilities. Visitors should not be allowed until the for passing infection worker has shown no signs and symptoms for 14 days, and the number of staff involved in onto work sites. caring for those in isolation should eb 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 COVID-19 and the arrangements for medical waste, which may increase in volume and which can remain infection of large infectious for several days (depending upon the material). numbers of people. Ensure medical facilities are stocked with adequate supplies of medical PPE, as a minimum: ü Gowns, aprons ü Medical masks and some respirators (N95 or FFP2) ü Gloves (medical, and heavy duty for cleaners) ü Eye protection (goggles or face screens) ü 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: 34 Activity Risks and Impacts Mitigation Measures • 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) • 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) References and sources of further information 35 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 36 Annex 4. Recommended Biomedical Waste Management Procedures 37 38 39 40 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 design and construction of the Saint James facility. This Due-Diligence is based on a review of the available information related to the facility, and a site visit by the Safeguards Specialist(s) assigned to the project by the GoCD. 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 reference the major safeguards elements for screening, design, supervision, and construction elements covered in the ESMP. (The elements for operations and decommissioning are also described in the ESMP but will be verified in future once the facility is operational.) For each of the major ESHS elements within the ESMP related to design and construction, 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. 41 Table 1. Compliance Checklist ESHS Element Due-Diligence Aspect / Issue Compliance Variance / Explanation Status SCREENING Was the sub-project screened No / Partly The screening was done using the ESMF screening Satisfactory after site selection and is 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 of ESHS requirements? Satisfactory 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 No / Partly The final stages of the and restored, all wastes Satisfactory project are underway and removed, and ready for will include clean-up operation? Were any biomedical wastes No / Satisfactory None encountered and if so were they managed appropriately as described in the ESMP? SUPERVISION Was there a Supervisor Yes / Satisfactory A clerk-of-works was on site. encharged with ESHS on the site? Were supervision reports No / Partly No reports are available but prepared and were they Satisfactory a discussion with the clerk- available for review? of-works did not reveal any issues during construction. 42 ESHS Element Due-Diligence Aspect / Issue Compliance Variance / Explanation Status PUBLIC Was the ESMP disclosed on No / Partly Publication will be done INFORMATION the GoCD 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 received No / Satisfactory None about the project? III. ACTION PLAN Not applicable. Table 1. Action Plan IV. SIGNATURES The inspection and due diligence was conducted by and approved by the following individuals: Name: Name: Title: Title: ___________________________________ ___________________________________ Signature/Date Signature/Date V. PHOTOGRAPHS AND OTHER DOCUMENTARY EVIDENCE Attach or refer to site photographs, inspection records, and/or other relevant information. Provide annotations and use as support for compliance and explanation for pending items 43