MINISTRY OF HEALTH ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN (ESMP) FOR THE MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEM PREPAREDNESS PROJECT (MCERHSPP) QUEEN ELIZABETH CENTRAL HOSPITAL PROJECT ID NO.: P173806 REPORT January 2025 Submitted by Green Arch Designs P O Box 31655, Blantyre Executive Summary This Environmental and Social Management Plan (ESMP) is for the rehabilitation of Queen Elizabeth Central Hospital through the Malawi Covid-19 Emergency Response and Health System Preparedness Project (MCERHSPP), under the Ministry of Health. The MCERHSPP objective is to prevent, detect and respond to the threat posed by COVID-19 (Coronavirus) and strengthen national systems for public health preparedness for future pandemics. The Rehabilitation works at Queen Elizabeth Central Hospital shall involve refurbishments of the following 6 major areas namely, Ward 4A, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors. The rehabilitation works for Ward 4A shall include demolition and extension to the ward from a total floor area of 560sqm to 674sqm. At the Main Operating Theatre, works will mainly focus on improving the interior finishes to render them fit for theatre purposes, resulting in additional 90sqm to the main building. The rehabilitation works in the kitchen involves stripping off all finishes which includes, worktops, removal of all sanitary ware, replacement of cold rooms and repurposing of some spaces to create more storage space for kitchen supplies. The works at Clinic Area shall involve reroofing of the area over the diabetic clinic which is about 160sqm and new floor finish. The sewer line works will focus repairing areas that are servicing the clinic area, kitchen, main operating theatre and ward 4A. Works will involve rerouting of some blocked pipes by building of new manholes and installing new pipes. The rehabilitation of corridors will focus on areas leading to the clinic area, kitchen, main operating theatre and ward 4A. Works will involve painting and replacement of broken glass panes. The rehabilitation works will last for a period of 12 months, starting from November 2024 to October 2025, and will cost MK2,600,745,000.00. A budget of MK62,760,000.00, has been set aside to facilitate implementation of the ESMP. The ESMP will be implemented concurrently with the construction activities over the same 12-month timeframe. The Environmental and Social Assessment was conducted through desk studies, physical inspection of the site and surrounding areas and stakeholder consultations, and in accordance with the Terms of Reference provided for this assignment and the Environmental and Social Management Framework. The assessments showed that the project activities will generate different environmental and social impacts in the project area and beyond. Some of the impacts will be positive while others will be negative. The extent and significance of the impacts were also assessed, and measures were proposed i to enhance the positive impacts and mitigate the negative impacts. The key impacts identified are presented as follows: Planning Phase i. Creation of Job Opportunities: The project will create short-term job opportunities, employing around three hundred (skilled and unskilled) workers for not less than 200 days. ii. Skills transfer: Rehabilitation activities will provide opportunities for skills transfer to community members particularly the unskilled workers, an aspect that is crucial for empowerment, economic development, and sustainability iii. Improved Project Compliance to Environmental and Social Legislation: The preparation of this ESMP is a compliance requirement for both local Legislative frameworks, such as EMA of 2017 and the World Bank’s Environmental and Social Safeguards Standards (ESSS) including the World Bank’s Environment, Health and Safety Guidelines of 2007, thus extending to its implementation throughout the project lifespan Demolition and Construction Phase iv. Disturbance and disruption to service delivery: Disturbance and disruption to service delivery during hospital rehabilitation can impact patient care and operational efficiency. v. Temporary Air Quality Deterioration: Air pollution from dust generated by demolitions, rehabilitation works, and heavy machinery is a significant environmental issue that will arise on the project site. vi. Traffic Disruptions: Construction and renovation activities will increase the volume of vehicular traffic around the hospital area. This may congest the roads and affect other road users. vii. Loss of Vegetation and other ground cover: There is possibility of clearing land to create access for the contractor to bring in raw material and remove debris from the rehabilitation site which can have significant environmental impacts, including loss of habitat and reduced biodiversity. viii. Conflicts Over Use of Water and Sanitary Facilities: The construction works will bring in additional water pressure to the facility and also ii increase the inflow of people to toilets. This would eventually create conflicts between workers, staff and patients. ix. Increased Generation of Solid Waste, spills and effluent: The generation of construction and demolition waste comprising of hazardous and non- hazardous waste poses significant problem for waste management, health and safety concerns. x. Visual intrusion: The site is expected not to be pleasant to look at due to construction works such as demolitions, excavations, stockpiling of materials and mixing of concrete. xi. Increased Noise Levels from Machinery and Construction activities: Increases noise levels from machinery and construction activities can negatively impact public health and overall hospital community well- being and induce hearing loss on workers, staff and patients. xii. Increased risk of accidents and injuries on site affecting workers and communities: Accidents and injuries from falling objects, hazardous materials, moving vehicles or equipment during rehabilitation, pose a significant risk to project workers and communities during construction and rehabilitation. xiii. Increased risk of Defilement: the work may experience an increased rate of defilement during the construction period xiv. Increased cases of Gender-based violence (GBV) and Sexual Exploitation and Abuse: The construction site may create environments where GBV and SEA can occur, affecting both workers and the surrounding community. iii xv. Increased soil erosion and sediments into water courses: Soil erosion may be caused by exposure of soil surfaces to rain and wind during site clearing, earth moving, and excavation activities at QECH xvi. Natural Hazard (storms, etc.): Natural hazards, such as earthquakes, floods, hurricanes, cyclones, wildfires, and other extreme weather events, can have significant impacts on hospitals Operation and Maintenance xvii. Increased generation of wastewater: In the operation and maintenance (O&M) phase of hospitals, wastewater generation increases significantly due to the nature of healthcare activities, the size of the facility, and the diversity of operations involved. xviii. Increased demand for energy use and supply: An increase in energy demand during the O&M is typically a result of the continuous energy needs of running hospital services and infrastructure systems, maintaining equipment, supporting a larger workforce, and meeting operational efficiency timelines xix. Increased demand for water supply and use: The increase in water demand during the operation and maintenance phase of this project is primarily driven by the need to sustain operations, maintain equipment, support a growing workforce, comply with environmental standards, and ensure the smooth running of the hospital xx. Increased generation of waste: The completion of new structures shall increase the traffic and demand of service delivery at the hospital. This entails that the generation of wastes shall be increased at the hospital largely during administrative, housekeeping and health care services and maintenance functions. xxi. Air Quality Risks: During operation of the hospital, air emissions may increase from the HVAC systems, ventilation of medical gases and fugitive emissions released from sources such as medical storage areas, isolation wards, medical wards incineration and combustion from power generators. iv xxii. Soil and Water Pollution: In Health care facilities, contaminated wastewater may result from discharges from medical wards and operating theatres (body fluids and excreta, anatomical waste), laboratories, pharmaceutical and chemical stores, cleaning activities and x-ray facilities. xxiii. Increased cases of theft and vandalism: Increased cases of theft and vandalism during operation phase may impact the reputation of the facility and its ability to operate effectively. xxiv. Health and Safety Risks: Health and safety hazards may affect healthcare providers. General health and safety hazards occurring in HCFs include manual handling injuries, such as sprains and strains from lifting and carrying patients; falls, trips, and slips; injuries caused by moving objects; and mental stress. xxv. Increased amount of hazardous and medical material storage: During the operation phase of a hospital, the increased storage of hazardous and medical materials is driven by the need to maintain a large and diverse inventory of supplies and materials essential for patient care, medical treatments, research, and hospital operations v Table of Contents Executive Summary .................................................................................................. i List of Tables ............................................................................................................. ix List of Figures ............................................................................................................. x List of Annexes ......................................................................................................... xi Acronyms and Abbreviation .................................................................................xii Chapter 1 Introduction ............................................................................................ 1 1.1 Background Information ........................................................................ 1 1.2 Spatial Location and Size of Land......................................................... 2 1.3 Methodology for Preparing ESMP ......................................................... 5 1.3.1 Desk Studies ............................................................................................. 5 1.3.2 Physical Inspection of Project Site ......................................................... 5 1.3.3 Stakeholder Consultations ..................................................................... 7 Chapter 2 Project Description ............................................................................ 8 2.1 Nature of the Project .............................................................................. 8 2.1.1 Description of Rehabilitation Works ........................................................ 8 2.2 Project Cost, Duration and Estimated Number of Employees ......... 10 2.3 Main Activities of the Project ............................................................... 10 2.3.1 Planning and Design Phase ................................................................. 10 2.3.2 Construction phase .............................................................................. 12 2.3.3 Operation and Maintenance Phase .................................................. 15 2.4 Construction Process Inputs and Outputs ............................................... 16 2.4.1 Construction Material............................................................................. 17 2.4.2 Demolition and Construction Equipment........................................... 18 2.4.3 Construction Waste Generation and Management ........................ 19 Chapter 3 Legal and Policy Framework ......................................................... 20 3.1 Relevant Malawi Policies and Legislation .......................................... 20 3.2 Relevance of WB/IFC Environmental and Social Safeguards .......... 32 Chapter 4 Environmental and Social Setting .................................................. 38 4.1 Area of Influence .................................................................................. 38 vi 4.1.2 Physical Environment ............................................................................ 41 4.2 Facility Management and Health Safety Protocols .......................... 44 4.2.1 Water Supply ......................................................................................... 44 4.2.2 Energy Supply (including backups) .................................................... 45 4.2.3 Hazardous Materials ............................................................................. 45 4.2.4 Emergency Prevention and Response ............................................... 45 4.2.5 Sanitation Facilities ............................................................................... 46 4.2.6 Hygiene Practices ................................................................................. 46 4.2.7 Infection Prevention and control ........................................................ 46 4.2.8 Health Facility Capacity....................................................................... 46 4.2.9 Communication and Transport Systems ............................................. 47 4.2.10 Security .................................................................................................. 47 4.2.11 Waste Management ............................................................................ 47 Chapter 5 Assessment of Environmental and Social Impacts ........................... 49 5.1 Impact identification ............................................................................ 49 5.2 Significance Ranking of the Impacts .................................................. 52 5.3 Impact Significance Rating for the Identified Impacts ..................... 55 5.4 Description of Identified Impacts ........................................................ 55 5.4.1 Planning and Design Phase ................................................................... 55 5.4.2 Construction Phase............................................................................... 55 5.4.3 Demobilization Phase ........................................................................... 61 5.4.4 Operation Phase ................................................................................... 62 Chapter 6 Environmental and Social Management Plan .................................. 66 6.1 Environmental and Social Management Plan .................................. 66 6.2 Implementation of ESMP ...................................................................... 66 6.2.1 Ministry of Health ................................................................................... 66 6.2.2 Supervision Consultant ........................................................................... 67 6.2.3 The Contractor ........................................................................................ 68 6.2.4 Hospital Administration /DEHO/ Maintenance Team ....................... 69 6.3 Training and Capacity Building ......................................................... 155 6.4 ESMP Estimated Budget ..................................................................... 158 vii 6.5 Stakeholder Engagement, Grievance Redress Mechanism and Disclosure Process ............................................................................... 159 6.5.1 Stakeholder Engagement .................................................................. 159 6.5.2 Grievance Redress Mechanism (GRM) System ............................... 159 6.6.3 Disclosure Process ............................................................................... 162 Chapter 7 Conclusion and Recommendations ................................................ 163 7.1 Conclusion ........................................................................................... 163 7.2 Overall recommendations ................................................................. 163 References ............................................................................................................ 165 Annexes ................................................................................................................ 167 viii List of Tables Table 2-1: Proposed Rehabilitation Workforce.................................................... 10 Table 2-2: Legal Permits ......................................................................................... 11 Table 2-3: Estimates for Key Construction Materials and Quantities ................. 17 Table 2-4: Summary of Demolition and Construction Materials and Equipment ...................................................................................................................... 18 Table 2-5: Construction Waste and Proposed Management Measures .......... 19 Table 3-6: Relevant Malawi Policies and Legislation .......................................... 21 Table 3-7: Relevance of WB Environmental and Social Standards to the project ...................................................................................................................... 32 Table 3-8: Project Specific EHS standards............................................................ 36 Table 5-9: Potential Interactions of the Project with VECs. ................................ 50 Table 5-10: Impact Assessment Criteria and Scoring System ............................ 53 Table 6-11: Environmental and Social Management and Monitoring Plan ..... 70 Table 6-12: Proposed Training and Capacity Building Approach .................. 156 Table 6-13: Summary ESMP Implementation Budget ....................................... 158 ix List of Figures Figure 1-1: Queen Elizabeth Central Hospital........................................................ 2 Figure 1-2: Topographic Map of Queen Elizabeth Central Hospital. .................. 3 Figure 1-3: Location Map of Queen Elizabeth Central Hospital .......................... 4 Figure 4-4: Land use map for the Area of Impact. ............................................. 40 x List of Annexes Annex 1 - Environmental & Social Screening Form ........................................... 167 Annex 2 - Traffic Management Plan .................................................................. 171 Annex 3 - Technical Drawings for Proposed Ward A4, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors ...................................... 174 Annex 4 - Project Impacts and Ratings ............................................................. 186 Annex 5 - Stakeholder Engagement.................................................................. 200 Annex 6 - Terms of References ........................................................................... 211 Annex 7 - Code of Conduct for Contractor’s Personnel ................................. 214 Annex 8 - Code of Conduct for Contractor in Relation to Child Protection . 216 Annex 9 - GBV Management Plan ..................................................................... 218 Annex 10 - Grievance Reporting Form .............................................................. 220 Annex 11 - Grievance Resolution Implementation Minute (GRIM)................. 222 Annex 12 - Asbestos Containing Material (ACM) Management Plan ........... 224 Annex 13 - Queen Elizabeth Central Hospital (QECH) Relocation Plan ......... 231 xi Acronyms and Abbreviation AIDS Acquired Immune Deficiency Syndrome A&E Accidents and Emergency CEPA Centre for Environmental Policy and Advocacy COVID-19 Coronavirus Disease 2019 CO2 Carbon dioxide DLO District labour Officer DSWO District Social Welfare Officer EDO Environmental District Officer EHS Environment Health and Safety EIA Environmental Impact Assessment EMA Environment Management Act ESA Environmental and Social Assessment ESCP Environmental and Social Commitment Plan ESF Environmental and Social Framework. ESMF Environmental and Social Management Framework ESMMP Environmental and Social Management and Monitoring Plans ESMP Environment and Social Management Plan ESS Environmental and Social Standard FGD Focus Group Discussion GBV Gender-based violence GIIP Good International Industry Practice GRM Grievance Redress Mechanism GRIM Grievance Resolution Implementation Minute (GRIM) HCF Health Care Facility HREP Health Rights Education Program HIV Human Immunodeficiency Virus kgs Kilograms LMP Labour Management Plan MBS Malawi Bureau of Standards xii MCERHSPP Malawi Covid-19 Emergency Response and Health System Preparedness Project MEPA Malawi Environment and Protection Authority MoH Ministry of Health m2 Square meters NA Not Applicable NCIC National Construction Industry Council NOx nitrogen oxides PAD Project Appraisal Document PHIM Public Health Institute of Malawi PPE Personal protective equipment PIM Project Implementation Manual PIU Project Implementation Unit PVC polyvinyl chloride SEA Sexual Exploitation and Abuse: SEP Stakeholder Engagement Plan SH Sexual Harassment SO2 Sulphur dioxide sqm Square meters STI Sexually Transmitted Infections TIA Traffic Impact Assessment VECs Valued Environmental Component WHO The World Health Organization WB World Bank QECH Queen Elizabeth Central Hospital xiii Chapter 1 Introduction This is an Environmental and Social Management Plan (ESMP) for refurbishment works at Queen Elizabeth Central Hospital covering rehabilitation of Ward4A, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors. This Chapter provides an overview of the proposed project, project location, project proponent and objectives and methodology of the environmental scoping study and the potential users of the ESMP. The QECH geographical coordinates are -15.8030374 latitude and 35.0186918 longitude along the M2 road in Blantyre City. 1.1 Background Information The Malawi Covid-19 Emergency Response and Health System Preparedness Project (MCERHSPP) implemented under the Ministry of Health (MoH) seeks to fortify the national framework to detect, prevent, and respond to the ongoing COVID-19 pandemic and future health threats. The project’s development objective is to prevent, detect and respond to the threat posed by COVID-19 in Malawi and strengthen national systems for public health preparedness. The Ministry of Health, through the MCERHSPP initiative, intends to carry out rehabilitation and maintenance works at Queen Elizabeth Central Hospital on Ward 4A, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors. Considering the scale of the proposed civil works and environmental sensitivity at Queen Elizabeth Central Hospital, MCERHSPP recognises the need to assess anticipated positive and negative environmental and social impacts and propose measures for managing such impacts through an Environmental and Social Assessment (ESA) process. This ESMP including other ES documents such as Labour Management Plan (LMP), Stakeholder Engagement Plan (SEP) is a basis for managing, mitigating, and monitoring the environmental and social impacts and risks associated with the construction and operation phases of the proposed project. The objective of the ESMP was to assess and predict potential positive and negative social and environmental impacts (direct and indirect impacts and risks) during both construction and operation and maintenance phase and develop suitable enhancement and mitigation measures as indicated in the environmental and social management plan. The rehabilitation works will last for a period of 12 months, starting from November 2024 to October 2025, and will cost MK2,600,745,000.00. A budget of MK62,760,000.00 has been set aside to facilitate implementation of the ESMP. 1 1.2 Spatial Location and Size of Land Queen Elizabeth Central Hospital is a tertiary referral and teaching hospital in Blantyre City and provides care to the surrounding district hospitals, health clinics and private medical facilities. The hospital lies along the M2 road ( Figure 1-2). The detailed description of these focus areas and the works is given below: Figure 1-1: Queen Elizabeth Central Hospital 2 Figure 1-2: Topographic Map of Queen Elizabeth Central Hospital. 3 Figure 1-3: Location Map of Queen Elizabeth Central Hospital 4 1.3 Methodology for Preparing ESMP Various methods were used to enable the consultants to prepare an ESMP. These include literature review, physical inspection of the site and surrounding areas (focusing on conditions, approximate distances to sensitive receptors, existing management practices etc), stakeholder consultations and expert judgement. 1.3.1 Desk Studies The desk studies involved a review of Project Appraisal Document (PAD), Project Implementation Manual (PIM), World Banks’ Environmental and Social Framework (ESF), WB General EHS Guidelines including WB EHSG for Health Care Facilities , Malawi CERHSPP Environmental and Social Management Framework (ESMF), Environmental and Social Commitment Plan (ESCP), Labour Management Plan (LMP), the Stakeholder Engagement Plan (SEP), and the Socio-Economic Profile (SEP) for Blantyre City Council, relevant Malawi policies and legislation and including Project design documents for the proposed works. 1.3.2 Physical Inspection of Project Site The consultant undertook site investigations to the entire hospital in July 2024 to familiarize and understand the project impact area and the project area of influence, and capture baseline data on the existing environmental and social setting of the proposed project area. The physical inspection involved environmental and social screening to identify potential impacts and recommend appropriate mitigation measures. This analysis focused on environmental, social, health, economic and legal considerations to effectively support decision-making and promote sustainable development. Environmental factors and social factors were meticulously examined to identify and understand impact of project activities on sensitive features and nearby communities respectively. By carefully assessing land use patterns and community dynamics, ensured that proposed works respect and preserve local social structures. During the assessment, health impacts and risks during refurbishment were evaluated to safeguard workers and general community health. The findings of this investigation has been presented in section 4.2 and below is a summary; Power supply: Queen Elizabeth Central Hospital is currently utilizing electricity as main source of energy and Diesel-powered generators as power back up in times of power cuts. The total monthly estimated energy consumption is approximately 23620 KWh. 5 Water supply: Records at QECH indicate that the hospital uses about 19557 m3 per month which is obtained from Blantyre Water Board. The hospital officials indicated that there were substantial cases of leakage within the pipeline system. It is expected that the construction activities will not significantly affect the water supply system at the hospital as rehabilitation activities shall be abstracting water from the nearby Naperi river. Liquid waste: As for liquid waste, mainly from sanitary facilities, the hospital has an arrangement to dispose such waste through the existing Blantyre City Council sewer line that empties the wastewater at a designated waste water treatment plant located at Zingwangwa. Solid waste: QECH waste management system is designed to involve waste identification, segregation, collection, storage and disposal. However, it was observed that processes are faced with lots of challenges. For instance, there are inadequate waste collection bins and bin liners. Most healthcare workers did not display knowledge for undertaking the required processes. The consultant did not find records for specific amounts of waste for various types generated, identified, segregated etc. It was however observed that for non- hazardous solid waste, such as paper and cardboard, kitchen waste and plastics are collected and disposed at Blantyre City Council dumpsite located at Mzedi. Management of Hazardous waste: Queen Elizabeth Central Hospital, as one of the major healthcare institutions in the area, generates a significant amount of hazardous materials. The hospital uses colour coded bins that are lined with leak proof bags to segregate waste and for temporary storage prior to incineration. However, the hospital faces various challenges for it to undertake effective waste segregation ranging from inadequate resources i.e. coded bins, bin liners, public awareness and training for medical personnel. These challenges lead to mixing of waste at times. It is expected that the amount of hazardous waste produced will increase during Operation and maintenance phase. Medical waste: Medical waste disposal is an important process to ensure that hazardous materials are safely handled, treated and disposed. The hospital generates approximately 76, 060 kg of medical waste per annum which is usually incinerated within the hospital. 6 1.3.3 Stakeholder Consultations The consultant held stakeholder consultation meetings between 10th and 16th July 2024. The consultations reached out to various stakeholders like officials at Ministry of Health, MEPA, Blantyre City Council and Civil Society Organizations. Considering that the proposed project will be implemented within the hospital campus, stakeholder consultations were also conducted through key informant interviews and focus group discussion with relevant officials from hospital departments, local council and government agencies including Environment, Health and Safety and Infection Prevention control personnel. The consultant also conducted interviews with guardians. These guardians were selected from various hospitals to ensure that their input was well representative. Input from stakeholders provided the opportunity to assess potential risks and develop mitigation strategies to minimise environmental impacts on patient health and safety. The key findings from the consultations are presented in Annex 5. 7 Chapter 2 Project Description This chapter outlines the detailed description and scope of the proposed QECH rehabilitation project. It describes nature of the project, outlines the project activities including main inputs and outputs of the project activities and sources of raw materials at different phases of the project. The ESMP has been prepared based on the final design of the project which was prepared by Green Arch Design, the Design and Construction Supervision Consultant for the proposed rehabilitation project which was completed in September 2024. 2.1 Nature of the Project The rehabilitation works at QECH through the MCERHSPP focuses on 6 major areas namely the Ward 4A, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors. The selection of these units for rehabilitation was based on the hospital needs assessment. The rehabilitation works will be carried out in an already existing Hospital, and therefore the land related issues will not arise. The rehabilitation works may lead to disruptions, especially for patients, guardians, and health workers in the affected hospital sections due to the need to displace services and reorganize space for construction. This ESMP therefore proposes practical mitigation measures to these impacts including specifying them in the Environmental and social planning and design section. The project design has been structured with compliance to the World Bank’s ESS4. on (i) Infrastructure and Design and Safety, (ii) Safety of Services, (iii) Emergency Preparedness and Response, and (iv) management of Hazardous Materials. A relocation plan has been developed to minimize the impact of the rehabilitation works on hospital operations. This plan will serve as a vital tool for ensuring that essential services remain uninterrupted, and that patients, guardians, and health workers are kept informed and safe throughout the project. 2.1.1 Description of Rehabilitation Works The detailed description of the units to be rehabilitated is given below. 2.1.1.1 Ward 4A Rehabilitation works will include demolition and extension to the ward from a total floor area of 560sqm to 674sqm. The works will involve demolition of some walls, removal of asbestos roof tiles over the whole building and replacing with IBR sheets, replacement of sanitary fittings and some broken windowpanes, provision of new ceilings and wall paint. The extensions will make use of concrete bricks to match the existing exposed brick walls. Presence of asbestos 8 was confirmed by a study commissioned by World Bank and conducted by Malawi Bureau of Standard (MBS) in April 2024. 2.1.1.2 Main Operating Theatre The rehabilitation works will mainly focus on improving the interior finishes to render them fit for theatre purposes. The works further provide for minor extensions and repurposing of some areas to create office and storage space. The extension and repurposing of the areas has resulted in an additional 90sqm of space to the 830sqm main operating theatre building. The design specifies replacement of the dilapidated vinyl sheeting with new one repainting of walls, installation of new Heating, Ventilation and Air Conditioning (HVAC) system (air-conditioning systems that allows heating, ventilation and cooling), provision of new sluice to replace dysfunctional ones, servicing of doors and provision of new doors. The HVAC would be vital for maintaining a controlled environment that promotes patient safety, comfort, infection prevention, and effective surgery. The other key design provision in this building is the separation of entrance and exit zones; the existing theatre combines entry and exit zones which greatly compromises infection prevention. 2.1.1.3 Kitchen The rehabilitation works specifies stripping off all finishes which includes, worktops, removal of all sanitary ware, replacement of cold rooms and repurposing of some spaces to create more storage space for kitchen supplies. 2.1.1.4 Clinic Area The works provide for reroofing of the area over the diabetic clinic which is about 160sqm. The clinic area will receive new floor finish in form of epoxy coating, new doors to existing washrooms, provision of shelving in offices and repurposing of some storage space into additional clinic zone. 2.1.1.5 Sewer Line The rehabilitation to sewer line will focus repairing areas that are servicing the clinic area, kitchen, main operating theatre and ward 4A. Works will involve rerouting of some blocked pipes by building of new manholes and installing new pipes. 2.1.1.6 Corridors Rehabilitation to corridors will focus on areas leading to the clinic area, kitchen, main operating theatre and ward 4A. Works will involve painting and replacement of broken glass panes 9 2.2 Project Cost, Duration and Estimated Number of Employees The project will cost MK2,600,745,000.00 and is expected to be completed in 12 months. The demolition and rehabilitation works will require employ about 300 people with the roles depicted in Table 2-1. The engagement of this workforce will follow a phased approach based on need on and stage of the project Gender representation will be prioritised, striving for at least 40% representation of females wherever feasible. Engagement of these workers will not require onsite housing as the majority shall sourced locally. Table 2-1: Proposed Rehabilitation Workforce Role Number of Workers Project Manager 1 No Site Supervisor/Foreman 2 Architect/Engineer 3 Masons/Bricklayers 20 Carpenters 20 Plumbers 5 Electricians 5 Labourers 200 Painters/Plasterers 20 Roofers 10 Security Personnel 15 2.3 Main Activities of the Project The project implementation cycle comprises planning and design, construction, operation, and demobilization phases. The following sections highlight the main activities carried out during these phases. 2.3.1 Planning and Design Phase During the planning and design phase for refurbishment of Ward 4A, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors at Queen Elizabeth Central Hospital various key activities were will be undertaken i.e production and review of detailed designs, analysis and identification of existing biophysical characteristics, socio economic and environmental status, 10 assessment of the potential environmental impacts, formulation of mitigation measures and formulation of Environmental and Social Management plan (ESMP) . For instance, key activities in this phase, include performance of EHS Audit or assessment which also focuses on presence of asbestos containing materials, relocation of patients, guardians and services including identification of corrective action points, production and review of detailed designs; analysis and identification of existing biophysical characteristics, socio-economic and environmental status; assessment of the potential environmental impacts; formulation of mitigation measures and strategies; and formulation of Environmental and Social Management Plan (ESMP). Project planners will work closely with local authorities and regulatory agencies to obtain necessary permits and approvals for the installation works. This will involve securing environmental permits, building permits, and other regulatory clearances to ensure the project meets legal requirements and standards. Table 2-2 presents a summary of the permits Table 2-2: Legal Permits No Permits/Approval Issuing Authority Date Needed Required 1 Environmental and Malawi Environment Planning phase Social Assessment Protection Authority approval (MEPA) 2 Workplace Registration Department of Construction phase Certificate Occupational Safety and Health (Ministry of Labour) 3 Water Abstraction National Water Construction phase permit Resources Authority (NWRA) 4 Hazardous waste Malawi Environment Planning phase storage, collection and Protection Authority disposal (MEPA) 5 Sand Permit Blantyre City Council Construction phase 6 Quarry Permit Blantyre City Council Construction phase exempted when accessing licensed miners 11 7 Hazardous waste Malawi Environment Construction phase collection, transport Protection Authority and disposal (MEPA) agreement: 8 Solid waste collection, Blantyre City Council Construction phase transport and disposal agreement 2.3.1.1 Other EHS Consideration within planning and design Phase The 2024 asbestos assessment study commissioned by the World Bank, indicated the presence of Asbestos in Ward 4A on roofing materials at QECH. The project will involve rehabilitation of areas where Asbestos Containing Materials (ACM) were found. Asbestos fibres released into the environment has health implication that can cause severe respiratory diseases in humans through exposure. This ESMP therefore provides the ACM management plan (See Annex 12) to be implemented when handling ACMs before and during rehabilitation works in the sections of the hospital identified to contain asbestos. 2.3.2 Construction phase This phase will constitute mainly the refurbishment works by the contractor. The key activities will involve mobilization, land clearing during opening of access roads within the site and site for contractor. Other activities include, demolitions, excavations, trenching, backfilling with compaction consolidation, levelling and earth marking, transportation of construction materials, plumbing, installation of wall frames, roofing, drainage, wiring, lighting and finishing works. Additionally, during this phase, an assessment of existing utilities for potential relocation in collaboration with utility service providers will be provided to ensure safety and unimpeded access for construction activities will be undertaken. Furthermore, the displacement of hospital services and patients will occur prior to the commencement of works. A detailed description of some of the activities under this phase is as given below. i. Site clearing and preparation: This will involve clearing the designated area for construction activities and it is expected that ornamental grass and 4 trees may potentially be removed. 12 ii. Demolitions: This will involve bringing down of the old parts of the existing buildings to which the new structures will be connected including removal of asbestos containing material following ACM plan and sewer line pipes blocked with contaminated sediments/sludges. iii. Foundation excavation: To construct a brick-and-mortar building, the process will begin with site preparation and marking the layout. Excavations will be carried out using hand tools to reach a maximum depth of 1.5 meters. This will be done to allow progress of works in areas where use of machinery may be limited due to lack of space and also to reduce noise pollution., it is recommended to use machinery where possible to improve efficiency and reduce physical strain on workers. If machinery cannot be used due to space constraints, the number of workers will be increased to distribute the workload and minimize the risk of muscular disorders. in compliance with building regulations Once the excavation is complete, concrete footings will be installed to evenly distribute the weight of the structure. After pouring and curing the concrete foundation, waterproofing and drainage systems will be put in place to protect against moisture. Finally, backfilling around the foundation with compacted soil will be essential to ensure stability and prevent settling, which is crucial for longevity and safety of buildings. This methodical approach sets the groundwork for a durable and secure structure. iv. Concrete Mixing-Concrete production for the construction of a brick- and-mortar building will prioritize high-quality standards, especially in material sourcing and mix preparation. Cement will be sourced from reputable suppliers within Blantyre City, ensuring compliance with industry standards. Fine and coarse aggregates will come from licensed quarries that have passed rigorous laboratory testing, guaranteeing their suitability for construction. The contractor shall obtain a water abstraction permit to access water from the nearby Naperi River. v. Material transportation-Materials (Fine and coarse aggregates) will be sourced from quarries and transported to Queen Elizabeth Central Hospital using tipper trucks. Trucks will be utilized for transporting cement, timber, and reinforcement bars from local suppliers in Blantyre. vi. Material Storage-Materials such aggregates will be stored in specific areas near construction sites. Cement and reinforcement bars will be stored in temporary storage rooms. Timber will be used directly and as required areas, and there will be no need for timber stockpiling. 13 vii. Masonry, Concrete Works, and Related Activities - The construction of the building walls, foundations, floors, pavements, and drainage systems and other components of the project, will involve a lot of masonry work and related activities such as stone shaping, concrete mixing, plastering, slab construction, foundation construction, erection of building walls, and curing of fresh concrete surfaces. The activities will be labour- intensive, supported by light machinery such as concrete mixers to improve efficiency and ensure high-quality results. Proper planning and skilled labour will be essential to manage the demands of these tasks effectively. The project will use environmentally friendly materials such as cement blocks for construction. viii. Steel Structure Works-Structural steel will be utilized to reinforce the buildings where needed, enhancing their stability. This approach ensures a robust and stable framework for buildings capable of withstanding various loads and conditions. These steelworks will involve cutting, welding, and erection. The project will use steel metal for scaffolding requirements as opposed to wood planks. This choice will reduce pressure on the use of wood. ix. Roofing and sheet metal work- Roofing activities will include the various tasks such as sheet metal cutting, raising roofing materials, installation and fastening. These will be carried out to create a reliable and effective roofing system. x. Electrical Work- Construction activities of the premises will also involve installation of electrical equipment and appliances, including electrical cables, lighting apparatus and power sockets among others. Additionally, other related activities that involve electricity use, such as welding and metal cutting, will also be undertaken. xi. Plumbing – Plumbing will involve installation of pipe works for water supply and distribution and this will be carried out throughout all units and associated facilities. Similarly, pipework installation for wastewater and sewer systems will be conducted throughout all units and associated facilities. These installations will facilitate effective water management and contribute to the overall hygiene and functionality of the premises. xii. Waste Management Systems: Protocols for the proper disposal of all wastes including medical waste, involving segregation, handling, and tracking will be implemented, to maintain a safe environment during the construction period. 14 2.3.3 Operation and Maintenance Phase The operation and maintenance phase of the refurbished hospital facilities is crucial to ensuring efficient, safe, and sustainable operations throughout their intended lifespan. This phase involves several key activities and routines, including: • Training of Staff: Ongoing training for staff on the use and maintenance of equipment, safety protocols, and emergency response procedures to ensure competency will be provided. • Waste Management Systems: Protocols for the proper disposal of all wastes including segregation, handling, and tracking will be implemented, to maintain a safe environment during O&M. Although it is envisaged that the amount of waste increase due to completion of the new works will not be substantial, the hospital will have to ensure provision of adequate number of resources and trained personnel for handling such waste. • Corrective Maintenance Procedures: Developing a responsive system for addressing equipment failures or malfunctions, ensuring quick repairs to minimize downtime • Performance Evaluations: Periodically reviewing the effectiveness of operational procedures and maintenance routines, using metrics will be undertaken to assess performance and identify areas for enhancement. • Patient Care Protocols: Ensuring that all patient care processes integrate the latest technologies and best practices to enhance safety and outcomes. • Feedback Mechanisms: Channels for staff and patient feedback on facility operations, allowing for continuous improvement and adaptation to changing needs will be established. • Energy Supply and use: QECH uses power from ESCOM and sometimes diesel-powered generator as back up for its operations but will need to attain a balanced and sustainable energy mix and this will require coordinated technological development i.e. solar energy and use of energy efficient systems. • Water Supply and Use: Queen Elizabeth Central Hospital uses water from BWB for its operations. The hospital has installed plastic water tanks in strategic areas with total capacity of approximately 73,000 15 litres to ensure continued water supply during supply interruptions. The contractor will also develop a water management plan as part of C-ESMP making sure installation of efficient water sanitary facilities and systems to minimise water loses during operation and maintenance. • Hazardous and Medical Material Storage: There are various methods for handling hazardous materials which includes clear labelling of materials with their identity and hazards, storing materials in well-ventilated, secure, and properly labelled areas and restrict access to hazardous materials. During operation and maintenance phase of the hospital, QECH will have to ensure adequate number of storage bins in dedicated areas. Staff should receive training on safe handling, storage and disposal of hazardous and medical materials periodically. • Control of Air Emissions: Air quality emissions will need to be monitored during O&M phase. The EHS standard for monitoring air emissions has been provided in Table 3.2. The responsibility for monitoring will be with hospital administration and relevant key government agencies such as MEPA, Ministry of Health and Ministry of Labour. • Developing EHS plans and Procedures: EHS management plans and procedures for hospitals are crucial for hospitals to ensure compliance with regulations, safety improvement and sustainability. Considering the EHS gaps identified during the ESMP development, and anticipated increased demand for health care services alongside challenges and risks associated with managing EHS issues there will be need for QECH to develop EHS plans and procedures to mitigate risks, optimize operations, and meet changing regulatory requirements. 2.4 Construction Process Inputs and Outputs The construction process for refurbishment involves a range of inputs and outputs that are critical to the project's success. These inputs include Construction Materials, Equipment, Human Resources, Design Plans and Permits and Approvals. Similarly, the outputs will primarily consist of the constructed facilities, operations and maintenance manual, waste generation (construction debris, hazardous and packaging wastes) including environmental and social documents such ESMP, C-ESMP etc. 16 2.4.1 Construction Material Table 2-3 provides estimates for materials based on standard practices and the assumed size and scope of the project. The project will use various types of materials from licensed suppliers. These will include quarry stone, sand or quarry dust, wood or steel, cement blocks, cement, paints, roofing materials, windows, doors and other joinery, tilt, light fittings, fuel and oil, electricity, water, ceramic tiles, polythene, steel, steel pipes, PVC pipes, adhesives, copper wires, cardboards etc will also be sourced for the project. These estimates considered local material availability and specific project requirements; however, they are not final and may be subject to change as the project progresses. Table 2-3: Estimates for Key Construction Materials and Quantities Component Material Quantity Foundation Concrete 68 cubic meters Reinforcement Steel Bars 9 tons Walls Concrete Bricks 184,000 Bricks Mortar (cement, sand and 450 bags of cement, 60m³ sand water) Roof Steel Roofing Sheets 1,970square meters Timber for Roof Trusses 130cubic meters Concrete 41 cubic meters Screed Finish 565bags of cement, 60m³ sand Flooring Tiles 410 Square meters Epoxy Coating 1,220 Square meters Polyvinyl Sheet 620 Square meters Doors and Steel Door frames 47 Units Windows Steel Windows 85 Units Painting Paints 65 litres (Exterior), 1,895 litres (interior) Brick Sealer 590 Liters (Exterior) Special Incinerator Unit N/A Features Plumbing (PVC pipes, 995 meters piping fittings) Electrical Wiring Standard wiring, conduits, switches, sockets Ash Pit Concrete Blocks N/A Structure Mortar (cement and sand) N/A 17 Component Material Quantity Base and Concrete N/A Lid Packed Stone N/A Steel Lid N/A Finishing Plaster (internal) 260 bags of cement, 36m³ sand Compacted Hard-core 35 cubic meters 2.4.2 Demolition and Construction Equipment Considering that Malawi operates in a low-construction technology environment, it is anticipated that the construction equipment will be more basic and less mechanized for both demolition and construction. Table 2-4 provides a summary of the construction equipment expected for the construction phase. Table 2-4: Summary of Demolition and Construction Materials and Equipment SN Raw Material Source Mode of Delivery 1 Diesel (for the operation of Local approved Road truck the generator and suppliers machinery) 2 Construction Water Mudi river Existing water mains 3 Water bowser Contractor Road truck 4 Equipment (Tippers, light Contractor Road truck passenger vehicles, Engine generator and hand tools) 5 300 KVA Electrical generator Contractor Road truck set 6 Scaffolding & Shuttering Contractor Road truck 7 Truck Mounted/ Mobile Crane Contractor Road truck 8T 8 Loader Excavator/Backhoe Contractor Road truck 9 JCB Contractor Road truck 10 Picks, Hammers Contractor Road truck These pieces of equipment will be used across all areas of rehabilitation works generally with differing degrees from one area to the other. The other element 18 that will cut across are the type of materials being shifted. 2.4.3 Construction Waste Generation and Management The project is expected to produce different types of waste. Table 2-5 shows the expected type of waste and proposed management measures. For this project, each construction and rehabilitation work are expected to generate non-hazardous waste that can either be recycled, reused or disposed of at the Blantyre City Council recommended dumpsite within a radius of 12 kilometres from the site. Table 2-5: Construction Waste and Proposed Management Measures Material Estimated Waste Estimated Management Quantity Percentage Waste Measures Used Quantity Concrete 109 5% 5.25 m3 Reuse or apply as fill material (aggregate or base for roads and pavements) dispose. Reinforcement 9000 2% 180 kg Recycling Steel Concrete 184,000 10% 18400 Reuse or apply as fill Blocks material (aggregate or base for roads and pavements) dispose. Mortar 450 bags, 10% 45 bags Reuse (non- (Cement, 60 m3 (sand) structural work or Sand) sand filling material). Steel Roofing 1970 5% 98.5 m3 Recycling Sheets Timber 130 15% 19.5 m3 Reuse or recycle Paint (Exterior 1960 5% 98 litres Dispose or reuse and Interior Plumbing 995 10% 99.5 meters Recycling Materials (PVC damaged pieces or pipes, Fittings) reuse 19 Chapter 3 Legal and Policy Framework This Chapter reviews the Malawi’s legal, Policy and administration framework that will be applicable to the proposed refurbishment of Ward 4A, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors. The chapter also provides a review of international policies and legislation which have to be complied with in the process of implementing the project. Additionally, the chapter offers an account of all the regulatory licenses and approvals necessary for the proposed project to align with environmentally sound management practices and comply with pertinent existing legislation. 3.1 Relevant Malawi Policies and Legislation Malawi, in its commitment to sustainable development, actively integrates environmental considerations into its policies and practices. This dedication is evident in its adherence to international agreements, such as the 1992 Rio Declaration, which emphasizes the importance of environmental impact assessments (EIAs) for projects that could have significant environmental effects. 20 Table 3-1: Relevant Malawi Policies and Legislation Relevant Description Relevance to Project Activities Legislation National The policy outlines comprehensive strategies for environmental Environmental and social risk Environmental and social planning, focusing on key areas such as environmental assessments and integrating Policy (2004) and social impact assessments (ESIAs), audits, and monitoring. The environmental and social specific objective of ESIA is to eliminate or mitigate adverse management into project planning impacts, enhance environmental and social benefits and ensure and implementation will be continuous improvement. essential for promoting sustainability and community well- being. National Gender The National Gender Policy is a crucial framework for addressing The proposed project will Policy (2015) gender inequalities and fostering equitable development. Section contribute to addressing GBV by 1.3: offers guidelines Mainstreaming Gender integrating gender identifying risks and mitigation considerations into all areas of policy and practice and section measures for workers and provides guidelines for Economic Development and surrounding communities, sexual Empowerment of Women. Section 3.7 recognizes that GBV exploitation (for those seeking job especially violence against women, girls, and vulnerable groups opportunities), sexual harassment impedes social well-being and poverty reduction. The policy calls at the workplace, and other GBV for comprehensive strategies to prevent violence, support related spillover effects of the survivors, and promote safe environments. project. 21 Relevant Description Relevance to Project Activities Legislation National Water The policy addresses all aspects of water management including The project activities have the Policy (2005) development of water resources and service delivery and it potential to negatively affect the emphasizes that every Malawian has an equal right of access to water resources of the Mudi River. water and sanitation services for sustainable socio-economic The project will strive to minimize development of the country. The overall policy goal is sustainable pollution of the public water and management and utilization of water resources to promote water promote public health and of acceptable quality and of sufficient quantities and ensure hygiene and environmental availability of efficient and effective sanitation services that satisfy sustainability. the basic requirements of every Malawian and for the enhancement of the country’s natural ecosystems. The proposed project will therefore not contribute towards the degradation and depletion of water resources in the zone of influence. National The National Sanitation Policy provides a vehicle to transform the The project will implement and Sanitation Policy hygiene and sanitation situation in Malawi. It provides both adhere to best waste (2008) guidelines and an action plan whereby 2020 all the people of management practices which is Malawi will have access to improved sanitation, safe hygienic essential for environmental behaviour will be the norm and recycling of solid and liquid waste sustainability and compliance with will be widely practices leading to healthier living conditions, a policy provisions. Prioritizing waste better environment and a new way for sustainable wealth reduction, recycling, and reuse, in creation. the will contribute to environmental 22 Relevant Description Relevance to Project Activities Legislation sustainability while aligning with policy provisions One of the policy objectives is the improvement of hygiene, sanitation and recycling of waste in urban areas. The implementation of this project will therefore ensure that toilet and waste management facilities are provided to comply with the provisions of the policy. Section 3.1.1 promotes the improvement of hygiene, sanitation, and waste recycling in the country. National HIV and The goal of this policy is to prevent Human Immunodeficiency HIV/AIDS policy implies that the AIDS Policy (2005) Virus (HIV) infections, to reduce vulnerability to HIV, to improve the contractor will adhere to policy provision of treatment, care and support for people living with HIV guidelines to promote health and and Acquired inclusivity at a workplace. Furthermore, implementation of the project will put in place measures that can ensure 23 Relevant Description Relevance to Project Activities Legislation Immune Deficiency Syndrome (AIDS) and to mitigate the socio- minimum vulnerability of the public economic impact of HIV and AIDS on individuals, families, and workers to HIV and AIDS during communities and the nation. the implementation and operation of the project. National The National Equalization of Opportunities for Persons with The policy implication is that the Equalization of Disabilities Policy promotes the rights of people with disabilities and project will incorporate Opportunities for integrates them to play a full and participatory role in the society. requirement for contractors to Persons with For instance, specifically, Section 2, subsections 2.3 and 2.4.8 of provide job opportunities to Disabilities Policy the policy state that people with disabilities are most affected by people with disabilities to promote (2006) poor infrastructure, such as buildings that are not designed to economic empowerment and accommodate or meet their special needs. Similarly, Subsection inclusivity. 2.45 of the policy highlights significant barriers that people with disabilities face in accessing employment opportunities owing to discrimination, lack of education and job experience. The Constitution The Constitution of the Republic of Malawi (1995) is the supreme This provision implies that the of the Republic of law of the land. It contains, among other things, principles of Ministry of Health is responsible for Malawi, 1995 national policy in Section 13. The section sets out a broad ensuring that this project is framework for sustainable environmental and social management undertaken in an environmentally at various levels in Malawi. Among other issues, the section and socially responsible manner, provides for environmental and social issues under the Principles of National Policy. Section 13 (d) of the Constitution provides that the 24 Relevant Description Relevance to Project Activities Legislation state shall actively promote the welfare and development of the hence the preparation of this people of Malawi by progressively adopting and implementing ESMP. policies and legislation aimed at managing the environment responsibly. The Constitution further provides a framework for integrating environmental and social considerations into development programs. Environmental The Environment Management Act (EMA) of 2017 outlines the ESIA The proposed works will comply Management Act process in Malawi. EMA form the principal Act on environmental with Malawi's 2017 Environment (2017) management in Malawi. The Act provides the legal framework for Management Act, ensuring MEPA environmental planning and management. EMA provides legal approval for ESMP, adherence to powers, functions and duties of the Director General of the environmental standards, and Malawi Environment Protection Authority (MEPA) as well as MEPA avoidance of non-compliance Board in the implementation of the ESIA Process. Under Section 31, penalties. the Act outlines prescribed projects and activities that an ESIA is mandatory. Employment The National Employment (Amendment) Act was gazetted to To avoid the violation of any (Amendment) establish, reinforce, and regulate minimum standards of provisions of this Act, the Act, 2021 employment to ensure equity necessary for enhancing industrial contractor will conform and peace, accelerated economic growth and social justice, and for adhere to the relevant legal matters connected therewith and incidental thereto. requirements and abide by all provisions of this Act. 25 Relevant Description Relevance to Project Activities Legislation Section 4 of the Act prohibits forced labor. Therefore, Section 4 (1) states that no person shall be required to perform forced labor. Section 5 (1) states that no person shall discriminate against any employee or prospective employee on the grounds of race, color, sex, language, religion, political or other opinion, nationality, ethnic or social origin, disability, property, birth, marital or other status or family responsibilities in respect of recruitment, training, promotion, terms, and conditions of employment, termination of employment or other matters arising out of the employment relationship. Section 6 (1) of the Act states that every employer shall pay employees equal enumeration for work of equal value without distinction or discrimination of any kind, in particular, on basis of race, color, sex, language, religion, nationality, ethnic or social origin, disability, property, birth, marital or other status or family responsibilities and Section 6 (2) states that where a violation of subsection (1) is alleged, the employer shall bear the burden of proving that there was no violation. Section 12 of the Act prohibits employers from victimization of workers. The Act states that no employer shall inflict a disadvantage on an employee for anything done by the employee in pursuance of the provisions of this Part 26 Relevant Description Relevance to Project Activities Legislation Disability Act The act represents a crucial commitment to promoting equality This implies that the project will (2013) and safeguarding the rights of persons with disabilities. The act design buildings, facilities and enhances inclusion, respect for dignity, and equal opportunities infrastructure in such a manner that and rights for persons with disabilities. Sections 9 and 13 of the Act, all persons with disabilities will have play a critical role in ensuring that persons with disabilities are equal access opportunities. treated fairly and prohibit discrimination in accessing premises Gender Equality The Act makes provisions for integration of both male and female The implication of the Act on the Act (2015) in functions of society. The Act is intended to eliminate harmful proposed project is that sexual social and cultural practices, ensure more equal opportunity in harassment must be addressed by the workplace, enhance education and training opportunities contractors holistically, including by equally for male and female, enhance access to sexual and instituting the measures prescribed reproductive advice for everyone, and ensure that everyone is by law. The environmental and treated with dignity, integrity and without discrimination regardless social management plans is of sex. Section 6 (1) of the Act states that a person who commits developed in accordance with the an act of harassment if he or she engages in any form of principles guided by this Act. unwanted verbal, non-verbal, or physical conduct of a sexual nature in the circumstances would have anticipated that the other person would be offended, humiliated or intimidated, and (2) a person who sexually harasses another in terms of the preceding subsection is liable to a fine and imprisonment. 27 Relevant Description Relevance to Project Activities Legislation Public Health Act The Public Health Act (Amendment, 2015 governs health-related This project recognizes the (Amendment, issues, including environmental and occupational health and solid importance of practicing improved 2015) waste management. Section 59 prohibits nuisances in workplaces, hygiene and use of improved such as unclean conditions, offensive odours, poor ventilation, sanitary facilities. Effort will be and inadequate lighting, which endanger employee health. The made to provide toilet facilities for act requires developers to provide sanitary and health facilities in all genders and prevent nuisances workplace to promote health and well-being of the primary to maintain public health and occupants. safety. Occupation The Act regulates employment conditions for safety, health, and The ministry of Labour officials will Safety, Health, welfare in workplaces in Malawi. It mandates workplace assess the facility and make and Welfare Act registration, inspection of plant and machinery, and accident determinations of the adequacy of (1997) prevention. Part II requires workplaces to be registered with the the mitigation measures towards director maintaining a register. Part III outlines employer duties, occupational safety of the workers. including providing safe work systems, risk-free handling of The project will prioritize safety substances, and adequate employee training and supervision. measures, particularly concerning radiation exposure in a hospital Section 66, of the Act, defines the procedure to be followed in setting as this is crucial for case of the occurrence of an accident which either causes loss of protecting both patients and staff. life or disables a person from carrying out the normal duties at Personal protective equipment which he is employed. The act, states measure that relate to work (PPE) will be used supplementary or in confined spaces (section 55), measures taken to prevent and in emergencies through the deal with fire (section 56), matters relating to bulk storage of implementation of all safety 28 Relevant Description Relevance to Project Activities Legislation dangerous materials, matters dealing with noise (section 63) and measures in compliance with this general matters relating to health and safety. Environmental and Social Management Plan. Environment The Regulation provides for the management of general or This implies that the health facility Management municipal solid waste, liquid, and hazardous waste. Part III will need to effectively manage (Waste specifies the requirements for waste separation at source; general waste during rehabilitation to Management responsibility for proper storage of municipal waste; circumstance comply with these regulations and and Sanitation) for waste disposal by generator; collection of municipal solid protecting public health and Regulations (2008) waste; and disposal of general or ecological integrity through safe handling and disposal of waste. municipal solid waste. Part V provides for the requirements for The implementation of this project effluent discharge to the environment; effluent discharge to shall therefore ensure that the water; and need for monitoring of discharges to water to ensure requirements of this regulation are that discharges meet the effluent quality and prescribed complied with. environment standards. Part VI provides for the requirements for the categorization of hazardous waste and the labelling. Handling hazardous wastes and disposal of hazardous waste. Part VII provides for requirement for transportation and storage of waste; license for waste transportation of storage; and materials for storage of waste. 29 Relevant Description Relevance to Project Activities Legislation Public Health The World Health Organization (WHO) made an announcement The Ministry of Labour will inspect Corona Virus on March 11, 2020, that the COVID-19 outbreak has reached the workplaces for adherence and the Disease of 2019 level of a pandemic sparked global concerns and the project will ensure that COVID-19 (COVID-19) government of Malawi directed that all workplaces should be guidelines are implemented and (Prevention, decongested by working in shifts in all offices except for those in followed by both employers and Containment and the essential services. The proposed project will lead to human employees. Management) contact and therefore increase chances for the spread of COVID- Rules (2020) 19 pandemic. Public Health rules mandate both employers and employees to implement general preventive measures and disseminate COVID-19 guidelines and disseminate to all employees. Infection This policy states that all health care facilities (public and private) The rehabilitation of hospital Prevention and in Malawi shall have an active Infection Prevention Control (IPC) facilities at QECH will be part and Control Policy program in place, to promote IPC practices and surveillance parcel of the IPC program (2006) focusing on clients, patients, health care personnel and the environment. Child Care, The Act through its provisions in Part II, division 6, regarding the The implications of the Act Protection and protection of children is critical for safeguarding rights and well- regarding child trafficking, Justice being. Section 79 of the Act focuses on protecting children from especially in the context of the (Amendment) Act child trafficking, a vital measure for safeguarding the rights and proposed project, highlight the (2010) well-being of minors. Finally, section 80 of the Act, which focuses necessity for robust plans and 30 Relevant Description Relevance to Project Activities Legislation on protecting children from harmful cultural practices, is crucial for strategies to prevent child safeguarding their rights and promoting their well-being exploitation and labour. Penal Code, Section 138(1) of the Penal Code, which punishes the defilement The Environmental and Social Chapter 7:01 of girls under sixteen years of age with severe penalties, including Management Plan (ESMP) has life imprisonment, underscores the serious nature of this crime and incorporated preventive measures the commitment to protecting minors from sexual exploitation. for crimes, including child Sexual abuse and exploitation of children in construction sites is a exploitation and sexual abuse that serious and troubling issue that requires immediate attention and may be perpetuated by project action workers 31 3.2 Relevance of WB/IFC Environmental and Social Safeguards The World Bank Environmental and Social Framework outlines the Bank’s commitment to sustainable development through a comprehensive policy and a series of Environmental and Social Standards. These standards are specifically designed to assist Borrowers in implementing projects aimed at ending extreme poverty and promoting shared prosperity. Through the application of the Environmental and Social Standards, the World Bank aims to ensure that projects are designed and executed in a manner that is environmentally sound and socially responsible, benefiting both the communities involved and the broader ecosystem. The Environmental and Social Standards that apply to the project are given in Table 3-3. Table 3-3: Relevance of WB Environmental and Social Standards to the project Environmental & Main requirements and conducted activities to meet Social Standards them ESS 1 - ESS1 establishes the Client’s responsibilities for assessing, Assessment and managing, and monitoring environmental and social risks Management of and impacts associated with each stage of a project Environmental supported by the World Bank through Investment Project and Social Risks Financing. This is essential to achieve environmental and and Impacts social outcomes that align with the Environmental and Social Standards (ESSs). The objective of the standard is to identify, assess, evaluate, and manage environment and social risks and impacts in a manner consistent with the ESF. Adopt differentiated measures so that adverse impacts do not fall disproportionately on the disadvantaged or vulnerable, and they are not disadvantaged in sharing development benefits and opportunities. The proposed work has identified environmental and social (E&S) risks and impacts through consultations with health facility stakeholders. This process ensures that the concerns and insights of those directly affected by the project are considered. This ESMP has been prepared in line with this applicable standard. 32 Environmental & Main requirements and conducted activities to meet Social Standards them ESS 2 – Labour ESS2 identifies the significance of employment creation and Working and income generation as key components in the pursuit Conditions of poverty reduction and inclusive economic growth. It emphasizes that Borrowers can foster positive worker- management relationships and maximize the development benefits of a project by treating workers fairly and ensuring safe and healthy working conditions. ESS2 applies to project workers, including fulltime, part- time, temporary, seasonal, and migrant workers. The project includes a Labour Management Plan that guides the implementation of its activities, which will also apply to this sub-project. This plan ensures that all aspects related to labour are managed effectively and in accordance with relevant standards. ESS 3 – Recourse ESS3 focuses on promoting the sustainable use of and Efficiency, resources and minimizing negative impacts on human Pollution health and the environment. Key objectives and Prevention and requirements include, sustainable resource use, pollution Management mitigation, emission reduction, waste management, pesticide use management, water efficiency requirements, technical and financial feasibility. Requires technically and financially feasible measures to improve efficient consumption of energy, water, and raw materials, and introduces specific requirements for water efficiency where a project has high water demand. By adhering to the principles outlined in ESS3, projects can contribute to sustainable development while protecting human health and the environment. The MCERHSP project has prepared a Construction Manual that is comprehensive, user-friendly, and practical for construction workers. The manual provides guidance on the efficient use of raw materials, energy and including water during construction and operation. ESS 4 – ESS4 is a crucial aspect of environmental and social Community standards that emphasizes the need to manage health, 33 Environmental & Main requirements and conducted activities to meet Social Standards them Health and safety, and security risks associated with projects. Safety Borrowers can ensure they fulfil their responsibilities under ESS4, ultimately contributing to safer and more resilient communities. It's essential to prioritize the safety and well- being of patients during construction activities in hospitals. The MCERHSP project will ensure that construction activities are conducted safely and with minimal disruption, protecting vulnerable patients and maintaining a safe hospital environment. ESS 10 – This standard recognises that effective stakeholder Stakeholder engagement is crucial for the success of any project, Engagement especially in sensitive environments like hospitals. key and Information aspects of stakeholder engagement that align with the Disclosure principles of good international practice include early involvement, diverse stakeholder consultations, feedback mechanisms, collaborative decision-making among other aspects. Effective stakeholder engagement can enhance environmental and social sustainability, improve community acceptance, and contribute to a more successful design, implementation process and desired project outcomes. The MCERHSP project has developed SEP and has been engaging with stakeholders and will continue to do so throughout the project phases. The inclusion of a Grievance Redress Mechanism (GRM) in the Environmental and Social Management Plan (ESMP) is a vital component for effective stakeholder engagement. General EHS Infrastructure is central to sustainable development, Guidelines underpins economic growth and delivers the services that are essential to improve livelihoods and well-being. Despite all this, unsustainable, poorly planned and delivered infrastructure can have disastrous effects on the environment and societies. General EHS Guidelines contain information on cross-cutting environmental, health, and safety issues potentially applicable to all 34 Environmental & Main requirements and conducted activities to meet Social Standards them industry sectors and thus the guidelines have to be used together with the relevant Industry Sector Guidelines as they provide globally applicable guidance on the integration of sustainability throughout the entire infrastructure lifecycle i.e. the EHS provide guidance on structural safety of project infrastructure including fire and safety on new and existing buildings. The MCERHSP project recognises the importance of infrastructure approaches that respond to needs and demand for health care facilities and the significance of addressing sustainability issues as early in the planning process as possible and integration of relevant governance frameworks and heath care systems. As such the project will be guided by the principles of GIIP throughout its implementation. Environmental, The Environmental, Health, and Safety (EHS) Guidelines Health, and are technical reference documents with general and Safety Guidelines industry specific examples of Good International Industry for Health Care Practice (GIIP). The EHS Guidelines for Health Care Facilities (2007) Facilities include information relevant to the management of EHS issues associated with health care facilities (HCF) which includes a diverse range of facilities and activities involving general hospitals and small inpatient primary care hospitals, as well as outpatient, assisted living, and hospice facilities. Ancillary facilities may include medical laboratories and research facilities, mortuary centres, and blood banks and collection services. The MCERHSP project has considered environmental issues associated with HCF such as waste management emissions to air · and wastewater discharges. The project also intends to address occupational health and safety related issues such as exposure to infections and diseases, hazardous materials / waste, exposure to radiation and including fire safety. 35 Table below presents Project specific EHS standards that must be achieved during project Implementation of Rehabilitation works at QECH during both the construction, and operation and maintenance phases. Table 3-6: Project Specific EHS standards Parameter EHS standards Monitoring Frequency Air Quality PM10: 50 µg/m³ (24-hour average) Twice a day PM2.5: 25 µg/m³ (24-hour average) Twice a day CO: 10 mg/m³ (8-hour average) Twice a day NO2: 200 µg/m³ (1-hour average) Twice a day SO2: 500 µg/m³ (1-hour average) Twice a day Wastewater BOD5 (Biochemical Oxygen Demand): Quarterly Maximum 50 mg/L COD (Chemical Oxygen Demand): Maximum Quarterly 250 mg/L TSS (Total Suspended Solids): Maximum 100 Quarterly mg/L Ammonia: Maximum 10 mg/L pH: 6 – 9 Quarterly Oil & Grease: Maximum 10 mg/L Quarterly Water Quality pH: 6.5 – 8.5 Quarterly Total Dissolved Solids (TDS): Maximum 1000 Quarterly mg/L Turbidity: 5 NTU (Nephelometric Turbidity Units) Quarterly Coliforms: Should be absent per 100 mL Quarterly Arsenic: Maximum 0.01 mg/L Quarterly Chloride: Maximum 250 mg/L Quarterly Noise Levels Patient Rooms (Daytime) 30-40 dB(A) Daily 36 Parameter EHS standards Monitoring Frequency Patient Rooms (Night-time) 25-30 dB(A) Daily General Hospital Areas 40-45 dB(A) Daily Intensive Care Units (ICU) 40 dB(A) or less Daily Operating Rooms 40 dB(A) or less Staff Rooms, 45 dB(A) or less Daily Patient Rooms (Daytime) 30-40 dB(A) Daily Solid Waste Segregation into organic, recyclable, and Weekly Management non-recyclable categories. Regular collection and transportation using Weekly appropriate vehicles Disposal in sanitary landfills with proper Weekly leachate management Encouragement of recycling, composting, Weekly and waste minimization practices. Hazardous Waste Identification and classification of hazardous Weekly Management waste (chemical, medical, e-waste). Safe storage in designated facilities with spill Weekly containment Transportation using labelled and secure Weekly containers Disposal through incineration or secure Weekly landfilling with proper safeguards Personal protective equipment (PPE) for Daily workers handling hazardous waste. 37 Chapter 4 Environmental and Social Setting This chapter presents a comprehensive overview of the existing environment within the project area, focusing on the physical, biological, socio-economic, and structural aspects. This information serves as a crucial baseline for understanding the current conditions and will be valuable for future planning and decision-making. 4.1 Area of Influence Consistent with the World Bank Environment and Social Framework (ESF), specifically ESS1, the Area of Impact (AoI) refers to the geographic area where the environmental and social impacts of the project are anticipated to occur. Primary data was collected within a radius of 100 meters of the proposed construction site). In addition to the primary data collected, secondary data for the wider areas were also considered to assess the baseline conditions. The Area of Impact (AoI) for this proposed project encompasses the following: • Direct Impact Areas: These are regions where project activities will have immediate and tangible effects on the environment and local communities. According to Figure 4-4, the direct impact area is highlighted in red and encompasses the immediate area where the buildings will be constructed, which is within the premises of existing buildings. The direct impact area is located within the hospital boundary and will be subject to various construction activities, including excavation, building, and landscaping. The hospital buildings and structures adjacent to the construction site will be directly impacted by noise, dust, and potential disruptions due to construction activities. • Indirect Impact Areas: This encompasses regions that may not be directly involved in construction activities but will still experience effects as a result of the project. The broader hospital grounds and hospital access roads will experience indirect impacts such as increased traffic, noise, and potential changes in air quality. • Cumulative Impact Areas: These focus on the combined effects of the proposed project alongside other existing or planned developments in the region. The Cumulative Impact Area for the proposed project encompasses the commercial zones, specifically the shops and offices at Ginnery Corner. These areas are expected to experience cumulative impacts due to increased construction activities in the area. The cumulative impact area, particularly around commercial zones like Ginnery Corner, may experience several significant potential impacts 38 due to increased construction activity. The presence of construction traffic and activities in the cumulative impact area, particularly around commercial zones like Ginnery Corner, may significantly affect the accessibility and attractiveness of these spaces. The study area selected for the Environmental and Social Management Plan (ESMP) focuses on sensitive receptors that are most likely to be impacted by the project's development activities. Sensitive receptors include, but are not limited to, existing hospital structures and facilities within the hospital compound, green spaces within the hospital compound, roads and pathways within and around the hospital, and shops and offices in this commercial zone of Ginnery Corner. The identified sensitive receptors in the study area are particularly susceptible to adverse effects resulting from anthropogenic activities, such as noise, air emissions, traffic influx, and privacy issues. 39 Figure 4-4: Land use map for the Area of Impact. 40 4.1.2 Physical Environment 4.1.2.1 Topography of the Project Area The construction site for the proposed refurbishment works at Queen Elizabeth Central Hospital in Blantyre exhibits a gentle slope, with the northern side at an elevation of 1086 meters and the southern side at 1083 meters above sea level. The 3-meter elevation difference between the northern and southern sides of the construction site at Queen Elizabeth Central Hospital creates a beneficial natural drainage gradient for managing storm water runoff and preventing water accumulation. The slight elevation change of 3 meters at the construction site for the proposed refurbishment works at Queen Elizabeth Central Hospital will have important implications for both foundation design and erosion control. 4.1.2.2 Geology The geology of the project site at Queen Elizabeth Central Hospital reflects that of Blantyre City, characterized by ancient rock formations that date back to the late Pre-Cambrian period, approximately 500 million years ago. The project site at Queen Elizabeth Central Hospital is predominantly underlain by pyroxene granulite gneiss and syenitic gneiss. Pyroxene granulite gneiss, which constitutes a significant portion of the local geology, provides a stable and durable foundation ideal for construction. Syenitic gneiss, also present in the area, further contributes to the robustness of the geological foundation. These rock types, while generally impervious and poor in groundwater storage, offer excellent material properties for building foundations due to their stability and resistance to weathering. The geology of Blantyre City is significantly influenced by its proximity to the eastern edge of the southern branch of the Eastern African Rift, which has several implications for the region, particularly regarding seismic activity. Incorporating seismic-resistant design features into the construction of the building at Queen Elizabeth Central Hospital is essential. 4.1.2.3 Soils The soils at the project site are inferred to be similar to those found throughout Blantyre City, shaped by the underlying geological formations and regional soil characteristics. The project site is situated in an urban built-up area, leading to predominantly disturbed soils that have been altered by construction and other human activities. Despite this disturbance, the native soil characteristics remain significant. The soils in the region around Queen Elizabeth Central Hospital are typically derived from the weathering of ancient rock formations, specifically pyroxene granulite gneiss and syenitic gneiss. These soils are generally well-drained, which promotes good natural drainage and minimizes 41 the risk of waterlogging. The soil texture at the site is likely a mix of sandy loam and clay loam, reflecting the influence of the parent rock material. Given these characteristics, the project site will provide a stable foundation for construction. 4.1.2.4 Weather and Climate Conditions The Department of Climate Change and Meteorological Services plays a crucial role in monitoring weather conditions that can impact projects like the refurbishment of Queen Elizabeth Central Hospital. 4.1.2.4.1 Temperature The proposed project site is characterized by a generally cool climate, with mean annual temperatures that vary significantly between seasons. There are particularly two spells of uncomfortable weather; the hottest season associated with high humidity soon before the onset of the first rains (end October to November), and the frost along rivers, mist and chilly showers and winds characteristic of cold season in June and July (Blantyre SEP 2017). 4.1.2.4.2 Rainfall The annual rainfall for the proposed project site, inferred from Department of Climate Change and Meteorological Services, is typically between 800 mm and 1,200 mm, with average annual rainfall of 1,127. Most of the rainfall occurs between December and March. During the rainy season, the prevailing winds are generally from the northeast and are known as the northeast monsoon or locally as the Chiperoni winds. These winds bring moisture-laden air from the Indian Ocean, contributing to the rainfall in the region. 4.1.2.5 Water resources The proposed project site is situated approximately 350 meters west of the Naperi River. This proximity to the river is significant for considerations related to water management, potential flood risk, and the project's overall environmental impact. Blantyre urban where QECH is located has profoundly been impacted by climate change. The city is particularly at risk from climate hazards such as flash floods and landslides, exacerbated by intense rainfall from events like Tropical Cyclone Freddy in 2023. However, the topography of the exact location where the project is located is relatively flat and can only be impacted by floods of significant magnitude and this implies a lower flood risk at the site. 42 4.1.2.6 Flora and fauna The proposed site features a variety of vegetation and fauna, which are important for ecological considerations. It has 12 trees and Bermuda grass. The primary notable fauna in the project area includes birds, small reptiles such as lizards, and various types of insects. 4.1.2.7 Noise, Ambient Air Quality Including Particulate Material The concentration of air quality, heavy metals and noise levels in Blantyre City were analysed through air and noise measurements. Soil samples were also collected for analysis in both dry and rainy seasons. In the rainy season, the average concentration values of CO, TSP, PM10, and PM2.5 were 0.49 ± 0.65 mg/m3, 85.03 ± 62.18 μg/m3, 14.65 ± 8.13 μg/m3, and 11.52 ± 7.19 μg/m3, respectively. Dry season average concentration values increased to 1.31 ± 0.81 mg/m3, 99.86± 30.06 μg/m3, 24.35 ± 9.53 μg/m3, and 18.28 ± 7.14 μg/m3. Noise levels remained below public MS and WHO standards (85 dB). At QECH the incinerator was found not to be working during the environmental and social assessment one chamber malfunctioned (Burner for secondary chamber). This poses a significant risk of air pollution due to incomplete combustion. 4.1.2.8 Natural Hazards (such as flooding, earthquakes, seismic, etc.). The district lies on the southern part of the Malawi rift valley and is bisected by the Main Rift Fault on the west side. Thus, the rift is becoming seismically active which may eventually entail vulnerability in areas which have not been seismic including Blantyre District. Earthquakes occurring within 200-250km away from Blantyre City can have a serious impact depending on geology and construction methods. Some parts of Blantyre are covered by sediments and the city sits in proximity to the main rift fault which thus means the city is vulnerable to moderate or strong ground shaking resulting from rupture on the fault or seismic activity from surrounding areas. Such intensity can cause great damage to structures with poor construction materials especially in areas covered by sediments. Landslides pose greater risk during the rainy season, particularly during tropical cyclones which are becoming a recurrence, when very high rainfall intensities result in sliding of soil down slopes. Catchment areas of rivers are generally small, and flash floods can be observed following normal rainfall. A total of 19 earthquakes with a magnitude of four or above have struck within 300 km (186 mi) of Blantyre, Southern Region in the past 10 years. This comes down to a yearly average of 1 earthquake per year. 43 4.1.2.9 Ground Water (Depth and Uses) Blantyre district is 1792 km2 in area with undulating topography ranging from an elevation of about 780 to 1612 m above sea level comprising of hills, plateau and ridges and the natural drainage. The productivity of the crystalline basement rocks as aquifers varies widely according to degree of alteration and distribution of overlying colluvial deposits. Depths of weathering of the basement rocks on the plateau are typically around 10–30 m but can be thicker in fault zones and thinner close to outcropping inselbergs. This weathered layer forms a laterally extensive minor aquifer of considerable value for small-scale rural water supplies. The degree of weathering of the overburden is generally greatest close to the surface and higher permeability is typical in coarse-grained rock types. The frequency of faults and joints also has a major control on rock permeability. Groundwater levels in the basement aquifers are in most cases less than 15 m below surface. Seasonal fluctuations are typically 1–5 m. Yields of 0.25–0.5 l/s can usually be obtained from the basement rocks provided the saturated thickness of the weathered layer is more than 10 m. Such yields are usually adequate for hand-pumped supplies. 4.2 Facility Management and Health Safety Protocols 4.2.1 Water Supply The Queen Elizabeth Central Hospital receives its water supply from the Blantyre Water Board. The hospital is grappling with notable water supply challenges, even though it receives potable water from the Board. Key issues include outdated plumbing systems that frequently break down, insufficient funding for infrastructure improvements, and rising demand driven by population growth. the hospital units. The water consumption for the hospital is approximately 19,557 cubic meters per month. The proposed project shall apply for water abstraction permit from National Water Resources Authority (NRWA) to enable it abstract water from the nearby Naperi river. This arrangement shall prevent the project from using the existing water supply within the hospital mains for construction purposes except for minimal amounts that would be used for drinking and cooking purposes. This approach aims to enhance water accessibility and reliability, ensuring that the hospital can meet the needs of its patients and staff more effectively. The hospital has approximately twelve 5000 Ltr water tanks, which are used as backup when water supply is interrupted. It is envisaged that water consumption would not significantly increase during operational and maintenance phase if the current challenges area addressed i.e. installing larger waste storage areas and use of water efficient and saving technologies. 44 4.2.2 Energy Supply (including backups) The main power supply for QECH is the ESCOM grid and the total estimated monthly energy consumption in (KWh)/month is 574705. Queen Elizabeth Central Hospital is currently utilizing electricity as main source of energy. The is currently faced by intermittent power supply and uses diesel powered generators as power back in times of power cuts from ESCOM. It also expected the energy demand will not substantially increase during the operation and maintenance phase more particularly if the hospital focuses on using energy efficient systems and appliances and also consider installing renewable energy sources such as solar. 4.2.3 Hazardous Materials Queens Elizabeth Central Hospital, as one of the major healthcare institutions in the area, generates a significant number of hazardous materials. The hazardous materials are generally produced from laboratories and theatres. These materials include chemicals, body parts, blood, expired drugs, and sharp instruments such as scissors and knives. These materials have a high potential to cause harm to human health and the environment. The hospital uses colour coded bins that are lined with leak proof bags for segregation and temporary storage. The hazardous waste/materials are generally treated promptly through incineration. The incineration process is carried out within the shortest time possible of waste generation usually within two hours to ensure the material does not pose any risk. However, the hospital faces various challenges for it to undertake effective waste segregation ranging from inadequate resources i.e. coded bins, bin liners, public awareness and training for medical personnel. These challenges lead to mixing of waste at times. It is expected that the amount of hazardous waste produced will increase during Operation and maintenance phase. 4.2.4 Emergency Prevention and Response Queen Elizabeth Central Hospital is a specialised health care facility designed to focus on managing emergencies both natural and human made, while also prioritizing the prevention and immediate response to emergencies such as floods, cyclones, fire, disease outbreaks. However, the hospital has gaps in areas of firefighting equipment, chemicals, drugs and vaccines, trained personnel to handle crisis effectively during emergencies and disasters. This implies the need for effective measures in disaster preparedness, response to accidents and provision of urgent medical care during public health emergencies, mass casualty events or environmental disasters. 45 4.2.5 Sanitation Facilities QECH employs approximately 1,200 staff members, reflecting a diverse workforce that plays a critical role in delivering healthcare services. Of these 65% are female and 35% male. The hospital receives a substantial number of (1000-1,200) patients annually. Each ward typically includes at least six toilets— three for females and three for males. 4.2.6 Hygiene Practices QECH prioritizes hygiene and infection control, crucial in a healthcare setting. The hospital features handwashing stations in every ward and department, equipped with hand sanitizers. Employees participate in weekly training sessions to ensure proper waste management. Additionally, personal protective equipment (PPE) is provided at the departmental level. Disinfection occurs daily, both in the morning and evening. Cleaning agents include soap, chlorine, and the use of thorough abrasion for cleaning the wards. QECH prioritizes effective waste management to ensure a safe and hygienic environment for patients, staff, and the community. The hospital implements comprehensive procedures for collecting, managing, and disposing of both infectious and non-infectious waste. 4.2.7 Infection Prevention and control Queen Elizabeth Central Hospital uses chlorine-soapy water for cleaning, and this has become an effective strategy for maintaining high hygiene standards. Chlorine is a reliable choice for killing harmful pathogens and cleaning as it ensures that the wards and common areas remain safe for both patients and staff members mainly due to its disinfectant properties. Additionally, the hospital undertakes vector and disease control initiatives such as fumigation and Indoor Residual Spraying (IRS) to deal with mosquitoes, bedbugs and cockroaches. The hospital is fails to effectively implement infection prevention and control measures due to inadequate resources. 4.2.8 Health Facility Capacity QECH is a vital healthcare institution in Malawi, providing essential primary and secondary healthcare services to both the Blantyre District and the wider national community. Serving as a prominent referral hospital nationwide, it also has a department for the College of Medicine, KUHeS, which provides the hospital with skilled personnel who gain practical experience there. The hospital's infrastructure includes dedicated wards for inpatient care, 46 outpatient departments, laboratories, pharmacies, and specialized operating theatres for both major and minor surgeries. Offering a comprehensive array of medical services, QECH provides outpatient consultations, inpatient treatment, maternal and child health services, emergency care, laboratory testing, pharmacy services, HIV/AIDS management, and immunization programs. 4.2.9 Communication and Transport Systems Near Queen Elizabeth Central Hospital (QECH), Telekom Networks Malawi Limited (TNM) and Airtel serve as the primary providers of mobile phone services. Their presence contributes significantly to the telecommunications landscape in the region. Site visits and interviews confirmed excellent network connectivity provided by both providers. Transportation is easily accessible, with the site located within 42 meters of the southern side of the M2 road, where there is a bus stage along the M2 road. 4.2.10 Security Blantyre benefits from a collaborative security framework supported by both public and private institutions. The presence of the Malawi Police Service plays a crucial role in maintaining law and order in the area. 4.2.11 Waste Management Queen Elizabeth Central Hospital has a waste management system for handling and managing solid and liquid waste. The system involves waste identification, segregation, collection, storage and disposal in which non- hazardous wastes, such as paper and cardboard, kitchen waste are collected and disposed at Blantyre city council dumpsite in Mzedi by a private waste collection and handling company. The system also ensures that infectious and hazardous wastes are effectively segregated based on the color-coded system. In this regard, and if waste is mixed accidentally, such wastes are treated and considered as hazardous material. The actual amount of wastewater produced at the hospital is not known as no measurements are taken. However approximately 76060 kgs of waste is incinerated per annum. The existing pipes shall handle the new works wastewater. It must be noted that the Project under this facility is simply rehabilitating the units whose discharge shall be collected through the same pipe network. QECH has put in place the following management measures for managing waste; avoiding mixing of general health care waste with hazardous waste, prevent accidental release and entry of waste into wastewater streams, implementing procedures and mechanisms to provide for separate collection of urine, faeces, blood including vomit and hazardous wastes. The waste management system also 47 involves, segregating health care products containing PVC to avoid disposal via incineration, transporting waste to storage areas on designated trolleys, chemical disinfection to kill pathogens, labelling of wastes according to various waste streams. Medical waste is incinerated through the hospital incinerator located with the hospital premises Amount of wastewater that is produced is not measured or quantified due to lack of resources and the typical source of such waste is largely. laboratories, theaters, washrooms, laundry, kitchen etc. Hazardous and infectious medical liquid waste is disposed separately from sanitary wastewater i.e. infectious and hazardous liquid waste through incineration and sanitary waste through sewer line. The hospital does not have its own wastewater treatment plant. However, the notable pre- treatment methods include autoclaving, chemical disinfection and incineration. It is expected that wastewater from new works will be collected through the existing sewer line that connects to the main sewer line. Clogging and/or blockages and pipeline capacity (size) are the main constraints to effective management of liquid waste at QECH. In summary, based on the environmental and social assessment undertaken, several EHS gaps and liabilities were noted such as inadequate bins, bin liner, PPE, clogged pipes, leaking pipes, EHS trainings, equipment, EHS audits etc. It is anticipated that these challenges may be compounded by additional works due to increase in demand for health care services. There is need to ensure that these gaps are attended to as soon as possible to cater for the current situation and potential increase in demand for health services. 48 Chapter 5 Assessment of Environmental and Social Impacts This chapter outlines the anticipated beneficial and adverse impacts that may be direct and indirect, on each environmental feature at the project site. 5.1 Impact identification The process of impact identification involved considering positive and negative effects resulting from the interaction between project-related activities and valued environmental components (VECs) also encompassing all EHS aspects. These VECs encompass physical, biological, social, economic, or cultural aspects. The potential environmental impacts identified are based on the interactions between project activities and selected VECs. The selection of VECs was informed by the existing project environment (environmental baseline conditions), stakeholder consultations, and the consultant’s professional judgment. The potential interactions between the Project Related Activities and the Selected VECs for each project implementation phase are illustrated in Table 5-9. 49 Table 5-7: Potential Interactions of the Project with VECs. Project Phase Mobilisation Construction Demobilisation Operation Valued Environmental Component Earthworks Super-Structure Structural Framing Fit Out Air Quality - X x - - - x Noise & Vibration - x x x x - x Water Resources - x - - - - x Terrestrial Biodiversity - x - - - - - Public Health & Safety - x x x x x x Labour & Economic x x x x x x x Conditions Service Infrastructure & - x x - - - -x Utilities Soil and Land Capability - x - - - - - Visual Impact - x x x x - - Waste Management - x x x x x x Social Dynamics and - - - - - - - Community Well-being 50 Project Phase Mobilisation Construction Demobilisation Operation Valued Environmental Component Earthworks Super-Structure Structural Framing Fit Out Climate Change and Greenhouse Gas - - - - - - x Emissions Hazardous Materials and - - - - x - x Contamination Risks Primary construction material - - x x - - - extraction/harvesting Transportation of construction - x x x x x - materials Key No Substantial Interaction - Possible Interaction X 51 5.2 Significance Ranking of the Impacts This methodology was undertaken to identify potential environmental issues and associated impacts from the proposed project and assign them a significance ranking. Issues or aspects were reviewed and evaluated against a series of significance criteria to identify and document interactions between activities and aspects, as well as resources and receptors, providing a detailed discussion of impacts. The significance of environmental aspects is determined and ranked by considering criteria presented in Table 5-2. 52 Table 5-8: Impact Assessment Criteria and Scoring System CRITERIA SCORE 1 SCORE 2 SCORE 3 SCORE 4 SCORE 5 Impact Magnitude (M) Very low: Low: Medium: High: Very High: The degree of alteration of the No impact Slight Processes Processes Permanent affected environmental receptor on processes impact on continue but temporarily cessation of processes in a modified cease processes way Impact Extent (E) The geographical Site: Site only Local: Regional: National: International: extent of the impact on a given Inside Outside National Across borders environmental receptor activity activity area scope or or boundaries area level Impact Reversibility (R) The ability Reversible: Recoverable: Irreversible: Not of the environmental receptor to Recovery Recovery possible despite rehabilitate or restore after the without with action activity has caused environmental rehabilitation rehabilitation change Impact Duration (D) The length of Immediate: Short term: Medium Long term: Permanent: permanence of the impact on the term: 5-15 Project life Indefinite On impact 0-5 years environmental receptor years 53 CRITERIA SCORE 1 SCORE 2 SCORE 3 SCORE 4 SCORE 5 Probability of Occurrence (P) The Improbable Low Probable Highly Definite likelihood of an impact occurring in Probability Probability the absence of pertinent environmental management measures or mitigation Significance (S) is determined by [ = ( + + + ) × ] combining the above criteria in the = ( + + + ) × following formula: IMPACT SIGNIFICANCE RATING Total Score 4 to 15 16 to 30 31 to 60 61 to 80 81 to 100 Environmental Significance Rating Very low Low Moderate High Very High (Negative (-)) Environmental Significance Rating Very low Low Moderate High Very High (Positive (+)) 54 5.3 Impact Significance Rating for the Identified Impacts The assessed potential environmental and social impacts of the refurbishment project and their significance rankings have been presented in Annex 4. The impact significance without mitigation measures is assessed with the design controls. The residual impact remains following the application of mitigation and management measures and is thus the final level of impact associated with the development. Residual impacts also serve as the focus of management and monitoring activities during project implementation to verify that actual impacts are the same as predicted in this report. 5.4 Description of Identified Impacts This section outlines the project's potential positive and negative impacts at planning, construction, demobilization and operation phases. The construction phase has been subdivided into specific activities to track the specific impacts. 5.4.1 Planning and Design Phase During the planning phase, the developer will employ people to undertake various activities, which shall include surveys, design activities and obtaining the necessary permissions for implementing the project. From the planning phase, it is evident that the proposed project will have some positive impacts. 5.4.1.1 Anticipated Positive Impacts (Planning and Design Phase) 5.4.1.1.1 Enhanced Employment opportunities The developer shall employ people to undertake various surveys and designs and environmental assessment studies. The developer shall maximise employment of Malawians, both men and women. In these recruitments, qualified women shall be given priority. 5.4.2 Construction Phase 5.4.2.1 Anticipated Positive Impacts (Construction Phase) The positive impacts of the proposed project under construction phase are described in the subsections below. 5.1.1.1.1 Skills transfer The project refurbishments will facilitate the transfer of valuable skills to local workers. Through targeted training programs and hands-on experience during the project execution period, workers will acquire new technical skills and knowledge related to construction work. This skill will increase the chances of their employability after the project is closed which will foster sustainable development and improved job prospects in the community. 55 5.1.1.1.2 Creation of job opportunities During the construction phase, the contractor will employ construction staff that will form his execution workforce to help deliver the targeted output. The impact is short-term as it will last for the construction period only. Hence the impact is of low significance. 5.1.1.1.3 Improved project compliance to environmental and social legislations The project shall prepare environmental and social instruments during the planning stage which will be used during the project’s lifespan. These documents shall foster an enhanced safeguards compliance during the project implementation and thereby reduce negative effects of the project. 5.4.2.2 Anticipated Negative Impacts (Construction Phase) 5.4.2.2.1 Temporary Air Quality Deterioration Dust and particulate matter emissions are anticipated as short-term impacts of the construction activities during the site clearing, demolitions and excavation for the foundations of the various structures that are supposed to be constructed. This dust can present respiratory problems and cause nuisance issues when redeposited on clothes and surfaces, as well as hinder visibility. Furthermore, during the construction of structures, the use of cement and aggregates will further increase dust levels. Other plant and vehicles likely to be used during construction will also emit gases and particulate matter, including carbon dioxide (CO2), Sulphur dioxide (SO2), nitrogen oxides (NOx), and various other hydrocarbons. Despite these emissions, it is considered unlikely that ambient air quality standards will be exceeded. 5.4.2.2.2 Increased noise levels from machinery and construction activities. The construction machinery and equipment will generate noise that may induce discomfort and/or hearing loss to workers, members of staff for the hospital, patients, as well as the hospital community. Maximum noises generated can be audible over long distances but are generally of short duration. If maximum noise levels exceed 65dBa at a receptor, or if it is clearly audible with a significant number of instances where the noise level exceeds the prevailing ambient sound level with more than 15dBA, the noise can increase annoyance levels and may ultimately result in noise complaints. 56 5.4.2.2.3 Loss of vegetation and other ground cover There is possibility of clearing land to create access for the contractor’s vehicles access and materials. This may lead to loss of some native tree species around the area to allow the process to proceed. The contractor shall undertake a selective cutting of trees so that just a few should be cut. The impact of the loss of trees is expected to be of low significance because of the selective cutting and also a provision to replace the trees on site. 5.4.2.2.4 Increased risk of accidents and injuries on-site affecting workers and communities The work site will have a potential for accidents and injuries. Workers involved in construction works will be exposed to various occupational risks; the project activities will bring about hazards such as the use of large machinery and equipment; working at height; use of electrical tools; trips and falls, use of hazardous and flammable chemicals just to mention a few. Furthermore, the construction works will involve the movement of vehicles carrying various construction materials. This in turn will increase traffic on the hospital premises which would lead to increase of traffic accidents, which will in turn be managed by the traffic management plan (also focuses on transport of materials to and from the hospital as presented in Annex 2. These traffic accidents can also affect communities around the hospital. 5.4.2.2.5 Increase in spread of Infectious Diseases (spread of STIs, HIV and AIDS, Cholera and Covid 19) The project activities will lead to an increase of interactions at the hospital. These interactions may be amongst workers and the hospitals’ community. These interactions may consequently increase the likelihood of spreading of HIV and AIDS. It is therefore important for the Project to put in place measures to control the spread of the disease at the workplace. The Ministry of Health declared a cholera outbreak in Malawi on 3 March 2022, following laboratory confirmation of a case in the country. Cholera is an acute enteric infection caused by ingesting the bacteria Vibrio cholera present in contaminated water or food. It is mainly linked to insufficient access to safe drinking water and inadequate sanitation. It is an extremely virulent disease that can cause severe acute watery diarrhoea resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population and the setting. 57 The contractor shall also encourage to practice adequate preventive measures to control COVID 19 such as use of face masks, use of sanitizers on shared equipment and also provide hand washing facilities. 5.4.2.2.6 Increased cases of Gender-Based Violence (GBV) and Sexual Exploitation and Abuse (SEA) The construction site has the potential to create environments where gender- based violence (GBV) and sexual exploitation and abuse (SEA) may occur. These impacts can affect both workers and the surrounding community, including hospital staff, patients, and residents. The presence of construction workers, often from different areas and backgrounds, can increase the vulnerability of local women and girls to GBV and SEA. In addition, female workers on the construction site may face sexual harassment, discrimination, or exploitation from their colleagues or supervisors. A hostile work environment can lead to mental health issues, reduced job satisfaction, and decreased productivity among female workers. 5.4.2.2.7 Increased Generation of solid wastes, spills, and effluent The refurbishment activities will generate many types and varying quantities of wastes that will include construction rubbles, spoil from land clearing, packaging materials, vehicles and machine maintenance wastes and the chemicals spills from oils, lead based paints, Polychlorinated Biphenyls (PCBs), thinners, fuels etc may be hazardous. Effluents may include concrete spills, kitchen and bath wastewater cleaning wastewater, sewer system rehabilitation and many others. The discharge of human waste materials from the maintenance of broken sewer system into surface and ground water may potentially have several harmful impacts on water quality degradation and public health risks. The decline in water quality due to pathogens from such activities, can harm aquatic ecosystems and make the water unsafe for human and animal use. Sewer gas smell can also be irritating to patients, guardians, workers and the public. 5.4.2.2.8 Increased soil erosion and sediments into water courses Soil erosion may be caused by exposure of soil surfaces to rain and wind during site clearing, earth moving, and excavation activities at QECH. Additionally, this may potentially also lead to damaging of sewer system that may eventually lead to pollution of water resources in the nearby Mudi River. 58 5.4.2.2.9 Increased cases of child labour Evidence has shown that child labour is mostly engaged by subcontractors sometimes with the aid of the community in pursuit of benefits. Contractors are also known to recruit under aged children to carry out some work, mostly on short-term casual labour arrangements, especially offsite. Sometimes contractors and subcontractors can support suppliers of materials who directly engage child labour in the production of raw materials supplied to the project. In view of this, the probability is high that some contractors or subcontractors may be involved in this illegal act. Contractors shall therefore require following a code of conduct for contractor to child protection as presented in Annex 8. 5.4.2.2.10 Conflicts over use of water and sanitary facilities The construction project shall most likely rely on the water systems available at the hospital. Queen Elizabeth Central Hospital being a big facility, also requires huge amount of water to sustain its services. These two water requirements may lead to conflicts between hospital staff, patients, construction workers and construction works. The construction workers will also require sanitary facilities the time construction works will be undertaken. These would bring congestion to the existing toilets which are used by guardians, patients and hospital staff thereby raising some conflicts. 5.4.2.2.11 Traffic Disruption It is expected that during construction there will be increased movements of vehicles in and out of the hospital premises. Heavy trucks loaded with construction materials may congest the roads thereby causing delays to other road users 5.4.2.2.12Visual Intrusion The construction site is expected not to be a pleasant site to look at due to construction works such as demolitions, excavations, stockpiling of materials and mixing of concrete. Large quantities of dust generated during this period may contribute to reducing the aesthetic value of the land. 5.4.2.2.13 Risk of structural collapse Unstable structures can unexpectedly collapse during demolition, posing risks to workers and bystanders 59 5.4.2.2.14 Risk of Asbestos Containing Materials The older buildings being demolished may contain asbestos, or other hazardous materials that require careful handling and disposal. The contractor shall need to carefully plan and execute his works to reduce these risks, as presented in Asbestos Containing Material Plan attached under Annex 11. 5.4.2.2.15 Risk of fire and explosions The old buildings to be demolished had electric wire embedded within their walls. Demolition process shall need to work out the most safety measures to avoid fires and also explosions that may erupt as a result of mishandling. 5.4.2.2.16 Risk of falling trees There are about 4 trees close to the dental department that will have to be removed. These may cause injury to people nearby, damage buildings or vehicles, cause power outages, block roads and interfere with emergency services. 5.4.2.2.17 Disturbance and disruption to service delivery Disturbance and disruption to service delivery during hospital rehabilitation can impact patient care and operational efficiency. Proper arrangements shall have to be put in place to mitigate the disturbance to the public. 5.4.2.2.18 Increased risk of defilement The presence of construction workers may lead to an increased risk of sexual violence and defilement, including sexual abuse of minors and young girls from around the hospital and those who may come at the hospital unsupervised. 5.4.2.2.19 Increased risk of pollution of water resources by wastewater The construction excavations that will taking place at QECH may lead to damaging of sewer system that may eventually lead to pollution of water resources in the nearby Mudi River. 5.4.2.2.19 Increased cases of theft and vandalism Cases of theft and vandalism at a construction site can be particularly concerning, as they not only delay the project and incur financial losses but can also compromise safety and security. 60 5.4.2.2.20 Natural Hazard (storms, etc.) Natural hazards, such as earthquakes, floods, hurricanes, cyclones, wildfires, and other extreme weather events, can have significant impacts on hospitals. The effects can disrupt normal operations, endanger patients and staff, and damage infrastructure. 5.4.3 Demobilization Phase This is a critical stage marking completion of construction works and involves removal of equipment, all temporary structures and left materials and wastes on site. 5.4.3.1 Anticipated Positive Impacts (Demobilization Phase) 5.4.3.1.1 Reduced noise levels Cessation of construction works will result in reduced noise levels from plant and machinery as well as the workers. The impact is positive and is of low significance. 5.4.3.1.2 Reduced water Requirements During construction, a significant amount of water will be required. The demand for water will reduce during the demobilization phase after construction works are completed. 5.4.3.2 Anticipated Negative Impacts (Demobilization Phase) 5.4.3.2.1 Loss of Employment At the end of construction works, workers involved in construction works will be laid off. This will result in loss of employment and reduced income capacity for the people to be laid off. The impact is negative and is of low significance. 5.4.3.2.2 Increased generation of construction waste There would be an increase of wastes because of demolition of temporary site office, stockpiling rubble, scrap metals, wood planks and any other temporary structures that are on site. 5.4.3.2.3 Loss of business opportunities There would be loss of business to the various suppliers of the project for materials such as cement, blocks, iron sheets, timber etc. furthermore, informal businesses such as food markets would be closing their markets at such construction sites. The impact is negative and of low significance. 61 5.4.4 Operation Phase At this this stage, the constructed structures will have been handed over to beneficiaries for use. 5.4.4.1 Anticipated Positive Impacts (Operation and Maintenance Phase) 5.4.4.1.1 Creation of Employment Opportunities During the operation phase, the number of hospital members of staff will have to be increased. This is due to an increased capacity of the hospital from the new structures. People will have to be recruited in different portfolios to fill the created vacancies. 5.4.4.1.2 Improved infrastructure development The hospital will benefit from new structures that will be developed, thereby accord the hospital a better and improved platform for service delivery. 5.4.4.1.3 Improved healthcare service delivery system The new facilities will provide adequate space and equipment for delivering an improved healthcare system to the communities around Blantyre District. 5.4.4.1.4 Improved aesthetic Value The construction of the new structures and the landscaping that will be undertaken around the hospital will greatly enhance the aesthetic value of the area. Tree, grass, shrubs and flowers shall be planted wherever vegetation was destroyed. 5.4.4.2 Anticipated Negative Impacts (Operation and Maintenance Phase) 5.4.4.2.1 Increased generation of waste The completion of new structures shall increase the traffic and demand of service delivery at the hospital. This entails that the generation of wastes shall be increased at the hospital largely during administrative, housekeeping and health care services and maintenance functions. Such waste would include; infectious waste, sharps, pharmaceutical waste, genotoxic / cytotoxic waste, chemical and radioactive waste, waste with high content of heavy metals, pressurized containers including general health care wastes. 5.4.4.2.2 Risk of COVID 19 During the operation phase, an increased number of people shall be visiting the hospital due to improved services. These people will be intermingling and 62 socially interacting with one another. If preventive measures are not put in place, the risk of contracting COVID 19 will be increased. 5.4.4.2.3 Sexual Harassment and Sexual Exploitation (SEA) The increased presence of people at the hospital would also lead to increased cases of sexual harassment and or sexual exploitation. SEA in most facilities affects women and it is these women who have the right to greater equality. The success of reducing SEA is the responsibility of the developer at the project site. 5.4.4.2.4 Risk of Infection Transmission The health care workers and general hospital personnel are usually at risk of exposure to general infections, blood-borne pathogens, and other potential infectious materials (OPIM) during care and treatment, as well as during collection, handling, treatment, and disposal of health care waste. The risk is likely to increase during operational phase as more patients and guardians are likely to visit the hospital triggering an increase in infection rate if preventive measures are not properly followed or adhered to i.e. exposure control plan for blood-borne pathogens, information on infection control policies and procedures, standard Precautions to treat all blood and other potentially infectious materials with appropriate precautions, including immunization for workers, use of gloves23, masks, gowns etc. 5.4.4.2.5 Air Quality Risks During operation of the hospital, air emissions may increase from the HVAC systems, ventilation of medical gases and fugitive emissions released from sources such as medical storage areas, isolation wards, medical wards incineration and combustion from power generators. Exhaust air, including isolation wards, laboratories, and waste storage and treatment facilities) may be potentially contaminated with biological agents, pathogens, or other toxic materials and increase health related risks to workers, patients and guardians at the hospital. 5.4.4.2.6 Soil and Water Pollution Following the rehabilitation of the hospital, the generation of contaminated wastewater shall increase. This may result from discharges from medical wards, operating theaters, laboratories, chemical stores, cleaning activities and incineration. 63 5.4.4.2.7 Noise Pollution Noise pollution in health care facilities is a growing concern and can have negative effects on both patients and health care workers. The common sources of noise pollution emanate from various sources including medical equipment, footsteps, conversation, movement, HVAC systems (air- conditioning system that allows heating, ventilation and cooling) and renovation activities. 5.4.4.2.8 Health and Safety Risks Health and safety hazards may affect healthcare providers. General health and safety hazards occurring in HCFs include manual handling injuries, such as sprains and strains from lifting and carrying patients; falls, trips, and slips; injuries caused by moving objects; and mental stress. Furthermore, cleaning and maintenance personnel, and workers involved in waste management handling, treatment, and disposal, may also be exposed to such hazards. 5.4.4.2.9 Increased cases of theft and vandalism Increased cases of theft and vandalism during operation phase may impact the reputation of the facility and its ability to operate effectively. 5.4.4.2.10 Increased demand for water supply and use The increase in water demand during the operation and maintenance phase of this project is primarily driven by the need to sustain operations, maintain equipment, support a growing workforce, comply with environmental standards, and ensure the smooth running of the hospital. Some key areas that increase water demand include an increase in water consumption resulting from increased number of hospital workforce and patients visiting the hospital; an increase of water demand for routine maintenance activities, including cleaning of machinery, equipment and infrastructure and sanitation. 5.4.4.2.11 Increased demand for energy use and supply An increase in energy demand during the O&M is typically a result of the continuous energy needs of running hospital services and infrastructure systems, maintaining equipment, supporting a larger workforce, and meeting operational efficiency timelines. As hospital services scale up and move toward full operational capacity, the demand for energy grows so are the energy losses. 64 5.4.4.2.12 Increased generation of wastewater In the operation and maintenance (O&M) phase of hospitals, wastewater generation increases significantly due to the nature of healthcare activities, the size of the facility, and the diversity of operations involved. Hospitals are complex environments with a variety of water-intensive functions, ranging from patient care to sanitation and medical processes. 5.4.4.2.13 Increased amount of hazardous and medical material storage During the operation phase of a hospital, the increased storage of hazardous and medical materials is driven by the need to maintain a large and diverse inventory of supplies and materials essential for patient care, medical treatments, research, and hospital operations. Proper storage of these materials is crucial for safety, compliance with health regulations, and the overall smooth functioning of the hospital. Many of these materials, such as controlled drugs, medical gases, radioactive materials, and waste, pose significant hazards and require specialized storage conditions to ensure safety for both staff and patients 65 Chapter 6 Environmental and Social Management Plan 6.1 Environmental and Social Management Plan The Environmental and Social Management Plan (ESMP) is a crucial framework designed to identify, mitigate, and manage the environmental and social impacts of construction activities. It emphasizes the importance of adaptability, recognizing that conditions and key factors can evolve throughout the construction process. As such, the ESMP will be subject to a regular regime of periodic review during project implementation. Table 6-1 forms the core of this ESMP for the construction phase of the proposed project respectively. In general, the table outlines the potential environmental and social risks associated with the project and details all the necessary mitigation measures, their financial costs, as well as the institutions responsible for their implementation. Additionally, construction contractor will prepare a C-ESMP that provides details/specifics, and the Hospital will prepare an updated and complete EHS management plan (procedures, staffing, training, etc.) prior to end of construction. 6.2 Implementation of ESMP The ESMP will be implemented to effectively address all activities identified as having potentially significant impacts on the environment, both during normal operations and under upset conditions. The implementation of the project environment and social component will be overseen by different institutional arrangements. The players include the following: 6.2.1 Ministry of Health The Ministry of Health (MoH) has established a Project Implementation Unit (PIU) to effectively coordinate all aspects of the project’s implementation. The PIU will play a crucial role in ensuring that project activities align with environmental and social standards. To enhance its capacity, the PIU has recruited an environmental and social expert to help in monitoring processes. The PIU as such will be responsible for overseeing the monitoring activities conducted by the Construction Supervision Consultant. On the other hand, the contractor shall have a resident engineer and an environmental and social safety officer who shall work hand in hand with the consultant. The District Health Environmental Officer and the maintenance team at the QECH shall be the first layer of regular supervision. These staff members will assist in day-to-day monitoring, promptly identifying and addressing any issues related to environmental and social management. Their familiarity with the hospital’s 66 operations and community relations will be invaluable in ensuring the ESMP’s effectiveness. They will also coordinate with the PIU to implement and adapt the ESMP based on emerging needs. The main activities of the PIU regarding environmental and social safeguards are: i. Planning and implementation of ESMP in collaboration with QECH staff. ii. Ensuring that the social and environmental protection and mitigation measures and EHS terms and conditions are included in the construction bids and contracts. iii. Supervision and monitoring of the progress of activities of the contractors with support from QECH staff for immediate on-site insights. iv. Provide guidance to construction teams in conducting subsequent monitoring and reporting and in undertaking corrective options with feedback from QECH staff v. Responsible for modifications to the ESMP when unforeseen changes are observed during implementation. vi. Responsible for the review and approval of contractor C-ESMP. vii. Ensure submission of periodical environmental and social management and monitoring reports to the World Bank. viii. Promote improved social and environmental performance through the effective use of management systems; and ix. External communications with other implementing partners, government ministries and agencies, and non-government organisations on the matters of mutual interest related to environmental management under the project development. x. To develop and implement an effective O&M plan prior to the end of the construction 6.2.2 Supervision Consultant Monitoring activities will be overseen by the supervising consultant for QECH and ZCH. The Consultant is responsible for both subprojects and shall provide a dedicated Resident Engineer for each hospital. These Resident Engineers will serve as lead supervisors for their respective sites, ensuring focused and consistent oversight. The contract will clearly specify site requirements and 67 responsibilities for each Resident Engineer to maintain accountability and performance standards. Within the supervision team, there shall be a qualified Environmental and Social Expert. Among the immediate and follow-up tasks of the Environmental and Social Expert shall include. i. Assist in developing and preparing the C-ESMP ii. Development of a monitoring tool or checklist based on the ESMP and C-ESMP and guided by the project physical layout. iii. Develop a monitoring program for the works targeting specific project working sites, material sites, sensitive environment and social areas, etc. iv. Prepare monthly site meetings to involve the Contractor, Client and Stakeholders. v. Monitoring environmental and social compliance vi. Monthly reports in addition to continuous communications to the Contractor, Client, the Authorities and the stakeholders as situations require. vii. The Resident Engineer will convene monthly meetings for progress reporting by the Contractor and the supervision team. 6.2.3 The Contractor The Contractor is expected to prioritize environmental and social considerations throughout project implementation. To ensure effective implementation of impact mitigation measures, the Contractor will mobilize an in-house Environmental and Social Expert with the following responsibilities: i. Customise the project ESMP and generate a Construction Environmental and Social Management Plan as a tool to guide the implementation and monitoring of indicators. File a copy with the Resident Engineer. ii. Procure necessary equipment for environmental and OHS measurements or engage some appropriate expert personnel for the activity in specific environment quality aspects including air quality, noise, water, and soil quality, iii. Monthly reporting throughout the project period including immediate reporting of significant ES incidents. 68 iv. Ensure that all subcontractors and service providers comply with the project ESMP and C-ESMP 6.2.4 Hospital Administration /DEHO/ Maintenance Team i. Facilitate awareness meetings about various relocations planned at the hospital ii. Institute and ensure the functionality of GRM systems. iii. Monitor implementation progress of the project and the related instruments, including asbestos containing material management plan, ESMP, Traffic management plan, etc. iv. Provide clear communication about the experiences and areas requiring attention to contractors, consultants and the Ministry during the project implementation. v. Maintaining and managing physical infrastructure, medical equipment and utilities during the operation and maintenance phase vi. Ensure proper waste disposal and recycling processes are followed to minimize environmental impacts during O&M phase vii. Maintain and update safety protocols to prevent accidents, manage emergencies and ensure safe patient care during the O&M phase NB: The Hospital has an IPC (Infection, Prevention and Control Unit that manages solid waste, medical waste, waste treatment, hazardous waste disposal and a Maintenance Unit that manages functionality of water supply systems including energy back up etc. These units will collaborate to support the functionality of both existing and new facilities and ensure sustainability 69 Table 6-9: Environmental and Social Management and Monitoring Plan Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator POSITIVE IMPACTS Planning and Design Phase Enhance i. Inform local Ongoing during MK75,000.00 Number of Monthly Project MoH d communities of planning and awareness Management employm employment design phase meetings Team ent opportunities and conducted opportuni prioritize their ties employment ii. Ensure that equally Ongoing during MK75,000.00 Monthly Project MoH qualified women planning and Management will be given design phase Team priority iii. Undertake Before MK100,000.00 Number of Once before Project EDO; PIU E&S community liaison construction liaison construction Management Expert meetings to notify phase starts meetings; starts Team the community of community the awareness commencement level date, inform them 70 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator of the grievance mechanism, and labour policy. Construction Phase Skill i. Conduct regular Ongoing during MK500,000.00 Number of Quarterly Contractor Ministry of transfer training on various and post- training Health (MoH) construction construction sessions programs conducted; staff competency levels ii. Employ local Monthly during MK0.00 Number of Quarterly Contractor MoH workers that post-construction workers attended period. trained specialized training from approved and registered training, institutions. 71 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Develop and Monthly during MK0.00 Number of Quarterly Contractor MoH implement EHS post-construction workers training program period. trained Creation i. Inform local Before MK100,000.00 Number of Once before Contractor District Labour of Job communities of construction local workers construction Office (DLO); Opportun employment phase starts employed starts PIU E&S Expert, ities opportunities and Hospital prioritize their Administration employment. ii. Treat employees in Ongoing during MK0.00 Number of Ongoing Contractor DLO; PIU E&S compliance with construction compliance Expert Malawi Labour phase reports with Regulations and labor labor and working regulations conditions as per the project's Labour Management Plan. 72 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Pay the same rates Ongoing during MK0.00 Pay equity Ongoing Contractor DLO; PIU E&S for workers working construction records Expert on similar tasks phase regardless of gender and origin. iv. Have workers sign Before MK0.00 Number of Once before Contractor DLO; PIU E&S a code of employment signed codes employment Expert conduct. starts of conduct starts v. Sensitize workers to During induction MK50,000.00 Number of Ongoing Contractor DLO; PIU E&S a full range of risks and ongoing sensitization Expert related to sessions; occupational worker health and safety, awareness labor rights, public levels health, community safety, sexual harassment, and GBV. vi. Ensure that 30% of Ongoing during MK0.00 Workforce Ongoing Contractor DLO; PIU E&S the workforce are construction gender ratio Expert women. phase 73 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator Improved i. Develop a Before MK500,000.00 Approved C- Once before Contractor PIU E&S Expert project contractors ESMP construction ESMP construction complian that will include phase starts starts ce to Occupational environm Health and Safety ental and Plan, Traffic social Management legislation Plan, Waste s Management Plan among others. ii. Solicit views of the Before MK1,000,000.00 Number of Once before Project Environment public and construction consultations construction Management District Officer stakeholders phase starts held; starts Team (EDO); PIU E&S through stakeholder Expert consultations to feedback ensure that their incorporated concerns are considered in the project documents. iii. 74 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Obtain relevant Before M1,100,000.00 Number of Once before Project EDO; PIU E&S approvals and construction approvals and construction Management Expert certificates from phase starts certificates starts Team authorities, obtained including the Malawi Environment Protection Authority and Blantyre City Council. These include Sand Permits, Quarry permits, Water abstraction permit, Occupational Safety and Health Certificate, waste collection, storage and disposal permit etc Demobilization Phase 75 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator Reduced i. Develop and Before MK100,000.00 Number of Once before Project EDO; PIU E&S noise implement site demobilization plans demobilization Management Expert, Hospital levels demobilization starts developed Team Administration plan Reduced ii. Develop and Before MK100,000.00 Number of Once before Project EDO; PIU E&S water implement site demobilization Plans demobilization Management Expert, Hospital requirem demobilization starts developed Team Administration ents plan Operation and Maintenance Phase EHS i. Prepare an Prior to end of K100,000.00 Number of Ongoing Hospital EDO; PIU E&S Manage updated and construction plans Administration Expert ment complete EHS period supported by Enhance management consultants d plan/system (procedures, staffing, training, etc.) prior to end of construction 76 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Conduct joint EHS Prior to end of K0 Number of Ongoing Hospital EDO; PIU E&S Management of O construction reports Administration Expert & M phase in period supported by conjunction with consultants that of all facilities and operations. iii. Conduct a Operation Phase K0 Number of Ongoing Hospital EDO; PIU E&S complete review (To be plans Administration Expert and updating (or developed or developed or supported by developing new) reviewed prior to reviewed consultants of all EHS O&M the end of phase plan, construction (procedures, phase) systems, staffing, and required budget resources for EHS staffing and equipment) iv. Incorporate any Planning Phase K0 Number of Ongoing Consultant EDO; PIU E&S additional Reports Expert, Hospital equipment or Administration facility enhancements to 77 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator the existing hospital facilities to handle the increase demand from the new project into new design considerations. v. Develop O&M EHS Operation Phase K0 Number of Ongoing Hospital EDO; PIU E&S management (To be plans Administration Expert plan/systems that developed prior developed or supported by (a) complies with: to the end of reviewed consultants construction • in-county EHS phase) regulatory requirements • WB EHSG for Health Care Facilities. • Good International Industry Practice 78 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator guidance for hospital EHS management • WB ESS4 measures on (i) Emergency Preparedness and Response, and (ii) Management and Safety of Hazardous Materials (b) that includes • measures for env sampling/monitori ng, training, and adequate staffing and budgets vi. complete details on water supply, wastewater collection and 79 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator treatment, medical waste management and disposal, air emission controls, worker occupation health and safety Creation i. Inform local As operation MK120,000.00 Number of Once before Contractor District Labour of communities of phases local workers operation phase Office (DLO); employm employment commences employed starts PIU E&S Expert, ent opportunities and Hospital opportuni prioritize their Administration ties employment. ii. Treat employees in Ongoing during MK0.00 Number of Ongoing Contractor DLO; PIU E&S compliance with operation phase compliance Expert Malawi Labour reports with Regulations and labour labour and working regulations conditions as per the project's Labour Management Plan. 80 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Pay the same rates Ongoing during MK0.00 Pay equity Ongoing Contractor DLO; PIU E&S for workers working operation phase records Expert on similar tasks regardless of gender and origin. iv. Have workers sign Before MK0.00 Number of Once before Contractor DLO; PIU E&S a code of employment signed codes employment Expert conduct. starts of conduct starts v. Sensitize. workers During induction MK200,000.00 Number of Ongoing Contractor DLO; PIU E&S to a full range of and ongoing sensitization Expert risks related to sessions; occupational worker health and safety, awareness labour rights, levels public health, community safety, sexual harassment, and GBV. vi. Ensure that 30% of Ongoing during MK0.00 Workforce Ongoing Contractor DLO; PIU E&S the workforce are operation phase gender ratio Expert women. 81 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator Improved i. Keep the ground During operation MK550,000.00 State of the Ongoing MoH MoH infrastruct and buildings tidy phase surroundings ure all the time develop ment Improved i. Conduct trainings Ongoing during MK500,000.00 Number of Quarterly MoH MoH healthcar to workforce and operation phase trainings e delivery development system ii. Hire more staff for Ongoing during MK100,000.00 Number of ongoing MoH MoH the infrastructure. operation phase staff hired Improved i. Keep ground and Ongoing during MK300,000.00 State of the Ongoing MoH MoH aesthetic building tidy at all operation phase surroundings value times ii. Plant trees, grass, During operation MK400,000.00 Number of Ongoing MoH MoH shrubs wherever phase trees and vegetation was shrubs planted removed and survived iii. Area Ongoing MoH MoH landscaped 82 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator and maintained NEGATIVE IMPACTS Construction Phase Temporar iii. Sprinkle water During site MK250,000.00 Frequency of Daily Contractor EDO; PIU E&S y Air during the site clearing and water Expert, Hospital Quality clearing and excavation sprinkling; dust Administration Deteriorat excavation phase levels ion regularly, particularly during dry and windy periods, to mitigate dust dispersion. iv. Transport Ongoing during MK200,000.00 Compliance Ongoing Contractor EDO; PIU E&S particulate or transport with transport Expert powdery protocols construction materials or residues with adequate load 83 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator cover to prevent/restrain the dispersion of particulate matter. v. Unload Ongoing during MK0.00 Drop-height Ongoing Contractor EDO; PIU E&S transported material compliance; Expert powdery materials handling dust levels to drop-height regulation equipment to ensure the lowest drop height possible in these operations. vi. Minimize Ongoing during MK250,000.00 Amount of soil Ongoing Contractor EDO; PIU E&S stockpiling of excavation stockpiled; Expert excavated soils compliance within the with removal construction site schedule by immediate removal and 84 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator transportation to the dumping site. vii. Carry out regular Ongoing; MK200,000.00 Maintenance Monthly Contractor EDO; PIU E&S maintenance of monthly logs; vehicle Expert vehicles and maintenance emission levels avoid the use of old vehicles and mobile construction equipment which emit black smoke. viii. Contractor should Ongoing during MK100,000.00 Number of Monthly Contractor EDO; PIU E&S avoid buying construction stores records Expert cement, leas based paint and other materials that are offensive including PCBs or through encapsulation and ventilation 85 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ix. Collection of noise Ongoing during MK300,000.00 Compliance Ongoing Contractor EDO; PIU E&S measurements, construction with work Expert and possibly air hours; noise quality (dust – level readings particulate material) x. Use of water Ongoing during K0 Number of Ongoing Contractor EDO; PIU E&S suppression for construction reports Expert control of loose materials resulting from excavation of foundations Increased i. Limit noisy Ongoing during MK0.00 Compliance Daily Contractor EDO; PIU E&S noise construction construction with work Expert, Hospital levels activities only to phase hours; noise Administration from daytime hours. level readings machiner y and constructi on activities 86 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Selecting Ongoing during K0.00 Number of Weekly Contractor EDO; PIU E&S equipment with construction reports Expert lower sound power phase levels iii. Installing suitable Ongoing during K100,000.00 Maintenance Weekly Contractor EDO; PIU E&S mufflers on engine construction records Expert exhausts and phase compressor components iv. Notify hospital As needed MK0.00 Number of As needed Contractor EDO; PIU E&S management and during notifications Expert staff residential construction sent; area at least phase community twenty-four hours in feedback advance if particularly noisy activities are anticipated. v. Ensure that noise Ongoing during MK110,000.00 Noise level Weekly Contractor EDO; PIU E&S levels at the construction readings; Expert hospital do not phase exceed 55 dB (A) 87 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator and keep noise compliance levels for workers with standards below 80 dB (A). vi. Place stationary During MK150,000.00 Placement Once during Contractor EDO; PIU E&S noise sources (e.g., equipment compliance; setup Expert the generator) setup noise level away from sensitive readings receptors such as wards and staff houses. vii. Use silent During MK0.00 Number of Once during Contractor EDO; PIU E&S generators equipment setup silent setup Expert generators Loss of i. Confining land During site MK0.00 Area cleared; Once during Contractor EDO; PIU E&S tree and clearing to preparation compliance preparation Expert other worksite. with site ground boundaries cover 88 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Protect the Before and MK150,000.00 Condition of Once before Contractor EDO; PIU E&S existing tree on the during tree; construction and Expert project site's construction effectiveness regularly during boundary by of barriers installing physical barriers to prevent accidental damage during construction activities. iii. Plant trees around During MK100,000.00 Number of Once during Contractor EDO; PIU E&S for sustainability of Construction trees planted rainy season Expert the structures Increased a. Working at Height risk of accidents i. Carry our risk During MK70,000.00 Number of Once before Contractor DLO; PIU E&S and assessments Construction assessments construction Expert injuries whenever working starts on-site at height and a affecting systematic work workers plan must be developed to 89 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator eliminate or minimise risks ii. Use secure and During MK70,000.00 Secure Once before Contractor DLO; PIU E&S stable ladders or Construction assessment construction Expert scaffolding that reports starts meet safety standards for working at height. iii. Minimize and During K0 Assessment Once before Contractor DLO; PIU E&S avoiding working Construction Reports construction Expert at height where starts possible b. Moving Objects i. Carryout During MK50,000.00 Awareness Once before Contractor DLO; PIU E&S awareness for Construction meetings construction Expert workers on the starts need to take precautions to avoid being struck by moving objects. 90 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Provide PPE to During MK100,000.00 Records of PPE Once before Contractor DLO; PIU E&S workers Construction construction Expert starts c. Slips, Trips, and Falls i. Maintain During K0 Cleanliness Once before Contractor DLO; PIU E&S cleanliness and Construction reports construction Expert improve lighting starts and use anti-slip mats in high-risk areas. ii. Carryout regular During MK200,000.00 Number of Once before Contractor DLO; PIU E&S Inspections and Construction training construction Expert provide training: reports starts Educate employees about safe practices iii. Wear appropriate During K0 Assessment Once before Contractor DLO; PIU E&S footwear and Construction reports construction Expert always report starts hazards 91 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator d. Ergonomics, repetitive motion, manual handling i. Train workers on During MK70,000.00 Training Once before Contractor DLO; PIU E&S correct manual Construction session reports construction Expert handling starts techniques. ii. use lifting During K0 Number of Once before Contractor DLO; PIU E&S equipment where Construction lifting construction Expert appropriate equipment starts e. Electrical (Electrocution) i. Provide workers During K200,000.00 Records for Once before Contractor DLO; PIU E&S with PPE (boots, Construction PPEs construction Expert gloves, long- starts sleeved garments, and face shields. 92 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Maintain a safe During K0 Assessment Once before Contractor DLO; PIU E&S distance from Construction reports construction Expert power lines and starts marking areas where powered equipment is in use f. Noise i. Enforce use of During K0 Number of Ongoing Contractor DLO; PIU E&S hearing protection Construction equipment Expert ii. Use acoustic During K0 Number of Ongoing Contractor DLO; PIU E&S insulating materials Construction pads installed Expert Enforce periodic During K0 Number of Ongoing Contractor DLO; PIU E&S medical hearing Construction equipment Expert checks on personnel exposed to high noise levels g. Vibration 93 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator i. Choose less During K0 Number of Ongoing Contractor DLO; PIU E&S vibrating Construction equipment Expert equipment ii. Install vibration During K0 Number of Ongoing Contractor DLO; PIU E&S dampening pads Construction pads installed Expert iii. Limit the duration During K0 Number of Ongoing Contractor DLO; PIU E&S of exposure to Construction hours Expert vibrations provided h. Industrial/vehicle driving and site traffic i. Train and licencing During K0 Number of Ongoing Contractor DLO; PIU E&S vehicle operators Construction trainings Expert ii. Ensure drivers During K0 Number of Ongoing Contractor DLO; PIU E&S undergo medical Construction medical Expert surveillance reports iii. Install audible During K200,000.00 Number of Ongoing Contractor DLO; PIU E&S backup alarms on Construction equipment Expert construction vehicles 94 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Establish speed During K0 Number of Ongoing Contractor DLO; PIU E&S limits, operating Construction rules and Expert rules and procedures procedures i. Fire and explosion i. Provide worker During K0 Number of Ongoing Contractor DLO; PIU E&S training in handling Construction training Expert flammable sessions materials, and in fire prevention and suppression ii. Store flammables During K0 Number of Ongoing Contractor DLO; PIU E&S away from ignition Construction stores reports Expert sources and oxidizing materials j. Asbestos Containing Materials i. Implement ACM During K0 Number of Ongoing Contractor DLO; PIU E&S plan provided in Construction plans Expert annex 12 implemented 95 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Avoid use of ACM During K0 Non-ACM Ongoing Contractor DLO; PIU E&S in renovation Construction reports Expert activities iii. Utilize specially During K0 Number of Ongoing Contractor DLO; PIU E&S trained personnel in Construction trained Expert removing ACM personnel (should there be utilized any) h. C-ESMP to include During K0 Number of Ongoing Contractor DLO; PIU E&S OHS plan Construction plans Expert i. Quickly contain the During K600,000.00 Once Once sewer Contractor DWO; PIU E&S spill to prevent Construction damage damage occurs Expert further happens contamination. This can involve using barriers, or absorbent materials ii. Inform local During K0 Once sewer Contractor DWO; PIU E&S authorities, Construction damage occurs Expert environmental 96 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator agencies, and the public about the spill to ensure appropriate measures are taken iii. Conduct a rapid During K600,000.00 Once sewer Contractor DWO; PIU E&S assessment of the Construction damage occurs Expert spill's extent (i.e. in case of a broken sewer line) and potential impacts on water quality, aquatic life, and nearby communities iv. Regularly test water During K400,000.00 Once sewer Contractor DWO; PIU E&S quality Construction damage occurs Expert downstream for pathogens, nutrients, and other 97 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator pollutants to assess the impact v. Develop and During K0 Assessment Once before Contractor DLO; PIU E&S implement safety Construction reports construction Expert and preventive starts measures for water-related diseases, waste disposal, such as toxicity, air pollution, spread of disease etc. Increased i. Erect safety barriers Before MK120,000.00 Number of Once before Contractor DLO; PIU E&S risk of around the construction barriers construction Expert accidents construction site to begins erected; starts and and prevent incidence of ongoing injuries unauthorized unauthorized on-site access. access affecting patients, guardians and nearby 98 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator communi ties ii. Schedule During MK0.00 Delivery Ongoing Contractor DLO; PIU E&S construction construction schedule Expert deliveries and phase compliance; heavy machinery community movement during feedback off-peak hours to minimize disruption. iii. Conduct During MK0.00 Number of Ongoing Contractor DLO; PIU E&S community construction sensitization Expert awareness and phase meetings notification iv. Develop During MK0.00 Number of Ongoing Contractor DLO; PIU E&S emergency construction plans Expert preparedness and phase response plan 99 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator v. Coordinate with Before MK0.00 Number of Once before Contractor DLO; PIU E&S hospital construction coordination construction Expert Administration to begins meetings; starts and ensure that availability of ongoing alternative routes alternative and access points routes are available during construction. vi. Hire transporters During MK0.00 Number of Ongoing Contractor DLO; PIU E&S whose vehicles construction compliant Expert have valid phase vehicles and Certificate of drivers Fitness (CoF) and drivers with the appropriate driving licence category. vii. Construction During MK150,000.00 Compliance Ongoing Contractor DLO; PIU E&S vehicles to construction with speed Expert observe a 20 phase limits; number km/hr speed limit of signposts on the hospital 100 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator campus. Put in place signposts indicating the speed limits on the construction site. Increase i. Carry out monthly Ongoing; MK150,000.00 Number of Monthly Contractor DEHO (DEHO); in health and safety monthly health PIU E&S Expert Infectious talks for education Disease construction sessions; (spread workers in liaison worker of STIs, with health participation HIV and personnel using AIDS, and the toolbox talks. Covid-19) ii. Free condoms are Ongoing MK200,000.00 Availability Ongoing Contractor DEHO; PIU E&S to be made and usage of Expert available to all condoms (100%) workers by placing them in the workers’ toilets to ensure access and confidentiality. 101 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Sensitize Ongoing MK70,000.00 Number of Ongoing Contractor DEHO; PIU E&S construction sensitization Expert workers on Covid- sessions; 19 prevention worker including hand compliance washing with soap, use of hand sanitizers, proper use of face masks, and workspace disinfection among others. iv. Distribute Ongoing MK150,000.00 Number of IEC Ongoing Contractor DEHO; PIU E&S information, materials Expert education, and distributed; communication worker (IEC) materials on awareness Covid-19, HIV and AIDS prevention, and cholera. v. Provide necessary Ongoing MK100,000.00 Availability Ongoing Contractor DEHO; PIU E&S PPE and other and usage of Expert materials (e.g. PPE; 102 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator cloth masks, hand compliance sanitizers, hand- with health washing facilities) protocols to help prevent construction workers from contracting and spreading Covid-19 at the workplace. Increased i. Develop an Before MK60,000.00 Existence of Once before Contractor District Social GBV and induction program construction induction work starts Welfare Office SEA cases including a code phase starts program; (DSWO); PIU of conduct for all number of E&S Expert workers which signed codes they will be of conduct required to sign prior to starting their work. ii. Ensure a copy of Before MK40,000.00 Number of Once before Contractor DSWO; PIU E&S the code of construction signed codes work starts Expert conduct is phase starts of conduct presented to all construction 103 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator workers and signed by each of them. iii. Implement a GBV During MK150,000.00 Existence and Ongoing Contractor DSWO; PIU E&S management construction implementatio Expert plan as presented phase n of GBV in Annex 9. management plan iv. Provide clear, Ongoing during MK250,000.00 Number of Ongoing Contractor DSWO; PIU E&S trusted, and construction reported Expert responsive phase cases; channels for filing resolution time GBV/SEA/SH cases to the police or other relevant government authorities. v. Ensure the Ongoing during MK80,000.00 Existence and Ongoing Contractor DSWO; PIU E&S availability of an construction accessibility of Expert effective phase GRM; number Grievance Redress 104 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator Mechanism of grievances (GRM). addressed Increased i. Provide adequate Before MK250,000.00 Number and Once before Contractor EDO; PIU E&S generatio on-site waste construction type of waste construction Expert n of solid receptors such as phase starts receptor starts and wastes, colour-coded bins compliance ongoing spills, and or skips for with waste effluent temporary waste management storage. Use of protocols rubbish pits should be discouraged. ii. Arrange with the Before MK100,000.00 Number of Once before Contractor EDO; PIU E&S District Council to construction waste disposal construction Expert identify a suitable phase starts sites identified; starts and site or sites (new or compliance ongoing existing) for waste with disposal disposal at different protocols project sites, if possible, within 5 km radius. 105 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Contractor to Before MK100,000.00 Number of Once before Contractor EDO; PIU E&S prepare Waste construction plans construction Expert management plan phase starts starts and as part of C-ESMP ongoing covering, waste types, waste collection and disposal, monitoring etc and based on risk mitigation hierarchy i.e. re- use, recycling, incineration, disposal (The generic waste Mgt. Plan to include the following sections: Introduction, Waste Handling Guidelines, Waste Type Identification, Waste Minimization, /Reduction, Waste 106 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator Segregation, Waste Disposal iv. Obtain permits to Before MK100,000.00 Number of Once before Contractor EDO; PIU E&S handle, store, construction permits construction Expert transport, and phase starts obtained; starts and dispose of compliance ongoing hazardous waste with from the hazardous Environmental waste Authority in regulations advance of construction. v. Segregate and During MK150,000.00 Segregation Ongoing Contractor EDO; PIU E&S clearly label construction and labelling Expert hazardous waste phase compliance; and store in condition of suitable drums or storage containers in facilities secure facilities that have a banded impermeable layer. 107 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator vi. Promote good Ongoing MK80,000.00 Cleanliness Ongoing Contractor EDO; PIU E&S housekeeping and and Expert sanitation practices organization at each site. of the site; worker compliance vii. Provide spill-control During MK100,000.00 Availability Ongoing Contractor EDO; PIU E&S kits and materials construction and usage of Expert (e.g. oil binding phase spill-control agents, sand, kits; number of shovels, etc.) to spill incidents drivers and workers, to clean up spills, if necessary. viii. Remove large During MK600,000.00 Number of Ongoing Contractor EDO; PIU E&S solids and debris Construction times Expert using screens and removed grit chambers ix. Channel During K100,000.00 Monitoring Ongoing Contractor EDO; PIU E&S wastewater Construction Reports Expert, Hospital through the existing Admin, sewer line that runs 108 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator from the hospital to Blantyre City the Blantyre City Council Council Wastewater Treatment plant at Zingwangwa ensuring proper connection and maintenance. x. Collect and During K0 Monitoring Ongoing Contractor EDO; PIU E&S dispose clogged Construction Reports Expert, Hospital sludge at Admin, wastewater Blantyre City treatment plant Council i. Include clauses in During bid MK0 Number of Once at bidding Contractor EDO; PIU E&S contracts that process contracts stage Expert Increased explicitly prohibit streamlined cases of child labour and child outline the labour consequences for non-compliance 109 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Collaborate with During MK120,000.00 Number of Ongoing Contractor EDO; PIU E&S local government construction collaborative Expert agencies to phase meetings strengthen enforcement of child labor laws and raise awareness in the community iii. Strategically erect During MK700,000.00 Number of Ongoing during Contractor EDO; PIU E&S 3-meter-high construction placards construction Expert phase raised placards carrying messages on the prevention of child labour at construction sites. 110 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator Conflicts i. Schedule water During MK0 Number of Ongoing Contractor and EDO; PIU E&S over use usage for construction water usage Hospital Expert of water phase plan Managers construction works and sanitary facilities ii. Store 5000 litres of During MK600,000.00 Number of At onset of Contractor Consultant, PIU, water for Construction tanks installed construction E&S Expert Phase phase construction per day in the tank. The tanks will be filled with water from Mudi River to ensure smooth flow of work iii. Construct During K1,200,000.00 Number of At onset of Contractor Consultant, PIU, adequate toilets construction latrines construction E&S Expert phase phase based on the number of 111 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator employees by gender (1-5 is 1 toilet; 6-15 are 2 toilets; 16-30 are 3; add 1 toilet for every additional 10 people i. The movement During MK0 Records of Ongoing Contractor Consultant, PIU, of heavy Construction time deliveries E&S Expert Phase vehicles to and from the site will Traffic be conducted Disruption during periods of the day when peak flow is minimal 112 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Drivers of these During MK700,000.00 Copies of Ongoing Contractor Consultant, PIU, vehicles will be Construction driver’s E&S Expert Phase licence licenced and proficient in driving these vehicles iii. Drivers under the During K250,000.00 State of drivers Ongoing Contractor Consultant, PIU, influence of Construction E&S Expert Phase narcotics and alcohol will not be allowed to operate these vehicles and must be removed from the site 113 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Develop a traffic During MK0.00 Number of At onset of Contractor Consultant, PIU, Management Construction Traffic plans construction E&S Expert Phase phase Plan within the C- ESMP v. Conduct During MK800,000.00 Number of Ongoing Contractor Consultant, PIU, periodical safety construction training E&S Expert phase sessions trainings for all drivers on site i. Screen off During MK800,000.00 Number of Ongoing Contractor Consultant, PIU, Visual construction site Construction barricades E&S Expert Intrusion Phase provided ii. Landscape the During MK1,300,000.00 Area At project Contractor Consultant, PIU, area upon Construction landscaped completion E&S Expert Phase stage completion of construction 114 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator i. Develop a During MK400,000.00 Number of On going during Contractor Consultant, PIU, comprehensive demolitions plans demolitions E&S Expert, Risk of demolition plan Hospital structural that outlines Administration collapse methods, sequencing, and safety protocols. ii. Engage structural During MK200,000.00 Number of At onset of Contractor Consultant, PIU, engineers to demolitions Engineers demolitions E&S Expert, Hospital advise on safe Administration demolition practices, especially for complex or large structures. iii. Use controlled During MK650,000.00 Number of On going during Contractor Consultant, PIU, methods (e.g., demolitions methods set demolitions E&S Expert selective demolition, 115 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator dismantling) rather than explosive demolition when feasible to minimize risks iv. Implement safety During MK1, 000 000.00 Number of At onset of Contractor Consultant, PIU, barriers, fencing, demolitions safety barriers demolitions E&S Expert and signage around the demolition site to keep unauthorized personnel at a safe distance v. Design, During K0 Assessment Once before Contractor DLO; PIU E&S construct, demolition reports construction Expert operate, starts and decommissio n the 116 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator structural elements of the project in accordance with national legal requirements , the EHSGs and other GIIP requirements . extreme weather events. Risk of i. Ensure workers use During MK1,000,000.00 Number of Ongoing during Contractor Consultant, PIU, hazardou appropriate PPE, demolitions PPEs provided demolitions E&S Expert, s Hospital such as respirators, materials Administration gloves, and 117 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator protective clothing ii. Implement proper During MK2,500,000.00 Number of At onset of Contractor Consultant, PIU, abatement demolitions procedures demolitions E&S Expert, Hospital procedures for Administration hazardous materials like asbestos including licensed removal iii. Provide training for During MK1,200,000,00 Number of At onset of Contractor Consultant, PIU, workers on demolitions Trainings demolitions E&S Expert, sessions Hospital handling hazardous Administration materials and recognizing potential risks 118 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Monitor air quality During MK500 000.00 Number of Ongoing during Contractor Consultant, PIU, and surrounding demolitions monitoring demolitions E&S Expert, attempts Hospital environments to Administration detect hazardous emissions during demolition v. Control the safety During K0 Assessment Once before Contractor DLO; PIU E&S of deliveries of demobilization reports construction Expert hazardous starts vi. materials, and of storage, transportation, and disposal of hazardous materials and wastes 119 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator i. Properly remove or During MK400,000.00 Number of At onset of Contractor Consultant, PIU, secure any demolitions flammable demolitions E&S Expert, materials Hospital Risk of fire flammable or removed Administration and explosive materials explosion before demolition starts ii. Ensure that During MK400,000.00 Number of At onset of Contractor Consultant, PIU, electrical systems demolitions times to demolitions E&S Expert, remove Hospital are properly de- electricals Administration energized and isolated before work begins iii. Create a During MK100,000.00 Number of At onset of Contractor Consultant, PIU, comprehensive demolitions plans demolitions E&S Expert, Hospital plan that includes Administration evacuation procedures, 120 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator emergency contacts, and firefighting equipment availability iv. Have appropriate During MK1,500,000.00 Number of Ongoing during Contractor Consultant, PIU, firefighting demolitions equipment demolitions E&S Expert, Hospital equipment readily Administration available on-site, including extinguishers and hoses Natural i. Use of During K0 Assessment Once before Contractor DLO; PIU E&S Hazards engineering Demobilization reports construction Expert (Wind controls (such as starts storms, containment, floods, automatic fires) 121 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. alarms, and shut- off systems) proportionate to the nature and scale of the hazard. iii. Ensure access to During K0 Assessment Once before Contractor DLO; PIU E&S emergency Demobilization reports construction Expert starts equipment on- site. iv. Ensure effective During K0 Assessment Once before Contractor DLO; PIU E&S notification Demobilization reports construction Expert procedures starts v. for designated emergency responders. 122 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator vi. Training program During K0 Assessment Once before Contractor DLO; PIU E&S for emergency Demobilization reports construction Expert starts responders including drills at regular intervals. i. All designs for During MK0 Number of Ongoing during Contractor Consultant, PIU, buildings must be demolitions designs demolitions E&S Expert, certified Hospital Admin certified and approved by registered engineers and architects ii. All designs for During MK0 Number of Ongoing during Contractor Consultant, PIU, buildings must be demolitions designs demolitions E&S Expert, produced Hospital Admin climate adaptive 123 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Consider the During K0 Assessment Once before Contractor DLO; PIU E&S incremental risks of Demolition reports construction Expert starts the public mainly patients and guardians’ potential exposure to operational accidents or natural hazards i. Hire certified During MK1,500,000.00 Number of At onset of Contractor Consultant, PIU, arborists or tree demolitions arborists hired demolitions E&S Expert removal specialists Risk of falling who have trees experience with tree cutting near structures 124 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Develop a During MK100,000.00 Number of At onset of Contractor Consultant, PIU, detailed cutting demolitions plans demolitions E&S Expert plan that outlines the methods to be used, including safety measures, equipment needed, and a clear timeline. iii. Define safety During MK150,000.00 Number of At onset of Contractor Consultant, PIU, zones around the demolitions zones defined demolitions E&S Expert tree and nearby structures where personnel and traffic should not enter during the cutting process 125 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Have an During MK1,100,000.00 Response Plan At onset of Contractor Consultant, PIU, emergency demolitions demolitions E&S Expert response plan in place, including first aid supplies and communication procedures, in case of accidents i. If necessary, During MK1,500,000.00 Number of Once at Contractor Consultant, PIU, Disturban construction relocations beginning of E&S Expert, ce and consider constructions Hospital disruption temporarily Administration to service relocating affected delivery services to minimize disruption 126 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Clearly mark During MK800,000.00 Number of Once at Contractor Consultant, PIU, alternative routes construction alternative beginning of E&S Expert, routes constructions Hospital and entrances to Administration ensure patients and staff can navigate the facility safely iii. Keep patients, During MK150,000.00 Number of Once at Contractor Consultant, PIU, staff, and visitors construction notices beginning of E&S Expert, provided constructions Hospital informed about Administration construction schedules, potential disruptions, and alternative access routes 127 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Phase the During K0 Number of At onset of Contractor Consultant, PIU, rehabilitation work construction phase plans construction E&S Expert, Hospital to limit the areas Administration affected at any given time, allowing some services to continue with minimal interruption v. Set up a dedicated During K0 Number of At onset of Contractor Consultant, PIU, hotline or feedback construction phase plans construction E&S Expert, Hospital system for patients, Administration staff, and visitors to report any issues arising from construction activities, which 128 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator can be addressed promptly i. Conduct During MK100,000.00 Number of At onset of Contractor Consultant, PIU, community construction phase plans construction E&S Expert Increased awareness Risk of campaigns on risks Defileme nt of defilement and importance of child protection ii. Conduct thorough During K0 Number of At onset of Contractor Consultant, PIU, background construction phase plans construction E&S Expert investigation on all workers and ensure that all those with a history of sexual offences are not employed 129 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Enforce laws During MK50,000.00 Number of At onset of Contractor Consultant, PIU, against defilement construction phase plans construction E&S Expert rigorously and ensure that perpetrators are prosecuted iv. Conduct During MK100,000.00 Number of At onset of Contractor Consultant, PIU, awareness construction phase plans construction E&S Expert meetings on GRM including reporting for defilement cases Demobilization Phase i. Provide advance Towards end of MK0 Number of Once towards Contractor EDO; PIU E&S Loss of notice to workers construction notices issued end of Expert employm about the phase construction ent demobilization timeline, allowing 130 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator them time to prepare for the transition ii. Offer support Towards end of MK300,000.00 Number of Last Quarter of Contractor EDO; PIU E&S services such as construction trainings construction Expert resume writing phase conducted Phase workshops, job search assistance, and interview preparation to help workers secure new employment iii. Provide retraining Towards end of MK200,000.00 Number of Last Quarter of Contractor EDO; PIU E&S or upskilling construction trainings construction Expert programs to equip phase conducted Phase workers with skills relevant to other industries, enhancing their employability 131 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iv. Collaborate with Towards end of MK350,000.00 Number of Last Quarter of Contractor EDO; PIU E&S local businesses to construction collaborative construction Expert identify potential phase meetings Phase job openings and ensure a smooth transition for workers. i. Develop a waste At onset of MK800,000.00 Number of Once at onset of Contractor EDO; PIU E&S management demobilization plans demobilization Expert Increased plan specifically phase developed generatio for the n of demobilization wastes phase, outlining how to minimize waste generation ii. Identify materials During MK0 Number Once at onset of Contractor EDO; PIU E&S that can be demobilization reports demobilization Expert recycled or phase reused, such as construction materials, packaging, and equipment, and 132 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator establish processes for their recover iii. Inform the local During MK200,000.00 Number of Once at onset of Contractor EDO; PIU E&S community about demobilization sensitization demobilization Expert waste phase meetings management efforts, encouraging them to participate in recycling initiatives and proper waste disposal xi. Train workers on During MK1,000,000.00 Number of Once at onset of Contractor EDO; PIU E&S proper waste demobilization trainings demobilization Expert management phase conducted, practices, and workers emphasizing the trained importance of reducing waste generation and following 133 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator segregation protocol i. Provide local Towards end of MK0 Number of Once at end of Contractor EDO; PIU E&S businesses with construction notices issued construction Expert advance notice of phase phase Loss of the demobilization business schedule, allowing opportuni them to prepare ties for potential impacts on their operations ii. Foster partnerships Towards end of MK300,000.00 Number of Last Quarter of Contractor EDO; PIU E&S between the construction partnership construction Expert project team and phase meetings Phase local businesses to identify potential collaborative opportunities that can arise during and after demobilization 134 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Organize Towards end of MK600,000.00 Number of Last Quarter of Contractor EDO; PIU E&S networking events construction events construction Expert or forums for local phase organized Phase businesses to connect with project stakeholders, facilitating discussions on future opportunities Operation and Maintenance Phase Increased i. Promoting use of O&M Phase K0 Record of Ongoin Hospital Administration MoH demand water efficient efficient g for water appliances such as appliances supply low flow shower and use heads and toilets, and sensor taps 135 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ii. Public awareness O&M Phase K300,000.00 Number of Ongoin Hospital Administration MoH on the importance sensitization g of water meetings conservation and efficient usage iii. Use advanced leak O&M Phase K0 Number of Ongoin Hospital Administration MoH detection and reports g repair technologies to detect and repair leaks in water distribution systems i. Train hospital staff O&M Phase K0 Number of Ongoin Hospital Administration MoH on energy saving training g Increased practices such as sessions demand switching off for equipment when energy not in use, use and optimising supply thermostat settings and ensuring that rooms are well 136 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator sealed to avoid energy wastage ii. Public awareness O&M Phase K0 Number of Ongoin Hospital Administration MoH on how they can awareness g reduce energy meetings consumption iii. Install energy O&M Phase K2,000,000.00 Reports on Ongoin Hospital Administration MoH saving energy saving g technologies such technologies as demand installed controlled ventilation, variable speed fans, energy efficient bulbs, fridge etc iv. Optimise cost and O&M Phase K0 Reports Ongoin Hospital Administration MoH efficiency and g consider using low emission and fuel- efficient power backup systems 137 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator i. Segregation and O&M Phase K0 Number of Ongoin Hospital Administration MoH Increased pretreatment of segregation g generatio hazardous material and pre- n of containing waste treatment wastewat such as oil and reports er grease through grease trap ii. Regular O&M Phase K0 Number of Ongoin Hospital Administration MoH environmental monitoring g monitoring and reports inspections Increased iii. Training of workers O&M Phase K0 Number of Ongoin Hospital Administration MoH amount on release training g of prevention sessions Hazardou including drills to s and specific hazardous medical materials material storage iv. Ensure availability O&M Phase K3,000,000.00 Reports on Ongoin Hospital Administration MoH of PPEs to all PPEs g workers handling 138 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator hazardous medical materials i. Formulate an On going and MK1,000,000.00 Number of Daily Hospital MoH exposure control during monitoring and Administrationstration plan for blood- operational reports quarterl borne pathogens phase y Risk of infection Transmissi Number of on Exposure control plan for blood- borne pathogens ii. Provide workers On going and MK0 Number of On Hospital Administration MoH and visitors with during notices going information on operational infection control phase policies and procedures 139 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Provide adequate On going and MK1,000,000.00 Number of Daily Hospital Administration MoH supplies of PPE for during workers with and on- personnel involved operational PPEs going in waste phase management iv. Provide washing On going and MK,100,000.00 facilities for during personal hygiene, operational particularly at phase waste storage locations. i. Incinerator should On going and MK100,000.00 Number of Annually Hospital Administration MoH, EDO, have permits issued during permits EAD, MEPA by authorized operational regulatory phase agencies and be operated and maintained by trained employees to ensure proper combustion temperature, time, and turbulence 140 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator specifications necessary for adequate combustion of waste. Air ii. Implement best On going and MK 200,000.00 Number of Daily Hospital Administration MoH, EDO, Emissions waste during monitoring and EAD, MEPA management operational reports monthly protocols including phase removal of the following items from waste destined for incineration: halogenated plastics (e.g. PVC), pressurized gas containers, large amounts of active chemical waste, etc before incineration 141 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Use wet scrubbers On going and MK 1,000,000.00 Number of Daily Hospital Administration MoH, EDO, to control acid gas during monitoring and EAD, MEPA emissions operational reports monthly phase iv. Control particulate On going and MK 1,000,000.00 Number of Daily Hospital Administration MoH, EDO, matter through the during monitoring and EAD, MEPA use of scrubbers operational reports monthly and / or phase electrostatic precipitators v. Regulate On going and MK 0 Number of Daily Hospital Administration MoH, EDO temperature to during monitoring and control amount of operational reports monthly volatile heavy phase metals vi. Management of On going and MK 0 Number of Daily Hospital Administration MoH, EDO incineration during monitoring and residues such as fly operational reports monthly phase 142 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ash and bottom ash i. Implement waste On going and MK 0 Number of Daily Hospital Administration MoH, EDO segregation during monitoring and measures to avoid operational reports monthly entry of solid waste phase into the wastewater stream ii. Train healthcare On going and MK 500,000.00 Number of Annually Hospital Administration MoH, EDO Soil and workers on waste during training reports Water management operational Pollution practices phase iii. Establish and On going and MK 0 Number of Daily Hospital Administration MoH, EDO implement during monitoring and recycling programs operational reports monthly for non- phase contaminated materials 143 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator i. Plant trees, shrubs On going and MK 0 Number of Annually Hospital Administration MoH, EDO, and other natural during monitoring DFO elements around operational reports the heath care phase facility to absorb and block externa Noise noise Pollution ii. Use noise reducing On going and MK 0 Number of Daily Hospital Administration MoH, EDO, and energy during monitoring and EAD efficient HVAC operational reports quarterl systems i.e quiet air phase y conditioning units iii. Educate On going and MK 0 Number of monthly Hospital Administration MoH, EDO, healthcare workers during toolbox talks EAD and staff about operational and staff noise awareness phase awareness and noise campaigns reduction practices, including 144 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator controlling the volume of voices, reducing door slams and using quieter equipment iv. Implement noise On going and MK 0 Number of monthly Hospital Administration MoH, EDO, and vibration during toolboxes talks EAD monitoring systems operational and staff phase awareness campaigns i. Develop a On going and MK 0 Number of monthly Hospital Administration MoH, EDO, comprehensive during toolboxes talks EAD plan to control operational and staff radiation phase awareness Health exposure with key campaigns and stakeholders Safety Risks ii. Install smoke On going and MK 1,000,000.00 Number of monthly Hospital Administration MoH, EDO, alarms and during toolboxes talks EAD sprinkler systems; operational and staff phase awareness campaigns 145 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Maintain fire On going and MK 0 Number of monthly Hospital Administration MoH, EDO, safety systems in during toolboxes talks EAD proper working operational and staff order, including phase awareness self-closing doors campaigns in escape routes and ventilation ducts with fire safety flaps iv. Train staff on On going and MK 500,000 Number of monthly Hospital Administration MoH, EDO, operation of fire during toolboxes talks EAD extinguishers and operational and staff evacuation phase awareness procedures campaigns v. Develop a facility On going and MK 0 Number of monthly Hospital Administration MoH, EDO, fire prevention or during toolboxes talks EAD emergency operational and staff response and phase awareness evacuation plans campaigns with adequate guest information 146 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator vi. Ensure secure On going and MK 500,000.00 Number of monthly Hospital Administration MoH, EDO, chemical storage during toolboxes talks EAD for hazardous operational and staff materials i.e phase awareness flammable campaigns materials, disinfectants, pharmaceuticals etc vii. Implement On going and MK 0 Number of monthly Hospital Administration MoH, EDO, protocols for during toolboxes talks EAD segregating and operational and staff labelling phase awareness hazardous wastes campaigns i.e. sharps viii. Provide PPEs to all On going and MK 0 Number of monthly Hospital Administration MoH, EDO, personnel during toolboxes talks EAD working with operational and staff hazardous phase awareness materials campaigns 147 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator ix. Provide training On going and MK 200,000.00 Number of monthly Hospital Administration MoH, EDO, to all employees during toolboxes talks EAD on hazards operational and staff associated with phase awareness materials in the campaigns facility x. Implement On going and MK 1,000,00.00 Number of monthly Hospital Administration MoH, EDO, medical during toolboxes talks EAD surveillance for operational and staff employees who phase awareness are routinely campaigns exposed to hazardous materials i. Employ full time During onset of K500,000.00 Number of Monthly Hospital Administration MoH, EDO and Increased security guards operation phase personnel EAD cases of theft and ii. equip the facility During onset of K600,000.00 Number of Ongoin Hospital Administration MoH, EDO and vandalism with high-resolution operation phase cameras g EAD security cameras 148 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Mark restricted During onset of K0 Reports Ongoin Hospital Administration MoH, EDO and areas "restricted" operation phase g EAD and ensure they are locked or monitored iv. Ensure that During onset of K100,000.00 Reports Ongoin Hospital Administration MoH, EDO and medical operation phase g EAD equipment, technology, and pharmaceuticals are securely stored in lockable cabinets or rooms when not in use v. Provide adequate During onset of K100,000.00 Number of Ongoin Hospital Administration MoH, EDO and lighting around the operation phase lighting points g EAD building's exterior, parking areas, entrances, and sensitive areas is essential 149 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator vi. Engage with local During onset of K0 Number of Ongoin Hospital Administration MoH, EDO and law enforcement operation phase meetings g EAD to increase patrols around the healthcare facility i. Employ full time During onset of K500,000.00 Number of Monthly Hospital Administration MoH, EDO and security guards operation phase personnel EAD ii. equip the facility During onset of K600,000.00 Number of Ongoin Hospital Administration MoH, EDO and with high-resolution operation phase cameras g EAD security cameras iii. Mark restricted During onset of K0 Reports Ongoin Hospital Administration MoH, EDO and areas "restricted" operation phase g EAD and ensure they are locked or monitored iv. Ensure that During onset of K100,000.00 Reports Ongoin Hospital Administration MoH, EDO and medical operation phase g EAD equipment, technology, and pharmaceuticals are securely stored 150 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator in lockable cabinets or rooms when not in use v. Provide adequate During onset of K100,000.00 Number of Ongoin Hospital Administration MoH, EDO and lighting around the operation phase lighting points g EAD building's exterior, parking areas, entrances, and sensitive areas is essential vi. Engage with local During onset of K0 Number of Ongoin Hospital Administration MoH, EDO and law enforcement operation phase meetings g EAD to increase patrols around the healthcare facility i. Develop a During onset of MK800,000.00 Number of First MoH Blantyre City Increased comprehensive operation phase plans quarter Council generatio waste developed of n of management plan Operati wastes that outlines on procedures for waste reduction, 151 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator segregation, and disposal throughout the operational phase ii. Encourage During operation MK50,000.00 Number of Ongoin MoH Blantyre City practices that phase training g in Council minimize waste sessions operatio generation, such as n phase optimizing processes, reusing materials, and reducing packaging iii. Provide ongoing During operation K1,100,000.00 Number of Ongoin MoH Blantyre City training for staff on phase trainings g in Council waste conducted operatio management n phase practices, emphasizing the importance of reducing waste and following 152 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator segregation protocols iv. Involve the local During operation MK150,000.00 Number of Ongoin MoH Blantyre City community in phase sensitization g in Council waste reduction meetings operatio initiatives and n phase awareness campaigns to foster a culture of sustainability Natural i. Use of engineering During MK1,500,000.00 Number of Ongoin Contractor Consultant, Hazards controls (such as construction and equipment g during PIU, E&S Expert, (Wind containment, operation demoliti Hospital Admin storms, automatic ons floods, fires) ii. Alarms, And Shut- Off Systems) Proportionate To The Nature And Scale Of The Hazard. 153 Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Period Cost (MK) Performance Frequency Responsibility Responsibility Indicator iii. Ensure access to During MK2,000,000.00 Number of Ongoin Contractor Consultant, emergency construction and equipment g during PIU, E&S Expert, equipment on-site. operation demoliti Hospital Admin ons iv. Ensure effective During MK500,000.00 Number of Ongoin Contractor Consultant, notification construction and equipment g during PIU, E&S Expert, procedures for operation demoliti Hospital Admin designated ons emergency responders. Ensure construction During MK1,500,000.00 Number of Ongoin Contractor Consultant, and clearing of water construction and equipment g during PIU, E&S Expert, ways operation demoliti Hospital Admin ons TOTAL MK62,760,000.00 NB: This is an initial ESMP plan and supplementary details will be developed in C-ESMP for construction and O&M EHS Plan for O&M phase. 154 6.3 Training and Capacity Building The Training and Capacity Building Plan is designed to ensure that all members involved in the project—specifically the Ministry of Health (MoH) Project Implementation Unit (PIU), the Supervision Consultant team, and the Contractor’s team—are well-equipped to implement and oversee the Environmental and Social Management Plan (ESMP) effectively. The objectives of training and capacity building approach are as follows: i. Ensure all team members understand the ESMP and their roles in its implementation. ii. Develop skills and competencies required for effective monitoring, reporting, and management of environmental and social impacts. iii. Ensure all activities comply with the ESMP, World Bank guidelines, and local regulations. iv. Foster a culture of continuous improvement in environmental and social performance. To effectively raise awareness among project workers and stakeholders at multiple levels, a cascading model will be implemented to ensure information flows smoothly from the national level to field levels as shown in Table 6-10. This approach ensures that training on environmental and social risk management is fully integrated into the project cycle and operational procedures, leading to more effective implementation and compliance. 155 Table 6-10: Proposed Training and Capacity Building Approach Level Responsibility Audience Topics / Themes Estimated Cost Party (MK) National External PIU Staff, MoH • Introduction to ESMP MK2,800,000.00 Consultant Staff • ESMP Planning and Implementation • Monitoring and Reporting • Environmental and Social Safeguards • Corrective Action Planning • Communication and Stakeholder Engagement Hospital Environmental Hospital Project • Introduction to ESMP MK2,500,000.00 Level Specialist Implementation • Development of Monitoring Tools Team • Organize and conduct trainings on EHS related training during O&M phase • Monitoring Program Development • Reporting and Communication • Emergency Response and Contingency Planning Contractor Environmental Contractor • Customizing the ESMP and develop MK1,000,000.00 Level Specialist Environmental construction Environmental and Social Management Plan (CESMP) 156 Level Responsibility Audience Topics / Themes Estimated Cost Party (MK) and Social Expert, • Organize and conduct trainings on EHS Contractor’s Staff related training during O&M phase • Equipment Use for Environmental Measurements • Monthly Reporting • Compliance with Environmental and Social Standards Workers Contractor All project Workers • Anticipated project impacts and Part of project level Environmental mitigation measures at each stage costs (Weekly and Safety defending on specific works Toolbox Specialist • Grievance Redress Mechanism (GRM), training) Gender based Violence (GBV), Abuse of child labour, Child marriage, Defilement • Occupational Health and Safety measures including first Aid • Code of Conduct 157 To ensure the effectiveness of the Training and Capacity-Building Plan, regular evaluations and monitoring will be implemented through the following: i. Evaluate participants' knowledge before and after training sessions. ii. Collect feedback from participants to improve future training sessions. iii. Regularly review monitoring reports to ensure compliance and identify areas for improvement. iv. Conduct quarterly review meetings with all stakeholders to assess progress and address any issues. 6.4 ESMP Estimated Budget Table 6-116-4 lists estimated cost items for the implementation of mitigation measures for the ESMP, which have been included in the overall project budget. Table 6-11: Summary ESMP Implementation Budget SN Activity/Cost Item Potential Cost (MK) 1 Trainings for Hospital Project Implementation Team MK2,500,000.00 (venue, travel, refreshments, etc.) 2 Trainings for contractors (venue, travel, MK2,085,000.00 refreshments, etc.) 3 Printing of awareness raising materials / grievance MK3,000,000 redress materials 4 Personal Protective Equipment MK8,500,000 5 Cost of obtaining clearances or permits MK2,000,000 6 Implementation of ESMP during Construction Phase MK21,075,000 7 External monitoring or supervision consultant MK2,000,000 8 Implementation of ESMP during O & M phase MK23,600,00 Total MK62,760,000.00 NB: This Table does not include cost of construction materials that have a bearing on safeguards. Such costs shall be included in the BoQs as part of main project costs 158 6.5 Stakeholder Engagement, Grievance Redress Mechanism and Disclosure Process 6.5.1 Stakeholder Engagement A separate Stakeholder Engagement Plan (SEP) has been prepared for the Project, based on the World Bank’s Environmental and Social Standard 10 on Stakeholder Engagement. During the ESMP development process, consultations were conducted with various stakeholders. These included members from the Ministry of Health and MEPA from the central level, civil society organizations, Blantyre City Council and officials from Queen Elizabeth Central Hospital. The solicited ideas from this consultation process have been incorporated especially into the legislation that has been reviewed for ESMP and also the potential impacts and their mitigation measures. These stakeholder engagement processes shall also be undertaken during construction phase. Effective public consultations during this phase helps address potential issues before they escalate promoting transparency and fostering positive relationships so that the project can achieve greater acceptance and success. The hospital shall further be required to conduct stakeholder engagements during operation and maintenance phase. Consultations at this phase play a critical role in ensuring on going engagement with the community and stakeholder. This phase typically involves the long-term operation of the infrastructure or facility, and public consultations help address concerns that arise during the operational phase, ensuring that the project continues to meet community needs and regulatory requirements. Summary of proceedings from the consultation process has been attached as Annex 5. 6.5.2 Grievance Redress Mechanism (GRM) System The rehabilitation works at QECH will employ a diverse workforce. To ensure the rights of all workers are respected, a dedicated Workers Grievance Redress Management Committee (WGRMC) will be established to address workers' grievances at the project site. This committee must be the primary point of reference for any complaints, concerns, injustices, or issues workers may face during construction. The mechanism aims to protect workers' rights, promote participation, provide support and benefits to all contractors’ workers, and ensure compliance with Malawi’s labour laws, World Bank Environmental and Social Standards (ESS 2), and GIIPs. 159 6.5.2.1 Institutional Arrangements at Hospital Level The contractor will establish a WGRMC that must consist of: • Workers’ Representatives: One representative per worker group or section (e.g., general labourers, skilled labourers). These representatives must act as intermediaries between workers and the WGRMC. The worker’s representative should deliberately include female representatives. • Hospital Ombudsman: QECH has an existing GRM that the hospital ombudsman's office handles. This must link with the workers’ committee to collect all such cases from workers and finally consolidate and help to resolve together with those from the hospital community. The hospital ombudsman shall continue to use the existing processes for case management. To ensure structured grievance management, the WGRMC members must choose the positions of Chairperson, Vice Chairperson, Secretary, and Vice Secretary. 6.6.2.2 Process and Procedures for Workers GRM All complaints or allegations that are criminal, such as rape, defilement, theft, or any other illegal activity, must be promptly reported to the Police or relevant government authorities for investigation and action in compliance with the World Bank requirements and national legal requirements, ensuring due process and protection of affected individuals. The following process must be implemented to ensure that workers' grievances are addressed promptly and fairly: Stage 1: Complaint Uptake • Submission Methods: Workers may submit complaints directly to their Workers’ Representative or WGRMC members. Grievance boxes must be installed at strategic locations (e.g., canteen areas, entrances, resting areas) to allow workers to submit their grievances anonymously. If workers prefer direct communication, they may also submit their complaints to WGRMC members via phone or text. • Documentation: The Secretary of the WGRMC must record every received complaint in a Grievance Register provided in Annex 10a. This register must track the date of the complaint, the nature of the grievance, the complainant's details (if provided), and the actions taken. The committee must maintain a copy of the register to ensure easy tracking and accountability for each grievance. 160 • Confidentiality: The GRM must allow anonymous reporting through grievance boxes or digital methods to protect workers' identities if they do not wish to be named. Stage 2: Assessment, Acknowledgment, and Response • Acknowledgement: The WGRMC must acknowledge each grievance within 24 hours of submission. The worker must be informed of the receipt of their grievance through their preferred communication method (verbal, text, or written acknowledgement). • Assessment: The WGRMC must assess the grievance to determine its legitimacy and whether it requires immediate action or further investigation. The assessment must verify the facts of the grievance with the contractor, the workers involved, and relevant documentation. • Response: The committee must develop an appropriate response or resolution plan within five (5) working days of receiving the grievance. If corrective measures are necessary, the responsible parties (e.g., contractor, safety officer) must be informed, and the actions must be taken immediately. Stage 3: Resolution or Escalation • Resolution at WGRMC Level: If the grievance is straightforward and can be resolved quickly, the WGRMC must mediate and take appropriate corrective actions within five (5) days. These actions may include adjustments to working conditions, addressing safety concerns, or resolving payment disputes. • Escalation: If the grievance cannot be resolved at the WGRMC level or if the worker is unsatisfied with the proposed resolution, the complaint must be escalated to the Hospital Grievance Redress Management Committee. • Written Resolution Agreement: If an agreement is reached between the parties, a Grievance Resolution Agreement Minute (provided in Annex 10b) must be signed by both the worker and the WGRMC members. The document must outline the agreed-upon corrective measures. Stage 4: Monitoring and Documentation All grievances must be logged in a Grievance Register provided in Annex 10a that tracks the complaint’s status, actions taken, and outcomes. The contractor's ESHS Safeguards Specialist must regularly update this register, which must be available for review by the Consultant and Client. The Secretary 161 must check the grievance boxes daily to ensure timely identification and addressing of grievances. Monthly grievance reports must be prepared to track trends and ensure that grievances are handled promptly and effectively. 6.6.2.3 Monitoring and Evaluation The Workers GRM must be monitored regularly to ensure that it is functioning effectively and that complaints are resolved in a timely manner. Key performance indicators (KPIs) must include: o Number of complaints received. o Percentage of grievances resolved at the first level. o Time taken to resolve grievances. o Trends in types of grievances 6.6.3 Disclosure Process This ESMP will be disclosed after approval and disclosures have already been done for the SEP and the Environmental and Social Commitment Plan (ESCP) that have been prepared for this project. 162 Chapter 7 Conclusion and Recommendations 7.1 Conclusion The environmental and social assessment established that refurbishments at Queen Elizabeth Hospital will have positive impacts to the hospital. The impacts will include increasing employment opportunities, skills transfer to local community, improved healthcare delivery system, and improved infrastructure development. However, despite the outlined positive impacts, the proposed development will come up with some negative impacts such as temporary air quality deterioration, mostly during construction phase, increased generation of waste (solid and liquid), potential for accidents and injuries on site affecting workers, elevated noise levels from machinery and construction activities, increased Gender Based Violence and SEA cases, among others. The proposed project design has integrated mitigation measures with a view to ensuring compliance with all the applicable laws and procedures. The structures will be built to the required planning/architectural/structural standards as required by Ministry of Health and NCIC. In relation to the proposed mitigation measures that will be incorporated during construction and operational phases; the project is considered beneficial and important. It is our considerable opinion that the proposed development is a timely venture that will subscribe to the development of the country. It is thus our recommendation that the project be allowed to go ahead with the implementation provided the outlined mitigation measures are adhered to. Major concerns should nevertheless be focused towards minimizing the occurrence of impacts that would degrade the general environment. This will however be overcome through close adherence and implementation of the recommended Environmental and Social Management and Monitoring Plans (ESMMPs). 7.2 Overall recommendations It is the consultant’s view that the project be allowed to proceed on condition that the measures proposed in this ESMMP are fully implemented. Recommendations for the prevention and mitigation of adverse impacts are as follows: a) All solid waste materials (which could be hazardous) and debris resulting from demolitions activities must be disposed of at the designated waste management sites and by following proper guidelines. 163 b) Construction activities must be undertaken only during the day i.e., between 7:30 am – 5:00 pm to minimize disturbance to the surrounding hospital community including patients. c) Traffic along the access/connecting roads should be controlled during construction and especially when heavy trucks are turning in and out of the sites to ensure that no accidents are caused by the site’s activities. d) During construction, all loose soils must be compacted to prevent any erosion by wind or water. Other appropriate soil erosion control measures can be adapted. Any stockpiles of earth should be enclosed, covered or sprinkled with water during dry or windy conditions to minimize generation of dust particles into the air. e) Once earthworks have been done, restoration of the worked areas should be carried out immediately by backfilling, landscaping/ levelling and planting of low grass (in open areas), flowers and suitable tree species. f) Ensure proper water usage during construction and operation phases. Contractor can import water using bowsers and tankers with the approval of relevant water authority in case water supply is not adequate at the hospital, to avoid interruptions to hospital services. g) Drains should be properly designed, installed and regularly maintained to prevent storm water (run-off) from accumulating within the site and spreading to the neighbourhood. These must effectively drain the storm from the premise into the existing public drainage system along the road. h) Workers must be provided with complete protective and safety gear. They must have working boots, complete overalls, helmets, gloves, earmuffs, nose-masks, goggles etc. i) The contractor must provide adequate security during the construction period and especially during the night when there are no construction activities; and 164 References 1. Government of Malawi (1997), Guidelines for Environmental Impact Assessment (EIA) in Malawi. Environmental Affairs Department, Lilongwe. 2. Government of Malawi (2010), Child Care, Protection and Justice Act, Lilongwe, Malawi 3. Government of Malawi (2015), Environmental Management Act, Lilongwe, Malawi 4. Government of Malawi (2008), Environment Management (Waste and Sanitation) Regulations, Lilongwe, Malawi. 5. Government of Malawi (2013), Disability Act (Amendment), Lilongwe, Malawi 6. Government of Malawi, Gender Equality Act, Lilongwe, Malawi 7. Government of Malawi (1997), Occupational Health, Safety and Welfare Act. Ministry of Labor and Vocational Training, Lilongwe 8. Government of Malawi, Public Health (Amendment) Act, 2015, Lilongwe, Malawi 9. Government of Malawi (2012) National HIV/AIDS Policy, OPC, Lilongwe. 10. Government of Malawi (2015), National Gender Policy, Ministry of Women and Community Development, Lilongwe. 11. Government of Malawi, (1948), Public Health Act, Lilongwe, Malawi 12. Government of Malawi (2006), National Policy on Equalisation of Opportunities for Persons with Disabilities, Lilongwe, Malawi 13. The World Bank (2017), Environmental and Social Framework, 1818 H Street NW, Washington, DC 20433, USA. 14. National Statistical office (2018), Population and Housing Census report, Zomba, Malawi. 15. Government of Malawi (2020), Public Health (Corona Virus prevention, containment and treatment), Ministry of Health, Lilongwe, Malawi. 165 16. Government of Malawi (2013), Penal Code (Amendment) Act, Lilongwe, Malawi 17. The World Bank (2017), Environmental and Social Framework, 1818 H Street NW, Washington, DC 20433, USA. 18. Government of Malawi, (2021), Employment Act, Lilongwe, Malawi. 19. Government of Malawi, (2006) Infection Prevention and Control Policy, Lilongwe, Malawi. 20. Government of Malawi, (1995) Constitution of the Republic of Malawi, Lilongwe, Malawi. 21. International Finance Corporation-WB, 2007, Environmental, Health, and Safety Guidelines for Health Care Facilities. 22. International Finance Corporation-WB, 2007, Environmental, Health, and Safety (EHS) Guidelines General EHS Guidelines 166 Annexes Annex 1 - Environmental & Social Screening Form 167 168 169 170 Annex 2 - Traffic Management Plan A Traffic Management Plan (TMP) is an essential component in ensuring safe and efficient movement of vehicles, pedestrians, and emergency responders around the Project site. The plan helps minimize disruptions, ensures accessibility, improves safety, and enhances visitor experience. This section provides a generic component of Traffic Plan. The contractor shall have to develop a specific Traffic Management Plan for specific sites as part of the C- ESMP. The following plan aims to minimize traffic congestion, enhance road safety, and ensure smooth transportation operations. A1 Assessment and Planning • Traffic Impact Assessment (TIA): Conduct a thorough TIA to understand the potential impact of construction activities on local traffic patterns. This should include peak traffic times, road capacities, and key congestion points. • Stakeholder Consultation: Engage with local authorities, community leaders, and stakeholders to discuss the proposed traffic management measures and obtain necessary approvals. A2 Traffic Control Measures • Temporary Traffic Signals and Signs: Install temporary traffic signals and signs around the construction site to guide drivers and pedestrians. Clearly mark detour routes and alternative pathways. • Road Closures and Diversions: Plan and schedule road closures and diversions during off-peak hours to minimize disruption. Provide advance notice to the public about these changes. • Dedicated Construction Routes: Designate specific routes for construction vehicles to minimize their impact on general traffic. Ensure these routes avoid high pedestrian areas and critical hospital access points. 171 A3 Construction Logistics • Staging Areas: Establish staging areas for construction materials and equipment to reduce on-site congestion. These areas should be located away from main traffic routes. • Scheduled Deliveries: Coordinate the timing of deliveries to avoid peak traffic hours. Use smaller, more frequent deliveries if necessary to reduce the impact on traffic flow. A4 Pedestrian Safety • Pedestrian Pathways: Create safe and clearly marked pedestrian pathways around the construction site. Use barriers to separate pedestrians from construction activities. • Crossing Guards: Deploy crossing guards at critical points to assist pedestrians, especially during peak hospital visiting hours. A5 Public Communication • Information Dissemination: Use multiple channels (e.g., local radio, social media, hospital newsletters) to keep the public informed about construction schedules, road closures, and alternative routes. • Signage and Maps: Provide clear signage and maps around the hospital to help drivers and pedestrians navigate the area during construction. A6 Emergency Access • Uninterrupted Emergency Routes: Ensure that access routes for emergency vehicles to the hospital are always clear and unobstructed. Coordinate with hospital security and local emergency services to develop contingency plans. • Regular Coordination: Hold regular coordination meetings with emergency services to review and adjust access routes as needed. A7 Monitoring and Adjustments • Traffic Monitors: Deploy traffic monitors to observe and report on traffic conditions in real-time. Use their feedback to make immediate adjustments to traffic control measures. 172 • Regular Reviews: Conduct weekly reviews of traffic management measures and make necessary adjustments based on feedback from stakeholders and observed traffic patterns. A8 Post-Construction • Site Restoration: Ensure that all temporary traffic control devices are removed and the area is restored to its original condition. Repair any road surfaces or pedestrian pathways damaged during construction. • Feedback and Evaluation: Collect feedback from the community and stakeholders on the effectiveness of the traffic management plan. Use this feedback to improve future projects. 173 Annex 3 - Technical Drawings for Proposed Ward A4, Main Operating Theatre, Kitchen, Clinic Area, Sewer Line and Corridors Queens Elizabeth Central Hospital Kitchen (Floor Plan) 174 Queens Elizabeth Central Hospital Kitchen (Floor Plan) Side Elevation 175 Queens Elizabeth Central Hospital Kitchen (Floor Plan): Dilapidation Schedule 176 Queens Elizabeth Central Hospital: Ward 4A (Layout Plan) 177 Queens Elizabeth Central Hospital: Ward 4A (Side Elevation) 178 Dilapidated Schedule: Queens Elizabeth Central Hospital: Ward 4A 179 Queens Elizabeth Central Hospital Main Theatre Layout 180 Queens Elizabeth Central Hospital: Ward 4A: Dilapidated Schedule Theatre 181 Queens Elizabeth Central Hospital O.P.D Clinic (Layout Plan) 182 Queens Elizabeth Central Hospital O.P.D Clinic Dilapidated Schedule-OPD Area 183 Dilapidated Schedule for Orthopedic & Psychiatry Section 184 Rehabilitation Of Queens Elizabeth Central Hospital Corridors/Corridor Details 185 Annex 4 - Project Impacts and Ratings Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 1 Mobilisation Labour & Creation of job Positive 2 3 3 2 3 30 Low Economic opportunities. Conditions 2 Mobilisation Labour & Improved project Positive 3 3 3 2 3 33 Moderate Economic compliance to Conditions national environmental and social requirements Demolition and Construction Phase 3 Site clearing & Air Quality Temporary Air Quality Negative 2 2 1 1 2 12 Very Low Excavation Deterioration 186 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 4 Site clearing & Noise & Elevated noise levels Negative 3 2 1 1 3 21 Low Excavation Vibration from machinery and construction activities. 5 Site clearing & Terrestrial Loss of trees and other Negative 2 3 1 2 2 16 Low Excavation Biodiversity ground cover. 6 Site clearing & Public Health & Potential for accidents Negative 3 3 3 3 3 36 Moderate Excavation Safety and injuries on-site affecting workers. 7 Site clearing & Public Health & Potential for accidents Negative 3 2 3 2 2 20 Low Excavation Safety and injuries on-site affecting near-by communities. 187 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 8 Site clearing & Public Health & Infectious Disease Negative 3 3 5 5 2 32 Moderate Excavation Safety Impact (spread of STIs, HIV and AIDS, and Covid 19) 9 Site clearing & Social Dynamics Gender-Based Negative 3 3 3 2 3 33 Moderate Excavation and Community Violence (GBV) and Well-being Sexual Exploitation and Abuse (SEA) Impact 10 Site clearing & Waste Generation of solid Negative 3 2 1 2 3 24 Low Excavation Management and hazardous waste requiring proper disposal and management. 188 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 11 Demolitions Public Health Risk of fire and Negative 1 1 3 1 2 12 Very Low and Safety explosion 12 Demolitions Public Health Risk of hazardous Negative 2 2 2 3 2 18 Low and Safety materials 13 Demolitions Public Health Risk of structural Negative 2 2 3 2 2 18 Low and Safety collapse 14 Demolitions Public Health Potential for accidents Negative 3 3 3 3 3 36 Moderate and Safety and injuries affecting workers and patients 15 Demolitions Soil erosion Increased soil erosion Negative 1 2 2 2 2 14 Moderate and sediments into water 189 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 16 Demolitions Safety of Poor safety of services Negative 3 2 2 2 2 18 Low services 17 Super structure Infrastructure Provision of poor Negative 3 3 2 2 2 20 Low and equipment infrastructure and design and equipment design and services services 16 Super Structure Labour & Creation of job Positive 3 3 3 2 3 33 Moderate Economic opportunities. Conditions 17 Super Structure Air Quality Temporary Air Quality Negative 2 2 1 1 2 12 Very Low Deterioration 190 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 18 Super Structure Noise & Elevated noise levels Negative 2 2 1 1 3 18 Low Vibration from machinery and construction activities. 19 Super Structure Public Health & Potential for accidents Negative 3 2 3 2 3 30 Low Safety and injuries on-site affecting workers. 20 Super Structure Public Health & Potential for accidents Negative 2 1 3 2 3 24 Low Safety and injuries on-site affecting near-by communities. 21 Super Structure Public Health & Infectious Disease Negative 3 3 5 2 3 39 Moderate Safety Impact (spread of STIs, 191 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning HIV and AIDS, and Covid 19) 22 Super Structure Waste Generation of solid Negative 3 2 1 2 3 24 Low Management and hazardous waste requiring proper disposal and management. 23 Super Structure Social Dynamics Gender-Based Negative 3 2 1 2 3 24 Low and Community Violence (GBV) and Well-being Sexual Exploitation and Abuse (SEA) Impact 192 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 24 Structural Labour & Creation of job Positive 3 3 3 2 3 33 Moderate Framing Economic opportunities. Conditions 25 Structural Noise & Elevated noise levels Negative 3 2 1 1 3 21 Low Framing Vibration from machinery and construction activities. 26 Structural Public Health & Potential for accidents Negative 3 2 3 1 3 27 Low Framing Safety and injuries on-site affecting workers. 27 Structural Public Health & Potential for accidents Negative 2 2 3 2 3 27 Low Framing Safety and injuries on-site affecting near-by communities. 193 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 28 Structural Public Health & Infectious Disease Negative 3 3 5 2 3 39 Moderate Framing Safety Impact (spread of STIs, HIV and AIDS, and Covid 19) 29 Structural Visual Impact Visual intrusion from Negative 2 2 3 2 3 27 Low Framing construction equipment, structures, and stockpiles. 30 Structural Waste Generation of solid Negative 2 2 1 1 3 18 Low Framing Management and hazardous waste requiring proper disposal and management. 194 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 31 Fit Out Labour & Creation of job Positive 3 3 3 2 3 33 Moderate Economic opportunities. Conditions 32 Fit Out Noise & Elevated noise levels Negative 3 2 1 1 3 21 Low Vibration from machinery and construction activities. 33 Fit Out Public Health & Potential for accidents Negative 3 2 3 1 3 27 Low Safety and injuries on-site affecting workers. 34 Fit Out Public Health & Potential for accidents Negative 2 2 3 2 3 27 Low Safety and injuries on-site affecting near-by communities. 195 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 35 Fit Out Public Health & Infectious Disease Negative 3 3 5 2 3 39 Moderate Safety Impact (spread of STIs, HIV and AIDS, and Covid 19) 36 Fit Out Visual Impact Visual intrusion from Negative 2 2 3 2 3 27 Low construction equipment, structures, and stockpiles. 37 Fit Out Waste Generation of solid Negative 3 3 3 2 3 33 Moderate Management and hazardous waste requiring proper disposal and management. 196 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning Demobilization Phase 38 Demobilisation Labour & Creation of job Negative 3 3 3 2 3 33 Moderate Economic opportunities. Conditions 39 Demobilisation Noise & Elevated noise levels Negative 2 2 3 1 2 16 Low Vibration from machinery and construction activities. 40 Demobilisation Public Health & Potential for accidents Negative 3 3 3 3 3 36 Moderate Safety and injuries on-site affecting workers. 41 Demobilisation Waste Generation of solid Negative 3 2 1 1 3 21 Low Management and hazardous waste requiring proper 197 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning disposal and management. Operation and Maintenance Phase 42 Hospital Noise Pollution Increased generation Negative 2 4 3 3 3 36 Moderate operations of noise by patient and staff 43 Hospital Air Quality Air quality risk Negative 1 4 2 2 3 33 Moderate Operations 44 Hospital Health and Increased health and Negative 3 4 2 3 3 36 Moderate operations Safety safety risks 198 Impact Reversibility Significance Rating Impact Magnitude Nature of Impact Impact Duration Potential Activity Impact Extent Project Activity VEC Environmental & Social Probability of Significance Occurrence No Impact Planning 45 Hospital Theft and Increased cases of Negative 1 4 2 1 2 16 Low Operations Vandalism theft and vandalism 46 Hospital Hazardous Increased amount of Negative 2 4 2 2 2 20 Low Operations medical hazardous medical materials material waste 47 Hospital Waste Water Increased generation Negative 3 2 3 3 3 33 Moderate Operations of waste water 48 Hospital Energy Use and Increased demand for Negative 2 4 3 3 3 36 Moderate Operations Supply energy use and supply 49 Hospital Water supply Increased demand for Negative 2 4 3 3 3 36 Moderate Operations and use water supply and use 199 Annex 5 - Stakeholder Engagement 5.1 General Background Public and stakeholder consultations are very key to successful designing and implementation of environmental and social safeguards for any project including QECH rehabilitation. As such we consulted key institutions and general public represented by guardians on what are the possible risks and impacts of the project and how to enhance or mitigate the impacts. A group of guardians that were interviewed were selected from various hospitals to ensure that their views input was a balanced representation of their hospitals. This step is not an option but a requirement by government of Malawi according to guidelines and also WB as the funder according to its ESF. For this project, we consulted QECH management and staff, patients and guardians, Blantyre City Council, MEPA, Centre for Environmental Policy and Advocacy (CEPA) and Health Rights Education Program (HREP); The issues covered during the consultations cantered on the following key areas: a. ES related challenges already existing in the area and the project can help address b. Positive impacts anticipated from the project c. How the positive impacts can be enhanced by the project? d. Risks anticipated if the project is implemented e. Negative social impacts, construction and operation activities will cause and should be included in ESMP. f. If sensitive features exist in the area that the project may negatively affect including monuments and relics. g. Activities that can likely threaten the environment to which the project will be implemented h. Proposed interventions to be included in the ESMP to improve the environmental performance of the project i. Labor issues- How best can this project ensure that local labour is used over migrant labour. j. Other issues that should be included in the ESMP. 200 5.2 Objectives Public and Stakeholder consultations were aimed at done to: • Inform public and also discuss the nature and scale of adverse impacts of the project on their welfare and livelihoods in a more transparent and direct manner and seek their participation in the project cycle. • Give stakeholders a chance to have a say and express their views and concerns in the planning and implementation of the project that affect them directly or indirectly. • Inform local authorities of the impacts, solicit their views on the project and discuss their share of the responsibility for the sound implementation and functioning of the overall project construction and operations activities. 5.3 Findings of public and Stakeholder consultations Consultations were done from 10th to 16th July 2024 and Table 5-1 summarizes issues that were raised by stakeholders at different levels. National Team Members Consulted Name/Institution/Role /Contact Patrick Chipweteka Environmental Health 0888869838 Officer/Inspector, BT City Council Maziko Matemba Executive Director 0999951274 Health Rights Education Program (HREP) Mary Chilimampunga Deputy Director 0999246996 (Environmental Education and extension) National Parks and Wildlife Patrick Nyirenda Senior Environmental Officer, MEPA Herbert Mwalukomo Executive Director 0881038910 Center for Environmental Policy and Advocacy (CEPA) 201 Name/Institution/Role /Contact Aaron Khombe Historian 0991821183/0888566022 Department of Museums and Monuments Key informant Interview Name/Institution/ /Role /Contact Patrick Chipweteka Environmental Health 0888869838 Officer/Inspector, BT City Council Maxwell Mbulaje Blantyre District 0999942117 Assembly mbulaje@yahoo.co.uk Environmental District Officer Patrick Nyirenda Senior Environmental Officer, MEPA 202 Table 5-1: Summary of issues discussed, and comments raised by stakeholders Stakeholder Meeting Responses How the issue has to be addressed or enhanced Place Blantyre City Sewer line and the general drainage system The consultant and contractor shall look at possibilities Council is old and dysfunctional leading to blockages of handling this issue. and leakages of sewage and wastewater. Buildings are congested that ventilation is The corridors need to be opened up compromised especially during peak period. Possible impacts are air pollution through dust The contractor shall do watering to control dust during demolition of the structures. Noise pollution specially from machines. Use of noise free generators and traffic management plan Since the place is already congested, The contractor shall identify alternative routes to moving debris will be a challenge. ferrying the debris Acknowledge only local government As such, any suggestion by contractors to dispose handles waste management. waste should get approval from the BCC. Should the contractor have a site, they must manage smoke that pollute the air, oils that pollute the soil and the 203 Stakeholder Meeting Responses How the issue has to be addressed or enhanced Place Asbestos containing material (ACM) disposal BCC can provide land for encasing the ACM in an needs further consultation. underground structure. BCC should supervise the disposal process by a certified ACM handler or MEPA should. BCC will be rehabilitating the sewer system soon under MWSP I Project and it will increase the capacity through use of larger pipes. There are no guidelines for disposing Decisions are made on the way which is a challenge hazardous waste like asbestos in Malawi. but we need to properly manage the waste and the disposal process. Construction people come with more money They should be informed that they came for work and than most people ate the hospital. Some will go. start relationships with them, may get infected as the hospital is for people with ailments. Some families may breakdown. Some people working for contractors steal Strict supervision is needed to ensure the contractor material, do poor job and risk our lives. follows standards. The contractor should also Sometimes our work is made difficult. How do supervise own workers. you mop a floor that is full of sand? 204 Stakeholder Meeting Responses How the issue has to be addressed or enhanced Place Construction work cause dust Should use hoarding to prevent people going into dusty work areas and water the ground and their work. Getting injured because of workplace Should use hoarding to prevent people going into materials dusty work areas and water the ground and their work. This means use of respiratory masks and not the ordinary masks. Wetting the material adequately to reduce the rate of release of the fibre. Need proper and protected transport to ensure the asbestos is not releasing the fibre. It must be disposed underground in a concrete pit. During the demolition, employ dust suppression measures to protect workers and the public by wetting the areas as well as hoarding the area i.e. barricading. The contractor will need to apply for hazardous waste license from MEPA. 205 Stakeholder Meeting Responses How the issue has to be addressed or enhanced Place Burnt bricks and wooden materials are Use of eco-friendly materials in the construction so contributing to deforestation. such as concrete blocks, stabilized soil brick (SSB) or ceramic bricks produced by licensed suppliers; timber from licensed suppliers or steel Noise from plants and machinery Working hours should be controlled to minimize noise since it is a hospital and patients eg only working during day since noise is faster at night. Central The hospitals are part of human inhabited We have smaller type of wildlife especially trees which Government area where most of the notable wildlife is may have special status and cutting needs license displaced. form Forestry. Rivers close by are habitats to marine life and The contractor shall have an ESMP that shall guide make sure hazardous effluent and other him on management of wastes, and as required by waste are not channelled to the rivers. The local councils. The contractor shall also register with construction site has to register as a Ministry of labour as is required by law workplace under Occupational and Health safety under Mini, of Labor. Increased business opportunities. 206 Stakeholder Meeting Responses How the issue has to be addressed or enhanced Place Also make sure that the project is not The contractor shall only employ workers that are employing children as labor and that women above the age of 18 are given equal; opportunities with me. Make sure that the workers are protected SEA and abuse is one of the areas under monitoring. from sexual exploitation and Abuse. Make sure that waste disposal is managed The contractor shall dispose of wastes in designated and is not deposited in protected areas like areas as required by the local councils. forests. Hazardous material will need special treatment. Malawi Hospitals have a rich history behind The consultant and Contractor shall preserve all them. A concept that portrays how monuments and relic. Where these have become a Malawians were treated by the colonial hard, follow the laws. At QECH, there is a tree that was masters; It is the symbol of racism that was planted by the Queen Mother in the 1950s. It should there. The masters and the locals never used never be cut. the same hospital. In Blantyre, the masters used the hospital buildings in Sunny side near ADRA office and where Malawi Blood Transfusion is. 207 5.4 Evidence of consultations (Signing sheets and Pictures) 208 209 Consultation meeting with Ground Workers Consultation Meeting with maintenance Team 210 Annex 6 - Terms of References B1. Overview - Development of an Environmental and Social Management Plan The Consultant shall prepare an environmental and social management plan comprising a programme of assessing and managing the impacts during the implementation, operation and post-operation phases, including decommissioning. This will provide time frames and implementation mechanisms, reporting responsibilities, description and technical details of monitoring measures, assessment of the institutional needs, staffing requirements and cost outlay for implementation. The plan should show how management and mitigation methods are phased with project implementation. The plan shall also include measures to prevent health hazards and ensure safety in the working environment for the employees and the communities adjacent to the project site and project-affected people. B2. Environmental, Social, Health and Safety Compliance The Consultant will undertake several tasks to ensure that all aspects of the project, including the design, construction and implementation, are capable of achieving compliance with World Bank ESS requirements. The Consultant will prepare the contractor bidding documents to include all the ESS requirements. The Client shall share the Environmental and Social Management Plan (ESMP) and any related safeguards instruments as they outline the environmental, social, health and safety policies that will apply to the project. The Consulting Firm shall address Environmental and Social Management matters in accordance with national law and the World Bank Environmental and Social Framework (ESF). In particular, the Consulting Firm should pay attention to the project safeguards instruments which include but not limited to the Environmental and Social Management Framework (ESMF), Environmental and Social Commitment Plan (ESCP), Stakeholder Engagement Plan (SEP) and Labor Management Procedures (LMP). The Consultant shall ensure that the Contractor delivers its ES obligations under its contract. This includes, but is not limited to, the following: (a) Review the Contractor’s Environment and Social Management Plan (C- ESMP), including all updates and revisions at frequencies specified in the Contractor’s contract, and at least once every 6 months; 211 (b) Review all other applicable Contractor's documents related to ES aspects, including the health and safety manual, security management plan and SEA prevention and response action plan; (c) Review and consider the ES risks and impacts of any design change proposals and advise if there are implications for compliance with ESIA, ESMP, consent/permits and other relevant project requirements; (d) Undertake, as required, audits, supervisions and/or inspections of any sites where the Contractor is undertaking activities under its contract to verify the Contractor's compliance with ES requirements (including relevant requirements on SEA/SH); (e) Undertake audits and inspections of the Contractor's accident logs, community liaison records, monitoring findings and other ES related documentation, as necessary, to confirm the Contractor's compliance with ES requirements (including relevant requirements on SEA/SH); (f) Determine remedial action/s and their timeframe for implementation in the event of noncompliance with the Contractor's ES obligations; (g) Ensure appropriate representation at relevant meetings, including site meetings and progress meetings, to discuss and agree on appropriate actions to ensure compliance with ES obligations; (h) Ensure that the Contractor’s actual reporting (content and timeliness) is in accordance with the Contractor’s contractual obligations; (i) Review and critique, in a timely manner, the Contractor’s ES documentation (including regular reports and incident reports) regarding the accuracy and efficacy of the documentation; (j) Undertake liaison, from time to time and as necessary, with project stakeholders to identify and discuss any actual or potential ES issues; B3. Grievance Redress Mechanism The Consultant will ensure that the Contractor (a) establishes and maintains a grievance redress mechanism including types of grievances to be recorded and how to protect confidentiality, for example, those reporting allegations of SEA and/or SH. 212 (b) Maintains a master Grievance Log to track progress on grievance resolution. The Consultant is an engaged and proactive player in seeing that grievances are received, recorded, and brought to the attention of the correct party for quick resolution. (c) The Consultant shall notify the Client of any observed trends in grievance types to see if further actions can be done to resolve the situation. 213 Annex 7 - Code of Conduct for Contractor’s Personnel We are the Contractor, [enter name of Contractor]. We have signed a contract with [enter name of Employer] for [enter description of the Works]. These Works will be carried out at [enter the Site and other locations where the Works will be carried out]. Our contract requires us to implement measures to address environmental and social risks related to the Works, including the risks of sexual exploitation, sexual abuse and sexual harassment. This Code of Conduct is part of our measures to deal with environmental and social risks related to the Works. It applies to all our staff, labourers and other employees at the Works Site or other places where the Works are being carried out. It also applies to the personnel of each subcontractor and any other personnel assisting us in the execution of the Works. All such persons are referred to as “Contractor’s Personnel” and are subject to this Code of Conduct. This Code of Conduct identifies the behaviour that we require from all Contractor’s Personnel. Our workplace is an environment where unsafe, offensive, abusive or violent behaviour will not be tolerated and where all persons should feel comfortable raising issues or concerns without fear of retaliation. REQUIRED CONDUCT Contractor’s Personnel shall: 1. carry out his/her duties competently and diligently; 2. comply with this Code of Conduct and all applicable laws, regulations and other requirements, including requirements to protect the health, safety and well-being of other Contractor’s Personnel and any other person; 3. maintain a safe working environment including by: a. ensuring that workplaces, machinery, equipment and processes under each person’s control are safe and without risk to health; b. wearing required personal protective equipment; c. using appropriate measures relating to chemical, physical and biological substances and agents; and d. following applicable emergency operating procedures. 4. report work situations that he/she believes are not safe or healthy and remove himself/herself from a work situation which he/she reasonably 214 believes presents an imminent and serious danger to his/her life or health; 5. treat other people with respect, and not discriminate against specific groups such as women, people with disabilities, migrant workers or children; 6. not engage in Sexual Harassment, which means unwelcome sexual advances, requests for sexual favours, and other verbal or physical conduct of a sexual nature with other Contractor’s or Employer’s Personnel; 7. not engage in Sexual Exploitation, which means any actual or attempted abuse of position of vulnerability, differential power or trust, for sexual purposes, including, but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another; 8. not engage in Sexual Abuse, which means the actual or threatened physical intrusion of a sexual nature, whether by force or under unequal or coercive conditions; 9. not engage in any form of sexual activity with individuals under the age of 18, except in case of pre-existing marriage; 10. complete relevant training courses that will be provided related to the environmental and social aspects of the Contract, including on health and safety matters, Sexual Exploitation and Abuse (SEA), and Sexual Harassment (SH); 11. report violations of this Code of Conduct; and 12. not retaliate against any person who reports violations of this Code of Conduct, whether to us or the Employer, or who makes use of the grievance mechanism for Contractor’s Personnel or the project’s Grievance Redress Mechanism. I [enter name of employee], have read and understood the contents of this Code of Conduct. I do hereby agree that I shall comply to this code of conduct every time that I execute my services at this site, signed……………………………. 215 Annex 8 - Code of Conduct for Contractor in Relation to Child Protection The contractor will be required to prepare a code of conduct in relation to child protection among others that they shall be following when undertaking construction works. These rules shall form part of the assessment criteria when selecting the contractor. A satisfactory code of conduct will contain obligations on all project staff (including sub-contractor s and day workers) that are suitable to address the following issues, as a minimum. Additional obligations may be added to respond to concerns of the region, the location, and the project sector or to specific project requirements. The issues to be addressed include: 1. Compliance with applicable laws, rules, and regulations of the jurisdiction. 2. Protection of children (including prohibitions against abuse, defilement, or otherwise unacceptable behaviour with children, limiting interactions with children, and ensuring their safety in project areas). 3. Sexual harassment (for example to prohibit use of language or behaviour, towards women or children, that is inappropriate, harassing, abusive, sexually provocative, demeaning or culturally inappropriate). 4. Violence or exploitation (for example the prohibition of the exchange of money, employment, goods, or services for sex, including sexual favours or other forms of humiliating, degrading, or exploitative behaviour). 5. Compliance with applicable health and safety requirements (including wearing prescribed personal protective equipment, preventing avoidable accidents and a duty to report conditions or practices that pose a safety hazard or threaten the environment). 6. The use of illegal substances. 7. Non-discrimination (for example based on family status, ethnicity, race, gender, religion, language, marital status, birth, age, disability, or political conviction). 8. Interactions with community members (for example to convey an attitude of respect and non-discrimination). 9. Sanitation requirements. 216 10. Avoidance of conflicts of interest (such that benefits, contracts, or employment, or any sort of preferential treatment or favours, are not provided to any person with whom there is a financial, family, or personal connection). 11. Respecting reasonable work instructions (including regarding environmental and social norms). 12. Protection and proper use of property (for example, to prohibit theft, carelessness or waste). 13. Duty to report violations of this Code; and 14. Non-retaliation against workers who report violations of the Code, if that report is made in good faith. The Code of conduct should be written in local and plain language, and signed by each worker to indicate that they have: • Received a copy of the code. • Had the code explained to them; • Acknowledged that adherence to this Code of conduct is a condition of employment; and • Understood that violations of the Code can result in serious consequences, up to and including dismissal, or referral to legal authorities. 217 Annex 9 - GBV Management Plan Prevention of GBV is a multifaceted effort which should deal with or focus on: 1. women empowerment or agent of change 2. women participation and capacity to influence decision making 3. women economic empowerment 4. increased access to sexual and reproductive health and rights 5. incorporate men and boys in efforts (as perpetrators, victims and agents of change) 6. social gender norms and behaviour transformation (challenging gender stereotyping) The specific prevention measures have been included in a GBV Management plan to ensure the implementation of actions in this regard and to allow for close monitoring of the contractor. Action Activities Responsibilities party • Identify GBV service providers in the area. • Identify vulnerable groups within the community. QECH Stakeholder • Inform community members about the details (NDH); engagement of the Project and the GBV risks associated with DSWO the project. • GBV training including what to do in case of grievance. GBV training for • Training and sensitisation of all workers GRC, contractor associated with the Project on GBV and how and staff, NDH; the project can contribute to GBV risks. consultants and Contractor; • Training and sensitisation of adjoining adjoining DSWO communities on GBV risks, channels to report community GBV incidents and services available for GBV members survivors. 218 • Have the CoCs signed by all those with Codes of conduct physical presence in the site. NDH; signed and Contractor • Train construction workers on the behaviour understood obligation under the CoCs. • Grievance redress committees to ensure confidential complaint uptake mechanisms Handling GBV are in place. complaints • The GBV cases should be immediately GRM (including support reported to the Police (Victim Support Unit), of survivors) District Social Welfare Office, psychosocial support institutions working in the project area or district. Provision of separate, safe and • Ensure construction sites have separate easily accessible NDH; facilities like toilets and/or bathrooms for men facilities for Contractor and women. women and men working on the site • Selection of monitoring indicators (such as: No. of reported cases of GBV; Resolved cases and time it took to address the complaints, No. of NDH; workers that have attained GBV training Monitoring and Contractor; courses; No./percentage of workers that have reporting DSWO signed CoC and No. of GBV cases that were referred to the GBV service provider). • Ensure new risks are uncovered and mitigated. 219 Annex 10 - Grievance Reporting Form GRIEVANCE REPORTING PHIM/GRM ……...............…….…………/…….……………………….… (Location) (Reference No.) 1. Complainant’s Information (This information must be provided. The identity of complainants will be kept confidential if they request so.) Names and Signatures Positions/ Addresses: E-mail: Titles Organizations (Dr/Mr/Ms/Mrs) (If any) TA/VGE Contact Tel. Authorised If yes Description of Representative? Group Please indicate how you prefer to be contacted (e-mail, mobile, etc.): 2. Brief Description of the problem: 3. Description of the Complaint (a) What harm do you believe the COVID-19 Emergency Project caused or is likely to cause to you? (b) Why do you believe that the alleged harm results directly from the COVID-19 Emergency Project? (c) Do you have any other supporting documents that you would like to share? 4. Previous Efforts to Resolve the Complaint 220 (a) Have you raised your complaint with any other authorities? No Yes  (a)Have you raised your complaint with any other authorities? No  Yes  If Yes (Please, provide the following details): When?: • How and with whom the issues were raised? • Please describe any response received from and/or any actions taken by the project level grievance mechanism. • Please also explain why the response or actions taken are not satisfactory. If No, Why? (b) How do you wish to see the complaint resolved? 5. Name of the person who completed this form: Signature: Date: 221 Annex 11 - Grievance Resolution Implementation Minute (GRIM) GRIEVANCE RESOLUTION REE NO.: PHIM/GRM/.............…….…………/…….……………… (Location) (Reference No.) IMPLEMENTATION MINUTE (GRIM) RESPONDENT DETAILS COMPLAINANT DETAILS Full name Full name Address: Address: Phone No. Phone No. (home/cell) (home/cell) IF IF ANY ANY Email: Email: Date of complaint resolution SUMMARY OF RESOULTION IMPLEMENTATION SIGNATURES Chairperson Complainant Signature Signature Name of Name of Chairperson Complainant Date Date 222 Secretary Witness Signature Signature Name of Name of Secretary Complainant’s Witness Date Date 223 Annex 12 - Asbestos Containing Material (ACM) Management Plan 1.0 Overview The initial assessment for presence of asbestos at Queen Elizabeth Central Hospital (QECH), showed that samples taken from the roofing sheets (Sample:BT-QUEENS-W3A-ROOF) had tested positive and negative for wall plaster and ceiling boards (Samples: BT-QUEENS-3A-WALL and BT-QUEENS-3A- CEILING). This relates only to the samples tested and does not imply approval by Malawi Bureau of Standards of the quality and/or performance of the commodities that had been tested. This implies that there is a risk of potential finds of asbestos and associated health risks. It's crucial to prioritize safety during the rehabilitation of Queen Elizabeth Central Hospital, more particularly regarding asbestos management. The aim is to eliminate exposure to asbestos through the identification and removal of asbestos where feasible. Where elimination is not possible, exposure is to be minimized so far as is reasonably practicable. This Asbestos Containing Material (ACM) Plan serves as an important framework for handling potential risks associated with asbestos during the demolition and rehabilitation of structures at QECH. No work can start on the demolition of structures or their parts without an appropriate assessment for the presence of asbestos. 1.1Aim of the Asbestos Containing Material Management Plan The aim of the ACM plan is to ensure the safe removal, handling, storage, transportation and disposal of asbestos containing materials during rehabilitation works at QECH. 1.2 Objectives of the Asbestos Containing Material Management Plan The objectives of this ACM plan are: • Provide guidance to manage any asbestos contaminated material (ACM) discovered Queen Elizabeth Central Hospital. • Provide guidance and build capacity of the contractor and subcontractors on the risks and impacts associated with removal, handling, storage, transportation, and disposal of asbestos containing material. • Ensure appropriate procedures are in place for safe removal, handling, packaging, transportation, storage, and disposal of asbestos. • Provide guidance to manage asbestos related incidents and ensure effective record keeping for asbestos’ disposal and incidents. 224 • Provide guidance on safeguarding and protection of patients from exposure to asbestos fibre and ensure effective relocation plan. 1.3 Scope of the ACM Plan The scope of the ACM plan is to provide guidance on the handling, packaging, temporary storage, transportation, and disposal of asbestos containing material that may be discovered during rehabilitation at QECH. 1.4 Proposed Activities under the Asbestos Management Plan The following proposed activities will be conducted under the asbestos management plan: • Engage with MEPA and Blantyre City Council further guidance on handling and disposal of asbestos containing material. • Ensure that the hazardous waste license for contractor, that may be engaged to transport hazardous waste is valid. • Identify a suitable and approved dump site for disposal of the asbestos Containing Material (ACM) with guidance from MEPA. • Conduct a due diligence and site visit for identified contractor and dump site and ensure that they are fully licensed with MEPA and have the required capacity for transportation and disposal of the asbestos containing material. 2.0 Roles and Responsibilities • QECH Project Management Team and MC-ERHSP PIU will be responsible for review of ACM plan and include in the request for bids. This is to ensure contractors can properly plan and cost for these works. • The contractor will be responsible for the adoption of ACM plan and include it as part of their C-ESMP including costing its execution in the bid document. • The contractor is accountable and responsible for managing asbestos risks effectively through implementation of ACM Plan as part of their Contractor’s ESMP. • QECH project Management Team and MCERHSP PIU will be responsible for supervision and monitoring of the implementation of the ACM Management Plan 225 • QECH Project Management Team and MCERHSP PIU will ensure that there are training sessions on the management of the ACM Plan as this is essential for the safety and effectiveness of the project. • QECH Project Management Team will have ultimate authority over the management of Asbestos Containing Materials (ACMs), crucial for ensuring safety and compliance throughout the project implementation. • Workers must avoid actions that could put themselves or their colleagues at risk of exposure through adherence to established safe work procedures at all times and promptly report any hazards or unsafe work methods to their supervisor to ensure a safer work environment. • 3.0 Asbestos Management Control Arrangements • QECH Project Management Team and MCERHSP PIU shall jointly develop asbestos removal plan for approval by the Malawi Environment Protection Authority (MEPA) in line with the Environment Management (Chemicals and Toxic Substances Management) Regulations). Developing a comprehensive removal plan for Asbestos Containing Materials (ACMs) before their removal is a critical step to ensure compliance with environmental regulations and to protect public health • Conduct risk assessment for the removal of ACM- provide a risk assessment and plan of work on ACM. QECH project Management Team and MCERHSP PIU will review the removal plan of work and risk assessments. • Removal of any ACM will require a permit-to-work by MEPA. Any work on the ACMs must be done by a competent and approved ACM Specialist. The contractor shall undertake training of all personnel involved in the removal of ACM; • ACMs should be labelled clearly with the asbestos warning sign or some other warning system (for example color coding) can be used; and • ACM may be covered in plastic sheeting before being buried at a safe site identified in consultation with MEPA, QECH project Management Team and the Blantyre City Council. 226 Table 1- ACM Management, Removal and Disposal Plan Activities Responsibility Specific Management Measure Planning for QECH project • Developing and implementing a relocation plan required for relocation of protection of Management patients and services and prevent patient and guardians congestion and patients and Team, MCERHSP protection from asbestos fibres. guardians from PIU Contractor • Ensure effective and regular inspections for asbestos in order to identify asbestos exposure potential asbestos-containing materials and assess their condition as asbestos- containing materials can release harmful fibres into the air that can affect patients and guardians. • Install public notices and carry general awareness campaigns on dangers of asbestos and need for protection. Planning for QECH project • Conduct an asbestos audit before starting rehabilitation work to ensure safety Asbestos Management and compliance Containing Team, MCERHSP • Develop a detailed ACM Management Plan as part of a Contractors’ materials removal PIU Contractor Environmental and Social Management Plan (ESMP) to ensure safety and (i.e. removal of regulatory compliance asbestos containing roof tiles • QECH project Management Team and MCERHSP PIU will before removal of over the whole ACM, develop a removal plan that will be approved by MEPA in line with the building and Environment Management (Chemicals and Toxic Substances Management) replacing with IBR Regulations. sheets) • Conduct risk assessment for the removal of ACM and provide plan of work on ACM. PIU will review the removal plans of work and risk assessments. 227 • Removal of any ACM will require a permit-to-work by MEPA. Any work on the ACMs must be done by a competent and approved ACM Specialist. Training shall be undertaken to all personnel involved in the removal of ACM. (Removal of Contractor • Removal and disposal of asbestos containing roof tiles over the whole building asbestos and replacing with IBR sheets should comply and adhere to the approved containing roof tiles removal plan over the whole • Removal and disposal of ACM in buildings should only be performed by building and specially trained personnel, following, internationally recognized procedures. replacing with IBR sheets) • When possible, the asbestos will be appropriately contained and sealed to minimize exposure. • The asbestos will be treated with a wetting agent prior to removal to minimize asbestos dust. • Provide adequate Personal Protective Equipment to all personnel handling asbestos, including respirators and disposable clothing. • Protection of walls, floors, and other surfaces with plastic sheeting. • Removing the ACM using wet methods, and promptly placing the material in impermeable containers. • Final clean-up with special vacuums. Transportation and Contractor, QECH, • If asbestos material is to be stored temporarily, the wastes should be securely Storage of ACM MEPA enclosed inside closed containments and marked appropriately. 228 • Transporting ACM in leak-tight containers to a secure dumpsite operated in a manner that precludes air and water contamination that could result from ruptured containers. • ACMs should be labelled clearly with the asbestos warning sign or some other warning system (for example colour coding) can be used. Disposal of ACM Contractor, QECH, • Disposal of the removed ACM and contaminated materials in an approved MEPA dumpsite • ACM may be covered in plastic sheeting before being disposed of at a safe site identified in consultation with MEPA, QECH and the Blantyre City Council. • Provide adequate protection to personnel handling asbestos, including respirators and disposable clothing. • The removed asbestos will not be reused. ACM activities PIU Engineer, • The PIU engineer and QECH through competent personnel shall supervise the Monitoring QECH, MEPA works with ACM. • An ACM Specialist shall be hired by the contractor to assure application of proper protective measures in work with ACM in existing structures. • Monitoring as the work progresses, as well as final air sampling for clearance, by an entity independent of the contractor removing the ACM. 229 Conclusion This Asbestos Containing Material (ACM) has been prepared through document review, field surveys and consultations. The plan has serves as an important framework for handling potential risks associated with asbestos during the demolition and rehabilitations of structures at QECH. Monitoring of management measures will be done to ensure compliance with the site-specific Contractor Environmental and Social management plan (CESMP) prior to commencement of works. The monitoring will also ensure compliance with this ACM Plan. Monitoring is the responsibility of PIU Engineer, QECH, MEPA who will ensure that the contractor adheres to this ACM plan. The World Bank will provide overall monitoring during the Banks implementation support missions and as may become necessary. 230 Annex 13 - Queen Elizabeth Central Hospital (QECH) Relocation Plan Rehabilitation works proposed for QECH will focus on existing buildings that currently provide essential hospital services. These buildings are utilized by hospital staff and are occupied by patients and their guardians. The objective is to enhance the functionality and safety of these facilities while ensuring minimal disruption to ongoing medical services and QECH will implement this relocation plan to ensure the continuity of care and minimize disruptions during the rehabilitation works. To ensure patient safety, quality of care, and staff efficiency, and ensure quality care of health services, QECH, will ensure execution of the following measures: detailed assessment, prioritization of critical services, effective communication and engagement, identifying temporary care locations and maintaining essential services, patient and guardians notification, effective communication, patient flow and navigation, rehabilitation works phasing, infection control and noise reduction, infection control and noise reduction, formal agreements, monitoring service delivery, contingency planning, and reopening of services which would effectively manage the rehabilitation project and ensure that patient care remains uninterrupted and of high quality. 231 S/N Activities Management Measure Responsibility Plan execution Plan Monitoring 1.0 Assessment and Pre-Planning Phase 1.1 Detailed Impact • Identify all services that will be affected by the Hospital MCERHSP PIU Assessment rehabilitation project Management, QECH project • Determine space requirements for temporarily Management Team displaced departments and services and Contractor • Estimate the volume of patients to be affected, including critical cases, high-risk patients, and how ongoing treatments will be administered. 1.2 Prioritization of • Non-disruptive Services: Identify services that should Hospital MCERHSP PIU Critical Services have minimal disturbances and prioritize to maintain Management, QECH these even during the rehabilitation works. project Management Team • Phased Construction: Organize the project in phases and Contractor to avoid the total shutdown of key departments and services. • Timeline Management: Develop a detailed timeline with milestones to ensure the project stays on track and disruptions are minimized. 232 1.3 Stakeholder • Form Taskforce: Involving hospital management, QECH project MCERHSP PIU engagement heads of department, contractor, and including Management Team patients/ guardians in the planning process to and Contractor understand their needs and concerns and to manage the displacement plan. • Regulatory Compliance: Ensure all plans meet local health regulations, especially concerning patient safety and facility standards. 2.0 Temporary Relocation of Services 2.1 Identify • Maximize available space within the hospital i.e. less Hospital MCERHSP PIU, Temporary Care critical care areas into temporary treatment zones for Management Ministry of Locations and displaced services (internal relocation). Health Maintaining • Emergency Services: Maintain full capacity for essential services emergency services cases by relocating emergency services to an easily accessible area. 3.0 Communication Strategy 3.1 Patient and • Advance Communication: Notify patients and their Hospital MCERHSP PIU Guardians guardians in time of any disruptions i.e. signage, Management, QECH Notification verbal notifications, hospital websites, and social project media updates. Management Team • Provision of detailed information on service relocations, expected disruptions, alternative 233 locations, and how to access care during construction and rehabilitation works period. 3.2 Effective • Ensure workers awareness of the temporary Hospital MCERHSP PIU Communication adjustments, emergency protocols, and patient care Management, QECH (workers) guidelines. project Management Team • Organize regular briefings to address any concerns. • Feedback Mechanism: Implement a system for staff to provide feedback and raise concerns, allowing for quick adjustments to the displacement plan if needed. 3.3 Patient Flow and • On-Site Signage: Ensure clear and visible signage Contractor, QECH QECH Navigation around the hospital for navigating to temporary units. project Administration Management Team 4.0 Phased Rehabilitation works and Disruption Minimization 4.1 Rehabilitation • Service and displacement Staggering: Schedule Contractor, Hospital MCERHSP PIU works Phasing rehabilitation works in stages to ensure only a portion Management, QECH of services are affected at any given time, project maintaining the hospital’s operational capacity. Management Team 4.2 Infection Control • Physical Barriers: Set up physical barriers between Contractor, MCERHSP PIU, and Noise construction zones and active hospital areas to Ministry of Reduction reduce noise and dust. Health, QECH Administration 234 • Infection Control: Work closely with infection control teams to control increases in the risk of infections. Ensure air quality control systems are in place to protect patients from contaminants. 5.0 Coordination with External Partners 5.1 Formal • Establish networks and formal agreements with other Hospital Ministry of Agreements healthcare facilities to manage patient overflow for management, Health, QECH specialized care and emergencies. Administration • Coordinate resource sharing with partners to ensure effective patient care service delivery. 6.0 Monitoring, Adjustment, and Contingency Plans 6.1 Monitoring • Patient Flow: Continuously monitor patient flow, wait Hospital Ministry of Service Delivery times, and treatment delays in temporary locations Management, Health, QECH and adjust as necessary to address bottlenecks. Administration • Quality Assurance: Conduct regular reviews to ensure the quality of care remains uncompromised despite the rehabilitation works and changes. 6.2 Contingency • Plan for Delays: Prepare for possible delays in Hospital Ministry of Planning construction and rehabilitation works or other Management Health, QECH unexpected disruptions. Keep contingency spaces Administration and resources on standby. 235 7.0 Post-Construction Transition Plan 7.1 Recommissioning • Patient Notification: Inform patients once services Hospital Ministry of of Services return to their original locations, using clear Management, QECH Health, QECH communication channels. project Administration Management Team • Adjustment of Operations: Make any final adjustments to ensure smooth operations once rehabilitation is complete. 236 Below is the plan showing relocation of various facilities and services during rehabilitation of QECH. No Unit Remarks 1 Renovation of Theatres During renovations, Theatres I and II will Unit relocate to Theatre IV for urgent and elective emergency cases. From 4th Nov, 2024, elective cases will be treated at the ENT Theatre. Entry of workers into the Theatre will be through Oxygen plant area and anesthesia unit. During mass casualties, the Burns Theatre will also be used as an alternative for general surgery use. 2 Renovation of Kitchen Kitchen will relocate to Eye Unit where (5) of the (8) pots will be installed and longer shifts plan for kitchen workers will be employed to offset the pot shortfall. Maintenance works in the Eye unit will also be undertaken to ensure functionality of the eye unit as a Kitchen. There will also be a standby power generator at the unit. 3 Renovation of Ward 4A The ward will relocate to the Tents The official information from QECH Administration regarding this relocation plan is attached below. Conclusion The QECH rehabilitation project requires careful and effective planning including flexibility to maintain uninterrupted patient care and accessibility to essential services. Coordinating with key and relevant stakeholders, ensuring clear communication, and maintaining continuous monitoring are crucial for the success of the rehabilitation project. 237 238 239