Republic of Malawi Ministry of Health Malawi COVID-19 Emergency Response and Health Systems Preparedness Project CHSU Compound, Area 3, Mtunthama Drive, Private Bag 65, Lilongwe 3, Malawi Name of Project: Malawi COVID-19 Emergency Response and Health Systems Preparedness Project PROJECT ID NO.: P173806 Environmental and Social Management Plan (ESMP) for Installation of A Mechanical Incinerator at Likoma District Hospitak Site in Likoma. February 2025 Submitted by: Project Implementing Unit (PIU) Executive Summary This is an Environmental and Social Management Plan (ESMP) for installing a mechanical incinerator at Likoma District Hospital in Likoma District. Under the auspices of the Malawi Ministry of Health, the Malawi Covid-19 Emergency Response and Health System Preparedness Project (MCERHSPP) aims to fortify the national framework to detect, prevent, and respond to the ongoing COVID-19 pandemic and future health threats. The project's objective is to prevent, detect, and respond to COVID-19 in Malawi while strengthening national systems for public health preparedness. Likoma District Hospital benefits from the MCERHSPP initiative, which is the installing of a mechanical incinerator. This report serves as a basis for managing, mitigating, and monitoring the environmental and social impacts associated with the project's construction and operation phases. The objective of the Environmental and Social Management Plan (ESMP) was to assess and predict potential positive and negative social and environmental impacts and develop suitable enhancement and mitigation measures. Specifically, that the ESMP aligns itself with the requirements of a) National Waste Management Regulations of 2017; b)those of the World Bank’s 2007 Environment, Health, and Safety Guidelines for Health Care Facilities which specify that Controlled-air incineration (also referred to as pyrolytic, starved-air, two-stage incineration, or modular combustion) is the most widely used HWI technology. Single-chamber and drum / brick incinerators should be used only as a last resort option; and c) those of the World Bank’s Environmental and Social Standards to the project, such as the ESS 3 – Recourse and Efficiency, Pollution Prevention and Management and ESS 4 – Community Health and Safety The incinerator house will cover an overall length of 13.95 meters and a width of 7.85 meters. The building's height varies due to its sloped roof design, with one side at 3.85 meters and the other side at 3.3 meters. The building's structure is made of concrete blocks with a painted finish. The primary entrance (E1) is located on the left side of the building, opening into a corridor that leads to an office. The entrance door (D1) is 0.9 meters wide. The office space is strategically positioned near the entrance for easy supervision and administration. It measures 4.0 meters in length and 2.2 meters in width, providing ample space for office activities. The main area of the building is dedicated to the incinerator, which is centrally located. The room's total length is 13.55 meters, and its width is 3.44 meters, providing sufficient working space around the incinerator. Adjacent to the incinerator room, are several rooms designated for waste handling and hygiene. These include (i) Bathroom: 1.0 meters wide and 1.5 meters in length; (ii) Toilet Room: 1.0 meters wide and 1.5 meters in length; and (iii) Waste Room (WRRM): Each washroom is 1.05 meters in width and 1.5 meters in length, with five rooms in total. These waste rooms are designated rooms where waste will be temporarily stored and managed before incineration. These rooms are critical for ensuring proper segregation, handling, and preparation of waste materials prior to their incineration. In addition, leachate control including spill containment for hazardous waste will adhere to the World Bank’s/IFC Industry-Specific Impacts and Management (For full details see Annex 8). An ash pit will be constructed to contain the ash generated from the incineration process securely. The ash pit will have a total depth of 4.0 meters, with the main section being 3.75 meters deep equipped. It will be covered with a 24-gauge galvanized steel lift-off lid, which will include a handle to facilitate easy access. This design will ensure that the ash pit can be securely closed to prevent any spillage or contamination while allowing for straightforward removal when needed. The top layer of the ash pit will include 300mm of well-compacted hardcore. Meanwhile, the Mechanical Incinerator Technical Specification are outlined below. Equipment type: • Static burning chambers type • Load Capacity: 100 - 200 kg • Burn rate: 50 - 60kg/hr, class 1 or 2 • Fuel type: Diesel • Average Fuel Consumption: 10 - 15 (litres/hr) • Auto ignition • Automatic control and temperature Monitoring (computerized) • Manual ash/ leftovers removal • Fuel gas filtration system Primary Chamber: • Residence time shall not be less than two (2) seconds • Oxygen content of the emitted gasses shall not be less than 11%. Ensure both primary and the combustion temperatures are maintained until all waste has been completely combusted. • Flame contact with all the gases shall be achieved • The primary combustion chamber shall be accepted as the primary combustion zone and shall be equipped with a burner/s burning gas or low sulphur liquid fuel. • Primary air supply is to be controlled efficiently. Air supply in the primary chamber should be regulated between 30% - 80% of stoichiometric amount. Suitable flow measurement devices shall be provided the primary air ducting. • The minimum combustion temperature of the primary chamber shall not be less than 800 °C. • The combustion air shall be supplied through a separate forced draft fan after accounting for the air supplied through burners. Secondary Chamber: • Residence time shall not be less than two (2) seconds • Oxygen content of the emitted gasses shall not be less than 11%. Ensure both primary and the combustion temperatures are maintained until all waste has been completely combusted. • Flame contact with all the gases shall be achieved • Secondary air supply is to be controlled efficiently. Air supply in the secondary chamber should be regulated between 170% - 120% of stoichiometric amount. Suitable flow measurement devices shall be provided the secondary air ducting. • Combustion efficiency (C.E.) shall be at least 99.0% • Suitably designed pollution control devices such as scrubbers, filters or electrostatic precipitators, shall be installed/retrofitted with the incinerator to achieve emission limits • The combustion air shall be supplied through a separate forced draft fan after accounting for the air supplied through burners. • Ensure the gas temperature as measured against the inside wall in the secondary chamber and not in the flame zone, is not less than 1200 °C. For full details on the Mechanical Incinerator Technical Specifications (including the Chimney) and Manpower requirements, please refer to Annex 6. On the overall, the general steps followed during the assessment were desk studies, physical inspection of the site and surrounding areas, stakeholder consultations, and reporting and documentation. The desk studies involved reviewing project-related documents. Site inspection and stakeholder consultations were conducted 17th of December 2024. This ESMP has outlined the potential positive and negative environmental and social impacts of the project's construction phase. The construction phase is divided into specific activities to track their impacts: mobilisation, construction, finishing, and demobilisation. The key impacts identified are presented as follows: i. Enhanced Waste Management and Environmental Protection: The installation of a healthcare waste mechanical incinerator will help in ensuring the safe and efficient disposal of medical waste, the risk of infection within the HOSPITAL is significantly reduced. ii. Creation of Job Opportunities: The construction project will create short-term job opportunities, employing around thirty construction staff for less than 90 days. This impact, while temporary, provides valuable employment to the local community. iii. Traffic Congestion and Accidents: Increased construction and renovation activity can lead to additional vehicular traffic around the HOSPITAL, exacerbating congestion and raising the risk of road accidents. iv. Air Quality Deterioration: Though unlikely to exceed ambient air quality standards, dust and particulate matter emissions are anticipated during construction. Activities such as breaking down structures and using machinery can generate significant dust and emissions. v. Elevated Noise Levels from Machinery and Construction Activities: Construction machinery and equipment generate noise that may impair workers’ hearing and disturb the HOSPITAL community. vi. Potential for Accidents and Injuries On-site: Workers will be exposed to various occupational risks during construction, including using large machinery, working at height, and handling hazardous materials. vii. Gender-based violence (GBV) and Sexual Exploitation and Abuse (SEA) Impact: The construction site may create environments where GBV and SEA can occur, affecting both workers and the surrounding community. viii. Generation of Solid Wastes, Spills, and Effluent: Various construction activities will generate waste and spills that can impact the environment. ix. Land degradation resulting from sand mining: The construction works will require sand for concrete works, likely sourced from rivers within the district. Sand extraction can potentially impact the aquatic habitat, water quality, river dynamics, key aquatic species, and food availability. x. Water and Soil Pollution: Construction activities can lead to water and soil pollution, which can affect the water bodies and land. Based on the nature of the project the estimated budget for the implementation of the project is as follows: a) the Civil Works cost is begged at a) US$ 330,000, b) Meanwhile, the Supply, Installation, Commissioning and Training inclusive are begged at US$ 50,000. Together, the Total cost of project implementation is estimated at US$380,000. At a current Rate of 1US$ to MK1,736.36, this gives a Total cost of MK659,816,800. On the other hand, the environmental and social management along with monitoring plans are estimated at about MK31,225,000. Table of Contents Executive Summary ........................................................................................................................ 2 List of Tables ............................................................................................................................... viii List of Figures .............................................................................................................................. viii Introduction ..................................................................................................................................... 1 1.1 Background Information ....................................................................................................... 1 1.2 Spatial Location and Size of Land ........................................................................................ 1 1.3 Methodology for Preparing ESMP ....................................................................................... 5 1.3.1 Desk Studies................................................................................................................... 5 1.3.2 Physical Inspection of Project Sites ............................................................................... 5 1.3.3 Stakeholder Consultations ............................................................................................. 5 Project Description.......................................................................................................................... 6 2.1 Nature of the Project ............................................................................................................. 6 2.1.1 Description of the Hospital Incinerator.......................................................................... 6 2.2 Project Cost, and Duration and Estimated Number of Employees ....................................... 8 2.3 Main Activities of the Project ............................................................................................... 9 2.3.1 Planning and design phase ............................................................................................. 9 2.3.2 Construction phase ....................................................................................................... 10 2.3.3 Water supply planning and design ............................................................................... 14 2.3.4 Operation and Maintenance Phase ............................................................................... 14 Legal Framework .......................................................................................................................... 16 3.1 Relevant Malawi Policies and Legislation .......................................................................... 16 3.2 World Bank Environmental and Social Framework ........................................................... 18 Environmental and Social Setting................................................................................................. 21 4.1 Physical Environment ......................................................................................................... 21 4.1.1 Topography .................................................................................................................. 21 4.1.2 Geology ........................................................................................................................ 21 4.1.3 Soils.............................................................................................................................. 21 4.1.4 Land use ....................................................................................................................... 21 4.1.5 Climatic Conditions ..................................................................................................... 21 4.2 Vegetation ........................................................................................................................... 23 4.3 Facility Management and Health Safety Protocols ............................................................. 23 4.3.1 Water Supply ............................................................................................................... 23 4.3.2 Sanitation Facilities...................................................................................................... 23 4.3.3 Hygiene Practices......................................................................................................... 23 4.3.4 Infections Prevention and Control ............................................................................... 24 4.3.5 Waste Management ...................................................................................................... 24 4.3.6 Health Facility Capacity .............................................................................................. 25 4.3.7 Healthy Status and HIV &AIDS Prevalence at the Facility ........................................ 25 4.3.8 Communication and Transport Systems ...................................................................... 25 4.3.9 Security ........................................................................................................................ 26 Assessment of Environmental and Social Impacts ....................................................................... 27 5.1 Impact identification ........................................................................................................... 27 5.2 Significance Ranking of the Impacts .................................................................................. 28 5.3 Impact Significance Rating for the Identified Impacts ....................................................... 29 5.4 Description of Identified Impacts ....................................................................................... 29 5.4.1 Anticipated Positive Impacts ....................................................................................... 29 5.4.2 Anticipated Negative Impacts ...................................................................................... 30 Environmental and Social Management Plan ............................................................................... 33 6.1 Environmental and Social Management Plan ..................................................................... 33 6.2 Implementation of ESMP ................................................................................................... 33 6.2.1 Ministry of Health ........................................................................................................ 33 6.2.2 Supervision Consultant ................................................................................................ 34 6.2.3 The Contractor ............................................................................................................. 34 ANNEXURES ...............................................................................Error! Bookmark not defined. Annex 1: Project impacts and their ratings ....................................Error! Bookmark not defined. A2-1: Stakeholder Consultations ...................................................Error! Bookmark not defined. A2.1 Stakeholder Consultation Checklist for the ESMP ...........Error! Bookmark not defined. A2.2 Stakeholder Consultations.................................................Error! Bookmark not defined. A2.3 Stakeholders Comments ....................................................Error! Bookmark not defined. Annex 3: Code of Conduct for Contractor in Relation to Child ProtectionError! Bookmark not defined. Annex 4: GRM and GBV Management Plan ................................Error! Bookmark not defined. A4.4 Recommended Grievance Redress Time Frame ...........Error! Bookmark not defined. Annex 5: Floor Lay out for Likoma District Hospital ..................Error! Bookmark not defined. Annex 6: Layout Plans of the Incinerator Building .......................Error! Bookmark not defined. A6-1: Site Layout Plan...............................................................Error! Bookmark not defined. A6-2: Incinerator House Layout Plan ........................................Error! Bookmark not defined. A6-3: Incinerator House Elevation Details ................................Error! Bookmark not defined. A6-4: Ash Pit Design .................................................................Error! Bookmark not defined. Annex 7: Mechanical Incinerator Technical Specifications and ManpowerError! Bookmark not defined. List of Tables Table 2-1: Proposed Construction Workforce ................................................................................ 9 Table 2-2: Summary of construction Raw Materials .................................................................... 12 Table 2-3: Summary of construction equipment .......................................................................... 12 Table 2-4: Main expected type of waste and proposed management measures ........................... 14 Table 0-1: Relevance of WB Environmental and Social Standards to the project ....................... 19 Table 0-1: Average weather data for Likoma District .................................................................. 22 Table 0-1: Potential Interactions of the Project with VECs. ......................................................... 27 Table 0-2: Impact Assessment Criteria and Scoring System ........................................................ 28 Table 0-1: Environmental and Social Management Plan ............................................................. 35 List of Figures Figure 1-1: Proposed site for installation of mechanical incinerator. ............................................. 2 Figure 1-2: Site Map of Likoma District Hospital. ......................................................................... 3 Figure 1-3: Location Map of Likoma District Hospital. ................................................................. 4 Figure 2-1: 4R Principles of Waste Management………………………………………………..11 Figure 2-2: Recommended Waste Receptacles…..........................................................................12 Figure 4-1: Trees (Eucalyptus) found on site…………………………………………………….22 Figure 4-2: Out-Patient Department cases for the past 6 months ................................................. 25 Introduction This is an Environmental and Social Management Plan (ESMP) for installing a mechanical incinerator at Likoma District Hospital in Likoma District. This chapter provides background information on the project, details of the project proponent, project justification, objectives for developing the ESMP, methodology employed, and potential users of the ESMP. 1.1 Background Information Under the auspices of the Malawi Ministry of Health, the Malawi Covid-19 Emergency Response and Health System Preparedness Project (MCERHSPP) aims to fortify the national framework to detect, prevent, and respond to the ongoing COVID-19 pandemic and future health threats. The project's objective is to prevent, detect, and respond to COVID-19 in Malawi while strengthening national systems for public health preparedness. Likoma District Hospital benefits from the MCERHSPP initiative of installing a mechanical incinerator. Considering the proposed civil works at the health facility, MCERHSPP recognizes the need to assess anticipated environmental and social impacts and propose measures for managing these impacts. This report serves as a basis for managing, mitigating, and monitoring the environmental and social impacts associated with the project's construction and operation phases. The objective of the Environmental and Social Management Plan (ESMP) was to assess and predict potential positive and negative social and environmental impacts and develop suitable enhancement and mitigation measures. This was done following the Environment Management Act of 2017, the Environmental Impact Assessment Guidelines 1997, and the World Bank Environmental and Social Framework. The proposed installation of a mechanical incinerator at Likoma District Hospital is vital for enhancing infection control. The installation of a Mechanical Incinerator aims at improving the hospital's capacity to dispose various medical wastes, including those related to COVID-19. Undoubtedly, the Mechanical Incinerator will ensure proper medical waste disposal, minimizing the risk of infection spread within the hospital and surrounding areas. Aligned with national public health preparedness initiatives, these works reinforce Likoma District Hospital's role in combating current health challenges while laying the groundwork for sustainable healthcare infrastructure development in the district. 1.2 Spatial Location and Size of Land Likoma District Hospital is located at Likoma Boma (Town). The hospital is on the Southern side of the Likoma Boma. The proposed site for the incinerator is idle land, with three trees of Eucalyptus species. Next to it is the newly constructed Ash Pit, which will act as a support when the Ash pit to be constructed will be full. The hospital is about 500 meters further South, where the building hosting the maintenance personnel offices and workshop is located. Figures 1-1, 1-2 and 1-3 give more information on the spatial location of the site. For full Floor layout of the Likoma District Hospital, please refer to Annex 5 of this ESMP. 1 Idle site for proposed incinerator Installation Three Eucalptus Trees to be cut at the Site Figure 1-1: Proposed site for installation of mechanical incinerator at Likoma hospital. 2 Figure 1-2: Site Map of Likoma District Hospital. 3 Figure 1-3: Location Map of Likoma District Hospital. 4 1.3 Methodology for Preparing ESMP The general steps followed during the assessment were desk studies, physical inspection of the site and surrounding areas, stakeholder consultations, and reporting and documentation. 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 Industry EHS guidelines, 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 socioeconomic profile for Likoma District Council. 1.3.2 Physical Inspection of Project Sites The study team conducted a site inspection on 6th and 7th October 2024 to conduct a detailed environmental and social screening of the proposed site and its surroundings. During this environmental and social screening process, various factors were assessed to identify potential impacts and devise appropriate mitigation measures. This comprehensive analysis encompassed environmental, social, health, economic, and legal considerations, ensuring a holistic approach to decision-making and sustainable development. Environmental factors were meticulously examined to identify sensitive nearby features. Social factors were equally paramount, focusing on understanding the impact on nearby communities. Assessing potential land use patterns or changes in community dynamics ensured that the proposed works respected and preserved local social structures. Health impacts were carefully evaluated, particularly regarding potential risks associated with emissions from the incinerator. Finally, legal and regulatory compliance was rigorously assessed to ensure national and international standards adherence. This included identifying necessary permits, licenses, or approvals required for the installation and operation of the incinerator, thereby ensuring that the project operated within the bounds of the law. 1.3.3 Stakeholder Consultations Considering that the proposed project will be done within the hospital campus, stakeholder consultations were mainly done through key informant interviews with relevant heads of hospital departments. These consultations were done on 6th and 7th October 2024. These included the Hospital administrator, the District Environmental Health Officer, Laboratory Technicians, Radiology staff, Maintenance Supervisors (who oversee Waste Management Staff), and Waste Management Staff. Interviews with patients were also conducted with randomly selected patients at the hospital. Consulting patients helped identify concerns about indoor air quality, noise levels, or other environmental factors affecting their rehabilitation work experience. Consulting patients also allowed us to assess potential risks and develop mitigation strategies to minimise environmental impacts on patient health and safety. Key issues raised during the meeting are provided in Annex 2. 5 Project Description This chapter provides an overview of the project's current status within the project cycle, aiming to facilitate comprehension regarding the level of detail and the available planning or design options. It delineates the primary activities carried out during the project's implementation phase, encompassing details such as the machinery type to be utilised during the installation, the nature of generated waste, on-site facilities, waste management strategies, and estimated project costs. 2.1 Nature of the Project The project entails undertaking two components of sub-projects as follows a) the comprehensive rehabilitation of the existing X-ray roo at Likoma District Hospital and installing state-of-the-art digital X-ray equipment; and b) the installation of a medical incinerator to ensure proper disposal of hazardous waste generated during medical procedures, contributing to infection control and environmental sustainability efforts within the hospital premises. Overall, the project combines infrastructure upgrades with the implementation of advanced medical technologies to improve healthcare delivery and safety standards at Likoma District Hospital. But of interest to this ESMP is the installation of a Mechanical Incinerator at this hospital. 2.1.1 Description of the Hospital Incinerator A medical waste incinerator is a crucial component of healthcare waste management systems, designed to safely and efficiently dispose of hazardous medical waste generated by hospitals, clinics, and other healthcare facilities. Engineered to meet stringent environmental and safety standards, these incinerators are pivotal in mitigating public health risks associated with improper medical waste disposal. Powered by diesel fuel, these incinerators utilise high temperatures to completely destroy pathogens, infectious agents, and other hazardous substances present in medical waste, safeguarding the health and well-being of healthcare workers and the community. . The detail of the Incinerator to be installed are given in Annex 6. Meanwhile, those of the Incinerator building are given in Annex 1. Considering that the installation and operation of medical waste incinerators follow prescribed standards, the ESMP utilised the WHO Safe Management of Wastes from Healthcare Activities guidelines. Based on WHO recommendations, the following are the key design considerations of the incinerator: i. Load Capacity: The incinerator's load capacity has to be designed to accommodate the estimated volume of medical waste generated by the healthcare facility. WHO guidelines suggest that incinerators for healthcare waste should have a minimum capacity of 50-100 kg per hour to effectively handle the waste generated by hospitals and clinics. The incinerator is expected to have a capacity of 50 kg per hour. ii. Energy Source: The incinerator will be powered by diesel fuel, commonly used in Malawi. Diesel fuel is preferred to electricity because it is reliable and more convenient, as the Likoma can have times of extensive blackouts. Diesel engines provide the necessary heat to reach and maintain the high temperatures required for the complete combustion of medical waste. iii. Combustion Chamber: The incinerator will feature a combustion chamber where medical waste is loaded for disposal. The chamber will be lined with refractory materials to withstand high temperatures and ensure efficient combustion. WHO guidelines 6 recommend a minimum operating temperature of 850-1100°C to ensure complete destruction of pathogens and hazardous substances in the waste. iv. Air Pollution Control Devices: To mitigate air pollution emissions, the incinerator has to be equipped with air pollution control devices such as scrubbers, filters, and particulate matter control systems. These devices remove harmful pollutants, including dioxins, furans, and heavy metals, from the incinerator's exhaust gases before they are released into the atmosphere. v. Required Space: The incinerator installation requires a designated area within the healthcare facility. WHO guidelines recommend that the incinerator be located in a well- ventilated area away from patient care areas and residential buildings. The incinerator should also have a stable foundation with adequate space for safe operation and maintenance. vi. Operational Safety Features: Safety features such as temperature monitoring systems, flame detection sensors, and automatic shut-off mechanisms must be incorporated into the incinerator to prevent accidents and ensure safe operation. Additionally, the incinerator should be equipped with fire suppression systems and emergency backup power sources to minimise risks during operation. vii. Associated Incinerator Facilities: The description provided above viii. Chimney Specifications: According to the WHO specifications, the Chimney specifications are given as follows: • The maximum exit velocity of the emissions shall not be less 10 meters per second • The stack should be insulated to maintain maximum outlet temperature • Sampling platform and port for measurement of emissions shall be provided It shall be not less than 12 metres from the ground The chimney shall be made of these materials:- (a) High temperature resistant steel ranging from 304L to316L stainless steel (highly preferred 316L(ASTM A240) (b) Refractory ceramic lining (e.g. alumina or silica-based AI203-90%) (c) Thickness 8-10mm (d) Flue gas velocity 20m/s (e) Temperature resistant 3000 degree Celsius (f) Lifespan 20years (g) Second flue pipe from absorption chamber should be lined with heat resistant granite with stand 300 degrees Celsius temperature (h) Spark arrestor (chimney cap) (i) Anchor bolts on top of the chimney and middle of the chimney (j) 10.Gasket high temperature resistant (e.g. graphite) (k) 11.Acces ladder and platforms for easy maintenance (l) 12.pressure rating 500-1000pa (5-10 inH20) (m) 13. Chimney height to be 18 metres 7 As already alluded to, the medical waste incinerator will be installed in a standalone building that is yet to be constructed 500 meters from the main hospital. Several associated facilities and infrastructure are necessary to ensure safe and efficient operation: i. Access Corridor: A dedicated and paved access corridor connecting the incinerator building to the main hospital is essential for transporting medical waste to the facility. The corridor will be two meters wide and paved with concrete to accommodate waste disposal personnel with easy access. ii. Waste Collection Area: Adjacent to the incinerator building, a designated waste collection area is required for temporarily storing medical waste before incineration. This area should be equipped with appropriate waste bins or containers to segregate different types of waste and prevent cross-contamination. The World Bank’s EHS guidelines requirements shall apply. The Guidelines stipulate how hazardous waste from Health Care facilities should be handled. These guidelines also emphasize that Health care facilities should establish, operate and maintain a health care waste management system (HWMS) adequate for the scale and type of activities and identified hazards. They further elaborate infectious and / or hazardous wastes should be identified and segregated according to its category using a color-coded system, including practices such as On-site Handling, Collection, Transport and Storage: a. Seal and replace waste bags and containers when they are approximately three quarters full. Full bags and containers should be replaced immediately. b. Identify and label waste bags and containers properly prior to removal. c. Transport waste to storage areas on designated trolleys / carts, which should be cleaned and disinfected regularly. d. Waste storage areas should be located within the facility and sized to the quantities of waste generated, with the following design considerations: e. Hard, impermeable floor with drainage, and designed for cleaning / disinfection with available water supply iii. Storage Facility: A secure storage facility is needed to store spare parts, maintenance equipment, and supplies for the incinerator. This facility should be located within the incinerator building to ensure easy access for maintenance staff. iv. Utility Infrastructure: Adequate lighting, water supply, and drainage infrastructure should be installed to support the incinerator's operation. This includes electrical connections for powering the lights, water supply for cooling and cleaning purposes, and drainage systems to manage wastewater and runoff. v. Safety Features: Safety features such as fire suppression systems, emergency lighting, and first aid stations should be installed within the incinerator building to mitigate potential hazards and ensure personnel safety. vi. Fencing and Security: Perimeter fencing and security measures should be implemented to restrict access to the incinerator facility and prevent unauthorised entry. This helps safeguard the incinerator equipment and ensures safety and security protocol compliance. 2.2 Project Cost, and Duration and Estimated Number of Employees Based on the nature of the project the estimated budget for the implementation of the project is as follows: a) the Civil Works cost is begged at a) US$ 330,000, b) Meanwhile, the Supply, Installation, Commissioning and Training inclusive are begged at US$ 50,000. Together, the Total cost of project implementation is estimated at US$380,000. At a current Rate of 1US$ to 8 MK1,736.36, this gives a Total cost of MK659,816,800. Meanwhile, it is expected to be completed in six months. In addition, the cost for the implementation an ESMP and its monitoring is pegged at MK31,225,000.The construction works will require between 25 and 30 people, most workers will be from the neighbouring Villages and will not need normal Transport,with the roles depicted in Table 2-1. Gender representation will be prioritised, striving for at least 30% representation of females wherever feasible. Table 2-1: Proposed Construction Workforce Role Number of Workers Project Manager 1 Site Supervisor/Foreman 1 Architect/Engineer 1 Masons/Bricklayers 2-4 Carpenters 4-6 Plumbers 1-2 Electricians 1-2 Laborers 4-5 Painters/Plasterers 1-2 Roofers 1-2 Security Personnel 1-2 2.3 Main Activities of the Project The project implementation cycle comprises planning and design, construction, operation, and decommissioning 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 the installation of a medical waste incinerator at Likoma District Hospital, several key activities will be undertaken to ensure the successful implementation of these essential healthcare infrastructure projects. This phase will involve a series of key activities to assess needs, evaluate site conditions, develop technical designs, ensure regulatory compliance, and engage stakeholders to lay the groundwork for effective project execution. During this phase, one of the initial activities was the needs assessment, which involved consulting with hospital administrators and healthcare professionals to identify specific requirements and objectives for the installation of the medical waste incinerator. This process helped define the project's scope and priorities, ensuring that it aligns with the hospital's goals and objectives for improving healthcare delivery and waste management practices. Following the needs assessment, a thorough site survey and evaluation were conducted to assess the hospital's existing infrastructure, utilities, and environmental conditions. Based on the findings of the site survey and needs assessment, detailed technical designs and specifications will be developed to install the medical waste incinerator. This will involve determining the structural requirements and specifying the incinerator's size, capacity, and operational features. 9 Throughout the planning and design phase, regulatory compliance will be a paramount consideration. 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. 2.3.2 Construction phase During the construction phase of rehabilitating the existing X-ray room and installing a medical waste incinerator at Likoma District Hospital, several activities will be undertaken to ensure the successful completion of the project. Here's a description of the key activities: 2.3.2.1 Site Preparation for Construction of Incinerator House and Associated Facilities During the site preparation phase, meticulous efforts are undertaken to prepare the construction site for installing the medical waste incinerator and associated facilities at Likoma District Hospital. The following activities will be done as part of site preparation: 1) Site Clearing and Preparation • Clearing the designated area for the standalone building and incinerator installation, which currently consists of idle land covered with grass. • Removal of grass and vegetation to create a clean and level surface conducive to building construction and equipment installation. The site has no trees and as such no tree will be cut down. 2) Utility Assessment and Relocation • Assessment of existing utilities, notably moving of the two-phase electricity power line traversing the construction site. • Coordination with utility providers, specifically ESCOM, to relocate the power line, ensuring safety and unimpeded access for construction activities. 3) Soil Stabilization and Drainage • Implement soil stabilisation measures to fortify the stability and integrity of the construction site and prevent soil erosion. • Establish adequate drainage systems to manage surface water runoff effectively, thereby averting water accumulation during construction and incinerator operation. 2.3.2.2 Construction of Standalone Building for the Incinerator Constructing the standalone building to house the new medical waste incinerator and associated facilities, such as storage areas, ventilation systems, and administrative offices. The construction will follow architectural and engineering plans to ensure the building meets structural and safety requirements, including proper ventilation and fire safety measures. The main activities to be executed on the site during building work are as follows: • Foundation excavation—To construct a brick-and-mortar building, foundation excavation will begin with site preparation and marking the layout. Hand tools will be employed to excavate to a depth of 1.5 meters, adhering to building requirements. Concrete footings will then be installed to distribute the building’s weight evenly. After the concrete foundation is poured and cured, waterproofing and drainage systems will be implemented. The final step will involve 10 backfilling around the foundation with compacted soil to ensure stability and prevent settling, which is crucial for the building’s longevity and safety. • Concrete Mixing—Concrete production for constructing a brick-and-mortar building will adhere to high-quality standards, particularly in sourcing materials and preparing the concrete mix. Cement will be obtained from reputable suppliers within Likoma District, and fine and coarse aggregates will come from licensed quarries in Lilongwe District that meet rigorous laboratory testing standards. The mixing water, crucial for achieving the correct concrete consistency, will be sourced from the existing Central Region Water Board water mains, which meet the quality standards to achieve maximum concrete strength and durability. Additives such as retarders or plasticisers will be used as the mix design requires to modify the concrete's properties. • Material transportation—Materials (fine and coarse aggregates) from quarries in Lilongwe will be transported by tipper trucks to Likoma District Hospital. A ten-tonne truck will be adequate to transport other materials like cement, timber, and reinforcement bars from local suppliers found at Likoma Boma or Mzuzu City to the hospital. • Material Storage—Materials like aggregates will be stored in specific areas near construction sites. Cement and reinforcement bars will be stored in special storage rooms. Timber will be used directly in the required areas, so there will be no stockpiling of timber. • Masonry, Concrete Works, and Related Activities - The construction of the building walls, foundations, floors, pavements, and drainage systems, among other components of the project, will involve a lot of masonry work and related activities. General masonry and related activities will include stone shaping, concrete mixing, plastering, slab construction, foundation construction, erection of building walls, and curing of fresh concrete surfaces. These activities are known to be labour-intensive and will be supplemented by lite machinery such as concrete mixers. • Steel Structure Works—Where necessary, the buildings will be reinforced with structural steel for stability. Structural steelworks will involve cutting, welding, and erection. • Roofing and sheet metal work—Roofing activities will include sheet metal cutting, raising roofing materials such as clay roofing tiles and structural steel, and fastening the roofing materials to the roof. • Electrical Work—Electrical work during the construction of the premises will include installing electrical equipment and appliances, including electrical cables, lighting apparatus, power sockets, etc. In addition, other activities involving electricity use, such as welding and metal cutting, will be performed. • Plumbing - Pipework installation for water supply and distribution will occur within all units and associated facilities. Similarly, pipework installation for wastewater and sewer pipes will occur within all units and associated facilities. 2.3.2.3 Construction Material The primary raw materials for construction are cement hollow blocks (400mm x 200mm x 200mm). Table 2-1 summarises the raw materials inputs, while 2 2 summarises construction equipment for the construction phase. 11 Table 2-2: Summary of construction Raw Materials SN Raw Material Estimated Quantity Source 1 Cement Hollow Blocks 3,500 blocks (400mm x Local suppliers 200mm x 200mm). 2 Cement 15 tons. Local suppliers 3 Fine aggregate 25 cubic meters. Licensed Quarry 4 Coarse Aggregate 20 cubic meters. Licensed Quarry 5 Steel Bars (Rebar) 2 tons. Local suppliers 6 Iron Sheets 100 square meters. Local suppliers 7 Steel Roofing Framework 150 linear meters. Local suppliers 8 Water 30 cubic meters. Local suppliers 9 Waterproofing Material 200 square meters. Local suppliers 10 Paint and Other Finishes 500 litres of paint for internal Local suppliers and external finishes. 2.3.2.4 Construction Equipment A summary of construction equipment for the construction phase has been provided in Table 2-3. Table 2-3: Summary of construction equipment SN Raw Material Source Mode of Delivery 1 Diesel (for the operation of the Local approved suppliers Road truck generator and machinery) 2 Construction Water Existing water sources from Existing water Central Region Water Board mains 3 Equipment (Tippers, scaffolding Contractor Road truck materials, light passenger vehicles, Engine generator and hand tools) 2.3.2.5 Construction Waste Generation and Management The project is expected to produce different types of waste. Table 2-4 shows the expected type of waste and proposed management measures. For this project, the construction work is expected to generate non-hazardous waste that can comply with the 4R principles of Reduce, Reuse, Recover and finally disposed of at the Likoma Local Council Dumpsite (See Figure 2-1). 12 Figure 2-1: The 4R Principles concept. Considering that the designated Waste disposal site in Likoma Island is a bit far from the hospital premises, measures of temporary storage should be put in place using the Receptacles as shown in Figure 2-2. Thus, the construction site may require having a proper waste collection by use of relevant Receptacles as shown below. Figure 2-2: Recommended Waste Management Receptacles. Source: Dr. Godfrey Mvuma (2010) 13 With respect to disposal of hazardous wastes e.g. paints, oils and glass, disposal will be done in consultation with MEPA and Likoma District Council/Mzuzu City Council. For liquid waste, the construction and rehabilitation work will utilise the existing septic tank for the construction staff, who are expected not to exceed 20 people when operating at total capacity. Table 2-4: Main expected type of waste and proposed management measures Waste type Source/activity Estimated Management Measure quantity Concrete waste Brocken cement 200 Kgs Reused; or disposal at Likoma blocks, demolition Local Council dumpsite of walls Plastics, wood and Used as packaging 2 tonnes Recycle; or disposal at Likoma glass (packaging materials Local Council dumpsite waste) Steel Bars (Rebar) Cut- Scraps 10 kgs Recycle offs Human Waste Toilets facilities 200 litres Existing Septic Tank Iron Sheets Offcuts Offcuts and/or 5 square Recycle damaged sheets meters 2.3.3 Water supply planning and design The incinerator installation works will have an implication on water use and supply. Water supply issues will likely emerge since the Likoma hospital site to which the facilities will be installed is connected to piped water supplied by Likoma District Water Supply (LDWS). This being the case, if the construction works use water from LDWS, the water bills may increase at the hospital site. This then can be addressed by putting in place payment arrangements of the water bills by the contractor before commencement of construction activities. Additionally, to ensure prudence of using treated water for construction works, water efficiency measures are suggested and as a requirement under ESS3 and as presented in Annexure 8 as follows: i) Identify and use alternative water sources, such as surface water from nearby source e.g. the Lake Malawi for construction activities. ii) Set up a system to capture and store rainwater for use in construction activities. iii) Educate workers on the importance of water conservation and efficient practices. 2.3.4 Operation and Maintenance Phase The operation and maintenance phase of the newly installed hospital facilities is a critical component of the overall project lifecycle. This phase encompasses all necessary activities to ensure that the medical waste Mechanical Incinerator and the modern digital X-ray machine operate efficiently, safely, and sustainably over their intended lifespan. The following are detailed operational tasks and maintenance routines that will be put in place to facilitate the smooth running of these essential medical technologies. 14 i. Training of Staff: Personnel responsible for operating the incinerator will be trained in proper medical waste handling and operational procedures. Similarly, radiologists and technicians will be trained on the optimal use of digital X-ray machines. ii. Quality Control Tests: Regular quality control tests are conducted to ensure that the Incinerator machine works optimally. iii. Proper Segregation of Waste: Medical waste will be segregated by type at the point of generation to ensure effective disposal. iv. Regular Inspections: Routine inspections are conducted to assess the condition of the incinerator. v. Replacement of Parts: Critical parts such as filters or refractory lining are replaced according to wear and usage. 15 Legal Framework This chapter provides a review of the legal framework relevant to the proposed project and outlines its potential impacts on the project. It also references key legislation. 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, committed to the 1992 Rio Declaration's Principle 17, mandates environmental impact assessments (EIA) for activities with significant environmental impacts. The project aligns with the 2017 EMA and various sectoral policies, ensuring sustainable environmental management and responsible resource use. Table 3-1 below outlines these relevant legislative frameworks. Table 3-1: Relevant Malawi Legislative Framework Piece of Description Relevance to Project Activities Legislation National The policy provides strategies for environmental and social Project activities will integrate Environmental planning, environmental and social impact assessment, environmental and social management and Policy (2004) environmental and social audits, and environmental and protection during project planning and social monitoring, among others. On ESIAs, the objective implementation. is to regularly review and administer the guidelines for ESIAs, audits, monitoring, and evaluation so that adverse environmental and social impacts can be eliminated or mitigated and environmental and social benefits enhanced. Environmental The Act is the main law for environmental protection and The proposed works will comply with Management sustainable resource use. Section 7 establishes MEPA and Malawi's 2017 Environment Management Act (2017) its authority over environmental assessments. Section Act, ensuring MEPA approval for ESMP, 31provides requirements for MEPA approval for projects adherence to environmental standards, and needing an ESIA. Sections 99-104 prescribe penalties for avoidance of non-compliance penalties. ESIA non-compliance, hazardous substance mismanagement, and pollution, including fines of up to fifty million Kwacha and imprisonment of up to fifteen years. National The National Gender Policy provides guidelines to reduce The proposed project will contribute to Gender Policy gender inequalities, promote participation, and achieve addressing GBV by identifying risks and (2015) equitable development. Section 1.3 provides guidelines for mitigation measures for workers and mainstreaming gender, and section 3.6 promotes the surrounding communities, sexual economic development and empowerment of women. exploitation (for those seeking job Section 3.7 recognizes that GBV, especially violence opportunities), sexual harassment at the against women, girls, and vulnerable groups, severely workplace, and other GBV related spillover impedes social well-being and poverty reduction. effects of the project. Gender The Act in Chapter 25:06 promotes gender equality and The implication of the Act on the proposed Equality Act equal integration, influences empowerment, dignity, and project is that sexual harassment must be (2015) opportunities for men and women in all functions of society, addressed by contractors holistically, prohibits and provides redress for sex discrimination, including by instituting the measures harmful practices, and sexual harassment, provides for prescribed by law. public awareness on the promotion of gender equality and connected matters. Section 6(1) of the Act states that a person who commits an act of harassment if he or she engages in any form of unwanted verbal, non-verbal, or physical conduct of a sexual nature in the circumstances 16 Piece of Description Relevance to Project Activities Legislation 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 specified under subsection (2). National Section 1.3 of the National Water Policy explains that the The project activities have the potential to Water Policy policy provides an enabling framework for integrated water negatively affect the water resources of the (2005) resources management in Malawi. Section 3.4.9 stresses rivers in the project area. It is therefore that Pollution control of water resources shall adopt the recommended that the implementation of ‘Polluter–Pays’ principle to ensure water user's the project's activities should minimize responsibility. Section 5 points out that environmental pollution of the public water, promoting degradation has negatively affected surface and public health and hygiene and groundwater quality, among other factors. Section 5.2.2 - environmental sustainability. Ensuring and promoting proper management and disposal of wastes. National The National Sanitation Policy provides a vehicle to The proposed project will ensure that liquid Sanitation transform Malawi's hygiene and sanitation situation. and solid waste management encourages Policy (2008) Section 3.1.1 promotes the improvement of hygiene, waste reduction, recycling, and reuse sanitation, and waste recycling in the country. before final disposal, complying with the policy's provisions. National HIV The policy aims to prevent HIV infections, reduce The proposed project will implement an and AIDS vulnerability, improve treatment and support for those HIV/AIDS policy and support program, Policy (2005) living with HIV/AIDS, and mitigate its socio-economic ensuring no pre-employment HIV testing impact. Chapter 7 addresses HIV/AIDS in the workplace, or discrimination based on HIV status. highlighting issues like absenteeism, low productivity, and Employees will not be forced to disclose discrimination. their HIV status, and any voluntary disclosures will remain confidential. National The Policy promotes the rights of people with disabilities The policy on the proposed project implies Equalization and integrates them to enable them to play a full and that the contractor will be required to of participatory role in society. provide job opportunities to people with Opportunities Section 2, subsections 2.3 and 2.4.8 of the policy state that disabilities to ensure that they are also for Persons people with disabilities are most affected by poor economically empowered. with infrastructure, such as buildings not designed to Disabilities accommodate or meet their special needs. Similarly, Policy (2006) Subsection 2.45 of the policy states that people with disabilities have restricted employment opportunities, mainly due to discrimination, inadequate education, job experience, and confidence. Disability Act This act is a significant step towards ensuring equal The project will ensure that buildings, (2013) opportunities and rights for persons with disabilities. facilities, and infrastructure are accessible Promoting policies and legislation that aim to equalise to all persons with disabilities. and promote opportunities, protect rights, and fully integrate persons equal employment opportunities for with disabilities into all aspects of life recognises their persons with disabilities. inherent dignity and well-being. Sections 9 and 13 of the acts are particularly commendable, as they prohibit discrimination in accessing premises, provision of services, and employment opportunities based on disability. Public Health The Public Health Act of 1948 governs health-related The proposed projects must ensure suitable Act (1948) issues, including environmental and occupational health toilet facilities for all genders, manage and solid waste management. Section 59 prohibits stormwater effectively and prevent nuisances in workplaces, such as unclean conditions, nuisances to maintain public health and 17 Piece of Description Relevance to Project Activities Legislation offensive odours, poor ventilation, and inadequate lighting, safety. Compliance with these provisions is which endanger employee health. It also addresses the need essential for the project's success. for sanitary latrines and proper wastewater discharge. Section 88 mandates separate toilets for males and females in public buildings. Occupation The Act regulates employment conditions for safety, health, Safety measures, particularly shielding and Safety, Health, and welfare in workplaces in Malawi. It mandates limiting radiation exposure, will be and Welfare workplace registration, inspection of plant and machinery, prioritised. Personal protective equipment Act (1997) and accident prevention. Part II requires workplaces to be will be used supplementally or in registered with the director maintaining a register. Part III emergencies. The hospital must implement outlines employer duties, including providing safe work all ESMP safety measures. systems, risk-free handling of substances, and adequate employee training and supervision. Environment The regulations, under the Environment Management Act, Likoma Island Hospital must manage all Management expand on the 1948 Public Health Act. Hazardous waste is waste during rehabilitation, ensuring (Waste identified by categories in the Seventh Schedule and compliance with these regulations for safe Management characteristics in the Eighth Schedule, such as storage, handling, and disposal to protect and corrosiveness and flammability. Section 8 mandates waste public health and the environment. Sanitation) generators to safely store general waste to prevent health Regulations hazards. (2008) Public Health Public Health rules mandate both employers and employees The Ministry of Labour will inspect Corona Virus to implement general preventive measures, such as self- workplaces for adherence. The developer Disease of quarantine for at-risk individuals, covering mouth and nose of the two proposed projects must ensure 2019 when coughing or sneezing, avoiding touching the face, COVID-19 guidelines are implemented (COVID-19) eating thoroughly cooked food, and avoiding handshakes and followed by both employers and (Prevention, and close contact. Employers must form a team to employees. Containment implement these guidelines and disseminate them to all and employees. Employees must cooperate and report non- Management) compliance. Rules (2020) Child Care, The Act in Part II, division 6 emphasizes the protection of The implication of the Act on the proposed Protection and children from undesirable practices. The undesirable project is that plans and strategies must be Justice practices are outlined in sections 79 and 80. Section 79 of in place to guard against child trafficking, (Amendment) the Act protects any child from child trafficking. Section 80 including through recruitment (child Act (2010) protects a child from harmful cultural practices. labour). Penal Code, Section 138 (1) of the Penal Code punishes the defilement The ESMP has articulated how project will Chapter 7:01 of girls under sixteen years of age (punishable with life guard against the perpetuation of the crime imprisonment). Sexual abuse and exploitation of children is by project workers. a common practice in construction in sites. 3.2 World Bank Environmental and Social Framework The World Bank Environmental and Social Framework sets out the World Bank’s commitment to sustainable development through a Bank Policy and a set of Environmental and Social Standards designed to support Borrowers’ projects to end extreme poverty and promote shared prosperity. The Environmental and Social Standards set out the requirements for Borrowers relating to the identification and assessment of environmental and social risks and impacts associated with projects supported by the Bank through Investment Project Financing. The Bank believes that the 18 application of these standards, by focusing on the identification and management of environmental and social risks, will support Borrowers in their goal to reduce poverty and increase prosperity in a sustainable manner for the benefit of the environment and their citizens. The Environmental and Social Standards that apply to the project are given in Table 3-2 below. Table 3-2: Relevance of WB Environmental and Social Standards to the project Environmental Main requirements and conducted activities to meet them & Social Standards ESS 1 - ESS1 sets out the Client’s responsibilities for assessing, managing, and monitoring Assessment and environmental and social risks and impacts associated with each stage of a project Management of supported by the Bank through Investment Project Financing, to achieve environmental Environmental and social outcomes consistent with the Environmental and Social Standards (ESSs). and Social The objective of the standard is to identify, assess, evaluate, and manage environment Risks and and social risks and impacts in a manner consistent with the ESF. Adopt differentiated Impacts 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 E&S risks and impacts based on consultations with health facility stakeholders. This ESMP has also been prepared in line with the standard. ESS 2 – Labour ESS2 recognizes the importance of employment creation and income generation in the and Working pursuit of poverty reduction and inclusive economic growth. Borrowers can promote Conditions sound worker-management relationships and enhance the development benefits of a project by treating workers in the project fairly and providing safe and healthy working conditions. ESS2 applies to project workers, including fulltime, part-time, temporary, seasonal, and migrant workers. The project has a Labour Management Plan that guides implementation of its activities, and this will apply to this sub-project. The LMP includes occupational health and Safety and workers grievance redress mechanism. This ESMP has also identified impacts related to labour and working conditions and their mitigation measures are also provided. ESS 3 – ESS3 Promote the sustainable use of resources, including energy, water, and raw Recourse and materials. Avoid or minimise adverse impacts on human health and the environment Efficiency, caused by pollution from project activities. Avoid or minimise project-related emissions Pollution of short and long-lived climate pollutants. Avoid or minimise generation of hazardous Prevention and and non-hazardous waste. Minimise and manage the risks and impacts associated with Management pesticide use. 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. The MCERHSP project has prepared a Construction Manual for construction workers that will guide them in environmentally friendly construction methods that will use cement blocks but also promote efficient energy and water usage and management during construction. ESS 4 – ESS4 addresses the health, safety, and security risks and impacts on project-affected Community communities and the corresponding responsibility of Borrowers to avoid or minimize Health and such risks and impacts, with particular attention to people who, because of their Safety circumstances, may be vulnerable. The construction works under the MCERHSP project will take place in Hospitals where there will be patients that need special protection 19 Environmental Main requirements and conducted activities to meet them & Social Standards from possible accidents. The project has ensured that the ESMP documents has provided mitigation measures to ensure community safety. ESS 10 – This ESS recognizes the importance of open and transparent engagement between the Stakeholder borrower and project stakeholders as an essential element of good international practice. Engagement Effective stakeholder engagement can improve the environmental and social and Information sustainability of projects, enhance project acceptance, and make a significant Disclosure contribution to successful project design and implementation. The MCERHSP project has been engaging with stakeholders and will continue to do so throughout the project life cycle. This ESMP also has a Grievance Redress Mechanism that is to be used at each project site and this GRM is in line with provisions of the projects Stakeholder Engagement Plan (SEP). 3.2.1 World Bank Guidelines on Air Quality Standards and Waste Handling The World Bank Environmental Health and Safety Guidelines address both a) Air Quality Standards and b) Waste Handling. Summary of examples are highlighted below. a) Air Quality Standards - Emissions to Air: The EHS stipulates that the sources of air emissions at HCFs may include exhaust air from heating, ventilation, and air conditioning (HVAC) systems, ventilation of medical gases and fugitive emissions released from sources such as medical waste storage areas, medical technology areas, and isolation wards. Emissions may include exhaust from medical waste incineration if this waste management option is selected by the facility. In addition, air emissions may result from combustion related to power generation. Recommended prevention and control for power generation combustion source emissions are addressed in the General EHS Guidelines. b) Waste Management: The EHS Guidelines stipulate further in connection with the waste management aspects, they emphasize that Waste from health care facilities (HCF) can be divided into two separate groups. The first consists of general waste, similar in composition to domestic waste, generated during administrative, housekeeping, and maintenance functions. The second group consists of specific categories of hazardous health care waste. These guidelines emphasize that the health care facilities should establish, operate and maintain a health care waste management system (HWMS) adequate for the scale and type of activities and identified hazards. Facility operators should undertake regular assessment of waste generation quantities and categories to facilitate waste management planning and investigate opportunities for waste minimization on a continuous basis. In addition to the guidance provided on solid and hazardous waste management in the General EHS Guidelines. 20 Environmental and Social Setting This chapter provides an overview of the existing environment for the project, which is related to the proposed areas' physical, biological, socio-economic, and structural aspects. It also provides basic baseline information in the project area. The information provides a basis for the changes that might come due to the implementation of the project or future environmental changes that are likely to occur. It also forms a part of baseline information within the project area that might be used for future planning. 4.1 Physical Environment 4.1.1 Topography The proposed site for the incinerator is situated about 500 Metres from the current Likoma Island hospital. The terrain becomes hilly toward the eastern and northern parts, while the northern, southern, and western areas are generally flat and rolling. The site features slopes ranging from 1 to 2 degrees and sits between 1,300 to 1,700 meters above sea level. 4.1.2 Geology According to the Likoma District Socio-Economic Profile (2017), the predominant geological formations in the hospital's project area are semi-pyelitic rocks of graphite in nature. These rocks contribute to the overall geological landscape and influence factors such as soil composition, groundwater flow, and land stability within the hospital site. 4.1.3 Soils The proposed incinerator site was observed to have sandy loam soils, providing a sturdy foundation for supporting the proposed infrastructure. The good soils, which are well-drained and fertile nature, prevent waterlogging and support construction activities and other adverse conditions over time. 4.1.4 Land use The proposed project's primary land use is a hospital facility, which includes hospital buildings, emergency services areas, parking lots, support services areas, educational and research facilities, accessibility features, and security infrastructure. These elements are strategically planned to ensure efficient patient care, safety, and sustainability. The actual site is an idle land with three trees of Eucalyptus species. 4.1.5 Climatic Conditions Local climatic conditions are crucial in operating a medical waste mechanical incinerator. This section highlights essential climatic factors such as temperature, humidity, wind speed and direction, and rainfall, pivotal for the incinerator's performance. Due to the unavailability of specific weather data at Likoma District Hospital, district-wide climatic data was utilised. The district's geographical proximity and topographical uniformity justify this approach, as similar meteorological conditions are likely prevalent across the area, making district-level data a reliable proxy for the site. Table 4-1 provides average weather data from World Weather Online (https://www.worldweatheronline.com/Likoma-weather-averages/Likoma/mw.aspx) from 2010 to 2023. 21 Table 4-1: Average weather data for Likoma District Month Temperature Rainfall (MM) Relative Weed Speed Humidity (%) (Kph) January 28 250 84 8 February 28 200 85 8 March 28 160 83 9 April 26 50 76 10 May 26 9 73 10 June 24 2 67 11 July 24 1 65 11 August 24 1 59 12 September 25 1 53 13 October 28 3 54 14 November 29 60 57 12 December 29 200 84 10 4.1.5.1 Temperature The mean annual temperature varies from 29 degrees Celsius Maximum to 22 degrees Celsius Minimum. However, temperatures can occasionally soar as high as 29 degrees Celsius during the months of November and December, as shown in Table 4-1 above. 4.1.5.2 Rainfall Table 4-1 above shows the rainfall trend for the district typically follows a seasonal pattern, with most of the precipitation occurring during the rainy season, typically from November or December to March or April. During this period, the district receives the bulk of its annual rainfall. However, like many regions, rainfall patterns can vary from year to year due to factors such as climate variability and local weather systems. The hospital experiences its rainy season from November/December to March/April. 4.1.5.3 Relative Humidity As shown in Table 4-1, the relative humidity ranges from around 60% to 80% throughout the year. However, it can vary based on seasonal and weather conditions. During the rainy season, which generally occurs from November to April, relative humidity tends to be higher due to increased moisture from rainfall. Conversely, during the dry season, which spans from May to October, relative humidity may decrease somewhat as precipitation becomes less frequent. Overall, Likoma district experiences a humid subtropical climate year-round with relatively high humidity levels because of its locality in the Lake Malawi. 4.1.5.4 Wind Speed Wind patterns are primarily influenced by local topography and broader atmospheric conditions. Prevailing winds typically come from the southeast due to factors like nearby mountains or coastlines. However, occasional gusts from other directions occur due to temporary weather systems or local terrain features. Wind speeds range from 10 to 15 kph (6 to 9 miles per hour), contributing to climate dynamics affecting temperature, humidity, and airborne particles. Understanding these patterns is crucial for construction works. 22 4.2 Vegetation The proposed site for the incinerator is currently undeveloped and next to the existing hospital structures. The specific site has three Eucalyptus trees that will be cut down (See Figure 4-1). However, on the far surrounding areas of the site, there are scattered trees and grass. Figure 4-1: The three Eucalyptus Trees on site 4.3 Facility Management and Health Safety Protocols 4.3.1 Water Supply The district water supply provides water to the facility and is noted for its highly reliable water supply. The proposed project will utilise the same water source throughout the construction and operational phases. While on site, we were assured by the Hospital Authorities that the water consumption resulting from the operation of the incinerator would not put a strain on the total water demand of the hospital. 4.3.2 Sanitation Facilities Likoma District Hospital has sanitation facilities. Each ward has four toilets, two designated for females and two for males. Additionally, the hospital's departmental offices include toilets available for staff use. 4.3.3 Hygiene Practices Likoma District Hospital is equipped with handwashing stations in each ward, each stocked with hand sanitisers, to promote awareness about hygiene practices throughout the premises. Management conducts training sessions for every new employee, although according to protocol, these training sessions should ideally occur annually, contingent upon the availability of funds. 23 The most recent training session was conducted in November 2023. However, only about 50% of staff adhere to these hygiene practices. However, it must be emphasized that in the context of handling infectious waste, there will be alignment with the World Bank EHS guidelines, such that Infectious and / or hazardous wastes should be identified and segregated according to its category using a color-coded system. If different types of waste are mixed accidentally, waste should be treated as hazardous. Other segregation considerations include the following: i. Avoid mixing general health care waste with hazardous health care waste to reduce disposal costs. ii. Segregate waste containing mercury for special disposal. iii. Management of mercury containing products and associated waste should be conducted as part of a plan involving specific personnel training in segregation and clean up procedures. iv. Segregate waste with a high content of heavy metals (e.g. cadmium, thallium, arsenic, lead) to avoid entry into wastewater streams. v. Separate residual chemicals from containers and remove to proper disposal containers to reduce generation of contaminated wastewater. Different types of hazardous chemicals should not be mixed. vi. Establish procedures and mechanisms to provide for separate collection of urine, faeces, blood, vomits, and other wastes from patients treated with genotoxic drugs. Such wastes are hazardous and should be treated accordingly (see Table 1). vii. Aerosol cans and other gas containers should be segregated to avoid disposal via incineration and related explosion hazard. viii. Segregate health care products containing PVC9 to avoid disposal via incineration. 4.3.4 Infections Prevention and Control Likoma District Hospital employs chlorine-soapy water for cleaning and decontamination purposes within its wards and other hospital areas. The wards undergo cleaning procedures twice a day, both during the day and night shifts, ensuring a high standard of cleanliness and hygiene. Additionally, the facility is equipped with infrared TB detectors installed in various wards, including the X-ray room, to aid in the early identification of TB cases. This proactive approach helps reduce the transmission of TB within the hospital setting, where transmission can occur among patients and healthcare workers. 4.3.5 Waste Management Waste from various departments and wards is collected and disposed of at the hospital accordingly. Infectious and non-infectious waste undergo proper disposal by being thrown into the batch burner twice to thrice a week. The X-ray room also generates waste, such as cartons, which are managed accordingly. Non-infectious or hazardous waste is disposed of in designated rubbish bins. When these bins become full, waste collectors empty them and dispose of them at a dump site. Regarding water waste management, the water used for mopping is directed into sluices in each department. These sluices are connected to soakaways around the facility, ensuring proper water waste disposal. 24 4.3.6 Health Facility Capacity Likoma District Hospital is a cornerstone in delivering primary and secondary healthcare services to the community. The hospital boasts essential infrastructure comprising wards for inpatient care, outpatient departments, laboratory facilities, pharmacy services, and operating theatres tailored for minor surgeries. Offering a wide array of medical services, Likoma District Hospital provides outpatient consultations, inpatient care, maternal and child health services, emergency care, laboratory services, pharmacy services, HIV and AIDS management, and immunisation programs. 4.3.7 Healthy Status and HIV &AIDS Prevalence at the Facility The project site is situated within Likoma District Hospital. As per reports from Likoma District Hospital, the most prevalent diseases observed over the past six months include Malaria (7792 cases), diarrhoea (2708 cases), and respiratory diseases such as coughing and flu (493 cases). These Out-Patient Department (OPD) cases for the past six months are illustrated in Figure 4-2. Remarkably, there has been encouraging progress in combating HIV and AIDS within Likoma District. According to the Malawi HIV subnational estimates using the Naomi model of 2022, the prevalence rate stood at three percent. However, through the collaborative efforts of key stakeholders in the district, this rate has been successfully reduced to 1.4 percent. Figure 4-2: Out-Patient Department cases for the past 6 months 4.3.8 Communication and Transport Systems Telekom Networks Malawi Limited (TNM) and Airtel are the main providers of mobile phone services in the project area, resulting in widespread cellular network coverage (Socio-Economic Profiles: 2017-2022). During site visits and interviews, it was established that network connectivity for both providers is excellent. 25 4.3.9 Security Security in Likoma is provided by both public and private institutions. The hospital's crime rate is low, with petty theft being the most common type. 4.3.10 Energy The surrounding area of project is serviced with electricity provided by ESCOM. Though the proposed project is being implemented in an already being supplied by ESCOM, the proposed transfer and fuel tank must be fully implemented as per the design to address the energy needs for the incineration project and to avoid increasing demand of electricity at hospital site and affecting operations of the institution. 26 Assessment of Environmental and Social Impacts This chapter provides a description of expected occurrence of beneficial and adverse impacts, both direct and indirect, for each feature of the environment in the project site. There is a highlight of possible cumulative and synergistic effects. The section includes a discussion of the analytical methods used to forecast impact of how environmental and social data was gathered, and of the methods and criteria used to judge impact severity and significance. The chapter concludes with a summary of those impacts considered to be of greatest significance and measures proposed to avoid, reduce and/or manage them. It also discusses the distribution of adverse and beneficial impacts locally and regionally. 5.1 Impact identification Identifying impacts considers both positive and negative impacts resulting from the interaction between project-related activities and valued environmental components (VECs). VECs can be physical, biological, social, economic, or cultural. The identified potential environmental impacts are based on the interaction between the project-related activities and selected VECs. VECs were selected based on the existing project environment (environmental baseline conditions), opinions/views obtained from stakeholder consultations, and the consultant’s professional judgment. For this project, the selected VECs include atmospheric environment, acoustic environment, wetlands, a terrestrial environment, public health and safety, labour and economy, and public services infrastructure/utilities. The potential interactions between the Project Related Activities and the Selected VECs for each project implementation phase are illustrated in Table 5-1. Table 5-1: Potential Interactions of the Project with VECs. Project Phase Mobilisation Construction Demobi- Operation Valued Environmental Earth- Super- Structural Fit- lisation Component Works Structure Framing Out Air Quality - x x - - - x Noise & Vibration - x x x x - - Water Resources - - - - - - - Terrestrial Biodiversity - x - - - - - Public Health & Safety - x x x x x x Labour & Economic Conditions - x x x x x x Service Infrastructure & Utilities - x x - - - - 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 Climate Change and Greenhouse - - - - - - x Gas Emissions Hazardous Materials and - - x - x - x Contamination Risks Key No Substantial Interaction - Possible Interaction x 27 5.2 Significance Ranking of the Impacts The key objective of implementing this methodology was to identify any potential environmental issues and associated impacts likely to arise from the proposed project, and to propose a significance ranking. Issues or aspects were reviewed and ranked against a series of significance criteria to identify and record interactions between activities and aspects, and resources and receptors to provide a detailed discussion of impacts. The assessment considered direct1, indirect2, and secondary3, as well as cumulative impacts4. A standard risk assessment methodology was used to rank the identified environmental impacts pre- and post-mitigation (i.e. residual impact). The significance of environmental aspects is determined and ranked by considering criteria5 presented in Table 5-2. Table 5-2: 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 on Slight impact Processes Processes Permanent affected environmental receptor processes on processes continue but temporarily cessation of in a modified cease processes way Impact Extent (E) The geographical Site: Site Local: Inside Regional: National: International: extent of the impact on a given only activity area Outside National Across borders or environmental receptor activity area scope or level boundaries Impact Reversibility (R) The Reversible: Recoverable: Irreversible: Not ability of the environmental receptor Recovery Recovery possible despite to 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 On impact 0-5 years term: 5-15 Project life Indefinite environmental receptor years 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 [𝑆 = (𝐸 + 𝐷 + 𝑅 + 𝑀) × 𝑃] combining the above criteria in the 𝑆𝑖𝑔𝑛𝑖𝑓𝑖�𝑎𝑛�𝑒 = (𝐸𝑥𝑡𝑒𝑛𝑡 + 𝐷𝑢𝑟𝑎𝑡𝑖𝑜𝑛 + 𝑅𝑒𝑣𝑒𝑟𝑠𝑖�𝑖𝑙𝑖𝑡𝑦 + 𝑀𝑎𝑔𝑛𝑖𝑡𝑢𝑑𝑒) following formula: × 𝑃𝑟𝑜�𝑎�𝑖𝑙𝑖𝑡𝑦 IMPACT SIGNIFICANCE RATING Total Score 4 to 15 16 to 30 31 to 60 61 to 80 81 to 100 Environmental Significance Very low Low Moderate High Very High Rating (Negative (-)) 1 Impacts that arise directly from activities that form an integral part of the Project. 2 Impacts that arise indirectly from activities not explicitly forming part of the Project. 3 Secondary or induced impacts caused by a change in the Project environment. 4 Impacts are those impacts arising from the combination of multiple impacts from existing projects, the Project and/or future projects. 5 The definitions given are for guidance only, and not all the definitions will apply to all the environmental receptors and resources being assessed. Impact significance was assessed with and without mitigation measures in place. 28 CRITERIA SCORE 1 SCORE 2 SCORE 3 SCORE 4 SCORE 5 Environmental Significance Very low Low Moderate High Very High Rating (Positive (+)) 5.3 Impact Significance Rating for the Identified Impacts Annexe 1 presents the assessed potential environmental and social impacts and their significance rankings. 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 construction phase's potential positive and negative environmental and social impacts. The construction phase has been subdivided into specific activities to track the specific impacts. The impacts are organised according to the stages of the project life cycle, specifically construction and operation. 5.4.1 Anticipated Positive Impacts The positive impacts of the proposed project are described in the subsections below. 5.4.1.1 Improved Healthcare Services The rehabilitation of the x-ray room significantly enhances the hospital's diagnostic capabilities. With upgraded equipment and facilities, medical staff can perform more accurate and timely medical imaging, which is crucial for diagnosing various conditions. This improvement leads to better patient outcomes as doctors can make more informed decisions about treatment plans. Furthermore, having a state-of-the-art x-ray room reduces the need for patients to travel to other facilities for imaging services, ensuring quicker access to necessary medical care. 5.4.1.2 Enhanced Waste Management and Environmental Protection The installation of a healthcare waste mechanical incinerator brings substantial benefits in terms of waste management and environmental protection. By ensuring the safe and efficient disposal of medical waste, the risk of infection within the hospital is significantly reduced. Proper incineration of hazardous materials prevents the release of harmful substances into the environment, thereby protecting soil, water, and air quality. This upgrade also enhances the overall operational efficiency of the hospital, as modern waste management systems streamline processes and reduce the burden on staff. In turn, this allows the hospital to focus more resources on patient care, improving the quality of healthcare services provided. 5.4.1.3 Creation of job opportunities During the construction phase, the contractor will employ construction staff and prepare relevant environmental and social safeguard documents. The impact is short-term as it will last for less than 90 days during the construction phase but will also involve at least twenty people. Hence the impact is of low significance. 29 5.4.1.4 Improved project compliance to environmental and social legislations During the mobilisation phase, the project will involve preparing related environmental and social instruments that will be used for the project’s lifespan. These documents could include a Contractors-ESMP and other related documents. The impact is expected to be of high significance as it will be used for the entirety of the project. 5.4.2 Anticipated Negative Impacts 5.4.2.1 Disruption of Healthcare Services During the construction period of the Incinerator house, there is expected increase in noise, dust, and movement of construction personnel and equipment within the hospital premises. This can disrupt the normal functioning of other departments, causing inconvenience to both patients and staff. These disruptions may result in reduced efficiency of healthcare delivery, increased stress for healthcare workers, and a possible decline in patient satisfaction. Effective planning and communication are essential to minimize these impacts and ensure that critical services remain available during the construction period. 5.4.2.2 Temporary Air Quality Deterioration Dust and particulate matter emissions are anticipated as short-term impacts of the construction activities during the site clearing and excavation for the foundations of the incinerator housing. Site clearing and excavation work generate dust from the disturbance of soil and other materials. This dust can present respiratory problems and cause nuisance issues when redeposited on clothes and surfaces, as well as hinder visibility. During the construction of the 25 square meter building to house the incinerator, the use of cement and aggregates will further increase dust levels. Additionally, vehicles, electricity generators, and other machinery likely to be used during construction will 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. During operational phase, workers will be prone to various risks such as heat and harmful emissions, therefore it is recommended that the right personal protective equipment (PPE) such as masks and heat-resistant PPE including ventilators should be provided. 5.4.2.3 Elevated noise levels from machinery and construction activities. Construction machinery and equipment will generate noise that may impair the hearing of workers 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. 5.4.2.4 Loss of a tree and other ground cover The impact of the loss of trees is expected to be of low significance as the project sites has one tree on the boundary of that site that is not going to be cut down. 30 5.4.2.5 Potential for accidents and injuries on-site affecting workers 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 in proximity to water, working at height, use of electrical tools, trips and falls, use of hazardous and flammable chemicals just to mention a few. 5.4.2.6 Potential for accidents and injuries on-site affecting nearby communities. The construction works will involve the movement of vehicles carrying various construction materials. Civil and structural construction will increase traffic on the hospital premises as vehicles will be used for various activities. During construction, it is expected that there will be an increase in road traffic on the access roads due to the transportation of goods, and equipment. 5.4.2.7 Infectious Disease Impact (spread of STIs, HIV and AIDS, and Covid 19) Interactions between workers and the communities and even amongst themselves can increase the likelihood of spreading HIV and AIDS. Therefore, it is important for the Project to put measures in place to control the spread of the disease at the workplace. The Ministry of Health declared a cholera outbreak in Malawi on March 3, 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. 5.4.2.8 Gender-Based Violence (GBV) and Sexual Exploitation and Abuse (SEA) Impact 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. 5.4.2.9 Generation of solid wastes, spills, and effluent Various construction activities are expected to generate many types and varying quantities of wastes that will include construction rubbles, spoil from land clearing, packaging materials, vehicles and machine maintenance wastes, remains from form works, general mixed wastes (glass, wooden pallets, plastic, paper, metal scraps and cut-offs, fillings, food items etc.), material residues, hazardous wastes (used oils, discarded fuels and paints, termite proofing material residues, discarded thinners and cleaning agents etc.) and others. Spillages of chemicals, oils, paints, thinners, fuel, and other hazardous fluids, pastes or powders together with affected soils or surfaces should be regarded as hazardous waste. Effluents may include concrete spills, kitchen and bath wastewater cleaning wastewater and others. 31 5.4.2.10 Soil erosion and land degradation, water pollution from runoff and hazardous materials As the site is now, the risks of soil erosion, land degradation and Water pollution are very minimal. It is a flat land used as agricultural land now. In the context of hazardous materials risks, as indicated in Subsection 4.2.3, there will be alignment with the World Bank EHS guidelines, such that Infectious and / or hazardous wastes should be identified and segregated according to its category using a color-coded system. 5.4.2.11 Management of Risk of Ash in an Ash-pit once full The ash in the Ash-pit will be emptied after the pit is full. This will be done in line with the existing Waste Management Regulation of 2017 and the World Bank EHS Guidelines on Health Care Facilities of 30 April 2007, which deal with the Second Group of waste which include hazardous waste resulting from health care waste. The Ash will be emptied and packaged properly and then disposed at the District Council’s designated controlled Waste Dumpsite. 32 Environmental and Social Management and Monitoring Plan 6.1 Environmental and Social Management Plan An Environmental and Social Management Plan (ESMP) has been developed to assist in mitigating and managing environmental impacts associated with the construction works. It is noteworthy that key factors and processes may change during the construction works and considerable provisions have been made for dynamism and flexibility of the ESMP. As such, the ESMP will be subject to a regular regime of periodic review during project implementation. This 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. 6.2 Implementation of ESMP The ESMP shall be implemented to address all activities that have been identified to have potentially significant impacts on the environment during normal operations and 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 oversee the responsibility of coordinating all matters pertaining to the implementation of the project. The PIU has recruited an environmental and social expert to monitor environmental compliance and the social dimensions of the project. The PIU as such will be responsible for overseeing the monitoring activities conducted by the Construction Supervision Consultant. The main activities of the PIU regarding environmental and social safeguards are: i. Planning and implementation of ESMP. ii. Ensuring that the social and environmental protection and mitigation measures in the ESMP are incorporated in the site specific Environmental and Social Action Plans. iii. Supervision and monitoring of the progress of activities of the contractors. iv. Provide guidance to construction teams in conducting subsequent monitoring and reporting and in undertaking corrective options. v. Responsible for modifications to the ESMP when unforeseen changes are observed during implementation. vi. Ensure submission of periodical environmental and social management and monitoring reports to the World Bank. vii. Promote improved social and environmental performance through the effective use of management systems; and viii. 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. 33 6.2.2 Supervision Consultant Monitoring activities will be the responsibility of the supervision with the Resident Engineer being the leader. Among other staff, the Resident Engineer will have a qualified Environmental and Social Expert. Among the immediate and follow-up tasks of the Environmentalist and Social Experts at the Resident Engineers office will include. i. Development of a monitoring tool or checklist based on the ESMP and guided by the project physical layout. ii. Develop a monitoring program for the works targeting specific project working sites, material sites, sensitive environment and social areas, etc. iii. Prepare monthly site meetings to involve the Contractor, Client and Stakeholders. iv. Monthly reports in addition to continuous communications to the Contractor, Client, the Authorities and v. the Stakeholders as situations require, vi. 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 integrate environmental and social focus during project Management. To ensure effective implementation of the project impacts mitigation measures, therefore, the contractor will mobilise in-house Environment and Social Expert with the following responsibilities: i. Evaluate and review the ESMP developed from the main ESIA process and internalise the provisions for implementation based on the realities of the project. ii. Customise the project ESMP and generate a Construction Environmental and Social Management Plan (C-ESMP) and OHS Plan as a tool to guide the implementation and monitoring of indicators. The Site File copy should be with the Resident Engineer. iii. Procure necessary equipment for environment measurements or engage some appropriate expert personnel for the activity in specific environment quality aspects including air quality, noise, water, and soil quality, iv. Monthly reporting throughout the project period. 6.2.4 The Hospital Management and the project’s PIU Both the Hospital Management and the Covid-19 Project Implementation Unit (PIU) will work hand in hand to inspect and supervise the installation of the Incinerator, ensuring compliance with the World Bank's Environmental and Social Framework (ESF) and Environmental, Health, and Safety (EHS) Guidelines. 34 Table 6-1: Environmental and Social Management and Monitoring Plan Impact Impact Mitigation Measures Implementation Implementation Key Monitoring Implementation Monitoring Code Period and Monitoring Performance Frequency Responsibility Responsibility Costs Combined Indicator in (MWK) P-1M1 Improved Conduct regular training Ongoing during MK2,000,000.00 Number of Quarterly Hospital Ministry of Healthcare programs for medical and post- training Management Health (MoH) Services staff on the use and construction sessions maintenance of the conducted; upgraded Incinerator staff equipment. competency levels Organize health Monthly during MK500,000.00 Number of Monthly Hospital MoH awareness campaigns to post-construction awareness Management inform the community period . campaigns; about the new community Incineration services awareness available at the hospital. level Conduct regular service Ongoing; MK2,000,000.00 Maintenance Quarterly Hospital MoH of the machine. quarterly basis logs; machine Maintenance uptime Team P-1M2 Contain increased Construct a wastewater During MK1, 500,000 Reduced Ongoing during Contractor and MoH, Hospital risk of soil and and fuel spills sump construction phase Wastewater construction Hospital Management water containment within the and during and fuel spills phase and Maintenance and PIU (During contamination/ site and implement strict operation phase quarterly basis Team Construction pollution� protocols on spills during operation phase including control phase contamination by fuel spills P-1M3 Enhanced Waste Implement strict Ongoing on MK1,000,000.00 Compliance Monthly Hospital Waste MoH Management and protocols for monthly basis with waste Management Environmental segregating different during post- segregation Team Protection types of medical waste construction protocols at the source. Categories include infectious waste, hazardous waste, Ash waste and general waste, as per WHO guidelines. 35 Ensure that color-coded Ongoing on MK2,000,000.00 Number of bins Monthly Hospital Waste MoH; MEPA bins and clearly labelled monthly basis and containers Management containers are used for during post- in use; Team different types of waste. construction compliance rate Train hospital staff on Ongoing on MK1,500,000.00 Number of Monthly Hospital Waste MoH; MEPA proper waste handling monthly basis training Management and segregation during post- sessions; staff Team practices to minimize construction compliance the risk of infection and contamination. Designate storage areas Ongoing on MK2,000,000.00 Designated Monthly Hospital MoH; MEPA for hazardous and non- monthly basis storage areas; Management hazardous waste, during post- compliance ensuring they are secure construction with standards and comply with health and safety standards outlined in the World Bank’s Environmental, Health, and Safety (EHS) Guidelines. Ensure that waste Ongoing on MK1,500,000.00 Storage area Monthly Hospital MoH; MEPA storage areas are well- monthly basis conditions; Management ventilated, protected during post- security from the elements, and construction measures inaccessible to unauthorized personnel. Implement measures to Ongoing on MK1,000,000.00 Number of Monthly Hospital Waste MoH; MEPA prevent spills and leaks, monthly basis spill incidents; Management including secondary during post- containment Team containment systems for construction measures in liquid waste. place Establish a routine Annually during MK2,000,000.00 Maintenance Annually Hospital MoH; MEPA maintenance schedule and post- logs; Maintenance for the incinerator to construction incinerator Team ensure it operates efficiency efficiently and effectively. 36 P1M1; Creation of Job Inform local Before MK100,000.00 Number of Once Contractor District Labour Opportunities communities of construction phase local workers Office (DLO); employment starts employed PIU E&S Expert opportunities and prioritize their employment. Treat employees in Ongoing during MK0.00 Compliance Ongoing Contractor DLO; PIU E&S compliance with Malawi construction phase with labour Expert Labour Regulations and regulations labour and working conditions as per the project's Labour Management Plan. Pay the same rates for Ongoing during MK0.00 Pay equity Ongoing Contractor DLO; PIU E&S workers working on construction phase records Expert similar tasks regardless of gender and origin. Have workers sign a Before MK0.00 Number of Once Contractor DLO; PIU E&S code of conduct. employment starts signed codes of Expert conduct Sensitize workers to a During induction MK50,000.00 Number of Ongoing Contractor DLO; PIU E&S full range of risks related and ongoing sensitization Expert to occupational health sessions; and safety, labour rights, worker public health, awareness community safety, levels sexual harassment, and GBV. Ensure that 30% of the Ongoing during MK0.00 Workforce Ongoing Contractor DLO; PIU E&S workforce are women. construction phase gender ratio Expert P1M2 Improved project Develop a contractors Before MK5,000,000 Approved C- Once Contractor PIU E&S Expert compliance to ESMP that will include construction phase ESMP environmental Occupational Health and starts and social Safety Plan, Traffic legislations Management Plan, Waste Management Plan among others. 37 Solicit views of the Before MK75,000.00 Number of Once Project Environment public and stakeholders construction phase consultations Management District Officer through consultations to starts held; Team (EDO); PIU ensure that their stakeholder E&S Expert concerns are considered feedback in the project incorporated documents. Undertake community Before MK50,000.00 Number of Once Project EDO; PIU E&S liaison meetings to construction phase liaison Management Expert notify the community of starts meetings; Team the commencement date, community inform them of the awareness grievance mechanism, level and labor policy. Obtain relevant Before MK2,000,000.00 Number of Once Project EDO; PIU E&S approvals and construction phase approvals and Management Expert certificates from starts certificates Team authorities, including the obtained Malawi Environment Protection Authority and Likoma District Council. P1M3 Disruption of Set up a temporary X- Before MK500,000.00 Availability of Once Hospital MoH Healthcare ray facility within the construction phase temporary Management Services hospital starts room Inform staff, patients, On-going during MK250,000.00 Availability of Ongoing Hospital MoH and visitors about the rehabilitation and temporary Management construction schedule installation phase room and expected disruptions well in advance. Use signage and announcements to keep everyone updated on progress and temporary arrangements. Designate specific Before MK150,000.00 Availability of Once Contractor Hospital access routes for construction phase temporary Management construction personnel starts room 38 and equipment to minimize interference with hospital operations. Ensure these routes are clearly marked and separate from patient and staff areas. P1- Air Emission Reduced costs incurred To operate MK00.00 Daily operation OngoingMK00.00 Hospital HEHO 1M1! from Incinerator in waste treatment, incinerator at Incinerator (Hospital Reduced and controlled proper Operator Environmental air pollution during temperature in Health Officer) treatment accordance with the Operation Manual P2- Temporary Air Sprinkle water during During site MK200,000.00 Frequency of Weekly Contractor EDO; PIU E&S 1M1 Quality the site clearing and clearing and water Expert Deterioration excavation phase excavation sprinkling; dust regularly, particularly levels during dry and windy periods, to mitigate dust dispersion. Transport particulate or Ongoing during MK150,000.00 Compliance Ongoing Contractor EDO; PIU E&S powdery construction transport with transport Expert materials or residues protocols with adequate load cover to prevent/restrain the dispersion of particulate matter. Unload transported Ongoing during MK0.00 Drop-height Ongoing Contractor EDO; PIU E&S powdery materials to material handling compliance; Expert drop-height regulation dust levels equipment to ensure the lowest drop height possible in these operations. Minimize stockpiling of Ongoing during MK150,000.00 Amount of soil Ongoing Contractor EDO; PIU E&S excavated soils within excavation stockpiled; Expert the construction site by compliance 39 immediate removal and with removal transportation to the schedule dumping site. Carry out regular Ongoing; monthly MK150,000.00 Maintenance Monthly Contractor EDO; PIU E&S maintenance of vehicles maintenance logs; vehicle Expert and avoid the use of old emission levels vehicles and mobile construction equipment which emit black smoke. P2- Elevated noise Limit noisy construction Ongoing during MK0.00 Compliance Daily Contractor EDO; PIU E&S 1M2 levels from activities only to construction phase with work Expert machinery and daytime hours. hours; noise construction level readings activities Notify hospital As needed during MK0.00 Number of As needed Contractor EDO; PIU E&S management and staff construction phase notifications Expert residential area at least sent; twenty-four hours in community advance if particularly feedback noisy activities are anticipated. Ensure that noise levels Ongoing during MK100,000.00 Noise level Weekly Contractor EDO; PIU E&S at the hospital do not construction phase readings; Expert exceed 55 dB (A) and compliance keep noise levels for with standards workers below 80 dB (A). Place stationary noise During equipment MK100,000.00 Placement Once Contractor EDO; PIU E&S sources (e.g., the setup compliance; Expert generator) away from noise level sensitive receptors such readings as wards and staff houses. P2- Loss of a tree and Confining land clearing During site MK0.00 Area cleared; Quarterly Contractor EDO; PIU E&S 1M3 other ground to worksite. preparation compliance Expert cover with site boundaries Protect the existing tree Before and during MK50,000.00 Condition of Monthly Contractor EDO; PIU E&S on the project site's construction tree; Expert 40 boundary by installing effectiveness physical barriers to of barriers prevent accidental damage during construction activities. P2- Potential for Develop and implement Before MK250,000.00 Existence of Quarterly Contractor DLO; PIU E&S 1M4 accidents and an Occupational Health construction phase OH&S plan; Expert injuries on-site and Safety Plan that starts compliance affecting workers aims to avoid, minimize, with safety and mitigate the site- protocols specific risk of workplace accidents. Provide OSH orientation During induction MK50,000.00 Number of Monthly Contractor DLO; PIU E&S training and hazard- and ongoing training Expert specific training. sessions; worker awareness levels Conduct a thorough risk Before excavation MK50,000.00 Risk Monthly Contractor DLO; PIU E&S assessment before starts assessment Expert excavation to identify report; potential hazards and implementation implement necessary of safety safety measures. measures Install barriers and During excavation MK150,000.00 Number of Monthly Contractor DLO; PIU E&S warning signs around barriers and Expert the excavation area to signs; prevent unauthorized compliance access and to alert with safety workers to potential protocols hazards. Use secure and stable During MK1,000,000.00 Equipment Monthly Contractor DLO; PIU E&S ladders or scaffolding construction inspection Expert that meet safety logs; standards for working at compliance height. with safety standards 41 Provide personal Before work at MK1,000,000.00 PPE Monthly Contractor DLO; PIU E&S protective equipment height begins availability and Expert (PPE), including safety usage; harnesses, helmets, and compliance non-slip footwear to all with safety workers working at standards height. Provide PPE, including Before MK500,000.00 PPE Monthly Contractor DLO; PIU E&S gloves, work suits, and construction availability and Expert boots, to all workers begins usage; handling cement during compliance construction works. with safety standards Carry out regular Ongoing; weekly MK50,000.00 Number of Annually Contractor DLO; PIU E&S toolbox talks as toolbox talks; Expert specified in the Health worker and Safety Plan of the attendance project. Install first aid kits Before MK250,000.00 Availability Once Contractor DLO; PIU E&S proportionate to each construction and Expert project site activity. begins accessibility of first aid kits Obtain medical Before MK200,000.00 Number of Ongoing Contractor DLO; PIU E&S insurance for the construction insured Expert workforce. begins workers Compensate injured As needed MK200,000.00 Number of Ongoing Contractor DLO; PIU E&S workers in line with the compensation Expert Workers’ Compensation cases handled; Act of 2000. compliance with Workers’ Compensation Act P2- Potential for Erect safety barriers Before MK150,000.00 Number of Once Contractor DLO; PIU E&S 1M5 accidents and around the construction construction barriers Expert injuries on-site site to prevent begins erected; affecting nearby unauthorized access. incidence of communities unauthorized access 42 Schedule construction During MK0.00 Delivery Ongoing Contractor DLO; PIU E&S deliveries and heavy construction phase schedule Expert machinery movement compliance; during off-peak hours to community minimize disruption. feedback Coordinate with hospital Before MK0.00 Number of Ongoing Contractor DLO; PIU E&S administration to ensure construction coordination Expert that alternative routes begins meetings; and access points are availability of available during alternative construction. routes Hire transporters whose During MK0.00 Number of Once Contractor DLO; PIU E&S vehicles have valid construction phase compliant Expert Certificate of Fitness vehicles and (CoF) and drivers with drivers the appropriate driving licence category. Construction vehicles to During MK50,000.00 Compliance Once Contractor DLO; PIU E&S observe a 20 km/hr construction phase with speed Expert speed limit on the limits; number hospital campus. Put in of signposts place signposts indicating the speed limits on the construction site. P2- Infectious Carry out monthly Ongoing; monthly MK150,000.00 Number of Once Contractor DEHO 1M6 Disease Impact health education for health (DEHO); PIU (spread of STIs, construction workers in education E&S Expert HIV and AIDS, liaison with health sessions; and Covid-19) personnel using the worker toolbox talks. participation Free condoms are to be Ongoing MK100,000.00 Availability Once Contractor DEHO; PIU made available to all and usage of E&S Expert (100%) workers by condoms placing them in the workers’ toilets to ensure access and confidentiality. 43 Sensitize construction Ongoing MK50,000.00 Number of Once Contractor DEHO; PIU workers on Covid-19 sensitization E&S Expert prevention including sessions; hand washing with soap, worker use of hand sanitizers, compliance proper use of face masks, and workspace disinfection among others. Distribute information, Ongoing MK250,000.00 Number of IEC Ongoing Contractor DEHO; PIU education, and materials E&S Expert communication (IEC) distributed; materials on Covid-19, worker HIV and AIDS awareness prevention, and cholera. Provide necessary PPE Ongoing MK150,000.00 Availability Once Contractor DEHO; PIU and other materials (e.g. and usage of E&S Expert cloth masks, hand PPE; sanitizers, hand-washing compliance facilities) to help prevent with health construction workers protocols from contracting and spreading Covid-19 at the workplace. P2- GBV and SEA Develop an induction Before MK50,000.00 Existence of Weekly Contractor District Social 1M7 Impact program including a construction phase induction Welfare Office code of conduct for all starts program; (DSWO); PIU workers which they will number of E&S Expert be required to sign prior signed codes of to starting their work. conduct Ensure a copy of the Before MK50,000.00 Number of Ongoing Contractor DSWO; PIU code of conduct is construction phase signed codes of E&S Expert presented to all starts conduct construction workers and signed by each of them. 44 Implement a GBV During MK250,000.00 Existence and Ongoing Contractor DSWO; PIU management plan as construction phase implementation E&S Expert presented in Annex 4. of GBV management plan Provide clear, trusted, Ongoing during MK150,000.00 Number of Ongoing Contractor DSWO; PIU and responsive channels construction phase reported cases; E&S Expert for filing GBV/SEA/SH resolution time cases to the police or other relevant government authorities. Ensure the availability Ongoing during MK50,000.00 Existence and Monthly Contractor DSWO; PIU of an effective construction phase accessibility of E&S Expert Grievance Redress GRM; number Mechanism (GRM). of grievances addressed Provide Heat resistant Operation phase - Existence of daily contractor PIU Incinerator PPE appropriate operators Install ventilators PPE exposure to Ventilator extreme heat installed P2- Generation of Provide adequate on-site Before MK250,000.00 Number and Daily Contractor EDO; PIU E&S 1M8 solid wastes, waste receptors such as construction phase type of waste Expert spills, and colour-coded bins or starts receptors; effluent skips for temporary compliance waste storage. Use of with waste rubbish pits should be management discouraged. protocols Arrange with the District Before MK50,000.00 Number of As needed Contractor EDO; PIU E&S Council to identify a construction phase waste disposal Expert suitable site or sites starts sites identified; (new or existing) for compliance waste disposal at with disposal different project sites if protocols possible within 5 km radius. 45 Obtain permits to Before MK50,000.00 Number of Weekly Contractor EDO; PIU E&S handle, store, transport, construction phase permits Expert and dispose of starts obtained; hazardous waste from compliance the Environmental with hazardous Authority in advance of waste construction. regulations Segregate and clearly During MK100,000.00 Segregation Once Contractor EDO; PIU E&S label hazardous waste construction phase and labelling Expert and store in suitable compliance; drums or containers in condition of secure facilities that storage have a banded facilities impermeable layer. Promote good Ongoing MK50,000.00 Cleanliness Quarterly Contractor EDO; PIU E&S housekeeping and and Expert sanitation practices at organization of each site. the site; worker compliance Provide spill-control kits During MK100,000.00 Availability Monthly Contractor EDO; PIU E&S and materials (e.g. oil construction phase and usage of Expert binding agents, sand, spill-control shovels, etc.) to drivers kits; number of and workers, to clean up spill incidents spills, if necessary. TOTAL COST ESMP IMPLEMENTATION AND MONITORING MK31,225,000 46 6.2.5 Implementation of ESMP The ESMMP shall be implemented to address all activities that have been identified to have potentially significant impacts on the environment during project implementation and operation. The implementation of the project environment and social component will be overseen by different institutional arrangements. The players are indicated in Table 6-2. Table 6-2: ESMMP Implementation Arrangement Responsible Roles and Responsibilities Party Ministry of • Custodian of the project Health / PIU • Provide support, oversight, and quality control to field staff working on environmental and social risk management. • Planning and implementation of ESMP. • Ensuring that the social and environmental protection and mitigation measures in the ESMP are incorporated in the site-specific Environmental and Social Action Plans. • Supervise and monitor the progress of contractors' activities. • Provide guidance to construction teams in conducting subsequent monitoring and reporting and in undertaking corrective options. • Responsible for modifications to the ESMP when unforeseen changes are observed during implementation. • Ensure the submission of periodic environmental and social management and monitoring reports to the World Bank. • Promote improved social and environmental performance through the effective use of management systems. • External communications with other implementing partners, government ministries and agencies, and non-government organisations on matters of mutual interest related to environmental management under the project development. Supervision • Development of a monitoring tool or checklist based on the ESMMP and guided by the project’s Engineer physical layout. • Develop a monitoring program for the works, targeting specific project working sites, material sites, sensitive environments, social areas, etc. • Prepare monthly site meetings to involve the Contractor, Client and Stakeholders. • Monthly reports in addition to continuous communications to the Contractor, Client, Authorities and Stakeholders as situations require. • The Consulting Engineer will convene monthly meetings for progress reporting by the Contractor and the supervision team. The • Customise the project ESMMP and generate a Construction Environmental and Social Management Contractor Plan as a tool to guide the implementation and monitoring of indicators. File a copy with the Resident Engineer. • Procure necessary equipment for environment measurements or engage some appropriate expert personnel for the activity in specific environment quality aspects, including air quality, noise, water, and soil quality, • Monthly reporting throughout the project period. Likoma • While the district council structures especially DESC has been involved in the ESMMP preparation, District major responsibility in monitoring the implementation of the project and ensuring quality works lies Council with the implementing Likoma hospital, especially the Maintenance officer. 47 6.2.6 Environmental and Social Management and Monitoring Plan implementation cost Below is a summary of the anticipated environmental and social risks associated with the rehabilitation works and provisions for managing them. The rehabilitation works are projected to take a minimum period of 3-6 months. The implementation and monitoring of this ESMP will be supervised by PIU and the Likoma District hospital 48 7. Capacity Development, Training and Reporting 7.1 Technical Assistance support for the implementation of safeguards The success of effective implementation of this ESMP will be rests on the availability of technical equipped staffs and other relevant implementing parties. Thus, the design and implementation of technical capacity building program for implementing institution with the right skills and knowledge is unavoidable. This effective capacity building program could be through availing of the required resources and training of staff and all other parties involved in this ESMP implementation, including the contractor. Project implementing bodies need to understand inherent social and environmental issues and values of the proposed installation of incinerators project at Likoma district hospitals and be able to identify and manage impacts. Given less familiarity on WB ESF by staff from the implementing institutions and other relevant institutions and stakeholders directly and/or indirectly engaged in the implementation of the proposed Likoma hospitals incinerator installation project, and to ensure successful implementation of the Environmental and Social Standards, there is need for capacity building through planning and implementation of project capacity building program. The training will provide the necessary technical support at all levels i.e. to the PIU in its work with contractors as well as other entities involved in the implementation of the ESMP. Given the nature of the works, it is anticipated that the safeguard technical assistance support and training will be provided at least 2 times (one on preconstruction phase and another on construction phase). An indicative training plan is indicated in Table 7-1. The WB safeguard specialists may participate in the capacity building activity in particular, in the training activities if appropriate. Other than administering trainings to staff from the implementing institution and other relevant institutions and stakeholders, the contractor will also be required to provide regular toolbox trainings to the workers. Toolbox trainings are aimed at equipping workers with capacity to avoid noncompliance to ESMP and facilitating effective implementation of remedial measures in case an incident has happened e.g. an accident. The tentative training plan is presented in Table 7-1 and reporting form in Appendix 3(b). 49 Table 7-1: Tentative Training Plan No. Description Training Module Frequency Participation of Training 1 Two-day • Objectives, need, legal requirements and use of Launch Project management team Training ESMP. workshop; 1 including relevant Staff Workshop month before from MoH, • Management of identified environmental and social the construction Environment and Social issues, mitigation strategies, monitoring and of the first Safeguards Specialists, reporting procedures (as per ESMP); contract contractor, Hospital management, District • Stakeholder engagement, consultation, and Environment Officer, partnerships. Director of Public • Grievance Redress Mechanism (GRM) works etc. • Gender based Violence (GBV), Abuse of child labour, issues etc. • Community/public health of patients during construction and operation of the incinerators • Occupational Health and Safety, • Safe transportation of waste • Medical waste management and disposal practices to check compliance with the World Bank Group’s EHS Guidelines and current WHO • COVID-19. infection prevention • Resource Efficiency and Pollution Prevention and Management 2. One day • Anticipated project impacts and mitigation measures At Project Community members, community • Grievance Redress Mechanism (GRM), Gender based Design and relevant hospital staff sensitization Violence (GBV), Abuse of child labour and issues linked during meeting Incinerator with labour influx., Child marriage installation • 3 Toolbox • Anticipated project impacts and mitigation measures at each Depending on All workers at the Training stage type of work, construction site • Grievance Redress Mechanism (GRM), Gender based task for the day and risk Violence (GBV), Abuse of child labour, Child marriage, assessment but defilement at least weekly • Occupational Health and Safety measures including first Aid • Code of Conduct • Resource Efficiency and Pollution Prevention and Management • COVID-19.infection prevention 50 7.2 Reporting Requirements The ESMP implementation progress reports should be prepared which summarize the results of all monitoring. The reports will give monitoring data in a standard format (Annexure A8.1. Performance reports should emphasize any significant violations of contract provisions by the contractor or any failure to implement requirements of the ESMP. Any significant incidents of environmental contamination should be summarized, along with actions taken to mitigate these and to prevent reoccurrence. Progress Reports should be submitted to C-ERHSP Project management team, and other relevant institutions monthly during construction . In case of follow up monitoring visit, a follow up form for reporting implementations of violations is also prepared and presented in Annexure A8.3). Regardless of the reporting forms (An incident reporting form is attached in Annexure 9) and periods, all accidents and incidents will be reported immediately. Notification will be given by the contractor to C- ERHSP Project, management team who will then report the incident to World Bank through the PMU within 48 hours of occurrence. Incidents to be reported will include but not limited to • near misses • fatality • Injuries • Spillage • GBV/SEA incidents The Incident report shall include. • Date, time and place of the incident • Description of the incident • Type of injury or damage sustained. • Person involved. • Corrective action undertaken to reduce spread or damage. 51 Conclusions And Recommendations 8.1. Conclusions This ESMP has presented the major guidelines that have to be followed for safeguards execution during incinerators installation at Likoma district hospital which are sub projects under Malawi COVID-19 Emergency Response and Health Systems Preparedness Project (C-ERHSPP). Though the proposed project will likely generate significant socio-economic benefits to the hospital as well as local people around Likoma district hospital, negative environmental and social impacts that the project activities are likely to bring have also been established by this ESMP. The key positive environmental and social impacts from the project includes but not limited to 1) Creation of temporary jobs to local communities; 2) increased skills transfer to local people; 3) increased business opportunities; 4) Significant infectious and non-infectious waste volume reduction at the hospital 5) Reduced transmission of infectious diseases transmitted through infectious wastes 6) Reduced exposure of communities to infectious materials and cross infection 7)Reduced costs incurred in waste treatment, 8)Reduced and controlled air pollution during waste treatment, 9)Increased income generating activity of the hospital, 10) Improved public safety and health, 11)Reduced Odor received by surrounding communities. On the other hand, negative impacts include but not limited to 1) Increased dust emissions, 2) Increased noise pollution, 3)Potential increase of hospital bills on water utilities, 4) Occupational safety and health risks, 5) Increased Public health and safety risks, 6) Increased risk of child labour, 7) Increased Gender-Based Violence (GBV) and Sexual Exploitation and Abuse (SEA), 8) Increased risk of spread of HIV and AIDS and STIs, 9) Increased Risk of Spread of COVID- 19, 10) Child marriage, 11) defilement and 12) Increased theft cases. Following the identified potential impacts, mitigation and enhancement measures have also been identified and must be well followed during the development and implementation of the project. 8.2. Recommendations Further to identification of impacts and subsequent prescription of mitigation or enhancement measures, this ESMP recommends the following: 1. The developer should give environmental protection and social considerations the necessary attention during implementation of the project: 2.The developer should adopt and implement all the recommendations and mitigation measures advanced in this ESMP and respective monitoring plan. 3. The developer should ensure adequate provision of capacity building to all key stakeholders who will be directly involved in the implementation of the project’s ESMPs, as it is an integral part to ensuring quality safeguards implementation in the project. With these conditions fully met and implemented, the recommendation is for this project to be allowed to proceed. 52 References 1. Government of Malawi (2017) Environment Management Act. Ministry of Natural Resources, Lilongwe, Malawi 2. Government of Malawi (2013). Water Resources Act, Lilongwe, Malawi 3. Government of Malawi (2012). National HIV and AIDS Policy, Lilongwe, Malawi 4. Government of Malawi (2005) National Water Policy, Ministry of Irrigation and Water Development, Tikwere House, Lilongwe 5. Government of Malawi (2013). The Gender Equality Act. Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi. 6. Government of Malawi (2013), Child Protection Policy, Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi. 7. Government of Malawi (1997). The Occupation Safety Health and Welfare Act. Ministry of Labour, Youth, Sports and Manpower Development, Lilongwe, Malawi. 8. Government of Malawi (1948), Public Health Act, Ministry of Health, Malawi. 9. Government of Malawi (2024); Ministry Of Health - Malawi. COVID-19 National Information Dashboard. (https://covid19.health.gov.mw/). 10. Government of Malawi (2008). Environment Management (Waste Management and Sanitation) Regulations. Ministry of Natural Resources, Energy and Mining, Lilongwe, Malawi. 11. Government of Malawi. (1997). Guidelines for Environmental Impact Assessment. Lilongwe, Malawi 12. Mvuma Godfrey (2010). UNDP Report on the establishment of Waste Management Systems in the cities of Abuja, Kano and Onitsha, Nigeria. 12. National Statistical office (2018), Population and Housing Census report, Zomba, Malawi 13. The World Bank (2017), Environmental and Social Framework, 1818 H Street NW, Washington, DC 20433, USA. 53 Annexures Annex 1: Layout Plans of the Incinerator Building A1.1 Site Layout Plan 54 A1.2 Incinerator House Layout Plan 55 A1.3 Incinerator House Elevation Details 56 A1.4 Ash Pit Design 57 Annex 2: Project impacts and their ratings Impact Extent Probability of Impact Code Reversibility Significance Occurrence Significane Magnitude Activity Project Potential Environmental & Social Nature of Duration VEC Code Activity Impact Impact Impact Impact Impact Rating P1 Mobilisation Labour & Economic Creation of job opportunities. P1M1 Positive 2 3 3 2 3 30 Low Conditions P1 Mobilisation Labour & Economic Improved project compliance to P1M2 Positive 3 3 3 2 3 33 Moderate Conditions national environmental and social requirements P2-1 Site clearing & Air Quality Temporary Air Quality Deterioration P2-1M1 Negative 2 2 1 1 2 12 Very Low Excavation P2-1 Site clearing & Noise & Vibration Elevated noise levels from machinery P2-1M2 Negative 3 2 1 1 3 21 Low Excavation and construction activities. P2-1 Site clearing & Terrestrial Biodiversity Loss of trees and other ground cover. P2-1M3 Negative 2 3 1 2 2 16 Low Excavation P2-1 Site clearing & Public Health & Safety Potential for accidents and injuries on- P2-1M4 Negative 3 2 3 2 3 30 Low Excavation site affecting workers. P2-1 Site clearing & Public Health & Safety Potential for accidents and injuries on- P2-1M5 Negative 3 2 3 2 2 20 Low Excavation site affecting near-by communities. P2-1 Site clearing & Public Health & Safety Infectious Disease Impact (spread of P2-1M6 Negative 3 3 5 5 2 32 Moderate Excavation STIs, HIV and AIDS, and Covid 19) P2-1 Site clearing & Social Dynamics and Gender-Based Violence (GBV) and P2-1M7 Negative 3 3 3 2 3 33 Moderate Excavation Community Well-being Sexual Exploitation and Abuse (SEA) Impact P2-1 Site clearing & Waste Management Generation of solid and hazardous P2-1M8 Negative 3 2 1 2 3 24 Low Excavation waste requiring proper disposal and management. P2-2 Super Structure Labour & Economic Creation of job opportunities. P2-2M1 Positive 3 3 3 2 3 33 Moderate Conditions P2-2 Super Structure Air Qulity Temporary Air Quality Deterioration P2-2M2 Negative 2 2 1 1 2 12 Very Low P2-2 Super Structure Noise & Vibration Elevated noise levels from machinery P2-2M3 Negative 2 2 1 1 3 18 Low and construction activities. P2-2 Super Structure Public Health & Safety Potential for accidents and injuries on- P2-2M4 Negative 3 2 3 2 3 30 Low site affecting workers. 58 Impact Extent Probability of Impact Code Reversibility Significance Occurrence Significane Magnitude Activity Project Potential Environmental & Social Nature of Duration VEC Code Activity Impact Impact Impact Impact Impact Rating P2-2 Super Structure Public Health & Safety Potential for accidents and injuries on- P2-2M5 Negative 2 1 3 2 3 24 Low site affecting near-by communities. P2-2 Super Structure Public Health & Safety Infectious Disease Impact (spread of P2-2M6 Negative 3 3 5 2 3 39 Moderate STIs, HIV and AIDS, and Covid 19) P2-2 Super Structure Waste Management Generation of solid and hazardous P2-2M8 Negative 3 2 1 2 3 24 Low waste requiring proper disposal and management. P2-2 Super Structure Social Dynamics and Gender-Based Violence (GBV) and P2-2M9 Negative 3 2 1 2 3 24 Low Community Well-being Sexual Exploitation and Abuse (SEA) Impact P2-3 Structural Labour & Economic Creation of job opportunities. P2-3M1 Positive 3 3 3 2 3 33 Moderate Framing Conditions P2-3 Structural Noise & Vibration Elevated noise levels from machinery P2-3M2 Negative 3 2 1 1 3 21 Low Framing and construction activities. P2-3 Structural Public Health & Safety Potential for accidents and injuries on- P2-3M3 Negative 3 2 3 1 3 27 Low Framing site affecting workers. P2-3 Structural Public Health & Safety Potential for accidents and injuries on- P2-3M4 Negative 2 2 3 2 3 27 Low Framing site affecting near-by communities. P2-3 Structural Public Health & Safety Infectious Disease Impact (spread of P2-3M5 Negative 3 3 5 2 3 39 Moderate Framing STIs, HIV and AIDS, and Covid 19) P2-3 Structural Visual Impact Visual intrusion from construction P2-3M6 Negative 2 2 3 2 3 27 Low Framing equipment, structures, and stockpiles. P2-3 Structural Waste Management Generation of solid and hazardous P2-3M7 Negative 2 2 1 1 3 18 Low Framing waste requiring proper disposal and management. P2-4 Fit Out Labour & Economic Creation of job opportunities. P2-4M1 Positive 3 3 3 2 3 33 Moderate Conditions P2-4 Fit Out Noise & Vibration Elevated noise levels from machinery P2-4M2 Negative 3 2 1 1 3 21 Low and construction activities. P2-4 Fit Out Public Health & Safety Potential for accidents and injuries on- P2-4M3 Negative 3 2 3 1 3 27 Low site affecting workers. P2-4 Fit Out Public Health & Safety Potential for accidents and injuries on- P2-4M4 Negative 2 2 3 2 3 27 Low site affecting near-by communities. 59 Impact Extent Probability of Impact Code Reversibility Significance Occurrence Significane Magnitude Activity Project Potential Environmental & Social Nature of Duration VEC Code Activity Impact Impact Impact Impact Impact Rating P2-4 Fit Out Public Health & Safety Infectious Disease Impact (spread of P2-4M5 Negative 3 3 5 2 3 39 Moderate STIs, HIV and AIDS, and Covid 19) P2-4 Fit Out Visual Impact Visual intrusion from construction P2-4M6 Negative 2 2 3 2 3 27 Low equipment, structures, and stockpiles. P2-4 Fit Out Waste Management Generation of solid and hazardous P2-4M7 Negative 2 2 1 1 3 18 Low waste requiring proper disposal and management. P3 Demobilisation Labour & Economic Creation of job opportunities. P3-M1 Negative 3 3 3 2 3 33 Moderate Conditions P3 Demobilisation Noise & Vibration Elevated noise levels from machinery P3-M2 Negative 2 2 3 1 2 16 Low and construction activities. P3 Demobilisation Public Health & Safety Potential for accidents and injuries on- P3-M3 Negative 2 2 3 2 3 27 Low site affecting workers. P3 Demobilisation Waste Management Generation of solid and hazardous P3-M4 Negative 3 2 1 1 3 21 Low waste requiring proper disposal and management. 60 Annex 3 A: Stakeholder Consultations A3.1 Stakeholder Consultation Checklist for the ESMP 1. What type of environmental and social positive impacts will result from this proposed project and how will these impacts be enhanced (State positive impacts for each phase of construction and operation)? 2. What type of environmental and social negative impacts should be expected during the construction of the proposed project and what are the proposed mitigation measures? 3. What type of environmental and social negative impacts should be expected during the operation and maintenance phase of the proposed project and what are the proposed mitigation measures? 4. Who else should be consulted regarding the environmental and social impacts of the proposed project? A3.2 Stakeholder Consultations Stakeholder participation involved engaging institutions within the project impact area and selected public institutions who expressed their views about the proposed projects. The stakeholder participation process tried to ensure that due consideration will be given to stakeholder values, concerns, and preferences when decisions regarding the project are made. The key objectives of stakeholder involvement were to: • Facilitate consideration of alternatives, mitigation measures and trade-offs (if any). • Ensure that important impacts are not overlooked, and benefits are maximized. • Reduce chances of conflict through early identification of contentious issues. • Provide an opportunity for the stakeholders to influence project design in a positive manner (thereby creating a sense of ownership of the proposal). • Improve transparency and accountability of decision-making; and • Increase public confidence in the Environmental and Social Impact Assessment process. Stakeholder participation in this project was facilitated through interviews and was guided by a checklist of questions that are presented in following sections. A3.3 Stakeholders Comments The comments stakeholders raised were collated and analysed to see which issues are of concern and should be addressed through the ESMP and are presented in Box below. The following subsections list these stakeholders and the comments they raised, whilst referencing to the impact assessment section and the proposed mitigation measures to elaborate how they contributed to the formulation of the ESMP of this report. This was done in respect to the fact that public concern is fundamental to the delineation and management of the project’s significant risks. 61 Key issues raised during the consultations. SN NAME ISSUES RAISED RECOMMENDATIONS 1 Paul Kayera Positive impacts Enhancement measure (Incinerator Good sanitation: the coming of the mechanical incinerator will Implementing strict health and safety protocols for Assstant- promote safely disposing of hazardous waste materials, incinerator operators and nearby communities to Likoma including medical waste, chemicals, and other harmful minimize exposure to pollutants and hazardous materials. District substances, thus reducing the risk of environmental Hospital) contamination. The project will increase in job opportunities for its residents. They should prioritize employing people from within the Both individuals with existing skills and those without project area and skilled specific qualifications may find employment opportunities during construction and operation Negative Impacts Mitigation measure The project often tends to employ individuals who are not They should ensure that they employ individuals from from the immediate area, which, in turn, diminishes the local within the local area people's opportunities to reap significant benefits from it Due to coming of the project there may be disruptions in sensitize people regarding issues of marriage disruptions marriages as some individuals, now having access to more that would be inevitable because of the migrant workers. money, might become involved in other sexual relationships The migrant workers coming to the project site may Community policing should be strongly emphasized to potentially lead to an uptick in theft or security concerns. The address and manage security concerns unfamiliarity of these workers with the local community and their temporary presence might create situations where security needs to be reinforced 2 Afuki arma Positive impacts Enhancement measure (Radiology Improved Healthcare Access: Rehabilitating the X-ray room Ensuring that the radiology team are proficient in Technician- will help diagnose and treat a wide range of medical operating the equipment Likoma conditions more effectively. District Negative Impacts Mitigation measure Hospital) The potential increase in cases of sexual abuse and harassment they should be code of conduct that should be followed because of the project for the workers 62 SN NAME ISSUES RAISED RECOMMENDATIONS Vehicles might cause accidents: The area can be an accident- The project should conduct monthly road safety prone area because of the frequent movement of vehicle to andawareness campaigns with community members. The from the site. contractor will also use vehicles that have valid Certificate of Fitness and drivers with the appropriate driving licence category. 3 Olipa Positive impacts Enhancement measure Simukoza Employment opportunities in the area are expected to improve they should make sure that they employ people from (Biomedical significantly because of the project within the area and even the disabled should be considered Maintenance Negative Impacts Mitigation measure Supervisor- increase in child labor because of the project they should make sure they employ people that above the Likoma minimum recommended age District Increased risk of injuries and accidents especially to children There is need to create safe space for children Hospital) Increased risk of sexual harassment between employers and Mainstream issues of awareness on the project employees Increased risk of spread of STIs including HIV/AIDS Consider distributing contraceptives on the project i.e. condoms Increased employment opportunities especially for the local Ensure that there is equal opportunity for both men and people women Contractor should Ensure that labour laws are followed 4 Lest loyani Positive impacts Enhancement measure (Waste The upcoming project of the incinerator will help proper waste Integrate waste-to-energy processes to convert non- management management recyclable waste into valuable energy, reducing reliance officer- on fossil fuels. Likoma modern incinerators are equipped with advanced pollution Design the incinerator facility with sustainability in mind, district control technologies that minimize the release of harmful incorporating energy-efficient buildings, green spaces, hospital) emissions, making them a more environmentally friendly and practices that minimize environmental impact. option compared to traditional waste disposal methods. The upcoming incinerator project aims to enhance waste Develop and implement methods for the safe handling, management practices by providing a more efficient method treatment, and recycling of incinerator ash for handling waste Negative Impacts Mitigation measure 63 SN NAME ISSUES RAISED RECOMMENDATIONS The introduction of the project to the area may potentially lead Provision of condoms and awareness campaigns to an increase in HIV/AIDS and STIs Noise pollution in the area: The use of heavy machinery on The Project should make sure that they use machines that the site will produce a lot of noise that can be harmful to the do not produce a lot of noise patients and workers Dust pollution in the area: Construction site will produce a lot The project will enforce dust suppression measures such of dust which can be very harmful to the people working on as spraying of water. the site, this might increase respiratory diseases like TB among the workers Annex 3-4: Evidence of consultations - Stakeholder Register 64 65 Annex 4: 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. 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. 66 • 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. 67 Annex 5: GRM and GBV Management Plan A5.1 General Grievance redress mechanism (GRM) is designed because the proposed incinerator installation projects at LIKOMA DISTRICT HOSPITAL site may affect the existing social balance at the institution and surrounding community. The purpose of a GRM is to establish a way for individuals, groups, or communities affected by the project activities to provide feedback, lodge complaints/grievances and have the grievances redressed. Complaints relating to proposed project's problems will be solved through negotiations to achieve consensus. A complaint will go through various stages before it can be transferred to the court. The enforcement unit will pay all administrative and legal fees relating to the acceptance of complaints. During consultations with stakeholders, it was reported that grievance redress mechanism committees (DGRC) should be established and there will be need for a worker (WGRC) and community grievance redress committee (CGRC) which can be accessed and used by workers and community ( LIKOMA DISTRICT HOSPITAL staff, the communities, community leaders)on the sub project. At higher level, a new Institutional grievance redress committee (IGRC) should be formulated, and its membership should comprise representation from community grievance redress committee and workers grievances redress committee and depending on the nature of the issue, an ex-official can be drawn from contractor, project workers and community members representation. This IGRC will be handling grievances that have been referred from CGRC and WGRC. The DGRC can be utilised as an institution to handle grievances referred from the IGRC. Representatives from project management and Institutional GRM will however participate in the DGRC to facilitate feedback processes. In case of failure to resolve a grievance at district level (DGRC), referral shall be made to the National Project Implementation Unit grievance redress committee (PIUGRC) as the highest committee for the project. Failure to resolve a grievance at PIUGRC level, then PAPs will be advised to seek further redress from the Courts. A5.2 Grievance Redress Procedure Following the GRM structure presented in Figure A5-1, the redress procedure will have 5 stages from when a grievance is first reported to when it is resolved. These stages are outlined below as follows. Stage 1: Complaint Uptake PAPs will present their complaints or grievances to the GRMC by filling a form provided as appendix 5. A drop-in box will be provided at the University and/or any other agreed location in the community to facilitate easy uptake of grievances. A WhatsApp message phone number, toll free number or email address will also be provided for grievances uptake. Stage 2: GRM Registry All grievances received will be entered into an accessible entering recording system as the GRM registry and shall be maintained at both community and district levels. Stage 3: Assessment, Analysis and Response 68 When a complaint is received by GRC, the GRM provides that a resolution be provided within 15 working days. Once complaints are received, the CGRC shall assess whether the complaint/grievance is related to the project or not. Stage 4: Resolution and Closure Where a resolution has been arrived at and the PAP accepts the resolution, the PAP shall be required to sign the resolution and closure section in the Grievance Community Log and Resolution Form as attached. Two members of the GRC (Chairperson and Secretary) shall also be required to counter sign. In the event that the grievance has not been resolved at GRC, it will be referred to District GRC and if the resolution is not reached at this level, the PAP has the option of seeking legal redress from civil courts. Stage 5: GRM Monitoring and Evaluation The GRM process will have to be monitored and evaluated to ensure effectiveness of the process and that the complaints submitted and related to the project have been dully received the required attention. This will be possible by reviewing the copies of registers that the grievances were recorded by the GRC and how they complaints registered were resolved. Lilongwe district council will be required to take the leading role in collaboration with C-ERHSP project management team. The monitoring will assist to track whether the GRM system is working efficiently and effectively and will inform the project to make any necessary adjustments. The evaluation will help to assess the impact of GRM in response to people’s complaints and whether the GRM principles were met or not during the project implementation. The visual representation of the grievance redress procedure is shown in Figure A5-1. WGRC or CGRC record confirmation with complainant that the Stage 5 grievance is closed. If grievance cannot be close, return to stage 2 by GRM Monitoring and Evaluation another higher Committee (IGRC, DGRC then PIUGRC) (Day 12-14) WGRC or CGRC identify action and provide response to the Stage 4 complainant in writing (Day 10) Resolution and Closure WGRC or CGRC (depending on type of grievance) meet and assess Stage 3 the significance of the grievance, gather evidence and might require Assessment, Analysis and Response site visit and discussions with the stakeholders involved (Day 5-8) WGRC and CGRC Representatives uptake and recording the grievances Stage 2 in either logbook for community grievances or workers grievances GRM Registry depending on type of complaint. (Day 1) PAP filling a form and drop-in box provided at the University and/or Stage 1 any other agreed location/ Calling toll free number, emailing or sending Complaint Uptake message by phone. (Day 1) Figure A5-1: GRM process for LIKOMA DISTRICT HOSPITAL site Incinerator installation project Full illustration of the GRM process is given in Figure A5-2 below. 69 Figure A5-2: Illustrating total Processes and Institutional arrangements for the GRM A5.3 Types of Grievances expected from the project. The project will receive any kind of grievances and complaints from both workers, hospital staff, students and communities. The types of grievances expected from the project are presented in the table A5-1. 70 Table A5-1: Expected community and work grievances Community issues Workers issues Environmental issues: noise, dust, and competition Contract workers unhappy of not having access to for water with contractor Personal Protective Equipment (PPE). Social issues: sexual harassment, child labour, Workers whose contracts are not renewed complaint security concerns, GBV etc. i.e. Recruitment and Contract Management issues Employment issues for local community (Only Workers without contracts (Working without contract recruiting migrant workers, recruitment based on with purposes of not fulfilling payment agreements corruption, dismissal from employment on and easy dismissal on unknown reasons etc.) unknown reasons etc.). Lack of clarification to overtime pay Compensations for injuries Sexual Harassment & GBV Community safety Worker dismissal without been given a chance to be heard. Unfair dismissal Criminal cases 1.1.1 A5.4 Grievance Redress Time Frame Table A5-2 presents the recommended time frames for addressing grievance or disputes. Table A5-2: Proposed GRM Time Frame Step Process Time frame 1 Receive and register grievance within 24 hours of receiving complaint 2 Acknowledge within 24 hours after registering grievance 3 Assess grievance Within 24 hours after acknowledgement 4 Assign responsibility Within 2 Days after assessing grievance 5 Development of response within 7 Days after receiving grievance 6 Implementation of response if agreement is reached within 7 Days after receiving grievance 7 Close grievance within 2 Days after agreement is reached 8 Initiate grievance review process if no agreement is reached within 7 Days from date when at the first instance agreement is not reached 9 Implement review recommendation and close grievance within 14 Days after receiving grievance 10 Grievance taken to court by complainant - 71 A5.5 Prevention of GBV 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. See Table A5-3. Table A5-3: Specific prevention measures Activities Action party Responsibilities • Identify GBV service providers in the area. LIKOMA • Identify vulnerable groups within the community. DISTRICT Stakeholder engagement • Inform community members about the details of the Project and the GBV risks HOSPITAL Site (NDH); DSWO associated with the project. • GBV training including what to do in case of grievance. GBV training for GRC, • Training and sensitisation of all workers associated with the Project on GBV and NDH; how the project can contribute to GBV risks. contractor and staff, consultants Contractor; and adjoining community • Training and sensitisation of adjoining communities on GBV risks, channels to DSWO members report GBV incidents and services available for GBV survivors. Codes of conduct signed and • Have the CoCs signed by all those with physical presence in the site. NDH; Contractor understood • Train construction workers on the behaviour obligation under the CoCs. • Grievance redress committees to ensure confidential complaint uptake mechanisms are in place. Handling GBV complaints GRM • The GBV cases should be immediately reported to the Police (Victim Support Unit), (including support of survivors) District Social Welfare Office, psychosocial support institutions working in the project area or district. 72 Activities Action party Responsibilities Provision of separate, safe and easily accessible facilities for • Ensure construction sites have separate facilities like toilets and/or bathrooms for NDH; Contractor women and men working on the men and women. site • Selection of monitoring indicators (such as: No. of reported cases of GBV; Resolved NDH; cases and time it took to address the complaints, No. of workers that have attained Monitoring and reporting Contractor; GBV training courses; No./percentage of workers that have signed CoC and No. of DSWO GBV cases that were referred to the GBV service provider). • Ensure new risks are uncovered and mitigated. 73 Annex 6: Mechanical Incinerator Technical Specifications and Manpower The Terms of Reference (ToRs) below stipulate the specification of the Incinerator requirements and the required manpower. MECHANICAL INCINERATOR TECHNICAL SPECIFICATIONS Equipment type: • Static burning chambers type • Load Capacity: 100 - 200 kg • Burn rate: 50 - 60kg/hr, class 1 or 2 • Fuel type: Diesel • Average Fuel Consumption: 10 - 15 (litres/hr) • Auto ignition • Automatic control and temperature Monitoring (computerized) • Manual ash/ leftovers removal • Fuel gas filtration system Primary Chamber: • Residence time shall not be less than two (2) seconds • Oxygen content of the emitted gasses shall not be less than 11%. Ensure both primary and the combustion temperatures are maintained until all waste has been completely combusted. • Flame contact with all the gases shall be achieved • The primary combustion chamber shall be accepted as the primary combustion zone and shall be equipped with a burner/s burning gas or low sulphur liquid fuel. • Primary air supply is to be controlled efficiently. Air supply in the primary chamber should be regulated between 30% - 80% of stoichiometric amount. Suitable flow measurement devices shall be provided the primary air ducting. • The minimum combustion temperature of the primary chamber shall not be less than 800 °C. • The combustion air shall be supplied through a separate forced draft fan after accounting for the air supplied through burners. Secondary Chamber: • Residence time shall not be less than two (2) seconds • Oxygen content of the emitted gasses shall not be less than 11%. Ensure both primary and the combustion temperatures are maintained until all waste has been completely combusted. • Flame contact with all the gases shall be achieved • Secondary air supply is to be controlled efficiently. Air supply in the secondary chamber should be regulated between 170% - 120% of stoichiometric amount. Suitable flow measurement devices shall be provided the secondary air ducting. • Combustion efficiency (C.E.) shall be at least 99.0% 74 • Suitably designed pollution control devices such as scrubbers, filters or electrostatic precipitators, shall be installed/retrofitted with the incinerator to achieve emission limits • The combustion air shall be supplied through a separate forced draft fan after accounting for the air supplied through burners. • Ensure the gas temperature as measured against the inside wall in the secondary chamber and not in the flame zone, is not less than 1200 °C. Chimney: • The maximum exit velocity of the emissions shall not be less 10 meters per second • The stack should be insulated to maintain maximum outlet temperature • Sampling platform and port for measurement of emissions shall be provided It shall be not less than 12 metres from the ground The chimney shall be made of these materials:- i. High temperature resistant steel ranging from 304L to316L stainless steel (highly preferred 316L(ASTM A240) ii. Refractory ceramic lining (e.g. alumina or silica-based AI203-90%) iii. Thickness 8-10mm iv. Flue gas velocity 20m/s v. Temperature resistant 3000 degree Celsius vi. Lifespan 20years vii. Second flue pipe from absorption chamber should be lined with heat resistant granite with stand 300 degrees Celsius temperature viii. Spark arrestor (chimney cap) ix. Anchor bolts on top of the chimney and middle of the chimney x. Gasket high temperature resistant (e.g. graphite) xi. Access ladder and platforms for easy maintenance xii. .pressure rating 500-1000pa (5-10 inH20) xiii. Chimney height to be 18 metres. Temperature: • The temperature shall be determined against the inside wall of the combustion chambers. • Care shall be taken not to measure the burner flame temperature. • An audible and visible alarm shall be installed to warn the operator when the secondary temperature drops to below the required temperature • The following instruments will also be required: o A carbon monoxide and/or oxygen meter/recorder o A smoke density meter/recorder o A gas flow meter/recorder 75 Insulation: Insulation to be used for masonry reinforced concrete, or non-combustible material shall prevent damage to the foundation from excessive heat and shall be of a thickness to limit the outer casting to maximum temperature of 66°C in an ambient temperature of 21°C when the incinerator is operating at full capacity. Refractory: • Refractory shall be super duty and heat-resistant to a minimum of 1100°C in the primary chamber and 1350°C in the secondary chamber. • Refractory shall also be abrasion resistant in the primary chamber, constructed of plastic or castable type refractory, designed to prevent bulging and destruction due to heat stress, capable of supporting more than twice the hourly burning rate and preventing leakage of fluids, and with a minimum thickness of 110 mm for walls and hearths. Additional Instruments: • Oxygen recorder shall be provided • Gas flow recorder shall be provided Additional Requirements: • Casing 5mm mild steel plate fully insulated • Minimum Temperatures 1300 oC • Maximum Temperatures 1500 oC • Control Panel • Dense/heavy duty Refractory concrete lining for maximum heat retention rated to 1500 – 1700 oC • Solid Hearth Support • Ashing Door, easy to use, sliding • Loading Door, wide enough for easy loading Assembling, Installation and commissioning of Incinerator at selected sites in Malawi and User training • The supplier must include installation of equipment, acceptance, commissioning of the whole system • The supplier must include in the bids the cost of all civil works including drainage system, plumbing works, electrical works and any other requirements needed for installation as the client will only accept the equipment ready for use without doing anything as regards to installation and any related works • The supplier will provide all equipment and measures necessary to ensure installation • The supplier should clearly indicate what needs to be done or to be availed for the sites to be ready for civil works and consequent installation as well as what the supplier will do to complete the installation. • The supplier should be ready to prepare identified sites for installation of equipment 76 • User level training on site for 3 personnel per each Machine in Malawi • The supplier should include the following in the incinerator building: o Office room of not less than 4X3 m, with two large ventilation windows o Toilet and bathroom, standard o Waste sorting area not less than 4 x5 m o Six waste receiving rooms well secured and labelled o Wash basin positioned close to toilet and bathroom o All main doors should have security bars o The building should be brick fenced Provision of Warranty and Maintenance Services • Two (2) years warranty from date of equipment acceptance by the client after successful installation. • Supplier shall provide number of scheduled service and maintenance visits in line with manufacturer’s prescription/recommendation for a period 2 years. • The Supplier shall include in the bid list of spare parts and consumables for the scheduled maintenance. • The supplier shall provide a separate costed list of corrective and preventive maintenance spare parts for a five (5) years’ service contract. The price for the service contract including spare parts should be submitted on a separate price schedule. • Submit relevant documents (like engineers’ CVs and registration) for a local service provider representing supplier if supplier is not operating within Malawi. • Supplier should provide evidence of local representative scheduled training and appointment agreement for the warranty and service contracts. Signed by Director of Health Technical Support Services – 15 Nov 2023 Slightly revised with additional technical specifications for chimney. This has been necessitated by the recent observations of multiple failures of chimneys of many Incinerators across the country-13 November 2024 (Head of PAM Division) 77 Annex 7: Resource Efficiency Measures (Use of Water) Purpose of Resource Efficiency measures (Use Water) These measures are project-specific and outline actions focusing on the use of water during Incinerator installations at Likoma District Hospital site. The purpose of these resource efficiency measures is to significantly contribute to sustainability and reduce environmental and social impacts due to use of water treated water for construction works of the project. The measures will have to be implemented based on the potential for the project to increase demand of water and thereby increasing pressure on the availability of the resources at Likoma District Hospital site. Scope of these Resource Efficiency measures (Use Water) These measures shall be applied during incinerators installation works at Likoma District Hospital site. These measures are applicable to works conducted by the contractor, including all works requiring supply of water for construction works. This is due to the potential of construction activities to increase demand of piped water which Likoma District Hospital site is supplied with, and the project’s construction activities may likely rely upon. The measures outline the considerations, actions, roles and responsibilities with respect to use of water during the works. Efficiency measures (Use of Water) During construction works, upon the contractor requiring water for use in various activities and all water works, the following measures shall be taken: 1. Exploring other sources of water for use in construction i) Likoma District Council Water Supply (NDCWS) water: Since the use of water supplied by NDCWS is confirmed for construction activities, the contractor therefore shall be responsible for striking an agreement with Likoma District Hospital site management on the amount of water likely to be used and the payment arrangements of the bill. This agreement shall be binding and certification of full payment of bill by Likoma District Hospital will be the determining factor for the contractor to receive their final payment from the project after completion of works. ii) Other sources of water for Construction works: This can also be considered by the contractor are as follows: a) Extracting water from surface water sources from the nearby Lilongwe River which is located within 1 km distance. b) Consider utilizing rainwater harvesting systems to capture and store rainwater for construction works and toilet flushing. c) Implement water-saving technologies such as low-flow faucets, toilets, and showerheads. d) Encourage water conservation practices among workers through awareness campaigns and training programs. 78 Annex 8: Suggested Forms for ESMP Reporting, Training and Follow-up This annex contains three templates to be used in conjunction with monitoring and reporting andfollow for ESMP implementation. A8.1 ESMP Reporting Form Subproject Application Field appraisal Application ESMP Written Chance find title received (date) undertaken approved developed warnings of procedures (yes or no) violation of invoked (date if (date if ESMP issued undertaken) approved) (yes or no) (yes/no) A8.2 ESMP Training Form Personnel No. of people trained Training received Relevant staffs from different institutions, including from MoH Safeguard specialists/officers C-ERHSP Project District focal points Hospital staff Community members etc. A8.3 Follow up on previous recommendations Recommendation Date of recommendation Action taken Recommendation implemented (yes/no) 79 Annex 9: Incidents Reporting Form for Bank and Borrower Use A9.1: Incidence Response Form Part B: To be completed by Borrower within 24 hours B1: Incident Details Date of Incident: Time: Date Reported to PIU: Date Reported to WB: Reported to PIU by: Reported to WB by: Notification Type: Email/phone call/media notice/other Full Name of Main Contractor: Full Name of Subcontractor: B2: Type of incident (please check all that apply)1 Fatality � Lost Time Injury � Displacement Without Due Process � Child Labor � Acts of Violence/Protest � Disease Outbreaks � Forced Labor � Unexpected Impacts on heritage resources � Unexpected impacts on biodiversity resources � Environmental pollution incident � Dam failure � Other � 1See Annex 1 for definitions B3: Description/Narrative of Incident Please replace text in italics with brief description, noting for example: I. What is the incident? II. What were the conditions or circumstances under which the incident occurred (if known)? III. Are the basic facts of the incident clear and uncontested, or are there conflicting versions? What are those versions? IV. Is the incident still ongoing or is it contained? V. Have any relevant authorities been informed? B4: Actions taken to contain the incident Short Description of Action Responsible Party Expected Date Status For incidents involving a contractor: Have the work been suspended (for example, under GCC8.9 of Works Contract)? Yes �; No �; Trading name of Contractor (if different from B1): Please attach a copy of the instructions suspending the works. B5: What support has been provided to affected people 80 A 9.2: Incident Types The following are incident types to be reported using the environmental and social incident response process: Fatality: Death of a person(s) that occurs within one year of an accident/incident, including from occupational disease/illness (e.g., from exposure to chemicals/toxins). Lost Time Injury: Injury or occupational disease/illness (e.g., from exposure to chemicals/toxins) that results in a worker requiring 3 or more days off work, or an injury or release of substance (e.g., chemicals/toxins) that results in a member of the community needing medical treatment. Acts of Violence/Protest: Any intentional use of physical force, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, deprivation to workers or project beneficiaries, or negatively affects the safe operation of a project worksite. Disease Outbreaks: The occurrence of a disease in excess of normal expectancy of number of cases. Disease may be communicable or may be the result of unknown etiology. Displacement Without Due Process: The permanent or temporary displacement against the will of individuals, families, and/or communities from the homes and/or land which they occupy without the provision of, and access to, appropriate forms of legal and other protection and/or in a manner that does not comply with an approved resettlement action plan. Child Labor: An incident of child labor occurs: (i) when a child under the age of 14 (or a higher age for employment specified by national law) is employed or engaged in connection with a project, and/or (ii) when a child over the minimum age specified in (i) and under the age of 18 is employed or engaged in connection with a project in a manner that is likely to be hazardous or interfere withthe child’s education or be harmful to the child’s health or physical, mental, spiritual, moral or social development. Forced Labor: An incident of forced labour occurs when any work or service not voluntarily performed is exacted from an individual under threat of force or penalty in connection with a project, including any kind of involuntary or compulsory labour, such as indentured labour, bonded labour, or similar labour-contracting arrangements. This also includes incidents when trafficked persons are employed in connection with a project. 81 Unexpected Impacts on heritage resources: An impact that occurs to a legally protected and/or internationally recognized area of cultural heritage or archaeological value, including world heritage sites or nationally protected areas not foreseen or predicted as part of project design or the environmental or social assessment. Unexpected impacts on biodiversity resources: An impact that occurs to a legally protected and/orinternationally recognized area of high biodiversity value, to a Critical Habitat, or to a Critically Endangered or Endangered species (as listed in IUCN Red List of threatened species or equivalent national approaches) that was not foreseen or predicted as part of the project design or the environmental and social assessment. This includes poaching or trafficking of Critically Endangered or Endangered species. Environmental pollution incident: Exceedances of emission standards to land, water, or air (e.g., from chemicals/toxins) that have persisted for more than 24 hrs. or have resulted in harm to the environment. Dam failure: A sudden, rapid, and uncontrolled release of impounded water or material through overtopping or breakthrough of dam structures. Other: Any other incident or accident that may have a significant adverse effect on the environment, the affected communities, the public, or the workers, irrespective of whether harm occurred on that occasion. Any repeated non-compliance or recurrent minor incidents which suggest systematic failures that the task team deems needing the attention of Bank management. 82 83