MALAWI MALAWI GOVERNMENT MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT P173806 ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN FOR CONSTRUCTION OF A NEW INFECTIOUS DISEASE UNIT AT QUEEN ELIZABETH CENTRAL HOSPITAL IN BLANTYRE CITY, MALAWI. NOVEMBER 2024 Executive Summary This is an Environmental and Social Management Plan (ESMP) for the construction of an Infectious Disease Hospital at Queen Elizabeth Central Hospital (QECH). QECH is a functional health facility that is situated in Blantyre. The hospital is in the city centre, near the junction of Chipembere Highway and the Mahatma Gandhi Road. The hospital is in a busy urban area, surrounded by commercial establishments at Ginnery Corner in the North and educational institutions in the other directions. Under the auspices of the Malawi Ministry of Health, the Malawi Covid-19 Emergency Response and Health System Preparedness Project (MCERHSPP) seeks to fortify the national framework to detect, prevent, and respond to the ongoing COVID-19 pandemic and future health threats. The project’s development objective is to prevent, detect and respond to the threat posed by COVID-19 in Malawi and strengthen national systems for public health preparedness. The proposed Infectious Disease Unit is meticulously designed to support various medical needs with comprehensive and detailed plans. The unit spans approximately 2,500 m2 and features three floors, each with specific functions and measurements to ensure optimal healthcare delivery. The ground floor includes isolation rooms. The first floor is dedicated to diagnostic and maternity services, this floor houses ultrasound, CT scan, and X-ray rooms, along with a receiving area and walkways. It includes waiting areas, public restrooms, washing machines, dryers, and ironing areas. The first floor houses the High Dependence Unit (HDU) and Intensive Care Unit (ICU), with VIP wards, nurse stations, and treatment rooms. The second floor of the isolation block is designated for children's wards, including a kids' lounge, classrooms, and treatment rooms. The second floor includes essential facilities such as a physiotherapy room, recreation area, public restrooms, and staff entry and exit points. The project costs are estimated to be USD 3,100,000.00 and is expected to be completed in 12 months. The construction works will require between 120 to 200 people. The ESMP preparation involved desk studies, site inspections, stakeholder consultations, and documentation. Desk studies reviewed the Environmental and Social Framework, World Bank Environment, Health and Safety Guideline, as well as project documents that included the Environment and Social Management Framework, Infection Control and Waste Management Plan, Stakeholder Engagement Plan (SEP), Labour Management Plan (LMP) and the Environmental and Social Commitment Plan (ESCP) and various national legislations. A site visit from 24 to 26 June 2024 assessed environmental, social, health, economic, and legal factors, focusing on identifying potential impacts and ensuring compliance with national and international standards. Stakeholder consultations included interviews with hospital department heads and randomly selected patients from 27 and 28 June 2024 to gather stakeholder insights. QECH serves as a major referral hospital, receiving a wide range of cases from across the Southern Region of Malawi. Many of these users are patients referred from various district hospitals, creating a highly diverse and transient patient population. Conducting comprehensive consultations with this broad and shifting group of patients, or extending consultations to communities from different hospitals, was therefore not feasible at this stage. A Stakeholder Engagement and Disclosure Plan (SEDP) specifically tailored for this project has been developed to ensure that affected and interested stakeholders are well-informed and have access to feedback mechanisms throughout the project lifecycle. i This ESMP should be read together with other plans prepared for the project, including the Environment and Social Management Framework, Infection Control and Waste Management Plan, Stakeholder Engagement Plan (SEP), Labour Management Plan (LMP) and the Environmental and Social Commitment Plan (ESCP). This ESMP has outlined the project's potential impacts and has an ESMP implementation cost of MK84,000,000. The key impacts identified are presented as follows: Positive Impacts: • Improved Healthcare Capacity and Quality: The unit will enhance healthcare capacity, offering comprehensive care and advanced diagnostics, hence improving patient outcomes. • Public Health Benefits: Control disease spread, enhance emergency response, and improve public health. • Creation of Job Opportunities: Create local jobs, and attract top healthcare professionals. Negative Impacts during Construction: i. Health and Safety Risks to the Hospital Community: Hospital staff, patients, and guardians could be at risk from falling debris or other accidental incidents related to construction works and machinery. ii. Traffic Congestion and Accidents: Increased construction activity will lead to additional vehicular traffic around the hospital, raising the risk of road accidents. iii. Temporary Air Quality Deterioration: Though unlikely to exceed ambient air quality standards, dust and particulate matter emissions are anticipated during construction. iv. Elevated Noise Levels and Vibration from Machinery and Construction Activities: Construction machinery and equipment generate noise that may disturb the hospital community. v. Potential for Accidents and Injuries On-site: Workers will be exposed to various occupational risks during construction, including the use of large machinery, working at height, and handling hazardous materials. vi. 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, patients and guardians. vii. Generation of Solid Wastes, E-Waste, Spills, and Effluent: Various construction activities will generate waste and spills that can impact the environment. viii. Increased incidences of child labour due to the presence of street kids: High numbers of street children surrounds the Hospital. These street kids may be at risk of being used as child labourers during the construction works. ix. Increase in Energy Consumption: Energy consumption will rise due to material transport, machinery use, and temporary power, contributing to emissions. x. Increase in Water Consumption: Water usage will surge for concrete mixing, dust suppression, equipment cleaning, and worker needs, potentially straining water supply to the hospital. ii xi. Discriminatory Working Conditions: Risks of discriminatory hiring, unequal pay, and harassment exist. Negative Impacts during Operation Phase: i. Increased Generation of Hazardous Waste: The unit will produce significant hazardous waste, including infectious materials and pharmaceuticals. ii. Emissions to Air: Air emissions from medical waste storage, and certain procedures can release pathogens and toxic gases, potentially spreading diseases and harming the public. iii. Wastewater Discharges: Wastewater from the unit, containing biological agents and chemicals, can contaminate water sources, and spreading diseases. iv. Expose Health Workers to Infections: Healthcare workers face risks from infectious diseases, hazardous chemicals, and injuries from medical instruments. iii Table of Contents Executive Summary ....................................................................................................................... i List of Tables ................................................................................................................................ vi List of Figures ............................................................................................................................... vi List of Acronyms ......................................................................................................................... vii Chapter One: Introduction .......................................................................................................... 1 Chapter Two: Project Description .............................................................................................. 2 2.1 Project Description ............................................................................................................................. 2 2.2 Project Location.................................................................................................................................. 2 2.3 Nature of the Project ........................................................................................................................... 3 2.4 Project Cost, and Duration and Estimated Number of Employees.............................................. 5 2.5 Main Activities of the Project .......................................................................................................... 6 2.6 Construction Process Inputs and Outputs ........................................................................................... 7 2.6.1 Construction Material ................................................................................................................. 7 2.6.2 Construction Waste Generation and Management ..................................................................... 9 Chapter Three: Legal Framework ............................................................................................ 10 3.1 Relevant Malawi Policies and Legislation ....................................................................................... 10 3.2 World Bank Environmental and Social Framework ......................................................................... 13 3.3 Relevant World Bank Environmental, Health, and Safety (EHS) Guidelines .................................. 15 3.4 Good International Industry Practices (GIIPs) ................................................................................. 16 3.5 Regulatory Licenses and Approvals ................................................................................................. 16 Chapter Four: Environmental and Social Setting ................................................................... 18 4.1 Area of Influence .............................................................................................................................. 18 4.2 Physical Environment ....................................................................................................................... 20 4.2.1 Topography of the Project Area ................................................................................................ 20 4.2.2 Geology ..................................................................................................................................... 20 4.2.3 Soils ........................................................................................................................................... 20 4.2.4 Weather and Climate Conditions .............................................................................................. 20 4.2.5 Water resources......................................................................................................................... 22 4.2.6 Flora and fauna......................................................................................................................... 22 4.3 Facility Management and Health Safety Protocols........................................................................... 22 4.3.1 Water Supply ............................................................................................................................. 22 4.3.2 Sanitation Facilities .................................................................................................................. 22 4.3.3 Hygiene Practices ..................................................................................................................... 22 4.3.5 Health Facility Capacity ........................................................................................................... 23 4.3.6 Cases Managed at the Facility .................................................................................................. 23 4.3.7 Communication and Transport Systems .................................................................................... 24 4.3.8 Security ...................................................................................................................................... 24 Chapter Five: Assessment of Environmental and Social Impacts.......................................... 25 iv 5.1 Impact identification ...................................................................................................................... 25 5.2 Description of Identified Impacts .................................................................................................. 25 5.2.1 Anticipated Positive Impacts .................................................................................................... 26 5.2.2 Anticipated Negative Impacts during Construction Phase ....................................................... 26 5.2.3 Anticipated Negative Impacts during Operation Phase ............................................................ 29 5.3 Significance Ranking of the Impacts............................................................................................. 30 5.4 Environmental and Social Management and Monitoring Plan ......................................................... 31 5.5 Contractor's Role in Developing the Construction Environmental and Social Management Plan ... 56 5.6 Implementation of ESMP ................................................................................................................. 57 5.7 Training and Capacity Building........................................................................................................ 58 5.8 ESMP Estimated Budget .................................................................................................................. 60 5.9 Stakeholder Engagement, Grievance Redress Mechanism, Disclosure, and Consultations ............. 60 5.9.1 Stakeholder Engagement and Consultations ............................................................................. 60 5.9.2 Grievance Redress Mechanism ................................................................................................. 61 Annex 1: Location Maps ............................................................................................................ 64 A1.1 Topography Map of the Project Site .............................................................................................. 64 A1.2 Location Map of Project Site in Relation to other Hospital Facilities ........................................... 64 A1.3 Proposed site with other existing facilities. ................................................................................... 65 Annex 2: Proposed layout plans ................................................................................................ 67 A1.1 Ground Floor Plan - Isolation ........................................................................................................ 67 A1.2 First Floor Plan - VIP Wards HDU & ICU ................................................................................... 68 A1.3 Second Floor Plan - Children Wards ............................................................................................. 69 A1.4 Middle Block - Ground Floor Plan (Diagnostics).......................................................................... 70 A1.5 Middle Block - First Floor Plan (Maternity) ................................................................................. 71 A1.6 Middle Block - Second Floor Plan (Recreation)............................................................................ 72 A1.7 Ground Floor - Male Ward ............................................................................................................ 73 A1.8 First Floor - Maternity Ward ......................................................................................................... 74 A1.9 Second Floor - General Female Ward ........................................................................................... 75 Annex 3: Project Impacts and their Ratings ............................................................................ 76 Annex 4: Stakeholder Consultations ......................................................................................... 80 A4.1 Stakeholder Consultation Checklist for the ESMP ........................................................................ 80 A4.2 Stakeholder Consultations ............................................................................................................. 80 A4.3 Stakeholders Comments ................................................................................................................ 80 Annex 5: Code of Conduct for Contractor ............................................................................... 87 Annex 6: Guide for Developing an Infection Control Plan ..................................................... 90 Annex 7: Life and Fire Safety Plan ........................................................................................... 93 v Annex 8: Traffic Management Plan .......................................................................................... 95 Annex 9: Stakeholder Engagement and Disclosure Plan for ESMP ...................................... 97 A9.1 Targeted Stakeholders ................................................................................................................... 97 A9.2 Disclosure Methods ....................................................................................................................... 97 A9.3 Feedback and Grievance Mechanisms ........................................................................................... 98 A9.4 Roles and Responsibilities ............................................................................................................. 98 A9.5 Monitoring and Reporting ............................................................................................................. 98 A9.6 Timeline for Disclosure and Engagement Activities ..................................................................... 99 A9.7 Record of Disclosure Efforts ......................................................................................................... 99 Annex 10: Grievance Redress Mechanism Registers ............................................................ 100 A10.1 Grievance Reporting Form ........................................................................................................ 100 A10.2 Grievance Registration .............................................................................................................. 101 A10. 3: Grievance Resolution Agreement Minute (GRAM) ................................................................ 102 A10.4: Grievance Resolution Implementation Minute (GRIM) ........................................................... 103 List of Tables Table 2-1: Estimated construction workforce ................................................................................. 5 Table 2-2: Estimated construction material and its usage .............................................................. 7 Table 2-3: Estimated waste types and quantities ............................................................................ 9 Table 3-1: Applicable national legislative pieces ......................................................................... 10 Table 3-2: Relevance of WB Environmental and Social Standards to the project ....................... 13 Table 3-3: Regulatory licenses and approvals relevant for the project ......................................... 16 Table 4-1: QECH common disease statistics for six months ........................................................ 23 Table 5-1: Potential Interactions of the Project with VECs. ......................................................... 25 Table 5-2: Significance Ranking Criteria ..................................................................................... 31 Table 5-3: Environmental and Social Management and Monitoring Plan ................................... 33 Table 5-4: ESMP Implementation Arrangement .......................................................................... 57 Table 5-5: Proposed Training and Capacity Building Approach.................................................. 58 Table 5-6: Summary ESMP Implementation Budget ................................................................... 60 Table 5-7: Key stakeholder comments and Responses Provided ................................................. 60 List of Figures Figure 4-1: Land use map for the Area of Impact. ....................................................................... 19 vi List of Acronyms AIDS Acquired immunodeficiency syndrome. CoF Certificate of fitness CoC Code of conduct COVID-19 Coronavirus Disease 2019 DCPC District Civil Protection Committees DESC District Environment Sub-Committee SC District Social Welfare Office EMA Environmental Management Act. ESF Environmental and Social Framework. ESMF Environmental and Social Management Framework. ESMP Environmental and Social Management Plan FGD Focus group discussion GBV Gender-based violence GRM Grievance redress committee GVH Group village headman HIV Human immunodeficiency virus IEC Information, Education, And Communication IFC International Finance Corporation KII Key informant interviews MCERHSPP Malawi Covid-19 Emergency Response and Health System Preparedness Project MEPA Malawi Environment Protection Authority MoH Ministry of Health OSC One-stop centres OSH Occupational safety and health PAP Project affected persons PDO Project development objective PEA Primary education administrator PPE Personal protective equipment SEA Sexual exploitation and abuse SGBV Sexual and gender-based violence SH Sexual harassment SRGBV Sexual Reproduction Gender Based Violence STI Sexually transmitted infection TA Traditional authority QECH Queen Elizabeth Central Hospital vii Chapter One: Introduction This Environmental and Social Management Plan (ESMP) is developed to support the environmental and social due diligence provisions for activities financed by the World Bank in the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project. The project will support the construction of an Infectious Disease Hospital at Blantyre. The Ministry of Health will be implementing the Project activities. This ESMP follows the World Bank Health and Safety Guidelines (EHS), Good International Industry Practice (GIIP), as well as the Environment Management Act (2017) and its associated regulations of Malawi. The objective of the ESMP is to assess and mitigate potential negative environmental and social risks and impacts of the Project consistent with the Environmental and Social Standards (ESSs) of the World Bank ESF and national requirements. More specifically, the ESMP aims to (a) assess the potential environmental and social risks and impacts of the proposed Project and propose mitigation measures; (b) specify appropriate roles and responsibilities, and outline the necessary reporting procedures, for managing and monitoring environmental and social issues related to the activities; (c) identify the staffing requirements, as well as the training and capacity building needed to successfully implement the provisions of the ESMP; (d) address mechanisms for public consultation and disclosure of project documents as well as redress of possible grievances; (e) establish the budget requirements for implementation of the ESMP; and (g) formulate the mitigation actions and presents them in an Environmental and Social Management Plan (ESMP). The construction of the infectious disease unit at Queen Elizabeth Central Hospital (QECH) represents a pivotal enhancement to Malawi's national healthcare infrastructure, aimed at bolstering the country's capacity to manage infectious diseases effectively. By aligning with The Malawi Vision 2063 and Health Sector Strategic Plan III (HSSP III), the project underscores Malawi's commitment to equitable healthcare access and quality improvement. The ESMP preparation involved desk studies, site inspections, stakeholder consultations, and documentation. Desk studies reviewed project documents and various national legislations. A site visit from 24 to 26 June 2024 assessed environmental, social, health, economic, and legal factors, focusing on identifying potential impacts and ensuring compliance with national and international standards. Stakeholder consultations included interviews with hospital department heads and randomly selected patients from 27 and 28 June 2024 to gather stakeholder insights. QECH serves as a major referral hospital, receiving a wide range of cases from across the Southern Region of Malawi. Many of these users are patients referred from various district hospitals, creating a highly diverse and transient patient population. Conducting comprehensive consultations with this broad and shifting group of patients, or extending consultations to communities from different hospitals, was therefore not feasible at this stage. This ESMP should be read together with other plans prepared for the project, including the Environment and Social Management Framework, Infection Control and Waste Management Plan, Stakeholder Engagement Plan (SEP), Labour Management Plan (LMP) and the Environmental and Social Commitment Plan (ESCP). 1 Chapter Two: Project Description 2.1 Project Description The Government of the Republic of Malawi through Ministry of Health has received financing from the International Development Association (IDA) towards the cost of The Malawi COVID- 19 Emergency Response and Health Systems Preparedness Project (MCERHSPP). The purpose of the COVID-19 Emergency Response and Health Systems Preparedness Project in Malawi is to prevent, detect and respond to the threat posed by COVID-19 (Coronavirus) and strengthen national systems for public health preparedness. The project consists of three components which are: • Component 1: Emergency COVID-19 Response—This component provides immediate support to Malawi to prevent COVID-19 from arriving or limit local transmission through surveillance and containment strategies. • Component 2: Supporting National and Subnational Prevention and Preparedness—This component supports strengthening the public health system's capacity to prepare for and respond to the COVID-19 pandemic, future pandemics, and other threats to health security. • Component 3: Implementation Management and Monitoring and Evaluation - Project Management, Monitoring and Evaluation (M&E) by the project implementation unit (PIU). Recognising the urgent need for robust health infrastructure, the project focuses on nationwide comprehensive rehabilitation of various district health facilities. The QECH benefits from the MCERHSPP initiative, which includes the construction of a new infectious disease unit. 2.2 Project Location QECH is a functional health facility that is situated in Blantyre (see map in Annex 1 – A1.1). The hospital is in the city centre, near the junction of Chipembere Highway and the Mahatma Gandhi Road (see map in Annex 1 – A1.2). It is adjacent to the Kamuzu University of Health Sciences on the west. The hospital is in a busy urban area, surrounded by commercial establishments and educational institutions. Various important landmarks surround the hospital. The Malawi College of Accountancy and the Malawi University of Business and Administrative Studies Campus are to the east. The proposed infectious disease unit site is within the hospital boundary. The access roads and secondary roads ensure good connectivity to the hospital. The proposed site for the new development is within the hospital grounds, surrounded by neighbouring structures. To the south of the proposed site, there is an under-five clinic 30 meters from the edge of the site. The maternity wing is located to the southeast, just 25 meters away from the site. To the southwest of the site, there is a roundabout that is just 15 meters away. The hospital is well-integrated into the city’s infrastructure, with reliable access to water supply, electricity, and sewage systems. The water supply is sourced from the Blantyre Water Board, which services the hospital with potable water. Electricity is provided by the Electricity Supply Corporation of Malawi (ESCOM), ensuring a stable power supply. The sewage system is connected to the city’s central sewer network, supporting efficient waste disposal and sanitation services. he hospital benefits from its proximity to major roads like Chipembere Highway, which connects the hospital to the broader Blantyre area and surrounding districts. Public transportation links, including minibuses and taxis, are readily available along these main roads, providing efficient transport options for staff, patients, and visitors. The area is also supported by a network 2 of secondary roads that ensure smooth access to the hospital grounds. The site is located within an urban zone designated for health services under Blantyre City Council’s zoning regulations, which permit healthcare-related infrastructure development. The land is exclusively reserved for medical use, and the surrounding areas comply with commercial and institutional zoning regulations, allowing for the coexistence of medical, educational, and commercial establishments. The site is not located within a designated flood zone, as determined by Blantyre City Council’s flood risk maps. However, during the rainy season, there may be minor risks of water pooling or localised flooding, which adequate drainage systems should mitigate during construction. While Malawi is generally considered a low seismic activity region, the hospital is in the southern part of the country, which has historically experienced mild tremors. Construction of the new unit will follow Malawi’s building codes, incorporating seismic-resistant designs as a precautionary measure. The site is not in an area prone to major natural hazards such as landslides or hurricanes. 2.3 Nature of the Project The proposed Infectious Disease Unit is meticulously designed to support various medical needs with comprehensive and detailed plans. The unit spans approximately 2,500 m2 and features three floors, each with specific functions and measurements to ensure optimal healthcare delivery. The architectural designs for the unit are provided in Annex 2 and they show that the facility will include the following: Ground Floor • Isolation Block: o Contains multiple isolation rooms equipped with attached bathrooms for patient care. o Includes staff facilities such as toilets, donning and doffing rooms, and nurse stations to safely manage isolation procedures. o Provides cleaner’s store, drug store, and linen storage for proper maintenance and supply management. o Features a central corridor connecting different sections of the isolation area and security posts to ensure controlled access. • General Wards: o Includes several 4-bed wards and 1-bed rooms, each with its own bathroom to accommodate patients. o Equipped with nursing stations, linen stores, staff toilets, treatment rooms, and sluice rooms for operational support. o Incorporates cleaner’s stores, record shelving areas, and security rooms, facilitating efficient management and safety within the ward. First Floor • VIP Wards, High Dependence Unit (HDU) & Intensive Care Unit (ICU) Block: o Features specialised VIP wards for patients requiring high-level care. o Houses the High Dependence Unit (HDU) and multiple ICU beds for critical care, ensuring patient needs are met at all levels. 3 o It contains nurse stations for monitoring patients and support rooms such as drug stores, linen storage, and cleaners’ stores. o Provides staff facilities, including staff toilets, on-duty doctors’ rooms, and general stores. o Includes security posts to maintain a secure environment for both patients and staff. • General Wards Block: o Designed with multiple 4-bed wards and 1-bed rooms, each equipped with attached bathrooms for patient care. o Includes nursing stations, linen stores, and staff toilets for supporting healthcare delivery. o Equipped with treatment rooms, sluice rooms, cleaner’s stores, and security rooms to facilitate patient care and maintain cleanliness. Second Floor Diagnostic and Maternity and Recreation Block o Houses diagnostic facilities such as ultrasound, CT scan, and X-ray rooms to support medical imaging needs. o Includes doctor’s offices, waiting areas, public toilets, and various rooms for sterilization, sorting, and laundry functions. o Equipped with washing machines, dryers, and ironing areas to support hospital operations. o Provides receiving areas, viewing and processing rooms, and central supply areas for sterile equipment management. • Children's Ward Block: o Designed with children’s wards, a kids’ lounge, bathrooms, and treatment rooms for pediatric care. o Includes nurse stations, drug stores, linen stores, and staff toilets. o Equipped with a ward classroom for educational purposes and security posts to ensure a safe environment for children. Additional Facilities Integrated within the IDU: The following essential facilities are integrated throughout the IDU to support patient care, disease prevention, and operational efficiency: i. Disease Prevention: Hand washing facilities at ward entries and the main entrance, and an isolation bay with at least 10 beds, separate toilets, and bathrooms. ii. Diagnostics: A laboratory for processing highly infectious samples and a radiology room for ultrasound and x-rays. iii. Treatment Facilities: 150-bed capacity covering various patient populations, including pregnant women (30 beds), adult women (20 beds), children (20 beds), adult males (25 beds), ICU (5 beds), HDU (30 beds), and isolation bay (15 beds), with separate areas for diarrheal diseases. iv. Operating Theatre: Four operating rooms, a nurse’s station, a changing room with a small office, a recovery room, and a storage room, situated close to the ICU and HDU. 4 v. Support Services: Staff toilets and bathrooms, waste disposal space, laundry facilities, an instrument sterilizing unit, physiotherapy space, and recreation/academic facilities including a conference room and six offices. Architectural Style and Sustainability: The Infectious Diseases Unit's architectural style balances modern healthcare functionality with sustainable design elements. To reduce energy consumption, the building will use energy-efficient materials, such as insulated glass and solar panels. The design incorporates natural ventilation systems and LED lighting to improve energy efficiency in compliance with Green Building Standards. The exterior will feature locally sourced, sustainable materials such as cement blocks and low-VOC paints, reducing the construction's carbon footprint. The roof will be fitted with rainwater harvesting systems to supply non-potable water for irrigation and cleaning purposes, reducing the hospital’s water supply strain. 2.4 Project Cost, and Duration and Estimated Number of Employees The project costs are estimated to be USD 3,100,000 and is expected to be completed in 12 months. The construction works will require between 120 to 200 people with the roles depicted in Table 2-1. The project will not involve the establishment of a workers' camp, and workers will not be housed on-site during the construction phase. Workers for the project will be recruited from within Blantyre city, which has a large pool of skilled and unskilled labourers. This will significantly reduce the need for accommodation facilities, as workers can commute daily to the construction site. Table 2-1: Estimated construction workforce Role Number Responsibility of People Management 5-8 Oversees the entire project, manages day-to-day operations, ensures and Supervision timelines, budgets, and safety protocols are met. Includes Project Manager, Construction Supervisors, and Site Engineers. Engineering and 20-30 Ensures structural integrity, installs systems (electrical, plumbing, Technical HVAC), and oversees civil works. Includes Architects, Civil Engineers, Electricians, Plumbers, and HVAC Technicians. Skilled Trades 50-70 Constructs frameworks, handles brickwork, stonework, concrete tasks, and installs flooring, roofing, and steel structures. Includes Carpenters, Masons, Roofers, Flooring Installers, Steel Workers, Plasterers, Tile Setters, Insulation Workers, and Welders. General Labor 20-30 Provides general labor support including site preparation, material handling, and cleanup. Safety and 4-6 Ensures safety regulations are followed, conducts inspections, manages Logistics delivery, and storage of materials and equipment. Includes Safety Officers and Logistics Coordinators. Surveying and 7 - 10 Conducts site surveys, oversees final stages of construction, and ensures Finishing all details and finishes meet specifications. Includes Surveyors and Finishing Foremen. Specialized 8 - 12 Installs drywall panels, glass windows, doors, partitions, and operates Installers heavy machinery. Includes Drywall Installers, Glass Installers, and Heavy Equipment Operators. 5 Support Services 10 - 15 Handles waste management, maintains exterior landscaping, and assists in miscellaneous tasks. Includes Waste Management Staff and Landscape Workers. 2.5 Main Activities of the Project The selected site is located within the QECH campus, a decision guided by proximity to essential hospital services and existing infrastructure. The site benefits from easy access to the Chipembere Highway, ensuring smooth transport of materials and construction vehicles. Additionally, the site is adjacent to the Mahatma Gandhi Road, which provides direct links to public transportation routes, making it easily accessible for workers and staff. The project implementation cycle for the proposed Infectious Disease Unit will include mobilisation, construction, finishing, and demobilisation phases. Significant progress has already been made during the mobilisation phase, while several tasks remain to be completed to ensure smooth project implementation. Below is a detailed breakdown of the activities undertaken thus far as of the disclosure of the ESMP. i. Site Selection: The proposed site for the Infectious Disease Unit has been carefully selected within the boundaries of QECH, a strategic location within the hospital campus. The site is ideal due to its proximity to critical care departments, including the under-five clinic, maternity wing, and general wards. This ensures seamless integration with the hospital's existing services. The site’s location was evaluated based on accessibility, environmental suitability, and the ability to minimise disruption to hospital operations during construction. The site selection process also included consultations with hospital management and relevant authorities to ensure it aligns with Blantyre's land use and zoning regulations for medical infrastructure. ii. Preliminary Planning: Initial project planning has been completed, covering high-level timelines and defining the project's scope. The proposed unit’s initial architectural designs and layout plans have been developed (as shown in Annex 2). The overall project design has considered the hospital's current and future needs, emphasising expanding its capacity to handle infectious diseases effectively. iii. Permitting Process: Preliminary engagement with regulatory bodies, including Blantyre City Council and the Malawi Environmental Protection Authority (MEPA), has been initiated. This has involved preparing and submitting initial documents, such as this ESMP. Early consultations with these authorities have also confirmed that the site meets all regulatory requirements, and necessary permits for the construction phase are being acquired. As the phase continues after disclosure of the ESMP, the following activities are to be executed: i. Detailed Project Planning and Scheduling: While preliminary planning is complete, detailed project scheduling remains to be finalised. This involves developing a comprehensive project schedule that outlines specific milestones, timelines for each phase of construction, resource allocation, and contingency planning. Detailed Gantt charts and the Critical Path Method will be used to ensure that all tasks are coordinated and completed within the projected timeline. Project risk assessments will also be conducted to mitigate potential delays or disruptions during construction. 6 ii. Assignment of Roles and Responsibilities: The project team will assign detailed roles and responsibilities to all personnel involved in the project. This will include defining the tasks for contractors, engineers, architects, environmental consultants, and safety officers. A Project Implementation Unit has been set up. Still, a more detailed breakdown of tasks, reporting structures, and timelines for each team member must be established to ensure efficient coordination across all stakeholders. iii. Finalisation of Permits: While initial discussions with regulatory bodies have been positive, final permits for construction, waste disposal, electrical work, and water and sewage connections are still required. The project team will continue to engage with Blantyre City Council, MEPA, and other relevant authorities to ensure that all legal requirements are met before commencing on-site construction. This includes finalising environmental approvals, health and safety assessments, and acquiring necessary licenses to ensure compliance with World Bank guidelines and Malawi’s regulatory framework. iv. Procurement of Materials and Equipment: Although initial procurement has begun, a detailed procurement strategy will be developed to source all remaining materials and medical equipment. This will include securing contracts for advanced medical technology such as ventilators, cardiac monitors, CT scanners, and telemedicine infrastructure. The project will also ensure the procurement of sustainable construction materials in alignment with the energy efficiency and green building goals. v. Site Preparation: Before construction can begin, further site preparation work will be required. This includes clearing any debris, levelling the site, and ensuring that temporary infrastructure (such as fencing, portable facilities, and security measures) is in place. Erosion control and drainage systems will be established to minimise the environmental impact during construction. Site preparation will also include setting up proper access routes for construction vehicles while maintaining minimal disruption to hospital operations. The construction phase will involve foundation work, building the main structural framework, constructing walls, partitions, and roofing, and installing plumbing, electrical, and HVAC systems. The finishing phase will include painting and installing tiles, fixtures, furniture, and specialized equipment. During demobilisation, temporary facilities and construction debris will be removed, and a formal handover to the Ministry of Health will be performed. 2.6 Construction Process Inputs and Outputs 2.6.1 Construction Material Table 2-2 provides estimates based on standard practices and the assumed size and scope of the project. Considering local material availability and specific project requirements, the estimated materials and quantities are not final and can change, considering local material availability and specific project requirements. Table 2-2: Estimated construction material and its usage Material Estimated Qty Source of Raw Material Usage Concrete 500 m3 Local suppliers in Blantyre Foundation, structural framework, floors, and columns. Reinforcing Steel 50 tons Imported from South Reinforcement for concrete Africa or local steel structures, beams, and columns. suppliers 7 Material Estimated Qty Source of Raw Material Usage Bricks/Blocks 100,000 units Locally manufactured, Construction of walls, partitions, and sourced from Blantyre structural components. Cement 1,000 bags Sourced from Local Concrete, mortar for brickwork, companies or local plastering, and rendering. distributors Sand 600 m3 Local quarries in Blantyre Concrete mix, mortar, plastering, and rendering. Gravel/Aggregate 400 m3 Local quarries in Blantyre Concrete mix for foundation, floors, and structural components. Plasterboard/ 5,000 m2 Imported from South Internal walls and ceilings. Drywall Africa or local suppliers Insulation 1,000 m2 Imported from South Thermal and acoustic insulation for Material Africa or local suppliers walls, ceilings, and floors. Roofing Sheets 2,500 m2 Local suppliers in Malawi Roofing for the building. Tiles 3,000 m2 Imported from South Flooring in different areas such as Africa or China or local wards, corridors, bathrooms, and suppliers laboratories. Paint 2,000 liters Local suppliers in Blantyre Painting walls, ceilings, and external surfaces. Glass Panels 500 m2 Imported from South Windows, doors, and partitions. Africa or China or local suppliers Doors 150 units Locally manufactured in Internal and external doors for Malawi various rooms and entrances. Windows 200 units Locally manufactured or Installation in various rooms for imported from South natural light and ventilation. Africa Plumbing Pipes 1,000 m Local suppliers in Blantyre Water supply and drainage systems. Electrical Wiring 10,000 m Local suppliers in Blantyre Electrical installations including lighting, power outlets, and equipment connections. HVAC Ducting 2,000 m Imported from South Ventilation, heating, and cooling Africa or China or local systems. suppliers Sanitary Fixtures 200 units Imported from South Installation of sinks, toilets, faucets, Africa or China or local and other plumbing fixtures. suppliers Furniture and Various Locally sourced and Furnishing patient rooms, offices, Fixtures imported laboratories, and common areas with necessary furniture and fixtures. Water 500,000 litres Sourced from Blantyre Mixing concrete, plastering, Water Board brickwork, cleaning, and general construction activities. Energy 200,000 kWh ESCOM (Electricity Powering construction equipment, Supply Corporation of lighting, HVAC installation, and Malawi) other electrical needs during construction. 8 2.6.2 Construction Waste Generation and Management The project is expected to produce different types of waste. Table 2-3 shows the expected type of waste and proposed management measures. The non-hazardous waste will be disposed of at the Blantyre city dumpsite at Mzedi. This dumpsite is located 10 kilometres north-east of the hospital. Table 2-3: Estimated waste types and quantities Type of Waste Description Estimated Qty Concrete Waste Excess concrete and slurry from mixing 10 cubic meters Steel Waste Scrap reinforcing steel and metal offcuts 2 tons Brick/Block Waste Broken bricks and blocks from construction 5,000 units Cement Bags Empty cement bags 1,000 bags Sand and Gravel Waste Excess sand and gravel 5 cubic meters Plasterboard/Drywall Waste Offcuts and damaged boards 500 square meters Insulation Material Waste Offcuts and unused insulation materials 200 square meters Roofing Waste Scrap roofing sheets and offcuts 250 square meters Tile Waste Broken or unused tiles 300 square meters Paint Waste Excess paint and empty cans 100 liters, 200 cans Glass Waste Broken glass panels 50 square meters Wood Waste Timber offcuts and damaged wood 3 cubic meters Plastic Waste Packaging materials and plastic offcuts 500 kg Electrical Wiring Waste Scrap wiring and cables 500 meters Plumbing Waste Excess piping and fixtures 200 meters General Construction Debris Mixed waste including packaging, small materials 10 cubic meters 9 Chapter Three: Legal Framework This chapter reviews the legal framework relevant to the proposed project and outlines its potential impacts. 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, which 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: Applicable national legislative pieces Piece of Description Relevance to Project Activities Legislation National The policy provides strategies for environmental and Interference: Project activities may Environmental social planning, environmental and social impact cause environmental and social Policy (2004) assessment, environmental and social audits, and impacts. Compliance: The project environmental and social monitoring, among others. will integrate environmental and On ESIAs, the objective is to regularly review and social management into its planning administer the guidelines for ESIAs, audits, and implementation to mitigate monitoring, and evaluation so that adverse adverse impacts in line with this environmental and social impacts can be eliminated policy. or mitigated and environmental and social benefits enhanced. Environmental The Act is the main law for environmental protection Interference: The project might Management and sustainable resource use. Section 7 establishes proceed without an ESIA or deviate Act (2017) MEPA and its authority over environmental from approved environmental assessments. Section 31provides requirements for standards. Compliance: The project MEPA approval for projects needing an ESIA. will obtain MEPA approval for the Sections 99-104 prescribe penalties for ESIA non- ESMP, adhere to environmental compliance, hazardous substance mismanagement, standards, and avoid penalties by and pollution, including fines of up to fifty million ensuring all activities align with this Kwacha and imprisonment of up to fifteen years. Act. National The National Gender Policy provides guidelines to Interference: Project activities may Gender Policy reduce gender inequalities, promote participation, lead to gender inequalities or an (2015) and achieve equitable development. Section 1.3 increased risk of GBV. provides guidelines for mainstreaming gender, and Compliance: The project will section 3.6 promotes the economic development and identify gender-related risks and empowerment of women. Section 3.7 recognizes that implement mitigation measures, GBV, especially violence against women, girls, and including promoting equal vulnerable groups, severely impedes social well- participation and addressing GBV being and poverty reduction. issues in workers and communities. Gender The Act in Chapter 25:06 promotes gender equality Interference: There is a risk of Equality Act and equal integration, influences empowerment, sexual harassment and (2015) dignity, and opportunities for men and women in all discrimination within the project's functions of society, prohibits and provides redress workforce. Compliance: The for sex discrimination, harmful practices, and sexual project will address these risks by harassment, provides for public awareness on the instituting anti-harassment policies promotion of gender equality and connected matters. and training, as well as setting up a Section 6(1) of the Act states that a person who 10 Piece of Description Relevance to Project Activities Legislation commits an act of harassment if he or she engages in grievance redress mechanism to any form of unwanted verbal, non-verbal, or physical comply with the Act. conduct of a sexual nature in the circumstances would have anticipated that the other person would be offended, humiliated or intimidated, and (2) a person who sexually harasses another in terms of the preceding subsection is liable to a fine and imprisonment specified under subsection (2). National Section 1.3 of the National Water Policy explains Interference: Construction Water Policy that the policy provides an enabling framework for activities may lead to water (2005) integrated water resources management in Malawi. pollution or over-extraction of water Section 3.4.9 stresses that Pollution control of water resources. Compliance: The project resources shall adopt the ‘Polluter–Pays’ principle to will implement measures to prevent ensure water user's responsibility. Section 5 points pollution, promote water out that environmental degradation has negatively conservation, and adopt the affected surface and groundwater quality, among ‘Polluter–Pays’ principle to protect other factors. Section 5.2.2 - Ensuring and promoting water resources. The River prone to proper management and disposal of wastes. pollution from the construction activities of the IDU are a) Naperi River and b) Mudi River. National The National Sanitation Policy provides a vehicle to Interference: Project activities may Sanitation transform Malawi's hygiene and sanitation situation. generate waste, affecting sanitation Policy (2008) Section 3.1.1 promotes the improvement of hygiene, in the area. Compliance: The sanitation, and waste recycling in the country. project will ensure proper waste management, focusing on reduction, recycling, and safe disposal, in line with the policy's provisions. National HIV The policy aims to prevent HIV infections, reduce Interference: Project activities may and AIDS vulnerability, improve treatment and support for increase workers' vulnerability to Policy (2005) those living with HIV/AIDS, and mitigate its socio- HIV/AIDS. Compliance: The economic impact. Chapter 7 addresses HIV/AIDS in project will implement an the workplace, highlighting issues like absenteeism, HIV/AIDS workplace policy, low productivity, and discrimination. provide support programs, and ensure no discrimination, maintaining confidentiality in accordance with the policy. National The Policy promotes the rights of people with Interference: Infrastructure may be Equalization disabilities and integrates them to enable them to inaccessible, and there could be of play a full and participatory role in society. limited employment opportunities Opportunities Section 2, subsections 2.3 and 2.4.8 of the policy for persons with disabilities. for Persons state that people with disabilities are most affected Compliance: The project will with by poor infrastructure, such as buildings not design accessible infrastructure and Disabilities designed to accommodate or meet their special actively provide job opportunities Policy (2006) needs. Similarly, Subsection 2.45 of the policy states for people with disabilities, that people with disabilities have restricted complying with the policy's employment opportunities, mainly due to requirements. The building has discrimination, inadequate education, job elevators to carry 13 passenger at experience, and confidence. once to ease access to the building and this has been indicated in the BoQ. 11 Piece of Description Relevance to Project Activities Legislation Disability Act This act is a significant step towards ensuring equal Interference: Project facilities (2013) opportunities and rights for persons with disabilities. might not be accessible to persons Promoting policies and legislation that aim to with disabilities. Compliance: The equalise opportunities, protect rights, and fully project will ensure that buildings integrate persons with disabilities into all aspects of and infrastructure are accessible and life recognises their inherent dignity and well-being. promote equal employment Sections 9 and 13 of the acts are particularly opportunities for persons with commendable, as they prohibit discrimination in disabilities, as per the Act. accessing premises, provision of services, and employment opportunities based on disability. Public Health The Public Health Act of 1948 governs health- Interference: Construction Act (1948) related issues, including environmental and activities may create nuisances or occupational health and solid waste management. health hazards. Compliance: The Section 59 prohibits nuisances in workplaces, such project will provide adequate as unclean conditions, offensive odours, poor sanitary facilities, manage waste ventilation, and inadequate lighting, which endanger effectively, and maintain workplace employee health. It also addresses the need for cleanliness to comply with health sanitary latrines and proper wastewater discharge. and safety regulations. Section 88 mandates separate toilets for males and females in public buildings. Occupation The Act regulates employment conditions for safety, Interference: There may be risks of Safety, Health, health, and welfare in workplaces in Malawi. It workplace accidents and unsafe and Welfare mandates workplace registration, inspection of plant conditions. Compliance: The Act (1997) and machinery, and accident prevention. Part II project will implement safety requires workplaces to be registered with the director measures, use protective equipment, maintaining a register. Part III outlines employer and ensure all activities are in line duties, including providing safe work systems, risk- with ESMP safety requirements to free handling of substances, and adequate employee comply with the Act. training and supervision. Environment The regulations, under the Environment Interference: Project activities may Management Management Act, expand on the 1948 Public Health generate hazardous waste, posing a (Waste Act. Hazardous waste is identified by categories in health risk. Compliance: The Management the Seventh Schedule and characteristics in the project will store, handle, and and Eighth Schedule, such as corrosiveness and dispose of waste safely and in Sanitation) flammability. Section 8 mandates waste generators compliance with these regulations to Regulations to safely store general waste to prevent health protect public health and the (2008) hazards. environment. Public Health Public Health rules mandate both employers and Interference: Project activities may Corona Virus employees to implement general preventive increase the risk of COVID-19 Disease of measures, such as self-quarantine for at-risk transmission among workers. 2019 individuals, covering mouth and nose when Compliance: The project will (COVID-19) coughing or sneezing, avoiding touching the face, implement and enforce COVID-19 (Prevention, eating thoroughly cooked food, and avoiding preventive guidelines for all workers Containment handshakes and close contact. Employers must form and employers, as required by these and a team to implement these guidelines and rules. Management) disseminate them to all employees. Employees must Rules (2020) cooperate and report non-compliance. Child Care, The Act in Part II, division 6 emphasizes the Interference: The project may Protection and protection of children from undesirable practices. unintentionally involve child labor Justice The undesirable practices are outlined in sections 79 or create risks of child trafficking. and 80. Section 79 of the Act protects any child from Compliance: The project will 12 Piece of Description Relevance to Project Activities Legislation (Amendment) child trafficking. Section 80 protects a child from implement strategies to prevent Act (2010) harmful cultural practices. child labor and trafficking, ensuring adherence to the Act's provisions. Penal Code, Section 138 (1) of the Penal Code punishes the Interference: There is a risk of Chapter 7:01 defilement of girls under sixteen years of age sexual exploitation by project (punishable with life imprisonment). Sexual abuse workers. Compliance:The ESMP and exploitation of children is a common practice in will include strict measures to construction in sites. prevent and address sexual exploitation, ensuring compliance with the Penal Code. 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 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. 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 Assessment and monitoring environmental and social risks and impacts associated with each Management of stage of a project supported by the Bank through Investment Project Environmental Financing, to achieve environmental and social outcomes consistent with the and Social Environmental and Social Standards (ESSs). The objective of the standard is Risks and to identify, assess, evaluate, and manage environment and social risks and Impacts impacts in a manner consistent with the ESF. Adopt differentiated measures so that adverse impacts do not fall disproportionately on the disadvantaged or vulnerable, and they are not disadvantaged in sharing development benefits and opportunities The proposed work has identified 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 and Working generation in the pursuit of poverty reduction and inclusive economic growth. Conditions Borrowers can promote 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 13 Environmental Main requirements and conducted activities to meet them & Social Standards 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. 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 Recourse and raw materials. Avoid or minimise adverse impacts on human health and the Efficiency, environment caused by pollution from project activities. Avoid or minimise Pollution project-related emissions of short and long-lived climate pollutants. Avoid or Prevention and minimise generation of hazardous and non-hazardous waste. Minimise and Management manage the risks and impacts associated with 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 material 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- Community affected communities and the corresponding responsibility of Borrowers to Health and avoid or minimize such risks and impacts, with particular attention to people Safety who, because of their 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 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 Stakeholder between the borrower and project stakeholders as an essential element of Engagement good international practice. Effective stakeholder engagement can improve and Information the environmental and social sustainability of projects, enhance project Disclosure acceptance, and make a significant 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). 14 3.3 Relevant World Bank Environmental, Health, and Safety (EHS) Guidelines In addition to the ESS, the project follows World Bank Group Environmental, Health, and Safety (EHS) Guidelines, which provide best practices and international standards for managing construction site activities, worker safety, and environmental protection. The following World Bank EHS Guidelines are critical for managing environmental and safety risks during the construction phase of the Infectious Disease Unit project: • General EHS Guidelines: These guidelines provide a foundation for construction site management, focusing on occupational health and safety, environmental protection, and waste management. They cover: o Air Quality: Managing dust emissions by suppressing dust during site preparation and construction activities. o Noise Management: Monitoring and controlling noise levels to protect hospital patients and staff from construction-related disturbances. o Waste Management: Safe handling, storage, and disposal of hazardous and non- hazardous waste, including construction debris. o Worker Safety: Providing personal protective equipment (PPE), training workers on safety protocols, and ensuring safe working conditions. o Emergency Preparedness and Response: Preparing for and managing emergencies related to construction, such as accidents, fires, and hazardous material spills. • EHS Guidelines for Occupational Health and Safety: These guidelines focus on ensuring the safety of workers on the construction site. The key aspects include: o Personal Protective Equipment (PPE): Workers must be provided with appropriate PPE (e.g., helmets, gloves, eye protection) to prevent injuries. o Fall Protection: Measures such as guardrails, safety nets, and harnesses must be installed to protect workers from falls, especially when working at heights. o Hazardous Materials Handling: Proper storage, labelling, and use of hazardous materials such as paints, solvents, and fuels must be followed to prevent exposure and accidents. o Training and Supervision: Regular training on safe work practices, first aid, and emergency procedures for all construction workers. • EHS Guidelines for Construction and Decommissioning: These guidelines specifically address the environmental and social impacts during the construction phase, including: o Site Preparation: Best practices for site clearance, excavation, and land grading to minimise environmental disruption. o Soil and Erosion Control: Implementing erosion control measures, such as sediment traps and retaining walls, to prevent soil loss and waterway pollution. o Water Use and Management: Efficient use of water during construction activities, avoiding excessive water use, and preventing contamination of nearby water bodies. o Vibration and Noise Management: Limiting construction-related vibrations and noise to protect sensitive hospital areas and avoid disrupting patient care. o Waste Management: Ensuring construction debris, hazardous materials, and wastewater are properly managed and disposed of to minimise pollution. 15 • EHS Guidelines for Health Care Facilities: These guidelines apply to both construction and operation of health care facilities. For the construction phase, relevant guidance includes: o Medical Waste Management: Ensuring that construction does not interfere with the hospital’s existing waste management systems, especially for medical waste. o Infection Prevention: Reducing the risk of construction-related contamination in healthcare areas by implementing strict hygiene and infection control measures. o Water and Sanitation: Protecting the hospital’s water and sanitation infrastructure during construction activities to ensure continued access to clean water and proper waste disposal. • EHS Guidelines for Water and Sanitation: These guidelines apply to managing water resources and wastewater disposal during construction: o Water Use Efficiency: Encouraging efficient water use on the construction site and preventing contamination of local water sources. o Wastewater Management: Properly collecting and treating construction wastewater to avoid contaminating surrounding areas, including rivers or groundwater. 3.4 Good International Industry Practices (GIIPs) In addition to the EHS Guidelines, the project incorporates Good International Industry Practices (GIIPs), including: • WHO Infection Prevention and Control (IPC) Guidelines: These guidelines offer a framework for reducing infection risks during health facility construction. Construction workers will be trained on infection control measures, and the hospital’s IPC protocols will be integrated into construction site management. • ISO 14001 and ISO 45001: These ISO standards will guide environmental and occupational health and safety management on the construction site. ISO 14001 will ensure that environmental risks are identified and mitigated, while ISO 45001 focuses on worker safety and preventing accidents. 3.5 Regulatory Licenses and Approvals Table 3-3 summarises all the regulatory licenses, approvals and standards that have to be obtained or met for the proposed project to ensure that the project activities are in line with sound and environmental management practices and comply with relevant legislation. Table 3-3: Regulatory licenses and approvals relevant for the project No Regulations/ Description Reference Issuing Approvals Institution 1 ESIA Certificate The ESMP approval will be provided EMA, 2017 and EIA MEPA after approval of the ESIA report Guidelines 1997 2 Workplace During construction the sites will have to Occupation Safety Ministry of Registration be registered and the contractors must Health and Welfare Labour Certificate commit to abide by occupational safety Act (1997) and health requirements of the OSHWA 16 No Regulations/ Description Reference Issuing Approvals Institution 3 Development It is a requirement to obtain a Physical Planning Blantyre Permission development permission issued by the Act, (2016) City local council’s planning committee Council 17 Chapter Four: 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 forms a part of baseline information within the project area that might be used for future planning. 4.1 Area of Influence Consistent with World Bank Environment and Social Framework (ESF), specifically ESS1, the Area of Impact (AoI) refers to the geographic area over which environmental and social impacts of a project are expected to occur. Primary data was collected within a radius of 100 meters of the proposed construction site (Figure 4-1). Secondary data for the wider areas were also considered to assess the baseline conditions. The AoI for this proposed project encompasses: • Direct Impact Areas: These are areas where the project activities directly affect the environment and communities. Using Figure 4-1, the direct impact area is indicated by the pink area and it includes the immediate area where the building will be constructed. It is directly within the hospital boundary and will be subject to construction activities such as excavation, building, and landscaping. The hospital buildings and structures adjacent to the construction site will be directly impacted by noise, dust, and potential disruptions due to construction activities. • Indirect Impact Areas: These include areas that may be indirectly affected by the project activities. As indicated in Figure 4-1, The proposed construction of the IDU at QECH is expected to have indirect impacts that are primarily contained within the hospital campus. QECH is a major referral hospital located in an urban setting, and the layout and infrastructure within the hospital grounds are designed to support a variety of medical services, minimising the need for off-campus impacts. The hospital campus includes several internal access roads, green spaces, and designated areas for patient and visitor activities. These areas may experience indirect effects associated with increased activity on the campus, such as slight increases in noise levels and vehicle traffic, particularly near construction zones. QECH is in a busy urban area surrounded by institutional and commercial neighbourhoods. Although indirect impacts are expected to remain primarily within the hospital campus, there may be minimal interaction with these, especially on roads leading to the hospital. However, due to the project’s containment within QECH grounds, the influence on these surrounding areas is anticipated to be limited. These institutions and commercial areas may experience temporary, minor changes in traffic flow or noise due to increased activity within the campus, but these effects are expected to be minimal. • Cumulative Impact Areas: These areas consider the combined impacts of the project in conjunction with other existing or planned projects in the region. The cumulative impact area encompasses the commercial areas including shops and offices at Ginnery Corner. These areas will experience cumulative impacts due to increased construction activity in the region. Potential impacts include changes in traffic patterns, increased noise levels, disruptions to business operations, and potential strain on local infrastructure. The presence of construction traffic and activities may affect the accessibility and attractiveness of these spaces, necessitating effective planning and mitigation strategies to manage these impacts. 18 Figure 4-1: Land use map for the Area of Impact. 19 4.2 Physical Environment 4.2.1 Topography of the Project Area The construction site for the proposed Infectious Disease Unit at Queen Elizabeth Central Hospital in Blantyre exhibits a gentle slope, with the northern side at an elevation of 1086 meters and the southern side at 1083 meters above sea level. This 3-meter elevation difference creates a natural drainage gradient towards the south, which is beneficial for managing stormwater runoff and preventing water accumulation. 4.2.2 Geology The geology of the project site has been inferred to that of Blantyre City, which is primarily characterised by ancient rock formations dating back to the late Pre-Cambrian period, approximately 500 million years ago. The site is predominantly underlain by pyroxene granulite gneiss and syenitic gneiss. Pyroxene granulite gneiss, which constitutes a significant portion of the local geology, provides a stable and durable foundation ideal for construction. Syenitic gneiss, also present in the area, further contributes to the robustness of the geological foundation. These rock types, while generally impervious and poor in groundwater storage, offer excellent material properties for building foundations due to their stability and resistance to weathering. The geology of Blantyre City is influenced by its proximity to the eastern edge of the southern branch of the Eastern African Rift, making it prone to seismic activity. 4.2.3 Soils The soils at the project site have been inferred to be like those found in Blantyre City, influenced by the underlying geological formations and regional soil characteristics. As part of an urban built- up area, the site predominantly features disturbed soils altered by construction and other human activities. Despite this disturbance, the native soil characteristics remain significant. Typically, the soils in this region are derived from the weathering of ancient rock formations, such as pyroxene granulite gneiss and syenitic gneiss. These soils are generally well-drained, which promotes good natural drainage and minimizes the risk of waterlogging. The soil texture at the site is likely a mix of sandy loam and clay loam, reflecting the influence of the parent rock material. Given these characteristics, the project site will provide a stable foundation for construction. 4.2.4 Weather and Climate Conditions Weather measurements are taken daily by the Department of Climate Change and Meteorological Services. 4.2.4.1 Temperature The proposed project site is generally cool with mean annual temperatures ranging from 10 degrees centigrade during cold season to 25 degrees centigrade during the hot season. There are particularly two spells of uncomfortable weather; the hottest season associated with high humidity soon before the onset of the first rains (end October to November), and the frost along rivers, mist and chilly showers and winds characteristic of cold season in June and July (Blantyre SEP 2017). 4.2.4.2 Rainfall The annual rainfall for the project site, inferred from Department of Climate Change and Meteorological Services, is typically between 800 mm and 1,200 mm, with average annual rainfall of 1,127. Most of the rainfall occurs between December and March. During the rainy season, the 20 prevailing winds are generally from the northeast and are known as the northeast monsoon or locally as the Chiperoni winds. These winds bring moisture-laden air from the Indian Ocean, contributing to the rainfall in the region. 4.2.4.3 Potential Climate Change Impacts on the Project Site in Blantyre City Like many other regions in Malawi, Blantyre City is experiencing the effects of climate change, which has increased the frequency and intensity of extreme weather events in recent years. Notable climate change-related events in Blantyre City include: • Intense Rainfall and Flooding: Blantyre has experienced episodes of heavy rainfall leading to urban flooding, particularly during the rainy season (December to March). Recent years have seen significant flood events that damaged infrastructure, including roads, buildings, and drainage systems. These flood events have also increased the risk of waterborne diseases in the city. • Heatwaves: Blantyre has experienced unseasonably high temperatures, particularly during the hottest season (October to November). These heatwaves can have severe health impacts, especially on vulnerable populations, including hospital patients and healthcare workers. The increased temperature has also increased energy demands for building cooling systems. • Storms and High Winds: The city has been subjected to strong winds and storms, particularly during the transition periods between seasons. These weather events have resulted in damage to building roofs, windows, and outdoor facilities, underscoring the necessity for storm-resistant construction in new developments. These climate-related events pose potential risks to the construction and operation of the proposed Infectious Disease Unit (IDU) at Queen Elizabeth Central Hospital (QECH). Addressing these risks is imperative to safeguard the facility's functionality, safety, and longevity. To mitigate the impacts of the climate change events in Blantyre City, the project design incorporates several resilience measures: • Improved Drainage Systems: Recognizing the increasing intensity of rainfall and flooding in Blantyre, the facility's design includes a comprehensive drainage system. This system is designed to manage stormwater effectively, channelling it away from the building to reduce the risk of flooding and waterlogging. Stormwater retention basins will also be constructed to handle sudden surges in rainfall. • Elevated Foundation: Given the history of urban flooding in Blantyre, the building's foundation will be above ground level. This elevation minimises the risk of water entering the facility during heavy rainfall, protecting critical infrastructure and patient areas. • Thermal Insulation and Ventilation: In response to the increasing heatwaves in Blantyre, the building will incorporate thermal insulation in its walls and roofing to maintain indoor temperatures and reduce the need for excessive air conditioning. Additionally, natural ventilation systems will enhance air circulation within the facility, improving indoor comfort during hot periods. 21 • Energy-Efficient Cooling Systems: To address the rising temperatures in the city, the facility will be equipped with energy-efficient HVAC systems capable of maintaining indoor comfort while minimising energy consumption. These systems are designed to operate efficiently even during peak heat periods. 4.2.5 Water resources The nearest flowing water body is Naperi River, located approximately 350 meters east side. This proximity to the river is significant for considerations related to water management, potential flood risk, and the project's overall environmental impact. 4.2.6 Flora and fauna The proposed site has vegetation, with 12 trees and Bermuda grass. The primary notable fauna in the project area includes birds, small reptiles such as lizards, and various types of insects. 4.3 Facility Management and Health Safety Protocols 4.3.1 Water Supply The hospital receives its water supply from the Blantyre Water Board, which consistently provides potable water to the facility. The hospital has approximately twelve 5000-liter water tanks, used as backup when the water supply is interrupted, serving both the hospital campus and nearby private institutions. The proposed project will utilize water from the same board for both the construction and operational phases. It must be noted that the building wastewater will be connected to the current wastewater system. 4.3.2 Sanitation Facilities QECH employs approximately 1,200 staff, 65% female and 35% male. Despite frequent program changes, the number of wards is not consistently recorded. Each ward typically includes at least six toilets—three for females and three for males. The hospital's departmental offices also provide toilets for staff members. 4.3.3 Hygiene Practices QECH features handwashing stations in every ward and department, each equipped with hand sanitizers to promote hygiene awareness throughout the premises. Employees participate in weekly training sessions to ensure proper waste management. Additionally, personal protective equipment (PPE) is provided at the departmental level. Disinfection occurs daily, both in the morning and evening. Cleaning agents include soap, chlorine, and the use of thorough abrasion for cleaning the wards. The waste produced by departments and wards at QECH is currently collected and managed, but some areas require improvement. Infectious and non-infectious waste is intended to undergo proper disposal processes; however, some practices that do not align with best practices or safety standards have been observed. Infectious waste is typically incinerated using a batch burner daily. However, there have been instances of open burning due to inadequate worker training and a lack of proper safeguarding measures. This open burning practice does not comply with environmental and health safety standards and presents risks to both the hospital community and the surrounding 22 environment. The hospital will implement enhanced training programs for waste management workers to address this, focusing on safe handling, segregation, and disposal practices. Non- infectious waste is generally segregated into designated bins. When complete, trained waste collectors empty these bins, which are then transported to the designated dumpsite near Chiradzulu District. However, non-infectious waste disposal will be strictly monitored to prevent inappropriate burning practices and ensure safe handling. Biohazardous infectious waste is meant explicitly for incineration in a dedicated incinerator. Only trained personnel will be allowed to operate the incinerator to improve current practices, ensuring proper waste burning and reducing emissions. For liquid waste, cleaning water is directed into sluices within each department and flows into soakaways around the facility. While this method ensures some level of waste disposal, a review and upgrade of the liquid waste disposal system will be conducted to ensure compliance with environmental health standards and reduce any potential contamination risks. 4.3.5 Health Facility Capacity QECH plays a crucial role in delivering essential primary and secondary healthcare services to both the Blantyre District and the wider national community. Serving as a prominent referral hospital nationwide, it also has a department for the College of Medicine, KUHeS, which provides the hospital with skilled personnel who gain practical experience there. The hospital's infrastructure includes dedicated wards for inpatient care, outpatient departments, laboratories, pharmacies, and specialized operating theaters for both major and minor surgeries. Offering a comprehensive array of medical services, QECH provides outpatient consultations, inpatient treatment, maternal and child health services, emergency care, laboratory testing, pharmacy services, HIV/AIDS management, and immunization programs. 4.3.6 Cases Managed at the Facility QECH is visited by approximately 1,000 individuals daily. Its catchment area is about 210,444 people. The most common prevalent diseases are malaria, respiratory infection, and diarrhoea. Table 4-1: QECH common disease statistics for six months Common Disease From December 2023 to May 2024 total statistics Malaria 2293 Respiratory Infection 92882 Diarrhoea 1212 Sepsis 1257 Table 4-1 presents data on the incidence of four common diseases from December 2023 to May 2024. Respiratory infections were the most prevalent during this period, with 9,282 cases reported. During the hot season (October to November), respiratory infections tend to be lower compared to the rainy and cold seasons due to drier air and warmer temperatures, which are less conducive to the survival and spread of respiratory pathogens. Conversely, the cold season (June to August) typically sees a rise in respiratory cases due to lower temperatures, increased indoor crowding, and 23 the presence of cold winds. This seasonal trend indicates that the December to May period, which includes the rainy season and transition to the cold season, is particularly associated with higher respiratory infection rates. Malaria was the second most common disease, with 2,293 cases, followed by sepsis with 1,257 cases, and diarrhoea, which accounted for 1,212 cases. This data highlights respiratory infections as a significant health concern compared to malaria, sepsis and diarrhoea. Data from the QECH Light House indicates that the HIV prevalence rate at QECH from January to December 2023 is 3.5%, with the rate ranging from 3.2% to 3.7%. 4.3.7 Communication and Transport Systems In the project area, Telekom Networks Malawi Limited (TNM) and Airtel are the primary providers of mobile phone services, leading to extensive coverage of cellular networks. Site visits and interviews confirmed excellent network connectivity provided by both providers. Transportation is easily accessible, with the site located within 42 meters of the southern side of the M2 road, where there is a bus stage along the M2 road. 4.3.8 Security Blantyre's security is upheld by both public and private institutions, with the Malawi Police serving as the public sector representative. At the hospital, the crime rate is low, mostly involving incidents of petty theft. 24 Chapter Five: Assessment of Environmental and Social Impacts This chapter outlines the anticipated beneficial and adverse impacts, direct and indirect, on each environmental feature at the project site. 5.1 Impact identification Identifying impacts involves considering positive and negative effects resulting from the interaction between project-related activities and valued environmental components (VECs). These VECs encompass physical, biological, social, economic, or cultural aspects. The potential environmental impacts identified are based on the interactions between project activities and selected VECs. The selection of VECs was informed by the existing project environment (environmental baseline conditions), stakeholder consultations, and the consultant’s professional judgment. The potential interactions between the project-related activities and the selected VECs for each project implementation phase are illustrated in Table 5-1. Table 5-1: Potential Interactions of the Project with VECs. Construction Construction of Demobilisation Operation Sub - structure super-structure Finishing Activity Code P1 P2 P3 P4 P5 VEC Air Quality x x x x x Noise & Vibration x x x x x Water Resources x x x x - Aquatic Ecosystem - - - - - Construction materials extraction x x - - - Construction materials transportation x x x x - Wetlands - - - - - Terrestrial Biodiversity x - - - - Public Health & Safety x x x x x Labour & Economic Conditions x x x x Service Infrastructure & Utilities x x x x x Transportation & Access x x x x x Land Use & Resources x x x x - Soil and Land Capability x x x x - Visual Impact x x x - - Waste Management x x x x x Social Dynamics and Community Well- x x x x - being Climate Change and Greenhouse Gas x x x x x Emissions Hazardous Materials and Contamination x x x x x Risks Cultural & Historical Heritage - - - - - Key No Substantial Interaction - Possible Interaction x 5.2 Description of Identified Impacts This section outlines the project's construction phase's potential positive and negative environmental and social impacts. The construction phase is divided into specific activities to track 25 their impacts: mobilisation, demolition, construction, finishing, and demobilisation. The impacts are organised according to the stages of the project life cycle, specifically construction and operation. 5.2.1 Anticipated Positive Impacts 5.2.1.1 Improved Healthcare Capacity and Quality The construction of the 150-bed capacity Infectious Diseases Unit at Queen Elizabeth Central Hospital will significantly enhance the healthcare capacity and quality in Blantyre, Malawi. By adding 150 beds, the hospital can accommodate more patients, particularly those requiring specialized care for infectious diseases. This expansion is crucial in a region where healthcare resources are often stretched thin. The unit will include isolation wards, Intensive Care Units (ICUs), High Dependence Units (HDUs), and children wards, ensuring comprehensive care for a variety of infectious diseases. Furthermore, the new diagnostic facilities such as ultrasound, CT scan, X-ray, and laboratories will improve the accuracy and speed of diagnoses, leading to better patient outcomes. These advanced diagnostic tools are essential for timely and effective treatment, reducing the burden of disease on both patients and healthcare providers. 5.2.1.2 Public Health Benefits The establishment of a specialized infectious diseases unit will play a critical role in controlling and containing infectious diseases within the community. This unit will provide a dedicated space for isolating and treating patients with highly contagious diseases, thereby preventing the spread of infections within the hospital and the broader community. In addition, the improved infrastructure will enhance the hospital's emergency response readiness, allowing for more effective management of health emergencies, including outbreaks and pandemics. By containing infectious diseases more efficiently, the new unit will contribute to the overall improvement of public health in Blantyre and surrounding areas. 5.2.1.3 Creation of Job Opportunities The construction of the new unit will bring significant economic and social benefits to the community. During the construction phase, the project will create job opportunities for local workers, providing a boost to the local economy. In the long term, the operation of the new unit will require additional healthcare staff, creating more permanent employment opportunities. The presence of a state-of-the-art healthcare facility will also attract healthcare professionals to the area, further enhancing the quality of care available. 5.2.1.4 Environmental Sustainability Benefits The project will incorporate sustainable construction practices, minimizing its environmental footprint. The use of efficient waste management systems will ensure that the new unit operates in an environmentally responsible manner. Improved sanitation facilities will enhance hygiene standards, reducing the risk of hospital-acquired infections. By implementing these sustainable practices, the project will contribute to environmental conservation while providing high-quality healthcare services. 5.2.2 Anticipated Negative Impacts during Construction Phase 26 5.2.2.1 Traffic Congestion and Potential Accidents to Patients, Pedestrians and Vehicles Given the location of Queen Elizabeth Central Hospital (QECH) in a densely populated area with significant commercial and transportation activity, the construction activities are expected to exacerbate traffic congestion. Increased vehicular traffic from the transportation of construction materials and equipment will further congest the roads around the hospital. This congestion poses a higher risk of road accidents involving vehicles and pedestrians, including vulnerable hospital patients and staff. 5.2.2.2 Temporary Air Quality Deterioration During construction, significant dust and particulate matter emissions are anticipated. Construction activities, including the use of cement and aggregates, will also elevate dust levels. Additionally, machinery and vehicles used during construction will emit gases and particulate matter, such as carbon dioxide, sulfur dioxide, nitrogen oxides, and other hydrocarbons. While it is unlikely that ambient air quality standards will be exceeded, these emissions can still adversely affect the health of patients, staff, and nearby residents. 5.2.2.3 Elevated Noise Levels from Machinery and Construction Activities Construction machinery and equipment will produce elevated noise levels, which can impair the hearing of workers and disturb the hospital community. Noise generated by these activities can be heard over long distances, albeit typically for short durations. If noise levels exceed 65 dBA at a receptor or significantly surpass the ambient sound level by more than 15 dBA, it can increase annoyance levels and result in noise complaints. Similarly, vibrations from heavy machinery, such as excavators and pile drivers, can cause discomfort and disruption within the hospital, particularly in sensitive areas such as patient wards and diagnostic facilities. The combined effect of noise and vibration may lead to disturbances that impact hospital operations, affect patient recovery, and disrupt the working environment of the hospital staff. 5.2.2.4 Potential for Accidents and Injuries On-site Affecting Workers Construction workers will face various occupational hazards during the project. These hazards include operating large machinery and equipment, working at heights, using mechanical and electrical tools, and handling hazardous and flammable chemicals, excavations. The construction site itself poses risks such as slips, trips, and falls, which can lead to injuries. 5.2.2.5 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 STIs, HIV and AIDS, and COVID-19. It is, therefore, important for the project to put in place measures to control the spread of disease at the workplace. The Ministry of Health declared a cholera outbreak in Malawi on 3 March 2022, following laboratory confirmation of a case in the country. Cholera is an acute enteric infection caused by ingesting the bacteria Vibrio cholera present in contaminated water or food. It is mainly linked to insufficient access to safe drinking water and inadequate sanitation. It is an extremely virulent disease that can cause severe acute watery diarrhoea, resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population, and the setting. 27 5.2.2.6 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 guardians. 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. 5.2.2.7 Generation of Solid Wastes, E-Waste, Spills, and Effluent Various construction activities are expected to generate many types and varying quantities of wastes that will include construction rubble, 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, and cleaning wastewater. Additionally, equipment and electrical work installation will generate e-waste, such as discarded cables, electrical fittings, and damaged electronic components. 5.2.2.8 Water and Soil Pollution Construction activities can lead to water and soil pollution. Runoff carrying construction debris, dust, and potentially hazardous substances such as oils, fuels, and chemicals used in the process can contaminate water resources and soil. This poses risks to aquatic life in the Naperi River, affects plant growth, and poses health risks to humans, potentially entering the food chain . 5.2.2.9 Increased incidences of child labour due to the presence of street kids According to the International Labour Organization (ILO, 2021), poverty remains the primary reason children are compelled to work. The link between child labour supply and the need for supplemental family income or self-support is a significant concern, particularly in developing countries. Recent observations indicate a high number of street children in the vicinity of the hospital, increasing the risk of these children being exploited for child labour during the construction activities. 5.2.2.10 Increase in Energy Consumption The construction of the 150-bed capacity Infectious Diseases Unit at Queen Elizabeth Central Hospital will significantly increase energy consumption. Key activities contributing to this include transporting construction materials and equipment to the site, which involves extensive fuel use by trucks and heavy vehicles. Additionally, operating construction machinery like excavators, bulldozers, and cement mixers consumes substantial fuel. Temporary power supply systems, such as generators, will also provide electricity for lighting and power tools, further elevating energy demands. This increased energy consumption increases greenhouse gas emissions, contributing to 28 air pollution and climate change. Implementing energy-efficient practices and alternative energy sources can help mitigate these impacts. 5.2.2.11 Increase in Water Consumption The construction of the Infectious Diseases Unit will result in a significant increase in water consumption. This increase is necessary for various construction activities, including concrete mixing, which requires large amounts of water for the foundation, walls, and other structures. Water is also used for dust suppression, cleaning construction equipment, and maintaining hygiene in temporary sanitary facilities for workers. Additionally, providing adequate drinking water for workers is essential. This heightened water demand can strain local water resources, especially in water scarcity areas. Water-saving measures, such as using recycled water for non-potable purposes and optimising water use in concrete mixing, can help reduce the impact on local water resources. Besides, contractor would be advised to look into the option of utilizing Naper River water which is only a few metres away from Queens Central hospital. 5.2.2.12 Discriminatory Working Conditions There is a significant risk of discriminatory working conditions. Unfair hiring practices may favour certain groups based on gender, age, or ethnicity. Workers might face unequal pay and benefits, with temporary labourers receiving lower compensation than permanent staff. On-site harassment and discrimination, particularly against female workers, can affect mental and physical well-being. Inclusivity issues may arise, lacking support for diversity and accommodations for disabilities. Health and safety measures might also be inconsistently applied, putting certain workers at greater risk. Implementing fair hiring, equal pay, anti-harassment policies, inclusivity programs, and comprehensive safety training can mitigate these risks. 5.2.2.13 Health and Safety Risks to the Hospital Community During construction, hospital staff, patients, and guardians could face significant health and safety risks. These risks include potential exposure to falling debris, accidental incidents involving heavy machinery, and disruptions to hospital operations. Patients, especially those in critical condition, may be particularly vulnerable to dust, noise, and vibrations. Additionally, there could be risks associated with restricted access to emergency services and patient care due to temporary obstructions or re-routing caused by construction activities. 5.2.2.14 Cutting Down of Trees The proposed construction site currently has twelve (12) mature trees that provide shade and a natural, calming environment for patients, guardians, and hospital staff. These trees offer a place for respite and contribute to the overall greenery and aesthetic of the hospital grounds. However, the construction activities for the new facility will necessitate the removal of three (3) trees, while the remaining nine (9) will be preserved to continue offering shade and environmental benefits. Recognising the importance of maintaining a green environment, the project design includes a tree replacement plan that will involve planting approximately twelve (12) new trees in suitable locations around the hospital grounds. This initiative will compensate for the trees lost and enhance the green space within the hospital setting. 5.2.3 Anticipated Negative Impacts during Operation Phase 29 5.2.3.1 Increased Generation of Hazardous Waste The operation of the Infectious Diseases Unit will result in the generation of significant amounts of both general and hazardous waste. Hazardous waste includes infectious materials such as used needles, syringes, bandages, and other medical supplies contaminated with bodily fluids. Pharmaceutical waste, including expired or unused medications, also falls into this category. Improper segregation and disposal of these wastes can lead to contamination of the environment, posing risks to public health. This contamination can occur through accidental punctures, spills, or exposure to infectious agents, which can cause disease outbreaks both within the healthcare facility and in the surrounding community. 5.2.3.2 Emissions to Air Air emissions during the operation of the unit can arise from several sources including faulty designs. The HVAC systems, used to maintain air quality and temperature within the facility, can circulate airborne pathogens if not properly maintained. Medical waste storage areas and isolation wards may release bioaerosols, which are airborne particles containing biological agents like bacteria, viruses, and fungi. These emissions can potentially spread infectious diseases if they escape into the environment. Additionally, certain medical procedures and laboratory operations may release toxic gases or vapors, further contributing to air pollution and posing health risks to both healthcare workers and the public. 5.2.3.3 Wastewater Discharges The Infectious Diseases Unit will generate wastewater containing biological agents, pharmaceuticals, and chemicals from various hospital activities. This includes wastewater from patient care activities, laboratory processes, and cleaning operations. Contaminants in the wastewater, such as antibiotics, pathogens, and disinfectants, can enter the municipal sewage system. Without proper treatment, these substances can contaminate water sources, spreading waterborne diseases and negatively impacting aquatic ecosystems. However, it is expected that the wastewater discharge from the Unit would not be abnormally high. The current system should be able to contain it. 5.2.3.4 Expose Health Workers to Infections Healthcare workers in the Infectious Diseases Unit will be exposed to various occupational hazards. These include the risk of contracting infectious diseases from patients or contaminated materials, exposure to hazardous chemicals used in medical treatments and cleaning, and the potential for injuries from sharps and other medical instruments. Handling and disposing hazardous waste present a constant risk of infection, while using radiation in certain diagnostic and treatment procedures poses additional safety concerns. These occupational hazards can result in illness, injury, and long-term health issues for healthcare workers if not properly managed. 5.3 Significance Ranking of the Impacts The primary goal of implementing this methodology was to identify potential environmental issues and associated impacts from the proposed project and to assign a significance ranking to them. Issues or aspects were reviewed and evaluated against a series of significance criteria to identify and document interactions between activities and aspects, as well as resources and receptors, providing a detailed discussion of impacts. The significance of environmental aspects is determined and ranked by considering criteria presented in Table 5-2. 30 Table 5-2: Significance Ranking Criteria 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 (-)) Environmental Significance Very low Low Moderate High Very High Rating (Positive (+)) Annex 3 presents the assessed potential environmental and social impacts along with their significance rankings. The significance of impacts without mitigation measures is evaluated with the design controls already in place. Residual impact refers to the remaining level of impact after applying mitigation and management measures, representing the final impact level associated with the development. Residual impacts are the primary focus of management and monitoring activities during project implementation to ensure that actual impacts align with the predictions in this report. 5.4 Environmental and Social Management and Monitoring Plan An Environmental and Social Management and Monitoring Plan 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 the dynamism and flexibility of the ESMP. As such, the ESMP will be subject to a regular periodic review regime during project implementation. Table 31 5-3 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, and the institutions responsible for their implementation. 32 Table 5-3: Environmental and Social Management and Monitoring Plan Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility P3M1 Improved i. Conduct regular Start: Beginning of MK750,000 Number of Monthly QECH MoH Healthcare training programs equipment staff trained Administration Capacity and for medical staff installation; End: 1 Quality month after installation ii. Organize health Start: 1 month after MK250,000 Number of Quarterly QECH MoH awareness equipment campaigns Administration campaigns for the installation; End: 3 conducted; community months after community installation awareness level iii. Conduct regular Start: Post- MK200000 / Equipment Quarterly QECH MoH servicing and installation; End: year uptime; Administration maintenance of the Ongoing, quarterly number of hospital equipment maintenance checks P1M1 Creation of i. Inform local Before construction MK100,000 Number of Before Contractor Supervising Job communities of phase starts local workers constructio Consultant Opportunitie employment employed n begins (SC); PIU E&S s opportunities and Expert prioritize their employment. ii. Treat employees in Ongoing during MK0 Compliance Monthly Contractor SC; PIU E&S compliance with construction phase with labour Expert Malawi Labour regulations Regulations and labour and working conditions as per the project's Labour Management Plan. iii. Pay the same rates Ongoing during MK0 Pay equity Monthly Contractor SC; PIU E&S for workers construction phase records Expert working on similar tasks regardless of gender and origin. 33 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility iv. Have workers sign Before employment MK0 Number of Before Contractor SC; PIU E&S a code of conduct. starts signed codes employmen Expert The code of guide is of conduct t starts provided in Annex 5. v. Sensitize workers During induction MK50,000 Number of Monthly Contractor SC; PIU E&S to a full range of and ongoing sensitization Expert risks related to sessions; occupational health worker and safety, labour awareness rights, public levels health, community safety, sexual harassment, and GBV. vi. Ensure that 30% of Ongoing during MK0 Workforce Monthly Contractor SC; PIU E&S the workforce are construction phase gender ratio Expert women. P1M2 Environmen i. Develop a Before construction MK5,000,000 Approved C- Before Contractor PIU E&S tal contractors ESMP phase starts ESMP constructio Expert Sustainabilit that will include n begins y Benefits relevant sub-plans. ii. Solicit views of the Before construction MK75,000 Number of Before Project PIU E&S public and phase starts consultations constructio Management Expert stakeholders held; n begins Team through stakeholder consultations to feedback ensure that their incorporated concerns are considered in the project documents. iii. Undertake Before construction MK50,000 Number of Before Project PIU E&S community liaison phase starts liaison constructio Management Expert meetings to notify meetings; n begins Team the community of community the commencement 34 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility date, inform them awareness of the grievance level mechanism, and labour policy. iv. Obtain relevant Before construction MK2,000,000 Number of Before Project PIU E&S approvals and phase starts approvals and constructio Management Expert certificates from certificates n begins Team authorities, obtained including the Malawi Environment Protection Authority and Lilongwe City Council. P2M4 Traffic i. Develop and Before construction MK5,000,000 Traffic Weekly Contractor SC; PIU E&S Congestion implement a Traffic starts Management Expert and Management Plan Plan in place Accidents using guidance provided in Annex 8. ii. Employ flaggers During construction MK200,000/m Flaggers and Weekly Contractor SC; PIU E&S and traffic wardens phases onth wardens Expert to direct traffic deployed during critical during peak periods of times construction. iii. Ensure safe Before construction MK250,000 Crossings and Weekly Contractor SC; PIU E&S pedestrian starts signage Expert movement by installed installing well- marked crossings and signage near the site. 35 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility iv. Schedule delivery Throughout MK0 Reduced Weekly Contractor SC; PIU E&S of materials and construction (Operational traffic Expert heavy equipment cost) disruption movement during during peak off-peak hours. hours v. Erect safety barriers Before construction MK1,000,000 Safety Weekly Contractor SC; PIU E&S around the starts barriers Expert construction site to installed prevent unauthorized access. vi. Hire transporters Throughout MK200,000/m Transporters Monthly Contractor SC; PIU E&S with valid CoF and construction onth comply with Expert appropriately CoF and licensed drivers. licensing vii. Ensure construction Throughout MK150,000 Speed limit Monthly Contractor SC; PIU E&S vehicles observe a construction signs installed Expert 20 km/hr speed and observed limit on the hospital campus. P2M1 Temporary i. Plan construction Before demolition MK0 Reduced dust Weekly Contractor PIU E&S Air Quality works to minimize start (Operational levels during Expert Deterioratio dust, avoid windy cost) demolition n periods ii. Wet down entire Throughout MK0 Regular Daily Contractor PIU E&S construction area excavation and (Operational wetting Expert periodically, construction works cost) schedule wherever possible. maintained iii. Transport During material MK150,000 Properly Weekly Contractor PIU E&S particulate transport covered loads Expert materials with observed adequate load cover iv. Unload powdery During material MK150,000 Minimal dust Weekly Contractor PIU E&S materials using unloading observed Expert drop-height during unloading 36 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility regulation equipment v. Regular Throughout MK150,000 Emission Monthly Contractor PIU E&S maintenance of construction levels within Expert vehicles, avoid old acceptable vehicles emitting limits black smoke P2M2 Elevated i. Limit noisy and Ongoing during MK0 Compliance Daily Contractor PIU E&S noise levels high-vibration construction phase (Operational with work Expert and construction cost) hours; noise vibrations activities only to level readings from daytime hours. machinery, ii. Notify hospital As needed during MK0 Number of As needed Contractor PIU E&S workers and management at construction phase (Operational notifications Expert construction least twenty-four cost) sent; activities hours in advance if community particularly noisy feedback or vibration- inducing activities are anticipated. iii. Ensure that noise Ongoing during MK100,000 Noise level Monthly Contractor PIU E&S levels at the construction phase readings; Expert hospital do not compliance exceed 55 dB (A) with and that vibrations standards remain within acceptable limits. iv. Place stationary During equipment MK100,000 Placement As needed Contractor PIU E&S noise sources (e.g., setup compliance; Expert the generator) and noise level heavy-vibration readings inducing equipment away from sensitive receptors such as wards and staff houses. 37 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility v. Regular Ongoing during MK100,000 Noise level Monthly Contractor PIU E&S maintenance of construction phase readings; Expert machinery to compliance minimize noise and with vibration. standards vi. Code of conduct for Ongoing during MK100,000 Monthly Contractor PIU E&S workers- noise construction phase Expert observation. P2M3 Potential for i. Erect safety barriers Before construction MK150,000 Number of Weekly Contractor SC; PIU E&S accidents around the begins barriers Expert and injuries construction site to erected; on-site prevent incidence of affecting unauthorized unauthorized communities access. access ii. Schedule During construction MK0 Delivery Monthly Contractor SC; PIU E&S construction phase schedule Expert deliveries and compliance; heavy machinery community movement during feedback off-peak hours to minimize disruption. iii. Coordinate with Before construction MK0 Number of Quarterly Contractor SC; PIU E&S hospital begins coordination Expert administration to meetings; ensure that availability of alternative routes alternative and access points routes are available during construction. iv. Hire transporters During construction MK0 Number of Quarterly Contractor SC; PIU E&S whose vehicles phase compliant Expert have valid vehicles and Certificate of drivers Fitness (CoF) and drivers with the 38 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility appropriate driving licence category. v. Construction During construction MK50,000 Compliance Before Contractor SC; PIU E&S vehicles to observe phase with speed constructio Expert a 20 km/hr speed limits; n begins limit on the hospital number of campus. Put in signposts place signposts indicating the speed limits on the construction site. P2M5 Infectious i. Carry out monthly Ongoing; monthly MK150,000 Number of Monthly Contractor SC; PIU E&S Disease health education for health Expert Impact construction education (spread of workers in liaison sessions; STIs, HIV with health worker and AIDS, personnel using the participation and Covid- toolbox talks. 19) ii. Free condoms are to Ongoing MK100,000 Availability Monthly Contractor SC; PIU E&S be made available and usage of Expert to all (100%) condoms workers by placing them in the workers’ toilets to ensure access and confidentiality. iii. Sensitize Ongoing MK50,000 Number of Before Contractor SC; PIU E&S construction sensitization employmen Expert workers on Covid- sessions; t starts 19 prevention worker including hand compliance washing with soap, use of hand sanitizers, proper use of face masks, and workspace 39 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility disinfection among others. iv. Distribute Ongoing MK250,000 Number of Monthly Contractor SC; PIU E&S information, IEC materials Expert education, and distributed; communication worker (IEC) materials on awareness Covid-19, HIV and AIDS prevention, and cholera. v. Provide necessary Ongoing MK150,000 Availability Monthly Contractor SC; PIU E&S PPE and other and usage of Expert materials (e.g. cloth PPE; masks, hand compliance sanitizers, hand- with health washing facilities) protocols to help prevent construction workers from contracting and spreading Covid-19 at the workplace. P2M6 GBV and i. Develop an Before construction MK50,000 Existence of Before Contractor SC; PIU E&S SEA Impact induction program phase starts induction constructio Expert including a code of program; n begins conduct for all number of workers which they signed codes will be required to of conduct sign prior to starting their work. ii. Ensure a copy of Before construction MK50,000 Number of Before Contractor SC; PIU E&S the code of conduct phase starts signed codes constructio Expert is presented to all of conduct n begins construction workers and signed by each of them. 40 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility iii. Implement a GBV During construction MK250,000 Existence and Before Contractor SC; PIU E&S management plan phase implementati constructio Expert as presented in on of GBV n begins Annex 10. management plan iv. Provide clear, Ongoing during MK150,000 Number of Before Contractor SC; PIU E&S trusted, and construction phase reported constructio Expert responsive cases; n begins channels for filing resolution GBV/SEA/SH time cases to the police or other relevant government authorities. v. Ensure the Ongoing during MK50,000 Existence and Weekly Contractor SC; PIU E&S availability of an construction phase accessibility Expert effective Grievance of GRM; Redress number of Mechanism grievances (GRM). addressed P2M8 Generation i. Provide adequate Before construction MK250,000 Number and Weekly Contractor SC; PIU E&S of solid on-site waste phase starts type of waste Expert wastes, e- receptors such as receptors; wastes, colour-coded bins compliance spills, and or skips for with waste effluent temporary storage management of general waste, protocols hazardous waste, and e-waste. Use of rubbish pits should be discouraged. ii. Contractor to Before construction MK2,500,000 Availability Monthly Contractor SC; PIU E&S prepare waste phase starts of plan Expert management procedures. 41 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility iii. Arrange with the Before construction MK50,000 Number of Weekly Contractor SC; PIU E&S District Council to phase starts waste Expert identify a suitable disposal sites site or sites (new or identified; existing) for waste compliance disposal at different with disposal project sites if protocols possible within 5 km radius. iv. Obtain permits to Before construction MK50,000 Number of Weekly Contractor SC; PIU E&S handle, store, phase starts permits Expert transport, and obtained; dispose of compliance hazardous waste, with including e-waste, hazardous from the Malawi waste Environment regulations Protection Authority in advance of construction. v. Segregate and During construction MK100,000 Segregation Weekly Contractor SC; PIU E&S clearly label phase and labelling Expert hazardous waste compliance; and e-waste, and condition of store in suitable storage drums or containers facilities in secure facilities that have a banded impermeable layer. vi. Promote good Ongoing MK50,000 Cleanliness Monthly Contractor SC; PIU E&S housekeeping and and Expert sanitation practices organization at each site, of the site; including proper worker handling of e-waste compliance 42 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility to prevent contamination. vii. Provide spill- During construction MK100,000 Availability Monthly Contractor SC; PIU E&S control kits and phase and usage of Expert materials (e.g. oil spill-control binding agents, kits; number sand, shovels, etc.) of spill to drivers and incidents workers, to clean up spills, if necessary. Ensure that e-waste is handled separately and disposed of by certified handlers. P2M9 Water and i. Engineer an Start: Pre- MK5,000,000 Effective Weekly Contractor SC; PIU E&S Soil effective drainage demolition; End: runoff Expert Pollution system to manage During demolition management stormwater runoff from the construction site by ensuring that the system directs runoff to designated collection areas where it can be treated or safely discharged. ii. Establish Start: Pre- MK1,500,000 No incidents Daily Contractor SC; PIU E&S designated areas for demolition; End: of storm drain Expert storing demolition Throughout contamination debris and construction construction materials away from storm drains. 43 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility iii. Use approved Start: During MK5,000,000 Compliance Daily Contractor SC; PIU E&S disposal methods demolition; End: with waste Expert and sites, and avoid Post-construction disposal illegal dumping of regulations construction waste, including hazardous materials. iv. Use containment Start: Pre- MK3,000,000 Zero incidents Weekly Contractor SC; PIU E&S systems such as demolition; End: of hazardous Expert spill containment Throughout spills pallets, bunded construction areas, and drip trays to store hazardous substances like oils, fuels, and chemicals. This will prevent leaks and spills from contaminating soil and water. v. Ensure that spill Start: Pre- MK1,000,000 Availability Weekly Contractor SC; PIU E&S kits are readily demolition; End: and Expert available on-site. Throughout accessibility These kits should construction of spill kits include absorbent materials, gloves, protective clothing, and disposal bags. vi. In case of a spillage Start: During MK1,500,000 Number of Monthly Contractor SC; PIU E&S incident, quickly demolition; End: successfully Expert identify the type Throughout contained and source of the construction spills spill (e.g., oil, fuel, chemicals). If it is safe to do so, stop 44 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility the source of the spill to prevent further leakage. vii. To contain the spill, Start: During MK1.500,000 Number of Daily Contractor SC; PIU E&S use absorbent demolition; End: spills Expert materials from the Throughout effectively spill kit to create a construction contained barrier around the spill to prevent it from spreading. Immediately block any nearby drains or waterways to prevent contamination. viii. To clean up, use Start: During MK2,500,000 Proper As needed Contractor SC; PIU E&S absorbent pads or demolition; End: disposal of Expert other materials to Throughout used soak up the spilt construction absorbent substance. Gather materials the used absorbent materials and place them in the provided disposal bags. Seal the bags and store them in a designated area for proper disposal according to MEPA guidance. P2M10 Increased i. During the Ongoing during MK0 Compliance As needed Contractor SC; PIU E&S incidences recruitments of the construction phase with labour Expert of child construction regulations labour due workers, use to presence national of street kids identification cards 45 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility to ascertain the age of the prospective workers. ii. Ensure that all Ongoing during MK0 Compliance As needed Contractor SC; PIU E&S contractors and construction phase with labour Expert subcontractors regulations adhere to local and international labour laws prohibiting child labour. iii. Strategically, erect Ongoing during MK1,500,000 Number of Weekly Contractor SC; PIU E&S signage, which are construction phase erected Expert three metres high, signposts with prevention of child labour messages at construction sites iv. Set up an Before K750,000 Number for Weekly MoH SC; PIU E&S anonymous commencement of uptake Expert reporting system construction systems in where incidents of place child labour can be reported without fear of retribution. P2M11 Increased in i. Promote energy- Ongoing during MK10,000,000 Percentage of Monthly Contractor Supervising Energy efficient practices. construction phase energy from Consultant; Consumptio ii. Utilize renewable renewable PIU E&S n energy sources such energy Expert as solar panels for sources providing temporary power on-site, reducing reliance on diesel generators. 46 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility iii. Train workers on MK500,000 Number of energy-saving workers practices and the trained importance of reducing energy consumption. iv. Use of fuel- MK5,000,000 Amount of Contractor efficient vehicles fuel used and machinery. v. Optimise logistics Contractor to minimise transportation distances and fuel consumption. P2M12 Increased in i. Implement water- Ongoing during K5,000,000.00 Reduction in Monthly Contractor Supervising Water saving measures. construction phase total water Consultant; Consumptio usage PIU E&S n compared to Expert baseline. ii. Source non-potable Use of non- water from water potable water bodies within 2 km for radius for construction construction activities. purposes, ensuring it does not affect hospital water supplies. iii. Reuse water where Amount of possible e.g. use greywater greywater for dust reused suppression and (litres/month) sanitation purposes . iv. Monitor and Daily water minimize water usage logs wastage. maintained. 47 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility P2M13 Discriminat i. Treat employees in Ongoing during K2,500,000.00 Percentage of Monthly Contractor Supervising ory Working compliance with construction phase compliance Consultant; Conditions the Malawi Labour with labour PIU E&S Regulations and regulations. Expert labour and working conditions as per World Banks ESS 2. ii. Implement the Number of Monthly Contractor project as required grievances by the projects related to Labour labour Management Plan. management resolved. iii. Pay the same rates Percentage of Monthly Contractor for the workers workers paid working on similar equally for tasks regardless of similar tasks, gender and origin. disaggregated by gender and origin. iv. Report regularly on Frequency of Monthly Contractor workforce profile, reports labour grievances, submitted labour incidents (monthly or and workforce quarterly). management activities and results using World Bank templates, government requirements, and international good practice. v. Have workers sign Percentage of Monthly Contractor a code of conduct. workers who 48 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility have signed the code of conduct. vi. Sensitise workers to Number of Monthly Contractor a full range of risks workers related to trained / occupational health sensitised. and safety, labour rights risks, public health, community safety, sexual harassment, GBV, and other risks. P2M14 Potential for Develop and implement Before construction MK250,000.00 Existence of Quarterly Contractor Supervising accidents an Occupational Health phase starts OH&S plan; Consultant; and injuries and Safety Plan that aims compliance PIU E&S on-site to avoid, minimize, and with safety Expert affecting mitigate the site-specific protocols workers risk of workplace accidents including fires and explosions at the construction site. Provide OSH orientation During induction MK50,000.00 Number of Monthly training and hazard- and ongoing training specific training. sessions; worker awareness levels Conduct a thorough risk Before excavation MK50,000.00 Risk assessment before starts assessment excavation to identify report; potential hazards and implementati implement necessary on of safety safety measures. measures Install barriers and During excavation MK150,000.00 Number of warning signs around the barriers and 49 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility excavation area to prevent signs; unauthorized access and compliance to alert workers to with safety potential hazards. protocols Use secure and stable During construction Billed under Equipment ladders or scaffolding that the BoQ.00 inspection meet safety standards for logs; working at height. compliance with safety standards Provide personal Before work at MK1,000,000.0 PPE protective equipment height begins 0 availability (PPE), including safety and usage; harnesses, helmets, and compliance non-slip footwear to all with safety workers working at standards height. Provide PPE, including Before construction MK500,000.00 gloves, work suits, and begins boots, to all workers handling cement during construction works. Implement permit During construction MK1,500,000.0 systems of work 0 Ensure regular servicing During construction of equipment Hire competent people During construction and provide orientation and training before undertaking tasks/operating machines Toolbox talks During construction P2M15 Health and Erect physical barriers During construction MK10,00,000.0 Percentage of Monthly Contractor Supervising Safety Risks and place clear signage 0 the Consultant; to the around the construction construction PIU E&S site to restrict site with Expert 50 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility Hospital unauthorised access and adequate Community protect hospital staff, signage patients, and visitors from installed. potential hazards. Ensure regular inspection During construction Number of and maintenance of machinery construction machinery to maintenance prevent accidents or and mechanical failures, in inspection accordance with logs manufacturer guidelines completed on time Install debris netting and During construction Percentage of ensure the safe scaffolding construction of equipped with scaffolding to protect the debris netting hospital community from falling materials. Establish a During construction Number of communication protocol communicatio with hospital management n logs or to notify them of high-risk notifications construction activities, sent to enabling hospital hospital operations to be adjusted management as necessary. before high- risk activities. Ensure that clear and During construction Percentage of unobstructed emergency time access routes are emergency maintained throughout the access routes construction period to are clear and avoid disrupting patient unobstructed care and hospital services. during construction. 51 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility P2M16 Cutting Minimize tree removal by During construction MK300,000.00 Number of Monthly Contractor Down of preserving as many trees trees planted Trees as possible during and preserved construction. Implement a 1:3 tree replacement ratio, meaning that for each tree removed, three new trees will be planted in suitable areas within or around the hospital grounds. Select Indigenous and climate-resilient tree species for planting, ensuring that they can thrive in the local environment and contribute to biodiversity. P3M1 Increased Segregate waste at the Before operations of Hospital Proper Monthly QECH Infection MoH - Generation source the facility Operational segregation, Prevention Environmental of Use color-coded bins for commence Budget treatment, and Committee Health Unit Hazardous different types of waste disposal Train staff on waste Waste management protocols Monitor and audit waste management practices regularly Establish, operate and maintain a facility specific Infection Control Waste Management Plan (ICWMP) and WHO Covid-19 Guidelines. that will promote, (i) waste minimization, reuse, and recycling; (ii) waste 52 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility segregation; (iii) safe handling, collection, storage and disposal. The sluice rooms should Include in design Included in Once before Design MoH - Planning be strategically located to design cost construction Consultant Department minimise the movement phase of contaminated materials through clean areas. Consider having exits to corridors towards a dedicated waste holding area on the floor or for the hospital. Provide for a central Include in design Included in Availability storage area within the design cost of temporary hospital facility where waste storage different types of waste facility will be brought for safe retention until it is collected for offsite disposal/incineration. P3M2 Emissions to Maintain and replace air During operation Hospital Air quality Quarterly Hospital MoH - Air filters regularly Operational meets safety Management Environmental Budget standards. Health Unit / Use UVGI in air handling Design stage Included in Quarterly Design Health units design cost Consultant Technical Conduct air quality During operation Hospital Quarterly Hospital Support testing and adjust systems Operational Management Services as needed. Budget (HTSS) Ensure proper storage of department medical waste. Use sealed containers to prevent emissions from medical waste storage. 53 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility Inspect and maintain medical waste storage facilities regularly. Monitor air quality around storage areas P3M3 Increased Procedures and During operation Hospital Wastewater Monthly Hospital MoH - wastewater mechanisms for separate Operational quality meets Management Environmental discharge collection of urine, faeces, Budget discharge Health Unit blood, and vomit from standards patients treated with genotoxic drugs to avoid their entry into the wastewater stream. Ensure compliance with During operation local discharge regulations Use chemical During operation neutralization treatments where chemical contaminants are released in wastewater. Test and monitor During operation wastewater quality regularly P3M3 Expose Develop and implement During operation Hospital Reduced Monthly Hospital MoH - Quality Workers to an Infection Prevention Operational incidence of Management Management Infections Plan using guidance Budget occupational Directorate provided in Annex 5. The illnesses plan will include an exposure control plan for blood-borne pathogens, information on infection control policies and procedures, and standard precautions to treat all blood and other 54 Impact Impact Mitigation Measures Implementation Implement Performance Monitoring Implementation Monitoring Code Period Cost (MWK) Indicator Frequency Responsibility Responsibility potentially infectious materials with appropriate precautions. Develop a Life and Fire Before operation Safety plan using phase guidance provided in Annex 6. This will ensure the safety of patients, staff, and visitors by minimising the risk of fire and ensuring effective emergency response measures are in place. Install handwashing Design stage Included in facilities in critical areas design cost that will include At entrance and exits, patient care areas, high-traffic areas, nursing stations, and in procedure and treatment rooms. Train workers on During operation Hospital handling hazardous Operational materials regularly Budget Establish a health During operation surveillance system MWK 61,500,000.00 55 5.5 Contractor's Role in Developing the Construction Environmental and Social Management Plan The contractor is required to prepare a Construction Environmental and Social Management Plan (CESMP) that outlines how they will manage environmental and social risks during the construction phase of the Infectious Disease Unit (IDU) and associated infrastructure projects. The CESMP will be an essential component of the project’s overall Environmental and Social Management Plan (ESMP) and must align with the requirements of the World Bank Environmental and Social Framework (ESF), national environmental regulations, and project-specific ESMP. Key Responsibilities of the Contractor in Developing the CESMP: • The contractor is required to develop the CESMP based on the broader ESMP prepared for the project. The CESMP must translate the ESMP’s requirements into actionable and site- specific measures for managing environmental and social risks during construction. • The contractor must conduct a site-specific environmental and social risk assessment to identify any additional risks that may not have been covered in the broader ESMP. This includes assessing risks related to air quality, water contamination, soil erosion, noise and vibration, waste management, occupational health and safety, and community impacts. • Develop and adhere to a set of Environmental and Social Rules that govern their daily activities on the construction site. • The CESMP must comply with all Malawi’s environmental and labour laws, including those related to waste management, pollution control, occupational safety, and labour conditions. The contractor should ensure that their CESMP meets these national standards and any relevant international standards, such as the World Bank’s EHS Guidelines. • The CESMP must include detailed plans to protect both workers and the surrounding community during construction activities. This should cover the use of Personal Protective Equipment (PPE), safe working conditions, accident prevention strategies, and mitigation measures to address risks to the hospital community (e.g., dust control, noise reduction, restricted access areas). • The contractor should develop a waste management plan that includes the proper handling, storage, and disposal of construction waste, hazardous materials, and medical waste that may be encountered on site. Waste minimisation and recycling practices should also be outlined. • The contractor must prepare an Emergency Response Plan to deal with potential accidents, fires, hazardous spills, or other emergencies that could occur during construction. • The CESMP must outline how the contractor will monitor the effectiveness of the environmental and social mitigation measures. It should include procedures for regular site inspections, incident reporting, and submission of monthly environmental and social performance reports to the project management team. • The contractor must include a training plan in the CESMP to ensure that all workers are trained in the environmental, social, health, and safety requirements of the project. This will include training on the safe use of equipment, adherence to environmental guidelines, waste management, and how to report grievances or incidents. 56 5.6 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 are indicated in Table 5-4. Table 5-4: ESMP Implementation Arrangement Responsible Roles and Responsibilities Party Ministry of Construction Phase: 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. • Ensure engineering measures of the ESMP are considered in the design of the facility • 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. Operation Phase: • Oversee the implementation of the ESMP and maintain compliance with environmental and social standards post-construction. • Ensure that environmental and social management continues in areas such as waste management, water usage, energy efficiency, and patient and staff safety. • Engage with hospital operational staff to address ongoing environmental and social risks, including managing hazardous waste, infection control, and ensuring safe air and water quality. • Coordinate with relevant ministries and agencies for periodic audits, inspections, and adherence to long-term environmental and social policies. Supervision Construction Phase: Consultant • Development of a monitoring tool or checklist based on the ESMP and guided by the project’s physical layout. • Ensure ESMP measures including engineering and administrative are inline with contractor method statement • 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. 57 Responsible Roles and Responsibilities Party Operation Phase: • Ensure all ESMP measures required for the operational phase are in place before construction completion. • Conduct a final inspection to confirm that all environmental and social safeguards for operation are integrated. • Support the Ministry of Health with recommendations for long-term monitoring tools and reporting mechanisms that can be adopted by the facility management. The Contractor Construction Phase • Customise the project ESMP and generate a Contractor Environmental and Social Management 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. Operation Phase: • Prepare a handover plan to ensure that all environmental and social measures are documented and communicated to the Ministry of Health for continuity in the operational phase. 5.7 Training and Capacity Building The Training and Capacity Building Plan aims to equip the project implementation team with the knowledge, skills, and competencies required to effectively implement and oversee the Environmental and Social Management Plan (ESMP). This plan covers the Ministry of Health (MoH) Project Implementation Unit (PIU), the Supervision Consultant team, and the Contractor’s team. The objectives of training and capacity building approach are as follows: i. Ensure all team members understand the ESMP and their roles in its implementation. ii. Develop skills and competencies required for effective monitoring, reporting, and management of environmental and social impacts. iii. Ensure all activities comply with the ESMP, World Bank guidelines, and local regulations. iv. Foster a culture of continuous improvement in environmental and social performance. Given the need to raise awareness among project workers and stakeholders at multiple levels, a cascading model will be implemented where information flows from the national level to the field levels as shown in Table 5-5. This approach ensures that training on environmental and social risk management is integrated into the project cycle and operational procedures. Table 5-5: Proposed Training and Capacity Building Approach Level Responsibility Audience Topics / Themes Estimated Cost Party (MK) National External PIU Staff, MoH • Introduction to ESMP MK10,000,000 Consultant Staff • ESMP Planning and Implementation • Monitoring and Reporting 58 Level Responsibility Audience Topics / Themes Estimated Cost Party (MK) • Environmental and Social Safeguards • Corrective Action Planning • Communication and Stakeholder Engagement Hospital Environmental Hospital • Introduction to ESMP MK7,500,000 Level Specialist Project • Development of Monitoring (Construction Implementation Tools Phase) Team • Monitoring Program Development • Reporting and Communication • Emergency Response and Contingency Planning Contractor Environmental Contractor • Customizing the ESMP MK5,000,000 Level Specialist Environmental • Construction Environmental and Social and Social Management Plan Expert, (CESMP) Contractor’s • Equipment Use for Staff Environmental Measurements • Monthly Reporting • Compliance with Environmental and Social Standards • OHS and incident reporting Hospital External Hospital • Infection Control and Waste MK20,000,000 Level Consultant / Operational Management specific to the (Operational Environmental Staff (Doctors, new IDU. Phase) Specialist Nurses, • Safe Handling and Disposal of Technicians, Hazardous Materials. Maintenance • Environmental and Social Staff) Safeguards Compliance in Daily Operations. • Use and Maintenance of Medical and Diagnostic Equipment. • Emergency Response and Evacuation Procedures. • Patient and Staff Safety Measures. • Use of Digital Health Records and Telemedicine Tools. • Regular Environmental Monitoring and Reporting. To ensure the effectiveness of the training and capacity-building plan, regular evaluations and monitoring will be conducted. This will involve: i. Evaluate participants' knowledge before and after training sessions. ii. Collect feedback from participants to improve future training sessions. 59 iii. Regularly review monitoring reports to ensure compliance and identify areas for improvement. iv. Conduct quarterly review meetings with all stakeholders to assess progress and address any issues. 5.8 ESMP Estimated Budget Table 5-6 lists estimated cost items for the implementation for the ESMP, which have been included in the overall project budget. Table 5-6: Summary ESMP Implementation Budget SN Activity/Cost Item Potential Cost (MK) 1 Trainings for project implementing team (venue, MK42,500,000 travel, refreshments, etc.) 2 Printing of awareness raising materials / MK3,000,000 grievance redress materials 3 Personal Protective Equipment MK4,500,000 4 Cost of obtaining clearances or permits MK10,000,000 5 Implementation of site-specific ESMPs and MK25,000,000 other site-specific plans 6 Travel and accommodation budget for MK9,000,000 environmental and social staff site visits 7 External monitoring or supervision consultant MK10,000,000 Total MK104,000,000 5.9 Stakeholder Engagement, Grievance Redress Mechanism, Disclosure, and Consultations 5.9.1 Stakeholder Engagement and Consultations A separate Stakeholder Engagement Plan (SEP) has been prepared for the Project, based on the World Bank’s Environmental and Social Standard 10 on Stakeholder Engagement. This ESMP will be disclosed after approval, and disclosures have already been made for the SEP and the Environmental and Social Commitment Plan (ESCP) that have been prepared for this project. In addition, Annex 9 of this ESMP provides a Stakeholder Engagement and Disclosure Plan (SEDP) specifically tailored for this project. This plan is based on the MCEPRP SEP and outlines detailed engagement and disclosure activities to ensure that affected and interested stakeholders are well- informed and have access to feedback mechanisms throughout the project lifecycle. Annex 4 describes the stakeholder consultations conducted on 27 and 28 June 2024 and feedback on this ESMP. The critical comments raised were related to the design considerations and are in Table 5-7. Table 5-7: Key stakeholder comments and Responses Provided Key Comment Response Incorporate a dedicated mortuary to prevent Due to budget constraints, a dedicated mortuary will not be the transfer of highly infectious cadavers to included. The existing hospital mortuary will be utilised with the main hospital mortuary. improvements in safety protocols. 60 Key Comment Response Integrate negative pressure rooms to ensure Negative pressure rooms have been integrated into the design, complete isolation of internal spaces from as shown in the architectural plans. These rooms will help the external environment. contain infectious agents and prevent their spread to other areas. Include decontamination chambers at egress Decontamination chambers have been incorporated at strategic points for staff to undergo decontamination egress points to ensure thorough decontamination of staff after potential exposure. before leaving the isolation areas. Consider private patient rooms for those The design includes private patient rooms to cater to electing for private treatment. individuals seeking private treatment, enhancing patient comfort and care. Ensure distinct segregation between adult The facility design ensures segregation between adult and and paediatric patients. paediatric patients, with dedicated wards and treatment areas for each group. Include lecture halls and offices for trainees Lecture halls and offices for medical trainees have been to foster clinical education and practical included in the design to support continuous education and training. practical training. Include a dedicated kitchen for staff to A dedicated kitchen for staff has been incorporated to reduce minimise unnecessary movement in and out the need for staff to leave the unit for meals, enhancing of the unit. infection control. Strictly control and restrict entry to the unit Access to the unit will be strictly controlled through a to prevent unauthorized access. dedicated security system, ensuring only authorized personnel can enter. Implement continuous training programs for Continuous training programs will be part of the operational staff on managing infectious diseases. strategy to keep staff updated on best practices in infectious disease management. Provide adequate parking space for staff to The design includes additional parking space to accommodate address the current shortage at QECH. the needs of the unit's staff, reducing congestion at QECH. Ensure separate ingress and egress points to Separate ingress and egress points have been incorporated into streamline movement and reduce cross- the design to improve the flow of movement and reduce the contamination risks. risk of cross-contamination. 5.9.2 Grievance Redress Mechanism The construction of the IDU will employ a diverse workforce. To ensure the rights of all workers are respected, a dedicated Workers Grievance Redress Management Committee (WGRMC) must be established to address workers' grievances at the project site. This committee must be the primary point of reference for any complaints, concerns, injustices, or issues workers may face during construction. The mechanism aims to protect workers' rights, promote participation, provide support and benefits to all contractors’ workers, and ensure compliance with Malawi’s labour laws, World Bank Environmental and Social Standards (ESS 2), and GIIPs. 5.9.2.1 Institutional Arrangements for Workers GRM The contractor must establish a WGRMC that must consist of: • Workers’ Representatives: One representative per worker group or section (e.g., general labourers, skilled labourers). These representatives must act as intermediaries between workers and the WGRMC. The worker’s representative should deliberately include female representatives. • Hospital Ombudsman: QECH has an existing GRM that the hospital ombudsman's office handles. This must link the hospital community’s grievances to the construction project. 61 • Environmental, Social, Health, and Safety (ESHS) Expert: Ensure health and safety regulations are followed and assist in grievance resolution. To ensure structured grievance management, the WGRMC members must choose the positions of Chairperson, Vice Chairperson, Secretary, and Vice Secretary. 5.9.2.2 Process and Procedures for Workers GRM All complaints or allegations that are criminal, such as rape, defilement, theft, or any other illegal activity, must be promptly reported to the Police or relevant government authorities for investigation and action in compliance with the World Bank requirements and national legal requirements, ensuring due process and protection of affected individuals. The following process must be implemented to ensure that workers' grievances are addressed promptly and fairly: Stage 1: Complaint Uptake • Submission Methods: Workers may submit complaints directly to their Workers’ Representative or WGRMC members. Grievance boxes must be installed at strategic locations (e.g., canteen areas, entrances, resting areas) to allow workers to submit their grievances anonymously. If workers prefer direct communication, they may also submit their complaints to WGRMC members via phone or text. • Documentation: The Secretary of the WGRMC must record every received complaint in a Grievance Register provided in Annex 10. This register must track the date of the complaint, the nature of the grievance, the complainant's details (if provided), and the actions taken. The ESHS Safeguards Specialist must maintain a copy of the register to ensure easy tracking and accountability for each grievance. • Confidentiality: The GRM must allow anonymous reporting through grievance boxes or digital methods to protect workers' identities if they do not wish to be named. Stage 2: Assessment, Acknowledgment, and Response • Acknowledgement: The WGRMC must acknowledge each grievance within 24 hours of submission. The worker must be informed of the receipt of their grievance through their preferred communication method (verbal, text, or written acknowledgement). • Assessment: The WGRMC must assess the grievance to determine its legitimacy and whether it requires immediate action or further investigation. The assessment must verify the facts of the grievance with the contractor, the workers involved, and relevant documentation. • Response: The committee must develop an appropriate response or resolution plan within five (5) working days of receiving the grievance. If corrective measures are necessary, the responsible parties (e.g., contractor, safety officer) must be informed, and the actions must be taken immediately. Stage 3: Resolution or Escalation • Resolution at WGRMC Level: If the grievance is straightforward and can be resolved quickly, the WGRMC must mediate and take appropriate corrective actions within five (5) days. These actions may include adjustments to working conditions, addressing safety concerns, or resolving payment disputes. 62 • Escalation: If the grievance cannot be resolved at the WGRMC level or if the worker is unsatisfied with the proposed resolution, the complaint must be escalated to the Hospital Grievance Redress Management Committee. • Written Resolution Agreement: If an agreement is reached between the parties, a Grievance Resolution Agreement Minute (provided in Annex 10) must be signed by both the worker and the WGRMC members. The document must outline the agreed-upon corrective measures. Stage 4: Monitoring and Documentation All grievances must be logged in a Grievance Register provided in Annex 10 that tracks the complaint’s status, actions taken, and outcomes. The contractor's ESHS Safeguards Specialist must regularly update this register, which must be available for review by the Consultant and Client. The Secretary must check the grievance boxes daily to ensure timely identification and addressing of grievances. Monthly grievance reports must be prepared to track trends and ensure that grievances are handled promptly and effectively. 5.9.2.3 Monitoring and Evaluation The Workers GRM must be monitored regularly to ensure that it is functioning effectively and that complaints are resolved in a timely manner. Key performance indicators (KPIs) must include: o Number of complaints received. o Percentage of grievances resolved at the first level. o Time taken to resolve grievances. o Trends in types of grievances. 63 Annex 1: Location Maps A1.1 Topography Map of the Project Site A1.2 Location Map of Project Site in Relation to other Hospital Facilities 64 A1.3 Proposed site with other existing facilities. 65 66 Annex 2: Proposed layout plans A1.1 Ground Floor Plan - Isolation 67 A1.2 First Floor Plan - VIP Wards HDU & ICU 68 A1.3 Second Floor Plan - Children Wards 69 A1.4 Middle Block - Ground Floor Plan (Diagnostics) 70 A1.5 Middle Block - First Floor Plan (Maternity) 71 A1.6 Middle Block - Second Floor Plan (Recreation) 72 A1.7 Ground Floor - Male Ward 73 A1.8 First Floor - Maternity Ward 74 A1.9 Second Floor - General Female Ward 75 Annex 3: Project Impacts and their Ratings Impact Extent Probability of Impact Code Reversibility Significance Occurrence Significane Magnitude Activity Project Potential Environmental & Nature of Duration VEC Code Activity Social 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 P2-1M1 Negative 2 2 1 1 2 12 Very Low Excavation Deterioration P2-1 Site clearing & Noise & Vibration Elevated noise levels from P2-1M2 Negative 3 2 1 1 3 21 Low Excavation machinery and construction activities. P2-1 Site clearing & Terrestrial Biodiversity Loss of trees and other ground P2-1M3 Negative 2 3 1 2 2 16 Low Excavation cover. P2-1 Site clearing & Public Health & Safety Potential for accidents and injuries P2-1M4 Negative 3 2 3 2 3 30 Low Excavation on-site affecting workers. P2-1 Site clearing & Public Health & Safety Potential for accidents and injuries P2-1M5 Negative 3 2 3 2 2 20 Low Excavation on-site affecting near-by communities. P2-1 Site clearing & Public Health & Safety Infectious Disease Impact (spread P2-1M6 Negative 3 3 5 5 2 32 Moderate Excavation of STIs, HIV and AIDS, and Covid 19) P2-1 Site clearing & Social Dynamics and Gender-Based Violence (GBV) P2-1M7 Negative 3 3 3 2 3 33 Moderate Excavation Community Well-being and 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 Quality Temporary Air Quality P2-2M2 Negative 2 2 1 1 2 12 Very Low Deterioration 76 Impact Extent Probability of Impact Code Reversibility Significance Occurrence Significane Magnitude Activity Project Potential Environmental & Nature of Duration VEC Code Activity Social Impact Impact Impact Impact Impact Rating P2-2 Super Structure Noise & Vibration Elevated noise levels from P2-2M3 Negative 2 2 1 1 3 18 Low machinery and construction activities. P2-2 Super Structure Public Health & Safety Potential for accidents and injuries P2-2M4 Negative 5 2 3 5 5 75 Ligh on-site affecting workers. P2-2 Super Structure Public Health & Safety Potential for accidents and injuries P2-2M5 Negative 2 1 3 2 3 24 Low on-site affecting near-by communities. P2-2 Super Structure Public Health & Safety Infectious Disease Impact (spread P2-2M6 Negative 3 3 5 2 3 39 Moderate of 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) P2-2M9 Negative 3 2 1 2 3 24 Low Community Well-being and 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 P2-3M2 Negative 3 2 1 1 3 21 Low Framing machinery and construction activities. P2-3 Structural Public Health & Safety Potential for accidents and injuries P2-3M3 Negative 3 2 3 1 3 27 Low Framing on-site affecting workers. P2-3 Structural Public Health & Safety Potential for accidents and injuries P2-3M4 Negative 2 2 3 2 3 27 Low Framing on-site affecting near-by communities. P2-3 Structural Public Health & Safety Infectious Disease Impact (spread P2-3M5 Negative 3 3 5 2 3 39 Moderate Framing of 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. 77 Impact Extent Probability of Impact Code Reversibility Significance Occurrence Significane Magnitude Activity Project Potential Environmental & Nature of Duration VEC Code Activity Social Impact Impact Impact Impact Impact Rating 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 P2-4M2 Negative 3 2 1 1 3 21 Low machinery and construction activities. P2-4 Fit Out Public Health & Safety Potential for accidents and injuries P2-4M3 Negative 3 2 3 1 3 27 Low on-site affecting workers. P2-4 Fit Out Public Health & Safety Potential for accidents and injuries P2-4M4 Negative 2 2 3 2 3 27 Low on-site affecting near-by communities. P2-4 Fit Out Public Health & Safety Infectious Disease Impact (spread P2-4M5 Negative 3 3 5 2 3 39 Moderate of 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 P3-M2 Negative 2 2 3 1 2 16 Low machinery and construction activities. P3 Demobilisation Public Health & Safety Potential for accidents and injuries P3-M3 Negative 2 2 3 2 3 27 Low on-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. 78 79 Annex 4: Stakeholder Consultations A4.1 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? A4.2 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 purpose of stakeholder involvement was to: • Inform the stakeholders about the proposal and its likely effects. • Canvass their inputs, views, and concerns; and • Take account of the information and views of the public in the EIA and decision making. 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. A4.3 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. 80 CONSULTATION MINUTES FOR PROPOSEED CONSTRUCTION OF A NEW INFECTIOUS DISEASE UNIT AT QUEEN ELIZABETH CENTRAL HOSPITAL IN BLANTYRE CITY, MALAWI HELD ON 24TH JUNE 2024. Meeting Agenda: 1. Opening Remarks 2. Introducing the MCERHSPP 3. Medical Doctors reaction to introduction of the project 4. Considerations on the project`s design plans 5. Discussions on potential Environmental and Social Impacts from the proposed project 6. Closing Remarks Members present:3 SN Name Institution Position Contact 2 Nlaziona Banda QECH Pulmonologist 008 Specialist SN DISCUSSION AGREED ACTION 1 Opening Remarks: The meeting commenced at 2 pm, and Gracious Chinguwo and Julius Kalonga, the Environmental and Social Research Consulting (ESRC) delivered the opening remarks at the QECH. 2 Introduction: 2.1 The meeting began with the introduction phase, during this everyone had the opportunity to introduce themselves and state their respective positions. 3 Introducing the Project: 3.1 Julius Kalonga from ESRC expressed his appreciation to the medical doctors for attending the meeting before introducing the project. He conveyed that the The Government of the Republic of Malawi through Ministry of Health has received financing from the International Development Association (IDA) towards the cost of The Malawi COVID-19 Emergency Response and Health Systems Preparedness Project and intends to apply part of the proceeds for the construction of infectious Diseases units in 3 central hospitals of Queen Elizabeth in Blantyre. ESRC, as a consultancy firm, has been entrusted with the responsibility of conducting the ESMP for construction of a new Infectious Disease Unit at Queen Eizabeth Central Hospital in Blantyre City, Malawi. The ESMP aimed to evaluate and anticipate potential social and environmental 81 SN DISCUSSION AGREED ACTION impacts associated with the construction of the infectious disease unit. 4 Medical Doctor’s reaction to introduction of the project: 4.1 The Medical Doctors expressed their gratitude of the QECH benefitting Infectious Disease Unit from this project, that it will help the hospital to deal with infectious diseases well. 5 Considerations on project design plans: The 1. The unit should incorporate a dedicated Medical Doctors were asked of what to consider in mortuary to prevent the transfer of the proposed Infectious Disease Unit at QECH highly infectious cadavers to the main hospital mortuary, which lacks adequate containment capabilities. 2. The architectural design should integrate negative pressure rooms to ensure complete isolation of internal spaces from the external environment. 3. The design must include decontamination chambers at egress points for staff to undergo thorough decontamination procedures following potential exposure to infectious agents. 4. Consideration should be given to incorporating private patient rooms for those electing for private treatment. 5. There should be distinct segregation between adult and pediatric patients within the facility. 6. The facility should include lecture halls and offices for trainees, fostering an environment conducive to clinical education and practical training for medical students from institutions such as KUHeS. 7. A dedicated kitchen for staff should be included to minimize the necessity for movement in and out of the unit. 8. Entry to the unit should be strictly controlled and restricted. 9. Continuous training programs for staff on the management of infectious diseases should be implemented. 82 SN DISCUSSION AGREED ACTION 10. Provision for adequate parking space for staff should be made, addressing the current shortage of parking at QECH. 11. The design should feature separate ingress and egress points to streamline movement and reduce cross- contamination risks. 6 Anticipated Positive Impacts of the project according to the Medical Doctors: The Medical Doctors were asked of potential positive impacts of the project as the following were the key potential impacts identified: 6.1.1 The Medical Doctors also put forward the The project’s construction phase should suggestion that the project's implementation would consider employing from the community. lead to an increase in job opportunities. 6.1.2 Medical doctors anticipated that the facility would They should consider including lecturer rooms provide research and teaching opportunity. and students’ office in the facility. 6.1.3 The facility will provide specialised patient care The government should employ more specialist. even for dangerous infectious diseases. 6.2 Anticipated Negative Impacts of the project according to the Medical Doctors: The Medical Doctors were asked of potential negative impacts of the project as the following were the key potential impacts identified: 6.2.1 Influx of patients over limited staff Government should employ more staff for QECH 6.2.2 Non-compliance of infectious disease measures to All health safety measures should be followed. contain infections. Health staff getting infected while on duty Health staff should get compensated when infected while on duty. 7 Closing Remarks In the concluding remarks, the Medical Doctors expressed sincere appreciation to the Environmental and Social Research Consulting (ESRC) team for consulting them. NAME ISSUES RAISED SUGGESTED MEASURES Samuel The infectious disease unit at the The unit will need to implement advanced diagnostic Banda and hospital will help identify diseases technologies and provide continuous training for Diana quickly, thereby preventing their medical staff. Dodoma spread Establish a rapid response protocol for emerging Environm infectious threats. 83 ental The establishment of the infectious a proper landscaping plan should be developed to Health disease unit may lead to deforestation plant new trees and vegetation around the infectious Officers on the site, as there are disease unit to maintain and enhance the green space. approximately trees in the area that provide benefits such as shade hospital It will require relocating people. This Use signage and regular updates to guide people to is because the area currently serves as alternative parking and waiting areas a space where staff park their cars to Ensure clear and accessible pathways to and from the stay in the shade, and it is also a unit to minimize disruption to other hospital areas common spot where patients' guardians and other visitors usually sit. The project will create may create Frequently spray water on construction sites, dust emissions resulting from the use particularly on unpaved roads, excavation areas, and of heavy machinery during material stockpiles, to keep dust particles from construction works becoming airborne Erect solid barriers or fences around the construction site to contain dust within the area. Kamone will have access to more specialized Investing in continuous education and training Chimphan and detailed data on infectious programs for lab personnel enhances go-HMS diseases, enhancing the overall quality of the hospital's data. More people will be employed at the They should employ more workers to meet the facility. demand on the ground. Patients will be accessing good free They should employ more workers to meet the services that might be expensive in demand on the ground. other hospitals to access The unit can provide valuable data they should use advanced statistical ways of keeping for research on infectious diseases, data. potentially leading to improved treatments and interventions. The project will create jobs for Offer job opportunities for both men and females and healthcare professionals during the offering fair wages operation phase and employment of both skilled and unskilled workers during construction phase The project will create may create Erect temporary barriers or enclosures around the dust emissions resulting from the use construction site to contain dust and prevent it from of heavy machinery during spreading. construction works Use water sprays or dust suppression systems to minimize dust during construction activities. Provide construction workers and staff with appropriate PPE, such as masks and respirators, to protect them from inhaling dust. The project may promote issues of Ensure strict enforcement of existing child labor laws child labor, as some parents might and regulations. send their children to do business at the construction sites. During the construction work, there Develop and implement comprehensive waste may be issues of improper waste management plans for both construction sites and management, leading to land infectious diseases facilities. These plans should 84 pollution, such as oil spillages due to include procedures for segregating, storing, and the use of vehicles. Additionally, disposing of different types of waste. during the operation of the unit there Ensure that chemicals and hazardous waste are stored might be a risk of improper handling securely and labelled correctly to prevent spills and waste generated from the unit accidents during operation Finess Ensure all resources are available for the unit Leonard, Patient 85 86 Annex 5: Code of Conduct for Contractor 1. Purpose This Code of Conduct ensures that all contractor employees, supervisors, and subcontractors maintain a high standard of ethical behaviour, respect, and integrity during construction activities. The code aims to create a safe, respectful, and inclusive working environment and minimise risks such as environmental damage, safety hazards, child labour, gender-based violence (GBV), and sexual exploitation and abuse (SEA). 2. Scope This Code of Conduct applies to all contractor staff, including permanent and temporary workers, subcontractors, and other individuals or entities working on the construction site. 3. General Responsibilities All contractor employees are expected to: • Comply with all national laws, regulations, and standards, as well as the Environmental and Social Management Plan (ESMP), Occupational Health and Safety (OHS) guidelines, and the requirements of this project. • Report any violations of this code or inappropriate behaviour to the Workers’ Grievance Redress Mechanism (GRM). • Ensure safety and avoid any actions that could harm themselves, other workers, hospital staff, patients, guardians, or the community. 4. Health, Safety, and Environment • Follow all health and safety guidelines, including the proper use of Personal Protective Equipment (PPE), safe operation of machinery, and adherence to safety protocols. • Protect the natural environment by minimising waste, using designated waste disposal facilities, and avoiding unnecessary destruction of flora and fauna around the project site. • Immediately report workplace accidents, injuries, spills, or hazardous conditions to the site supervisor. 5. Zero Tolerance for Child Labor • Under no circumstances shall child labour be used on the construction site. All workers must be of legal working age as defined by national labour laws and World Bank Environmental and Social Standards (ESS 2). • Workers' ages shall be verified before employment, and ongoing monitoring will ensure compliance with this requirement. 6. Prevention of Gender-Based Violence (GBV) and Sexual Exploitation and Abuse (SEA) 87 • All workers must behave respectfully toward the community, patients, hospital staff, and fellow workers. GBV, including sexual harassment, discrimination, or any form of abuse, will not be tolerated. • Sexual exploitation and abuse of vulnerable individuals, such as patients, guardians, or community members, is strictly prohibited. • Workers must avoid inappropriate conduct, including but not limited to making unwelcome advances, comments of a sexual nature, and coercion of sexual favours. • Workers are prohibited from engaging in transactional sex, whether for goods, money, or services. • All incidents of GBV or SEA must be reported immediately to the Workers’ Grievance Redress Mechanism (GRM). 7. Prohibition of Discrimination • Treat all individuals with dignity and respect regardless of gender, age, disability, ethnicity, religion, or sexual orientation. • Recruitment, promotion, and employment practices shall be free from discrimination. All job applicants and employees will have equal opportunities based on their skills and qualifications. 8. Respect for Local Community and Hospital Operations • Respect the local community's rights, cultures, and practices, including hospital staff and patients. • Avoid disrupting hospital operations, including maintaining controlled access to the construction site and minimising noise, dust, and pollution. • Follow the established communication protocols with hospital management to coordinate construction activities, particularly those that may impact hospital operations. 9. Appropriate Use of Equipment and Resources • All construction equipment and resources shall be used responsibly and only for their intended purposes. • Avoid misuse or damage to property, machinery, materials, and equipment provided for the project. • Theft, vandalism, or unauthorised use of project resources is strictly prohibited. 10. Substance Abuse • The use, possession, or distribution of illegal drugs, alcohol, or other intoxicating substances on the construction site is strictly prohibited. • Workers found under the influence of substances while on duty will face disciplinary action, including potential termination of employment. 88 11. Reporting and Accountability • All workers must report any violations of this Code of Conduct to their supervisor, the contractor's Environmental, Social, Health, and Safety (ESHS) Officer, or through the Workers’ Grievance Redress Mechanism (GRM). • Supervisors and management are responsible for acting promptly and fairly on reported incidents and ensuring that all reports are treated confidentially and without retaliation against the complainant. 12. Disciplinary Actions Violations of this Code of Conduct will result in disciplinary action, which may include: • Verbal or written warnings. • Mandatory retraining on the Code of Conduct. • Suspension or termination of employment. • Referral to law enforcement authorities, especially in cases involving criminal activities such as GBV, SEA, theft, or violence. 13. Acknowledgment All contractor employees, supervisors, and subcontractors must sign this Code of Conduct to acknowledge their understanding of the requirements and their commitment to adhering to these standards throughout the project's duration. Signature: ___________________________ Name: ___________________________ Position: ___________________________ Date: ___________________________ 89 Annex 6: Guide for Developing an Infection Control Plan Please follow the structured guide below to assist in developing a hospital-specific infection control plan for the Infectious Disease Unit at the Queen Elizabeth Central Hospital. This guide integrates key components from WHO and World Bank guidelines and provides clear directives for implementation. A6.1 Establish Governance and Responsibilities • Infection Prevention Committee (IPC): Form a multidisciplinary team including healthcare workers, infection control specialists, and administrative staff to oversee and implement the infection control plan. • Infection Prevention Officer (IPO): Appoint a trained individual responsible for the daily management and monitoring of infection control practices. A6.2 Develop Comprehensive Infection Control Policies • Hand Hygiene: o Implement WHO’s "My Five Moments for Hand Hygiene". o Ensure hand washing facilities and alcohol-based hand rubs are accessible at key locations such as entry points, patient rooms, and treatment areas. o Train all staff on proper hand hygiene techniques. • Personal Protective Equipment (PPE): o Define and provide appropriate PPE for different tasks and areas. o Train staff on the correct use, donning, doffing, and disposal of PPE. • Isolation Precautions: o Develop protocols for isolating patients with infectious diseases. o Ensure isolation rooms have negative pressure ventilation and dedicated hand washing facilities. A6.3 Implement Environmental Cleaning and Disinfection Protocols • Routine Cleaning: o Establish daily cleaning schedules using EPA-approved disinfectants. o Focus on high-touch surfaces such as doorknobs, bed rails, and medical equipment. • Terminal Cleaning: o Perform thorough cleaning and disinfection of patient rooms upon discharge or transfer. • Waste Management: o Segregate, handle, and dispose of medical waste according to WHO guidelines. o Use colour-coded bins and ensure proper labelling. A6.4 Establish Surveillance and Reporting Systems • Infection Surveillance: 90 o Monitor hospital-acquired infections (HAIs) by collecting and analyzing data on infection rates, sources, and trends. • Outbreak Management: o Develop protocols for identifying and managing infection outbreaks, including steps for isolation, treatment, and reporting to health authorities. A6.5 Create an Antibiotic Stewardship Program • Antibiotic Use Policies: o Implement guidelines for the appropriate use of antibiotics to prevent the development of resistant strains. • Monitoring and Review: o Regularly review antibiotic prescribing patterns and adjust policies based on surveillance data. A6.6 Provide Staff Training and Education • Ongoing Education: o Conduct regular training sessions on infection prevention and control practices. • Competency Assessments: o Periodically assess staff proficiency in infection control procedures. A6.7 Educate Patients and Visitors • Information Dissemination: o Provide educational materials on infection prevention to patients and visitors using posters, pamphlets, and digital displays. • Visitor Policies: o Restrict visitor access to high-risk areas and provide hand hygiene and PPE guidelines. A6.8 Ensure Facility Design and Maintenance Support Infection Control • Ventilation Systems: o Ensure proper ventilation in patient rooms and treatment areas to reduce airborne transmission, using HEPA filters where necessary. • Facility Layout: o Design the unit to minimize cross-contamination, with dedicated pathways for clean and contaminated materials. A6.9 Prepare for Emergencies • Emergency Infection Control Procedures: o Develop protocols for infection control during emergencies such as pandemics or natural disasters. • Supply Chain Management: 91 o Maintain a stockpile of essential infection control supplies, including PPE, disinfectants, and antibiotics. A6.10 Implementation and Continuous Monitoring • Regular Audits: o Conduct regular audits to ensure compliance with infection control practices. • Feedback Mechanism: o Establish a system for reporting and addressing infection control hazards promptly. • Continuous Improvement: o Data from surveillance and audits should be used to improve infection control measures continually. 92 Annex 7: Life and Fire Safety Plan A7.1 General Safety Measures 1. Fire Detection and Alarm Systems: o Install smoke detectors and fire alarms throughout the unit, ensuring they are connected to a central alarm system. o Place manual call points at strategic locations, including near exits and in high-risk areas. 2. Emergency Lighting and Signage: o Ensure all escape routes and exits are clearly marked with illuminated signs. o Install emergency lighting along escape routes to provide visibility during power outages. 3. Fire Suppression Systems: o Equip the facility with fire extinguishers, ensuring they are appropriate for different types of fires (e.g., electrical, chemical). o Install sprinkler systems in high-risk areas like the laboratory, radiology room, and operating theatres. 4. Evacuation Plans: o Develop and display clear evacuation maps on each floor, indicating all exits, escape routes, and assembly points. o Conduct regular fire drills to ensure staff and patients are familiar with evacuation procedures. 5. Fire Safety Training: o Provide comprehensive fire safety training for all staff, including the use of fire extinguishers and evacuation protocols. o Include specific training for handling infectious disease areas and the safe movement of patients in such zones. A7.2 Ground Floor Safety Measures 1. Wide Walkways (3,600 mm to 4,200 mm): o Ensure walkways are free of obstructions to facilitate rapid evacuation. o Maintain clear access to emergency services. 2. Public Restrooms (1,200 mm wide): o Install fire-resistant doors and keep them closed to prevent the spread of smoke and fire. 3. Physiotherapy and Recreation Rooms (3,000 mm to 3,600 mm wide): 93 o Equip these rooms with smoke detectors and ensure windows can be used as alternative escape routes. A7.3 Second Floor Safety Measures 1. Diagnostic and Maternity Services: o Due to the presence of electrical equipment, equip the ultrasound, CT scan, and X- ray rooms with localised fire suppression systems. o Ensure waiting areas have clear signage and escape routes. 2. Storage/Records and Collection Points (1,000 mm to 2,000 mm wide): o Use fire-resistant materials for storage areas and ensure proper ventilation. A7.4 Isolation and ICU Safety Measures 1. Isolation Rooms (3,400 mm wide): o Ensure these rooms have independent ventilation systems to prevent cross- contamination. o Provide direct access to evacuation routes and ensure these routes are not shared with general wards. 2. ICU and HDU: o Place nurse stations strategically to monitor all exits and escape routes. o Equip VIP wards with additional safety measures, such as personal fire alarms. A7.5 Children's Ward Safety Measures 1. Children's Wards (1,200 mm to 1,600 mm wide): o Install child-friendly emergency exits and ensure staff are trained to assist children during evacuations. o Equip classrooms and lounges with smoke detectors and fire suppression systems. A7.6 General Wards Safety Measures 1. 4-bed Wards (2,500 mm to 5,600 mm wide): o Ensure wide corridors to facilitate the movement of beds and medical equipment during an evacuation. o Install fire doors that automatically close in the event of a fire. A7.7 Implementation and Monitoring • Regular Audits: Conduct fire safety audits to ensure compliance with Malawi regulations and International Best Practices. • Maintenance: Ensure all fire safety equipment is regularly maintained and inspected. • Reporting: Establish a system for reporting and addressing fire safety hazards promptly. 94 Annex 8: Traffic Management Plan Given the dense population and significant commercial and transportation activity around Queen Elizabeth Central Hospital, it is crucial to implement a comprehensive traffic management plan during the construction of the 150-bed Infectious Diseases Unit. The following plan aims to minimize traffic congestion, enhance road safety, and ensure smooth transportation operations. A8.1 Assessment and Planning • Traffic Impact Assessment (TIA): Conduct a thorough TIA to understand the potential impact of construction activities on local traffic patterns. This should include peak traffic times, road capacities, and key congestion points. • Stakeholder Consultation: Engage with local authorities, community leaders, and stakeholders to discuss the proposed traffic management measures and obtain necessary approvals. Also note that the project SEP provides the guidance for carrying out consultation for the project, and participation of project representatives (PIU) in these events is a must. A8.2 Traffic Control Measures • Temporary Traffic Signals and Signs: Install temporary traffic signals and signs around the construction site to guide drivers and pedestrians. Clearly mark detour routes and alternative pathways. • Road Closures and Diversions: Plan and schedule road closures and diversions during off-peak hours to minimize disruption. Provide advance notice to the public about these changes. • Dedicated Construction Routes: Designate specific routes for construction vehicles to minimize their impact on general traffic. Ensure these routes avoid high pedestrian areas and critical hospital access points. A8.3 Construction Logistics • Staging Areas: Establish staging areas for construction materials and equipment to reduce on-site congestion. These areas should be located away from main traffic routes. • Scheduled Deliveries: Coordinate the timing of deliveries to avoid peak traffic hours. Use smaller, more frequent deliveries if necessary to reduce the impact on traffic flow. A8.4 Pedestrian Safety • Pedestrian Pathways: Create safe and clearly marked pedestrian pathways around the construction site. Use barriers to separate pedestrians from construction activities. • Crossing Guards: Deploy crossing guards at critical points to assist pedestrians, especially during peak hospital visiting hours. A8.5 Public Communication 95 • Information Dissemination: Use multiple channels (e.g., local radio, social media, hospital newsletters) to keep the public informed about construction schedules, road closures, and alternative routes. • Signage and Maps: Provide clear signage and maps around the hospital to help drivers and pedestrians navigate the area during construction. A8.6 Emergency Access • Uninterrupted Emergency Routes: Ensure that access routes for emergency vehicles to the hospital are always clear and unobstructed. Coordinate with hospital security and local emergency services to develop contingency plans. • Regular Coordination: Hold regular coordination meetings with emergency services to review and adjust access routes as needed. A8.7 Monitoring and Adjustments • Traffic Monitors: Deploy traffic monitors to observe and report on traffic conditions in real-time. Use their feedback to make immediate adjustments to traffic control measures. • Regular Reviews: Conduct weekly reviews of traffic management measures and make necessary adjustments based on feedback from stakeholders and observed traffic patterns. A8.8 Post-Construction • Site Restoration: Ensure that all temporary traffic control devices are removed and the area is restored to its original condition. Repair any road surfaces or pedestrian pathways damaged during construction. • Feedback and Evaluation: Collect feedback from the community and stakeholders on the effectiveness of the traffic management plan. Use this feedback to improve future projects. 96 Annex 9: Stakeholder Engagement and Disclosure Plan for ESMP This Stakeholder Engagement and Disclosure Plan aims to ensure that all stakeholders, including affected communities and QECH campus users, are well-informed about the project and its potential impacts and have channels to provide feedback. The key objectives of this plan are as follows: • Inform stakeholders about the project's potential environmental and social impacts, such as noise and traffic. • Provide accessible channels for feedback and inquiries. • Demonstrate a commitment to engaging stakeholders, addressing their concerns, and managing risks responsibly. A9.1 Targeted Stakeholders • Affected Parties: o QECH staff, patients, guardians, and visitors who use the facilities and will be directly impacted by construction activities. o Nearby institutions include commercial establishments and educational institutions who may be affected by noise, dust, and traffic during construction. • Interested Parties: o Broader community members, including those who may use the highway adjacent to the QECH for access. o Government agencies, local leaders, and community representatives who have a vested interest in public health and environmental management. • Vulnerable Groups: o Patients with specific health needs, children, elderly individuals, and people with disabilities who construction activities may particularly impact. A9.2 Disclosure Methods • On-site Information Display: o Post informative signs and posters around the QECH campus (entrances, waiting areas, construction site) detailing the project, expected impacts, mitigation measures, and contact information for feedback. • Public Notice Boards: o Set up notice boards at community centres, local government offices, and nearby high-traffic locations to reach residents. • Electronic and Print Media: o Use the Ministry of Health website, local newspapers, and community radio announcements to reach a wider audience, especially potential users from outside Blantyre. • Periodic Updates: 97 o Monthly updates on construction progress, scheduled activities, and any high- impact work to keep stakeholders informed. A9.3 Feedback and Grievance Mechanisms • Grievance Redress Mechanism (GRM): o Dedicated Phone Line: For calls and texts related to concerns or inquiries. o Email Contact: A specific email address for written submissions. o Feedback Boxes: Physical boxes on the QECH campus and nearby community centers for anonymous submissions. • Daily Review of Feedback: o Daily monitoring of feedback channels to ensure timely response to issues. • Documentation: o Maintain a log of all feedback, documenting responses, actions taken, and timelines for follow-up. Documenting of the GRM will use GRM registers provided in Annex 10. A9.4 Roles and Responsibilities • Ministry of Health / PIU: o Oversee the implementation of the engagement plan, ensure that information is disseminated, and respond to stakeholder concerns through the GRM. o Submit quarterly reports on engagement activities and feedback to the World Bank as part of the ESMP monitoring. • QECH Administration: o Facilitate access to QECH facilities for posting notices, placing feedback boxes, and sharing information with hospital users. • Contractor and Supervision Consultant: o Ensure that construction activities minimise disruptions and that stakeholder concerns related to construction are addressed promptly. A9.5 Monitoring and Reporting • Regular Review: o Weekly reviews of stakeholder feedback to identify and address common concerns. All documented feedback will be reviewed for timely resolution. • Monthly Reporting: o Summarise stakeholder engagement activities, feedback, and corrective actions in monthly reports for internal review and submission to the PIU. • Performance Evaluation: 98 o Periodic assessments to ensure that engagement methods are effective and stakeholder concerns are being addressed, with modifications to the plan as necessary. A9.6 Timeline for Disclosure and Engagement Activities • Pre-Construction Phase: o Initial disclosure of the ESMP and key project details, with an emphasis on anticipated impacts and feedback mechanisms. • Construction Phase: o Regular updates, including high-impact activities and continuous availability of feedback mechanisms. • Operational Phase: o Periodic engagement and feedback mechanisms remain open to address any ongoing community concerns. A9.7 Record of Disclosure Efforts A record of all disclosure activities will be maintained, including: • Locations and times of information postings. • Summary of outreach through media and public notices. • Documentation of meetings, queries received, and responses given to illustrate the project’s commitment to transparent communication and engagement. 99 Annex 10: Grievance Redress Mechanism Registers A10.1 Grievance Reporting Form 1. Complainant’s Information (The identity of complainants must be kept confidential if they request so.) 2. Brief Description of the problem: 3. Description of the Complaint (a) What harm do you believe the project caused or is likely to cause to you? (b) Why do you believe that the alleged harm results directly from the PROJECT? (c) Do you have any other supporting documents that you would like to share? 4. Previous Efforts to Resolve the Complaint (a) Have you raised your complaint with any other authorities? No� Yes � (a)Have you raised your complaint with any other authorities? No � Yes � If Yes (Please, provide the following details): When?: • How and with whom the issues were raised? • Please describe any response received from and/or any actions taken by the project level grievance mechanism. • Please also explain why the response or actions taken are not satisfactory. If No, Why? (b) How do you wish to see the complaint resolved? 5. Name of the person who completed this form: Signature: Date: 100 A10.2 Grievance Registration * This Form will be linked to FORM I according to REFERENCE NUMBER: 1. Complainant Details:- Name of Complainant: (NB if more than 1 complainant, Category of Complainant (enter code - see codes below): include details of 1 complainant) State Preferred mode of contact (Phone, Email): Phone: Email: 2. Classification of Complaint (Put an X in applicable box) Discrimination Sexual harassment Unsatisfactory working conditions Non reimbursement of property Payment Issues Other forms of workplace bullying Other (specify): Unsafe practices or working conditions Sexual abuse 3. Propellant of Grievance Community Member(s) Other (Specify): 4. Recommendation by Complainant (Please write in the box - attach if necessary) Refer to Form I Item 4(b) 5. Complaint Registered by: Name: Signature: Date: Position: 6. Complainant Notified of Receipt of Complaint by (to be done within 5 days upon Complaint Registration): Name: Signature: Date: Position: 7. Mode of Communication used: Telephone (include telephone number used) Email (include e-mail address used ) Post Office Box/Bag (include box number used) 101 A10. 3: Grievance Resolution Agreement Minute (GRAM) RESPONDENT DETAILS COMPLAINANT DETAILS Full name Full name Address: Address: Phone No. Phone No. (home/cell) IF (home/cell) ANY IF ANY Email: Email: Date of Location complaint resolution SUMMARY OF RESOULTION (a) Brief description of Complaint: (b) Brief description of Resolution SIGNATURES Respondent Complainant Signature Signature Name of Name of Respondent Complainant Date Date Witness Witness Signature Signature Name of Name of Respondent’s Complainant’s Witness Witness Date Date 102 A10.4: Grievance Resolution Implementation Minute (GRIM) RESPONDENT DETAILS COMPLAINANT DETAILS Full name Full name Address: Address: Phone No. Phone No. (home/cell) (home/cell) IF ANY IF ANY Email: Email: Date of complaint resolution SUMMARY OF RESOULTION IMPLEMENTATION SIGNATURES Respondent Complainant Signature Signature Name of Name of Respondent Complainant Date Date Witness Witness Signature Signature Name of Name of Respondent’s Complainant’s Witness Witness Date Date 103