The Co-operative Republic of Guyana Ministry of Health Guyana COVID-19 Emergency Response Project (P175268) Final Version STAKEHOLDER ENGAGEMENT PLAN May 6, 2021 1 Contents List of Acronyms ............................................................................................................................ 3 I. Introduction ................................................................................................................... 4 II. Project components and Project Development Objective (PDO) ............................... 6 III. Summary of previous stakeholder engagement activities .......................................... 9 IV. Stakeholder identification and analysis ..................................................................... 17 4.1. Project Affected Parties ........................................................................................................... 18 4.2. Other interested parties .......................................................................................................... 20 4.3. Disadvantaged / vulnerable individuals or groups .................................................................. 20 4.4. Summary of project stakeholder needs .................................................................................. 22 4.5. Language needs for Indigenous Peoples ................................................................................. 36 V. Stakeholder Engagement Program ............................................................................. 38 5.1. Proposed strategy for information disclosure ......................................................................... 39 5.2. Stakeholder Engagement Plan ................................................................................................. 41 5.3 Reporting back to stakeholders ...................................................................................................... 42 VI. Resources and Responsibilities for implementing stakeholder engagement activities....................................................................................................................... 43 6.1. Resources ................................................................................................................................. 43 6.2. Management functions and responsibilities ........................................................................... 43 VII. Grievance Redress Mechanism ................................................................................... 45 7.1. Description of the project GRM ................................................................................................ 46 7.2. World Bank Grievance Redressal Service (GRS) ...................................................................... 50 7.3. Addressing Gender-Based Violence......................................................................................... 51 7.4. Building Grievance Redress Mechanism Awareness ............................................................... 52 VIII. Monitoring and Reporting .......................................................................................... 52 8.1. Reporting back to stakeholder groups..................................................................................... 52 Annex 1. Report on first round of consultations ....................................................................... 53 Annex 2. GRM logbook example ................................................................................................ 57 Annex 3. Report on second round of consultations. ................................................................. 58 Annex 4. Report on third round of consultations. ..................................................................... 65 2 List of Acronyms ESCP Environmental and Social Commitment Plan ESF Environmental and Social Framework ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan E&S Environmental and Social GPHC Georgetown Public Hospital Corporation HEOC Health Emergency Operations Centre HCW Health Care Workers HSDU Health Sector Development Unit ICU Intensive Care Unit IPP Indigenous Peoples Plan IPF Investment Project Financing LMP Labour Management Procedures MPA Multiphase Programmatic Approach MOH Ministry of Health NPHRL National Public Health Reference Laboratory PAHO Pan American Health Organization PEF Pandemic Emergency Financing Facility PDO Project Development Objective PIU Project Implementation Unit RDC Regional Democratic Councils RHO Regional Health Officers SPRP Strategic Preparedness and Response Program SEP Stakeholder Engagement Plant UNOPS United Nations Office for Project Services WB World Bank WBG World Bank Group WHO World Health Organization 3 I. Introduction An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS- CoV-2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China increased rapidly worldwide and on March 11, 2020, the World Health Organization (WHO) declared a global pandemic. As of October 13, 2020, there have been 37.70 million confirmed cases of COVID-19, including 1.07 million deaths in 216 countries, reported to WHO. The COVID-19 epidemic started in Guyana in March 2020, while its incidence substantially increased from August 2020. Guyana announced the first case of COVID-19 on 11 March 2020. On that same day, the WHO declared the outbreak of the COVID-19 as a global pandemic following its rapid spread across the world. On 31 July 2020, the total number of confirmed cases in Guyana was 4131, and the national incidence was less than 1 per 10,000 population for each week up to that point. The last available epidemiological bulletin for Guyana reported that 3,147 COVID-19 cases were confirmed as of October 3, 2020 and the national incidence reached 5.5 per 10,000 population during the fourth week of September 20202. The total number of COVID-19 active cases reached 807 by October 3, 2020, in Guyana. The regions with the highest number of active cases are: Region 4 (72.1 percent), where the capital city is located and which hosts more than 40 percent of the country’s population, Region 3 (8.6 percent), Region 1 (7.3 percent), Region 7 (4.8 percent). Region 1, and 7 are situated at the boarders with Venezuela and Brazil and host a high proportion of indigenous population. To tackle the COVID-19 outbreak, the MOH outlined a COVID-19 Preparedness and Response Plan and activated the Health Emergency Operations Centre (HEOC) to oversee coordination and implementation of the Plan and support inter-sectoral coordination. The Plan was designed at the beginning of the Guyana epidemic in March 2020, and then updated in July 20203. It included an assessment of the main risks and identifies strategic priority areas to effectively respond to COVID-19. One of the main risks identified in the Plan concerns the vulnerability to imported COVID-19 cases, as Guyana has unofficial points of entry with no screening facilities and human resource capacities. Other major risks concern difficulties in implementing physical distancing measures and limited health system’s capacity. The health system lacks adequate supplies, equipment, and personnel to respond to the outbreak, especially in the hinterland regions. In terms of personnel, for example, Guyana has 1 https://www.worldometers.info/coronavirus/country/guyana/ 2 PAH0 (2020). COVID-19 Epidemiological Bulletin Guyana Epidemiological Week 38 / September 19, 2020 3 Ministry of Public Health of Guyana (2020). Coronavirus Disease Covid-19 Preparedness and Response Plan 4 1.04 nurses and midwifes per 1,000 people and 0.8 physicians per 1,000 people, which is well below the LAC average of 5.06 and 2.2, respectively, suggesting a need for increasing numbers of health workers.4 Also, there is a need for improving the capacity of health personnel to fight COVID-19 by providing them with appropriate training. Because of the substantial increase in COVID-19 active cases over August and September 2020, the Ministry of Health (MOH) requested additional resources to finance its COVID-19 Response Plan and improve and decentralize the health system’s capacity in testing and treatment. The risk of limited health system’s capacity, originally detected in the COVID-19 Response Plan, become an issue as the outbreak grew. In terms of treatment, for example, Guyana counts only on 12 fully equipped Intensive Care Unit (ICU) beds concentred in the Georgetown Public Hospital. Also, the present testing capacity, based on the National Public Health Reference Laboratory (NPHRL), is unable to meet one of the pillars of the COVID-19 Plan (i.e., large-scale testing for COVID-19), especially in the hinterland regions. The national COVID-19 testing rate was 16.1 per 10,000 population during the week September 27- October 3, 2020; however, while Region 4 achieved a testing rate of 28 for 10,000 population, 5 out of 10 regions had a testing rate inferior to 10 per for 10,000 population5. The World Bank (WB) is already contributing to the government’s response to the pandemic. Guyana benefitted from a $1m grant through the World Bank administered Pandemic Emergency Financing Facility (PEF). The grant was disbursed to WHO/Pan American Health Organization (PAHO), Guyana’s implementing partner, in late July 2020. Through an ongoing operation, the Education Sector Improvement Project (Credit No. 6009-GY), the Bank is supporting the country’s efforts to adapt to COVID-19 in the education sector through the prioritizing of the curriculum, training of teachers and modifying the national assessments. Through the Guyana Secondary Education Improvement Project (Credit No. 5473-GY), The WB will finance smart classrooms and tablet programs at the secondary level to aid distance learning, specifically benefiting rural and hinterland populations. Additionally, a Global Partnership for Education grant (US$7m) is being prepared that will promote technology- assisted learning and support a tablets program for mathematics and literacy at the nursery and primary levels. As part of the WB contributions to the government’s response to the pandemic, the WB is financing an emergency response project to Guyana (Guyana COVID-19 Project). This response under the 4 World Bank (2020). Physicians (per 1,000 people) - Guyana, Latin America & Caribbean. Retrieved from https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=GY-ZJ 5 PAH0 (2020). COVID-19 Epidemiological Bulletin Guyana Epidemiological Week 40 / October 3, 2020 5 COVID-19 Strategic Preparedness and Response Program (SPRP) using the Multiphase Programmatic Approach (MPA) 6., approved by the World Bank Group’s (WBG) Board of Executive Directors on April 2, 2020 with an overall Program financing envelope of up to US$6.00 billion.7 The project supports adaptive learning throughout project implementation, as well as from such organizations as the WHO, PAHO, United Nations Office for Project Services (UNOPS), and others . Given the limited experience with the evolving pandemic, the exchange of information across countries, facilitated by international partners such as the WBG, will be instrumental for Guyana in terms of managing its response to COVID-19. The areas for learning include options for effective supply chain mechanisms during times of emergencies and disrupted global supply chains, including assessments for timely distribution of medicines and other medical supplies. II. Project components and Project Development Objective (PDO) The Guyana COVID-19 Project was prepared under the global framework of the World Bank Group COVID-19 Response financed under the Fast Track COVID-19 Facility. The PDO is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Guyana. The project’s cost will be 7.5 million USD. The activities funded by the Project are aligned with the overall Government of Guyana's strategy to prevent and control COVID-19 infections in the country and with the World Bank's COVID-19 MPA. The Project will contribute to the MOH’s efforts to enhance national systems to prevent further new cases of COVID-19, detect existing cases circulating in the communities across the country, isolate and quarantine asymptomatic COVID-19 positive cases, identify persons through contact tracing who might be at risk for infection by the COVID-19 virus and effectively treat COVID-19 cases in need of hospital care. It will also help create citizen buy-in and generate demand for services through a risk communication and awareness campaign for behaviour modification in the fight against COVID-19. In particular, the project will support the MOH’s strategy to strengthen the network of laboratories and 6 MPA is a World Bank financing instrument that allows countries the flexibility to implement an approach to achieve development objectives in stages when: the development challenge is complex; it would take a longer time to achieve the objectives; it would take a longer time to prepare one large project; the solution needs a broader and comprehensive approach; or when a stop-and-go approach is not feasible. Projects under an MPA program may be financed by 7 Global MPA PAD P173789. Report No. PCBASIC0219761 6 treatment facilities across the country, improving capacities of regional hubs to detect, trace and treat COVID-19 cases. Project components are: Component 1: Emergency Response to COVID-19 (US$ 7.00 million). This component focuses on three priority areas (priority areas 1,2, and 5)8 identified by the Government: (i) strengthen laboratory capacity, support screening and surveillance capacity to gain better intelligence on the COVID-19 virus presence and spread in Guyana; (ii) expand, decentralize and improve contact tracing particularly in border regions; and (iii) strengthen the health system for more effective treatment and care of symptomatic patients, quarantine and isolation of less severe and asymptomatic cases, and prepare for effective deployment of a safe and approved COVID-19 vaccine. This component will consist of 2 subcomponents. Subcomponent 1.1: Case Detection, Confirmation, Contact Tracing, Recording, Reporting . This subcomponent supports activities to strengthen the capacity of the system to diagnose and trace contacts of COVID-19 cases. In particular, it will focus on strengthening disease surveillance systems, public health laboratories, and epidemiological capacity for early detection and confirmation of cases and combining detection of cases with active contact tracing (focus areas 1 and 2). This will be addressed by: (i) Improving the diagnostic capacity for COVID-19 in the National Public Health Reference Laboratory and in selected hospital labs around the country; improving general laboratory services to enhance clinical management and screening of COVID-19 cases; establishing a laboratory capacity for surveillance studies with antibody testing; and establish a basic laboratory capacity in the newly established Georgetown Public Hospital Corporation (GPHC) Annex at Ocean View; (ii) Expanding the current contact tracing capacity by training and equipping gatekeepers and community officers (already part of an existing GOG program) located in the ten geographical regions of Guyana 8 The Government of Guyana has identified 9 priority areas for donor support to the COVID-19. These are: 1) Strengthening of laboratory capacity in the country to provide diagnostic capacity for COVID-19 and to support screening and surveillance capacity to gain better intelligence on the COVID-19 virus presence and spread in Guyana; 2)Expanding, decentralizing and improving contact tracing in the country, with a heavy presence in hinterland areas populated with indigenous population and in border areas with Brazil, Suriname and Venezuela; 3)Improving the epidemiology and surveillance system to utilize data and predict the spread of COVID-19, while establishing a regional capacity for epidemiology and surveillance work; 4) Implementing a strong non-pharmacological response for personal protection (NPIs) against COVID-19 infections; 5) Strengthening the health system for more effective treatment and care of symptomatic COVID-19 patients and quarantine and isolation of asymptomatic COVID-19 cases; 6) Implementing a strong communication, education and awareness program; 7) Implementing a social and financial instrument to support health frontline health workers and vulnerable households; 8) Establishing a mechanism to manage, implement the project and a mechanism for monitoring and evaluation; 9) Ensuring there is a contingency plan to deal with any additional emergency that might arise in the time period for this project 7 in contact tracing, by recruiting additional contact tracers to serve as trainer of trainers, and by rolling out the Go.Data data collection system across the country (currently operational only in Georgetown); and (iii) Strengthening the epidemiology and surveillance capacity in the MOH and in the Regions. This will be done by providing energy efficient equipment (when applicable), software and supplies to support testing (e.g. PCR machines, GeneXpert PCR machines, antigen test kits, antibody test kits, biosafety cabinets), nation-wide contact tracing, and epidemiological surveillance and projections. Staffing will also be strengthened by training activities and by hiring up 20 community-based contact tracers and 18 public health specialists/epidemiologists in the regions (especially regions 1, 2, 7, 8, 9, and 10). Subcomponent 1.2: Health System Strengthening. This subcomponent aims at strengthening the health system for more effective, and better quality, treatment and care of symptomatic COVID-19 patients, for isolation and quarantine of asymptomatic COVID-19 cases, and for preparing the system to access and deliver safe and approved COVID-19 vaccines. The interventions under this sub- component will, among others, focus on: (i) Expanding the ICU capacity; establishing higher-level critical care capacity and expanding bed capacity in selected hospitals in the regions; establishing isolation centres and quarantine facilities; (ii) Increasing and improving present cold-chain, storage facilities, and delivery systems for vaccines in preparation for the introduction of a COVID-19 vaccine, (including coordination with the COVAX Facility); (iii) Establishing teams for psychosocial support to vulnerable households, by strengthening the capacity of social workers and Gatekeepers in the communities; and (iv) Promoting preventative actions and increasing community awareness and participation. Among others, these will be implemented by procuring equipment and supplies for hospitals, ambulances for transporting COVID-19 patients, audio-visual technology for video- conferencing, and cold-chain equipment; training of community officers, social workers and gatekeepers on two particular aspects: (i) psychosocial support focusing on loneliness, domestic violence, gender-based violence, child abuse and other related topics; and (ii) preventive measures to limit the spread of communicable diseases taking into account the impacts of climate change (including airborne and vector-borne diseases); and by covering costs for developing and printing materials for nation-wide distribution, ensuring that messages are translated into local languages, using different media channels; procuring supplies to be distributed, including cloth for sewing cloth masks directly in the communities, based on MOH specifications, to promote community engagement and mask wearing. Facilities likely to benefit from project activities through purchase of equipment and/or training include GPHC, the new GPHC Annex at Liliendaal, New Amsterdam, Linden, and Bartica Hospital, as well as Mabarumba, Lethem and Suddie. The education and awareness materials 8 developed under the Project will include translated, appropriate, and culturally sensitive content for vulnerable populations (including indigenous population and the elderly), many of whom are also climate-vulnerable, to increase their understanding about the risks and impacts of the COVID-19. Component 2: Implementation Management and Monitoring and Evaluation (US$ 500,000). This component finances the required administrative and human resources and activities needed to implement the project and monitor and evaluate progress. It will finance staff, consultant costs, and operating costs associated with project implementation, coordination, and management, including support for procurement, financial management (FM), environmental and social risk management, monitoring and evaluation (M&E), reporting, and stakeholder engagement; information system maintenance; operating and administrative costs; and shorter- and longer-term capacity building for coordination and pandemic response and preparedness. This component will also finance performance audits focusing on key Project activities, which will be carried out by an external auditor under terms of reference acceptable to the Bank. All these activities will be carried out in accordance with WBG guidelines and procedures. III. Summary of previous stakeholder engagement activities Between October 2 and 5 2020, the PIU held a first round of public consultations during project preparation, with Indigenous Peoples, Regional Democratic Councils (RDC)9, and Regional Health Officers (RHO)10. Given the context of COVID-19, logistics constraints, lack of IT/internet connectivity, and a very short timeframe to prepare and conduct consultations, Indigenous Peoples, RDC, and RHO were among the few stakeholders who responded to the short notice and that were able to participate in the consultations. Given the mobility constraints due to the government measures to contain the spread of COVID-19, consultations were mainly through online channels such as Microsoft teams and telephone calls. Some of the consultations were face-to-face with stakeholders representing the Indigenous people adhering to social distancing measures and COVID protocols. For the preparation of the consultations, the PIU used as a reference the WB's Technical Note “Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, March 20, 202010.� 9 The Regional Democratic Council is the supreme Local Government Organ in each region with the responsibility for the overall management and administration of the Region and the coordination of the activities of all Local Democratic Organs within its boundaries. 10 Technical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings March 20, 2020, https://worldbankgroup.sharepoint.com/sites/wbunits/opcs/Knowledge%20Base/Public%20Consultations%20in%20WB% 20Operations.pdf 9 Consultations were held on the 2nd October 2020 with the Guyana Organization of Indigenous People, and the Amerindian Action Movement of Guyana. On the 5th October 2020 consultations were held with the National Toshaos Council and the Amerindian People Association. Also attending those consultations was a representative of the Ministry of Amerindian Affairs and an Indigenous Member of Parliament. On October 2nd, 2020, virtual Consultations (through Microsoft teams) were also held with the RDC of region 1, 2, & 9, and the RHO of Region 1,7,8,9 & 10. For these consultations the Ministry of Amerindian Affairs assisted by emailing copies of the draft of the Project along with prompt questions. Between the period of October 2-5, 2020, several Toshaos from various Indigenous communities (from regions 1, 2, 5, 6, 7, 8, 9 and 10) who have no internet connection were contacted and consulted individually over the phone. This steep was taken so that the consultation could be as wide and as inclusive as possible. The consultation's objective was to obtain stakeholders' perceptions and feedback on stakeholders mapping, GRM strategy, and Project's objectives, risks, and impacts. The report of this first round of consultations is included in this SEP as Annex 1. This Annex includes details of the consultations and its results, the list of participants (p.59-60), discussion points and conclusions. In overall, consultations showed that there is a strong support for the project components. The concerns expressed by participants related to the overall COVID-19 response coincide with the Project objectives. The social and economic fallout of COVID 19 in Guyana has impacted every community and this was acknowledged by the stakeholders. The concept of the WB project and its intended impact on the health sector and the general well-being of society was welcomed by all the stakeholders engaged. The stakeholders were very happy with the process that the PIU has taken to inform them and solicit their view and get their input notwithstanding the fact that virtual meeting and platform was something some of them are now getting accustomed to. Table 1 below shows how stakeholder’s feedback was included into project design. The obtained feedback from the first round of consultations was also taken into consideration for the preparation and finalization of the Indigenous Peoples Plans (IPPs). 10 Table 1. First round of consultations results and feedback incorporation into project design Stakeholders Feedback received from first round of consultations How it was addressed by the Project National While welcoming the Project some of the National Toshaos The PIU explained to them that while this is an ideal outcome, the Toshaos Council Council wanted the project to go a little further to include emergency nature of this project does not allow for civil works which would Polymerase Chain Reaction (PCR) testing in all regions. be required to achieve this goal. As such, the PIU selected laboratories and Some of the stakeholders also recommended putting ICU hospitals which already have the capacity to upgrade (adequately trained beds with relevant staffing and equipment at every staff, and physical structure). It was informed that the decision was taken to hospital. select those facilities that would have a bigger impact with the resources allocated for this project. The Amerindian One of the barriers to the project is the miscommunication As a result, as part of the citizen engagement activities, the Project will Peoples of information and fake news as it relates to the actual support the development of materials for communications risks campaigns Association, virus. According to some of the stakeholder’s social media to strengthen the flow of information by daily reporting the COVID-19 The Amerindian was being used to mis communicate and spread status in country and the education and awareness of risks and protective Action propaganda on the virus. Some of the messaging that were actions. To ensure inclusive development outcomes and equal share of Movement of spread included that COVID- 19 is fake, it’s a virus created project’s benefits, the campaign messages will be translated and Guyana to wipe out people in the Global South. To this end the disseminated in some Indigenous Peoples languages. This was reflected in stakeholders related that this resulted in low level of subcomponent 1.2. testing as some of the IPs are fearful of testing and in some areas, they are reluctant to follow MOH social distancing Also, risks communication campaigns messages’ will be translated in advice and wearing mask. The Stakeholders from the IP Spanish and Portuguese to ensure that migrants from Venezuela and Brazil that were engaged recommended that the MOH current have equal access to public services that treat and prevent COVID-19. risk communication strategy should be more cultural appropriate, and the locals should play a part in this. 11 National Stakeholders also asked for quarantine and isolation The MOH informed the stakeholders during consultations that these Toshaos Council facilities to be more culturally acceptable. According to issues (culturally appropriate diets, and access to PPE) was brought to (Most of the the stakeholder’s persons who were in the isolation and the MOH attention and it is already being addressed with funds from the Toshaos who quarantine facilities complained about the diet since it did Government of Guyana. were contacted not include the traditional indigenous meals. According to over the Phone) them this is one of the reasons why people are reluctant to On the procurement of clothing for face masks, as soon as the test since they are fearful of going into procurement plan is approved, more details will be provided. quarantine/isolation facilities. Stakeholders asked for more assistance in getting PPE (mask) for the local population. Stake holders also asked if the local community and women can make mask instead of the government procuring, since this will help the local communities with the economic fallout of COVID-19. Stakeholders recommended government to procured cloth and sewing machine and the local Amerindian Women’s groups can make cloth mask. This will also cater for mask for school children when school reopen. Guyana Local Toshaos also recommended the services of MOH and Ministry of Amerindian Affairs promise to do wider Organization of the Community Support Officers (CSO) include screening consultations with a view of getting other Toshaos views with the aim of Indigenous people at the entrance of the village. The geography of implementing such a system. These concerns will be addressed as well in People. the villages has only 1 or 2 entrance/exit points. the IPPs and necessary measures will be included. National Stakeholders requested that the screening of people Toshaos Council entering the villages comply with a full body sanitization (washing hands and spraying with sanitizer with 70% alcohol from head to toe, including accompanying luggage) upon entering a village. Some of them would like to see a mechanism put in place for those with high temperature to be transported to the nearest isolation facility so as not spread the infection to other villagers. This to them was critical since in indigenous communities the lifestyle is very communal. 12 The Amerindian Stakeholders asked for more assistance in getting PPE This feedback was included in subcomponent 1.2, Health System Peoples Association, (especially masks) for the local population. They also asked Strengthening, under which cloth for sewing cloth masks will be procured if the local community and women can make masks instead by the Project and distributed in the communities. In this way, the Project The Amerindian of the government procuring since this will help the local is aiming to engage the communities in the production and distribution Action Movement of communities with the economic fallout of COVID-19. Local of masks, to increase uptake of mask wearing and support a community- Guyana Toshaos also recommended the Community Service driven approach as they requested. This feedback is also included as part Officers (CSO) services include screening people at the of the citizen engagement commitments of the project. village entrance and ensuring the implementation of sanitizing activities. All the Regional RDC and RHO while supportive of all the measures outlined The PIU informed that funds were catered from MOH budget for risk Health Officers were worried about burnout of the health workers since allowance. Therefore, the project is not covering remuneration increase all of them have been working beyond the call of duty since or allowances as they will be covered by MOH resources. Also, it should the outbreak of COVID-19 in Guyana and their respective be noted that by providing better equipment to lab and health care regions. They asked for increase renumeration and allowances for the staff11. 11 More details about the consultation feedback are added as Annex 1 in this SEP. 13 A second round of consultations took place between December 4th -17th 2020. Stakeholders were consulted for the preparation of the ESMF, LMP and IPP. Feedback from these consultations is incorporated in the Environmental and Social (E&S) instruments. Stakeholders feedback was taken into consideration to prepare the ESMF, IPP and LMP, identify the possible positive and negative impacts and risks, and identify the best mitigation measures. For the second round of consultations, the PIU did a mapping of all the stakeholders and had planned to invite all of the identified stakeholders for consultations (the full list of the stakeholders identified for the project are included in this SEP section 4). However, due to the COVID-19 guidelines and time constrains, consultations were only held with stakeholders who were identified as Affected Parties and some of the Other interested parties (such as Standards and Technical Services, EHU) and some disadvantaged groups (such as LGBTQ groups). In the future, all efforts will be made to consult all the identified stakeholders. Given the limited time that was available, to ensure stakeholders participation the MOH through the Ministry of Amerindian Affairs invited the groups representing Amerindian People (for the preparation of the IPP) and MOH reached out to other stakeholders (such as medical organizations, and LGBTI groups) through via telephone to confirm their attendance at the end of November 2020. Consultations were held between the December 4th - 17th, 2020. The objective of the second round of consultations was to obtain feedback from stakeholders on the project's risks, impacts, and possible mitigation measures proposed by them and PIU. The PIU consulted with stakeholders the risks, and impacts identified during the preparation of the ESMF, IPPs, and LMP. Considering that those risks, and impacts can impact and affect differently each stakeholder groups, especial attention was given to identify risk and impacts per stakeholder group. Therefore, consultations were held separately from December 4-8, 2020, depending on the group of stakeholders. For example, to ensure full engagement of disadvantaged groups such as the Guyana Trans United, Rainbow House (GuyBow), Artistes in Direct Support, Comforting Hearts) Indigenous Peoples, were held independently and separate from the rest of the consultations. For the two round of consultations that were held, and for the future consultations during project cycle, the stakeholders will be notified about how their feedback are taken into consideration during consultations. This will be done through disclosing the report of the consultations (similar to Annex 1 of this SEP, and table 1 of this SEP). The report of the consultations will be available in the MOH website and will be added to the SEP as annex. Consultations were adapted to the Government of Guyana measures, policies, and guidelines in 14 response to the COVID-19 pandemic. They were in line with the WB's Technical Note: "Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, March 20, 2020", avoiding in-person gatherings, diversifying means of communication, and relying more on social media and online channels as well as traditional. Channels of communications (TV, newspaper, radio, dedicated phone-lines, public announcements, and mail) when stakeholders do not have access to online media or do not use them frequently. The Environmental and Social Commitment Plan (ESCP), this Stakeholder Engagement Plan (SEP), and the Interim Health and Safety Guidelines, were disclosed on October 2020, through the website of MOH: (https://www.health.gov.gy/index.php/world-news-3 and Facebook of MOH [https://www.facebook.com/mophguyana]. They are disclosed as well at the World Bank’s external website (www. http://documents.worldbank.org/curated/en/home). 15 Updated versions of SEP, ESCP, ESMF, IPP, and LMP (as annex of the ESMF), will be disclosed on the same websites during project implementation. The Documents will also be disclosed at the Regional Health Officer Office and The Regional Democratic Council. For consultations the link of the disclosed instruments and all other relevant documents will be shared at least one week in advance to reach as many stakeholders as possible. Likewise, during the consultations sessions there will be printed copies of all instruments and relevant documents of the project. Additionally, printed copies of the E&S instruments will be available at the Regional Democratic councils, Regional Health Officers and health facilities previous to the consultations. A third round of consultations will be conducted virtually in May-June 2021 on the ESMF, LMP, IPP, SEP. The consultations would be virtual due to travel restrictions. The consultations’ objective will be to share the final ESMF, LMP, IPP, SEP with stakeholders and obtain their feedback on their content. Among the topics that will be discussed are: • ESMF/ESMP o Summary of project components o Summary of policy, legal and regulatory framework o Summary of COVID-19 preparedness and Response o Summary of main environmental and social risks o Preliminary risk analysis o Procedures to address environmental and social issues o Consultations and stakeholder engagement o Grievance Procedures • LMP o Type of project workers o Summary of key potential labour risks and mitigation measures o Roles and responsibilities for Project Labour Management o Age employment o Summary of OHS measures o Measures against GBV including sexual harassment and sexual abuse o Code of conduct • IPP o Share with stakeholders the IPP before conducting consultations and request their feedback on the document o Summary of Legal and institutional framework 16 o Comparison between National Laws and ESS7 o Obtain feedback on the identification of Amerindian People as Project Affected Parties o Obtain feedback on Amerindian People specific needs for stakeholder engagement processes o Obtain feedback on engaging and consulting with Amerindian people throughout project cycle o Inform the stakeholders how their feedback from the first and second round of consultations was included in the project o Obtain feedback on project benefits to the Amerindian People, analysis of the relevance of the Project components to the Amerindian People, including risks, impacts and mitigation measures o Obtain feedback on measures to ensure that Amerindian People receive social and economic benefits from the project o Obtain feedback on the project’s measures to address GBV matters • SEP o Share with stakeholders the SEP final version before conducting consultations and request their feedback o Obtain stakeholders feedback on stakeholder identification and analysis o Obtain feedback on the proposed strategy for information disclosure o Obtain feedback on the proposed strategy for information disclosure o Obtain feedback on the strategy related to reporting back to stakeholders o Report to the stakeholders how their feedback from the first round of consultations was included/taken into consideration for the Project and the preparation of ESF instruments IV. Stakeholder identification and analysis Project stakeholders are defined as individuals, groups, or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively, or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with stakeholders throughout the Project development will likely involve the identification of persons who are legitimate representatives of stakeholder groups. Community representatives, faith groups, and non-government organizations may provide helpful insights into the 17 issues experienced by vulnerable groups and act conduits for dissemination of the Project-related information. Verification of stakeholder representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Considering the current pandemic situation in Guyana, the stakeholder identification largely occurred through virtual consultations, phone calls, and emails, and other non-traditional forms of communication through NGOs networks. For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) are divided into the following three (3) categories:  Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures;  Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way; and  Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status12, and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. Sexual orientation and gender identity could contribute to vulnerability as well. See section 2.4 for the relevant vulnerable groups for this project 4.1. Project Affected Parties Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, for the Guyana COVID-19 project, the following individuals and groups fall within this category: 12 Section 2.1 of Bank Directive: Addressing Risks and Impacts on Disadvantaged or Vulnerable Individuals or Groups issued on August 4, 2016 and updated March 27, 2021 indicates that “disadvantaged or vulnerable� refers to those individuals or groups who, by virtue of, for example, their age, gender, race, ethnicity, religion, physical, mental or other disability, social, civic or health status, sexual orientation, gender identity, economic disadvantages or indigenous status, and/or dependence on unique natural resources, may be more likely to be adversely affected by the project impacts and/or more limited than others in their ability to take advantage of a project’s benefits. 18 a) Indigenous Peoples o Indigenous Peoples. Guyana Organization of Indigenous people o Indigenous Peoples. The Amerindian People Association o Indigenous Peoples. Amerindian Action Movement o Indigenous Peoples. National Toshaos Council b) Frontline Health Care Workers o Guyana Medical Council (NGO) o Guyana Nurses Association (NGO) c) Community officers, social workers, gatekeepers in the communities. Through the Ministry of Amerindian Affairs and RDC. As of now, the recruitment process of the gatekeepers hasn’t begun so the PIU doesn’t know who the gatekeepers will be involved in the project. However, throughout project cycle, the PIU will ensure to engage as many gatekeepers as possible in the consultations processes. d) Health waste management workers from the Environmental Health Department Region e) Government Ministries • Health, • Labour, • Public Service, • Human Services & Social Security f) Communities adjacent to health facilities that manages covid-19 patients (To reach out to this communities, the engagement will be through consultations with the Regional Democratic council which is made up of elected officials of the people within the region. Persons subjected to COVID-19 quarantine or self-isolation mechanisms. The engagement will be through online surveys to protect the identity of these stakeholders). g) Family members of persons in quarantine or self-isolation. The engagement will be through online surveys to protect the identity of these stakeholders h) COVID-19 infected people. The engagement will be through online surveys to protect the identity of these stakeholders 19 i) Family members or relatives of COVID19 infected persons. The engagement will be through online surveys to protect the identity of these stakeholders 4.2. Other interested parties The projects’ stakeholders also include parties other than the directly affected communities, including:  General public who are interested in understanding the Governments prevention and response to COVID-19;  Standards and Technical Services, EHU, Ministry of Labor, Ministry of Public Services  PAHO/WHO, CDC, IOM  Private sector, Chamber of Commerce 4.3. Disadvantaged / vulnerable individuals or groups According to the WB Note “Addressing Risks and Impacts on Disadvantaged or Vulnerable Individuals or Groups�13, disadvantaged or vulnerable refers to those individuals or groups who, by virtue of, for example, their age, gender, ethnicity, religion, physical, mental or other disability, social, civic or health status, sexual orientation, gender identity, economic disadvantages or indigenous status, and/or dependence on unique natural resources, may be more likely to be adversely affected by the project impacts and/or more limited than others in their ability to take advantage of a project’s benefits. Such an individual/group is also more likely to be excluded from/unable to participate fully in the mainstream consultation process and as such may require specific measures and/or assistance to do so. This will consider age, including the elderly and minors, and including in circumstances where they may be separated from their family, the community or other individuals upon whom they depend. It is particularly important to understand how the project impacts will disproportionately fall on disadvantaged or vulnerable individuals or groups, and how they might be excluded from the projects benefits and then to consider ways to mitigate this. Engagement with vulnerable groups and individuals requires the special consideration to their situation and tailored outreach so they are not harmed and so they benefit from the project. Within the COIVD-19 context, the vulnerable or disadvantaged groups identified in the Project are: a) Elderly population. Example of stakeholders to be consulted: • National Commission of the Elderly 13 Bank Directive Addressing Risks and Impacts on Disadvantaged or Vulnerable Individuals or Groups, https://ppfdocuments.azureedge.net/e5562765-a553-4ea0-b787-7e1e775f29d5.pdf 20 • Sunset Senior Citizens clubs b) People living with disabilities. Example of stakeholders to be consulted: • Guyana Council of Organizations For Persons With Disabilities • Ministry of Human Services, and Social Security • National Commission on Disabilities c) LGBTQ+ groups. For example: • Guyana Trans United • Rainbow House (GuyBow) • Artistes in Direct Support • Comforting Hearts d) Women and children. Example of stakeholders to be consulted: • The Women and Gender Equality Commission • Ministry of Human Services and Social Security • Help & Shelter • ANIRA Foundation • Guyanese Women in Development • Guyana Responsible Parenthood Association e) Female Health Care Workers Example of stakeholders to be consulted: • PAHO • WHO f) Nurses, and other health workers Example of stakeholders to be consulted: Guyana Nurses Association g) Poor, economically marginalized, groups particularly asylum seekers and others without clear legal status. h) Migrants coming from Venezuela and Brazil. 21 i) Those with underlying health conditions such as Non-Communicable Disease (NCD). Example of stakeholders to be consulted: • WHO • Guyana Diabetic Association Information about the methodology that will be implemented to engage those stakeholders in the consultation process is described in section 4.5 Summary of stakeholder needs, table 2. 4.4. Summary of project stakeholder needs Considering the constraints to public consultation meetings related to the COVID-19 pandemic, and as it has been mentioned before, the SEP will take into account the World Bank technical guidance on “Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, March 20, 2020.�  Online formal meetings (Microsoft Teams)  One-on-one interviews through phone or apps (i.e., Viber, Messenger, WhatsApp)  Telephone consultations  Where possible in person consultations The following are some considerations for selecting channels of communication, in light of the current COVID-19 situation:  Avoid public gatherings (taking into account national restrictions or advisories), including public hearings, workshops and community meetings;  If smaller meetings are permitted/advised, conduct consultations in small-group sessions, such as focus group meetings. If not permitted or advised, make all reasonable efforts to conduct meetings through online channels;  Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders;  Employ traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, and mail), particularly to target stakeholders who do not have access to online channels or do not use them frequently. Traditional channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; 22  Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a context specific combination of email messages, mail, online platforms, dedicated phone lines with knowledgeable operators; and  Each of the proposed channels of engagement should clearly specify how feedback and suggestions can be provided by stakeholders. 23 Table 2. Identified stakeholders’ needs for consultations in the context of COVID-19 mobility constraints and distancing measures. Stakeholder group Key characteristics Preferred Notification Means Language needs Specific Needs Affected Parties Indigenous Peoples. Guyana NGO representing Amerindian Social Media , Radio , visits , English Participants would need Organization of Indigenous in area of health human rights Written information on assistance with people posters/flyers transportation (Water & land transportation) depending on the village they live) to get to meeting. Indigenous Peoples. The Represent 130 Amerindian Flyers printed specifically for English Adequate and timely Amerindian People Association groups from various regions the community, Radio notification of meeting of Guyana Indigenous Peoples. Amerindian NGO representing Amerindian Radio, News Papers, Visit with English Participant would need Action Movement on land rights and human civil society officials assistance with rights transportation (Water & land transportation depending on the village they live) to get to meeting Indigenous Peoples. National This is a body of elected chief Email, Social, Media, English They prefer to have Toshaos Council of all the Amerindian villages Television radio, Newspapers, meetings in the mid- in Guyana Visits morning and asked for help with transportation, reimbursement for phone calls. 14 14 During the consultations it was suggested that MOH consider paying for telephone cost however it is not necessary since MOH will be making the calls and so MOH will bear the cost. 24 Frontline Health Care Workers Front line health care workers Email, social media, virtual English Time off from work to would be represented by two consultations attend. Consultations will NGOs represented by the be scheduled taking into Nurses association and the consideration the Guyana Medical Council. stakeholders work schedule to ensure that they can fully participate in the consultation processes. Community officers, social Community officers will be Email, social media, virtual English Internet access and time- workers, gatekeepers in the performing voluntarily work. consultations off. communities. The Ministry of Amerindian Affairs and the RDC are These group of stakeholders will responsible of the program play an important part in coordination and the subcomponent 1.1 and 1.2. volunteer’s recruitment. It is Gatekeepers and community estimated that there will be officers are part of an existing between 2 or 3 gatekeepers in program launched by the each village in IPs territories. Government of Guyana located They will be also present in in the ten geographical regions. other regions without IP They are community presence. representatives that support the government on a voluntarily The Ministry of Amerindian basis to engage with citizens. Affairs and the RDC will share This project will equip them and with the PIU the final list of recruit some additional contact the gatekeepers once they are tracers to serve as trainer of selected. trainers, and by rolling out the Go.Data data collection system While there is no final list of across the country (currently gatekeepers, the operational only in consultations will involve the Georgetown); Ministry of Amerindian Affairs and the RDC. 25 The project will stablish teams When the list of gatekeepers for psychosocial support to is known, the PIU will ensure vulnerable households, by to engage them in the strengthening the capacity of consultation process. social workers and Gatekeepers in the communities; The project will promote preventative actions and increasing community awareness and participation. Among others, by training of community officers, social workers and gatekeepers on two particular aspects: (i) psychosocial support focusing on loneliness, domestic violence, gender-based violence, child abuse and other related topics; and (ii) preventive measures to limit the spread of communicable diseases taking into account the impacts of climate change (including airborne and vector-borne diseases). Health waste management These are workers in the Email, visits, virtual English Time off from work. workers Environmental Health consultations Consultations will be Department of the 10 Region scheduled taking into consideration the stakeholders work schedule to ensure that 26 they can fully participate in the consultation process. Government Ministries; (Health, Government agencies Email English Nonspecific needs. Labor, Public Service, Human Workers from Ministries Services& Social Security are available through online channels, telephone calls, and face-to-face meetings. However, adequate notice in advance will be appreciated. Communities adjacent to health To reach out to this Virtual consultations and face- English Adequate notice facilities that manages covid-19 communities, the engagement to-face consultations, radio patients will be through consultations social media with the Regional Democratic council is made up of elected officials of the people within the region. Other interested parties General public who are All citizens Radio, TV, social media (such as English Convenient time and interested in understanding the Facebook, MOH website, medium that is accessible Governments prevention and posters, flyers) response to COVID-19; Private Sector Commission Private sector Commission E-mail, virtual English Adequate notice and time which is a non-governmental to prepare umbrella body representing all private sector bodies in Guyana. 27 Standards and Technical These are departments in the Internal memo English Services, EHU, Ministry of Labor, MOH. These departments Ministry of Public Services have the responsibility for licensing and certification of hospital and laboratory as well as environmental and waste disposal. PAHO/WHO, CDC, IOM GOG international partners E-mail English Adequate timing and notice Disadvantaged / vulnerable individuals or groups Elderly population The National Commission of Email, phone call, radio English In case consultations are 11. National Commission of the Elderly is a semi- conducted in person, the Elderly autonomous body. It is transportation will be 12. Sunset Senior Citizens chaired by a representative available for those clubs from civil society and includes stakeholders with mobility representatives from: the difficulties. Transportation MOH, Ministry of Social will be provided from their Protection, National homes or the place they Commission on Disabilities, choose to be picked up, to and Parliamentary Political the place of the meeting Parties and the Pensioners and back. Association. Among its responsibilities are to advise 28 the Government of Guyana on The same principle will the formulation of a apply in case consultations comprehensive policy for the need to be done through elderly including matters online channels. Support relating to the care, financial will be provided to the security, health and medical, elderly groups in case they psychological, employment need help to connect to the and recreational needs of the online devices, or if they elderly. need to move to a different community to connect to The Senior Citizens’ Clubs the internet. provide opportunities for seniors to meet and share their knowledge. It also provides a platform for seniors to raise issues and concerns affecting them. People living with disabilities Virtual, email, radio English In case consultations are • Guyana Council conducted in person, of Organizations The Guyana Council of transportation will be For Persons With Organizations for Persons available for those Disabilities with Disabilities is a stakeholders with mobility • Ministry of collaborative forum that was difficulties. Transportation Human Services, established in January, 2008 will be provided from their and Social and is made up of the homes or the place they Security representatives of different choose to be picked up, to • National organizations for persons with the place of the meeting Commission on disabilities. Its members meet and back. Disabilities regularly to support each other in the hope of building a The same principle will apply in case consultations 29 stronger disability movement need to be done through in Guyana. online channels. Support will be provided to the The Ministry of Human people living with Services and Social Security is disabilities groups in case is committed to the they need help to connect sustainable development and to the online devices, or if rehabilitation of children, they need to move to a women, families, the elderly different community to and providing training and connect to the internet. social and welfare services/programmes to persons in difficult circumstances and disadvantaged persons. The National Commission on Disability (NCD) is appointed by and accountable to the President of Guyana. It was officially launched on December 10, 1997. LGBTQ+ groups Phone call, email English Adequate notice and a • SASOD SASOD is a Non-Profit convenient location • Guyana Trans Organization committed to United ending all forms of • Rainbow House homophobia in Guyana, (GuyBow) including transphobia, biphobia and lesbophibia. It promotes human rights of all people, especially those 30 facing discrimination in Guyana. Guyana Trans United is a Non- Profit Organization. Its main goals are to improve the quality of life of trans Guyanese and to ensure that their rights are recognized and upheld in all domains. GTU hosts monthly support group sessions for members, their families, other loved ones, and conducts outreaches in the ten (10) administrative regions of Guyana. GuyBow has been operating informally among the LGBT population of Guyana since the late 1990’s, and as a formally registered organization since 2000. It is one of the first organisations to serve the LGBT community in Guyana. The organization’s current focus is on strengthening and supporting lesbian, bisexual, and questioning women. 31 Women and children Email, phone call, social media English Previous feedback from • The Women and Gender The Women and Gender women stakeholders will Equality Commission Equality Commission is a be taken into account, to • Ministry of government organization that ensure that the times and Human Services and promote issues related to the dates proposed for the Social Security enhancement of the status of consultations do not • Help & Shelter women, girls and gender interfere with their work, • ANIRA Foundation, issues. or daily activities, and to ensure that they can Help and Shelter is a non- participate. governmental organization formed as a response to the high incidence of violence, alcoholism and poverty in Guyana, the increase in family instability and the lack of support for victims wishing to leave abusive situations and/or in need of counselling and crisis services. Help & Shelter has become a recognized leader in the fight against violence in Guyana, particularly in the areas of domestic, sexual and child abuse. The Anira Foundation is a Non-profit organization. It was created to empower women, girls and vulnerable youth to prepare themselves to take advantage of the 32 social and economic development opportunities which will make them better prepared to achieve their potential. Female Health Care Workers Email English Previous feedback from • PAHO PAHO and WHO as women stakeholders will • WHO international development be taken into account, to • Guyana Nurses agencies, have supported ensure that the times and Association closely the Government of dates proposed for the Guyana in the fight against consultations do not COVID-19. Since it has interfere with their work, supported with donations to or daily activities, and to the country, the organization ensure that they can fully is an important stakeholder participate in the that can advise on the consultations process. potential risks and impacts that female health care workers can experience as a consequence of the project implementation. They can also advise on the best mitigation measures. The Guyana Nurses Association (GNA), is a Non- Governmental, Non-Profit organization which was established in 1928 and registered in 1930 as a professional association under the Friendly Societies Act. 33 Poor, economically Email English Adequate notice marginalized, groups The International particularly asylum seekers and Organization for Migration is others without clear legal status the United Nations Migration • International Agency whose mission in Organization Guyana has implemented for several projects in various Migration fields. IOM Guyana also serves (IOM) as a Regional Coordination Office for the Caribbean. Migrant population The International Organization Radio, TV, social media (such as Spanish Key communication for Migration is the United Facebook, MOH website, Portuguese messages from the Nations Migration Agency posters, flyers) English communication risks whose mission in Guyana has campaigns will be translated implemented several projects in to Spanish and Portuguese. various fields. IOM Guyana also serves as a Regional Coordination Office for the Caribbean. 34 Those with underlying health Guyana Diabetic Association Email, Virtual English Convenient location and conditions such as Non- who is an NGO which adequate notice for Communicable Disease (NCD) represent diabetic patients. meeting • WHO • Guyana Diabetic Association 35 For the next rounds of consultations, there are possibilities to have some in-person consultations. However, most of the consultations to be carried out will be virtual. As explain in this SEP, most of the consultations have been carried out by phone and Microsoft teams. This approach is expected to continue throughout the life of the project given COVID-19 restrictions. For consultations on the IPP, village leaders, known as Toshaos, will continue to be engaged through phone calls, virtual meetings through Microsoft teams, and in some cases, in-person meetings. 4.5. Language needs for Indigenous Peoples In Guyana, less than 200 Indigenous Peoples out of approximately 70,000 speak an indigenous language and do not speak English. In Guyana from those 200 only 20% can read or write in those languages (subdivided in at least 5 different indigenous languages). English is the main language used by most indigenous people and for those that do not speak English, Toshaos15 will share the project’s messages and communicate with them in their own languages. Therefore, no document needs to be translated, however, one of the measures to engage those who do not speak English, the Toshaos will support with translation if needed during consultations. The project will use images, and pictures to complement the project messages. 15 Toshaos are the chiefs, heads of village councils, for their respective communities. Toshaos will determine who would need help with translation or interpretation during consultations. However, given MoH guidance to avoid public gatherings, and WB guidance to hold consultations to prevent the spread of COVID-19, as of now, the PIU has conducted virtual and some small in-person consultations with key stakeholders, such as Toshaos, Ministry of Amerindian Affairs, Regional Democratic Council, and IPs NGOs. This is expected to continue to be the case during project implementation. Toshaos speak English, and during consultations, they didn’t express any concern with the PIU holding consultations in English. Feedback from consultations will be included as annexes to Environmental and Social instruments such as SEP, IPP, and ESMF. V. Stakeholder Engagement Program The Project will emphasize citizen engagement aspects building on mechanisms supported by other World Bank-financed projects in the health sector. Measures will include: (i) A grievance redress mechanism with stipulated service standards for response times, (ii) Support to development of materials for risk communication campaigns (to be also funded by other sources, including by the GOG) to strengthen the flow of information by daily reporting the COVID-19 status in country and the education and awareness of risks and protective actions. To ensure inclusive development outcomes and an equal share of project’s benefits, the campaign messages will be translated and disseminated in Indigenous Peoples languages through different media channels including traditional ones such as radio, posters, and tv, (iii) Engagement of communities in the production and distribution of masks, to increase uptake of mask wearing and support a community- driven approach; and (iv) The project has incorporated a citizen-oriented design, including communication and information-sharing, a feedback mechanism for just-in-time feedback, GRM etc. The project has a citizen engagement indicator to reach targeted groups and that will result in feedback from stakeholders. The PIU will respond to this feedback systematically. The 4 target groups include: 1) Youth population, 2) Migrant Population (Spanish, Portuguese), 3) Indigenous people (in various local languages), 4) General Population. 38 5.1. Proposed strategy for information disclosure To meet best practice approaches, the project will apply the following principles for stakeholder engagement:  Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole lifecycle, Consultations would be carried out in an open and transparent manner;  Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analysing and addressing comments and concerns;  Inclusiveness and sensitivity: stakeholder identification will be undertaken to support better communications and build effective relationships. Sensitivity to stakeholders’ needs will be the key principle underlying the selection of engagement methods. Special attention will be given to vulnerable groups, in particular women, youth, elderly and the cultural sensitivities of diverse ethnic groups;  Flexibility: because social distancing is currently making traditional forms of engagement impossible, the methodology will adapt, see Section 3.2 below on the proposed approaches. 39 The Environmental and Social Specialist of the PIU will follow the proposed strategy for information disclosure as follows: Project stage Target stakeholders List of information Methods and timing proposed to be disclosed Preparation, •The Amerindian Action •Project objectives •Disclosure as draft on World prior to Movement of Guyana, and activities Bank and MOH websites and effectiveness •Guyana Organization of •Stakeholder MOH FB page in October 2020 Indigenous Peoples, Engagement Plan (https://www.health.gov.gy/inde •National Toshaos Council, (SEP) and x.php/world-news-3 •Ministry of Amerindian Grievance Redress and Facebook of MOH Affairs, Mechanism (GRM). https://www.facebook.com/mop •Regional Democratic •Interim Health hguyana] Council 1,7 & 9, and Safety •Physical copies of the •Regional Health Officer Guidelines instruments will be available region, 1,7,9,8. •Environmental during consultations. •The PIU also held and Social individual phone Commitment Plan consultations with several (ESCP) Toshaos (IPs chiefs) from Region 1,7,8,9, and 10. Project •Different government •Updated and final •MoH website and Facebook Implementation ministries and agencies ESF instruments Page. including Ministry of (ESMF, LMP, SEP, Information leaflets and Health, Ministry of Local IPP) by May 2021. brochures to be distributed with Government, Ministry of •Feedback of sufficient physical distancing Labour, Ministry of Human project measures Services and Social consultations (as •Public consultation meetings if Security, Regional Health annex of ESF situation improves. Department Hospitals and instruments). •Physical copies of the Medical Facilities •Information about instruments will be available Local government units project activities in during consultations. •Local communities line with the World particularly those around Health Organization proposed (WHO) COVID19 isolation/quarantine guidance on risk centres communication •Medical waste and community Collection and engagement. management workers •General public •Civil society organizations, community representatives, •IP organizations/ representatives 40 5.2. Stakeholder Engagement Plan The project will carry out targeted stakeholder engagement with all groups including vulnerable groups to understand concerns/needs in terms of accessing information, medical facilities and services and challenges they face at home, at workplaces, and in their communities. These approaches are captured in the table below. Consultations will be held every four months through different channels available such as Microsoft teams, phone calls, WhatsApp, Viber, etc., and when possible, in person meetings. The table below is a summary MOH’s existing National Strategy for COVID which address targeting of vulnerable populations. Project Topic of Method Target Responsibilities stage consultation / used stakeholders message Preparation, •Project scope •Virtual •Regional PIU prior to and timelines consultations Democratic Effectiveness •Infection and mainly through Councils (October 2020) prevention Microsoft teams, •Regional Health control protocol phone calls Department •Face-to-face •Hospitals and •Introduce the meeting with medical facilities project’s ESF small groups of •Affected instruments. stakeholders people and •Present the SEP other interested and the parties as Grievance appropriate Redress •Relevant NGOs Mechanism. and CSOs may also be included. Implementation •ESMF/LMP •Virtual •Regional Democratic PIU (May-June 2021, /IPP drafts, consultations Council, Ministry of October 2021, and final •Correspondenc Health, Local February 2022, SEP. The e by communities consultation phone/email particularly those June 2022, October s’ •Letters to local, around proposed objective will be regional, and isolation/quarantine 2022) to share the draft national centres ESMF/LMP/IPP, authorities •Health facilities and final SEP with •Face-to-face involved in the stakeholders and meeting with Treatment and 41 obtain their small groups of Management of feedback on these stakeholders COVID-19 patients instruments •Medical waste content. collection and •Updated management workers project’s ESF •NGOs involved with instruments. women, indigenous •Feedback of peoples, children, project migrants, and consultations LGBTQ+ •Information about project’s activities in line with the WHO COVID19 •guidance on risk communication and community engagement •COVID-19 Testing Strategy 5.3 Reporting back to stakeholders Stakeholders will be kept informed about the project progress, including reporting on project environmental and social performance and implementation of stakeholder’s engagement plan and grievance mechanism. This will be done by disclosing relevant consultations reports in the MOH website. During the consultations, the stakeholders will recapitulate on the feedback provided in the previous consultations, and the E&S specialist will inform them how their feedback was taken into consideration. Also, information relevant to Environmental and Social matters will be highlighted on the MOH website. Information leaflets and brochures will be distributed as well with sufficient physical distancing measures. Public consultations meetings will be also taken into consideration if the situation improves and in accordance with the Government of Guyana measures to contain the spread of COVID-19. 42 VI. Resources and Responsibilities for implementing stakeholder engagement activities 6.1. Resources The MOH will be in charge of stakeholder engagement activities. The budget for the SEP is estimated to be $56,000 E&S risk management resource USD $12,000 • Screening of activities. • Preparation and disclosure of activity level instruments. • Supervision, monitoring, and reporting. • Information and communication • Coordinating the Project’s GM Training and Communications $11,000 • E&S specialist/s to travel to provide ESHS training at national and provincial level. • Consultation activities in accordance with the SEP. Supervision, monitoring, and reporting $15,000 • E&S specialist/s to travel to provinces semi-annually for conducting project supervision, monitoring and reporting. Consultation (includes support for travel for Indigenous Peoples in case it is necessary) $18,000 TOTAL $56,000 6.2. Management functions and responsibilities The MOH is the implementing agency for the project and will have overall responsibility for project implementation including fiduciary, monitoring and evaluation, environmental and social safeguards. The MOH sits on the national COVID-19 Taskforce and provides high-level coordination and oversight for the MOH’s COVID-19 response activities. Within the MOH, the Health Sector Development Unit (HSDU) will be the Project Implementation Unit (PIU). The HSDU will be responsible for the preparation and implementation of the Environmental and Social Framework (ESF) and of the requirements of the WB for Investment Project Financing (IPF) operations. Among its responsibilities will be the preparation, implementation, and oversight of environmental and social instruments such as the SEP, the GRM, IPPs, ESMF, ESMPs, and the LMP. The PIU will recruit one full-time Environmental and Social Specialist within 30 days after project 43 effectiveness to prepare and implement the ESF of the WB. The instruments will be prepared within 60 days of project effectiveness. The specialist will be assisted by two officers being released on a part-time basis as necessary, the Principal Environmental Health Officer from the Environment Health Unit at the MOH, and the Director of Standards and Technical Standards. While an Environmental and Social Specialist is contracted by the PIU, the HSDU’s in house capacity will provide support to the related issues16. 16 The ESF is The Environmental and Social Framework (ESF) enables the World Bank and Borrowers to better manage environmental and social risks of projects and to improve development outcomes. It was launched on October 1, 2018. The ESF offers broad and systematic coverage of environmental and social risks. It makes important advances in areas such as transparency, non-discrimination, public participation, and accountability—including expanded roles for grievance mechanisms. It brings the World Bank’s environmental and social protections into closer harmony with those of other development institutions. 44 VII. Grievance Redress Mechanism The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of project. ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ It provides an avenue in addition to resort to judicial proceedings. The GRM will be in place once the final versions of the ESF instruments (ESMF, IPP, LMP, SEP) are disclosed in MoH’s website (May 2021). As of May 3, no project activities have commenced since the project is awaiting the approval of the procurement plan. The PIU Environmental and Social Specialist will be responsible of the management of the GRM implementation. The GRM will be maintained and implemented throughout project implementation. 45 This mechanism allows for individuals to lodge information requests and/or complaints on an identified or anonymous basis. Details on how to access the GRM are placed on the information board of the health facilities. Throughout the consultation process stakeholders are informed about the GRM. 7.1. Description of the project GRM There are different channels available to submit grievances: • Email: covisense2021G@gmail.com • Phone: 592-226-7400 • Physical address: Lot 1 Brickdam Georgetown • Suggestion boxes at COVID-19 facilities • During public consultations Attention to: Ms. Lesly Lowe, Project Environmental and Social Specialist. The steps for the GRM are described in the table below. Details on how to access the GRM will be placed on the information boards of health facilities. 46 Process Description Time frame Responsibility & remarks Receiving grievances Complaints can be filed face to face, via phone, via letter, As soon as the SEP is PIU Environmental and Social specialist or email, suggestion boxes, or recorded during finalised (May 2021) public/community interaction. The PIU Environmental until the end of the and Social specialist is in charge of receiving the project June 2023). complaints. Health facilities have sealed suggestion boxes which are opened twice weekly and will be available for the project. These boxes provide for customers/patients to lodge complains anonymously or they can choose to identify themselves by filling in information such as their name, address, e-mail, and telephone number. The complaint is logged in the facility logbook and then transmitted to the E&S specialist in a confidential manner. Grievance assessed and The Environmental and Social specialist is responsible of 1 working days PIU Environmental and Social logged recording the complaints in the project’s logbook (Annex 2). upon receipt specialist. In the case of complaints received through suggestion boxes, complaint the complaints are lodged in a complaint book at the facility level and it is then transmitted to the Environmental and Social specialist to log it in the project logbook. A separate GRM logbook would be used for project workers, and for the complaints receive from Indigenous Peoples. Grievance is acknowledged Acknowledgement of grievance to complainant. The 2-3 working days PIU Environmental and Social specialist Environmental and Social specialist contacts directly the upon receipt and complainant and confirms reception of the grievance and recording of the next steps. complaint by the E&S Specialist. For complaints transmitted through suggestion boxes from other facilities outside of Georgetown the 2- 3 days clock starts from the time MOH receives the complaint. When complaints are logged on or presented in suggestion boxes, the person in charge in each facility will reach out to the E&S specialist of the project. Codes will be used to protect survivor’s identity. Investigation Complaints are sorted and then forwarded to the relevant 7-10 working days PIU Environmental and Social specialist department of the MoH for investigations. Once assess the complaint and forwards to the investigations are completed recommendations made relevant department for investigation. are implemented. Resolution/Feedback Within 15 working PIU Environmental and Social specialist Once a redress to a grievance has been proposed by the days upon responsible department, this measure will be acknowledge of communicated to the E&S specialist of the PIU, who complaint. then will communicate the decision, to the aggravated party. they will communicate the solution to the E&S specialist. On completing investigations, the findings and redress measures are communicated to the aggrieved party if they identified themselves. Review/Appeal – Complainants are informed by the Environmental and Social Specialist, that if they are still not satisfied, once all possible redress has been proposed, they have the right to take legal recourse. The project will have a project level GRM which is described in this SEP, and a GRM for workers as it is requested in ESS2. The Project GRM is also culturally appropriate and accessible for IPs, taking into account their customary dispute settlement mechanisms (even though this dispute settlement mechanism is only applicable for land disputes). Details can be found in the IPP section 10. In the MoH website, there is going to be an information box in Spanish and Portuguese, with the contact details of the GRM focal point for the project (PIU E&S specialist, Leslyn Lowe) who will be responsible for processing all complaints from Venezuelan and Brazilian migrants. 7.2. World Bank Grievance Redressal Service (GRS) The complainant has the option of approaching the World Bank, if they find the established GRM cannot resolve the issue. The Grievance Redress Service (GRS) is an avenue for individuals and communities to submit complaints directly to the World Bank if they believe that a World Bank project has or is likely to have adverse effects on them, their community, or their environment. The GRS enhances the World Bank’s responsiveness and accountability to project-affected communities by ensuring that grievances are promptly reviewed and addressed. Any individual or community who believes that a World Bank-supported project has or is likely to, adversely affect them can submit a complaint. Complaints must be in writing and addressed to the GRS. They can be sent ONLINE – through the GRS website at www.worldbank.org/grs BY EMAIL at grievances@worldbank.org BY LETTER OR BY HAND delivery to any World Bank Country Office BY LETTER to the World Bank Headquarters in Washington at The World Bank Grievance Redress Service (GRS) MSN MC 10-1018 1818 H St NW Washington DC 20433, USA Complaints must: • identify the project subject of the complaint • clearly state the project’s adverse impact(s) • identify the individual(s) submitting the complaint • specify if the complaint is submitted by a representative of the person(s) or community affected by the 50 project • if the complaint is submitted by a representative, include the name, signature, contact details, and written proof of authority of the representative 7.3. Addressing Gender-Based Violence The PIU Environmental and Social Specialist GRM17 will be responsible for dealing with any gender- based violence (GBV) issues, should they arise). A list of GBV service providers will be kept available by the project. The GRM should assist GBV survivors by referring them to GBV Services Provider(s) for support immediately after receiving a complaint directly from a survivor, prior to the survivor consent, and in case they are interested in them. GBV cases will be logged by the PIU Environmental and Social specialist in the project GRM logbook. Survivor’s information will be protected by using codes. Specifically, the GRM will only record the following information related to the GBV complaint:  The nature of the complaint (what the complainant says in her/his own words without direct questioning);  If, to the best of their knowledge, the perpetrator was associated with the project; and,  If possible, the age and sex of the survivor.  Any cases of GBV brought through the GRM will be documented but remain closed/sealed to maintain the confidentiality of the survivor. Here, the GRM will primarily serve to:  Refer complainants to the GBV Services Provider; and  Record the resolution of the complaint  The PIU will also immediately notify both the Implementing Agency and the World Bank of any GBV complaints with the consent of the survivor. If there is an anonymous compliant, the PIU will share information on the case with the World Bank providing a code number to the case and avoiding disclosing any information that could help to identify the survivor. Notifications will be made to the Bank in line with the confidentiality approach and with references to guidance from the World Bank ESIRT and GPN on SEA/SH. 17 This will not be a new staff figure; this is the same Environmental and Social Specialist hired by the PIU and whose functions have been described across this SEP 51 7.4. Building Grievance Redress Mechanism Awareness The PIU Project Manager or Environmental and Social Specialist will brief all project stakeholders on the GRM of the project and explain the procedures and formats to be used, including reporting procedures. Awareness campaigns would be conducted targeting project stakeholders to inform them on the availability of the mechanism; various mediums will be used- as detailed in previous sections of the SEP. Awareness will also include appropriate reference to the ability of making complaints related to GBV/SEA/SH that are related to the project. The GRM will also be published on the MOH websites and/or Facebook page https://www.health.gov.gy/index.php/world-news-3 and Facebook of MOH https://www.facebook.com/mophguyana] Contact information for the GRM will be posted/disseminated within beneficiary communities. VIII. Monitoring and Reporting 8.1. Reporting back to stakeholder groups The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Quarterly summaries and internal reports on public and confidential grievances (these lasts ones will be handle with a code number to keep the anonymous profile of the complainant), enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. The monthly summaries will provide a way to assess both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and ef fective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders by publication of a standalone annual report on project’s interaction with the stakeholders or promotion through the MOH’s social media accounts. Further details will be outlined in the Updated SEP, upon approval of the E&S documents by MOH and WB 52 Annex 1. Report on first round of consultations Guyana COVID-19 Emergency Response Project Report-Stakeholder consultation with stakeholders First Round of Consultations Date of Consultation: October 02nd 2020 Venue: Board Room of the Ministry of Health (Microsoft Teams for Virtual Consultations) Ministry of Health Staff who participated – Dr. Leslie Ramsammy (Advisor to the Minister of Health) Mr. Rovin Sukhraj (Health Economist) Mr. Ganesh Tatkhan (M&E Officer PIU) Introduction and Background The Novel Corona Virus Disease (COVID-19) was first identified in the City of Wuhan in Hubei Providence, Peoples Republic of China in December 2019 with spread to all provinces and the special administrative regions (SAR) of Hong Kong and Macao in China. On 30 January 2020 the World Health Organization (WHO) declared this outbreak to be a public health emergency of international concern. The number of cases continued to increase globally with more than 93,000 confirmed cases globally. China, with total of 80,422 cases up to 4th March 2020 and with 2,218 deaths recorded the most cases to-date. All of WHO Regions now report cases of COVID-19 and globally, main clusters relating to transmission have since emerged in South Korea, Japan, Singapore and Malaysia in the Western Pacific Region, Thailand in South East Asia, Italy and France in European Region and Iran in the Eastern Mediterranean Region of the WHO. Outside of China, 76 countries now reported cases with 12,668 confirmed (%) and 214 deaths. Guyana announced the first case of COVID-19 on 11 March 2020. On that same day, the World Health Organization (WHO) declared the outbreak of the COVID-19 as a global pandemic following its rapid spread across the world. On 31 July 2020, the total number of confirmed cases in Guyana was 41318, and the national incidence was less than 1 per 10,000 population. The last available epidemiological bulletin for Guyana reported that 1,565 COVID-19 cases were confirmed by 5 September 2020 and the national incidence reached 3.8 per 10,000 population during the third and fourth week of August 2020.19 Figure 1 shows the evolution by week of the total number of COVID-19 cases in Guyana. The regions with the highest number of COVID-19 active cases (n=556) by September 5 are: Region 4 (50.9%) -- where the capital city is located, and which hosts more than 40% of the country’s population --, Region 3 (10.3%), Region 1 (10.1%), Region 9 (8.6%), and Region 7 (8.3%), the last 3 of which are 18 https://www.worldometers.info/coronavirus/country/guyana/ 19 PAH0 (2020). COVID-19 Epidemiological Bulletin Guyana Epidemiological Week 36 / September 5, 2020 53 situated at the boarders with Venezuela and Brazil and host a high proportion of indigenous population. The total number of deaths due to COVID-19 confirmed by September 5 is 47. Since that period the Government of Guyana enacted several mitigation measures as a response to the treat of COVID-19. Despite Guyana maintaining a positive economic outlook, the pandemic and containment measures, including travel restrictions and social distancing measures, are impacting employment and livelihood. Industries in the services sector will be most affected including retail trade, transport, food and accommodation services. The impacts will fall disproportionately on informal workers who account for approximately 60% of the workers in the sector. To tackle COVID-19 outbreak the MOH outlined a COVID-19 preparedness and response plan. The Plan included an assessment of the main risks and identifies strategic priority areas to effectively respond to COVID-19. One of the main risks identified in the Plan concerns the vulnerability to imported COVID-19 cases, as Guyana has unofficial points of entry with no screening facilities and human resource capacities. Another major risk concerns shortages of supplies, especially in the hinterland locations, and difficulties in implementing physical and social distancing measures. The last major risk identified is about the health system’s capacity. The health system lacks adequate medical equipment and personnel to respond to the outbreak, including Intensive Care Units (ICUs) and ventilators. Only 5 of the 10 regions can count on isolation facilities. The strategic priority areas identified in the Covid-19 Preparedness and Response Plan include: 1) Country-level coordination, planning, and monitoring; 2) Risk communication and community engagement, which refers to communicating to the public updates about COVID-19 status, preventive measures, and response interventions; 3) Surveillance, rapid-response teams, and case investigation; 4) Points of entry, which refers to the efforts and resources used to support surveillance and risk communication activities at points of entry; 5) National laboratories to manage large-scale testing for COVID-19; 6) Revision of infection prevention and control practices in communities and health facilities; 7) Case management, which refers to the development and implementation of care pathways for both COVID-19 and essential healthcare services, ensuring special considerations for vulnerable populations (i.e. elderly, patients with chronic diseases, pregnant and lactating women, and children); 8) Operations support and logistics arrangements for incident management and operations (e.g. surge staff deployments, procurement of essential supplies, staff risk allowance). Consultation Objectives The objectives of the consultations were to inform stakeholders of the project and its various components. Stakeholder consultations served as a valuable tool for stakeholder(s) to get feedback on project outcome and impact. It also gave valuable insight from stakeholders on risk mitigation during planning and implementation stage. Stakeholders were also be informed about the Stakeholder Engagement Plan (SEP) 54 and Grievance Redress Mechanism (GRM) Methodology The MOH recognize that for the project to be successful there must be a buy in by those who would be impacted by the project. To this end the MOH undertook one round of consultation with the local Indigenous Peoples and some health workers. Given the emergency nature of this project and the current limitation of travel and emergency further consultations would be held with other stakeholders. MOH has taken into consideration the World Bank technical guidance on “Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, March 20, 2020.� The MOH held several consultations with Indigenous Peoples and community leaders. Given the emergency nature of the loan and the short period of time to hold the first round of consultation as well and logistics and communication constrains, consultations were held in person, virtually and over individually over the phone. A mapping was done with all stake holders and a decision was taken to have consultations with a selected group based on their availability and logistics. There will be a second round of consultations to facilitate other stake holders. Consultations were held on 2nd October with the Guyana Organisation of Indigenous People, The Amerindian Action Movement of Guyana. On the 5th October consultations were held with the National Toshaos Council and the Amerindian People Association. Also present at those consultation were a representative of the Ministry of Amerindian Affairs and an Indigenous Member of Parliament. On the 2nd of October virtual Consultations were also held with the Regional Democratic Council of region 1&9, and the Regional Health Officers of Region 1,7,8,7,9 & 10. For these consultations the Ministry of Amerindian Affairs assisted by emailing copies of the draft of the Project along with prompt questions. Between the period of 2nd to 5th of October Several Toshaos from various Indigenous communities who have no internet connection were contacted and consulted individually over the phone. This step was taken so that the consultation could be as wide and as inclusive as possible. However due to the above-mentioned circumstances, logistics and time the project document and prompt questions were not shared with those stakeholders 7 days in advance. Agenda of the Consultations Welcome and Introduction 55 The background to Covid-19 in Guyana Description of the WB project, activates and its intended outcomes Present WB ESF and GRM Questions and Answers Open discussion (to get feedback from stakeholders on any other matter that was not included in the questionnaire). Concluding remarks Overall Response The social and economic fallout of COVID 19 in Guyana has impacted every community and this was acknowledged by the stake holders. The concept of the WB project and its intended impact on the health sector and the general well-being of society was welcomed by all the stake holders engaged. The stake holders were very happy with the process that the PIU has taken to inform them and solicit their view and get their input notwithstanding the fact that virtual meeting and platform was something some of them are now getting accustomed to. Recommendation from Participants While welcoming the Project some of the stakeholder wanted the project to go a little further to include PCR testing in all regions. Some of the stakeholders also recommended putting ICU beds with relevant staffing and equipment at every hospital. MOH Response: IT was explained to them that while this is an ideal outcome the emergency nature of this project does not allow for civil works which would be required to achieve such. As such the PIU has selected laboratories and hospital which already has the capacity to upgrade (adequately trained staff, and physical structure). The decision was taken to select those facilities that would have a bigger impact with the resources allocated for this project. Risk Commination One of the barriers to the project is the miscommunication of information and fake news as it relates to the actual virus. According to some of the stakeholder’s social media was being used to mis communicate and spread propaganda on the virus. Some of the messaging that were spread included t COVID-19 is fake, it’s a virus created to wipe out people in the Global South. To this end the stakeholders related that this resulted in low level of testing as some of the people in the IP are fearful of testing and in some areas, they are reluctant to follow MOH social distancing advice and wearing mask. The Stakeholders from the IP that were engaged recommended that the MOH current risk communication strategy should be more cultural appropriate and 56 the locals should play a part in this. The representative of the Ministry of Amerindian Affairs pledges their support in making the services of the Community Service Officers (CSO) available for this project as this is part of their task of improving livelihoods and well-being of Amerindians. The CSO are also locals who speak the local languages and the citizen would more trust the message coming from a local. Some of the stake holders added that they were also some misunderstanding in the local IP about the COVID- 19 testing as they thought it was an HIV test and persons reluctant to take the test. MOH Response: To this end the PIU welcomed the suggestions of the stakeholders to get the locals involved in the Risk communication and messaging. The pledge from the Ministry of Amerindian Affairs was also welcomed and it was agreed that a follow up meeting would be done with the Ministries to come up with a MOU for the CSO and determine what task they will undertake. The MOH also has given the undertaking to provide the necessary training of the CSO and mentioned that some of them may be used as contact tracers since they understand the topography of the hinterland and has already earned the trust of the local IP. Cultural Considerations Stakeholders also asked for quarantine and isolation facilities to be more culturally acceptable. According to the stakeholder’s persons who were in the isolation and quarantine facilities complained about the diet since it did not include the traditional indigenous meals. According to them this is one of the reasons why people are reluctant to test since they are fearful of going into quarantine/isolation facilities. MOH Response: The MOH informed the stake holders that this issue was brought to the Ministry attention and it is already being addressed with GOG funds. Concerns about PPE Stake holders asked for more assistance in getting PPE (mask) for the local population. Stake holders also asked if the local community and women can make mask instead of the government procuring, since this will help the local communities with the economic fallout of COVID-19. Stakeholders recommended government to procured cloth and sewing machine and the local Amerindian Women’s groups can make cloth mask. This will also cater for mask for school children when school reopen. 57 MOH promised to consider this idea. While it will be late to implement in this WB project it will be considered for other project or GOG funds. Screening and Testing Local Toshaos also recommended the services of the CSO include screening people at the entrance of the village and ensuring they sanities. Some of them would like to see a mechanism put in place for those with high temperature to be transported to the nearest isolation facility so as not spread the infection to other villagers. This to them was critical since in IP the lifestyle is very communal. MOH Response: MOH and Ministry of Amerindian Affairs promise to do wider consultations with a view of getting other Toshaos views with the aim of implementing such a system. Health Workers Regional Chairmen, RDC officers & RHO’s while supportive of all the measures outlined were worried about burnout of the health workers since all of them has been working beyond the call of duty since the outbreak of COVID-19 in Guyana and their respective regions. They asked for increase renumeration and allowances for the staff. MOH Response: MOH assured stakeholders that funds were catered in the budget for risk allowance. Conclusions: The overall consequences of these consultations are that there is strong support for the interventions that are included on the project document. The concerns expressed by participants relating to the overall COVID-19 response coincide with the Project objectives. There is need for continuous stakeholder engagement and this will be part of the project implementation. 58 Attachment List of organizations that attended consultations at the MOH Board Room Organisation Representative Designation Guyana Organization of Colin Kluaty Board member Indigenous People The Amerindian Peoples Jeal Larose Executive Director Association The Amerindian Action Pretty Debidin Executive Member Movement of Guyana Ministry of Amerindian Affairs Ryan Toolsieram Deputy Permeant Secretary Parliamentary Secretary Sarah Brown Member of Parliament National Toshaos Council Jude DaSilva Executive Director National Toshaos Council Nandane Jerry Programme Coordinator Organisation Representative Designation Regional Democratic Council 1 Brentol Ashley Regional Chairman Region 1 Regional Democratic Council 2 Vilma De Silva Regional Chairman Region 2 Regional Democratic Council 9 Bryan Allicock Regional Chairman Region 9 Regional Democratic Council 1 De Steveh Chefoon Regional Health officer Region 1 Regional Democratic Council 2 Dr Ranjeev Singh Regional Health officer Region 2 Regional Democratic Council 7 Dr Edward Segala Regional Health officer Region 7 Regional Democratic Council 8 Dr Chrissundra Abdool Regional Health officer Region 8 Regional Democratic Council 9 Dr Naail Uthman Regional Health officer Region 9 Regional Democratic Council 10 Dr Gregory Hariss Regional Chairman Region 10 Ministry of Amerindian Affairs Ryan Toolsieram Deputy Permeant Secretary Ministry of Health Michael Govier Hinterlang Coordinator In addition, several Toshaos from villages in Regions 1,2,5,6,7,8,9, &10 were engaged over the phone. 59 Names Village Nicholas Fredericks Shulinab Paul Pierre Kwebanna Russian Dorrick Yupukari Genieve Van Sluytman Fathers Beach Loretta Fiedtkou Muritaro Sharmain Rambajue Baramita Romeo Smith Karrau Howard Cornelius Wakapoa Aubrey Samuels Santa Mission Beverly Clenkian St Cutberts Colin Adrian Moraikabai Carl Peneux Orealla Oren Williams Batavia John Spencer Tasserene Mario Hastings Kako Charles Lewis Kanapang/Penak Edward Mc Garell Chenapou Zacharias Norman Annai District Rickey Boyle Kimbia Ralph Hendricks Capoey Charles Jerry Waramadong Errnest Samuels White Water Whanita Philllips Santa Rosa Flagan Carter Rockstone 60 Annex 2. GRM logbook example How was Date Document that Date of Name of Contact of Status of General Info in the Complaint complaint complaint confirms the Complaint Complainant complainant complaint incident resolved was closed complaint Address: Date of Email: incident: Phone : Location of incident: Address: Date of Email: incident: Phone : Location of incident: Address: Date of Email: incident: Phone : Location of incident: 57 Annex 3. Report on second round of consultations. Guyana COVID-19 Emergency Response Project Report-Stakeholder consultation with stakeholders Second Round of Consultations Date of Consultation: December 4th -18th 2020 Venue: Virtual Consultations (Microsoft team) , telephone calls Ministry of Health Staff who participated – Dr. Leslie Ramsammy (Advisor to the Minister of Health) Mr. Rovin Sukhraj (Health Economist) Introduction Background The Novel Corona Virus Disease (COVID-19) was first identified in the City of Wuhan in Hubei Providence, Peoples Republic of China in December 2019 with spread to all provinces and the special administrative regions (SAR) of Hong Kong and Macao in China. On 30 January 2020 the World Health Organization (WHO) declared this outbreak to be a public health emergency of international concern. The number of cases continued to increase globally with more than 93,000 confirmed cases globally. China, with total of 80,422 cases up to 4th March 2020 and with 2,218 deaths recorded the most cases to-date. All of WHO Regions now report cases of COVID-19 and globally, main clusters relating to transmission have since emerged in South Korea, Japan, Singapore and Malaysia in the Western Pacific Region, Thailand in South East Asia, Italy and France in European Region and Iran in the Eastern Mediterranean Region of the WHO. Outside of China, 76 countries now reported cases with 12,668 confirmed (%) and 214 deaths. Guyana announced the first case of COVID-19 on 11 March 2020. On that same day, the World Health Organization (WHO) declared the outbreak of the COVID-19 as a global pandemic following its rapid spread across the world. On 31 July 2020, the total number of confirmed cases in Guyana was 41317, and the national incidence was less than 1 per 10,000 population. The last available epidemiological bulletin for Guyana reported that 1,565 COVID-19 cases were confirmed by 5 September 2020 and the national incidence reached 3.8 per 10,000 population during the third and fourth week of August 2020.18 Figure 1 shows the evolution by week of the total number of COVID-19 cases in Guyana. The regions with the highest number of COVID- 19 active cases (n=556) by September 5 are: Region 4 (50.9%) -- where the capital city is located and which hosts more than 40% of the country’s population --, Region 3 (10.3%), Region 1 (10.1%), Region 9 (8.6%), and 17 https://www.worldometers.info/coronavirus/country/guyana/ 18 PAH0 (2020). COVID-19 Epidemiological Bulletin Guyana Epidemiological Week 36 / September 5, 2020 58 Region 7 (8.3%), the last 3 of which are situated at the boarders with Venezuela and Brazil and host a high proportion of indigenous population. The total number of deaths due to COVID-19 confirmed by September 5 is 47. Since that period the Government of Guyana enacted several mitigation measures as a response to the treat of COVID-19. Despite Guyana maintaining a positive economic outlook, the pandemic and containment measures, including travel restrictions and social distancing measures, are impacting employment and livelihood. Industries in the services sector will be most affected including retail trade, transport, food and accommodation services. The impacts will fall disproportionately on informal workers who account for approximately 60% of the workers in the sector. To tackle COVID-19 outbreak the MOH outlined a COVID-19 preparedness and response plan .The Plan included an assessment of the main risks and identifies strategic priority areas to effectively respond to COVID-19. One of the main risks identified in the Plan concerns the vulnerability to imported COVID-19 cases, as Guyana has unofficial points of entry with no screening facilities and human resource capacities. Another major risk concerns shortages of supplies, especially in the hinterland locations, and difficulties in implementing physical and social distancing measures. The last major risk identified is about the health system’s capacity. The health system lacks adequate medical equipment and personnel to respond to the outbreak, including Intensive Care Units (ICUs) and ventilators. Only 5 of the 10 regions can count on isolation facilities. The strategic priority areas identified in the Covid-19 Preparedness and Response Plan include: 1) Country-level coordination, planning, and monitoring; 2) Risk communication and community engagement, which refers to communicating to the public updates about COVID-19 status, preventive measures, and response interventions; 3) Surveillance, rapid-response teams, and case investigation; 4) Points of entry, which refers to the efforts and resources used to support surveillance and risk communication activities at points of entry; 5) National laboratories to manage large-scale testing for COVID-19; 6) Revision of infection prevention and control practices in communities and health facilities; 7) Case management, which refers to the development and implementation of care pathways for both COVID-19 and essential healthcare services, ensuring special considerations for vulnerable populations (i.e. elderly, patients with chronic diseases, pregnant and lactating women, and children); 8) Operations support and logistics arrangements for incident management and operations (e.g. surge staff deployments, procurement of essential supplies, staff risk allowance). Consultation Objectives The objectives of the consultations were to provide stake holders with information on the projects its intended objectives and to get their feedback so as to better implement the project. The consultations will 59 also give valuable insight from stake holders on risk mitigation during planning and implementation stage. Apart from the ESMF stakeholders were also consulted on the IPP, SEP and GRM. Methodology The MOH recognize that for the project to be successful there must be a buy in by those who would be impacted by the project. To this end the MOH undertook a second round of consultation with NGOs representing indigenous people (such as Guyana Organization of Indigenous Peoples, The Amerindian Association, and the Amerindian Action Movement of Guyana, the National Toshaos Council, all of these organizations are are recognized by the Indigenous Peoples as legitimate representatives.) MOH has taken into consideration the World Bank technical guidance on “Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, March 20, 2020.� The MOH held several consultations with stakeholders. Given the emergency nature of the loan and the short period of time to hold the consultation as well and logistics and communication constraints, consultations were held virtually via Microsoft teams, also by telephone. A mapping was done with all the stakeholders. A decision was taken to have consultations with a selected group based on the availability and access to internet since consultations were virtual. The organizations that participated were • Artistes in Direct Support, • Guyana Trans United, • Guyana Responsible Parenthood Association, • Guy Bow • Comforting Hearts, • Chief Medical Officer. Dr. Narine Singh • Regional Health Officers, • Matron of the Regional Hospitals • Guyana Medical Council • General Nursing Council • Environmental Health Unit MOH • Standard and Technical Services MOH • Guyana Organization of Indigenous People • The Amerindian Association • The Amerindian Action Movement of Guyana 60 • Ministry of Amerindian Affairs • National Toshaos Council • Between the period of December 4th – 18th Toshaos and Community Development Chairmen from every village were contacted via telephone to get their input on the project and consult on the IPP SEP and ESMF. This step was taken so that the consultation could be meaningful and to get the views of as many people as possible. List of participants Organisation Name of Participants Designation FACT Mr. Royston Savory Prevention Officer Artistes in Direct Support Ms. Desiree Edghill Executive Director Guyana Trans United Mr. Colin Balize Guyana Responsible Ms. Ronetta Knights Programme Manager Parenthood Association Guyana Responsible Dr. Pedro Hernandez Medical Manager Parenthood Association Guy Bow Shifanie Comforting Hearts Denzil Crawford Prevention Officer National Aids Programme Mr. Nazim Hussain Food Manager Secretariat (Guyana) Guyana Medical Council Dr. Navin Rambaran, Chairman General Nursing Council Ms. Linda Johnson, Chief Nursing Officer Guyana, (Guyana) Chairperson General Nursing council General Nursing Council Ms. Donett. Kellman Registar (Guyana) Regional Democratic Council Dr. Steven Cheefoon Regional Health Officer Region 1 Region 1 Regional Democratic Council Dr. Ranjeev Singh Regional Health Officer Region 2 Region 2 Mabaruma Hospital Loreen Sobers Ward Sister acting, Mabaruma Hospital Suddie Hospita,l Region 2 Ms. Herculese Matron Suddie Hospita,l Region 2 Ms. Laal Junior Matron Regional Democratic Council Dr. Erica Forte Regional Health Officer Region 2 Region 2 West Demerara Hospital, Muriel Moore Matron, West Demerara Region 3 Hospital Regional Democratic Council Dr. D. Nicholson Regional Health Officer Region 5 Region 5 Regional Democratic Council Dr, Vishalia Sharma Regional Health Officer Region 6 Region 6 New Amsterdam Hospital, Dr. Javid Azize Head of Covid Unit Region 6 Region 6 /New Amsterdam Hospital New Amsterdam Hospital, Suzette August Matron, New Amsterdam Region 6 Hospital 61 Regional Democratic Council Dr. Gregory Harris Regional Health Officer Region Region 10 10 Linden hospital Complex, Hazel Luther Register Nurse, Region 10 Linden Hospital complex, Annett Jones Matron Region 10 Guyana School of Nursing Hillary Christopher Principal tutor Ministry of Health Dr. Narine Singh, Chief Medical Officer Guyana Environmental Health Unit, Abigail Liverpool Principal Environmental Health Ministry of Health Officer Standards And Technical Dr. Julian Amsterdam Director Standards And Services, Ministry of Health Technical Services Agenda of the Consultations with NGOs 1. Welcome and Introduction 2. The background to Covid-19 in Guyana 3. Description of the WB project, activates and its intended outcomes 4. Description of IPP ESMF SEP and GRM 5. Questions and Answers 6. Open discussion (to get feedback from stakeholders on any other matter that was not included in the questionnaire). I. Overall Response Most of the Stakeholders were aware of the project since they were present at the first round of consultation or heard about it in the media. The project continues to receive positive response. II. Personal Protective Equipment - Some of the staff raised concern of PPE not being provided on a timely manner and at times they had to provide their own however this was a rear incident. MOH Response: The Ministry is currently purchasing and will continue to provide PPE but the particular incident was a rear one which was caused by logistic problems and it was remedied. MOH promise not to repeat and ask hospitals to keep buffer stocks for staff. III. Waste Disposal There were complains of color-coded bags not always being available at hospitals tor garbage segregation and the staff resorted to using regular disposal bags. The stake holder was keen to note 62 that this incident occurred a while back prior to Covid-19. MOH Response: There is adequate supply of bags being procured for all facilities. It is the responsibility of the hospital to requisite these in a timely manner and to always have stock on hand. The ministry also highlighted to the region in cases of emergency and stock outs there is a mechanism in place for emergency order and it is the responsibility of the RHO to ensure there is adequate supply. IV. Risk Communication and COVID-19 Measures Some of the organizations asked the curfew should be extended while others argued against it. There were arguments for stricter measures and enforcement of persons who are in public without wearing a mask. MOH Response: The MOH provide the technical guidelines and there is a cautious effort to reopen the country and business while taking all precautions. Government has to balance the response to the pandemic as well as economic activities as many businesses are cutting staff and going bankrupt. It was highlighted that while it is illegal to be in public without mask the GOG does not want to fill the courts and prisons as this can cause further problems. Instead the police have reverted to warning people not to be in public without masks and distributing masks. This approach is paying dividend with more people complying. V. Cold Chain The medical staff from the hinterland region raised concern about the government preparedness to receive vaccine response. MOH Response: While this project is not specific to vaccination it was noted that the cold chain and storage sites in every Region would be boosted with additional cold storage capacity and improved transportation. Equipment such as refrigerators, solar refrigerators and vaccine carriers will be procured under the WB response while other development partner and the Government will also provide equipment. Conclusions: The overall consequences of these consultations are that there is strong support for the interventions and the mechanism in place to safeguard the welfare of workers and the wellbeing of the nation. There was a clear need for continuous engagement with stakeholders to share information and get feedback and this will be done as part of the project implementation. 63 64 Annex 4. Report on third round of consultations. This section will be completed after the third round of consultations that will happen in May-June 2021. 65