The World Bank Niger COVID-19 Emergency Response Project (P173846) Appraisal Environmental and Social Review Summary Appraisal Stage (ESRS Appraisal Stage) Public Disclosure Date Prepared/Updated: 04/03/2020 | Report No: ESRSA00610 Apr 03, 2020 Page 1 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) BASIC INFORMATION A. Basic Project Data Country Region Project ID Parent Project ID (if any) Niger AFRICA P173846 Project Name Niger COVID-19 Emergency Response Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 3/31/2020 4/10/2020 Population Financing Borrower(s) Implementing Agency(ies) Republic of Niger Ministry of Health Proposed Development Objective(s) To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Niger Public Disclosure Financing (in USD Million) Amount Total Project Cost 13.90 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] The Niger proposed project is aligned to the country COVID-19 preparedness and response plan that amounts to US$175 million, out of which the World Bank is financing US$13.9 million. The World Bank support will focus on strategic activities that will provide a platform for all donors and interventions. The World Bank’s support will aim to align the many actors responding to the COVID-19 pandemic in Niger to promote synergies, complementarity and efficiency. The proposed project will consist of three components: Component 1: Emergency COVID-19 Response; Component 2: Communication campaign, community engagement and Behavior change; Component 3: Implementation Management and Monitoring and Evaluation. Apr 03, 2020 Page 2 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) D. Environmental and Social Overview D.1. Project location(s) and salient characteristics relevant to the ES assessment [geographic, environmental, social] This emergency operation will be implemented nationally. It will contribute to COVID-19 preparedness, monitoring, surveillance and response. The project components are not yet finalized and the specific locations where project sub- components will be implemented have not yet been identified. No major civil works will be financed. The project is not expected to impact natural habitats or cultural sites. The Project is expected to improve healthcare waste management in Niger. It should be noted that increasing insecurity related to attacks by armed groups in the Tillaberi, Diffa and Tahoua regions could negatively affect the implementation of project activities. D. 2. Borrower’s Institutional Capacity The REDISSE 3 and COVID-19 Emergency Response Projects will coordinate to support disease surveillance and response. REDISSE 3’s key objective is to strengthen national and regional cross-sectoral capacity for collaborative disease surveillance and epidemic preparedness in West Africa. The two projects will work closely to minimize the chances of duplication and maximize their synergies and by using the same project implementation unit (PIU). The PIU has experience with the Bank's ESF but it is relatively recent. A training and capacity building plan will be prepared and reflected in the ESCP. The environmental and social specialists already in the PIU will support this project and any other specialists needed such as those required for the implementation of the SEP will be contracted no later than 30 days after Project effectiveness. II. SUMMARY OF ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Substantial Public Disclosure Environmental Risk Rating Substantial The environmental risk classification for the project is Substantial under the World Bank ESF, mainly due to risks related to the management and disposal of highly infectious COVID-19 biomedical waste (Component 2) and because Niger is an FCV country with limited implementation capacity. Component 1 will finance the very basic renovation of treatment centers including painting and general repairs. Risks associated with the renovation are also deemed substantial even if the construction occurs prior to any surge in infectious cases, because workers would be working indoors, in close quarters, and may risk passing the virus to one another. Under such circumstances, occupational health and safety becomes of paramount importance and workers would need to be fully equipped to ensure their health and safety (working at 6m distances, wearing N95 masks, etc) as well equipped with the necessary PPE to ensure their physical safety in active work zones. Social Risk Rating Substantial The social risk rating of the project is Substantial. One key social risk related to the COVID-19 operations in general is that vulnerable social groups (poor, disabled, elderly, isolated communities, refugees and IDPs) may be unable to access facilities and services, which could increase their vulnerability and undermine the general objectives of the project. Other social risks include the rise of social tensions that could be exacerbated by the lack of awareness regarding the behavior change required to decrease transmission (social distancing, hand washing and hygiene), stigma associated with victims of COVID-19 and their families, perceived exclusion from key health facilities and services and misinformation regarding how COVID-19 is transmitted and prevented and sexual exploitation and abuse and harassment (SEA/H). The situation is further exacerbated by high insecurity in several regions of the country such as Tillaberi and Diffa that will make implementation, monitoring and supervision extremely difficult. Apr 03, 2020 Page 3 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: This operation is being processed as an emergency response using condensed procedures under the Fast Track COVID-19 Facility (FTCF). This standard is relevant because the management and handling of infectious Covid-19 waste generated by the laboratories and relevant health facilities that will administer diagnostic testing and the hospital disposal and waste management systems will both pose substantial environmental health and safety risks. Without the proper care and procedures in place, infectious waste streams could lead to illness and death among patients and lab workers due to inadequate adherence to occupational health and safety standards. To mitigate these risks, the ESMF approved for the REDISSE 3 project will be updated to include an Infection Control and Medical Waste Management Plan (ICMWMP) based on WHO protocols for managing risks associated with COVID-19. The ESMF/ICMWMP will adequately cover environmental and social infection control measures and procedures for the safe handling, storage, and processing of COVID-19 materials including techniques for preventing, minimizing, and controlling environmental and social impacts during the operation of project supported laboratories and medical facilities. The relevant parts of WHO’s COVID-19 Quarantine Guideline and COVID-19 biosafety guidelines will be incorporated into the ESMF and ICMWMP. Public Disclosure In addition, the project will support the renovation of hospitals and/or other treatment centers for patients. Construction workers recruited to rehabilitate these centers may be at risk from infection from each other, particularly if they work indoors in close quarters. The construction firms/individuals that will be recruited for upgrading of hospital or other treatment centers must follow ESMF/ICMWMP guidelines, integrating the risks and mitigation measures during the preparation and pre and post construction phase. The construction company(s)should ensure that these document(s) are understood by all workers before the start of works especially the sections that focus on occupational health and safety requirements for construction workers, including requirements to keep workers at least 6 ft apart, and to equip them with both health related safety (N95 masks) equipment, as well as personal protection equipment, and incorporating other WHO recommended guidelines. The ESMF will also provide mitigation measures related to other types of impacts related to the renovations such as hazardous and non-hazardous waste disposal for construction waste, noise, etc. The guidelines contained in the project's ESMF/ICMWMP will also include provisions to address the needs of patients, including the most vulnerable, to ensure that health workers have all the relevant information to protect themselves and patients. These will include provisions for the establishment of quarantine and isolation centers and their operation, considering the dignity and needs of patients and prevention of Sexual Exploitation and Abuse and Sexual Harassment (SEA/H). In terms of Niger's capacity to manage the environmental and social risks, the project will use the PIU for the REDISSE 3 project. It has some previous experience with managing Bank projects and the ESF and the PIU already has an environment and social specialist. In addition, the PIU will be reinforced by the recruitment of 2 additional specialists, Apr 03, 2020 Page 4 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) a social communication specialist and community mobilization specialist, to support the implementation of the activities to be financed under Component 2 and the SEP. ESS10 Stakeholder Engagement and Information Disclosure This standard is relevant. The main project stakeholders are the Ministry of Public Health, regional Health Agencies, COVID 19 committees, local authorities (governors and mayors/prefets), traditional authorities, religious leaders, civil society actors and local communities. A draft SEP has been prepared and disclosed. It outlines the characteristics and interests of the relevant stakeholder groups, including the timing and methods of their engagement throughout the project life. The SEP will be updated and redisclosed no later than 30 days after Project effectiveness to provide more detailed information regarding the methodologies for information sharing in fragility and conflict areas, stakeholder mapping and identification of existing community-based platforms that can be used to facilitate effective community engagement and participation as well as the monitoring and evaluation plan and WHO’s ethical principles for community engagement during pandemics. effective community engagement and participation. The draft SEP also includes the details of the REDISSE 3 GRM that will also be used for this project. Given the local context, the implementation of the GRM will involve the relevant traditional authorities, religious leaders, local authorities (mayors/prefets) and local communities in the project area as well as a national level focal point in the Public Disclosure PIU. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions This standard is relevant. Many activities supported by the project will be conducted by health care and laboratory workers and will include both the treatment of patients as well as the assessment of patient samples. The key risk for them is possible COVID-19 contamination (and other contagious illnesses as COVID-19 patients are likely to suffer from other illnesses that compromise the immune system). The PIU will ensure the application of OHS measures as outlined in WHO guidelines which will be captured in the updated ESMF/ICMWMP and the Labor Management Procedure (LMP). This includes: procedures for monitored entry into health care facilities, including minimizing visitors and undergoing strict checks before entering; procedures for protection of workers in relation to infection control precautions; provision of immediate and ongoing training on the procedures to all categories of workers, and post signage in all public spaces mandating hand hygiene and personal protective equipment (PPE); ensuring adequate supplies of PPE (particularly face masks, gowns, gloves, handwashing soap and sanitizer); and generally ensuring adequate OHS protections in accordance with the general and industry specific EHSGs and consistent with the evolving international best practice in relation to COVID-19 protection. Also, the PIU will ensure that they are regularly integrating the latest COVID-19 guidance by WHO as it develops. The PIU will develop procedures which respond to the specific health and safety issues posed by COVID-19 and protect workers’ rights as set out in ESS2. A Labor Management Procedure (LMP) will be prepared and disclosed no later than 30 days after Project effectiveness. Apr 03, 2020 Page 5 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) It will provide guidance regarding the policies and procedures that will govern health care workers, project staff and other workers hired under the project. Indeed, the envisaged works will be of minor scale and thus pose limited risks but workers will need to have access to necessary PPE and handwashing stations. In line with ESS2, the use of forced/conscripted or child labor in the Project is prohibited, both for small rehabilitation works and the operation of health care facilities. The LMP will also provide details regarding the establishment of a labor GRM to allow workers to quickly inform management of labor issues, such as a lack of PPE and unreasonable overtime via the PIU. ESS3 Resource Efficiency and Pollution Prevention and Management This standard is relevant. Medical and chemical waste (including water, reagents, infected materials, etc.) from the labs, hospitals and screening posts can have substantial negative impact on environment and human health. Waste that may be generated from medical facilities/ labs could include liquid and solid contaminated waste, chemicals and other hazardous materials, and other waste from labs and quarantine and isolation centers including of sharps, used in diagnosis and treatment. Each beneficiary medical facility/lab, following the requirements of the ESMF/ICMWMP and WHO COVID-19 guidance documents, and other best international practices, will follow and implement the ICMWMP developed as part of the updated ESMF to prevent or minimize such adverse impacts. The updated ESMF/ICMWMP will include guidance related to transportation and management of samples and medical goods or expired chemical products. Resources (water, air,etc.) used in quarantine facilities and labs will follow standards and measures in line with US-Center for Disease Control (CDC) and WHO environmental infection control guidelines for medical facilities. Public Disclosure ESS4 Community Health and Safety This standard is relevant. Medical waste management including incineration can produce pollution which can affect community health. To mitigate such risks, the ESMF/ICMWMP will provide guidance to protect community health from medical waste incineration and management including: - how Project activities will be carried out in a safe manner with low incidences of accidents and incidents in line with Good International Industry Practice (WHO guidelines); - measures in place to prevent or minimize the spread of infectious diseases; and - emergency preparedness measures. It is possible that some project activities may exacerbate SEA/H. The updated ESMF will include guidance for a SEA/H risk assessment and the preparation of a GBV Action Plan if found relevant. In addition, the WHO Code of Ethics and Professional Conduct for all workers in the quarantine facilities as well as the provision of gender-sensitive infrastructure such as segregated toilets and sufficient light in health facilities will be integrated during implementation. For the health centers that will be supported by the project and that may need to be protected by security personnel, a Security Risk Assessment (SRA) may need to be undertaken to identify the specific risks related to providing increased security at the various project sites and to propose adequate mitigation measures. If the use of security forces is required, a Security Management Plan will be prepared to manage social and community risks. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement Apr 03, 2020 Page 6 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) This standard is not currently relevant. The project will not require any land acquisition or economic displacement. All rehabilitation and renovation will take place in existing facilities. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources Waste from laboratories and other project sites could affect natural resources, if handled inappropriately. Given the possibility of both humans and animals catching the virus, it is important that contaminated waste does not enter into streams, rivers, gullies, etc. All personnel involved in the project must therefore follow the requirements outlined in the ESMF/ICMWMP to ensure safe handling of medical and hazardous waste. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities This standard is not currently relevant. There are no known Indigenous Peoples/Sub-Saharan Historically Underserved Traditional Local Communities in the project area of influence. If during implementation it is found that there are people in the project area who may meet the criteria of ESS 7, the project will undertake a screening and, based on its findings take appropriate measures, per the requirements of the ESF. ESS8 Cultural Heritage Public Disclosure This standard is not relevant at this time as the limited civil works are unlikely to affect cultural assets. Out of an abundance of caution, the ESMF will include measures for “Chance Finds” of archaeological or other cultural heritage. ESS9 Financial Intermediaries This standard is not currently relevant. There are no FI's involved in this project. B.3 Other Relevant Project Risks This project may be implemented in FCV contexts especially in the Tillaberi, Diffa and Tahaoua regions. These areas face on-going attacks by armed groups against government facilities, Niger Armed Forces (FAN), foreign military forces (Barkhan) and civilians. As a result, it should be noted that the contextual risks may outweigh the direct project risks and they cannot be entirely mitigated. It will be difficult to adequately supervise the activities that will be implemented in the insecure areas and there is a risk that project implementation could be interrupted by violence or conflict. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No The project does not involve any international waterways. OP 7.60 Projects in Disputed Areas No Apr 03, 2020 Page 7 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) The project is not in a disputed area. III. BORROWER’S ENVIRONMENTAL AND SOCIAL COMMITMENT PLAN (ESCP) DELIVERABLES against MEASURES AND ACTIONs IDENTIFIED TIMELINE ESS 1 Assessment and Management of Environmental and Social Risks and Impacts Communication specialist(a) and community mobilization specialist(s) should be recruited no later 07/2020 than 30 days after Project effectiveness. Updated ESMF that includes ICMWMP, CHSP and SEA/H assessment finalized and disclosed no later than 30 days after Project effectiveness. E&S risks and impacts must be assessed and managed consistent with ESS1 for any activities that will be implemented before the updated ESMF is finalized 06/2020 and disclosed. ESS 10 Stakeholder Engagement and Information Disclosure A draft SEP has been prepared and disclosed and shall be updated no later than 30 days after Project 06/2020 effectiveness. ESS 2 Labor and Working Conditions Public Disclosure The LMP will be prepared and disclosed before engaging project workers in the carrying out of Project activities. The Labor GRM will also be functional before engaging project workers in the carrying out of 06/2020 Project activities. ESS 3 Resource Efficiency and Pollution Prevention and Management Considered under the ESMF/ ICMWMP. 06/2020 ESS 4 Community Health and Safety Considered under the ESMF/ICMWMP and to include a SEA/H Risk assessment and SRA if necessary. 06/2020 ESS 5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement N/A ESS 6 Biodiversity Conservation and Sustainable Management of Living Natural Resources N/A ESS 7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities N/A ESS 8 Cultural Heritage Apr 03, 2020 Page 8 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) N/A ESS 9 Financial Intermediaries N/A B.3. Reliance on Borrower’s policy, legal and institutional framework, relevant to the Project risks and impacts Is this project being prepared for use of Borrower Framework? No Areas where “Use of Borrower Framework” is being considered: N/A IV. CONTACT POINTS World Bank Contact: Cedric Ndizeye Title: Senior Health Specialist Telephone No: 5350+3205 / Email: cndizeye@worldbank.org Public Disclosure Borrower/Client/Recipient Borrower: Republic of Niger Implementing Agency(ies) Implementing Agency: Ministry of Health V. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Cedric Ndizeye Practice Manager (ENR/Social) Kevin A Tomlinson Cleared on 02-Apr-2020 at 16:06:37 EDT Safeguards Advisor ESSA Nina Chee (SAESSA) Concurred on 03-Apr-2020 at 09:16:2 EDT Apr 03, 2020 Page 9 of 10 The World Bank Niger COVID-19 Emergency Response Project (P173846) Public Disclosure Apr 03, 2020 Page 10 of 10