(AF ESRS Appraisal Stage) - Additional Financing Appraisal Environmental and Social Review Summary Appraisal Stage
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Public Disclosure Authorized
The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
Public Disclosure Authorized
Additional Financing Appraisal Environmental and
Social Review Summary
Appraisal Stage
Public Disclosure Authorized
(AF ESRS Appraisal Stage)
Public Disclosure
Date Prepared/Updated: 05/12/2021 | Report No: ESRSAFA187
Public Disclosure Authorized
May 13, 2021 Page 1 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
BASIC INFORMATION
A. Basic Project Data
Country Region Borrower(s) Implementing Agency(ies)
Guyana LATIN AMERICA AND Co-operative Republic of Ministry of Health
CARIBBEAN Guyana
Project ID Project Name
P176546 AF Guyana COVID-19 Emergency Response Project
Parent Project ID (if any) Parent Project Name
P175268 Guyana COVID-19 Emergency Response Project
Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date
Health, Nutrition & Investment Project 5/24/2021 6/24/2021
Population Financing
Public Disclosure
Proposed Development Objective
To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health
preparedness in Guyana.
Financing (in USD Million) Amount
Current Financing 0.00
Proposed Additional Financing 0.00
Total Proposed Financing 0.00
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]
To prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health
preparedness in Guyana.
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AF Guyana COVID-19 Emergency Response Project (P176546)
D. Environmental and Social Overview
D.1. Detailed project location(s) and salient physical characteristics relevant to the E&S assessment [geographic,
environmental, social]
The Parent Project, Guyana COVID-19 Emergency Response Project (P175268), was approved for a US$7.5 million WB
credit on November 25, 2020 under the COVID-19 Strategic Preparedness and response Program (SPRP) and became
effective on December 15, 2020. It includes two components: (i) Emergency response to COVID-19; and (ii)
Implementation Management and M&E. The Parent Project mainly finances medical and non-medical equipment and
supplies, as well as the rollout of the national communications strategy, incorporating health prevention campaigns
targeting the general public, and training materials for health and community personnel. The purpose of the proposed
Additional Financing (AF) is to help the Government of Guyana (GoG) purchase and deploy the COVID-19 vaccines,
and to strengthen relevant health systems that are necessary for a successful deployment and to prepare for the
future. The proposed AF will help acquire doses to vaccinate approximately 10 percent of the country’s 800,000
people. The AF activities will build on the Parent Project as well as on the WB’s existing health portfolio in the country.
The AF activities will be added to Components 1 and 2 of the Parent Project.
As mentioned earlier, the Parent Project deals with acquisition of goods (medical equipment, testing supplies) and is
not intended to support any civil works. The only activities with physical footprints will be delivery and installation of
equipment associated with expansion of ICU capacity at various hospitals, establishment of isolation centers and
quarantine facilities, and upgrading of cold-chain and storage facilities. The project will be implemented at the
national level and will cover both urban and rural areas.
Public Disclosure
Environmental and social risks associated with the Parent Project activities are related to worker and community
health and safety, pollution and public health risks from inappropriate management of liquid and solid waste
materials arising from the clinical care operations, and social risks associated with exclusion of people such as
vulnerable and disadvantaged people (including ethnic minority communities). The project is not expected to impact
natural habitats or cultural heritage sites, nor do project activities have the potential to lead to involuntary
resettlement issues. Many of the environmental and social risks of the AF are shared with the Parent Project, but
there are specific vaccination-related risks related to the risk of exclusion of vulnerable populations such as
indigenous peoples, migrants, people living with disabilities, and the LGBTIQ+ community among other vulnerable
groups, cold chain expansion, vaccine transport, and vaccine related waste disposal.
The GoG developed a national vaccine coverage and purchase plan and is currently implementing it. The GOG is also
implementing an integrated approach for COVID-19 vaccine distribution, leveraging both fix vaccination sites and
mobile teams distributed across the Regions. There are currently 110 vaccination sites including both public and
private facilities. With respect to mobile teams, each of them is composed of five persons: two vaccinators (mostly
recruited from a pool of retired health workers/nurses), a surveillance person, a clerical staff, and an educator. Teams
can be strengthened with additional vaccination staff from health facilities, as well as with trained volunteers (e.g.
members of civil society and local communities, medical and nursing students) that assist with surveillance and
clerical duties. In addition to fixed vaccination sites and mobile teams, special sites are organized in collaboration with
religious leaders and local government bodies, such as the Neighborhood Democratic Councils (NDCs), to promote
COVID-19 vaccination through targeted outreach within communities, especially in coastal regions. From a logistics
perspective, vaccines are stored centrally at the National Vaccination Bond and distributed daily to regional stores,
May 13, 2021 Page 3 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
which redistribute them to vaccination sites. The National Vaccination Bond has ultra-cold storage capacity. All
regional stores have cold storage for +2 to +8°C; only Regions 2, 4, 6, and 10 have cold storage for -20°C. To ensure
that all Regions have access to vaccines while appropriate cold storage capacity is developed, Guyana is using
temperature-controlled shippers with dry ice. Vaccines are shipped two times a day from the National Vaccination
Bond using dry ice to ensure that temperature is maintained during travels via air, water, and land. The country’s
small size lessens many of the logistics and distribution challenges allowing, for example, for vaccines to be delivered
from the National Vaccination Bond to vaccination sites within 24 hours.
A monitoring and reporting system for COVID-19 vaccine deployment was designed and is under implementation.
Data on vaccination coverage and adverse events is collected at vaccination sites and by mobile teams and then
submitted, at the end of each day, to regional focal points. Regional focal points aggregate information collected at
the local level and submit it to the central level. Guyana faces challenges in terms of availability of computers and
tablets, electricity, and internet coverage, especially in remote regions; therefore, data is usually collected through
paper-based registers and cards and then aggregated and digitalized at the regional level. To strengthen COVID-19
vaccine deployment and the health system beyond the pandemic, the GoG is taking action to improve its health
information system. Specifically, the deployment plan includes strengthening the adverse event tracking system
technically supported by PAHO, as well as the logistical management information system (LMIS) supported by UNDP.
The LMIS will support the tracking of a) distribution of vaccines and ancillary supplies, b) persons who have been
vaccinated to plan for second doses, and c) different vaccine brands utilized.
Guyana has started establishing an active post-vaccination surveillance system. This includes information related to:
Public Disclosure
(i) coverage of vaccine; (ii) rapidly detect and evaluate possible adverse events associated with vaccination; (iii)
estimate the effectiveness of vaccine at preventing a spectrum of disease outcomes and subsequent transmission,
including different viral variants, as well as the duration of any protective effect; (iv) identify risk factors for and
outcomes of vaccine failure, including any impact on strain evolution; (v) monitor the overall impact of the
vaccination program on COVID-19 in the wider population including the indirect effect on groups not targeted by the
vaccination program; (vi) monitor the impact of the vaccination program on prevalence of antibodies against COVID-
19 as an indicator of population level immunity, and to monitor antibody waning in the population; (vii) monitor
attitudes to vaccination and identify barriers to high vaccine uptake; and (viii) monitor inequalities in each of these
outcome measures.
The AF includes a new component, Supporting National and Sub-national, Prevention and Preparedness and Health
System Resilience, through US$1 million grant from the Health Emergency Preparedness and Response Umbrella
Program (HEPRTF), which will support analytical and assessment capacity. These will include two sets of activities. The
first set will be directed to support preparedness through promoting a One Health approach, including: (i) the
conducting of a Joint External Evaluation, likely in collaboration with Pan-American Health Organizations (PAHO), with
training and dissemination activities; (ii) the implementation of a Performance of Veterinary Services (PVS)
assessment, likely in collaboration with the World Organization for Animal Health (OIE); and (iii) a One Health bridging
workshop and Training Program to support Guyana’s resilience, provide multi-sectoral training in health and
agriculture, to improve capacity for data collection, cross-sectoral surveillance, and integrated monitoring and
reporting systems. The second set of activities will be directed to strengthening the delivery and quality of care of
essential services, beyond COVID19. These activities will include the implementation of a health facility survey (e.g.
Service Delivery Indicators Survey (SDI) to obtain important information about readiness of facilities to provide
essential services and quality of services offered, including a patient exit interview survey to assess the experience of
May 13, 2021 Page 4 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
users with the services received; and a digital health assessment, likely in collaboration with PAHO. All those activities
will provide valuable information to assess the performance of the health system (in particular, primary health care)
and identify areas and functions that need further strengthening to enable the system to become more resilient to
emergencies, including health and climate shocks. The requirements set out in paragraphs 14–18 of ESS1 will be
applied to the component 3 (TA activities) as relevant and appropriate to the nature of the risks and impacts. The
Terms of Reference (ToR) of the technical studies will be reviewed to ensure consistencies with the ESS requirements.
D. 2. Borrower’s Institutional Capacity
There are no changes envisioned to the implementation arrangements in the AF. The Ministry of Health (MoH) is the
implementing agency for the Parent Project and will also be implementing the AF. It will have overall responsibility for
project implementation including fiduciary, monitoring and evaluation, and environmental and social risk
management. Within MoH, the Health Sector Development Unit (HSDU) is the Project Implementation Unit (PIU),
which also manages an IDB-funded health project as MoH streamlines its implementation capacity.
MoH assigned an Environment and Social Focal Point at the early stage of the Parent Project preparation, who was
responsible for the preparation of the environmental and social instruments for the Parent Project and ensuring
coordination with other PIU and MoH staff. This role will continue during project implementation. In addition, the PIU
has recruited one full-time Environment and Social Specialist, who will be the key person for day-to-day
Public Disclosure
environmental and social risk management in coordination with the Environmental and Social Focal Point. The
institutional arrangements for E&S risk management for the parent project will cover the responsibilities in the AF.
Since the Parent Project was the first loan for Guyana using the World Bank Environmental and Social Framework
(ESF), the World Bank E&S team delivered an introduction on the approach, rational and review of the standards
relevant to the project to the Government E&S focal point. The World Bank staff are also extending their support to
assist MoH during project implementation to undertake the planned environmental and social risk management
measures, including stakeholder engagement and preparation of required management plans to be applied under the
Project.
The PIU prepared the Environmental and Social Commitment Plan (ESCP), the SEP and the Interim Environmental and
Social Guidance during the Parent Project preparation. The MoH completed the Environmental and Social Specialist
recruitment process, and the selected candidate accepted the offer within 30 days of project effectiveness (by
February 1, 2021). This meets the ESCP requirement related to the organizational structure (1.1b). Also, the
designated Environmental and Social Focal Point continues to provide support on environmental and social issues.
Following the declaration of effectiveness, the PIU prepared the ESMF, the LMP (as part of ESMF), the IPP and
updated the SEP within 60 days of Parent Project effectiveness date. The contents of the instruments are materially
robust and the timeline in the ESCP is considered met, although some revisions were required based on the Bank’s
detailed review process. The final draft versions of the Parent Project ESMF including LMP, IPP and SEP were
approved by the Bank in early May 2021 and published on the MoH website
(https://www.health.gov.gy/index.php/world-news-3) to support virtual consultations. in May-June 2021. The client
will present the documents with stakeholders for their review and discuss them during the joint consultation sessions
to be had for the Parent Projects and the AF during May-June 2021. The implementing agency will also share quarterly
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AF Guyana COVID-19 Emergency Response Project (P176546)
reports with the Bank and with stakeholders throughout the Project implementation submitted not later than 45 days
after the end of each quarter.
The environmental and social performance of the project was rated ‘Satisfactory’ at the first implementation support
mission. However, the performance is now considered ‘Moderately Satisfactory’ due to delays in finalizing
consultations the E&S instruments for the Parent Projects. In addition, the GRMs as described in the SEP and IPP
(project level GRM) and in the LMP (project workers GRM) have not been fully implemented yet. As of now, the email
address, walk-in and phone number for calls are open; however, the suggestion boxes in the health facilities are not
operational. Additionally, the GRM has only been partially communicated to stakeholders. It was socialized during the
previous two rounds of consultations in October 2-5, 2020 and December 4-18, 2020 and is part of the SEP that was
disclosed in October 2020. The rationale provided by the client is that project activities have not started yet. A fully
functional project level GRM will be adopted no later than 60 days after AF effectiveness date.
The E&S instruments prepared for the Parent Project will be updated to include the provision of vaccination for AF.
The SEP will be updated including the activities of the AF by the ROC meeting date. The ESMF, the LMP, and the IPP,
will be updated no later than 60 days after AF effectiveness date.
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 risks remain as “Substantial” given the emergency context of the pandemic, inherent
occupational and community health and safety risks, issues associated with biomedical waste management and
limited capacity of the implementing agency with the World Bank’s Environmental and Social Framework (ESF). The
potential environmental and human health risks associated with the Parent Project activities are: (i) occupational
health and safety (OHS) risks resulting from the operation of medical facilities and laboratories involved in COVID-19
response which inherently expose staff to infection risk; (ii) infection control and waste management and disposal;
(iii) community health and safety issues related to the uncontrolled transmission of the covid-19 virus due to the
lack of adequate testing, laboratory and quarantine facilities and contamination due to the improper handling,
transportation and disposal of healthcare wastes. The AF continues to have the above mentioned risks. In addition,
the major health risk associated with the mass vaccination program is bloodborne pathogens from improper storage
and disposal of sharps. Further to that, the management and disposal of temperature-controlled packing does pose
some environmental challenges for a vaccination program on a large scale. There are also minor risks from small-
scale construction and waste disposal from the expansion of cold-chain and storage capacity, as the equipment is
delivered and installed.
Social Risk Rating Substantial
The social risk remains “Substantial” given the potential risks related with exclusion of vulnerable groups. Specific
risks include: i) Lack of adequate measures for the use of public and communal facilities in remote areas where
health facilities may be scarce. To mitigate the risk, the MoH is using mobile units to reach remote areas and this will
continue to be the case throughout project implementation to ensure that vaccinations are accessible to all; ii)
Social exclusion of vulnerable populations (particularly Indigenous Peoples, the LGBTI+ community, and migrants).
May 13, 2021 Page 6 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
Indigenous peoples and migrants could be at risk of exclusion if communication campaigns are not inclusive, lack
culturally sensitive language or transparent information regarding vaccination phasing. As a mitigation measure, the
project will ensure that communication campaigns are inclusive. Some of the risk communication campaigns
messages will be translated into Spanish, Portuguese, and some indigenous languages, to ensure messages related
to vaccinations reach indigenous peoples and migrants who do not speak English. Through the communications
campaign, the project will ensure that all individuals in Guyana can access voluntarily the vaccination services,
regardless of their nationality, sexual preferences, gender identification, ethnical, racial, socio-economic condition,
or cultural beliefs. The project will not condition access to vaccination upon proof of residence, nationality, or any of
the social characteristics described above. However, to keep track and register the doses that individuals receive,
the project will request some form of identification. Lack of identification will not be a reason to deny vaccination;
iii) Public mistrust: There is a risk of public mistrust toward acceptance of the vaccine (in terms of its potential side
effects, not its efficacy, according to the UNICEF vaccination hesitancy survey 2020). The project will ensure that
communications campaigns include messages on how vaccines work, their risks and benefits to build trust in
immunizations through citizen and community engagement and an aggressive communication campaign; iv) Risks of
Gender-Based Violence (GBV). Women and girls may be forced into exchanging sexual favors for access to testing,
treatment, vaccines or even supplies. The LMP code of conduct will include provisions to prevent and report power
abuses from project workers and civil servants, including the security forces against women and girls in exchange of
sexual favors.
B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered
Public Disclosure
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:
The standard is relevant for the AF, given the potential environmental, social, health and safety risks from the
hazardous and possibly infectious nature of the pathogen, chemicals, vaccines, and other materials to be acquired,
stored, transported, and administered, and the eventual disposal of the associated waste materials.
The Parent Project is expected to have long term positive environmental impacts, insofar as it should improve COVID-
19 surveillance, monitoring, treatment and containment. The scaled up activities financed by the AF are expected to
further enhance these positive impacts, through the additional investments in procurement of vaccines.
The adverse environmental, health and safety risks and impacts are likely to arise from exposure to the virus itself
should there be inadequate provision and use of personal protective equipment by health workers, increased risk of
exposure to communities in the immediate vicinity of health care facilities and vaccination centers, and health and
pollution impacts associated with the inadequate handling, treatment and disposal of cleaning products, biomedical
waste and expired or open vaccine vials, including risks and impacts associated with incremental waste volumes
resulting from large scale vaccination activities.
The ESMF prepared for the Parent Project addresses many of the risks from the AF. The ESMF was developed based
on the Bank’s ESMF-COVID template and includes measures for screening for infection prevention and healthcare
waste management, standard provisions for workers, community health and safety, and capacity strengthening for
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AF Guyana COVID-19 Emergency Response Project (P176546)
social, environment, health and safety management. Medical, solid and liquid wastes need to be treated as per
accepted standards for which an Infection Control and Waste Management Plan (ICWMP) was prepared as part of
the ESMF. In addition, the ICWMP covers: (a) anticipated waste composition and quantity; (b) existing medical, solid
and liquid waste management system, including deviation and gaps from the emission standards and other protocols;
(c) existing regulatory framework and supervision/monitoring arrangements; (d) plan for using the existing medical,
solid and liquid waste management system, including any measures to upgrade or remedy identified gaps and
deviations; and (e) additional arrangements for supervision and monitoring of waste management including used and
discarded PPE.
The ESMF will be updated to address the risks specific to the AF vaccination efforts including:
(i) vaccine safety and efficacy. Funds can only be used for the procurement of thoroughly tested and approved
vaccines, to mitigate the potentially adverse health effects of administering unsafe vaccines. In addition, the AF
includes a monitoring component for adverse health effects of the vaccine on people that received it.
(ii) Safe transport and storage of the vaccine. Cold chain requirements for vaccines have different storage
temperature requirements, ranging from temperatures as low as -70C to refrigerator temperatures of 2-8C and are
prone to rapid decay and ineffectiveness when not stored at the proper temperature, which could lead to high
wastage. Wasted vaccines may be dangerous, or at the very minimum ineffective, when administered. The Vaccine
Introduction Readiness Assessment Tool (VIRAT) and the Vaccine Readiness Assessment Framework (VRAF) were
used to assess institutional, operational and financial capacity gaps. The AF will fund necessary investments in cold
Public Disclosure
storage and logistics to enable the safe delivery of vaccines throughout the country, as well as the return of medical
waste to the main disposal facility.
(iii) Safe collection, transportation, treatment and disposal of vaccine wastes. All the vaccine related waste will be
collected and transported to the centralized hydroclave at GPHC for treatment and after that it will be disposed to
the regulated Haag Bosch landfill site.
(iv) Vaccine equitable distribution and access. Risks of elite capture or inability to distribute the vaccine safely to
the more remote areas could lead to vulnerable people missing out on vaccination.
The AF includes the retroactive financing provision for vaccines and possibly other supplies, which are expected to be
delivered after the project effectiveness and approval of the AF. The ESMF update will include guidelines for the due
diligence process before any retroactive reimbursement payments are made.
The ESMF for the Parent Project will be updated and disclosed no later than 60 days after AF effectiveness date and
will account for the AF related activities, which focus on the procurement, distribution and administration of safe
vaccines, in addition to expanding existing activities under the Parent Project, including vaccination awareness and
risk communication campaigns, training of vaccinators and other workers, activities related to vaccine storage and
cold chain facilities, and the transport and disposal of biomedical waste. These activities can largely be managed
using the mitigation measures proposed in the ESMF for the Parent Project, but specific guidance on the selection of
priority population groups to be vaccinated and monitoring of adverse health effects from vaccination will be
included in accordance with emerging WHO guidance. Measures to ensure the quality of vaccines is maintained
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AF Guyana COVID-19 Emergency Response Project (P176546)
throughout the supply chain in accordance with WHO guidance (the WHO’s Vaccine Management Handbook “How to
Monitor Temperatures in the Vaccine Supply Chain” 2015) for storage and transportation of vaccines will also be
incorporated. Where relevant, the World Bank Group’s Environment, Health and Safety (EHS) Guidelines, the WHO’s
specific COVID-19 guidelines on laboratory biosafety, and other WHO and international good practice guidelines on
COVID-19 medical waste management, diagnostic testing, administration of COVID19 health services, quarantine
guidelines, handling of medical supplies, and healthcare occupational health and safety (OHS), including those
requirements to support vaccination activities, will be referenced in the updated ESMF. The existing measures and
tools in the ESMF such as Infection Control and Waste Management Plan (ICWMP), Community Health and Safety
Plan (CHSP) and others as relevant will be revised to ensure they fully cover the additional risks associated with the
AF funded activities.
The ESMF will specify the measures to assess the risks associated with the deployment of security personnel or
excessive use of force and actions to mitigate such risks. Security forces should be instructed and trained, prior to
deployment and on a regular basis, on the use of force and appropriate conduct (including in its relations to civilian,
sexual exploitation and abuse (SEA), sexual harassment (SH) or excessive use of force), as will be set out in ESMF.
A COVID-19 vaccination communication plan has been developed. The Plan includes targeted communication
strategies (e.g. messages, activities, materials, and collaborating partners) for different population groups. Specific
actions are under implementation to combat misinformation and vaccine hesitancy (e.g. each vaccination teams
include at least one educator; and, health professionals conduct group educational activities in health facilities).
Demand generation measures are in place, and people can freely opt out of vaccination. This will clarify the issues of
Public Disclosure
informed consent and data protection regarding vaccination, particularly of vulnerable groups or communities with
limited access to information. The updated ESMF will determine how these risks will be mitigated, including
measures to ensure: (i) a robust and coordinated national communication strategy promoting the Project’s
objectives, including the vaccination roll-out, tailored to various audiences to address issues of access, discrimination,
and ethnicity; (ii) continuous education and awareness raising campaigns based on the information included in the
NVRP; (iii) development of materials (radio, infographics, TV broadcasts) in an inclusive and culturally sensitive
manner, particularly when discussing the benefits of vaccination; (iv) consult and inform the public of the content in
the NVRP, including the strategies that will be adopted regarding information disclosure, informed consent and
measures of transparency; and (v) a grievance redress mechanism that will allow for adaptive management. These
aspects will be complemented with the actions included in the project Stakeholder Engagement Plan. In addition, the
updated ESMF will also include provisions to support non-discrimination in provision of services and equal treatment
to all project beneficiaries, as well as identifying the barriers faced by poor, marginalized and ethnic minorities in
accessing healthcare centers and treatment. The ESMF will also describe the procedures, protocols, or other
measures that will be in place to ensure voluntary consent for vaccination and how policies will be developed to
ensure that there is no forced vaccination.
ESS10 Stakeholder Engagement and Information Disclosure
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AF Guyana COVID-19 Emergency Response Project (P176546)
ESS10 is relevant for the AF. The MoH prepared, consulted, and disclosed a final version of the Stakeholder
Engagement Plan (SEP) for the Parent Project in May 2021. The SEP has been further updated with the AF activities at
the processing of the AF, and adopted prior to the effectiveness date of the AF. The final version of the SEP (which
will cover all Parent Project activities, as well as AF activities) will be finalized no later than 60 days after AF
effectiveness date. The SEP will be implemented throughout project implementation.
Among Project Affected Parties are Indigenous Peoples, Frontline Health Care workers, community officers,
gatekeepers, health waste management workers, among others. Other interested parties include stakeholders who
are interested in understanding the government's prevention and response to COVID-19, and government ministries
and offices such as Standards and Technical Services, Environmental Health Unit.
Disadvantaged and vulnerable individuals are the elderly population, people living with disabilities, LGBTIQ+, women
and children, female health care workers, poor economically marginalized groups, migrants, and indigenous peoples,
and those with underlying health conditions such as non-communicable diseases.
The borrower conducted two rounds of consultations (for the preparation of the SEP in October 2020, and for the
preparation of the IPP, the ESMF, and the LMP in December 2020), with some of the stakeholders indicated
previously. Guyana has implemented different actions to combat misinformation and vaccine hesitancy. The MoH, in
partnership with UNICEF, conducted a COVID-19 vaccination hesitancy survey in 2020. Results show that only 68.0%
of respondents reported that they would accept taking the COVID-19 vaccine. Evidence shows that the rejection is
mainly because of its potential side effects. The results point to more males (males 10.3% and females 7.7%)
Public Disclosure
reporting that they previously hesitated or refused to get a vaccination either for themselves or their child/children.
In addition, misinformation and fake news have played an important role in hesitancy. The MoH has also identified
that some people have genuine fears of needles. To ensure that there is an appropriate community engagement, the
SEP will be updated and will include as project affected people, individuals that may be hesitant to vaccinations, or
that distrust government health programs. Information about the AF activities, including the communication
campaigns to build trust in immunization through citizen and community engagement will be added to the SEP. Like
the parent project, the AF communication campaigns will take into consideration culture and language including
Spanish and Portuguese to reach migrant populations.
To avoid consultation fatigue, the consultations for the AF will be held jointly with the consultations for the Parent
Project every four months. The first consultation on the AF activities will be held between May and June 2021. The
overall objective of the consultations will be to inform the stakeholders about Parent Project and AF activities.
Information about the benefits of the vaccinations will be shared as well to ensure that stakeholders have the correct
information and allow them to identify fake news. Consultations will be key to build trust among stakeholders on the
vaccinations program. During consultations, the MoH will inform stakeholders on how their feedback from previous
consultations has been addressed. A report of the consultations feedback and agreements to follow-up by the MoH
will be added as annexes to the SEP, ESMF, and IPP. The reports will be also available in a standalone document and
will be publicly disclosed in the MoH website.
The SEP has been updated to ensure that there is a section acknowledging the messages on principles of fair,
equitable, and inclusive vaccine access and allocation. The SEP includes a table of the priority groups and the
rationale for prioritizing certain groups. At this stage, the GoG has already finalized the vaccination for priority groups
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AF Guyana COVID-19 Emergency Response Project (P176546)
and vaccinations are now open for anyone 18 years old and above regardless of their nationality, legal residence
status, ethnicity, gender, economic status, vulnerability, or other characteristics. Identification documents are being
requested in vaccination sites to keep track of the people that has been vaccinated, track side effects, and to ensure
that people get their second dose. However, proof of residence, or lack ID are not conditions to get vaccinated. To
prevent elite capture or misuse of vaccines, the MoH will closely monitor vaccine registries to ensure vaccines reach
their intended destination and that the identified target groups receive the vaccines at the right time. This has been
included in the updated SEP.
Since security forces are likely to be used for the AF activities, the SEP will include a communication strategy on the
involvement of such forces under the project. The communication strategy for security forces will be included in the
SEP no later than 60 days after AF effectiveness date. The SEP for the Parent Project includes a project level GRM.
The GRM includes the available channels for stakeholders to submit complaints, such as email, telephone, and
suggestion boxes. The Environmental and Social Specialist has the overall responsibility of receiving, recording, and
monitoring the resolution of the grievances. The Specialist assesses the complaints and directs them to the
appropriate staff or department to solve the complaint. The project level GRM for the Parent Project will also apply
for activities under the AF. The SEP will include provisions in the GRM to ensure that any concerns or grievances
regarding the conduct of military forces are received, monitored, documented (taking into account the need to
protect confidentiality), resolved through the Project’s grievance mechanism, and reported to the Bank no later than
5 days after being received. The GRM will be updated to receive, register, and address concerns arising from
unintended health consequences after vaccination especially those resulting in serious adverse effects.
Public Disclosure
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
ESS2 is relevant. The MoH prepared, consulted, and disclosed a final version of the Labor Management Procedures
(LMP) for the Parent Project in May 2021. Additional workers for the AF will include direct workers such as
community health workers, data entry clerks, nurses, and patient care assistants. As of now, contracted, and primary
supply workers are not expected to be hired for the AF activities. The project will also use military personnel as civil
servants. As part of the National Deployment Vaccination program, around 400 military personnel have already been
placed at the service of the MoH to secure the deployment activities of vaccinations. They are securing sites where
vaccination, logistics, and other deployment activities are taking place. Like other civil servants, military personnel are
entitled to annual and sick leave. Security forces will need to adhere to the project’s code of conduct. Additionally,
the provisions of paragraphs 17 to 20 (Protecting the Work Force) and paragraphs 24 to 30 (Occupational Health and
Safety) of ESS2 will apply to all civil servants.
Key risks include contamination with COVID-19, abuse and stigmatization from the public, exposure to hazardous
substances, and risks of psychological distress and fatigue due to the nature of the work. The LMP for the Parent
Project includes mitigation measures such as providing Personal Protective Equipment (PPE) to project workers and
ensuring adherence to protocols and guidelines to prevent COVID-19; consultations will be key to raise awareness
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AF Guyana COVID-19 Emergency Response Project (P176546)
and recognition of health care workers to prevent abuses against them; also, the Mental Health Unit of the MoH will
be available for project workers that request the service. The risks and mitigation measures will be reviewed to
ensure that they are aligned with AF activities.
Where relevant, the World Bank Group’s Environment, Health and Safety (EHS) Guidelines, the WHO’s specific
COVID-19 guidelines on laboratory biosafety, the WHO’s Vaccine Management Handbook “How to Monitor
Temperatures in the Vaccine Supply Chain” (2015) and other WHO and GIIP guidelines on COVID-19 medical waste
management, diagnostic testing, administration of COVID19 health services, quarantine guidelines, handling of
medical supplies, and healthcare occupational health and safety (OHS), including those requirements to support
vaccination activities, will be referenced in the updated ESMF and LMP.
The key national laws and regulations protecting workers already part of the Parent Project LMP will be reviewed to
ensure that those apply and are relevant to the AF activities. As stated in LMP, the minimum age for component 1 of
the Parent Project related to community engagement, such as contact tracing, is 16 years old. However, the LMP for
the AF will be updated to include that the project will prohibit children under 18 years old from being employed in
vaccination sites and other health activities where hazardous materials are being handled.
The LMP includes a grievance redress mechanism to allow project workers to quickly inform management of labor
issues, such as lack of PPE, excessive overtime, working without a contract, or GBV cases. The use of child or forced
labor is forbidden in the Parent Project, and the same will apply to the AF per ESS2. The LMP will be finalized no later
than 60 days after AF effectiveness date to reflect relevant labor aspects related to the AF.
Public Disclosure
ESS3 Resource Efficiency and Pollution Prevention and Management
The standard was relevant for the Parent Project and remains so for the AF. Pollution prevention and management –
specifically for medical waste management – is an important activity under the Project. The project may generate
medical, solid and liquid wastes that could affect the health of care givers, local communities and the environment.
However, the amount of the waste to be generated directly from the project related activities are not expected to be
significant. The Parent Project ESMF included an Infection Control and Waste Management Plan (ICWMP) to assess
and manage waste of different kinds (solid, liquid, medical, hazardous and nonhazardous). The plan includes
separation of different kinds of waste, treatment, and transportation, storage and final disposal of wastes in
approved sites/through incineration/other methods as per ESS3 and related ESHGs, GIIP, WHO guidelines and the
draft medical waste guidelines of Guyana (2011).
The ICWMP will be expanded to include the waste types emerging to the AF components – including sharps, used and
expired vaccine vials. The AF will manage waste materials by returning them to the central storage facility for
treatment in the GPHC autoclave. Wastes will ultimately be disposed of in the Haag Bosch Sanitary Landfill. The PIU
will ensure the execution of the ICWMP throughout the project implementation period.
Dry ice (dry, frozen carbon dioxide) will be used in the transport of vaccines to ensure temperatures are kept
sufficiently low as required. Dry ice is currently imported from Trinidad, where a manufacturing plant was recently
installed to meet the needs for dry ice, estimated at 5000 pounds for a 3-day capacity (the typical time requirement
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AF Guyana COVID-19 Emergency Response Project (P176546)
for delivery to hinterland areas), although needs will vary depending on the type of vaccines being stored and
transported. The project ESMF update will include an assessment of any relevant environmental, health and safety
concerns, and those related to resource efficiency and pollution prevention under ESS3.
A cold chain assessment was conducted in February 2020 with support from PAHO/WHO. Resulting from this
evaluation, storage facilities have already been developed at the Cheddi Jagan International Airport and at several
domestic airstrips in the hinterland. Currently there are 14 recently constructed storage facilities, bringing the total
number of cold chain facilities to 20. This network will be upgraded through the AF to expand and decentralize the
cold chain facilities, which are still not fully equipped to manage all the requirements of the cold chain for the variety
vaccine types that may be used in Guyana. The updated ESMF will include a checklist for managing the minor
construction impacts expected from this expansion. In addition, the AF will fund the development of logistics plans
and protocols for equipment use and maintenance.
ESS4 Community Health and Safety
This Standard remains relevant for the AF. The ESMF for the Parent Project included a Community Health and Safety
Plan (CHSP) that addressed relevant risks to prevent the infection of community members during project activities
and to ensure that the areas surrounding any facilities, and visitors, are not placed at risk. In addition, an emergency
response plan was prepared as part of the CHSP in case of laboratory accidents/ emergencies (e.g. a fire response or
natural disaster).
Public Disclosure
The AF will pose additional risk to community health and safety due to the vaccination activities. The safety systems,
protocols and emergency preparedness measures for the storage, transport, use and disposal of vaccines to ensure
community health and safety will be detailed in the updated ESMF and CHSP. The team has engaged MoH in
numerous planning discussions, and the MoH has prepared VRAT/VRAF and the National Vaccination Deployment
Plan to assist in the due-diligence process as the ESMF is updated.
There are currently 110 vaccination sites including both public and private facilities. These are mainly at existing
public and private hospitals and health clinics, and also at sports clubs. Community centers, churches, and schools
are not planned to be used. Private pharmacies may also be engaged to administer vaccines. For remote areas and
to reach disabled persons, mobile teams will be deployed. NGOs and civil society will help with community
mobilization but not with actual vaccination activities. These specifics will be integrated into the updated
instruments.
The ICWMP will be updated to include the collection, transport and disposal of waste materials from the vaccination
efforts. This will include training for those vaccination centers located outside existing health facilities such as sports
centers. The risks associated with the transportation of vaccines and associated supplies, as well as the transport of
bio-infectious waste and expired or used vaccines vials to treatment and disposal facilities will be assessed in the
ESMF to ensure that adequate road safety and emergency response management actions are documented in the
relevant sections of the ICWMP, CHSP, and Emergency Preparedness and Response Plans.
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AF Guyana COVID-19 Emergency Response Project (P176546)
To maximize climate co-benefits, the project will also promote the use of climate-smart technologies and the
procurement and mobilization of energy efficient equipment including climate friendly refrigerators/freezers and the
use of clean energy solutions (such as solar), where possible. Extreme weather and seismic events may pose risk to
the implementation of vaccination activities. The ESMF will detail the requirements for emergency preparedness and
contingency plans to manage this risk.
As part of the government’s emergency response, the military will be used to assist with the transport logistics
associated with the distribution of the vaccine. The ESMF will specify measures to identify risks associated with the
deployment of such personnel (including sexual exploitation and abuse (SEA), sexual harassment (SH) or excessive
use of force) and required mitigation measures.
Another additional community health and safety risk to be addressed is the follow up and monitoring of vaccine
recipients for adverse reactions or side effects. The MoH has developed an Immunization Tracking System that will
be adapted for this purpose. All health facilities will be equipped with pharmovigilance and ESAVI (Events Supposedly
Attributable to Vaccination or Immunization) forms in case of any reactions when persons return to their locations.
All incidents will be investigated either by the local team or the national team depending on the severity of the case.
The WB is supporting the MoH in finalizing its communication strategy for the vaccination campaign which is
expected to (i) inform the general public, the priority groups and health care workers about the vaccination program,
its phases and implementation calendar; (ii) communicate in a uniform and transparent manner about the efficacy
and safety of the vaccine(s) proposed to be administered, their side effects, the associated environmental and social
Public Disclosure
impacts of their deployment and administration, and about the recommendations of public health authorities; (iii)
explain the prioritization rationale; and (iv) provide clear, uniform and coherent communication about the
vaccination program and in particular its first phase.
ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement
This standard is currently not relevant.
ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources
This standard is currently not relevant.
ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities
This standard is relevant. The MoH prepared, consulted, and disclosed a final version of the Indigenous Peoples Plan
for the Parent Project in May 2021. Two rounds of consultations for the Parent Project were held in October and
December 2020 with different organizations such as the Guyana Organization of Indigenous Peoples, the Amerindian
Association, the Amerindian Action Movement of Guyana, the Ministry of Amerindian Affairs, and the National
Toshaos Council. The IPP includes a very comprehensive mapping of indigenous stakeholders that is relevant for the
AF.
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AF Guyana COVID-19 Emergency Response Project (P176546)
Indigenous Peoples could face some risks and impacts regarding AF, such as limited access to vaccination for those
living in remote areas, hesitancy to get vaccinated, and lack of culturally appropriate messages. The IPP will be
updated to reflect that there are fixed and accessible vaccination sites for indigenous peoples in all ten regions of
Guyana. In addition, mobile vaccination units are used to reach remote areas with indigenous peoples' presence. On
vaccination hesitancy, the survey shows data segregated by gender and age groups; therefore, there is no available
data on hesitation by ethnicity. Since the only available data points that the leading cause of reluctance is
vaccination's side effects, the MoH will make a significant effort to debunking fake news around vaccinations through
the AF communication campaigns. Consultations will be critical to ensure that Toshaos, NGOs, the Ministry of
Amerindian Affairs, and other relevant organizations have the scientific information around vaccinations to share the
correct information with the communities they represent.
As stated in the IPP, Toshaos have not stated that COVID-19 treatment is against their traditional health practices nor
will it negatively impact their cultural heritage. On the contrary, during consultations for the Parent Project, they
have expressed their full support for the efforts of the MoH to prevent the spread of COVID-19.
The IPP includes some provisions to make the project's GRM described in SEP culturally appropriate and accessible to
Indigenous Peoples. The channels and grievances intake process will not be modified for the AF; therefore, no
updates will be necessary in this regard.
The IPP will be finalized no later than 60 days after the AF effectiveness date. Meaningful consultations will be held
Public Disclosure
every four months with overall project stakeholders, including Indigenous Peoples, during project implementation to
ensure constant engagement with them and ensure that their concerns about vaccinations are addressed. To make
the process in a culturally appropriate manner, the Toshaos will be involved in consultations as representative bodies
of the Indigenous communities. Their participation will ensure that the consultations are meaningful and in a
culturally appropriate manner. Also, the Ministry of Amerindian Affairs will continue to be engaged to ensure that
consultations and information disclosure are culturally relevant. The MoH will inform the Toshaos that vaccination is
voluntary, and indigenous peoples have the right to refuse the vaccination. This message will be replicated during
consultations.
ESS8 Cultural Heritage
This Standard is relevant. Although Parent Project and AF activities as currently proposed will not support any
activities that could adversely impact tangible or intangible cultural heritage, such as sacred sites or culturally
important buildings, the standard is relevant considering the distinct cultural health practices of the Indigenous
Peoples. The IPP has included appropriate measures in this aspect. In addition, the screening tool as part of the
project’s ESMF has provision to screen out activities that will negatively impact cultural heritage or will require the
development of the Cultural Heritage Plan. The relevance of the standard will be further reviewed during the early
stage of the project implementation.
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AF Guyana COVID-19 Emergency Response Project (P176546)
ESS9 Financial Intermediaries
The Standard is not relevant, as the project will not use financial intermediaries.
C. Legal Operational Policies that Apply
OP 7.50 Projects on International Waterways No
OP 7.60 Projects in Disputed Areas No
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:
None
IV. CONTACT POINTS
Public Disclosure
World Bank
Contact: Federica Secci Title: Senior Health Specialist
Telephone No: +1-202-473-9234 Email: fsecci@worldbank.org
Borrower/Client/Recipient
Borrower: Co-operative Republic of Guyana
Implementing Agency(ies)
Implementing Agency: Ministry of Health
V. FOR MORE INFORMATION CONTACT
May 13, 2021 Page 16 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
The World Bank
1818 H Street, NW
Washington, D.C. 20433
Telephone: (202) 473-1000
Web: http://www.worldbank.org/projects
Public Disclosure
May 13, 2021 Page 17 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
VI. APPROVAL
Public Disclosure
May 13, 2021 Page 18 of 19The World Bank
AF Guyana COVID-19 Emergency Response Project (P176546)
Task Team Leader(s): Federica Secci
Practice Manager (ENR/Social) Valerie Hickey Cleared on 12-May-2021 at 16:59:13 GMT-04:00
Public Disclosure
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