MEGHALAYA HEALTH SYSTEMS Public Disclosure Authorized STRENGTHENING PROJECT (P173589) Public Disclosure Authorized Environmental and Social Management Framework (ESMF) Public Disclosure Authorized Draft Report Public Disclosure Authorized February 2021 Table of Content ABBREVIATIONS AND ACRONYMS ............................................................................................ iv Executive Summary ............................................................................................................................. vi 1 Introduction ................................................................................................................................... 1 1.1 Background ............................................................................................................................. 1 1.2 Environmental Profile of Meghalaya ...................................................................................... 1 1.3 Socio-Cultural and Demographic Profile of Meghalaya .......................................................... 3 1.3.1 Demographic Profile ....................................................................................................... 3 1.3.2 Tribes of Meghalaya ........................................................................................................ 3 1.3.3 Religion ............................................................................................................................ 4 1.4 Health Status in Meghalaya .................................................................................................... 4 1.5 Health Care Facilities in Meghalaya ........................................................................................ 6 1.6 Protected Ares and Historic Sites ............................................................................................ 8 2 Project Description ..................................................................................................................... 10 2.1 Purpose of the ESMF ............................................................................................................. 10 2.2 Approach and Methodology ................................................................................................. 11 2.3 Project Components ............................................................................................................. 12 3 Legal and Regulatory Framework ............................................................................................ 19 3.1 Indian National Regulations and Standards .......................................................................... 19 3.2 Meghalaya State Specific Laws and Regulations .................................................................. 29 3.3 The World Bank’s Environmental and Social Standards (ESS) .............................................. 30 3.4 Guidance Related to COVID19 .............................................................................................. 37 4 Environmental and Social Baseline ........................................................................................... 40 4.1 Key Health Sector Challenges in Meghalaya ......................................................................... 40 4.2 Waste Management in Meghalaya ....................................................................................... 40 4.2.1 Solid Waste Management ............................................................................................. 40 4.2.2 Bio-Medical Waste Management ................................................................................. 41 4.2.3 Segregation and Collection of Waste ............................................................................ 43 4.2.4 Storage and Transportation of Bio-medical Waste ....................................................... 44 4.2.5 Treatment and Disposal of Bio-medical Waste............................................................. 45 4.2.6 Occupational Health and Safety Measures ................................................................... 45 4.2.7 Other Environmental Aspects ....................................................................................... 46 4.2.8 Infrastructure Condition and Access ............................................................................. 47 4.3 Status of Women in Meghalaya ............................................................................................ 48 4.3.1 Women work participation rate ................................................................................... 49 ii 4.4 Current Information Education and Communication (IEC) Mechanism ............................... 49 5 Assessment of Environmental and Social Risks and Impacts ................................................. 51 6 Environment and Social Management Plan (ESMP) .............................................................. 63 6.1 Negative List of Activities under the Project ......................................................................... 87 7 Framework Procedures For Environmental And Social Management ................................. 88 7.1 Environmental and Social Management procedures............................................................ 88 7.2 Sub-project Screening and Categorization ........................................................................... 90 7.3 Sub-project Implementation, Monitoring and Reporting ..................................................... 90 8 Stakeholder engagement and grievance redress mechanism .................................................. 91 8.1 Key Stakeholders ................................................................................................................... 91 8.2 Stakeholder Consultation During Preparation ...................................................................... 91 8.3 Stakeholder Engagement Plan (SEP) ..................................................................................... 98 8.4 Grievance Redress Mechanism ............................................................................................. 98 8.5 Process of Disclosure ............................................................................................................ 99 9 Institutional Arrangements, Responsibilities and Capacity Building .................................. 101 9.1 Institutional Arrangement .................................................................................................. 101 9.2 Monitoring and Evaluation ................................................................................................. 101 9.3 Training and Capacity Building ............................................................................................ 102 9.4 Indicative Budget ................................................................................................................ 103 ANNEX I: SUB-PROJECT SCREENING FORMAT FOR POTENTIAL ENVIRONMENTAL AND SOCIAL ISSUES ..................................................................................................................... 104 ANNEX II: LABOR MANAGEMENT PROCEDURES (LMP) .................................................. 110 ANNEX III: GENERIC BIOMEDICAL WASTE MANAGEMENT PLAN .............................. 117 ANNEX IV: TERMS OF REFERENCE FOR WASTES CHARACTERIZATION STUDY (SUGGESTIVE) ................................................................................................................................ 121 ANNEX V: GBV, Sexual Exploitation and Abuse (SEA)/ Sexual Harassment (SH) Guidance 123 ANNEX VI: STAKEHOLDER CONSULTATIONS DURING PREPARATION ..................... 125 ANNEX VII: HEALTH CARE FACILITIES WHERE BASELINE CONDUCTED ............... 127 iii ABBREVIATIONS AND ACRONYMS ADC Autonomous District Council ANC Antenatal care ANM Auxiliary nurse midwife ASHA Accredited social health activist BMW Bio-medical Waste Management BMWM Bio-medical Waste Management CBMWTF Common Bio-medical Waste Treatment Facility CERC Contingent Emergency Response Component CHC Community Health Centre CMO Chief Medical Officer CPCB Central Pollution Control Board CPHC Comprehensive Primary Health Care CTF Common treatment facility DH District Hospital DMHO District Medical and Health Officer DOHFW Department of Health and Family Welfare E&S Environmental and Social EIA Environmental Impact Assessment ESF Environmental and Social Framework of World Bank ESG Environmental, Health, and Safety Guidelines ESMF Environmental and Social management Framework ESMP Environmental and Social Management Plan ESS Environmental and Social Standard ETP Effluent Treatment plant FPIC Free, Prior, and Informed Consent GBV Gender Based Violence GDP Gross Domestic Product GHADC Garo Hills Autonomous District GoI Government of India GoM Government of Meghalaya GRM Grievance Redress Mechanism HCF Health Care Facility HR Human Resource HRH Health Human Resource HWC Health and Wellness Centre ICC Internal Complaints Committee ICT Information and communication technology IEC Information, Education, and Communication IMR Infant Mortality Rate IPA Internal performance agreement IPF Investment Project Financing IPM Internal Performance Management IT Information Technology JHADC Jaintia Hills Autonomous District JSSK Janani Shishu Suraksha Karyakaram KHADC Khasi Hills Autonomous District Council LCC Local Complaints Committee iv LDHF Low-dose-high-frequency LMP Labor Management Procedure MH Maternal Health MHIS Megha Health Insurance Scheme MMR Maternal Mortality