Federal Democratic Republic of Ethiopia Environmental and Social Management Public Disclosure Authorized Framework (ESMF) For Public Disclosure Authorized Africa CDC Regional Investment Financing Program (ACRIFP) (Revised ESMF Report) Public Disclosure Authorized Addis Ababa, May 2019 Public Disclosure Authorized 1 List of Abbreviations ACRIFP Africa CDC Regional Investment Financing Program AMR Antimicrobial Resistance BSL Bio-safety Level CDC Centre for Diseases Prevention and Control EA Environmental Assessment EIA Environmental Impact Assessment EMP Environmental Management Plan EOC Emergency Operating Centre EPHI Ethiopian Public Health Institute EPLAUA Environmental Protection, Land Administration and Use Authority ESIA Environmental and Social Impact Assessment ESMP Environmental and Social Management Plan FDRE Federal Democratic Republic of Ethiopia FEPA Federal Environmental Protection Authority FEPA Federal Environmental Protection Authority FEPA Federal Environmental Protection Agency FECCC Forest Environmental and Climate Change Commission FMOH Federal Ministry of Health GF Global Fund GoE Government of Ethiopia GTP Growth and Transformation Plan HCF Health Care Facility HCW Health Care Waste HCWM Health Care Waste Management HCWMNG Healthcare Waste Management National Guideline HCWMP Health Care Waste Management Plan HIV Human Immunodeficiency Virus HSDP Health Sector Development Plan HWMNG Healthcare Waste Management National Guideline HWMP Health Waste Management Plan IPPS Infection Prevention and Patient Safety MDG Millennium Development Goals 2 MOH Ministry of Health MPA Multiphase Programmatic Approach OP Operational Policy RG Risk group PHEM Public Health Emergency Management Unit (PHEM) PHID Public health infrastructure directorate PPSD Project Procurement Strategy for Development PVC Polyvinylchloride RHB Regional Health Bureau SNNPRS Southern Nations, Nationalities, and People's Regional State TB Tuberculosis WHO World Health Organization 3 I. Table of Contents List of Abbreviations .......................................................................................................... 2 I. Table of Contents ........................................................................................ 4 II. List of Table ................................................................................................. 7 III. List of Figures .............................................................................................. 7 Executive Summary ........................................................................................................... 8 1. Introduction ............................................................................................... 18 1.1 Background ............................................................................................................... 18 1.2 Objectives of the ESMF ............................................................................................ 19 1.3 Study Methodology ................................................................................................... 19 2. Project Description .................................................................................... 21 2.1 Project Development Objective ................................................................................. 21 2.2 Project Components ................................................................................................. 21 3. Social and Environmental Baseline Conditions ..................................... 28 3.1 General Environmental Setting ................................................................................. 28 3.1.1 Climate .............................................................................................................. 29 3.1.2 Physical environment ........................................................................................ 29 3.1.3 Biological environment ...................................................................................... 29 3.1.4 Soil and Geology .............................................................................................. 30 3.1.5 Water Resources .............................................................................................. 30 3.1.6 Natural vegetation and Forests ......................................................................... 30 3.1.7 Physical cultural resources ............................................................................... 31 3.1.8 Health Services in Ethiopia ............................................................................... 31 3.2 Environmental Setting Specific to the Regions ......................................................... 32 3.2.1 Tigray Regional State ....................................................................................... 32 3.2.2 Amhara Regional State ..................................................................................... 33 3.2.3 Afar Regional State ........................................................................................... 34 3.2.4 Somali Regional State ...................................................................................... 36 3.2.5 Oromia Regional State...................................................................................... 37 3.2.6 SNNP Regional State ....................................................................................... 39 3.2.7 Gambella Regional State .................................................................................. 40 3.2.8 Benshangul Gumuz Regional State .................................................................. 42 4. Legal and Institutional Framework .......................................................... 44 4.1 Background ............................................................................................................... 44 4.2 National Regulatory Framework ............................................................................... 44 4.2.1 Constitution ....................................................................................................... 45 4.2.2 Environmental Policy of Ethiopia ...................................................................... 45 4.2.3 Environmental Proclamations Regulation and Guidelines Relevant to this project ............................................................................................................... 46 4.2.4 Environmental and Social Impact Assessment Guidelines and Directives ....... 52 4.3 International Environmental Conventions ............................................................... 53 4.4 World Bank Safeguard Policies ................................................................................ 54 4.4.1 Comparison of the World Bank Safeguard and National Polices ...................... 59 5. Environmental and Social Impacts and Mitigation Measures ............... 61 5.1 Positive Impacts ........................................................................................................ 61 5.2 Negative Impacts and Proposed Mitigation Measures .............................................. 63 4 5.2.1 Impacts Specific to Proposed Project ............................................................... 63 5.2.2 Impacts during Construction Phase .................................................................. 66 5.2.3 Impacts during Laboratory Operation ............................................................... 72 5.2.3.1 Laboratory Biosafety Level and Risk Groups .................................................. 72 5.2.3.2 Risks on BSL 2 Laboratories .......................................................................... 73 5.2.3.3 Occupational Health and Safety and Community Health Concerns ................ 75 5.2.3.4 Occupational Health and Safety on BSL 2 Laboratories ................................. 75 5.2.3.5 Community Health and Safety on BSL 2 Laboratories ................................... 77 5.2.3.6 Potential impacts associated with BSL 2 laboratories operation ..................... 77 5.2.3.7 Strategies to mitigate the potential risks associated with BSL 2 Laboratories 78 5.2.4 Basic Principles and Practices for Effective Healthcare Waste Management in BSL 2 Laboratory .......................................................................................... 95 5.2.5 Occupational Health and Safety ..................................................................... 102 5.2.6 Impact of None-routine Emergency Events .................................................... 105 5.2.7 Risk due to Laboratory biosafety issues ......................................................... 106 5.2.8 Community Health and Safety ........................................................................ 110 5.2.9 Impacts during decommissioning .................................................................... 111 5.3 Generic Environmental and Social Management Framework (ESMF) .................... 111 6. ESMF Implementation and Monitoring Process ................................... 118 6.1 Sub-project Screening and Approval Process ........................................................ 118 6.2 ESMF Implementation Arrangement ....................................................................... 122 6.2.1 Institutional Arrangements .............................................................................. 122 6.2.2 Public Health Infrastructure Directorate (PHID) .............................................. 122 6.2.3 Environmental and Social Safeguards committee