IFC requires that this document is made available through the World Bank InfoShop and to the locally affected community no less than 30 days prior to project consideration by the IFC Board of Directors. The Summary of Project Information (SPI) also provides details of where the ERS has been made available to the locally affected community. The SPI must be sent to World Bank InfoShop no less than 30 days prior to project consideration by the IFC Board of Directors.

This is a category B project according to IFC’s Procedure for Environmental and Social Review of Projects because a limited number of specific environmental and social impacts may result that can be avoided or mitigated by adhering to generally recognized performance standards, guidelines or design criteria. Review of environmental and social issues for this project consisted of appraising technical and environmental/social information submitted by the project sponsor. The following potential environment, health and safety impacts of the projects were analyzed. - Systematic management of quality and environmental and occupational health and safety affairs; - Hygiene and implementation of good health care facility management practices; - Management of hazardous health-care waste; - Life and fire safety; and - Occupational health and safety; and - Internal auditing.

The sponsor has presented plans to address these impacts to ensure that the proposed project will upon implementation of the specific agreed measures, comply with the environmental and social requirements, host country laws and regulations and World Bank/IFC environment and social policies and environmental, health and safety guidelines. The information about how these potential impacts will be addressed by the sponsor/project is summarized in the paragraphs that follow. Further information is provided in the attached Corrective Action Plan (CAP). Systematic management of quality and environmental and occupational health and safety affairs. As part of the first IFC investment Euromedic developed Safety and Waste Management manuals for each center to guide operations and to ensure proper handling of hazardous health care waste and other hazardous materials. Additionally, Euromedic has instituted programs and internal controls to qualify for ISO 9001-2000 certification of completed centers once each operation reaches a steady state. All existing centers in Hungary, Poland, Romania, Bosnia have ISO certification except Constanta. This latter operation will seek certification in the near future. New centers facilitated by this investment will also seek and obtain ISO certification. Hygiene and implementation of good health care facility management practices. Euromedic follows internationally accepted guidelines and best practices for facility hygiene and sterilization and disinfection. This includes providing appropriate personal protective equipment (gowns, eyewear, decontamination supplies, utility gloves for cleaning, etc.); single-use materials; equipment and instruments (including engineering controls for radiation exposures); approved work practices including adherence to pathogenic and radiation exposure and post-exposure follow-up; and handling and disposal of contaminated instruments, consumables and equipment. Management of hazardous health-care waste. Each new center will develop and institutionalize a Safety and Waste Disposal Manual consistent with those developed for existing centers. These manuals provide systematic guidance for comprehensive waste management. Because the wastes generated by Euromedic centers are ultimately disposed according to the methods practiced by the hospital with which the center is associated, each center’s plan necessarily addresses the handling and storage of all pathogenic, infectious, and hazardous/radioactive wastes that it generates. Consistent with IFC’s Health Care Facilities guideline, wastes are segregated and color-coded to ensure proper handling and disposal. Many operations utilize state-of-the-art shredding and microwave technology to render bio- hazardous wastes inert to facilitate disposal with non-hazardous health care waste. For wastes that must be managed offsite, Euromedic contracts with locally licensed medical waste disposal companies. Non-hazardous health care waste is stored separately in refuse bins, collected by a licensed solid waste disposal contractor, and disposed at facilities operated by the municipal authorities. Radioactive waste is stored in segregated containers within shielded areas and allowed to decay until it has been determined through regular monitoring that mandated levels of source decay has occurred for it to be disposed according to the above described methods. Sanitary wastewater is, consistent with local permit requirements, discharged to municipal sewerage ansd associated treatment systems. Life and Fire Safety. Euromedic’s new clinics will be designed to comply with IFC Life and fire Safety guidelines and as such will adhere to both a selected set of international and host country life and fire safety norms. Occupational health and safety. Employees at each facility will be properly trained in health and safety and other internal procedures to ensure their personal safety and that of other employees and patients. Training courses and materials will be implemented consistent with existing centers’ Safety and Waste Management Manuals developed as part of the previous investment. All new employees will be trained, and refresher courses will be provided periodically. Training will include precautions and procedures for the safe use and handling of diagnostic, treatment and waste materials used in or generated by operations. Training will emphasize the need to utilize appropriate personal protective equipment PPE) given specific job assignments and activities and personal, mandatory responsibilities related to safe work practices as defined in each facility’s Safety and Waste Management manual. Internal auditing. To provide IFC with adequate information on operations each year, Euromedic will nominate an operations audit team consisting of staff from other centers and this team to perform an audit of a representative number of operations in which the members of the team are not routinely involved. The output of the audit team will be a report for internal purposes and to share with IFC. The report will define noted deficiencies, required rectification schedules and a summary of post audit actions taken to ensure continuing operations in compliance with internal procedures, safety and waste disposal manuals, ISO 9001-2000 operations procedures, and host country regulatory and IFC policy and guideline requirements.

[The following supporting documents provide further details of environmental and/or social issues.] [This ERS contains the full environmental and social documentation prepared for the project.]

Accordingly, IFC concludes that the proposed project will meet the applicable World Bank/IFC environment and social policies and the environmental, health and safety guidelines upon successful implementation of the agreed mitigation measures.

IFC will evaluate the project's compliance with the applicable environmental and social requirements during the lifetime of the project by reviewing the annual monitoring reports (AMRs) prepared for the project covering: - the status of implementation of any measures contained in the Environmental and Social Corrective Action Plans and - ongoing performance of project-specific environmental, health and safety activities as reflected in the results of periodic and quantitative sampling and measuring programs. Periodic site supervision visits will also be conducted.