25344 - Hosp Sao Luiz

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Environmental & Social Review Summary

Project Number

25344

Company Name

São Luiz Operadora Hospitalar S/A.

Date ESRS Disclosed

Dec 4, 2006

Country

Brazil

Region

Latin America and the Caribbean

Last Updated Date

Nov 30, 2016

Environmental Category

B - Limited

Status

Completed

Previous Events

Approved : Mar 2, 2007
Signed : Oct 23, 2007
Invested : Feb 22, 2008

Sector

Hospitals and Clinics

Industry

Health, Education and Life Sciences

Department

Regional Industry MAS LAC & EUR

Project Description

In 2004, as part of its strategy to expand its footprint and establish a network of private hospitals in Brazil, São Luiz Group (SLG or São Luiz) entered into a partnership with a local real estate investor to launch a 334-bed maternity and general hospital in the eastern region of the city of São Paulo, the Hospital e Maternidade Anália Franco (HMAF). As part of the deal, real estate investors will own and maintain the building and SLG will enter into a long term lease (15 years renewable for another 15 years) to rent the facility. Anália Franco is scheduled to open in May 2007 and includes:

- A modern architectural design, maximizing patient comfort and operating efficiency;
- A maternity and general hospital wings with separate entrances and elevators;
- A comprehensive range of services with particular emphasis on internal medicine, surgery, gynecology-obstetrics and pediatrics;
- A well equipped emergency ward interconnected to a diagnostic center;
- A vertical floor distribution in the following order:
Basement: diagnostic center;
Ground Floor: social and reception areas and auditorium for 150 people;
Mezzanine: hospital management;
First Floor: intensive care units;
Second Floor: general surgery center and obstetric center;
Third Floor: Hemodynamic Unit, dressing rooms, central supplies and blood bank;
Fourth to Seventh Floors: Maternity and inpatient wards; and
Top Floor: technical and water supply areas and heliport connected to hospital elevators.

Overview of IFC's Scope of Review

The project was reviewed primarily as a desk review with documents provided by the São Luiz Group (SLG), such as:

- Occupational Health and Safety policies;
- Environmental Management System;
- Solid Waste Statistics;
- Hazardous Material Management;
- Life and Fire Safety policies and procedures;
- Integration manual

- Interview at the SLG - 25th October 2006

From IFC: Mauricio Athie (Environmental Specialist) and Sergio Finger (Environmental Consultant)
From HMSL: Nelson Alvarez (RH) and Carlos Eduardo Lima (Occupational Health and Safety Supervisor)

- Site visit at Hospital Maternidade Anália Franco (HMAF) – 26th October 2006

From IFC: Geoffrey Willing (Senior Architectural Advisor), Luis Antonio Funcia (Country Officer, Health and Education Department) and Sergio Finger (Environmental Consultant)
From Client: Investors, Representatives from the Real Estate Company, the HMAF’s architect and HMSL Occupational Health and Safety Supervisor.

E & S Project Categorization and Applicable Standard

The following Performance Standards apply to this project:

- PS1: Social and Environmental Assessment and Management;
- PS2: Labor and Working Conditions;
- PS3: Pollution Prevention and Abatement;
- PS4: Community Health, Safety and Security.

The relevant guidelines have been provided to and discussed with the client in a meeting on October 25, 2006 and site visit on October 26, 2006 (i.e. General Environmental Guidelines, July 1998; Occupational Health and Safety Guidelines, June 2003; Life and Fire Safety Guidelines, December 2003; Hazardous Materials Management Guidelines, December 2001; and Health Care Facilities, May 2003).

This is a category B project according to IFC’s Procedure on Environment and Social Review of Projects because a limited number of specific environmental and social impacts can be avoided or mitigated by adhering to generally recognized performance standards, guidelines or design criteria.

Mitigation measures required to address any potential impact have been identified and are outlined in the Environmental and Social Issues and Mitigation.

Environmental and Social Mitigation Measures

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 - the host country laws and regulations and the World Bank/IFC environment and social policies and the 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.

- PS1: Social and Environmental Assessment and Management:

Environmental and Social Assessment:

HMSL has a well established Environmental and Social Management System. It is ISO 9001:2000 certified and it will be the first Hospital to obtain the ONA certification – which has just been issued by the ANS (Brazilian National Health Agency). The HMSL designates a specific supervisor to monitor Occupational Health and Safety issues and Environmental issues (emissions, effluents, wastes and noise).

Staff Management Program:

The Management of all programs is an attribution of SESMT (Serviço Especializado em Medicina do Trabalho) which is an internal committee specialized in Health and Safety issues. The SESMT mission is to identify, prevent and control or eliminate risks that can lead to incidents or accidents and promote programs for the prevention of Occupational diseases. SESMT currently relies on the following structure: 1 Environmental H&S Engineer, 4 Environmental H&S Technicians, 2 Environmental H&S Physicians, 2 Occupational Health Physicians, 2 Occupational Health Nurses, 1 Occupational Health Nursing aid and 1 Administrative assistant.

For the HMAF project, SESMT will be composed by 1 Environmental H&S Engineer, 4 Environmental H&S Technicians, 1 Environmental H&S Physician, 1 Occupational Health Physician, 1 Occupational Health Nurse and 1 Occupational Health Nursing aid.

Health and Safety Management Plan:

The HMSL H & S Management Plan is structured as follows:

1. PPRA – Programa de Prevenção de Riscos Ambientais (Environmental Risk Prevention Program):

This is a compulsory legal requirement following national, state and municipal codes (NR 09), serving to anticipate and control environmental risks in work environment (chemical, physical and biological), considering environmental protection and natural resources preservation.
- PCMSO – Programa de Controle Médico de Saúde Ocupacional (Occupational Health Medical Control Program)This is a program developed to Monitor employees’ health through medical exams.

2. CIPA – Comissão Interna de Prevenção de Acidentes – (Internal Commission for Accident Prevention):

The CIPA members are employees indicated by SLG and employees elected yearly by themselves. The CIPA promotes monthly meetings to:

- Investigate certain accidents and to debate measures to eliminate future occurrences;
- Promote trainings on accident prevention;
- Map existing risks;
- Yearly perform the Biosecurity Training;
- Promote the SIPAT which is the yearly one-week training on Occupational health and safety;

3. Other activities developed in the H&S Management Plan:

- Periodical Inspections to prevent accidents and risk situations.
- The use of Individual Protection Equipment – IPE.
- Unhealthy and dangerous activities and operations – monitoring and reporting activities for each employee involved in unhealthy and dangerous activities and operations.
- Monitoring other activities like safety in electric panels maintenance, inspection in boilers and vessels.
- Ergonomic analysis (yearly) of each workplace to verify healthy conditions of lightening, activities and repetitive stress injuries, among others.
- Analysis of Subcontractors – Check if the subcontractor is working accordingly, following the proposed work plan, analyzing the risks involved on each activity, the quality of materials involved, their use of IPEs and etc.

Life and Fire Safety:

IFC conducted a site visit of the Anália Franco facility (HMAF) on October 26, 2006, and found the facilities to be of a modern design and of high quality standards. Geoffrey Willing, IFC’s specialist on LF&S detected a lack of compliance with IFC’s guidelines in respect to the sprinkler system. Several suggestions to the client for potential improvement were made. These included:

- Adding sprinklers to underground garage levels;
- Adding sprinklers to the 170 seat auditorium;
- Adding sprinklers to the escape corridors leading to the fire isolated staircases;
- Checking the size of the water pumps, although they appear to be of sufficient size.

According to IFC policies, the client will have to obtain an independent certification of compliance with international L&FS codes. The client will require an independent consultant to assess L&FS aspects of Anália Franco facility, in order to verify compliance with NFPA 101 or other accepted international code. If the L&FS systems are not compliant, the real estate developers and sponsors have agreed to install sprinklers or other necessary intervention.

Fire Brigade:

Currently HMSL counts with fire brigades in both units (420 people) and 7 trainings per year. Both units also count with a Contingency and Emergency Plan, update by the Crisis Management Committee.

- PS2: Labor and Working Conditions:

Every new employee receives an Integration Manual disclosing HMSL policies. The manual contains approaches the following topics:

- HMSL History;
- Who are the Clients;
- HR policies;
- Training;
- Occupational Health and Safety;
- Hospital Infection Control;
- Workplace Health and Safety;
- Quality Management;
- Solid Waste Management Plan – PGRSS;
- Internal Communication;
- Corporative organization chart and organization charts of each unit;

- PS3: Pollution Prevention and Abatement:

Environmental Management System:

The EMS is mostly related to the Solid Waste Management Plan – PGRSS for all units. It includes planning, performing and assessing the solid waste management plan, which is updated yearly. Solid waste generated in HMSL operations is classified according to Brazilian code (NBR).

PGRSS targets are:

- To reduce waste generation sources;
- To organize waste storage, flow and collection;
- To train employees and contractors;
- To assess the companies contracted to waste disposal (incineration and microwave destruction);
- Monitor PGRSS performance.

All wastes are collected and separated in 4 classes (Average):

- Domestic waste (Administrative areas and other common areas) – 50%
- Chemical waste – Low generation
- Hazardous (infecting) waste – 35%
- Recyclable Waste (paper, plastic, Aluminum, cardboard) – 15%

The HMSL monitor solid waste generation through monthly reports, generating a statistical analysis

- PS4: Community Health, Safety and Security:

Emergency Preparedness and Response and Security Personnel Requirements are described on the Integration Manual, as part of the company’s policy.

Stakeholder Engagement

The client has promoted the following community engagement activities:

- São Luiz no McDia Feliz – campaign together with Mcdonald’s to raise funds to help children with cancer;
- Fundação Maria Carolina – campaign to raise funds to Maria Carolina foundation which provide food, home and school for children between 03 to 17 years;
- Prevenindo acidentes de trânsito – Campaign to reduce traffic accidents supported by São Paulo municipality;
- Cursos para Leigos – short courses on medical subjects for laypeople;
- São Luiz promove campanha do agasalho – Campaign to collect clothes and footwear.

The disclosure documentation of HMSL can be accessed from: http://www.saoluiz.com.br/responsablidade.

**Information on IFC's Policy and Performance Standards on Environmental and Social Sustainability can be found at www.ifc.org/sustainability

IFC supports its clients in addressing environmental and social issues arising from their business activities by requiring its real sector clients to set up and administer appropriate grievance mechanisms and/or procedures to address complaints from Affected Communities in relation to environmental and social issues arising from IFC's clients' business activities. Since 2012, IFC's Financial Intermediary clients applying the Performance Standards are required to develop External Communications Mechanisms to receive and review inquiries or complaints from any interested party regarding the E&S risks and impacts of their operations.

For IFC projects that are active or under consideration, individual(s), or their authorized representative(s), who allege they have been or will be adversely affected by E&S risks or impacts arising from IFC's clients' business activities, may submit a complaint to IFC directly for consideration. When receiving an E&S complaint, IFC engages with complainants and works with its clients to find solutions to E&S concerns as quickly and efficiently as possible.

Complaints can be submitted to IFC online at www.ifc.org/escomplaints or by email to EScomplaints@ifc.org.

IFC complaint response is separate from and complementary to IFC’s clients’ project level grievance mechanisms and IFC’s Independent Accountability Mechanism (CAO). Lodging a complaint directly with IFC does not, at any time, restrict access to CAO.

Affected communities have unrestricted access to the Compliance Advisor Ombudsman (CAO), the independent accountability mechanism for IFC and MIGA. CAO facilitates the resolution of complaints related to IFC and MIGA projects and sub-projects, undertakes reviews of IFC’s and MIGA’s environmental and social compliance, fosters public accountability for their commitments, and enhances the environmental and social performance of IFC and MIGA.

Independent of IFC and MIGA management and reporting directly to the IFC and MIGA Boards of Executive Directors, CAO helps resolve issues raised about the environmental and social impacts of projects through a neutral, collaborative, problem-solving approach via its Dispute Resolution function. It also reviews IFC’s and MIGA’s compliance with environmental and social policies, assesses related harm, and recommends remedial actions through its Compliance function. Additionally, CAO provides advice to IFC, MIGA, and their Boards to enhance environmental and social sustainability performance and minimize the risk of harm.

Complaints may relate to environmental and social harm regarding any aspect of the planning, implementation, or impact of a project or sub-project, and can be made by any individual, group, community, entity, or other party affected or likely to be affected by the environmental or social impacts of an IFC- or MIGA-financed business activity.

Complaints can be submitted by any of the following methods:

Online form: available at https://www.cao-ombudsman.org/
Mail/Hand Delivery to: 2121 Pennsylvania Avenue, NW, Washington, DC 20433, USA
Voice mail: +1 202 458 1973
Email: cao@worldbankgroup.org
SMS, WhatsApp, Telegram, and Signal: +1 202 650 2627

CAO receives and addresses complaints in accordance with the CAO Policy, which can be accessed at: https://www.cao-ombudsman.org/policies-guidelines.

This Environmental and Social Review Summary (ESRS) is prepared by IFC to disclose its findings and recommendations related to environmental and social considerations regarding potential investments. Its purpose is to enhance the transparency of IFC's activities. For any project documentation or data included or attached herein, whether prepared by the project sponsor or otherwise, authorization has been given for public release by the project sponsor. IFC considers that this ESRS is of adequate quality for release to the public, but has not necessarily independently verified all of the project information therein.
It is distributed in advance of IFC Board of Directors' consideration and may be periodically updated thereafter. Board dates are estimates only and this document should not be construed as presuming the outcome of the Board Directors’ decision. The following ESRS is disclosed in accordance with IFC's Access to Information Policy (AIP).

The map is for illustrative purposes and does not imply the expression of any opinion on the part of the World Bank, concerning the legal status of any country or territory or concerning the delimitation of frontiers or boundaries. Country borders or names do not necessarily reflect the World Bank Group's official position. In some cases, available project location information is limited to the country of the project's activities. Locations are approximate.

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Environmental & Social Review Summary

Project Description

Overview of IFC's Scope of Review

E & S Project Categorization and Applicable Standard

Identified Applicable Performance Standards

Environmental and Social Categorization and Rationale

Environmental and Social Mitigation Measures

Environmental and Social Mitigation Measures

Stakeholder Engagement

Stakeholder Engagement

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