27786 - Chuvash Health

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Environmental & Social Review Summary

Project Number

27786

Company Name

Chuvash Republic

Date ESRS Disclosed

Dec 4, 2008

Country

Russian Federation

Region

Europe

Last Updated Date

Nov 30, 2016

Environmental Category

B - Limited

Status

Completed

Previous Events

Approved : May 7, 2009
Signed : May 18, 2009
Invested : Jul 15, 2009

Sector

Hospitals and Clinics

Industry

Infrastructure

Department

Gbl Infrastructure & Natural Resources

Project Description

The proposed project will assist the CR in implementing the second phase of its health care restructuring program (2003-2010) that is currently being supported by the World Bank-financed federal HRIP. The Republic is one of two pilot regions and the current implementation of the HRIP is judged satisfactory. The proposed investments will complement the ongoing restructuring and strengthening of primary care, ambulatory services, hospital facilities, and emergency medical services by financing:
- establishment of the cardiovascular diseases ward in the central hospital of the republic to improve access to quality specialized health care services for heart disease and stroke;
- laboratory, diagnostic and medical equipment for the republican and rayon level facilities for early detection and treatment of Cardio Vascular Disease (“CVD”) and timely provision of emergency medical care for victims of road accidents and other injuries; and
- information technology equipment for the development of electronic medical records at different levels of the health system.

Overview of IFC's Scope of Review

The review of this project consisted of appraising technical, environmental, health, safety and social information submitted through the World Bank financed federal Health Reform Implementation Project (“HRIP”) which for several years has been promoted and implemented in the Chuvash Republic (“CR”) as one of two pilot regions in Russia. A World Bank team member from that project is participating in this Subnational Financing project.

E & S Project Categorization and Applicable Standard

While all Performance Standards (PS) are applicable to this investment, IFC’s environmental and social due diligence indicates that the investment will have impacts which must be managed in a manner consistent with the following Performance Standards:

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

No land acquisitions are foreseen as a consequence of the project. The project will not affect natural or modified habitats, and no impacts are expected on cultural heritage. The CR’s predominant ethnic group, Chuvash represents 67 % of the Chuvash Republic population and is the fourth largest ethnic group in the Russian Federation (after Russians, Ukrainians, and Tatars). The CR has two state languages: Chuvash and Russian. The Chuvash are thus not considered Indigenous Peoples under the Performance Standards.

This is a Category B project according to IFC’s Environmental and Social Review procedures because a limited number of specific environmental and social impacts may result which can be avoided or mitigated by adhering to generally recognized Performance Standards, guidelines or design criteria. The projects main impacts will be positive health benefits for the broader population and no negative effect with respect to environmental or social impacts, land acquisition, natural resources or cultural/indigenous people are foreseen.

Environmental and Social Mitigation Measures

PS1: Social and Environmental Assessment and Management Systems:

Over the past 5 years the authorities and the health management system has worked with the World Bank team to institutionalize the ongoing and contemplated health system restructuring efforts, to train staff in managing the reformed health care delivery system, to maintain the data bases to generate information for decisions on health policies and for changes in action plans, and to allocate resources most effectively.

This organizational work has resulted in a satisfactory professional basis within the CR for organizing its health care system according to modern and efficient principles with due respect to health and safety of both patients and health care personnel, and environmental effects of the offered procedures. The latter includes an appropriately managed medical waste management system.

PS2: Labor and Working Conditions:

The employees of the health care management system of CR are covered by HR policies reflecting the Russian employment norms and requirements. Salaries for all staff are above minimum wage. As part of the HRIP specific training are assured as needed and professional staff will be provided with opportunities for continuing professional development. Staff will receive regular medical checks and medical staff are required to maintain a current “health passport” (confirming that they do not have infectious diseases).

Employees have the right to collective bargaining and freedom of association (and there are regular monthly meetings of HR department staff and employees).

The CR is a republic with strong traditions in ethnic equality. The republics population is majority Chuvash and hiring is conducted in accordance with the Russian Labor Code with a strict policy against discrimination based on gender, race, age or nationality.

Protection of the work force in Russia is provided through legislation, in particular the Labor Code. The Labor Code was updated in 2006 to provide extensive protection for workers and ensure that a large array of social benefits must be provided. The project does not result in any retrenchment and the authorities strictly follow the commitment to minimum age requirements for all employees and contractors. OHS issues are addressed via training for all staff and through the provision of appropriate personal protective equipment for staff.

PS3: Pollution Prevention and Abatement:

Liquid effluents are discharged from the health care facilities to functioning municipal sewers and where need be there is pre-treatment of effluents prior to disposal (including disinfection as necessary).

Solid waste is recycled where practical. Solid waste which cannot be recycled (and which does not contain infectious or highly hazardous materials) is managed through approved disposal systems. As assessed during supervision missions for the World Bank HRIP, the medical waste management systems in the Chuvash Republic’s health facilities is judged to be satisfactory. IFC intends carry out an additional internal review of the medical waste management system before disbursement of the proposed loan, and if need be develop a specific Environmental and Social Action Plan (ESAP) to address any deficiencies found (see attached ESAP).

PS4: Community Health, Safety and Security:

The World Bank HRIP covers the overall health and safety management for the health care and management systems of the RC and the World Bank project has found the systems used satisfactory. As IFC’s project support will be limited to providing equipment for the emergency treatment systems a new review of the standards used at the republics hospitals was therefore not considered appropriate and needed for the current projects appraisal.

The proposed project will help Chuvash Republic to:

- reduce premature mortality, ill health and disability associated with the onset of preventable CVD and injuries and by providing quicker access to emergency health services when needed,
- return people who have suffered a stroke, an acute myocardial infarction, a traffic accident or a work-related injury to their normal activities more quickly through an effective rehabilitation infrastructure and assist these people to be less dependent on others and on the state.

IFC will work with the CR health authorities in setting up appropriate Life and Fire Safety criteria to be used around the clinics and facilities being equipped under this project (see attached ESAP).

There are no other significant community health risks associated with this investment.

Stakeholder Engagement

Client Documentation

File Name	Actions
Chuvash Health ESAP.pdf
Chuvash Health ESRS Russian.pdf

**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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