ENVIRONMENTAL REVIEW SUMMARY

Project Name AEF/NIGERIA: HYGEIA

Region Sub-Saharan Africa

Sector Hospital

Project No. 009628
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1. This project, which is to be financed through the Africa Enterprise Fund (AEF), is to upgrade the tertiary health care currently provided, establish 5 new clinics, invest in new equipment and develop a Health Management Organization (HMO) to offer services to other hospitals as soon as the proposed National Insurance Health Scheme is launched. Hygeia currently provides the following services: primary care, health assessment and specialist care in surgery, internal medicine, pediatrics, obstetrics and gynecology, orthorhinolaryngology, ophthalmology, psychiatry, dermatology, orthopedics, neurosurgery and physiotherapy. It has a 40 bed in –patient facility and also runs 10 satellite clinics for its corporate clients within clients’ premises. The managed care scheme started in 1997 and provides primary and secondary level health services to large corporate employers in Lagos on a fixed cost basis. In total, Hygeia employs 225 persons including 22 medical officers and 96 nurses. For the extension of its HMO, Hygeia will seek technical assistance from Health Partners an HMO type operation based in Minneapolis, USA.

2. This is a Category B project according to IFC''s environmental review procedure because specific impacts may result which can be avoided or mitigated by adhering to generally recognized performance standards, guidelines, or design criteria. The key environmental health and safety issues that were analyzed are as follows:

· Site location, prior use and land acquisition process;
· Handling and storage of medical material;
· Storage, handling and final disposal of chemicals;
· Source of water and power supply;
· Hygiene and implementation of good medical management practices;
· Waste management;
· CFC free air conditioning and cold storage equipment;
· Provision of employee protective clothing and equipment;
· Exposure of employees to radioactive material;
· Employees health and safety training; and
· Fire prevention.

3. IFC has reviewed environmental information supplied by Hygeia. Key elements of this information are described below.

4. Site location and acquisition: The existing hospital is a four story building located near the bridge between TinCan island port and Apapa port, within a high income residential area close to the lagoon. The footprint for the new hospital is about 4000m2, only 30% of which are built; the site will be landscaped with trees and grass. Sites for the new clinics will be purchased following recommendations from professional estate agents and will be in clean and well-drained surroundings. The sponsor will not engage in land acquisition practices which leads to the displacement of people.

5. Water and power supply: water and power are both supplied by the municipal authorities. However, 15 000 liters of fuel are to be stored on site in an above ground tank well away from the hospital buildings which will be used in the case of power outages. The sponsor has indicated that the fuel storage area will be protected by retention bunds which would prevent major spillage in the event of a breach.

6. Handling and storage of medical material: Medical material is to be stored either in a locked Pharmacy Store or in specially protected locked cupboards in the out patient clinic. Movements of drugs are to be fully documented by trained pharmacy, nursing or medical staff.

7. Hazardous Waste Management: At IFC’s request, the sponsor has commissioned a consultant to undertake the development and implementation of a comprehensive waste management plan. Hazardous and biomedical wastes, including laboratory cultures and organic reagents, blood, urine, fecal cultures and expired reagents as well as bodily fluids on linens, clothing or other absorptive material will be collected separately in color coded containers and incinerated in situ in a specifically built incinerator that the sponsor has undertaken to install. The Lagos Municipal Incinerator represents another facility which could be used if it is adequately licensed to accept these types of waste and deemed adequate after a site visit by the IFC environment department. Sharp objects such as needles and blades are currently being secured in refuse cans before being incinerated. Hazardous and bio-medical waste is also collected separately on the hospital premises but is disposed of by the Waste Disposal Authority to an authorized landfill.

8. Solid and liquid waste management: Solid non hazardous waste is secured in well secured plastic bags, collected in large refuse bins which are then regularly emptied by the Waste Management Board, to be disposed off in an authorized landfill. Sanitary waste is disposed off in 3 septic tanks incorporating filter soakaway and is emptied 4 times a year by a private contractor. The sludges are discharged to authorized landfill. Other wastewater, essentially kitchen wastewate and laundry waste water, is treated in separate soakaway pits. All treated effluents from the septic tanks and soakaway pits percolate into the ground. The Hospital has a well-reticulated storm water drainage system, which is connected into the storm drainage network of the city council. The capacity of the drainage system has proved to be sufficient even in times of high intensity rains.

9. CFC free equipment: At IFC request, the sponsor has made a commitment to only purchase CFC free equipment and to gradually replace all existing CFC bearing air conditioning units.

10. Protection of employees: a detailed description of all protective gear provided to employees has been submitted to IFC, together with all relevant health and safety procedures including protection against X-rays radiation. These are deemed to be adequate. Training on health related matters is carried out as part of the weekly “clinical meeting” which is held for all hospital staff and also as part of training and orientation programs which are conducted periodically. At IFC’s request, the sponsor has agreed to implement a formal health and safety procedure for all personnel which will also include an emergency response plan.

11. Fire protection and response: The hospital is currently equipped with a manual fire alarm and fire extinguishers are positioned throughout the hospital. A reel of hose is located on every floor and is directly connected to the water mains. The hospital has a contract with a fire and safety company which regularly services this equipment and provides training and fire drills for staff. The sponsor is committed to acquire smoke detectors, automatic sprinklers as well as an automatic fire alarm. The hospital also operates a “Non Smoking Policy”. The hospital has its own in house maintenance department in charge of ensuring the safety and maintenance of all mechanical, electrical and plumbing systems.

12. The ERS will be released at the Apapa Local Government Headquarters and an extract notice for the general public will be printed in a local newspaper and posted at the entrance of the hospital.

13. Based on its review of available information regarding potential environmental impacts and proposed mitigation measures, IFC concludes that the proposed project is being designed and will be operated to meet pertinent Government of Nigeria requirements and all relevant World Bank policies and environmental, health and safety guidelines.

14. IFC will monitor ongoing compliance with World Bank Group policies and guidelines during the life of the project by reviewing and evaluating the Environmental and Social Monitoring Reports (AMRs) to be submitted annually to IFC by the sponsor, and by conducting periodic site visits during project supervision.