Safe Motherhood Program

Environmental & Social Review Summary

This Environmental and Social Review Summary is prepared and distributed in advance of the IFC Board of Directors’ consideration of the proposed transaction. Its purpose is to enhance the transparency of IFC’s activities, and this document should not be construed as presuming the outcome of the Board of Director’s decision. Board dates are estimates only.
Any documentation which is attached to this Environmental and Social Review Summary has been prepared by the project sponsor and authorization has been given for public release. IFC has reviewed this documentation and considers that it is of adequate quality to be released to the public but does not endorse the content.

Project number	559785
Country	Yemen, Republic of
Sector	Health Care
Department	Health and Education
Company name	Saudi German Hospital Yemen
Environmental category	B
Status	Completed

Date ESRS disclosed	February 25, 2008

View Summary of Proposed Investment (SPI), click here

Overview

Category & Applicable Standards

Key Issues & Mitigation

Community Engagements

Client's Documentation

Overview of IFC's scope of review

IFC’s appraisal of this project consisted of Environmental and Social Specialists reviewing the technical, environmental and social information submitted by the sponsors, Saudi German Hospital (SGH) and University of Science and Technology Hospital (USTH), who were appraised separately as individual hospital projects through the Health and Education Department.

The actual GPOBA project will be initially two associated clinics, which may ultimately increase to six clinics by year 4 of the program. The two hospitals, Saudi German Hospital (SGH) and University of Science and Technology Hospital (USTH) will be the service providers and sponsors for the project.

1. The Saudi German Yemen Hospital (SGH), is an existing IFC client in Sana’a, Yemen, who initiated this program based on its interest in providing antenatal and maternal care services to women from poorer and underserved communities in Sana’a. The Saudi German Hospitals Group began its operations in 1998 and is one of the largest private for profit healthcare providers in the Middle East. SGH currently operates five hospitals in the MENA region and is about to establish a new hospital in Cairo, Egypt. The SGH hospital in Sana’s is a 300 bed state of the art facility.

The appraisal for this project took place during late 2006 and the Environmental and Social Review Summary. Please see the Environmental and Social Review Summary for Saudi German Hospital Group # ESRS 25431 which describes the project and the necessary environmental and social mitigation which the sponsor has committed to complete.

2. The University of Science and Technology Hospital (USTH) will be the other service provider and was appraised as a potential investment project by IFC. An IFC Environmental specialist visited the 144 bed teaching hospital in September 2007 and the sponsor, USTH has agreed to any mitigation of identified impacts that will be addressed through an Environmental and Social Action Plan (ESAP). USTH is a full service hospital and where the UST medical students complete their medical residency. It was established in March 2005 to improve access to quality healthcare services and health professionals in Sana’a. It is the second largest private hospital in Sana’a in terms of number of beds available. It is the first private hospital which is affiliated to a university medical school.

IFC recently published the Environmental and Social Review Summary (ESRS) for the project, please see #ESRS 26455 which describes the project and the necessary environmental and social mitigation which the sponsor has committed to complete in an attached ESAP.

Project description

The Queen of Sheba Safe Motherhood Program is a four year community based program that comprises the provision of a defined ‘Mother-Baby package’ of essential quality services such as antenatal care, birth attendance by skilled birth attendants, postnatal care, complicated care services and family planning. The program will target women (first time mothers and those with up to two children) of reproductive age (15-49) in two underserved districts in Sana’a, Yemen, in the first year (household income less than $2/day), based on certain defined eligibility criteria.

All services will be provided by the private sector:

- Two private Yemeni hospitals, the Saudi German Hospital (SGH) and University of Science and Technology Hospital (USTH) have been identified as appropriate clinical service providers for the first phase. Primary and secondary care services will be provided to targeted women by midwives at satellite clinics to be established in the districts and owned and managed by the hospitals. Patients requiring emergency or complicated care will be referred to the two private hospitals;

- SOUL, a reputable local Yemeni NGO, will serve as project implementation and promotion unit responsible for program promotion, awareness campaigns and targeting of eligible pregnant women; and

- A fiduciary agent will be the recipient of the GPOBA grant and manage the fund flow in the project. The private providers will bear the operational risks of the program as they will be reimbursed retroactively post service delivery and performance target verification by an independent verification expert (IVE).

Identified applicable performance standards

While all Performance Standards 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 applicable 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.

The project appraisal also assessed the applicability of:

- PS5: Land Acquisition and Involuntary Resettlement;
- PS6: Biodiversity Conservation and Sustainable Natural Resource Management;
- PS7: Indigenous Peoples;
- PS8: Cultural Heritage.

There will not be any land acquisition/resettlement and no impacts on indigenous people or cultural property are expected, nor will there be any impacts on natural habitats, forests, protected or sensitive areas.

Environmental and social categorization and rationale

The project involves a small number of health clinics to be operated in a peri-urban area, in existing buildings, most likely as rental property which will be retrofitted as a medical clinic. The key social, environmental, health and safety impacts associated with the project will include:

- potable water supply;
- waste management, in particular medical waste;
- worker health and safety including training and housekeeping;
- disinfection, sterilization, hygiene and implementation of good hospital management practices required to prevent infections among patients and employees;
- the service providers’ (USTH and SGH) corporate-wide, integrated environmental and health and safety management systems.

Given that the proposed clinics will be in urban or peri-urban areas of Sana’a, adverse impacts on environmentally sensitive areas are not expected to occur. The nature of clinical operations is such that it will be possible to readily design and implement engineering and management measures to mitigate any minor adverse impacts that result from the project. According to IFC’s Procedure for Environmental and Social Review Procedure, the project has been classified as a Category B.

Key environmental and social issues and mitigation

The links to the Environmental and Social Review Summaries for the two service providers/sponsors provide the details on the potential environment, health and safety and social aspect of these facilities that were analyzed. It is believed that the two service providers have adequate systems in place to ensure that the proposed project will comply with the environmental and social requirements, of host country laws and regulations and the World Bank/IFC social and environmental Performance Standards and environmental, health and safety (EHS) guidelines. The information about how these potential impacts will be addressed by the sponsor/project is summarized in the ESRSs and by attached Environmental and Social Action Plan, in the case of USTH.

Both sponsors have policies and operational procedures in the key areas with regard to Environmental and Social Management Plans and have committed to any further formalization of such plans as necessary. Given the size and scope of SGH’s operations in the Middle East region, the Group has developed a very strong and effective management team. This includes a corporate quality management team and systems that implement programs at all SGH’s facilities. This has resulted in excellent EHS performance throughout the Group. SGH has achieved ISO 9001:2000 (Quality) certification from an international certifier (TUV of Germany). Education and training are one of the core values and is provided on a regular basis for all medical staff by in-house experts, medical consultants (frequently from Germany), and other experts as well as through conferences and workshops. SGH has a well known code of patient’s rights and responsibilities.

There is a very strong and well organized grievance procedure for both inpatients and out patients, with an open door policy. USTH is currently preparing for ISO 9001 certification and will incorporate their well established operational procedures into a management system for EHS, including a detailed Heathcare Waste Management Plan. Training programs are according to international standards. USTH has acquired all the necessary permits and licenses needed to comply with both host country government’s requirements (Yemen) as well as the IFC EHS requirements.

The clinics will be rental properties in low rise units and will have necessary life and fire safety equipment. There is not expected to be any economic or physical displacement or resettlement of any sort as a result of this project and the creation of the clinics. There was no displacement during construction of either of the hospitals.

For each clinic, the respective hospitals will ensure that the clinic/program has:

- written procedures defining what to do on disinfection, sterilization, handling sharps and medical waste;
- trains staff on this procedure, periodically;
- implements an internal audit function (potentially audit half of the clinics per year);
- reports on any difficulties on the inception of program (report in M/E report);
- prepare Exception Report on any issues of note
- follows the broader corporate ESMP for all aspects of day to day operations, training of staff and safety of patients as per details in referenced ESRSs above.

The GPOBA program will monitor these items during Project Supervision. Each of the service providers/sponsors will be reporting annually in the form of annual monitoring reports as per IFC requirements.

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