Heart Center Tuzla

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	26191
Country	Bosnia and Herzegovina
Sector	Health Care
Department	Health and Education
Company name	Zdravstvena ustanova Specijalizirana bolnica Center BH
Environmental category	B
Status	Pending Disbursement

Date ESRS disclosed	April 22, 2008

Previous Events	Signed: June 27, 2008 Approved: June 26, 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

The review of this project consisted of appraising written technical, environmental and social information submitted by Heart Center BH, in response to questions asked by IFC and visits by IFC to the project site in Tuzla, and meeting with Heart Center management.

Project description

The project consists of establishing 88-bed full-service Specialist Hospital and Heart Center (the Center) in Tuzla, Bosnia and Herzegovina (BiH). The total project cost is estimated to be €20.6 million. IFC was requested to provide a €4.6 million A Loan to finance part of the project. Construction for the center began nine months ago and its official opening is expected in the second quarter of 2008. The Center will have capacity for 88 beds (including 35 hospital rooms and 12 ICU beds) and will offer the following services:

- Cardiology and Cardiac Surgery (invasive, coronography, stent implantations, electrophysiology)
- Surgical and Cardiological procedures on adults (coronary bypass, valve replacement, heart tumors, etc)
- Surgeries of congenital heart disorders in children
- Vascular surgery and other services included in regular health insurance (various reconstructions, lasers, varicose vein surgery, fistula, etc)
- Promotion of health

The Center will offer telemedicine capabilities as well as an education center. If appropriate and beneficial, the Center also plans to open satellite centers in the future to increase the population’s ease of access. The target market will consist of four categories of patients ranked from highest to lowest priority. Targeted patients will come from all cantons of Bosnia and Herzegovina (population of 3.8 million) including but not limited to Tuzla Canton (502,000 inhabitants), Sarajevo Canton (401,687 inhabitants), and the rest of Bosnia in addition to neighboring countries that do not have their own cardiovascular clinics (e.g. Kosovo, Montenegro).

Key environmental and social issues and mitigation

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, IFC Performance Standards, and IFC 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 Environmental and Social Action Plan (ESAP).

- PS1: Social and Environmental Assessment and Management Systems

Environmental, Social, Health and Safety issues are being dealt with through separate processes that the company has undertaken as part of the licensing/permitting procedures. The Center has conducted a formalized EHS assessment that did not identify any EHS aspect of the Center’s operations that can have negative influence on the environment. EHS aspects that may have limited negative impact on the environment and are associated with limited quantity and range of hazardous waste can be prevented or mitigated through implementation of appropriate management plans.

The Center has developed a Feasibility Study for the project, based on how the project has been defined and accompanying documentation obtained from the Municipality of Tuzla (cadastre plans, and legal title of the land). Based on this an Urban Planning permit for project site Slavinovici, where the Center will be developed, was issued by Municipality of Tuzla. In order to get a Construction Permit, the Center had to prepare a number of different documents i.e. architectural design, structural design, design for electric wiring, water supply and waste water management, siting of the project regarding its fire and life safety aspects and influence on local community, life and fire safety protection design of the building. For detailed technological design/scheme of the Center, which defines position and functionality of all premises of the Center, the company hired a specialized consultancy which has a relevant experience in similar health care projects. In the licensing/permitting process the company followed applicable standards in BH i.e Cantonal, BH and some ex–Yugoslav Standards.

After the building is completed a process called “technical certification” of the building is conducted, which is a rigorous auditing process lasting for at least one month to check if the building/project and equipment has been built according to previously approved documentation. The Center has an internal team of 3 engineers for quality control of building materials installation and hires third party independent professionals to test quality of products of its suppliers. The Center intend to hire additional staff for EHS issues i.e occupational health and safety and life and fire safety engineer, maintenance officers, and other technical staff for utilities management.

The Center’s relations with the subcontractors are defined through contracts. These contracts specify the mutual obligations regarding the quality of work, standards of the construction building, workers health and safety. The contracts ensure that there is minimum two years warranty period for all works executed under the contracts. Environmental due diligence of projects has been outsourced as there is no internal staff responsible for this.

The Center has agreed to develop a Healthcare Waste Management System (HWMS) to manage medicinal infectious waste. The HWMS shall be submitted to IFC for review as a condition of disbursement.

- PS2: Labor and Working Conditions

Human Resources Policy and Working Conditions:

The Center will have HR policy, procedures and manual based on the Bosnian Labor Law and will comply with IFC PS2. The Center will have individual contracts for staff, and will use individual bargaining, compensation, and bonuses schemes, based on annual performance. Management will organize informal discussions with the staff and encourage performance and individual recognition. Disciplinary and grievance policy will be developed as part of the HR Policy. In hiring new employees the Center uses transparent and competitive procedures through public announcement, newspaper and internet, and interviews with the potential candidates. As the positions that will be open in the Center have become very popular among potential applicants, the Center has designed a very transparent process to enable the best candidates to be short listed and selected. Several selection/interviewing committees are performing initial screening and preliminary interviewing followed by short listing for specific positions. The final round of interviews will be performed by the senior specialists and the management of the Center.

The Center does not engage with suppliers or contractors who have employees below the legal employment age, which for Bosnia is 18 years. The number of subcontractor’s work force during the construction phase is expected to be 70 in addition to the Center work force of 10 engineering and technical staff; 10 construction specialists; 20 workers. The Center will request its subcontractors during construction work, to apply the requirements of PS2 which relates to non-employee workers. The subcontractors must meet the minimum age requirement and have to be socially insured in compliance with Labor Law. The subcontractors must have professional licenses to operate and hire.

Occupational Health and Safety:

Occupational health and safety hazards for the health care providers, cleaning and maintenance personnel, and personnel involved in handling, treatment and disposal of health care waste are associated with exposure to infections and diseases, hazardous material and fire. These aspects need to be treated as part of the health care waste management system (HWMS). The Center will hire a specialist to manage OHS aspects of the operations. The occupational health and safety aspects of the Center’s operations will be controlled by the Cantonal Health Inspectorate. The Center’s workers are insured for health and social risk through workers’ compensation under the national social and health insurance scheme.

During construction, the Center will be responsible for ensuring the security and safety, and safety training of contractors’ employees, according to the requirements of PS2.

The Center has agreed to develop a formal HR policy as a condition of disbursement.

- PS3: Pollution Prevention and Abatement

IFC guidelines for energy, water, and liquid and solid waste will be applied during both the construction and operational phases of the project. During the construction phase, IFC guidelines should be reflected in contracts between the Center and contractors.

Energy:

Power at the new buildings will be provided by the National electric grid. As a back up option a diesel generator of 500 kW with the reservoir, secured in the containment bund, will be available.

Water Supply and Quality:

The municipal water utility will provide pre-treated potable water. Boiler room will have two boilers able to produce technical water for heating. Light oil fuel is placed in 60 m3 tank secured in the underground concrete containment. Fire prevention and fighting equipment, as per Regulation for fire protection in the boiler rooms, is in place.

Hazardous Health Care Waste:

The management of this waste will be defined by HWMS. The Center will have a package unit “Sterigerms” able to, through combination of autoclaving and compacting of waste, neutralize contaminated waste e.g syringes, needles, tubes, catheters, bandages etc and transform it into the domestic household waste ready for disposal at the landfills.

Waste Water:

Sanitary waste water and process waste water will have separate collection and treatment systems. Sanitary waste water will be treated with oil skimmers before it is discharged in to the city sewage system. Any waste water generated in the boiler rooms will be treated so that oil and grease is removed. Process waste water from the operating theatres will be collected, ducted to the compact treatment package plants where it will be disinfected and sterilized and discharged off to the city sewage system.

Household Solid Waste:

Solid waste consists mainly of paper that is disposed of through recycling and collection by public and private companies.

- PS4: Community Health, Safety and Security

The Center will evaluate health and safety (including L&FS as mentioned below) risks and impacts that could affect the local community during the design, construction, operation of the project, and will establish measures to prevent or mitigate such risks and impacts commensurate with the identified risks and impacts.

Fire and Life Safety:

The new Center building, like all new buildings accessible to the public and financed by IFC, must be designed, constructed and operated in full compliance with all local building codes, local fire department regulations, and local legal/insurance requirements and in accordance with an internationally acceptable fire and life standard.

Bosnian Law on Fire and Safety requires any new building design to be benchmarked against the standards set in the Law. The Center has drafted life and fire safety plan which must be approved by the Inspectorate for Protection Against Fire at the Cantonal level before the operational permit for the health care operations is approved. The Center will have a designated engineer that deals with fire and safety systems controls.

IFC is requiring the Center to prepare an L&FS Master Plan identifying major risks, applicable codes, standards and regulations and mitigation measures. The Master Plan will be prepared by a suitably qualified professional acceptable to IFC. On the basis of the Master Plan, its findings and recommendations, IFC will determine whether additional conditions in a Corrective Action Plan (CAP) are needed, and agree with the Company on a mutually acceptable time frame for implementing these conditions. The qualified professional who prepares the L&FS Master Plan will also undertake a review at the time of L&FS systems testing and commissioning and certify that construction of these systems has been carried out in accordance with the accepted design. Findings and recommendations of this review may also be incorporated into the CAP, as needed, along with a mutually acceptable time frame for implementation.

Contractors for design of the new buildings and the construction will apply sound principles of environmental and safety engineering during the siting and construction phase, and these principles will be stipulated between the contractors and the Center in their contracts, to prevent and/or avoid any reputational or other risk for the Center associated with potential adverse environmental and social performance of the contractors activities. Structural elements will be designed and constructed by qualified and experienced professionals and certified and approved by competent authorities or professionals.

Security personnel:

The Center already has contracted a licensed security company for the construction site.

The Center agreed to develop L&FS Master Plan identifying major risks, applicable codes, standards and regulations and mitigation measures as a condition of first disbursement.

IFC PROJECTS

RECENTLY DISCLOSED