T.C. SAĞLIK BAKANLIĞI Proje Yönetim Destek Birimi
T.C. SAĞLIK BAKANLIĞI Proje Yönetim Destek Birimi

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Stakeholder Engagement Plan TURKEY

Güncelleme Tarihi: 16/09/2020

TURKEY EMERGENCY COVID-19 HEALTH PROJECT

Stakeholder Engagement Plan

DRAFT v1

April 8, 2020

 

1. Introduction/Project Description

An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased thirteenfold and the number of affected countries has tripled. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world.  As of March 22, 2020, the outbreak has resulted in an estimated 319,067 cases and 13,689 deaths in 188 countries. 

 

Since its first COVID-19 case was detected on March 11, the Government of Turkey has gradually introduced a range of public health measures in line with WHO guidance.  Measures have included moving from hygiene guidance to the closure of major events, social venues, schools and all major commercial outlets, and recommending physical distancing to curb transmission.  Most residents appear to have followed Government guidance, with major metropolitan areas shut down.  The Government has also announced an economic package totaling approximately TL 100 billion (US$15 billion) to stem the impact on firms and targeted households, including deferral of social security and payroll tax on the part of firms, increasing the minimum pension, increased allocation for social assistance beneficiaries, and unspecified provisions for strengthening social services for older persons.

 

The Ministry of Health (MoH) has been leading the Turkish Government’s COVID-19 pandemic response.As part of detection and response capabilities, on March 18, the MoH Emergency Health Services General Directorate (GD) put into practice the Hospital Calamity and Emergency Action Plan (HAP). This plan grants Emergency Health Services GD the responsibility of conducting any type of emergency plan on behalf of the MoH. While Turkey has adequate intensive care bed capacity for COVID-19 but lacks access to protective equipment and ventilators. As per the recent MoH Coronavirus Circular, all state and private health institutions meeting criteria set by the Health Ministry were declared pandemic hospitals. Therefore, MoH believes that all ICU bed capacity can be used to respond to COVID-19 outbreak; and that needs are concentrated in equipment and supplies for health workers in the form of personal protective equipment, ventilators, and medicines.

 

 

Turkey also hosts nearly four million refugees and asylum-seekers who have been receiving health services largely through donor-financed health facilities prior to the COVID-19 outbreak and will likely require additional support during the pandemic.  This population includes 3.6 million Syrian nationals and close to 330,000 registered refugees and asylum-seekers of other nationalities, where Afghans and Iranians are major groups. Over 98% of refugees live across Turkey’s 81 provinces. Syrians have access to health care through public hospitals, Migrant Health Centers (providing primary health services) and units operating under community health centers. Syrians who are not registered with the Government of Turkey have limited access to primary or referral health care but are provided with emergency care and essential public health services free-of charge, and then referred for registration. 

 

This proposed Turkey Emergency COVID-19 Health Project responds to the Government of Turkey’s request to strengthen its capacity to respond to urgent health complications associated with COVID-19.  The Turkish health system is not sufficiently equipped to contain the spread of disease and provide the necessary treatment without additional support. This project will provide support to the resilience and capacity of the health sector. Follow on operations to support economic recovery are also under preparation and will be processed in parallel to this Project. The Project objectives are to prevent, detect and respond to the threat posed by COVID-19 in Turkey. This objective is aligned to the results chain of the global COVID-19 Strategic Preparedness and Response Program (SPRP).

 

The project comprises the two components:

 

Component 1 Emergency COVID-19 Response comprises:

Sub-component 1.1. Strengthening testing and surveillance systems and procurement of front-line equipment addressing the immediate health system needs for medical equipment, supplies and training to diagnose and triage cases affected by the COVID-19 emergency.  

Sub-component 1.2. Supporting disease management and treatment will finance medical equipment and supplies required for diagnosis and treatment of COVID-19 patients in intensive care, as well as limited operating expenses. The hospitals in which ICUs to treat COVID-19 patients will be established have been identified based on an assessment of existing service availability and the need to expand the availability of relevant specialist care in order to ensure equitable access.

Sub-Component 1.3. Enhancing Public Health Awareness and Behavioral Change will expand and enhance information and communication activities to increase the commitment of government, private sector, and civil society to curbing the COVID-19 pandemic, raise awareness and knowledge among the general population about the risk and potential impact of the pandemic, and to develop multi-sectoral strategies to address the pandemic. 

Sub-Component 1.4. Upgrading pandemic surveillance and response plans will finance an assessment, knowledge-exchange and capacity-building for enhancing the national pandemic preparedness and response plan to address potential cyclical future phases associated with COVID-19 or other pandemics, including the capacity for immediate testing, screening, surveillance and monitoring and information technology equipment and training to enhance the surveillance system for outbreak detection, rapid data collection, analysis, assessment and timely reporting. This subcomponent will finance the updating of disaster emergency plans to incorporate challenges associated with reducing the spread and management of the COVID-19 virus.

 

Component 2. Project Management, Monitoring and Evaluation [US$2 million]

This component will support the administrative and human resources needed to  implement the Project and monitor and evaluate progress.It will finance staff and consultant costs associated with project management, procurement, financial management, environmental and social safeguards, monitoring and evaluation, reporting and stakeholder engagment; operating and administrative costs;  technical assistance to strengthen the Project’s emergency response (e.g. development of testing, treatment, referral and discharge protocols); and longer-term capacity-building for pandemic preparedness.

The MPA will include a monitoring and prospective evaluation framework for the overall facility and for operations at the country and sub-regional or regional levels.  The approach will include baseline assessments, benchmarking, rapid learning, and multi-country analysis to inform tactical adaptations within and across countries.

As per the World Bank Environmental and Social Standard (ESS) 10 --Stakeholders Engagement and Information Disclosure-- the implementing agencies should provide stakeholders with timely, relevant, understandable and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination and intimidation.

 

The overall objective of this Stakeholder Engagement Plan (SEP) is to define a program for stakeholder engagement about the Project, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make complaints about project and any activities related to the project. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases.


2. Stakeholder identification and analysis

Project stakeholders are defined as individuals, groups or other entities who:

(i)                are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and

(ii)              may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way.


Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e. the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. Verification of stakeholder representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Depending on the different needs of the identified stakeholders, the legitimacy of the community representatives can be verified by checking with a random sample of community members using techniques that would be appropriate and effective considering the need to also prevent coronavirus (COVID19) transmission.

 

2.1 Methodology 

In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement:

 

·   Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation;

·   Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns;

·   Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the projects is inclusive. All stakeholders are encouraged to be involved in the consultation process, to the extent the current circumstances permit. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, in particular women, youth, elderly and the cultural sensitivities of diverse ethnic groups.

 

For the purposes of effective and tailored engagement, stakeholders of the proposed project can be divided into the following core categories:

 

·   Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures;

 

·   Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way; and

 

·   Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status[1], and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project.


2.2.
Affected parties

Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category:

-        COVID-19 infected people in hospitals and their families & relatives

-        People in quarantine/isolation centers and their families & relatives

-        Workers in quarantine/isolation facilities, hospitals, diagnostic laboratories

-        Communities in the vicinity of the project’s planned quarantine/isolation facilities, hospitals, laboratories

-        Public/private health care workers (Doctors, Nurses, Public Health Inspectors, Midwives, laboratory technicians/staff) and emergency personnel

-        Staff at medical and testing facilities, and public health agencies engaged in the response

-        Staff of prisons/detention facilities & security services

-        People at risk of contracting COVID-19 (e.g. returning pilgrims, refugees and migrants, staff at temporary accommodation centers (refugee camps), medical and other tourists, tour guides, hotels and & their staff, associates of those infected, inhabitants of areas where cases have been identified)

-        Ministry of Health; Turkey Institutes of Health Administration (TÜSEB); Turkey Pharmaceuticals and Medical Devices Agency (TİTCK);

-        Provincial, District, and Municipal government administrations

-        Municipal Councils, Municipal waste collection and disposal workers

-        Ministry of Health, Ministry of Health/Emergency Health Services General Directorate (GD), Health Calamity Coordination Center (SAKOM) officials,

-        Staff and students of educational institutions (from pre-school to higher education)

-        Staff and inhabitants at orphanages, elderly, children and other care institutions and private service providers;

-        Airline and border control staff, law enforcement authorities and their staff (e.g. Police, Army, Navy, Air Force etc.) especially those deployed to search suspected cases and quarantine them.

-        Other public authorities (e.g. Turkey’s Civil Aviation Authority, Department of Immigration and Emigration, Ministry of Defense etc.)

2.3. Other interested parties

The project stakeholders also include parties other than the directly affected communities, including:

-        The public at large

-        Community based organizations, national civil society groups and NGOs, etc.

-        Goods and service providers involved in the project’s wider supply chain

-        Regulatory agencies (e.g. President’s Office, Ministry of Interior, Directorate of Religious Affairs, Ministry of Agriculture and Forestry, Ministry of Transport and Infrastructure, Ministry of Youth and Sports, Ministry of Environment and Urban Planning, Ministry of Family, Labor and Social Services, Social Services Directorates, Provincial Councils, District and Municipal Councils etc.

-        Media and other interest groups, including social media & the Government Information Department

-        National and international health organizations/associations (e.g. theTurkish Medical Association, TTB Specialist Associations, Public Health Experts Association, Turkish Clinical Microbiology and Infectious Diseases Association, Turkish Thoracic Society, and Turkish Intensive Care Association, Red Crescent Society, WHO, Global Fund

-        Other donor organizations (ADB, EBRD, IsDB, KfW, USAID, and GIZ);

-        Interested international NGOs, Diplomatic mission and UN agencies (especially UNICEF, WHO), EU, bilateral agencies and others

-        Academics

-        Private Sector

-        Schools, universities and other education institutions closed down due to the virus

-        Mosques, churches and other religious institutions

-        Transport workers (e.g. cab/taxi drivers)

-        Businesses with international links; and

-        Public at large.

 

2.4. Disadvantaged / vulnerable individuals or groups

It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project. It is similarly important to ensure that project-related awareness raising and stakeholder engagement be adapted to take into account particular constraints, concerns and cultural sensitivities of such groups and individuals and to ensure their full understanding of project activities and benefits.The vulnerability may stem from person’s origin, gender, age, health condition, current economic constraints and financial insecurity, disadvantaged status in the community (e.g. refugees, minorities or marginal groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project so that their awareness of and input to the overall process are commensurate to those of the other stakeholders.

 

Within the Project, the vulnerable or disadvantaged groups include but are not limited to the following:

 

-      the elderly and people with chronic diseases and pre-existing conditions

-      People with disabilities

-        Pregnant women, infants and children

-        Refugees, migrants, citizens with limited Turkish language abilities

-        People living below poverty line

-        The unemployed and homeless

-        Women-headed households and/or single mothers with underage children;

-        Extended low-income families;

-        Staff and residents of orphanages, elderly, children and other care institutions and private service providers;

-        People under domestic violence risk;

 

Vulnerable groups in the population will be further confirmed and consulted through dedicated means, as appropriate. Description of the methods of engagement to be undertaken by the project is provided in the following sections.

 

3. Stakeholder Engagement Program

3.1. Summary of stakeholder engagement done during project preparation

Given the emergency nature of this operation and the transmission dynamics of COVID-19, consultations during the project preparation phase were limited to relevant government officials, health experts, hospital administrators and others from institutions working in health sector. This Stakeholder Engagement Plan as well as the Labor Management Procedures that will be prepared under the project will be subject to disclosure and consultation before their finalization. The Project includes considerable resources to implement the actions included in the SEP. A more detailed account of these actions will be prepared as part of the update of this SEP, which is expected to take place within 30 days after the project effectiveness date. The SEP will be continuously updated throughout the project implementation period, as required.

 

 

3.2. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement

Strong citizen and community engagement is a precondition for the effectiveness of the Project.Stakeholder engagement under the project will be carried out on two fronts: (i) consultations with stakeholders throughout the entire project cycle to inform them about the project, including their concerns, feedback and complaints about the project and any activities related to the project; and to improve the design and implementation of the project, which will happen through the SEP, and (ii) awareness-raising activities to sensitize communities on risks of COVID-19 which is happening as part of project design

In terms of consultations with stakeholders on the project design, activities and implementation arrangements, etc., the revised SEP, expected to be updated within 30 days after the project effectiveness date as mentioned above, and continuously updated throughout the project implementation period when required, will clearly lay out:

-        Type of Stakeholder to be consulted

-        Anticipated Issues and Interests   

-        Stages of Involvement

-        Methods of Involvement               

-        Proposed Communications Methods

-        Information Disclosure

-        Responsible authority/institution

With the evolving situation, as the Turkish Government has taken measures to impose strict restrictions on public gatherings, meetings and people’s movement, the general public has also become increasingly concerned about the risks of transmission, particularly through social interactions. Hence alternative ways will be adopted to manage consultations and stakeholder engagement in accordance with the local laws, policies and new social norms in effect to mitigate prevention of the virus transmission.

These alternate approaches that will be practiced for stakeholder engagement will include: having consultations in small groups if smaller meetings are permitted, else making reasonable efforts to conduct meetings through online channels (e.g. webex, skype etc.);  diversifying means of communication and relying more on social media, chat groups, dedicated online platforms & mobile Apps (e.g. Facebook, Twitter, WhatsApp groups, project weblinks/websites etc.); and employing traditional channels of communications such TV, radio, dedicated phone-lines, sms broadcasting, public announcements when stakeholders do not have access to online channels or do not use them frequently.  

 

For the awareness-raising activities under Component 1.3. Enhancing Public Health Awareness and Behavioral Change, will expand and enhance information and communication activities to increase the commitment of government, private sector, and civil society to curbing the COVID-19 pandemic, raise awareness and knowledge among the general population about the risk and potential impact of the pandemic, and to develop multi-sectoral strategies to address the pandemic.  Key activities to be financed include: (a) training of additional health care personnel throughout health and non-health care institutions (e.g. through schools, municipal facilities); (b) information and communication activities to increase the attention and commitment of above stakeholders to raise awareness, knowledge and understanding of key public health and behavioral interventions specifically among the at-risk population and among the general public.

WB’s ESS10 and the relevant national policy or strategy for health communication & WHO’s “COVID-19 Strategic Preparedness and Response Plan -- Operational Planning Guidelines to Support Country Preparedness and Response” (2020) will be the basis for the project’s stakeholder engagement. In particular, Pillar 2 on Risk Communication and Community Engagement outlines the following approach:

“It is critical to communicate to the public what is known about COVID19, what is unknown, what is being done, and actions to be taken on a regular basis. Preparedness and response activities should be conducted in a participatory, community-based way that are informed and continually optimized according to community feedback to detect and respond to concerns, rumours and misinformation. Changes in preparedness and response interventions should be announced and explained ahead of time and be developed based on community perspectives. Responsive, empathic, transparent and consistent messaging in local languages through trusted channels of communication, using community-based networks and key influencers and building capacity of local entities, is essential to establish authority and trust.”

Stakeholder engagement will be held during the entire project period and special attention accorded to poor and vulnerable groups such as women, refugees, youth, elderly, female headed households etc. Given the linguistic diversity, language preferences have also been considered. All efforts will be made to evince a feedback, record the same, and address as appropriate.

 

Table 1: Stakeholder consultation plan related to COVID-19

Project stage

Topic of consultation / message

Method used

Target stakeholders

Responsibilities

Preparation

·        Need of the project? What does this mean?

·        planned activities

·        E&S principles, Environment and social risk and impact management,

·        E&S plans prepared for this project: InInfection Control and Medical Waste Management Plan (ICWMP), Stakeholder Engagement Plan (SEP) and Labor Management Procedures (LMP) to address working conditions, health and safety of workers in health sector as well as their grievance arrangements

·        Grievance Redress mechanisms (GRM)

·        Health and safety impacts

·        Phone, email, letters

·        One-on-one meetings

·        FGDs spell out

·        Outreach activities

·        Appropriate adjustments to be made to take into account the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, etc.)

·   Government officials from relevant line agencies at local level

·   Health institutions

·   Health workers and experts

 

Environment and Social Specialist

 

PIU/or PMU or PMSU – please update and make consistent throughout the SEP

·        Need of the project

·        planned activities

·        Environment and social risk and impact management

·        Grievance Redress mechanisms (GRM)

·        Outreach activities that are culturally appropriate and accessible in languages of refugees/migrants and citizens with limited Turkish language (e.g. Arabic, Persian)

·        Appropriate adjustments to be made to take into account the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, etc.)

·   Affected individuals and their families

·   Vulnerable groups

·   Refugees/immigrants 

Environment and Social Specialist

 

PIU

Implementation

·        Project scope and ongoing activities

·        SEP and project related grievance arrangements

·        Health and safety of public and health workers addressed in LMP and in worker’s grievance arrangements

·        Environmental concerns under ICWMP

·        Training and workshops

·        Disclosure of information through Brochures, flyers, website, etc. in Turkish and other languages (Arabic, Persian)

·        Information desks at municipalities offices and health facilities

·        Appropriate adjustments to be made to take into account the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, etc.)

·   Government officials from relevant line agencies at local level

·   Health institutions

·   Health workers and experts

 

Environment and Social Specialist

 

PIU

·        Project scope and ongoing activities

·        SEP and project related grievance arrangements

·        Health and safety of public and health workers addressed in LMP and in worker’s grievance arrangements

·        Environmental concerns under ICWMP

·        Public meetings in affected municipalities/localities

·        Brochures, posters in Turkish and other relevant languages

·        Information desks in local government offices and health facilities with translation facilities available for refugees/migrants as needed

·        Appropriate adjustments to be made to take into account the need for social distancing (use of audio-visual materials, technologies such as telephone calls, SMS, emails, radio, tv etc.)

·   Affected individuals and their families

·   Local communities

·   Vulnerable groups

 

Environment and Social Specialist

 

PIU

 

 

 

3.3. Stakeholder Engagement Plan

As mentioned above, stakeholder engagement will be carried out for (i) consultations with stakeholders throughout the entire project cycle to inform them about the project, including their concerns, feedback and complaints, (ii) information and communication activities to increase the attention and commitment of above stakeholders to undertake awareness raising activities to sensitize the at-risk population and the general public on risks of COVID-19. 

 

Table 2. Summary of stakeholder needs, and suggested notification means

Stakeholder group

Key characteristics

Expectations

Specific communication needs (accessibility, large print, child care, daytime meetings)

Language needs

Engagement method (email, phone, radio, letter)

 

Affected Parties

COVID-19 infected people;

 

Wide range of people affected by COVID-19.

High Risk as they can spread infections

Medical examination and treatment in hospitals, ad-hoc financial support to low-income households with infected family member(s)

Daytime phone calls, text messages and emails

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

SMS and messaging, TV, radio, phone

 

People under COVID-19 quarantine;

 

Diverse range of people isolated from the community, different nationalities.

High Risk requiring psycho-social support

Favorable conditions to stay in quarantine facilities

Daytime consultations on transmission, self-care, risks/ complications

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

SMS and messaging, phone

 

Relatives of COVID-19 infected people;

 

Frustrated family members and unaware care-givers.

Moderate Risk requiring full information.

Large print outs and disseminations, special instructions from health workers, hand hygiene and PPEs

Special instructions from health workers to prevent transmission 

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Leaflets, phone,

 

Relatives of people under COVID-19 quarantine

Frightened family members and concerned surrounding people.

Low Risk. Anxious and plan next steps

Reliable information and educational materials regarding self-care and social distancing

Information and educational materials

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Print-outs, social media group postings, phone calls, e-mails

 

Neighboring communities to laboratories, quarantine centers, and screening posts

Concerned residents of local communities and employees of local enterprises/ line organizations.

Moderate Risk. Requiring full information.

Awareness raising, waste management precautions, hand hygiene and PPEs;

Special sessions for parents with young children to avoid outbreaks

Daytime phone calls to local community leaderships, distribution of leaflets

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Print outs, information boards;

Info sessions by community leaders and local health worker

 

People at COVID-19 risks

Discouraged elderly 65+; suspecting people leaving with AIDS/HIV; people with chronic medical conditions, such as diabetes and heart disease; travelers, inhabitants of border communities.

Low Risk. Full awareness.

Behavior instructions for people with chronic diseases, ad-hoc supportive treatment for HIV/AIDS positive people, instructions on extra personal health safety, awareness raising campaigns, hand hygiene and PPEs

Daytime phone calls to their relatives, text messaging of the emergency hotline contact numbers, accessibility problems

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Health worker consultations and emergency contacts available, phones, print outs, ads, radio

 

Public health workers

 

Unprepared managers, doctors, nurses, lab assistants, cleaners

High Risks.

Occupational health and biosafety measures, PPEs, hands-on training programs, infection control and risk management planning

Daytime hands-on simulations, burn-out syndromes

Turkish, and also other languages as relevant ie Arabic,

Trainings, print outs,

 

Medical waste collection and disposal workers;

 

Medical nurses, cleaners, hospital incinerators’ workers, waste removal & transfer workers in community or rural health houses

High Risk.

Occupational health and  safety (OHS) measures, training, PPEs, waste management plans, safe waste transfer vehicles for rural health facilities

Daytime trainings and guidance

Turkish, and also other languages as relevant ie Arabic,

Written instructions, trainings

 

Employees of large public places, like public markets, supermarkets

Managers, salesmen, marketing specialists, workers, cashiers, security officers

OHS measures, hand hygiene and PPEs, extra safety measures, like social distancing

Distribution of leaflets on extra safety measures in their workplaces

Turkish, and also other languages as relevant ie Arabic,

 

Written instructions from SSES, OHS trainings, social media platforms

 

Returning pilgrims, refugees, labor migrants and laborers working on remote construction sites

Frustrated and forced to travel laborers with relatively mid income.

Moderate Risk.

Initial epidemiological screening at aircrafts and airports, trains, busses and train/bus stations, medical check-ups, placement in quarantine facilities and continuous monitoring.

Internet access, mobile telecommuting through their relatives and employers

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Social media platforms, e-mails, letters to foreign contractors working in the country

 

Point of entry staff at airports and border control staff

At risk employees working at the front lines with large amount of people

High Risk.

Emergency risk management skills, improved working conditions, hand hygiene and PPEs

Emergency risk management skills, information on referral mechanisms and algorithm of their actions

Turkish, and also other languages as relevant ie Arabic,

English 

Extra OHS trainings, letters

 

Airlines and other international transport businesses

 

Large and diverse staff

High Risk.

Timely notices on travel bans and relevant timely safety actions to be taken from their side; increased safety measures, extra OHS and first medical aid trainings for their staff

Timely notices on travel bans and relevant timely safety actions to be taken from their side; increased safety measures, extra OHS and first medical aid trainings for their staff

Turkish, English

Letters, e-mails, alert notices at the MoTI, airline, train and bus company websites

 

Other interested parties (Risks are Low to Moderate)

 

MoH and its provincial & local branches

 

Implementing agency and coordinating unit for COVID-19 emergency rapid response

Requires financing for immediate emergency response needs (medical supplies, equipment, staff preparedness capacity building, quality laboratories, improved quarantine centers and screening posts, enough PPEs; effective community engagement and outreach)

Risk Communication Strategy and Action Plan to be developed/updated and implemented in line with national pandemic plan, effective coordination of the diverse stakeholder engagement activities

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Letters, meetings, e-mails, VCs

 

MoH, schools and educational facilities

 

The policy makers and supervisors of a wide network of educational and social service providers

Needs information and educational materials on prevention measures, capacity building of educators on prevention measures

Interagency communication lines and guidance on relevant outreach to schools and colleges

Turkish

Letters, meetings, e-mails, VCs

 

Mass media and journalists

National, regional and local newspapers, online news agencies, local and national TVs channels

Training to improve knowledge and techniques to arrange for media coverage of COVID-19 related emergency response procedures

Training to improve knowledge and techniques to arrange for media coverage of COVID-19 related emergency response procedures

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

e-mails, social media platforms, websites

 

Civil society organizations

Non-for-profit organizations on regional, national and local levels that pursue environmental and socio-economic interests and may become partners of the project

Donor funding to contribute to emergency response procedures

Donor funding to contribute to community outreach and emergency response procedures

Turkish

e-mails, social media platforms, websites

 

Social media platforms users;

 

Users of Facebook, Instagram, Twitter etc., active internet users

Reliable information sources, timely updates on real current situation with COVID-19 in the country, online information on how to filter false information and fake news

24/7 communications, timely and reliable source information

 

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

social media platforms and groups, special COVID-19 website to be created and maintained

 

Implementing agencies for the WB-funded projects working in health, social protection, water supply and sanitation sectors

Relevant PIUs/PCUs, MoH

Timely awareness and invitation for participation, joint action plan with their emergency response contributions

Daytime communications, timely awareness and invitation for participation, joint action plan with their emergency response contributions

Turkish, English

Letters, meetings, e-mails, VCs, participation in multisectoral task force or coordination meetings

 

Other national, international health organizations,

development donors & partners

Red Crescent Society, WHO, GIZ, Global Fund, UNICEF, UNDP, USAID, ADB, EBRD, IsDB , EU

Frequent donor coordination meetings to avoid duplication, mapping of donor activities, synergies between donor-funded investments

Frequent donor coordination meetings to avoid duplication, mapping of donor activities, synergies between donor-funded investments

English

Letters, DCC meetings, e-mails, VCs, list serves

 

Public at large

 

Urban, rural, peri-urban residents, expats and their family members residing in the country

Updated and reliable information on the current situation to reduce dissemination of false rumors and panic

Daytime communications, diverse communication channels, easy to understand tips, large print-outs

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Mass media, SMS messaging, information boards, social media, MoH website & hotlines, COVID-19 website

 

Vulnerable and disadvantage groups (Risks are Substantial)

 

Retired elderly and people with disabilities

Aged people of 65+, unable to work, physically and mentally disables people staying

Economic and social support from social workers and ad-hoc payments, home-based family doctor consultations

Daytime communications, accessibility problems, social worker assistance

Turkish

Frequent social workers home visits, mahalla committee

 

Pregnant women, infants and children;

 

Reproductive age women, babies of 0-18-month age, children with weak immune system

Frequent medical check-ups by family doctors, access to free hospital services and free testing at labs

Daytime communications, child care support during meetings

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Community leaders, mahalla committee, family doctors, women’s associations (?)

 

Women-headed households and/or single mothers with underage children;

Single mothers, divorced, widows, abandoned wives

Economic support to afford the prevention and treatment costs, access to free hospital services and free testing at labs

Daytime communications, child care support

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Community leaders, mahalla committee, family doctors,

women’s associations (?)

 

Extended low-income families;

 

The families have 6 or more members, many of them are underaged to work

Economic support to afford the prevention and treatment costs, access to free hospital services and no cost lab testing services

Daytime communications

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Community leaders, mahalla committee, family doctors

 

Unemployed

 

Laborers with professional skills or unskilled workers

Economic support to afford the prevention and treatment costs.

Tuition waivers to obtain vocational skills certificates

Large print-outs, limited access to online resources

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Employment agency leaflets, sms

 

Residents and workers of public orphanages and elderly houses

Lonely and abandoned people residing in boarding schools or houses, underpaid workers

Need funding to improve living conditions, in-house medical services and nutrition

Accessibility problems

Turkish, and also other languages as relevant ie Arabic,

Persian, English 

Letters to the Managers of Houses, site visit to assess their poor situation

 

 

 

 

 

3.4  Public awareness on COVID 19:

The Ministry of Health has already put in place a national pandemic plan and has been executing all measures in line with the plan with constant updates. The MoH has already in place a public health emergency communication strategy in line with its national pandemic plan and will strengthen its risk communication strategy under the project taking into consideration the following steps and guidelines.

 

Table 3: For stakeholder engagement relating to public awareness, the following steps will be taken:

Step 1: Design of communication strategy

-        Assess the level of ICT penetration among key stakeholder groups by using secondary sources to identify the type of communication channels that can be effectively used in the project context. Take measures to equip and build capacity of stakeholder groups to access & utilize ICT – as part of the Project? This seems to go beyond what is being done in the Project.

-        Conduct rapid behavior assessment to understand key target audience, perceptions, concerns, influencers and preferred communication channels.

-        Update the Risk Communication strategy for COVID-19 prepared in line with national pandemic plan, including details of anticipated public health measures.  

-        Work with organizations supporting people with disabilities to develop messaging and communication strategies to reach them. 

-        Prepare local messages and pre-test through participatory process, especially targeting key stakeholders, vulnerable groups and at-risk populations

-        Identity & partner with tele/mobile communication companies, ICT service providers and trusted community groups (e.g., community-based organizations, community leaders, religious leaders, health workers, community volunteers) and local networks to support the communication strategy.

Step 2: Implementation of the Communication Strategy

-        Establish and utilize clearance processes for timely dissemination of messages and materials in Turkish and also in Arabic, Persian and English, where relevant, for timely dissemination of messages and materials and adopt relevant communication channels (including social media/online channels). 

-        Project will take measure to ensure that women and other vulnerable groups are able to access messaging around social isolation, prevention methods and government streamlined messaging pathways by radio, short messages to phones.

-        Specific messages/awareness targeting women/girls will also be disseminated on risks and safeguard measures to prevent GBV/SEA spell out in quarantine facilities, managing increased burden of care work and also as female hospital workers.

-        Engage with existing health and community-based networks, media, local NGOs, schools, local governments and other sectors such healthcare service providers, education sector, defense, business, travel and food/agriculture sectors, ICT service providers using a consistent mechanism of communication.

-        Utilize two-way ‘channels’ for community and public information sharing such as hotlines (text and talk), responsive social media, where available, and TV and Radio shows, with systems to detect and rapidly respond to and counter misinformation.

-        Establish large-scale community engagement strategy for social and behavior change approaches to ensure preventive community and individual health and hygiene practices in line with the national public health containment recommendations. Given the need to also consider social distancing, the strategy would focus on using IT-based technology, telecommunications, mobile technology, social media platforms, and broadcast media, etc.

Step 3: Learning and Feedback

-        Systematically establish community information and feedback mechanisms including through social media monitoring, community perceptions, knowledge, attitude, and practice surveys, and direct dialogues and consultations. In the current context, these will be carried out virtually to prevent COVID 19 transmission.

-        Ensure changes to community engagement approaches are based on evidence and needs, and ensure all engagement is culturally appropriate and empathetic.

-        Document lessons learned to inform future preparedness and response activities.

This Stakeholder Engagement Plan as well as the Labor Management Procedures and Infection Control and Medical Waste Management Plan that will be prepared under the Project will also be consulted and disclosed. The Project includes considerable resources to implement the above-mentioned activities and actions. The details of this will be prepared during the update of this SEP, expected to be updated within 30 days after the project effectiveness date, and continuously updated throughout the project implementation period when required.

 

3.4. Proposed strategy for information disclosure

Table 4: Information Disclosure Proposed Methods during Implementation Stage

Project stage 

Information to be disclosed 

Methods proposed 

Timelines/ Locations

Target stakeholders 

Percentage reached 

Responsibilities 

National level  

Prevention tips 

 

Audio reels 

Video clips 

  

National radio and TV twice daily  

Adults, adolescents, children 

99% of population 

PIU

Social Specialist  

Dos and Don’ts 

Printed booklets

Online material embedded in distance learning 

National wide 

Schools 

99% 

MoE school departments 

Dos and Don’ts  

Information & educational materials 

Social media platforms 

Internet users, youth 

99% of population 

PIU

Social Specialist  

Hotline 

Phone consultations 

24/7 MoH ALO 184 Information Center  

Public at large 

TBD 

Health professionals 

Quarantine measures, travel bans 

 

Leaflets, e-news 

List serves, internet news, website news, info boards 

Travelers 

N/A 

Airport and border staff  

Regional level  

Prevention tips 

 

Audio reels 

Video clips 

  

regional radio and TV twice daily  

Adults, adolescents, children 

95% of each region 

PIU Social specialist  

Outreach Officer through regional TV and Radio companies 

Helplines 

Phone consultations 

24/7 regional focal points at health facilities 

People at risk, infected, relatives of infected people  

95 % in each region 

Medical focal points at provincial  level 

Quarantine measures, travel bans 

Leaflets 

Info boards 

Travelers 

N/A 

International and domestic airport and border staff  

WHO COVID-19 guidance documents and protocols 

Print-outs and e-materials, trainings 

Provincial centers, quarterly  

Medical staff 

100% 

Provincial health institutions managers 

District level 

Treatment protocols and practices  

Print-outs and e-materials, trainings 

District centers, quarterly  

Medical staff 

100% 

District health institutions managers 

Prevention tips 

Emergency contact numbers 

Posters on   

info board at health facilities entrances 

District centers, constantly 

District center population 

100% 

District authorities, hospitals managers, Health Centers 

Community level 

Treatment protocols and practices  

Print-outs and e-materials, trainings 

District centers, quarterly  

Medical staff of rural health facilities  and PCH 

District health institutions managers 

Prevention tips 

Emergency contact numbers 

Posters on  info board at mosques and rural health facilities entrances 

Rural health facilities, mosques, constantly 

Local communities

100 % 

Health Facility managers, local Imams,

Prevention tips 

Emergency contact numbers 

In-house outreach 

Vulnerable households 

People at risk 

100 % 

Family doctors, nurses, social workers 

 

The project will ensure that the different activities for stakeholder engagement, including information disclosure, are inclusive and culturally sensitive. Measures will also be taken to ensure that the vulnerable groups outlined above will have the chance to participate and benefit from project activities. This will include among others, household-outreach through SMS, telephone calls, etc., depending on the social distancing requirements, in Turkish and in other languages such as Arabic and Persian as relevant, the use of verbal communication, audiovisuals or pictures instead of text, etc. Further, while country-wide awareness campaigns will be established, specific communications in at local & international airports, hotels, for schools, at hospitals, quarantine centers and laboratories will be timed according to the need, and also adjusted to the specific local circumstances.

 

Table 5: A preliminary strategy for information disclosure is as follows:

Project stage

Target stakeholders

 

List of

information to be disclosed

Methods and timing proposed

Preparation of social distancing and risk communication strategy

Government entities; local communities; vulnerable groups; NGOs and academics; health workers; media representatives; health agencies; others

Project concept, E&S principles and obligations, documents, Consultation process/SEP, Project documents- SEP, LMP, ICWMP, GRM procedure, update on project development

Dissemination of information via dedicated project website (is there a URL already?), Facebook site, sms broadcasting (for those who do not have smart phones) including  hard copies at designated public locations; Information leaflets and brochures; and meetings, including with vulnerable groups while making appropriate adjustments to formats in order to take into account the need for social distancing.

Implementation of public awareness campaigns

Affected parties, public at large, vulnerable groups, public health workers, government entities, other public authorities

Update on project development; the social distancing and risk communication strategy

Public notices; Electronic publications via online/social media and press releases; Dissemination of hard copies at designated public locations; Press releases in the local media; Information leaflets and brochures; audio-visual materials, separate focus group meetings with vulnerable groups, while making appropriate adjustments to consultation formats in order to take into account the need for social distancing (e.g., use of mobile technology such as telephone calls, SMS, etc).

During preparation of ICWMP, LMP

People under COVID-19 quarantine, including workers in the facilities; Relatives of patients/affected people; neighboring communities; public health workers; other public authorities; Municipal & Provincial councils; District/Divisional Secretaries; civil society organizations, Religious Institutions/bodies.

Project documents, technical designs of the isolation units and quarantine facilities, SEP, relevant E&S documents, GRM procedure, regular updates on Project development

Public notices; Electronic publications and press releases on the Project web-site & via social media; Dissemination of hard copies at designated public locations; Press releases in the local media; Consultation meetings, separate focus group meetings with vulnerable groups, while making appropriate adjustments to consultation formats in order to take into account the need for social distancing (e.g., use of mobile technology such as telephone calls, SMS, etc).

During project implementation

COVID-affected persons and their families, neighboring communities to laboratories, quarantine centers, hotels and workers, workers at construction sites of quarantine centers, public health workers, MoH, airline and border control staff, police, military, government entities, Municipal councils;

SEP, relevant E&S documents; GRM procedure; regular updates on Project development

Public notices; Electronic publications and press releases on the Project web-site & via social media; Dissemination of hard copies at designated public locations; Press releases in the local media; Consultation meetings, separate focus group meetings with vulnerable groups, while making appropriate adjustments to consultation formats in order to take into account the need for social distancing (e.g., use of mobile technology such as telephone calls, SMS, etc).


3.5. Future of the project

Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the Stakeholder Engagement Plan and the grievance mechanism. This will be important for the wider public, but equally and even more so for suspected and/or identified COVID-19 cases as well as their families.

 

3.6 Proposed strategy to incorporate the views of vulnerable groups

The project will carry out targeted consultations with vulnerable groups to understand concerns/needs in terms of accessing information, medical facilities and services and other challenges they face at home, at work places and in their communities.  In addition to specific consultations with vulnerable groups and women, the project will partner with other line ministries and also source to private sector entities to engage children and adolescents to understand their concerns, fears and needs. Some of the strategies that will be adopted to effectively engage and communicate to vulnerable group will be:  

 

-        Women: ensure that community engagement teams (are these part of the project design or an E&S response?) are gender-balanced and promote women’s leadership within these, design online and in-person surveys and other engagement activities so that women in unpaid care work can participate; consider provisions for childcare, transport, and safety for any in-person community engagement activities.

 

-        Pregnant women: develop education materials for pregnant women on basic hygiene practices, infection precautions, and how and where to seek care based on their questions and concerns.

 

-        Elderly and people with existing medical conditions: develop information on specific needs and explain why they are at more risk & what measures to take to care for them; tailor messages and make them actionable for particular living conditions (including assisted living facilities), and health status; target family members, health care providers and caregivers.

 

-        People with disabilities: provide information in accessible formats, like braille, large print; offer multiple forms of communication, such as text captioning or signed videos, text captioning for hearing impaired, online materials for people who use assistive technology.

 

-        Children: design information and communication materials in a child-friendly manner & provide parents with skills to handle their own anxieties and help manage those in their children.

 

-        Refugees/migrants: provide information in relevant language (Arabic, Persian, etc) with the support of YIMER-Directorate General of Migration Management’s Communication Center as needed, and ensure that community engagement teams have the requisite language abilities and are gender-balanced to ensure outreach to women in these communities.

 

4. Resources and Responsibilitiesfor implementing stakeholder engagement activities

4.1. Resources

The Ministry of Health will be the implementing agency for the project. The same Project Management and Support Unit (PMSU) under the Turkey Health Systems Strengthening and Support Project (P152799) (HSSSP), will be utilized with an additional support from one Environment and one Social specialist assigned to the PMSU. The PMSU has the required experience and will be in charge of implementing the stakeholder engagement activities in partnership with the Public Health Directorate. There is a tentative budget allocated around 150.000 USD for the implementation of SEP which is included under Sub-Component 1.3. Enhancing Public Health Awareness and Behavioral Change which will be publicized after negotiations of the project.

 

4.2. Management functions and responsibilities

The Project will be implemented by the MOH through the existing Project Management and Support Unit (PMSU) that implements the ongoing World Bank-financed Turkey Health System Strengthening Project. The PMU will support the MOH and directly implement technical activities, including procurement of medical supplies and equipment for activities under Component 1. Selected activities, such as coordination, communication and training may be outsourced to third parties through contract agreements if needed. The PMU will report regularly to the Vice Minister of Health in charge of this operation and the ongoing Health Systems Strengthening Project.

 

The stakeholder engagement activities will be documented through project progress reports, to be shared with the World Bank on a quarterly basis.

 

5. Grievance Mechanism

The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM:

  • Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects;
  • Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants;
  • Supports accessibility, anonymity, confidentiality and transparency in handling complaints and grievances; 
  • Avoids the need to resort to judicial proceedings (unless as a last resort).

 

 

5.1. Description of GRM

 

The client has also an existing GRM, also utilized under the current World Bank project to enable stakeholders to raise their concerns/ grievances/ comments/ suggestions, if any. Ministry of Health in Turkey has a free hotline, by dialling 184 “Alo 184” managed through a call center which is 7/24 available and accessible from everywhere in the country. It serves both the health workers as well as the wider public on questions, health emergency situation, grievances and other requests related with health services. The hotline also provides translation support in 6 languages (English, German, French, Arabic, Russian, and also includes specialized services for disabled under the “Unimpeded Health Communication Center (ESIM)”. The ESIM provides services 7/24 in sign language in order to ensure access of the disabled citizens to the health services. Available free of charge on the mobile phones, ESIM offers live interpreting services for the persons with hearing disorder while calling 112 ambulance center, getting appointment from the Central Appointment System and during medical examinations.

 

Grievances received by MoH’s GRM system, ALO 184, are resolved no later than 14 days which is dictated under the Law of Right to Information No 4982. The requests/inquiries/grievances related to the Project will be tracked under a separate IT module which will be developed as part of this Project under this existing GRM and reported every quarter to the World Bank during implementation. The project will have a webpage under the MoH website and will share information regularly on the activities and results. It will also have an online complaint box inserted into the webpage in addition to the national GRM. The SEP will be updated once the project specific web-page and a project specific hotline will be assigned under the PMSU.  

 

 

In updated version of the SEP, a fuller description of the GRM will focus on typology of complaints and complainants to provide more efficient management. Possible examples: the highly vulnerable, persons with disabilities, people facing language barriers, disruptions in areas neighboring facilities, etc.The contact information for the GRM will be provided in the updated SEP which will be finalized 30 days after the project effectiveness date.

 

Communities and individuals who believe that they are adversely affected by a World Bank supported project may submit complaints to existing project-level grievance redress mechanisms or the Bank’s Grievance Redress Service (GRS). The GRS ensures that complaints received are promptly reviewed in order to address project-related concerns. Project affected communities and individuals may submit their complaint to the Bank’s independent Inspection Panel which determines whether harm occurred, or could occur, as a result of Bank non-compliance with its policies and procedures. Complaints may be submitted at any time after concerns have been brought directly to the World Bank's attention, and Bank Management has been given an opportunity to respond.  For information on how to submit complaints to the Bank’s corporate Grievance Redress Service (GRS), please visit: http://www.worldbank.org/en/projects-operations/products-and-services/grievance-redress-service. For information on how to submit complaints to the World Bank Inspection Panel, please visit www.inspectionpanel.org.



6. Monitoring and Reporting

The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Quarterly summaries and internal reports on public grievances, enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions, will be collated by the designated GRM officer, and referred to the senior management of the project. The quarterly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways:

 

-        Publication of a standalone annual report on project’s interaction with the stakeholders.

 

-        Monitoring of a beneficiary feedback indicator on a regular basis. The indicator will be determined in the updated SEP and may include: number of consultations, including by using telecommunications carried out within a reporting period (e.g. monthly, quarterly, or annually); number of public grievances received within a reporting period (e.g. monthly, quarterly, or annually) and number of those resolved within the prescribed timeline; number of press materials published/broadcasted in the local, regional, and national media.

 

Further details will be outlined in the updated SEP, to be prepared and disclosed within 30 days after the project effectiveness date.

 

 

 



[1] Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources.