Malawi Health Emergency Preparedness, Response and Resilience Project – Environmental and Social Review Summary (ESRS) August 2026

"Additional Financing Appraisal Environmental and Social Review Summary" – Malawi Health Emergency Preparedness, Response and Resilience Project Using the Multiphase Programmatic Approach (P505187) · Report No: ESRSAA1567 · Date Prepared/Updated: 16 August 2026 · Appraisal Stage: AF ESRS Appraisal Stage · Operation ID: P505187 · Product: Investment Project Financing (IPF) · Approval Fiscal Year: 2024 · Beneficiary Country: Malawi · Region: Eastern and Southern Africa · Practice Area (Lead): Health, Nutrition & Population · Borrower: Republic of Malawi · Implementing Agency: Ministry of Health and Sanitation · Estimated Appraisal Date: 12 August 2026 · Estimated Board Date: 31 August 2026 · Total Project Cost: US$74,410,297.00 · Environmental and Social Risk Classification (ESRC): Moderate · Purpose: Provides an environmental and social review summary for the Additional Financing of the Malawi Health Emergency Preparedness, Response and Resilience Project. Assesses the environmental and social risks and impacts of the expanded project scope (including construction of a National Reference Laboratory block in Lilongwe, a climate-resilient hospital block in Chikwawa, and completion of works in Zomba and Blantyre) and outlines the Borrower's institutional capacity and required environmental and social instruments. Essential reading for project implementers, environmental and social specialists, contractors, government officials, and development partners involved in health infrastructure and emergency preparedness in Malawi.

Project Context

· The project is part of the Health Emergency Preparedness, Response and Resilience (HEPRR) Program using the Multiphase Programmatic Approach (MPA) approved by the World Bank's Executive Directors on 29 September 2023 (P180127) · Phase I provided financing for Kenya, Ethiopia, Sao Tome and Principe, ECSA-HC, and IGAD · Aligned with the Program Development Objective of the HEPRR Program

Project Development Objective (PDO)

· To strengthen health system resilience and multisectoral preparedness and response to health emergencies in the Republic of Malawi

Project Components

Component 1: Strengthening the Preparedness and Resilience of the Health System to Manage Health Emergencies · Subcomponent 1.1: Enhancing Multisectoral Planning, Financing, and Governance for Improved Resilience to Health Emergencies · Subcomponent 1.2: Strengthening Health Workforce Development · Subcomponent 1.3: Improving Access to Quality Health Commodities and Scoping Local Pharmaceutical Production · Subcomponent 1.4: Enhancing Information Systems for HEs and Digital in Health Transformation

Component 2: Improving Early Detection and Response to HEs Through a Multisectoral Approach · Subcomponent 2.1: Collaborative Multisectoral Surveillance and Laboratory Diagnostics · Subcomponent 2.2: Emergency Management, Coordination, and Essential Service Continuity · Subcomponent 2.3: Risk Communication and Community Engagement (RCCE), Empowerment, and Social Protection During HEs

Component 3: Project Management · Subcomponent 3.1: Enhancing Project Monitoring and Evaluation (M&E) · Subcomponent 3.2: Delivering Tailored Technical Assistance and Facilitating a Learning Agenda · Subcomponent 3.3: Strengthening Project Management through Support of Implementing Institutions and Multisectoral Collaboration

Component 4: Contingent Emergency Response Component (CERC) · Facilitates rapid financing through reallocation of uncommitted project funds in event of natural disaster, formal declaration of national emergency, or formal government request

Climate Change Alignment

· Project consistent with both adaptation and mitigation goals of the Paris Agreement · Expected to have a considerable contribution to improving climate adaptation and resilience · Not anticipated to contribute to Greenhouse Gases (GHG) emissions · Aligned with Malawi's commitment to reduction of GHG

Environmental and Social Overview

Project scope: · Nationwide implementation across Malawi · Primarily focuses on strengthening systems for preparedness, early detection, and response to health emergencies · Investments in surveillance, laboratory systems, workforce capacity, and digital health platforms · Largely institutional, programmatic, and capacity-building in nature · Most interventions embedded within existing health facilities and administrative structures

Additional Financing and restructuring: · Expands scope to include targeted, small to medium scale infrastructure investments:

• Construction of one block of the proposed National Reference Laboratory in Lilongwe
• Construction of a climate-resilient hospital block in Chikwawa
• Completion of unfinished health infrastructure in Zomba and Blantyre
• Supply and installation of diagnostic equipment (e.g., radiology units) within existing facilities · Interventions remain largely within existing health facility footprints or urban settings · Introduce typical construction-related risks – site-specific, low to moderate in magnitude, readily mitigated through established E&S instruments

Borrower's Institutional Capacity

Current capacity: · PIU embedded within Ministry of Health (MoH) · Experience from previous World Bank-financed operations (under both former Safeguards Policies and ESF) · Most previous operations have now closed; dedicated E&S specialists released · Institutional continuity partially diminished; lessons learned not fully institutionalized · Currently retains a single Environmental and Social Specialist responsible for managing both environmental and social risks · Combined E&S role reflects manageable complexity of risks and moderate scale of environmental risks

Capacity constraints: · Increasing scope under Additional Financing (civil works, contractor oversight) places additional demands on technical supervision, compliance monitoring, and reporting · E&S functions remain largely project-based, with limited integration into MoH institutional systems

Mitigation measures: · Continued strengthening through targeted training · Enhanced supervision arrangements · Clear delineation of responsibilities for E&S compliance · Capacity building for PIU staff, contractors, and health facility personnel on ESF requirements, OHS, healthcare waste management, and stakeholder engagement · Reinforced monitoring and reporting systems · Effective contractor oversight · Maintain functional grievance redress mechanisms

Overall assessment: Borrower demonstrates adequate capacity to manage identified risks in a manner consistent with the ESF; sustained support and targeted capacity strengthening critical

Environmental and Social Risk Classification (ESRC)

Overall classification: Moderate

Environmental Risk Rating: Moderate · Interventions largely focused on strengthening health systems through technical assistance, capacity building, institutional support – limited direct physical footprint · Most activities (training, vulnerability assessments, development of designs and BoQs, preparation of E&S assessments) are upstream in nature · Any downstream impacts are indirect, site-specific, and linked to future investments · Infrastructure components relatively small to medium scale · All located on government-owned land without incumbrances and encroachment within urban settings · No risk of land acquisition · No significant risks to sensitive environmental receptors or biodiversity · Key environmental risks typical of healthcare and small-scale construction:

• Generation and management of general, construction, medical, and hazardous waste (including potential asbestos in older structures)
• Occupational health and safety risks
• Community health and safety concerns
• E-waste from digital and solar systems
• Localized pollution (air, water, and soil) · Risks predictable, temporary, low to moderate in magnitude, confined within known project footprints · Well-known and established mitigation measures and E&S instruments available

Social Risk Rating: Moderate · Activities largely system-oriented, institutional, and capacity-building · NO physical displacement or irreversible social impacts · Context-specific risks:

• Potential exclusion of vulnerable and marginalized groups in project design and implementation
• Inequitable access to project benefits (training, employment opportunities, health services)
• Data privacy, confidentiality, and ethical use of patient-level information with scale-up of digital health systems
• Labor and workforce risks: unfair/non-transparent recruitment practices, potential workplace discrimination, overburdening of health workers
• Occupational conditions: risks of sexual harassment, non-compliance with ESS2 requirements
• Downstream implications of technical assistance (designs/plans that may translate into physical investments) · Risks predictable, site and activity-specific, effectively managed through established E&S instruments

Environmental and Social Standards (ESS) Applicability

ESS1 – Assessment and Management of Environmental and Social Risks and Impacts: Relevant · Additional Financing introduces civil works (National Reference Laboratory block in Lilongwe, climate-resilient hospital block in Chikwawa, completion of works in Zomba and Blantyre) · Activities confined to existing government-owned health facility compounds in already disturbed urban settings · Site-specific ESIAs to be prepared, reviewed, and cleared by the Bank prior to commencement of civil works · Site-specific ESMPs, including C-ESMPs, to ensure risks related to labor, OHS, community health and safety, pollution prevention, waste management, SEA/SH, and stakeholder engagement are adequately assessed and mitigated · For completion of outstanding works in Zomba and Blantyre, existing ESIAs, ESMPs, and C-ESMPs remain valid · Updated IPCWMPs to be implemented across all sites · SEP, LMP, GBV/SEA/SH measures, and project grievance mechanisms to be maintained and strengthened · All technical assistance activities to be prepared in accordance with ToR acceptable to the Bank and consistent with ESF requirements

ESS10 – Stakeholder Engagement and Information Disclosure: Relevant · Structured approach to stakeholder engagement established through SEP · SEP operationalized and refined based on implementation experience · Introduction of civil works broadens scope and nature of stakeholder interactions · SEP to be updated to reflect revised scope, incorporating targeted engagement strategies for communities surrounding civil works sites (Lilongwe, Chikwawa, Zomba, Blantyre) · SEP to continue prioritizing inclusive participation, ensuring vulnerable groups (PWD, elderly, underserved populations) are effectively consulted · Project-level GRM to be strengthened to ensure accessibility, responsiveness, and confidentiality (including dedicated provisions for GBV/SEA/SH complaints) · Information disclosure enhanced through multiple channels (community meetings, health facility notices, digital platforms) · Greater emphasis on systematic documentation, monitoring, and feedback loops

ESS2 – Labor and Working Conditions: Relevant · Introduction of additional civil works alongside ongoing system strengthening activities · Labor force now includes: direct workers (PIU), contracted workers (construction), and primary supply workers · Key risks: OHS hazards associated with construction and healthcare environments; variability in contractor compliance; non-transparent or discriminatory recruitment practices; workplace misconduct including SEA/SH; operational pressures on existing healthcare workers · Existing LMP to be updated to reflect inclusion of civil works · Enhanced provisions for contractor management, OHS aligned with GIIP, clear requirements for Codes of Conduct and fair recruitment · C-ESMPs to incorporate detailed labor and OHS measures · Accessible and confidential worker grievance mechanisms to be maintained · Increased emphasis on supervision and monitoring (routine site inspections, integration of labor performance into contractor oversight, targeted capacity building)

ESS3 – Resource Efficiency and Pollution Prevention and Management: Relevant · Addition of civil works increases volume and diversity of waste streams and resource demands · Key risks: construction waste (including potentially hazardous materials such as asbestos); infectious and hazardous healthcare waste; e-waste; pollution from laboratory effluent and chemically contaminated wastewater; localized air emissions; incremental increases in water and energy consumption · All activities confined to already developed sites – risks localized, predictable, manageable · Site-specific ESMPs and C-ESMPs to include detailed provisions for construction waste management, pollution prevention, dust and noise control, safe handling of hazardous materials (including asbestos) · IPCWMPs to be updated and tailored to each facility – segregation, storage, transportation, treatment, disposal · Training of medical and facility staff reinforced · Application of World Bank Group EHS Guidelines (including healthcare facilities) · Resource efficiency integrated: energy and water efficient design principles, solar energy utilization, efficient water systems, climate-resilient design features · Enhanced supervision and monitoring

ESS4 – Community Health and Safety: Relevant · Introduction of additional civil works within existing health facility settings · Key risks: exposure of patients, facility users, and communities to construction hazards (dust, noise, vibration, restricted access); traffic and road safety risks; community exposure to improperly managed waste streams; public health risks from infectious and hazardous waste; GBV/SEA/SH risks from worker-community interactions · Risks localized, temporary, predictable · Site-specific ESMPs and C-ESMPs to include provisions for community health and safety (access management, dust and noise control, safe construction practices in active service environments) · IPCWMPs to ensure safe handling, storage, transportation, disposal of medical, laboratory, and e-waste · Road and traffic safety measures: traffic management plans, signage, community awareness · SEA/SH Action Plan integrated within ESMPs – Codes of Conduct, worker training, confidential grievance channels · Community awareness and information disclosure aligned with SEP

ESS5 – Land Acquisition, Restrictions on Land Use and Involuntary Resettlement: Not Currently Relevant · Proposed civil works within existing government hospitals and facilities · Not relevant

ESS6 – Biodiversity Conservation and Sustainable Management of Living Natural Resources: Not Currently Relevant · Civil works within established facility footprints · Not expected to result in measurable impacts on biodiversity or living natural resources · Site-specific environmental considerations (screening for proximity to sensitive receptors, vegetation management, pollution control) to be incorporated into ESIAs and ESMPs

ESS7 – Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities: Not Currently Relevant · Not applicable in Malawi – no Indigenous Peoples in Malawi

ESS8 – Cultural Heritage: Relevant · Activities confined to existing, brownfield, already disturbed urban health facility environments · Likelihood of encountering known cultural heritage resources is low · Residual risk of chance finds during excavation · Chance finds procedures to be included in all site-specific ESIAs and ESMPs

ESS9 – Financial Intermediaries: Not Currently Relevant

Required Environmental and Social Risk Management Activities

(i) Site-Specific Environmental and Social Impact Assessments (ESIAs): To be prepared for new civil works (Lilongwe and Chikwawa) and cleared by the Bank prior to commencement of civil works

(ii) Environmental and Social Management Plans (ESMPs): To be prepared/updated for all subprojects, incorporating mitigation measures for construction, OHS, community health and safety, and pollution risks

(iii) Contractor Environmental and Social Management Plans (C-ESMPs): To be prepared by contractors and approved prior to civil works, detailing site-specific implementation arrangements

(iv) Labor Management Procedures (LMP): To be updated to reflect contractor engagement, OHS requirements, worker GRM, and Codes of Conduct prior to commencement of civil works

(v) Stakeholder Engagement Plan (SEP): To be updated to reflect expanded scope, including targeted engagement for civil works sites and continued inclusion of vulnerable groups

(vi) Environmental and Social Commitment Plan (ESCP): To be updated as needed to capture additional commitments and timelines associated with Additional Financing and civil works

Contact Point

World Bank Task Team Leader: Vikram Rajan (Senior Health Specialist), Email: vrajan@worldbank.org

ADM Environmental and Social Specialist: James Chacha Maroa

Approval

· Practice Manager/Manager: Ernest E. Massiah – 07 July 2026 · Country Director: Efrem Zephnath Chilima – 11 August 2026