Up to EUR 130 million sovereign loan to the Republic of Turkey, for the benefit of the Ministry of Health (MoH), to finance the purchase of ventilators and ICU monitors, and other emergency medical equipment urgently needed in public hospitals to fight the Covid-19 pandemic.
The project aims to support the Government of Turkey in uplifting its healthcare emergency response in public hospitals across the country and to help the emergency response efforts against the Covid-19 crisis. The loan proceeds will be used to equip Turkey's existing and new public hospitals built to provide adequate and timely healthcare services to the pandemic patients.
The project supplements the ICU bed capacity in the country, including in Istanbul pandemic hospital in Yesilkoy. This pandemic hospital along with other Covid-19 hospitals will remain in service for possible future waves of Covid-19 cases, as well as other emergencies related to earthquakes, risk of which is particularly high in the country and requires ample sector capacity.
The project reduces the funding gap of the government's emergency health programme and is complementary to other loans provided by IFIs in the country to fight the pandemic.
ETI score: 65
The project contributes to the "resilient" quality by providing financing to strengthen the resilience of the health system amid the Covid-19 pandemic. This investment will allow the health sector to respond more effectively to the crisis and build capacity to respond to other health emergencies in the future.
The project also contributes to the "inclusive" quality by aiming to improve and upgrade training provision for healthcare workers in Turkey and strengthen gender equality in the sector, building on a close mutual coordination with MoH.
The Ministry of Health will be the beneficiary of the loan and is responsible for proposing and executing government policy on health, planning and providing healthcare and protecting patients. The Ministry of Treasury and Finance will be the borrower and represents the Republic of Turkey.
EBRD Finance Summary
A sovereign loan with a grace period of 3years and a tenor of up to 10 years.
Total Project Cost
The the loan will be provided in parallel with a World Bank crisis response - a sovereign loan to the health sector which helps reduce the funding gap for the government's response programme. The EBRD's collaboration with the World Bank ensures complementarity and efficient project implementation.
The Bank is additional thanks to:
-Policy, sector, institutional, or regulatory change
-Standard-setting: helping projects and clients achieve higher standards
Environmental and Social Summary
Categorised B under 2019 ESP. Environmental & Social Due Diligence (ESDD) has been carried out internally in accordance with ESD COVID-19 approach. ESDD included review of the World Bank documentation on their preceding similar project with the MoH (Turkey Emergency COVID-19 Health Project), discussions with the World Bank on their approach and findings from their ESDD; information received from the MoH for the completion of the ESDD Questionnaire; review of on-line information on the MoH website and the Turkish Medical Association website; and discussions with MoH's Project Management & Support Unit (PMSU).
The ESDD showed that the Bank's financing of the MoH's procurement of ventilators, ICU monitors and other emergency equipment have limited environmental and social impacts. It also showed that the MoH's comprehensive COVID-19 response strategy & Pandemic Action Plan by testing, contact tracing and isolating the cases have been effectively in line with the WHO guidance. The Bank's project will support the WHO policy recommendation to strengthen ICU capacities to treat seriously ill COVID-19 patients. The ICU equipment and others to be procured under this project will be derived from priority needs of the MoH's Pandemic Hospitals, WHO priority medical devices in the context of COVID-19 and the World Bank advisory. The project will comply with international standards including relevant WHO guidelines and EU standards as well as EBRD PR including Antibiotics Stewardship defined by EBRD Performance (PR) 4.
As the project does not involve any new construction but only procurement of medical equipment for already constructed hospitals, it is not associated with resettlement and economic displacement, bio-diversity and cultural heritage issues and it is not required to go through Turkish EIA procedures. Key environmental issues associated with the project is medical waste management and wastewater treatment. Medical waste in Turkey is treated at off-site medical incinerators and autocracy facilities with official recording & tracking systems.
Wastewater is discharged into municipal wastewater collection systems to be treated in a wastewater treatment plant in compliance with Turkish law. The MoH has asserted that the country's medical waste treatment capacities are still sufficient under the COVID-19 situation. The project does not define location and facility-specific workforce in relation to labour and Occupational Health & Safety (OHS) issues. Therefore, the ESDD has considered the health and safety issues concerning the healthcare workers handing ICU equipment and diagnostic equipment to be procured under the project in public hospitals.
The existing Environmental and Social Commitment Plan (ESCP) and Stakeholder Engagement Plan (SEP) developed for WB's Turkey Emergency COVID-19 Health Project and to be implemented by PMSU are comprehensive. The development of an E&S Management Framework (ESMF) by the World Bank is at its final stage to be implemented by the concerned healthcare facilities under their loan. EBRD will require the same robust E&S management requirements to apply for the hospitals covered under this project.
Given the wider workforce and numeral healthcare facilities subject to the project impacts, the ESMF in the ESCP provides an overarching management structure to adequately cover the issues. The ESMF includes (i) an Infection Control and Waste Management Plan (ICWMP); (ii) Labour management procedures (LMP) addressing labour risks associated with the project including specific occupational health and safety (OHS) for healthcare workers (including facility management workers) to protect themselves and prevent infection while providing treatment in line with the World Health Organization (WHO) guidelines; (iii) mitigation measures during collection of samples and laboratory testing for COVID-19 or during the transport of potentially affected samples or persons in line with WHO guidance (iv) mitigation measures for water, sanitation, hygiene and waste management for COVID-19 in line with WHO guidance; (v) measures to prevent the wider community to be exposed to the virus, with a particular focus on high-risk individuals.
Under the ESMF, each concerned healthcare facility will apply infection control and waste management planning following the requirements in accordance with Good International Practices including relevant WHO guidelines and EU standards as well as Antimicrobial Stewardship. The SEP has identified key stakeholders as well as has set itself as a key instrument for outreach to the community at large on issues related to social distancing, higher risk demographics, self-quarantine, and quarantine, and citizen participation. It is critical that these messages be widely disseminated, repeated often, and clearly understood. The MoH has a free hotline through a call center which is 7/24 available and accessible from everywhere in the country. The MoH has also been using this as a Grievance redress mechanism for people to raise concerns, requests related. 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. An email address has also been set specially to receive concerns from MoH employees. The ESCP & SEP have been disclosed to the public on the MoH's website.
EBRD will monitor the project through reviews of annual environmental & social reports and periodic lender supervisor reports as well as site visits, as necessary.
Technical Cooperation and Grant Financing
A comprehensive Technical Cooperation (TC) package includes a Gender and Economic Inclusion TC, which aims at fostering an inclusive environment for healthcare workers in close collaboration with MoH, as well as a project implementation support TC, aiming to leverage MoH's implementation capacity for an efficient delivery of the project.
Company Contact Information
Izzet Yerdes (Ministry of Treasury and Finance General Directorate of Foreign Economic Relations)
+90 312 204 73 62
Inönü Bulvari No:36 06510 Emek/Ankara
PSD last updated
12 Nov 2020
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Independent Project Accountability Mechanism (IPAM)
If efforts to address environmental, social or public disclosure concerns with the Client or the Bank are unsuccessful (e.g. through the Client’s Project-level grievance mechanism or through direct engagement with Bank management), individuals and organisations may seek to address their concerns through the EBRD’s Independent Project Accountability Mechanism (IPAM).
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